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Khoche S. If a tree falls in the forest, is there an echo? Lessons learnt from the STS database analysis. J Cardiothorac Vasc Anesth 2024; 38:1112-1114. [PMID: 38514291 DOI: 10.1053/j.jvca.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Swapnil Khoche
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, University of California, San Diego, Thornton Hospital, 9444 Campus Point Drive #7651, La Jolla, California 92093.
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2
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Tanguturi VK, Hung J. More TAVRs or Targets in Aortic Stenosis? A Call for Targeted Data Tracking to Improve Our Care of Valvular Heart Disease. Circ Cardiovasc Qual Outcomes 2023; 16:e010073. [PMID: 37339187 DOI: 10.1161/circoutcomes.123.010073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Affiliation(s)
- Varsha K Tanguturi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston
| | - Judy Hung
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston
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3
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Crousillat DR, Amponsah DK, Camacho A, Kandanelly RR, Bapat D, Chen C, Selberg A, Shaqdan A, Tanguturi VK, Picard MH, Hung JW, Elmariah S. Racial and Ethnic Differences in the Clinical Diagnosis of Aortic Stenosis. J Am Heart Assoc 2022; 11:e025692. [PMID: 36533618 PMCID: PMC9798798 DOI: 10.1161/jaha.122.025692] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Racial and ethnic minority groups are underrepresented among patients undergoing aortic valve replacement in the United States. We evaluated the impact of race and ethnicity on the diagnosis of aortic stenosis (AS). Methods and Results In patients with transthoracic echocardiography (TTE)-confirmed AS, we assessed rates of AS diagnosis as defined by assignment of an International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) code for AS within a large multicenter electronic health record. Multivariable Cox proportional hazard and competing risk regression models were used to evaluate the 1-year rate of AS diagnosis by race and ethnicity. Among 14 800 patients with AS, the 1-year diagnosis rate for AS following TTE was 37.4%. Increasing AS severity was associated with an increased likelihood of receiving an AS diagnosis (moderate: hazard ratio [HR], 3.05 [95% CI, 2.86-3.25]; P<0.0001; severe: HR, 4.82 [95% CI, 4.41-5.28]; P<0.0001). Compared with non-Hispanic White, non-Hispanic Black (HR, 0.65 [95% CI, 0.54-0.77]; P<0.0001) and non-Hispanic Asian individuals (HR, 0.72 [95% CI, 0.57-0.90], P=0.004) were less likely to receive a diagnosis of AS. Additional factors associated with a decreased likelihood of receiving an AS diagnosis included a noncardiology TTE ordering provider (HR, 0.92 [95% CI, 0.86-0.97]; P=0.005) and TTE performed in the inpatient setting (HR, 0.72 [95% CI, 0.66-0.78]; P<0.0001). Conclusions Rates of receiving an ICD diagnostic code for AS following a diagnostic TTE are low and vary significantly by race and ethnicity and disease severity. Further studies are needed to determine if efforts to maximize the clinical recognition of TTE-confirmed AS may help to mitigate disparities in treatment.
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Affiliation(s)
- Daniela R. Crousillat
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA,Division of Cardiovascular SciencesUniversity of South FloridaTampaFL
| | - Daniel K. Amponsah
- Department of Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Alexander Camacho
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Ritvik R. Kandanelly
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Devavrat Bapat
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Chen Chen
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Alexandra Selberg
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Ayman Shaqdan
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Varsha K. Tanguturi
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Michael H. Picard
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Judy W. Hung
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Sammy Elmariah
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA,Cardiology DivisionUniversity of California San FranciscoSan FranciscoCA
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4
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Amponsah DK, Crousillat DR, Elmariah S. Racial and Ethnic Disparities in the Treatment of Aortic Stenosis: Current Challenges and Future Strategies for Achieving Equity in Care. Curr Treat Options Cardio Med 2022. [DOI: 10.1007/s11936-022-00963-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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5
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Sparrow RT, Sanjoy SS, Lindman BR, Tang GHL, Kaneko T, Wasfy JH, Pershad A, Villablanca PA, Guerrero M, Alraies MC, Choi YH, Sposato LA, Mamas MA, Bagur R. Racial, ethnic and socioeconomic disparities in patients undergoing transcatheter mitral edge-to-edge repair. Int J Cardiol 2021; 344:73-81. [PMID: 34555446 DOI: 10.1016/j.ijcard.2021.09.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Transcatheter mitral edge-to-edge repair (TEER) is an increasingly common procedure performed on patients with severe mitral regurgitation. This study assessed the impact of race/ethnicity and socioeconomic status on in-hospital complications after TEER. METHODS Cohort-based observational study using the National Inpatient Sample between October 2013 and December 2018. The population was stratified into 4 groups based on race/ethnicity and quartiles of neighborhood income levels. The primary outcome was in-hospital complications, defined as the composite of death, bleeding, cardiac and vascular complications, acute kidney injury, and ischemic stroke. RESULTS 3795 hospitalizations for TEER were identified. Patients of Black and Hispanic race/ethnicity comprised 7.4% and 6.4%, respectively. We estimated that White patients received TEER with a frequency of 38.0/100,000, compared to 29.7/100,000 for Blacks and 30.5/100,000 for Hispanics. In-hospital complications occurred in 20.2% of patients and no differences were found between racial/ethnic groups (P = 0.06). After multilevel modelling, Black and Hispanic patients had similar rate of overall in-hospital complications (OR: 0.84, CI:0.67-1.05 and OR: 0.84, CI:0.66-1.07, respectively) as compared to White patients, however, higher rates of death were observed in Black patients. Individuals living in income quartile-1 had worse in-hospital outcomes as compared to quartile-4 (OR: 1.19, CI:0.99-1.42). CONCLUSION In this study assessing racial/ethnic disparities in TEER outcomes, aged-adjusted race/ethnicity minorities were less underrepresented as compared to other structural heart interventions. Black patients experienced a higher rate of in-hospital death, but similar overall rate of post-procedural adverse events as compared to White patients. Lower income levels appear to negatively impact on in-hospital outcomes. BRIEF SUMMARY This study appraises race/ethnic and socioeconomical disparities in access and outcomes following transcatheter mitral edge-to-edge repair. Racial minority groups were less underrepresented as compared to other structural heart interventions. While Black patients experienced a higher rate of in-hospital death, they experienced similar overall rate of post-procedural complications compared to White patients. Lower income levels also appeared to negatively impact on outcomes.
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Affiliation(s)
| | - Shubrandu S Sanjoy
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Brian R Lindman
- Cardiovascular Medicine Division, Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jason H Wasfy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ashish Pershad
- University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Pedro A Villablanca
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, MI, USA
| | - Mayra Guerrero
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - M Chadi Alraies
- Wayne State University, Detroit Medical Center, Detroit, MI, USA
| | - Yun-Hee Choi
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Luciano A Sposato
- London Health Sciences Centre, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences; Stroke, Dementia & Heart Disease Laboratory; Kathleen and Dr. Henry Barnett Chair in Stroke Research; Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - Rodrigo Bagur
- London Health Sciences Centre, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom.
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Hyland PM, Xu J, Shen C, Markson LJ, Manning WJ, Strom JB. Race, sex and age disparities in echocardiography among Medicare beneficiaries in an integrated healthcare system. Heart 2021; 108:956-963. [PMID: 34615667 DOI: 10.1136/heartjnl-2021-319951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/08/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To identify potential race, sex and age disparities in performance of transthoracic echocardiography (TTE) over several decades. METHODS TTE reports from five academic and community sites within a single integrated healthcare system were linked to 100% Medicare fee-for-service claims from 1 January 2005 to 31 December 2017. Multivariable Poisson regression was used to estimate adjusted rates of TTE utilisation after the index TTE according to baseline age, sex, race and comorbidities among individuals with ≥2 TTEs. Non-white race was defined as black, Asian, North American Native, Hispanic or other categories using Medicare-assigned race categories. RESULTS A total of 15 870 individuals (50.1% female, mean 72.2±12.7 years) underwent a total of 63 535 TTEs (range 2-55/person) over a median (IQR) follow-up time of 4.9 (2.4-8.5) years. After the index TTE, the median TTE use was 0.72 TTEs/person/year (IQR 0.43-1.33; range 0.12-26.76). TTE use was lower in older individuals (relative risk (RR) for 10-year increase in age, 0.91, 95% CI 0.89 to 0.92, p<0.001), women (RR 0.97, 95% CI 0.95 to 0.99, p<0.001) and non-white individuals (RR 0.95, 95% CI 0.93 to 0.97, p<0.001). Black women in particular had the lowest relative use of TTE (RR 0.92, 95% CI 0.88 to 0.95, p<0.001). The only clinical conditions associated with increased TTE use after multivariable adjustment were heart failure (RR 1.04, 95% CI 1.00 to 1.08, p=0.04) and chronic obstructive pulmonary disease (RR 1.05, 95% CI 1.00 to 1.10, p=0.04). CONCLUSIONS Among Medicare beneficiaries with multiple TTEs in a single large healthcare system, the median TTE use after the index TTE was 0.72 TTEs/person/year, although this varied widely. Adjusted for comorbidities, female sex, non-white race and advancing age were associated with decreased TTE utilisation.
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Affiliation(s)
- Patrick M Hyland
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jiaman Xu
- Harvard Medical School, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts, USA
| | - Changyu Shen
- Harvard Medical School, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts, USA
| | - Lawrence J Markson
- Harvard Medical School, Boston, Massachusetts, USA.,Information Systems, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Warren J Manning
- Harvard Medical School, Boston, Massachusetts, USA.,Departments of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jordan B Strom
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA .,Harvard Medical School, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts, USA
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Abstract
Purpose of review Pregnancy is associated with significant hemodynamic changes, making it a potentially high-risk period for women with underlying cardiovascular disease. Echocardiography remains the preferred modality for diagnosis and monitoring of pregnant women with cardiovascular disease as it is widely available and does not require radiation. This paper reviews the role of echocardiography along the continuum of pregnancy in at-risk patients, with a focus on key cardiac disease states in pregnancy. Recent findings In the preconception stage, risk stratification scores such as CARPREG II, ZAHARA and the modified WHO remain central to counseling and planning. As such, echocardiography serves an important role in assessing the severity of pre-existing structural disease. Among women with pre-existing cardiovascular disease who become pregnant-as well as those who develop cardiovascular symptoms during pregnancy-echocardiography is a key imaging tool for assessment of hemodynamic and structural changes and is recommended as the first-line imaging modality when appropriate by both the American College of Obstetricians and Gynecologists (ACOG) and the Food and Drug Administration (FDA). However, routine screening intervals during pregnancy for various cardiac lesions are not well defined, resulting in clinical heterogeneity in care. Summary Echocardiography is the imaging modality of choice for defining, risk stratifying, and monitoring cardiovascular changes throughout pregnancy. Once identified, at-risk patients should receive careful individual counseling and follow-up with a multidisciplinary team. Echocardiography serves as a widely available tool for serial monitoring of pregnant women with cardiovascular disease throughout pregnancy and the postpartum period.
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Affiliation(s)
| | - Esther F. Davis
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA USA
| | - Amy A. Sarma
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
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Lindman BR, Arnold SV, Bagur R, Clarke L, Coylewright M, Evans F, Hung J, Lauck SB, Peschin S, Sachdev V, Tate LM, Wasfy JH, Otto CM. Priorities for Patient-Centered Research in Valvular Heart Disease: A Report From the National Heart, Lung, and Blood Institute Working Group. J Am Heart Assoc 2020; 9:e015975. [PMID: 32326818 PMCID: PMC7428554 DOI: 10.1161/jaha.119.015975] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Over the past decade, the field of valvular heart disease (VHD) has rapidly transformed, largely as a result of the development and improvement of less invasive transcatheter approaches to valve repair or replacement. This transformation has been supported by numerous well-designed randomized trials, but they have centered almost entirely on devices and procedures. Outside this scope of focus, however, myriad aspects of therapy and management for patients with VHD have either no guidelines or recommendations based only on expert opinion and observational studies. Further, research in VHD has often failed to engage patients to inform study design and identify research questions of greatest importance and relevance from a patient perspective. Accordingly, the National Heart, Lung, and Blood Institute convened a Working Group on Patient-Centered Research in Valvular Heart Disease, composed of clinician and research experts and patient advocacy experts to identify gaps and barriers to research in VHD and identify research priorities. While recognizing that important research remains to be done to test the safety and efficacy of devices and procedures to treat VHD, we intentionally focused less attention on these areas of research as they are more commonly pursued and supported by industry. Herein, we present the patient-centered research gaps, barriers, and priorities in VHD and organized our report according to the "patient journey," including access to care, screening and diagnosis, preprocedure therapy and management, decision making when a procedure is contemplated (clinician and patient perspectives), and postprocedure therapy and management. It is hoped that this report will foster collaboration among diverse stakeholders and highlight for funding bodies the pressing patient-centered research gaps, opportunities, and priorities in VHD in order to produce impactful patient-centered research that will inform and improve patient-centered policy and care.
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Affiliation(s)
- Brian R Lindman
- Cardiovascular Medicine Division Structural Heart and Valve Center Vanderbilt University Medical Center Nashville TN
| | | | - Rodrigo Bagur
- Division of Cardiology University Hospital London Health Sciences Centre London Ontario Canada
| | | | - Megan Coylewright
- Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH
| | - Frank Evans
- National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda MD
| | - Judy Hung
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
| | - Sandra B Lauck
- Centre for Heart Valve Innovation St. Paul's Hospital University of British Columbia Vancouver British Columbia Canada
| | | | - Vandana Sachdev
- National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda MD
| | | | - Jason H Wasfy
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
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Strom JB, Tanguturi VK, Nagueh SF, Klein AL, Manning WJ. Demonstrating the Value of Outcomes in Echocardiography: Imaging-Based Registries in Improving Patient Care. J Am Soc Echocardiogr 2019; 32:1608-1614. [PMID: 31563437 PMCID: PMC6899196 DOI: 10.1016/j.echo.2019.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Jordan B Strom
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Varsha K Tanguturi
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sherif F Nagueh
- Department of Cardiology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas
| | - Allan L Klein
- The Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Warren J Manning
- Departments of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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