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Frownfelter J, Blau S, Zettler M, Miller K, Kish J, Valley AW, Gajra A. Impact of augmented intelligence (AI) on identification and management of depression in oncology. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e14059] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14059 Background: Depression is common in patients with cancer and is associated with worse cancer treatment outcomes. Depression is often underdiagnosed/treated as cancer clinicians are focused on the complex aspects of therapy and care coordination. AI has a potential application in the identification of patients at high risk for depression. Jvion has developed a prescriptive analytics solution (the Machine), which uses AI algorithms and machine learning techniques applied to combined clinical and exogenous datasets to identify patients with a propensity for poor clinical outcomes. The Machine was applied to depression risk (within next 6 months), and recommended patient-specific, dynamic, and actionable insights. While the Machine requires no additional documentation within the electronic health record (EHR) to generate its insights, those insights can be integrated back in to any EHR. Herein, we report the results of a pilot study evaluating the impact of AI-driven insights on depression screening and management at a single oncology practice. Methods: All patients were scored weekly using the Machine depression vector. The Machine risk-stratified the patients and generated recommendations for the provider to consider as they developed a care plan. Patients identified as “at risk” by the Machine were assessed for depression (PHQ-9) by the clinical team regardless of prior screening results. The rate per 1000 unique patients per month (PPM) of depression screenings, case management evaluations, and antidepressant prescriptions were calculated for the 5 months prior to and 17 months post deployment of the Machine in the practice. Results: The oncology practice has 21 providers managing an average of 4329 unique PPM. The mean rate of depression screenings increased from 6.0 per 1000 PPM pre- deployment to 16.2 per 1000 PPM post deployment (+271%). The downstream workflow outcomes of case management evaluations increased from 11.6 to 21.4 per 1000 PPM (+184%) and antidepressant prescriptions increased from 9.2 to 15.5 per 1000 PPM (+168%) pre and post-implementation respectively. The providers reported high satisfaction with the use of the AI solution in depression screening. Conclusions: This oncology practice found deployment of the Jvion AI solution to be feasible. The Machine-generated insights for depression risk were actionable, could be incorporated into workflow, and increased the number of patients identified. If confirmed in larger studies, AI-driven insights may improve the identification and management of depression in patients with cancer.
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Affiliation(s)
| | - Sibel Blau
- Rainier Hematology Oncology/NWMS, Seattle, WA
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Gajra A, Zettler M, Kish J, Miller K, Frownfelter J, Valley AW, Blau S. Impact of augmented intelligence (AI) on utilization of palliative care (PC) services in oncology. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.12015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12015 Background: Timely integration of palliative care in the management of patients with advanced cancer is a quality benchmark in oncology. However, PC is often underutilized as evidenced by delays in identification of appropriate patients, in referrals to a PC service, and in enrollment to hospice. Jvion has developed a prescriptive analytics solution, the Machine, which combines AI algorithms with machine learning techniques and applies them to clinical and exogenous datasets to identify patients with a propensity for poor outcomes. The Machine was applied to risk for patients’ mortality within next 30 days, and recommended patient-specific, dynamic, and actionable insights. Use of the Machine requires no additional documentation within the electronic health record (EHR) and the insights generated can be integrated back in to any EHR to help inform the care plan. Herein, we report the results of a study evaluating the impact of AI-driven insights on PC utilization at a large community oncology practice. Methods: All patients were scored weekly using the Machine PC vector. The Machine risk stratified the patients and generated recommendations for the provider to consider as they developed a care plan. Patients identified as “at risk” by the Machine were assessed for a supportive care visit (PC referral) and then were referred as deemed clinically appropriate. The average monthly rates of PC consults and hospice referrals were calculated 5 months prior to and for 17 months after the launch of the Machine in the practice. Results: The oncology practice has 21 providers managing an average of 4329 unique patients per month (PPM). The mean rate of PC consults increased from 17.3 to 29.1 per 1000 PPM pre and post Machine deployment respectively (+168%). The mean monthly rate of hospice referrals increased by 8-fold from 0.2 to 1.6 per 1000 PPM pre and post deployment respectively. Eliminating the first 6 months of Machine deployment to account for user learning curve, the mean rates of monthly PC consults nearly doubled over baseline to 33.0, and hospice referrals rose 12-fold to 2.4 per 1000 patients in months 7-17 post Machine deployment. Conclusions: This oncology practice found deployment of this novel AI solution to be feasible and effective at generating actionable insights. These AI driven insights could be incorporated into workflow and improved the decision-making for whether and when a patient should be referred to PC and/or hospice services for end of life care. Further study is needed to confirm the value of AI for management of cancer patients at end of life.
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Affiliation(s)
| | | | | | | | | | | | - Sibel Blau
- Rainier Hematology Oncology/NWMS, Seattle, WA
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Zettler M, Feinberg BA, Kish J, Gajra A. Gender-based disparities in clinical trials supporting FDA approval of oncology drugs. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.2058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2058 Background: Adequate gender representation in clinical trials of new drugs is critical in order to accurately detect possible differences in response and toxicity (Özdemir et al, JCO 2018). The under-representation of women in oncology clinical trials has been previously described, however data on registrational trials, which are the basis for drug approval and inform the prescribing information, is lacking. We conducted an analysis of the trials supporting Food and Drug Administration approval of oncology drugs over a 5-year period to evaluate the representation of women vs. men. Methods: Prescribing information for novel new drugs approved from 2014-2018 was reviewed for the proportions of men and women in the evaluable population of the supporting clinical trials. Sex-specific cancers were excluded. Prevalence estimates for the indications were obtained from the Surveillance, Epidemiology and End Results database and the published literature. A participation to prevalence ratio (PPR) was calculated for each trial by dividing the percentage of women in the trial by the percentage of women in the disease population. A PPR value closer to unity represents even gender distribution and the range 0.8-1.2 is considered to reflect an acceptable representation of women. Data are presented using descriptive statistics. Results: A total of 46 oncology drugs were approved based on 56 trials enrolling 13,862 patients (7941 [57%] men; 5,921 [43%] women). Of the 56 trials, 38 (68%) had a PPR within the 0.8-1.2 range, 15 (27%) fell between 0.4-0.7, and 3 (5%) had a PPR of 1.3. The proportion of trials with unbalanced gender representation was comparable for hematological malignancy and solid tumor indications and did not improve over time. Fewer unbalanced trials were Phase III or employed a randomized design. Nine of the 18 (50%) unbalanced trials enrolled <100 subjects, compared to 3 of the 38 (8%) balanced trials. Conclusions: A third of registrational trials for oncology drugs lacked balanced gender distribution. Of the trials lacking balance, the vast majority (80%) had under-representation of women. Phase I-II trials and smaller trials had greater gender disparity, a concerning finding in a precision medicine environment where an increasing number of registration trials have double digit accrual. Further research is needed to understand the implications of unbalanced gender accrual in registrational trials, and to develop strategies for preventing disparities.
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Zettler M, Nabhan C. Fulfillment of Postmarketing Requirements to the FDA for Therapies Granted Oncology Indications Between 2011 and 2016. JAMA Oncol 2019; 4:993-994. [PMID: 29801111 DOI: 10.1001/jamaoncol.2018.0610] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Marjorie Zettler
- Cardinal Health Specialty Solutions, Cardinal Health, Dublin, Ohio
| | - Chadi Nabhan
- Cardinal Health Specialty Solutions, Cardinal Health, Dublin, Ohio
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Zettler M, Basch E, Nabhan C. Surrogate End Points and Patient-Reported Outcomes for Novel Oncology Drugs Approved Between 2011 and 2017. JAMA Oncol 2019; 5:1358-1359. [PMID: 31268471 DOI: 10.1001/jamaoncol.2019.1760] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Marjorie Zettler
- Cardinal Health Specialty Solutions, Cardinal Health, Dublin, Ohio
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill
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Federspiel JJ, Anstrom KJ, Xian Y, McCoy LA, Effron MB, Faries DE, Zettler M, Mauri L, Yeh RW, Peterson ED, Wang TY. Comparing Inverse Probability of Treatment Weighting and Instrumental Variable Methods for the Evaluation of Adenosine Diphosphate Receptor Inhibitors After Percutaneous Coronary Intervention. JAMA Cardiol 2018; 1:655-65. [PMID: 27438179 DOI: 10.1001/jamacardio.2016.1783] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE There is increasing interest in performing comparative effectiveness analyses in large observational databases, yet these analyses must adjust for treatment selection issues. OBJECTIVES To conduct comparative safety and efficacy analyses of prasugrel vs clopidogrel bisulfate after percutaneous coronary intervention and to evaluate inverse probability of treatment weighting (a propensity score method) and instrumental variable methods. DESIGN, SETTING, AND PARTICIPANTS This study used data from the Treatment With Adenosine Diphosphate Receptor Inhibitors-Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) study. Included in the study were patients undergoing percutaneous coronary intervention for myocardial infarction, 26.0% of whom received prasugrel. The study dates were April 4, 2010, to October 31, 2012. EXPOSURES Choice of initial antiplatelet agent (prasugrel or clopidogrel). MAIN OUTCOMES AND MEASURES Safety and efficacy outcomes included 1-year composite major adverse cardiovascular events, moderate to severe bleeding, and stent thrombosis. Hospitalizations for pneumonia, bone fractures, and planned percutaneous coronary intervention were used as the falsification end points. RESULTS The study cohort comprised 11 784 participants (mean [SD] age, 60.0 [11.6] years, and 28.0% were female). Using inverse probability of treatment weighting adjustment, prasugrel and clopidogrel had similar major adverse cardiovascular events (hazard ratio [HR], 0.98; 95% CI, 0.83-1.16) and bleeding outcomes (1.18; 0.77-1.80), but prasugrel had a lower rate of stent thrombosis (0.51; 0.31-0.85). Using instrumental variable methods, prasugrel use was associated with a lower rate of the major adverse cardiovascular event end point (HR, 0.68; 95% CI, 0.47-1.00) but nonsignificant differences in the rates of bleeding (0.95; 0.41-2.08) and stent thrombosis (0.67; 0.16-2.00). There was no significant treatment difference noted in any of the falsification end-point rates when analyses were performed using inverse probability of treatment weighting, although the bone fracture end point approached statistical significance. Nevertheless, a lower rate of pneumonia-related hospitalizations was noted in the prasugrel-treated patients when analyses were performed using instrumental variable methods. CONCLUSIONS AND RELEVANCE Conclusions regarding the safety and efficacy of antiplatelet therapy varied depending on analytic technique, and none were concordant with the results from randomized trials. In addition, both statistical strategies demonstrated concerning associations when tested in the falsification analyses. A high level of scrutiny and careful attention to assumptions and validity are required when interpreting complex analyses of observational data.
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Affiliation(s)
- Jerome J Federspiel
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina2Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Kevin J Anstrom
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina3Department of Biostatistics, Duke University, Durham, North Carolina
| | - Ying Xian
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Lisa A McCoy
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | | | | | | | - Laura Mauri
- Harvard Clinical Research Institute, Boston, Massachusetts6Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert W Yeh
- Harvard Clinical Research Institute, Boston, Massachusetts7Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina8Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Tracy Y Wang
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina8Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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Jackson LR, Peterson ED, McCoy LA, Ju C, Zettler M, Baker BA, Messenger JC, Faries DE, Effron MB, Cohen DJ, Wang TY. Impact of Proton Pump Inhibitor Use on the Comparative Effectiveness and Safety of Prasugrel Versus Clopidogrel: Insights From the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) Study. J Am Heart Assoc 2016; 5:JAHA.116.003824. [PMID: 27792656 PMCID: PMC5121485 DOI: 10.1161/jaha.116.003824] [Citation(s) in RCA: 12] [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] [Indexed: 11/16/2022]
Abstract
Background Proton pump inhibitors (PPIs) reduce gastrointestinal bleeding events but may alter clopidogrel metabolism. We sought to understand the comparative effectiveness and safety of prasugrel versus clopidogrel in the context of proton pump inhibitor (PPI) use. Methods and Results Using data on 11 955 acute myocardial infarction (MI) patients treated with percutaneous coronary intervention at 233 hospitals and enrolled in the TRANSLATE‐ACS study, we compared whether discharge PPI use altered the association of 1‐year adjusted risks of major adverse cardiovascular events (MACE; death, MI, stroke, or unplanned revascularization) and Global Use of Strategies To Open Occluded Arteries (GUSTO) moderate/severe bleeding between prasugrel‐ and clopidogrel‐treated patients. Overall, 17% of prasugrel‐treated and 19% of clopidogrel‐treated patients received a PPI at hospital discharge. At 1 year, patients discharged on a PPI versus no PPI had higher risks of MACE (adjusted hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.21‐1.58) and GUSTO moderate/severe bleeding (adjusted HR 1.55, 95% CI 1.15‐2.09). Risk of MACE was similar between prasugrel and clopidogrel regardless of PPI use (adjusted HR 0.88, 95% CI 0.62‐1.26 with PPI, adjusted HR 1.07, 95% CI 0.90‐1.28 without PPI, interaction P=0.31). Comparative bleeding risk associated with prasugrel versus clopidogrel use differed based on PPI use but did not reach statistical significance (adjusted HR 0.73, 95% CI 0.36‐1.48 with PPI, adjusted HR 1.34, 95% CI 0.79‐2.27 without PPI, interaction P=0.17). Conclusions PPIs did not significantly affect the MACE and bleeding risk associated with prasugrel use, relative to clopidogrel. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01088503.
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Affiliation(s)
- Larry R Jackson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Lisa A McCoy
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Christine Ju
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | | | | | | | | | - David J Cohen
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Tracy Y Wang
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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Jackson LR, Ju C, Zettler M, Messenger JC, Cohen DJ, Stone GW, Baker BA, Effron M, Peterson ED, Wang TY. Outcomes of Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention Receiving an Oral Anticoagulant and Dual Antiplatelet Therapy. JACC Cardiovasc Interv 2015; 8:1880-9. [DOI: 10.1016/j.jcin.2015.08.018] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 08/13/2015] [Indexed: 10/22/2022]
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Wang TY, Henry TD, McCoy LA, Berger PB, Cohen DJ, Effron MB, Zettler M, Baker BA, Messenger JC, Peterson ED. Contemporary use of platelet function and pharmacogenomic testing among patients with acute myocardial infarction undergoing percutaneous coronary intervention in the United States. Am Heart J 2015; 170:706-14. [PMID: 26386794 DOI: 10.1016/j.ahj.2015.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although platelet function and pharmacogenomic testing have been studied in clinical trials, their adoption into contemporary practice is unknown. METHODS We studied patterns of platelet function and pharmacogenomic testing among 10,048 patients with acute myocardial infarction treated with percutaneous coronary intervention at 226 US hospitals in the TRANSLATE-ACS observational study between April 2010 and October 2012, excluding those receiving research protocol-mandated testing. Inverse probability-weighted propensity adjustment was used to compare 1-year bleeding and major adverse cardiac event risks between patients with and without testing. RESULTS Overall, 337 (3.4%) patients underwent predischarge platelet function testing, whereas 85 (0.9%) underwent pharmacogenomic testing; 82% and 93% of hospitals never performed any platelet function or pharmacogenomic testing, respectively. Patients undergoing testing were more likely to be on an adenosine diphosphate receptor inhibitor preadmission or to have percutaneous coronary intervention of a previously treated lesion. Tested patients were more likely than nontested patients to be switched from clopidogrel to prasugrel/ticagrelor (25.7% vs 9.7%, P < .001) and were more likely to be on prasugrel/ticagrelor 6 months postdischarge (33.8% vs 25.1%, P < .001). No significant differences in 1-year bleeding and major adverse cardiac event risks were observed between tested and nontested patients (adjusted hazard ratios 1.06 [95% CI 0.68-1.65] and 1.21 [95% CI 0.94-1.54], respectively). CONCLUSIONS Platelet function and pharmacogenomic testing are rarely performed in contemporary myocardial infarction patients in the United States. When tested, patients were more likely to be treated with higher-potency adenosine diphosphate receptor inhibitors, yet no significant differences in longitudinal outcomes were observed.
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Mathews R, Peterson ED, Honeycutt E, Chin CT, Effron MB, Zettler M, Fonarow GC, Henry TD, Wang TY. Early Medication Nonadherence After Acute Myocardial Infarction: Insights into Actionable Opportunities From the TReatment with ADP receptor iNhibitorS: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome (TRANSLATE-ACS) Study. Circ Cardiovasc Qual Outcomes 2015; 8:347-56. [PMID: 26038524 PMCID: PMC4512913 DOI: 10.1161/circoutcomes.114.001223] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [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: 06/19/2014] [Accepted: 05/07/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Nonadherence to prescribed evidence-based medications after acute myocardial infarction (MI) can contribute to worse outcomes and higher costs. We sought to better understand the modifiable factors contributing to early nonadherence of evidence-based medications after acute MI. METHODS AND RESULTS We assessed 7425 acute MI patients treated with percutaneous coronary intervention at 216 US hospitals participating in TReatment with ADP receptor iNhibitorS: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome (TRANSLATE-ACS) between April 2010 and May 2012. Using the validated Morisky instrument to assess cardiovascular medication adherence at 6 weeks post MI, we stratified patients into self-reported high (score, 8), moderate (score, 6-7), and low (score, <6) adherence groups. Moderate and low adherence was reported in 25% and 4% of patients, respectively. One third of low adherence patients described missing doses of antiplatelet therapy at least twice a week after percutaneous coronary intervention. Signs of depression and patient-reported financial hardship because of medication expenses were independently associated with a higher likelihood of medication nonadherence. Patients were more likely to be adherent at 6 weeks if they had follow-up appointments made before discharge and had a provider explain potential side effects of their medications. Lower medication adherence may be associated with a higher risk of 3-month death/readmission (adjusted hazard ratio, 1.35; 95% confidence interval, 0.98-1.87) although this did not reach statistical significance. CONCLUSIONS Even early after MI, a substantial proportion of patients report suboptimal adherence to prescribed medications. Tailored patient education and pre discharge planning may represent actionable opportunities to optimize patient adherence and clinical outcomes. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01088503.
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Affiliation(s)
- Robin Mathews
- From the Duke Clinical Research Institute, Durham, NC (R.M., E.D.P., E.H., T.Y.W.); National Health Centre Singapore, Singapore, Singapore (C.T.C.); Lilly, USA, LLC, Indianapolis (M.B.E., M.Z.); Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles (G.C.F.); and Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital (T.D.H.).
| | - Eric D Peterson
- From the Duke Clinical Research Institute, Durham, NC (R.M., E.D.P., E.H., T.Y.W.); National Health Centre Singapore, Singapore, Singapore (C.T.C.); Lilly, USA, LLC, Indianapolis (M.B.E., M.Z.); Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles (G.C.F.); and Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital (T.D.H.)
| | - Emily Honeycutt
- From the Duke Clinical Research Institute, Durham, NC (R.M., E.D.P., E.H., T.Y.W.); National Health Centre Singapore, Singapore, Singapore (C.T.C.); Lilly, USA, LLC, Indianapolis (M.B.E., M.Z.); Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles (G.C.F.); and Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital (T.D.H.)
| | - Chee Tang Chin
- From the Duke Clinical Research Institute, Durham, NC (R.M., E.D.P., E.H., T.Y.W.); National Health Centre Singapore, Singapore, Singapore (C.T.C.); Lilly, USA, LLC, Indianapolis (M.B.E., M.Z.); Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles (G.C.F.); and Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital (T.D.H.)
| | - Mark B Effron
- From the Duke Clinical Research Institute, Durham, NC (R.M., E.D.P., E.H., T.Y.W.); National Health Centre Singapore, Singapore, Singapore (C.T.C.); Lilly, USA, LLC, Indianapolis (M.B.E., M.Z.); Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles (G.C.F.); and Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital (T.D.H.)
| | - Marjorie Zettler
- From the Duke Clinical Research Institute, Durham, NC (R.M., E.D.P., E.H., T.Y.W.); National Health Centre Singapore, Singapore, Singapore (C.T.C.); Lilly, USA, LLC, Indianapolis (M.B.E., M.Z.); Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles (G.C.F.); and Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital (T.D.H.)
| | - Gregg C Fonarow
- From the Duke Clinical Research Institute, Durham, NC (R.M., E.D.P., E.H., T.Y.W.); National Health Centre Singapore, Singapore, Singapore (C.T.C.); Lilly, USA, LLC, Indianapolis (M.B.E., M.Z.); Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles (G.C.F.); and Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital (T.D.H.)
| | - Timothy D Henry
- From the Duke Clinical Research Institute, Durham, NC (R.M., E.D.P., E.H., T.Y.W.); National Health Centre Singapore, Singapore, Singapore (C.T.C.); Lilly, USA, LLC, Indianapolis (M.B.E., M.Z.); Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles (G.C.F.); and Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital (T.D.H.)
| | - Tracy Y Wang
- From the Duke Clinical Research Institute, Durham, NC (R.M., E.D.P., E.H., T.Y.W.); National Health Centre Singapore, Singapore, Singapore (C.T.C.); Lilly, USA, LLC, Indianapolis (M.B.E., M.Z.); Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles (G.C.F.); and Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital (T.D.H.)
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Mathews R, Wang TY, Honeycutt E, Henry TD, Zettler M, Chang M, Fonarow GC, Peterson ED. Persistence with secondary prevention medications after acute myocardial infarction: Insights from the TRANSLATE-ACS study. Am Heart J 2015; 170:62-9. [PMID: 26093865 DOI: 10.1016/j.ahj.2015.03.019] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/30/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Persistent use of secondary prevention therapies after acute myocardial infarction (MI) is critical to optimizing long-term outcomes. METHODS Medication persistence was assessed among 7,955 MI patients in 216 hospitals participating in the Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome study from 2010 to 2012. Persistence was defined as continuation of aspirin, adenosine diphosphate receptor inhibitors, β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins from discharge to 6 months post-MI. Multivariable logistic regression modeling was used to determine factors associated with nonpersistence, defined as <80% persistence with all medication classes. RESULTS Overall, 31% of MI patients stopped taking a least 1 medication by 6 months. The most common reasons cited for medications discontinuation were side effects and physician instruction (57%), whereas financial concerns were cited in 8% overall. After multivariable modeling, black race (odds ratio 1.36, 95% CI 1.15-1.62), older age (odds ratio 1.07, 95% CI 1.02-1.12), atrial fibrillation (odds ratio 1.67, 95% CI 1.33-2.09), dialysis (odds ratio 1.79, 95% CI 1.15-2.78), and depression (odds ratio 1.22, 95% CI 1.02-1.45) were associated with lower likelihood of persistence. Private insurance (odds ratio 0.85, 95% 0.76-0.95), prescription cost assistance (odds ratio 0.63, 95% CI 0.54-0.75), and outpatient follow-up arranged before discharge (odds ratio 0.89, 95% CI 0.80-0.99) were associated with higher persistence. CONCLUSIONS Nearly one-third of MI patients are no longer persistent with their prescribed medications by 6 months. Patients at high risk for nonpersistence may be identified by clinical and sociodemographic features. These observations underscore key opportunities to optimize longitudinal use of secondary prevention therapies.
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Jackson LR, Peterson E, McCoy L, Ju C, Zettler M, Baker B, Messenger J, Faries D, Effron M, Cohen D, Wang T. IMPACT OF PROTON PUMP INHIBITOR USE ON THE COMPARATIVE SAFETY AND EFFECTIVENESS OF PRASUGREL VERSUS CLOPIDOGREL: INSIGHTS FROM TRANSLATE-ACS. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60225-x] [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: 10/23/2022]
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Vora A, Peterson E, McCoy L, Effron M, Anstrom K, Faries D, Zettler M, Fonarow G, Baker B, Stone G, Wang T. SELECTION OF PRASUGREL VERSUS CLOPIDOGREL AMONG MYOCARDIAL INFARCTION PATIENTS WITH HIGH VERSUS LOW PREDICTED MORTALITY AND BLEEDING RISKS: INSIGHTS FROM TRANSLATE-ACS. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60107-3] [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: 11/27/2022]
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Henry TD, Peterson E, Cohen D, Ju C, Stone GW, Messenger JC, Fonarow GC, Effron MB, Baker BA, Zettler M, Wang TY. TCT-494 Safety and Effectiveness of Prasugrel vs. Clopidogrel in the Setting of Bivalirudin vs. Heparin Use: 30-day Results from TRANSLATE-ACS. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Effron MB, Wang T, Fonarow G, Henry T, Zettler M, Baker B, McCoy L, Peterson E. EFFICACY AND SAFETY OF PRETREATMENT AONG CONTEMPORARY ACUTE MYOCARDIAL INFARCTION PATIENTS TREATED WITH PERCUTANEOUS CORONARY INTERVENTION: INSIGHTS FROM THE TRANSLATE-ACS STUDY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60101-7] [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: 11/30/2022]
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Wang TY, McCoy L, Henry TD, Effron MB, Messenger JC, Cohen DJ, Mark DB, Stone GW, Zettler M, Singh M, Fonarow GC, Peterson ED. Early Post-Discharge Bleeding and Antiplatelet Therapy Discontinuation Among Acute Myocardial Infarction Patients Treated With Percutaneous Coronary Intervention. J Am Coll Cardiol 2014; 63:1700-2. [DOI: 10.1016/j.jacc.2013.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/01/2013] [Accepted: 12/09/2013] [Indexed: 10/25/2022]
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Angiolillo DJ, Curzen N, Gurbel P, Vaitkus P, Lipkin F, Li W, Jakubowski JA, Zettler M, Effron MB, Trenk D. Pharmacodynamic evaluation of switching from ticagrelor to prasugrel in patients with stable coronary artery disease: Results of the SWAP-2 Study (Switching Anti Platelet-2). J Am Coll Cardiol 2013; 63:1500-9. [PMID: 24333493 DOI: 10.1016/j.jacc.2013.11.032] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [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: 10/28/2013] [Revised: 11/15/2013] [Accepted: 11/26/2013] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The goal of this study was to evaluate the pharmacodynamic effects of switching patients from ticagrelor to prasugrel. BACKGROUND Clinicians may need to switch between more potent P2Y12 inhibitors because of adverse effects or switch to the use of a once-daily dosing regimen due to compliance issues. METHODS After a 3- to 5-day run-in phase with a ticagrelor 180-mg loading dose (LD) followed by a ticagrelor 90-mg twice-daily maintenance dose (MD), aspirin-treated patients (N = 110) with stable coronary artery disease were randomized to continue ticagrelor or switch to prasugrel 10-mg once-daily MD, with or without a 60-mg LD. Pharmacodynamic assessments were defined according to P2Y12 reaction unit (PRU) (P2Y12 assay) and platelet reactivity index (vasodilator-stimulated phosphoprotein phosphorylation assay) at baseline (before and after the run-in phase) and 2, 4, 24, and 48 h and 7 days after randomization. RESULTS Platelet reactivity was significantly greater at 24 and 48 h after switching to prasugrel versus continued therapy with ticagrelor, although to a lesser extent in those receiving an LD. Mean PRU remained significantly higher in the combined prasugrel groups versus the ticagrelor group (least-squares mean difference: 46 [95% confidence interval 25 to 67]) and did not meet the primary noninferiority endpoint (upper limit of the confidence interval ≤45), although PRU in the prasugrel cohort was lower at 7 days than at 24 or 48 h. Accordingly, rates of high on-treatment platelet reactivity were higher at 24 and 48 h in both prasugrel groups. At 7 days, there was no difference in high on-treatment platelet reactivity rate between the combined prasugrel and ticagrelor groups. CONCLUSIONS Compared with continued ticagrelor therapy, switching from ticagrelor to prasugrel therapy was associated with an increase in platelet reactivity that was partially mitigated by the administration of an LD.
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Affiliation(s)
- Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida.
| | - Nicholas Curzen
- Southampton University Hospital, Southampton, United Kingdom
| | - Paul Gurbel
- Sinai Center for Thrombosis Research, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Paul Vaitkus
- Medical Affairs, Daiichi Sankyo, Inc., Parsippany, New Jersey
| | - Fred Lipkin
- Medical Affairs, Daiichi Sankyo, Inc., Parsippany, New Jersey
| | - Wei Li
- Medical Affairs, Daiichi Sankyo, Inc., Parsippany, New Jersey
| | | | - Marjorie Zettler
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana
| | - Mark B Effron
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana
| | - Dietmar Trenk
- Department of Clinical Pharmacology, Clinic for Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
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Wang TY, Henry TD, Mccoy LA, Berger PB, Cohen DJ, Effron MB, Zettler M, Vaitkus PT, Messenger JC, Peterson ED. Contemporary use of platelet function and pharmacogenomic testing among acute myocardial infarction patients treated with PCI in the United States: insights from the TRANSLATE-ACS study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4875] [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: 11/14/2022] Open
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Xian Y, Wang T, Kaltenbach L, Effron M, Henry T, Bach R, Zettler M, Vaitkus P, Fonarow G, Peterson E. THE ASSOCIATION OF DISCHARGE ASPIRIN DOSE AND OUTCOMES IN ACUTE MYOCARDIAL INFARCTION: INSIGHTS FROM THE TRANSLATE-ACS STUDY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60112-6] [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: 11/26/2022]
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Mathews R, Peterson E, Honeycutt E, Chin CT, Ryan K, Effron M, Zettler M, Rozek M, Henry T, Wang T. MEDICATION NONADHERENCE AMONG PATIENTS WITH ACUTE MYOCARDIAL INFARCTION TREATED WITH PERCUTANEOUS CORONARY INTERVENTION: INSIGHTS FROM THE TRANSLATE-ACS STUDY. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61815-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tardif JC, Carrier M, Kandzari DE, Emery R, Cote R, Heinonen T, Zettler M, Hasselblad V, Guertin MC, Harrington RA. Effects of pyridoxal-5′-phosphate (MC-1) in patients undergoing high-risk coronary artery bypass surgery: Results of the MEND-CABG randomized study. J Thorac Cardiovasc Surg 2007; 133:1604-11. [PMID: 17532963 DOI: 10.1016/j.jtcvs.2007.01.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 07/07/2006] [Revised: 12/21/2006] [Accepted: 01/02/2007] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Coronary artery bypass graft surgery remains associated with significant postoperative cardiovascular morbidity and mortality in high-risk patients. MC-1 (pyridoxal-5'-phosphate monohydrate) inhibits purinergic receptors and intracellular influx of Ca2+, thereby reducing cellular injury during experimental ischemia and reperfusion. The MEND-CABG trial tested the hypothesis that MC-1 reduces cardiovascular morbidity and mortality after coronary artery bypass graft. METHODS In a phase 2, double-blinded, placebo-controlled study, 901 patients scheduled for coronary artery bypass graft surgery with cardiopulmonary bypass and at high risk for subsequent cardiac or neurologic complications were randomly assigned to receive oral MC-1 (250 mg or 750 mg/d once daily) or placebo beginning 3 to 10 hours prior to surgery and continued to postoperative day 30. RESULTS At 30 days, MC-1 250 mg (compared with placebo) reduced the composite of death, nonfatal cerebral infarction, and nonfatal myocardial infarction by 14.0% (P = .3124) with peak creatinine kinase-myocardial band > or =50 ng/mL (prespecified primary end point); 32.3% (P = .0349) with peak creatinine kinase-myocardial band > or =70 ng/mL; and 37.2% (P = .0283) with peak creatinine kinase-myocardial band > or =100 ng/mL. Myocardial infarctions with peak creatinine kinase-myocardial band> or =100 ng/mL were reduced by 47.2% in the MC-1 250-mg group versus placebo (P = .0083). Greater efficacy was demonstrated with 250 mg than with the 750-mg dose of MC-1. CONCLUSIONS In high-risk patients undergoing coronary artery bypass graft, treatment with MC-1 did not significantly affect the prespecified primary end point but was associated with a significant reduction in perioperative myocardial infarction with creatinine kinase-myocardial band > or =100 ng/mL. A larger, well-powered trial is needed to evaluate the cardioprotective effects of MC-1.
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Müller L, Zettler M, Schultz B. Zur Abhängigkeit der Elektrodenaktivität vom Pt/Ir-Verhältnis in der Aktivschicht bei der Chlorentwicklung. Z PHYS CHEM 1984. [DOI: 10.1515/zpch-1984-26572] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hearion G, Scholz F, Schmidt W, Zettler M. pK 3-Werte von Lösungsmittelionen und Lösungsmitteln. Z PHYS CHEM 1982. [DOI: 10.1515/zpch-1982-26379] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hearion G, Scholz F, Schmidt W, Zettler M. pK3-Werte von Lösungsmittelionen und Lösungsmitteln. Z PHYS CHEM 1982. [DOI: 10.1515/zpch-1982-0179] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kehlen H, Vogel L, Zettler M. Schallgeschwindigkeiten und Kompressibilitäten in binären flüssigen Mischungen aus Tetraalkylen des Siliciums und des Zinns. Z PHYS CHEM 1980. [DOI: 10.1515/zpch-1980-26105] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kehlen H, Vogel L, Zettler M. Schallgeschwindigkeiten und Kompressibilitäten in binären flüssigen Mischungen aus Tetraalkylen des Siliciums und des Zinns. Z PHYS CHEM 1980. [DOI: 10.1515/zpch-1980-0105] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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