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Alhuarrat MAD, Barssoum K, Chowdhury M, Mathai SV, Helft M, Grushko M, Singh P, Jneid H, Motiwala A, Faillace RT, Sokol SI. Comparison of In-Hospital Outcomes between Early and Late Catheter-Directed Thrombolysis in Acute Pulmonary Embolism: A Retrospective Observational Study. J Clin Med 2024; 13:1093. [PMID: 38398406 PMCID: PMC10889518 DOI: 10.3390/jcm13041093] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
The purpose of this study is to evaluate whether early initiation of catheter-directed thrombolysis (CDT) in patients presenting with acute pulmonary embolism is associated with improved in-hospital outcomes. A retrospective cohort was extracted from the 2016-2019 National Inpatient Sample database, consisting of 21,730 weighted admissions undergoing CDT acute PE. From the time of admission, the sample was divided into early (<48 h) and late interventions (>48 h). Outcomes were measured using regression analysis and propensity score matching. No significant differences in mortality, cardiac arrest, cardiogenic shock, or intracranial hemorrhage (p > 0.05) were found between the early and late CDT groups. Late CDT patients had a higher likelihood of receiving systemic thrombolysis (3.21 [2.18-4.74], p < 0.01), blood transfusion (1.84 [1.41-2.40], p < 0.01), intubation (1.33 [1.05-1.70], p = 0.02), discharge disposition to care facilities (1.32 [1.14-1.53], p < 0.01). and having acute kidney injury (1.42 [1.25-1.61], p < 0.01). Predictors of late intervention were older age, female sex, non-white ethnicity, non-teaching hospital admission, hospitals with higher bed sizes, and weekend admission (p < 0.01). This study represents a comprehensive evaluation of outcomes associated with the time interval for initiating CDT, revealing reduced morbidity with early intervention. Additionally, it identifies predictors associated with delayed CDT initiation. The broader ramifications of these findings, particularly in relation to hospital resource utilization and health disparities, warrant further exploration.
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Affiliation(s)
- Majd Al Deen Alhuarrat
- Division of Internal Medicine, NYC Health + Hospitals, Jacobi Medical Center, Albert Einstein College Medicine, Bronx, NY 10461, USA; (M.A.D.A.); (R.T.F.)
| | - Kirolos Barssoum
- Division of Cardiology, University of Texas Medical Branch, Houston, TX 77002, USA; (K.B.); (H.J.); (A.M.)
| | - Medhat Chowdhury
- Ascension Providence Southfield Campus, Southfield, MI 48075, USA
| | - Sheetal Vasundara Mathai
- Division of Internal Medicine, NYC Health + Hospitals, Jacobi Medical Center, Albert Einstein College Medicine, Bronx, NY 10461, USA; (M.A.D.A.); (R.T.F.)
| | - Miriam Helft
- College of Art and Sciences, New York University, New York, NY 10003, USA
| | - Michael Grushko
- Division of Cardiology, NYC Health + Hospitals, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (M.G.); (P.S.)
| | - Prabhjot Singh
- Division of Cardiology, NYC Health + Hospitals, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (M.G.); (P.S.)
| | - Hani Jneid
- Division of Cardiology, University of Texas Medical Branch, Houston, TX 77002, USA; (K.B.); (H.J.); (A.M.)
| | - Afaq Motiwala
- Division of Cardiology, University of Texas Medical Branch, Houston, TX 77002, USA; (K.B.); (H.J.); (A.M.)
| | - Robert T. Faillace
- Division of Internal Medicine, NYC Health + Hospitals, Jacobi Medical Center, Albert Einstein College Medicine, Bronx, NY 10461, USA; (M.A.D.A.); (R.T.F.)
| | - Seth I. Sokol
- Division of Cardiology, NYC Health + Hospitals, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (M.G.); (P.S.)
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Mathai SV, Apple SJ, Xu X, Pang L, Flatow E, Friedman A, Rios S, Benites Moya CJ, Alhuarrat MAD, Parker M, Sokol SI, Faillace RT. Differential Mortality Among Heart Failure Patients Across Different COVID-19 Surges in New York City. J Healthc Qual 2024:01445442-990000000-00058. [PMID: 38214648 DOI: 10.1097/jhq.0000000000000421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
ABSTRACT Learning from the healthcare system's response to the COVID-19 pandemic is essential to better prepare for potential future crises. We sought to assess mortality rates for patients admitted for acute decompensated heart failure (HF) and to analyze which factors demonstrated a statistically significant correlation with this primary endpoint. We performed a retrospective analysis of patients hospitalized with a primary diagnosis of acute decompensated HF within the New York City Health and Hospitals 11-hospital system across the different COVID surge periods. Mortality information was collected in 4,405 participants (mean [SD] age 70.54 [14.44] years, 1885 [42.87%] female).The highest mortality existed in the first surge (9.02%), then improved to near prepandemic levels (3.65%) in the second (3.91%) and third surges (5.94%, p < 0.0001). In-hospital mortality inversely correlated with receipt of a COVID-19 vaccination, but had no correlation with left ventricular ejection fraction or the number of vaccination doses. Mortality for acute decompensated HF patients improved after the first surge, suggesting that hospitals adequately adapted to provide quality care. As future infectious outbreaks may occur, emergency preparedness must ensure that adequate focus and resources remain for other clinical entities, such as HF, to ensure optimal care is delivered across all areas of illness.
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Alhuarrat MAD, Garg V, Borkowski P, Nazarenko N, Alhuarrat MR, Abushairah A, Al Zyoud B, Bitsis EM, Barzallo D, Alemu R, Kharawala A, Nagraj S, Abdou C, Faillace RT, Rai D, Minuti A, Palaiodimos L. Epidemiologic and Clinical Characteristics of Marantic Endocarditis: A Systematic Review and Meta-analysis of 416 Reports. Curr Probl Cardiol 2024; 49:102027. [PMID: 37557941 DOI: 10.1016/j.cpcardiol.2023.102027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 08/11/2023]
Abstract
Nonbacterial thrombotic endocarditis (NBTE) is a distinctive condition marked by the presence of aseptic fibrin depositions on cardiac valves due to hypercoagulability and endocardial damage. There is a scarcity of large cohort studies clarifying factors associated with morbidity and mortality of this condition. A systematic literature review was performed utilizing the PubMed, Embase, Cochrane, and Web-of-Science databases to retrieve case reports and series documenting cases of NBTE from inception until September-2022. A descriptive analysis of basic characteristics was carried out, followed by multivariate regression analysis to identify risk factors associated with morbidity and mortality. A total of 416 case reports and series were identified, of which 450 patients were extracted. The female-to-male ratio was around 2:1 with an overall sample median age of 48 (interquartile range [IQR]:34-61). Stroke-like symptoms were the most common presentation and embolic phenomena occurred in 70% of cases, the majority of which were due to stroke. Cancer was associated with higher embolic complications (aOR:6.38, 95% CI = 3.75-10.83, p < 0.01) in comparison to other NBTE etiologies, while age, sex, and vegetation size were not (p > 0.05). All-cause in-hospital mortality was 36%, with cancer etiology being associated with higher mortality: 56% (aOR:3.64, 95% CI = 1.57-8.43, p < 0.01) in comparison to other NBTE etiologies:19%. A significant decrease in NBTE mortality was seen in recent years in comparison to admissions that occurred during the 20th century (aOR:0.07, 95% CI = 0.04-0.15, p < 0.01). While there has been an observed improvement in overall in-hospital mortality rates for patients admitted with NBTE in recent years, it is important to note that cases associated with a cancer etiology are still linked to high morbidity and mortality during hospitalization.
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Affiliation(s)
- Majd Al Deen Alhuarrat
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY.
| | - Vibhor Garg
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
| | - Pawel Borkowski
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
| | - Natalia Nazarenko
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
| | | | | | - Batool Al Zyoud
- Division of Pharmacy, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
| | | | - Diego Barzallo
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
| | - Rebeca Alemu
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
| | - Amrin Kharawala
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
| | - Sanjana Nagraj
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
| | | | - Robert T Faillace
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
| | - Devash Rai
- Department of Cardiology, Rochester Regional Health, Rochester, NY
| | - Aurelia Minuti
- Head, Research & Education, D. Samuel Gottesman Library, Albert Einstein College of Medicine, Bronx, NY
| | - Leonidas Palaiodimos
- Department of Medicine, NYC Health + Hospitals/ Jacobi, Albert Einstein College Medicine, Bronx, NY
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Pinsino A, Carey MR, Husain S, Mohan S, Radhakrishnan J, Jennings DL, Nguonly AS, Ladanyi A, Braghieri L, Takeda K, Faillace RT, Sayer GT, Uriel N, Colombo PC, Yuzefpolskaya M. The Difference Between Cystatin C- and Creatinine-Based Estimated GFR in Heart Failure With Reduced Ejection Fraction: Insights From PARADIGM-HF. Am J Kidney Dis 2023; 82:521-533. [PMID: 37086965 DOI: 10.1053/j.ajkd.2023.03.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/02/2023] [Indexed: 04/24/2023]
Abstract
RATIONALE & OBJECTIVE The clinical implications of the discrepancy between cystatin C (cysC)- and serum creatinine (Scr)-estimated glomerular filtration rate (eGFR) in patients with heart failure (HF) and reduced ejection fraction (HFrEF) are unknown. STUDY DESIGN Post-hoc analysis of randomized trial data. SETTING & PARTICIPANTS 1,970 patients with HFrEF enrolled in PARADIGM-HF with available baseline cysC and Scr measurements. EXPOSURE Intraindividual differences between eGFR based on cysC (eGFRcysC) and Scr (eGFRScr; eGFRdiffcysC-Scr). OUTCOMES Clinical outcomes included the PARADIGM-HF primary end point (composite of cardiovascular [CV] mortality or HF hospitalization), CV mortality, all-cause mortality, and worsening kidney function. We also examined poor health-related quality of life (HRQoL), frailty, and worsening HF (WHF), defined as HF hospitalization, emergency department visit, or outpatient intensification of therapy between baseline and 8-month follow-up. ANALYTICAL APPROACH Fine-Gray subdistribution hazard models and Cox proportional hazards models were used to regress clinical outcomes on baseline eGFRdiffcysC-Scr. Logistic regression was used to investigate the association of baseline eGFRdiffcysC-Scr with poor HRQoL and frailty. Linear regression models were used to assess the association of WHF with eGFRcysC, eGFRScr, and eGFRdiffcysC-Scr at 8-month follow-up. RESULTS Baseline eGFRdiffcysC-Scr was higher than +10 and lower than-10mL/min/1.73m2 in 13.0% and 35.7% of patients, respectively. More negative values of eGFRdiffcysC-Scr were associated with worse outcomes ([sub]hazard ratio per standard deviation: PARADIGM-HF primary end point, 1.18; P=0.008; CV mortality, 1.34; P=0.001; all-cause mortality, 1.39; P<0.001; worsening kidney function, 1.31; P=0.05). For a 1-standard-deviation decrease in eGFRdiffcysC-Scr, the prevalences of poor HRQoL and frailty increased by 29% and 17%, respectively (P≤0.008). WHF was associated with a more pronounced decrease in eGFRcysC than in eGFRScr, resulting in a change in 8-month eGFRdiffcysC-Scr of-4.67mL/min/1.73m2 (P<0.001). LIMITATIONS Lack of gold-standard assessment of kidney function. CONCLUSIONS In patients with HFrEF, discrepancies between eGFRcysC and eGFRScr are common and are associated with clinical outcomes, HRQoL, and frailty. The decline in kidney function associated with WHF is more marked when assessed with eGFRcysC than with eGFRScr. PLAIN-LANGUAGE SUMMARY Kidney function assessment traditionally relies on serum creatinine (Scr) to establish an estimated glomerular filtration rate (eGFR). However, this has been challenged with the introduction of an alternative marker, cystatin C (cysC). Muscle mass and nutritional status have differential effects on eGFR based on cysC (eGFRcysC) and Scr (eGFRScr). Among ambulatory patients with heart failure enrolled in PARADIGM-HF, we investigated the clinical significance of the difference between eGFRcysC and eGFRScr. More negative values (ie, eGFRScr>eGFRcysC) were associated with worse clinical outcomes (including mortality), poor quality of life, and frailty. In patients with progressive heart failure, which is characterized by muscle loss and poor nutritional status, the decline in kidney function was more pronounced when eGFR was estimated using cysC rather than Scr.
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Affiliation(s)
- Alberto Pinsino
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center; Division of Critical Care Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
| | - Matthew R Carey
- Department of Medicine, Columbia University Irving Medical Center
| | - Syed Husain
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center; Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center
| | - Jai Radhakrishnan
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center
| | - Douglas L Jennings
- Department of Pharmacy, Columbia University Irving Medical Center; Department of Pharmacy Practice, Long Island University College of Pharmacy, New York
| | - Austin S Nguonly
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center
| | - Annamaria Ladanyi
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center
| | - Lorenzo Braghieri
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center; Department of Medicine, Cleveland Clinic, Cleveland, OH
| | - Koji Takeda
- Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center
| | | | - Gabriel T Sayer
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center
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Krouss M, Israilov S, Mestari N, Talledo J, Alaiev D, Moskovitz JB, Faillace RT, Uppal A, Fagan I, Curcio J, Scott J, Bouton M, Ford K, Cohen V, Wei EK, Cho HJ. Choosing Wisely and Promoting High-Value Care and Staff Safety During the COVID-19 Pandemic in a Large Safety Net System. Qual Manag Health Care 2023:00019514-990000000-00062. [PMID: 37817318 DOI: 10.1097/qmh.0000000000000431] [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: 10/12/2023]
Abstract
BACKGROUND AND OBJECTIVES As the COVID-19 pandemic brought surges of hospitalized patients, it was important to focus on reducing overuse of tests and procedures to not only reduce potential harm to patients but also reduce unnecessary exposure to staff. The objective of this study was to create a Choosing Wisely in COVID-19 list to guide clinicians in practicing high-value care at our health system. METHODS A Choosing Wisely in COVID-19 list was developed in October 2020 by an interdisciplinary High Value Care Council at New York City Health + Hospitals, the largest public health system in the United States. The first phase involved gathering areas of overuse from interdisciplinary staff across the system. The second phase used a modified Delphi scoring process asking participants to rate recommendations on a 5-point Likert scale based on criteria of degree of evidence, potential to prevent patient harm, and potential to prevent staff harm. RESULTS The top 5 recommendations included avoiding tracheal intubation without trial of noninvasive ventilation (4.4); not placing routine central venous catheters (4.33); avoiding routine daily laboratory tests and batching laboratory draws (4.19); not ordering daily chest radiographs (4.17); and not using bronchodilators in the absence of reactive airway disease (4.13). CONCLUSION We successfully developed Choosing Wisely in COVID-19 recommendations that focus on evidence and preventing patient and staff harm in a large safety net system to reduce overuse.
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Affiliation(s)
- Mona Krouss
- Department of Quality and Safety (Drs Krouss, Israilov, and Wei, Ms Mestari, and Mr. Talledo and Alaiev) and Medical Professional Affairs (Dr Bouton, Ms Ford, and Mr Cohen), New York City Health + Hospitals, New York City, New York; Department of Medicine, Icahn School of Medicine, New York City, New York (Drs Krouss and Curcio); Department of Emergency Medicine, New York City Health + Hospitals/Jacobi, Bronx, New York (Drs Moskovitz and Faillace); Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York (Dr Moskovitz); Department of Public Health, Hofstra School of Health and Human Services, Hempstead, New York (Dr Moskovitz); Department of Medicine, New York City Health + Hospitals/Bellevue, New York City, New York (Drs Uppal and Fagan); Department of Medicine, New York University Grossman School of Medicine, New York City, New York (Drs Uppal and Fagan); Department of Medicine, New York City Health + Hospitals/Elmhurst, Queens, New York (Dr Curcio); Department of Radiology, New York City Health + Hospitals/Kings County, Brooklyn, New York (Dr Scott); Department of Radiology, SUNY Downstate Medical Center, Brooklyn, New York (Dr Scott); Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts (Dr Cho)
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Alhuarrat MAD, Pargaonkar S, Rahgozar K, Safiriyu I, Zhang X, Faillace RT, Di Biase L. Comparison of in-hospital outcomes and complications of left atrial appendage closure with the Watchman device between males and females. Europace 2023; 25:euad228. [PMID: 37503957 PMCID: PMC10445300 DOI: 10.1093/europace/euad228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
AIMS Left atrial appendage occlusion (LAAO) with WATCHMAN device is being used for patients with atrial fibrillation (AFB) and, as an off-label use, atrial flutter (AFL) who can't comply with long-term anticoagulation. We aim to study the differences in outcomes between sexes in patients undergoing Watchman device implantation. METHODOLOGY The National Inpatient Sample was queried between 2016 and 2019 using ICD-10 clinical modification codes I48x for AFB and AFL. Patients who underwent LAAO were identified using the procedural code 02L73DK. Comorbidities and complications were identified using ICD procedure and diagnosis codes. Differences in primary outcomes were analyzed using multivariable regression and propensity score matching. RESULTS 38 105 admissions were identified, of which 16 795 (44%) were females (76 ± 7.6 years) and 21 310 (56%) were males (75 ± 8 years). Females were more likely to have cardiac (frequencies: 5.8% vs 3.75%, aOR: 1.5 [1.35-1.68], p1 day inpatient (1.79 [1.67-1.93], P < 0.01) and be discharged to a facility (1.54 [1.33-1.80], P < 0.01). CONCLUSION Females are more likely to develop cardiac, renal, bleeding, pulmonary and TEE-related complications following LAAO procedure, while concurrently showing higher mortality, length of stay and discharge to facilities.
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Affiliation(s)
- Majd Al Deen Alhuarrat
- Division of Internal Medicine, Jacobi Medical Center, Albert Einstein College Medicine, Bronx, NY, USA
| | - Sumant Pargaonkar
- Division of Internal Medicine, Jacobi Medical Center, Albert Einstein College Medicine, Bronx, NY, USA
| | - Kusha Rahgozar
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Israel Safiriyu
- Division of Internal Medicine, Jacobi Medical Center, Albert Einstein College Medicine, Bronx, NY, USA
| | - Xiadong Zhang
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Robert T Faillace
- Division of Internal Medicine, Jacobi Medical Center, Albert Einstein College Medicine, Bronx, NY, USA
| | - Luigi Di Biase
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
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Mangeshkar S, Nazarenko N, Varrias D, Spanos M, Borkowski P, Alhuarrat MAD, Li W, Kishore P, Faillace RT. A Case of Type V Hyperlipoproteinemia Resistant to Insulin Treatment. Cureus 2023; 15:e41424. [PMID: 37546045 PMCID: PMC10403339 DOI: 10.7759/cureus.41424] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Type V hyperlipoproteinemia or multifactorial chylomicronemia syndrome is a rare lipid disorder triggered mainly by uncontrolled diabetes, obesity, poor diet, or particular medications. It is associated with an increased risk of acute pancreatitis and accelerated coronary artery disease which may manifest in younger age groups. We present a case of a 42-year-old male who presented to the emergency department (ED) complaining of a non-healing hand injury. Upon laboratory workup, the patient was found to have an elevated total cholesterol (TC) of 1129 mg/dL, very low levels of high-density lipoprotein (HDL) and triglycerides (TG) > 4000 mg/dL with an inability to calculate low-density lipoprotein (LDL). Lipoprotein electrophoresis revealed an actual TG level of > 7000 mg/dL, increased chylomicrons, normal B and pre-B-lipoproteins, and increased L-lipoproteins with an elevated Apolipoprotein B. Despite these derangements, the patient did not exhibit any abdominal complaints, demonstrating a normal lipase level. The physical exam was indicative of bilateral arcus senilis and obesity. Insulin drip was initiated along with intravenous (IV) hydration and it required 12 days to bring triglycerides down to less than 1000 mg/dL. The total cholesterol was also seen to be down trending to around 500 mg/dL and the HDL improved to 22 mg/dL. We present this case as a unique presentation of asymptomatic chylomicronemia resistant to insulin treatment with an elevated ApoB but with no evidence of pancreatitis or coronary artery disease.
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Affiliation(s)
- Shaunak Mangeshkar
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Natalia Nazarenko
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Dimitrios Varrias
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Michail Spanos
- Cardiovascular Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Pawel Borkowski
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Majd Al Deen Alhuarrat
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Weijia Li
- Cardiology, AdventHealth Orlando, Orlando, USA
| | | | - Robert T Faillace
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
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Peppas S, Palaiodimos L, Nagraj S, Kokkinidis DG, Tiwari N, Kharawala A, Mojadidi MK, Mojaddedi S, Ntaios G, Faillace RT, Tobis JM. Right-to-Left Shunt in Divers with Neurological Decompression Sickness: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 11:healthcare11101407. [PMID: 37239692 DOI: 10.3390/healthcare11101407] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the association between the presence of a right-to-left shunt (RLS) and neurological decompression sickness (NDCS) and asymptomatic brain lesions among otherwise healthy divers. BACKGROUND Next to drowning, NDCS is the most severe phenotype of diving-related disease and may cause permanent damage to the brain and spinal cord. Several observational reports have described the presence of an RLS as a significant risk factor for neurological complications in divers, ranging from asymptomatic brain lesions to NDCS. METHODS We systematically reviewed the MEDLINE, Embase, and CENTRAL databases from inception until November 2021. A random-effects model was used to compute odds ratios. RESULTS Nine observational studies consisting of 1830 divers (neurological DCS: 954; healthy divers: 876) were included. RLS was significantly more prevalent in divers with NDCS compared to those without (62.6% vs. 27.3%; odds ratio (OR): 3.83; 95% CI: 2.79-5.27). Regarding RLS size, high-grade RLS was more prevalent in the NDCS group than the no NDCS group (57.8% versus 18.4%; OR: 4.98; 95% CI: 2.86-8.67). Further subgroup analysis revealed a stronger association with the inner ear (OR: 12.13; 95% CI: 8.10-18.17) compared to cerebral (OR: 4.96; 95% CI: 2.43-10.12) and spinal cord (OR: 2.47; 95% CI: 2.74-7.42) DCS. RLS was more prevalent in divers with asymptomatic ischemic brain lesions than those without any lesions (46.0% vs. 38.0%); however, this was not statistically significant (OR: 1.53; 95% CI: 0.80-2.91). CONCLUSIONS RLS, particularly high-grade RLS, is associated with greater risk of NDCS. No statistically significant association between RLS and asymptomatic brain lesions was found.
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Affiliation(s)
- Spyros Peppas
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center, Bronx, NY 10461, USA
- Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Sanjana Nagraj
- Department of Medicine, Jacobi Medical Center, Bronx, NY 10461, USA
- Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale University/Yale New Haven Hospital, New Haven, CT 06520, USA
| | - Nidhish Tiwari
- Department of Medicine, Jacobi Medical Center, Bronx, NY 10461, USA
- Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Amrin Kharawala
- Department of Medicine, Jacobi Medical Center, Bronx, NY 10461, USA
- Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Mohammad K Mojadidi
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Sanauallah Mojaddedi
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 382 21 Larissa, Greece
| | - Robert T Faillace
- Department of Medicine, Jacobi Medical Center, Bronx, NY 10461, USA
- Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Jonathan M Tobis
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
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Chandiramani R, Spirito A, Johnson JW, Mehta A, Vogel B, Faillace RT, Mehran R. Antiplatelet therapy for coronary artery disease in 2023: current status and future prospects. Expert Rev Cardiovasc Ther 2023; 21:311-328. [PMID: 37073647 DOI: 10.1080/14779072.2023.2201437] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Antiplatelet therapy is the cornerstone for prevention and management of ischemic complications among patients with coronary artery disease. Over the past decades, advancement in stent technologies and increasing awareness about the prognostic impact of major bleeding have led to evolving priorities in the management of antithrombotic regimens, from exclusive concerns regarding recurrent ischemic events to an individualized equipoise between ischemic and bleeding risk through a patient-centered comprehensive approach. AREAS COVERED The purpose of this review is to highlight the current evidence that supports the various management strategies for antiplatelet therapy and discuss future directions of pharmacological regimens for coronary syndromes. We will also discuss the rationale behind use of antiplatelet therapy, current guideline recommendations, risk scores for ischemic and bleeding risk evaluation, and tools to help assess treatment response. EXPERT OPINION While tremendous advancements have been made in antithrombotic agents and regimens, future directions for antiplatelet therapy in patients with coronary artery disease would involve focus on novel therapeutic targets, development of new antiplatelet agents, implementation of more innovative regimens with current agents and further research to validate contemporary antiplatelet strategies.
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Affiliation(s)
- Rishi Chandiramani
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James W Johnson
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adhya Mehta
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert T Faillace
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Liaqat W, Palaiodimos L, Li W, Karamanis D, Tahir A, Tzoumas A, Nagraj S, Tiwari N, Grushko M, Kokkinidis D, Gashi E, Leider J, Coyle C, Faillace RT. Correction: Epidemiologic and clinical characteristics of infective endocarditis: a single-center retrospective study in the Bronx, New York. Infection 2023:10.1007/s15010-023-02004-z. [PMID: 37072605 DOI: 10.1007/s15010-023-02004-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Affiliation(s)
- Wasla Liaqat
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA.
- Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Weijia Li
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dimitrios Karamanis
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Department of Health Informatics, Rutgers School of Health Professions, Newark, NJ, USA
- Department of Economics, University of Peiraeus, Attica, Greece
| | - Arooj Tahir
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andreas Tzoumas
- Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sanjana Nagraj
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nidhish Tiwari
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Grushko
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Damianos Kokkinidis
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Eleonora Gashi
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jason Leider
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christina Coyle
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Robert T Faillace
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
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Pargaonkar SR, Takahashi T, Romero GH, Apple SJ, Bangalore S, Grushko MJ, Sokol S, Thankachen J, Denesopolis J, Faillace RT. PERCUTANEOUS THROMBECTOMY USING ANGIOVAC SYSTEM AS A DIAGNOSTIC AND THERAPEUTIC TOOL IN MANAGING RIGHT ATRIAL MASS IN A HIGH-RISK PATIENT. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03296-5] [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: 03/07/2023]
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Apple SJ, VIKASH FNU, Moya CJB, Pargaonkar SR, Sokol S, Faillace RT. THE ROLE OF ANTICOAGULATION IN SPONTANEOUS CORONARY ARTERY DISSECTION COMPLICATED BY A DISTAL INTRALUMINAL THROMBUS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04410-8] [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: 03/06/2023]
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Varrias D, Parker M, Pargaonkar SR, Al Deen Alhuarrat M, Khasnavis S, SAFIRIYU ISRAELA, Kharawala A, Coleman K, Villela MA, Mountantonakis SE, Faillace RT. NOT A RESPIRATORY ARRHYTHMIA: SECOND DEGREE SINOATRIAL EXIT BLOCK AS THE 1STSIGN OF A RIGHT VENTRICULAR MYOCARDIAL INFARCTION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04299-7] [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: 03/06/2023]
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Csecs I, Abbott JD, Thachil R, Kundu A, Chatterjee S, Sardar P, Faillace RT. RELATIONSHIP WITH INDUSTRY AND OTHER ENTITIES IN CURRENT CARDIOVASCULAR CLINICAL PRACTICE GUIDELINES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02736-5] [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: 03/06/2023]
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Wang YC, Fu Y, Li W, Leiderman E, Faillace RT, Tiwari N, Tauras JM. A RARE CASE OF TAKOTSUBO CARDIOMYOPATHY COMPLICATING SEVERE SEPSIS IN A POST CARDIAC TRANSPLANT PATIENT. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03595-7] [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: 03/06/2023]
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Alhuarrat MAD, Pargaonkar SR, Safiriyu I, Kharawala A, Varrias D, Faillace RT, Jacobi. SEX DISPARITIES IN THE OUTCOMES OF SEPTAL ABLATION PROCEDURE FOR HYPERTROPHIC CARDIOMYOPATHY PATIENTS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00972-5] [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: 03/06/2023]
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Chugh Y, Gupta K, Krishna HB, Ayala RQ, Zepeda I, Grushko M, Faillace RT. Safety and efficacy of apixaban, dabigatran and rivaroxaban in obese and morbidly obese patients with heart failure and atrial fibrillation: A real-world analysis. Pacing Clin Electrophysiol 2023; 46:50-58. [PMID: 36419246 DOI: 10.1111/pace.14623] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/29/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Atrial fibrillation and heart failure are combined risk factors for thromboembolic events. Obese and morbidly obese individuals have been underrepresented in clinical trials studying safety and efficacy of direct oral anticoagulants (DOACs). OBJECTIVES Study the comparative safety and efficacy of DOACs in obese and morbidly obese patients with atrial fibrillation or flutter, and concomitant congestive heart failure. METHODS In the present single-center retrospective observational study, patients with an ICD-9 code of atrial fibrillation or atrial flutter, and congestive heart failure on a DOAC (apixaban[n = 155], rivaroxaban[n = 335], dabigatran[n = 393]) were followed for a median 12.5 months (IQR: 22.1 months). Obesity was defined as a body mass index, BMI ≥ 30 and < 40 kg/m2 [n = 614], and morbid obesity as BMI ≥ 40 kg/m2 [n = 269]. Clinical endpoints were grouped into safety (composite of intracranial-hemorrhage, gastrointestinal-bleeds, hemorrhagic-stroke, and other bleeds), and efficacy (composite of ischemic-stroke and systemic-embolism) endpoints. Cox proportional hazard models were used to compare safety, efficacy, and all-cause mortality outcomes. RESULTS In obese patients, no statistical difference was observed in efficacy of DOACs. A statistical difference was observed in the safety of DOACs in obese patients. Apixaban was found to be safer than dabigatran [hazard ratio [HR] 0.37 (0.16-0.87), p = .02] and rivaroxaban [HR 0.29 (0.12-0.67), p = .004]. In morbidly obese patients, there was no overall statistical difference in the efficacy or safety of DOACs. CONCLUSION In obese patients with congestive heart failure and atrial fibrillation or atrial flutter on DOACs, apixaban has the most favorable safety profile compared to rivaroxaban and dabigatran.
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Affiliation(s)
- Yashasvi Chugh
- Baylor Heart and Vascular Hospital, Dallas, Texas, USA.,Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kashvi Gupta
- University of Missouri at Kansas City, Kansas City, Missouri, USA
| | | | - Renato Quispe Ayala
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ignacio Zepeda
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael Grushko
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Robert T Faillace
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Shin D, Krouss M, Alaiev D, Mestari N, Talledo J, Zaurova M, Chandra K, Manchego PA, Tsega S, Uppal A, Faillace RT, Moskovitz J, Ford K, Bouton M, Cho HJ. Reducing unnecessary routine laboratory testing for noncritically ill patients with COVID-19. J Hosp Med 2022; 17:961-966. [PMID: 36330542 PMCID: PMC9878235 DOI: 10.1002/jhm.12993] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/05/2022] [Accepted: 09/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Reducing unnecessary routine laboratory testing is a Choosing Wisely® recommendation, and new areas of overuse were noted during the COVID-19 pandemic. OBJECTIVE To reduce unnecessary repetitive routine laboratory testing for patients with COVID-19 during the pandemic across a large safety net health system. DESIGNS, SETTINGS AND PARTICIPANTS This quality improvement initiative was initiated by the System High-Value Care Council at New York City Health + Hospitals (H + H), the largest public healthcare system in the United States consisting of 11 acute care hospitals. INTERVENTION four overused laboratory tests in noncritically ill hospitalized patients with COVID-19 were identified: C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), and procalcitonin. A two-pronged electronic health record intervention was implemented consisting of (1) nonintrusive, informational nudge statements placed on selected order sets, and (2) a forcing function of one consecutive day limit on ordering. MAIN OUTCOME AND MEASURES The average of excess tests per encounter days (ETPED) for each of four target laboratory testing only in patients with COVID-19. OBJECTIVE Interdisciplinary System High-Value Care Council identified four overused laboratory tests (inflammatory markers) in noncritically ill hospitalized patients with COVID-19: C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), and procalcitonin. Within an 11-hospital safety net health system, a two-pronged electronic health record intervention was implemented consisting of (1) nonintrusive, informational nudge statements placed on selected order sets, and (2) a forcing function of one consecutive day limit on ordering. The preintervention period (March 16, 2020 to January 24, 2021) was compared to the postintervention period (January 25, 2021 to March 22, 2022). RESULTS Time series linear regression showed decreases in CRP (-17.9%, p < .05), ferritin (-37.6%, p < .001), and LDH (-30.1%, p < .001). Slope differences were significant (CRP, ferritin, and LDH p < 0.001; procalcitonin p < 0.05). Decreases were observed across weekly averages: CRP (-19%, p < .01), ferritin (-37.9%, p < .001), LDH (-28.7%, p < .001), and procalcitonin (-18.4%, p < .05). CONCLUSION This intervention was associated with reduced routine inflammatory marker testing in non-intensive care unit COVID-19 hospitalized patients across 11 hospitals. Variation was high among individual hospitals.
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Affiliation(s)
- Dawi Shin
- Department of Quality and SafetyNew York City Health + HospitalsNew York CityNew YorkUSA
- Department of MedicineIcahn School of MedicineNew York CityNew YorkUSA
| | - Mona Krouss
- Department of Quality and SafetyNew York City Health + HospitalsNew York CityNew YorkUSA
- Department of MedicineIcahn School of MedicineNew York CityNew YorkUSA
| | - Daniel Alaiev
- Department of Quality and SafetyNew York City Health + HospitalsNew York CityNew YorkUSA
| | - Nessreen Mestari
- Department of Quality and SafetyNew York City Health + HospitalsNew York CityNew YorkUSA
| | - Joseph Talledo
- Department of Quality and SafetyNew York City Health + HospitalsNew York CityNew YorkUSA
| | - Milana Zaurova
- Department of Quality and SafetyNew York City Health + HospitalsNew York CityNew YorkUSA
| | - Komal Chandra
- Department of Quality and SafetyNew York City Health + HospitalsNew York CityNew YorkUSA
| | - Peter A. Manchego
- Department of Quality and SafetyNew York City Health + HospitalsNew York CityNew YorkUSA
| | - Surafel Tsega
- Department of Quality and SafetyNew York City Health + HospitalsNew York CityNew YorkUSA
- Department of MedicineNYC Health + Hospitals/Kings County Hospital CenterNew York CityNew YorkUSA
| | - Amit Uppal
- Department of Medicine, Division of Pulmonary Disease and Critical Care MedicineBellevue Hospital Center and NYU Langone HealthNew York CityNew YorkUSA
| | - Robert T. Faillace
- Department of Emergency MedicineNYC Health + Hospitals/JacobiNew YorkThe BronxUSA
| | - Joshua Moskovitz
- Department of Emergency MedicineNYC Health + Hospitals/JacobiNew YorkThe BronxUSA
| | - Kenra Ford
- Office of Medical and Professional AffairsNew York City Health + HospitalsNew York CityNew YorkUSA
| | - Michael Bouton
- Enterprise Information Technology ServicesNYC Health + HospitalsNew York CityNew YorkUSA
| | - Hyung J. Cho
- Department of Quality and SafetyNew York City Health + HospitalsNew York CityNew YorkUSA
- Department of MedicineNew York University Grossman School of MedicineNew York CityNew YorkUSA
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Liaqat W, Palaiodimos L, Li W, Karamanis D, Tahir A, Tzoumas A, Nagraj S, Tiwari N, Grushko M, Kokkinidis D, Gashi E, Leider J, Coyle C, Faillace RT. Epidemiologic and clinical characteristics of infective endocarditis: a single-center retrospective study in the Bronx, New York. Infection 2022; 50:1349-1361. [PMID: 35614176 DOI: 10.1007/s15010-022-01846-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/01/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE There is paucity of data on the epidemiological, microbiological, and clinical characteristics of patients admitted with infective endocarditis (IE) in the Bronx, New York. PATIENT AND METHODS We conducted a retrospective study at Jacobi Medical Center, a tertiary care hospital in the Bronx. All adult patients who were hospitalized with a primary diagnosis of new-onset IE between January 1st, 2010 and September 30th, 2020 were included. The primary outcome was in-hospital mortality. A logistic regression model was used to identify baseline variables associated with in-hospital mortality. RESULTS 182 patients were included in this analysis (female sex: 38.5%, median age: 54 years). 46 patients (25.3%) reported intravenous drug use. 153 patients (84.1%) had positive blood cultures. Staphylococcus aureus (S. aureus) was the most common isolated pathogen (45.1% of monomicrobial IE). Nearly half of the cases secondary to S. aureus were methicillin resistant Staphylococcus aureus (MRSA) (34/69). 164 patients (90.1%) were diagnosed with native valve IE. The mitral valve was involved in 32.4% of patients followed by the aortic valve (19.8%). The in-hospital mortality was 18.1%. The mortality was higher in the cohort 2010-2015 compared to the cohort 2016-2020 (22.1% vs 14.6%). Increasing age, MRSA IE, and active malignancy were the only variables found to have significant association with in-hospital death. CONCLUSION S. aureus was the most common causative agent and MRSA accounted for about half of the S. aureus IE cases. The incidence of IE in patients with intravenous drug use increased over time, while the median age decreased. The in-hospital death rate was higher in 2010-2015 compared to 2016-2020.
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Affiliation(s)
- Wasla Liaqat
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA.
- Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Weijia Li
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dimitrios Karamanis
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Department of Health Informatics, Rutgers School of Health Professions, Newark, NJ, USA
- Department of Economics, University of Peiraeus, Attica, Greece
| | - Arooj Tahir
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andreas Tzoumas
- Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sanjana Nagraj
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nidhish Tiwari
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Grushko
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Damianos Kokkinidis
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Eleonora Gashi
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jason Leider
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christina Coyle
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Robert T Faillace
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
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Li W, Rios S, Nagraj S, Hajra A, Saralidze T, Varrias D, Mathai SV, Novakovic M, Hupart KH, Miles JA, Katamreddy A, Palaiodimos L, Faillace RT. Statin Use in Hospitalized Patients with COVID-19: A Comprehensive Analysis of the New York City Public Hospital System. Am J Med 2022; 135:897-905. [PMID: 35296403 PMCID: PMC8920066 DOI: 10.1016/j.amjmed.2022.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/10/2022] [Accepted: 02/03/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Statins have been commonly used for primary and secondary cardiovascular prevention. We hypothesized that statins may improve in-hospital outcomes for hospitalized patients with Coronavirus disease 2019 (COVID-19) due to its known anti-inflammatory effects. METHODS We conducted a retrospective study at the largest municipal health care system in the United States, including adult patients who were hospitalized for COVID-19 between March 1 and December 1, 2020. The primary endpoint was in-hospital death. Propensity score matching was conducted to balance possible confounding variables between patients receiving statins during hospitalization (statin group) and those not receiving statins (non-statin group). Multivariate logistic regression was used to evaluate the association of statin use and other variables with in-hospital outcomes. RESULTS There were 8897 patients eligible for study enrollment, with 3359 patients in the statin group and 5538 patients in the non-statin group. After propensity score matching, both the statin and non-statin groups included 2817 patients. Multivariate logistic regression analysis showed that the statin group had a significantly lower risk of in-hospital mortality (odds ratio 0.71; 95% confidence interval, 0.63-0.80; P < .001) and mechanical ventilation (OR 0.80; 95% confidence interval, 0.71-0.90; P < .001) compared with the non-statin group. CONCLUSION Statin use was associated with lower likelihood of in-hospital mortality and invasive mechanical ventilation in hospitalized patients with COVID-19.
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Affiliation(s)
- Weijia Li
- Department of Medicine, New York City Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Saul Rios
- Department of Medicine, New York City Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY.
| | - Sanjana Nagraj
- Department of Medicine, New York City Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Adrija Hajra
- Department of Medicine, New York City Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Tinatin Saralidze
- Department of Medicine, New York City Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Dimitrios Varrias
- Department of Medicine, New York City Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Sheetal Vasundara Mathai
- Department of Medicine, New York City Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Marko Novakovic
- Department of Medicine, New York City Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Kenneth H Hupart
- Department of Medicine, New York City Health + Hospitals/Coney Island Brooklyn NY, Albert Einstein College of Medicine, Bronx, NY
| | - Jeremy A Miles
- Department of Medicine, New York City Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Adarsh Katamreddy
- Department of Medicine, New York City Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Leonidas Palaiodimos
- Department of Medicine, New York City Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Robert T Faillace
- Department of Medicine, New York City Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY
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Pinsino A, Fabbri M, Braghieri L, Bohn B, Gaudig AJ, Kim A, Takeda K, Naka Y, Sayer GT, Uriel N, Demmer RT, Faillace RT, Husain SA, Mohan S, Colombo PC, Yuzefpolskaya M. The difference between cystatin C- and creatinine-based assessment of kidney function in acute heart failure. ESC Heart Fail 2022; 9:3139-3148. [PMID: 35762103 DOI: 10.1002/ehf2.13975] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 04/03/2022] [Accepted: 05/08/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS Acute heart failure (HF) is associated with muscle mass loss, potentially leading to overestimation of kidney function using serum creatinine-based estimated glomerular filtration rate (eGFRsCr ). Cystatin C-based eGFR (eGFRCysC ) is less muscle mass dependent. Changes in the difference between eGFRCysC and eGFRsCr may reflect muscle mass loss. We investigated the difference between eGFRCysC and eGFRsCr and its association with clinical outcomes in acute HF patients. METHODS AND RESULTS A post hoc analysis was performed in 841 patients enrolled in three trials: Diuretic Optimization Strategy Evaluation (DOSE), Renal Optimization Strategies Evaluation (ROSE), and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF). Intra-individual differences between eGFRs (eGFRdiff ) were calculated as eGFRCysC -eGFRsCr at serial time points during HF admission. We investigated associations of (i) change in eGFRdiff between baseline and day 3 or 4 with readmission-free survival up to day 60; (ii) index hospitalization length of stay (LOS) and readmission with eGFRdiff at day 60. eGFRCysC reclassified 40% of samples to more advanced kidney dysfunction. Median eGFRdiff was -4 [-11 to 1.5] mL/min/1.73 m2 at baseline, became more negative during admission and remained significantly different at day 60. The change in eGFRdiff between baseline and day 3 or 4 was associated with readmission-free survival (adjusted hazard ratio per standard deviation decrease in eGFRdiff : 1.14, P = 0.035). Longer index hospitalization LOS and readmission were associated with more negative eGFRdiff at day 60 (both P ≤ 0.026 in adjusted models). CONCLUSIONS In acute HF, a marked difference between eGFRCysC and eGFRsCr is present at baseline, becomes more pronounced during hospitalization, and is sustained at 60 day follow-up. The change in eGFRdiff during HF admission and eGFRdiff at day 60 are associated with clinical outcomes.
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Affiliation(s)
- Alberto Pinsino
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA.,Division of Critical Care Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Matteo Fabbri
- Department of Medicine, NYC Health + Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lorenzo Braghieri
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Bruno Bohn
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Andrea Kim
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Koji Takeda
- Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Yoshifumi Naka
- Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Gabriel T Sayer
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Robert T Faillace
- Department of Medicine, NYC Health + Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Syed A Husain
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, NY, USA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
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22
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Katamreddy A, Ye AM, Vorchheimer DA, Hardoon I, Faillace RT, Taub CC. Exploring the Changes in Code Status During the COVID-19 Pandemic and the Implications for Future Pandemic Care. Am J Hosp Palliat Care 2022; 39:1364-1370. [PMID: 35452316 PMCID: PMC9038937 DOI: 10.1177/10499091221092699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective: We aim to explore patterns of inpatient code status during the COVID-19 pandemic compared with a similar timeframe the previous year, as well as utilization of palliative care services. Methods: This is a retrospective cohort study using data from the Montefiore Health system of all inpatient admissions between March 15-May 31, 2019 and March 15-May 31, 2020. Univariate logistic regression was performed with full code status as the outcome. All statistically significant variables were included in the multivariable logistic regression. Results: The total number of admissions declined during the pandemic (16844 vs 11637). A lower proportion of patients had full code status during the pandemic (85.1% vs 94%, P < .001) at the time of discharge/death. There was a 20% relative increase in the number of palliative care consultations during the pandemic (12.2% vs 10.5%, P < .001). Intubated patients were less often full code (66.5% vs 82.2%, P < .001) during the pandemic. Although a lower portion of COVID-19 positive patients had a full code status compared with non-COVID patients (77.6% vs 92.4%, P<.001), there was no statistically significant difference in code status at death (38.3% vs 38.3%, P = .96). Conclusions: The proportion of full code patients was significantly lower during the pandemic. Age and COVID status were the key determinants of code status during the pandemic. There was a higher demand for palliative care services during the pandemic.
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Affiliation(s)
- Adarsh Katamreddy
- Department of Medicine, 24502Albert Einstein College of Medicine/Jacobi Medicine Center, Bronx, NY, USA
| | | | - David A Vorchheimer
- Division of Cardiovascular Disease, Department of Medicine, 384397Albert Einstein College of Medicine/Montefiore Medicine Center, Bronx, NY, USA
| | - Isaac Hardoon
- Palliative Care, Department of Family and Social Medicine, 12285Albert Einstein College of Medicine/ Montefiore Medicine Center, Bronx, NY, USA
| | - Robert T Faillace
- Department of Medicine, 24502Albert Einstein College of Medicine/Jacobi Medicine Center, Bronx, NY, USA
| | - Cynthia C Taub
- Division of Cardiovascular Disease, Department of Medicine, 384397Albert Einstein College of Medicine/Montefiore Medicine Center, Bronx, NY, USA
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23
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Wang YC, Xu X, Hajra A, Apple S, Kharawala A, Duarte G, Liaqat W, Fu Y, Li W, Chen Y, Faillace RT. Current Advancement in Diagnosing Atrial Fibrillation by Utilizing Wearable Devices and Artificial Intelligence: A Review Study. Diagnostics (Basel) 2022; 12:diagnostics12030689. [PMID: 35328243 PMCID: PMC8947563 DOI: 10.3390/diagnostics12030689] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 02/04/2023] Open
Abstract
Atrial fibrillation (AF) is a common arrhythmia affecting 8–10% of the population older than 80 years old. The importance of early diagnosis of atrial fibrillation has been broadly recognized since arrhythmias significantly increase the risk of stroke, heart failure and tachycardia-induced cardiomyopathy with reduced cardiac function. However, the prevalence of atrial fibrillation is often underestimated due to the high frequency of clinically silent atrial fibrillation as well as paroxysmal atrial fibrillation, both of which are hard to catch by routine physical examination or 12-lead electrocardiogram (ECG). The development of wearable devices has provided a reliable way for healthcare providers to uncover undiagnosed atrial fibrillation in the population, especially those most at risk. Furthermore, with the advancement of artificial intelligence and machine learning, the technology is now able to utilize the database in assisting detection of arrhythmias from the data collected by the devices. In this review study, we compare the different wearable devices available on the market and review the current advancement in artificial intelligence in diagnosing atrial fibrillation. We believe that with the aid of the progressive development of technologies, the diagnosis of atrial fibrillation shall be made more effectively and accurately in the near future.
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Affiliation(s)
- Yu-Chiang Wang
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
- Correspondence:
| | - Xiaobo Xu
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
| | - Adrija Hajra
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
| | - Samuel Apple
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
| | - Amrin Kharawala
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
| | - Gustavo Duarte
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
| | - Wasla Liaqat
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
| | - Yiwen Fu
- Department of Medicine, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA 95051, USA;
| | - Weijia Li
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
| | - Yiyun Chen
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
| | - Robert T. Faillace
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, The Bronx, New York, NY 10461, USA; (X.X.); (A.H.); (S.A.); (A.K.); (G.D.); (W.L.); (W.L.); (Y.C.); (R.T.F.)
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24
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Nagraj S, Sohal S, Varrias D, Tzoumas A, Peppas S, Novakovic M, Mathai SV, Kokkinidis D, Thachil R, Faillace RT. INCIDENCE AND OUTCOMES OF IN-HOSPITAL CARDIAC ARREST DURING THE CORONAVIRUS DISEASE 2019 PANDEMIC AND THE PRECEDING ERA: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2022. [PMCID: PMC8972419 DOI: 10.1016/s0735-1097(22)03132-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Katamreddy A, Uppal D, Ramani G, Rios S, Miles J, Wang YC, Faillace RT. Day-to-day variation in sleep duration is associated with increased all-cause mortality. J Clin Sleep Med 2022; 18:921-926. [PMID: 34534068 PMCID: PMC8883106 DOI: 10.5664/jcsm.9664] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES There is a paucity of data on the association between day-to-day variation in sleep pattern and all-cause mortality. We aimed to investigate whether day-to-day variation in sleep duration and onset of sleep are associated with cardiovascular and all-cause mortality. METHODS We used data belonging to 388 unique patients from the Midlife in the United States 2 Biomarker study (2004-2009). Information on sleep onset, duration, and sleep-wake cycles was collected for 7 consecutive days using the Actiwatch device. Sleep irregularity was assessed using mean and standard deviations in sleep duration and time of onset of sleep over 7 days. Cox proportional regression analysis and the Fine and Gray subdistribution method were used with all-cause and cardiovascular mortality, respectively. RESULTS Over a median of 8.6 years of follow-up, 37 patients died, including 10 deaths resulting from cardiovascular causes. There was no statistically significant increase in cardiovascular mortality with variation in sleep duration in the highest vs the lowest tertile (hazard ratio, 4.00; 0.45-35.48; P = .21). However, increased all-cause mortality was seen in the highest vs the lowest tertile (hazard ratio, 3.99; 1.33-11.94; P = .01). Multivariable model adjusting for confounders had higher all-cause mortality with increased sleep duration variation in the highest vs the lowest tertile: hazard ratio, 4.85; 1.52-15.49; P < .01). CONCLUSIONS Day-to-day variation in sleep duration is associated with increased all-cause mortality but not cardiovascular mortality after adjusting for mean sleep duration, inflammation, diabetes, age, body mass index, renal function, and blood pressure. Irregularity in the onset of sleep is not associated with all-cause mortality or cardiovascular mortality. CITATION Katamreddy A, Uppal D, Ramani G, et al. Day-to-day variation in sleep duration is associated with increased all-cause mortality. J Clin Sleep Med. 2022;18(3):921-926.
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Affiliation(s)
- Adarsh Katamreddy
- Department of Medicine, NYC Health + Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, New York,Address correspondence to: Adarsh Katamreddy, MD, 3N21, Department of Medicine Offices, 1400 Pelham Parkway South, Bronx, NY 10461; Tel: (646) 321-0800;
| | - Dipan Uppal
- Department of Medicine, NYC Health + Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, New York
| | - Gokul Ramani
- Department of Medicine, NYC Health + Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, New York
| | - Saul Rios
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Jeremy Miles
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Yu Chiang Wang
- Department of Medicine, NYC Health + Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, New York
| | - Robert T. Faillace
- Department of Medicine, NYC Health + Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, New York
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26
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Katamreddy A, Kokkinidis DG, Miles J, Siasos G, Giannakoulas G, Faillace RT. Elevated red cell distribution width and cardiovascular mortality in ASCVD risk cohorts: National Health and Nutrition Examination Survey (NHANES III). Rev Cardiovasc Med 2022; 23:51. [DOI: 10.31083/j.rcm2302051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/19/2021] [Accepted: 09/06/2021] [Indexed: 11/06/2022] Open
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27
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Palaiodimos L, Ali R, Teo HO, Parthasarathy S, Karamanis D, Chamorro-Pareja N, Kokkinidis DG, Kaur S, Kladas M, Sperling J, Chang M, Hupart K, Cha-Fong C, Srinivasan S, Kishore P, Davis N, Faillace RT. Obesity, Inflammation, and Mortality in COVID-19: An Observational Study from the Public Health Care System of New York City. J Clin Med 2022; 11:jcm11030622. [PMID: 35160073 PMCID: PMC8836690 DOI: 10.3390/jcm11030622] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/09/2022] [Accepted: 01/24/2022] [Indexed: 01/08/2023] Open
Abstract
Severe obesity increases the risk for negative outcomes in patients with coronavirus disease 2019 (COVID-19). Our objectives were to investigate the effect of BMI on in-hospital outcomes in our New York City Health and Hospitals’ ethnically diverse population, further explore this effect by age, sex, race/ethnicity, and timing of admission, and, given the relationship between COVID-19 and hyperinflammation, assess the concentrations of markers of systemic inflammation in different BMI groups. A retrospective study was conducted in hospitalized patients with COVID-19 in the public health care system of New York City from 1 March 2020 to 31 October 2020. A total of 8833 patients were included in this analysis (women: 3593, median age: 62 years). The median body mass index (BMI) was 27.9 kg/m2. Both overweight and obesity were independently associated with in-hospital death. The association of overweight and obesity with death appeared to be stronger in men, younger patients, and individuals of Hispanic ethnicity. We did not observe higher concentrations of inflammatory markers in patients with obesity as compared to those without obesity. In conclusion, overweight and obesity were independently associated with in-hospital death. Obesity was not associated with higher concentrations of inflammatory markers.
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Affiliation(s)
- Leonidas Palaiodimos
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Correspondence: (L.P.); (S.P.)
| | - Ryad Ali
- Department of Health Informatics, Rutgers School of Health Professions, Newark, NJ 07107, USA; (R.A.); (D.K.); (S.S.)
| | - Hugo O. Teo
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
| | - Sahana Parthasarathy
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Correspondence: (L.P.); (S.P.)
| | - Dimitrios Karamanis
- Department of Health Informatics, Rutgers School of Health Professions, Newark, NJ 07107, USA; (R.A.); (D.K.); (S.S.)
| | - Natalia Chamorro-Pareja
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Damianos G. Kokkinidis
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
| | - Sharanjit Kaur
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
| | - Michail Kladas
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jeremy Sperling
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Michael Chang
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
| | - Kenneth Hupart
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
| | - Colin Cha-Fong
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Shankar Srinivasan
- Department of Health Informatics, Rutgers School of Health Professions, Newark, NJ 07107, USA; (R.A.); (D.K.); (S.S.)
| | - Preeti Kishore
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Nichola Davis
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Robert T. Faillace
- NYC Health + Hospitals, New York, NY 10461, USA; (H.O.T.); (N.C.-P.); (D.G.K.); (S.K.); (M.K.); (J.S.); (M.C.); (K.H.); (C.C.-F.); (P.K.); (N.D.); (R.T.F.)
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Koslowsky J, Kakkar A, Faillace RT, Sokol SI. Pulmonary Embolism Response Team (PERT) - A New Paradigm for the Treatment of Pulmonary Embolism. Curr Pharm Des 2021; 28:535-549. [PMID: 34781864 DOI: 10.2174/1381612827666211115153910] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 10/06/2021] [Indexed: 11/22/2022]
Abstract
Pulmonary embolism (PE) is the third leading cause of cardiovascular mortality. Patients with PE can present with a wide array of symptoms, ranging from mild to life threatening. The mainstay of PE treatment is anticoagulation; however, there are many advanced options available for more severe patients, including catheter-directed interventions, surgical treatments, and hemodynamic support. Although different risk scores and clinical guidelines exist, the primary treating teams are frequently left uncertain on the most suitable treatment for a specific complex patient. Pulmonary Embolism Response Teams (PERT), composed of multidisciplinary experts, have emerged and been implemented in many centers and are available 24 hours a day to help guide the primary team. PERTs have changed the way complex PE patients are managed. In centers with a PERT, teams are called upon very frequently and there is a significant increase in the use of advanced treatments for PE, although there are differences between centers based upon the center's specific PERT protocol and available capabilities. As PE is an evolving area, and more studies are necessary, PERTs around the world can help advance the field and improve the treatment offered to PE patients.
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Affiliation(s)
- Jonathan Koslowsky
- Department of Medicine, Division of Cardiology NYC Health + Hospitals / Jacobi Medical Center, Bronx, NY. United States
| | - Amit Kakkar
- Department of Medicine, Division of Cardiology NYC Health + Hospitals / Jacobi Medical Center, Bronx, NY. United States
| | - Robert T Faillace
- Department of Medicine, Division of Cardiology NYC Health + Hospitals / Jacobi Medical Center, Bronx, NY. United States
| | - Seth I Sokol
- Department of Medicine, Division of Cardiology NYC Health + Hospitals / Jacobi Medical Center, Bronx, NY. United States
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Gurin MI, Lin YJ, Bernard S, Goldberg RI, Narula N, Faillace RT, Alviar CL, Bangalore S, Keller NM. Cardiogenic shock complicating multisystem inflammatory syndrome following COVID-19 infection: a case report. BMC Cardiovasc Disord 2021; 21:522. [PMID: 34715788 PMCID: PMC8555861 DOI: 10.1186/s12872-021-02304-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/05/2021] [Accepted: 10/05/2021] [Indexed: 12/31/2022] Open
Abstract
Background With the high prevalence of COVID-19 infections worldwide, the multisystem inflammatory syndrome in adults (MIS-A) is becoming an increasingly recognized entity. This syndrome presents in patients several weeks after infection with COVID-19 and is associated with thrombosis, elevated inflammatory markers, hemodynamic compromise and cardiac dysfunction. Treatment is often with steroids and intravenous immunoglobulin (IVIg). The pathologic basis of myocardial injury in MIS-A, however, is not well characterized. In our case report, we obtained endomyocardial biopsy that revealed a pattern of myocardial injury similar to that found in COVID-19 cardiac specimens. Case presentation A 26-year-old male presented with fevers, chills, headache, nausea, vomiting, and diarrhea 5 weeks after his COVID-19 infection. His SARS-CoV-2 PCR was negative and IgG was positive, consistent with prior infection. He was found to be in cardiogenic shock with biventricular failure, requiring inotropes and diuretics. Given concern for acute fulminant myocarditis, an endomyocardial biopsy (EMB) was performed, showing an inflammatory infiltrate consisting predominantly of interstitial macrophages with scant T lymphocytes. The histologic pattern was similar to that of cardiac specimens from COVID-19 patients, helping rule out myocarditis as the prevailing diagnosis. His case was complicated by persistent hypoxemia, and a computed tomography scan revealed pulmonary emboli. He received IVIg, steroids, and anticoagulation with rapid recovery of biventricular function. Conclusions MIS-A should be considered as the diagnosis in patients presenting several weeks after COVID-19 infection with severe inflammation and multi-organ involvement. In our case, EMB facilitated identification of MIS-A and guided therapy. The patient’s biventricular function recovered with IVIg and steroids. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02304-y.
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Affiliation(s)
- Michael I Gurin
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Medical Center, 462 First Avenue, NBV 17 South Room 5, New York, NY, 10016, USA.
| | - Yue J Lin
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Samuel Bernard
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Medical Center, 462 First Avenue, NBV 17 South Room 5, New York, NY, 10016, USA
| | - Randal I Goldberg
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Medical Center, 462 First Avenue, NBV 17 South Room 5, New York, NY, 10016, USA
| | - Navneet Narula
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, USA
| | - Robert T Faillace
- Department of Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY, USA
| | - Carlos L Alviar
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Medical Center, 462 First Avenue, NBV 17 South Room 5, New York, NY, 10016, USA
| | - Sripal Bangalore
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Medical Center, 462 First Avenue, NBV 17 South Room 5, New York, NY, 10016, USA
| | - Norma M Keller
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Medical Center, 462 First Avenue, NBV 17 South Room 5, New York, NY, 10016, USA
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Varrias D, Palaiodimos L, Balasubramanian P, Barrera CA, Nauka P, Melainis AA, Zamora C, Zavras P, Napolitano M, Gulani P, Ntaios G, Faillace RT, Galen B. The Use of Point-of-Care Ultrasound (POCUS) in the Diagnosis of Deep Vein Thrombosis. J Clin Med 2021; 10:3903. [PMID: 34501350 PMCID: PMC8432124 DOI: 10.3390/jcm10173903] [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] [Received: 07/25/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022] Open
Abstract
Acute lower extremity proximal deep venous thrombosis (DVT) requires accurate diagnosis and treatment in order to prevent embolization and other complications. Point-of-care ultrasound (POCUS), a clinician performed, and clinician interpreted bedside ultrasound examination has been increasingly used for DVT evaluation mainly in the urgent and critical care setting, but also in the ambulatory clinics and the medical wards. Studies have demonstrated that POCUS has excellent diagnostic accuracy for acute proximal DVT when performed by well-trained users. However, there is significant heterogeneity among studies on the necessary extent of training and universally acceptable standardized education protocols are needed. In this review, we summarize the evidence that supports the use of POCUS to diagnose acute proximal DVT and focus on methodology and current technology, sensitivity and specificity, pre-test probability and the role of D-dimer, time and resources, education, limitations, and future directions.
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Affiliation(s)
- Dimitrios Varrias
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Prasanth Balasubramanian
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Christian A Barrera
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Peter Nauka
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
- Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Angelos Arfaras Melainis
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Christian Zamora
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Phaedon Zavras
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Marzio Napolitano
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Perminder Gulani
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - George Ntaios
- Department of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece;
| | - Robert T. Faillace
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Benjamin Galen
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
- Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
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Hanumanthu BKJ, Nair AS, Katamreddy A, Gilbert JS, You JY, Offor OL, Kushwaha A, Krishnan A, Napolitano M, Palaidimos L, Morante J, Tekwani S, Mehta S, Gupta A, Goraya H, Sun M, Faillace RT, Gulani P. Sepsis-induced cardiomyopathy is associated with higher mortality rates in patients with sepsis. Acute Crit Care 2021; 36:215-222. [PMID: 34311515 PMCID: PMC8435447 DOI: 10.4266/acc.2021.00234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/18/2021] [Indexed: 12/04/2022] Open
Abstract
Background Patients with sepsis are at risk for developing sepsis-induced cardiomyopathy (SIC). Previous studies offer inconsistent results regarding the association of SIC and mortality. This study sought to assess whether SIC is linked to mortality in patients with sepsis and to evaluate predictors of the development of SIC. Methods In this retrospective study, patients admitted to the medical intensive care unit with a diagnosis of sepsis in the absence of acute coronary syndrome were included. SIC was identified using transthoracic echo and was defined by a new onset decline in left ventricular ejection fraction (LVEF) ≤50%, or ≥10% decline in LVEF compared to baseline in patients with a history of heart failure with reduced ejection fraction. Multivariable logistic regression analysis was performed using the R software program. Results Of the 359 patients in the final analysis, 19 (5.3%) had SIC. Eight (42.1%) of the 19 patients in the SIC group and 60 (17.6%) of the 340 patients in the non-SIC group died during hospitalization. SIC was associated with an increased risk for all-cause in-hospital mortality (odds ratio [OR], 4.46; 95% confidence interval [CI], 1.15–18.69; P=0.03). Independent predictors for the development of SIC were albumin level (OR, 0.47; 95% CI, 0.23–0.93; P=0.03) and culture positivity (OR, 8.47; 95% CI, 2.24–55.61; P=0.006). Concomitant right ventricular hypokinesis was noted in 13 (68.4%) of the 19 SIC patients. Conclusions SIC was associated with an increased risk for all-cause in-hospital mortality. Low albumin level and culture positivity were independent predictors of SIC.
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Affiliation(s)
| | - Anika Sasidharan Nair
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Adarsh Katamreddy
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | | | - Jee Young You
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Obiageli Lynda Offor
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Ankit Kushwaha
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Ankita Krishnan
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Marzio Napolitano
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Leonidas Palaidimos
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Joaquin Morante
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Seema Tekwani
- Critical Care Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Suchita Mehta
- Critical Care Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Aanchal Gupta
- Pulmonary and Critical Care Medicine, Beth Israel Lahey Health, Burlington, MA, USA
| | - Harmeen Goraya
- Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences Medical Center, Little Rock, AR, USA
| | - Mengyang Sun
- Critical Care Liaison, Department of Obstetrics and Gynecology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Robert T Faillace
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Perminder Gulani
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
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Tzoumas A, Giannopoulos S, Kakargias F, Kokkinidis DG, Giannakoulas G, Faillace RT, Bakoyiannis C, Doulamis IP, Avgerinos DV. Repeat Coronary Artery Bypass Grafting: A Meta-Analysis of Off-Pump versus On-Pump Techniques in a Large Cohort of Patients. Heart Lung Circ 2021; 30:1281-1291. [PMID: 33810970 DOI: 10.1016/j.hlc.2021.02.015] [Citation(s) in RCA: 3] [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: 08/26/2020] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Redo coronary artery bypass grafting (CABG) can be performed with either the off-pump (OPCAB) or the on-pump (ONCAB) technique. METHOD Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), this meta-analysis compared the safety and efficacy of OPCAB versus ONCAB redo CABG. RESULTS Twenty-three (23) eligible studies were included (OPCAB, n=2,085; ONCAB, n=3,245). Off-pump CABG significantly reduced the risk of perioperative death (defined as in-hospital or 30-day death rate), myocardial infarction, atrial fibrillation, and acute kidney injury. The two treatment approaches were comparable regarding 30-day stroke and late all-cause mortality. CONCLUSIONS Off-pump redo CABG resulted in lower perioperative death and periprocedural complication rates. No difference was observed in perioperative stroke rates and long-term survival between the two techniques.
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Affiliation(s)
| | - Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | | | - Damianos G Kokkinidis
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - George Giannakoulas
- Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Robert T Faillace
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christos Bakoyiannis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ilias P Doulamis
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Dimitrios V Avgerinos
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian, New York, NY, USA
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Abstract
Background Amiodarone causes less drug-induced torsade de pointes (TdP) compared to other class III antiarrhythmics. Two theories proposed for this finding include that amiodarone has less repolarization heterogeneity, and/or decreases early after depolarization (EADs). Corrected QT (QTc) dispersion as measured on a surface electrocardiogram (ECG) represents spatial heterogeneity of ventricular repolarization. Objective The purpose of this study was to analyze the difference in QT dispersion between amiodarone and other class III antiarrhythmics and to determine the etiology of TdP. Methods This was a retrospective, observational study at Montefiore Medical Center between January 2005 and January 2015. Inclusion criteria were adults >18 years on amiodarone, dofetilide, or sotalol with prolonged QT interval on 12-lead ECG. ECGs were reviewed by three blinded observers. QTc was calculated using the Bazett and Framingham formulas. QTc dispersion was calculated by subtracting the shortest from the longest QTc. Analysis of variance (ANOVA) was applied for comparison between antiarrhythmic groups with Bonferroni correction for multiple comparisons. Results A total of 447 ECGs were reviewed and 77 ECGs met inclusion criteria. The average QT dispersion for amiodarone, dofetilide, and sotalol was 0.050, 0.037, and 0.034, respectively (p=0.006) and the average QTc dispersion by Bazett was 0.053, 0.038, and 0.037 (p=0.008) and by Framingham was 0.049, 0.036, and 0.035 (p=0.009), respectively. Conclusion Our results show that given the increase in QT dispersion seen with amiodarone, heterogeneous ventricular repolarization as measured by QTc dispersion likely does not account for the lower incidence of drug-induced TdP seen with amiodarone. The ability of amiodarone to decrease EADs via sodium-channel blockade is more likely the explanation for its lower incidence of drug-induced TdP.
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Affiliation(s)
- Ari Friedman
- Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, USA
| | - Jeremy Miles
- Cardiology, Montefiore Medical Center, Bronx, USA
| | - Jared Liebelt
- Cardiology, North Shore University Health Systems-Metro Chicago, Chicago, USA
| | | | | | - Rosy Thachil
- Cardiology, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, USA
| | - Michael Grushko
- Cardiology, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, USA
| | - Robert T Faillace
- Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, USA
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Aoi S, Kakkar AM, Golowa Y, Grushko M, Coyle CM, Elrafei T, Langston MD, Faillace RT, Bangalore S, Sokol SI. Saddle pulmonary embolism and clot in transit in COVID-19 infection: a case report of catastrophic venous thromboembolism. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33628997 PMCID: PMC7891250 DOI: 10.1093/ehjcr/ytaa437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/21/2020] [Accepted: 10/28/2020] [Indexed: 12/23/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) is associated with a coagulopathy favouring thrombosis over bleeding that imparts a poor prognosis. Clot in transit (CIT) is considered a rare entity and the most severe form of venous thromboembolism (VTE), carrying a higher mortality than isolated pulmonary embolism (PE). The incidence of this phenomenon in patients with COVID-19 infection is unknown and likely under-recognized. Case summary During the peak of the COVID-19 pandemic in New York City, a 70-year-old Hispanic female presented with syncope due to a saddle PE further complicated by a highly mobile CIT. Polymerase chain reaction was positive for COVID-19 infection, however, there was no evidence of lung parenchymal involvement or hyper-inflammation. Based on consensus from a multidisciplinary team, aspiration thrombectomy was attempted to treat this extreme case of VTE, however, the patient died during the procedure. Discussion This case raises awareness to the most catastrophic form of VTE, presenting in an early phase of COVID-19 infection without the typical hyper-inflammation and severe lung injury associated with development of COVID-related coagulopathy. It also serves to inform on the critical role echocardiography has in the comprehensive evaluation and re-evaluation of hospitalized patients with COVID-19, and the importance of a multidisciplinary organized approach in clinical decision-making for this complex and poorly understood disease and its sequelae.
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Affiliation(s)
- Shunsuke Aoi
- Department of Medicine/Cardiology, New York City Health + Hospitals Corporation, Jacobi Medical Center 1400 Pelham Parkway, Bronx, NY 10461, USA
| | - Amit M Kakkar
- Department of Medicine/Cardiology, New York City Health + Hospitals Corporation, Jacobi Medical Center 1400 Pelham Parkway, Bronx, NY 10461, USA
| | - Yosef Golowa
- Department of Radiology, Montefiore Medical Center 111 E 210th St, Bronx, NY 10467, USA
| | - Michael Grushko
- Department of Medicine/Cardiology, New York City Health + Hospitals Corporation, Jacobi Medical Center 1400 Pelham Parkway, Bronx, NY 10461, USA
| | - Christina M Coyle
- Department of Medicine/Infectious Disease, New York City Health + Hospitals Corporation, Jacobi Medical Center 1400 Pelham Parkway, Bronx, NY 10461, USA
| | - Tarek Elrafei
- Department of Medicine/Hematology Oncology, New York City Health + Hospitals Corporation, Jacobi Medical Center 1400 Pelham Parkway, Bronx, NY 10461, USA
| | - Matthew D Langston
- Department of Medicine/Pulmonary and Critical Care, New York City Health + Hospitals Corporation, Jacobi Medical Center 1400 Pelham Parkway, Bronx, NY 10461, USA
| | - Robert T Faillace
- Department of Medicine/Cardiology, New York City Health + Hospitals Corporation, Jacobi Medical Center 1400 Pelham Parkway, Bronx, NY 10461, USA
| | - Sripal Bangalore
- Department of Medicine, New York University Grossman School of Medicine 550 First Avenue, New York, NY 10016, USA
| | - Seth I Sokol
- Department of Medicine/Cardiology, New York City Health + Hospitals Corporation, Jacobi Medical Center 1400 Pelham Parkway, Bronx, NY 10461, USA
- Corresponding author. Tel: +718 918 5735,
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Katamreddy A, Kokkinidis DG, Miles JA, Faillace RT. Elevated red cell distribution width is associated with negative P wave amplitude in lead V1: national health and nutrition examination survey (NHANES III). Am J Cardiovasc Dis 2020; 10:356-361. [PMID: 33224583 PMCID: PMC7675171] [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] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Red cell distribution (RDW) is associated with atrial fibrillation (AF) incidence. However, its relationship with precursors of AF has not been established. We aim to investigate if association exists between RDW and negative P wave amplitude in V1, a marker of left atrial abnormality. METHODS NHANES III is a complex, multistage, clustered design survey of noninstitutionalized United States population between 1988-94. A Sample of 6403 individuals was extracted after excluding missing demographic, laboratory, anthropometric and ECG data and major ECG abnormalities. Variables were selected and univariate analysis was done first with a level of significance at P<0.01 (99% confidence). All the significant variables were included in a multivariate linear regression model. RESULTS 53.58% of subjects were female. Racial distribution was caucasian 50.2%, hispanic 23.9% and african american 21.7%. Age, PR interval, heart rate, systolic blood pressure, red cell distribution width, glycated hemoglobin, serum cholesterol, serum ferritin, and body mass index showed a significant correlation with negative P wave amplitude in V1 (P<0.001). After including all these variables in a multivariate regression model, only age, body mass index, systolic blood pressure, PR interval, heart rate and red cell distribution width had a P≤0.001. CONCLUSIONS Increased RDW is independently associated with negative P wave amplitude in V1 after correcting for other cardiovascular risk factors. Further studies are required to analyze the reason for this correlation.
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Affiliation(s)
- Adarsh Katamreddy
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine Bronx, NY, USA
| | - Damianos G Kokkinidis
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine Bronx, NY, USA
| | - Jeremy A Miles
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine Bronx, NY, USA
| | - Robert T Faillace
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine Bronx, NY, USA
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Miles JA, Mejia M, Rios S, Sokol SI, Langston M, Hahn S, Leiderman E, Salgunan R, Soghier I, Gulani P, Joshi K, Chung V, Morante J, Maggiore D, Uppal D, Friedman A, Katamreddy A, Abittan N, Ramani G, Irfan W, Liaqat W, Grushko M, Krouss M, Cho HJ, Bradley SM, Faillace RT. Characteristics and Outcomes of In-Hospital Cardiac Arrest Events During the COVID-19 Pandemic: A Single-Center Experience From a New York City Public Hospital. Circ Cardiovasc Qual Outcomes 2020; 13:e007303. [PMID: 32975134 PMCID: PMC7673640 DOI: 10.1161/circoutcomes.120.007303] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Patients hospitalized for severe coronavirus disease 2019 (COVID-19) infection are at risk for in-hospital cardiac arrest (IHCA). It is unknown whether certain characteristics of cardiac arrest care and outcomes of IHCAs during the COVID-19 pandemic differed compared with a pre-COVID-19 period. Methods: All patients who experienced an IHCA at our hospital from March 1, 2020 through May 15, 2020, during the peak of the COVID-19 pandemic, and those who had an IHCA from January 1, 2019 to December 31, 2019 were identified. All patient data were extracted from our hospital’s Get With The Guidelines–Resuscitation registry, a prospective hospital-based archive of IHCA data. Baseline characteristics of patients, interventions, and overall outcomes of IHCAs during the COVID-19 pandemic were compared with IHCAs in 2019, before the COVID-19 pandemic. Results: There were 125 IHCAs during a 2.5-month period at our hospital during the peak of the COVID-19 pandemic compared with 117 IHCAs in all of 2019. IHCAs during the COVID-19 pandemic occurred more often on general medicine wards than in intensive care units (46% versus 33%; 19% versus 60% in 2019; P<0.001), were overall shorter in duration (median time of 11 minutes [8.5–26.5] versus 15 minutes [7.0–20.0], P=0.001), led to fewer endotracheal intubations (52% versus 85%, P<0.001), and had overall worse survival rates (3% versus 13%; P=0.007) compared with IHCAs before the COVID-19 pandemic. Conclusions: Patients who experienced an IHCA during the COVID-19 pandemic had overall worse survival compared with those who had an IHCA before the COVID-19 pandemic. Our findings highlight important differences between these 2 time periods. Further study is needed on cardiac arrest care in patients with COVID-19.
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Affiliation(s)
- Jeremy A Miles
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx.,Division of Cardiology, Montefiore Medical Center (J.A.M.), Albert Einstein College of Medicine, Bronx
| | - Mateo Mejia
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Saul Rios
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Seth I Sokol
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Matthew Langston
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Steven Hahn
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Ephraim Leiderman
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Reka Salgunan
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Israa Soghier
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Perminder Gulani
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Keval Joshi
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Virginia Chung
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Joaquin Morante
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Diane Maggiore
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Dipan Uppal
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Ari Friedman
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Adarsh Katamreddy
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Nathaniel Abittan
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Gokul Ramani
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Wakil Irfan
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Wasla Liaqat
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Michael Grushko
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Mona Krouss
- Department of Quality and Safety, NYC Health and Hospitals (M.K., H.J.C.).,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (M.K.)
| | - Hyung J Cho
- Department of Quality and Safety, NYC Health and Hospitals (M.K., H.J.C.).,Department of Medicine, NYU Grossman School of Medicine (H.J.C.)
| | - Steven M Bradley
- Cardiology and Healthcare Delivery Innovation Center, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (S.M.B.)
| | - Robert T Faillace
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
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Israilov S, Krouss M, Zaurova M, Jalon HS, Conley G, Shulman P, Ivanyuk M, Jalkut E, Saladini-Aponte C, Sharma-Cooper H, Smeltz R, Faillace RT, Wei EK, Cho HJ. National Outreach of Telepalliative Medicine Volunteers for a New York City Safety Net System COVID-19 Pandemic Response. J Pain Symptom Manage 2020; 60:e14-e17. [PMID: 32479861 PMCID: PMC7258838 DOI: 10.1016/j.jpainsymman.2020.05.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 11/26/2022]
Abstract
The coronavirus disease 2019 surge in New York City created an increased demand for palliative care (PC) services. In staff-limited settings such as safety net systems, and amid growing reports of health care worker illness, leveraging help from less-affected areas around the country may provide an untapped source of support. A national social media outreach effort recruited 413 telepalliative medicine volunteers (TPMVs). After expedited credentialing and onboarding of 67 TPMVs, a two-week pilot was initiated in partnership with five public health hospitals without any previous existing telehealth structure. The volunteers completed 109 PC consults in the pilot period. Survey feedback from TPMVs and on-site PC providers was largely positive, with areas of improvement identified around electronic health record navigation and continuity of care. This was a successful, proof of concept, and quality improvement initiative leveraging TPMVs from across the nation for a PC pandemic response in a safety net system.
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Affiliation(s)
- Sigal Israilov
- Department of Quality and Safety, NYC Health and Hospitals, New York, New York, USA; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mona Krouss
- Department of Quality and Safety, NYC Health and Hospitals, New York, New York, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Milana Zaurova
- Department of Quality and Safety, NYC Health and Hospitals, New York, New York, USA; NYC Health and Hospitals/Elmhurst, New York, New York, USA; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hillary S Jalon
- Department of Quality and Safety, NYC Health and Hospitals, New York, New York, USA
| | - Georgia Conley
- Department of Quality and Safety, NYC Health and Hospitals, New York, New York, USA
| | - Pavel Shulman
- NYC Health and Hospitals/Kings County, New York, New York, USA; Department of Medicine, SUNY Downstate, New York, New York, USA
| | - Marina Ivanyuk
- Department of Medicine, NYC Health and Hospitals/Coney Island, New York, New York, USA
| | - Elizabeth Jalkut
- Department of Medicine, NYC Health and Hospitals/Woodhull, New York, New York, USA
| | | | - Haseen Sharma-Cooper
- Department of Psychiatry, NYC Health and Hospitals/North Central Bronx, New York, New York, USA
| | - Robert Smeltz
- NYC Health and Hospitals/Bellevue, New York, New York, USA; Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Robert T Faillace
- Department of Medicine, NYC Health and Hospitals/Jacobi, New York, New York, USA; Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
| | - Eric K Wei
- Department of Quality and Safety, NYC Health and Hospitals, New York, New York, USA
| | - Hyung J Cho
- Department of Quality and Safety, NYC Health and Hospitals, New York, New York, USA; Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.
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Chugh Y, Bavishi C, Mojadidi MK, Elgendy IY, Faillace RT, Brilakis ES, Tamis‐Holland J, Mamas M, Chugh SK. Safety of transradial access compared to transfemoral access with hemostatic devices (vessel plugs and suture devices) after percutaneous coronary interventions: A systematic review and
meta‐analysis. Catheter Cardiovasc Interv 2020; 96:285-295. [DOI: 10.1002/ccd.29061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/28/2020] [Accepted: 05/24/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Yashasvi Chugh
- Mount Sinai St Luke's Roosevelt Hospital New York New York
| | - Chirag Bavishi
- Rhode Island Hospital Warren Alpert Medical School of Brown University Providence Rhode Island
| | | | - Islam Y. Elgendy
- Massachusetts General Hospital and Harvard Medical School Boston Massachusetts
| | - Robert T. Faillace
- Jacobi Medical Center/Albert Einstein College of Medicine New York New York
| | - Emmanouil S. Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Minneapolis Minnesota
| | | | - Mamas Mamas
- Keele Cardiovascular Research Group Centre for Prognosis Research, Keele University United Kingdom
| | - Sanjay Kumar Chugh
- Jaipur National University Hospital and Medical College Institute for Medical Sciences and Research Center Jaipur India
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Pinsino A, Mondellini GM, Royzman EA, Hoffman KL, D'Angelo D, Mabasa M, Gaudig A, Zuver AM, Masoumi A, Garan AR, Mohan S, Husain SA, Toma K, Faillace RT, Giles JT, Takeda K, Takayama H, Naka Y, Topkara VK, Demmer RT, Radhakrishnan J, Colombo PC, Yuzefpolskaya M. Cystatin C- Versus Creatinine-Based Assessment of Renal Function and Prediction of Early Outcomes Among Patients With a Left Ventricular Assist Device. Circ Heart Fail 2020; 13:e006326. [PMID: 31959016 DOI: 10.1161/circheartfailure.119.006326] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Estimated glomerular filtration rate (eGFR) based on serum creatinine (sCr) improves early after left ventricular assist device (LVAD) implantation but subsequently declines. Although sCr is a commonly accepted clinical standard, cystatin C (CysC) has shown superiority in assessment of renal function in disease states characterized by muscle wasting. Among patients with an LVAD, we aimed to (1) longitudinally compare CysC-eGFR and sCr-eGFR, (2) assess their predictive value for early postoperative outcomes, and (3) investigate mechanisms which might explain potential discrepancies. METHODS A prospective cohort (n=116) with CysC and sCr concurrently measured at serial time points, and a retrospective cohort (n=91) with chest computed tomography performed within 40 days post-LVAD were studied. In the prospective cohort, the primary end point was a composite of in-hospital mortality, renal replacement therapy, or severe right ventricular failure. In the retrospective cohort, muscle mass was estimated using pectoralis muscle area indexed to body surface area (pectoralis muscle index). RESULTS In the prospective cohort, sCr-eGFR significantly improved early post-LVAD and subsequently declined, whereas CysC-eGFR remained stable. CysC-eGFR but not sCr-eGFR predicted the primary end point: odds ratio per 5 mL/(min·1.73 m2) decrease 1.16 (1.02-1.31) versus 0.99 (0.94-1.05). In retrospective cohort, for every 5 days post-LVAD, a 6% decrease in pectoralis muscle index was observed (95% CI, 2%-9%, P=0.003). After adjusting for time on LVAD, for every 1 cm2/m2 decrease in pectoralis muscle index, there was a 4% decrease in 30-day post-LVAD sCr (95% CI, 1%-6%, P=0.004). CONCLUSIONS Initial improvement in sCr-eGFR is likely due to muscle wasting following LVAD surgery. CysC may improve assessment of renal function and prediction of early postoperative outcomes in patients with an LVAD.
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Affiliation(s)
- Alberto Pinsino
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY.,Department of Medicine, NYC Health + Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, NY (A.P., R.T.F.)
| | - Giulio M Mondellini
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Eugene A Royzman
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Katherine L Hoffman
- Department of Healthcare Policy & Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY (K.L.H., D.D.)
| | - Debra D'Angelo
- Department of Healthcare Policy & Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY (K.L.H., D.D.)
| | - Melissa Mabasa
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Antonia Gaudig
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Amelia M Zuver
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Amirali Masoumi
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - A Reshad Garan
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine (S.M., S.A.H., K.T., J.R.), Columbia University Irving Medical Center, New York, NY.,Department of Epidemiology, Mailman School of Public Health (S.M.), Columbia University Irving Medical Center, New York, NY
| | - Syed A Husain
- Division of Nephrology, Department of Medicine (S.M., S.A.H., K.T., J.R.), Columbia University Irving Medical Center, New York, NY
| | - Katherine Toma
- Division of Nephrology, Department of Medicine (S.M., S.A.H., K.T., J.R.), Columbia University Irving Medical Center, New York, NY
| | - Robert T Faillace
- Department of Medicine, NYC Health + Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, NY (A.P., R.T.F.)
| | - Jon T Giles
- Division of Rheumatology, Department of Medicine (J.T.G.), Columbia University Irving Medical Center, New York, NY
| | - Koji Takeda
- Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University Irving Medical Center, New York, NY
| | - Hiroo Takayama
- Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University Irving Medical Center, New York, NY
| | - Yoshifumi Naka
- Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University Irving Medical Center, New York, NY
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (R.T.D.)
| | - Jai Radhakrishnan
- Division of Nephrology, Department of Medicine (S.M., S.A.H., K.T., J.R.), Columbia University Irving Medical Center, New York, NY
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
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Abstract
The spectrum of electrocardiographic changes seen with hyperkalemia is known to progress gradually with increasing serum levels of potassium. Initial changes are limited to peaked T waves and QT shortening, which subsequently progress to prolonged QRS/QT intervals, and finally sinus arrest, sinus bradycardia and asystole. We report a unique case of severe sinus bradycardia with atrial bigeminy and junctional rhythm in the setting of moderate hyperkalemia, a rarely reported electrocardiographic finding.
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Buhari O, Dayyab FM, Igbinoba O, Atanda A, Medhane F, Faillace RT. The association between heavy metal and serum cholesterol levels in the US population: National Health and Nutrition Examination Survey 2009-2012. Hum Exp Toxicol 2019; 39:355-364. [PMID: 31797685 DOI: 10.1177/0960327119889654] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Few studies have examined the relationship between heavy metal and serum cholesterol levels, and no recent study has examined this relationship in the US population. METHODS AND RESULTS A total of 19,591 individuals aged 0-80 years were included in the National Health and Nutrition Examination Survey 2009-2012; the current study was composed of survey participants for whom some or all low-density lipoprotein cholesterol (LDL-C), serum triglyceride, high-density lipoprotein cholesterol, total cholesterol, blood lead (Pb), total blood mercury (Hg), and blood cadmium (Cd) levels had been measured. Three tertiles (T1-T3) of heavy metals were used to explore dose-response association between heavy metal exposure and serum cholesterol level. Logistic regression was used to explore the relationship between tertiles of blood heavy metal levels and serum cholesterol levels after adjusting for age, sex, and socioeconomic status. We have shown that the groups with the highest levels of Pb, Hg, and Cd had a 56%, 73%, and 41% chance, respectively, of having a high total cholesterol level. In study subjects with the highest Pb levels, there was also a 22% chance of being in the group with the highest LDL-C level. An increase in total cholesterol and LDL-C levels was observed from the first to the third tertiles of the heavy metals studied. CONCLUSION Increasing blood Pb, Hg, and Cd levels were associated with significantly increased odds of high total cholesterol after adjusting for age, sex, and socioeconomic status.
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Affiliation(s)
- O Buhari
- Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - F M Dayyab
- Department of Epidemiology, Texas A&M University, College Station, TX, USA.,Department of Epidemiology, Infectious Diseases Hospital, Kano, Nigeria
| | - O Igbinoba
- Department of Epidemiology, Texas A&M University, College Station, TX, USA
| | - A Atanda
- Department of Epidemiology, George Washington University Hospital, Washington, DC, USA
| | - F Medhane
- Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - R T Faillace
- Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
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Miles JA, Quispe R, Mehlman Y, Patel K, Lama Von Buchwald C, You JY, Sokol S, Faillace RT. Racial differences and mortality risk in patients with heart failure and hyponatremia. PLoS One 2019; 14:e0218504. [PMID: 31216316 PMCID: PMC6583993 DOI: 10.1371/journal.pone.0218504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/04/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hyponatremia is a well-established poor prognostic marker in patients with heart failure. Whether the mortality risk is comparable among different races of patients with heart failure and hyponatremia is unknown. MATERIALS AND METHODS Consecutive patients admitted with acute decompensated heart failure and an admission sodium level<135 mEq/L from 1/1/2001 through 12/31/10 were identified. Patients were divided into four groups based on self-reported race: white, African American, Hispanic and other. African Americans were used as the reference group for statistical analysis. The primary outcome was all-cause mortality. RESULTS We included 4,343 patients, from which 1,356 (31%) identified as white, 1,248 (29%) as African American, 780 (18%) as Hispanic and 959 (22%) as other. During a median follow-up of 23 months, a total of 2,384 patients died: 678 were African American, 820 were white, 298 were Hispanic and 588 were other. After adjusting for baseline demographics, comorbidities and medication use, Hispanic patients had a 45% less risk of death as compared to African Americans (HR .55, CI .48-.64, p<0.05). There was no difference in mortality between white and African American patients (HR 1.04, CI .92-1.2, p = 0.79). CONCLUSION Hispanic patients admitted for heart failure and who were hyponatremic on admission had an independent lower risk of mortality compared to other groups. These findings may be due to the disparate activity of the renin-angiotensin-aldosterone system among various racial groups. This observational study is hypothesis generating and suggests that treatment of patients with heart failure and hyponatremia should perhaps be focused more on renin-angiotensin-aldosterone system reduction in certain racial groups, yet less in others.
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Affiliation(s)
- Jeremy A. Miles
- Department of Medicine, Division of General Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
- * E-mail:
| | - Renato Quispe
- Department of Medicine, Division of General Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Yonatan Mehlman
- Department of Medicine, Division of General Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Kavisha Patel
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Claudia Lama Von Buchwald
- Department of Medicine, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Jee Young You
- Department of Medicine, Division of General Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Seth Sokol
- Department of Medicine, Division of General Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Robert T. Faillace
- Department of Medicine, Division of General Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
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Li DL, Quispe R, Onyekwelu C, Faillace RT, Taub CC. Racial differences of heart failure with midrange ejection fraction (HFmrEF): a large urban centre-based retrospective cohort study in the USA. BMJ Open 2019; 9:e026479. [PMID: 31048442 PMCID: PMC6501992 DOI: 10.1136/bmjopen-2018-026479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES We aimed to study the racial differences in clinical presentations, survival outcomes and outcome predictors among patients with heart failure (HF) with midrange ejection fraction (HFmrEF, EF 40%-49%). DESIGN This is a retrospective study. SETTING Adults with HF diagnosis at Montefiore Medical Center, Bronx, New York between 2008 and 2012, with an inpatient echocardiogram showing left ventricular ejection fraction of 40%-49% were included as HFmrEF population. PARTICIPANTS 1,852 HFmrEF patients are included in the study (56% male, mean age 67 years). There were 493 (26.5%) non-Hispanic whites, 541 (29.2%) non-Hispanic black, 489 (26.4%) Hispanics and 329 (17.8%) other racial populations. OUTCOME MEASURES Cumulative probabilities of all-cause mortality among different racial groups were estimated and multivariable adjusted Cox proportional regressions were performed to assess predictors of mortality. RESULTS Among the HFmrEF patients, white patients were older and were less likely to be on guideline-directed medications. Blacks had a lower prevalence of prior myocardial infarction comparing to other groups. Hispanics had more chronic diseases and yet better survival comparing to whites and blacks after adjustment for age, sex and comorbidities. Distinct sets of survival predictors were revealed in individual racial groups. Baseline use of mineralocorticoid receptor antagonist (MRA) was associated with lower mortality among HFmrEF patients in general (HR 0.61, 95% CI 0.37 to 0.99). CONCLUSIONS There are significant racial/ethnic differences in clinical phenotypes, survival outcomes and mortality predictors of HFmrEF. Furthermore, the use of MRA predicted a reduced mortality in HFmrEF patients.
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Affiliation(s)
- Dan Leslie Li
- Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Renato Quispe
- Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
- Ciccarone Center for the Prevention of Heart Disease, The Johns Hopkins Schoold of Medicine, Baltimore, Maryland, USA
| | - Chioma Onyekwelu
- Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Robert T Faillace
- Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Cynthia C Taub
- Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Mastoris I, Kokkinidis DG, Bikakis I, Archontakis-Barakakis P, Papanastasiou CA, Jonnalagadda AK, Schizas D, Bakoyiannis C, Palaiodimos L, Faillace RT. Catheter-directed thrombolysis vs. anticoagulation for the prevention and treatment of post-thrombotic syndrome in deep vein thrombosis: An updated systematic review and meta-analysis of randomized trials. Phlebology 2019; 34:675-682. [DOI: 10.1177/0268355519835618] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Oral anticoagulation therapy was the mainstay of deep vein thrombosis treatment but recently, catheter-directed thrombolysis has emerged as an alternative. Objective To compare the efficacy and safety of the two strategies. Methods Medline, Embase and Cochrane CENTRAL were reviewed. Outcomes of interest included post-thrombotic syndrome, thromboembolic events, mortality, bleeding risk and iliofemoral patency. A random effects model meta-analysis was performed. Heterogeneity was assessed with I square. Results Four randomized controlled trials (RCTs) including 1005 patients met the inclusion criteria. Catheter-directed thrombolysis was more likely to prevent overall post-thrombotic syndrome compared to anticoagulation only (OR: 0.32; 95% CI: 0.12–0.85; I2=87.2%), and to lead to iliofemoral vein patency (OR: 2.7; 95% CI: 1.08–6.75; I2=55.3%) but no difference was noted in thromboembolic events (OR = 0.5; 95% CI: 0.08–3.02, I2=55.1%), bleeding and mortality rates. Conclusions Catheter-directed thrombolysis can decrease post-thrombotic syndrome rates and improve iliofemoral vein patency compared to anticoagulation when used for the treatment of deep vein thrombosis.
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Affiliation(s)
- Ioannis Mastoris
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Division of Cardiology, University of Kansas Medical Center, Kansas City, KS, USA
- Ioannis Mastoris and Damianos G Kokkinidis contributed equally to the manuscript
| | - Damianos G Kokkinidis
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Ioannis Mastoris and Damianos G Kokkinidis contributed equally to the manuscript
| | - Iosif Bikakis
- Division of Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | | | - Christos A Papanastasiou
- Division of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Christos Bakoyiannis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Robert T Faillace
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Abstract
Coronary artery ectasia (CAE) can present as an acute coronary syndrome (ACS) with a high clot burden in ectatic coronary arteries. Thrombectomy with intracoronary thrombolysis often does not ensure immediate blood flow. Also, there have not been clear guidelines regarding long-term management in such cases. A 40-year-old male presented with anginal chest discomfort and a working diagnosis of non-ST elevation myocardial infarction (NSTEMI) was made. The initial angiography showed thrombotic occlusion of several large and ectatic coronary arteries with visibly swirling blood flow. The culprit lesions were treated with balloon angioplasty and multiple rounds of thrombectomy yielding red thrombi. Interestingly, the post-intervention antegrade flow decreased in both vessels (Thrombolysis in Myocardial Infarction (TIMI) score: 0), possibly because of the distal migration of the clots. Peri-procedure, the patient received two boluses of eptifibatide, 180 mcg/kg each, followed by a continuous infusion of 2 mcg/kg/minute for 18 hours. Afterward, the patient was started on ticagrelor and continued on daily aspirin, high-intensity statin, beta blocker, and Coumadin® with heparin bridge. During the one year follow-up period, the Coumadin was switched to rivaroxaban, ticagrelor was stopped after six months, and the patient was continued on guideline-directed medical therapy (GDMT) for coronary artery disease (CAD) with favorable outcomes. The presented case gives us an insight into not only the intra-procedural but also the post-procedural management of ACS in the setting of CAE, and that is thrombectomy alone followed by longer duration oral anticoagulation in addition to GDMT for CAD. However, it will be interesting to see future studies aimed toward defining the duration as well as the choice of anticoagulation, i.e., dual antiplatelet therapy (DAPT) alone or in combination with warfarin/novel oral anticoagulants (NOACs).
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Affiliation(s)
- Muhammad Waqas
- Internal Medicine, Albert Einstein College of Medicine / Jacobi Medical Center, Bronx, USA
| | - Lilian L Bizzocchi
- Internal Medicine, Albert Einstein College of Medicine / Jacobi Medical Center, Bronx, USA
| | - Mark A Menegus
- Cardiology, Albert Einstein College of Medicine / Jacobi Medical Center, Bronx, USA
| | - Robert T Faillace
- Cardiology, Albert Einstein College of Medicine / Jacobi Medical Center, Bronx, USA
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Kokkinidis DG, Palaiodimos L, Mastoris I, Karamanis D, Faillace RT. The best DEFENSE for high-risk patent foramen ovale: An updated meta-analysis of six randomized trials. Arch Cardiovasc Dis 2018; 112:150-152. [PMID: 30594572 DOI: 10.1016/j.acvd.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Received: 05/27/2018] [Revised: 06/12/2018] [Accepted: 06/18/2018] [Indexed: 01/16/2023]
Affiliation(s)
- Damianos G Kokkinidis
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 10461 NY, USA
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 10461 NY, USA.
| | - Ioannis Mastoris
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 10461 NY, USA
| | | | - Robert T Faillace
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 10461 NY, USA
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Kokkinidis DG, Papanastasiou CA, Jonnalagadda AK, Oikonomou EK, Theochari CA, Palaiodimos L, Karvounis HI, Armstrong EJ, Faillace RT, Giannakoulas G. The predictive value of baseline pulmonary hypertension in early and long term cardiac and all-cause mortality after transcatheter aortic valve implantation for patients with severe aortic valve stenosis: A systematic review and meta-analysis. Cardiovascular Revascularization Medicine 2018; 19:859-867. [DOI: 10.1016/j.carrev.2018.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/17/2018] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
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Lama von Buchwald C, Faillace RT. Water-bottle heart. Eur Heart J 2018; 39:2431-2432. [DOI: 10.1093/eurheartj/ehy225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Claudia Lama von Buchwald
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 1440 Pelham Parkway South, Bronx, NY, USA
| | - Robert T Faillace
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 1440 Pelham Parkway South, Bronx, NY, USA
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Madan N, Christia P, Faillace RT. Cardiac Allograft Vasculopathy: Pathogenesis and Role of Coronary Computed Tomography Angiography in the Diagnosis and Surveillance. ACTA ACUST UNITED AC 2018. [DOI: 10.12970/2311-052x.2018.06.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Palaiodimos L, Kokkinidis DG, Faillace RT, Foley TR, Dangas GD, Price MJ, Mastoris I. Percutaneous closure of patent foramen ovale vs. medical treatment for patients with history of cryptogenic stroke: A systematic review and meta-analysis of randomized controlled trials. Cardiovasc Revasc Med 2018; 19:852-858. [PMID: 29576519 DOI: 10.1016/j.carrev.2018.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/04/2018] [Accepted: 02/23/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with history of cryptogenic stroke are more likely to have a patent foramen ovale (PFO) and should be managed with antithrombotic agents, while the alternative option is percutaneous closure of PFOs. Our aim was to perform a meta-analysis of randomized controlled trials (RCTs) comparing percutaneous closure vs. medical treatment for patients with PFO and prior cryptogenic stroke. METHODS Medline, Scopus and Cochrane databases were reviewed. A random-effect model meta-analysis was used and I-square was utilized to assess the heterogeneity. New ischemic stroke was defined as the primary endpoint. A sensitivity analysis was performed for Amplatzer device. Subgroup analyses were performed for different patient and PFO characteristics for the composite endpoints as defined by the included RCTs. RESULTS In total of 3440 patients were included in this meta-analysis. Closure devices were superior to medical therapy for prevention of recurrent ischemic strokes (HR = 0.29; CI: 0.02-0.56), but were associated with increased risk of new onset of atrial fibrillation (AF) and atrial flutter (RR = 4.67; CI: 2.22-9.81). However, in the sensitivity analysis for Amplatzer device, there was no difference between the two groups in new onset of atrial arrhythmias. Closure devices were superior across all different subgroups when compared to medical treatment with the exception of patients with a small shunt. CONCLUSION This meta-analysis shows that closure devices for patients with PFO and history of cryptogenic stroke can significantly decrease the risk of a new ischemic stroke. The use of Amplatzer device was not associated with increased risk of newly diagnosed atrial arrhythmias.
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Affiliation(s)
- Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States.
| | - Damianos G Kokkinidis
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Robert T Faillace
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - T Raymond Foley
- Cardiac Catheterization Laboratory, Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA, United States
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, NY, New York, United States
| | - Matthew J Price
- Cardiac Catheterization Laboratory, Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA, United States
| | - Ioannis Mastoris
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
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