108 results on '"Fleischmann KE"'
Search Results
2. Personalized Prediction of Lifetime Benefits with Statin Therapy for Asymptomatic Individuals: A Modeling Study
- Author
-
Fleischmann, Kirsten, Ferket, BS, van, BJH, Heeringa, J, Spronk, S, Fleischmann, KE, Nijhuis, RLG, Hofman, A, Steyerberg, EW, and Hunink, MGM
- Abstract
Background: Physicians need to inform asymptomatic individuals about personalized outcomes of statin therapy for primary prevention of cardiovascular disease (CVD). However, current prediction models focus on short-term outcomes and ignore the competing ri
- Published
- 2012
3. Oral Abstract session: Different imaging modalities for the approach of coronary artery disease: Friday 5 December 2014, 16: 30–18: 00Location: Agora
- Author
-
Petersen, S E, Genders, TSS, Pugliese, F, Dastidar, AG, Fleischmann, KE, Nieman, K, and Hunink, MGM
- Published
- 2014
4. Comparative cost-effectiveness of non-invasive imaging tests in patients presenting with chronic stable chest pain with suspected coronary artery disease: a systematic review
- Author
-
Waardhuizen, Claudia, Khanji, M Y, Genders, Tessa, Ferket, Bart, Fleischmann, KE, Hunink, Myriam, Petersen, SE, Radiology & Nuclear Medicine, and Epidemiology
- Published
- 2016
5. Predictive Value of Updating Framingham Risk Scores with Novel Risk Markers in the US General Population
- Author
-
Ferket, Bart, van Kempen, Bob, Hunink, Myriam, Agarwal, I, Kavousi, Maryam, Franco Duran, OH, Steyerberg, Ewout, Max, W, Fleischmann, KE, Ferket, Bart, van Kempen, Bob, Hunink, Myriam, Agarwal, I, Kavousi, Maryam, Franco Duran, OH, Steyerberg, Ewout, Max, W, and Fleischmann, KE
- Abstract
Background: According to population-based cohort studies CT coronary calcium score (CTCS), carotid intima-media thickness (cIMT), high-sensitivity C-reactive protein (CRP), and ankle-brachial index (ABI) are promising novel risk markers for improving cardiovascular risk assessment. Their impact in the U. S. general population is however uncertain. Our aim was to estimate the predictive value of four novel cardiovascular risk markers for the U. S. general population. Methods and Findings: Risk profiles, CRP and ABI data of 3,736 asymptomatic subjects aged 40 or older from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 exam were used along with predicted CTCS and cIMT values. For each subject, we calculated 10-year cardiovascular risks with and without each risk marker. Event rates adjusted for competing risks were obtained by microsimulation. We assessed the impact of updated 10-year risk scores by reclassification and C-statistics. In the study population (mean age 56 +/- 11 years, 48% male), 70% (80%) were at low (<10%), 19% (14%) at intermediate (>= 10-<20%), and 11% (6%) at high (>= 20%) 10-year CVD (CHD) risk. Net reclassification improvement was highest after updating 10-year CVD risk with CTCS: 0.10 (95%CI 0.02-0.19). The C-statistic for 10-year CVD risk increased from 0.82 by 0.02 (95%CI 0.01-0.03) with CTCS. Reclassification occurred most often in those at intermediate risk: with CTCS, 36% (38%) moved to low and 22% (30%) to high CVD (CHD) risk. Improvements with other novel risk markers were limited. Conclusions: Only CTCS appeared to have significant incremental predictive value in the U. S. general population, especially in those at intermediate risk. In future research, cost-effectiveness analyses should be considered for evaluating novel cardiovascular risk assessment strategies.
- Published
- 2014
6. Atrial fibrillation and quality of life Response
- Author
-
Fleischmann, KE, Lamas, GA, Mangione, CM, and Goldman, L
- Subjects
Cardiovascular System & Hematology ,Public Health and Health Services ,Cardiorespiratory Medicine and Haematology - Published
- 2009
7. Personalized Prediction of Lifetime Benefits with Statin Therapy for Asymptomatic Individuals: A Modeling Study
- Author
-
Ferket, Bart, van Kempen, Bob, Heeringa, Jan, Spronk, Sandra, Fleischmann, KE, Nijhuis, RLG, Hofman, Bert, Steyerberg, Ewout, Hunink, Myriam, Ferket, Bart, van Kempen, Bob, Heeringa, Jan, Spronk, Sandra, Fleischmann, KE, Nijhuis, RLG, Hofman, Bert, Steyerberg, Ewout, and Hunink, Myriam
- Abstract
Background: Physicians need to inform asymptomatic individuals about personalized outcomes of statin therapy for primary prevention of cardiovascular disease (CVD). However, current prediction models focus on short-term outcomes and ignore the competing risk of death due to other causes. We aimed to predict the potential lifetime benefits with statin therapy, taking into account competing risks. Methods and Findings: A microsimulation model based on 5-y follow-up data from the Rotterdam Study, a population-based cohort of individuals aged 55 y and older living in the Ommoord district of Rotterdam, the Netherlands, was used to estimate lifetime outcomes with and without statin therapy. The model was validated in-sample using 10-y follow-up data. We used baseline variables and model output to construct (1) a web-based calculator for gains in total and CVD-free life expectancy and (2) colo Conclusions: We developed tools to predict personalized increases in total and CVD-free life expectancy with statin therapy. The predicted gains we found are small. If the underlying model is validated in an independent cohort, the tools may be useful in discussing with patients their individual outcomes with statin therapy.
- Published
- 2012
8. Reply to the letter to the editor
- Author
-
Fleischmann, KE, Hunink, Myriam, Kuntz, KM, Douglas, PS, and Radiology & Nuclear Medicine
- Published
- 1999
9. 2009 ACCF/AHA focused update on perioperative beta blockade: a report of the American college of cardiology foundation/American heart association task force on practice guidelines.
- Author
-
Fleischmann KE, Beckman JA, Buller CE, Calkins H, Fleisher LA, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Robb JF, and Valentine RJ
- Published
- 2009
- Full Text
- View/download PDF
10. Cost-effectiveness of dual-chamber pacing compared with ventricular pacing for sinus node dysfunction.
- Author
-
Rinfret S, Cohen DJ, Lamas GA, Fleischmann KE, Weinstein MC, Orav J, Schron E, Lee KL, and Goldman L
- Published
- 2005
- Full Text
- View/download PDF
11. Impact of valvular regurgitation and ventricular dysfunction on long-term survival in patients with chest pain.
- Author
-
Fleischmann KE, Lee RT, Come PC, Goldman L, Cook EF, Weissman MA, Johnson PA, Lee TH, Fleischmann, K E, Lee, R T, Come, P C, Goldman, L, Cook, E F, Weissman, M A, Johnson, P A, and Lee, T H
- Abstract
Doppler echocardiography is often used in evaluating patients with chest pain, but information on prognostic value of this testing and data to help guide selective use are limited. We prospectively studied 448 patients admitted from the emergency department for acute chest pain to assess the utility of qualitative echocardiographic data in predicting long-term survival and the incremental value of this information over routine clinical and electrocardiographic data. Doppler echocardiograms, recorded an average of 21 hours after presentation, were analyzed independently by 2 echocardiographers for global left and right ventricular function and valvular disease. Regional function was assessed by wall motion index. Data on long-term survival were collected with an average follow-up of 35.0 +/- 12.1 months. In univariate Cox regression analysis, left ventricular function and size, wall motion index, right ventricular function, and aortic, mitral, and tricuspid insufficiency were significant predictors of total and cardiovascular mortality. In multivariate analysis, moderate or severe left ventricular dysfunction (mortality rate ratio 3.2, 95% confidence intervals 1.8 to 5.8] and more than mild valvular regurgitation (mortality rate ratio 2.0, 95% confidence interval 1.1 to 3.6) were independent predictors of mortality in a model adjusted for clinical and electrocardiographic data. These factors were more common in patients aged >60 years, in those with prior acute myocardial infarction or angina, and in those with rales on physical examination. In the absence of these clinical characteristics, only 8 of 124 patients (7%) had moderate or severe left ventricular dysfunction or valvular regurgitation. In patients with moderate or severe regurgitation, a murmur was noted on the admission physical examination in 41 of 69 cases (59%). We conclude that echocardiographic evidence of moderate or severe left ventricular dysfunction or valvular regurgitation identifies a high-risk group for overall and cardiovascular mortality in patients with chest pain, and this evidence may not be detected clinically. [ABSTRACT FROM AUTHOR]
- Published
- 1997
- Full Text
- View/download PDF
12. Oral Abstract session: Different imaging modalities for the approach of coronary artery disease: Friday 5 December 2014, 16:30-18:00 * Location: Agora
- Author
-
Jovanovic, I, Tesic, M, Giga, V, Petrovic, O, Petrovic, MT, Stepanovic, J, Trifunovic, D, Vujisic-Tesic, B, Beleslin, B, Djordjevic-Dikic, A, Petersen, S E, Genders, TSS, Pugliese, F, Dastidar, AG, Fleischmann, KE, Nieman, K, Hunink, MGM, Cameli, M, Lisi, M, Righini, FM, Sparla, S, Di Tommaso, C, Lunghetti, S, Galderisi, M, Mondillo, S, Djordjevic-Dikic, A, Boskovic, N, Tesic, M, Paunovic, I, Giga, V, Stepanovic, J, Kostic, J, Dobric, M, Trifunovic, D, Beleslin, B, Vilela, AA, Assef, JE, Barretto, RBM, Le Bihan, D, Melchior, W, Ramos, RF, Santos, ES, Souza, AGMR, Voilliot, D, Odille, FO, Mandry, DM, Huttin, OH, Andronache, MA, Marie, PYM, Felblinger, JF, Aliot, EA, Sadoul, NS, De Chillou, CDC, Liou, K, Ho, S, Cranney, G, Ooi, S, Carminati, MC, Boniotti, C, Pontone, G, Andreini, D, Pepi, M, and Caiani, EG
- Abstract
Background: Slow coronary flow (SCF) is a well-known clinical phenomenon, characterized by delayed opacification of coronary arteries in the absence of coronary artery stenosis. It is hypothesized that impaired endothelial function reduces coronary flow velocity reserve (CFVR), and results in microvascular ischemia causing chest pain. Also, left ventricular (LV) global longitudinal systolic strain (GLS) can be affected in this setting. The aim of this study was to: 1) evaluate how LV-GLS and CFVR are affected in patients with positive exercise tests and coronary angiograms with or without SCF. 2) examine relations between CFVR and LV-GLS. Methods: Examined group consisted of 24 female pts (mean age 58±8 years) with ECG positive exercise tests and coronary angiograms without stenosis. TIMI Flow Grade (TFG) was used as a grading system for SCF, based on the rate of dye entry into the distal landmarks of the vessel bed. According to that, examined group was subdivided into: Group 1 (7 pts with SCF (TGF<3)) and Group 2 (17 pts with TGF 3). Twenty healthy control subjects (mean age 55±9 years) were also enrolled. GLS was obtained from the three standard apical views and off-line image analysis was performed using commercial software with speckle tracking methodology derived from 2D gray-scale images. Transthoracic Doppler echocardiography CFVR was performed in left anterior descending coronary (LAD) and right coronary artery (RCA) and calculated as the ratio between hyperemic maximal flow velocity (induced with i.v. infusion of adenosine 0.14mg/kg/min) and resting flow velocity. Results Examined group compared to the control group had significantly impaired LV-GLS (-17.5±2.2 vs. -21.9±2.5, p<0.001), CFVR LAD (2.60±0.56 vs. 3.34±0.67, p<0.001) and CFVR RCA (2.48±0.42 vs. 3.20±0.64, p<0.001). Group 1 in comparison to Group 2 had lower LV-GLS (-15.9±1.3 vs. -18.2±2.2, p=0.021), CFVR LAD (2.04±0.16 vs. 2.84±0.48, p<0.001) and CFVR RCA (2.08±0.19 vs. 2.65±0.38, p=0.001). In the examined group LV-GLS correlated both with CFVR LAD (r=-0.449, p=0.028) and CFVR RCA (r=-0.514, p=0.010). Conclusions: This study shows that blunted CFVR values in SCF setting are associated with depressed LV-GLS, demonstrating an important pathophysiological link between the impairment of microcirculation and longitudinal LV systolic function.
- Published
- 2014
- Full Text
- View/download PDF
13. Personalized prediction of lifetime benefits with statin therapy for asymptomatic individuals: a modeling study.
- Author
-
Ferket BS, van Kempen BJ, Heeringa J, Spronk S, Fleischmann KE, Nijhuis RL, Hofman A, Steyerberg EW, and Hunink MG
- Published
- 2012
- Full Text
- View/download PDF
14. 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American college of cardiology foundation/American heart association task force on practice guidelines.
- Author
-
Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, and Robb JF
- Published
- 2009
- Full Text
- View/download PDF
15. Atrial fibrillation and quality of life after pacemaker implantation for sick sinus syndrome: data from the Mode Selection Trial (MOST)
- Author
-
Fleischmann KE, Orav EJ, Lamas GA, Mangione CM, Schron EB, Lee KL, Goldman L, and MOST investigators
- Published
- 2009
- Full Text
- View/download PDF
16. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery.
- Author
-
Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, and Ettinger SM
- Published
- 2007
17. Comparative effectiveness and cost-effectiveness of computed tomography screening for coronary artery calcium in asymptomatic individuals.
- Author
-
van Kempen BJ, Spronk S, Koller MT, Elias-Smale SE, Fleischmann KE, Ikram MA, Krestin GP, Hofman A, Witteman JC, and Hunink MG
- Published
- 2011
18. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: executive summary.
- Author
-
Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, and Ettinger SM
- Published
- 2007
- Full Text
- View/download PDF
19. ACC/AHA 2006 Guideline Update on Perioperative Cardiovascular Evaluation for Noncardiac Surgery: Focused Update on Perioperative Beta-Blocker Therapy A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society for Vascular Medicine and Biology.
- Author
-
Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Faxon DP, Fuster V, and Halperin JL
- Published
- 2006
- Full Text
- View/download PDF
20. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
- Author
-
Thompson A, Fleischmann KE, Smilowitz NR, de Las Fuentes L, Mukherjee D, Aggarwal NR, Ahmad FS, Allen RB, Altin SE, Auerbach A, Berger JS, Chow B, Dakik HA, Eisenstein EL, Gerhard-Herman M, Ghadimi K, Kachulis B, Leclerc J, Lee CS, Macaulay TE, Mates G, Merli GJ, Parwani P, Poole JE, Rich MW, Ruetzler K, Stain SC, Sweitzer B, Talbot AW, Vallabhajosyula S, Whittle J, and Williams KA Sr
- Abstract
Aim: The "2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery" provides recommendations to guide clinicians in the perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery., Methods: A comprehensive literature search was conducted from August 2022 to March 2023 to identify clinical studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline., Structure: Recommendations from the "2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery" have been updated with new evidence consolidated to guide clinicians; clinicians should be advised this guideline supersedes the previously published 2014 guideline. In addition, evidence-based management strategies, including pharmacological therapies, perioperative monitoring, and devices, for cardiovascular disease and associated medical conditions, have been developed.
- Published
- 2024
- Full Text
- View/download PDF
21. Potential Mediators for Treatment Effects of Novel Diabetes Medications on Cardiovascular and Renal Outcomes: A Meta-Regression Analysis.
- Author
-
Rodriguez-Valadez JM, Tahsin M, Masharani U, Park M, Hunink MGM, Yeboah J, Li L, Weber E, Berkalieva A, Avezaat L, Max W, Fleischmann KE, and Ferket BS
- Subjects
- Humans, Albumins therapeutic use, Creatinine, Glucagon-Like Peptide-1 Receptor agonists, Glycated Hemoglobin, Hypoglycemic Agents adverse effects, Proportional Hazards Models, Weight Loss, Cardiovascular Diseases drug therapy, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 drug therapy, Sodium-Glucose Transporter 2 Inhibitors adverse effects, Stroke drug therapy
- Abstract
Background: Prior research suggests clinical effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) are mediated by changes in glycated hemoglobin, body weight, systolic blood pressure, hematocrit, and urine albumin-creatinine ratio. We aimed to confirm these findings using a meta-analytic approach., Methods and Results: We updated a systematic review of 9 GLP-1RA and 13 SGLT2i trials and summarized longitudinal mediator data. We obtained hazard ratios (HRs) for cardiovascular, renal, and mortality outcomes. We performed linear mixed-effects modeling of LogHRs versus changes in potential mediators and investigated differences in meta-regression associations among drug classes using interaction terms. HRs generally became more protective with greater glycated hemoglobin reduction among GLP-1RA trials, with average HR improvements of 20% to 30%, reaching statistical significance for major adverse cardiovascular events (ΔHR, 23%; P =0.02). Among SGLT2i trials, associations with HRs were not significant and differed from GLP1-RA trials for major adverse cardiovascular events ( P
interaction =0.04). HRs for major adverse cardiovascular events, myocardial infarction, and stroke became less efficacious (ΔHR, -15% to -34%), with more weight loss for SGLT2i but not for GLP-1RA trials (ΔHR, 4%-7%; Pinteraction <0.05). Among 5 SGLT2i trials with available data, HRs for stroke became less efficacious with larger increases in hematocrit (ΔHR, 123%; P =0.09). No changes in HRs by systolic blood pressure (ΔHR, -11% to 9%) and urine albumin-creatinine ratio (ΔHR, -1% to 4%) were found for any outcome., Conclusions: We confirmed increased efficacy findings for major adverse cardiovascular events with reduction in glycated hemoglobin for GLP1-RAs. Further research is needed on the potential loss of cardiovascular benefits with increased weight loss and hematocrit for SGLT2i.- Published
- 2024
- Full Text
- View/download PDF
22. Evaluation of premature ventricular complexes during in-hospital ECG monitoring as a predictor of ventricular tachycardia in an intensive care unit cohort.
- Author
-
Suba S, Hoffmann TJ, Fleischmann KE, Schell-Chaple H, Marcus GM, Prasad P, Hu X, Badilini F, and Pelter MM
- Subjects
- Adult, Humans, Electrocardiography, Ventricular Premature Complexes diagnosis, Tachycardia, Ventricular diagnosis
- Abstract
In-hospital electrocardiographic (ECG) monitors are typically configured to alarm for premature ventricular complexes (PVCs) due to the potential association of PVCs with ventricular tachycardia (VT). However, no contemporary hospital-based studies have examined the association of PVCs with VT. Hence, the benefit of PVC monitoring in hospitalized patients is largely unknown. This secondary analysis used a large PVC alarm data set to determine whether PVCs identified during continuous ECG monitoring were associated with VT, in-hospital cardiac arrest (IHCA), and/or death in a cohort of adult intensive care unit patients. Six PVC types were examined (i.e., isolated, bigeminy, trigeminy, couplets, R-on-T, and run PVCs) and were compared between patients with and without VT, IHCA, and/or death. Of 445 patients, 48 (10.8%) had VT; 11 (2.5%) had IHCA; and 49 (11%) died. Isolated and run PVC counts were higher in the VT group (p = 0.03 both), but group differences were not seen for the other four PVC types. The regression models showed no significant associations between any of the six PVC types and VT or death, although confidence intervals were wide. Due to the small number of cases, we were unable to test for associations between PVCs and IHCA. Our findings suggest that we should question the clinical relevance of activating PVC alarms as a forewarning of VT, and more work should be done with larger sample sizes. A more precise characterization of clinically relevant PVCs that might be associated with VT is warranted., (© 2023 The Authors. Research in Nursing & Health published by Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
23. Premature ventricular complexes during continuous electrocardiographic monitoring in the intensive care unit: Occurrence rates and associated patient characteristics.
- Author
-
Suba S, Hoffmann TJ, Fleischmann KE, Schell-Chaple H, Prasad P, Marcus GM, Badilini F, Hu X, and Pelter MM
- Subjects
- Humans, Male, Electrocardiography, Intensive Care Units, Hospitals, Monitoring, Physiologic, Ventricular Premature Complexes diagnosis, Ventricular Premature Complexes epidemiology, Ventricular Premature Complexes complications, Clinical Alarms adverse effects
- Abstract
Aims and Objectives: This study examined the occurrence rate of specific types of premature ventricular complex (PVC) alarms and whether patient demographic and/or clinical characteristics were associated with PVC occurrences., Background: Because PVCs can signal myocardial irritability, in-hospital electrocardiographic (ECG) monitors are typically configured to alert nurses when they occur. However, PVC alarms are common and can contribute to alarm fatigue. A better understanding of occurrences of PVCs could help guide alarm management strategies., Design: A secondary quantitative analysis from an alarm study., Methods: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was followed. Seven PVC alarm types (vendor-specific) were described, and included isolated, couplet, bigeminy, trigeminy, run PVC (i.e. VT >2), R-on-T and PVCs/min. Negative binomial and hurdle regression analyses were computed to examine the association of patient demographic and clinical characteristics with each PVC type., Results: A total of 797,072 PVC alarms (45,271 monitoring hours) occurred in 446 patients, including six who had disproportionately high PVC alarm counts (40% of the total alarms). Isolated PVCs were the most frequent type (81.13%) while R-on-T were the least common (0.29%). Significant predictors associated with higher alarms rates: older age (isolated PVCs, bigeminy and couplets); male sex and presence of PVCs on the 12-lead ECG (isolated PVCs). Hyperkalaemia at ICU admission was associated with a lower R-on-T type PVCs., Conclusions: Only a few distinct demographic and clinical characteristics were associated with the occurrence rate of PVC alarms. Further research is warranted to examine whether PVCs were associated with adverse outcomes, which could guide alarm management strategies to reduce unnecessary PVC alarms., Relevance to Clinical Practice: Targeted alarm strategies, such as turning off certain PVC-type alarms and evaluating alarm trends in the first 24 h of admission in select patients, might add to the current practice of alarm management., (© 2022 John Wiley & Sons Ltd.)
- Published
- 2023
- Full Text
- View/download PDF
24. Cardiovascular and Renal Benefits of Novel Diabetes Drugs by Baseline Cardiovascular Risk: A Systematic Review, Meta-analysis, and Meta-regression.
- Author
-
Rodriguez-Valadez JM, Tahsin M, Fleischmann KE, Masharani U, Yeboah J, Park M, Li L, Weber E, Li Y, Berkalieva A, Max W, Hunink MGM, and Ferket BS
- Subjects
- Adult, Humans, Risk Factors, Hypoglycemic Agents, Heart Disease Risk Factors, Cardiovascular Diseases, Cardiovascular System, Heart Failure, Diabetes Mellitus
- Abstract
Background: Eligibility for glucagon-like peptide 1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) has been expanded to patients with diabetes at lower cardiovascular risk, but whether treatment benefits differ by risk levels is not clear., Purpose: To investigate whether patients with varying risks differ in cardiovascular and renal benefits from GLP-1RA and SGLT2i with use of meta-analysis and meta-regression., Data Sources: We performed a systematic review using PubMed through 7 November 2022., Study Selection: We included reports of GLP-1RA and SGLT2i confirmatory randomized trials in adult patients with safety or efficacy end point data., Data Extraction: Hazard ratio (HR) and event rate data were extracted for mortality, cardiovascular, and renal outcomes., Data Synthesis: We analyzed 9 GLP-1RA and 13 SGLT2i trials comprising 154,649 patients. Summary HRs were significant for cardiovascular mortality (GLP-1RA 0.87 and SGLT2i 0.86), major adverse cardiovascular events (0.87 and 0.88), heart failure (0.89 and 0.70), and renal (0.84 and 0.65) outcomes. For stroke, efficacy was significant for GLP-1RA (0.84) but not for SGLT2i (0.92). Associations between control arm cardiovascular mortality rates and HRs were nonsignificant. Five-year absolute risk reductions (0.80-4.25%) increased to 11.6% for heart failure in SGLT2i trials in patients with high risk (Pslope < 0.001). For GLP1-RAs, associations were nonsignificant., Limitations: Analyses were limited by lack of patient-level data, consistency in end point definitions, and variation in cardiovascular mortality rates for GLP-1RA trials., Conclusions: Relative effects of novel diabetes drugs are preserved across baseline cardiovascular risk, whereas absolute benefits increase at higher risks, particularly regarding heart failure. Our findings suggest a need for baseline risk assessment tools to identify variation in absolute treatment benefits and improve decision-making., (© 2023 by the American Diabetes Association.)
- Published
- 2023
- Full Text
- View/download PDF
25. Lifetime Cardiovascular Disease Risk by Coronary Artery Calcium Score in Individuals With and Without Diabetes: An Analysis From the Multi-Ethnic Study of Atherosclerosis.
- Author
-
Ferket BS, Hunink MGM, Masharani U, Max W, Yeboah J, Burke GL, and Fleischmann KE
- Subjects
- Aged, 80 and over, Calcium, Coronary Vessels, Humans, Nutrition Surveys, Prospective Studies, Risk Assessment, Risk Factors, United States epidemiology, Atherosclerosis diagnosis, Cardiovascular Diseases diagnosis, Coronary Artery Disease diagnosis, Coronary Artery Disease epidemiology, Diabetes Mellitus epidemiology, Vascular Calcification diagnosis
- Abstract
Objective: To assess lifetime cardiovascular disease (CVD) risk by coronary artery calcium (CAC) score in individuals with diabetes from the Multi-Ethnic Study of Atherosclerosis (MESA) and compare risk with that in individuals without diabetes., Research Design and Methods: We developed a microsimulation model with well, diabetes, post-CVD, and death health states using multivariable time-dependent Cox regression with age as time scale. We initially used 10-year follow-up data of 6,769 MESA participants, including coronary heart disease (CHD) (n = 272), heart failure (n = 201), stroke (n = 186), and competing death (n = 619) and assessed predictive validity at 15 years. We externally validated the model in matched National Health and Nutrition Examination Survey (NHANES) participants. Subsequently, we predicted CVD risk until age 100 years by diabetes, 10-year pooled cohort equations risk, and CAC score category (0, 1-100, or 100+)., Results: The model showed good calibration and discriminative performance at 15 years, with discrimination indices 0.71-0.78 across outcomes. In the NHANES cohort, predicted 15-year mortality risk corresponded well with Kaplan-Meier risk, especially for those with diabetes: 29.6% (95% CI 24.9-34.8) vs. 32.4% (95% CI 27.2-37.2), respectively. Diabetes increased lifetime CVD risk, similar to shifting one CAC category upward (from 0 to 1-100 or from 1-100 to 100+). Patients with diabetes and CAC score of 0 had a lifetime CVD risk that overlapped with that of individuals without diabetes who were at low 10-year pooled cohort equations risk (<7.5%)., Conclusions: Patients with diabetes carry a spectrum of CVD risk. CAC scoring may improve decisions for preventive interventions for patients with diabetes by better delineating lifetime CVD risk., (© 2022 by the American Diabetes Association.)
- Published
- 2022
- Full Text
- View/download PDF
26. Diagnostic and prognostic significance of premature ventricular complexes in community and hospital-based participants: A scoping review.
- Author
-
Suba S, Fleischmann KE, Schell-Chaple H, Prasad P, Marcus GM, Hu X, and Pelter MM
- Subjects
- Disease-Free Survival, Humans, Survival Rate, Atrial Fibrillation diagnosis, Atrial Fibrillation etiology, Atrial Fibrillation mortality, Coronary Disease diagnosis, Coronary Disease etiology, Coronary Disease mortality, Stroke diagnosis, Stroke etiology, Stroke mortality, Ventricular Premature Complexes complications, Ventricular Premature Complexes diagnosis, Ventricular Premature Complexes mortality
- Abstract
Background: While there are published studies that have examined premature ventricular complexes (PVCs) among patients with and without cardiac disease, there has not been a comprehensive review of the literature examining the diagnostic and prognostic significance of PVCs. This could help guide both community and hospital-based research and clinical practice., Methods: Scoping review frameworks by Arksey and O'Malley and the Joanna Briggs Institute (JBI) were used. A systematic search of the literature using four databases (CINAHL, Embase, PubMed, and Web of Science) was conducted. The review was prepared adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR)., Results: A total of 71 relevant articles were identified, 66 (93%) were observational, and five (7%) were secondary analyses from randomized clinical trials. Three studies (4%) examined the diagnostic importance of PVC origin (left/right ventricle) and QRS morphology in the diagnosis of acute myocardial ischemia (MI). The majority of the studies examined prognostic outcomes including left ventricular dysfunction, heart failure, arrhythmias, ischemic heart diseases, and mortality by PVCs frequency, burden, and QRS morphology., Conclusions: Very few studies have evaluated the diagnostic significance of PVCs and all are decades old. No hospital setting only studies were identified. Community-based longitudinal studies, which make up most of the literature, show that PVCs are associated with structural and coronary heart disease, lethal arrhythmias, atrial fibrillation, stroke, all-cause and cardiac mortality. However, a causal association between PVCs and these outcomes cannot be established due to the purely observational study designs employed., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2021
- Full Text
- View/download PDF
27. Long-term Predictions of Incident Coronary Artery Calcium to 85 Years of Age for Asymptomatic Individuals With and Without Type 2 Diabetes.
- Author
-
Ferket BS, Hunink MGM, Masharani U, Max W, Yeboah J, and Fleischmann KE
- Subjects
- Aged, Aged, 80 and over, Calcium, Humans, Incidence, Male, Middle Aged, Risk Assessment, Risk Factors, Atherosclerosis, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease epidemiology, Coronary Artery Disease etiology, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 epidemiology, Vascular Calcification diagnostic imaging, Vascular Calcification epidemiology
- Abstract
Objective: To examine the utility of repeated computed tomography (CT) coronary artery calcium (CAC) testing, we assessed risks of detectable CAC and its cardiovascular consequences in individuals with and without type 2 diabetes ages 45-85 years., Research Design and Methods: We included 5,836 individuals (618 with type 2 diabetes, 2,972 without baseline CAC) from the Multi-Ethnic Study of Atherosclerosis. With logistic and Cox regression we evaluated the impact of type 2 diabetes, diabetes treatment duration, and other predictors on prevalent and incident CAC. We used time-dependent Cox modeling of follow-up data (median 15.9 years) for two repeat CT exams and cardiovascular events to assess the association of CAC at follow-up CT with cardiovascular events., Results: For 45 year olds with type 2 diabetes, the likelihood of CAC at baseline was 23% vs. 17% for those without. Median age at incident CAC was 52.2 vs. 62.3 years for those with and without diabetes, respectively. Each 5 years of diabetes treatment increased the odds and hazard rate of CAC by 19% (95% CI 8-33) and 22% (95% CI 6-41). Male sex, White ethnicity/race, hypertension, hypercholesterolemia, obesity, and low serum creatinine also increased CAC. CAC at follow-up CT independently increased coronary heart disease rates., Conclusions: We estimated cumulative CAC incidence to age 85 years. Patients with type 2 diabetes develop CAC at a younger age than those without diabetes. Because incident CAC is associated with increased coronary heart disease risk, the value of periodic CAC-based risk assessment in type 2 diabetes should be evaluated., (© 2021 by the American Diabetes Association.)
- Published
- 2021
- Full Text
- View/download PDF
28. Estimating Long-Term Health Utility Scores and Expenditures for Cardiovascular Disease From the Medical Expenditure Panel Survey.
- Author
-
Morey JR, Jiang S, Klein S, Max W, Masharani U, Fleischmann KE, Hunink MGM, and Ferket BS
- Subjects
- Health Expenditures, Humans, Quality of Life, Surveys and Questionnaires, United States epidemiology, Cardiovascular Diseases diagnosis, Cardiovascular Diseases epidemiology, Cardiovascular Diseases therapy, Heart Failure diagnosis, Heart Failure epidemiology, Heart Failure therapy
- Abstract
Background: Long-term health utility scores and costs used in cost-effectiveness analyses of cardiovascular disease prevention and management can be inconsistent, outdated, or invalid for the diverse population of the United States. Our aim was to develop a user friendly, standardized, publicly available code and catalog to derive more valid long-term values for health utility and expenditures following cardiovascular disease events., Methods: Individual-level Short Form-12 version 2 health-related quality of life and expenditure data were obtained from the pooled 2011 to 2016 Medical Expenditure Panel Surveys. We developed code using the R programming language to estimate preference-weighted Short Form-6D utility scores from the Short Form-12 for quality-adjusted life year calculations and predict annual health care expenditures. Result predictors included cardiovascular disease diagnosis (myocardial infarction, ischemic stroke, heart failure, cardiac dysrhythmias, angina pectoris, and peripheral artery disease), sociodemographic factors, and comorbidity variables., Results: The cardiovascular disease diagnoses with the lowest utility scores were heart failure (0.635 [95% CI, 0.615-0.655]), angina pectoris (0.649 [95% CI, 0.630-0.667]), and ischemic stroke (0.649 [95% CI, 0.635-0.663]). The highest annual expenditures were for heart failure ($20 764 [95% CI, $17 500-$24 027]), angina pectoris ($18 428 [95% CI, $16 102-$20 754]), and ischemic stroke ($16 925 [95% CI, $15 672-$20 616])., Conclusions: The developed code and catalog may improve the quality and comparability of cost-effectiveness analyses by providing standardized methods for extracting long-term health utility scores and expenditures from Medical Expenditure Panel Survey data, which are more current and representative of the US population than previous sources.
- Published
- 2021
- Full Text
- View/download PDF
29. The Association Between Secondhand Smoke Exposure and Survival for Patients With Heart Failure.
- Author
-
Psotka MA, Rushakoff J, Glantz SA, De Marco T, and Fleischmann KE
- Subjects
- Aged, Aged, 80 and over, Cohort Studies, Cotinine analysis, Female, Humans, Longitudinal Studies, Male, Middle Aged, Heart Failure mortality, Tobacco Smoke Pollution statistics & numerical data
- Abstract
Background: The effect of secondhand tobacco smoke (SHS) exposure on patients with heart failure (HF) is uncertain. We investigated the association of mortality with SHS exposure for patients with HF., Methods: Nonsmokers with clinical HF were enrolled from 2003 to 2008 in a single-center longitudinal cohort study. The effect of SHS exposure determined by high-sensitivity urinary cotinine on mortality was estimated by multivariable proportional hazards modeling., Results: Mortality was assessed after median 4.3 years. Of 202 patients, enrollment urinary cotinine levels were below the limit of detection for 106 (52%) considered unexposed to SHS. The median detectable cotinine was 0.47 ng/mL (interquartile range: [0.28, 1.28]). Participants were 41% female, 65 ± 17 years old, and 57% white race. Elevated cotinine was associated with increased mortality after multivariate adjustment: hazard ratio (HR) per 1 ng/mL increase in urinary cotinine: 1.15, 95% confidence interval (CI): 1.08-1.23, P < .001. Higher age (HR per 5-year increase: 1.32, 95% CI: 1.22-1.43, P < .001), male sex (HR vs female: 1.52, 95% CI: 1.02-2.28, P = .040), and New York Heart Association class (HR for class III vs I: 2.91, 95% CI: 1.71-4.99, P < .001) were also associated with mortality., Conclusions: SHS exposure is associated with a dose-dependent increase in mortality for patients with HF., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
30. Fully Automated Echocardiogram Interpretation in Clinical Practice.
- Author
-
Zhang J, Gajjala S, Agrawal P, Tison GH, Hallock LA, Beussink-Nelson L, Lassen MH, Fan E, Aras MA, Jordan C, Fleischmann KE, Melisko M, Qasim A, Shah SJ, Bajcsy R, and Deo RC
- Subjects
- Amyloidosis physiopathology, Automation, Cardiomyopathy, Hypertrophic physiopathology, Humans, Hypertension, Pulmonary physiopathology, Predictive Value of Tests, Reproducibility of Results, Stroke Volume, Ventricular Function, Left, Amyloidosis diagnostic imaging, Cardiomyopathy, Hypertrophic diagnostic imaging, Deep Learning, Echocardiography methods, Hypertension, Pulmonary diagnostic imaging, Image Interpretation, Computer-Assisted methods
- Abstract
Background: Automated cardiac image interpretation has the potential to transform clinical practice in multiple ways, including enabling serial assessment of cardiac function by nonexperts in primary care and rural settings. We hypothesized that advances in computer vision could enable building a fully automated, scalable analysis pipeline for echocardiogram interpretation, including (1) view identification, (2) image segmentation, (3) quantification of structure and function, and (4) disease detection., Methods: Using 14 035 echocardiograms spanning a 10-year period, we trained and evaluated convolutional neural network models for multiple tasks, including automated identification of 23 viewpoints and segmentation of cardiac chambers across 5 common views. The segmentation output was used to quantify chamber volumes and left ventricular mass, determine ejection fraction, and facilitate automated determination of longitudinal strain through speckle tracking. Results were evaluated through comparison to manual segmentation and measurements from 8666 echocardiograms obtained during the routine clinical workflow. Finally, we developed models to detect 3 diseases: hypertrophic cardiomyopathy, cardiac amyloid, and pulmonary arterial hypertension., Results: Convolutional neural networks accurately identified views (eg, 96% for parasternal long axis), including flagging partially obscured cardiac chambers, and enabled the segmentation of individual cardiac chambers. The resulting cardiac structure measurements agreed with study report values (eg, median absolute deviations of 15% to 17% of observed values for left ventricular mass, left ventricular diastolic volume, and left atrial volume). In terms of function, we computed automated ejection fraction and longitudinal strain measurements (within 2 cohorts), which agreed with commercial software-derived values (for ejection fraction, median absolute deviation=9.7% of observed, N=6407 studies; for strain, median absolute deviation=7.5%, n=419, and 9.0%, n=110) and demonstrated applicability to serial monitoring of patients with breast cancer for trastuzumab cardiotoxicity. Overall, we found automated measurements to be comparable or superior to manual measurements across 11 internal consistency metrics (eg, the correlation of left atrial and ventricular volumes). Finally, we trained convolutional neural networks to detect hypertrophic cardiomyopathy, cardiac amyloidosis, and pulmonary arterial hypertension with C statistics of 0.93, 0.87, and 0.85, respectively., Conclusions: Our pipeline lays the groundwork for using automated interpretation to support serial patient tracking and scalable analysis of millions of echocardiograms archived within healthcare systems.
- Published
- 2018
- Full Text
- View/download PDF
31. An 8-week, open-label, dose-finding study of nimodipine for the treatment of progranulin insufficiency from GRN gene mutations.
- Author
-
Sha SJ, Miller ZA, Min SW, Zhou Y, Brown J, Mitic LL, Karydas A, Koestler M, Tsai R, Corbetta-Rastelli C, Lin S, Hare E, Fields S, Fleischmann KE, Powers R, Fitch R, Martens LH, Shamloo M, Fagan AM, Farese RV Jr, Pearlman R, Seeley W, Miller BL, Gan L, and Boxer AL
- Abstract
Introduction: Frontotemporal lobar degeneration-causing mutations in the progranulin ( GRN ) gene reduce progranulin protein (PGRN) levels, suggesting that restoring PGRN in mutation carriers may be therapeutic. Nimodipine, a Food and Drug Administration-approved blood-brain barrier-penetrant calcium channel blocker, increased PGRN levels in PGRN-deficient murine models. We sought to assess safety and tolerability of oral nimodipine in human GRN mutation carriers., Methods: We performed an open-label, 8-week, dose-finding, phase 1 clinical trial in eight GRN mutation carriers to assess the safety and tolerability of nimodipine and assayed fluid and radiologic markers to investigate therapeutic endpoints., Results: There were no serious adverse events; however, PGRN concentrations (cerebrospinal fluid and plasma) did not change significantly following treatment (percent changes of -5.2 ± 10.9% in plasma and -10.2 ± 7.8% in cerebrospinal fluid). Measurable atrophy within the left middle frontal gyrus was observed over an 8-week period., Discussion: While well tolerated, nimodipine treatment did not alter PGRN concentrations or secondary outcomes.
- Published
- 2017
- Full Text
- View/download PDF
32. Appropriate Reconciliation of Cardiovascular Medications After Elective Surgery and Postdischarge Acute Hospital and Ambulatory Visits.
- Author
-
Lee JS, Gonzales R, Vittinghoff E, Corbett KK, Fleischmann KE, Sehgal N, and Auerbach AD
- Subjects
- Cardiovascular Diseases drug therapy, Female, Hospitalization, Humans, Male, Middle Aged, Patient Discharge standards, Pharmaceutical Preparations administration & dosage, Retrospective Studies, Risk Factors, Elective Surgical Procedures, Medication Reconciliation, Patient Discharge statistics & numerical data, Primary Health Care
- Abstract
Objective: To describe appropriate discharge reconciliation of cardiovascular medications and assess associations with postdischarge healthcare utilization in surgical patients., Design: Retrospective cohort study from January 2007 to December 2011., Setting: An academic medical center., Patients: Seven hundred and fifty-two adults undergoing elective noncardiac surgery and taking antiplatelet agents, beta-blockers, renin-angiotensin system inhibitors, or statin lipid-lowering agents before surgery., Measurements: Primary predictor: appropriate discharge reconciliation of preoperative cardiovascular medications (continuation without documented contraindications). Primary outcomes: acute hospital visits (emergency department visits or hospitalizations) and unplanned ambulatory visits (primary care or surgical) at 30 days after surgery., Results: Preoperative medications were appropriately reconciled in 436 (58.0%) patients. For individual medications, appropriate discharge reconciliation occurred for 156 of the 327 patients on antiplatelet agents (47.7%), 507 of the 624 patients on beta-blockers (81.3%), 259 of the 361 patients on renin-angiotensin system inhibitors (71.8%), and 302 of the 406 patients on statins (74.4%). In multivariable analyses, appropriate reconciliation of all preoperative medications was not associated with acute hospital (adjusted odds ratio [AOR], 0.94; 95% confidence interval [CI], 0.63-1.41) or unplanned ambulatory visits (AOR, 1.48; 95% CI, 0.94-2.35). Appropriate reconciliation of statin therapy was associated with lower odds of acute hospital visits (AOR, 0.47; 95% CI, 0.26-0.85). There were no other statistically significant associations between appropriate reconciliation of individual medications and either outcome., Conclusions: Although large gaps in appropriate discharge reconciliation of chronic cardiovascular medications were common in patients undergoing elective surgery, these gaps were not consistently associated with postdischarge acute hospital or ambulatory visits., (© 2017 Society of Hospital Medicine)
- Published
- 2017
- Full Text
- View/download PDF
33. Cost-effectiveness of the polypill versus risk assessment for prevention of cardiovascular disease.
- Author
-
Ferket BS, Hunink MG, Khanji M, Agarwal I, Fleischmann KE, and Petersen SE
- Subjects
- Administration, Oral, Adult, Aged, Amlodipine economics, Amlodipine therapeutic use, Antihypertensive Agents administration & dosage, Cardiovascular Diseases diagnosis, Cardiovascular Diseases etiology, Computer Simulation, Cost-Benefit Analysis, Drug Combinations, Dyslipidemias complications, Dyslipidemias diagnosis, Female, Humans, Hydrochlorothiazide economics, Hydrochlorothiazide therapeutic use, Hydroxymethylglutaryl-CoA Reductase Inhibitors administration & dosage, Hypertension complications, Hypertension diagnosis, Losartan economics, Losartan therapeutic use, Male, Middle Aged, Models, Economic, Primary Prevention methods, Quality-Adjusted Life Years, Risk Assessment, Risk Factors, Simvastatin economics, Simvastatin therapeutic use, Tablets, Time Factors, Treatment Outcome, Antihypertensive Agents economics, Antihypertensive Agents therapeutic use, Cardiovascular Diseases economics, Cardiovascular Diseases prevention & control, Drug Costs, Dyslipidemias drug therapy, Dyslipidemias economics, Hydroxymethylglutaryl-CoA Reductase Inhibitors economics, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Hypertension drug therapy, Hypertension economics, Primary Prevention economics
- Abstract
Objective: There is an international trend towards recommending medication to prevent cardiovascular disease (CVD) in individuals at increasingly lower cardiovascular risk. We assessed the cost-effectiveness of a population approach with a polypill including a statin (simvastatin 20 mg) and three antihypertensive agents (amlodipine 2.5 mg, losartan 25 mg and hydrochlorothiazide 12.5 mg) and periodic risk assessment with different risk thresholds., Methods: We developed a microsimulation model for lifetime predictions of CVD events, diabetes, and death in 259 146 asymptomatic UK Biobank participants aged 40-69 years. We assessed incremental costs and quality-adjusted life-years (QALYs) for polypill scenarios with the same combination of agents and doses but differing for starting age, and periodic risk assessment with 10-year CVD risk thresholds of 10% and 20%., Results: Restrictive risk assessment, in which statins and antihypertensives were prescribed when risk exceeded 20%, was the optimal strategy gaining 123 QALYs (95% credible interval (CI) -173 to 387) per 10 000 individuals at an extra cost of £1.45 million (95% CI 0.89 to 1.94) as compared with current practice. Although less restrictive risk assessment and polypill scenarios prevented more CVD events and attained larger survival gains, these benefits were offset by the additional costs and disutility of daily medication use. Lowering the risk threshold for prescription of statins to 10% was economically unattractive, costing £40 000 per QALY gained. Starting the polypill from age 60 onwards became the most cost-effective scenario when annual drug prices were reduced below £240. All polypill scenarios would save costs at prices below £50., Conclusions: Periodic risk assessment using lower risk thresholds is unlikely to be cost-effective. The polypill would become cost-effective if drug prices were reduced., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)
- Published
- 2017
- Full Text
- View/download PDF
34. Comparative cost-effectiveness of non-invasive imaging tests in patients presenting with chronic stable chest pain with suspected coronary artery disease: a systematic review.
- Author
-
van Waardhuizen CN, Khanji MY, Genders TSS, Ferket BS, Fleischmann KE, Hunink MGM, and Petersen SE
- Subjects
- Computed Tomography Angiography economics, Cost-Benefit Analysis, Humans, Positron-Emission Tomography economics, Tomography, Emission-Computed, Single-Photon economics, Chest Pain diagnostic imaging, Coronary Artery Disease diagnostic imaging
- Abstract
Coronary artery disease (CAD) remains one of the leading causes of morbidity and mortality globally. The most cost-effective imaging strategy to diagnose CAD in patients with stable chest pain is however uncertain. To review the evidence on comparative cost-effectiveness of different imaging strategies for patients presenting with stable chest pain symptoms suggestive for CAD. Systematic review. Studies performing a formal economic evaluation or decision analysis in the English language published between January 1995 and December 2015 were identified using PubMed, Medline (OvidSP), Embase, Web of Science, Cochrane economic evaluations library, and EconLit. Reviews and meta-analyses were excluded. Two independent reviewers assessed titles and abstracts. Of the 4498 titles identified, 70 met our selection criteria. One reviewer used a modified version of the CHEERS checklist to assess study quality. One reviewer extracted data on study details, which were checked by a second reviewer. There is a major heterogeneity between the available cost-effectiveness studies included in this study. The included studies compared very different testing strategies in very different ways and provided mostly short-term results. Strategies of no-testing and xECG were underrepresented. Nonetheless, the findings from this systematic review suggest that for patients with a low to intermediate prior probability of having obstructive CAD, computed tomography coronary angiography (CTCA) may be cost-effective as an initial diagnostic imaging test in comparison with CAG or other non-invasive diagnostic tests. If functional testing is required, stress echocardiography (SE) or single-photon emission computed tomography (SPECT) are suggested to be cost-effective initial strategies in patients with intermediate prior probability of CAD. Yet, other functional testing strategies such as xECG and positron-emission tomography (PET) scanning have not been studied as intensely. Immediate CAG is suggested to be a cost-effective strategy for patients at a high prior probability of having obstructive CAD whom may benefit from revascularization. The study emphasizes the inextricable link between clinical effectiveness and economic efficiency. Evidence suggests that the optimal diagnostic imaging strategy for individuals suspected of having CAD is CTCA for low and intermediate disease probability, followed by SE or SPECT as necessary, and invasive CAG for high disease probability. Further studies are needed to evaluate the cost-effectiveness of alternative non-invasive tests, including a no-testing strategy.
- Published
- 2016
- Full Text
- View/download PDF
35. The Role of Randomized and Nonrandomized Studies in Evaluating Diagnostic Strategies.
- Author
-
Hunink MGM and Fleischmann KE
- Published
- 2016
- Full Text
- View/download PDF
36. Comparing the cost-effectiveness of four novel risk markers for screening asymptomatic individuals to prevent cardiovascular disease (CVD) in the US population.
- Author
-
van Kempen BJ, Ferket BS, Steyerberg EW, Max W, Myriam Hunink MG, and Fleischmann KE
- Subjects
- Biomarkers blood, C-Reactive Protein metabolism, Calcinosis prevention & control, Cardiovascular Diseases diagnosis, Cardiovascular Diseases economics, Coronary Artery Disease blood, Coronary Artery Disease prevention & control, Female, Humans, Male, Mass Screening economics, Predictive Value of Tests, Risk Factors, Sensitivity and Specificity, United States, Ankle Brachial Index economics, C-Reactive Protein economics, Calcinosis diagnosis, Calcinosis economics, Carotid Intima-Media Thickness economics, Coronary Artery Disease diagnosis, Coronary Artery Disease economics, Cost-Benefit Analysis economics
- Abstract
Background: High sensitivity CRP (hsCRP), coronary artery calcification on CT (CT calcium), carotid artery intima media thickness on ultrasound (cIMT) and ankle-brachial index (ABI) improve prediction of cardiovascular disease (CVD) risk, but the benefit of screening with these novel risk markers in the U.S. population is unclear., Methods and Results: A microsimulation model evaluating lifelong cost-effectiveness for individuals aged 40-85 at intermediate risk of CVD, using 2003-2004 NHANES-III (N=3736), Framingham Heart Study, U.S. Vital Statistics, meta-analyses of independent predictive effects of the four novel risk markers and treatment effects was constructed. Using both an intention-to-treat (assumes adherence <100% and incorporates disutility from taking daily medications) and an as-treated (100% adherence and no disutility) analysis, quality adjusted life years (QALYs), lifetime costs (2014 US $), and incremental cost-effectiveness ratios (ICER in $/QALY gained) of screening with hsCRP, CT coronary calcium, cIMT and ABI were established compared with current practice, full adherence to current guidelines, and ubiquitous statin therapy. In the intention-to-treat analysis in men, screening with CT calcium was cost effective ($32,900/QALY) compared with current practice. In women, screening with hsCRP was cost effective ($32,467/QALY). In the as-treated analysis, statin therapy was both more effective and less costly than all other strategies for both men and women., Conclusions: When a substantial disutility from taking daily medication is assumed, screening men with CT coronary calcium is likely to be cost-effective whereas screening with hsCRP has value in women. The individual perceived disutility for taking daily medication should play a key role in the decision., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
37. The new lipid guidelines: what do primary care clinicians think?
- Author
-
Jamé S, Wittenberg E, Potter MB, and Fleischmann KE
- Subjects
- Adult, Aged, American Heart Association, Cross-Sectional Studies, Female, Humans, Hypercholesterolemia complications, Male, Middle Aged, Practice Patterns, Physicians', United States, Young Adult, Coronary Artery Disease prevention & control, Guideline Adherence, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Hypercholesterolemia drug therapy, Physicians, Primary Care, Practice Guidelines as Topic
- Abstract
Background: Little is known about the opinions of primary care clinicians regarding the newly released 2013 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for the Prevention of Primary and Secondary Atherosclerotic Disease. This survey was created to assess the awareness, attitudes, and practices of primary care clinicians on adoption of the new guidelines and to explore obstacles to implementation and suggestions for improving shared decision-making., Methods: Six hundred practicing clinicians within the San Francisco Bay Area Collaborative Research Network were invited to participate in this cross-sectional, Internet-based pilot survey of primary care clinicians. These survey data were collected in March 2014, approximately 4 months after the release of the new guidelines and 1 month after the release of the ACC/AHA risk estimator application., Results: One hundred eighty-three clinicians responded to the survey. Of those respondents, 176 (96%) were aware of the guidelines. The majority (64%) reported implementing the new guidelines with at least some of their patients, while a minority (25%) reported adopting the guidelines for many of their patients. Disagreeing with the guidelines was the main hindrance to adoption., Conclusions: While many primary care clinicians are aware of the new guidelines, a substantial proportion has yet to implement them into their clinical practice, and obstacles remain for full adoption. Further understanding of clinicians' views, opinions, and needs is necessary to optimize the approach to lipid management and ensure integration into current practice., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
38. Papillary Fibroelastoma: Move Over Myxoma.
- Author
-
Fleischmann KE and Schiller NB
- Subjects
- Female, Humans, Male, Fibroma epidemiology, Heart Neoplasms epidemiology
- Published
- 2015
- Full Text
- View/download PDF
39. The optimal imaging strategy for patients with stable chest pain: a cost-effectiveness analysis.
- Author
-
Genders TS, Petersen SE, Pugliese F, Dastidar AG, Fleischmann KE, Nieman K, and Hunink MG
- Subjects
- Computer Simulation, Coronary Angiography economics, Echocardiography economics, Electrocardiography, Exercise Test, Female, Humans, Magnetic Resonance Imaging economics, Male, Middle Aged, Quality of Life, Sensitivity and Specificity, Tomography, Emission-Computed, Single-Photon economics, Tomography, X-Ray Computed economics, Chest Pain etiology, Coronary Artery Disease diagnosis, Cost-Benefit Analysis, Diagnostic Imaging economics
- Abstract
Background: The optimal imaging strategy for patients with stable chest pain is uncertain., Objective: To determine the cost-effectiveness of different imaging strategies for patients with stable chest pain., Design: Microsimulation state-transition model., Data Sources: Published literature., Target Population: 60-year-old patients with a low to intermediate probability of coronary artery disease (CAD)., Time Horizon: Lifetime., Perspective: The United States, the United Kingdom, and the Netherlands., Intervention: Coronary computed tomography (CT) angiography, cardiac stress magnetic resonance imaging, stress single-photon emission CT, and stress echocardiography., Outcome Measures: Lifetime costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios., Results of Base-Case Analysis: The strategy that maximized QALYs and was cost-effective in the United States and the Netherlands began with coronary CT angiography, continued with cardiac stress imaging if angiography found at least 50% stenosis in at least 1 coronary artery, and ended with catheter-based coronary angiography if stress imaging induced ischemia of any severity. For U.K. men, the preferred strategy was optimal medical therapy without catheter-based coronary angiography if coronary CT angiography found only moderate CAD or stress imaging induced only mild ischemia. In these strategies, stress echocardiography was consistently more effective and less expensive than other stress imaging tests. For U.K. women, the optimal strategy was stress echocardiography followed by catheter-based coronary angiography if echocardiography induced mild or moderate ischemia., Results of Sensitivity Analysis: Results were sensitive to changes in the probability of CAD and assumptions about false-positive results., Limitations: All cardiac stress imaging tests were assumed to be available. Exercise electrocardiography was included only in a sensitivity analysis. Differences in QALYs among strategies were small., Conclusion: Coronary CT angiography is a cost-effective triage test for 60-year-old patients who have nonacute chest pain and a low to intermediate probability of CAD., Primary Funding Source: Erasmus University Medical Center.
- Published
- 2015
- Full Text
- View/download PDF
40. Aspirin for primary prevention: what's a clinician to do?
- Author
-
Psotka MA and Fleischmann KE
- Subjects
- Aspirin adverse effects, Hemorrhage chemically induced, Humans, Primary Prevention trends, Aspirin administration & dosage, Cardiovascular Diseases prevention & control, Physician's Role, Primary Prevention methods
- Published
- 2015
- Full Text
- View/download PDF
41. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Developed in collaboration with the American College of Surgeons, American Society of Anesthesiologists, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists, and Society of Vascular Medicine Endorsed by the Society of Hospital Medicine.
- Author
-
Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, and Wijeysundera DN
- Subjects
- American Heart Association, Cardiology organization & administration, Cardiovascular Diseases surgery, Humans, Pain Management methods, Surgical Procedures, Operative standards, United States, Cardiology standards, Cardiovascular Diseases diagnosis, Pain Management standards, Perioperative Care standards
- Published
- 2015
- Full Text
- View/download PDF
42. Perioperative beta blockade in noncardiac surgery: a systematic review for the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
- Author
-
Wijeysundera DN, Duncan D, Nkonde-Price C, Virani SS, Washam JB, Fleischmann KE, and Fleisher LA
- Subjects
- American Heart Association, Cardiovascular Diseases epidemiology, Humans, Practice Guidelines as Topic, Risk Factors, Time Factors, United States, Adrenergic beta-Antagonists therapeutic use, Cardiovascular Diseases mortality, Cardiovascular Diseases prevention & control, General Surgery, Patient Care Management methods, Perioperative Care methods
- Abstract
Objective: To review the literature systematically to determine whether initiation of beta blockade within 45 days prior to noncardiac surgery reduces 30-day cardiovascular morbidity and mortality rates., Methods: PubMed (up to April 2013), Embase (up to April 2013), Cochrane Central Register of Controlled Trials (up to March 2013), and conference abstracts (January 2011 to April 2013) were searched for randomized controlled trials (RCTs) and cohort studies comparing perioperative beta blockade with inactive control during noncardiac surgery. Pooled relative risks (RRs) were calculated under the random-effects model. We conducted subgroup analyses to assess how the DECREASE-I (Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography), DECREASE-IV, and POISE-1 (Perioperative Ischemic Evaluation) trials influenced our conclusions., Results: We identified 17 studies, of which 16 were RCTs (12 043 participants) and 1 was a cohort study (348 participants). Aside from the DECREASE trials, all other RCTs initiated beta blockade within 1 day or less prior to surgery. Among RCTs, beta blockade decreased nonfatal myocardial infarction (MI) (RR: 0.69; 95% confidence interval [CI]: 0.58 to 0.82) but increased nonfatal stroke (RR: 1.76; 95% CI: 1.07 to 2.91), hypotension (RR: 1.47; 95% CI: 1.34 to 1.60), and bradycardia (RR: 2.61; 95% CI: 2.18 to 3.12). These findings were qualitatively unchanged after the DECREASE and POISE-1 trials were excluded. Effects on mortality rate differed significantly between the DECREASE trials and other trials. Beta blockers were associated with a trend toward reduced all-cause mortality rate in the DECREASE trials (RR: 0.42; 95% CI: 0.15 to 1.22) but with increased all-cause mortality rate in other trials (RR: 1.30; 95% CI: 1.03 to 1.64). Beta blockers reduced cardiovascular mortality rate in the DECREASE trials (RR: 0.17; 95% CI: 0.05 to 0.64) but were associated with trends toward increased cardiovascular mortality rate in other trials (RR: 1.25; 95% CI: 0.92 to 1.71). These differences were qualitatively unchanged after the POISE-1 trial was excluded., Conclusions: Perioperative beta blockade started within 1 day or less before noncardiac surgery prevents nonfatal MI but increases risks of stroke, death, hypotension, and bradycardia. Without the controversial DECREASE studies, there are insufficient data on beta blockade started 2 or more days prior to surgery. Multicenter RCTs are needed to address this knowledge gap., (© 2014 by the American College of Cardiology Foundation and the American Heart Association, Inc.)
- Published
- 2014
- Full Text
- View/download PDF
43. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
- Author
-
Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, and Wijeysundera DN
- Subjects
- American Heart Association, Cardiovascular Diseases diagnosis, Cardiovascular Diseases prevention & control, Humans, Monitoring, Physiologic, Pain Management, Risk Factors, United States, Cardiovascular Diseases epidemiology, Cardiovascular System physiopathology, General Surgery, Patient Care Management methods, Perioperative Care methods
- Published
- 2014
- Full Text
- View/download PDF
44. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
- Author
-
Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, and Wijeysundera DN
- Subjects
- American Heart Association, Cardiology organization & administration, Cardiovascular Diseases surgery, Humans, Pain Management methods, Surgical Procedures, Operative standards, United States, Cardiology standards, Cardiovascular Diseases diagnosis, Pain Management standards, Perioperative Care standards
- Published
- 2014
- Full Text
- View/download PDF
45. Predictive value of updating Framingham risk scores with novel risk markers in the U.S. general population.
- Author
-
Ferket BS, van Kempen BJ, Hunink MG, Agarwal I, Kavousi M, Franco OH, Steyerberg EW, Max W, and Fleischmann KE
- Subjects
- Adult, Aged, Ankle Brachial Index, Cardiovascular Diseases diagnosis, Carotid Intima-Media Thickness, Cohort Studies, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Proportional Hazards Models, Risk Factors, Treatment Outcome, United States epidemiology, Biomarkers metabolism, Cardiovascular Diseases epidemiology, Nutrition Surveys
- Abstract
Background: According to population-based cohort studies CT coronary calcium score (CTCS), carotid intima-media thickness (cIMT), high-sensitivity C- reactive protein (CRP), and ankle-brachial index (ABI) are promising novel risk markers for improving cardiovascular risk assessment. Their impact in the U.S. general population is however uncertain. Our aim was to estimate the predictive value of four novel cardiovascular risk markers for the U.S. general population., Methods and Findings: Risk profiles, CRP and ABI data of 3,736 asymptomatic subjects aged 40 or older from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 exam were used along with predicted CTCS and cIMT values. For each subject, we calculated 10-year cardiovascular risks with and without each risk marker. Event rates adjusted for competing risks were obtained by microsimulation. We assessed the impact of updated 10-year risk scores by reclassification and C-statistics. In the study population (mean age 56±11 years, 48% male), 70% (80%) were at low (<10%), 19% (14%) at intermediate (≥10-<20%), and 11% (6%) at high (≥20%) 10-year CVD (CHD) risk. Net reclassification improvement was highest after updating 10-year CVD risk with CTCS: 0.10 (95%CI 0.02-0.19). The C-statistic for 10-year CVD risk increased from 0.82 by 0.02 (95%CI 0.01-0.03) with CTCS. Reclassification occurred most often in those at intermediate risk: with CTCS, 36% (38%) moved to low and 22% (30%) to high CVD (CHD) risk. Improvements with other novel risk markers were limited., Conclusions: Only CTCS appeared to have significant incremental predictive value in the U.S. general population, especially in those at intermediate risk. In future research, cost-effectiveness analyses should be considered for evaluating novel cardiovascular risk assessment strategies.
- Published
- 2014
- Full Text
- View/download PDF
46. Diagnostic performance and comparative cost-effectiveness of non-invasive imaging tests in patients presenting with chronic stable chest pain with suspected coronary artery disease: a systematic overview.
- Author
-
van Waardhuizen CN, Langhout M, Ly F, Braun L, Genders TS, Petersen SE, Fleischmann KE, Nieman K, and Hunink MG
- Subjects
- Algorithms, Cardiac Imaging Techniques economics, Chest Pain etiology, Chronic Disease, Coronary Artery Disease economics, Cost-Benefit Analysis, Humans, Cardiac Imaging Techniques methods, Coronary Artery Disease diagnosis
- Abstract
Several non-invasive imaging techniques are currently in use for the diagnostic workup of adult patients with stable chest pain suspected of having coronary artery disease (CAD). In this paper, we present a systematic overview of the evidence on diagnostic performance and comparative cost-effectiveness of new modalities in comparison to established technologies. A literature search for English language studies from 2009 to 2013 was performed, and two investigators independently extracted data on patient and study characteristics. The reviewed published evidence on diagnostic performance and cost-effectiveness support a strategy of CTCA as a rule out (gatekeeper) test of CAD in low- to intermediate-risk patients since it has excellent diagnostic performance and as initial imaging test is cost-effective under different willingness-to-pay thresholds. More cost-effectiveness research is needed in order to define the role and choice of cardiac stress imaging tests.
- Published
- 2014
- Full Text
- View/download PDF
47. Risk factors and prognosis for clot formation on cardiac device leads.
- Author
-
Rahbar AS, Azadani PN, Thatipelli S, Fleischmann KE, Nguyen N, and Lee BK
- Subjects
- Female, Humans, Incidence, Male, Middle Aged, Prognosis, Risk Assessment, Risk Factors, San Francisco epidemiology, Cardiac Resynchronization Therapy Devices statistics & numerical data, Defibrillators, Implantable statistics & numerical data, Electrodes, Implanted statistics & numerical data, Heart Diseases epidemiology, Thrombosis epidemiology
- Abstract
Background: Clot formation on cardiac device leads is poorly understood. We sought to determine how often clot is seen on device leads by transthoracic echo (TTE), identify risk factors, and to describe the natural history of this phenomenon., Methods: We reviewed 71,888 echocardiographic studies performed at the University of California, San Francisco from 2005 to 2011. We searched for cases where clot was found adhered to a device lead with no diagnosis of endocarditis. For every case, three age-matched controls with a device but no clot were selected from the echo database., Results: We found 15 cases with clot adhered to a device lead among 1,086 patients with devices who had TTE (1.4%). In univariate analysis, females had more than four times greater odds of having a clot on their device lead and patients with a history of atrial fibrillation (AF) had an eight times greater odds. Percentage mode switch was also associated with clot formation. Only AF was still associated with clot formation after multivariate analysis. Follow-up data were available for nine of 15 patients. All nine patients had intensification of their anticoagulant/antiplatelet regimen following clot discovery. Complete resolution or shrinkage of clot was observed in eight of nine patients. The one case with no change was a patient who continued taking only aspirin (higher dose) after clot discovery. None of the nine patients had embolic phenomenon., Conclusion: Patients with AF are at higher risk for clot formation on device leads. After clot detection, treatment with anticoagulants usually results in resolution of the clot without embolic phenomenon., (©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.)
- Published
- 2013
- Full Text
- View/download PDF
48. Coronary computed tomography versus exercise testing in patients with stable chest pain: comparative effectiveness and costs.
- Author
-
Genders TS, Ferket BS, Dedic A, Galema TW, Mollet NR, de Feyter PJ, Fleischmann KE, Nieman K, and Hunink MG
- Subjects
- Aged, Chest Pain physiopathology, Cohort Studies, Cost-Benefit Analysis economics, Exercise Test methods, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Standard of Care economics, Tomography, X-Ray Computed methods, Chest Pain diagnostic imaging, Chest Pain economics, Exercise Test economics, Tomography, X-Ray Computed economics
- Abstract
Background: To determine the comparative effectiveness and costs of a CT-strategy and a stress-electrocardiography-based strategy (standard-of-care; SOC-strategy) for diagnosing coronary artery disease (CAD)., Methods: A decision analysis was performed based on a well-documented prospective cohort of 471 outpatients with stable chest pain with follow-up combined with best-available evidence from the literature. Outcomes were correct classification of patients as CAD- (no obstructive CAD), CAD+ (obstructive CAD without revascularization) and indication for Revascularization (using a combination reference standard), diagnostic costs, lifetime health care costs, and quality-adjusted life years (QALY). Parameter uncertainty was analyzed using probabilistic sensitivity analysis., Results: For men (and women), diagnostic cost savings were €245 (€252) for the CT-strategy as compared to the SOC-strategy. The CT-strategy classified 82% (88%) of simulated men (women) in the appropriate disease category, whereas 83% (85%) were correctly classified by the SOC-strategy. The long-term cost-effectiveness analysis showed that the SOC-strategy was dominated by the CT-strategy, which was less expensive (-€229 in men, -€444 in women) and more effective (+0.002 QALY in men, +0.005 in women). The CT-strategy was cost-saving (-€231) but also less effective compared to SOC (-0.003 QALY) in men with a pre-test probability of ≥ 70%. The CT-strategy was cost-effective in 100% of simulations, except for men with a pre-test probability ≥ 70% in which case it was 59%., Conclusions: The results suggest that a CT-based strategy is less expensive and equally effective compared to SOC in all women and in men with a pre-test probability <70%., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
49. Prehospital electrocardiographic manifestations of acute myocardial ischemia independently predict adverse hospital outcomes.
- Author
-
Zègre Hemsey JK, Dracup K, Fleischmann KE, Sommargren CE, Paul SM, and Drew BJ
- Subjects
- Acute Coronary Syndrome epidemiology, Age Factors, Aged, Atrial Fibrillation epidemiology, Female, Humans, Hypertension epidemiology, Male, Prognosis, Randomized Controlled Trials as Topic, Retrospective Studies, Shock, Cardiogenic epidemiology, Smoking adverse effects, Ventricular Fibrillation epidemiology, Electrocardiography, Emergency Medical Services, Myocardial Ischemia epidemiology, Outcome Assessment, Health Care
- Abstract
Background: Prehospital electrocardiography (PH ECG) is becoming the standard of care for patients activating Emergency Medical Services for symptoms of acute coronary syndrome (ACS). Little is known about the prognostic value of ischemia found on PH ECG., Objective: The purpose of this study was to determine whether manifestations of acute myocardial ischemia on PH ECG are predictive of adverse hospital outcomes., Methods: This study was a retrospective analysis of all PH ECGs recorded in 630 patients who called 911 for symptoms of ACS and were enrolled in a prospective clinical trial. ST-segment monitoring software was added to the PH ECG device with automatic storage and transmission of ECGs to the destination Emergency Department. Patient medical records were reviewed for adverse hospital outcomes., Results: In 630 patients who called 911 for ACS symptoms, 270 (42.9%) had PH ECG evidence of ischemia. Overall, 37% of patients with PH ECG ischemia had adverse hospital outcomes compared with 27% of patients without PH ECG ischemia (p < 0.05). Those with PH ECG ischemia were 1.55 times more likely to have adverse hospital outcomes than those without PH ECG ischemia (95% CI 1.09-2.21; p < 0.05), after controlling for other predictors of adverse hospital outcomes (i.e., age, sex, and medical history)., Conclusions: Evidence of ischemia on PH ECG is an independent predictor of adverse hospital outcomes. ST-segment monitoring in the prehospital setting can identify high-risk patients with symptoms of ACS and provide important prognostic information at presentation to the Emergency Department., (Published by Elsevier Inc.)
- Published
- 2013
- Full Text
- View/download PDF
50. Family caregiving in pulmonary arterial hypertension.
- Author
-
Hwang B, Howie-Esquivel J, Fleischmann KE, Stotts NA, and Dracup K
- Subjects
- Adaptation, Psychological, Adult, Aged, Cross-Sectional Studies, Female, Health Status, Health Status Indicators, Humans, Male, Middle Aged, Psychometrics, Self Care, Social Support, Statistics as Topic, Surveys and Questionnaires, Young Adult, Caregivers psychology, Depression psychology, Hypertension, Pulmonary psychology, Stress, Psychological
- Abstract
Background: Pulmonary arterial hypertension (PAH) is a devastating disease that places a significant burden on patients and their families. However, family caregiving, to the best of our knowledge, has never been described in this population. This study sought to describe depressive symptoms, types of performed care tasks, social support, and the impact of caregiving among family caregivers of patients with PAH., Methods and Results: Data were obtained from 35 dyads of patients with PAH (mean age, 51 years; 63% were female; 54% had World Health Organization functional class III symptoms) and their family caregivers (mean age, 52 years; 60% were female; 68% were spouses). Five caregivers (14%) were identified as manifesting moderate to severe depressive symptoms. The majority of caregivers reported that their daily activities were centered around caregiving responsibilities. More than 85% of caregivers were involved in managing care for the patient, and more than half helped the patient with self-management activities. The level of caregivers' perceived social support was low, especially for emotional and informational support. Lower levels of social support were significantly associated with more severe depressive symptoms in caregivers (r = -.50, P = .002)., Conclusion: Caregivers of patients with PAH play a significant role in patients' medical care and self-management, yet they lack sufficient emotional support or information to meet the demands of caregiving. These findings underscore the importance of supporting family caregivers of patients with PAH., (Copyright © 2012 Elsevier Inc. All rights reserved.)
- Published
- 2012
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.