83 results on '"Setri Fugar"'
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2. Cost and outcomes of acute cardiovascular disease hospitalizations in a tertiary hospital in Ghana
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Lambert Tetteh Appiah, Samuel Blay Nguah, Priscilla Abrafi Opare-Addo, Setri Fugar, Jessey Mahama Holu, Yvonne Commodore-Mensah, Bernard C. Nkum, Charles Agyemang, and Fred Stephen Sarfo
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Cardiovascular diseases ,Heart failure ,Stroke ,Cost ,Hospitalization ,length of stay ,Medicine - Abstract
ABSTRACTBackground Cardiovascular diseases (CVDs) are on the rise in Sub-Saharan Africa. The management of these CVDs comes at an exorbitant cost to both individuals and health institutions. However, data on the economic impact of the most common CVDs in Ghana are lacking. Our objective was to describe the in-patient cost and outcomes of acute CVD admissions in a leading teaching hospital in Ghana.Methods We retrospectively reviewed hospital admissions, cost of hospitalization, length of stay, and CVD outcomes following admissions between January 2018 and December 2019.Results A total of 1975 patients with a mean age of 62.2 (±16.1) years were admitted over the study period of which 52.6% were males.The top 3 most prevalent CVDs among admitted patients were stroke(48.5%), hypertensive urgencies/emergencies(42.7%), and heart failure(29.4%). The overall case fatality rate (CFR) was 21.5% (95% CI: 19.7%−23.3%). The CFR for stroke, hypertensive urgencies/emergencies, and heart failure were 28.9%, 17.6%, and 14.1%, respectively. Median (IQR) length of stay and cost of treatment across all CVDs was 5(3–9) days and USD $195.29(137.9–288.9), respectively. The highest median cost for admission was for stroke (USD $211.19).Conclusion The average cost of CVD hospitalization is over a hundred times the daily minimum wage of the average Ghanaian. A greater emphasis on primordial and primary prevention is warranted to curtail the economic burden of CVDs in developing economies such as Ghana.
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- 2023
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3. The top 100 Twitter influencers in cardiology Running title: Cardiology influencers on Twitter
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Onoriode Kesiena, Henry K Onyeaka, Setri Fugar, Alexis K Okoh, and Annabelle Santos Volgman
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twitter ,cardiology ,influence ,h-index ,Public aspects of medicine ,RA1-1270 - Abstract
Importance: Twitter represents a growing aspect of the social media experience and is a widely used tool for public education in the 21st century. In the last few years, there has been concern about the dissemination of false health information on social media. It is therefore important that we assess the influencers of this health information in the field of cardiology. Objective: We sought to identify the top 100 Twitter influencers within cardiology, characterize them, and examine the relationship between their social media activity and academic influence. Design: Twitter topic scores for the topic search “cardiology” were queried on May 01, 2020 using the Right Relevance application programming interface (API). Based on their scores, the top 100 influencers were identified. Among the cardiologists, their academic h-indices were acquired from Scopus and these scores were compared to the Twitter topic scores. Result: We found out that 88/100 (88%) of the top 100 social media influencers on Twitter were cardiologists. Of these, 63/88 (72%) were males and they practiced mostly in the United States with 50/87 (57%) practicing primarily in an academic hospital. There was a moderately positive correlation between the h-index and the Twitter topic score, r = +0.32 (p-value 0.002). Conclusion: Our study highlights that the top ranked cardiology social media influencers on Twitter are board-certified male cardiologists practicing in academic settings in the US. The most influential on Twitter have a moderate influence in academia. Further research should evaluate the relationship between other academic indices and social media influence.
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- 2021
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4. Hyperdynamic left ventricular ejection fraction is associated with higher mortality in COVID-19 patients
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Annas Rahman, Max Ruge, Alex Hlepas, Gatha Nair, Joanne Gomez, Jeanne du Fay de Lavallaz, Setri Fugar, Nusrat Jahan, Annabelle Santos Volgman, Kim A. Williams, Anupama Rao, Karolina Marinescu, and Tisha Suboc
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Left ventricular ejection fraction ,Heart failure ,Hyperdynamic ,COVID-19 ,SARS-CoV-2 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Study objective: To compare the characteristics and outcomes of COVID-19 patients with a hyperdynamic LVEF (HDLVEF) to those with a normal or reduced LVEF. Design: Retrospective study. Setting: Rush University Medical Center. Participants: Of the 1682 adult patients hospitalized with COVID-19, 419 had a transthoracic echocardiogram (TTE) during admission and met study inclusion criteria. Interventions: Participants were divided into reduced (LVEF
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- 2022
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5. Does the 'July effect' of new trainees at teaching hospitals impact outcomes for patients hospitalized with heart failure? Real-world analyses of more than half a million US admissions
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Ahmed A. Kolkailah, Marwan S. Abougergi, Parth V. Desai, Axi Patel, Setri Fugar, Alexis K. Okoh, Ahmed Al-Ogaili, Sameer A. Hirji, Tsuyoshi Kaneko, Annabelle Santos Volgman, Rami Doukky, Justin L. Grodin, and Darren K. McGuire
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July effect ,Heart failure ,Outcomes ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Introduction: The “July effect” refers to the potential of adverse clinical outcomes related to the annual turnover of trainees. We investigated whether this impacts inpatient heart failure (HF) outcomes. Methods: Data from all adults (≥18 years) admitted with a primary diagnosis of HF at US teaching hospitals from the 2012–2014 National Inpatient Sample were analyzed. Non-teaching hospital admissions were excluded. The primary outcome was in-hospital mortality. Secondary metrics included hospital length of stay (LOS) and total cost adjusted for inflation. Logistic and linear regression models were used to adjust for confounders. Admissions were classified into 4 quarters (Q1–Q4), based on the academic calendar. Q1 and Q4 were designated to assess the effect of novice (July effect) versus experienced trainees, respectively. Results: There were 699,675 HF admissions during Q1 and Q4 in the study period. Mean age was 71 ± 15 years and 48% were females. There were 20,270 in-hospital deaths, with no difference between Q1 and Q4; crude odds ratio (OR) 1.00, 95% confidence interval (CI) 0.94–1.07, p = 0.95. After risk adjustment, there was no in-hospital mortality difference between Q1 and Q4 admissions; adjusted OR 0.96, 95% CI 0.89–1.03, p = 0.23. There was no difference in hospital LOS or total cost; 5.8 versus 5.8 days, p = 0.66 and $13,755 versus $13,586, p = 0.46, in Q1 and Q4, respectively. Conclusions: In this nationally representative sample, there was no evidence of a “July effect” on inpatient HF outcomes in the US. This suggests that HF patients should not delay seeking care during trainee transitions at teaching hospitals.
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- 2022
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6. Nutrition Intervention for Reduction of Cardiovascular Risk in African Americans Using the 2019 American College of Cardiology/American Heart Association Primary Prevention Guidelines
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Kim Allan Williams, Ibtihaj Fughhi, Setri Fugar, Monica Mazur, Sharon Gates, Stephen Sawyer, Hena Patel, Darrius Chambers, Ronald McDaniel, Jochen R. Reiser, and Terry Mason
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African Americans ,cardiovascular risk ,nutrition intervention ,plant-based diet ,vegan diet ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Introduction: The 2019 American College of Cardiology/American Heart Association (ACC/AHA) Prevention Guidelines emphasize reduction in dietary sodium, cholesterol, refined carbohydrates, saturated fat and sweetened beverages. We hypothesized that implementing this dietary pattern could reduce cardiovascular risk in a cohort of volunteers in an urban African American (AA) community church, during a 5-week ACC/AHA-styled nutrition intervention, assessed by measuring risk markers and adherence, called HEART-LENS (Helping Everyone Assess Risk Today Lenten Nutrition Study). Methods: The study population consisted of 53 volunteers who committed to eat only home-delivered non-dairy vegetarian meals (average daily calories 1155, sodium 1285 mg, cholesterol 0 mg; 58% carbohydrate, 17% protein, 25% fat). Body mass index (BMI) and fasting serum markers of cardiometabolic and risk factors were measured, with collection of any dietary deviation. Results: Of 53 volunteers, 44 (mean age 60.2 years, 37 women) completed the trial (88%); 1 was intolerant of the meals, 1 completed both blood draws but did not eat delivered food, and 7 did not return for the tests. Adherence to the diet was reported at 93% in the remaining 44. Cardiometabolic risk factors improved significantly, highlighted by a marked reduction in serum insulin (−43%, p = 0.000), hemoglobin A1c (6.2% to 6.0%, p = 0.000), weight and BMI (−10.2 lbs, 33 to 31 kg/m2, p = 0.000), but with small reductions of fasting glucose (−6%, p = 0.405) and triglyceride levels (−4%, p = 0.408). Additionally, improved were trimethylamine-N-oxide (5.1 to 2.9 µmol/L, −43%, p = 0.001), small dense low-density lipoprotein cholesterol (LDL) (24.2 to 19.1 mg/dL, −21%, p = 0.000), LDL (121 to 104 mg/dL, −14%, p = 0.000), total cholesterol (TC) (190 to 168 mg/dL, −12%, p = 0.000), and lipoprotein (a) (LP(a)) (56 to 51 mg/dL, −11%, p = 0.000); high sensitivity C-reactive protein (hs-CRP) was widely variable but reduced by 16% (2.5 to 2.1 ng/mL, p = NS) in 40 subjects without inflammatory conditions. Soluble urokinase plasminogen activator (suPAR) levels were not significantly changed. The ACC/AHA pooled cohort atherosclerotic cardiovascular disease (ASCVD) risk scores were calculated for 41 and 36 volunteers, respectively, as the ASCVD risk could not be calculated for 3 subjects with low lipid fractions at baseline and 8 subjects after intervention (p = 0.184). In the remaining subjects, the mean 10-year risk was reduced from 10.8 to 8.7%, a 19.4% decrease (p = 0.006), primarily due to a 14% decrease in low-density lipoprotein cholesterol and a 10 mm Hg (6%) reduction in systolic blood pressure. Conclusions: In this prospective 5-week non-dairy vegetarian nutrition intervention with good adherence consistent with the 2019 ACC/AHA Guidelines in an at-risk AA population, markers of cardiovascular risk, cardiometabolism, and body weight were significantly reduced, including obesity, low-density lipoprotein cholesterol (LDLc) density, LP(a), inflammation, and ingestion of substrates mediating production of trimethylamine-N-oxide (TMAO). Albeit reduced, hs-CRP and suPAR, were not lowered consistently. This induced a significant decrease in the 10-year ASCVD risk in this AA cohort. If widely adopted, this could dramatically reduce and possibly eradicate, the racial disparity in ASCVD events and mortality, if 19% of the 21% increase is eliminated by this lifestyle change.
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- 2021
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7. Congenital Absence of Left Circumflex Artery: A Case Report and Review of the Literature
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Setri Fugar, Lydia Issac, Alexis Kofi Okoh, Christelle Chedrawy, Nadia El Hangouche, and Neha Yadav
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Congenital absence of the left circumflex artery is a rare coronary anomaly with few reported cases in the literature. These patients are usually diagnosed incidentally when they undergo coronary angiography or coronary CT to rule out underlying coronary artery disease. In this article, we report a case of a 46-year-old man who was incidentally found to have a congenitally absent left circumflex artery with a superdominant right coronary artery after a workup was initiated for frequent premature ventricular contractions and regional wall motion on echocardiogram. A review of the clinical presentation, symptoms, and diagnostic modalities used to diagnose this entity is presented.
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- 2017
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8. Acute Heart Failure Exacerbation with Cardiogenic Shock and Elevated Systemic Vascular Resistance Treated with a Combination of Nicardipine and Dobutamine Therapy
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Lydia E. Issac, Setri Fugar, Naser Yamani, and Burhan Mohamedali
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Acute heart failure is a common reason for hospital admission and is usually caused by decreased cardiac output either as a result of an intrinsic cardiac issue or as a result of severe hypertension with elevated afterload. We present a patient with a history of HFrEF who presented with acute heart failure, found to have hypotension requiring Dobutamine support and an elevated systemic vascular resistance requiring Nicardipine drip, with subsequent recovery of cardiac function.
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- 2017
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9. Patient perceptions about laparoscopy at Komfo Anokye Teaching Hospital, Ghana
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Adam Gyedu, Setri Fugar, Raymond Price, and Juliane Bingener
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patient perception ,laparoscopy ,ghana ,Medicine - Abstract
Introduction: laparoscopy has become the gold standard for many surgical cases in the developed world. It however, remains a rarity in developing countries for several reasons, a major one being cost. This study aimed to determine the knowledge and attitude of patients attending Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana toward laparoscopic surgery and their willingness to pay for .Methods: a cross-sectional survey was conducted among patients attending specialist clinics at KATH.Results: 1070 patients participated. Mean age was 40,15years. 54% were city-dwellers. 14% had salary-paying jobs. None had undergone prior laparoscopic surgery. 3% had knowledge of laparoscopy. 95% preferred laparoscopy to open surgery mainly because of faster recovery and less post-op pain. Age =45years (AOR=0.53,p=0.03) and higher education (AOR=2.00,p=0.04) were significant predictors of patient choice. Among those preferring laparoscopy, 78% were willing to pay more than the baseline cost of open surgery for laparoscopy. A history of previous abdominal surgery (AOR=0.67,p=0.02), having a salaried job compared with being unemployed (AOR=2.36,p=0.01) and living in the city compared with the village (AOR=1.78,p=0.04) were significant predictors of patients' willingness to pay more for laparoscopy.Conclusion: knowledge about laparoscopy and its benefits are severely lacking among patients at KATH. Once educated about its benefits, most people prefer laparoscopy even if they needed to pay more for it even in resource-limited countries like Ghana.
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- 2015
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10. Derivation and validation of the bridge to transplantation with left ventricular assist device score for 1 year mortality after heart transplantation. The BTT-LVAD score
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Alexis K Okoh, Setri Fugar, Sheriff Dodoo, Mariam Selevany, Nawar Al-Obaidi, Ebru Ozturk, Swaiman Singh, Rajiv Tayal, Leonard Y Lee, Mark J Russo, and Margarita Camacho
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Heart Failure ,Biomaterials ,Treatment Outcome ,Risk Factors ,Biomedical Engineering ,Heart Transplantation ,Humans ,Medicine (miscellaneous) ,Bioengineering ,Heart-Assist Devices ,General Medicine ,Article ,Retrospective Studies - Abstract
Background: To derive and validate a risk score that accurately predicts 1-year mortality after heart transplantation (HT) in patients bridged to transplant (BTT) with a left ventricular assist device (LVAD). Methods: The UNOS database was queried to identify patients BTT with an LVAD between 2008 and 2018. Patients with ⩾1-year follow up were randomly divided into derivation (70%) and validation (30%) cohorts. The primary endpoint was 1-year mortality. A simple additive risk score was developed based on the odds of 1-year mortality after HT. Risk groups were created, and survival was estimated and compared. Results: A total of 7759 patients were randomly assigned to derivation ( n = 5431) and validation ( n = 2328) cohorts. One-year post-transplant mortality was 9.8% ( n = 760). A 33-point scoring was created from six recipient variables and two donor variables. Risk groups were classified as low (0–5), intermediate (6–10), and high (>10). In the validation cohort, the predicted 1-year mortality was significantly higher in the high-risk group than the intermediate and low-risk groups, 14.7% versus 9% versus 6.1% respectively (log-rank test: p Conclusion: The BTT-LVAD Score can serve as a clinical decision tool to guide therapeutic decisions in advanced heart failure patients.
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- 2022
11. Timing of Nonurgent Transesophageal Echocardiography and The Risk of Embolic Events Among Patients Admitted With Infective Endocarditis. A Review of the National Inpatient Sample
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Dennis Danso Kumi, Edwin Gwira-Tamattey, Sadichhya Karki, Elikplim Akaho, Nana Yaa Ampaw, Ayesha Abbasi, Joshua Tetteh Narh, Setri Fugar, and Jonathan Tottleben
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General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
12. Does the 'July effect' of new trainees at teaching hospitals impact outcomes for patients hospitalized with heart failure? Real-world analyses of more than half a million US admissions
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Setri Fugar, Justin L. Grodin, Darren K. McGuire, Parth V Desai, Annabelle Santos Volgman, Sameer A. Hirji, Ahmed A Kolkailah, Axi Patel, Alexis K. Okoh, Rami Doukky, Marwan S. Abougergi, Tsuyoshi Kaneko, and Ahmed Al-Ogaili
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July effect ,medicine.medical_specialty ,business.industry ,Confounding ,General Medicine ,Odds ratio ,Risk adjustment ,Annual turnover ,medicine.disease ,Confidence interval ,Primary outcome ,Heart failure ,Emergency medicine ,Medicine ,business - Abstract
Introduction The “July effect” refers to the potential of adverse clinical outcomes related to the annual turnover of trainees. We investigated whether this impacts inpatient heart failure (HF) outcomes. Methods Data from all adults (≥18 years) admitted with a primary diagnosis of HF at US teaching hospitals from the 2012–2014 National Inpatient Sample were analyzed. Non-teaching hospital admissions were excluded. The primary outcome was in-hospital mortality. Secondary metrics included hospital length of stay (LOS) and total cost adjusted for inflation. Logistic and linear regression models were used to adjust for confounders. Admissions were classified into 4 quarters (Q1–Q4), based on the academic calendar. Q1 and Q4 were designated to assess the effect of novice (July effect) versus experienced trainees, respectively. Results There were 699,675 HF admissions during Q1 and Q4 in the study period. Mean age was 71 ± 15 years and 48% were females. There were 20,270 in-hospital deaths, with no difference between Q1 and Q4; crude odds ratio (OR) 1.00, 95% confidence interval (CI) 0.94–1.07, p = 0.95. After risk adjustment, there was no in-hospital mortality difference between Q1 and Q4 admissions; adjusted OR 0.96, 95% CI 0.89–1.03, p = 0.23. There was no difference in hospital LOS or total cost; 5.8 versus 5.8 days, p = 0.66 and $13,755 versus $13,586, p = 0.46, in Q1 and Q4, respectively. Conclusions In this nationally representative sample, there was no evidence of a “July effect” on inpatient HF outcomes. This suggests that HF patients should not delay seeking care during trainee transitions at teaching hospitals.
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- 2022
13. Health and Healthcare Disparities: Impact on Resource Utilization and Costs After Transcatheter Aortic Valve Replacement
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John Kassotis, Setri Fugar, Nehal Dhaduk, Leonard Y. Lee, Justin Gold, Mark J. Russo, Alexis K Okoh, Chunguang Chen, and Aakash Shah
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,Transcatheter aortic ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Medicare ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Risk Factors ,Health care ,medicine ,Humans ,Hospital Mortality ,Healthcare Disparities ,Intensive care medicine ,Aged ,Retrospective Studies ,business.industry ,Aortic Valve Stenosis ,General Medicine ,medicine.disease ,United States ,Stenosis ,Treatment Outcome ,030228 respiratory system ,Aortic Valve ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Resource utilization - Abstract
Objective We investigated health and healthcare disparities in the treatment of aortic stenosis with transcatheter aortic valve replacement (TAVR) and how they affect resource utilization and costs. Methods We retrospectively reviewed all patients who were discharged alive after TAVR between 2012 and 2017 from the National Inpatient Sample. Patients were stratified by race and outcomes investigated were in-hospital complications, total procedural costs, and resource utilization. High resource utilization (HRU) was defined as length of stay (LOS) ≥7 days or discharge to a nonhome location. Multivariable regression models were used to identify predictors of HRU. Results TAVR patients ( N = 29,464) were stratified into Caucasians ( n = 25,691), others ( n = 1,274), Hispanics ( n = 1,267), and African Americans (AA, n = 1,232). More AA and Hispanics had TAVR at urban teaching centers ( P = 0.003) and were less likely to be Medicare beneficiaries ( P < 0.001). Distribution of TAVR patients in the lowest income quartile showed AA (50%) versus Caucasian (20%) versus Hispanic (33%, P < 0.001). In-hospital complications were higher among Hispanics and AA than Caucasians with prolonged LOS, procedural costs, and HRU. On multivariable analysis, independent predictors of HRU were TAVR year ( P < 0.001), advanced age ( P < 0.001), female sex ( P < 0.001), non-Caucasian race ( P = 0.038), history of coronary artery bypass grafting ( P < 0.001), smoking ( P < 0.001), chronic lung disease ( P = 0.003), stroke ( P < 0.001), and lowest income quartile ( P = 0.002). Conclusions There exist significant healthcare and health disparities among patients undergoing TAVR in the United States. Consequently, this unequal access to care and determinants of heath translate into higher resource utilization and costs.
- Published
- 2021
14. The top 100 Twitter influencers in cardiology
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Annabelle Santos Volgman, Setri Fugar, Alexis K. Okoh, Onoriode Kesiena, and Henry K. Onyeaka
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influence ,medicine.medical_specialty ,Brief Report ,Twitter ,Scopus ,General Medicine ,Positive correlation ,Influencer marketing ,cardiology ,Internal medicine ,Cardiology ,medicine ,Relevance (information retrieval) ,Social media ,Health information ,h-index ,Psychology ,Public education - Abstract
Importance Twitter represents a growing aspect of the social media experience and is a widely used tool for public education in the 21st century. In the last few years, there has been concern about the dissemination of false health information on social media. It is therefore important that we assess the influencers of this health information in the field of cardiology. Objective We sought to identify the top 100 Twitter influencers within cardiology, characterize them, and examine the relationship between their social media activity and academic influence. Design Twitter topic scores for the topic search “cardiology” were queried on May 01, 2020 using the Right Relevance application programming interface (API). Based on their scores, the top 100 influencers were identified. Among the cardiologists, their academic h-indices were acquired from Scopus and these scores were compared to the Twitter topic scores. Result We found out that 88/100 (88%) of the top 100 social media influencers on Twitter were cardiologists. Of these, 63/88 (72%) were males and they practiced mostly in the United States with 50/87 (57%) practicing primarily in an academic hospital. There was a moderately positive correlation between the h-index and the Twitter topic score, r = +0.32 (p-value 0.002). Conclusion Our study highlights that the top ranked cardiology social media influencers on Twitter are board-certified male cardiologists practicing in academic settings in the US. The most influential on Twitter have a moderate influence in academia. Further research should evaluate the relationship between other academic indices and social media influence.
- Published
- 2021
15. Factors associated with bleeding events in patients on rivaroxaban for non-valvular atrial fibrillation: A real-world experience
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Andrea Torres, Yasmeen Golzar, Juan Del Cid Fratti, Hashim Mann, Tauseef Akhtar, Setri Fugar, Chineme Nwaichi, Alok Uprety, and Jishanth Mattumpuram
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Male ,medicine.medical_specialty ,Gastrointestinal bleeding ,Hemorrhage ,030204 cardiovascular system & hematology ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Rivaroxaban ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,Outpatient pharmacy ,Aged ,Retrospective Studies ,Aspirin ,business.industry ,Anticoagulants ,Atrial fibrillation ,Retrospective cohort study ,Odds ratio ,Middle Aged ,medicine.disease ,Stroke ,Female ,Warfarin ,Cardiology and Cardiovascular Medicine ,business ,Factor Xa Inhibitors ,medicine.drug - Abstract
Background Rivaroxaban is a direct oral anticoagulant (DOAC) approved for the treatment of non-valvular atrial fibrillation (NVAF). Data related to the risk factors associated with rivaroxaban-induced bleeding in patients with NVAF remain scarce in the community setting. We sought to investigate these bleeding risk factors in a racially diverse patient population. Methods We conducted a single-center, retrospective study based on a chart review of patients who received rivaroxaban from our outpatient pharmacy from January 2015 to April 2018 for NVAF. Any reported bleeding event (BE) was recorded as either major or minor bleeding event. Demographic and clinical data were collected and analyzed. Results Of the 327 patients included in our analysis, 105 (32%) were female, and the mean age was 62 ± 12 years. Among the included patients, 176 (54%) patients were black, 71 (22%) were white, 51 (15.6%) were Hispanic, 13 (4%) were Asian, and 15 (4.6%) belonged to other races. 89 (27.2%) of the patients had co-prescription of aspirin. A total of 24 (7.3%) patients developed BE, out of which 9 (2.7%) patients had a major BE, and 15 (4.5%) patients had minor BE. Non-fatal gastrointestinal bleeding and epistaxis were the most common type of BE. On multivariable analysis, concurrent aspirin use (81 to 325 mg) (P = 0.03; odds ratio (OR) 2.60 [1.08–6.28]) and increasing age (P = 0.00; OR 1.06 [1.01–1.11]) were independent predictors of BE. Conclusion In community practice, aspirin co-prescription is common among NVAF patients prescribed rivaroxaban. Increasing age and concurrent aspirin use are independent predictors of BE.
- Published
- 2020
16. Effect of intensive and standard blood pressure control on cardiovascular outcomes based on body mass index: sub-analysis of the sprint trial
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Edwin Okyne, Setri Fugar, Ahmed A Kolkailah, Kim A. Williams, Christopher Dodoo, Alfred Solomon, Ebru Öztürk, Nana Ama Afari Yeboah, Annabelle Santos Volgman, Tania Campagnoli, and Alexis K. Okoh
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Blood pressure control ,medicine.medical_specialty ,business.industry ,MEDLINE ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Blood pressure ,Sprint ,Internal Medicine ,Physical therapy ,medicine ,Clinical endpoint ,030212 general & internal medicine ,Intervention trial ,business ,human activities ,Body mass index ,Cardiovascular outcomes - Abstract
The present study is a sub-analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) that aimed to evaluate the role of intensive vs. standard hypertensive treatment on cardiovascular outcomes according to the body mass indices of trial participants. SPRINT participants were categorized according to their baseline BMI values into normal (BMI ≥ 18.5 to 0.05). In this sub-analysis of the SPRINT trial, intensive blood pressure control had a beneficial effect in reducing the primary endpoint and all-cause mortality irrespective of the participants’ BMI.
- Published
- 2020
17. Invasive and Doppler Transvalvular gradients after transcatheter aortic valve replacement
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Setri Fugar, Christina Anderson, J White, R Geroux, K Deka, M Al-Amoodi, C Lama Von Buchwald, and Clifford J. Kavinsky
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symbols.namesake ,medicine.medical_specialty ,Transcatheter aortic ,Valve replacement ,business.industry ,Internal medicine ,medicine.medical_treatment ,symbols ,Cardiology ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Doppler effect - Abstract
Background Differences in mean gradients after Transcatheter valve replacement (TAVR) vary depending on the valve type and the modality used to measure the gradients. Currently there is a paucity of data on the relationship between invasive and doppler derived gradients after TAVR. Purpose We sort to assess the difference in doppler, and catheter derived aortic valve gradients after TAVR Methods This is a single center retrospective study using consecutive patients who presented for TAVR on account of native aortic valve stenosis at our institution from May 2012 till December 2020. Patients with both intraoperative invasive and postoperative doppler derived pressure gradients were included in the analysis. Student T-test were used to compare mean gradients. Pearson's correlation test was used to examine the correlation between measured gradients. Results A total of 587 patients were included in our study. Fifty one percent were male and 462 (78.7%) underwent TAVR with a balloon expandable valve. In the entire cohort the mean gradient measured invasively was significantly lower than those measured by echo doppler (4.48±3.25 vs. 5.57±3.11, P Conclusion Post TAVR gradients were all significantly lower when measured invasively as compared to those measured using doppler. Self-expanding valves overall had higher residual gradients. Further studies are needed to assess the correlations between invasively measured gradients and clinical outcomes post TAVR. Funding Acknowledgement Type of funding sources: None.
- Published
- 2021
18. Cardiac arrest in patients hospitalized for COVID-19: a tertiary medical center retrospective cohort study
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Tisha Suboc, Joanne Michelle D. Gomez, S Luo, Jeremiah Wasserlauf, L Golemi, Setri Fugar, Kim A. Williams, C J Chiang, J. A. Simmons, Annabelle Santos Volgman, and J M Du-Fay-De-Lavallaz
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medicine.medical_specialty ,Epidemiology, Prognosis, Outcome ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Emergency medicine ,Medicine ,AcademicSubjects/MED00200 ,Retrospective cohort study ,In patient ,Center (algebra and category theory) ,Cardiology and Cardiovascular Medicine ,business ,Abstract Supplement - Abstract
Background/Introduction Patients with COVID-19 are at increased risk for mortality during hospitalization. Better definition of the incidence, predictors, and outcomes of cardiac arrest during hospitalization for COVID-19 may support early identification and intervention. Purpose To estimate the incidence of in-hospital cardiac arrest in patients with COVID-19, describe the temporal trends in incidence of and survival after cardiac arrest, summarise characteristics of those who experienced a cardiac arrest, and compare the characteristics of survivors versus non-survivors of cardiac arrest. Methods We conducted a retrospective cohort study of patients admitted for COVID-19 to a tertiary medical center comprising three hospitals between March and November 2020. Data entry is ongoing for more than 2000 patients admitted through 2021. Clinical variables extracted via review of electronic medical records included age, sex, race/ethnicity, body mass index, history of cardiovascular disease (ie., coronary artery disease, congestive heart failure, atrial fibrillation, or cerebrovascular event), other comorbidities included in the Charlson comorbidity index, date of admission, duration of hospitalization, all cardiac arrest events during hospitalization, presenting rhythm during first cardiac arrest, and death. Data were described using summary statistics. Multivariable logistic regression was used to evaluate associations. Results Among 1666 patients, 107 (6.4%) experienced at least one in-hospital cardiac arrest event during hospitalization for COVID-19, of which 25 (23%) survived to hospital discharge. From March to October 2020, there was a decrease in estimated cardiac arrest incidence in-hospital from 8.2% to 3%, whereas estimated survival to hospital discharge after an arrest remained similar at approximately 20% (Figure). Compared to those who did not, patients who experienced in-hospital cardiac arrest were older and more likely to have existing cardiovascular disease, as well as other comorbidities. Similar factors were associated with lower chance of survival after cardiac arrest (Table). Patients with pulseless ventricular tachycardia/fibrillation (VT/VF) as presenting rhythm in cardiac arrest had better survival to hospital discharge compared to those with other rhythms (OR 3.3, p=0.02). Younger age (per 10 years, OR=0.7, p=0.03) and fewer comorbidities (per one fewer comorbidity, OR=1.5, p=0.05) were associated with better survival after cardiac arrest in multivariable logistic regression. Conclusion There was a decline in estimated incidence of cardiac arrest during hospitalization for COVID-19 since beginning of pandemic, with survival to hospital discharge after cardiac arrest estimated to be stable at around 20%. Younger age and fewer comorbidities especially cardiovascular disease were associated with better survival after an in-hospital cardiac arrest. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Rush University Medical Center Figure 1Table 1
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- 2021
19. Soluble urokinase-type plasminogen activator receptor (suPAR) is associated with risk for thromboembolic complications and mortality in patients with COVID-19
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Annabelle Santos Volgman, Tisha Suboc, Salim S. Hayek, Joanne Michelle D. Gomez, Jochen Reiser, S Luo, A M Zemke, Kim A. Williams, J M Du-Fay-De-Lavallaz, J. A. Simmons, Beata Samelko, and Setri Fugar
- Subjects
Urokinase ,medicine.medical_specialty ,Kidney ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Gastroenterology ,medicine.anatomical_structure ,SuPAR ,Internal medicine ,Hospital admission ,medicine ,In patient ,Cardiology and Cardiovascular Medicine ,Receptor ,business ,Plasminogen activator ,medicine.drug - Abstract
Background/Introduction The high prevalence of thromboembolism in patients with COVID-19 causes significant morbidity and mortality. The soluble urokinase-type plasminogen activator receptor (suPAR), a known inflammatory and immune mediator in several renal and cardiovascular conditions, has recently been shown to correlate with acute kidney injury and severe respiratory failure in COVID-19. To date, no study has investigated the association between suPAR and thromboembolism in COVID-19. Purpose To evaluate associations between suPAR, thromboembolic complications, and mortality in COVID-19. Methods We conducted a retrospective cohort study of a random sample of 109 patients among those hospitalised at a tertiary medical centre comprising three hospitals between March and June 2020 for COVID-19 who had blood samples collected and stored on admission. Serum suPAR was measured using a commercially available enzyme immunoassay. Baseline (hospital admission) variables extracted from electronic medical records included age, sex, race/ethnicity, body mass index (BMI), history of cardiovascular disease (including deep venous thrombosis [DVT] and pulmonary embolism [PE]), serum creatinine, serum D-dimer, incident DVT/PE, and death during hospitalization. Patients were subsequently grouped by suPAR quartiles. Associations between suPAR, thromboembolic complications (PE and/or DVT), and overall mortality were evaluated using multivariable logistic regression. Results Among the 109 patients, mean age was 56 (standard deviation [SD], 16) years, 34 (39%) were women, mean BMI was 35 (SD, 8) kg/m2, 78 (71%) had coexisting cardiovascular disease, median creatinine level was 1.2 (interquartile range [IQR]: 0.8–2.3) mg/dl, median D-dimer level was 1.5 (IQR, 0.8–6.4) μg/ml, and median suPAR level was 10.1 (IQR: 4.1–14.4) pg/mL. Seven (6%) patients were found to have PE, 18 (17%) developed PE/DVT, and 22 (20%) died during the admission (Table). Per quartile higher suPAR level, there was higher risk for PE or DVT (OR=2.02, 95% CI 1.07–3.83, p=0.03). Compared to those in the lowest suPAR quartile, patients in the highest quartile had 11.1 times higher risk for PE/DVT (OR=11.1, 95% CI 1.51–81.8, p=0.02, Figure). SuPAR is also associated with overall mortality, with 2.25 times higher risk of death seen per quartile increase in suPAR level (OR= 2.25, 95% CI 1.24–4.06, p=0.007). Conclusion Higher suPAR levels at the time of hospital admission is associated with higher risk for thromboembolic complications i.e., PE and DVT, as well as mortality in patients with COVID-19. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Rush University Medical Center
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- 2021
20. Nutrition Intervention for Reduction of Cardiovascular Risk in African Americans Using the 2019 American College of Cardiology/American Heart Association Primary Prevention Guidelines
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Jochen Reiser, Hena Patel, Kim A. Williams, Monica Mazur, Ibtihaj Fughhi, Setri Fugar, Sharon Gates, Darrius Chambers, Ronald McDaniel, Stephen Sawyer, and Terry Mason
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cardiovascular risk ,Male ,medicine.medical_specialty ,Saturated fat ,Population ,Guidelines as Topic ,Article ,chemistry.chemical_compound ,Eating ,Internal medicine ,Early Medical Intervention ,medicine ,Early Intervention, Educational ,Humans ,TX341-641 ,education ,Aged ,African Americans ,education.field_of_study ,Nutrition and Dietetics ,Triglyceride ,Cholesterol ,business.industry ,Nutrition. Foods and food supply ,Vegetarian nutrition ,vegan diet ,Middle Aged ,medicine.disease ,Obesity ,United States ,nutrition intervention ,Diet ,Black or African American ,Primary Prevention ,chemistry ,plant-based diet ,Cardiovascular Diseases ,Heart Disease Risk Factors ,Cardiology ,Female ,business ,Body mass index ,Biomarkers ,Food Science ,Blood drawing - Abstract
Introduction: The 2019 American College of Cardiology/American Heart Association (ACC/AHA) Prevention Guidelines emphasize reduction in dietary sodium, cholesterol, refined carbohydrates, saturated fat and sweetened beverages. We hypothesized that implementing this dietary pattern could reduce cardiovascular risk in a cohort of volunteers in an urban African American (AA) community church, during a 5-week ACC/AHA-styled nutrition intervention, assessed by measuring risk markers and adherence, called HEART-LENS (Helping Everyone Assess Risk Today Lenten Nutrition Study). Methods: The study population consisted of 53 volunteers who committed to eat only home-delivered non-dairy vegetarian meals (average daily calories 1155, sodium 1285 mg, cholesterol 0 mg, 58% carbohydrate, 17% protein, 25% fat). Body mass index (BMI) and fasting serum markers of cardiometabolic and risk factors were measured, with collection of any dietary deviation. Results: Of 53 volunteers, 44 (mean age 60.2 years, 37 women) completed the trial (88%), 1 was intolerant of the meals, 1 completed both blood draws but did not eat delivered food, and 7 did not return for the tests. Adherence to the diet was reported at 93% in the remaining 44. Cardiometabolic risk factors improved significantly, highlighted by a marked reduction in serum insulin (−43%, p = 0.000), hemoglobin A1c (6.2% to 6.0%, p = 0.000), weight and BMI (−10.2 lbs, 33 to 31 kg/m2, p = 0.000), but with small reductions of fasting glucose (−6%, p = 0.405) and triglyceride levels (−4%, p = 0.408). Additionally, improved were trimethylamine-N-oxide (5.1 to 2.9 µmol/L, −43%, p = 0.001), small dense low-density lipoprotein cholesterol (LDL) (24.2 to 19.1 mg/dL, −21%, p = 0.000), LDL (121 to 104 mg/dL, −14%, p = 0.000), total cholesterol (TC) (190 to 168 mg/dL, −12%, p = 0.000), and lipoprotein (a) (LP(a)) (56 to 51 mg/dL, −11%, p = 0.000), high sensitivity C-reactive protein (hs-CRP) was widely variable but reduced by 16% (2.5 to 2.1 ng/mL, p = NS) in 40 subjects without inflammatory conditions. Soluble urokinase plasminogen activator (suPAR) levels were not significantly changed. The ACC/AHA pooled cohort atherosclerotic cardiovascular disease (ASCVD) risk scores were calculated for 41 and 36 volunteers, respectively, as the ASCVD risk could not be calculated for 3 subjects with low lipid fractions at baseline and 8 subjects after intervention (p = 0.184). In the remaining subjects, the mean 10-year risk was reduced from 10.8 to 8.7%, a 19.4% decrease (p = 0.006), primarily due to a 14% decrease in low-density lipoprotein cholesterol and a 10 mm Hg (6%) reduction in systolic blood pressure. Conclusions: In this prospective 5-week non-dairy vegetarian nutrition intervention with good adherence consistent with the 2019 ACC/AHA Guidelines in an at-risk AA population, markers of cardiovascular risk, cardiometabolism, and body weight were significantly reduced, including obesity, low-density lipoprotein cholesterol (LDLc) density, LP(a), inflammation, and ingestion of substrates mediating production of trimethylamine-N-oxide (TMAO). Albeit reduced, hs-CRP and suPAR, were not lowered consistently. This induced a significant decrease in the 10-year ASCVD risk in this AA cohort. If widely adopted, this could dramatically reduce and possibly eradicate, the racial disparity in ASCVD events and mortality, if 19% of the 21% increase is eliminated by this lifestyle change.
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- 2021
21. Statins and Incidence of Contrast-Induced Acute Kidney Injury Following Coronary Angiography - Five Year Experience at a Tertiary Care Center
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Jayakumar Sreenivasan, Heyi Li, Setri Fugar, Muhammad Shahzeb Khan, Morgan Tarbutton, Axi Patel, Neha Yadav, Min Zhuo, and Sisir Siddamsetti
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Male ,medicine.medical_specialty ,Acute coronary syndrome ,Time Factors ,Statin ,medicine.drug_class ,medicine.medical_treatment ,Contrast Media ,Renal function ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Risk Assessment ,Tertiary Care Centers ,03 medical and health sciences ,chemistry.chemical_compound ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Acute Coronary Syndrome ,Aged ,Retrospective Studies ,Creatinine ,business.industry ,Incidence ,Incidence (epidemiology) ,Percutaneous coronary intervention ,General Medicine ,Odds ratio ,Acute Kidney Injury ,Middle Aged ,Protective Factors ,medicine.disease ,chemistry ,Conventional PCI ,Cardiology ,Female ,Illinois ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Role of statins in prevention of contrast-induced acute kidney injury (CI-AKI) in patients undergoing coronary angiography remains controversial. We studied the use of statins in decreasing CI-AKI following coronary angiography. Methods We reviewed all patients who underwent coronary angiography with or without PCI and had a follow-up creatinine from January 2012 to December 2016 at a single tertiary care center in the United States. CI-AKI was defined as 0.3 mg/dL absolute rise in creatinine. Patients who were on moderate to high-intensity statins or received moderate to high-intensity statins prior to coronary angiography were included in the statin group. Crude and adjusted odds ratios (AOR) were calculated using univariate multiple logistic regression analysis. Results Out of 2055 patients (females = 30.7%, mean age 58.0 ± 12.5 years, statin group = 886, non-statin group = 1169), 293 (14.3%) developed CI-AKI. Mean estimated glomerular filtration rate (eGFR) was not significantly different between the statin and the non-statin group (86.5 mL/min/1.73 m 2 vs 87.1 mL/min/1.73 m 2 , p = 0.65). There was no significant difference in the incidence of CI-AKI between statin and non-statin group (14.4% vs 14.1%, p = 0.83). When adjusted for other risk factors, statin use was not significantly associated with decreased risk of CI-AKI (AOR) = 0.8, [95% confidence interval (CI) = 0.6–1.1, p = 0.19]. Results remained statistically non-significant on subgroup analysis of patients with acute coronary syndrome (ACS) (OR = 0.8, 95% CI = 0.6–1.2, p = 0.27), patients who had percutaneous coronary intervention (PCI) (OR = 1.1, 95% CI = 0.6–1.7, p = 0.81) and patients with eGFR 2 (OR = 0.9, 95% CI = 0.6–1.5, p = 0.9). Conclusion Statin use prior to coronary angiography is not associated with decreased incidence of CI-AKI.
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- 2019
22. Effect of Transcatheter Aortic Valve Implantation on Renal Function in Patients With Previous Renal Dysfunction
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Amer Hawatmeh, Kamrani Kambiz, Dileep Unnikrishnan, Alexis K. Okoh, Marc Cohen, Setri Fugar, Bruce Haik, Mohammad Thawabi, Christoph Sossou, Mark J. Russo, and Chunguang Chen
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Male ,medicine.medical_specialty ,Transcatheter aortic ,Renal function ,030204 cardiovascular system & hematology ,Logistic regression ,Cohort Studies ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Renal Insufficiency ,030212 general & internal medicine ,Aged ,Aged, 80 and over ,Ejection fraction ,business.industry ,Incidence ,Incidence (epidemiology) ,Stroke Volume ,Aortic Valve Stenosis ,Stroke volume ,medicine.disease ,Logistic Models ,Treatment Outcome ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Glomerular Filtration Rate ,Cohort study - Abstract
The study aims to investigate the incidence of immediate renal function improvement in renal dysfunction patients who had transcatheter aortic valve implantation (TAVI). TAVI patients with ≥ moderate reduced renal function [estimated GFR ≤ 60 ml/min/1.73 m2] at baseline were identified from a prospectively maintained database. Patients were divided into 3 groups based on percent change [(discharge eGFR − baseline eGFR/baseline GFR) × 100] in eGFR post-TAVR. Improvement ≥ 10%, no change, Decline ≥ 10%. Multivariable logistic regression was performed to identify factors that predicted improvement/decline in GFR postprocedure. Out of 677 patients, 359 (53%) had eGFR ≤ 60 ml/min/1.73 m2. Of these, 188 (52%) had an improvement in eGFR ≥ 10%, 125 (34%) had no change and 48 (14%) observed decline ≥ 10%. All groups had similar proportions of females and age was comparable in patient groups. Patients in whom a decline in eGFR was observed had significantly higher Society of thoracic Surgeons scores (10.7 vs 8.2 vs 8.2; p = 0.007) and incidence of liver disease (6% vs, 0% vs 2%; p = 0.014) than the no-change or improved groups respectively. On multivariable analysis, independent predictors of decline/improvement in eGFR were being female, low left ventricular ejection fraction and baseline liver dysfunction. In conclusion, over half of patients with compromised renal function who underwent TAVI experience an immediate improvement in kidney function post-TAVI. Being female, baseline liver dysfunction and a low left ventricular ejection fraction is associated with an immediate decline in eGFR.
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- 2019
23. Impact of Baseline Mitral Regurgitation on Postoperative Outcomes After Left Ventricular Assist Device Implantation as Destination Therapy
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Olivia Chan, R. Yanagida, S. Chaudari, Ravi Karanam, M. Schultheis, Margarita Camacho, Alexis K. Okoh, Mark J. Russo, Mark J. Zucker, Setri Fugar, and Christopher Nnaoma
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Pulmonary disease ,Regurgitation (circulation) ,Internal medicine ,medicine ,Humans ,In patient ,Postoperative Period ,Aged ,Retrospective Studies ,Heart Failure ,Transplantation ,Mitral regurgitation ,business.industry ,Incidence ,Incidence (epidemiology) ,Mitral Valve Insufficiency ,Middle Aged ,equipment and supplies ,Survival Rate ,Treatment Outcome ,Ventricular assist device ,Concomitant ,Cardiology ,Female ,Surgery ,Heart-Assist Devices ,business ,Destination therapy - Abstract
Currently, there are no guidelines for management of moderate to severe mitral regurgitation (MR) in patients undergoing left ventricular assist device (LVAD) implantation. The present study aimed to investigate the impact of baseline MR on short and midterm survival in patients who had LVAD as destination therapy (DT).The DT-LVAD patients were classified into 2 groups based on baseline MR status: ≥ moderate MR and moderate MR. Baseline clinical characteristics and post-LVAD implant adverse events were compared. Unadjusted mortality rates at 30 days, 1 year, and 2 years were analyzed.Of 91 patients studied, 62 (68%) had ≥ moderate MR before LVAD implantation; ≥ moderate MR patients had a higher incidence of concomitant pulmonary disease (11% vs 0%; P = .001) and ≥ moderate tricuspid regurgitation (55% vs 23%, P = .004) than moderate MR patients. Other baseline clinical characteristics were similar in both groups. Post-LVAD adverse events did not differ between the 2 groups. Survival rates at 30 days, 1 year, and 2 years for both groups (≥ moderate MR vs moderate MR) were 90% vs 100% (P = .03), 63% vs 90% (P = .001), and 52% vs 83% (P = .002), respectively. On multivariable analysis, age, female sex, ≥ moderate tricuspid regurgitation, and ≥ moderate MR at baseline were found to be independent predictors of overall all-cause mortality. Overall survival was significantly lower in the ≥ moderate MR group than the moderate MR group (log-rank test, P = .03).In DT LVAD patients, ≥ moderate MR is common and is associated with worse survival at both short and midterm follow-up.
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- 2019
24. Rate and impact of venous thromboembolism in patients with ST-segment elevation myocardial infarction: Analysis of the Nationwide Inpatient Sample database 2003–2013
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Alfonso Tafur, Ahmed Al-Ogaili, Luis Diaz Quintero, Harry E Fuentes, Ali Ayoub, Christian Torres, Setri Fugar, Wael Dakkak, Neha Yadav, and Ahmed A Kolkailah
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Male ,Gastrointestinal bleeding ,Time Factors ,Databases, Factual ,Population ,Hemorrhage ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Vte prophylaxis ,computer.software_genre ,Risk Assessment ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,ST segment ,In patient ,Hospital Mortality ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Hospital Costs ,education ,Aged ,Retrospective Studies ,Aged, 80 and over ,Inpatients ,education.field_of_study ,Database ,business.industry ,Venous Thromboembolism ,Length of Stay ,Middle Aged ,equipment and supplies ,medicine.disease ,United States ,Hospitalization ,Treatment Outcome ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business ,computer ,Venous thromboembolism - Abstract
Venous thromboembolism (VTE) and coronary artery disease are major health issues that cause substantial morbidity and mortality. New data have emerged suggesting that these two conditions could have a close relationship. Thus, we sought to determine the trends in annual rate of VTE occurrence in patients with ST-segment elevation myocardial infarction (STEMI) and measure its impact on in-hospital mortality, bleeding complications, and cost and length of hospitalization. We queried the 2003–2013 Nationwide Inpatient Sample databases to identify adults with primary diagnosis of STEMI. VTE events were then allocated. Inpatient outcomes of patients with VTE were compared to those without VTE. Out of 2,495,757 hospitalizations for STEMI, VTE was diagnosed in 25,149 (1%) hospitalizations. Patients who experienced VTE were older (mean age: 67.5 vs 64.8, p < 0.01) and had a higher proportion of black patients (10.1% vs 7.7%, p < 0.001) and females (40.1% vs 35%, p < 0.001) compared to patients without VTE. There was an increasing trend in the rate of VTE during the study period (2003: 0.8% vs 2013: 1.0%, p < 0.001). Patients with VTE had a prolonged hospitalization (median: 9 vs 3 days, p < 0.001), increased cost, higher risk of gastrointestinal bleeding (OR: 2.13, p < 0.001), intracranial hemorrhage (OR: 2.14, p < 0.001), blood transfusions (OR: 1.94, p < 0.001), and mortality (OR: 1.39, p < 0.001). The rate of VTE occurrence in patients with STEMI in our study was 10 per 1000 admissions. VTE was associated with more bleeding complications, longer hospital stays, higher costs, and mortality. These findings suggest that a more aggressive approach for VTE prophylaxis may be warranted in this population.
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- 2019
25. Clinical and Functional Outcomes Associated with Age after Transapical Transcatheter Aortic Valve Replacement
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Nathan Kang, Chen Chunguang, Mark J. Russo, Setri Fugar, Alexis K. Okoh, Marc Cohen, Nicky Haik, and Haik Bruce
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Transcatheter aortic ,medicine.medical_treatment ,Subclavian Artery ,030204 cardiovascular system & hematology ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,High morbidity ,0302 clinical medicine ,Aortic valve replacement ,Valve replacement ,Internal medicine ,Heart Septum ,medicine ,Humans ,Postoperative Period ,030212 general & internal medicine ,Perioperative Period ,Aged ,Aged, 80 and over ,business.industry ,Incidence ,Aortic Valve Stenosis ,General Medicine ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,Survival Analysis ,Femoral Artery ,Survival Rate ,Treatment Outcome ,Echocardiography ,Aortic Valve ,Cardiology ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective Transcatheter aortic valve replacement (TAVR) via a transapical (TA) approach has been associated with high morbidity. The aim of this study is to investigate the association of age and clinical and functional outcomes after TA-TAVR. Methods Patients who had TA-TAVR at a single center were divided into 3 age groups: 85 years (Group III). Pre- and postoperative clinical, functional status, and procedure-related outcomes were compared among patient groups. A multivariable Cox proportional hazards model was used to assess the impact of age on overall all-cause mortality. Results Out of 183 TA-TAVR cases performed, 117 met the study criteria. These included 15 aged 85 years. Short-term (30-day) clinical and functional status improved significantly for all age groups. The incidence of acute kidney injury, access site complications, and requirement for permanent pacemaker were similar for all age groups at 30 days. After a median follow-up of 26 months, overall all-cause survival rates were 86% for Group I, 88% for Group II, and 83% for Group III at 1 year. Cox proportional hazards model showed frailty status (HR: 1.84; 95% CI, 1.23 to 2.69; P = 0.003) but not age as an independent predictor of overall all-cause mortality. Conclusions Findings from this study suggest that both older and younger patients benefit from TA-TAVR with comparable operative outcomes. Age should not be an exclusion criterion for TA-TAVR.
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- 2019
26. Prasugrel vs. Ticagrelor for Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis
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Setri Fugar, Muhammad Shahzeb Khan, Abdur Rahman Khan, Farouk Mookadam, Saed Alnaimat, Muhammad Mustafa Memon, Rami Doukky, Safi U. Khan, Richard A. Krasuski, Muhammad Usman, and Naser Yamani
- Subjects
Ticagrelor ,Acute coronary syndrome ,medicine.medical_specialty ,Prasugrel ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,P2Y12 ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Acute Coronary Syndrome ,business.industry ,Percutaneous coronary intervention ,General Medicine ,medicine.disease ,Clopidogrel ,Observational Studies as Topic ,Conventional PCI ,Cardiology and Cardiovascular Medicine ,business ,Prasugrel Hydrochloride ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
The newer P2Y12 inhibitors have better efficacy than clopidogrel. However, whether ticagrelor or prasugrel have a better comparative safety and efficacy profile, especially in the long-term, remains inconclusive. We compared prasugrel and ticagrelor in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). MEDLINE and the Cochrane library were queried for randomized controlled trials (RCTs) or observational studies comparing prasugrel with ticagrelor in patients with ACS undergoing PCI. Random-effects pooling was used to calculate odds ratios (ORs) with 95% confidence intervals (CI). Analyses were stratified by duration of follow-up (short term [≤ 3 months] and long term [≥ 1 year]) and study design. In total, 14 studies (six RCTs, eight observational studies), including 40,188 patients, met eligibility criteria. Pooled analysis did not indicate that prasugrel significantly decreased all-cause mortality compared with ticagrelor in the short term (OR 0.49; 95% CI 0.20–1.20; p = 0.11) or long term (OR 0.74; 95% CI 0.48–1.15; p = 0.38). Pooled observational studies showed significantly lower long-term all-cause mortality (OR 0.63; 95% CI 0.43–0.92; p = 0.02) and short-term stent thrombosis (OR 0.46; 95% CI 0.28–0.75; p = 0.002) with prasugrel. No significant difference was observed in the risk of nonfatal myocardial infarction, ischemic stroke, bleeding, or repeat revascularization between the two groups. Results remained similar after stratification according to follow-up and study design. The present analysis suggests that prasugrel might have a better efficacy profile than ticagrelor in patients with ACS undergoing PCI. However, this advantage was only seen in pooled observational studies and is likely to be affected by selection bias.
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- 2019
27. Association Between Cannabis Use and Complications Related to Crohn’s Disease: A Retrospective Cohort Study
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Roberto Simons-Linares, Yuchen Wang, Palash Jaiswal, Rohit Agrawal, Isaac Paintsil, William E. Trick, Setri Fugar, Chimezie Mbachi, Bashar M. Attar, Vikram Kotwal, and Benjamin
- Subjects
Adult ,Male ,Marijuana Abuse ,Parenteral Nutrition ,medicine.medical_specialty ,Abdominal Abscess ,Physiology ,medicine.medical_treatment ,Disease ,03 medical and health sciences ,0302 clinical medicine ,Crohn Disease ,Internal medicine ,Intestinal Fistula ,Prevalence ,medicine ,Humans ,Blood Transfusion ,Correlation of Data ,Propensity Score ,Colectomy ,Retrospective Studies ,Crohn's disease ,biology ,business.industry ,Gastroenterology ,Retrospective cohort study ,Middle Aged ,medicine.disease ,biology.organism_classification ,United States ,Parenteral nutrition ,030220 oncology & carcinogenesis ,Propensity score matching ,Female ,030211 gastroenterology & hepatology ,Cannabis ,business ,Complication - Abstract
Crohn’s disease is an idiopathic inflammatory process that is occasionally associated with complications, which cause significant morbidity and mortality. The anti-inflammatory effect of cannabis in intestinal inflammation has been shown in several experimental models; it is unknown whether this correlates with fewer complications in Crohn’s disease patients. To compare the prevalence of Crohn’s disease-related complications among cannabis users and non-users in patients admitted with a primary diagnosis of Crohn’s disease or a primary diagnosis of Crohn’s related complication and a secondary diagnosis of Crohn’s disease between 2012 and 2014. We used data from the Healthcare Cost and Utilization Project–National Inpatient Sample. Cannabis users (615) were compared directly after propensity score match to non-users, in aspects of various complications and clinical end-points. Among matched cohorts, Cannabis users were less likely to have the following: active fistulizing disease and intra-abdominal abscess (11.5% vs. 15.9%; aOR 0.68 [0.49 to 0.94], p = 0.025), blood product transfusion (5.0% vs. 8.0%; aOR 0.48 [0.30 to 0.79], p = 0.037), colectomy (3.7% vs. 7.5%; aOR 0.48 [0.29–0.80], p = 0.004), and parenteral nutrition requirement (3.4% vs. 6.7%, aOR 0.39 [0.23 to 0.68], p = 0.009). Cannabis use may mitigate several of the well-described complications of Crohn’s disease among hospital inpatients. These effects could possibly be through the effect of cannabis in the endocannabinoid system.
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- 2019
28. Discharge disposition of older patients undergoing trans‐catheter aortic valve replacement and its impact on survival
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Komalpreet Kaur, Bruce Haik, Nicky Haik, Marc Cohen, Swaiman Singh, Chunguang Chen, Mark J. Russo, Setri Fugar, and Alexis K. Okoh
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Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Hospitals, Rehabilitation ,030204 cardiovascular system & hematology ,Logistic regression ,Risk Assessment ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Aortic valve replacement ,Risk Factors ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Mortality rate ,Incidence (epidemiology) ,Age Factors ,Aortic Valve Stenosis ,General Medicine ,medicine.disease ,Long-Term Care ,Patient Discharge ,Nursing Homes ,Log-rank test ,Catheter ,Treatment Outcome ,Aortic Valve ,Propensity score matching ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Patients undergoing transcatheter aortic valve replacement (TAVR) are likely to be discharged to a location other than home. We aimed to assess the association between discharge disposition after TAVR and patient survival at 1 year. Methods Patients admitted from home and survived till discharge after TAVR were divided into two groups based on discharge disposition (home discharge vs. non-home discharge). Pre-operative factors predicting the odds of not being discharged home were identified by using multivariable logistic regression analysis. Study patients were matched one-to-one via a propensity scoring method. Differences in procedural outcomes were compared. Survival of both unmatched and matched pairs was evaluated by using the Kaplan-Meier method with the Kleine-Moesch-Berger stratified log-rank test. Results Out of 1,160 TAVR patients, 851 were admitted from home and survived till discharge. The incidence non-home discharge was 19% (n = 159). Factors that were significantly associated with non-home discharge were older age, non-transfemoral approach, female sex, frailty status, history of chronic lung disease, pacemaker placement and insulin-dependent diabetes mellitus. One-to-one propensity score matching resulted in 141 patient pairs with similar age, operative risk, frailty and functional status. At 1-year follow-up, all-cause mortality rates were significantly higher in the non-home group than their home counterparts (18% vs. 3%, P = 0.006; stratified log rank test: P = 0.006). Conclusions A considerable number of TAVR patients are discharged to a location other than home after the procedure. Not being discharged home after TAVR is associated with a high mortality risk at 1 year.
- Published
- 2019
29. C-32 | Comparison of Post-TAVR and Predischarge Doppler Gradients after Transcatheter Aortic Valve Replacement in Balloon and Self-expandable Transcatheter Valves
- Author
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Setri Fugar, Khrystyna Deka, Christina Anderson, Claudia Lama von Buchwald, Rachel E. Geroux, Maria S. Gerges, Jennifer White, Fareed Moses S. Collado, Hussam Suradi, and Clifford J. Kavinsky
- Published
- 2022
30. Sex Differences in COVID-19 Hospitalization and Mortality
- Author
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Joanne Michelle D, Gomez, Jeanne M, Du-Fay-de-Lavallaz, Setri, Fugar, Alexandra, Sarau, J Alan, Simmons, Brian, Clark, Rupa M, Sanghani, Neelum T, Aggarwal, Kim A, Williams, Rami, Doukky, and Annabelle Santos, Volgman
- Subjects
Hospitalization ,Male ,Intensive Care Units ,Sex Characteristics ,SARS-CoV-2 ,COVID-19 ,Humans ,Female ,Comorbidity ,Hospital Mortality ,Illinois ,Retrospective Studies - Published
- 2021
31. Sex Differences in Coronavirus Disease 2019 (COVID-19) Hospitalization and Mortality
- Author
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Annabelle Santos Volgman, Joanne Michelle D. Gomez, Neelum T. Aggarwal, Setri Fugar, Kim A. Williams, Rupa Sanghani, Brian Clark, Alexandra Sarau, J Alan Simmons, Rami Doukky, and Jeanne M Du-Fay-de-Lavallaz
- Subjects
medicine.medical_specialty ,business.industry ,Retrospective cohort study ,General Medicine ,Odds ratio ,030204 cardiovascular system & hematology ,medicine.disease ,Comorbidity ,Intensive care unit ,Confidence interval ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Internal medicine ,Epidemiology ,Cohort ,medicine ,030212 general & internal medicine ,business ,Sex characteristics - Abstract
Background: To investigate sex differences in coronavirus disease 2019 (COVID-19) outcomes in a large Illinois-based cohort. Methods: A multicenter retrospective cohort study compared males versus females with COVID-19 infections from March 1, 2020, to June 21, 2020, in the Rush University System. We analyzed sex differences in rates of hospitalization, intensive care unit (ICU) admission, vasopressor use, endotracheal intubation, and death in this cohort. A multivariable model correcting for age and sum of comorbidities was used to explore associations between sex and COVID-19-related outcomes. Results: There were 8108 positive COVID-19 patients-4300 (53.0%) females and 3808 (47.0%) males. Males had higher rates of hospitalization (19% vs. 13%; p < 0.001), ICU transfer (8% vs. 4%; p < 0.001), vasopressor support (4% vs. 2%; p < 0.001), and endotracheal intubation (5% vs. 2%; p < 0.001). Of those who died, 92 were males and 64 were females (2% vs. 1%; p = 0.003). A multivariable model correcting for age and sum of comorbidities showed a significant association between male sex and mortality in the total cohort (odds ratio, 1.96; 95% confidence interval, 1.34-2.90; p = 0.001). Conclusion: Male sex was independently associated with death, hospitalization, ICU admissions, and need for vasopressors or endotracheal intubation, after correction for important covariates.
- Published
- 2021
32. Visual Abstract - Supplemental material for Health and Healthcare Disparities: Impact on Resource Utilization and Costs After Transcatheter Aortic Valve Replacement
- Author
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Okoh, Alexis K., Dhaduk, Nehal, Aakash M. Shah, Gold, Justin, Setri Fugar, Kassotis, John, Chunguang Chen, Lee, Leonard Y., and Russo, Mark J.
- Subjects
FOS: Clinical medicine ,110323 Surgery - Abstract
Supplemental material, Visual Abstract, for Health and Healthcare Disparities: Impact on Resource Utilization and Costs After Transcatheter Aortic Valve Replacement by Alexis K. Okoh, Nehal Dhaduk, Aakash M. Shah, Justin Gold, Setri Fugar, John Kassotis, Chunguang Chen, Leonard Y. Lee, and Mark J. Russo in Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
- Published
- 2021
- Full Text
- View/download PDF
33. Abstract 16269: Does the 'July Effect' Impact Heart Failure Outcomes? A Real-World Analysis of More Than Half a Million Nationwide Admissions
- Author
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Axi Patel, Setri Fugar, Ahmed A Kolkailah, Parth V Desai, Rami Doukky, Ahmed Al-Ogaili, Tsuyoshi Kaneko, Sameer A. Hirji, Alexis K. Okoh, Marwan S. Abougergi, and Annabelle Santos Volgman
- Subjects
July effect ,medicine.medical_specialty ,business.industry ,Physiology (medical) ,Family medicine ,Heart failure ,medicine ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Academic medicine - Abstract
Background: The “July effect” is a well-described phenomenon in academic medicine, relating to the annual influx of new trainees. We examined whether the “July effect” impacts inpatient outcomes of admissions for heart failure (HF). Methods: Between 2012 and 2014, we included adult patients (≥18 years) with a primary diagnosis of HF, defined using ICD-9 codes, from the National Inpatient Sample. We excluded non-teaching hospitals. Primary endpoint was in-hospital mortality. Secondary endpoints included hospital length of stay (LOS) and total cost adjusted for inflation. Logistic regression and adjusted odds ratio (OR) were used to adjust for confounders. Based on academic calendar, we classified admissions into 4 quarters (Q1-4). Q1 and Q4 were designated to assess the effect of novice (July effect) vs. seasoned trainees, respectively. Results: We identified 699,675 HF admissions during Q1 and Q4 over the study period. Mean age was 71 years and 48% were females. There were 20,270 in-hospital deaths (Q1 9,695 vs. Q4 10,575). After adjusting for confounders, there was no mortality difference between Q1 and Q4 admissions; adjusted OR 0.96, p = 0.23 (Figure). Similarly, there was no difference in hospital LOS or total cost; 5.8 vs. 5.8 days, p = 0.66 and $13,755 vs. $13,586, p = 0.46, in Q1 and Q4, respectively. Conclusion: In the largest study to date, there was no evidence of a “July effect” on inpatient HF outcomes. This may be credited to the well-defined guidelines which facilitate safe patient care in these patients.
- Published
- 2020
34. Abstract 16010: Congestive Heart Failure and Coronavirus Disease 2019 Illness Severity
- Author
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Gatha G Nair, Max Ruge, Tisha Suboc, J. Allan Simmons, Annabelle Santos Volgman, Joanne Michelle D. Gomez, Nusrat Jahan, Prutha Lavani, Karolina Marinescu, Kim A. Williams, Anupama Rao, Setri Fugar, and Jeanne du Fay de Lavallaz
- Subjects
medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Disease ,medicine.disease ,Physiology (medical) ,Heart failure ,Pandemic ,Medicine ,Illness severity ,Vulnerable population ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine - Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic has killed hundreds of thousands worldwide. Those with cardiovascular disease represent a vulnerable population with higher risk for contracting COVID-19 and worse prognosis with higher case fatality rates. Congestive heart failure (CHF) may lead to worsening COVID-19 symptoms. However, it is unclear if CHF is an independent risk factor for severe COVID-19 infection or if other accompanying comorbidities are responsible for the increased risk. Methods: From March to June 2020, data was obtained from adult patients diagnosed with COVID-19 infection who were admitted in the Rush University System for Health (RUSH) in Illinois. Heart failure patients, determined by ICD code assignments extracted from the electronic medical records, were identified. Multivariable logistic regression was performed between predictor variables and a composite outcome of severe infection consisting of Intensive Care Unit (ICU) admission, intubation, or in-hospital mortality. Results: In this cohort (n=1136), CHF [odds ratio (OR) 1.02] alone did not predict a more severe illness. Prior myocardial infarction [(MI), OR 3.55], history of atrial fibrillation [(AF), OR 2.14], and male sex (OR 1.55) were all significantly (p Conclusions: Prior MI, history of AF, and male sex predicted more severe COVID-19 illness course in our cohort, but pre-existing heart failure alone did not. However, CHF patients who are females and older in age are at risk for severe infection. These findings help clinicians identify patients with comorbidities early at risk for severe COVID-19 illness.
- Published
- 2020
35. Abstract 15842: Body Mass Index in Covid-19: An Independent Risk Factor for Severe Infections
- Author
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Setri Fugar, Alexander Hlepas, Joanne Michelle M Gomez, Annabelle Santos Volgman, Alan Simmons, Gianna N. Bosco, Jeanne du Fay de Lavallaz, Tisha Suboc, Charlotte Bai, Sean Swearingen, Brian Clark, and Kim A. Williams
- Subjects
medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Cholesterol ,business.industry ,medicine.disease ,Obesity ,chemistry.chemical_compound ,chemistry ,Physiology (medical) ,Internal medicine ,Diabetes mellitus ,Pandemic ,medicine ,Risk factor ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
Introduction: The coronavirus disease 2019 (COVID-19) led to a global pandemic. Comorbidities such as hypertension, diabetes mellitus, elevated cholesterol, cardiac/pulmonary diseases, and obesity were postulated as prognostic factors for a worse outcome. Hypothesis: Obese COVID-19 patients have a worse prognosis. Methods: From March to June 2020, we obtained data on all patients ≥18 y.o. who were admitted with a positive COVID-19 test at the Rush System, Chicago. Multivariable logistic regression analysis was performed between predictors and a composite outcome of intubation and in-hospital mortality. Results: Among the 1345 admitted patients, 69 (5%) were underweight (BMI40kg/m2). In a multivariable model assessing the risk for the in-hospital death or intubation, underweight patients showed decreased risk (odds ratio (OR) 0.31) while obesity class III patients showed increased risk (OR 1.68, Figure 1) when compared to normal BMI. When accounting for obesity classes, male sex, atrial fibrillation and coronary artery disease were also independent predictors adverse outcomes. Conclusions: Consistent with previous research, morbidly obese patients had a higher risk for a worse outcome, even when accounting for numerous comorbidities. Underweight patients appeared to be protected. Higher body mass leads to inherent changes in lung function, increased risk of thrombosis, greater viral replication, higher release of adipokines and higher inflammation. Inversely, fewer adipocytes could possibly limit the risk for cytokine storm by reducing the amount of proinflammatory factors released. Figure: Odds ratios with 95% confidence intervals for the outcome of death or intubation in all COVID-19 positive admitted patients.
- Published
- 2020
36. Abstract 16173: Clinical Characteristics and Short-term Outcomes of Hospitalized Patients With Sars-cov-2 Infection and Reduced Left Ventricular Ejection Fraction
- Author
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Gatha G Nair, Setri Fugar, Tisha Suboc, Alan Simmons, Kim A. Williams, Annas Rahman, Alexander Hlepas, J. D. de Lavallaz, Karolina Marinescu, Max Ruge, Nusrat Jahan, Charlotte Bai, Anupama K Rao, Annabelle Santos Volgman, J. M. M. Gomez, and Priya Patel
- Subjects
medicine.medical_specialty ,2019-20 coronavirus outbreak ,Ejection fraction ,Demographics ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Hospitalized patients ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Cardiomyopathy ,medicine.disease ,Physiology (medical) ,Internal medicine ,Heart failure ,Cardiology ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction: Early studies of coronavirus disease 2019 (COVID-19) patients suggested that heart failure (HF) may lead to poorer prognosis. We evaluated demographics and short-term clinical outcomes of patients with evidence of left ventricular systolic dysfunction (LVSD) in comparison to those with preserved LV systolic function (PSF). Methods: In this retrospective study of patients hospitalized for COVID-19 between March and June 2, 2020 at Rush Health Systems in Metro Chicago, demographics, comorbidities and clinical outcomes of patients who demonstrated LVSD (ejection fraction [EF] Results: Out of 1,312 hospitalized patients, 225 underwent TTE, and 44 patients showed LVSD. Demographics were similar between two groups, with exception of a higher prevalence of African American (AA) race (48 % vs. 29%; p=0.03) in the LVSD group. While 82% of patients in the LVSD cohort had history of chronic HF, only 26% of patients in the PSF had pre-existing HF (p Conclusions: In our COVID-19 admissions, LVSD was more common in AA patients. Patients with LVSD had a higher risk of ventricular arrhythmias. However, there were no differences between need for ICU admission or intubation, vasopressor requirements, length of stay or death between patients with LVSD and those without. Longitudinal follow-up studies are needed to identify differences in long-term sequelae of COVID-19 infection with evidence for LVSD.
- Published
- 2020
37. Abstract 17393: Sex Differences in COVID-19 Hospitalization and Mortality in Chicagoland
- Author
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J Alan Simmons, Setri Fugar, Joanne Michelle D. Gomez, Neelum T. Aggarwal, Rupa Sanghani, Jeanne M Du-Fay-de-Lavallaz, Kim A. Williams, Rami Doukky, Brian Clark, Annabelle Santos Volgman, and Alexandra Sarau
- Subjects
Coronavirus disease 2019 (COVID-19) ,business.industry ,Physiology (medical) ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Demography - Abstract
Introduction: The novel coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide. Higher COVID-19 mortality in men compared to women seen in many countries is not yet explained. We analyzed sex differences in COVID-19 outcomes in a large Illinois-based cohort. Methods: This is a multicenter retrospective cohort study of confirmed COVID-19 infections from March 1–June 3, 2020 in Rush University System. We compared men and women with COVID-19 infection for the rates of hospitalization, intensive care unit (ICU) admission, vasopressor use, endotracheal intubation, and death. A multivariable model correcting for age, race, and sum of comorbidities (obesity, hypertension, diabetes, coronary artery disease, heart failure, end-stage renal disease, asthma, chronic obstructive pulmonary disease, active smoking) was used to determine independent association with outcomes. Results: Of the 8,086 patients who tested positive, 4,267 (53%) were females, while 3,819 (47%) were males. Males had a higher rate of hospitalization (19% vs. 14%; p Conclusions: There were more women who tested positive for COVID-19 disease. Male sex was independently associated with higher rates of death, hospitalization, ICU admissions, need for vasopressors or endotracheal intubation, after correction for important covariates. The interplay of biological and and behavioral factors is likely responsible for the worse outcomes observed in men with COVID-19 infection. Further investigations into the pathophysiology of sex differences in COVID-19 outcomes responses are needed.
- Published
- 2020
38. Anemia (Hemoglobin ≤ 13 g/dL) as a Risk Factor for Contrast-Induced Acute Kidney Injury Following Coronary Angiography
- Author
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Muhammad Shahzeb Khan, Setri Fugar, Min Zhuo, Parth Desai, Jayakumar Sreenivasan, Heyi Li, and Neha Yadav
- Subjects
Male ,medicine.medical_specialty ,Anemia ,medicine.medical_treatment ,Contrast Media ,030204 cardiovascular system & hematology ,Coronary Angiography ,Severity of Illness Index ,03 medical and health sciences ,chemistry.chemical_compound ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Severity of illness ,Humans ,Medicine ,030212 general & internal medicine ,Risk factor ,Retrospective Studies ,Creatinine ,business.industry ,Acute kidney injury ,Percutaneous coronary intervention ,Retrospective cohort study ,Odds ratio ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,chemistry ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Contrast-induced acute kidney injury (CI-AKI) following coronary angiography is associated with increased mortality. The association between severity of anemia and CI-AKI following coronary angiography is not well-established. In this retrospective study, we aimed at assessing the association of anemia of various severity with the risk of CI-AKI in patients who underwent coronary angiography. We included all patients who underwent coronary angiography with or without percutaneous coronary intervention from January 2012 to December 2016 at a single tertiary care hospital. CI-AKI was defined as ≥0.3 mg/dL increase in creatinine from baseline and anemia was defined as baseline hemoglobin ≤13 g/dL. Patients were stratified into three subgroups-mild (11.1 to 13.0 g/dL), moderate (9.1 to 11.0 g/dL) and severe anemia (7.0 to 9.0 g/dL). Crude and adjusted odds ratios (AOR) were calculated using univariate multiple logistic regression analysis. Of 2,055 patients (females = 30.7%, mean age 58.0 ± 12.5 years) who underwent coronary angiography, 293 (14.3%) developed CI-AKI. Presence of anemia was associated with increased risk of developing CI-AKI (AOR = 5.3, 95% confidence interval [CI] = 3.8 to 7.3, p0.001). Risk of CI-AKI was increasingly higher with increasing severity of the anemia; mild (AOR = 3.4, 95% CI = 2.5 to 4.7, p0.001), moderate (AOR = 9.8, 95% CI = 6.9 to 14.2, p0.001) and severe (AOR = 13.7, 95% CI = 8.2 to 23.1, p0.001). In conclusion, severity of anemia is a strong predictor of CI-AKI following coronary angiography.
- Published
- 2018
39. Does natriuretic peptide monitoring improve outcomes in heart failure patients? A systematic review and meta-analysis
- Author
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Muhammad Shahzeb Khan, Setri Fugar, Haris Riaz, Jayakumar Sreenivasan, Tariq Jamal Siddiqi, Mohammad Hassan Murad, Vincent M. Figueredo, Farouk Mookadam, and Muhammad Usman
- Subjects
medicine.medical_specialty ,medicine.drug_class ,Subgroup analysis ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Natriuretic Peptide, Brain ,Natriuretic peptide ,medicine ,Humans ,030212 general & internal medicine ,Natriuretic Peptides ,Randomized Controlled Trials as Topic ,Heart Failure ,Ejection fraction ,business.industry ,Stroke Volume ,Guideline ,medicine.disease ,Peptide Fragments ,Treatment Outcome ,Relative risk ,Heart failure ,Meta-analysis ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Background Current guidelines do not support the use of serial natriuretic peptide (NP) monitoring for heart failure with preserved (HFpEF) or reduced ejection fraction (HFrEF) treatment, despite some studies showing benefit. We conducted an updated meta-analysis to address whether medical therapy in HFpEF or HFrEF should be titrated according to NP levels. Methods MEDLINE, Scopus and Cochrane CENTRAL databases were searched for randomized controlled trials (RCTs) comparing NP versus guideline directed titration in HF patients through December 2017. The key outcomes of interest were mortality, HF hospitalizations and all-cause hospitalizations. Risk ratios and 95% confidence intervals were pooled using random effects model. Sub-group analyses were performed for type of NP used, average age and acute or chronic HF. Results Eighteen trials including 5116 patients were included. Meta-analysis showed no significant difference between the NP-guided arm versus guideline directed titration in all-cause mortality (RR = 0.91 [0.81, 1.03]; p = 0.13), HF hospitalizations (RR = 0.81 [0.65, 1.01]; p = 0.06), and all cause hospitalizations (RR = 0.93 [0.86, 1.01]; p = 0.09). The results were consistent upon subgroup analysis by biomarker type (NT-proBNP or BNP) and type of heart failure (acute or chronic and HFrEF or HFpEF). Sub-group analysis suggested that NP-guided treatment was associated with decreased all-cause hospitalizations in patients younger than 72 years of age. Conclusion The available evidence suggests that NP-guided therapy provides no additional benefit over guideline directed therapy in terms of all-cause mortality and HF-related hospitalizations in acute or chronic HF patients, regardless of their ejection fraction.
- Published
- 2018
40. TCT-287 National Trends and Age Differences in Treatment and Outcomes of Patients With Mitral Regurgitation in the United States
- Author
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Setri Fugar, Tom C. Nguyen, Mark W. Russo, Tsuyoshi Kaneko, Isaac George, Leonard Y. Lee, Alexis K. Okoh, Vinod H. Thourani, Ankur Sethi, Michael Mack, and Molly Szerlip
- Subjects
medicine.medical_specialty ,Mitral regurgitation ,Age differences ,business.industry ,Internal medicine ,Cardiology ,medicine ,National trends ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
41. CHARACTERICS OF HISPANIC, NON HISPANIC WHITE AND NON-HISPANIC BLACK PATIENTS SCREENED AND HOSPITALIZED FOR COVID-19 IN CHICAGO, USA
- Author
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Neelum T. Aggarwal, Rupa Sanghani, Rami Doukky, Setri Fugar, Joanne Michelle D. Gomez, Kim A. Williams, Jeanne M Du-Fay-de-Lavallaz, Tisha Suboc, Brian Clark, and Annabelle Santos Volgman
- Subjects
White (horse) ,Spotlight on Special Topics ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Demography - Published
- 2021
42. CLINICAL PREDICTORS OF COAGULOPATHY EVENTS IN HOSPITALIZED PATIENTS WITH COVID-19 DISEASE
- Author
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Setri Fugar, Laith Derbas, Joanne Michelle D. Gomez, Jeanne M Du-Fay-de-Lavallaz, Benjamin Schwartz, Annabelle Santos Volgman, Kim A. Williams, Anna Zemke, Tisha Suboc, and Ethan Ritz
- Subjects
medicine.medical_specialty ,Text mining ,Spotlight on Special Topics ,Coronavirus disease 2019 (COVID-19) ,Hospitalized patients ,business.industry ,medicine ,Coagulopathy ,Disease ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,medicine.disease ,business - Published
- 2021
43. TOP 100 SOCIAL MEDIA INFLUENCERS IN THE FIELD OF CARDIOLOGY
- Author
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Emmanuella Salia, Oluwaseun Famojuro, Joseph Atarere, Henry K. Onyeaka, Onoriode Kesiena, Akintayo Akinleye, Chike C. Udoye, and Setri Fugar
- Subjects
business.industry ,Field (Bourdieu) ,Medicine ,Social media ,Public relations ,Cardiology and Cardiovascular Medicine ,business ,Influencer marketing - Published
- 2021
44. THE DIFFERENCE IN THE IMPACT OF SOCIOECONOMIC STATUS ON SURGICAL VS TRANSCATHETER MITRAL VALVE REPAIR
- Author
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Mark Russo, Alexis K. Okoh, Setri Fugar, Paige Newell, Tsuyoshi Kaneko, Sameer A. Hirji, John Kassotis, Xiaoyan Deng, Fady Soliman, Chunguang Chen, Leonard Y. Lee, and Abdul Hakeem
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Transcatheter mitral valve repair ,Cardiology and Cardiovascular Medicine ,business ,Socioeconomic status ,Surgery - Published
- 2021
45. Congenital Absence of Left Circumflex Artery: A Case Report and Review of the Literature
- Author
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Neha Yadav, Setri Fugar, Christelle Chedrawy, Alexis K. Okoh, Lydia Issac, and Nadia El Hangouche
- Subjects
Coronary angiography ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Left circumflex artery ,Case Report ,030204 cardiovascular system & hematology ,Coronary Anomaly ,Diagnostic modalities ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Internal medicine ,medicine ,cardiovascular diseases ,Wall motion ,business.industry ,medicine.disease ,lcsh:RC666-701 ,Right coronary artery ,cardiovascular system ,Cardiology ,Radiology ,Presentation (obstetrics) ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
Congenital absence of the left circumflex artery is a rare coronary anomaly with few reported cases in the literature. These patients are usually diagnosed incidentally when they undergo coronary angiography or coronary CT to rule out underlying coronary artery disease. In this article, we report a case of a 46-year-old man who was incidentally found to have a congenitally absent left circumflex artery with a superdominant right coronary artery after a workup was initiated for frequent premature ventricular contractions and regional wall motion on echocardiogram. A review of the clinical presentation, symptoms, and diagnostic modalities used to diagnose this entity is presented.
- Published
- 2017
46. Trends in Cancer Prevalence Among Liver, Heart and Lung Transplant Recipients in the United States, 2005 to 2014: Presidential Poster Award
- Author
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Madhu Mathew, Setri Fugar, Chimezie Mbachi, Anthonia Ijeli, Ayokunle T. Abegunde, and Benjamin
- Subjects
medicine.medical_specialty ,Lung ,medicine.anatomical_structure ,Hepatology ,Presidential system ,business.industry ,Internal medicine ,Gastroenterology ,medicine ,business ,Cancer prevalence - Published
- 2018
47. Impact of chronic thrombocytopenia on in-hospital outcomes and healthcare resource utilization after transcatheter aortic valve replacement
- Author
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Omid Behnamfar, Mark Kosinski, Clifford J. Kavinsky, Rami Doukky, Setri Fugar, Neeraj Jolly, Soziema Salia, Ali Mahmood, Alisha F. Alabre, and Alexis K. Okoh
- Subjects
Male ,medicine.medical_specialty ,Blood transfusion ,Time Factors ,Databases, Factual ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Risk Assessment ,Sepsis ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Risk Factors ,Health care ,medicine ,Humans ,heterocyclic compounds ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Hospital Mortality ,Hospital Costs ,Aged ,Aged, 80 and over ,Inpatients ,business.industry ,Acute kidney injury ,General Medicine ,Perioperative ,Aortic Valve Stenosis ,Length of Stay ,medicine.disease ,Thrombocytopenia ,Patient Discharge ,United States ,enzymes and coenzymes (carbohydrates) ,Treatment Outcome ,Cohort ,Emergency medicine ,Chronic Disease ,Health Resources ,Female ,Cardiology and Cardiovascular Medicine ,business ,Resource utilization - Abstract
BACKGROUND There is little data on the impact of chronic thrombocytopenia (CTP) on outcomes after transcatheter aortic valve repair (TAVR). Most studies are from single centers and mostly focused on postprocedure thrombocytopenia. OBJECTIVES This study sought to report on the impact of CTP (>1 year) on in-hospital outcomes and healthcare resource utilization after TAVR. METHODS From the National Inpatient Sample (NIS) between 2012 and 2015, we identified patients with CTP who underwent TAVR. A 1:1 propensity-matched cohort was created to examine in-hospital outcomes in patients with and without CTP. The primary outcome was in-hospital mortality. Secondary outcomes included postprocedure complications, length of stay, total cost, and discharge disposition. RESULTS A matched pair of 4,300 patients with and without CTP were identified. Patients with CTP had higher in-hospital mortality as compared to no CTP patients (6.0 vs. 3.3%, p-value .007), increased postprocedure hemorrhage, platelet and blood transfusion, vascular complications, postop sepsis, and acute kidney injury. With regards to resource utilization, CTP patients had a longer length of stay, higher total cost and were more likely to be discharged to a facility (34.1 vs. 27.6%) other than home (All, p-value
- Published
- 2019
48. Hypertension in older adults: Assessment, management, and challenges
- Author
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Setri Fugar, Hena Patel, Estefania Oliveros, Kim A. Williams, Alan Goldberg, Stella Kyung, and Nidhi Madan
- Subjects
Population ageing ,medicine.medical_specialty ,Aging ,hypertension ,Health Status ,Population ,Reviews ,Blood Pressure ,Review ,030204 cardiovascular system & hematology ,older adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Healthy Lifestyle ,Intensive care medicine ,education ,Stroke ,Aged ,Geriatrics ,Aged, 80 and over ,education.field_of_study ,geriatrics ,business.industry ,Public health ,Age Factors ,General Medicine ,medicine.disease ,antihypertensive agents ,blood pressure monitoring ,Treatment Outcome ,Heart failure ,Practice Guidelines as Topic ,Arterial stiffness ,Cardiology and Cardiovascular Medicine ,business ,Risk Reduction Behavior - Abstract
Hypertension in older adults is related to adverse cardiovascular outcomes, such as heart failure, stroke, myocardial infarction, and death. The global burden of hypertension is increasing due to an aging population and increasing prevalence of obesity, and is estimated to affect one third of the world's population by 2025. Adverse outcomes in older adults are compounded by mechanical hemodynamic changes, arterial stiffness, neurohormonal and autonomic dysregulation, and declining renal function. This review highlights the current evidence and summarizes recent guidelines on hypertension, pertaining to older adults. Management strategies for hypertension in older adults must consider the degree of frailty, increasingly complex medical comorbidities, and psycho‐social factors, and must therefore be individualized. Non‐pharmacological lifestyle interventions should be encouraged to mitigate the risk of developing hypertension, and as an adjunctive therapy to reduce the need for medications. Pharmacological therapy with diuretics, renin‐angiotensin system blockers, and calcium channel blockers have all shown benefit on cardiovascular outcomes in older patients. Given the economic and public health burden of hypertension in the United States and globally, it is critical to address lifestyle modifications in younger generations to prevent hypertension with age.
- Published
- 2019
49. Racial Disparities and Outcomes After Left Ventricular Assist Device Implantation as Bridge to Transplantation or Destination Therapy
- Author
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Margarita Camacho, Alexis K. Okoh, Molly Schultheis, Sari Kaplon, Nathan Kang, Setri Fugar, Mark J. Zucker, Ravindra Karanam, Mark J. Russo, and Olivia Chan
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Prosthesis-Related Infections ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,White People ,Body Mass Index ,Prosthesis Implantation ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Internal medicine ,Outcome Assessment, Health Care ,medicine ,Humans ,Mortality ,Aged ,Proportional Hazards Models ,Retrospective Studies ,African american ,Heart Failure ,business.industry ,Arrhythmias, Cardiac ,General Medicine ,Health Status Disparities ,Hispanic or Latino ,Middle Aged ,medicine.disease ,Prosthesis Failure ,Black or African American ,Survival Rate ,030228 respiratory system ,Social Class ,Ventricular assist device ,Heart failure ,Cardiology ,Educational Status ,Surgery ,Bridge to transplantation ,Female ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business ,Destination therapy - Abstract
Objective We sought to investigate outcomes after left ventricular assist device (LVAD) implantation in advanced heart failure patients stratified by race. Methods Patients who had LVADs inserted at a single center as a bridge to transplant (BTT) or destination therapy (DT) were divided into 3 groups based on race: Caucasian, African American (AA), and Hispanic. Postoperative outcomes including complications, discharge disposition, and survival at defined time points were compared. Cox proportional hazards were used to identify factors associated with 1-year all-cause survival. Results A total of 158 patients who had LVADs as BTT ( n = 63) and DT ( n = 95) were studied. Of these, 56% ( n = 89) were Caucasians, 35% ( n = 55) were AA, and 9% ( n = 14) were Hispanics. AA patients had higher BMI and lower socioeconomic status and educational level, and were more likely to be single or divorced. Operative outcomes were similar among all 3 groups. Unadjusted 30-day, 6-month, 1-year, and 2-year survival rates for Caucasians versus AA versus Hispanics were 82% versus 89% versus 93%, P = 0.339; 74% versus 80% versus 71%, P = 0.596; 67% versus 76% versus 71%, P = 0.511; and 56% versus 62% versus 68%, P = 0.797. On multivariate analysis, device-related infection, malfunction, and abnormal rhythm were factors associated with overall all-cause mortality. Conclusion AA patients who undergo LVAD implantation as BTT or DT have lower socioeconomic status and educational level compared to their Caucasian or Hispanic counterparts. These differences, however, do not translate into postimplant survival outcomes.
- Published
- 2019
50. Effect of intensive and standard blood pressure control on cardiovascular outcomes based on body mass index: sub-analysis of the sprint trial
- Author
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Setri, Fugar, Alexis K, Okoh, Christopher, Dodoo, Ahmed A, Kolkailah, Edwin, Okyne, Ebru, Özturk, Alfred, Solomon, Nana Ama Afari, Yeboah, Tania, Campagnoli, Annabelle, Volgman, and Kim, Williams
- Subjects
Treatment Outcome ,Risk Factors ,Hypertension ,Humans ,Blood Pressure ,Antihypertensive Agents ,Body Mass Index - Abstract
The present study is a sub-analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) that aimed to evaluate the role of intensive vs. standard hypertensive treatment on cardiovascular outcomes according to the body mass indices of trial participants. SPRINT participants were categorized according to their baseline BMI values into normal (BMI ≥ 18.5 to25), overweight (BMI ≥ 25 to30), and obese (BMI ≥ 30) groups. The primary cardiovascular outcome was a composite of myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death from cardiovascular cause. Cox regression analysis was used to calculate hazard ratios for the study outcome in intensive and standard BP treatment among those with varying BMI. Among 9237 participants with, 1682, 3599, and 3956 were normal, overweight and obese, respectively. After a median follow-up of 3.26 years, the hazard ratios for the primary endpoint were 0.82 (95% CI 0.58, 1.16), 0.71 (95% CI 0.54, 0.94), and 0.76 (95% CI 0.59, 0.98) for the normal, overweight, and obese participants, respectively (P value for interaction 0.79). The effect of intensive versus standard SBP treatment for the other secondary endpoints and serious adverse events were all similar in participants of different BMI (all P-interaction 0.05). In this sub-analysis of the SPRINT trial, intensive blood pressure control had a beneficial effect in reducing the primary endpoint and all-cause mortality irrespective of the participants' BMI.
- Published
- 2019
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