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Douglas PS, Mack MJ, Acosta DA, Benjamin EJ, Biga C, Hayes SN, Ijioma NN, Jay-Fuchs L, Khandelwal AK, McPherson JA, Mieres JH, Roswell RO, Sengupta PP, Stokes N, Wade EA, Yancy CW. 2022 ACC Health Policy Statement on Building Respect, Civility, and Inclusion in the Cardiovascular Workplace. J Am Coll Cardiol 2022; 79:2153-2184. [DOI: 10.1016/j.jacc.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Douglas PS, Mack MJ, Acosta DA, Benjamin EJ, Biga C, Hayes SN, Ijioma NN, Jay-Fuchs L, Khandelwal AK, McPherson JA, Mieres JH, Roswell RO, Sengupta PP, Stokes N, Wade EA, Yancy CW. SOCIAL DETERMINANTS OF MORTALITY FROM COVID-19, A RETROSPECTIVE STUDY OF 6,000 PATIENTS. J Am Coll Cardiol 2022. [PMID: 35307518 PMCID: PMC8972426 DOI: 10.1016/s0735-1097(22)03144-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jain V, Gupta K, Bhatia K, Bansal A, Arora S, Khandelwal AK, Rosenberg JR, Levisay JP, Tommaso CL, Ricciardi MJ, Qamar A. Management of STEMI during the COVID-19 pandemic: Lessons learned in 2020 to prepare for 2021. Trends Cardiovasc Med 2020; 31:135-140. [PMID: 33338636 PMCID: PMC7831899 DOI: 10.1016/j.tcm.2020.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Received: 09/20/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 01/25/2023]
Abstract
As the prevalence of asymptomatic COVID-19 continues to increase, there is an increasing possibility that patients with COVID-19 may presen with ST-segment elevation myocardial infarction (STEMI). With social distancing and restricted access to preventive healthcare and emergency services, the management of acute cardiac emergencies such as myocardial infarction has suffered collateral damage. Thus far, global trends suggest a decrease in STEMI activations with possible worse outcomes due to delayed presentation and management. In this review, we discuss the challenges to STEMI management in the COVID-19 era and provide potential solutions for adherence to evidence-based therapies as the pandemic progresses into the year 2021.
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Affiliation(s)
- Vardhmaan Jain
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland OH, United States
| | - Kartik Gupta
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, United States
| | - Kirtipal Bhatia
- Division of Cardiology, St. Luke's Roosevelt Hospital at Mount Sinai Icahn School of Medicine, New York, NY, United States
| | - Agam Bansal
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland OH, United States
| | - Sameer Arora
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Akshay K Khandelwal
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, United States
| | - Jonathan R Rosenberg
- Section of Interventional Cardiology, NorthShore University Health System, Evanston, IL, United States
| | - Justin P Levisay
- Section of Interventional Cardiology, NorthShore University Health System, Evanston, IL, United States
| | - Carl L Tommaso
- Section of Interventional Cardiology, NorthShore University Health System, Evanston, IL, United States
| | - Mark J Ricciardi
- Section of Interventional Cardiology, NorthShore University Health System, Evanston, IL, United States
| | - Arman Qamar
- Section of Interventional Cardiology, NorthShore University Health System, Evanston, IL, United States.
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O'Neill BP, Cohen MG, Basir MB, Schreiber T, Kapur NK, Dixon S, Khandelwal AK, Grines C, Ohman EM, O'Neill WW. Outcomes Among Patients Transferred for Revascularization With Impella for Acute Myocardial Infarction With Cardiogenic Shock from the cVAD Registry. Am J Cardiol 2019; 123:1214-1219. [PMID: 30777319 DOI: 10.1016/j.amjcard.2019.01.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/05/2019] [Accepted: 01/09/2019] [Indexed: 11/28/2022]
Abstract
The outcomes for patients transferred with cardiogenic shock and later treated with revascularization and Impella support have not previously been studied. To evaluate these outcomes, patients in cardiogenic shock were recruited from the catheter-based ventricular assist device registry, a prospective registry enrolling patients who underwent percutaneous coronary intervention with hemodynamic support using Impella 2.5 or CP. Analysis was performed on subgroups of patients who were characterized as those directly admitted to a tertiary care hospital (direct), or those transferred from an outside hospital (transfer). Patients who were transferred with acute myocardial infarction with cardiogenic shock (AMICS) more often presented in shock were in shock longer than 24 hours, and were more likely to be on intra-aortic balloon pump but were less likely to sustain cardiac arrest. The number of pressors, EF, diseased, and treated vessels were similar between the 2 groups. Despite baseline differences, the mortality was similar in the transfer versus direct patients (47.0% vs 53.5% p = 0.19). In a multivariate model, the factors independently associated with 30-day mortality in AMICS treated with revascularization and Impella support were cardiopulmonary resuscitation (CPR) (p <0.01), age (p <0.01), and ST-segment elevation myocardial infarction (STEMI) (p = 0.02). Whether the patient was transferred or directly admittedly with AMICS was not an independent predictor of death. In conclusion, these findings suggest that considerations should be given to transfer patients with AMICS to allow them to be treated in a contemporary manner.
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Affiliation(s)
- Brian P O'Neill
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania. Brian.O'
| | - Mauricio G Cohen
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Mir Babar Basir
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | | | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, MA
| | - Simon Dixon
- Department of Cardiology, Beaumont Hospital, Royal Oak, Michigan
| | | | - Cindy Grines
- Northwell Health, North Shore University Hospital, Manhasset, New York
| | - Erik Magnus Ohman
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
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Abstract
Pheochromocytoma, a rare catecholamine-secreting tumor, typically manifests itself with paroxysmal hypertension, tachycardia, headache, and diaphoresis. Less often, symptoms related to substantial hemodynamic compromise and cardiogenic shock occur. We report the case of a 66-year-old woman who presented with abdominal pain. Examination revealed a large right adrenal mass, cardiogenic shock, and severe heart failure in the presence of normal coronary arteries. Within days, the patient's hemodynamic status and left ventricular ejection fraction improved markedly. Results of imaging and biochemical tests confirmed the diagnosis of pheochromocytoma-induced takotsubo cardiomyopathy. Medical therapy and right adrenalectomy resolved the patient's heart failure, and she was asymptomatic postoperatively. We recommend awareness of the link between pheochromocytoma and takotsubo cardiomyopathy, and we discuss relevant diagnostic and management principles.
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Brennan JM, Curtis JP, Dai D, Fitzgerald S, Khandelwal AK, Spertus JA, Rao SV, Singh M, Shaw RE, Ho KK, Krone RJ, Weintraub WS, Weaver WD, Peterson ED. Enhanced Mortality Risk Prediction With a Focus on High-Risk Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2013; 6:790-9. [DOI: 10.1016/j.jcin.2013.03.020] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 03/12/2013] [Accepted: 03/15/2013] [Indexed: 01/29/2023]
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Abstract
OBJECTIVE To determine resident and faculty perceptions of the pharmaceutical industry's influence on medical education. DESIGN, SETTING, AND PARTICIPANTS Anonymous survey of categorical residents and faculty in the department of medicine at a large, Midwestern, urban, independent academic medical center. MAIN RESULTS Eighty-one residents (69.2%) and 196 faculty (75.7%) responded to the survey. Residents believed that a significantly higher percentage of primary care and subspecialist faculty receives industry income or gifts compared to faculty respondents. Many faculty, and to a significantly greater degree residents, indicated that income or gifts influence the teaching of both internal attending physicians and visiting faculty in a variety of educational settings. The majority of residents (61.7%) and faculty (62.2%) believed that annual income or gifts less than $10,000 could influence an attending physician's teaching. Most residents (65.4%) and faculty (74%) preferred that lecturers report all financial relationships with industry regardless of which relationships the lecturer believes are relevant. CONCLUSIONS Most internal medicine residents and their faculty perceive that industry influences teaching in different educational settings, and want teachers to disclose all of their financial relationships with industry. This information may guide further development of policies and curricula addressing industry relationships within graduate medical education.
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Affiliation(s)
- Peter Y Watson
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, USA
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McCullough PA, Khandelwal AK, McKinnon JE, Shenkman HJ, Pampati V, Nori D, Sullivan RA, Sandberg KR, Kaatz S. Outcomes and Prognostic Factors of Systolic as Compared With Diastolic Heart Failure in Urban America. ACTA ACUST UNITED AC 2005; 11:6-11. [PMID: 15722664 DOI: 10.1111/j.1527-5299.2005.03731.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We sought to describe a large heart failure (HF) population with respect to systolic and diastolic abnormalities in terms of demographics, echocardiographic parameters, and survival. Using data abstracted from the Resource Utilization Among Congestive Heart Failure (REACH) study, a targeted subpopulation of 3471 patients had electrocardiographic, echocardiographic, and clinical data taken from automated sources during the first year of diagnosis. Among the HF population, 1811 (52.2%) had diastolic HF. Prevalence of diastolic HF trended with age, from 46.4% in those less than 45 years to 58.7% in those 85 years or older (p=0.001 for trend). Patients with diastolic HF had a higher mean ejection fraction (55.7% vs. 28.0%), lower left ventricular end-systolic diameter (3.11 vs. 4.74 cm), and lower left atrium:aortic outlet ratio (1.28 vs. 1.38) (p=0.001 for each comparison). Annualized age, sex, and race-adjusted mortality were 11.2% and 13.0% for those with diastolic and systolic HF, respectively (p=0.001). In a large, racially mixed, urban HF population, those with diastolic HF predominate and enjoy better-adjusted survival than counterparts with systolic HF.
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Affiliation(s)
- Peter A McCullough
- Division of Cardiology, William Beaumont Hospital, 4949 Coolidge Highway, Royal Oak, MI 48073, USA.
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Shenkman HJ, Pampati V, Khandelwal AK, McKinnon J, Nori D, Kaatz S, Sandberg KR, McCullough PA. Congestive heart failure and QRS duration: establishing prognosis study. Chest 2002; 122:528-34. [PMID: 12171827 DOI: 10.1378/chest.122.2.528] [Citation(s) in RCA: 166] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
STUDY OBJECTIVES There is a lack of epidemiologic information about duration of QRS complex in the general heart failure population. We sought to describe age, sex, and clinical subset specific prevalence of QRS prolongation in this population. METHODS Data were abstracted from the Resource Utilization Among Congestive Heart Failure Study, which identified 29,686 patients with heart failure from a large, mixed-model managed-care organization during 1989 to 1999. A target population of 3,471 had echocardiographic data and ECG data obtained from automated sources during the first year of diagnosis. Systolic dysfunction was defined as heart failure plus a left ventricular ejection fraction < 45%. MEASUREMENTS AND RESULTS Among the heart failure population, 20.8% of the subjects had a QRS duration > or = 120 ms. A total of 425 men (24.7%) and 296 women (16.9%) had a prolonged QRS duration (p < 0.01). There was a linear relationship between increased QRS duration and decreased ejection fraction (p < 0.01). A prolonged QRS duration of 120 to 149 ms demonstrated increased mortality at 60 months (p = 0.001), when adjusted for age, sex, and race (p = 0.001). Systolic dysfunction was associated with graded increases in mortality across ascending levels of QRS prolongation. CONCLUSIONS Approximately 20% of a generalized heart failure population can be expected to have a prolonged QRS duration within the first year of diagnosis, suggesting that as many as 20% of patients with heart failure may be candidates for biventricular pacing.
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Khandelwal AK, McKinnon JE, Shenkman HJ, Pampati V, Nori D, Kaatz S, Sandberg KR, McCullough PA. Epidemiology of systolic and diastolic dysfunction heart failure in 3,471 urban patients. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)80850-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tripathi SK, Mandal AK, Khandelwal AK. Immunisation status of under fives: completion of primary immunisation--an immunisation clinic base study. Indian J Public Health 1991; 35:23. [PMID: 1791071] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- S K Tripathi
- Department of Clinical pharmacology, P.G.I.M.E.R., Chandigarh, India
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