171 results on '"Lena Sun"'
Search Results
2. Patient-reported and Clinical Outcomes Among Patients Hospitalized for Heart Failure With Reduced Versus Preserved Ejection Fraction
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ANTHONY E. Peters, ROBERT J. MENTZ, JIE-LENA SUN, JOSEPHINE L. HARRINGTON, MARAT FUDIM, BROOKE ALHANTI, ADRIAN F. HERNANDEZ, JAVED BUTLER, RANDALL C. STARLING, and STEPHEN J. GREENE
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Heart Failure ,Hospitalization ,Quality of Life ,Humans ,Aftercare ,Stroke Volume ,Patient Reported Outcome Measures ,Prognosis ,Cardiology and Cardiovascular Medicine ,Patient Discharge - Abstract
Differences between patients hospitalized for heart failure with reduced ejection fraction (HFrEF) vs HF with preserved EF (HFpEF) are not well-characterized, particularly as pertains to in-hospital decongestion and longitudinal patient-reported outcomes. The objective of this analysis was to compare patient-reported and clinical outcomes between patients hospitalized with HFrEF vs HFpEF.The Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial enrolled 7141 patients hospitalized for HF with reduced or preserved EF. We assessed the association between an EF ≤ 40% vs an EF40% with in-hospital decongestion, risk of rehospitalization and mortality, and quality of life as measured by the EuroQOL 5 Dimensions (EQ-5D). Among 5800 patients (81%) with complete EF data, 4782 (82%) had an EF ≤40% and 1018 (18%) had an EF40%. Both groups demonstrated similar rates of decongestion by weight change and urine volume through 24 hours, a similar risk of 30-day mortality and HF rehospitalization, and a similar 180-day mortality. Patients with HFpEF had worse EQ-5D scores at hour 24 (median 0.76, [interquartile range (IQR) 0.51-0.84] vs 0.78 [IQR 0.57-0.84]; P = .01) that persisted through discharge (0.81 [IQR 0.69-0.86] vs 0.83 [IQR 0.71-1.00]; P.001) and the 30-day follow-up (0.78 [IQR 0.60-0.85] vs 0.83 [IQR 0.71-1.00]; P.001). After adjustment, these differences were attenuated and not statistically significant.In this large, multinational cohort of patients hospitalized for HF, patients with an EF ≤ 40% vs an EF40% experienced similar in-hospital decongestion and postdischarge clinical outcomes. Patients with an EF40% reported worse in-hospital and postdischarge patient-reported health status, but these measures were similar to HFrEF after accounting for other clinical factors.
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- 2022
3. Clinical Profile, Health Care Costs, and Outcomes of Patients Hospitalized for Heart Failure With Severely Reduced Ejection Fraction
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Josephine Harrington, Jie‐Lena Sun, Gregg C. Fonarow, Stephen B. Heitner, Punag H. Divanji, Gary Binder, Larry A. Allen, Brooke Alhanti, Clyde W. Yancy, Nancy M. Albert, Adam D. DeVore, G. Michael Felker, and Stephen J. Greene
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Heart Failure ,Aftercare ,costs ,Stroke Volume ,Health Care Costs ,Cardiorespiratory Medicine and Haematology ,Medicare ,outcomes ,Cardiovascular ,Patient Discharge ,United States ,Hospitalization ,Heart Disease ,Clinical Research ,Humans ,Cardiology and Cardiovascular Medicine ,ejection fraction ,Aged - Abstract
Background Many patients with heart failure (HF) have severely reduced ejection fraction but do not meet threshold for consideration of advanced therapies (ie, stage D HF). The clinical profile and health care costs associated with these patients in US practice is not well described. Methods and Results We examined patients hospitalized for worsening chronic heart failure with reduced ejection fraction ≤40% from 2014 to 2019 in the GWTG‐HF (Get With The Guidelines‐Heart Failure) registry, who did not receive advanced HF therapies or have end‐stage kidney disease. Patients with severely reduced EF defined as EF ≤30% were compared with those with EF 31% to 40% in terms of clinical profile and guideline‐directed medical therapy. Among Medicare beneficiaries, postdischarge outcomes and health care expenditure were compared. Among 113 348 patients with EF ≤40%, 69% (78 589) had an EF ≤30%. Patients with severely reduced EF ≤30% tended to be younger and were more likely to be Black. Patients with EF ≤30% also tended to have fewer comorbidities and were more likely to be prescribed guideline‐directed medical therapy (“triple therapy” 28.3% versus 18.2%, P P =0.11). Conclusions Among patients hospitalized for worsening chronic heart failure with reduced ejection fraction in US clinical practice, most patients have severely reduced EF ≤30%. Despite younger age and modestly higher use of guideline‐directed medical therapy at discharge, patients with severely reduced EF face heightened postdischarge risk of death and HF hospitalization.
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- 2023
4. High‐Sensitivity Troponin I in Hospitalized and Ambulatory Patients With Heart Failure With Preserved Ejection Fraction: Insights From the Heart Failure Clinical Research Network
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Marat Fudim, Andrew P. Ambrosy, Jie‐Lena Sun, Kevin J. Anstrom, Bradley A. Bart, Javed Butler, Omar AbouEzzeddine, Stephen J. Greene, Robert J. Mentz, Margaret M. Redfield, Yogesh N.V. Reddy, Muthiah Vaduganathan, Eugene Braunwald, Adrian F. Hernandez, Barry A. Borlaug, and G. Michael Felker
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clinical outcomes ,heart failure with preserved ejection fraction ,high‐sensitivity troponin ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background We sought to study the prevalence of high‐sensitivity troponin and its association with cardiac structure and outcomes in ambulatory and hospitalized patients with heart failure with a preserved ejection fraction (HFpEF). Methods and Results A post hoc analysis utilized data from HFpEF patients: DOSE (Diuretic Optimization Strategies Evaluation) and CARRESS‐HF (Cardiorenal Rescue Study in Acute Decompensated Heart Failure) enrolled patients hospitalized with acute HFpEF, and RELAX (Phosphodiesterase‐5 Inhibition to Improve Clinical Status and Exercise Capacity in Heart Failure With Preserved Ejection Fraction) enrolled ambulatory patients with HFpEF. High‐sensitivity troponin I (hs‐TnI) was measured in hospitalized patients at baseline, at 72 to 96 hours, on day 7, and on day 60. In ambulatory patients hs‐TnI was measured at baseline and at week 24. In the ambulatory cohort, correlations between hs‐TnI and cardiac structure and function were assessed. The association between hs‐TnI and a 60‐day composite of emergency room visits, readmissions, and death was assessed for hospitalized patients using multivariable Cox proportional hazard models. The study population included 139 hospitalized and 212 ambulatory patients with HFpEF and hs‐TnI measured at baseline. The median (25th, 75th percentiles) baseline troponin was 17.6 (11.1, 41.0) ng/L in hospitalized patients and 9.5 (5.3, 19.7) ng/L in ambulatory patients (P99% percentile upper reference limit was 86% in hospitalized patients and 53% among ambulatory patients, with stable elevation in ambulatory patients during follow‐up. HFpEF patients with a hs‐TnI above the median were older with worse left ventricular hypertrophy and diastolic dysfunction. Continuously valued hs‐TnI (per doubling) was associated with increased risk of composite end point (adjusted hazard ratio 1.20, 95% confidence interval 1.00‐1.43; P=0.042). Conclusions Hs‐TnI is commonly elevated among both hospitalized and ambulatory patients with HFpEF. Increased hs‐TnI levels are associated with worse cardiac structure and increased risk of adverse events.
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- 2018
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5. Association Between Endovascular Therapy Time to Treatment and Outcomes in Patients With Basilar Artery Occlusion
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Raed A. Joundi, Jie-Lena Sun, Ying Xian, Brooke Alhanti, Raul G. Nogueira, Deepak L. Bhatt, Gregg C. Fonarow, Jeffrey Saver, Lee H. Schwamm, and Eric E. Smith
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Male ,Endovascular Procedures ,Arterial Occlusive Diseases ,Stroke ,Treatment Outcome ,Basilar Artery ,Physiology (medical) ,Humans ,Female ,Cardiology and Cardiovascular Medicine ,Intracranial Hemorrhages ,Aged ,Retrospective Studies ,Thrombectomy - Abstract
Background: Basilar artery occlusion (BAO) is a devastating condition without definitive evidence to guide treatment. Whereas the association between faster treatment times with endovascular therapy (EVT) and better outcomes in anterior circulation is well established, whether this relationship exists for patients with BAO is not well delineated. Methods: We used individual-level patient data from the Get With The Guidelines–Stroke nationwide US registry prospectively collected from January 2015 to December 2019. We identified individuals with BAO treated with EVT within 24 hours of symptom onset. The primary outcomes examined were in-hospital mortality, discharge home, ambulatory at discharge, independent at discharge (modified Rankin Scale score 0 to 2), substantial reperfusion (modified Thrombolysis in Cerebral Infarction score 2b or 3), and symptomatic intracranial hemorrhage. Using logistic regression models, we evaluated the association between time from symptom onset to treatment with EVT and outcomes. Results: Among 3015 patients with BAO treated with EVT, the mean age was 65.9 years, 38.8% were women, and the median National Institutes of Health Stroke Scale score at presentation was 17 (interquartile range, 8–26). Median onset to EVT time was 406 minutes (interquartile range, 252–688). From 2015 to 2019, there was an overall increase in the median onset to EVT times (380–411 minutes; P =0.016) but no significant change in the proportion of patients treated within 6 hours of symptom onset (48.4%–44.0%; P =0.17). After risk adjustment for patient and hospital-level factors, there were significantly lower odds of in-hospital mortality (adjusted odds ratio [aOR], 0.55 [95% CI, 0.45–0.68]) and symptomatic intracranial hemorrhage (aOR, 0.52 [95% CI, 0.32–0.84]) and significantly higher odds of ambulation at discharge (aOR, 1.72 [95% CI, 1.37–2.16]), discharge home (aOR, 2.19 [95% CI, 1.73–2.77]), and independence at discharge (aOR, 2.21 [95% CI, 1.66–2.95]) when onset to EVT time was ≤6 hours compared with >6 hours. The fastest decay in good outcomes per hour occurred within 6 hours of symptom onset. Conclusions: Among patients receiving EVT for BAO, faster treatment from symptom onset was associated with improved outcomes. These findings support efforts to achieve rapid treatment with EVT for patients with BAO.
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- 2022
6. Comparing New York Heart Association Class and Patient-Reported Outcomes Among Patients Hospitalized for Heart Failure
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Michael F. Cosiano, Andrew Vista, Jie-Lena Sun, Brooke Alhanti, Josephine Harrington, Javed Butler, Randall C. Starling, Robert J. Mentz, and Stephen J. Greene
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Cardiology and Cardiovascular Medicine - Abstract
Background: Alignment between clinician-reported New York Heart Association (NYHA) class compared and patient-reported outcomes among patients hospitalized for heart failure is unclear. Methods: ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) was a global randomized trial comparing nesiritide versus placebo among patients hospitalized for heart failure, irrespective of ejection fraction. Among patients with complete baseline data for NYHA class and the patient-reported EuroQOL-5 dimensions ([EQ-5D], both utility index and visual analog scale), levels of each scale were mapped across 4 prespecified categories “best” to “worst.” Minor and moderate-severe discordance were defined as NYHA class and EQ-5D differing by 1 level and ≥2 levels, respectively. Multivariable models assessed factors independently associated with moderate-severe discordance, and associations between discordance and clinical outcomes. Results: Among 5741 patients, concordance, minor discordance, and moderate-severe discordance between NYHA class and EQ-5D utility index occurred in 22%, 40%, and 38% of patients, respectively. For NYHA class and EQ-5D visual analog scale, this categorization occurred in 29%, 48%, and 23%. Discordance was more often due to disproportionately higher EQ-5D score (78% of discordance cases with utility index, and 70% with visual analog scale). NYHA class IV, higher EQ-5D scores, race, and geographic region were among patient factors independently associated with moderate-severe discordance. Magnitude of discordance was not associated with clinical outcomes; however, EQ-5D utility index disproportionately worse than NYHA class was associated with increased 180-day mortality (adjusted hazard ratio 1.27 [95% CI, 1.01–1.60]; P =0.04). Conclusions: In a global trial cohort of patients hospitalized for heart failure, the majority of patients exhibited discordance between clinician-reported NYHA class and patient-reported health status. Multiple patient factors were independently associated with moderate-severe discordance, and patients who perceived their health status as worse than the clinician’s perception had higher mortality. Registration: URL: http://www.clinicaltrials.gov ; Unique identifier: NCT00475852.
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- 2023
7. Estimated Glomerular Filtration Rate Variability in Patients With Heart Failure and Chronic Kidney Disease
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Stephen J. Greene, Jie-Lena Sun, Robert J. Mentz, Aaron M. Hein, Julia J. Scialla, Karen Chiswell, Linda K. Shaw, and Patrick H. Pun
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medicine.medical_specialty ,Ejection fraction ,business.industry ,Mortality rate ,Renal function ,Hemodynamics ,030204 cardiovascular system & hematology ,medicine.disease ,Confidence interval ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Internal medicine ,Heart failure ,medicine ,Cardiology ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease - Abstract
Background Greater variability in the estimated glomerular filtration rate (eGFR) is associated with higher mortality in patients with chronic kidney disease (CKD). Heart failure (HF) is common in CKD and may increase variability through changes in hemodynamic and volume regulation. We sought to determine if patients with vs without HF have higher kidney function variability in CKD, and to define the association with mortality. Methods and Results Patients undergoing coronary angiography from 2003 to 2013 with an eGFR of less than 60 mL/min/1.73 m2 were evaluated from the Duke Databank for Cardiovascular Disease. Variability in the eGFR, measured as the coefficient of variation (CV) of residuals from the regression of eGFR vs time, was calculated spanning 3 months to 2 years after catheterization. Mortality was assessed 2 to 7 years after catheterization. Patients were grouped into 3 HF phenotypes: HF with reduced ejection fraction, HF with preserved ejection, and no HF. Regression was used to evaluate associations between HF phenotypes and variability in the eGFR and between variability in the eGFR and mortality rate with stratification by HF phenotype. Among 3767 participants, the median eGFR at baseline was 45 mL/min/1.73 m2 (interquartile range 33-53 mL/min/1.73 m2), and longitudinal measures of eGFR over 21 months had within-patient residual variability (CV) of 14% (9%–20%). In adjusted analyses, variability in the eGFR was greater in those with HF with preserved ejection (n = 695, CV difference 0.98%, 95% confidence interval 0.14%–1.81%) or HF with reduced ejection fraction (n = 800, CV difference 2.51%, 95% confidence interval 1.66%–3.37%) relative to no HF (n = 2272). In 3068 participants eligible for mortality analysis, the presence of HF and greater variability in the eGFR were each associated independently with higher mortality, but there was no evidence of interaction between variability in the eGFR and any HF phenotype (all P for interaction ≥.49). Conclusions Variability in the eGFR is greater in patients with HF and associated with mortality. Prediction algorithms and classification schemes should consider not only static, but also dynamic eGFR variability in HF and CKD prognostication.
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- 2021
8. Pro‐Inflammatory Biomarkers in Stable Versus Acutely Decompensated Heart Failure With Preserved Ejection Fraction
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Abraham Abernethy, Sadi Raza, Jie‐Lena Sun, Kevin J. Anstrom, Russell Tracy, Johannes Steiner, Peter VanBuren, and Martin M. LeWinter
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biomarker ,decompensated heart failure ,diastolic dysfunction ,diastolic heart failure ,ejection fraction ,heart failure ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundUnderlying inflammation has been increasingly recognized in heart failure with a preserved ejection fraction (HFpEF). In this study we tested the hypothesis that pro‐inflammatory biomarkers are elevated in patients with acutely decompensated HFpEF (AD‐HFpEF) compared with patients with stable HFpEF (S‐HFpEF). Methods and ResultsUsing a post hoc analysis the serum biomarkers tumor necrosis factor‐alpha, high‐sensitivity C‐reactive protein interleukin 6 and pentraxin 3 (PTX3) and clinical, demographic, echocardiographic‐Doppler and clinical outcomes data were analyzed in HFpEF patients enrolled in NHLBI Heart Failure Research Network clinical trials which enrolled patients with either AD‐HFpEF or S‐HFpEF. Compared to S‐HFpEF, AD‐HFpEF patients had higher levels of PTX3 (3.08 ng/mL versus 1.27 ng/mL, P
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- 2018
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9. Patients With Type 2 Diabetes Are More Resistant To Diuresis And Have Worse Acute Heart Failure Outcomes: Findings From ASCEND-HF
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Josephine Harrington, Stephen Greene, Jie-Lena Sun, Brooke Alhanti, Marat Fudim, Michael Felker, Javed Butler, Randall Starling, Christopher O'Connor, Adrian Hernandez, and Robert Mentz
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Cardiology and Cardiovascular Medicine - Published
- 2023
10. Estimating the real-world performance of the PROMISE minimal-risk tool
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Pamela S. Douglas, Jie-Lena Sun, Christopher B. Fordyce, Karen Chiswell, Patel, James E. Udelson, Tracy Y. Wang, Udo Hoffmann, Michael G. Nanna, and Sreekanth Vemulapalli
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Male ,medicine.medical_specialty ,Computed Tomography Angiography ,medicine.medical_treatment ,Myocardial Infarction ,Medical Overuse ,030204 cardiovascular system & hematology ,Coronary Angiography ,Chest pain ,Revascularization ,Risk Assessment ,Coronary artery disease ,Angina ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Myocardial Revascularization ,medicine ,Humans ,Angina, Stable ,030212 general & internal medicine ,Myocardial infarction ,Cardiac catheterization ,business.industry ,Coronary Stenosis ,Middle Aged ,Prognosis ,medicine.disease ,Coronary Vessels ,United States ,Outcome and Process Assessment, Health Care ,Heart Disease Risk Factors ,Cohort ,Cardiology ,Female ,Myocardial infarction diagnosis ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Stable chest pain is a common indication for cardiac catheterization. We assessed the prognostic value of the Prospective Multicenter Imaging Study for Evaluation (PROMISE) Minimal-Risk Tool in identifying patients who are at very low risk of obstructive coronary artery disease (CAD) or downstream cardiovascular adverse outcomes. Methods We applied the PROMISE Minimal-Risk Tool to consecutive patients without known CAD who underwent elective cardiac catheterization for stable angina from January 1, 2000 to December 31, 2014 in the Duke Databank for Cardiovascular Disease (DDCD). Patients with scores >0.46 (top decile of lowest-risk from the PROMISE cohort) were classified as low-risk. Logistic regression modeling compared likelihood of freedom from obstructive coronary artery disease on index angiography, 2-year survival, and 2-year survival free of myocardial infarction (MI) and MI/revascularization between low- and non low-risk patients. Alternative cut points to define low- risk patients were also explored. Results Among 6251 patients undergoing cardiac catheterization for stable chest pain, 1082 (17.3%) were low-risk per the PROMISE minimal-risk tool. Among low risk patients, obstructive coronary artery disease was observed in 14.9% and left main disease (≥ 50% Stenosis) was rare (0.9%). Compared with other patients, low risk patients had a higher likelihood of freedom from obstructive coronary disease on index catheterization (85.1% vs. 44.2%, OR 4.84, 95% CI 4.06-5.77). Low risk patients had significantly higher survival (98.2% vs. 94.4%, OR 3.18, 95% CI 1.99-5.08), MI-free survival (97.2% vs. 91.9%, OR 3.03, 95% CI 2.07-4.45), and MI/revascularization-free survival (86.2 vs. 59.9%, OR 4.19, 95% CI 3.48-5.05) at 2 years than non-low risk patients. Operating characteristics for predicting the outcomes of interest varied modestly depending on the low-risk cut-point used but the positive predictive value for 2 year freedom from death was >98% regardless. Conclusion The PROMISE minimal-risk tool identifies 17% of stable chest pain patients referred to cardiac catheterization as low risk. These patients have a low prevalence of obstructive CAD and better survival than non-low risk patients. While this suggests that these patients are unlikely to benefit from catheterization, further research is needed to confirm a favorable downstream prognosis with medical management alone.
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- 2021
11. Early diuretic strategies and the association with In-hospital and Post-discharge outcomes in acute heart failure
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Christopher M. O'Connor, W.H. Wilson Tang, Jie-Lena Sun, Marat Fudim, Randall C. Starling, Veraprapas Kittipibul, G. Michael Felker, Jeffrey M. Testani, Toi Spates, Robert J. Mentz, and Adrian F. Hernandez
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Male ,Randomization ,Post discharge ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Patient Readmission ,Time-to-Treatment ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Bolus (medicine) ,Furosemide ,Oral administration ,Natriuretic Peptide, Brain ,medicine ,Humans ,030212 general & internal medicine ,Mortality ,Diuretics ,Infusions, Intravenous ,Heart Failure ,Creatinine ,business.industry ,Middle Aged ,medicine.disease ,Peptide Fragments ,United States ,Hospitalization ,Regimen ,Outcome and Process Assessment, Health Care ,chemistry ,Anesthesia ,Heart failure ,Injections, Intravenous ,Female ,Drug Monitoring ,Diuretic ,Cardiology and Cardiovascular Medicine ,business - Abstract
Decongestion is a primary goal during hospitalizations for decompensated heart failure (HF). However, data surrounding the preferred route and strategy of diuretic administration are limited with varying results in prior studies.This is a retrospective analysis using patients from ASCEND-HF with a stable diuretic strategy in the first 24 hours following randomization. Patients were divided into three groups: intravenous (IV) continuous, IV bolus and oral strategy. Baseline characteristics, in-hospital outcomes, 30-day composite cardiovascular mortality or HF rehospitalization and 180-day all-cause mortality were compared across groups. Inverse propensity weighted modeling was used for adjustment.Among 5,738 patients with a stable diuretic regimen in the first 24 hours (80% of overall ASCEND trial), 3,944 (68.7%) patients received IV intermittent bolus administration of diuretics, 799 (13.9%) patients received IV continuous therapy and 995 (17.3%) patients with oral administration. Patients in the IV continuous group had a higher baseline creatinine (IV continuous 1.4 [1.1-1.7]; intermittent bolus 1.2 [1.0-1.6]; oral 1.2 [1.0-1.4] mg/dL; P0.001) and high NTproBNP (IV continuous 5,216 [2,599-11,603]; intermittent bolus 4,944 [2,339-9,970]; oral 3,344 [1,570-7,077] pg/mL; P0.001). There was no difference between IV continuous and intermittent bolus group in weight change, total urine output and change in renal function till 10 days/discharge (adjusted P0.05 for all). There was no difference in 30 day mortality and HF readmission (adjusted OR 1.08 [95%CI: 0.74, 1.57]; P = 0.701) and 180 days mortality (adjusted OR 1.04 [95%CI: 0.75, 1.43]; P = 0.832).In a large cohort of patients with decompensated HF, there were no significant differences in diuretic-related in-hospital, or post-discharge outcomes between IV continuous and intermittent bolus administration. Tailoring appropriate diuretic strategy to different states of acute HF and congestion phenotypes needs to be further investigated.
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- 2021
12. Growth differentiation factor‐15, treatment with liraglutide, and clinical outcomes among patients with heart failure
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Brooke Alhanti, Adrian F. Hernandez, Steven McNulty, Robert J. Mentz, Muthiah Vaduganathan, Barry A. Borlaug, Abhinav Sharma, Stephen J. Greene, G. Michael Felker, Eric J. Velazquez, Adam D. DeVore, Kenneth B. Margulies, Marat Fudim, Andrew P. Ambrosy, and Jie Lena Sun
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Male ,medicine.medical_specialty ,GDF‐15 ,Growth Differentiation Factor 15 ,Short Communication ,Short Communications ,Heart failure ,030204 cardiovascular system & hematology ,Placebo ,law.invention ,03 medical and health sciences ,Ventricular Dysfunction, Left ,0302 clinical medicine ,Randomized controlled trial ,law ,Interquartile range ,Internal medicine ,medicine ,Humans ,Diseases of the circulatory (Cardiovascular) system ,030212 general & internal medicine ,Ejection fraction ,business.industry ,Hazard ratio ,Stroke Volume ,Odds ratio ,Liraglutide ,medicine.disease ,Confidence interval ,GLP‐1 receptor agonist ,RC666-701 ,embryonic structures ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims Associations between growth differentiation factor‐15 (GDF‐15), cardiovascular outcomes, and exercise capacity among patients with a recent hospitalization for heart failure (HHF) and heart failure with reduced ejection fraction (HFrEF) are unknown. We utilized data from the ‘Functional Impact of GLP‐1 for Heart Failure Treatment’ (FIGHT) study to address these knowledge gaps. Methods and results FIGHT was a randomized clinical trial testing the effect of liraglutide (vs. placebo) among 300 participants with HFrEF and a recent HHF. Multivariable regression models evaluated associations between baseline GDF‐15 and change in GDF‐15 (per 1000 pg/mL increase from baseline to 30 days) with clinical outcomes (at 180 days) and declines in exercise capacity (6 min walk distance ≥ 45 m). At baseline (n = 249), median GDF‐15 value was 3221 pg/mL (interquartile range 1938–5511 pg/mL). Participants in the highest tertile of baseline GDF‐15 were more likely to be male and have more co‐morbidities. After adjustment, an increase in GDF‐15 over 30 days was associated with higher risk of death or HHF [hazard ratio 1.35, 95% confidence interval (CI) 1.11–1.64]. In addition, higher baseline GDF‐15 (per 1000 pg/mL until 6000 pg/mL) and an increase in GDF‐15 over 30 days were associated with declining 6 min walk distance (odds ratio 1.26, 95% CI 1.02–1.55 and odds ratio 1.37, 95% CI 1.12–1.69, respectively). GDF‐15 levels remained stable among participants randomized to liraglutide. Conclusions An increase in GDF‐15 over 30 days among patients in HFrEF was independently associated with an increased risk of cardiovascular events and declining exercise capacity. These results support the value of longitudinal GDF‐15 trajectory in informing risk of heart failure disease progression.
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- 2021
13. Clinical Profile, Health Care Costs, and Outcomes of Patients Hospitalized for Heart Failure With Severely Reduced Ejection Fraction.
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Harrington, Josephine, Jie-Lena Sun, Fonarow, Gregg C., Heitner, Stephen B., Divanji, Punag H., Binder, Gary, Allen, Larry A., Alhanti, Brooke, Yancy, Clyde W., Albert, Nancy M., DeVore, Adam D., Michael Felker, G., and Greene, Stephen J.
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- 2023
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14. International Variation in Outcomes Among People with Cardiovascular Disease or Cardiovascular Risk Factors and Impaired Glucose Tolerance: Insights from the NAVIGATOR Trial
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Marilia Harumi Higuchi dos Santos, Abhinav Sharma, Jie‐Lena Sun, Karen Pieper, John J.V. McMurray, Rury R. Holman, and Renato D. Lopes
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cardiovascular disease ,diabetes mellitus ,risk factor ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundRegional differences in risk of diabetes mellitus and cardiovascular outcomes in people with impaired glucose tolerance are poorly characterized. Our objective was to evaluate regional variation in risk of new‐onset diabetes mellitus, cardiovascular outcomes, and treatment effects in participants from the NAVIGATOR (Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research) trial. Methods and ResultsNAVIGATOR randomized people with impaired glucose tolerance and cardiovascular risk factors or with established cardiovascular disease to valsartan (or placebo) and to nateglinide (or placebo) with a median 5‐year follow‐up. Data from the 9306 participants were categorized by 5 regions: Asia (n=552); Europe (n=4909); Latin America (n=1406); North America (n=2146); and Australia, New Zealand, and South Africa (n=293). Analyzed outcomes included new‐onset diabetes mellitus; cardiovascular death; a composite cardiovascular outcome of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke; and treatment effects of valsartan and nateglinide. Respective unadjusted 5‐year risks for new‐onset diabetes mellitus, cardiovascular death, and the composite cardiovascular outcome were 33%, 0.4%, and 4% for Asia; 34%, 2%, and 6% for Europe; 37%, 4%, and 8% for Latin America; 38%, 2%, and 6% for North America; and 32%, 4%, and 8% for Australia, New Zealand, and South Africa. After adjustment, compared with North America, European participants had a lower risk of new‐onset diabetes mellitus (hazard ratio 0.86, 95% CI 0.78–0.94; P=0.001), whereas Latin American participants had a higher risk of cardiovascular death (hazard ratio 2.68, 95% CI 1.82–3.96; P
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- 2017
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15. Prognostic Role of Prior Heart Failure Hospitalization among Patients Hospitalized for Worsening Chronic Heart Failure
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Javed Butler, Stephen J. Greene, Robert J. Mentz, Jie-Lena Sun, Marco Metra, Adrian F. Hernandez, Adriaan A. Voors, Vanessa Blumer, Christopher M. O'Connor, and Cardiovascular Centre (CVC)
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Male ,medicine.medical_specialty ,heart failure ,Article ,Risk Factors ,Internal medicine ,Natriuretic Peptide, Brain ,Humans ,Medicine ,Hospital Mortality ,Prospective Studies ,Aged ,business.industry ,Stroke Volume ,Middle Aged ,medicine.disease ,mortality ,Survival Rate ,Increased risk ,Heart failure ,Chronic Disease ,Disease Progression ,Cardiology ,Female ,Natriuretic Agents ,prognosis ,Cardiology and Cardiovascular Medicine ,business ,hospitalization - Abstract
Background: Hospitalization for heart failure (HF) is associated with increased risk of death among patients with chronic HF. The degree to which hospitalization for HF is a distinct biologic entity with independent prognostic value versus a marker of higher risk chronic HF patients is unclear. Methods: After excluding patients with new-onset HF, the ASCEND-HF trial (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) included 4205 patients hospitalized for worsening chronic HF with reduced or preserved ejection fraction. The present analysis compared patients by presence or absence of prior HF hospitalization within 12 months and by timing of prior HF hospitalization relative to index hospitalization. Associations with 180-day all-cause mortality were assessed, including adjustment for 27 prespecified clinical factors. Results: Overall, 2241 (53.3%) patients had a HF hospitalization within the prior 12 months and 1964 (46.7%) did not. Mortality rates at 180 days were 15.5% and 11.9%, respectively. In unadjusted analyses, prior HF hospitalization was associated with increased risk of 180-day mortality (HR, 1.35 [95% CI, 1.14–1.59]; P P =0.064). Similarly, after adjustment, compared with patients without prior hospitalization, prior HF hospitalization was not associated with mortality, irrespective of timing (0–4 months: HR, 1.10 [95% CI, 0.87–1.39], P =0.41; 4–8 months: HR, 0.95 [95% CI, 0.70–1.27]; P =0.72; 8–12 months: HR, 1.06 [95% CI, 0.74–1.51], P =0.77; >12 months: HR, 0.81 [95% CI, 0.63–1.06], P =0.12). Conclusions: In this cohort of patients hospitalized for worsening HF, prior HF hospitalization was not associated with 180-day mortality after comprehensively accounting for patient characteristics measured during the index patient visit. Clinical confounders measured at the point-of-care may explain previously observed associations between prior HF hospitalization and mortality, and these clinical factors may be a more direct means of predicting patient survival. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00475852.
- Published
- 2021
16. Prospectively assessed neurodevelopmental outcomes in studies of anaesthetic neurotoxicity in children: a systematic review and meta-analysis
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Mary Ellen McCann, Caleb Ing, Michael J. Zaccariello, David O. Warner, Andrew Davidson, Anneke Grobler, Lena Sun, Guohua Li, Terry E. Goldberg, and William M. Jackson
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Pediatrics ,medicine.medical_specialty ,Anesthetics, General ,Intelligence ,Child Behavior ,CBCL ,Child Behavior Disorders ,Cochrane Library ,Nervous System ,Risk Assessment ,Executive Function ,Child Development ,Risk Factors ,medicine ,Humans ,Child Behavior Checklist ,Intelligence quotient ,business.industry ,Age Factors ,Confidence interval ,Behavior Rating Inventory of Executive Function ,Anesthesiology and Pain Medicine ,Child, Preschool ,Relative risk ,Meta-analysis ,Neurotoxicity Syndromes ,business - Abstract
Background Whether exposure to a single general anaesthetic (GA) in early childhood causes long-term neurodevelopmental problems remains unclear. Methods PubMed/MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Library were searched from inception to October 2019. Studies evaluating neurodevelopmental outcomes and prospectively enrolling children exposed to a single GA procedure compared with unexposed children were identified. Outcomes common to at least three studies were evaluated using random-effects meta-analyses. Results Full-scale intelligence quotient (FSIQ); the parentally reported Child Behavior Checklist (CBCL) total, externalising, and internalising problems scores; and Behavior Rating Inventory of Executive Function (BRIEF) scores were assessed. Of 1644 children identified, 841 who had a single exposure to GA were evaluated. The CBCL problem scores were significantly higher (i.e. worse) in exposed children: mean score difference (CBCL total: 2.3 [95% confidence interval {CI}: 1.0–3.7], P=0.001; CBCL externalising: 1.9 [95% CI: 0.7–3.1], P=0.003; and CBCL internalising problems: 2.2 [95% CI: 0.9–3.5], P=0.001). Differences in BRIEF were not significant after multiple comparison adjustment. Full-scale intelligence quotient was not affected by GA exposure. Secondary analyses evaluating the risk of these scores exceeding predetermined clinical thresholds found that GA exposure was associated with increased risk of CBCL internalising behavioural deficit (risk ratio [RR]: 1.47; 95% CI: 1.08–2.02; P=0.016) and impaired BRIEF executive function (RR: 1.68; 95% CI: 1.23–2.30; P=0.001). Conclusions Combining results of studies utilising prospectively collected outcomes showed that a single GA exposure was associated with statistically significant increases in parent reports of behavioural problems with no difference in general intelligence.
- Published
- 2021
17. PROPHETIC
- Author
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Claire Greenshields, Helen K. Donnelly, Marin H. Kollef, Thomas L. Holland, Jie Lena Sun, Jonas Santiago, Badih A. Kabchi, Matthew Sims, Marcus J. Zervos, Daniel B. Rubin, Adrian Coles, Sara B. Calvert, Peidi Gu, Pamela Tenaerts, Vance G. Fowler, Stephen P. Bergin, John Farley, Ana C. Bardossy, Karen Chiswell, John H. Powers, and Michael J. Durkin
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Critical Care and Intensive Care Medicine ,medicine.disease ,Logistic regression ,Identified patient ,Clinical trial ,03 medical and health sciences ,Pneumonia ,0302 clinical medicine ,Parenteral nutrition ,030228 respiratory system ,Emergency medicine ,Epidemiology ,Medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Prospective cohort study ,Cause of death - Abstract
Background Pneumonia is the leading infection-related cause of death. The use of simple clinical criteria and contemporary epidemiology to identify patients at high risk of nosocomial pneumonia should enhance prevention efforts and facilitate development of new treatments in clinical trials. Research Question What are the clinical criteria and contemporary epidemiology trends that are helpful in the identification of patients at high risk of nosocomial pneumonia? Study Design and Methods Within the ICUs of 28 US hospitals, we conducted a prospective cohort study among adults who had been hospitalized >48 hours and were considered high risk for pneumonia (defined as treatment with invasive or noninvasive ventilatory support or high levels of supplemental oxygen). We estimated the proportion of high-risk patients who experienced the development of nosocomial pneumonia. Using multivariable logistic regression, we identified patient characteristics and treatment exposures that are associated with increased risk of pneumonia development during the ICU admission. Results Between February 6, 2016, and October 7, 2016, 4,613 high-risk patients were enrolled. Among 1,464 high-risk patients (32%) who were treated for possible nosocomial pneumonia, 537 (37%) met the study pneumonia definition. Among high-risk patients, a multivariable logistic model was developed to identify key patient characteristics and treatment exposures that are associated with increased risk of nosocomial pneumonia development (c-statistic, 0.709; 95% CI, 0.686-0.731). Key factors associated with increased odds of nosocomial pneumonia included an admission diagnosis of trauma or cerebrovascular accident, receipt of enteral nutrition, documented aspiration risk, and receipt of systemic antibacterials within the preceding 90 days. Interpretation Treatment for nosocomial pneumonia is common among patients in the ICU who are receiving high levels of respiratory support, yet more than one-half of patients who are treated do not fulfill standard diagnostic criteria for pneumonia. Application of simple clinical criteria may improve the feasibility of clinical trials of pneumonia prevention and treatment by facilitating prospective identification of patients at highest risk.
- Published
- 2020
18. Elevated Uric Acid Prevalence and Clinical Outcomes in Patients with Heart Failure with Preserved Ejection Fraction: Insights from RELAX
- Author
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Shira Perl, Brooke Alhanti, Matthew T. Roe, Magnus K. Bjursell, Robert J. Mentz, Barbara L. Lytle, Jie-Lena Sun, and Anthony P. Carnicelli
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Male ,medicine.medical_specialty ,medicine.drug_class ,Vasodilator Agents ,030204 cardiovascular system & hematology ,Sildenafil Citrate ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Internal medicine ,Troponin I ,Natriuretic peptide ,Humans ,Medicine ,030212 general & internal medicine ,Hyperuricemia ,Aged ,Heart Failure ,biology ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Uric Acid ,Gout ,Clinical trial ,Cystatin C ,Heart failure ,biology.protein ,Cardiology ,Female ,business ,Heart failure with preserved ejection fraction - Abstract
Purpose We aimed to 1) describe characteristics of patients with heart failure with preserved ejection fraction (HFpEF) enrolled in RELAX stratified by normal or elevated baseline serum uric acid (sUA) level; 2) evaluate the association between sUA level and surrogate clinical measures; and 3) assess associations between changes in sUA level over time and changes in surrogate clinical measures. Methods We analyzed 212 patients with HFpEF and normal or elevated (>6 mg/dL) baseline sUA measurements from the RELAX trial. Variables examined included clinical characteristics, cardiopulmonary exercise testing, 6-minute walk testing, quality of life, echocardiography, and serum biomarker testing. Baseline characteristics between groups were compared and scatter plots with quadratic regression lines and linear regression modeling were used to assess the relationship between baseline sUA and clinical measures. Kaplan–Meier curves were used to describe composite death or cardiovascular/renal hospitalization. Results The prevalence of elevated baseline sUA was 68.9%. Patients with elevated sUA had more baseline comorbidities and poorer functional status on cardiopulmonary exercise testing than those without. After adjustment, significant associations between baseline sUA levels and cystatin C, N-terminal pro B-type natriuretic peptide, high-sensitivity troponin I, and high-sensitivity C-reactive protein were identified. Higher baseline sUA was also associated with worsening peak VO2, 6-minute walk testing, and left ventricular mass. No significant association was found between baseline sUA levels and the composite of death or cardiovascular/renal hospitalization at 24 weeks. Conclusion sUA is an important marker of comorbidities and functional status in patients with HFpEF. Clinical trials of sUA-lowering therapies in patients with HFpEF are promising.
- Published
- 2020
19. Titration of medical therapy and clinical outcomes among patients with heart failure with reduced ejection fraction: Findings from the HF-ACTION trial
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Jacob B. Pierce, Robert J. Mentz, Jie-Lena Sun, Brooke Alhanti, David J. Whellan, William E. Kraus, Ileana L. Piña, Mona Fiuzat, Christopher M. O'Connor, and Stephen J. Greene
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Heart Failure ,Hospitalization ,Angiotensin Receptor Antagonists ,Ventricular Dysfunction, Left ,Adrenergic beta-Antagonists ,Humans ,Angiotensin-Converting Enzyme Inhibitors ,Stroke Volume ,Cardiology and Cardiovascular Medicine - Abstract
Clinical guidelines recommend titration of angiotensin converting enzyme inhibitors (ACEi) and beta-blockers among patients with heart failure with reduced ejection fraction (HFrEF) to maximally tolerated doses. Patient characteristics associated with dose titration and clinical outcomes subsequent to dose titration remain poorly characterized.Among 1999 ambulatory patients with chronic HFrEF in the HF-ACTION trial, use and dosing of ACEi and evidence-based beta-blockers were examined at baseline and 6-month follow-up. Multivariable logistic regression models were used to assess factors associated with dose escalation (medication initation or dosing increase) or dose de-escalation (medication discontinuation or dosing decrease). Cox proportional hazard regression models were used to examine associations between dose trajectory group (stable target, stable sub-target, dose escalation, and dose de-escalation) and subsequent mortality and hospitalization outcomes.For both ACEi and beta-blockers, hospitalization for heart failure in the 6 months prior to enrollment (odds ratio [OR] 2.32 [95% confidence interval 1.58-3.42]) for ACEi; 1.42 [1.05-1.9] for beta-blockers) and higher systolic blood pressure (OR 1.01 [1.00-1.03] per 1 mmHg increase for ACEi; 1.01 [1.00-1.02] for beta-blockers) were associated with dose escalation. Hospitalization 6 months prior to enrollment for any cause (including HF or non-HF causes) was associated with dose de-escalation (OR 1.60 [1.14-2.25] for ACEi; 1.67 [1.20-2.33] for beta-blockers). After adjustment for patient characteristics, compared with stable target dosing, dose de-escalation of either medication was associated with greater all-cause mortality (adjusted hazard ratio [aHR] 1.64 [1.11-2.42] for ACEi; 1.62 [1.04-2.53] for beta-blockers). Compared with stable target dosing, both dose de-escalation (aHR 1.98 [1.36-2.87]) and stable sub-target dosing (aHR 1.49 [1.18-1.87]) of beta-blockers were associated with greater cardiovascular mortality or hospitalization for heart failure.Among outpatients with chronic HFrEF, patient characteristics including recent hospitalization status and blood pressure were associated with odds of subsequent escalation and de-escalation of ACEi and beta-blocker therapy. Compared with patients receiving guildeline-recommended target doses, dose de-escalation of either medication and sub-target dosing of beta-blockers were associated with greater morbidity and mortality over long-term follow-up.
- Published
- 2022
20. Biomarker Profile of Left Atrial Myopathy in Heart Failure With Preserved Ejection Fraction: Insights From the RELAX Trial
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Jie Lena Sun, Javed Butler, Adrian F. Hernandez, Margaret M. Redfield, Brooke Alhanti, Sanjiv J. Shah, Jae K. Oh, Eric J. Velazquez, Muthiah Vaduganathan, Fawaz Alenezi, and Ravi B. Patel
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medicine.medical_specialty ,Strain (injury) ,030204 cardiovascular system & hematology ,Jugular venous pressure ,Article ,03 medical and health sciences ,0302 clinical medicine ,Muscular Diseases ,Left atrial ,Interquartile range ,Internal medicine ,Natriuretic Peptide, Brain ,Humans ,Medicine ,030212 general & internal medicine ,Myopathy ,Heart Failure ,business.industry ,Stroke Volume ,Atrial fibrillation ,medicine.disease ,Peptide Fragments ,Cardiology ,Biomarker (medicine) ,Atrial Function, Left ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Heart failure with preserved ejection fraction ,Biomarkers - Abstract
BACKGROUND: While left atrial (LA) mechanical dysfunction in heart failure with preserved ejection fraction (HFpEF) is associated with poor clinical outcomes, the influence of LA myopathy on temporal changes in cardiovascular biomarkers is unclear. METHODS AND RESULTS: We evaluated biomarker correlates of LA myopathy, as defined by reduced LA strain, and the associations of LA strain with longitudinal changes in biomarkers among participants in the Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Heart Failure with Preserved Ejection Fraction (RELAX) trial. LA speckle-tracking was performed on baseline echocardiograms of RELAX participants to measure LA reservoir and LA contractile strain. Of the 216 RELAX participants, 169 (78%) had measurable LA strain and biomarker data. Participants with LA reservoir strain below median (13.5%, interquartile range: 10–22.5%) were older, more likely to have atrial fibrillation, and had higher jugular venous pressure (P
- Published
- 2020
21. PROPHETIC EU: Prospective Identification of Pneumonia in Hospitalized Patients in the Intensive Care Unit in European and United States Cohorts
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Stephen P Bergin, Sara B Calvert, John Farley, Jie-Lena Sun, Karen Chiswell, Willem Dieperink, Jan Kluytmans, Juan Carlos Lopez-Delgado, Rafael Leon-Lopez, Marcus J Zervos, Marin H Kollef, Matthew Sims, Badih A Kabchi, Daniel Rubin, Jonas Santiago, Mukil Natarajan, Pamela Tenaerts, Vance G Fowler, Thomas L Holland, Marc J Bonten, Sebastiaan J Hullegie, and Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)
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VENTILATOR-ASSOCIATED PNEUMONIA ,Intensive care units ,antibacterial agent ,CHALLENGES ,Respiradors ,Pneumònia ,health care-associated pneumonia ,Pneumonia ,mechanical ventilator ,DAPTOMYCIN ,intensive care unit ,Respirators ,Infectious Diseases ,bacterial pneumonia ,DESIGN ,Oncology ,FAILURE ,BURDEN ,health care–associated pneumonia ,Unitats de cures intensives - Abstract
Background The prospective identification of patients at high risk for hospital-acquired/ventilator-associated bacterial pneumonia may improve clinical trial feasibility and foster antibacterial development. In a prior study conducted in the United States, clinical criteria were used to prospectively identify these patients; however, these criteria have not been applied in a European population. Methods Adults considered high risk for pneumonia (treatment with ventilation or high levels of supplemental oxygen) in the intensive care units of 7 European hospitals were prospectively enrolled from June 12 to December 27, 2017. We estimated the proportion of high-risk patients developing pneumonia according to US Food and Drug Administration guidance and a subset potentially eligible for antibacterial trial enrollment. We compared patient characteristics, treatment exposures, and pneumonia incidence in a European cohort and a previously described US cohort. Results Of 888 high-risk patients, 211/888 (24%) were treated for possible pneumonia, and 150/888 (17%) met the Food and Drug Administration definition for hospital-acquired/ventilator-associated bacterial pneumonia. A higher proportion of European patients treated for possible pneumonia met the pneumonia definition (150/211 [71%] vs 537/1464 [37%]; P Conclusions Clinical criteria prospectively identified high-risk patients with high rates of pneumonia in the European cohort. Despite higher rates of established risk factors and incident pneumonia, European patients were significantly less likely to receive antibiotics for possible pneumonia than US patients. Different treatment practices may contribute to lower rates of antibacterial trial enrollment in the United States.
- Published
- 2022
22. Lower urine sodium predicts longer length of stay in acute heart failure patients: Insights from the ROSE AHF trial
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JoAnn Lindenfeld, Neal K. Lakdawala, Michael M. Givertz, Samantha Ly, Kevin J. Anstrom, Finnian R. Mc Causland, Lynne W. Stevenson, Jie-Lena Sun, and Jonathan W. Cunningham
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Male ,medicine.medical_specialty ,kidney disease ,medicine.medical_treatment ,Population ,Clinical Investigations ,Urology ,Renal function ,Diuresis ,030204 cardiovascular system & hematology ,Urine sodium ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,Renal Insufficiency ,030212 general & internal medicine ,Diuretics ,education ,Aged ,Aged, 80 and over ,Heart Failure ,Nesiritide ,clinical trials ,education.field_of_study ,business.industry ,Sodium ,General Medicine ,Length of Stay ,Middle Aged ,Prognosis ,medicine.disease ,United States ,3. Good health ,Heart failure ,Acute Disease ,Female ,clinical pharmacology ,Diuretic ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease ,medicine.drug - Abstract
Background In patients hospitalized with acute heart failure (AHF), low urine sodium concentration (U Na) after diuretic treatment may identify patients at risk for longer length of stay (LOS) and adverse events. We investigated the prognostic significance of 24‐hour cumulative postdiuretic urine sodium concentration in a multicenter clinical trial population. Methods The Renal Optimization Strategies Evaluation AHF (ROSE AHF) trial randomized 360 patients with AHF and renal dysfunction receiving intravenous diuretic to dopamine, nesiritide, or placebo. Sodium concentration was measured in cumulative urine sample collected during the first 24 hours after randomization in 298 patients. Based on prior studies, lower U Na was defined as ≤60 mmol/L. Results Lower U Na was present in 142 (48%) patients, who had longer LOS (7 days vs 5 days, P
- Published
- 2019
23. Outcomes of Endovascular Therapy in Patients With Prestroke Mobility Impairment
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Shreyansh Shah, Lee H. Schwamm, Brooke Alhanti, Gregg C. Fonarow, Kevin N. Sheth, Jie-Lena Sun, Barbara L. Lytle, Rachel Beekman, Deepak L. Bhatt, Eric E. Smith, and Ying Xian
- Subjects
Aged, 80 and over ,Male ,Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,Endovascular Procedures ,Hospital mortality ,Middle Aged ,Endovascular therapy ,Stroke ,Clinical trial ,Treatment Outcome ,Ischemic stroke ,Emergency medicine ,Humans ,Medicine ,Female ,In patient ,Registries ,Neurology (clinical) ,Mobility Limitation ,Cardiology and Cardiovascular Medicine ,business ,Aged ,Thrombectomy - Abstract
Background and Purpose: Patients with prestroke mobility impairment (PSMI) were excluded from endovascular clinical trials. There are limited data regarding safety and outcomes of endovascular thrombectomy in this population. We used a large, national data set (Get With The Guidelines–Stroke) to evaluate the safety and outcomes of endovascular thrombectomy in patients with PSMI. Methods: We included patients who underwent endovascular thrombectomy in the Get With The Guidelines–Stroke registry between 2015 and 2019. PSMI was defined as the inability to ambulate independently. Generalized estimating equations for logistic regression models were used to evaluate the association between PSMI and outcomes. Results: Of 56 762 patients treated with endovascular thrombectomy, 2919 (5.14%) had PSMI. PSMI was not associated with symptomatic intracranial hemorrhage (6.0% versus 5.4%; P =0.979). In-hospital death or discharge to hospice occurred in 32.3% of patients with PSMI versus 17.5% without PSMI (adjusted odds ratio, 1.45 [1.32–1.58]). Conclusions: While procedural adverse outcomes were no higher in patients with PSMI, further study is necessary to determine clinical benefit in this population.
- Published
- 2021
24. Unsupervised Machine Learning To Define Acute Hfpef Phenotypes: Findings From Ascend-hf
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Evan Murray, Stephen Greene, Vishal Rao, Jie-Lena Sun, Brooke Alhanti, Vanessa Blumer, Javed Butler, Tariq Ahmad, Adrian Hernandez, and Robert Mentz
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Cardiology and Cardiovascular Medicine - Published
- 2022
25. Emergency Department Visits Versus Hospital Readmissions Among Patients Hospitalized for Heart Failure
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ANAND Shah, ROBERT J. MENTZ, JIE-LENA SUN, VISHAL N. RAO, BROOKE ALHANTI, VANESSA BLUMER, RANDALL STARLING, JAVED BUTLER, and STEPHEN J. GREENE
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Heart Failure ,Hospitalization ,Creatinine ,Aftercare ,Humans ,Cardiology and Cardiovascular Medicine ,Emergency Service, Hospital ,Patient Readmission ,Patient Discharge ,Retrospective Studies - Abstract
Worsening heart failure (HF) often requires hospitalization but in some cases may be managed in the outpatient or emergency department (ED) settings. The predictors and clinical significance of ED visits without admission vs hospitalization are unclear.The ASCEND-HF trial included 2661 US patients hospitalized for HF with reduced or preserved ejection fraction. Clinical characteristics were compared between patients with a subsequent all-cause ED visit (with ED discharge) within 30 days vs all-cause readmission within 30 days. Factors associated with each type of care were assessed in multivariable models. Multivariable models landmarked at 30 days evaluated associations between each type of care and subsequent 150-day mortality.Through 30-day follow-up, 193 patients (7%) had ED discharge, 459 (17%) had readmission, and 2009 (76%) had neither urgent visit. Patients with ED discharge vs readmission were similar with respect to age, sex, systolic blood pressure, ejection fraction, and coronary artery disease, whereas ED discharge patients had a modestly lower creatinine (P.01). Among patients with either event within 30 days, a higher creatinine and prior HF hospitalization were associated with a higher likelihood of readmission, as compared with ED discharge (P.02). Landmarked at 30 days, rates of death during the subsequent 150 days were 21.0% for patients who were readmitted and 11.4% for patients discharged from the ED. Compared with patients who were readmitted, ED discharge was independently associated with lower 150-day mortality (adjusted hazard ratio 0.58, 95% confidence interval 0.36-0.92, P = .02).In this cohort of US patients hospitalized for HF, worse renal function and prior HF hospitalization were associated with a higher likelihood of early postdischarge readmission, as compared with ED discharge. Although subsequent mortality was high after discharge from the ED, this risk of mortality was significantly lower than patients who were readmitted to the hospital.
- Published
- 2021
26. Patient Phenotypes, Cardiovascular Risk, and Ezetimibe Treatment in Patients After Acute Coronary Syndromes (from IMPROVE-IT)
- Author
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Abhinav Sharma, Jie-Lena Sun, Tariq Ahmad, Matthew T. Roe, Yuliya Lokhnygina, Nihar R. Desai, and Michael A. Blazing
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Male ,Simvastatin ,Acute coronary syndrome ,medicine.medical_specialty ,Randomization ,Ezetimibe, Simvastatin Drug Combination ,030204 cardiovascular system & hematology ,Risk Assessment ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Randomized controlled trial ,Risk Factors ,law ,Cause of Death ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Myocardial infarction ,Acute Coronary Syndrome ,Coronary Artery Bypass ,Adverse effect ,Aged ,business.industry ,Unstable angina ,Proportional hazards model ,Anticholesteremic Agents ,ST elevation ,Middle Aged ,Ezetimibe ,medicine.disease ,Survival Rate ,Phenotype ,Treatment Outcome ,North America ,Cardiology ,Drug Therapy, Combination ,Female ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Risk prediction following acute coronary syndrome (ACS) remains challenging. Data-driven machine-learning algorithms can potentially identify patients at high risk of clinical events. The Improved Reduction of Outcomes: Vytorin Efficacy International Trial randomized 18,144 post-ACS patients to ezetimibe + simvastatin or placebo + simvastatin. We performed hierarchical cluster analysis to identify patients at high risk of adverse events. Associations between clusters and outcomes were assessed using Cox proportional hazards models. The primary outcome was cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, unstable angina hospitalization, or coronary revascularization ≥30 days after randomization. We evaluated ezetimibe's impact on outcomes across clusters and the ability of the cluster analysis to discriminate for outcomes compared with the Global Registry of Acute Coronary Events (GRACE) score. Five clusters were identified. In cluster 1 (n = 13,252), most patients experienced a non-STEMI (54.8%). Cluster 2 patients (n = 2,719) had the highest incidence of unstable angina (n = 83.3%). Cluster 3 patients (n = 782) all identified as Spanish descent, whereas cluster 4 patients (n = 803) were primarily from South America (56.2%). In cluster 5 (n = 587), all patients had ST elevation. Cluster analysis identified patients at high risk of adverse outcomes (log-rank p0.0001); Cluster 2 (vs 1) patients had the highest risk of outcomes (hazards ratio 1.33, 95% confidence interval 1.24 to 1.43). Compared with GRACE risk, cluster analysis did not provide superior outcome discrimination. A consistent ezetimibe treatment effect was identified across clusters (interaction p = 0.882). In conclusion, cluster analysis identified significant difference in risk of outcomes across cluster groups. Data-driven strategies to identify patients who may differentially benefit from therapies and for risk stratification require further evaluation.
- Published
- 2019
27. Recovery of left ventricular function is associated with improved outcomes in LVAD recipients
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Cameron Olsen, Aditya Mandawat, Jie-Lena Sun, Taylor Triana, Karen Chiswell, and Ravi Karra
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Pulmonary and Respiratory Medicine ,Transplantation ,Treatment Outcome ,Humans ,Surgery ,Stroke Volume ,Heart-Assist Devices ,Recovery of Function ,Cardiology and Cardiovascular Medicine ,Ventricular Function, Left ,Article - Abstract
The significance of recovered left ventricular ejection fraction (LVEF) in LVAD recipients, outside of pump explantation, is unclear.Patients undergoing first LVAD implantation at Duke University Hospital between 2006 and 2017 were evaluated for LVEF recovery up to 2 years following implant. Occurrence of gastrointestinal bleeding (GIB), hospitalization for heart failure (HF), pump thrombosis and death were assessed before and after LVEF recovery.Of 286 patients who met inclusion criteria, 9.8% reached a "threshold" of recovery with an LVEF ≥ 40%. 17.4% achieved "relative" recovery with an increase in LVEF ≥ 10% since LVAD implantation. For either definition, recovered patients had a lower incidence of a composite endpoint of GIB, HF hospitalization, pump thrombosis, or death compared to patients without recovery. Patients with "threshold" recovery had 4.7 events per 100 patient-years (95% CI, 0.7-33.6) compared to 48.8 events per 100 patient-years (95% CI, 39.5-60.3) without "threshold" recovery [p = .020]. Those with "relative" recovery had 14.1 events per 100 patient-years [95% CI, 5.9-33.8] versus 50.7 events per 100 patient-years (95% CI, 40.7-63.0) without "relative" recovery [p = 0.005]. However, improved outcomes in the "relative" recovery group were limited to those who also met the "threshold" definition. Importantly, among patients who achieved "threshold" recovery, the incidence of the composite endpoint declines in the postrecovery period, suggesting that LVEF recovery mechanistically results in improved outcomes.An LVEF ≥ 40% associates with better outcomes in LVAD recipients. Methods to promote recovery could reduce morbidity and mortality related to LVAD support.
- Published
- 2021
28. Atrial branch coronary artery stenosis as a mechanism for atrial fibrillation
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Sean D. Pokorney, Samuel I. Berchuck, Karen Chiswell, Jie-Lena Sun, Laine Thomas, W. Schuyler Jones, Manesh R. Patel, and Jonathan P. Piccini
- Subjects
Risk Factors ,Physiology (medical) ,Atrial Fibrillation ,Coronary Stenosis ,Humans ,Constriction, Pathologic ,Coronary Artery Disease ,Cardiology and Cardiovascular Medicine ,Coronary Angiography - Abstract
The etiology of atrial fibrillation (AF) is multifactorial and incompletely understood.The purpose of this study was to evaluate the association between coronary artery disease (CAD) affecting atrial tissue and AF.Patients from a single center with obstructive CAD during cardiac catheterization (January 1, 2007, through December 1, 2013) were included in a matched case-control analysis on the basis of the presence or absence of new-onset AF within 12 months of catheterization. Quantitative measurements of stenosis severity were performed for the sinoatrial nodal artery, atrioventricular (AV) nodal artery, and right intermediate atrial artery (RIAA) as well as the right coronary, left circumflex, and left anterior descending proximal to the takeoff for each atrial level artery. A multivariable logistic regression model identified factors associated with AF.Of 1794 patients, 115 (6%) developed AF within 1 year of catheterization. The matched cohort included 110 patients with and 110 patients without AF within 12 months of catheterization. Higher odds of AF at 1 year were associated with increasing lesion stenosis severity in the RIAA (odds ratio [OR] 1.41 per 10% increase in lesion severity above 50%; 95% confidence interval [CI] 1.01-1.97; P = .047) and AV nodal artery (OR 1.58 per 10% increase in lesion severity above 50%; 95% CI 1.00-2.49; P = .050). Odds of AF diagnosis during the year after catheterization increased with the number of atrial arteries with50% lesion (OR 1.53 for each additional artery; 95% CI 1.08-2.15; P = .015).In patients with obstructive CAD, disease of the AV nodal artery and RIAA as well as a higher burden of CAD within all arteries supplying blood flow to the atrial myocardium were associated with higher odds of new-onset AF at 1 year.
- Published
- 2021
29. Abstract P384: Outcomes of Endovascular Therapy in Patients With Pre-Stroke Mobility Impairment
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Brooke Alhanti, Lee H. Schwamm, Deepak L. Bhatt, Shreyansh Shah, Rachel Beekman, Gregg C. Fonarow, Jie-Lena Sun, Eric E. Smith, Barbara L. Lytle, Ying Xian, and Kevin N. Sheth
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,medicine.disease ,Endovascular therapy ,Clinical trial ,Ischemic stroke ,Emergency medicine ,medicine ,In patient ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Abstract
Background and Purpose: Patients with pre-stroke mobility impairment were excluded from endovascular clinical trials. There is limited data regarding safety and outcomes of endovascular thrombectomy (EVT) in this population. We used a large, national dataset (Get With The Guidelines (GWTG)-Stroke) to evaluate the safety and outcomes of EVT in patients with pre-stroke mobility impairment (PSMI). Methods: We included patients who underwent EVT in the GWTG-Stroke registry between 2015 and 2019. PSMI was defined as inability to ambulate independently and poor outcome was defined as in-hospital mortality or discharge to hospice. GEE logistic regression models were used to evaluate the association between PSMI and outcomes. Results: Of 56,762 patients treated with EVT, 2919 (5.14%) had PSMI. Patients with PSMI were older (median 79 [IQR 70-87] vs 70 [59-80], P80 years and NIHSS >20 had a poor outcome. Conclusions: Amongst patients with PSMI treated with EVT, two thirds survived and one third were discharged to home or to inpatient rehabilitation. Advanced age and increased stroke severity increased the likelihood of poor outcomes. EVT appears safe in patients with PSMI, yet further study of effectiveness in this population is warranted.
- Published
- 2021
30. Prophetic EU: Prospective Identification of Pneumonia in Hospitalized Patients in the Intensive Care Unit–A Comparison of European and United States Cohorts
- Author
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Mukil Natarajan, Daniel B. Rubin, Jan Kluytmans, Willem Dieperink, Sebastiaan J. Hullegie, John Farley, Thomas L. Holland, Karen Chiswell, Jie-Lena Sun, Pamela Tenaerts, Vance G. Fowler, Stephen P. Bergin, Matthew Sims, Juan Carlos Lopez-Delgado, Jonas Santiago, Sara B. Calvert, Marcus J. Zervos, Rafael Leon-Lopez, Badih A. Kabchi, Marc J.M. Bonten, and Marin H. Kollef
- Subjects
medicine.medical_specialty ,business.industry ,Ceftobiprole ,Declaration ,Bacterial pneumonia ,medicine.disease ,Institutional review board ,Clinical trial ,Informed consent ,Intensive care ,Family medicine ,Cohort ,Medicine ,business - Abstract
Background: Prospective identification of patients at high risk of nosocomial pneumonia may improve clinical trial feasibility and foster antibacterial development. Clinical criteria prospectively identified patients at highest risk of hospital-acquired/ventilator-associated bacterial pneumonia (HABP/VABP) in the United States (US). Whether these findings are applicable in a European population is unknown. Methods: Adults considered high risk for pneumonia (treatment with ventilation or high levels of supplemental oxygen) in the intensive care units of seven European hospitals were prospectively enrolled. We estimated the proportion of high-risk patients developing HABP/VABP, defined according to US Food and Drug Administration (FDA) guidance, and the subset potentially eligible for antibacterial trial enrollment. We compared patient characteristics, exposures, and HABP/VABP incidence in European and US cohorts. Findings: Of 888 high-risk patients enrolled between June 12 and December 27, 2017, 211/888 (24%) were treated for possible pneumonia and 150/888 (17%) met the FDA definition for HABP/VABP. A higher proportion of European high-risk patients treated for possible pneumonia met the HABP/VABP definition (150/211 [71%] versus 537/1464 [37%] in US, p
- Published
- 2021
31. Realization of Bio-Coal Injection into the Blast Furnace
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Lena Sundqvist Ökvist, Maria Lundgren, Lars-Erik From, Joakim Eck, Martin Kjellberg, and Hesham Ahmed
- Subjects
bio-coal ,charcoal ,reducing agent ,injection ,CO2 emission ,Mining engineering. Metallurgy ,TN1-997 - Abstract
The steel industry accounts, according to the International Energy Agency, for ~6.7% of global CO2 emissions, and the major portion of its contribution is from steelmaking via the blast furnace (BF) route. In the short term, a significant reduction in fossil CO2 emissions can be achieved through the introduction of bio-coal into the BF as part of cold bonded briquettes, by injection, or as part of coke. The use of bio-coal-containing residue briquettes was previously demonstrated in industrial trials in Sweden, whereas bio-coal injection was only tested on a pilot scale or in one-tuyere tests. Therefore, industrial trials replacing part of the pulverized coal (PC) were conducted. It was concluded that the grinding, conveying, and injection of up to 10% of charcoal (CC) with PC can be safely achieved without negative impacts on PC injection plant or BF operational conditions and without losses of CC with the dust. From a process point of view, higher addition is possible, but it must be verified that grinding and conveying is feasible. Through an experimentally validated computational fluid flow model, it was shown that a high moisture content and the presence of oversized particles delay devolatilization and ignition, lowering the combustion efficiency. By using CC with similar heating value to PC, compositional variations in the injected blend are not critical.
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- 2024
- Full Text
- View/download PDF
32. The Cost-Effectiveness of Palliative Care: Insights from the PAL-HF Trial
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Gillian D Sanders, James A. Tulsky, Mona Fiuzat, Daniel B. Mark, Haider J. Warraich, Robert J. Mentz, Bradi B. Granger, Donald H. Taylor, Jie-Lena Sun, Joseph G. Rogers, Christopher M. O'Connor, Karen E. Steinhauser, and Brystana G. Kaufman
- Subjects
Marginal cost ,medicine.medical_specialty ,Palliative care ,Cost effectiveness ,Cost-Benefit Analysis ,030204 cardiovascular system & hematology ,Medicare ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Randomized controlled trial ,law ,Intervention (counseling) ,medicine ,Humans ,030212 general & internal medicine ,health care economics and organizations ,Aged ,Heart Failure ,business.industry ,Mortality rate ,Palliative Care ,medicine.disease ,humanities ,United States ,Heart failure ,Emergency medicine ,Quality of Life ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background In a randomized control trial, Palliative Care in Heart Failure (PAL-HF) improved heart failure–related quality of life, though cost-effectiveness remains unknown. The aim of this study was to evaluate the cost-effectiveness of the PAL-HF trial, which provided outpatient palliative care to patients with advanced heart failure. Methods and Results Outcomes for usual care and PAL-HF strategies were compared using a Markov cohort model over 36 months from a payer perspective. The model parameters were informed by PAL-HF trial data and supplemented with meta-analyses and Medicare administrative data. Outcomes included hospitalization, place of death, Medicare expenditures, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios. Simulated mortality rates were the same for PAL-HF and usual care cohorts, at 89.7% at 36 months. In the base case analysis, the PAL-HF intervention resulted in an incremental gain of 0.03 QALYs and an incremental cost of $964 per patient for an incremental cost-effectiveness ratio of $29,041 per QALY. In 1-way sensitivity analyses, an intervention cost of up to $140 per month is cost effective at $50,000 per QALY. Of 1000 simulations, the PC intervention had a 66.1% probability of being cost effective at a $50,000 willingness-to-pay threshold assuming no decrease in hospitalization. In a scenario analysis, PAL-HF decreased payer spending through reductions in noncardiovascular hospitalizations. Conclusions These results from this single-center trial are encouraging that palliative care for advanced heart failure is an economically attractive intervention. Confirmation of these findings in larger multicenter trials will be an important part of developing the evidence to support more widespread implementation of the PAL-HF palliative care intervention.
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- 2020
33. Performance of Guideline Recommendations for Prevention of Myocardial Infarction in Young Adults
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Michael G. Nanna, Michel Zeitouni, Eric D. Peterson, Karen Chiswell, Jie Lena Sun, and Ann Marie Navar
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Adult ,Male ,medicine.medical_specialty ,Statin ,medicine.drug_class ,Myocardial Infarction ,030204 cardiovascular system & hematology ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,University medical ,030212 general & internal medicine ,Myocardial infarction ,Young adult ,Stroke ,Aged ,Retrospective Studies ,business.industry ,Age Factors ,Guideline ,Middle Aged ,medicine.disease ,Practice Guidelines as Topic ,Female ,Statin therapy ,Cardiology and Cardiovascular Medicine ,business ,Very high risk - Abstract
The 2018 cholesterol guidelines of the American Heart Association and the American College of Cardiology (AHA/ACC) changed 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitor (statin) eligibility criteria for primary prevention to include multiple risk enhancers and novel intensive lipid-lowering therapies for secondary prevention.This study sought to determine how guideline changes affected identification for preventive therapy in young adults with premature myocardial infarction (MI).The study identified adults presenting with first MI at Duke University Medical Center in Durham, North Carolina. Statin therapy eligibility was determined using the 2013 ACC/AHA and 2018 AHA/ACC guidelines criteria. The study also determined potential eligibility for intensive lipid-lowering therapies (very high risk) under the 2018 AHA/ACC guidelines, by assessing the composite of all-cause death, recurrent MI, or stroke rates in adults considered "very high risk" versus not.Among 6,639 patients with MI, 41% were 55 years of age ("younger"), 35% were 55 to 65 years of age ("middle-aged"), and 24% were 66 to 75 years of age ("older"). Younger adults were more frequently smokers (52% vs. 38% vs. 22%, respectively) and obese (42% vs. 34% vs. 31%, respectively), with metabolic syndrome (21% vs. 19% vs. 17%, respectively) and higher low-density lipoprotein cholesterol (117 vs. 107 vs. 103 mg/dl, respectively) (p trend 0.01 for all). Pre-MI, fewer younger adults met guideline indications for 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitor (statin) therapy than middle-aged and older adults. The 2018 guideline identified fewer younger adults eligible for statin therapy at the time of their MI than the 2013 guideline (46.4% vs. 56.7%; p 0.01). Younger patients less frequently met very high-risk criteria for intensive secondary prevention lipid-lowering therapy (28.3% vs. 40.0% vs. 81.4%, respectively; p 0.01). Over a median 8 years of follow-up, very high-risk criteria were associated with increased risk of major adverse cardiovascular events in individuals 55 years of age (hazard ratio: 2.09; 95% confidence interval: 1.82 to 2.41; p 0.001), as was the case in older age groups (p interaction = 0.54).Most younger patients with premature MI are not identified as statin candidates before their event on the basis of the 2018 guidelines, and most patients with premature MI are not recommended for intensive post-MI lipid management.
- Published
- 2020
34. Effects of Liraglutide on Worsening Renal Function Among Patients With Heart Failure With Reduced Ejection Fraction: Insights From the FIGHT Trial
- Author
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Eric J. Velazquez, Adam D. DeVore, Abhinav Sharma, Marat Fudim, Andrew P. Ambrosy, G. Michael Felker, Barry A. Borlaug, Robert J. Mentz, Lauren B. Cooper, Adrian F. Hernandez, Jie Lena Sun, Steven McNulty, Stephen J. Greene, Brahim Redouane, Muthiah Vaduganathan, and Kenneth B. Margulies
- Subjects
Male ,medicine.medical_specialty ,Renal function ,Functional impact ,Kidney ,Incretins ,Risk Assessment ,Glucagon-Like Peptide-1 Receptor ,Ventricular Function, Left ,Article ,Text mining ,Double-Blind Method ,Risk Factors ,Internal medicine ,medicine ,Humans ,Aged ,Heart Failure ,Ejection fraction ,business.industry ,Liraglutide ,Stroke Volume ,Middle Aged ,medicine.disease ,Hospitalization ,Treatment Outcome ,Heart failure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Glomerular Filtration Rate - Abstract
Background: The FIGHT (Functional Impact of GLP-1 [glucagon-like peptide-1] for Heart Failure Treatment) trial randomized 300 patients with heart failure with reduced ejection fraction (HFrEF) and a recent hospitalization for heart failure to liraglutide versus placebo. While there was no difference in the primary outcome (rank score of time to death, time to rehospitalization for heart failure, and change in NT-proBNP [N-terminal pro-B-type natriuretic peptide]), there was a significant increase in cystatin C among patients randomized to liraglutide raising concern of adverse renal outcomes. We performed a post hoc analysis of FIGHT to investigate whether liraglutide was associated with worsening renal function (WRF). Methods: The relationship between randomization to liraglutide and WRF was evaluated using logistic regression models. Two hundred seventy-four patients (91%) had complete data to assess for WRF defined as: increase in SCr ≥0.3 mg/dL, or ≥25% decrease in estimated glomerular filtration rate, or an increase in cystatin C ≥0.3 mg/L from baseline to 180-days. Results: Patients with WRF (n=113, 41%), compared with those without, were older, had more comorbidities, and lower utilization of guideline-directed medical treatment. Logistic regression models showed that age and baseline cystatin C levels were associated with WRF. In adjusted models, liraglutide was not associated with excess risk of WRF compared with placebo (odds ratio, 1.02 [95% CI, 0.62–1.67]). There was also no difference in the rank score when WRF was added as a fourth-tier outcome. Conclusions: Liraglutide was not associated with WRF among patients with HFrEF and a recent hospitalization for heart failure. These data support the relative renal safety profile of liraglutide among patients with HFrEF. Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01800968.
- Published
- 2020
35. Rate pressure product and the components of heart rate and systolic blood pressure in hospitalized heart failure patients with preserved ejection fraction: Insights from ASCEND-HF
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Justin A. Ezekowitz, John R. Teerlink, Jie Lena Sun, Phillip J. Schulte, Randall C. Starling, Adriaan A. Voors, Robert J. Mentz, Adrian F. Hernandez, Paul W. Armstrong, Christopher M. O'Conner, Amanda K. Verma, and Cardiovascular Centre (CVC)
- Subjects
Male ,Aging ,Left ,Blood Pressure ,Cardiorespiratory Medicine and Haematology ,030204 cardiovascular system & hematology ,Cardiovascular ,Left ventricular hypertrophy ,Ventricular Function, Left ,Alberta ,0302 clinical medicine ,Heart Rate ,Natriuretic Peptide, Brain ,80 and over ,Ventricular Function ,030212 general & internal medicine ,Netherlands ,Aged, 80 and over ,Ejection fraction ,Brain ,General Medicine ,Stroke volume ,Middle Aged ,Prognosis ,Survival Rate ,Heart Disease ,Cardiology ,Female ,RATE REDUCTION ,TRIAL ,Patient Safety ,Natriuretic Agents ,Drug ,Cardiology and Cardiovascular Medicine ,INTERVENTION ,circulatory and respiratory physiology ,CLINICAL-OUTCOMES ,medicine.medical_specialty ,EXERCISE ,Article ,Dose-Response Relationship ,03 medical and health sciences ,Natriuretic Peptide ,Clinical Research ,LEFT-VENTRICULAR HYPERTROPHY ,Internal medicine ,Heart rate ,medicine ,Humans ,Clinical Trials ,Blood Pressure Control and Regulation ,METAANALYSIS ,Aged ,Heart Failure ,Inpatients ,Dose-Response Relationship, Drug ,HYPERTENSION ,business.industry ,BETA-BLOCKERS ,Stroke Volume ,medicine.disease ,United States ,Good Health and Well Being ,Rate pressure product ,Blood pressure ,Cardiovascular System & Hematology ,Heart failure ,business ,Heart failure with preserved ejection fraction ,MERIT-HF - Abstract
Background: Heart rate and systolic blood pressure (SBP) are prognostic markers in heart failure (HF) with reduced ejection fraction (HFrEF). Their combination in rate pressure product (RPP) as well as their role in heart failure with preserved ejection fraction (HFpEF) remains unclear.Hypothesis: RPP and its components are associated with HFpEF outcomes.Methods: We performed an analysis of Acute Study of Clinical Effectiveness of Nesiritide in Subjects With Decompensated Heart Failure (ASCEND-HF; http://www.clinicaltrials.gov NCT00475852), which studied 7141 patients with acute HF. HFpEF was defined as left ventricular ejection fraction >= 40%. Outcomes were assessed by baseline heart rate, SBP, and RPP, as well as the change of these variables using adjusted Cox models.Results: After multivariable adjustment, in-hospital change but not baseline heart rate, SBP, and RPP were associated with 30-day mortality/HF hospitalization (hazard ratio [HR]: 1.17 per 5-bpm heart rate, HR: 1.20 per 10-mm Hg SBP, and HR: 1.02 per 100 bpm x mm Hg RPP; all P Conclusions: An increase in heart rate and SBP from baseline to discharge was associated with increased 30-day mortality/HF hospitalization in HFpEF patients with acute exacerbation. These findings suggest value in monitoring the trend of vital signs during HFpEF hospitalization.
- Published
- 2018
36. Apixaban following acute coronary syndromes in patients with prior stroke: Insights from the APPRAISE-2 trial
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Karen S. Pieper, C. Michael Gibson, Danny Liaw, Renato D. Lopes, Lars Wallentin, John H. Alexander, Matthew W. Sherwood, Jie Lena Sun, Basil S. Lewis, Robert A. Harrington, Stefan James, Harald Darius, Shaun G. Goodman, and Daniel T. Laskowitz
- Subjects
Male ,medicine.medical_specialty ,Acute coronary syndrome ,Pyridones ,Myocardial Infarction ,030204 cardiovascular system & hematology ,Placebo ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Cause of Death ,Internal medicine ,Diabetes mellitus ,Outcome Assessment, Health Care ,Diabetes Mellitus ,Secondary Prevention ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Acute Coronary Syndrome ,Blood Coagulation ,Stroke ,Aged ,Cause of death ,Vascular disease ,business.industry ,Middle Aged ,medicine.disease ,Cardiology ,Pyrazoles ,Female ,Apixaban ,Cardiology and Cardiovascular Medicine ,business ,Factor Xa Inhibitors ,medicine.drug - Abstract
Background and Purpose Patients with prior stroke are at greater risk for recurrent cardiovascular events post-acute coronary syndromes (ACS) and may have a different risk/benefit profile with antithrombotic therapy than patients without prior stroke. Methods We studied 7391 patients with ACS from APPRAISE-2, stratified by the presence or absence of prior stroke. Baseline characteristics and outcomes of cardiovascular death, myocardial infarction (MI), or stroke were compared between groups. Interactions between prior stroke, treatment assignment (apixaban vs placebo), and outcomes were tested before and after multivariable adjustment with Cox proportional hazards models. Results A total of 902 patients (12%) had prior stroke. Those with prior stroke were older (69 vs 67 years), had more hypertension (91% vs 77%), peripheral vascular disease (22% vs18%), and impaired renal function (38% vs 30%) but less diabetes (44% vs 48%) than those without prior stroke. Patients with prior stroke vs no prior stroke had higher unadjusted rates of cardiovascular death (4.8% vs 4.0%), MI (11.2% vs 7.1%), and ischemic stroke (3.2% vs 0.9%). Patients with prior stroke assigned to apixaban had similar rates of the composite of cardiovascular death, MI, or stroke compared with those assigned to placebo (HR 1.39; 95% CI 0.92–2.08). Patients without prior stroke assigned to apixaban had similar rates of cardiovascular death, MI, or ischemic stroke compared with those assigned to placebo (HR 0.87; 95% CI 0.73–1.04; P-interaction = .041). Median follow-up was 240 days. Conclusions Patients with prior stroke are at higher risk for recurrent cardiovascular events post-ACS and had a differential risk/benefit profile with oral anticoagulation.
- Published
- 2018
37. Sudden cardiac death after acute heart failure hospital admission: insights from ASCEND-HF
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Jie Lena Sun, Robert J. Mentz, Sean D. Pokorney, Randall C. Starling, Adrian F. Hernandez, Justin A. Ezekowitz, Paul W. Armstrong, Christopher M. O'Connor, Phillip J. Schulte, Adriaan A. Voors, Eric J. Velazquez, John R. Teerlink, and Sana M. Al-Khatib
- Subjects
medicine.medical_specialty ,Ejection fraction ,business.industry ,Mortality rate ,medicine.medical_treatment ,Hazard ratio ,030204 cardiovascular system & hematology ,medicine.disease ,Ventricular tachycardia ,Implantable cardioverter-defibrillator ,Sudden cardiac death ,03 medical and health sciences ,0302 clinical medicine ,Heart failure ,Internal medicine ,medicine ,Cardiology ,030212 general & internal medicine ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business - Abstract
AIMS The incidence of and factors associated with sudden cardiac death (SCD) early after an acute heart failure (HF) hospital admission have not been well defined. METHODS AND RESULTS We assessed SCD and ventricular arrhythmias in the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial, which included patients with acute HF with reduced or preserved ejection fraction. SCD, resuscitated SCD (RSCD), and sustained ventricular tachycardia/ventricular fibrillation (VT/VF) were adjudicated from randomization through 30 days and were combined into a composite endpoint. Baseline characteristics associated with this composite were determined by logistic regression. RSCD and VT/VF were included as time-dependent variables in a Cox model evaluating the association of these variables with 180-day all-cause mortality. Among 7011 patients, the 30-day all-cause mortality rate was 3.8%; SCD accounted for 17% of these deaths. The 30-day composite event rate was 1.8% (n = 121). Ten patients had more than one event with 30-day Kaplan-Meier event rates of 0.6% for SCD [95% confidence interval (CI) 0.5%-0.9%, n = 43], 0.4% for RSCD (95% CI 0.2%-0.5%, n = 24), and 0.9% for VT/VF (95% CI 0.7%-1.2%, n = 64). In the multivariable model, chronic obstructive pulmonary disease, history of VT, male sex, and longer QRS duration were associated with SCD, RSCD, or VT/VF. A RSCD or VT/VF event was associated with higher 180-day mortality (adjusted hazard ratio 6.6, 95% CI 4.8-9.1, P
- Published
- 2017
38. THE ASSOCIATION OF GUIDELINE-BASED SURVEILLANCE AND LONG-TERM MORTALITY AMONG PATIENTS WITH MODERATE AND SEVERE MITRAL REGURGITATION
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Jennifer A. Rymer, Karen Chiswell, Tracy Y. Wang, Jie-Lena Sun, and Pamela S. Douglas
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Mitral regurgitation ,Pediatrics ,medicine.medical_specialty ,business.industry ,medicine ,Long term mortality ,Guideline ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
39. Duration of general anaesthetic exposure in early childhood and long-term language and cognitive ability
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Guohua Li, Caleb Ing, Lena Sun, Mary Hegarty, Ming Sun, B. S. von Ungern-Sternberg, Charles DiMaggio, J.W. Perkins, Howard Andrews, and Andrew J. O. Whitehouse
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Time Factors ,Adolescent ,Anesthetics, General ,Neuropsychological Tests ,Article ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,030225 pediatrics ,Humans ,Medicine ,Young adult ,Child ,Retrospective Studies ,Language Disorders ,Pregnancy ,business.industry ,Medical record ,Infant ,Retrospective cohort study ,Western Australia ,medicine.disease ,Comorbidity ,Confidence interval ,Anesthesiology and Pain Medicine ,Quartile ,Child, Preschool ,Anesthesia ,Cohort ,Female ,Cognition Disorders ,business ,Follow-Up Studies - Abstract
Background The anaesthetic dose causing neurotoxicity in animals has been evaluated, but the relationship between duration of volatile anaesthetic (VA) exposure and neurodevelopment in children remains unclear. Methods Data were obtained from the Western Australian Pregnancy Cohort (Raine) Study, with language (Clinical Evaluation of Language Fundamentals: Receptive [CELF-R] and Expressive [CELF-E] and Total [CELF-T]) and cognition (Coloured Progressive Matrices [CPM]) assessed at age 10 yr. Medical records were reviewed, and children divided into quartiles based on total VA exposure duration before age three yr. The association between test score and exposure duration quartile was evaluated using linear regression, adjusting for patient characteristics and comorbidity. Results Of 1622 children with available test scores, 148 had documented VA exposure and were split into the following quartiles: ≤25, >25 to ≤35, >35 to ≤60 and >60 min. Compared with unexposed children, CELF-T scores for children in the first and second quartiles did not differ, but those in the third and fourth quartiles had significantly lower scores ([3rd quartile – Unexposed] -5.3; 95% confidence interval [CI], (-10.2 – -0.4), [4th quartile – Unexposed] -6.2; 95% CI, (-11.6 – -0.9). CELF-E showed similar findings, but significant differences were not found in CELF-R or CPM for any quartile. Conclusions Children with VA exposures ≤35 min did not differ from unexposed children, but those with exposures >35 min had lower total and expressive language scores. It remains unclear if this is a dose-response relationship, or if children requiring longer exposures for longer surgeries have other clinical reasons for lower scores.
- Published
- 2017
40. Noncardiovascular deaths are more common than cardiovascular deaths in patients with cardiovascular disease or cardiovascular risk factors and impaired glucose tolerance: Insights from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial
- Author
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Flávio de Souza Brito, Abhinav Sharma, Jie-Lena Sun, Laine Thomas, Renato D. Lopes, Rury R. Holman, and Steven M. Haffner
- Subjects
Male ,medicine.medical_specialty ,Population ,Disease ,030204 cardiovascular system & hematology ,Impaired glucose tolerance ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Cause of Death ,Internal medicine ,Glucose Intolerance ,medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,education ,Intensive care medicine ,Aged ,Cause of death ,education.field_of_study ,business.industry ,Hazard ratio ,Middle Aged ,medicine.disease ,Valsartan ,Cardiovascular Diseases ,Female ,Skin cancer ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,medicine.drug - Abstract
Background Patients with impaired glucose tolerance have an elevated risk of cardiovascular (CV) death; however, the causes and risk factors associated with non-CV deaths are poorly understood. Methods The NAVIGATOR trial enrolled 9,306 participants with impaired glucose tolerance and CV disease or at high CV risk, with a median follow-up of 6.4 years. Using this population, we identified (1) the proportion of deaths attributed to CV, non-CV, and unknown causes, and (2) the risk factors associated with non-CV death. Results During the NAVIGATOR trial follow-up, 622 patients died. Investigators reported 244 (39.2%) CV deaths, 313 (50.3%) non-CV deaths, and 65 (10.5%) deaths of unknown cause. Myocardial infarction was the leading cause of investigator-reported death (57/622 [9.2%]). Among non-CV deaths, the most commonly identified cause related to malignancy (177/313 [56.5%]). Using adjudicated causes of death, Cox proportional hazard models identified 3 independent prognostic markers that increased the risk of non-CV death: history of non–melanoma skin cancer (hazard ratio 2.67 [95% CI 1.65-4.33]; P < .0001), white blood cell count (1 unit N5000/mm3; 1.10 [1.02-1.18]; P = .011), and serum potassium levels (per 1 mmol/L above any value; 1.67 [1.302.15]; P < .0001). Conclusions Despite the high baseline CV risk among patients in the NAVIGATOR trial, the most common cause of death was non-CV. The high burden of non-CV death in this population has potential implications for future CV event–driven trials.
- Published
- 2017
41. Assessing for a Differential Treatment Effect with Nesiritide by Body Mass Index
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Marat Fudim, Marius Chukwurah, Stephen J. Greene, Randall C. Starling, Robert J. Mentz, Jie-Lena Sun, and Brooke Alhanti
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Nesiritide ,medicine.medical_specialty ,Ejection fraction ,business.industry ,Peripheral edema ,Brain natriuretic peptide ,medicine.disease ,Placebo ,Obesity ,Internal medicine ,Heart failure ,medicine ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Body mass index ,medicine.drug - Abstract
Introduction Visceral fat is associated with increased clearance of natriuretic peptides. As such, a brain natriuretic peptide (BNP) deficiency has been observed in obese patients, both healthy individuals and those with cardiovascular disease. This study investigated if obese patients with heart failure (HF) exhibited a differential response to nesiritide, a BNP analogue, compared with non-obese patients with regards to reduction of symptoms and clinical outcomes in the ASCEND-HF (Acute Study of Clinical Effectiveness if Nesiritide and Decompensated Heart Failure) trial. Hypothesis Due to enhanced BNP clearance, obese patients with acutely decompensated HF will exhibit a reduced response to nesiritide with regards to dyspnea relief and clinical outcomes. Methods We described baseline congestion phenotype and dyspnea at 6 and 24 hours (not moderately or markedly better) by body mass index (BMI) category ( 35 kg/m2). We assessed for an interaction between BMI (as a categorical variable and continuous measure) and treatment (nesiritide vs. placebo) for the endpoints of 6-hour and 24-hour dyspnea and 30-day rehospitalization or all-cause mortality. We used random-intercept multilevel logistic regression models including pre-specified adjustment covariates, treatment and the BMI x treatment interaction. Results Of the 7,141 patients with HF (including both reduced and preserved ejection fraction), we examined 7077 patients (99%) with baseline BMI data. Among the 7,077 patients, 4,506 (63.7%) had BMI 35 kg/m2. Baseline NT-proBNP levels were lower among patients with higher BMI (median of 5,261 vs. 3633 vs. 2,663 pg/mL, respectively, p 35 had less baseline pulmonary congestion and more peripheral edema. Patients with BMI >35 had more persistent dyspnea at 6 and 24 hours compared to patients with BMI 0.4) (Table). Conclusions Compared with non-obese patients, obese patients with acute HF had lower BNP levels and a different phenotype of congestion as well as more persistent dyspnea at 6 and 24 hours. There was no evidence of a differential treatment effect with nesiritide based on obesity status.
- Published
- 2020
42. Nitrate Use And Changes In Functional Status In Black Patients With Chronic Heart Failure With Reduced Ejection Fraction: Insights From The HF-ACTION Trial
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Stephen J. Greene, David J. Whellan, Jie-Lena Sun, Ileana L. Piña, Robert J. Mentz, Brooke Alhanti, Christopher M. O'Connor, William E. Kraus, and Lonnie T. Sullivan
- Subjects
education.field_of_study ,medicine.medical_specialty ,Ejection fraction ,Randomization ,business.industry ,Population ,Renal function ,Hydralazine ,medicine.disease ,Clinical trial ,Internal medicine ,Diabetes mellitus ,Heart failure ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,education ,business ,medicine.drug - Abstract
Introduction Nitrate therapy (in combination with hydralazine) is recommended in black patients with heart failure with reduced ejection fraction (HFrEF) and NYHA class III-IV symptoms receiving optimal ACE/ARB and beta-blocker therapy to improve clinical outcomes; yet the effect of nitrates on functional status is not well characterized. Hypothesis We hypothesized that black patients taking nitrates would have greater improvements in measures of functional status over time compared with those not taking nitrates. Methods The HF-ACTION trial randomized 2,331 patients with chronic HFrEF (EF ≤35%) to usual care plus exercise training versus usual care alone. We analyzed data from self-identified black participants stratified by baseline nitrate use. Unadjusted and adjusted hierarchical linear regression models were used to determine the association of nitrate use with changes in functional status (6-minute walk distance [6MWD], and peak VO2) from baseline to 3 months and to explore an interaction with exercise training. Results Among 749 black patients, 198 (26%) were on nitrates at baseline. Patients taking nitrates were older, with worse NYHA class symptoms, more ischemic disease and diabetes and worse renal function than those not on nitrates. Baseline 6MWD and peak VO2 were worse among patients on nitrates than those not on nitrates (median 308 vs. 361 m and 12.4 vs. 13.4 mL/kg/min, respectively). After adjustment, there was no significant association between nitrate use and change in 6MWD or peak VO2 (Table). These results were consistent irrespective of randomization to exercise training or usual care (interaction p-values>0.05). Conclusions In this clinical trial population of self-identified black patients with chronic HFrEF, approximately one-fourth of patients were receiving nitrates at baseline and these patients tended to have worse baseline functional status. After adjustment, nitrate use was not associated with greater improvements in functional status from baseline to 3 months, and findings were consistent irrespective of concurrent exercise training. Further efforts are needed to determine optimal approaches for improving exercise capacity in black patients with HFrEF.
- Published
- 2020
43. Anesthetic management of a patient with familial dysautonomia for renal transplant surgery
- Author
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GURBUXANI, GEETA, NEETA, SARAIYA, and LENA, SUN
- Published
- 2008
44. Adverse Renal Response to Decongestion in the Obese Phenotype of Heart Failure With Preserved Ejection Fraction
- Author
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G. Michael Felker, Masaru Obokata, Steven McNulty, Gregory D. Lewis, Jeffrey M. Testani, W.H. Wilson Tang, Hrishikesh Chakrabothy, Yogesh N.V. Reddy, Sanjiv J. Shah, Jie Lena Sun, Omar F. AbouEzzeddine, Margaret M. Redfield, Lynne W. Stevenson, and Barry A. Borlaug
- Subjects
Male ,medicine.medical_specialty ,Hemodynamics ,Renal function ,030204 cardiovascular system & hematology ,Kidney ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Natriuretic Peptide, Brain ,medicine ,Humans ,030212 general & internal medicine ,Obesity ,Prospective Studies ,Plasma Volume ,Ventricular remodeling ,Aged ,Volume of distribution ,Aged, 80 and over ,Heart Failure ,Ejection fraction ,business.industry ,Stroke Volume ,Middle Aged ,medicine.disease ,Peptide Fragments ,Phenotype ,Heart failure ,Creatinine ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Heart failure with preserved ejection fraction ,business ,Body mass index ,Glomerular Filtration Rate - Abstract
Background Patients with heart failure (HF) with preserved ejection fraction (HFpEF) and obesity display a number of pathophysiologic features that may render them more or less vulnerable to negative effects of decongestion on renal function, including greater right ventricular remodeling, plasma volume expansion and pericardial restraint. We aimed to contrast the renal response to decongestion in obese compared to nonobese patients with HFpEF Methods and Results National Institutes of Health heart failure network studies that enrolled patients with acute decompensated HFpEF (EF ≥ 50%) were included (DOSE, CARRESS, ROSE, and ATHENA). Obese HFpEF was defined as a body mass index ≥ 30 kg/m2. Compared to nonobese HFpEF (n = 118), patients with obese HFpEF (n = 214) were an average of 9 years younger (71 vs 80 years, 0.5 mg/dL) (9 vs 0%, P = 0.002). Conclusions Despite being nearly a decade younger, obese patients with HFpEF experience greater deterioration in renal function during decongestion than do nonobese patients with HFpEF. Further study to elucidate the complex relationships between volume distribution, cardiorenal hemodynamics and adiposity in HFpEF is needed.
- Published
- 2019
45. Haemoconcentration during treatment of acute heart failure with cardiorenal syndrome: from the CARRESS-HF trial
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Marat Fudim, Bradley A. Bart, G. Michael Felker, Adam D. DeVore, Adrian F. Hernandez, Javed Butler, Jie-Lena Sun, Stephen J. Greene, Steven McNulty, Robert J. Mentz, Vanessa Blumer, and Andrew P. Ambrosy
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Renal function ,Cardiorenal syndrome ,Comorbidity ,Hematocrit ,Kidney Function Tests ,law.invention ,Randomized controlled trial ,law ,Internal medicine ,Hemofiltration ,medicine ,Humans ,Aged ,Heart Failure ,medicine.diagnostic_test ,Cardio-Renal Syndrome ,business.industry ,Middle Aged ,medicine.disease ,Hospitalization ,Heart failure ,Acute Disease ,Cardiology ,Hemoglobinometry ,Female ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
46. High‐Sensitivity Troponin I in Hospitalized and Ambulatory Patients With Heart Failure With Preserved Ejection Fraction: Insights From the Heart Failure Clinical Research Network
- Author
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Kevin J. Anstrom, Adrian F. Hernandez, Omar F. AbouEzzeddine, Margaret M. Redfield, Robert J. Mentz, Muthiah Vaduganathan, Jie-Lena Sun, Stephen J. Greene, Marat Fudim, Javed Butler, Bradley A. Bart, Barry A. Borlaug, G. Michael Felker, Eugene Braunwald, Yogesh N.V. Reddy, and Andrew P. Ambrosy
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Hospitalized patients ,030204 cardiovascular system & hematology ,Risk Assessment ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Humans ,Cardiac structure ,030212 general & internal medicine ,Aged ,Randomized Controlled Trials as Topic ,Aged, 80 and over ,Heart Failure ,biology ,troponin ,business.industry ,Troponin I ,Editorials ,Stroke Volume ,Middle Aged ,medicine.disease ,Troponin ,Up-Regulation ,3. Good health ,Hospitalization ,Treatment Outcome ,Editorial ,Clinical research ,Heart failure ,High sensitivity troponin ,Ambulatory ,biology.protein ,Cardiology ,biomarker ,Female ,Cardiology and Cardiovascular Medicine ,business ,Heart failure with preserved ejection fraction ,Biomarkers - Abstract
Background We sought to study the prevalence of high‐sensitivity troponin and its association with cardiac structure and outcomes in ambulatory and hospitalized patients with heart failure with a preserved ejection fraction ( HF p EF ). Methods and Results A post hoc analysis utilized data from HF p EF patients: DOSE (Diuretic Optimization Strategies Evaluation) and CARRESS ‐ HF (Cardiorenal Rescue Study in Acute Decompensated Heart Failure) enrolled patients hospitalized with acute HF p EF , and RELAX (Phosphodiesterase‐5 Inhibition to Improve Clinical Status and Exercise Capacity in Heart Failure With Preserved Ejection Fraction) enrolled ambulatory patients with HF p EF . High‐sensitivity troponin I (hs‐TnI) was measured in hospitalized patients at baseline, at 72 to 96 hours, on day 7, and on day 60. In ambulatory patients hs‐TnI was measured at baseline and at week 24. In the ambulatory cohort, correlations between hs‐TnI and cardiac structure and function were assessed. The association between hs‐TnI and a 60‐day composite of emergency room visits, readmissions, and death was assessed for hospitalized patients using multivariable Cox proportional hazard models. The study population included 139 hospitalized and 212 ambulatory patients with HF p EF and hs‐TnI measured at baseline. The median (25th, 75th percentiles) baseline troponin was 17.6 (11.1, 41.0) ng/L in hospitalized patients and 9.5 (5.3, 19.7) ng/L in ambulatory patients ( P 99% percentile upper reference limit was 86% in hospitalized patients and 53% among ambulatory patients, with stable elevation in ambulatory patients during follow‐up. HF p EF patients with a hs‐TnI above the median were older with worse left ventricular hypertrophy and diastolic dysfunction. Continuously valued hs‐TnI (per doubling) was associated with increased risk of composite end point (adjusted hazard ratio 1.20, 95% confidence interval 1.00‐1.43; P =0.042). Conclusions Hs‐TnI is commonly elevated among both hospitalized and ambulatory patients with HF p EF . Increased hs‐TnI levels are associated with worse cardiac structure and increased risk of adverse events.
- Published
- 2018
47. Bivariate Mixed Effects Analysis of Clustered Data with Large Cluster Sizes
- Author
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Karen S. Pieper, Jie Lena Sun, and Daowen Zhang
- Subjects
Statistics and Probability ,Restricted maximum likelihood ,Computer science ,Inference ,Bivariate analysis ,Maximization ,030204 cardiovascular system & hematology ,Missing data ,01 natural sciences ,Biochemistry, Genetics and Molecular Biology (miscellaneous) ,Article ,Generalized linear mixed model ,010104 statistics & probability ,03 medical and health sciences ,0302 clinical medicine ,Statistics ,Expectation–maximization algorithm ,0101 mathematics ,Computational problem - Abstract
Linear mixed effects models are widely used to analyze a clustered response variable. Motivated by a recent study to examine and compare the hospital length of stay (LOS) between patients undertaking percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) from several international clinical trials, we proposed a bivariate linear mixed effects model for the joint modeling of clustered PCI and CABG LOS’s where each clinical trial is considered a cluster. Due to the large number of patients in some trials, commonly used commercial statistical software for fitting (bivariate) linear mixed models failed to run since it could not allocate enough memory to invert large dimensional matrices during the optimization process. We consider ways to circumvent the computational problem in the maximum likelihood (ML) inference and restricted maximum likelihood (REML) inference. Particularly, we developed an expected and maximization (EM) algorithm for the REML inference and presented an ML implementation using existing software. The new REML EM algorithm is easy to implement and computationally stable and efficient. With this REML EM algorithm, we could analyze the LOS data and obtained meaningful results.
- Published
- 2016
48. Psychosocial Factors, Exercise Adherence, and Outcomes in Heart Failure Patients
- Author
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Lauren B. Cooper, Phillip J. Schulte, Steven J. Keteyian, Christopher M. O'Connor, Lawton S. Cooper, Robert J. Mentz, Ileana L. Piña, Jie Lena Sun, David J. Whellan, Jerome L. Fleg, William E. Kraus, and Eric S. Leifer
- Subjects
Male ,medicine.medical_specialty ,Article ,law.invention ,Social support ,Randomized controlled trial ,Quality of life ,law ,Humans ,Medicine ,Exercise ,Aged ,Heart Failure ,Exercise Tolerance ,business.industry ,Hazard ratio ,Social Support ,Stroke Volume ,Middle Aged ,medicine.disease ,Confidence interval ,Hospitalization ,Clinical trial ,Treatment Outcome ,Heart failure ,Quality of Life ,Physical therapy ,Patient Compliance ,Female ,Cardiology and Cardiovascular Medicine ,business ,Psychosocial - Abstract
Background— Psychosocial factors may influence adherence with exercise training for heart failure (HF) patients. We aimed to describe the association between social support and barriers to participation with exercise adherence and clinical outcomes. Methods and Results— Of patients enrolled in Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION), 2279 (97.8%) completed surveys to assess social support and barriers to exercise, resulting in the perceived social support score (PSSS) and barriers to exercise score (BTES). Higher PSSS indicated higher levels of social support, whereas higher BTES indicated more barriers to exercise. Exercise time at 3 and 12 months correlated with PSSS ( r = 0.09 and r = 0.13, respectively) and BTES ( r =−0.11 and r =−0.12, respectively), with higher exercise time associated with higher PSSS and lower BTES (All P P =0.035), which corresponded to a borderline association between increasing BTES and cardiovascular death or HF hospitalization in the exercise group (hazard ratio 1.25, 95% confidence interval 0.99, 1.59), but no association in the usual care group (hazard ratio 0.83, 95% confidence interval 0.66, 1.06). Conclusions— Poor social support and high barriers to exercise were associated with lower exercise time. PSSS did not impact the effect of exercise training on outcomes. However, for cardiovascular death or HF hospitalization, exercise training had a greater impact on patients with lower BTES. Given that exercise training improves outcomes in HF patients, assessment of perceived barriers may facilitate individualized approaches to implement exercise training therapy in clinical practice. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00047437.
- Published
- 2015
49. EVALUATING THE 2018 AHA/ACC LIPID GUIDELINE PERFORMANCE TO IDENTIFY PATIENTS AT HIGH RISK FOR PREMATURE CARDIOVASCULAR DISEASE
- Author
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Michel Zeitouni, Michael G. Nanna, Eric D. Peterson, Jie-Lena Sun, Karen Chiswell, and Ann Marie Navar
- Subjects
medicine.medical_specialty ,Statin ,Cholesterol ,business.industry ,medicine.drug_class ,Disease ,Guideline ,chemistry.chemical_compound ,chemistry ,Internal medicine ,Primary prevention ,medicine ,Young adult ,Cardiology and Cardiovascular Medicine ,business - Abstract
The 2018 American Heart Association/American College of Cardiology cholesterol guideline changed statin eligibility criteria for primary prevention to include multiple new risk “enhancers”. Whether this improved identification of young adults at risk for premature CVD compared with the prior
- Published
- 2020
50. Relationship Between Enrolling Country Income Level and Patient Profile, Protocol Completion, and Trial End Points
- Author
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Faiez Zannad, João Pedro Ferreira, Adriaan A. Voors, Javed Butler, Marco Metra, Robert J. Mentz, Adrian F. Hernandez, Adrian Coles, Justin A. Ezekowitz, Christopher M. O'Connor, Jie-Lena Sun, Robert M. Califf, Paul W. Armstrong, Stephen J. Greene, and Cardiovascular Centre (CVC)
- Subjects
Male ,Time Factors ,Databases, Factual ,Social Determinants of Health ,heart failure ,030204 cardiovascular system & hematology ,NESIRITIDE ,0302 clinical medicine ,CLINICAL CHARACTERISTICS ,Risk Factors ,Natriuretic Peptide, Brain ,Patient profile ,Multicenter Studies as Topic ,Medicine ,030212 general & internal medicine ,PREDICTORS ,Randomized Controlled Trials as Topic ,OUTCOMES ,clinical trial ,Middle Aged ,SPIRONOLACTONE ,Treatment Outcome ,income ,Income level ,Female ,Natriuretic Agents ,Cardiology and Cardiovascular Medicine ,Inclusion (education) ,hospitalization ,Endpoint Determination ,Research Subjects ,Article ,03 medical and health sciences ,Globalization ,REGISTRIES ,MANAGEMENT ,Humans ,Healthcare Disparities ,GLOBALIZATION ,Lower income ,Aged ,Retrospective Studies ,Protocol (science) ,business.industry ,HOSPITALIZED HEART-FAILURE ,Patient Selection ,Health Status Disparities ,Clinical trial ,business ,Demography - Abstract
Background: Globalization of clinical trials fosters inclusion of higher and lower income countries, but the influence of enrolling country income level on heart failure trial performance is unclear. This study sought to evaluate associations between enrolling country income level, acute heart failure patient profile, protocol completion, and trial end points. Methods and Results: The ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) trial included 7141 patients with acute heart failure from 30 countries. Country income data in gross national income per capita in current US dollars from the year 2007 (ie, the year trial enrollment began) were abstracted from the World Bank. Patients were grouped by enrolling country income level (ie, high [>$11 455], upper middle [$3706–$11 455], lower middle [$936–$3705], and low [P P for interaction, 0.03). Conclusions: In this global acute heart failure trial, patients from higher income countries had lower rates of protocol completion, higher rates of adverse events, and similar mortality rates. After adjustment for race, geographic region, and clinical factors, enrollment from a higher income country was associated with worse clinical outcomes, driven by higher rates of rehospitalization. Variation in enrolling country income level may influence study end points and trial performance independent of geographic region. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00475852.
- Published
- 2018
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