Circulation-Cardiovascular Quality and Outcomes最新文献

{"title":"Posttraumatic Stress Disorder and the Risk of Heart Failure Hospitalizations Among Individuals With Coronary Artery Disease.","authors":"Zakaria Almuwaqqat, Chang Liu, Yi-An Ko, Lisa Elon, Kasra Moazzami, Maggie Wang, Nancy Murrah, Lucy Shallenberger, Tené T Lewis, Amit J Shah, Paolo Raggi, J Douglas Bremner, Arshed A Quyyumi, Viola Vaccarino","doi":"10.1161/CIRCOUTCOMES.124.011040","DOIUrl":"10.1161/CIRCOUTCOMES.124.011040","url":null,"abstract":"<p><strong>Background: </strong>Posttraumatic stress disorder (PTSD) is associated with maladaptive dysregulation of stress response systems, which could lead to an increased risk of heart failure. We investigated whether PTSD was independently associated with first and recurrent heart failure hospitalizations in the setting of coronary artery disease.</p><p><strong>Methods: </strong>Individuals with stable coronary artery disease and without heart failure at baseline were enrolled in 2 parallel prospective cohort studies in metropolitan Atlanta, GA. Participants underwent a structured clinical interview to assess their lifetime history of PTSD. Current PTSD symptoms were assessed using the PTSD symptom checklist. Participants were followed up for a median time of 4.9 years. The primary end point was first or recurrent hospitalization for heart failure. Secondary end points included cardiovascular death and nonfatal myocardial infarction with and without hospitalization for heart failure. Survival analysis for repeated events was used to assess the association of PTSD with adverse events.</p><p><strong>Results: </strong>We studied 736 individuals with a mean age of 60±10 years; 36% were Black, and 35% were women. In total, 69 (9.4%) patients met the criteria for PTSD. Having a PTSD diagnosis was associated with the primary end point of first or recurrent heart failure hospitalizations, with a hazard ratio of 4.4 (95% CI, 2.6-7.3). The results were minimally attenuated after adjusting for demographic and clinical factors (hazard ratio, 3.7 [95% CI, 2.1-6.3]). Similarly, a 10-point increase in the PTSD symptom checklist score was associated with a 30% (95% CI, 10%-50%) increase in heart failure hospitalizations. PTSD was not associated with an end point of cardiovascular death or nonfatal myocardial infarction, which excluded hospitalizations due to heart failure.</p><p><strong>Conclusions: </strong>Among patients with coronary artery disease, PTSD is associated with incident and recurrent heart failure hospitalizations. Future research is needed to investigate whether PTSD management can reduce the risk of heart failure.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011040"},"PeriodicalIF":6.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11652216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Female-Specific Risk Factors in Cardiovascular Disease: Important or Superfluous?","authors":"Setareh Salehi Omran, Michelle Leppert","doi":"10.1161/CIRCOUTCOMES.124.011666","DOIUrl":"10.1161/CIRCOUTCOMES.124.011666","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011666"},"PeriodicalIF":6.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Significance and Associations of Neural Network-Derived Electrocardiographic Features.","authors":"Arunashis Sau, Antônio H Ribeiro, Kathryn A McGurk, Libor Pastika, Nikesh Bajaj, Mehak Gurnani, Ewa Sieliwonczyk, Konstantinos Patlatzoglou, Maddalena Ardissino, Jun Yu Chen, Huiyi Wu, Xili Shi, Katerina Hnatkova, Sean L Zheng, Annie Britton, Martin Shipley, Irena Andršová, Tomáš Novotný, Ester C Sabino, Luana Giatti, Sandhi M Barreto, Jonathan W Waks, Daniel B Kramer, Danilo Mandic, Nicholas S Peters, Declan P O'Regan, Marek Malik, James S Ware, Antonio Luiz P Ribeiro, Fu Siong Ng","doi":"10.1161/CIRCOUTCOMES.123.010602","DOIUrl":"10.1161/CIRCOUTCOMES.123.010602","url":null,"abstract":"<p><strong>Background: </strong>Subtle, prognostically important ECG features may not be apparent to physicians. In the course of supervised machine learning, thousands of ECG features are identified. These are not limited to conventional ECG parameters and morphology. We aimed to investigate whether neural network-derived ECG features could be used to predict future cardiovascular disease and mortality and have phenotypic and genotypic associations.</p><p><strong>Methods: </strong>We extracted 5120 neural network-derived ECG features from an artificial intelligence-enabled ECG model trained for 6 simple diagnoses and applied unsupervised machine learning to identify 3 phenogroups. Using the identified phenogroups, we externally validated our findings in 5 diverse cohorts from the United States, Brazil, and the United Kingdom. Data were collected between 2000 and 2023.</p><p><strong>Results: </strong>In total, 1 808 584 patients were included in this study. In the derivation cohort, the 3 phenogroups had significantly different mortality profiles. After adjusting for known covariates, phenogroup B had a 20% increase in long-term mortality compared with phenogroup A (hazard ratio, 1.20 [95% CI, 1.17-1.23]; <i>P</i><0.0001; phenogroup A mortality, 2.2%; phenogroup B mortality, 6.1%). In univariate analyses, we found phenogroup B had a significantly greater risk of mortality in all cohorts (log-rank <i>P</i><0.01 in all 5 cohorts). Phenome-wide association study showed phenogroup B had a higher rate of future atrial fibrillation (odds ratio, 2.89; <i>P</i><0.00001), ventricular tachycardia (odds ratio, 2.00; <i>P</i><0.00001), ischemic heart disease (odds ratio, 1.44; <i>P</i><0.00001), and cardiomyopathy (odds ratio, 2.04; <i>P</i><0.00001). A single-trait genome-wide association study yielded 4 loci. <i>SCN10A</i>, <i>SCN5A</i>, and <i>CAV1</i> have roles in cardiac conduction and arrhythmia. <i>ARHGAP24</i> does not have a clear cardiac role and may be a novel target.</p><p><strong>Conclusions: </strong>Neural network-derived ECG features can be used to predict all-cause mortality and future cardiovascular diseases. We have identified biologically plausible and novel phenotypic and genotypic associations that describe mechanisms for the increased risk identified.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e010602"},"PeriodicalIF":6.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7616866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicenter Analysis of the Relationship Between Operative Team Familiarity and Safety and Efficiency Outcomes in Cardiac Surgery.","authors":"Tyler M Bauer, Allison M Janda, Xiaoting Wu, Carol Ling, Douglas C Shook, Gabriela Querejeta-Roca, Kenneth G Shann, Trevor Smith, Michael R Mathis, Tsuyoshi Kaneko, Thoralf M Sundt, Robert B Schonberger, Steven D Harrington, Roger D Dias, Francis D Pagani, Donald S Likosky, Steven Yule","doi":"10.1161/CIRCOUTCOMES.124.011065","DOIUrl":"10.1161/CIRCOUTCOMES.124.011065","url":null,"abstract":"<p><strong>Background: </strong>Safety in cardiac surgical procedures is predicated on effective team dynamics. This study associated operative team familiarity (ie, the extent of clinical collaboration among surgical team members) with procedural efficiency and Society of Thoracic Surgeons (STS) adjudicated patient outcomes.</p><p><strong>Methods: </strong>Institutional STS adult cardiac surgery registry and electronic health record data from 2014 to 2021 were evaluated across 3 quaternary hospitals. Team familiarity was defined as the mean number of cardiac operations performed by surgeon-anesthesiologist, surgeon-perfusionist, and anesthesiologist-perfusionist dyads within 1 year of the operation. The primary outcomes were (1) safety, measured by the STS' composite major morbidity and operative mortality measure, and (2) procedural efficiency, assessed by cardiopulmonary bypass duration. Team familiarity was stratified by terciles (low, moderate, and high) for crude analyses and analyzed continuously for adjusted analyses. Multivariable logistic and linear regression models were used to assess the association between team familiarity and outcomes.</p><p><strong>Results: </strong>Team familiarity was calculated for 13 581 operations. The median (interquartile range) patient age was 64 (55-72) years, and 31.9% (4328/13 581) were women. Terciles of team familiarity were defined as low (<6.00 average shared operations), moderate (6.00-9.67), and high (>9.67). Teams in lower terciles had higher observed STS morbidity and mortality rates (low, 17.9%; moderate, 18.0%; high, 16.0%; <i>P</i>=0.02) and longer median cardiopulmonary bypass duration (low, 137 minutes; moderate, 131 minutes; high, 118 minutes; <i>P</i><0.001). After risk adjustment, team familiarity was not significantly associated with STS morbidity and mortality (estimate, -0.001 [95% CI, -0.998 to 0.997]) but was inversely associated with cardiopulmonary bypass duration (estimate, -2.02 minutes per 1 unit increase in team familiarity [95% CI, -2.30 to -1.75]).</p><p><strong>Conclusions: </strong>Increased team familiarity was not associated with STS morbidity and mortality but was inversely correlated with cardiopulmonary bypass duration, demonstrating potential benefit. Interventions aimed at improving team familiarity among operative teams may increase procedural efficiency.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":"17 12","pages":"e011065"},"PeriodicalIF":6.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Primary Care in Achieving Life's Essential 8: A Scientific Statement From the American Heart Association.","authors":"Madeline R Sterling, Erin P Ferranti, Beverly B Green, Nathalie Moise, Randi Foraker, Soohyun Nam, Stephen P Juraschek, Cheryl A M Anderson, Paul St Laurent, Jeremy Sussman","doi":"10.1161/HCQ.0000000000000134","DOIUrl":"10.1161/HCQ.0000000000000134","url":null,"abstract":"<p><p>To reduce morbidity and mortality rates of cardiovascular disease, an urgent need exists to improve cardiovascular health among US adults. In 2022, the American Heart Association issued Life's Essential 8, which identifies and defines 8 health behaviors and factors that, when optimized through a combination of primary prevention, risk factor management, and effective treatments, can promote ideal cardiovascular health. Because of its central role in patient care across the life span, primary care is in a strategic position to promote Life's Essential 8 and improve cardiovascular health in the United States. High-quality primary care is person-centered, team-based, community-aligned, and designed to provide affordable optimized health care. The purpose of this scientific statement from the American Heart Association is to provide evidence-based guidance on how primary care, as a field and practice, can support patients in implementing Life's Essential 8. The scientific statement aims to describe the role and functions of primary care, provide evidence for how primary care can be leveraged to promote Life's Essential 8, examine the role of primary care in providing access to care and mitigating disparities in cardiovascular health, review challenges in primary care, and propose solutions to address challenges in achieving Life's Essential 8.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e000134"},"PeriodicalIF":6.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Life in Subcutaneous or Transvenous Implantable Cardioverter-Defibrillator Patients: A Secondary Analysis of the PRAETORIAN Trial.","authors":"Reinoud E Knops, Jolien A de Veld, Abdul Ghani, Lucas V A Boersma, Juergen Kuschyk, Mikhael F El Chami, Hendrik Bonnemeier, Elijah R Behr, Tom F Brouwer, Stefan Kääb, Suneet Mittal, Shari Pepplinkhuizen, Anne-Floor B E Quast, Lonneke Smeding, Willeke van der Stuijt, Anouk de Weger, Nick R Bijsterveld, Sergio Richter, Marc A Brouwer, Joris R de Groot, Kirsten M Kooiman, Pier D Lambiase, Petr Neuzil, Kevin Vernooy, Marco Alings, Timothy R Betts, Frank A L E Bracke, Martin C Burke, Jonas S S G de Jong, David J Wright, Ward P J Jansen, Zachary I Whinnett, Peter Nordbeck, Michael Knaut, Berit T Philbert, Jurren M van Opstal, Alexandru B Chicos, Cornelis P Allaart, Alida E Borger van der Burg, Jose M Dizon, Marc A Miller, Dmitry Nemirovksy, Ralf Surber, Gaurav A Upadhyay, Jan G P Tijssen, Arthur A M Wilde, Louise R A Olde Nordkamp","doi":"10.1161/CIRCOUTCOMES.124.010822","DOIUrl":"10.1161/CIRCOUTCOMES.124.010822","url":null,"abstract":"<p><strong>Background: </strong>The subcutaneous implantable cardioverter-defibrillator (S-ICD) was developed to overcome the risk of lead-related complications associated with the transvenous implantable cardioverter-defibrillator (TV-ICD). In contrast to the TV-ICD, the S-ICD is a completely extrathoracic device. Subsequently, complications differ between these 2 implantable cardioverter-defibrillators, which might impact patient perceptions of the therapies. This prespecified secondary analysis of the PRAETORIAN trial evaluates differences in quality of life.</p><p><strong>Methods: </strong>The PRAETORIAN trial (A Prospective, Randomized Comparison of Subcutaneous and Transvenous Implantable Cardioverter Defibrillator Therapy) randomized patients with an implantable cardioverter-defibrillator indication, without the need for pacing to S-ICD or TV-ICD therapy. Two questionnaires were collected at baseline, discharge, 12 months, and 30 months. The Duke Activity Status Index measures cardiac-specific physical functioning, and the 36-Item Short Form Health Survey measures physical and mental well-being, with the subscales bodily pain and mental health being of interest in this analysis. Mann-Whitney <i>U</i> tests were used to compare study arms, and a mixed model was used to describe the questionnaire outcomes over time.</p><p><strong>Results: </strong>Patients were randomized to S-ICD (n=426) and TV-ICD (n=423). In the S-ICD group, 20% were women versus 19% in the TV-ICD group. The median age was 63 (interquartile range, 54-69) years in the S-ICD group versus 64 (interquartile range, 56-69) years in the TV-ICD group. There were no significant differences in the Duke Activity Status Index and 36-Item Short Form Health Survey subscales for bodily pain and mental health between the groups at any time point. Patients with a shock in the last 90 days had significantly lower scores for social functioning (<i>P</i>=0.008) and role limitations due to emotional problems (<i>P</i>=0.001) than patients without a shock, but this effect did not differ between treatment arms.</p><p><strong>Conclusions: </strong>In a large randomized cohort of patients with an S-ICD or TV-ICD, no difference in overall quality of life was observed. However, implantable cardioverter-defibrillator shocks resulted in a reduction in quality of life, regardless of the device type or appropriateness.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01296022.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":"17 11","pages":"e010822"},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Housing Insecurity and Cardiovascular Care: A Call to Action for Veteran Health.","authors":"Martine Webb, Nicholas K Brownell","doi":"10.1161/CIRCOUTCOMES.124.011530","DOIUrl":"10.1161/CIRCOUTCOMES.124.011530","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011530"},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Major Adverse Cardiovascular Outcomes in Families With MASLD: A Population-Based Multigenerational Cohort Study.","authors":"Fahim Ebrahimi, Ramin Ebrahimi, Hannes Hagström, Johan Sundström, Jiangwei Sun, David Bergman, Anders Forss, Jonas F Ludvigsson","doi":"10.1161/CIRCOUTCOMES.124.010912","DOIUrl":"10.1161/CIRCOUTCOMES.124.010912","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is a risk factor for cardiovascular disease. However, whether family members of individuals with MASLD also share an increased cardiovascular risk is unknown.</p><p><strong>Methods: </strong>We created a nationwide multigenerational cohort study identifying all family members of Swedish adults diagnosed with biopsy-proven MASLD (1969-2017) and of matched general population comparators (by age, sex, calendar year, and county of residence). We calculated incidence rates and used Cox models to calculate adjusted hazard ratios (aHRs) and 95% CIs for incident major adverse cardiovascular events (MACE), including acute myocardial infarction, stroke, hospitalization for heart failure, or cardiovascular death. Cox models were adjusted for education, country of birth, diabetes, hypertension, obesity, dyslipidemia, chronic kidney disease, chronic obstructive pulmonary disease, and the Charlson comorbidity index.</p><p><strong>Results: </strong>We identified 22 267 MASLD first-degree relatives (FDRs; parents, siblings, and offspring) and 5687 MASLD spouses, as well as 118 056 comparator FDRs and 29 389 comparator spouses without earlier cardiovascular disease. Overall, the mean age was 41.8 years (SD, 18.0), and 51.5% were females. Over a median of 24.6 years, the incidence rate for MACE was higher in MASLD FDRs than in comparator FDRs (65.0 versus 62.5/10 000 person-years; aHR, 1.06 [95% CI, 1.01-1.11]). MASLD FDRs had higher rates of acute myocardial infarction (23.0 versus 20.9/10 000 person-years; aHR, 1.09 [95% CI, 1.01-1.18]) and cardiovascular death (aHR, 1.09 [95% CI, 1.01-1.18]). Across generations of FDRs, the risk of MACE was uniformly increased with no differences by relationship (ie, parents, siblings, and offspring; <i>P</i>_interaction>0.05). MASLD spouses were also at an increased risk of MACE (117.6 versus 103.5/10 000 person-years; aHR, 1.09 [95% CI, 1.01-1.18]).</p><p><strong>Conclusions: </strong>First-degree relatives of individuals with biopsy-proven MASLD are at slightly higher risk of incident MACE, but absolute risks do not support early screening for cardiovascular disease. Shared lifestyle factors may be the main contributors, as spouses of MASLD patients also had higher risks of MACE.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e010912"},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response by Heo et al to Letters Regarding Article, \"Adequacy of Dialysis and Incidence of Atrial Fibrillation in Patients Undergoing Hemodialysis\".","authors":"Ga Young Heo, Hyung Woo Kim","doi":"10.1161/CIRCOUTCOMES.124.011519","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011519","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":"17 11","pages":"e011519"},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying Pill Disutility Associated With Starting Versus Continuing Cardioprotective Medication: A Randomized Experiment.","authors":"Alexander Chaitoff, Julie C Lauffenburger, Nancy Haff, Katharina Tabea Jungo, Niteesh K Choudhry","doi":"10.1161/CIRCOUTCOMES.124.011069","DOIUrl":"10.1161/CIRCOUTCOMES.124.011069","url":null,"abstract":"<p><strong>Background: </strong>Quantifying patient-reported pill disutility is important for understanding the risk-benefit tradeoffs of taking medications. The objective of this study was to quantify and compare the pill disutility associated with starting a new medication and continuing an existing medication for cardiometabolic disease prevention in a sample of older adults in the United States.</p><p><strong>Methods: </strong>We enrolled adults aged ≥60 years from an online panel. Respondents completed a survey that included a 2-armed experiment that randomized them to either a starting or a continuing scenario in which they were instructed that their doctor recommended they start or continue, respectively, a daily medication that prevents heart attacks and strokes. Pill disutility was calculated using a time-tradeoff method with time willing to trade obtained via alternating dichotomous choice contingent valuation design. Pill disutility was described within each scenario overall and by subgroups and then compared across scenarios using the Kruskal-Wallis test and multivariable fractional logistic regression.</p><p><strong>Results: </strong>A total of 621 respondents with a mean age of 69 years were included in the final analysis. A majority were taking medications (n=84.5%, n=525) and had at least 1 chronic cardiometabolic disease (78.7%, n=489). Pill disutility associated with starting a new medication was 0.0662 (SD, 0.13), while pill disutility associated with continuing an existing medication was 0.0378 (SD, 0.10; <i>P</i><0.001). Participants randomized to the starting scenario had higher odds of higher pill disutility versus participants randomized to the continuing scenario in both multivariable testing (odds ratio, 1.66 [95% CI, 1.15-2.40]) and across subgroups.</p><p><strong>Conclusions: </strong>Pill disutility for a daily cardioprotective medication, when obtained from a sample of older adults utilizing rigorous ascertainment methods, is higher than previously reported, especially with regard to starting the medication. These represent the first estimates that can be used in cost-effectiveness modeling involving both prescribing and deprescribing.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":"17 11","pages":"e011069"},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}