Circulation-Cardiovascular Quality and Outcomes最新文献

{"title":"Associations of Social, Behavioral, and Clinical Factors With Sex Differences in Stroke Recurrence and Poststroke Mortality.","authors":"Chen Chen, Mathew J Reeves, Kevin He, Lewis B Morgenstern, Lynda D Lisabeth","doi":"10.1161/CIRCOUTCOMES.124.011082","DOIUrl":"10.1161/CIRCOUTCOMES.124.011082","url":null,"abstract":"<p><strong>Background: </strong>Few population-based studies have assessed sex differences in stroke recurrence. In addition, contributors to sex differences in recurrence and poststroke mortality, including social factors, are unclear. We investigated sex differences in these outcomes and the contribution of social, clinical, and behavioral factors to the sex differences.</p><p><strong>Methods: </strong>First-ever ischemic stroke cases identified from 2008 to 2019 from the population-based Brain Attack Surveillance in Corpus Christi Project in Texas were included and followed for recurrence and all-cause mortality through 2020. Sex differences in outcomes with and without adjustment for potential confounding factors, including social, behavioral, and clinical factors, were examined using Cox proportional hazard models. Factors that changed the log hazard ratio (HR) for sex by at least 10% after adjustment were identified as confounders/contributors. Final models were adjusted for all identified confounders.</p><p><strong>Results: </strong>Of 2326 participants (mean age, 68 years; 48% women; 57% Mexican American), over median follow-ups of 5.4 years for recurrence and 3.7 years for mortality, 274 recurrences and 965 deaths occurred. No significant sex differences in recurrence were noted in unadjusted (HR, 0.89 [95% CI, 0.70-1.13]), age-adjusted (HR, 0.92 [95% CI, 0.72-1.18]), or fully adjusted models (HR, 0.88 [95% CI, 0.67-1.16]). Although women had a higher crude mortality rate than men (HR, 1.22 [95% CI, 1.08-1.38]), this sex difference disappeared after age adjustment (HR, 0.91 [95% CI, 0.80-1.03]). Other factors contributing to the sex difference included education, marital status, prestroke depression, health behaviors, initial stroke severity, prestroke disability, comorbidities, atrial fibrillation, and coronary artery disease. After simultaneously adjusting for all identified confounders, women had lower poststroke mortality (HR, 0.79 [95% CI, 0.68-0.91]).</p><p><strong>Conclusions: </strong>Sex differences in stroke recurrence were not apparent. Women had a higher unadjusted poststroke mortality rate but lower adjusted mortality than men. Social and psychosocial factors, alongside clinical factors, primarily explained the sex disparity in poststroke mortality.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011082"},"PeriodicalIF":6.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11835519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014815","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":"How to Put Survival After Cardiothoracic Interventions in the General Population Context: A Case-Based Practical Guideline to Calculate Cumulative Matched-General-Population Survival.","authors":"Xu Wang, Maximiliaan L Notenboom, Kevin M Veen, Pepijn Grashuis, Eleni-Rosalina Andrinopoulou, Jonathan R G Etnel, Ad J J C Bogers, Mostafa M Mokhles, Johanna J M Takkenberg","doi":"10.1161/CIRCOUTCOMES.123.009993","DOIUrl":"10.1161/CIRCOUTCOMES.123.009993","url":null,"abstract":"<p><strong>Background: </strong>Observed patient survival after cardiothoracic interventions should ideally be placed in the context of matched-general-population survival. This study outlines several methodologies of matching general population mortality to the study sample, subsequently calculating cumulative matched-general-population survival, highlighting their respective advantages, disadvantages, and limitations.</p><p><strong>Methods: </strong>A multicenter data set containing survival data after the Ross procedure was used for methodological illustration. General population mortality was extracted from country-specific life tables in the Human Mortality Database. The matched-general-population mortality, also known as background mortality, was obtained by matching general population mortality to the study sample using different matching strategies, iteratively considering median/individual age and median/individual calendar year, besides country and sex. The corresponding cumulative matched-general-population survival was calculated subsequently. Sensitivity analyses were performed to assess the impact of varying patient ages on survival estimates by adding and subtracting 15 years from individual patients. A web-based Shiny Application (App) was developed to easily calculate cumulative matched-general-population survival.</p><p><strong>Results: </strong>In total, 1431 hospital survivors from the Ross procedure from 5 countries (25.7% female; median age, 48.5 [interquartile range, 42.7-54.0] years) were included. Fifteen-year survival was 88.3% (95% CI, 85.3-90.6). Cumulative matched-general-population 15-year survival varied from 87.7% to 89.8% using the 3 methods of different complexities. For 15-year-older patients, the cumulative matched-general-population 15-year survival was 67.4%, 59.8%, and 63.2%, respectively, using the simplest to the most comprehensive matching methods; for 15-year-younger patients, it was 96.9%, 96.1%, and 96.7%, respectively.</p><p><strong>Conclusions: </strong>Different methodologies to match general population mortality to observed patient mortality yield variable estimates of cumulative matched-general-population survival, especially in older patients. The cumulative matched-general-population survival should ideally be calculated by considering country, sex, individual patient age, and calendar year (both updated annually). This method can be easily implemented using the web-based Shiny App enclosed in this article.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e009993"},"PeriodicalIF":6.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972978","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":"Comparison of Associations of Food Security Instruments and Mediators With Premature All-Cause and Cardiovascular Disease Death in US Adults.","authors":"Ling Tian, Byron C Jaeger, Allison N Marshall, Kirsten S Dorans, Caryn N Bell, Katherine P Theall, Jing Chen, Jiang He, Joshua D Bundy","doi":"10.1161/CIRCOUTCOMES.124.011209","DOIUrl":"10.1161/CIRCOUTCOMES.124.011209","url":null,"abstract":"<p><strong>Background: </strong>Food insecurity is associated with high morbidity and mortality and is typically measured with the 10-item US Adult Food Security Survey Module. Shorter instruments may capture similar information, but this has not been validated against mortality in general populations.</p><p><strong>Methods: </strong>A nationally representative sample of individuals aged 20 to 74 years from the US National Health Interview Survey 2011 to 2018 was included, with deaths linked to the National Death Index through 2019. Cardiovascular disease deaths were ascertained by <i>International Classification of Diseases-Tenth Revision</i> codes for heart disease or stroke. Standard 10-, 6-, and 2-item food security instruments were compared for associations with premature all-cause and cardiovascular disease deaths occurring before age 75 years using Cox regression adjusted for demographics and social determinants of health and C statistics. Findings were replicated in the National Health and Nutrition Examination Survey 2004 to 2018, and differences were explored using mediation analysis.</p><p><strong>Results: </strong>We included 218 136 National Health Interview Survey participants (mean age, 45.3 years; 50.8% women). Over a mean 5.0-year follow-up, 7025 premature deaths were observed (1711 from cardiovascular disease). In multivariable-adjusted models, hazard ratios (95% CIs) for all-cause death were similar among food security instruments (10-item, 1.22 [1.13, 1.32]; 6-item, 1.23 [1.13, 1.34]; and 2-item, 1.23 [1.14, 1.32]), and C statistics were identical (0.823). Hazard ratios (95% CIs) for cardiovascular disease deaths were also similar among food security instruments (10-item, 1.38 [1.17, 1.62]; 6-item, 1.27 [1.07, 1.51]; and 2-item, 1.41 [1.20, 1.66]), and C statistics ranged from 0.852 to 0.853. In the National Health and Nutrition Examination Survey replication (n=37 027, mean 7.8-year follow-up), associations were attenuated and became not statistically significant after adjustment for several cardiometabolic intermediates, particularly enrollment in food assistance programs, diabetes, low diet quality, inadequate or excessive sleep, and depression.</p><p><strong>Conclusions: </strong>A 2-item food security instrument captures similar mortality risk information compared with 10- and 6-item instruments. Furthermore, potential intermediate cardiometabolic factors may explain associations between food insecurity and mortality.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011209"},"PeriodicalIF":6.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11835522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957694","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":"Quality of Life Outcomes With a Risk-Based Precision Testing Strategy Versus Usual Testing in Stable Patients With Suspected Coronary Disease: Results From the PRECISE Randomized Trial.","authors":"Daniel B Mark, Yanhong Li, Michael G Nanna, Michelle D Kelsey, Melanie R Daniels, Campbell Rogers, Manesh R Patel, Khaula N Baloch, Benjamin J W Chow, Kevin J Anstrom, Sreekanth Vemulapalli, Jonathan R Weir-McCall, Gregg W Stone, Derek S Chew, Pamela S Douglas","doi":"10.1161/CIRCOUTCOMES.124.011414","DOIUrl":"10.1161/CIRCOUTCOMES.124.011414","url":null,"abstract":"<p><strong>Background: </strong>The PRECISE (Prospective Randomized Trial of the Optimal Evaluation of Cardiac Symptoms and Revascularization) trial compared an investigational precision diagnostic testing strategy (n=1057) with usual testing (n=1046) in patients with stable chest pain and suspected coronary artery disease. Quality of life (QOL) outcomes were a prespecified secondary end point.</p><p><strong>Methods: </strong>We assessed QOL by structured interviews in all trial participants at baseline and 45 days, 6 months, and 12 months postrandomization. QOL assessments included angina-related QOL (19-item Seattle Angina Questionnaire [SAQ-19]), generic health status (EQ-5D), and a 4-item care satisfaction survey (at 45 days only). The prespecified primary comparison was the 6-month SAQ Summary score outcomes (scale, 0 to 100; higher scores indicate greater health status). QOL data collection rates were high, with 99% complete baseline SAQ scores and 86.5% complete at the 6-month primary comparison follow-up. All comparisons were made as randomized.</p><p><strong>Results: </strong>At baseline, mean SAQ Summary scores were 70.9 in the Precision Strategy group (n=1050) and 70.4 in the Usual Testing group (n=1042). By 6 months, mean SAQ Summary scores had improved to 89.9 in the Precision Strategy group and 89.2 in the Usual Testing group, with a mean adjusted difference of 0.8 (95% CI, -0.3 to 2.0). The SAQ component scores showed similar improvement from baseline in both groups and no statistically significant or clinically meaningful differences between the 2 groups at any follow-up time point. By 6 months, 66% of patients in both groups were chest pain-free. EQ-5D visual analog scores also improved from baseline and showed no difference between groups during follow-up. Care satisfaction scores were high and similar at 45 days.</p><p><strong>Conclusions: </strong>In stable patients with symptoms suggesting coronary artery disease, angina-related and overall QOL improved substantially over the initial 6 months independent of the testing strategy assigned.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03702244.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011414"},"PeriodicalIF":6.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081812","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":"Economic Outcomes With Precision Diagnostic Testing Versus Usual Testing in Stable Chest Pain: Results From the PRECISE Randomized Trial.","authors":"Derek S Chew, Daniel B Mark, Yanhong Li, Michael G Nanna, Michelle D Kelsey, Melanie R Daniels, Linda Davidson-Ray, Khaula N Baloch, Campbell Rogers, Manesh R Patel, Kevin J Anstrom, Nick Curzen, Sreekanth Vemulapalli, Pamela S Douglas","doi":"10.1161/CIRCOUTCOMES.123.011008","DOIUrl":"10.1161/CIRCOUTCOMES.123.011008","url":null,"abstract":"<p><strong>Background: </strong>The PRECISE (Prospective Randomized Trial of the Optimal Evaluation of Cardiac Symptoms and Revascularization) demonstrated that a precision diagnostic strategy reduced the primary composite of death, nonfatal myocardial infarction, or catheterization without obstructive coronary artery disease by 65% in patients with nonacute chest pain compared with usual testing. Medical cost was a prespecified secondary end point.</p><p><strong>Methods: </strong>PRECISE randomized 2103 patients between December 2018 and May 2021 to usual testing or a precision strategy that used deferred testing for the lowest risk patients (20%) and coronary computed tomographic angiography with selective computed tomography-derived fractional flow reserve for the remainder. Resource use consumption data were collected from all study participants and hospital cost data from US participants (n=1125) to estimate total medical costs. The primary and secondary economic outcomes were total costs at 12 months and at 45 days, respectively, from the US health care system perspective. The mean cost differences between the 2 strategies were reported by intention-to-treat.</p><p><strong>Results: </strong>At 45 days, total costs were similar between the precision strategy and usual testing (mean difference, $182 [95% CI, -$555 to $661]). By 12 months, percutaneous coronary intervention and coronary artery bypass surgery had been performed in 7.2% and 2.0% of precision strategy patients and 3.5% and 1.7% of usual testing patients, respectively. At 1 year, precision strategy costs were $5299 versus $4821 for usual testing (mean difference, $478 [95% CI, -$889 to $1437]; <i>P</i>=0.43). Precision care decreased mean per-patient diagnostic cost by 27% and increased mean per-patient revascularization costs by 67%.</p><p><strong>Conclusions: </strong>In the PRECISE trial, the precision strategy, a risk-based approach endorsed by current clinical practice guidelines, improved the clinical efficiency of testing and had similar costs to usual testing at 45 days and a nonsignificant $478 cost difference at 1 year.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03702244.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011008"},"PeriodicalIF":6.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081811","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":"High Time for High-Dose Flu Vaccines in Cardiovascular Patients?","authors":"Bahar Behrouzi, Jacob A Udell","doi":"10.1161/CIRCOUTCOMES.124.011857","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011857","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":"18 2","pages":"e011857"},"PeriodicalIF":6.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450752","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":"Evaluation of Peer Review of Percutaneous Coronary Intervention Operator Performance.","authors":"Jacob A Doll, Annika L Hebbe, Carol E Simons, Elliot J Stein, Stephan Eisenbarth, Stephen W Waldo, Sunil V Rao, David H Au","doi":"10.1161/CIRCOUTCOMES.124.011159","DOIUrl":"10.1161/CIRCOUTCOMES.124.011159","url":null,"abstract":"<p><strong>Background: </strong>Case-based peer review of percutaneous coronary intervention (PCI) is used by many hospitals for quality improvement and to make decisions regarding physician competency. However, there are no studies testing the reliability or validity of peer review for PCI performance evaluation.</p><p><strong>Methods: </strong>We recruited interventional cardiologists from 12 Veterans Affairs Health System facilities throughout the United States to provide PCI cases for review. Ten reviewers performed blinded reviews such that each case was reviewed twice. Cases were rated on a scale of 1 to 5 (with 5 being the best) for 6 care domains (Appropriateness, Lesion Suitability, Strategy, Technical Performance, Outcome, and Documentation) with a summary performance score calculated as the average of all domains. Separately, reviewers determined whether the standard of care was met. Interobserver reliability of the summary performance score was calculated using interclass correlation coefficient. We examined procedural complications and 30-day mortality and major adverse cardiac events for all PCIs performed by these operators from 2019 to 2022 when stratified in tertiles by summary performance score.</p><p><strong>Results: </strong>Of the 65 cases provided by 13 operators, the mean summary performance score was 3.90 (SD=0.78) out of 5. The interclass correlation coefficient was 0.53, indicating moderate interobserver reliability. For 19 cases (29.2%), 1 reviewer indicated that the performance did not meet the standard of care; however, the second reviewer disagreed in all these cases. Average performance scores ranged from 3.35 to 4.38. Among the 3390 PCIs performed by reviewed cardiologists from 2019 to 2022, the lowest-rated tertile had higher rates of complications (2.9% versus 1.8%, <i>P</i><0.01) and major adverse cardiac events (10.6% versus 8.0%, <i>P</i><0.01) compared with the highest-rated tertile.</p><p><strong>Conclusions: </strong>Case-based peer review identifies variation in physician performance that is correlated with PCI outcomes. However, reviewer disagreements about the standard of care raise concerns about the use of peer review for high-stakes assessments of physician competency.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011159"},"PeriodicalIF":6.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923766","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":"Integrating Out-of-Pocket Costs Into Shared Decision-Making for Heart Failure With Reduced Ejection Fraction: A Stepped-Wedge Trial (POCKET-COST-HF).","authors":"Neal W Dickert, Candace D Speight, Madeline Balser, Henry Biermann, J Kelly Davis, Scott D Halpern, Yi-An Ko, Advaita Krishnan, Daniel D Matlock, Andrea R Mitchell, Miranda A Moore, Sarah C Montembeau, Alanna A Morris, Kathleen Noonan, Birju R Rao, Laura D Scherer, Caroline E Sloan, Peter A Ubel, Larry A Allen","doi":"10.1161/CIRCOUTCOMES.124.011273","DOIUrl":"10.1161/CIRCOUTCOMES.124.011273","url":null,"abstract":"<p><strong>Background: </strong>Guideline-directed medical therapy for heart failure (HF) with reduced ejection fraction can entail high out-of-pocket (OOP) costs, prompting concerns about financial toxicity and access. OOP costs are generally unavailable during encounters. This trial assessed the impact of providing patient-specific OOP costs to patients and clinicians.</p><p><strong>Methods: </strong>This trial was conducted between June 2021 and August 2023 at 6 clinics in 2 health systems using a stepped-wedge, clinic-level cluster-randomized design. Adult patients with HF with reduced ejection fraction (left ventricular ejection fraction ≤40%) were enrolled. The intervention was built upon the EPIC-HF (Electronically Delivered, Patient-Activation Tool for Intensification of Medications for Chronic Heart Failure with Reduced Ejection Fraction) checklist of approved HF with reduced ejection fraction medications. Patients and clinicians received this checklist with (intervention) or without (control) patient-specific OOP cost estimates for higher-cost medications at the time of encounter. Estimates were obtained by providing pharmacy benefit information to a financial navigation firm. Encounters were audio-recorded, and patients were surveyed 2 weeks later. The primary outcome was cost-informed decision-making, defined by mentioning HF medication cost during the encounter. The primary analysis used a generalized linear mixed model. Secondary outcomes were assessed via transcript subcoding and analysis of survey responses.</p><p><strong>Results: </strong>Demographic characteristics of 247 patients (mean age, 62.9 years; 29.5% female; 26.3% Black; and 3.2% Hispanic/LatinX) treated by 39 clinicians in intervention and control periods were similar. In the primary model, the rate of cost-informed decision-making was higher in the intervention group than the control group (68% versus 49%; <i>P</i>=0.021). Baseline rates of cost discussions and the impact of the intervention varied across sites. When cost discussions were present, fewer discussions in the intervention group involved contingency plans to address potential costs (16.5% versus 31.9%; <i>P</i>=0.028). Most other secondary outcomes were not significantly different.</p><p><strong>Conclusions: </strong>Disclosing comprehensive OOP medication costs to patients with HF with reduced ejection fraction increased cost-informed decision-making. Further work is needed to optimize implementation and assess the impact on medication choices and adherence.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04793880.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011273"},"PeriodicalIF":6.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774101","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":"Realizing the Promise of Artificial Intelligence-Enabled Cardio-Oncology Care.","authors":"Elsie G Ross, Paul L Hess","doi":"10.1161/CIRCOUTCOMES.124.011581","DOIUrl":"10.1161/CIRCOUTCOMES.124.011581","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011581"},"PeriodicalIF":6.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957515","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":"Relationship Between Race, Predelivery Cardiology Care, and Cardiovascular Outcomes in Preeclampsia/Eclampsia Among a Commercially Insured Population.","authors":"Ikeoluwapo Kendra Bolakale-Rufai, Shannon M Knapp, Brownsyne Tucker Edmonds, Sadiya Khan, LaPrincess C Brewer, Selma Mohammed, Amber Johnson, Sula Mazimba, Daniel Addison, Khadijah Breathett","doi":"10.1161/CIRCOUTCOMES.124.011643","DOIUrl":"10.1161/CIRCOUTCOMES.124.011643","url":null,"abstract":"<p><strong>Background: </strong>It is unknown whether predelivery cardiology care is associated with future risk of major adverse cardiovascular events (MACE) in preeclampsia/eclampsia (PrE/E). We sought to determine the cumulative incidence of MACE by race and whether predelivery cardiology care was associated with the hazard of MACE up to 1 year post-delivery for Black and White patients with PrE/E.</p><p><strong>Methods: </strong>Using Optum's de-identified Clinformatics Data Mart Database, we identified Black and White patients with PrE/E who had a delivery between 2008 and 2019. MACE was defined as the composite of heart failure, acute myocardial infarction, stroke, and death. Cumulative incidence functions were used to compare the incidence of MACE by race. Regression models were used to assess the hazard of MACE by cardiology care for each race. Separate hazards were calculated for the first 14 days and the remainder of the year.</p><p><strong>Results: </strong>Among 29 336 patients (83.4% White patients, 16.6% Black patients, 99.5% commercially insured, mean age: 30.9 years) with PrE/E, 11.2% received cardiology care (10.9% White patients, 13.0% Black patients). Black patients had higher incidence of MACE than White patients at 1 year post-delivery (2.7% versus 1.4%) with the majority within 14 days of delivery (Black patients: 58.7%; White patients: 67.8%). After adjusting for age and comorbidities, receipt of cardiology care was associated with a lower hazard of MACE for White patients within 14 days after delivery (hazard ratio, 0.31 [95% CI, 0.21-0.46]; <i>P</i><0.001) but not Black patients (hazard ratio, 1.00 [95% CI, 0.60-1.67]; <i>P</i>=0.999). The effect of the interaction between race and cardiology care was significant in the first 14 days (<i>P</i><0.001) but not the remainder of the year (<i>P</i>=0.56).</p><p><strong>Conclusions: </strong>Among a well-insured population of patients with PrE/E, Black patients had a higher cumulative incidence of MACE up to a year post-delivery. Cardiology care was associated with a lower hazard of MACE only for White patients during the first 14 days after delivery.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011643"},"PeriodicalIF":6.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631183","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}