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Yousuf OK, Kennedy K, Russo A, Varosy P, Lindsay BD, Steinberg B, Atwater BD, Calkins H, Spertus JA. Appropriateness of implantable cardioverter-defibrillator device implants in the United States. Heart Rhythm 2024; 21:397-407. [PMID: 38123044 DOI: 10.1016/j.hrthm.2023.12.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The appropriate use criteria (AUCs) are a diverse group of indications aimed to better evaluate the benefits of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy. OBJECTIVE The purpose of this study was to quantify the proportion of ICD and cardiac resynchronization therapy with defibrillator (CRT-D) implants as appropriate, may be appropriate (MA), or rarely appropriate (RA) on the basis of the AUC guidelines. METHODS This is a multicenter retrospective study of patients within the National Cardiovascular Data Registry undergoing ICD implantation between April 2018 and March 2019 at >1500 US hospitals. The appropriateness of ICD implants was adjudicated using the AUC. RESULTS Of 309,318 ICDs, 241,438 were primary prevention implants (78.1%) and 67,880 secondary prevention implants (21.9%); 243,532 (79%) were mappable to the AUC. For primary prevention, 185,431 ICDs (96.4%) were appropriate, 5660 (2.9%) MA, and 1205 (0.6%) RA. For secondary prevention, 47,498 ICDs (92.7%) were appropriate, 2581 (5%) MA, and 1157 (2.3%) RA. A significant number of RA devices were implanted in patients with New York Heart Association class IV heart failure who were ineligible for advanced therapies (53.9%) and those with myocardial infarction within 40 days (18.1%). The appropriateness of the pacing lead was more variable, with 48,470 dual-chamber ICD implants (62%) being classified as appropriate, 29,209 (37.4%) MA, and 448 (0.6%) RA. Among CRT-D implants, 63,848 (82.2%) were appropriate, 9900 (12.7%) MA, and 3940 (5.1%) RA for left ventricular pacing. A total of 99,754 implants were deemed appropriate but excluded from Centers for Medicare & Medicaid Services National Coverage Determination. More than 92% of hospitals had an RA implant rate of <4%. CONCLUSION In this large national registry, 95% of mappable ICD and CRT-D implants were considered appropriate, with <2% of RA implants. Nearly 100,000 appropriate implants are excluded by Centers for Medicare & Medicaid Services National Coverage Determination.
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Affiliation(s)
- Omair K Yousuf
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; Carient Heart & Vascular, Manassas, Virginia; Inova Heart and Vascular Institute, Fairfax, Virginia; University of Virginia Health, Manassas, Virginia.
| | - Kevin Kennedy
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | | | | | | | | | - Brett D Atwater
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; Inova Heart and Vascular Institute, Fairfax, Virginia
| | - Hugh Calkins
- Johns Hopkins Medical Institution, Baltimore, Maryland
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
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Advani R, Chandrasekaran S. Chronic hypertension diagnosed by the American Heart Association and American College of Cardiology criteria is associated with increased risk of developing hypertensive disorders of pregnancy. Am J Obstet Gynecol MFM 2024; 6:101269. [PMID: 38145820 DOI: 10.1016/j.ajogmf.2023.101269] [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: 09/14/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND ACOG uses a systolic blood pressure (SBP) ≥140 or diastolic blood pressure (DBP) ≥90 documented at <20 weeks of gestation to define chronic hypertension. In the nonpregnant state, the American Heart Association (AHA) and the American College of Cardiology (ACC) define chronic hypertension using lower diagnostic thresholds of SBP ≥130 or DBP ≥80. It remains unclear whether using more conservative guidelines in pregnancy improves identification of those at risk for gestational hypertension (GHTN) or preeclampsia (PRE). OBJECTIVE We sought to investigate whether subjects with chronic hypertension based on the American Heart Association and American College of Cardiology criteria had an increased risk for gestational hypertension and preeclampsia than those without chronic hypertension. STUDY DESIGN We conducted a retrospective cohort study utilizing a clinical database at a diverse, large urban, safety-net hospital. Subjects aged 18 to 40 years with singleton gestations and first trimester prenatal care were included. We defined subjects that met the criteria for stage 1 chronic hypertension based on first trimester systolic blood pressure and diastolic blood pressure cutoffs satisfying the American Heart Association and American College of Cardiology criteria (systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg). Those who did not meet these criteria had a systolic blood pressure <130 mm Hg and a diastolic blood pressure <90 mm Hg. We did not include those with chronic hypertension based on the American College of Obstetricians and Gynecologists criteria in this cohort (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg at <20 weeks); therefore, those who met the American Heart Association and American College of Cardiology criteria solely consisted of subjects with systolic blood pressure of 130 to 139 mm Hg and diastolic blood pressure of 80 of 89 mm Hg. By doing this, we were able to specifically investigate the increased risk for this specific population, which remains unclear. Diagnoses of gestational hypertension and preeclampsia were based on the established American College of Obstetricians and Gynecologists criteria. Preeclampsia included those with and without severe features. Tests for normality were performed. Student t-tests or rank sum tests were performed as appropriate for continuous variables; chi-square or Fisher's exact tests were performed for categorical variables. Generalized linear models were performed to calculate risk ratios while controlling for appropriate confounders. RESULTS Of N=3354 subjects, 18% (n=629) were diagnosed with stage 1 chronic hypertension based on American Heart Association and American College of Cardiology criteria. Those with American Heart Association and American College of Cardiology stage 1 chronic hypertension had increased rates of gestational hypertension (35.4% vs 20%; P<.001) and preeclampsia (22.3% vs 10%; P<.001) than those without Stage 1 chronic hypertension based on these criteria. When controlling for maternal age, race, first trimester body mass index, pregestational diabetes, and substance use, those with the American Heart Association and American College of Cardiology stage 1 chronic hypertension had an almost 1.5-fold higher adjusted risk ratio of experiencing gestational hypertension (adjusted risk ratio, 1.49±0.10; P<.001) and almost 2-fold increased adjusted risk ratio of experiencing preeclampsia (adjusted risk ratio, 1.98±0.19; P<.001). CONCLUSION Our data suggest an increased risk for developing gestational hypertension and preeclampsia for subjects satisfying the American Heart Association and American College of Cardiology cutoff for stage 1 chronic hypertension. Future studies need to consider whether diagnosis of chronic hypertension in pregnancy should conform with American Heart Association and American College of Cardiology criteria, and if those with stage 1 chronic hypertension based on American Heart Association and American College of Cardiology criteria require the same preventative measures and interventions utilized by those diagnosed by American College of Obstetricians and Gynecologists criteria.
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Affiliation(s)
- Raina Advani
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA.
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Behnoush AH, Khalaji A, Naderi N, Ashraf H, von Haehling S. ACC/AHA/HFSA 2022 and ESC 2021 guidelines on heart failure comparison. ESC Heart Fail 2023; 10:1531-1544. [PMID: 36460629 PMCID: PMC10192289 DOI: 10.1002/ehf2.14255] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 08/12/2022] [Revised: 11/12/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022] Open
Abstract
The 2022 American College of Cardiology/American Heart Association/Heart Failure Society of America (ACC/AHA/HFSA) and the 2021 European Society of Cardiology (ESC) both provide evidence-based guides for the diagnosis and treatment of heart failure (HF). In this review, we aimed to compare recommendations suggested by these guidelines highlighting the differences and latest evidence mentioned in each of the guidelines. While the staging of HF depends on left ventricular ejection fraction, the Universal Definition of HF, suggested in 2021, is described in 2022 ACC/AHA/HFSA guidelines. Both guidelines recommend invasive and non-invasive tests to diagnose. Despite being identical in the backbone, some differences exist in medical therapy and devices, which can be partially attributed to the recent trials published that are presented in the American guidelines. The recommendation of implantable cardioverter defibrillator for prevention in HF with reduced ejection fraction (HFrEF) patients, made by ACC/AHA/HFSA guidelines, is among the bold differences. It seems that ACC/AHA/HFSA guidelines emphasize the quality of life, cost-effectiveness, and optimization of care given to patients. On the other hand, the ESC guidelines provide recommendations for certain comorbidities. This comparison can guide clinicians in choosing the proper approach for their own settings and the writing committees in addressing the differences in order to have better consistency in future guidelines.
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Affiliation(s)
| | | | - Nasim Naderi
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Haleh Ashraf
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
- Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CenterGöttingenGermany
- German Center for Cardiovascular Research (DZHK)Partner Site GöttingenGöttingenGermany
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Dunn K, Kopel J, Diab M, Babb F. Analyzing and Improving the Utilization of Statin Drugs in Family Medicine Patients with Type II Diabetes. J Community Hosp Intern Med Perspect 2023; 13:35-38. [PMID: 37877046 PMCID: PMC10593177 DOI: 10.55729/2000-9666.1162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/25/2022] [Accepted: 01/05/2023] [Indexed: 10/26/2023] Open
Abstract
Background Statins are the primary drug used to reduce morbidity and mortality for cardiovascular disease. However, many type II diabetes mellitus (T2DM) patients who are currently not on a statin would otherwise qualify. Therefore, we investigated the proportion of T2DM patients on a statin compared to the total number of T2DM patients eligible to be on a statin. We also examined potential barriers that prevent T2DM patients from being prescribed statins by physicians. Methods A retrospective chart study on family medicine patients was collected data on age, race, cholesterol readings, blood pressure, and whether the patient was on blood pressure medications, aspirin, and/or a statin. The information gathered was used to determine the patients' 10-year risk of cardiovascular disease. A survey was given to residents and faculty to assess the cost, side effects, and other behavioral factors had on a patients' choice to be on a statin. Results Among the 706 T2DM patients, we found that a large proportion (75.2%) were both eligible and prescribed a statin according to the American Heart Association Guidelines. In addition, over 58% of the patients had a 0%-25% 10-year risk of cardiovascular disease risk. Among the 14 family medicine physicians surveyed, the fear of or history of side effects with statin medications were the greatest barriers to starting statins. Conclusion The large proportion of family medicine patients that were eligible were prescribed a statin. According to the survey, physicians Believed that the greatest barrier for a patient starting on a statin is the fear of or history of side effects with statin medications.
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Affiliation(s)
- Keegan Dunn
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX,
USA
| | - Jonathan Kopel
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX,
USA
| | - Mousab Diab
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX,
USA
| | - Franklyn Babb
- Professor of Family Medicine, Texas Tech University Health Sciences Center, Lubbock, TX,
USA
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Denoble AE, Goldstein SA, Pettker CM. Antihypertensives in Pregnancy. Obstet Gynecol Clin North Am 2023; 50:39-78. [PMID: 36822710 DOI: 10.1016/j.ogc.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Hypertensive disorders of pregnancy (HDP) can result in significant maternal morbidity and even mortality. Available data suggest that many antihypertensives can be safely used in pregnant patients, albeit with close supervision of parameters like fetal growth and amniotic fluid volume. This article summarizes current guidelines on the diagnosis and treatment of hypertension in pregnancy and provides an in-depth guide to the available safety and efficacy data for antihypertensives during pregnancy and postpartum.
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Khan Z, Rakhit R. Secondary prevention lipid management following ACS: a missed opportunity? Br J Cardiol 2022; 29:35. [PMID: 37332272 PMCID: PMC10270297 DOI: 10.5837/bjc.2022.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Affiliation(s)
| | - Roby Rakhit
- Professor of Cardiology Royal Free Hospital, Pond Street, London NW3 2QG
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Malenka DJ, Bhatt DL, Bradley SM, Shahian DM, Draoui J, Segawa CA, Koutras C, Abbott JD, Blankenship JC, Vincent R, Windle J, Tsai TT, Curtis J, Roe M, Masoudi FA. The National Cardiovascular Data Registry Data Quality Program 2020: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79:1704-12. [PMID: 35483759 DOI: 10.1016/j.jacc.2022.02.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/25/2022] [Accepted: 02/01/2022] [Indexed: 11/21/2022]
Abstract
The National Cardiovascular Data Registry is a group of registries maintained by the American College of Cardiology Foundation. These registries are used by a diverse constituency to improve the quality and outcomes of cardiovascular care, to assess the safety and effectiveness of new therapies, and for research. To achieve these goals, registry data must be complete and reliable. In this article, we review the process of National Cardiovascular Data Registry data collection, assess data completeness and integrity, and report on the current state of the data. Registry data are complete. Accuracy is very good but variable, and there is room for improvement. Knowledge of the quality of data is essential to ensuring its appropriate use.
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Hariri E, Kassas I, Hammoud MA, Hansra B, Akhter MW, Fisher DZ, Smith CS, Barringhaus KG. Same day discharge following non-elective PCI for non-ST elevation acute coronary syndromes. Am Heart J 2022; 246:125-135. [PMID: 34998967 DOI: 10.1016/j.ahj.2021.12.015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM Timing of discharge after percutaneous coronary intervention (PCI) is a crucial aspect of procedural safety and patient turnover. We examined predictors and outcomes of same-day discharge (SDD) after non-elective PCI for non-ST elevation acute coronary syndromes (NSTE-ACS) in comparison with next-day discharge (NDD). METHODS Baseline demographic, clinical, and procedural data were collected as were in-hospital outcomes and post-PCI length of stay (LOS) for all patients undergoing non-elective PCI for NSTE-ACS between 2011 and 2014 at a central tertiary care center. Thirty day and 1-year mortality and bleeding as well as 30-day readmission rates were determined from social security record and medical chart review. Logistic regression was performed to identify predictors of SDD, and propensity-matched analysis was done to examine the differences in outcomes between NDD and SDD. RESULTS Out of 2,529 patients who underwent non-elective PCI for NSTE-ACS from 2011 to 2014, 1,385 met the inclusion criteria (mean age = 63 years; 26% women) and were discharged either the same day of (N = 300) or the day after (N = 1,085) PCI. Thirty-day and one-year mortality and major bleeding rates were similar between the 2 groups. Logistic regression identified male sex, radial access, negative troponin biomarker status, and procedure start time as predictors of SDD. In propensity-matched analyses, there was no difference in 30-day mortality and readmission between SDD and NDD groups. CONCLUSIONS SDD after non-elective PCI for NSTE-ACS may be a reasonable alternative to NDD for selected low-risk patients with comparable mortality, bleeding, and readmission rates.
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Affiliation(s)
- Essa Hariri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland OH
| | - Ibrahim Kassas
- Advocate Christ Medical Center/University of Illinois at Chicago, Oak Lawn, IL; Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Mazen Al Hammoud
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Barinder Hansra
- Division of Cardiology, Department of Medicine, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA
| | - Mohammed W Akhter
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA; Division of Cardiovascular Medicine, Duke University School of Medicine, Durham, NC
| | - Daniel Z Fisher
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Craig S Smith
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Kurt G Barringhaus
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA; Division of Cardiology, Columbia VA Health Care System, University of South Carolina School of Medicine, PRISMA Health, Columbia, SC.
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Mohananey D, Aljadah M, Smith AAH, Haines JF, Patel S, Villablanca P, Ramakrishna H. The 2020 ACC/AHA Guidelines for Management of Patients With Valvular Heart Disease: Highlights and Perioperative Implications. J Cardiothorac Vasc Anesth 2021; 36:1467-1476. [PMID: 34011447 DOI: 10.1053/j.jvca.2021.04.013] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/10/2021] [Indexed: 12/26/2022]
Abstract
Valvular heart disease contributes to a large burden of morbidity and mortality in the United States. During the last decade there has been a paradigm shift in the management of valve disease, primarily driven by the emergence of novel transcatheter technologies. In this article, the latest update of the American College of Cardiology/American Heart Association valve heart disease guidelines is reviewed.
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Affiliation(s)
- Divyanshu Mohananey
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Michael Aljadah
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Aaron A H Smith
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jeremiah F Haines
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Sahishnu Patel
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
| | | | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Abstract
The last half century has seen extraordinary advances in the field of cardiology, including innovations in medications, diagnostic modalities, and therapeutics. Even so, cardiovascular disease remains the leading cause of morbidity and mortality globally, with suboptimal quality of care, inconsistent health outcomes, and unsustainable costs. It is clear that cardiovascular medicine must undergo a digital transformation to enhance the delivery of quality care and to improve outcomes. To meet this need, the American College of Cardiology developed an innovation program focused on the digital transformation of cardiovascular care, with the goal of improving heart health for individuals and populations.
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Affiliation(s)
| | - Rashmee U Shah
- UNIVERSITY OF UTAH SCHOOL OF MEDICINE, SALT LAKE CITY, UTAH
| | - Regina S Druz
- ST. FRANCIS HOSPITAL, CATHOLIC HEALTH SERVICES OF LONG ISLAND, ROSLYN, NEW YORK
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Hadaegh F, Asgari S, Moosaie F, Orangi M, Sarvghadi F, Khalili D, Azizi F. The risk and added values of the atherosclerotic cardiovascular risk enhancers on prediction of cardiovascular events: Tehran lipid and glucose study. J Transl Med 2021; 19:25. [PMID: 33407576 PMCID: PMC7789723 DOI: 10.1186/s12967-020-02686-1] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/21/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In 2013 American College of Cardiology and the American Heart Association released a guideline on the management of atherosclerotic cardiovascular disease (ASCVD) including a composite of death from CVD, non-fatal myocardial infarction, or non-fatal stroke (hard CVD). This guideline recommended a risk score that was calculated using pooled cohort equations (ASCVD-PCE). The guideline was updated in 2018/2019 and further risk discussion was suggested for deciding whether to continue or initiate statin therapy among non-diabetic individuals with ASCVD-PCE score ranged 5-20%. They recommended a risk discussion with considering risk enhancing factors (ASCVD-REFs) including family history of premature CVD, chronic kidney disease, triglycerides ≥ 175 mg/dl, low-density lipoprotein cholesterol (LDL-C) ≥ 160 mg/dl, metabolic syndrome (Mets), and for women premature menopause, and hypertensive disorders of pregnancy (HDP). In the current study, we aimed to examine the predictability of recommended ASCVD-REFs on incident hard CVD in non-diabetic individuals with LDL-C 70-189 mg/dl, with ASCVD-PCE risk 5-20% during 10 and 15-year follow-up. METHODS Among a total of 3546 non-diabetic individuals aged 40-75 years, after excluding those with ASCVD-PCE score < 5% and ≥ 20% (n = 2342), 1204 individuals (women = 332) were included. The univariable and multivariable (further adjusted for ASCVD-PCE) Cox regression analysis were used to evaluate the association of each potential ASCVD-REFs with hard CVD. Additionnaly, the role of different components of Mets and a history of gestational diabetes (GDM)/macrosomia was also examined. The predictive ability of each significant ASCVD-REFs, then was evaluated by the discrimination accuracy and risk reclassification index. RESULTS During the 10-year follow-up, 73 hard CVD events occurred. Although in univariable analysis, high blood pressure (BP) component of Mets, GDM/macrosomia, and HDP remained as significant ASCVD-REFs, in the multivariable analysis, only the history of HDP (5.35 (1.22-23.38)) and GDM/macrosomia (3.18 (1.05-9.65)) showed independent risks. During the 15-year follow-up, Mets (1.47 (1.05-2.06)) and its components of high waist circumference (1.40 (1.0-1.95)) and high BP (1.52 (1.07-2.15)) significantly increased the risk. These ASCVD-REFs did not improve discrimination or predictive ability. CONCLUSIONS In a decade follow-up, only conditions specific for women and in longer follow-up, the presence of Mets perse, and its components of high WC and high BP were shown as significant ASCVD-REFs.
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Affiliation(s)
- Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran.
| | - Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | | | - Meysam Orangi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Farzaneh Sarvghadi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
- Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Leucker TM. Highlights from the first ever virtual American College of Cardiology World Congress of Cardiology 2020 (ACC.20/WCC). Cardiovasc Res 2020; 116:e75-e77. [PMID: 32406489 DOI: 10.1093/cvr/cvaa099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thorsten M Leucker
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Blalock 547 600 N. Wolfe Street, Baltimore, MD 21287, USA
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Abstract
The use of the internet for health advice and information has burgeoned over recent years. This corresponds with an increasing number of people living with heart failure and, in the context of a greater focus on patient engagement, producing accurate online health information is becoming vitally important. To help meet this need, major cardiology societies have designed dedicated, patient-specific areas on their websites. This article aims to provide an overview of the patient information resources from three main professional societies: the European Society of Cardiology, American Heart Association and American College of Cardiology. A summary of the content of these dedicated websites and two smartphone apps is provided, along with a brief look into the future role of these technologies and resources in supporting both patients and their clinicians in the management of heart failure.
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Affiliation(s)
- Nida Ahmed
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Sabahat Ahmed
- GKT School of Medical Education, King's College London London, UK
| | - Julia Grapsa
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital London, UK
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Affiliation(s)
- Henry Seligman
- National Heart and Lung Institute, Imperial College London, United Kingdom (H.S., A.N., D.F.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (H.S., A.N., D.F.)
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Australia (A.T.-P.)
| | - Alexandra Nowbar
- National Heart and Lung Institute, Imperial College London, United Kingdom (H.S., A.N., D.F.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (H.S., A.N., D.F.)
| | - Darrel Francis
- National Heart and Lung Institute, Imperial College London, United Kingdom (H.S., A.N., D.F.)
- Imperial College Healthcare NHS Trust, London, United Kingdom (H.S., A.N., D.F.)
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Hauspurg A, Parry S, Mercer BM, Grobman W, Hatfield T, Silver RM, Parker CB, Haas DM, Iams JD, Saade GR, Wapner RJ, Reddy UM, Simhan H. Blood pressure trajectory and category and risk of hypertensive disorders of pregnancy in nulliparous women. Am J Obstet Gynecol 2019; 221:277.e1-277.e8. [PMID: 31255629 PMCID: PMC6732036 DOI: 10.1016/j.ajog.2019.06.031] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Recently updated American College of Cardiology/ American Heart Association (ACC/AHA) guidelines redefine blood pressure categories as stage 1 hypertension (systolic, 130-139 mm Hg or diastolic, 80-89 mm Hg), elevated (systolic, 120-129 mm Hg and diastolic, <80 mm Hg), and normal (<120/<80 mm Hg), but their relevance to an obstetric population is uncertain. OBJECTIVE We sought to evaluate the risk of gestational hypertension or preeclampsia based on early pregnancy blood pressure category and trajectory. STUDY DESIGN We utilized data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort, a prospective observational study of nulliparous women with singleton pregnancies conducted at 8 clinical sites between 2010 and 2014. Women included in this analysis had no known history of prepregnancy hypertension (blood pressure, ≥140/90 mm Hg) or diabetes. We compared the frequency of hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension, among women based on ACC/AHA blood pressure category at a first-trimester study visit and blood pressure trajectory between study visits in the first and second trimesters. Blood pressure trajectories were categorized based on blood pressure difference between visits 1 and 2 as stable (<5 mm Hg difference), upward (≥5 mm Hg), or downward (≤-5 mm Hg). Associations of blood pressure category and trajectory with preeclampsia and gestational hypertension were assessed via univariate analysis and multinomial logistic regression analysis with covariates identified a priori. RESULTS A total of 8899 women were included in the analysis. Study visit 1 occurred at a mean gestational age of 11.6 ± 1.5 weeks and study visit 2 at a mean gestational age of 19.0 ± 1.6 weeks. First-trimester blood pressure category was significantly associated with both preeclampsia and gestational hypertension, with increasing blood pressure category associated with a higher risk of all hypertensive disorders of pregnancy. Elevated blood pressure was associated with an adjusted relative risk of 1.54 (95% confidence interval, 1.18-2.02) and stage 1 hypertension was associated with adjusted relative risk of 2.16 (95% confidence interval, 1.31-3.57) of any hypertensive disorder of pregnancy. Stage 1 hypertension was associated with the highest risk of preeclampsia with severe features, with an adjusted relative risk of 2.48 (95% confidence interval, 1.38-8.74). Both systolic and diastolic blood pressure trajectories were also significantly associated with the risk of hypertensive disorders of pregnancy independent of blood pressure category (P < .001). Women with a blood pressure categorized as normal and with an upward systolic trajectory had a 41% increased risk of any hypertensive disorder of pregnancy (adjusted relative risk, 1.41; 95% confidence interval, 1.20-1.65) compared to women with a downward systolic trajectory. CONCLUSION In nulliparous women, blood pressure category and trajectory in early pregnancy are independently associated with risk of preeclampsia and gestational hypertension. Our study demonstrates that blood pressure categories with lower thresholds than those traditionally used to identify individuals as hypertensive may identify more women at risk for preeclampsia and gestational hypertension.
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Affiliation(s)
- Alisse Hauspurg
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian M Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, Ohio
| | - William Grobman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
| | - Tamera Hatfield
- Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, California
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | | | - David M Haas
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Jay D Iams
- Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio
| | - George R Saade
- University of Texas Medical Branch, University of Texas, Galveston, Texas
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Hyagriv Simhan
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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16
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Kalra A, Bhatt DL, Wei J, Anderson KL, Rykowski S, Kerkar PG, Kumar G, Maddox TM, Oetgen WJ, Virani SS. Electronic health records and outpatient cardiovascular disease care delivery: Insights from the American College of Cardiology's PINNACLE India Quality Improvement Program (PIQIP). Indian Heart J 2018; 70:750-752. [PMID: 30392517 PMCID: PMC6204447 DOI: 10.1016/j.ihj.2018.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 12/17/2017] [Accepted: 03/04/2018] [Indexed: 11/17/2022] Open
Abstract
Background There has been a push toward implementation of electronic health records (EHRs) in federally-funded hospitals under the current policies initiated by the Indian government, with a lack of evidence supporting their adoption. We analyzed data from the American College of Cardiology’s PINNACLE (Practice Innovation and Clinical Excellence) India Quality Improvement Program (PIQIP) to evaluate the association between EHR use and quality of cardiovascular disease care in India. Methods and Results Between 2011–2016, we collected data on performance measures for patients with coronary artery disease (CAD), heart failure (HF) and atrial fibrillation (AF) among 17 participating practices in PIQIP. There were 19,035 patients with CAD, 9,373 patients with HF, and 1,127 patients with AF. Documentation of co-morbidity burden in patients with CAD was lower among practices with EHR—hypertension (49.8% vs. 52.1%, p = 0.003), diabetes (34.9% vs. 38.3%, p < 0.001), and hyperlipidemia (0.2 vs. 3.9%, p < 0.001). On the contrary, documentation of medication prescription was higher in CAD patients seen at practices with EHR—aspirin (63.2% vs. 17.8%, p < 0.001), clopidogrel (41.7% vs. 27.4%, p < 0.001), beta-blockers (61.4% vs. 9.8%, p < 0.001), and ACE-i or ARBs (53.9% vs. 16.4%, p < 0.001). Similarly, documentation of receipt of beta-blockers (43.8% vs. 10.7%, p < 0.001), ACE-i or ARBs (40.8% vs. 16.1%, p < 0.001), and beta-blockers + ACE-i or ARBs (36.4% vs. 3.6%, p < 0.001) was also significantly higher in patients with HF seen at practices with EHR. Among patients with AF, documentation of oral anticoagulation use was significantly higher among EHR practices—warfarin (42.5% vs. 26.1%, p < 0.001). Conclusions Documentation of receipt of guideline-directed medical therapy in CAD, HF, and AF was significantly higher in practices with EHRs in India compared with sites without EHRs. Our findings shed a spotlight on the value of EHRs in future health care policy-making in India with regard to widespread adoption of EHRs in primary and advanced specialty care settings across public and private sectors.
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Affiliation(s)
- Ankur Kalra
- Division of Cardiology, Department of Medicine, Kalra Hospital SRCNC (Sri Ram Cardio-thoracic and Neurosciences Centre) Pvt. Ltd., New Delhi, India; Division of Cardiovascular Medicine, Department of Medicine, Case Western Reserve University School of Medicine, United States
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, United States
| | - Jessica Wei
- American College of Cardiology Foundation, Washington, DC, United States
| | - Karen L Anderson
- American College of Cardiology Foundation, Washington, DC, United States
| | - Stefan Rykowski
- American College of Cardiology Foundation, Washington, DC, United States
| | - Prafulla G Kerkar
- King Edward VII Memorial Hospital and Seth G S Medical College, Mumbai, India; Asian Heart Institute and Research Center, Mumbai, India
| | | | - Thomas M Maddox
- Veterans Affairs Eastern Colorado Health Care System, United States; University of Colorado School of Medicine, United States; Colorado Cardiovascular Outcomes Research Consortium, Denver, CO, United States
| | - William J Oetgen
- American College of Cardiology Foundation, Washington, DC, United States
| | - Salim S Virani
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States; Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, United States; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States.
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17
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Hashimoto T, Ako J. Report of the Annual Scientific Session of the American College of Cardiology (ACC) 2018, Orlando. Circ J 2018; 82:1491-1496. [PMID: 29709996 DOI: 10.1253/circj.cj-18-0405] [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] [Indexed: 11/09/2022]
Abstract
The 67thAnnual Scientific Session and Expo of the American College of Cardiology (ACC) were held at the Orange County Convention Center, Orlando, from March 10-12, 2018. This meeting offered 2,700 accepted abstracts presented in oral and poster sessions by 2,100 experts and 37 Late-Breaking Clinical Trials and Featured Clinical Research presentations. This report introduces the key presentations and highlights from the ACC 2018 Scientific Session.
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Affiliation(s)
- Takuya Hashimoto
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
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18
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Evans AS, Weiner M, Patel PA, Baron EL, Gutsche JT, Jayaraman A, Renew JR, Martin AK, Fritz AV, Gordon EK, Riha H, Patel S, Ghadimi K, Guelaff E, Feinman JW, Dashell J, Munroe R, Lauter D, Weiss SJ, Silvay G, Augoustides JG, Ramakrishna H. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2017. J Cardiothorac Vasc Anesth 2017; 32:1-13. [PMID: 29174660 DOI: 10.1053/j.jvca.2017.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 10/08/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Adam S Evans
- Division of Cardiothoracic Anesthesiology, Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Menachem Weiner
- Division of Cardiothoracic Anesthesiology, Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elvera L Baron
- Division of Cardiothoracic Anesthesiology, Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Arun Jayaraman
- Division of Cardiothoracic and Vascular Anesthesiology, Mayo Clinic, Scottsdale, AZ
| | - J Ross Renew
- Division of Cardiothoracic Anesthesiology, Mayo Clinic, Jacksonville, FL
| | - Archer K Martin
- Division of Cardiothoracic Anesthesiology, Mayo Clinic, Jacksonville, FL
| | - Ashley V Fritz
- Division of Cardiothoracic Anesthesiology, Mayo Clinic, Jacksonville, FL
| | - Emily K Gordon
- Cardiovascular and Thoracic Section, Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hynek Riha
- Cardiothoracic Anesthesiology and Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Saumil Patel
- Cardiovascular and Thoracic Section, Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kamrouz Ghadimi
- Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care, Duke University, Durham, NC
| | - Eric Guelaff
- Cardiovascular and Thoracic Section, Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Cardiovascular and Thoracic Section, Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jillian Dashell
- Cardiovascular and Thoracic Section, Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ray Munroe
- Cardiovascular and Thoracic Section, Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Derek Lauter
- Cardiovascular and Thoracic Section, Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - George Silvay
- Division of Cardiothoracic Anesthesiology, Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - John G Augoustides
- Cardiovascular and Thoracic Section, Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Harish Ramakrishna
- Division of Cardiothoracic and Vascular Anesthesiology, Mayo Clinic, Scottsdale, AZ
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19
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Fernando RJ, Johnson SD, Augoustides JG, Patel PA, Gutsche JT, Dashiell JM, Feinman JW, Zhou E, Weiss SJ, Goldhammer JE, Panikkath PV, Gerstein NS. Simultaneous Right-Sided and Left-Sided Infective Endocarditis: Management Challenges in a Multidisciplinary Setting. J Cardiothorac Vasc Anesth 2017; 32:1041-1049. [PMID: 29249580 DOI: 10.1053/j.jvca.2017.07.031] [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: 07/21/2017] [Indexed: 02/08/2023]
Affiliation(s)
- Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest University School of Medicine, Winston Salem, NC
| | - Sean D Johnson
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest University School of Medicine, Winston Salem, NC
| | - John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jillian M Dashiell
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Zhou
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jordan E Goldhammer
- Adult Cardiothoracic Anesthesiology, Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Pramod V Panikkath
- Division of Cardiac Anesthesia, Department of Anesthesiology, University of New Mexico, Albuquerque, NM
| | - Neal S Gerstein
- Division of Cardiac Anesthesia, Department of Anesthesiology, University of New Mexico, Albuquerque, NM
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20
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Abstract
The 66thAnnual Scientific Sessions and Expo of the American College of Cardiology (ACC) were held at the Walter E. Washington Convention Center, Washington DC, from March 17thto 19th, 2017. This meeting offered 23 Late-Breaking Clinical Trial (LBCT) presentations, 17 Featured Clinical Research presentations with and without LBCT, and 2,572 abstracts presented in oral and poster sessions by over 2,000 experts. This report presents the highlights of this meeting, including the opening showcase, several important LBCTs and some international joint symposiums.
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Affiliation(s)
- Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
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21
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Konstantinov VO. [The Role of non-Statin Therapy for Lowering the Concentration of low-Density Lipoprotein Cholesterol and Reducing the Risk of Developing Atherosclerotic Cardiovascular Complications]. Kardiologiia 2017; 57:68-72. [PMID: 28762924] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The article provides comments on 2016 American College of Cardiology Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk. The reasons for publishing this document are discussed, in particular appearance of results of conducted during last 3 years clinical trials of new highly effective non-statin medications. The article contains descriptions of indications, contraindications to the use of these agents as of their possible side effects. The preferred order of their administration in combination with statins in different categories of patients is also presented.
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Affiliation(s)
- V O Konstantinov
- North-western State Medical University named after I.I. Mechnikov, St.-Petersburg, Russia
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22
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Ramakrishna H, Gutsche JT, Patel PA, Evans AS, Weiner M, Morozowich ST, Gordon EK, Riha H, Bracker J, Ghadimi K, Murphy S, Spitz W, MacKay E, Cios TJ, Malhotra AK, Baron E, Shaefi S, Fassl J, Weiss SJ, Silvay G, Augoustides JGT. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2016. J Cardiothorac Vasc Anesth 2016; 31:1-13. [PMID: 28041810 DOI: 10.1053/j.jvca.2016.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 10/05/2016] [Indexed: 12/11/2022]
Affiliation(s)
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Adam S Evans
- Department of Anesthesiology, Cleveland Clinic Florida, Weston, FL
| | - Menachem Weiner
- Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | | | - Emily K Gordon
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hynek Riha
- Cardiothoracic Anesthesiology and Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Joseph Bracker
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kamrouz Ghadimi
- Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care, Duke University, Durham, NC
| | - Sunberri Murphy
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Warren Spitz
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emily MacKay
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | - Elvera Baron
- Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Shahzad Shaefi
- Cardiothoracic Anesthesiology and Critical Care, Department of Anesthesiology, Harvard Medical School, Boston, MA
| | - Jens Fassl
- Cardiovascular and Thoracic Section, Department of Anesthesia and Intensive Care Medicine, University of Basel, Basel, Switzerland
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - George Silvay
- Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Kalra A, Glusenkamp N, Anderson K, Kalra RN, Kerkar PG, Kumar G, Maddox TM, Oetgen WJ, Virani SS. American College of Cardiology (ACC)'s PINNACLE India Quality Improvement Program (PIQIP)-Inception, progress and future direction: A report from the PIQIP Investigators. Indian Heart J 2016; 68 Suppl 3:S1-S4. [PMID: 28038717 PMCID: PMC5198880 DOI: 10.1016/j.ihj.2016.09.005] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 08/29/2016] [Accepted: 09/14/2016] [Indexed: 01/23/2023] Open
Abstract
Cardiovascular diseases have surpassed infectious disorders to become the leading cause of morbidity and mortality in India.1 A national-level registry comprehensively documenting the current-day prevalence of cardiovascular risk factors and disease burden among patients seeking care in the outpatient setting in India is currently non-existent. With a burgeoning urban population, the cardiovascular disease burden in India is set to skyrocket, with an estimated 18 million productive years of life lost by 2030.2 While there are limited quality improvement registries in India, for example, the Kerala acute coronary syndrome and Trivandrum heart failure registries, their focus is on in-patient care quality improvement, while the vast majority of patients with cardiovascular diseases worldwide, including India, interact with the health care system in the outpatient setting.3,4 Recognizing this unmet need, the American College of Cardiology partnered with local stakeholders in India to establish India's first outpatient cardiovascular disease performance measurement initiative in 2011, the PINNACLE (Practice Innovation and Clinical Excellence) India Quality Improvement Program (PIQIP).5 This manuscript discusses the inception of the PIQIP registry, the progress it has made and challenges thus far, and its future direction and the promise it holds for cardiovascular care quality improvement in India.
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Affiliation(s)
- Ankur Kalra
- Division of Cardiology, Department of Medicine, Kalra Hospital SRCNC (Sri Ram Cardio-Thoracic and Neurosciences Centre) Pvt. Ltd., New Delhi, India; Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States; Weill Cornell Medical College, New York, NY, United States; Safety, Quality, Informatics and Leadership, 2016-17, Harvard Medical School, Boston, MA, United States.
| | | | - Karen Anderson
- American College of Cardiology, Washington, DC, United States
| | - Ram N Kalra
- Division of Cardiology, Department of Medicine, Kalra Hospital SRCNC (Sri Ram Cardio-Thoracic and Neurosciences Centre) Pvt. Ltd., New Delhi, India
| | - Prafulla G Kerkar
- King Edward VII Memorial Hospital and Seth GS Medical College, Mumbai, India; Asian Heart Institute and Research Center, Mumbai, India
| | | | - Thomas M Maddox
- Veterans Affairs Eastern Colorado Health Care System, Denver, CO, United States; University of Colorado School of Medicine, Denver, CO, United States; Colorado Cardiovascular Outcomes Research Consortium, Denver, CO, United States
| | | | - Salim S Virani
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States; Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, United States; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
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24
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Kalra A, Pokharel Y, Hira RS, Risch S, Vicera V, Li Q, Kalra RN, Kerkar PG, Kumar G, Maddox TM, Oetgen WJ, Glusenkamp N, Turakhia MP, Virani SS. Cardiovascular Disease Performance Measures in the Outpatient Setting in India: Insights From the American College of Cardiology's PINNACLE India Quality Improvement Program (PIQIP). J Am Heart Assoc 2015; 4:JAHA.115.001910. [PMID: 25994444 PMCID: PMC4599418 DOI: 10.1161/jaha.115.001910] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND India has a growing burden of cardiovascular disease (CVD), yet data on the quality of outpatient care for patients with coronary artery disease, heart failure, and atrial fibrillation in India are very limited. We collected data on performance measures for 68 196 unique patients from 10 Indian cardiology outpatient departments from January 1, 2011, to February 5, 2014, in the American College of Cardiology's PINNACLE (Practice Innovation and Clinical Excellence) India Quality Improvement Program (PIQIP). PIQIP is India's first national outpatient CVD quality-improvement program. METHODS AND RESULTS In the PIQIP registry, we estimated the prevalence of CVD risk factors (hypertension, diabetes, dyslipidemia, and current tobacco use) and CVD among outpatients. We examined adherence with performance measures established by the American College of Cardiology, the American Heart Association, and the American Medical Association Physician Consortium for Performance Improvement for coronary artery disease, heart failure, and atrial fibrillation. There were a total of 68 196 patients (155 953 patient encounters), with a mean age of 50.6 years (SD 18.2 years). Hypertension was present in 29.7% of patients, followed by diabetes (14.9%), current tobacco use (7.6%), and dyslipidemia (6.5%). Coronary artery disease was present in 14.8%, heart failure was noted in 4.0%, and atrial fibrillation was present in 0.5% of patients. Among eligible patients, the reported use of medications was as follows: aspirin in 48.6%, clopidogrel in 37.1%, and statin-based lipid-lowering therapy in 50.6% of patients with coronary artery disease; RAAS (renin-angiotensin-aldosterone system) antagonist in 61.9% and beta-blockers in 58.1% of patients with heart failure; and oral anticoagulants in 37.0% of patients with atrial fibrillation. CONCLUSIONS This pilot study, initiated to improve outpatient CVD care in India, presents our preliminary results and barriers to data collection and demonstrates that such an initiative is feasible in a resource-limited environment. In addition, we attempted to outline areas for further improvement in outpatient CVD care delivery in India.
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Affiliation(s)
- Ankur Kalra
- Division of Cardiology, Department of Medicine, Kalra Hospital SRCNC (Sri Ram Cardio-thoracic & Neurosciences Centre) Pvt. Ltd., New Delhi, India (A.K., R.N.K.) Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN (A.K.) Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN (A.K.)
| | - Yashashwi Pokharel
- Department of Medicine, Baylor College of Medicine, Houston, TX (Y.P., R.S.H., S.S.V.)
| | - Ravi S Hira
- Department of Medicine, Baylor College of Medicine, Houston, TX (Y.P., R.S.H., S.S.V.)
| | - Samantha Risch
- American College of Cardiology Foundation, Washington, DC (S.R., V.V., Q.L., W.J.O., N.G.)
| | - Veronique Vicera
- American College of Cardiology Foundation, Washington, DC (S.R., V.V., Q.L., W.J.O., N.G.)
| | - Qiong Li
- American College of Cardiology Foundation, Washington, DC (S.R., V.V., Q.L., W.J.O., N.G.)
| | - Ram N Kalra
- Division of Cardiology, Department of Medicine, Kalra Hospital SRCNC (Sri Ram Cardio-thoracic & Neurosciences Centre) Pvt. Ltd., New Delhi, India (A.K., R.N.K.)
| | - Prafulla G Kerkar
- King Edward VII Memorial Hospital and Seth G S Medical College, Asian Heart Institute and Research Center, Mumbai, India (P.G.K.)
| | | | - Thomas M Maddox
- Veterans Affairs Eastern Colorado Health Care System, Denver, CO (T.M.M.) University of Colorado School of Medicine, Denver, CO (T.M.M.) Colorado Cardiovascular Outcomes Research Consortium, Denver, CO (T.M.M.)
| | - William J Oetgen
- American College of Cardiology Foundation, Washington, DC (S.R., V.V., Q.L., W.J.O., N.G.)
| | - Nathan Glusenkamp
- American College of Cardiology Foundation, Washington, DC (S.R., V.V., Q.L., W.J.O., N.G.)
| | - Mintu P Turakhia
- Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, Palo Alto, CA (M.P.T.)
| | - Salim S Virani
- Department of Medicine, Baylor College of Medicine, Houston, TX (Y.P., R.S.H., S.S.V.) Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Houston, TX (S.S.V.)
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Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, Matheny ME, Kosiborod M, Amin AP, Messenger JC, Rumsfeld JS, Spertus JA. Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC Cardiovasc Interv 2014; 7:1-9. [PMID: 24456715 DOI: 10.1016/j.jcin.2013.06.016] [Citation(s) in RCA: 423] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 06/06/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study sought to examine the contemporary incidence, predictors and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions. BACKGROUND Acute kidney injury (AKI) is a serious and potentially preventable complication of percutaneous coronary interventions (PCIs) that is associated with adverse outcomes. The contemporary incidence, predictors, and outcomes of AKI are not well defined, and clarifying these can help identify high-risk patients for proactive prevention. METHODS A total of 985,737 consecutive patients underwent PCIs at 1,253 sites participating in the National Cardiovascular Data Registry Cath-PCI registry from June 2009 through June 2011. AKI was defined on the basis of changes in serum creatinine level in the hospital according to the Acute Kidney Injury Network (AKIN) criteria. Using multivariable regression analyses with generalized estimating equations, we identified patient characteristics associated with AKI. RESULTS Overall, 69,658 (7.1%) patients experienced AKI, with 3,005 (0.3%) requiring new dialysis. On multivariable analyses, the factors most strongly associated with development of AKI included ST-segment elevation myocardial infarction (STEMI) presentation (odds ratio [OR]: 2.60; 95% confidence interval [CI]: 2.53 to 2.67), severe chronic kidney disease (OR: 3.59; 95% CI: 3.47 to 3.71), and cardiogenic shock (OR: 2.92; 95% CI: 2.80 to 3.04). The in-hospital mortality rate was 9.7% for patients with AKI and 34% for those requiring dialysis compared with 0.5% for patients without AKI (p < 0.001). After multivariable adjustment, AKI (OR: 7.8; 95% CI: 7.4 to 8.1, p < 0.001) and dialysis (OR: 21.7; 95% CI: 19.6 to 24.1; p < 0.001) remained independent predictors of in-hospital mortality. CONCLUSIONS Approximately 7% of patients undergoing a PCI experience AKI, which is strongly associated with in-hospital mortality. Defining strategies to minimize the risk of AKI in patients undergoing PCI are needed to improve the safety and outcomes of the procedure.
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Affiliation(s)
- Thomas T Tsai
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; University of Colorado Denver, Denver, Colorado.
| | - Uptal D Patel
- Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina
| | - Tara I Chang
- Stanford School of Medicine, Palo Alto, California
| | - Kevin F Kennedy
- Mid America Heart Institute, Kansas City, Missouri; University of Missouri at Kansas City School of Medicine, Kansas City, Missouri
| | | | - Michael E Matheny
- Tennessee Valley Health System VA, Nashville, Tennessee; Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mikhail Kosiborod
- Mid America Heart Institute, Kansas City, Missouri; University of Missouri at Kansas City School of Medicine, Kansas City, Missouri
| | - Amit P Amin
- Mid America Heart Institute, Kansas City, Missouri; University of Missouri at Kansas City School of Medicine, Kansas City, Missouri
| | - John C Messenger
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - John S Rumsfeld
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; Denver VA Medical Center, Denver, Colorado
| | - John A Spertus
- Mid America Heart Institute, Kansas City, Missouri; University of Missouri at Kansas City School of Medicine, Kansas City, Missouri
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Mizuno N, Funabashi N, Takaoka H, Kobayashi Y. Percentage of poster and oral abstracts at the American College of Cardiology 58th Annual Scientific Session 2009 that achieved publication with their journal impact factors. Int J Cardiol 2013; 168:594-5. [PMID: 23484739 DOI: 10.1016/j.ijcard.2013.01.237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/18/2013] [Indexed: 11/20/2022]
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Opotowsky AR, Perlstein T, Landzberg MJ, Colan SD, O'Gara PT, Body SC, Ryan LF, Aranki S, Singh MN. A shifting approach to management of the thoracic aorta in bicuspid aortic valve. J Thorac Cardiovasc Surg 2012; 146:339-46. [PMID: 23142124 DOI: 10.1016/j.jtcvs.2012.10.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [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: 07/08/2012] [Revised: 09/21/2012] [Accepted: 10/16/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The scientific understanding of aortic dilation associated with bicuspid aortic valve (BAV) has evolved during the past 2 decades, along with improvements in diagnostic technology and surgical management. We aimed to evaluate secular trends and predictors of thoracic aortic surgery among patients with BAV in the United States. METHODS We used the 1998-2009 Nationwide Inpatient Sample, an administrative dataset representative of US hospital admissions, to identify hospitalizations for adults aged 18 years or more with BAV and aortic valve or thoracic aortic surgery. Covariates included age, gender, year, aortic dissection, endocarditis, thoracic aortic aneurysm, number of comorbidities, hospital teaching status and region, primary insurance, and concomitant coronary artery bypass surgery. RESULTS Between 1998 and 2009, 48,736 ± 3555 patients with BAV underwent aortic valve repair or replacement and 1679 ± 120 patients with BAV underwent isolated thoracic aortic surgery. The overall number of surgeries increased more than 3-fold, from 4556 ± 571 in 1998/1999 to 14,960 ± 2107 in 2008/2009 (P < .0001). The proportion of aortic valve repair or replacement including concomitant thoracic aortic surgery increased from 12.8% ± 1.4% in 1998/1999 to 28.5% ± 1.6% in 2008/2009, which mirrored an increasing proportion of patients with a diagnosis of thoracic aortic aneurysm. Mortality was equivalent for patients undergoing aortic valve repair or replacement with thoracic aortic surgery and those undergoing isolated aortic valve repair or replacement (1.8% ± 0.3% vs 1.5% ± 0.2%; multivariable odds ratio, 1.02; 95% confidence interval, 0.67-1.57), with decreasing mortality over the study period (from 2.5% ± 0.6% in 1998/1999 to 1.5% ± 0.2% in 2008/2009; multivariable odds ratio per 2-year increment, 0.89; 95% confidence interval, 0.81-0.99; P = .03). Total charges for BAV surgical hospitalizations increased more than 7.5-fold from approximately $156 million in 1998 to $1.2 billion in 2009 (inflation-adjusted 2009 dollars). CONCLUSIONS There was a marked increase in the use of thoracic aortic surgery among patients with BAV.
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Pepine CJ. Creating and adopting an ACC ethical code of conduct. J Am Coll Cardiol 2003; 42:2028-9. [PMID: 14662269 DOI: 10.1016/j.jacc.2003.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Conley RB. AMA's gift guidelines. Food Drug Cosmet Med Device Law Dig 2001; 10:19-27. [PMID: 11654936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Blankenship JC, Bateman TM, Haines DE, Pearlman AS, Schoenfeld MH, Sigel CJ, Wolk MJ, Wood DL. ACC expert consensus document on ethical coding and billing practices for cardiovascular medicine specialists. American College of Cardiology. J Am Coll Cardiol 1999; 33:1076-86. [PMID: 10091839 DOI: 10.1016/s0735-1097(99)00015-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Winters WL, McIntosh HD, Cheitlin MD, Elon R, Graboys TB, King SB, Murdaugh C, Orentlicher D, Ports TA, Rainer WG. Ethics in cardiovascular medicine. Task Force II: The relation of cardiovascular specialists to patients, other physicians and physician-owned organizations. J Am Coll Cardiol 1990; 16:11-6. [PMID: 2358584 DOI: 10.1016/0735-1097(90)90448-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
1. The American College of Cardiology acknowledges the continuum of changing societal, medical and economic perspectives affecting traditional medical ethics. Primacy of patient responsibility remains paramount to the cardiovascular specialist who at the same time should participate in the development of broader societal programs. 2. Medical decisions should be freely and jointly formulated by the patient and the cardiovascular specialist with appropriate sensitivity to such matters as mental competence, pertinent medical information and standards of care, sufficient time for contemplation, informed consent, patient right of refusal, physician right to refuse to provide inappropriate care and the right of patient, physician or third party payer to seek consultation or additional opinions. 3. The cardiovascular specialist should make a special effort to clarify and document patient preferences regarding end-of-life treatment through some form of advance directive. 4. The cardiovascular specialist bears a moral obligation to provide medical care to any patient who is HIV positive or has AIDS. 5. A conflict of interest occurs when a cardiovascular specialist places personal or financial interest ahead of the welfare and health of a patient. Professional accountability should be established through local or regional peer review. 6. The American College of Cardiology encourages and supports a renewed dedication to the principles of medical ethics, particularly in the field of cardiovascular disease. Cardiovascular specialists are encouraged to participate in the promulgation of medical ethics by teaching and by example, individually and with others.
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Parmley WW, Schlant RC, Crelinsten GL, Engelhardt HT, Klocke FJ, Siegler M. Ethics in cardiovascular medicine. Task Force I: Background and general principles. J Am Coll Cardiol 1990; 16:7-10. [PMID: 2358607 DOI: 10.1016/0735-1097(90)90447-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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21st Bethesda Conference: Ethics in cardiovascular medicine. October 5-6, 1989, Bethesda, Maryland. J Am Coll Cardiol 1990; 16:1-36. [PMID: 2358581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Ryan TJ, Graham TP, Annas GJ, DeMaria AN, Fost NC, Fuster V, Harvey JC, Levinsky NG, McCullough LB, Rettig RA. Ethics in cardiovascular medicine. Task Force III: Perspective on the allocation of limited resources in cardiovascular medicine. J Am Coll Cardiol 1990; 16:17-23. [PMID: 2113544 DOI: 10.1016/0735-1097(90)90449-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Dustan HP, Hamilton MP, McCullough LB, Page LB. Sociopolitical and ethical considerations in the treatment of cardiovascular disease in the elderly. J Am Coll Cardiol 1987; 10:14A-7A. [PMID: 11644009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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