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Kianoush S, Al-Rifai M, Kalra A, Bk A, Mehta A, Sadaf MI, Misra A, Khalid U, Lavie CJ, Kayani WT, Virani SS. Use of preventive cardiovascular health care among Asian American individuals: A National Health Interview Survey Study. Curr Probl Cardiol 2022:101241. [PMID: 35513186 DOI: 10.1016/j.cpcardiol.2022.101241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/19/2022]
Abstract
The risk of atherosclerotic cardiovascular disease (ASCVD) varies across Asian Americans. Heterogeneity in preventive health care use may have a role in health disparity across Asian American populations. We included 318,069 White, Chinese, Asian Indian, Filipino, and 'other Asian' (Japanese, Korean, and Vietnamese) participants with and without self-reported history of ASCVD or ASCVD risk factors (including hypertension, hypercholesterolemia, and diabetes) from 2006-2018 National Health Interview Survey (NHIS). We used multivariable logistic regression models adjusted for age, sex, US birth, education, insurance coverage, and a comorbidity score to assess the association between Asian American race/ethnicity and annual health care use. Adjusted odds ratios (aOR) with 95% confidence intervals were reported. Of the total, 187,093 participants did not report ASCVD or ASCVD risk factors (mean age, 40.2 ± 0.1 y; 52% women), and 130,976 participants reported ASCVD or ASCVD risk factors (mean age, 58.3 ± 0.9 y; 49.5% women). Compared with White individuals, among the group without ASCVD or ASCVD risk factors (N=187,093), 'other Asian' adults were less likely to visit general practitioner (aOR=0.80, 0.72-0.89), or check blood pressure (aOR=0.77, 0.66-0.89), blood cholesterol (aOR=0.80, 0.70-0.92), and fasting blood sugar (aOR=0.73, 0.63-0.84). Among participants with ASCVD or ASCVD risk factors (N=130,976), Asian Indian adults were more likely to visit general practitioner (aOR=1.29, 1.01-1.66), or check blood pressure (aOR=1.27, 0.83-1.96), blood cholesterol (aOR=1.46, 1.00-2.15), and fasting blood sugar (aOR=1.49, 1.11-1.99). Annual preventive health care use is heterogenous across the Asian American populations.
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Affiliation(s)
- Sina Kianoush
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Mahmoud Al-Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Ankur Kalra
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, IN
| | - Anupama Bk
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Anurag Mehta
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, GA
| | - Murrium I Sadaf
- Division of Cardiology, University of Arkansas Medical Center, Little Rock, AR
| | - Arunima Misra
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Umair Khalid
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Waleed T Kayani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX; DeBakey Heart and Vascular Institute, Houston Methodist, Houston, TX; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX.
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Sadaf MI, O'Bryan J, Biese K, Chen S, Deyo Z, Mendys P, Sears SF, Tuttle H, Walker TJ, Gehi AK. Characteristics of patients presenting to emergency department for primary atrial fibrillation or flutter at an academic medical center. Indian Heart J 2021; 73:588-593. [PMID: 34627574 PMCID: PMC8514404 DOI: 10.1016/j.ihj.2021.08.005] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/04/2021] [Accepted: 08/16/2021] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE In the United States, atrial fibrillation (AF) accounts for over 400,000 hospitalizations annually. Emergency Department (ED) physicians have few resources available to guide AF/AFL (atrial flutter) patient triage, and the majority of these patients are subsequently admitted. Our aim is to describe the characteristics and disposition of AF/AFL patients presenting to the University of North Carolina (UNC) ED with the goal of developing a protocol to prevent unnecessary hospitalizations. METHODS We performed a retrospective electronic medical chart review of AF/AFL patients presenting to the UNC ED over a 15-month period from January 2015 to March 2016. Demographic and ED visit variables were collected. Additionally, patients were designated as either having primary or secondary AF/AFL where primary AF/AFL patients were those in whom AF/AFL was the primary reason for ED presentation. These primary AF/AFL patients were categorized by AF symptom severity score according to the Canadian Cardiovascular Society Severity of Atrial Fibrillation (CCS-SAF) Scale. RESULTS A total of 935 patients presented to the ED during the study period with 202 (21.5%) having primary AF/AFL. Of the primary AF/AFL patients, 189 (93.6%) had mild-moderate symptom severity (CCS-SAF ≤ 3). The majority of primary AF/AFL patients were hemodynamically stable, with a mean (SD) SBP of 123.8 (21.3), DBP of 76.6 (14.1), and ventricular rate of 93 (21.9). Patients with secondary AF/AFL were older 76 (13.1), p < 0.001 with a longer mean length of stay 6.1 (7.7), p = 0.31. Despite their mild-moderate symptom severity and hemodynamic stability, nearly 2/3 of primary AF/AFL patients were admitted. CONCLUSION Developing a protocol to triage and discharge hemodynamically stable AF/AFL patients without severe AF/AFL symptoms to a dedicated AF/AFL clinic may help to conserve healthcare resources and potentially deliver more effective care.
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Affiliation(s)
- Murrium I Sadaf
- Department of Internal Medicine, Yale-New Haven Medical Center, New Haven, CT, USA
| | - James O'Bryan
- Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Kevin Biese
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah Chen
- Division of Cardiology, Department of Internal Medicine, Chapel Hill, NC, USA
| | - Zachariah Deyo
- Department of Pharmacy, UNC Medical Center, Chapel Hill, NC, USA
| | - Phil Mendys
- Department of Pharmacy, UNC Medical Center, Chapel Hill, NC, USA; North American Medical Affairs, Pfizer, NY UNC, USA
| | - Samuel F Sears
- Departments of Psychology, Cardiovascular Sciences, and Public Health, East Carolina University, Greenville, NC, USA
| | - Heather Tuttle
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - T Jennifer Walker
- Division of Cardiology, Department of Internal Medicine, Chapel Hill, NC, USA
| | - Anil K Gehi
- Division of Cardiology, Department of Internal Medicine, Chapel Hill, NC, USA.
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Satish P, Sadaf MI, Valero-Elizondo J, Grandhi GR, Yahya T, Zawahir H, Javed Z, Mszar R, Hanif B, Kalra A, Virani S, Cainzos-Achirica M, Nasir K. Heterogeneity in cardio-metabolic risk factors and atherosclerotic cardiovascular disease among Asian groups in the United States. Am J Prev Cardiol 2021; 7:100219. [PMID: 34611645 PMCID: PMC8387290 DOI: 10.1016/j.ajpc.2021.100219] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 04/20/2021] [Revised: 05/27/2021] [Accepted: 06/13/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The Asian American population in the U.S. comprises various, ethnically diverse subgroups. Traditionally, this population has been studied as a single, aggregated group, potentially masking differences in risk among subgroups. Analyses using disaggregated data can help better characterize the health needs of different Asian subpopulations and inform targeted, effective public health interventions. We assessed the prevalence of cardiovascular disease (CVD) risk factors and atherosclerotic CVD (ASCVD) and their associations with socioeconomic factors among Chinese, Asian Indian, Filipino and Other Asian subjects, compared with non-Hispanic White (NHW) subjects in the U.S. METHODS : Cross-sectional study using data from 298,286 adults from the National Health Interview Survey (NHIS) from 2007 to 2018. We utilized chi-squared tests to compare characteristics across subgroups. Weighted proportions and unadjusted and adjusted logistic regression models were utilized to examine the associations between Asian subgroups, self-reported CVD risk factors and self-reported ASCVD, as well as between socioeconomic factors within each Asian subgroup. RESULTS : Asian Indian subjects had the highest prevalence of diabetes (12.5%), while Filipino subjects had the highest prevalence of hyperlipidemia (27.7%), hypertension (29.8%) and obesity (19.8%). Despite this, the prevalence of self-reported ASCVD was lower in all Asian groups compared with NHWs. Chinese subjects had the lowest odds of having each of the CVD risk factors assessed. CONCLUSION : We found considerable heterogeneity in the distribution of risk factors as well as ASCVD among Asian subgroups in the US. Compared with health system or community-based reports, the prevalence of risk factors and ASCVD may be underestimated in some Asian NHIS subgroups. There is an urgent need for efforts to improve recruitment of Asian participants of heterogeneous socioeconomic backgrounds in national surveys, as well as to perform a thorough assessment of risk factors and disease in this population, not relying solely on self-report.
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Affiliation(s)
- Priyanka Satish
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
| | - Murrium I. Sadaf
- Yale New Haven Medical Center (Waterbury) Internal Medicine Residency Program, Waterbury, CT, United States
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Gowtham R. Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, United States
| | - Tamer Yahya
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
| | - Hassan Zawahir
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
| | - Zulqarnain Javed
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Reed Mszar
- Yale/YNHH Center for Outcomes Research and Evaluation, New Haven, CT, United States
| | - Bashir Hanif
- Dean, Faculty of Cardiology, College of Physicians and Surgeons Pakistan (CPSP), Pakistan
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH, United States
| | - Salim Virani
- Section of Cardiovascular Research, Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
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Husain A, Masoudi EA, Mirzaei M, Joodi G, Sadaf MI, Lin FC, Simpson RJ. Missed Opportunities for Prevention of Sudden Death. N C Med J 2021; 82:95-99. [PMID: 33649122 DOI: 10.18043/ncm.82.2.95] [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: 11/11/2022]
Abstract
BACKGROUND We assessed patterns of health care utilization to further characterize chronic comorbidities prior to sudden death. METHOD From March 1, 2013, through February 28, 2015, all out-of-hospital deaths aged 18-64 reported by emergency medical services in Wake County, North Carolina, were screened to adjudicate 399 sudden death victims. Retrospective analysis of clinical records on victims determined health care utilization. Health care utilization frequency was assessed by latent growth curve analysis. RESULTS Medical records were available for 264 victims (aged 53.5 ± 9.2) who were predominantly male (65%) and white (64%). Of these, 210 (80%) victims had at least one visit within two years of death and 73 (28%) had a visit within one month of death. Over the two years prior to death, there was an increasing frequency of doctor visits (P < .001). Victims averaged 3.7 ± 4.6 yearly visits and were categorized into low (0.4 visits/year), medium (3.3 visits/year), and high (11.4 visits/year) tiers of visit frequency. The high visit tier had a greater prevalence of coronary artery disease (38%), hypertension (80%), diabetes (58%), depression (74%), anxiety (64%), and substance misuse (46%) (P < .001). LIMITATIONS Those who were non-free-living, minors, without formal medical records, and adults aged 65 and older were excluded from the analysis. CONCLUSIONS A majority of sudden death victims utilized health care within two years prior to death and had comorbidities that may have contributed to their unexpected death. The increasing frequency of visits prior to death provided an opportunity for health care providers to address potential victims' chronic medical conditions to potentially prevent death.
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Affiliation(s)
- Aamir Husain
- Resident physician, Department of Medicine, University of Illinois Chicago, Chicago, Illinois.
| | - Elham A Masoudi
- Resident physician, Department of Medicine, Cone Health, Greensboro, North Carolina
| | - Mojtaba Mirzaei
- Resident physician, Department of Medicine, Yale-New Haven Medical Center, Waterbury Hospital, Waterbury, Connecticut
| | - Golsa Joodi
- Resident physician, Department of Medicine, Yale University, New Haven, Connecticut
| | - Murrium I Sadaf
- Resident physician, Department of Medicine, Yale-New Haven Medical Center, Waterbury Hospital, Waterbury, Connecticut
| | - Feng-Chang Lin
- Associate professor, University of North Carolina at Chapel Hill Department of Biostatistics and NC TraCS Institute, Chapel Hill, North Carolina
| | - Ross J Simpson
- Professor of medicine, University of North Carolina Division of Cardiology, Chapel Hill, North Carolina
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Sadaf MI, Caldwell M, Young LA, Mirzaei M, Chen S, Joodi G, Lin FC, Wu Y, Simpson RJ. High Prevalence of Diabetes Mellitus and Mental Illness Among Victims of Sudden Death. South Med J 2021; 114:86-91. [PMID: 33537789 DOI: 10.14423/smj.0000000000001213] [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: 11/23/2022]
Abstract
OBJECTIVES Diabetes mellitus (DM) increases the risk of cardiovascular disease and is associated with sudden death. Mental illness among individuals with DM may confound medical care. This study assessed the association of mental illness with DM and poorly controlled DM in sudden death victims. METHODS We screened out-of-hospital deaths ages 18 to 64 years in Wake County, North Carolina from 2013 to 2015 to adjudicate sudden deaths. We abstracted demographics and clinical characteristics from health records. Mental illness included anxiety, schizophrenia, bipolar disorder, or depression. Poorly controlled DM was defined as a hemoglobin A1c >8 or taking ≥3 medications for glycemic control. Logistic regression assessed the association between DM and mental illness. RESULTS Among victims with available records, 109 (29.4%) had DM. Of those, 62 (56.9%) had mental illness. Mental illness was present in 53.42% and 63.89% of victims with mild and poorly controlled DM, respectively. Mental illness was associated with DM (adjusted odds ratio 2.46, 95% confidence interval 1.57-3.91). Victims with poorly controlled DM were more likely to have mental illness (adjusted odds ratio 2.66, 95% confidence interval 1.14-6.18). CONCLUSIONS DM is a common comorbid condition in sudden death victims. Among victims, mental illness is associated with the control of DM. Early management of comorbid mental illnesses may improve the care of patients with DM and reduce the incidence of sudden death.
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Affiliation(s)
- Murrium I Sadaf
- From the Department of Internal Medicine, Yale-New Haven Medical Center, Waterbury, Connecticut, the Department of Medicine, Division of Endocrinology, Maine Medical Partners Endocrinology & Diabetes Center, Scarborough, Maine, the Department of Medicine, Division of Endocrinology, University of North Carolina, Chapel Hill, the Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, the Division of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and the Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill
| | - Marie Caldwell
- From the Department of Internal Medicine, Yale-New Haven Medical Center, Waterbury, Connecticut, the Department of Medicine, Division of Endocrinology, Maine Medical Partners Endocrinology & Diabetes Center, Scarborough, Maine, the Department of Medicine, Division of Endocrinology, University of North Carolina, Chapel Hill, the Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, the Division of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and the Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill
| | - Laura A Young
- From the Department of Internal Medicine, Yale-New Haven Medical Center, Waterbury, Connecticut, the Department of Medicine, Division of Endocrinology, Maine Medical Partners Endocrinology & Diabetes Center, Scarborough, Maine, the Department of Medicine, Division of Endocrinology, University of North Carolina, Chapel Hill, the Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, the Division of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and the Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill
| | - Mojtaba Mirzaei
- From the Department of Internal Medicine, Yale-New Haven Medical Center, Waterbury, Connecticut, the Department of Medicine, Division of Endocrinology, Maine Medical Partners Endocrinology & Diabetes Center, Scarborough, Maine, the Department of Medicine, Division of Endocrinology, University of North Carolina, Chapel Hill, the Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, the Division of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and the Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill
| | - Sarah Chen
- From the Department of Internal Medicine, Yale-New Haven Medical Center, Waterbury, Connecticut, the Department of Medicine, Division of Endocrinology, Maine Medical Partners Endocrinology & Diabetes Center, Scarborough, Maine, the Department of Medicine, Division of Endocrinology, University of North Carolina, Chapel Hill, the Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, the Division of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and the Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill
| | - Golsa Joodi
- From the Department of Internal Medicine, Yale-New Haven Medical Center, Waterbury, Connecticut, the Department of Medicine, Division of Endocrinology, Maine Medical Partners Endocrinology & Diabetes Center, Scarborough, Maine, the Department of Medicine, Division of Endocrinology, University of North Carolina, Chapel Hill, the Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, the Division of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and the Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill
| | - Feng-Chang Lin
- From the Department of Internal Medicine, Yale-New Haven Medical Center, Waterbury, Connecticut, the Department of Medicine, Division of Endocrinology, Maine Medical Partners Endocrinology & Diabetes Center, Scarborough, Maine, the Department of Medicine, Division of Endocrinology, University of North Carolina, Chapel Hill, the Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, the Division of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and the Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill
| | - Yunhan Wu
- From the Department of Internal Medicine, Yale-New Haven Medical Center, Waterbury, Connecticut, the Department of Medicine, Division of Endocrinology, Maine Medical Partners Endocrinology & Diabetes Center, Scarborough, Maine, the Department of Medicine, Division of Endocrinology, University of North Carolina, Chapel Hill, the Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, the Division of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and the Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill
| | - Ross J Simpson
- From the Department of Internal Medicine, Yale-New Haven Medical Center, Waterbury, Connecticut, the Department of Medicine, Division of Endocrinology, Maine Medical Partners Endocrinology & Diabetes Center, Scarborough, Maine, the Department of Medicine, Division of Endocrinology, University of North Carolina, Chapel Hill, the Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, the Division of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, and the Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill
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Siddiqui WJ, Sadaf MI, Zain M, Mazhar R, Abbas R, Khan MH, Ahmed F, Zuberi O, Al-Saghir YM, Goldman J, Aggarwal S. Renal Injury in All-Comers After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Cureus 2020; 12:e7985. [PMID: 32523841 PMCID: PMC7273432 DOI: 10.7759/cureus.7985] [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] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Acute kidney injury (AKI) following aortic valve replacement is associated with poor prognosis. Transcatheter aortic valve replacement (TAVR) is a novel strategy with a percutaneous approach and early recovery time. We conducted this meta-analysis to compare TAVR to surgical aortic valve replacement (SAVR) and their respective renal outcomes. Methods We searched for randomized controlled trials (RCTs) using MEDLINE, PUBMED, and Google Scholar databases from their inception till April 6, 2019, and included eight trials comparing TAVR to SAVR in cases that reported AKIs. Results We found a significant reduction in AKI after TAVR compared to SAVR at 30 days [n = 66 vs. n = 160, respectively; odds ratio (OR) = 0.38, 95% confidence interval (CI) = 0.28-0.51; p: <0.00001, I2 = 0%]. At one year, a trend towards reduced renal failure was noted in the TAVR arm compared to the SAVR arm (n = 74 vs. n = 129, respectively; OR = 0.57, 95% CI = 0.32-1.01; p = 0.05, I2 = 69%). Conclusion Based on our findings and analysis, we have concluded that TAVR is associated with significantly reduced renal injury at 30 days when compared to SAVR.
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Affiliation(s)
- Waqas J Siddiqui
- Cardiology/Nephrology, Drexel University College of Medicine, Philadelphia, USA.,Cardiology/Nephrology, Orange Park Medical Center, Orange Park, USA
| | - Murrium I Sadaf
- Internal Medicine, Yale School of Medicine, New Haven, USA.,Internal Medicine, Waterbury Hospital, Waterbury, USA
| | - Muhammad Zain
- Internal Medicine, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, PAK
| | - Rabia Mazhar
- Internal Medicine, Orange Park Medical Center, Orange Park, USA
| | - Ramla Abbas
- Internal Medicine, Orange Park Medical Center, Orange Park, USA
| | - Mohammad H Khan
- Internal Medicine, Orange Park Medical Center, Orange Park, USA
| | - Faiza Ahmed
- Medicine, Wynford Chelation Center, Toronto, CAN
| | - Omer Zuberi
- Cardiology, Orange Park Medical Center, Orange Park, USA
| | | | - Jesse Goldman
- Nephrology, Thomas Jefferson University, Philadelphia, USA
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Siddiqui WJ, Rawala MS, Abid W, Zain M, Sadaf MI, Abbasi D, Alvarez C, Mansoor F, Hasni SF, Aggarwal S. Is Physiologic Stress Test with Imaging Comparable to Anatomic Examination of Coronary Arteries by Coronary Computed Tomography Angiography to Investigate Coronary Artery Disease? - A Systematic Review and Meta-Analysis. Cureus 2020; 12:e6941. [PMID: 32190493 PMCID: PMC7067363 DOI: 10.7759/cureus.6941] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective Coronary computed tomography angiography (CCTA) is a noninvasive diagnostic modality that remains underutilized compared to functional stress testing (ST) for investigating coronary artery disease (CAD). Several patients are misdiagnosed with noncardiac chest pain (CP) that eventually die from a cardiovascular event in subsequent years. We compared CCTA to ST to investigate CP. Methods We searched MEDLINE, PubMed, Cochrane Library, and Embase from January 1, 2007 to July 1, 2018 for randomized controlled trials (RCTs) comparing CCTA to ST in patients who presented with acute or stable CP. We used Review Manager (RevMan) [Computer program] Version 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) for review and analysis. Results We included 16 RCTs enrolling 21,210 patients; there were more patients with hyperlipidemia and older patients in the ST arm compared to the CCTA arm. There was no difference in mortality: 103 in the CCTA arm vs. 110 in the ST arm (risk ratio [RR] = 0.93, 95% confidence interval [CI] = 0.71-1.21, P = .58, and I2 = 0%). A significant reduction was seen in myocardial infarctions (MIs) after CCTA compared to ST: 115 vs. 156 (RR = 0.71, CI = 0.56-0.91, P < .006, I2=0%). On subgroup analysis, the CCTA arm had fewer MIs vs. the ST with imaging subgroup (RR = 0.70, CI = 0.54-0.89, P = .004, I2 = 0%) and stable CP subgroup (RR = 0.66, CI = 0.50-0.88, P = .004, I2 = 0%). The CCTA arm showed significantly higher invasive coronary angiograms and revascularizations and significantly reduced follow-up testing and recurrent hospital visits. A trend towards increased unstable anginas was seen in the CCTA arm. Conclusions Our analysis showed a significant reduction in downstream MIs, hospital visits, and follow-up testing when CCTA is used to investigate CAD with no difference in mortality.
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Affiliation(s)
- Waqas J Siddiqui
- Cardiology/Nephrology, Drexel University College of Medicine, Philadelphia, USA
| | | | - Waqas Abid
- Interventional Radiology, Christiana Hospital, Newark, USA
| | - Muhammad Zain
- Internal Medicine, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, PAK
| | | | - Danish Abbasi
- Cardiovascular Diseases, University of Arkansas, Little Rock, USA
| | | | | | - Syed Farhan Hasni
- Heart Failure and Transplant, Albert Einstein Hospital, Philadelphia, USA
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Kropp CM, Huber NL, Sager D, Tripp C, Burch A, Naniwadekar A, Nekkanti R, Sadaf MI, Mounsey JP, Sears SF. Mobile-ECG screening in rural pharmacies: rates of atrial fibrillation and associated risk factors. Heart Lung 2020; 49:377-380. [PMID: 32014313 DOI: 10.1016/j.hrtlng.2020.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 08/22/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Atrial fibrillation (AFib) is a growing health concern, affecting more than 40 million patients worldwide and increasing stroke risk by five times. Community screening initiatives in rural healthcare establishments are becoming more feasible with the development of innovative, mobile-ECG (mECG) technology. The purpose of this research was to characterize increased rates of stroke risk factors and to determine AFib incidence in rural, pharmacy settings. METHODS The researchers examined the prevalence of risk factors associated with AFib and calculated CHA₂DS₂-VASc stroke risk scores in a previously undiagnosed AFib community sample of 250 participants. Eligible participants at two rural pharmacies were administered a 1-lead mECG reading. Participants were then asked to complete questionnaires on demographic and medical history information. All participants were given educational materials on AFib and medical referrals when indicated. RESULTS Prevalence rates of six, known independent stroke risk factors (CHA₂DS₂-VASc scores: (2.68 ± 1.35)) were significantly higher in the study sample than reported national US averages. Screening via mECG indicated preliminary AFib rates of approximately 4%; however, upon independent adjudication of the readings from three electrophysiologists AFib prevalence ranged between 1% and 8%. DISCUSSION Collectively, an alarming rate of untreated stroke risk in a rural pharmacy sample was identified by the researchers utilizing mECG technology. These results suggest potential value to the use of mECG technology to screen for AFib in at-risk communities.
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Affiliation(s)
- Caley M Kropp
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Nichelle L Huber
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - David Sager
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Connor Tripp
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Ashley Burch
- Department of Psychology, East Carolina University, Greenville, NC, USA; Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Aditi Naniwadekar
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Rajasekhar Nekkanti
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Murrium I Sadaf
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - J Paul Mounsey
- Department of Psychology, East Carolina University, Greenville, NC, USA; Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Samuel F Sears
- Department of Psychology, East Carolina University, Greenville, NC, USA; Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA.
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Joodi G, Maradey JA, Bogle B, Mirzaei M, Sadaf MI, Pursell I, Henderson C, Mounsey JP, Simpson RJ. Coronary Artery Disease and Atherosclerotic Risk Factors in a Population-Based Study of Sudden Death. J Gen Intern Med 2020; 35:531-537. [PMID: 31808130 PMCID: PMC7018927 DOI: 10.1007/s11606-019-05486-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 02/14/2019] [Accepted: 09/23/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sudden death is a public health problem with major impact on society. Coronary artery disease (CAD) is believed to underlie 60-80% of these deaths. While deaths from CAD have decreased in the recent decades, sudden death rates remain unacceptably high. OBJECTIVE We aimed to assess the prevalence of CAD and its risk factors among 18-64-year-old adults in a population-based case registry of sudden deaths and compare them to a living population from the same geographical area. DESIGN From 2013 to 2015, all sudden deaths among 18-64-year-old adults in Wake County, NC, were identified (n = 371). A comparison group was formed by randomly selecting individuals from an electronic health record repository of a major healthcare system in the area (N = 4218). MAIN MEASURES Prevalence of CAD and its risk factors among cases of sudden death and living population across sex and age groups. Odds of sudden death associated with atherosclerotic risk factors and comorbidities. KEY RESULTS CAD was present in 14.8% of sudden death cases. Among sudden death victims, most risk factors and comorbidities were more common in the older age group, except for obesity which was more common in younger cases, and diabetes which was equally prevalent in younger and older cases. Compared to living population, sudden death cases had higher prevalence of atherosclerotic risk factors across all gender and age groups. Sudden death cases had a numerically higher number of risk factors compared to living population, regardless of age group or presence of CAD. CONCLUSIONS Coronary artery disease is not common among sudden death cases, but risk factors and comorbidities are prevalent. Our findings support the changing etiology of sudden death. In the absence of clinically diagnosed CAD, use of novel imaging modalities and biomarkers may identify high-risk individuals and lead to prevention of sudden death.
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Affiliation(s)
- Golsa Joodi
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Joan A Maradey
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Brittany Bogle
- Senior Data Scientist, Data Science Elite Team, IBM Corporation, Durham, NC, USA
| | - Mojtaba Mirzaei
- Division of Cardiology, Department of Medicine , University of North Carolina, Chapel Hill, NC, USA
| | - Murrium I Sadaf
- Department of Internal Medicine, Yale University School of Medicine, Waterbury, CT, USA
| | - Irion Pursell
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Cory Henderson
- Division of Cardiology, Department of Medicine , University of North Carolina, Chapel Hill, NC, USA
| | - John Paul Mounsey
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Ross J Simpson
- Division of Cardiology, Department of Medicine , University of North Carolina, Chapel Hill, NC, USA.
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Abadie BQ, Hansen B, Walker J, Deyo Z, Biese K, Armbruster T, Tuttle H, Sadaf MI, Sears SF, Pasi R, Gehi AK. Likelihood of Spontaneous Cardioversion of Atrial Fibrillation Using a Conservative Management Strategy Among Patients Presenting to the Emergency Department. Am J Cardiol 2019; 124:1534-1539. [PMID: 31522772 DOI: 10.1016/j.amjcard.2019.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 01/08/2023]
Abstract
Numerous emergency department (ED) atrial fibrillation (AF) protocols have been developed to reduce hospitalizations, focusing on the use of cardioversion in the ED. An alternative strategy of rate control with early specialty follow-up may be more widely applicable. The likelihood of spontaneous cardioversion with such a protocol is unknown. Between 2015 and 2018, 157 patients who presented to the ED with a primary diagnosis of AF and were hemodynamically stable and with low to moderate symptom severity were discharged with early follow-up at an AF specialty clinic. Rhythm at short-term (within 72 hours), within 30-day follow-up, and need for electrical cardioversion was tabulated. Various demographic and co-morbidity variables were assessed to determine their association with likelihood of spontaneous cardioversion. At an average of 2.3 days, 63% and within 30 days, 83% had spontaneous cardioversion. By 90 days, only 6.3% required electrical cardioversion. Diabetes (38% vs 69%, p <0.01), coronary artery disease (39% vs 66%, p = 0.02), reduced ejection fraction (40% vs 72%, p <0.01), dilated right atrium (43% vs 73%, p <0.01) and moderate-to-severely dilated left atrium (38% vs 78%, p <0.01) predicted those who were less likely to convert to sinus rhythm. Most patients who present to the ED with AF will spontaneously convert to sinus rhythm by short-term (2 to 3 days) follow-up with a rate control strategy. In conclusion, aggressive use of electrical cardioversion in the ED may be unnecessary in hemodynamically stable patients without severe symptoms.
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Hummel JP, Kadado AJ, Baker M, Gehi AK, Mounsey JP, Sadaf MI, Enriquez AD, Freeman JV, Akar JG. Atrial Fibrillation Thermographic and Endoscopic Monitoring of Patients: Safety Algorithm for the Esophagus: AF TEMP-SAFE Study. Circ Arrhythm Electrophysiol 2019; 11:e006814. [PMID: 30562101 DOI: 10.1161/circep.118.006814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/16/2022]
Affiliation(s)
- James P Hummel
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison (J.P.H.)
| | - Anis John Kadado
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT (A.J.K., A.D.E., J.V.F., J.G.A.)
| | - Matthew Baker
- Division of Cardiology, University of North Carolina, Chapel Hill (M.B., A.K.G., M.I.S.)
| | - Anil K Gehi
- Division of Cardiology, University of North Carolina, Chapel Hill (M.B., A.K.G., M.I.S.)
| | - J Paul Mounsey
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC (J.P.M.)
| | - Murrium I Sadaf
- Division of Cardiology, University of North Carolina, Chapel Hill (M.B., A.K.G., M.I.S.)
| | - Alan D Enriquez
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT (A.J.K., A.D.E., J.V.F., J.G.A.)
| | - James V Freeman
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT (A.J.K., A.D.E., J.V.F., J.G.A.)
| | - Joseph G Akar
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT (A.J.K., A.D.E., J.V.F., J.G.A.)
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Masoudi EA, Mirzaei M, Joodi G, Hussain A, Sadaf MI, Flowers JP, Simpson RJ. RECENT HEALTH CARE VISITS, SYMPTOMS, AND CLINICAL CHARACTERISTICS OF SUDDEN UNEXPECTED DEATH VICTIMS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32415-5] [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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Bazemore TC, Bolger LE, Sears SF, Sadaf MI, Gehi AK. Gender differences in symptoms and functional status in patients with atrial fibrillation undergoing catheter ablation. Pacing Clin Electrophysiol 2018; 42:224-229. [PMID: 30548873 DOI: 10.1111/pace.13577] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 11/21/2018] [Accepted: 12/03/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Catheter ablation improves symptoms and quality of life in patients with atrial fibrillation (AF); however, despite its benefit, women are less likely than men to undergo catheter ablation. Women with AF have been described to have more frequent and severe symptoms with a lower quality of life than men, and it is therefore unclear why women are less likely to undergo catheter ablation. We prospectively characterized gender differences in AF symptoms among men and women undergoing ablation at UNC using questionnaire data. METHODS Functional capacity was assessed with the Duke Activity Status Index (DASI) and quality of life was assessed with the Canadian Cardiovascular Society Symptoms of AF score (CCS-SAF) and the AF Effect on Quality-of-Life Questionnaire Tool (AFEQT). RESULTS Among 191 patients in the study, women were less likely to undergo catheter ablation and had higher rates of paroxysmal AF and higher CHADS2 -VASc scores than men. Women had a worse functional capacity with significantly lower DASI scores than men; quality of life was also worse among women, with higher CCS-SAF scores and lower AFEQT scores than men. After adjustment for AF type, there was a persistent gender difference for functional capacity and symptom measures. CONCLUSIONS At the time of catheter ablation, women with AF had a significantly lower functional status with worse symptoms and a lower quality of life than men. The role of this symptom difference on the gender gap in enrollment for catheter ablation is unclear and likely due to multiple patient and provider factors.
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Affiliation(s)
- Taylor C Bazemore
- Division of Cardiology, Chapel Hill: Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Lauren E Bolger
- Division of Cardiology, Chapel Hill: Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Samuel F Sears
- Department of Psychology and Cardiovascular Sciences, East Carolina University, Greenville, North Carolina
| | - Murrium I Sadaf
- Division of Cardiology, Chapel Hill: Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.,Department of Internal Medicine, Yale-New Haven Medical Center, Waterbury, Connecticut
| | - Anil K Gehi
- Division of Cardiology, Chapel Hill: Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Hosadurg N, Bogle BM, Joodi G, Sadaf MI, Pursell I, Mendys PM, Mounsey JP, Simpson RJ. Lipid Profiles in Out-of-Hospital Sudden Unexpected Death. Mayo Clin Proc Innov Qual Outcomes 2018; 2:257-266. [PMID: 30225459 PMCID: PMC6132208 DOI: 10.1016/j.mayocpiqo.2018.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 06/24/2018] [Accepted: 06/27/2018] [Indexed: 11/18/2022] Open
Abstract
Objective To determine the association between serum lipid measurements and the occurrence of out-of-hospital sudden unexpected death (OHSUD). Patients and Methods We compared 139 OHSUD cases (43 female patients [30.9%]) and 968 controls (539 female patients [55.7%]) from Wake County, North Carolina, from March 1, 2013, through February 28, 2015. Individuals were included if they were aged 18 to 64 years and had lipid measurements in the 5 years before their death (cases) or the most recent health care encounter (controls). Covariates were abstracted from medical records for all subjects, and those with triglyceride (TG) levels greater than 400 mg/dL (to convert to mmol/L, multiply by 0.0259) were excluded for low-density lipoprotein (LDL)–related analyses. Results By linear regression using age- and sex-adjusted models, cases of OHSUD had lower adjusted mean total cholesterol (170.3±52.2 mg/dL vs 188.9±39.7 mg/dL; P<.001), LDL cholesterol (90.9±39.6 mg/dL vs 109.6±35.2 mg/dL; P<.001), and non–high-density lipoprotein (HDL) (121.6±49.8 mg/dL vs 134.3±39.6 mg/dL; P<.001) levels and a higher adjusted TG/HDL-C ratio (4.7±7 vs 3±2.7; P<.001) than did controls. By logistic regression using age- and sex-adjusted models, the odds of OHSUD were elevated per unit increase in TG/HDL-C ratio (1.08; 95% CI, 1.03-1.12). Conclusion Out-of-hospital sudden unexpected death cases had more favorable levels of total cholesterol, LDL cholesterol, and non-HDL, possibly indicating a lack of association between traditional lipid cardiovascular risk factors and sudden unexpected death. A comparatively elevated TG/HDL-C ratio in cases may corroborate an evolving hypothesis of how vasoactive and prothrombotic remnant-like lipoprotein particles contribute to sudden unexpected death.
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Affiliation(s)
- Nisha Hosadurg
- Department of Internal Medicine, Tufts University School of Medicine, Boston, MA
- Correspondence: Address to Nisha Hosadurg, MD, Department of Internal Medicine, Tufts Medical Center, 800 Washington St, Boston, MA 02111.
| | - Brittany M. Bogle
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Golsa Joodi
- Division of Cardiology, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Murrium I. Sadaf
- Division of Cardiology, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Irion Pursell
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Philip M. Mendys
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC
| | - John P. Mounsey
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ross J. Simpson
- Division of Cardiology, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Vandermolen JL, Sadaf MI, Gehi AK. Management and Disposition of Atrial Fibrillation in the Emergency Department: A Systematic Review. J Atr Fibrillation 2018; 11:1810. [PMID: 30455832 DOI: 10.4022/jafib.1810] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/11/2018] [Revised: 03/19/2018] [Accepted: 05/26/2018] [Indexed: 12/18/2022]
Abstract
Introduction Management of atrial fibrillation (AF) and atrial flutter (AFL) in the emergency department (ED) varies greatly, and there are currently no United States guidelines to guide management with regard to patient disposition after ED treatment. The aim of this systematic review was to evaluate the literature for decision aids to guide disposition of patients with AF/AFLin the ED, and assess potential outcomes associated with different management strategies in the ED. Methods and Results A systematic review was done using PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE, combining the search terms "Atrial Fibrillation", "Atrial Flutter", "Emergency Medicine", "Emergency Service", and "Emergency Treatment". After removal of duplicates, 754 articles were identified. After initial screening of titles and abstracts, 69full text articles were carefully reviewed and 34 articles were ultimately included in the study based on inclusion and exclusion criteria. The articles were grouped into four main categories: decision aids and outcome predictors, electrical cardioversion-based protocols, antiarrhythmic-based protocols, and general management protocols. Conclusion This systematic review is the first study to our knowledge to evaluate the optimal management of symptomatic AF/AFLin the ED with a direct impact on ED disposition. There are several viable management strategies that can result in safe discharge from the ED in the right patient population, and decision aids can be utilized to guide selection of appropriate patients for discharge.
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Affiliation(s)
- Justin L Vandermolen
- Division of Cardiology, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Murrium I Sadaf
- Division of Cardiology, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Anil K Gehi
- Division of Cardiology, Department of Medicine, University of North Carolina, Chapel Hill, NC
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