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1. Long term health outcomes in people with diabetes 12 months after hospitalisation with COVID-19 in the UK: a prospective cohort studyResearch in context

Author

Safoora Gharibzadeh, Ash Routen, Cameron Razieh, Francesco Zaccardi, Claire Lawson, Clare Gillies, Simon Heller, Melanie Davies, Helen Atkins, Stephen C. Bain, Nazir L. Lone, Krisnah Poinasamy, Tunde Peto, Elizabeth Robertson, Bob Young, Desmond Johnston, Jennifer Quint, Jonathan Valabhji, Khalida Ismail, Michael Marks, Alex Horsley, Annemarie Docherty, Ewen Harrison, James Chalmers, Ling-Pei Ho, Betty Raman, Chris Brightling, Omer Elneima, Rachel Evans, Neil Greening, Victoria C. Harris, Linzy Houchen-Wolloff, Marco Sereno, Aarti Shikotra, Amisha Singapuri, Louise Wain, Claudia Langenberg, John Dennis, John Petrie, Naveed Sattar, Olivia Leavy, Mattew Richardson, Ruth M. Saunders, Anne McArdle, Hamish McASuley, Tom Yates, Kamlesh Khunti, C.E. Brightling, R.A. Evans, L.V. Wain, J.D. Chalmers, V.C. Harris, L.P. Ho, A. Horsley, M. Marks, K. Poinasamy, B. Raman, A. Shikotra, A. Singapuri, R. Dowling, C. Edwardson, O. Elneima, S. Finney, N.J. Greening, B. Hargadon, L. Houchen--Wolloff, O.C. Leavy, H.J.C. McAuley, C. Overton, T. Plekhanova, R.M. Saunders, M. Sereno, C. Taylor, S. Terry, C. Tong, B. Zhao, D. Lomas, E. Sapey, C. Berry, C.E. Bolton, N. Brunskill, E.R. Chilvers, R. Djukanovic, Y. Ellis, D. Forton, N. French, J. George, N.A. Hanley, N. Hart, L. McGarvey, N. Maskell, H. McShane, M. Parkes, D. Peckham, P. Pfeffer, A. Sayer, A. Sheikh, A.A.R. Thompson, N. Williams, W. Greenhalf, M.G. Semple, M. Ashworth, H.E. Hardwick, L. Lavelle-Langham, W. Reynolds, V. Shaw, B. Venson, A.B. Docherty, E.M. Harrison, J.K. Baillie, L. Daines, R. Free, S. Kerr, N.I. Lone, D. Lozano-Rojas, K. Ntotsis, R. Pius, J. Quint, M. Richardson, M. Thorpe, M. Halling-Brown, F. Gleeson, J. Jacob, S. Neubauer, S. Siddiqui, J.M. Wild, S. Aslani, G. Baxter, M. Beggs, C. Bloomfield, M.P. Cassar, A. Chiribiri, E. Cox, D.J. Cuthbertson, V.M. Ferreira, L. Finnigan, S. Francis, P. Jezzard, G.J. Kemp, H. Lamlum, E. Lukaschuk, C. Manisty, G.P. McCann, C. McCracken, K. McGlynn, R. Menke, C.A. Miller, A.J. Moss, T.E. Nichols, C. Nikolaidou, C. O'Brien, G. Ogbole, B. Rangelov, D.P. O'Regan, A. Pakzad, S. Piechnik, S. Plein, I. Propescu, A.A. Samat, L. Saunders, Z.B. Sanders, R. Steeds, T. Treibel, E.M. Tunnicliffe, M. Webster, J. Willoughby, J. Weir McCall, C. Xie, M. Xu, H. Baxendale, M. Brown, B. Gooptu, R.G. Jenkins, D. Jones, I. Koychev, C. Langenberg, A. Lawrie, P.L. Molyneaux, J. Pearl, M. Ralser, N. Sattar, J.T. Scott, T. Shaw, D. Thomas, D. Wilkinson, L.G. Heaney, A. De Soyza, D. Adeloye, J.S. Brown, J. Busby, C. Echevarria, J. Hurst, P. Novotny, C. Nicolaou, I. Rudan, M. Shankar-Hari, S. Walker, B. Zheng, J.R. Geddes, M. Hotopf, K. Abel, R. Ahmed, L. Allan, C. Armour, D. Baguley, D. Baldwin, C. Ballard, K. Bhui, G. Breen, K. Breeze, M. Broome, T. Brugha, E. Bullmore, D. Burn, F. Callard, J. Cavanagh, T. Chalder, D. Clark, A. David, B. Deakin, H. Dobson, B. Elliott, J. Evans, R. Francis, E. Guthrie, P. Harrison, M. Henderson, A. Hosseini, N. Huneke, M. Husain, T. Jackson, I. Jones, T. Kabir, P. Kitterick, A. Korszun, J. Kwan, A. Lingford-Hughes, P. Mansoori, H. McAllister-Williams, K. McIvor, B. Michael, L. Milligan, R. Morriss, E. Mukaetova-Ladinska, K. Munro, A. Nevado-Holgado, T. Nicholson, S. Paddick, C. Pariante, J. Pimm, K. Saunders, M. Sharpe, G. Simons, J.P. Taylor, R. Upthegrove, S. Wessely, S. Amoils, C. Antoniades, A. Banerjee, A. Bularga, P. Chowienczyk, J.P. Greenwood, A.D. Hughes, K. Khunti, C. Lawson, N.L. Mills, A.N. Sattar, C.L. Sudlow, M. Toshner, P.J.M. Openshaw, D. Altmann, R. Batterham, N. Bishop, P.C. Calder, C.M. Efstathiou, J.L. Heeney, T. Hussell, P. Klenerman, F. Liew, J.M. Lord, P. Moss, S.L. Rowland-Jones, W. Schwaeble, R.S. Thwaites, L. Turtle, S. Walmsley, D. Wraith, M.J. Rowland, A. Rostron, B. Connolly, D.F. McAuley, D. Parekh, J. Simpson, C. Summers, J. Porter, R.J. Allen, R. Aul, S. Barratt, P. Beirne, J. Blaikley, R.C. Chambers, N. Chaudhuri, C. Coleman, E. Denneny, L. Fabbri, P.M. George, M. Gibbons, B. Guillen Guio, I. Hall, E. Hufton, I. Jarrold, G. Jenkins, S. Johnson, M.G. Jones, S. Jones, F. Khan, P. Mehta, J. Mitchell, J.E. Pearl, K. Piper Hanley, P. Rivera-Ortega, L.C. Saunders, D. Smith, M. Spears, L.G. Spencer, S. Stanel, I. Stewart, D. Thickett, R. Thwaites, S. Walsh, D.G. Wootton, L. Wright, S. Heller, M.J. Davies, H. Atkins, S. Bain, J. Dennis, K. Ismail, D. Johnston, P. Kar, P. McArdle, A. McGovern, T. Peto, J. Petrie, E. Robertson, K. Shah, J. Valabhji, B. Young, L.S. Howard, Mark Toshner, J. Newman, L. Price, A. Reddy, J. Rossdale, C. Sudlow, M. Wilkins, S.J. Singh, W.D.-C. Man, N. Armstrong, E. Baldry, M. Baldwin, N. Basu, M. Beadsworth, L. Bishop, A. Briggs, M. Buch, G. Carson, H. Chinoy, C. Dawson, E. Daynes, S. Defres, L. Gardiner, P. Greenhaff, S. Greenwood, M. Harvie, L. HOuchen-Wolloff, S. MacDonald, A. McArdle, A. McMahon, M. McNarry, G. Mills, C. Nolan, K. O'Donnell, Pimm, J. Sargent, L. Sigfrid, M. Steiner, D. Stensel, A.L. Tan, I. Vogiatzis, J. Whitney, D. Wilson, M. Witham, T. Yates, C. Laing, K. Bramham, P. Chowdhury, A. Frankel, L. Lightstone, S. McAdoo, K. McCafferty, M. Ostermann, N. Selby, C. Sharpe, M. Willicombe, L. Houchen-Wolloff, J. Bunker, R. Gill, C. Hastie, R. Nathu, N. Rogers, N. Smith, A. Shaw, L. Armstrong, B. Hairsine, H. Henson, C. Kurasz, L. Shenton, S. Fairbairn, A. Dell, N. Hawkings, J. Haworth, M. Hoare, A. Lucey, V. Lewis, G. Mallison, H. Nassa, C. Pennington, A. Price, C. Price, A. Storrie, G. Willis, S. Young, K. Chong-James, C. David, W.Y. James, A. Martineau, O. Zongo, A. Sanderson, V. Brown, T. Craig, S. Drain, B. King, N. Magee, D. McAulay, E. Major, J. McGinness, R. Stone, A. Haggar, A. Bolger, F. Davies, J. Lewis, A. Lloyd, R. Manley, E. McIvor, D. Menzies, K. Roberts, W. Saxon, D. Southern, C. Subbe, V. Whitehead, H. El-Taweel, J. Dawson, L. Robinson, D. Saralaya, L. Brear, K. Regan, K. Storton, J. Fuld, A. Bermperi, I. Cruz, K. Dempsey, A. Elmer, H. Jones, S. Jose, S. Marciniak, C. Ribeiro, J. Taylor, L. Watson, J. Worsley, R. Sabit, L. Broad, A. Buttress, T. Evans, M. Haynes, L. Jones, L. Knibbs, A. McQueen, C. Oliver, K. Paradowski, J. Williams, E. Harris, C. Sampson, C. Lynch, E. Davies, C. Evenden, A. Hancock, K. Hancock, M. Rees, L. Roche, N. Stroud, T. Thomas-Woods, M. Babores, J. Bradley-Potts, M. Holland, N. Keenan, S. Shashaa, H. Wassall, E. Beranova, H. Weston, T. Cosier, L. Austin, J. Deery, T. Hazelton, H. Ramos, R. Solly, S. Turney, L. Pearce, W. McCormick, S. Pugmire, W. Stoker, A. Wilson, L.A. Aguilar Jimenez, G. Arbane, S. Betts, K. Bisnauthsing, A. Dewar, G. Kaltsakas, H. Kerslake, M.M. Magtoto, P. Marino, L.M. Martinez, T.S. Solano, E. Wynn, W. Storrar, M. Alvarez Corral, A. Arias, E. Bevan, D. Griffin, J. Martin, J. Owen, S. Payne, A. Prabhu, A. Reed, C. Wrey Brown, T. Burdett, J. Featherstone, A. Layton, C. Mills, L. Stephenson, N. Easom, P. Atkin, K. Brindle, M.G. Crooks, K. Drury, R. Flockton, L. Holdsworth, A. Richards, D.L. Sykes, S. Thackray-Nocera, C. Wright, K.E. Lewis, A. Mohamed, G. Ross, S. Coetzee, K. Davies, R. Hughes, R. Loosley, L. O'Brien, Z. Omar, H. McGuinness, E. Perkins, J. Phipps, A. Taylor, H. Tench, R. Wolf-Roberts, O. Kon, D.C. Thomas, S. Anifowose, L. Burden, E. Calvelo, B. Card, C. Carr, D. Copeland, P. Cullinan, P. Daly, L. Evison, T. Fayzan, H. Gordon, S. Haq, C. King, K. March, M. Mariveles, L. McLeavey, N. Mohamed, S. Moriera, U. Munawar, J. Nunag, U. Nwanguma, L. Orriss-Dib, A. Ross, M. Roy, E. Russell, K. Samuel, J. Schronce, N. Simpson, L. Tarusan, C. Wood, N. Yasmin, R. Reddy, A.-M. Guerdette, M. Hewitt, K. Warwick, S. White, A.M. Shah, C.J. Jolley, O. Adeyemi, R. Adrego, H. Assefa-Kebede, J. Breeze, S. Byrne, P. Dulawan, A. Hayday, A. Hoare, A. Knighton, M. Malim, S. Patale, I. Peralta, N. Powell, A. Ramos, K. Shevket, F. Speranza, A. Te, A. Ashworth, J. Clarke, C. Coupland, M. Dalton, E. Wade, C. Favager, J. Greenwood, J. Glossop, L. Hall, T. Hardy, A. Humphries, J. Murira, J. Rangeley, G. Saalmink, B. Whittam, N. Window, J. Woods, G. Coakley, L. Allerton, A. Berridge, J. Brown, S. Cooper, A. Cross, S.L. Dobson, J. Earley, K. Hainey, J. Hawkes, V. Highett, S. Kaprowska, A.L. Key, S. Koprowska, N. Lewis-Burke, G. Madzamba, F. Malein, S. Marsh, C. Mears, L. Melling, M.J. Noonan, L. Poll, J. Pratt, E. Richardson, A. Rowe, K.A. Tripp, B. Vinson, L.O. Wajero, S.A. Williams-Howard, J. Wyles, S.N. Diwanji, P. Papineni, S. Gurram, S. Quaid, G.F. Tiongson, E. Watson, B. Al-Sheklly, C. Avram, P. Barran, J. Blaikely, N. Choudhury, D. Faluyi, T. Felton, T. Gorsuch, Z. Kausar, N. Odell, R. Osbourne, K. Radhakrishnan, S. Stockdale, D. Trivedi, A. Ayoub, G. Burns, G. Davies, H. Fisher, C. Francis, A. Greenhalgh, P. Hogarth, J. Hughes, K. Jiwa, G. Jones, G. MacGowan, D. Price, H. Tedd, S. Thomas, S. West, S. Wright, A. Young, M.J. McMahon, P. Neill, D. Anderson, H. Bayes, D. Grieve, I.B. McInnes, A. Brown, A. Dougherty, K. Fallon, L. Gilmour, K. Mangion, A. Morrow, K. Scott, R. Sykes, R. Touyz, E.K. Sage, F. Barrett, A. Donaldson, M. Patel, D. Bell, R. Hamil, K. Leitch, L. Macliver, J. Quigley, A. Smith, B. Welsh, G. Choudhury, S. Clohisey, A. Deans, J. Furniss, S. Kelly, D.E. Newby, D. Connell, A. Elliott, C. Deas, S. Mohammed, J. Rowland, A.R. Solstice, D. Sutherland, C.J. Tee, D. Arnold, S. Barrett, H. Adamali, A. Dipper, S. Dunn, A. Morley, L. Morrison, L. Stadon, S. Waterson, H. Welch, B. Jayaraman, T. Light, P. Almeida, J. Bonnington, M. Chrystal, C. Dupont, A. Gupta, L. Howard, W. Jang, S. Linford, L. Matthews, R. Needham, A. Nikolaidis, S. Prosper, K. Shaw, A.K. Thomas, N.M. Rahman, M. Ainsworth, A. Alamoudi, A. Bates, A. Bloss, A. Burns, P. Carter, M. Cassar, K.M. Channon, J. Chen, F. Conneh, T. Dong, R.I. Evans, E. Fraser, X. Fu, M. Havinden-Williams, N. Kanellakis, P. Kurupati, X. Li, C. Megson, K. Motohashi, D. Nicoll, G. Ogg, E. Pacpaco, M. Pavlides, Y. Peng, N. Petousi, J. Propescu, N. Rahman, N. Talbot, E. Tunnicliffe, B. Patel, R.E. Barker, D. Cristiano, N. Dormand, M. Gummadi, S. Kon, K. Liyanage, C.M. Nolan, S. Patel, O. Polgar, P. Shah, J.A. Walsh, H. Jarvis, S. Mandal, S. Ahmad, S. Brill, L. Lim, D. Matila, O. Olaosebikan, C. Singh, L. Garner, C. Johnson, J. Mackie, A. Michael, J. Pack, K. Paques, H. Parfrey, J. Parmar, N. Diar Bakerly, P. Dark, D. Evans, E. Hardy, A. Harvey, D. Holgate, S. Knight, N. Mairs, N. Majeed, L. McMorrow, J. Oxton, J. Pendlebury, C. Summersgill, R. Ugwuoke, S. Whittaker, W. Matimba-Mupaya, S. Strong-Sheldrake, J. Bagshaw, M. Begum, K. Birchall, R. Butcher, H. Carborn, F. Chan, K. Chapman, Y. Cheng, L. Chetham, C. Clark, Z. Coburn, J. Cole, M. Dixon, A. Fairman, J. Finnigan, H. Foot, D. Foote, A. Ford, R. Gregory, K. Harrington, L. Haslam, L. Hesselden, J. Hockridge, A. Holbourn, B. Holroyd-Hind, L. Holt, A. Howell, E. Hurditch, F. Ilyas, C. Jarman, E. Lee, J.-H. Lee, R. Lenagh, A. Lye, I. Macharia, M. Marshall, A. Mbuyisa, J. McNeill, S. Megson, J. Meiring, L. Milner, S. Misra, H. Newell, T. Newman, C. Norman, L. Nwafor, D. Pattenadk, M. Plowright, P. Ravencroft, C. Roddis, J. Rodger, P. Saunders, J. Sidebottom, J. Smith, L. Smith, N. Steele, G. Stephens, R. Stimpson, B. Thamu, N. Tinker, K. Turner, H. Turton, P. Wade, J. Watson, I. Wilson, A. Zawia, M. Ali, A. Dunleavy, N. Msimanga, M. Mencias, T. Samakomva, S. Siddique, J. Teixeira, V. Tavoukjian, J. Hutchinson, L. Allsop, K. Bennett, P. Buckley, M. Flynn, M. Gill, C. Goodwin, M. Greatorex, H. Gregory, C. Heeley, L. Holloway, M. Holmes, J. Kirk, W. Lovegrove, T.A. Sewell, S. Shelton, D. Sissons, K. Slack, S. Smith, D. Sowter, S. Turner, V. Whitworth, I. Wynter, L. Warburton, S. Painter, J. Tomlinson, C. Vickers, T. Wainwright, D. Redwood, J. Tilley, S. Palmer, G.A. Davies, L. Connor, A. Cook, T. Rees, F. Thaivalappil, C. Thomas, A. Butt, M. Coulding, S. Kilroy, J. McCormick, J. McIntosh, H. Savill, V. Turner, J. Vere, E. Fraile, J. Ugoji, S.S. Kon, H. Lota, G. Landers, M. Nasseri, S. Portukhay, A. Hormis, A. Daniels, J. Ingham, L. Zeidan, M. Chablani, L. Osborne, N. Ahwireng, B. Bang, D. Basire, A. Checkley, R. Evans, M. Heightman, T. Hillman, S. Janes, R. Jastrub, M. Lipman, S. Logan, M. Merida Morillas, H. Plant, J.C. Porter, K. Roy, E. Wall, B. Williams, N. Ahmad Haider, C. Atkin, R. Baggott, M. Bates, A. Botkai, A. Casey, B. Cooper, J. Dasgin, K. Draxlbauer, N. Gautam, J. Hazeldine, T. Hiwot, S. Holden, K. Isaacs, V. Kamwa, D. Lewis, S. Madathil, C. McGhee, K. Mcgee, A. Neal, A. Newton Cox, J. Nyaboko, Z. Peterkin, H. Qureshi, L. Ratcliffe, J. Short, T. Soulsby, J. Stockley, Z. Suleiman, T. Thompson, M. Ventura, S. Walder, C. Welch, S. Yasmin, K.P. Yip, P. Beckett, C. Dickens, U. Nanda, M. Aljaroof, H. Arnold, H. Aung, M. Bakali, M. Bakau, M. Bingham, M. Bourne, C. Bourne, P. Cairns, L. Carr, A. Charalambou, C. Christie, S. Diver, S. Edwards, H. Evans, J. Finch, S. Glover, N. Goodman, B. Gootpu, K. Hadley, P. Haldar, W. Ibrahim, L. Ingram, A. Lea, D. Lee, P. McCourt, T. Mcnally, A. Moss, W. Monteiro, M. Pareek, S. Parker, A. Rowland, A. Prickett, I.N. Qureshi, R. Russell, N. Samani, M. Sharma, J. Skeemer, M. Soares, E. Stringer, T. Thornton, M. Tobin, E. Turner, T.J.C. Ward, F. Woodhead, J. Wormleighton, A. Yousuf, C. Childs, S. Fletcher, M. Harvey, E. Marouzet, B. Marshall, R. Samuel, T. Sass, T. Wallis, H. Wheeler, R. Dharmagunawardena, E. Bright, P. Crisp, M. Stern, A. Wight, L. Bailey, A. Reddington, A. Ashish, J. Cooper, E. Robinson, A. Broadley, K. Howard, L. Barman, C. Brookes, K. Elliott, L. Griffiths, Z. Guy, D. Ionita, H. Redfearn, C. Sarginson, A. Turnbull, K. Holmes, and K. Lewis

Subjects
Diabetes, Covid-19, Long Covid, Medicine (General), R5-920
Abstract

Summary: Background: People with diabetes are at increased risk of hospitalisation, morbidity, and mortality following SARS-CoV-2 infection. Long-term outcomes for people with diabetes previously hospitalised with COVID-19 are, however, unknown. This study aimed to determine the longer-term physical and mental health effects of COVID-19 in people with and without diabetes. Methods: The PHOSP-COVID study is a multicentre, long-term follow-up study of adults discharged from hospital between 1 February 2020 and 31 March 2021 in the UK following COVID-19, involving detailed assessment at 5 and 12 months after discharge. The association between diabetes status and outcomes were explored using multivariable linear and logistic regressions. Findings: People with diabetes who survived hospital admission with COVID-19 display worse physical outcomes compared to those without diabetes at 5- and 12-month follow-up. People with diabetes displayed higher fatigue (only at 5 months), frailty, lower physical performance, and health-related quality of life and poorer cognitive function. Differences in outcomes between diabetes status groups were largely consistent from 5 to 12-months. In regression models, differences at 5 and 12 months were attenuated after adjustment for BMI and presence of other long-term conditions. Interpretation: People with diabetes reported worse physical outcomes up to 12 months after hospital discharge with COVID-19 compared to those without diabetes. These data support the need to reduce inequalities in long-term physical and mental health effects of SARS-CoV-2 infection in people with diabetes. Funding: UK Research and Innovation and National Institute for Health Research. The study was approved by the Leeds West Research Ethics Committee (20/YH/0225) and is registered on the ISRCTN Registry (ISRCTN10980107).

Published
2025
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2. Long-term impact of COVID-19 hospitalisation among individuals with pre-existing airway diseases in the UK: a multicentre, longitudinal cohort study – PHOSP-COVID

Author

Omer Elneima, John R. Hurst, Carlos Echevarria, Jennifer K. Quint, Samantha Walker, Salman Siddiqui, Petr Novotny, Paul E. Pfeffer, Jeremy S. Brown, Manu Shankar-Hari, Hamish J.C. McAuley, Olivia C. Leavy, Aarti Shikotra, Amisha Singapuri, Marco Sereno, Matthew Richardson, Ruth M. Saunders, Victoria C. Harris, Linzy Houchen-Wolloff, Neil J. Greening, Ewen M. Harrison, Annemarie B. Docherty, Nazir I. Lone, James D. Chalmers, Ling-Pei Ho, Alex Horsley, Michael Marks, Krisnah Poinasamy, Betty Raman, Rachael A. Evans, Louise V. Wain, Aziz Sheikh, Chris E. Brightling, Anthony De Soyza, Liam G. Heaney, J.K. Baillie, N.I. Lone, E. Pairo-Castineira, N. Avramidis, K. Rawlik, S Jones, L. Armstrong, B. Hairsine, H. Henson, C. Kurasz, A. Shaw, L. Shenton, H. Dobson, A. Dell, S. Fairbairn, N. Hawkings, J. Haworth, M. Hoare, V. Lewis, A. Lucey, G. Mallison, H. Nassa, C. Pennington, A. Price, C. Price, A. Storrie, G. Willis, S. Young, K. Poinasamy, S. Walker, I. Jarrold, A. Sanderson, K. Chong-James, C. David, W.Y. James, P. Pfeffer, O. Zongo, A. Martineau, C. Manisty, C. Armour, V. Brown, J. Busby, B. Connolly, T. Craig, S. Drain, L.G. Heaney, B. King, N. Magee, E. Major, D. McAulay, L. McGarvey, J. McGinness, T. Peto, R. Stone, A. Bolger, F. Davies, A. Haggar, J. Lewis, A. Lloyd, R. Manley, E. McIvor, D. Menzies, K. Roberts, W. Saxon, D. Southern, C. Subbe, V. Whitehead, A. Bularga, N.L. Mills, J. Dawson, H. El-Taweel, L. Robinson, L. Brear, K. Regan, D. Saralaya, K. Storton, S. Amoils, A. Bermperi, I. Cruz, K. Dempsey, A. Elmer, J. Fuld, H. Jones, S. Jose, S. Marciniak, M. Parkes, C. Ribeiro, J. Taylor, M. Toshner, L. Watson, J. Worsley, L. Broad, T. Evans, M. Haynes, L. Jones, L. Knibbs, A. McQueen, C. Oliver, K. Paradowski, R. Sabit, J. Williams, I. Jones, L. Milligan, E. Harris, C. Sampson, E. Davies, C. Evenden, A. Hancock, K. Hancock, C. Lynch, M. Rees, L. Roche, N. Stroud, T. Thomas-Woods, S. Heller, T. Chalder, K. Shah, E. Robertson, B. Young, M. Babores, M. Holland, N. Keenan, S. Shashaa, H. Wassall, L. Austin, E. Beranova, T. Cosier, J. Deery, T. Hazelton, H. Ramos, R. Solly, S. Turney, H. Weston, M. Ralser, L. Pearce, S. Pugmire, W. Stoker, A. Wilson, W. McCormick, E. Fraile, J. Ugoji, L. Aguilar Jimenez, G. Arbane, S. Betts, K. Bisnauthsing, A. Dewar, N. Hart, G. Kaltsakas, H. Kerslake, M.M. Magtoto, P. Marino, L.M. Martinez, M. Ostermann, J. Rossdale, T.S. Solano, M. Alvarez Corral, A. Arias, E. Bevan, D. Griffin, J. Martin, J. Owen, S. Payne, A. Prabhu, A. Reed, W. Storrar, N. Williams, C. Wrey Brown, T. Burdett, J. Featherstone, C. Lawson, A. Layton, C. Mills, L. Stephenson, Y. Ellis, P. Atkin, K. Brindle, M.G. Crooks, K. Drury, N. Easom, R. Flockton, L. Holdsworth, A. Richards, D.L. Sykes, S. Thackray-Nocera, C. Wright, S. Coetzee, K. Davies, R. Hughes, R. Loosley, H. McGuinness, A. Mohamed, L. O'Brien, Z. Omar, E. Perkins, J. Phipps, G. Ross, A. Taylor, H. Tench, R. Wolf-Roberts, L. Burden, E. Calvelo, B. Card, C. Carr, E.R. 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Nolan, B. Patel, S. Patel, O. Polgar, P. Shah, S. Singh, J.A. Walsh, M. Gibbons, S. Ahmad, S. Brill, J. Hurst, H. Jarvis, L. Lim, S. Mandal, D. Matila, O. Olaosebikan, C. Singh, C. Laing, H. Baxendale, L. Garner, C. Johnson, J. Mackie, A. Michael, J. Newman, J. Pack, K. Paques, H. Parfrey, J. Parmar, A. Reddy, M. Halling-Brown, P. Dark, N. Diar-Bakerly, D. Evans, E. Hardy, A. Harvey, D. Holgate, S. Knight, N. Mairs, N. Majeed, L. McMorrow, J. Oxton, J. Pendlebury, C. Summersgill, R. Ugwuoke, S. Whittaker, W. Matimba-Mupaya, S. Strong-Sheldrake, P. Chowienczyk, J. Bagshaw, M. Begum, K. Birchall, R. Butcher, H. Carborn, F. Chan, K. Chapman, Y. Cheng, L. Chetham, C. Clark, Z. Coburn, J. Cole, M. Dixon, A. Fairman, J. Finnigan, H. Foot, D. Foote, A. Ford, R. Gregory, K. Harrington, L. Haslam, L. Hesselden, J. Hockridge, A. Holbourn, B. Holroyd-Hind, L. Holt, A. Howell, E. Hurditch, F. Ilyas, C. Jarman, A. Lawrie, J-H. Lee, E. Lee, R. Lenagh, A. Lye, I. Macharia, M. Marshall, A. 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McNarry, K.E. Lewis, M. Coulding, S. Kilroy, J. McCormick, J. McIntosh, V. Turner, J. Vere, A. Butt, H. Savill, S.S. Kon, G. Landers, H. Lota, S. Portukhay, M. Nasseri, A. Daniels, A. Hormis, J. Ingham, L. Zeidan, M. Chablani, L. Osborne, S. Aslani, A. Banerjee, R. Batterham, G. Baxter, R. Bell, A. David, E. Denneny, A.D. Hughes, W. Lilaonitkul, P. Mehta, A. Pakzad, B. Rangelov, B. Williams, J. Willoughby, M. Xu, N. Ahwireng, D. Bang, D. Basire, J.S. Brown, R.C. Chambers, A. Checkley, R. Evans, M. Heightman, T. Hillman, J. Jacob, R. Jastrub, M. Lipman, S. Logan, D. Lomas, M. Merida Morillas, H. Plant, J.C. Porter, K. Roy, E. Wall, T. Treibel, N. Ahmad Haider, C. Atkin, R. Baggott, M. Bates, A. Botkai, A. Casey, B. Cooper, J. Dasgin, C. Dawson, K. Draxlbauer, N. Gautam, J. Hazeldine, T. Hiwot, S. Holden, K. Isaacs, T. Jackson, V. Kamwa, D. Lewis, J.M. Lord, S. Madathil, C. McGhee, K. McGee, A. Neal, A. Newton-Cox, J. Nyaboko, D. Parekh, Z. Peterkin, H. Qureshi, L. Ratcliffe, E. 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Spencer, B. Vinson, M. Ashworth, K. Abel, H. Chinoy, B. Deakin, M. Harvie, C.A. Miller, S. Stanel, P. Barran, D. Trivedi, H. McAllister-Williams, S. Paddick, A. Rostron, J.P. Taylor, D. Baguley, C. Coleman, E. Cox, L. Fabbri, S. Francis, I. Hall, E. Hufton, S. Johnson, F. Khan, P. Kitterick, R. Morriss, N. Selby, L. Wright, C. Antoniades, A. Bates, M. Beggs, K. Bhui, K. Breeze, K.M. Channon, D. Clark, X. Fu, M. Husain, X. Li, E. Lukaschuk, C. McCracken, K. McGlynn, R. Menke, K. Motohashi, T.E. Nichols, G. Ogbole, S. Piechnik, I. Propescu, J. Propescu, A.A. Samat, Z.B. Sanders, L. Sigfrid, M. Webster, L. Kingham, P. Klenerman, H. Lamlum, G. Carson, M. Taquet, L. Finnigan, L.C. Saunders, J.M. Wild, P.C. Calder, N. Huneke, G. Simons, D. Baldwin, S. Bain, L. Daines, E. Bright, P. Crisp, R. Dharmagunawardena, M. Stern, L. Bailey, A. Reddington, A. Wight, A. Ashish, J. Cooper, E. Robinson, A. Broadley, L. Barman, C. Brookes, K. Elliott, L. Griffiths, Z. Guy, K. Howard, D. Ionita, H. Redfearn, C. Sarginson, and A. Turnbull

Subjects
Medicine
Abstract

Background The long-term outcomes of COVID-19 hospitalisation in individuals with pre-existing airway diseases are unknown. Methods Adult participants hospitalised for confirmed or clinically suspected COVID-19 and discharged between 5 March 2020 and 31 March 2021 were recruited to the Post-hospitalisation COVID-19 (PHOSP-COVID) study. Participants attended research visits at 5 months and 1 year post discharge. Clinical characteristics, perceived recovery, burden of symptoms and health-related quality of life (HRQoL) of individuals with pre-existing airway disease (i.e., asthma, COPD or bronchiectasis) were compared to the non-airways group. Results A total of 615 out of 2697 (22.8%) participants had a history of pre-existing airway diseases (72.0% diagnosed with asthma, 22.9% COPD and 5.1% bronchiectasis). At 1 year, the airways group participants were less likely to feel fully recovered (20.4% versus 33.2%, p

Published
2024
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3. Prevalence of physical frailty, including risk factors, up to 1 year after hospitalisation for COVID-19 in the UK: a multicentre, longitudinal cohort studyResearch in context

Author

Hamish J.C. McAuley, Rachael A. Evans, Charlotte E. Bolton, Christopher E. Brightling, James D. Chalmers, Annemarie B. Docherty, Omer Elneima, Paul L. Greenhaff, Ayushman Gupta, Victoria C. Harris, Ewen M. Harrison, Ling-Pei Ho, Alex Horsley, Linzy Houchen-Wolloff, Caroline J. Jolley, Olivia C. Leavy, Nazir I. Lone, William D-C Man, Michael Marks, Dhruv Parekh, Krisnah Poinasamy, Jennifer K. Quint, Betty Raman, Matthew Richardson, Ruth M. Saunders, Marco Sereno, Aarti Shikotra, Amisha Singapuri, Sally J. Singh, Michael Steiner, Ai Lyn Tan, Louise V. Wain, Carly Welch, Julie Whitney, Miles D. Witham, Janet Lord, Neil J. Greening, K. Abel, H. Adamali, D. Adeloye, O. Adeyemi, R. Adrego, L.A. Aguilar Jimenez, S. Ahmad, N. Ahmad Haider, R. Ahmed, N. Ahwireng, M. Ainsworth, B. Al-Sheklly, A. Alamoudi, M. Ali, M. Aljaroof, A.M. All, L. Allan, R.J. Allen, L. Allerton, L. Allsop, P. Almeida, D. Altmann, M. Alvarez Corral, S. Amoils, D. Anderson, C. Antoniades, G. Arbane, A. Arias, C. Armour, L. Armstrong, N. Armstrong, D. Arnold, H. Arnold, A. Ashish, A. Ashworth, M. Ashworth, S. Aslani, H. Assefa-Kebede, C. Atkin, P. Atkin, R. Aul, H. Aung, L. Austin, C. Avram, A. Ayoub, M. Babores, R. Baggott, J. Bagshaw, D. Baguley, L. Bailey, J.K. Baillie, S. Bain, M. Bakali, M. Bakau, E. Baldry, D. Baldwin, M. Baldwin, C. Ballard, A. Banerjee, B. Bang, R.E. Barker, L. Barman, S. Barratt, F. Barrett, D. Basire, N. Basu, M. Bates, A. Bates, R. Batterham, H. Baxendale, H. Bayes, M. Beadsworth, P. Beckett, M. Beggs, M. Begum, P. Beirne, D. Bell, R. Bell, K. Bennett, E. Beranova, A. Bermperi, A. Berridge, C. Berry, S. Betts, E. Bevan, K. Bhui, M. Bingham, K. Birchall, L. Bishop, K. Bisnauthsing, J. Blaikely, A. Bloss, A. Bolger, C.E. Bolton, J. Bonnington, A. Botkai, C. Bourne, M. Bourne, K. Bramham, L. Brear, G. Breen, J. Breeze, A. Briggs, E. Bright, C.E. Brightling, S. Brill, K. Brindle, L. Broad, A. Broadley, C. Brookes, M. Broome, A. Brown, J. Brown, J.S. Brown, M. Brown, V. Brown, T. Brugha, N. Brunskill, M. Buch, P. Buckley, A. Bularga, E. Bullmore, L. Burden, T. Burdett, D. Burn, G. Burns, A. Burns, J. Busby, R. Butcher, A. Butt, S. Byrne, P. Cairns, P.C. Calder, E. Calvelo, H. Carborn, B. Card, C. Carr, L. Carr, G. Carson, P. Carter, A. Casey, M. Cassar, J. Cavanagh, M. Chablani, T. Chalder, J.D. Chalmers, R.C. Chambers, F. Chan, K.M. Channon, K. Chapman, A. Charalambou, N. Chaudhuri, A. Checkley, J. Chen, Y. Cheng, L. Chetham, C. Childs, E.R. Chilvers, H. Chinoy, A. Chiribiri, K. Chong-James, G. Choudhury, N. Choudhury, P. Chowienczyk, C. Christie, M. Chrystal, D. Clark, C. Clark, J. Clarke, S. Clohisey, G. Coakley, Z. Coburn, S. Coetzee, J. Cole, C. Coleman, F. Conneh, D. Connell, B. Connolly, L. Connor, A. Cook, B. Cooper, J. Cooper, S. Cooper, D. Copeland, T. Cosier, M. Coulding, C. Coupland, E. Cox, T. Craig, P. Crisp, D. Cristiano, M.G. Crooks, A. Cross, I. Cruz, P. Cullinan, D. Cuthbertson, L. Daines, M. Dalton, P. Daly, A. Daniels, P. Dark, J. 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Wheeler, S. White, V. Whitehead, J. Whitney, S. Whittaker, B. Whittam, V. Whitworth, A. Wight, J. Wild, M. Wilkins, D. Wilkinson, B. Williams, N. Williams, J. Williams, S.A. Williams-Howard, M. Willicombe, G. Willis, J. Willoughby, A. Wilson, D. Wilson, I. Wilson, N. Window, M. Witham, R. Wolf-Roberts, C. Wood, F. Woodhead, J. Woods, D.G. Wootton, J. Wormleighton, J. Worsley, D. Wraith, C. Wrey Brown, C. Wright, L. Wright, S. Wright, J. Wyles, I. Wynter, M. Xu, N. Yasmin, S. Yasmin, T. Yates, K.P. Yip, B. Young, S. Young, A. Young, A.J. Yousuf, A. Zawia, L. Zeidan, B. Zhao, B. Zheng, and O. Zongo

Subjects
COVID-19, Physical frailty, Long-COVID, Fried's frailty phenotype, Hospitalisation, Medicine (General), R5-920
Abstract

Summary: Background: The scale of COVID-19 and its well documented long-term sequelae support a need to understand long-term outcomes including frailty. Methods: This prospective cohort study recruited adults who had survived hospitalisation with clinically diagnosed COVID-19 across 35 sites in the UK (PHOSP-COVID). The burden of frailty was objectively measured using Fried's Frailty Phenotype (FFP). The primary outcome was the prevalence of each FFP group—robust (no FFP criteria), pre-frail (one or two FFP criteria) and frail (three or more FFP criteria)—at 5 months and 1 year after discharge from hospital. For inclusion in the primary analysis, participants required complete outcome data for three of the five FFP criteria. Longitudinal changes across frailty domains are reported at 5 months and 1 year post-hospitalisation, along with risk factors for frailty status. Patient-perceived recovery and health-related quality of life (HRQoL) were retrospectively rated for pre-COVID-19 and prospectively rated at the 5 month and 1 year visits. This study is registered with ISRCTN, number ISRCTN10980107. Findings: Between March 5, 2020, and March 31, 2021, 2419 participants were enrolled with FFP data. Mean age was 57.9 (SD 12.6) years, 933 (38.6%) were female, and 429 (17.7%) had received invasive mechanical ventilation. 1785 had measures at both timepoints, of which 240 (13.4%), 1138 (63.8%) and 407 (22.8%) were frail, pre-frail and robust, respectively, at 5 months compared with 123 (6.9%), 1046 (58.6%) and 616 (34.5%) at 1 year. Factors associated with pre-frailty or frailty were invasive mechanical ventilation, older age, female sex, and greater social deprivation. Frail participants had a larger reduction in HRQoL compared with before their COVID-19 illness and were less likely to describe themselves as recovered. Interpretation: Physical frailty and pre-frailty are common following hospitalisation with COVID-19. Improvement in frailty was seen between 5 and 12 months although two-thirds of the population remained pre-frail or frail. This suggests comprehensive assessment and interventions targeting pre-frailty and frailty beyond the initial illness are required. Funding: UK Research and Innovation and National Institute for Health Research.

Published
2023
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7. Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: a prospective multicentre cohort study

Author

Callum Jackson, Iain D Stewart, Tatiana Plekhanova, Peter S Cunningham, Andrew L Hazel, Bashar Al-Sheklly, Raminder Aul, Charlotte E Bolton, Trudie Chalder, James D Chalmers, Nazia Chaudhuri, Annemarie B Docherty, Gavin Donaldson, Charlotte L Edwardson, Omer Elneima, Neil J Greening, Neil A Hanley, Victoria C Harris, Ewen M Harrison, Ling-Pei Ho, Linzy Houchen-Wolloff, Luke S Howard, Caroline J Jolley, Mark G Jones, Olivia C Leavy, Keir E Lewis, Nazir I Lone, Michael Marks, Hamish J C McAuley, Melitta A McNarry, Brijesh V Patel, Karen Piper-Hanley, Krisnah Poinasamy, Betty Raman, Matthew Richardson, Pilar Rivera-Ortega, Sarah L Rowland-Jones, Alex V Rowlands, Ruth M Saunders, Janet T Scott, Marco Sereno, Ajay M Shah, Aarti Shikotra, Amisha Singapuri, Stefan C Stanel, Mathew Thorpe, Daniel G Wootton, Thomas Yates, R Gisli Jenkins, Sally J Singh, William D-C Man, Christopher E Brightling, Louise V Wain, Joanna C Porter, A A Roger Thompson, Alex Horsley, Philip L Molyneaux, Rachael A Evans, Samuel E Jones, Martin K Rutter, John F Blaikley, C Jackson, I D Stewart, T Plekhanova, P S Cunningham, A L Hazel, B Al-Sheklly, R Aul, C E Bolton, T Chalder, J D Chalmers, N Chaudhuri, A B Docherty, G Donaldson, C L Edwardson, O Elneima, N J Greening, N A Hanley, V C Harris, E M Harrison, L-P Ho, L Houchen-Wolloff, L S Howard, C J Jolley, M G Jones, O C Leavy, K E Lewis, N I Lone, M Marks, H J C McAuley, M A McNarry, B Patel, K Piper-Hanley, K Poinasamy, B Raman, M Richardson, P Rivera-Ortega, S L Rowland-Jones, A V Rowlands, R M Saunders, J T Scott, M Sereno, A M Shah, A Shikotra, A Singapuri, S C Stanel, M Thorpe, D G Wootton, T Yates, G Jenkins, S J Singh, W D-C Man, C E Brightling, L V Wain, J C Porter, R Thompson, A Horsley, P L Molyneaux, R A Evans, S E Jones, M K Rutter, J F Blaikley, K Abel, H Adamali, D Adeloye, O Adeyemi, R Adrego, L A Aguilar Jimenez, S Ahmad, N Ahmad Haider, R Ahmed, N Ahwireng, M Ainsworth, A Alamoudi, M Ali, M Aljaroof, AM All, L Allan, R J Allen, 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Wright, S Wright, J Wyles, I Wynter, M Xu, N Yasmin, S Yasmin, K P Yip, B Young, S Young, A Young, A J Yousuf, A Zawia, L Zeidan, B Zhao, B Zheng, O Zongo, Apollo - University of Cambridge Repository, PHOSP-COVID Study Collaborative Group, and Group, PHOSP-COVID Study Collaborative

Subjects
Pulmonary and Respiratory Medicine, PHOSP-COVID Study Collaborative Group
Abstract

Data sharing: The PHOSP-COVID study protocol, consent form, definition, and derivation of clinical characteristics and outcomes, training materials, regulatory documents, information about requests for data access, and other relevant study materials are available online. UK Biobank information can be released once necessary approvals have been obtained. Other data (eg, the R code and protocol) will be made available on reasonable request to the corresponding author. Copyright © 2023 The Author(s). Background: Sleep disturbance is common following hospital admission both for COVID-19 and other causes. The clinical associations of this for recovery after hospital admission are poorly understood despite sleep disturbance contributing to morbidity in other scenarios. We aimed to investigate the prevalence and nature of sleep disturbance after discharge following hospital admission for COVID-19 and to assess whether this was associated with dyspnoea. Methods: CircCOVID was a prospective multicentre cohort substudy designed to investigate the effects of circadian disruption and sleep disturbance on recovery after COVID-19 in a cohort of participants aged 18 years or older, admitted to hospital for COVID-19 in the UK, and discharged between March, 2020, and October, 2021. Participants were recruited from the Post-hospitalisation COVID-19 study (PHOSP-COVID). Follow-up data were collected at two timepoints: an early time point 2–7 months after hospital discharge and a later time point 10–14 months after hospital discharge. Sleep quality was assessed subjectively using the Pittsburgh Sleep Quality Index questionnaire and a numerical rating scale. Sleep quality was also assessed with an accelerometer worn on the wrist (actigraphy) for 14 days. Participants were also clinically phenotyped, including assessment of symptoms (ie, anxiety [Generalised Anxiety Disorder 7-item scale questionnaire], muscle function [SARC-F questionnaire], dyspnoea [Dyspnoea-12 questionnaire] and measurement of lung function), at the early timepoint after discharge. Actigraphy results were also compared to a matched UK Biobank cohort (non-hospitalised individuals and recently hospitalised individuals). Multivariable linear regression was used to define associations of sleep disturbance with the primary outcome of breathlessness and the other clinical symptoms. PHOSP-COVID is registered on the ISRCTN Registry (ISRCTN10980107). Findings: 2320 of 2468 participants in the PHOSP-COVID study attended an early timepoint research visit a median of 5 months (IQR 4–6) following discharge from 83 hospitals in the UK. Data for sleep quality were assessed by subjective measures (the Pittsburgh Sleep Quality Index questionnaire and the numerical rating scale) for 638 participants at the early time point. Sleep quality was also assessed using device-based measures (actigraphy) a median of 7 months (IQR 5–8 months) after discharge from hospital for 729 participants. After discharge from hospital, the majority (396 [62%] of 638) of participants who had been admitted to hospital for COVID-19 reported poor sleep quality in response to the Pittsburgh Sleep Quality Index questionnaire. A comparable proportion (338 [53%] of 638) of participants felt their sleep quality had deteriorated following discharge after COVID-19 admission, as assessed by the numerical rating scale. Device-based measurements were compared to an age-matched, sex-matched, BMI-matched, and time from discharge-matched UK Biobank cohort who had recently been admitted to hospital. Compared to the recently hospitalised matched UK Biobank cohort, participants in our study slept on average 65 min (95% CI 59 to 71) longer, had a lower sleep regularity index (–19%; 95% CI –20 to –16), and a lower sleep efficiency (3·83 percentage points; 95% CI 3·40 to 4·26). Similar results were obtained when comparisons were made with the non-hospitalised UK Biobank cohort. Overall sleep quality (unadjusted effect estimate 3·94; 95% CI 2·78 to 5·10), deterioration in sleep quality following hospital admission (3·00; 1·82 to 4·28), and sleep regularity (4·38; 2·10 to 6·65) were associated with higher dyspnoea scores. Poor sleep quality, deterioration in sleep quality, and sleep regularity were also associated with impaired lung function, as assessed by forced vital capacity. Depending on the sleep metric, anxiety mediated 18–39% of the effect of sleep disturbance on dyspnoea, while muscle weakness mediated 27–41% of this effect. Interpretation: Sleep disturbance following hospital admission for COVID-19 is associated with dyspnoea, anxiety, and muscle weakness. Due to the association with multiple symptoms, targeting sleep disturbance might be beneficial in treating the post-COVID-19 condition. Funding: UK Research and Innovation, National Institute for Health Research, and Engineering and Physical Sciences Research Council. UK Research and Innovation, National Institute for Health Research, and Engineering and Physical Sciences Research Council.

Published
2023
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8. SARS-CoV-2-specific nasal IgA wanes 9 months after hospitalisation with COVID-19 and is not induced by subsequent vaccination

Author

Felicity Liew, Shubha Talwar, Andy Cross, Brian J. Willett, Sam Scott, Nicola Logan, Matthew K. Siggins, Dawid Swieboda, Jasmin K. Sidhu, Claudia Efstathiou, Shona C. Moore, Chris Davis, Noura Mohamed, Jose Nunag, Clara King, A.A. Roger Thompson, Sarah L. Rowland-Jones, Annemarie B. Docherty, James D. Chalmers, Ling-Pei Ho, Alexander Horsley, Betty Raman, Krisnah Poinasamy, Michael Marks, Onn Min Kon, Luke Howard, Daniel G. Wootton, Susanna Dunachie, Jennifer K. Quint, Rachael A. Evans, Louise V. Wain, Sara Fontanella, Thushan I. de Silva, Antonia Ho, Ewen Harrison, J. Kenneth Baillie, Malcolm G. Semple, Christopher Brightling, Ryan S. Thwaites, Lance Turtle, Peter J.M. Openshaw, Beatrice Alex, Petros Andrikopoulos, Benjamin Bach, Wendy S. Barclay, Debby Bogaert, Meera Chand, Kanta Chechi, Graham S. Cooke, Ana da Silva Filipe, Thushan de Silva, Gonçalo dos Santos Correia, Marc-Emmanuel Dumas, Jake Dunning, Tom Fletcher, Christopher A. Green, William Greenhalf, Julian Griffin, Rishi K. Gupta, Ewen M. Harrison, Antonia Y.W. Ho, Karl Holden, Peter W. Horby, Samreen Ijaz, Say Khoo, Paul Klenerman, Andrew Law, Matthew Lewis, Sonia Liggi, Wei Shen Lim, Lynn Maslen, Alexander J. Mentzer, Laura Merson, Alison M Meynert, Mahdad Noursadeghi, Michael Olanipekun, Anthonia Osagie, Massimo Palmarini, Carlo Palmieri, William A. Paxton, Georgios Pollakis, Nicholas Price, Andrew Rambaut, David L Robertson, Clark D. Russell, Vanessa Sancho-Shimizu, Caroline Sands, Janet T. Scott, Louise Sigfrid, Tom Solomon, Shiranee Sriskandan, David Stuart, Charlotte Summers, Olivia V. Swann, Zoltan Takats, Panteleimon Takis, Richard S. Tedder, Emma C. Thomson, Lance C.W. Turtle, Maria Zambon, Thomas M. Drake, Cameron J. Fairfield, Stephen R. Knight, Kenneth A. Mclean, Derek Murphy, Lisa Norman, Riinu Pius, Catherine A. Shaw, Marie Connor, Jo Dalton, Carrol Gamble, Michelle Girvan, Sophie Halpin, Janet Harrison, Clare Jackson, James Lee, Laura Marsh, Daniel Plotkin, Stephanie Roberts, Egle Saviciute, Sara Clohisey, Ross Hendry, Susan Knight, Eva Lahnsteiner, Gary Leeming, Lucy Norris, James Scott-Brown, Sarah Tait, Murray Wham, Richard Clark, Audrey Coutts, Lorna Donelly, Angie Fawkes, Tammy Gilchrist, Katarzyna Hafezi, Louise MacGillivray, Alan Maclean, Sarah McCafferty, Kirstie Morrice, Lee Murphy, Nicola Wrobel, Gail Carson, Kayode Adeniji, Daniel Agranoff, Ken Agwuh, Dhiraj Ail, Erin L. 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Subjects
SARS-CoV-2 variants, Mucosal immunity, Nasal antibody, SDG 3 - Good Health and Well-being, Biochemistry, Genetics and Molecular Biology(all), SARS-CoV-2 immunity, Vaccination, COVID-19, General Medicine, Convalescent, General Biochemistry, Genetics and Molecular Biology
Abstract

Data sharing statement This is an Open Access article under the CC BY 4.0 license The ISARIC4C protocol, data sharing and publication policy are available at https://isaric4c.net. ISARIC4C's Independent Data and Material Access Committee welcomes applications for access to data and materials (https://isaric4c.net). The PHOSP-COVID protocol, consent form, definition and derivation of clinical characteristics and outcomes, training materials, regulatory documents, information about requests for data access, and other relevant study materials are available online: https://phosp.org/resource/. Access to these materials can be granted by contacting phosp@leicester.ac.uk and Phospcontracts@leicester.ac.uk. All data used in this study is available within ODAP and accessible under reasonable request. Data access criteria and information about how to request access is available online: https://phosp.org/resource/. If criteria are met and a request is made, access can be gained by signing the eDRIS user agreement. Supplementary data are available online at https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(22)00584-9/fulltext#supplementaryMaterial . Copyright © 2022 The Author(s). Background: Most studies of immunity to SARS-CoV-2 focus on circulating antibody, giving limited insights into mucosal defences that prevent viral replication and onward transmission. We studied nasal and plasma antibody responses one year after hospitalisation for COVID-19, including a period when SARS-CoV-2 vaccination was introduced. Methods: In this follow up study, plasma and nasosorption samples were prospectively collected from 446 adults hospitalised for COVID-19 between February 2020 and March 2021 via the ISARIC4C and PHOSP-COVID consortia. IgA and IgG responses to NP and S of ancestral SARS-CoV-2, Delta and Omicron (BA.1) variants were measured by electrochemiluminescence and compared with plasma neutralisation data. Findings: Strong and consistent nasal anti-NP and anti-S IgA responses were demonstrated, which remained elevated for nine months (p < 0.0001). Nasal and plasma anti-S IgG remained elevated for at least 12 months (p < 0.0001) with plasma neutralising titres that were raised against all variants compared to controls (p < 0.0001). Of 323 with complete data, 307 were vaccinated between 6 and 12 months; coinciding with rises in nasal and plasma IgA and IgG anti-S titres for all SARS-CoV-2 variants, although the change in nasal IgA was minimal (1.46-fold change after 10 months, p = 0.011) and the median remained below the positive threshold determined by pre-pandemic controls. Samples 12 months after admission showed no association between nasal IgA and plasma IgG anti-S responses (R = 0.05, p = 0.18), indicating that nasal IgA responses are distinct from those in plasma and minimally boosted by vaccination. Interpretation: The decline in nasal IgA responses 9 months after infection and minimal impact of subsequent vaccination may explain the lack of long-lasting nasal defence against reinfection and the limited effects of vaccination on transmission. These findings highlight the need to develop vaccines that enhance nasal immunity. Funding: This study has been supported by ISARIC4C and PHOSP-COVID consortia. ISARIC4C is supported by grants from the National Institute for Health and Care Research and the Medical Research Council. Liverpool Experimental Cancer Medicine Centre provided infrastructure support for this research. The PHOSP-COVD study is jointly funded by UK Research and Innovation and National Institute of Health and Care Research. The funders were not involved in the study design, interpretation of data or the writing of this manuscript. This work is supported by the following grants: The PHOSP-COVD study is jointly funded by UK Research and Innovation and National Institute for Health and Care Research (grant references: MR/V027859/1 and COV0319). ISARIC4C is supported by grants from the National Institute for Health and Care Research (award CO-CIN-01) and the Medical Research Council (grant MC_PC_19059) Liverpool Experimental Cancer Medicine Centre provided infrastructure support for this research (grant reference: C18616/A25153). Other grants which have supported this work include: the UK Coronavirus Immunology Consortium [funder reference:1257927], the Imperial Biomedical Research Centre (NIHR Imperial BRC, grant IS-BRC-1215-20013), the Health Protection Research Unit (HPRU) in Respiratory Infections at Imperial College London and NIHR HPRU in Emerging and Zoonotic Infections at University of Liverpool, both in partnership with Public Health England, [NIHR award 200907], Wellcome Trust and Department for International Development [215091/Z/18/Z], Health Data Research UK (HDR UK) [grant code: 2021.0155], Medical Research Council [grant code: MC_UU_12014/12], and NIHR Clinical Research Network for providing infrastructure support for this research. FL is supported by an MRC clinical training fellowship [award MR/W000970/1]. LPH is supported by Oxford NIHR Biomedical Research Centre. AART is supported by a BHF Intermediate Clinical Fellowship (FS/18/13/33281). SLRJ receives support from UKRI, GCRF, Rosetrees Trust, BHIVA, EDCTP, Globvac. JDC has grants from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Gilead Sciences, Grifols, Novartis and Insmed. RAE holds a NIHR Clinician Scientist Fellowship (CS-2016-16-020). AH is currently supported by UK Research and Innovation. NIHR and NIHR Manchester BRC. BR receives support from BHF Oxford Centre of Research Excellence, NIHR Oxford BRC and MRC. SJD is funded by an NIHR Global Research Professorship [NIHR300791]. DW is supported by an NIHR Advanced Fellowship. AH has received support from MRC and the Coronavirus Immunology Consortium (MR/V028448/1). LVW has received support from UKRI, GSK/Asthma + Lung UK and NIHR for this study. MGS has received support from NIHR UK, MRC UK and Health Protection Research Unit in Emerging & Zoonotic Infections, University of Liverpool. JKB is supported by the Wellcome Trust (223164/Z/21/Z) and UKRI (MC_PC_20004, MC_PC_19025, MC_PC_1905, MRNO2995X/1, and MC_PC_20029). PJMO is supported by a NIHR Senior Investigator Award [award 201385]. LT is supported by the Wellcome Trust [clinical career development fellowship grant number 205228/Z/16/Z], the Centre of Excellence in Infectious Diseases Research (CEIDR) and the Alder Hey Charity.

Published
2022
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9. Determinants of recovery from post-COVID-19 dyspnoea: analysis of UK prospective cohorts of hospitalised COVID-19 patients and community-based controls

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Bang Zheng, Giulia Vivaldi, Luke Daines, Olivia C. Leavy, Matthew Richardson, Omer Elneima, Hamish J.C. McAuley, Aarti Shikotra, Amisha Singapuri, Marco Sereno, Ruth M. Saunders, Victoria C. Harris, Linzy Houchen-Wolloff, Neil J. Greening, Paul E. Pfeffer, John R. Hurst, Jeremy S. Brown, Manu Shankar-Hari, Carlos Echevarria, Anthony De Soyza, Ewen M. Harrison, Annemarie B. Docherty, Nazir Lone, Jennifer K. Quint, James D. Chalmers, Ling-Pei Ho, Alex Horsley, Michael Marks, Krishna Poinasamy, Betty Raman, Liam G. Heaney, Louise V. Wain, Rachael A. Evans, Christopher E. Brightling, Adrian Martineau, Aziz Sheikh, K. Abel, H. Adamali, D. Adeloye, O. Adeyemi, R. Adrego, L.A. Aguilar Jimenez, S. Ahmad, N. Ahmad Haider, R. Ahmed, N. Ahwireng, M. Ainsworth, B. Al-Sheklly, A. Alamoudi, M. Ali, M. Aljaroof, A.M. All, L. Allan, R.J. Allen, L. Allerton, L. Allsop, P. Almeida, D. Altmann, M. Alvarez Corral, S. Amoils, D. Anderson, C. Antoniades, G. Arbane, A. Arias, C. Armour, L. Armstrong, N. 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Mariveles, M. Marks, E. Marouzet, S. Marsh, B. Marshall, M. Marshall, J. Martin, A. Martineau, L.M. Martinez, N. Maskell, D. Matila, W. Matimba-Mupaya, L. Matthews, A. Mbuyisa, S. McAdoo, H. McAllister-Williams, A. McArdle, P. McArdle, D. McAulay, G.P. McCann, J. McCormick, W. McCormick, P. McCourt, L. McGarvey, C. McGee, K. Mcgee, J. McGinness, K. McGlynn, A. McGovern, H. McGuinness, I.B. McInnes, J. McIntosh, E. McIvor, K. McIvor, L. McLeavey, A. McMahon, M.J. McMahon, L. McMorrow, T. Mcnally, M. McNarry, J. McNeill, A. McQueen, H. McShane, C. Mears, C. Megson, S. Megson, P. Mehta, J. Meiring, L. Melling, M. Mencias, D. Menzies, M. Merida Morillas, A. Michael, C. Miller, L. Milligan, C. Mills, G. Mills, N.L. Mills, L. Milner, S. Misra, J. Mitchell, A. Mohamed, N. Mohamed, S. Mohammed, P.L. Molyneaux, W. Monteiro, S. Moriera, A. Morley, L. Morrison, R. Morriss, A. Morrow, A.J. Moss, P. Moss, K. Motohashi, N. Msimanga, E. Mukaetova-Ladinska, U. Munawar, J. Murira, U. Nanda, H. Nassa, M. Nasseri, A. Neal, R. Needham, P. Neill, S. Neubauer, D.E. Newby, H. Newell, T. Newman, J. Newman, A. Newton-Cox, T. Nicholson, D. Nicoll, A. Nikolaidis, C.M. Nolan, M.J. Noonan, C. Norman, P. Novotny, J. Nunag, L. Nwafor, U. Nwanguma, J. Nyaboko, C. O'Brien, K. O'Donnell, D. O'Regan, L. O'Brien, N. Odell, G. Ogg, O. Olaosebikan, C. Oliver, Z. Omar, P.J.M. Openshaw, L. Orriss-Dib, L. Osborne, R. Osbourne, M. Ostermann, C. Overton, J. Owen, J. Oxton, J. Pack, E. Pacpaco, S. Paddick, S. Painter, A. Pakzad, S. Palmer, P. Papineni, K. Paques, K. Paradowski, M. Pareek, D. Parekh, H. Parfrey, C. Pariante, S. Parker, M. Parkes, J. Parmar, S. Patale, B. Patel, M. Patel, S. Patel, D. Pattenadk, M. Pavlides, S. Payne, L. Pearce, J.E. Pearl, D. Peckham, J. Pendlebury, Y. Peng, C. Pennington, I. Peralta, E. Perkins, Z. Peterkin, T. Peto, N. Petousi, J. Petrie, P. Pfeffer, J. Phipps, J. Pimm, K. Piper Hanley, R. Pius, H. Plant, S. Plein, T. Plekhanova, M. Plowright, K. Poinasamy, O. Polgar, L. Poll, J.C. Porter, J. Porter, S. Portukhay, N. Powell, A. Prabhu, J. Pratt, A. Price, C. Price, D. Price, L. Price, A. Prickett, J. Propescu, S. Prosper, S. Pugmire, S. Quaid, J. Quigley, J. Quint, H. Qureshi, I.N. Qureshi, K. Radhakrishnan, N.M. Rahman, M. Ralser, B. Raman, A. Ramos, H. Ramos, J. Rangeley, B. Rangelov, L. Ratcliffe, P. Ravencroft, A. Reddington, R. Reddy, A. Reddy, H. Redfearn, D. Redwood, A. Reed, M. Rees, T. Rees, K. Regan, W. Reynolds, C. Ribeiro, A. Richards, E. Richardson, M. Richardson, P. Rivera-Ortega, K. Roberts, E. Robertson, E. Robinson, L. Robinson, L. Roche, C. Roddis, J. Rodger, A. Ross, G. Ross, J. Rossdale, A. Rostron, A. Rowe, A. Rowland, J. Rowland, M.J. Rowland, S.L. Rowland-Jones, K. Roy, M. Roy, I. Rudan, R. Russell, E. Russell, G. Saalmink, R. Sabit, E.K. Sage, T. Samakomva, N. Samani, C. Sampson, K. Samuel, R. Samuel, A. Sanderson, E. Sapey, D. Saralaya, J. Sargant, C. Sarginson, T. Sass, N. Sattar, K. Saunders, R.M. Saunders, P. Saunders, L.C. Saunders, H. Savill, W. Saxon, A. Sayer, J. Schronce, W. Schwaeble, J.T. Scott, K. Scott, N. Selby, M.G. Semple, M. Sereno, T.A. Sewell, A. Shah, K. Shah, P. Shah, M. Shankar-Hari, M. Sharma, C. Sharpe, M. Sharpe, S. Shashaa, A. Shaw, K. Shaw, V. Shaw, A. Sheikh, S. Shelton, L. Shenton, K. Shevket, A. Shikotra, J. Short, S. Siddique, S. Siddiqui, J. Sidebottom, L. Sigfrid, G. Simons, J. Simpson, N. Simpson, A. Singapuri, C. Singh, S. Singh, S.J. Singh, D. Sissons, J. Skeemer, K. Slack, A. Smith, D. Smith, S. Smith, J. Smith, L. Smith, M. Soares, T.S. Solano, R. Solly, A.R. Solstice, T. Soulsby, D. Southern, D. Sowter, M. Spears, L.G. Spencer, F. Speranza, L. Stadon, S. Stanel, N. Steele, M. Steiner, D. Stensel, G. Stephens, L. Stephenson, M. Stern, I. Stewart, R. Stimpson, S. Stockdale, J. Stockley, W. Stoker, R. Stone, W. Storrar, A. Storrie, K. Storton, E. Stringer, S. Strong-Sheldrake, N. Stroud, C. Subbe, C.L. Sudlow, Z. Suleiman, C. Summers, C. Summersgill, D. Sutherland, D.L. Sykes, R. Sykes, N. Talbot, A.L. Tan, L. Tarusan, V. Tavoukjian, A. Taylor, C. Taylor, J. Taylor, A. Te, H. Tedd, C.J. Tee, J. Teixeira, H. Tench, S. Terry, S. Thackray-Nocera, F. Thaivalappil, B. Thamu, D. Thickett, C. Thomas, D.C. Thomas, S. Thomas, A.K. Thomas, T. Thomas-Woods, T. Thompson, A.A.R. Thompson, T. Thornton, M. Thorpe, R.S. Thwaites, J. Tilley, N. Tinker, G.F. Tiongson, M. Tobin, J. Tomlinson, C. Tong, M. Toshner, R. Touyz, K.A. Tripp, E. Tunnicliffe, A. Turnbull, E. Turner, S. Turner, V. Turner, K. Turner, S. Turney, L. Turtle, H. Turton, J. Ugoji, R. Ugwuoke, R. Upthegrove, J. Valabhji, M. Ventura, J. Vere, C. Vickers, B. Vinson, E. Wade, P. Wade, L.V. Wain, T. Wainwright, L.O. Wajero, S. Walder, S. Walker, E. Wall, T. Wallis, S. Walmsley, J.A. Walsh, S. Walsh, L. Warburton, T.J.C. Ward, K. Warwick, H. Wassall, S. Waterson, E. Watson, L. Watson, J. Watson, J. Weir McCall, C. Welch, H. Welch, B. Welsh, S. Wessely, S. West, H. Weston, H. Wheeler, S. White, V. Whitehead, J. Whitney, S. Whittaker, B. Whittam, V. Whitworth, A. Wight, J. Wild, M. Wilkins, D. Wilkinson, B. Williams, N. Williams, J. Williams, S.A. Williams-Howard, M. Willicombe, G. Willis, J. Willoughby, A. Wilson, D. Wilson, I. Wilson, N. Window, M. Witham, R. Wolf-Roberts, C. Wood, F. Woodhead, J. Woods, D.G. Wootton, J. Wormleighton, J. Worsley, D. Wraith, C. Wrey Brown, C. Wright, L. Wright, S. Wright, J. Wyles, I. Wynter, M. Xu, N. Yasmin, S. Yasmin, T. Yates, K.P. Yip, B. Young, S. Young, A. Young, A.J. Yousuf, A. Zawia, L. Zeidan, B. Zhao, B. Zheng, O. Zongo, and PHOSP-COVID Study Collaborative Group

Subjects
Long COVID, Oncology, Recovery, Health Policy, Dyspnoea, Cohort, Internal Medicine, COVID-19
Abstract

Data sharing statement: PHOSP-COVID: The protocol, consent form, definition and derivation of clinical characteristics and outcomes, training materials, regulatory documents, requests for data access and other relevant study materials are available online at https://www.phosp.org. COVIDENCE UK: De-identified participant data will be made available upon reasonable request to the corresponding author. Supplementary data is available online at: https://www.sciencedirect.com/science/article/pii/S2666776223000546?via%3Dihub#appsec1 . Copyright © 2023 The Author(s). Background: The risk factors for recovery from COVID-19 dyspnoea are poorly understood. We investigated determinants of recovery from dyspnoea in adults with COVID-19 and compared these to determinants of recovery from non-COVID-19 dyspnoea. Methods: We used data from two prospective cohort studies: PHOSP-COVID (patients hospitalised between March 2020 and April 2021 with COVID-19) and COVIDENCE UK (community cohort studied over the same time period). PHOSP-COVID data were collected during hospitalisation and at 5-month and 1-year follow-up visits. COVIDENCE UK data were obtained through baseline and monthly online questionnaires. Dyspnoea was measured in both cohorts with the Medical Research Council Dyspnoea Scale. We used multivariable logistic regression to identify determinants associated with a reduction in dyspnoea between 5-month and 1-year follow-up. Findings: We included 990 PHOSP-COVID and 3309 COVIDENCE UK participants. We observed higher odds of improvement between 5-month and 1-year follow-up among PHOSP-COVID participants who were younger (odds ratio 1.02 per year, 95% CI 1.01–1.03), male (1.54, 1.16–2.04), neither obese nor severely obese (1.82, 1.06–3.13 and 4.19, 2.14–8.19, respectively), had no pre-existing anxiety or depression (1.56, 1.09–2.22) or cardiovascular disease (1.33, 1.00–1.79), and shorter hospital admission (1.01 per day, 1.00–1.02). Similar associations were found in those recovering from non-COVID-19 dyspnoea, excluding age (and length of hospital admission). Interpretation: Factors associated with dyspnoea recovery at 1-year post-discharge among patients hospitalised with COVID-19 were similar to those among community controls without COVID-19. Funding: PHOSP-COVID is supported by a grant from the MRC-UK Research and Innovation and the Department of Health and Social Care through the National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19. The views expressed in the publication are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health and Social Care. COVIDENCE UK is supported by the UK Research and Innovation, the National Institute for Health Research, and Barts Charity. The views expressed are those of the authors and not necessarily those of the funders. PHOSP-COVID: This study would not be possible without all the participants who have given their time and support. We thank all the participants and their families. We thank the many research administrators, health-care and social-care professionals who contributed to setting up and delivering the study at all of the 65 NHS trusts/Health boards and 25 research institutions across the UK, as well as all the supporting staff at the NIHR Clinical Research Network, Health Research Authority, Research Ethics Committee, Department of Health and Social Care, Public Health Scotland, and Public Health England, and support from the ISARIC Coronavirus Clinical Characterisation Consortium. We thank Kate Holmes at the NIHR Office for Clinical Research Infrastructure (NOCRI) for her support in coordinating the charities group. The PHOSP-COVID industry framework was formed to provide advice and support in commercial discussions, and we thank the Association of the British Pharmaceutical Industry as well NOCRI for coordinating this. We are very grateful to all the charities that have provided insight to the study: Action Pulmonary Fibrosis, Alzheimer's Research UK, Asthma + Lung UK, British Heart Foundation, Diabetes UK, Cystic Fibrosis Trust, Kidney Research UK, MQ Mental Health, Muscular Dystrophy UK, Stroke Association Blood Cancer UK, McPin Foundations, and Versus Arthritis. We thank the NIHR Leicester Biomedical Research Centre patient and public involvement group and Long Covid Support. COVIDENCE UK: We thank all participants of COVIDENCE UK, and the following organisations who supported study recruitment: Asthma UK/British Lung Foundation, the British Heart Foundation, the British Obesity Society, Cancer Research UK, Diabetes UK, Future Publishing, Kidney Care UK, Kidney Wales, Mumsnet, the National Kidney Federation, the National Rheumatoid Arthritis Society, the North West London Health Research Register (DISCOVER), Primary Immunodeficiency UK, the Race Equality Foundation, SWM Health, the Terence Higgins Trust, and Vasculitis UK.

Published
2023
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10. A Natural Language Processing-Based Approach for Identifying Hospitalizations for Worsening Heart Failure Within an Integrated Health Care Delivery System

Author

Alan Iwahashi, Anand Narayanan, Kevin Kheder, Navneet Sanghera, Sue Hee Sung, Rajeev Masson, Xian Shen, Alexander B. Hardwick, Joaquim Cristino, Harshith R. Avula, Rishi V. Parikh, Jesse K. Fitzpatrick, Alan S. Go, Phuong-Quang Lam, Andrew P. Ambrosy, and Van N. Selby

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Cardiology, computer.software_genre, Cohort Studies, Epidemiology, medicine, Humans, Precision Medicine, Original Investigation, Aged, Natural Language Processing, Heart Failure, Ejection fraction, Diagnostic Tests, Routine, business.industry, Delivery of Health Care, Integrated, Research, General Medicine, Middle Aged, medicine.disease, Prognosis, Health care delivery, Hospitalization, Online Only, Cardiovascular Diseases, Heart failure, Disease Progression, Pacific islanders, Population study, Female, Smartphone, Hemodialysis, Artificial intelligence, business, computer, Natural language processing, Cohort study, Forecasting
Abstract

Key Points Question What are the overall burden and temporal trends in the rate of hospitalizations for worsening heart failure (WHF)? Findings This cohort study of 118 002 patients found that applying rigorous and prespecified diagnostic criteria to electronic health record data was associated with a more than 2-fold increase in the number of hospitalizations for WHF identified compared with estimates using a principal discharge diagnosis alone. There has been a gradual increase in the rate of hospitalizations for WHF over time, with a more noticeable increase observed among patients with heart failure with a preserved ejection fraction. Meaning These findings suggest that population temporal trends based on a principal hospital discharge diagnosis of heart failure may underreport the increasing burden of hospitalizations for WHF, particularly among those with heart failure with a preserved ejection fraction, compared with a comprehensive approach using structured and unstructured electronic health record data., Importance The current understanding of epidemiological mechanisms and temporal trends in hospitalizations for worsening heart failure (WHF) is based on claims and national reporting databases. However, these data sources are inherently limited by the accuracy and completeness of diagnostic coding and/or voluntary reporting. Objective To assess the overall burden of and temporal trends in the rate of hospitalizations for WHF. Design, Setting, and Participants This cohort study, performed from January 1, 2010, to December 31, 2019, used electronic health record (EHR) data from a large integrated health care delivery system. Exposures Calendar year trends. Main Outcomes and Measures Hospitalizations for WHF (ie, excluding observation stays) were defined as 1 symptom or more, 2 objective findings or more including 1 sign or more, and 2 doses or more of intravenous loop diuretics and/or new hemodialysis or continuous kidney replacement therapy. Symptoms and signs were identified using natural language processing (NLP) algorithms applied to EHR data. Results The study population was composed of 118 002 eligible patients experiencing 287 992 unique hospitalizations (mean [SD] age, 75.6 [13.1] years; 147 203 [51.1%] male; 1655 [0.6%] American Indian or Alaska Native, 28 451 [9.9%] Asian or Pacific Islander, 34 903 [12.1%] Black, 23 452 [8.1%] multiracial, 175 840 [61.1%] White, and 23 691 [8.2%] unknown), including 65 357 with a principal discharge diagnosis and 222 635 with a secondary discharge diagnosis of HF. The study population included 59 868 patients (20.8%) with HF with a reduced ejection fraction (HFrEF) (, This cohort study uses rule-based natural language processing algorithms applied to electronic health record data to examine the overall burden of and temporal trends in the rate of hospitalizations for worsening heart failure overall and by the degree of systolic dysfunction.

Published
2021

11. Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study

Author

Helen McShane, A Alamoudi, D Parekh, G Burns, R. Gisli Jenkins, Marco Sereno, R Djukanovic, Onn Min Kon, N I Lone, David M. Evans, L Daines, N A Hanley, Z. Omar, William Greenhalf, Nicola Williams, K Storton, Asaf David, T Wallis, E Pacpaco, H McCauley, L. O'Brien, K Hainey, P. Novotny, C Tong, L Ingram, S Gurram, C Avram, C Coleman, Edward T. Bullmore, Richard G. Brown, R Aul, K A Tripp, D. Cristiano, A Michael, Michael C Steiner, Padmasayee Papineni, A Howell, Gail Carson, Peter J. M. Openshaw, Simon Heller, G Madzamba, K Paradowski, S Singh, K Bramham, Teresa Light, David Price, V Shaw, A Yousuf, T Dong, T Hiwot, G Simons, Philip L. Molyneaux, A Ashworth, Ashley C. Brown, N Magee, A L Tan, R A Evans, Mark Toshner, Robert Sykes, W Saxon, S Finney, A Mohamed, P Cairns, Christos P Kotanidis, J D Chalmers, O Adeyemi, L Knibbs, A J Moss, S L Rowland-Jones, O M Kon, L P Ho, A Martineau, B Zhao, M G Crooks, J Meiring, Ewen M Harrison, Louise V. Wain, S Wright, E Robertson, David A. Lomas, H Lamlum, David E. Newby, P Chowdhury, K Mangion, Toby Hillman, E Turner, H McAllister-Williams, S West, J McGinness, B Whittam, T. Gorsuch, K Dempsey, L Mcgarvey, K Poinasamy, K Shevket, Emma Baldry, M Buch, N French, Olivia C. Leavy, Stephen C. J. Parker, H Newell, Louise M. Howard, O. Zongo, P Beirne, C Sharpe, N Mills, C David, M Bayley, Carmine M. Pariante, P Haldar, Z Kausar, A Dipper, I Hall, P McArdle, G Ogg, Rachael A. Evans, A.J. Buttress, M Pareek, Paul E Pfeffer, Denise Anderson, James D. Chalmers, P Kar, Caroline J. Jolley, S Plein, Nigel J. Brunskill, C Oliver, John R. Hurst, Clive Ballard, F Barrett, D Baguley, Nick P. Talbot, N Chaudhuri, A Young, Jonathan P. Busby, H Dobson, K Holmes, Liam G Heaney, Ruth E Barker, Anthony N. Price, David J. Stensel, L Brear, Louise Sigfrid, Marcia Soares, Patrice Carter, J R Hurst, John R. Geddes, Donghyung Lee, L Watson, J M Lord, H Parfrey, N Odell, J Glossop, K. Liyanage, Bryan Williams, S Neubauer, O Elneima, David R Baldwin, G Mallison, C Francis, A Te, D Foote, F Woodhead, A De Soyza, A Atkins, M Stern, A Morley, E Bright, N Basu, Simon E. Brill, D Southern, D Forton, L G Heaney, B Raman, Malcolm G Semple, M Mariveles, Charalambos Antoniades, Nawar Diar Bakerly, Swapna Mandal, Aroon D. Hingorani, E K Sage, Ania Korszun, A Hosseini, Louise Allan, M Toshner, Fergus V. Gleeson, Cherie Armour, J Quigley, S Drain, Thomas Kabir, M Havinden-Williams, Ben G. Marshall, S Patale, C Bourne, L Wright, Rachel L. Batterham, S Jones, S Linford, Salman Siddiqui, C Laing, A Horsley, S Greenwood, A Lingford-Hughes, S. Jose, Stefan Neubauer, S L Dobson, M Rahman, Alex D. McMahon, S Young, A Frankel, Joe Dennis, Claire M. Nolan, J Fuld, J Mayet, Nayia Petousi, Brij Patel, A Fairman, F Speranza, A Bularga, Colin Berry, Charlotte L. Edwardson, A Lloyd, H Jones, N Mairs, H Assefa-Kebede, L Gilmour, D Jones, Siobhan Kelly, I Cruz, Tim Rees, A Haggar, R. Wolf-Roberts, R Flockton, R Dowling, Geraldine Landers, C. Price, P Neill, John B. Cole, A L Key, Elaine Hardy, P Kitterick, Elodie Murali, Carly Welch, P Crisp, Rachel C. Chambers, L Carr, P C Calder, A McQueen, S Defres, A Dewar, F Adeyemi, Avan Aihie Sayer, D W Connell, M Halling-Brown, Neil J. Greening, M Andrews, Linda MacLiver, Kevin A. Davies, E Wade, Elizabeth M. Tunnicliffe, H Jarvis, Kathryn M. Abel, N Hart, A J Yousuf, Nicholas Easom, Alexander Richards, Lee B. Smith, P Dulawan, Janet T Scott, Amisha Singapuri, E Sapey, G Willis, P M George, S Bain, H. Tench, S S Kon, N Window, M J Rowland, A. J. Shah, B Card, A Knighton, P Chowienczyk, Luke Daines, Cathie Sudlow, Joseph Jacob, J Rossdale, S Paddick, Ifan Jones, A Storrie, Sonia Johnson, Huzaifa Adamali, Gail Davies, R G Jenkins, J Murira, Kamlesh Khunti, W Y James, Ajay M. Shah, A B Docherty, Donna J. Menzies, R Morriss, K Piper Hanley, James J Furniss, C Overton, P Mansoori, Phil Harrison, P Greenhaff, A Humphries, H. McGuinness, Gerome Breen, Hayley Hardwick, Davies Adeloye, P Pfeffer, H Lota, Daniel G. Wootton, William Monteiro, A Holbourn, R Hamil, Y Ellis, Traolach S. Brugha, A Alli, D Wraith, Jennifer K Quint, H Atkins, I Peralta, David C. Thomas, A Bolger, J Rodgers, S Portukhay, David Wilson, Michael Sharpe, Steven Kerr, T Plekhanova, J Lewis, S. Quaid, O Olaosebikan, L Lim, K Roy, A Checkley, A Newton Cox, A Dougherty, Bill Deakin, R Pius, A Hoare, N. Dormand, T Craig, Dhruv Parekh, Betty Raman, K E Lewis, Christopher E. Brightling, L G Spencer, Z Suleiman, E R Chilvers, Keith M. Channon, A Saratzis, R Lenagh, N Diar Bakerly, I Macharia, G Kaltsakas, L Morrison, M Ralser, K Fallon, C J Tee, JM Watson, J Nunag, R Gregory, J E Pearl, C Wright, K Regan, D Johnston, P Hogarth, Najib M. Rahman, G P McCann, Julie Evans, N Easom, Joseph Hughes, J Skeemer, H Baxendale, E Hufton, B Elliott, L V Wain, Ardythe L. Morrow, Meenal Patel, S Glover, C Xie, M Harvie, Alan Hughes, David B. Thomas, N Choudhury, Mark J. Tobin, Elizabeta B. Mukaetova-Ladinska, Richard W. Francis, J L Heeney, Shyam Madathil, Ellen Guthrie, S Yasmin, H Turton, M Marks, I Koychev, Melanie J. Davies, John P Greenwood, Daniel Peckham, E Lee, Iain B. McInnes, K Hadley, Charlotte Summers, J Chen, A Prickett, Timothy R Nicholson, K Lewis, A Cross, Jamie Brown, G Ross, H Wheeler, Manu Sharma, Igor Rudan, A Routen, M J Noonan, J Wild, K Jiwa, B. Welsh, Jonathan Pimm, J Kwan, A Lucey, C Favager, K Brindle, Nazir I Lone, Naveed Sattar, C Christie, James E. Mitchell, M Wilkins, C Coupland, T Thornton, Christian P Subbe, Alex Horsley, J Blaikely, G F Toingson, S Walsh, A Lea, Jennifer A. Smith, Margot W. Parkes, M Dixon, Luke Howard, N Majeed, A Hayday, Jack A. Sargeant, Michael Pavlides, K Leitch, J. Pendlebury, Andrew Donaldson, T Peto, Thomas A Jackson, N Rahman, M Gibbons, J Phipps, S Logan, D Wilkinson, J Breeze, D Holgate, R Osbourne, M Hoare, M Malim, Ryan S Thwaites, Stephen R Knight, W Ibrahim, J Rowland, Andrew M. Taylor, B Al-Sheklly, R. Loosley, S Megson, C Summersgill, Z Coburn, R Evans, I Wilson, B Pathmanathan, Jeremy George, A Angyal, S Betts, A Deans, C E Brightling, S Kerr, N Selby, L Price, A Ramos, S N Diwanji, P Kurupati, J S Brown, K Scott, A Sheikh, Krisnah Poinasamy, R Ugwuoke, Teresa Thompson, K Chong-James, Gerry P McCann, John R. Petrie, R Hughes, E. Watson, K McIvor, Trudie Chalder, Melissa Heightman, B Gooptu, H Evans, Thomas Yates, R Ahmed, Nicholas Hart, R Allen, W Schwaeble, J Simpson, Sara Clohisey, Janet M. Lord, R Bell, R Baggott, Clare J Taylor, Keir Lewis, Lynda Connor, F Thaivalappil, Kathryn J Saunders, Lynsey S. Hall, Richard Kevin Stone, Aliki Thomas, L Turtle, H Tedd, L Matthews, J Bambrough, S Stanel, M J McMahon, L Chetham, Enya Daynes, R Hurst, Angela Cook, M Aljaroof, Ling-Pei Ho, Paul Moss, H Arnold, S Fairbairn, Anthony J. Rostron, L Garner, Kyle Harrington, Douglas Grieve, B Connolly, Khalida Ismail, Craig Johnson, E. Russell, T Hussell, S Kon, Claudia Langenberg, E Wall, A Rowland, Miriam Harvey, N Powell, Catherine Pennington, N Armstrong, J C Porter, A Ient, Matthew Hotopf, R Parvin, M Richardson, I Smith, L Lightstone, J. Dasgin, Lynne Armstrong, A Charalambou, J R Geddes, C. Clark, E Gourlay, A Botkai, G Choudhury, J Bonnington, Matthew A. Brown, Paul Dark, S Thackray-Nocera, J Woods, E Stringer, R Free, Aarti Shikotra, J Jacob, P Clift, W Man, Sally J Singh, B King, Nikki Gautam, A Zawia, K McCafferty, L Milligan, S Whittaker, A Elmer, H Chinoy, H Welch, J Haworth, A Shikotra, Matthew J. Rowland, A Singapuri, M McNarry, F. Davies, F Khan, T Mcnally, Alfred A.R. Thompson, A McArdle, V Brown, Helen L. Fisher, M Spears, Peter Jezzard, Morag Henderson, D Thickett, U Munawar, M Broome, Graeme Jones, M. Gummadi, S Marciniak, L Poll, E Calvelo, J Hawkes, D Saralaya, S Walder, Omer Elneima, E M Harrison, C E Bolton, S J Singh, Khalid Shah, S Diver, M Willicombe, M Ainsworth, H Nassa, O C Leavy, D C Thomas, R Upthegrove, C Singh, C Echevarria, Sebastian Edwards, N Lewis-Burke, C Bloomfield, D L Sykes, J Parmar, Sam M. Janes, Simon Wessely, Shaney L Barratt, Judith Clarke, S McAdoo, G MacGowan, Hamish McAuley, L O Wajero, C Dobson, David J. Burn, Daniel Lasserson, Gill Arbane, Matthew Richardson, D McAulay, Rhian M. Touyz, Miles D. Witham, E Major, J Whitney, C J Jolley, Michael Beadsworth, N Goodman, S Walmsley, Daniel F. McAuley, Kath Chapman, Paul Cullinan, Margaret Jones, K P Yip, Nilesh J. Samani, M Bourne, Jeremy S. Brown, A Bloss, Alison M. Lawrie, Timothy Felton, L Bishop, T Sass, Oliver Polgar, M Bakali, N Hawkings, T Chalder, Mujtaba Husain, B Jayaraman, Hannah Bayes, Vicky Kamwa, B Hargadon, Y Peng, C Jolley, D Matila, Clare E. Mackay, J Worsley, R Dharmagunawardena, R Samuel, L Fabbri, R Russell, K Bhui, David W. Clark, S Heller, Anne Dell, J Nyaboko, N Huneke, Michael Marks, L Hesselden, A Greenhalgh, L Broad, M Bakau, Susan P. Walker, Marlies Ostermann, Smitaa Patel, E Fraser, R I Evans, V Whitehead, S Ahmad, C King, B Young, David T Arnold, Paul Klenerman, S Dunn, H McAuley, D Faluyi, B Holroyd-Hind, H Qureshi, E Bradley, Brendan G Cooper, P Shah, L Houchen, Shelley Fletcher, Todd Evans, Andrew Smith, Jill Walsh, Amanda F. Elliott, V Harris, L Holdsworth, A Ford, R Saunders, K Vellore, Jonathan Finch, A McGovern, D Nicoll, A Briggs, J Oxton, G A Davies, Milton Ashworth, T I de Silva, V Lewis, James Stockley, S Byrne, Alison G. Harvey, M Sereno, Marc Lipman, S Terry, A Moss, L. McMorrow, Nick A Maskell, Annemarie B Docherty, R Sabit, J Kenneth Baillie, Jennifer M. Short, Louise Stadon, Aziz Sheikh, S A Williams-Howard, Atul Gupta, D Altmann, J Cavanagh, S Francis, E. Perkins, E McIvor, P Atkin, Julie Williams, D Sutherland, J Rangeley, Derek Bell, J Valabhji, J K Baillie, Isobel D. Stewart, P McCourt, P Rivera-Ortega, N J Greening, Anthony De Soyza, M Dalton, Group, PHOSP-COVID Collaborative, Apollo - University of Cambridge Repository, Baguley, David, National Institute for Health Research, UKRI MRC COVID-19 Rapid Response Call, and UK Research and Innovation

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, Pediatrics, medicine.medical_specialty, Health Status, medicine.medical_treatment, MEDLINE, Comorbidity, Disease, Logistic regression, PHOSP-COVID Collaborative Group, 1117 Public Health and Health Services, Cognition, SDG 3 - Good Health and Well-being, medicine, Humans, Prospective Studies, Prospective cohort study, Aged, Mechanical ventilation, United Kingdom/epidemiology, business.industry, COVID-19, 1103 Clinical Sciences, Articles, Middle Aged, Mental health, United Kingdom, Middle age, Hospitalization, Mental Health, Acute Disease, COVID-19/complications, Female, business, 1199 Other Medical and Health Sciences, Follow-Up Studies
Abstract

Background The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. Methods The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a multicentre, long-term follow-up study of adults (aged ≥18 years) discharged from hospital in the UK with a clinical diagnosis of COVID-19, involving an assessment between 2 and 7 months after discharge, including detailed recording of symptoms, and physiological and biochemical testing. Multivariable logistic regression was done for the primary outcome of patient-perceived recovery, with age, sex, ethnicity, body-mass index, comorbidities, and severity of acute illness as covariates. A post-hoc cluster analysis of outcomes for breathlessness, fatigue, mental health, cognitive impairment, and physical performance was done using the clustering large applications k-medoids approach. The study is registered on the ISRCTN Registry (ISRCTN10980107). Findings We report findings for 1077 patients discharged from hospital between March 5 and Nov 30, 2020, who underwent assessment at a median of 5·9 months (IQR 4·9–6·5) after discharge. Participants had a mean age of 58 years (SD 13); 384 (36%) were female, 710 (69%) were of white ethnicity, 288 (27%) had received mechanical ventilation, and 540 (50%) had at least two comorbidities. At follow-up, only 239 (29%) of 830 participants felt fully recovered, 158 (20%) of 806 had a new disability (assessed by the Washington Group Short Set on Functioning), and 124 (19%) of 641 experienced a health-related change in occupation. Factors associated with not recovering were female sex, middle age (40–59 years), two or more comorbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial but only weakly associated with the severity of acute illness. Four clusters were identified with different severities of mental and physical health impairment (n=767): very severe (131 patients, 17%), severe (159, 21%), moderate along with cognitive impairment (127, 17%), and mild (350, 46%). Of the outcomes used in the cluster analysis, all were closely related except for cognitive impairment. Three (3%) of 113 patients in the very severe cluster, nine (7%) of 129 in the severe cluster, 36 (36%) of 99 in the moderate cluster, and 114 (43%) of 267 in the mild cluster reported feeling fully recovered. Persistently elevated serum C-reactive protein was positively associated with cluster severity. Interpretation We identified factors related to not recovering after hospital admission with COVID-19 at 6 months after discharge (eg, female sex, middle age, two or more comorbidities, and more acute severe illness), and four different recovery phenotypes. The severity of physical and mental health impairments were closely related, whereas cognitive health impairments were independent. In clinical care, a proactive approach is needed across the acute severity spectrum, with interdisciplinary working, wide access to COVID-19 holistic clinical services, and the potential to stratify care. Funding UK Research and Innovation and National Institute for Health Research.

Published
2021
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12. Transthyretin Stabilization by AG10 in Symptomatic Transthyretin Amyloid Cardiomyopathy

Author

Uma Sinha, Jose Nativi-Nicolau, Cameron W. Turtle, Martha Grogan, Satish Rao, Sanjiv J. Shah, Jonathan C. Fox, Stephen B. Heitner, Jignesh Patel, Ronald M. Witteles, Mathew S. Maurer, Van N. Selby, Mazen Hanna, Rodney H. Falk, Daniel Jacoby, and Daniel P. Judge

Subjects
Male, endocrine system, medicine.medical_specialty, Cardiomyopathy, 030204 cardiovascular system & hematology, Benzoates, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Pharmacokinetics, Internal medicine, medicine, Humans, 030212 general & internal medicine, Aged, Aged, 80 and over, Heart Failure, Amyloid Neuropathies, Familial, biology, business.industry, Amyloidosis, nutritional and metabolic diseases, Middle Aged, medicine.disease, Transthyretin, Tolerability, Pharmacodynamics, Heart failure, biology.protein, Pyrazoles, Female, Cardiology and Cardiovascular Medicine, business, Amyloid cardiomyopathy
Abstract

Background Transthyretin (TTR) amyloidosis is an underdiagnosed disease caused by destabilization of TTR due to pathogenic mutations or aging. Both pathogenic and protective mutations illuminate mechanisms of disease and potential interventions. AG10 is a selective, oral TTR stabilizer under development for transthyretin amyloidosis cardiomyopathy (ATTR-CM) that mimics a protective TTR mutation. Objectives This randomized, double-blind, placebo-controlled study evaluated safety, tolerability, pharmacokinetics, and pharmacodynamics of AG10 in ATTR-CM patients with symptomatic, chronic heart failure. Methods ATTR-CM, New York Heart Association functional class II to III subjects (n = 49, mutant or wild-type) were randomized 1:1:1 to AG10 400 mg, AG10 800 mg, or placebo twice daily for 28 days. Safety and tolerability were assessed by clinical and laboratory criteria. AG10 plasma levels were measured. TTR stability was assessed by changes in serum TTR, and 2 established ex vivo assays (fluorescent probe exclusion and Western blot). Results AG10 treatment was well-tolerated, achieved target plasma concentrations and demonstrated near-complete stabilization of TTR. TTR stabilization was more complete and less variable at the higher dose with stabilization by fluorescent probe exclusion of 92 ± 10% (mean ± SD) at trough and 96 ± 9% at peak (both p Conclusions AG10 has the potential to be a safe and effective treatment for patients with ATTR-CM. A phase 3 trial is ongoing. (Study of AG10 in Amyloid Cardiomyopathy; NCT03458130)

Published
2019
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13. Rationale and design of the pragmatic randomized trial of icosapent ethyl for high cardiovascular risk adults (MITIGATE)

Author

Jesse K. Fitzpatrick, Alan S. Go, Umar I. Malik, Andrew P. Ambrosy, Rachel Thomas, Harshith R. Avula, Craig Granowitz, Deepak L. Bhatt, Van N. Selby, Jacek Skarbinski, Choon H. Goh, Thida C. Tan, Rishi V. Parikh, Matthew D. Solomon, and Sephy Philip

Subjects
Male, medicine.medical_specialty, 030204 cardiovascular system & hematology, Article, icosapent ethyl, law.invention, coronavirus disease 2019, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Humans, Medicine, Prospective Studies, viral upper respiratory infection, 030212 general & internal medicine, Medical prescription, Prospective cohort study, Respiratory Tract Infections, triglycerides, Aged, seasonal flu, Intention-to-treat analysis, business.industry, COVID-19, atherosclerotic cardiovascular disease, Middle Aged, Atherosclerosis, Intention to Treat Analysis, Clinical trial, Eicosapentaenoic Acid, Cardiovascular Diseases, Emergency medicine, Ambulatory, Cohort, Platelet aggregation inhibitor, Female, Hydroxymethylglutaryl-CoA Reductase Inhibitors, business, Cardiology and Cardiovascular Medicine, Platelet Aggregation Inhibitors
Abstract

Objective: The MITIGATE study aims to evaluate the real-world clinical effectiveness of pre-treatment with icosapent ethyl (IPE), compared with usual care, on laboratory-confirmed viral upper respiratory infection (URI)-related morbidity and mortality in adults with established atherosclerotic cardiovascular disease (ASCVD). Background: IPE is a highly purified and stable omega-3 fatty acid prescription medication that is approved for cardiovascular risk reduction in high-risk adults on statin therapy with elevated triglycerides. Preclinical data and clinical observations suggest that IPE may have pleiotropic effects including antiviral and anti-inflammatory properties that may prevent or reduce the downstream sequelae and cardiopulmonary consequences of viral URIs. Methods: MITIGATE is a virtual, electronic health record (EHR)-based, open-label, randomized, pragmatic clinical trial enrolling ∼16,500 participants within Kaiser Permanente Northern California (KPNC) – a fully integrated and learning health care delivery system with 21 hospitals and >255 ambulatory clinics serving ∼4.5 million members. Adults ≥50 years with established ASCVD and no prior history of coronavirus disease 2019 (COVID-19) will be prospectively identified and pre-randomized in a 1:10 allocation ratio (∼1,500 IPE: ∼15,000 usual care) stratified by age and previous respiratory health status to the intervention (IPE two grams by mouth twice daily with meals) vs. the control group (usual care) for a minimum follow-up duration of 6 months. The co-primary endpoints are moderate-to-severe laboratory-confirmed viral URI and worst clinical status due to a viral URI at any point in time. Conclusion: The MITIGATE study will inform clinical practice by providing evidence on the real-world clinical effectiveness of pre-treatment with IPE to prevent and/or reduce the sequelae of laboratory-confirmed viral URIs in a high-risk cohort of patients with established ASCVD.

Published
2021
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14. Induced Pluripotent Stem Cell–Derived Podocyte-Like Cells as Models for Assessing Mechanisms Underlying Heritable Disease Phenotype: Initial Studies Using Two Alport Syndrome Patient Lines Indicate Impaired Potassium Channel Activity

Author

Wai-Ling Lieuw, Teresa H. Vandekolk, Sharon D. Ricardo, John M. Haynes, James N. Selby, Sheetal Saini, Joan K. Ho, Craig L. Fisher, Katie Leach, Isaiah P. L. Abad, and Judith Savige

Subjects
Collagen Type IV, Male, 0301 basic medicine, Potassium Channels, Adolescent, Induced Pluripotent Stem Cells, Nephritis, Hereditary, Calcium in biology, Cell Line, Podocyte, 03 medical and health sciences, 0302 clinical medicine, Glomerular Basement Membrane, medicine, Humans, Alport syndrome, Large-Conductance Calcium-Activated Potassium Channel alpha Subunits, Induced pluripotent stem cell, Pharmacology, Mesangial cell, Podocytes, Chemistry, Glomerular basement membrane, Middle Aged, medicine.disease, Cell biology, Potassium channel activity, Phenotype, 030104 developmental biology, medicine.anatomical_structure, Focal Adhesion Protein-Tyrosine Kinases, Molecular Medicine, Calcium, Stem cell, Receptors, Calcium-Sensing, 030217 neurology & neurosurgery, Signal Transduction
Abstract

Renal podocyte survival depends upon the dynamic regulation of a complex cell architecture that links the glomerular basement membrane to integrins, ion channels, and receptors. Alport syndrome is a heritable chronic kidney disease where mutations in α3, α4, or α5 collagen genes promote podocyte death. In rodent models of renal failure, activation of the calcium-sensing receptor (CaSR) can protect podocytes from stress-related death. In this study, we assessed CaSR function in podocyte-like cells derived from induced-pluripotent stem cells from two patients with Alport Syndrome (AS1 & AS2) and a renal disease free individual [normal human mesangial cell (NHMC)], as well as a human immortalized podocyte-like (HIP) cell line. Extracellular calcium elicited concentration-dependent elevations of intracellular calcium in all podocyte-like cells. NHMC and HIP, but not AS1 or AS2 podocyte-like cells, also showed acute reductions in intracellular calcium prior to elevation. In NHMC podocyte-like cells this acute reduction was blocked by the large-conductance potassium channel (KCNMA1) inhibitors iberiotoxin (10 nM) and tetraethylammonium (5 mM), as well as the focal adhesion kinase inhibitor PF562271 (N-methyl-N-(3-((2-(2-oxo-2,3-dihydro-1H-indol-5-ylamino)-5-trifluoromethyl-pyrimidin-4-ylamino)-methyl)-pyridin-2-yl)-methanesulfonamide, 10 nM). Quantitative polymerase chain reaction (qPCR) and immunolabeling showed the presence of KCNMA1 transcript and protein in all podocyte-like cells tested. Cultivation of AS1 podocytes on decellularized plates of NHMC podocyte-like cells partially restored acute reductions in intracellular calcium in response to extracellular calcium. We conclude that the AS patient-derived podocyte-like cells used in this study showed dysfunctional integrin signaling and potassium channel function, which may contribute to podocyte death seen in Alport syndrome.

Published
2018
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15. Detecting Suspected Pump Thrombosis in Left Ventricular Assist Devices via Acoustic Analysis

Author

Maziyar Baran Pouyan, Cynthia Partida, Van N. Selby, Liviu Klein, James M. Rehg, Georg Wieselthaler, Beren Semiz, Omer T. Inan, Leticia Blazquez-Arroyo, and Sinan Hersek

Subjects
Male, Sound Spectrography, heart failure, Left ventricular assist device, 030204 cardiovascular system & hematology, Cardiovascular, Medical and Health Sciences, Harmonic analysis, 0302 clinical medicine, Computer-Assisted, Engineering, Health Information Management, 030212 general & internal medicine, Feature set, Assistive Technology, screening and diagnosis, Rehabilitation, Signal Processing, Computer-Assisted, Hematology, Middle Aged, Thrombosis, Computer Science Applications, Correlation, Detection, Blood, machine learning, Heart Sounds, Correlation analysis, Cardiology, Feature extraction, Female, Algorithms, Biotechnology, medicine.medical_specialty, Early detection, pump thrombosis, Bioengineering, Pumps, Article, 03 medical and health sciences, Clinical Research, Internal medicine, Information and Computing Sciences, medicine, Humans, Electrical and Electronic Engineering, Pump thrombosis, Aged, Extramural, business.industry, Stethoscopes, Acoustics, medicine.disease, Centrifugal pump, 4.1 Discovery and preclinical testing of markers and technologies, Signal Processing, Heart-Assist Devices, Decision threshold, business, Medical Informatics
Abstract

Objective: Left ventricular assist devices (LVADs) fail in up to 10% of patients due to the development of pump thrombosis. Remote monitoring of patients with LVADs can enable early detection and, subsequently, treatment and prevention of pump thrombosis. We assessed whether acoustical signals measured on the chest of patients with LVADs, combined with machine learning algorithms, can be used for detecting pump thrombosis. Methods: 13 centrifugal pump (HVAD) recipients were enrolled in the study. When hospitalized for suspected pump thrombosis, clinical data and acoustical recordings were obtained at admission, prior to and after administration of thrombolytic therapy, and every 24 hours until laboratory and pump parameters normalized. First, we selected the most important features among our feature set using LDH-based correlation analysis. Then using these features, we trained a logistic regression model and determined our decision threshold to differentiate between thrombosis and non-thrombosis episodes. Results: Accuracy, sensitivity and precision were calculated to be 88.9%, 90.9% and 83.3%, respectively. When tested on the post-thrombolysis data, our algorithm suggested possible pump abnormalities that were not identified by the reference pump power or biomarker abnormalities. Significance: We showed that the acoustical signatures of LVADs can be an index of mechanical deterioration and, when combined with machine learning algorithms, provide clinical decision support regarding the presence of pump thrombosis.

Published
2020

16. Heart-lung transplantation: A viable option for connective tissue diseases

Author

Nicholas A. Kolaitis, Teresa De Marco, Francesco Boin, Lily Stern, Mandar A. Aras, Van N. Selby, and Liviu Klein

Subjects
Adult, medicine.medical_specialty, Cardiac output, Databases, Factual, Heart-Lung Transplantation, medicine.medical_treatment, genetic processes, 030230 surgery, environment and public health, 03 medical and health sciences, 0302 clinical medicine, Mixed connective tissue disease, Internal medicine, medicine, Lung transplantation, Humans, Pulmonary wedge pressure, Connective Tissue Diseases, Transplantation, business.industry, fungi, Graft Survival, medicine.disease, Connective tissue disease, enzymes and coenzymes (carbohydrates), medicine.anatomical_structure, health occupations, Cardiology, Vascular resistance, 030211 gastroenterology & hepatology, CTD, business, Lung Transplantation
Abstract

BACKGROUND While lung transplantation (LTx) has been effective for connective tissue disease (CTD) patients with pulmonary involvement, outcomes for heart-lung transplantation (HLTx) are less defined. The aim of this study is to evaluate HLTx in CTD patients utilizing the UNOS database. METHODS HLTx patients with CTD (HLTx-CTD) were compared to both LTx patients with CTD (LTx-CTD) and HLTx patients with all other indications (HLTx-OI) from 1999 to 2018. Primary outcome was 1- and 5-year graft survival. Secondary outcomes included freedom from first-year rejection and outcomes prior to transplant discharge. RESULTS 1143/29 323 adults received first-time HLTx or LTx for CTD. Seventeen were HLTx-CTD (3.3% of total HLTx) and 1126 were LTx-CTD (3.9% of total LTx). There were 492 HLTx-OI. Transplant hemodynamic values including cardiac output, pulmonary capillary wedge pressure, and calculated pulmonary vascular resistance were significantly worse for HLTx-CTD vs LTx-CTD (4.2 vs 5.4 L/min, P = .005; 14 vs 10 mm Hg, P = .009; 439 vs 267 dynes, P = .007, respectively). Cardiac status 1 was more common for HLTx-CTD vs HLTx-OI (94% vs 56%, P

Published
2019

17. Noninvasive estimation of pulmonary vascular resistance improves portopulmonary hypertension screening in liver transplant candidates

Author

Nicholas A. Kolaitis, Mandar A. Aras, Van N. Selby, Alexander Papolos, Francis Y. Yao, Jacqueline T. DesJardin, Teresa De Marco, Yana Svetlichnaya, Lucas S. Zier, John P. Roberts, Liviu Klein, and Marcella Manicardi

Subjects
Male, medicine.medical_specialty, Cardiac Catheterization, Heart disease, Hypertension, Pulmonary, 030230 surgery, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Internal medicine, medicine.artery, Hypertension, Portal, Medicine, Ventricular outflow tract, Cutoff, Humans, Retrospective Studies, Transplantation, Portopulmonary hypertension, business.industry, Ultrasonography, Doppler, Middle Aged, medicine.disease, Prognosis, Liver Transplantation, Blood pressure, medicine.anatomical_structure, ROC Curve, Echocardiography, Pulmonary artery, Vascular resistance, Cardiology, 030211 gastroenterology & hepatology, Female, Vascular Resistance, business, Follow-Up Studies
Abstract

Despite limitations in sensitivity and specificity, estimation of the pulmonary artery systolic pressure (ePASP) on echocardiography is used for portopulmonary hypertension (PoPH) screening in liver transplant (LT) candidates. We proposed that alternative echocardiographic models, such as estimated pulmonary vascular resistance (ePVR), may provide improved testing characteristics in PoPH screening. In a retrospective analysis of 100 LT candidates, we found that the formula ePVR = ePASP/VTIRVOT + 3 if MSN (VTIRVOT = right ventricular outflow tract time velocity integral; MSN = mid-systolic notching of the VTIRVOT Doppler signal) significantly improves accuracy of PoPH screening compared to ePASP. We determined the optimal ePVR cutoff for PoPH screening to be 2.76 Wood units, as this cutoff provided 100% sensitivity and 73% specificity in screening for clinically significant PoPH. Comparatively, ePASP at a cutoff of 40 mm Hg provided 91% sensitivity and 48% specificity. We devised a new screening algorithm based on the use of ePVR at intermediate ePASP values (35-54 mm Hg), and we confirmed the testing characteristics of this algorithm in a separate validation cohort of 50 LT candidates. In screening LT candidates for PoPH, the ePASP lacks accuracy, leading to unnecessary RHCs and undiagnosed cases of PoPH. A screening algorithm which incorporates the ePVR may be more reliable.

Published
2019

18. Current Treatment Strategies in Pulmonary Hypertension Associated with Left Heart Disease

Author

Van N. Selby and Teresa De Marco

Subjects
Transplantation, medicine.medical_specialty, education.field_of_study, Hepatology, business.industry, Immunology, Population, Diastole, Hemodynamics, medicine.disease, Pulmonary hypertension, Nephrology, Internal medicine, Heart failure, medicine, Cardiology, Treatment strategy, Surgery, Left heart disease, education, business, Complication
Abstract

Pulmonary hypertension (PH) is a common complication of left heart disease (LHD) and is associated with impaired functional capacity and decreased survival. Recent guidelines have proposed a new classification system for PH-LHD that is based on the diastolic pulmonary gradient. Despite a sound physiologic basis, subsequent studies have not found a significant correlation between the diastolic pulmonary gradient and meaningful outcomes. Treatment of PH-LHD focuses on optimizing the left heart disease. The use of medications for the treatment of combined post- and pre-capillary PH in left heart disease is controversial. While several small studies have shown hemodynamic or symptomatic improvement, none have been demonstrated to clearly improve long-term outcomes. Large, event-driven trials of PH-LHD are needed to guide the optimal management of this population.

Published
2015
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19. Commentary

Author

M. Maria Glymour, Van N. Selby, and Elizabeth Rose Mayeda

Subjects
Selection bias, Medical education, Epidemiology, business.industry, media_common.quotation_subject, Clinical epidemiology, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Medicine, 030212 general & internal medicine, business, Patient centered, media_common
Published
2016
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20. The Diastolic Pulmonary Gradient Does Not Predict Survival in Patients With Pulmonary Hypertension Due to Left Heart Disease

Author

Ryan J. Tedford, Stuart D. Russell, Teresa A De Marco, Edward K. Kasper, Van N. Selby, Emmanouil Tampakakis, Michael Felker, Thomas P. Cappola, and Peter J. Leary

Subjects
medicine.medical_specialty, business.industry, Diastole, food and beverages, medicine.disease, Pulmonary hypertension, Heart failure, Internal medicine, medicine, Cardiology, In patient, Left heart disease, Cardiology and Cardiovascular Medicine, business
Abstract

Objectives: This study sought to evaluate if diastolic pulmonary gradient (DPG) can predict survival in patients with pulmonary hypertension due to left heart disease (PH-LHD).Background: P...

Published
2015
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21. Overview of WHO Group 2 Pulmonary Hypertension Due to Left Heart Disease

Author

Christopher Barnett and Van N. Selby

Subjects
medicine.medical_specialty, business.industry, Internal medicine, valvular heart disease, medicine, Cardiology, Hemodynamics, General Medicine, Left heart disease, medicine.disease, business, Pulmonary hypertension
Abstract

Background: Left heart disease (LHD) is the most common cause of pulmonary hypertension (PH) and is associated with poor patient outcomes, especially among patients undergoing heart transplant evaluation. Implications for clinicians: Left heart disease should be considered in all patients undergoing an evaluation for PH. Correct management of PH from LHD is to optimize treatment of LHD. Pulmonary vasodilators used to treat pulmonary arterial hypertension should not be used in patients with PH from LHD. Conclusions: Additional research is needed to better understand how PH develops in patients with LHD and to investigate the role for treatment targeting PH in these patients.

Published
2015
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22. Gore-Tex Mesh as Cause for Distal Outflow Graft Obstruction in Ventricular Assist Device Patients

Author

T. De Marco, Liviu Klein, Sonia Sharma, M. Coleman, Michele Kassemos, Mandar A. Aras, G.M. Wieselthaler, Van N. Selby, N. Colaco, and S. Bhattacharya

Subjects
Pulmonary and Respiratory Medicine, Transplantation, medicine.medical_specialty, business.industry, medicine.medical_treatment, Gradual onset, Anastomosis, Surgery, Ventricular assist device, medicine, Right ventricular failure, Cumulative incidence, Outflow, Implant, Cardiology and Cardiovascular Medicine, business
Abstract

Purpose Re-do sternotomy following left ventricular assist device (LVAD) implant can occur due to cardiac transplantation or device complication. A polytetrafluoroethylene membrane (Gore-Tex) has been used to cover portions of the outflow graft to reduce adhesions. We describe 3 cases of late-presenting extrinsic compression of the distal outflow graft from a Gore-Tex membrane in both HVAD and HMII devices. Methods We conducted a retrospective analysis of all LVAD implants which included a Gore-Tex membrane at our institution between 1/2012-6/2018. We defined cases of extrinsic outflow graft obstruction (OGO) by clinical presentation, CT imaging, and intraoperative findings. Results During the study period, 158 LVADs with tubular Gore-Tex outflow graft coverage were implanted (93 HVAD, 59 HM2, 4 HM3). Three cases of extrinsic OGO (1 HVAD, 2 HM2) were identified, for a cumulative incidence of 1.9% (1.44 per 100 patient years). The average time to clinical presentation was 1157 ± 155 days. Each case presented with persistent low-flow alarms detected via remote monitoring in the absence of power spikes or clinical symptoms. Markers of hemolysis (LDH, plasma free hemoglobin) were normal, INR was therapeutic, and echocardiograms did not indicate volume depletion or right ventricular failure. In each case, CT imaging demonstrated critical narrowing of the distal outflow graft (N=2) or aortic anastomosis (N=1) (Fig A). Each patient underwent surgical exploration; upon incision of the overlying Gore-Tex membrane, a proteinaceous material was drained resulting in immediate improvement in flows and avoidance of pump exchange (Fig B). Conclusion We highlight 3 cases of a previously undescribed mechanism of OGO by extrinsic compression, resulting from accumulation of proteinaceous material underneath the Gore-Tex membrane. Each presented with gradual onset of low flows without additional symptoms, suggesting that a high level of clinical suspicion is necessary to ensure appropriate management.

Published
2019
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23. AG10 CONSISTENTLY STABILIZES TRANSTHYRETIN TO A HIGH LEVEL IN BOTH WILD TYPE AND MUTANT AMYLOID CARDIOMYOPATHY: RESPONDER ANALYSES FROM A PHASE 2 CLINICAL TRIAL

Author

Satish Rao, Mathew S. Maurer, Jonathan C. Fox, Daniel Jacoby, Stephen B. Heitner, Daniel P. Judge, Van N. Selby, Martha Grogan, Rodney H. Falk, Sanjiv J. Shah, Ronald M. Witteles, and Uma Sinha

Subjects
endocrine system, biology, business.industry, Amyloidosis, Mutant, Cardiomyopathy, Wild type, nutritional and metabolic diseases, Phases of clinical research, 030204 cardiovascular system & hematology, medicine.disease, Highly selective, 03 medical and health sciences, Transthyretin, 0302 clinical medicine, Cancer research, biology.protein, Medicine, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, Amyloid cardiomyopathy, business
Abstract

AG10 is a highly selective and potent oral transthyretin (TTR) stabilizer under development for TTR amyloidosis (ATTR). ATTR cardiomyopathy (ATTR-CM) is under-diagnosed with no FDA-approved therapies indicated for its treatment. Hypothesis: At doses investigated, AG10 achieves complete stabilization

Published
2019
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24. BLOOD-BIOMARKER-BASED ACOUSTICAL FEATURE SELECTION IMPROVES OVERALL CLASSIFICATION ACCURACY FOR PUMP THROMBOSIS IN LEFT VENTRICULAR ASSIST DEVICES

Author

Sinan Hersek, Georg Wieselthaler, Liviu Klein, Beren Semiz, Leticia B. Arroyo, Cynthia Partida, Omer T. Inan, and Van N. Selby

Subjects
business.industry, Feature selection, 030204 cardiovascular system & hematology, Machine learning, computer.software_genre, Biomarker (cell), 03 medical and health sciences, 0302 clinical medicine, Blood biomarkers, Black box, Medicine, 030212 general & internal medicine, Biosignal, Artificial intelligence, Cardiology and Cardiovascular Medicine, Pump thrombosis, business, computer
Abstract

The performance of biosignal classification hinges on feature selection, yet in many cases such features are selected ad hoc with an empirical, black box approach. Combining heterogeneous data streams -specifically physiologically meaningful blood biomarkers and biosignal features – can

Published
2019
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25. Use of Ventricular Assist Device Acoustical Signatures to Detect Device Thrombosis

Author

Liviu Klein, Van N. Selby, Georg Wieselthaler, Beren Semiz, Maziyar Baran Pouyan, Omer T. Inan, Cynthia Partida, Sinan Hersek, and Leticia Blazquez

Subjects
medicine.medical_specialty, 021103 operations research, Stethoscope, business.industry, Dimensionality reduction, medicine.medical_treatment, 05 social sciences, 0211 other engineering and technologies, 02 engineering and technology, medicine.disease, Centrifugal pump, Thrombosis, law.invention, law, Feature (computer vision), Ventricular assist device, Internal medicine, 0502 economics and business, medicine, Cardiology, Post treatment, Cardiology and Cardiovascular Medicine, Pump thrombosis, business, 050203 business & management
Abstract

Background Pump thrombosis (PT), the most common cause of failure in ventricular assist devices (VADs), can be mitigated with earlier diagnosis before triggering any clinical events or requiring VAD replacement. Hypothesis Acoustical signatures of VADs can provide substantial information regarding PT. Methods We included 10 patients (6 axial, 4 centrifugal VADs) presenting with pump power elevations and recurrent abnormal hemolysis markers consistent with suspected PT. VAD sounds were recorded multiple times using a digital stethoscope (EKO Core) at baseline or before developing thrombosis (normal baseline), during thrombosis episodes and after treatment with heparin or tissue plasminogen activator (Fig. (a)). The 2 types of pumps were analyzed separately (42 recordings from axial and 30 recordings from centrifugal) using 3 steps: (1) Extracting features (time-frequency, acoustic and nonlinearity features) from each recording; (2) Feature importance ranking using Extreme Gradient Boosting (XGBoost) to evaluate which features were most relevant for distinguishing among different states; (3) Principal Component Analysis (PCA) for dimensionality reduction and 2D visualization (Fig. (b)). Results We found that separation among the different states is achieved using the combination of XGBoost feature importance ranking and PCA (Fig. (c)). The suggested pipeline of analysis can overcome the problems emerging from inter-subject variability. In both pumps, sounds recorded from VADs with PT had different signatures than baseline sounds. Better separation was observed for axial pumps relative to centrifugal pumps, which may be due to the difference in operating speeds (average 9400 vs 2600 rpms, respectively). We observed a slight overlap between the post treatment and baseline episodes, suggesting the possible presence of residual PT that is not identified by hemolysis biomarkers and/or pump powers. Conclusion Applying machine learning algorithms on pump acoustical signals provides substantial information regarding thrombosis states, and potentially allows for sensitive detection of PT assisting hemolysis biomarkers and pump powers.

Published
2018
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26. Minimally-invasive Implantation of a Centrifugal Continuous-flow Left Ventricular Assist Device is Associated With Decreased Early Right Ventricular Failure

Author

T. De Marco, Liviu Klein, Van N. Selby, M. Janmohamed, G.M. Wieselthaler, and Mitchell A. Psotka

Subjects
Pulmonary and Respiratory Medicine, Transplantation, medicine.medical_specialty, business.industry, Continuous flow, medicine.medical_treatment, Ventricular assist device, Internal medicine, Cardiology, Medicine, Right ventricular failure, Surgery, Cardiology and Cardiovascular Medicine, business
Published
2018
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27. Abstract 18894: The Myocardial Contraction Fraction Predicts Survival in Patients With AL Cardiac Amyloidosis. A Report From iCCAT, The International Consortium for Cardiac Amyloid Transplantation

Author

Marc J. Semigran, Jignesh Patel, Mathew S. Maurer, Teresa De Marco, Karla Verkouw, Van N. Selby, Giuseppe Feltrin, David A. Baran, David C. Seldin, Mazen Hanna, Mark J. Zucker, Jerry D. Estep, and Ronald M. Witteles

Subjects
medicine.medical_specialty, Contraction (grammar), Ejection fraction, business.industry, Cardiomyopathy, Diastolic heart failure, medicine.disease, Transplantation, Cardiac amyloidosis, Physiology (medical), Internal medicine, medicine, Cardiology, In patient, Cardiology and Cardiovascular Medicine, business, Cardiac imaging
Abstract

Background: Cardiac amyloidosis is characterized by progressive ventricular thickening and diastolic heart failure. The left ventricular ejection fraction (EF) often remains normal even in advanced disease. The myocardial contraction fraction (MCF, the ratio of left ventricular stroke volume to myocardial volume) is a novel measure of myocardial shortening and may be superior to EF for predicting survival in cardiac amyloidosis. Methods: We measured MCF and EF from two-dimensional echocardiograms obtained in 86 subjects undergoing heart transplant evaluation for AL cardiac amyloidosis. Cox proportional hazards models and Kaplan-Meier survival analysis were used to compare MCF and EF as predictors of all-cause mortality. Subjects were censored at the time of heart transplant. Results: The mean age was 54.6 ± 7.9 years. The mean EF was 49.3 ± 12.7% and the mean MCF was 13.0 ± 5.5%. Over a median follow-up of 59 days (IQR 29-110 days), 38 subjects (44.2%) died and 48 (55.8%) underwent heart transplant. In unadjusted analyses, both MCF (HR 0.89, 95% CI 0.82-0.96, p = 0.002) and EF (HR 0.96, 95% CI 0.94-0.99, p = 0.015) predicted overall survival. In multivariate analyses adjusted for serum free light chain difference, the hazard ratio associated with each 5% absolute decrease in MCF was 2.11 (95% CI 1.32-3.38, p= 0.002). The hazard ratio associated with each 5% absolute decrease in EF was not statistically significant (HR 1.16, 95% CI 0.97-1.39, p=0.09). Conclusions: Myocardial contraction fraction is superior to EF for predicting survival in patients undergoing heart transplant evaluation for AL cardiac amyloidosis.

Published
2015
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28. PILOTING A RAPID ASSESSMENT TOOL IN CHILDREN'S ED

Author

R Cole, A Alcock, N Selby, T Sajjanhar, and S Issa

Subjects
Clinical audit, medicine.medical_specialty, business.industry, Vital signs, Workload, General Medicine, Emergency department, Critical Care and Intensive Care Medicine, medicine.disease, Triage, Rapid assessment, Skill mix, SAFER, Emergency medicine, Emergency Medicine, medicine, Medical emergency, business
Abstract

Objectives & Background The Children9s Emergency Department at University Hospital Lewisham sees up to 130 attendances daily. This can result in delays to triage and sick children being missed. In our department, 50–84% of children are triaged within 15 minutes (monthly variation). Peak median time to triage is 41 mins and can depend on skill mix. Our objective was to create a safe Rapid Triage Tool to assess patients rapidly and identify the most unwell patients early. Recent RCEM work on Vital Signs in Children Clinical Audit 2015–16 indicated the need for improvement. Our project supports standards 1 and 3. It can also help to meet the KPI for initial assessment of ambulance patients and the RCEM pain targets. Methods Rapid Assessment Tools were designed by extrapolating from the Manchester Triage System. One for trauma/injury and a second for medical illness figures 1 and 2. ▸ Pilot of 40 patients triaged- weekdays, evenings, weekends and night shifts ▸ Rapid Assessment was employed when the wait for triage was greater than 30 minutes and there were more than 3 patients waiting. It was done in one minute by a senior nurse with relevant training ▸ The nurse assesses the patient using the proforma, assigns a priority and indicates what actions are required ▸ Secondary nurse then acts on these and completes the triage- Figure 3. Results 40 patients were assessed using the Rapid Assessment Tool. ▸ Qualitative correlation to the traditional triage was made and the patients were shown to be given the same priority ranking in all cases ▸ It takes less than a minute to perform the Rapid Assessment compared to 5–20 minutes for the traditional triage. ▸ Flow through the initial stages in the department was quicker ▸ There was better use of the nursing skill mix ▸ The sickest patients were identified faster ▸ Figure 4 Conclusion This Rapid Triage Tool may be a safe tool to use in replacement of the traditional triage method. The perception from staff was that this felt safer and reduced the workload when there was large volume of patients. Further work ▸ Training is required to standardise the implementation of the Rapid Triage Tool ▸ A larger pilot will be conducted to make quantitative conclusions about the effects this has on overall triage time, time to treatment and the on meeting the RCEM Vital Signs and Pain Standards and the KPI ▸ This project has identified a number of areas for improvement such as an extra HCA at triage to facilitate the observations and providing all staff with mobile saturation probes

Published
2016
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29. Novel Techniques of Sound Wave Analysis Can Detect Ventricular Assist Device Thrombosis

Author

L. Blazquez Arroyo, T. De Marco, Sinan Hersek, G.M. Wieselthaler, M. Bran Pouyan, M. Janmohamed, Omer T. Inan, Van N. Selby, and Liviu Klein

Subjects
Pulmonary and Respiratory Medicine, Transplantation, medicine.medical_specialty, business.industry, medicine.medical_treatment, medicine.disease, Thrombosis, Ventricular assist device, Internal medicine, Cardiology, Medicine, Surgery, Cardiology and Cardiovascular Medicine, business, Sound wave
Published
2017
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30. Doppler Echocardiography Provides a Reliable Estimate of Elevated Pulmonary Vascular Resistance in Patients with Advanced Lung and Liver Disease

Author

Liviu Klein, J. Svetlichnaya, T. De Marco, Marcella Manicardi, M. Janmohamed, and Van N. Selby

Subjects
Pulmonary and Respiratory Medicine, Transplantation, medicine.medical_specialty, Lung, medicine.diagnostic_test, business.industry, Doppler echocardiography, medicine.disease, Liver disease, medicine.anatomical_structure, Internal medicine, medicine, Vascular resistance, Cardiology, Surgery, In patient, Cardiology and Cardiovascular Medicine, business
Published
2017
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31. Pre-Implant Atrial Fibrillation Predicts Gastrointestinal Bleeding Following Left Ventricular Assist Device Implantation

Author

T. De Marco, G.M. Wieselthaler, M. Janmohamed, J. Svetlichnaya, Liviu Klein, Van N. Selby, and Mitchell A. Psotka

Subjects
Pulmonary and Respiratory Medicine, Transplantation, medicine.medical_specialty, Gastrointestinal bleeding, business.industry, medicine.medical_treatment, Atrial fibrillation, medicine.disease, Internal medicine, Ventricular assist device, medicine, Cardiology, Surgery, Implant, Cardiology and Cardiovascular Medicine, business
Published
2017
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32. Model of End-Stage Liver Disease (MELD) and MELD-Sodium Scoring Systems Predict Development of Early Right Heart Failure in Patients Undergoing Ventricular Assist Device Implant

Author

G.M. Wieselthaler, Mitchell A. Psotka, J. Svetlichnaya, Liviu Klein, M. Janmohamed, A.F. Stein-Merlob, Van N. Selby, and T. De Marco

Subjects
Pulmonary and Respiratory Medicine, Transplantation, medicine.medical_specialty, business.industry, medicine.medical_treatment, End stage liver disease, 030204 cardiovascular system & hematology, Surgery, 03 medical and health sciences, 0302 clinical medicine, Right heart failure, 030228 respiratory system, Ventricular assist device, Internal medicine, medicine, Cardiology, In patient, Implant, Cardiology and Cardiovascular Medicine, business
Published
2017
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33. The Use of Circulatory Support While Awaiting Heart Transplant in Patients With AL and TTR: Amyloidosis: A Report From iCCAT, the International Consortium for Cardiac Amyloid Transplant

Author

Jignesh Patel, F. Giuseppe, Johannes Steiner, Sara Tabtabai, Mathew S. Maurer, David A. Baran, Marc J. Semigran, Jerry D. Estep, Van N. Selby, Andrea M. Cordero-Reyes, Mark J. Zucker, David C. Seldin, Mazen Hanna, Muthiah Vaduganathan, Ronald M. Witteles, and James R. Stone

Subjects
Pulmonary and Respiratory Medicine, Transplantation, medicine.medical_specialty, biology, business.industry, medicine.medical_treatment, Amyloidosis, Hazard ratio, Hemodynamics, equipment and supplies, medicine.disease, Confidence interval, Cardiac surgery, Transthyretin, Internal medicine, Ventricular assist device, Circulatory system, medicine, biology.protein, Cardiology, Surgery, Cardiology and Cardiovascular Medicine, Intensive care medicine, business
Abstract

s S95 to compare 1-year survival in patients (pts) receiving a left ventricular assist device (LVAD) as a bridge to transplantation (BTT) or to candidacy (BTC), or HTx from donors ≥ 55 years Methods: Pts receiving a continuous-flow LVAD as BTT/BTC (n= 61) were compared to those undergoing HTx from donors ≥ 55 years (HTx≥ 55y, n= 44 out of 212 adult HTx without prior bridging, 21%) between January 2006 and September 2014. Pts transplanted after LVAD were included in LVAD group only; survival lwas evaluated 1) according to first operation, with pts censored at the time of death or HTx or last follow-up visit, and 2) as overall survival, including postHTx outcome. Results: LVAD and HTx≥ 55y pts differ with respect to gender (Females 9.8 vs 41%, p> 0.005), prior cardiac surgery (11 vs 34%, p= 0.005), hemodynamic (PAPm 38±11 vs 22±8, p> 0.05; PCW 27±8 vs 16±7, p> 0.05). According to first operation, there were 8 deaths in LVAD (13%) and 13 in HTx≥ 55y (32%). Kaplan Meier survival curves estimated a 1-years survival of 87% in LVAD vs 70.5% in HTx≥ 55y pts, (hazard ratio 0.40; 95% confidence interval 0.17-0.97; p= 0.04 for LVAD vs HTx). Early (30 days) mortality was 4.9% in LVAD vs 20.5% in HTx≥ 55y, p0.005) in LVAD than in HTx pts. Nine LVAD pts (14.8%) were transplanted within 1 year, and 7 later; overall survival including post-Htx outcome was 76 % at 1-years. Conclusion: In possible HTx candidates, 1-y survival appears better with LVAD than with HTx from donors≥ 55y, but LVAD complications may require emergency, high risk HTx. Advantages and risks of LVAD or HTx with older donors should be carefully evaluated on an individual basis. Much efforts should be directed to reduce post-LVAD complications, in order to reduce readmissions, and increase the probability of success of subsequent HTx.

Published
2015
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34. What's new in the treatment of acute heart failure?

Author

John R. Teerlink and Van N. Selby

Subjects
Inotrope, medicine.medical_specialty, Cardiotonic Agents, Vasodilator Agents, Volume overload, Hemodynamics, Ultrafiltration, Internal medicine, medicine, Humans, Adverse effect, Intensive care medicine, Diuretics, Heart Failure, business.industry, Levosimendan, medicine.disease, Heart failure, Acute Disease, Practice Guidelines as Topic, Cardiology, Dobutamine, Cardiology and Cardiovascular Medicine, business, Antidiuretic Hormone Receptor Antagonists, medicine.drug
Abstract

Acute heart failure is associated with substantial morbidity and mortality. Goals of treatment are decongestion, correction of hemodynamic abnormalities, symptom relief, and reducing long-term morbidity and mortality. Loop diuretics are a first-line agent for treatment of volume overload, with ultrafiltration reserved for those who do not respond to pharmacologic therapy. In patients with normal or elevated blood pressure, vasodilators are used to correct hemodynamics and reverse central volume redistribution, although no currently available agent has been shown to improve outcomes. Intravenous inotropes and inodilators are associated with frequent adverse effects and are reserved for patients with hypotension and evidence of inadequate perfusion. Novel drugs designed to maximize hemodynamic benefits while minimizing adverse effects are under investigation, with several agents showing promise in clinical studies.

Published
2013

35. Elevated Diastolic Pulmonary Gradient Is Common in the Acute Respiratory Distress Syndrome but Does Not Predict Mortality

Author

Christopher Mullin, Roy G. Brower, Rachel L. Damico, T. De Marco, Ryan J. Tedford, Todd M. Kolb, Van N. Selby, Emmanouil Tampakakis, Thomas S. Metkus, Paul M. Hassoun, and Stephen C. Mathai

Subjects
Pulmonary and Respiratory Medicine, Transplantation, medicine.medical_specialty, business.industry, Internal medicine, medicine, Diastole, Cardiology, Surgery, Acute respiratory distress, Cardiology and Cardiovascular Medicine, business
Published
2016
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36. Device-Related Infection Rates of Continuous-Flow Ventricular Assist Devices Using a Thoracic Driveline Exit Site

Author

T. De Marco, M. Janmohamed, Mitchell A. Psotka, Van N. Selby, G.M. Wieselthaler, Liviu Klein, David E. Lowe, R.G. Kiel, and J.C. Cox

Subjects
Pulmonary and Respiratory Medicine, Exit site, Transplantation, medicine.medical_specialty, Continuous flow, business.industry, Device related infection, Medicine, Surgery, Cardiology and Cardiovascular Medicine, business, Intensive care medicine
Published
2016
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37. Heart-Lung Transplantation: A Viable Option for Systemic Sclerosis

Author

T. De Marco, Van N. Selby, R.G. Kiel, M. Janmohamed, Liviu Klein, and Lily Stern

Subjects
Pulmonary and Respiratory Medicine, Transplantation, medicine.medical_specialty, business.industry, Internal medicine, medicine, Cardiology, Surgery, Cardiology and Cardiovascular Medicine, business, Heart-Lung Transplantation
Published
2016
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38. Outcomes Following Minimally Invasive Implantation of a Centrifugal Continuous-Flow Left Ventricular Assist Device

Author

T. De Marco, Van N. Selby, J.C. Cox, Liviu Klein, David E. Lowe, R.G. Kiel, Mitchell A. Psotka, G.M. Wieselthaler, and M. Janmohamed

Subjects
Pulmonary and Respiratory Medicine, Transplantation, medicine.medical_specialty, business.industry, Continuous flow, medicine.medical_treatment, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Internal medicine, Ventricular assist device, medicine, Cardiology, Surgery, Cardiology and Cardiovascular Medicine, business
Published
2016
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39. Doppler echocardiography does not accurately estimate pulmonary artery systolic pressure in HIV-infected patients

Author

John S. MacGregor, Steven G. Deeks, Christopher Barnett, Catherine Donovan, Rebecca Scherzer, Jeffrey N. Martin, Priscilla Y. Hsue, Van N. Selby, and Juliana Morelli

Subjects
Male, medicine.medical_treatment, Hemodynamics, Blood Pressure, Doppler echocardiography, Cardiovascular, Medical and Health Sciences, Immunology and Allergy, Familial Primary Pulmonary Hypertension, education.field_of_study, screening and diagnosis, medicine.diagnostic_test, Doppler, Pulmonary, Middle Aged, Biological Sciences, Echocardiography, Doppler, Detection, Treatment Outcome, Infectious Diseases, medicine.vein, Echocardiography, Hypertension, Cardiology, HIV/AIDS, Female, Infection, 4.2 Evaluation of markers and technologies, medicine.medical_specialty, Hypertension, Pulmonary, Immunology, Population, Pulmonary Artery, Inferior vena cava, Article, Internal medicine, medicine.artery, Virology, medicine, Humans, education, Acquired Immunodeficiency Syndrome, business.industry, Psychology and Cognitive Sciences, Pulmonary artery catheter, medicine.disease, Pulmonary hypertension, Surgery, Blood pressure, Pulmonary artery, business
Abstract

Pulmonary arterial hypertension (PAH) is a recognized complication of HIV infection (HIV-related pulmonary arterial hypertension, HRPAH) that is associated with increased mortality[1, 2]. Although right heart catheterization (RHC) is required to definitively diagnose HRPAH, a pulmonary artery systolic pressure (PASP) 30 has been associated with increased mortality in patients with sickle cell disease[1], subjects with a DE-estimated PASP > 30 mmHg were offered RHC. RHC was performed using a balloon-tipped, flow-directed pulmonary artery catheter and hemodynamic values were obtained using standard methods. Analyses were performed using the SAS system, version 9.2 (SAS Institute, Inc., Cary, NC). The relationship of DE-estimated PASP with RHC-measured PASP was examined using Spearman correlation coefficients. The Bland-Altman method was then used to assess the agreement between DE-estimated and RHC-measured PASP. DE-estimated PASP within ±10 mmHg of the value measured on RHC was considered accurate, consistent with the cutoffs used in other recent publications[4]. Of 422subjects, 129 were found to have PASP > 30 mmHg on DE, 76 of whom consented to undergo RHC. Subjects who underwent RHC were 80% male, had a median age of 52 years (IQR 48 to 56), median duration of HIV infection of 17 years, and 76% were taking antiretroviral therapy. Average PASP estimated on DE was 35.1±11.5 mmHg and the average PASP measured on RHC was 33.9 ± 12.0 mmHg. DE PASP was positively correlated with the RHC PASP (r=0.49, p ±10 mmHg different from RHC) in 15 of 76 individuals (19.7%). Fourteen patients received a final diagnosis with PAH. Using the frequently employed threshold of a DE-estimated PASP of ≥ 35 mmHg as abnormal, 5 of the 14, or over 1/3, would have been missed by DE (table 1). Figure 1 Bland-Altman analysis demonstrating lack of agreement between the Doppler echocardiogram estimated pulmonary artery systolic pressure (PASP) and right heart catheterization measured PASP. Table 1 Comparison of Doppler echocardiography (DE) estimated pulmonary artery systolic pressure (PASP) and right heart catheterization measured PASP in patients with a final diagnosis of pulmonary arterial hypertension (PAH) (mean pulmonary artery pressure ≥25 ... The prevalence of PAH in HIV-infected individuals is 1,000 times higher than in the general population[1, 2] and is expected to increase[6]. Symptoms of HRPAH are non-specific so that appropriate testing is often delayed, and diagnosis with advanced, severe disease is common. Sensitive methods are needed to identify patients who require RHC for definitive diagnosis so that treatment may be initiated promptly[7]. In our cohort DE PASP was, on average, higher than RHC PASP, however limits of agreement were wide. At higher values of PASP, DE was the least accurate and tended to underestimate the RHC-measured PASP so that PASP 30 mmHg, so the accuracy of DE estimates below this value is uncertain. Additionally, the average PASP in our study was low, 33.9 mmHg, compared to a mean PASP of 68.5 and 57 mmHg in other studies, which could affect our assessment of DE PASP accuracy at higher PASP values. Although we did not perform DE and RHC simultaneously they were performed within one hour of each other and prior reports have confirmed that simultaneous DE and RHC do not improve DE estimation of PASP[4]. We did not account for echocardiographic findings such as right heart size, thickness and function which could modify clinical suspicion for PAH. Although other DE findings can raise or reinforce suspicion for PAH, major society guidelines consistently emphasize the importance of non-invasive DE estimate of PASP in cases of suspected PAH[3, 8]. In this study, we show for the first time in HIV- infected patients at risk for HRPAH that DE estimates of PASP are not accurate and using a DE PASP cutoff of >35 mmHg may miss patients with HRPAH . Because HRPAH is associated with high mortality and early and treatment could improve outcome, timely and accurate diagnosis is critical. RHC should be considered in HIV- infected patients with symptoms concerning for HRPAH, even if DE-estimated PASP is not >35 mmHg.

Published
2012

40. The Association of CD4+ T-Cell Count on Cardiovascular Risk in Treated HIV Disease

Author

Frederick Hecht, Kristinalisa Maka, Jeffrey N. Martin, Steven G. Deeks, Priscilla Y. Hsue, Jennifer E. Ho, Peter Ganz, Van N. Selby, and Rebecca Scherzer

Subjects
CD4-Positive T-Lymphocytes, Male, Brachial Artery, HIV Infections, Cardiovascular, Medical and Health Sciences, Gastroenterology, Interquartile range, Risk Factors, Antiretroviral Therapy, Highly Active, Hyperlipidemia, Immunology and Allergy, Viral, Brachial artery, vasodilation, Prospective cohort study, Ultrasonography, Biological Sciences, Middle Aged, Viral Load, Infectious Diseases, Cardiovascular Diseases, HIV/AIDS, RNA, Viral, Viral load, Nadir (topography), Adult, medicine.medical_specialty, Immunology, Antiretroviral Therapy, CD4 cell, Article, Clinical Research, Virology, medicine.artery, Internal medicine, Diabetes mellitus, medicine, Humans, Highly Active, Endothelium, business.industry, Psychology and Cognitive Sciences, HIV, medicine.disease, Confidence interval, cardiovascular diseases, CD4 Lymphocyte Count, Good Health and Well Being, Cross-Sectional Studies, RNA, business
Abstract

Objective: HIV-infected individuals are at high risk of developing cardiovascular disease. Whether earlier initiation of HIV therapy at higher CD4+ cell counts has any effect on cardiovascular risk as assessed by endothelial function is unknown. Design: Cross-sectional study of 74 antiretroviral-treated men with undetectable plasma HIV RNA levels. Methods: Participants underwent noninvasive assessment of endothelial function using brachial artery flow-mediated dilation (FMD). The association of nadir and current CD4+ T-cell count with FMD was assessed using multivariable linear regression. Results: The median age was 47 years [interquartile range (IQR) 42–55], median current CD4+ T-cell count was 659 cells/μl (IQR 542–845), and nadir CD4 cell count was 314 cells/μl (IQR 150–490). Twenty-eight percent had hypertension, and 32% hyperlipidemia. Nadir CD4+ T-cell count less than 350 cells/μl was associated with lower FMD in age-adjusted and race-adjusted analyses and remained an independent predictor of FMD after adjustment for cardiovascular risk factors (hypertension, diabetes, smoking, hyperlipidemia) and HIV-related characteristics (HIV duration, HAART duration). After multivariable adjustment, individuals with nadir CD4+ T-cell count less than 350 cells/μl had a 1.22% lower FMD compared with those with higher T-cell counts [95% confidence interval (CI) −2.20 to −0.19, P = 0.02]. Proximal CD4+ T-cell count showed little association with FMD. Conclusion: Among treated HIV-infected individuals, nadir CD4+ T-cell count less than 350 cells/μl is independently associated with lower FMD, suggesting that delayed therapy results in sustained harm to endothelial function. Our data support future prospective studies evaluating cardiovascular effects of HAART initiation at higher CD4+ cell counts.

Published
2012

41. Survival Following Heart Transplantation in Patients with Transthyretin Amyloid Cardiomyopathy

Author

T. De Marco, Jon A. Kobashigawa, Liviu Klein, Van N. Selby, Mathew S. Maurer, R. Mundayat, R.D. Kobes, Lily Stern, and M. Janmohamed

Subjects
Pulmonary and Respiratory Medicine, Heart transplantation, Transplantation, medicine.medical_specialty, biology, business.industry, Incidence (epidemiology), medicine.medical_treatment, Significant difference, Pulsatile flow, Transthyretin, Internal medicine, Induction therapy, medicine, biology.protein, Cardiology, Surgery, In patient, Cardiology and Cardiovascular Medicine, Amyloid cardiomyopathy, business
Abstract

s S177 patients who received an axial or centrifugal flow LVAD as compared to those who went directly to transplant. Methods: Ninety-seven patients underwent orthotopic heart transplant between January 2008 and October 2013. We performed a retrospective analysis of post transplant outcomes in patients with and without an isolated continuous flow LVAD as BTT. Patients with a permanent RVAD, pulsatile LVAD, re-transplant or dual-organ transplants were excluded. Eighty four patients were included in this analysis. Results: There was no statistically significant difference in baseline characteristics and post transplant outcomes between the groups. Conclusion: There was no difference in post transplant outcomes in patients bridged to transplant with an LVAD compared to those who went directly to transplant. There appeared to be a trend toward improved survival in the axial flow group and increased incidence of rejection in the centrifugal flow LVAD group. These findings should be further evaluated in future studies. Baseline Characteristics at Time of Transplant Axial Flow VAD n= 40 Centrifugal Flow VAD n= 16 Direct Transplant n= 28 p Age 54.9 ± 11.8 52.5±13.5 54.0±16.3 0.83 Gender (% male, n) 80% (32) 63% (10) 64% (18) 0.25 Race (% Caucasian, n) 53% (21) 69% (11) 57% (16) 0.54 BMI 28.0 ± 5.5 27.7 ± 6.0 26.4 ± 4.2 0.46 Diagnosis (% ICM, n) 35% (14) 38% (6) 36% (10) 0.99 1A Status at time of Transplant 80% (32) 81% (13) 64% (18) 0.28 Duration of LVAD support (days) 380 ± 252 296 ± 258 *** 0.12 Induction therapy 13% (5) 6% (1) 7% (2) 0.67 Post Transplant Outcomes Axial Flow VAD, n= 40 Centrifugal Flow VAD, n= 16 Direct Transplant, n= 28 p Length of stay after transplant (days) 17.6 ± 15.7 20.9 ± 14.6 18.5 ± 9.8 0.74 30 day survival 98% (39) 94% (15) 100% (28) 0.42 1 year survival 98% (39) 88% (14) 93% (26) 0.34 Incidence of rejection in the first year 28% (11) 38% (6) 25% (7) 0.06

Published
2014
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42. Right Ventricular Outflow Tract Doppler Envelope Notching Predicts Pulmonary Vascular Resistance in Patients with Advanced Liver Disease

Author

Francis Y. Yao, John P. Roberts, Teresa De Marco, Marcella Manicardi, M. Janmohamed, J. Svetlichnaya, and Van N. Selby

Subjects
medicine.medical_specialty, education.field_of_study, business.industry, Population, Hazard ratio, Diastole, medicine.disease, medicine.anatomical_structure, Blood pressure, Heart failure, Internal medicine, Cohort, Heart rate, medicine, Cardiology, Vascular resistance, Radiology, Cardiology and Cardiovascular Medicine, education, business
Abstract

Introduction: Cardiac time intervals are sensitive markers of cardiac dysfunction. The usefulness of the systolic ejection time (SET) to predict incident heart failure (HF), however, is unknown. Hypothesis: We hypothesized that SET is a strong predictor of incident HF in a community based cohort free of HF. Methods: We studied middle-aged African-Americans from the Jackson cohort of the Atherosclerosis Risk in Communities study (n52,077) who underwent echocardiography between 1993 and 1995 and were free of heart failure. SET was measured by pulsed-wave Doppler. Results: The mean age of the participants was 59 years, 37% were men, 58% had hypertension, 22% diabetes and 4% prevalent coronary heart disease (CHD). SET ranged from 194 to 778 ms (mean 341 6 35 ms)(Figure 1). During median follow-up of 16.7 years, 394 (19%) had incident HF. In unadjusted analyses, the risk of incident HF increased with decreasing SET below the mean of the population (Figure 1); HF risk was approximately 40% higher for participants with a SET below the mean vs. above the mean (Hazard Ratio (HR) 1.41 [1.16; 1.73], p50.001). Lower SET was also significantly associated with higher age, male gender, higher blood pressure (BP) and heart rate, lower fractional shortening (FS) and lower E/A-ratio (p for trend ! 0.001 for all). The SETwas similarly prognostic of FS and left atrium diameter (LAD) when assessed by c-statistics (0.58 for SET, 0.57 for FS and 0.59 for LAD). SET remained an independent predictor of incident HF after adjustment for age, gender, heart rate, body mass index, hypertension, diabetes, CHD, systolic and diastolic BP and conventional measures of systolic and diastolic function (FS, LAD and E/A-ratio)(HR 1.06 [1.01; 1.11], p50.013, per 10 ms decrease). Conclusion: SET is an independent predictor of incident HF in a community based cohort and provides similar prognostic information on the risk of future HF when compared to conventional measures of systolic and diastolic function.

Published
2015
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43. Characterization and Impact of Pulmonary Hypertension on Outcomes After Left Ventricular Assist Device Implantation

Author

Robert L. Kormos, Van N. Selby, Ryan J. Tedford, J.J. Teuteberg, Isabel E. Allen, and T. De Marco

Subjects
Pulmonary and Respiratory Medicine, Transplantation, medicine.medical_specialty, business.industry, medicine.medical_treatment, medicine.disease, Pulmonary hypertension, Internal medicine, Ventricular assist device, Emergency medicine, medicine, Cardiology, Surgery, Cardiology and Cardiovascular Medicine, business
Abstract

Characterization and Impact of Pulmonary Hypertension on Outcomes After Left Ventricular Assist Device Implantation V.N. Selby ,1 J.J. Teuteberg,2 I.E. Allen,3 R.J. Tedford,4 R.L. Kormos,5 T. De Marco.1 1Division of Cardiology, University of California, San Francisco, San Francisco, CA; 2Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA; 3Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; 4Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD; 5Department of Surgery, University of Pittsburgh, Pittsburgh, PA.

Published
2015
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44. Right Ventricular Outflow Tract Doppler Envelope Mid-Systolic Notching Predicts Pulmonary Vascular Disease in Patients With Advanced Lung Disease

Author

Jonathan P. Singer, T. De Marco, M. Janmohamed, J. Svetlichnaya, Jasleen Kukreja, Van N. Selby, Liviu Klein, and S.R. Hays

Subjects
Pulmonary and Respiratory Medicine, Transplantation, medicine.medical_specialty, Mid systolic, Vascular disease, business.industry, medicine.disease, symbols.namesake, Notching, Lung disease, Internal medicine, medicine, symbols, Cardiology, Ventricular outflow tract, Surgery, In patient, Radiology, Cardiology and Cardiovascular Medicine, business, Doppler effect, Envelope (motion)
Published
2015
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45. Cardiac arrest in patients who smoke crack cocaine

Author

Xiushui Ren, David D. Waters, Naji Younes, Priscilla Y. Hsue, Van N. Selby, Nora Goldschlager, David D. McManus, and Priya Pillutla

Subjects
Adult, Male, medicine.medical_treatment, Medical Records, Medicine, Humans, In patient, Cardiopulmonary resuscitation, Crack cocaine, Survival analysis, Aged, Retrospective Studies, business.industry, Illicit Drugs, Medical record, Case-control study, Retrospective cohort study, Middle Aged, Survival Analysis, Cardiopulmonary Resuscitation, Heart Arrest, Anesthesia, Case-Control Studies, cardiovascular system, Crack Cocaine, Female, San Francisco, Cardiology and Cardiovascular Medicine, business, Complication, Emergency Service, Hospital
Abstract

The aim of the study is to determine the clinical features and outcomes of cocaine users admitted to the hospital after cardiac arrest and compare them with nonusers. Cocaine is associated with cardiovascular complications, including ventricular arrhythmias; however, resuscitated cardiac arrest in relation to cocaine use is not a well-defined clinical entity. We reviewed available hospital charts at San Francisco General Hospital with the International Classification of Diseases, Ninth Revision diagnosis of cardiac arrest and cocaine use from 1994 to 2006. Clinical features and outcomes of cocaine users were compared with those of randomly selected control patients and age-matched controls with resuscitated cardiac arrest without cocaine use. We identified 22 patients with resuscitated cardiac arrest in the setting of cocaine use. Their average age was 42 +/- 10 years,20 years younger than nonusers (68 +/- 16 years, p0.01). After cardiac arrest, 12 of 22 patients (55%) who used cocaine had complete neurologic recovery in contrast to only 3 of 20 unmatched controls (15%, p0.01) and 7 of 41 age-matched controls (17%, p0.01). Only 10 of 22 cocaine users (46%) died compared with 15 of 20 unmatched controls (75%, p = 0.05) and 32 of 41 age-matched controls (78%, p0.01). In a combined analysis of all patients, cocaine use was the only significant predictor of neurologic recovery (p0.01) and survival (p0.01). In conclusion, cocaine use is associated with cardiac arrest. In patients with cardiac arrest, cocaine users are younger than nonusers and more likely to survive with neurologic recovery, even compared with age-matched controls with cardiac arrest.

Published
2006

46. The May 18, 1998 Indian Nuclear Test Seismograms at station NIL

Author

W R Walter, A J Rodgers, N Selby, and D Bowers

Subjects
Engineering, business.industry, Implosion, Tectonics, symbols.namesake, Amplitude, Surface wave, Epicenter, symbols, Rayleigh wave, business, Seismogram, Joint (geology), Seismology
Abstract

The last underground nuclear tests were conducted by India and Pakistan in May 1998. Although the Comprehensive Test Ban Treaty has not entered force, an International Monitoring System (IMS), established by the treaty is nearing completion. This system includes 170 seismic stations, a number of them originally established by IRIS. The station IRIS station NIL (Nilore, Pakistan) is close to a planned IMS primary station and recorded some very interesting seismograms from the May 18, 1998 Indian test. We carefully calibrated the path to NIL using a prior Mw 4.4 that occurred on April 4, 1995 about 110 km north of the Indian test site. We used joint epicentral location techniques along with teleseismic P waves and regional surface waves to fix the epicenter, depth, mechanism and moment of this event. From these we obtained a velocity model for the path to NIL and created explosion synthetic seismograms to compare with the data. Interestingly the observed Rayleigh waves are reversed, consistent with an implosion rather than an explosion source. The preferred explanation is that the explosion released tectonic stress near the source region, which can be modeled as a thrust earthquake of approximate Mw 4.0 plus a pure explosion. This more » tectonic release is sufficient to completely dominate the Rayleigh waves and produce the observed signal (Walter et al. 2005). We also examined the explosion at high frequencies of 6 6-8 Hz where many studies have shown that relative P/S amplitudes can discriminate explosions from a background of earthquakes (Rodgers and Walter, 2002). Comparing with the April 4 1995 earthquake we see the classic difference of relatively large P/S values for the explosion compared to the earthquakes despite the complication of the large tectonic release during the explosion. « less

Published
2005
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47. The Diastolic Pulmonary Gradient as a Predictor of Adverse Outcomes in Patients With Acute Decompensated Heart Failure

Author

N Galie, Raymond L. Benza, M. Janmohamed, Myung H. Park, Liviu Klein, T. De Marco, Jean-Luc Vachiery, Robert P. Frantz, James C. Fang, and Van N. Selby

Subjects
Pulmonary and Respiratory Medicine, Transplantation, medicine.medical_specialty, Acute decompensated heart failure, business.industry, Adverse outcomes, Diastole, medicine.disease, Internal medicine, medicine, Cardiology, Surgery, In patient, Cardiology and Cardiovascular Medicine, business
Published
2014
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48. Acute kidney injury - Human studies

Author

L. Locsey, I. Seres, F. Sztanek, M. Harangi, J. Padra, L. Asztalos, G. Paragh, C. A. Hutchison, A. Bevins, R. Langham, E. Mancini, O. Wirta, P. Cockwell, R. Keir, M. Vigano, A. Stella, N. Evans, M. Chappell, P. Fabbrini, M. Onuigbo, N. Onuigbo, S. Kim, J. H. Chang, J. Y. Jung, H. H. Lee, W. Chung, L. Zanoli, S. Rastelli, C. Marcantoni, C. Tamburino, P. Castellino, A. Cho, H. Choi, J. E. Lee, H. R. Jang, W. Huh, Y.-G. Kim, D. J. Kim, H. Y. Oh, N. Garcia-Fernandez, P. L. Martin-Moreno, N. Varo, J. M. Nunez-Cordoba, G. Schlieper, T. Kruger, M. Kelm, J. Floege, R. Westenfeld, A. J. Cho, S. Doganay, A. K. Oguz, I. Ergun, N. Bardachenko, O. Kuryata, L. Bardachenko, P. Ravani, F. Malberti, S. Pirelli, F. Scolari, B. Barrett, P. Presta, G. Lucisano, A. Rubino, F. Serraino, T. Amoruso, A. Renzulli, G. Fuiano, J. T. Kielstein, S. Tolk, A. Heiden, C. Kuhn, M. M. Hoeper, J. Lorenzen, M. Broll, V. Kaever, H. Burhenne, C. Hafer, H. Haller, O. Burkhardt, J. Kielstein, J. Zahalkova, N. Petejova, J. Strojil, K. Urbanek, S. Bertoli, C. Musetti, A. Cabiati, E. Assanelli, G. Lauri, I. Marana, M. De Metrio, M. Rubino, J. Campodonico, M. Grazi, M. Moltrasio, G. Marenzi, Z. Unarokov, T. Mukhoedova, P. Fidalgo, S. Coelho, B. Rodrigues, A. P. Fernandes, A. L. Papoila, F. Liano, K. Soto, J. Vanmassenhove, R. Vanholder, G. Glorieux, W. Van Biesen, R. Challiner, J. Ritchie, A. Hutchison, S. I. Zaharie, D. T. Maria, M. Zaharie, C. Vaduva, C. Grauntanu, D. Cana-Ruiu, E. Mota, M. Hayer, J. Baharani, M. Thomas, T. Eldehni, N. Selby, C. McIntyre, R. Fluck, N. Kolhe, R. M. Fagugli, F. Patera, P. R. Shah, K. K. Kaswan, V. B. Kute, A. V. Vanikar, M. R. Gumber, H. V. Patel, B. C. Munjappa, D. P. Enginner, V. V. Sainaresh, H. L. Trivedi, C. Teixeira, E. Nogueira, J. A. Lopes, E. Almeida, A. Pais de Lacerda, A. Gomes da Costa, C. Franca, F. Mariano, M. Morselli, D. Bergamo, Z. Hollo', S. Scella, M. Maio, C. Tetta, A. Dellavalle, M. Stella, G. Triolo, V. Cantaluppi, A. D. Quercia, P. Bertinetto, S. Giacalone, M. Tamagnone, E. Basso, E. Karvela, M. Gai, G. Leonardi, P. Anania, C. Guarena, C. M. Fenocchio, A. Pacitti, G. P. Segoloni, Y. O. Kim, H. G. Kim, B. S. Kim, H. C. S. Song, J.-K. Min, S. Y. Kim, W. D. Park, M. Dalboni, R. Narciso, M. Quinto, C. Grabulosa, E. Cruz, J. Monte, M. Durao, M. Cendoroglo, O. Santos, M. Batista, A. Bellasi, S. Giannone, A. Mordenti, A. Zanoni, A. Santoro, J. H. Lee, S. H. Ha, J. H. Kim, G. J. Lee, Y. C. Jung, P. Malindretos, G. Koutroumbas, A. Patrinou, G. Zagkotsis, P. Makri, I. Togousidis, C. Syrganis, G. Li Cavoli, C. Tortorici, L. Bono, A. Ferrantelli, C. Giammarresi, C. Zagarrigo, U. Rotolo, H. Kim, K. Jun, W. Choi, J.-M. Krzesinski, M.-C. Parotte, C. Vandevelde, J. Keenan, F. Dieterle, S. Sultana, M. Pinches, C. Ciorciaro, R. Schindler, V. Schmitz, J.-C. Gautier, X. Benain, J. Matchem, P. Murray, S. Adler, M. Haase, A. Haase-Fielitz, P. Devarajan, R. Bellomo, D. N. Cruz, G. Wagener, C. D. Krawczeski, J. L. Koyner, P. T. Murray, M. Zappitelli, S. Goldstein, K. Makris, C. Ronco, J. Martensson, C.-R. Martling, P. Venge, E. Siew, L. B. Ware, A. Ikizler, P. R. Mertens, A. Lacquaniti, A. Buemi, V. Donato, S. Lucisano, M. Buemi, S. Panagoutsos, P. Kriki, E. Mourvati, D. Tziakas, G. Chalikias, D. Stakos, S. Apostolakis, C. Tsigalou, T. Gioka, S. Konstantinides, V. Vargemezis, I. Torregrosa, C. Montoliu, A. Urios, C. Aguado, M. J. Puchades, M. A. Solis, I. Juan, R. Sanjuan, M. Blasco, J. Pineda, A. Carratala, C. Ramos, A. Miguel, A. Niculae, I. A. Checherita, R. Sandulovici, C. David, A. Ciocalteu, M. Espinoza, J. Hidalgo, E. Lorca, A. Santibanez, F. Arancibia, F. Gonzalez, M. Y. Park, E. J. Kim, S. J. Choi, J. K. Kim, S. D. Hwang, K.-h. Lee, S.-J. Seok, J.-O. Yang, E.-Y. Lee, S.-y. Hong, H.-w. Gil, E. Astapenko, A. Shutov, G. Savinova, V. Rechnik, M. J. Melo, M. Raimundo, A. Viegas, I. Camara, F. Antunes, M.-J. Kim, S. H. Kwon, S. W. Lee, J. H. Song, and J. W. Lee

Subjects
Transplantation, Pathology, medicine.medical_specialty, Human studies, Nephrology, business.industry, Acute kidney injury, medicine, medicine.disease, business
Published
2011
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50. An antihemolytic action of pyridoxal

Author

Paul N. Selby, Thomas R. Riggs, and Halvor N. Christensen

Subjects
Lysis, Pyridoxal, Cell Death, Potassium, chemistry.chemical_element, medicine.disease, Chloride, Hemolysis, General Biochemistry, Genetics and Molecular Biology, Vitamin B 6, chemistry.chemical_compound, chemistry, Biochemistry, medicine, Tonicity, medicine.drug
Abstract

SummaryPretreatment of erythrocytes with 10 mM pyridoxal makes the cells subsequently more resistant to lysis by hypotonic solutions. Indoleacetic acid shows the same behavior to a smaller degree. These effects are attributed to a net loss of cell solutes in the form of potassium and chloride which the agents produce.

Published
1954

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