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Ashur C, Zirille F, Aleong RG, Varosy PD, West JJ, Sandhu A, Tumolo AZ, Rosenberg MA, Sabzwari SRA, Barrett C, Cerbin L, Saqi B, Varela D, Zipse MM, Tzou WS, Garg L. Right versus left-sided implantation of left bundle branch area pacemaker insertion. J Interv Card Electrophysiol 2024; 67:257-258. [PMID: 37731143 DOI: 10.1007/s10840-023-01649-y] [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: 06/29/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Carmel Ashur
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA.
| | - Francis Zirille
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Ryan G Aleong
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Paul D Varosy
- Division of Cardiovascular Medicine, Veterans Affairs Eastern Colorado Health Care System, Aurora, CO, USA
| | - J Jason West
- Division of Cardiovascular Medicine, Denver Health, Denver, CO, USA
| | - Amneet Sandhu
- Division of Cardiovascular Medicine, Veterans Affairs Eastern Colorado Health Care System, Aurora, CO, USA
| | - Alexis Z Tumolo
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Michael A Rosenberg
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Syed Rafay Ali Sabzwari
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Christopher Barrett
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Lukasz Cerbin
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Bilal Saqi
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Daniel Varela
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Matthew M Zipse
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Wendy S Tzou
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
| | - Lohit Garg
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado Anschutz Medical Campus, 12505 E. 16Th Avenue, Aurora, CO, 80045, USA
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Ashur C, Tzou WS. Learning Before Burning: Mapping With Reversible Pulsed Field Ablation. Circ Arrhythm Electrophysiol 2024; 17:e012430. [PMID: 38284234 DOI: 10.1161/circep.123.012430] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Affiliation(s)
- Carmel Ashur
- Division of Cardiology, Cardiac Electrophysiology Section, University of Colorado Anschutz Medical Campus, Aurora
| | - Wendy S Tzou
- Division of Cardiology, Cardiac Electrophysiology Section, University of Colorado Anschutz Medical Campus, Aurora
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Sandhu A, Kaltenbach LA, Chiswell K, Shimoga V, Ashur C, Pribish A, Fonarow GC, Piccini JP, Ho PM, Varosy PD, Hess PL. Off-Label Dosing of Direct Oral Anticoagulants Among Inpatients With Atrial Fibrillation in the United States. Circ Cardiovasc Qual Outcomes 2023; 16:e010062. [PMID: 37929603 PMCID: PMC10842588 DOI: 10.1161/circoutcomes.123.010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Among patients hospitalized for atrial fibrillation, the frequency of off-label direct oral anticoagulant (DOAC) dosing, associated factors, hospital-level variation, and temporal trends in contemporary practice are unknown. METHODS Using the Get With The Guidelines-Atrial Fibrillation registry, patients admitted from January 1, 2014, to March 31, 2020, and discharged on DOACs were stratified according to receipt of underdosing, overdosing, or recommended dosing. Factors associated with off-label dosing (defined as underdosing or overdosing) were identified using logistic regression. Median odds ratio (OR) and time-series analyses were used to assess hospital-level variation and temporal trends, respectively. RESULTS Of 22 470 patients (70.1±12.1 years, 48.1% female, 82.5% White) prescribed a DOAC at discharge from hospitalization for atrial fibrillation (66% apixaban, 29% rivaroxaban, and 5% dabigatran), underdosing occurred among 2006 (8.9%), overdosing among 511 (2.3%), and recommended dosing among 19 953 (88.8%). The overall rate of off-label dosing was 11.2%. Patient-related factors associated with off-label dose included age (underdosing: OR, 1.06 per 1-year increase [95% CI, 1.06-1.07]; overdosing: OR, 1.07 per 1-year increase [95% CI, 1.06-1.09]), dialysis dependence (underdosing: OR, 5.50 [95% CI, 3.76-8.05]; overdosing: OR, 5.47 [95% CI, 2.74-10.88]), female sex (overdosing: OR, 0.79 [95% CI, 0.63-0.99]), and weight (overdosing: OR, 0.96 per 1-kg increase [95% CI, 0.95-1.00]). Across hospitals, the adjusted median OR for off-label DOAC dose was 1.45 (95% CI, 1.34-1.65; underdosing: OR, 1.52 [95% CI, 1.39-1.76]; overdosing: OR, 1.32 [95% CI, 1.20-1.84]), indicating significant hospital-level variation. Over the study period, recommended dosing significantly increased over time (81.9%-90.9%; P<0.0001 for trend) with a corresponding decline in underdosing (14.4%-6.6%; P<0.0001 for trend) and overdosing (3.8%-2.5%; P=0.001 for trend). CONCLUSIONS Over 1 in 10 patients hospitalized for atrial fibrillation are discharged on an off-label DOAC dose with significant variation across hospitals. While the proportion of patients receiving recommended dosing has significantly improved over time, opportunities to improve DOAC dosing persist.
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Affiliation(s)
- Amneet Sandhu
- Denver VA Medical Center, Section of Cardiology
- University of Colorado, Division of Cardiology
| | | | | | | | | | | | | | | | - P. Michael Ho
- Denver VA Medical Center, Section of Cardiology
- University of Colorado, Division of Cardiology
| | - Paul D. Varosy
- Denver VA Medical Center, Section of Cardiology
- University of Colorado, Division of Cardiology
| | - Paul L. Hess
- Denver VA Medical Center, Section of Cardiology
- University of Colorado, Division of Cardiology
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Conlon A, Ashur C, Washer L, Eagle KA, Hofmann Bowman MA. Response to "Potential for bias in assessing risk and protective factors for COVID-19: Commentary on Conlon et al.'s 'Impact of the influenza vaccination on COVID-19 infection rates and Severity'". Am J Infect Control 2021; 49:1090-1091. [PMID: 34294383 PMCID: PMC8289892 DOI: 10.1016/j.ajic.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 11/11/2022]
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Ashur C, Cascino TM, Lewis C, Townsend W, Sen A, Pekmezi D, Richardson CR, Jackson EA. Do Wearable Activity Trackers Increase Physical Activity Among Cardiac Rehabilitation Participants? A SYSTEMATIC REVIEW AND META-ANALYSIS. J Cardiopulm Rehabil Prev 2021; 41:249-256. [PMID: 33828045 DOI: 10.1097/hcr.0000000000000592] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective of this study was to review randomized controlled trials (RCT), which included a wearable activity tracker in an intervention to promote physical activity among cardiac rehabilitation (CR) participants, and to conduct a meta-analysis for the outcomes of step counts and aerobic capacity (V˙o2max). METHODS Eight databases were searched for RCTs that included an activity tracker, enrolled adults eligible for CR, and reported outcomes of step count or aerobic capacity. Mean differences were calculated for outcomes in the meta-analyses. RESULTS Nineteen RCTs with 2429 participants were included in the systematic review and 10 RCTs with 891 participants were included in the meta-analysis. Meta-analysis of three RCTs using a pedometer or accelerometer demonstrated a significant increase in daily step count compared with controls (n = 211, 2587 steps/d [95% CI, 916-5257]; I2 = 74.6% and P = .002). Meta-analysis of three RCTs using a pedometer or accelerometer intervention demonstrated a significant increase in V˙o2max compared with controls (n = 260, 2.6 mL/min/kg [95% CI, 1.6-3.6]; I2 = 0.0% and P < .0001). Meta-analysis of four RCTs using a heart rate monitor demonstrated a significant increase in V˙o2max compared with controls (n = 420, 1.4 mL/min/kg [95% CI, 0.4-2.3]; I2 = 0.0% and P = .006). CONCLUSIONS Use of activity trackers among CR participants was associated with significant increases in daily step count and aerobic capacity when compared with controls. However, study size was small and variability in intervention supports the need for larger trials to assess use of activity trackers in CR.
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Affiliation(s)
- Carmel Ashur
- Departments of Internal Medicine (Drs Ashur and Lewis) and Family Medicine (Drs Sen and Richardson), University of Michigan, Ann Arbor; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (Dr Cascino); Taubman Health Sciences Library, University of Michigan Library, Ann Arbor (Ms Townsend); Department of Health Behavior, University of Alabama at Birmingham School of Public Health, Birmingham (Dr Pekmezi); and Division of Cardiovascular Disease, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham (Dr Jackson)
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Cascino TM, Ashur C, Richardson CR, Jackson EA, McLaughlin VV. Impact of patient characteristics and perceived barriers on referral to exercise rehabilitation among patients with pulmonary hypertension in the United States. Pulm Circ 2020; 10:2045894020974926. [PMID: 33343883 PMCID: PMC7731716 DOI: 10.1177/2045894020974926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 08/04/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022] Open
Abstract
Exercise rehabilitation is underutilized in patients with pulmonary arterial hypertension despite improving exercise capacity and quality of life. We sought to understand the association between (1) patient characteristics and (2) patient-perceived barriers and referral to exercise rehabilitation. We performed a cross-sectional survey of patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension attending an International PAH meeting. Predictors of referral considered included gender, body mass index, subjective socioeconomic status, insurance type, age, and World Health Organization functional class and perceived barriers assessed using the Cardiac Rehabilitation Barriers Scale. Among 65 participants, those in the lowest subjective socioeconomic status tertile had reduced odds of referral compared to the highest tertile participants (odds ratio 0.22, 95% confidence interval: 0.05–0.98, p = 0.047). Several patient-perceived barriers were associated with reduced odds of referral. For every 1-unit increase in a reported barrier on a five-point Likert scale, odds of referral were reduced by 85% for my doctor did not feel it was necessary; 85% for prefer to take care of my health alone, not in a group; 78% many people with heart and lung problems don’t go, and they are fine; and 78% for I didn’t know about exercise therapy. The lack of perceived need subscale and overall barriers score were associated with a 92% and 77% reduced odds of referral, respectively. These data suggest the need to explore interventions to promote referral among low socioeconomic status patients and address perceived need for the therapy.
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Affiliation(s)
- Thomas M Cascino
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Carmel Ashur
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Elizabeth A Jackson
- Division of Cardiovascular Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Cascino T, Ashur C, Richardson C, Jackson E, McLaughlin V. Lower Socioeconomic Status Associated with Decreased Completion of Exercise Rehabilitation in Patients with Pulmonary Hypertension. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ashur C, Cascino T, Lewis C, Richardson C, Jackson E. WEARABLE TECHNOLOGY AS AN INTERVENTION FOR PATIENTS WITH CORONARY HEART DISEASE IN AN EXERCISE-BASED REHABILITATION PROGRAM: A SYSTEMATIC REVIEW. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32433-7] [Citation(s) in RCA: 5] [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: 11/17/2022]
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Grafton G, Cascino TM, Perry D, Ashur C, Koelling TM. Resting Oxygen Consumption and Heart Failure: Importance of Measurement for Determination of Cardiac Output With the Use of the Fick Principle. J Card Fail 2019; 26:664-672. [PMID: 30753933 DOI: 10.1016/j.cardfail.2019.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 02/01/2019] [Accepted: 02/03/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Resting oxygen consumption (VO2) is often estimated and frequently used to guide therapeutic decisions in symptomatic heart failure (HF) patients. The relationship between resting VO2 and symptomatic HF and the accuracy of estimations of VO2 in this population are unknown. METHODS AND RESULTS We performed a cross-sectional study of HF patients (n = 691) and healthy control subjects (n = 77). VO2 was measured with the use of a metabolic cart, and estimated VO2 was calculated with the use of the Dehmer, LaFarge, and Bergstra formulas and the thermodilution method. The measured and estimated VO2 were compared and the potential impact of estimations determined. In the multivariable model, resting VO2 decreased with increasing New York Heart Association (NYHA) functional class in a stepwise fashion (β NYHA functional class IV vs control = -36 mL O2/min; P < .001). Estimations of VO2 with the use of derived equations diverged from measured values, particularly for patients with NYHA functional class IV limitations. The percentage difference of measured VO2 versus estimated VO2 was >25% in 39% (n = 271), 25% (n = 170), 82% (n = 566), and 39% (n = 271) of HF patients when using the Dehmer, LaFarge, Bergstra, and thermodilution-derived estimations of VO2 respectively. CONCLUSIONS Resting VO2 decreases with increasing NYHA functional class and is lower than in control subjects. Using estimations of VO2 to calculate CO may introduce clinically important error.
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Affiliation(s)
- Gillian Grafton
- Division of Cardiovascular Medicine, Henry Ford, Detroit, Michigan
| | - Thomas M Cascino
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
| | - Daniel Perry
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Carmel Ashur
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Todd M Koelling
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
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Cobb LJ, Lee C, Xiao J, Yen K, Wong RG, Nakamura HK, Mehta HH, Gao Q, Ashur C, Huffman DM, Wan J, Muzumdar R, Barzilai N, Cohen P. Naturally occurring mitochondrial-derived peptides are age-dependent regulators of apoptosis, insulin sensitivity, and inflammatory markers. Aging (Albany NY) 2017; 8:796-809. [PMID: 27070352 PMCID: PMC4925829 DOI: 10.18632/aging.100943] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 04/02/2016] [Indexed: 01/04/2023]
Abstract
Mitochondria are key players in aging and in the pathogenesis of age-related diseases. Recent mitochondrial transcriptome analyses revealed the existence of multiple small mRNAs transcribed from mitochondrial DNA (mtDNA). Humanin (HN), a peptide encoded in the mtDNA 16S ribosomal RNA region, is a neuroprotective factor. An in silico search revealed six additional peptides in the same region of mtDNA as humanin; we named these peptides small humanin-like peptides (SHLPs). We identified the functional roles for these peptides and the potential mechanisms of action. The SHLPs differed in their ability to regulate cell viability in vitro. We focused on SHLP2 and SHLP3 because they shared similar protective effects with HN. Specifically, they significantly reduced apoptosis and the generation of reactive oxygen species, and improved mitochondrial metabolism in vitro. SHLP2 and SHLP3 also enhanced 3T3-L1 pre-adipocyte differentiation. Systemic hyperinsulinemic-euglycemic clamp studies showed that intracerebrally infused SHLP2 increased glucose uptake and suppressed hepatic glucose production, suggesting that it functions as an insulin sensitizer both peripherally and centrally. Similar to HN, the levels of circulating SHLP2 were found to decrease with age. These results suggest that mitochondria play critical roles in metabolism and survival through the synthesis of mitochondrial peptides, and provide new insights into mitochondrial biology with relevance to aging and human biology.
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Affiliation(s)
- Laura J Cobb
- Department of Pediatrics, Mattel Children's Hospital, and Division of Endocrinology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.,Current address: LCS Executive Consulting, North Hollywood, CA 91607, USA
| | - Changhan Lee
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - Jialin Xiao
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - Kelvin Yen
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - Richard G Wong
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - Hiromi K Nakamura
- Department of Pediatrics, Mattel Children's Hospital, and Division of Endocrinology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Hemal H Mehta
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - Qinglei Gao
- Department of Pediatrics, Mattel Children's Hospital, and Division of Endocrinology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Carmel Ashur
- Department of Pediatrics, Mattel Children's Hospital, and Division of Endocrinology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Derek M Huffman
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Junxiang Wan
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - Radhika Muzumdar
- Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Nir Barzilai
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Pinchas Cohen
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
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