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Impact Of Telemedicine On Mortality, Length Of Stay, And Cost Among Patients In Progressive Care Units: Experience From A Large Healthcare System, Donna Lee Armaiqnac, Anshul Saxena, Muni Rubens, Carlos Valle, Lisa-Mae Williams, Emir Veledar, Louis Gidel

Emir Veledar

OBJECTIVES:

To determine whether Telemedicine intervention can affect hospital mortality, length of stay, and direct costs for progressive care unit patients.

DESIGN:

Retrospective observational.

SETTING:

Large healthcare system in Florida.

PATIENTS:

Adult patients admitted to progressive care unit (PCU) as their primary admission between December 2011 and August 2016 (n = 16,091).

INTERVENTIONS:

Progressive care unit patients with telemedicine intervention (telemedicine PCU [TPCU]; n = 8091) and without telemedicine control (nontelemedicine PCU [NTPCU]; n = 8000) were compared concurrently during study period.

MEASUREMENTS AND MAIN RESULTS:

Primary outcome was progressive care unit and hospital mortality. Secondary outcomes were hospital length …

Life's Simple 7 And Incident Heart Failure: The Multi‐Ethnic Study Of Atherosclerosis, Oluseye Ogunmoroti, Ebenezer Oni, Erin D. Michos, Erica S. Spatz, Norrina B. Allen, Jamal S. Rana, Salim S. Virani, Ron Blankstein, Konstantinos N. Aronis, Roger S. Blumenthal, Emir Veledar, Moyses Szklo, Michael J. Blaha, Khurram Nasir

Emir Veledar

Background The American Heart Association introduced the Life's Simple 7 (LS7) metrics to assess and promote cardiovascular health. We sought to examine the association between the LS7 metrics and incident heart failure (HF) in a multiethnic cohort. Methods and Results We analyzed data from 6506 participants of the Multi‐Ethnic Study of Atherosclerosis free of cardiovascular disease at baseline. The LS7 metrics (smoking, physical activity, body mass index, diet, blood pressure, total cholesterol, and blood glucose) were graded on a scale of 0 to 2, with 2 indicating “ideal” status, 1 “intermediate” status, and 0 “poor” status. Points were summed, thus …

Itchyqol Bands: Pilot Clinical Interpretation Of Scores, Elyse M. Love, Gerardo A. Marrazzo, Seema Kini, Emir Veledar, Suephy C. Chen

Emir Veledar

No abstract provided.

Features Of Portal Hypertension Are Associated With Major Adverse Events In Fontan Patients: The Vast Study, Robert W. Elder, Nancy M. Mccabe, Camden Hebson, Emir Veledar, Rene Romero, Ryan M. Ford, William T. Mahle, Brian E. Kogon, Anurag Sahu, Maan Jokhadar, Michael E. Mcconnell, Wendy M. Book

Emir Veledar

No abstract provided.

Impact Of Donor Lung Gram Stain On Post-Transplant Pneumonia And Mortality: More Lungs Can Be Used To Save Lives, Sher Ali Khan, Emir Veledar, Cathy Logan, Sanjay Mehta, Gordon Yung, Saima Aslam

Emir Veledar

No abstract provided.

Estimates Of Mortality Benefit From Ideal Cardiovascular Health Metrics: A Dose Response Meta‐Analysis, Ehimen C. Aneni, Alessio Crippa, Chukwuemeka U. Osondu, Javier Valero‐Elizondo, Adnan Younus, Khurram Nasir, Emir Veledar

Emir Veledar

Background Several studies have shown an inverse relationship between ideal cardiovascular health (CVH) and mortality. However, there are no studies that pool these data to show the shape of the relationship and quantify the mortality benefit from ideal CVH.

Methods and Results We conducted a systematic internet literature search of multiple databases including MEDLINE, Web of Science, Embase, CINAHL, and Scopus for longitudinal studies assessing the relationship between ideal CVH and mortality in adults, published between January 1, 2010, and May 31, 2017. We included studies that assessed the relationship between ideal CVH and mortality in populations that were initially …

Endothelial Dysfunction Is Associated With Occult Coronary Artery Disease Detected By Positron Emission Tomography, Ambar Kulshreshtha, Yan Zheng, Arshed A. Quyyumi, Emir Veledar, John Votaw, Irina Uphoff, J. Douglas Bremmer, Jack Goldberg, Viola Vaccarino

Emir Veledar

Objective: Silent myocardial ischemia is common in asymptomatic subjects without a prior history of coronary artery disease (CAD) and is associated with increased morbidity and mortality. Our objective was to determine whether endothelial dysfunction is associated with silent myocardial ischemia and whether the association is independent of genetic and familial factors. Material and methods: We examined 416 male monozygotic and dizygotic twins aged 47 to 63 years, free of symptomatic CAD. Subclinical ischemia was diagnosed by [13N] ammonia positron emission tomography at rest and after adenosine stress. Endothelial function was measured by flow-mediated dilation (FMD) of the brachial artery. Generalized …

Economic Impact Of Moderate‐Vigorous Physical Activity Among Those With And Without Established Cardiovascular Disease: 2012 Medical Expenditure Panel Survey, Javier Valero‐Elizondo, Joseph A. Salami, Chukwuemeka U. Osondu, Oluseye Ogunmoroti, Alejandro Arrieta, Erica S. Spatz, Adnan Younus, Jamal S. Rana, Salim S. Virani, Ron Blankenstein, Michael J. Blaha, Emir Veledar, Khurram Nasir

Emir Veledar

Background Physical activity (PA) has an established favorable impact on cardiovascular disease (CVD) outcomes and quality of life. In this study, we aimed to estimate the economic effect of moderate‐vigorous PA on medical expenditures and utilization from a nationally representative cohort with and without CVD. Methods and Results The 2012 Medical Expenditure Panel Survey data were analyzed. Our study population was limited to noninstitutionalized US adults ≥18 years of age. Variables of interest included CVD (coronary artery disease, stroke, heart failure, dysrhythmias, or peripheral artery disease) and cardiovascular modifiable risk factors (CRFs; hypertension, diabetes mellitus, hypercholesterolemia, smoking, and/or obesity). Two‐part …

Epicardial Adipose Tissue Measured By Magnetic Resonance Imaging Predicts Abnormal Adenosine Stress Cardiovascular Magnetic Resonance Imaging And Future Adverse Cardiovascular Events, Joseph J. Lamanna, Chesnal D. Arepalli, Agathi R. Vrettou, Emily L. Ebert, Arash Harzand, Emir Veledar, John N. Oshinski, Stamatios Lerakis

Emir Veledar

No abstract provided.

Effect Of Thyroxin Treatment On Carotid Intima – Media Thickness (Cimt) Reduction In Patients With Subclinical Hypothyroidism (Sch): A Meta-Analysis Of Clinical Trials, Muhammad Aziz, Yugandhar Kandimalla, Archana Machavarapu, Anshul Saxena, Sankalp Das, Adnan Younus, Michelle Nguyen, Rehan Malik, Dixitha Anugula, Muhammad A. Latif, Choudhry Humayun, Idrees M. Khan, Ali Adus, Aisha Rasool, Emir Veledar, Khurram Nasir

Emir Veledar

Aim: Research shows that subclinical hypothyroidism (SCH) is related to an increased carotid intima–media thickness (CIMT), a surrogate marker of subclinical cardiovascular disease (CVD). It is controversial whether or not SCH should be treated to reduce CVD morbidity and mortality. This meta-analysis aimed to determine whether SCH is associated with an increase in CIMT as compared to Euthyroidism (EU) and whether thyroxin (T4) treatment in SCH can reverse the change in CIMT. Methods: Two independent reviewers conducted an extensive database research up to December 2016. A total of 12 clinical trials discussed the effect of Thyroxin on CIMT values at …

Consulting Communities When Patients Cannot Consent: A Multi-Center Study Of Community Consultation For Research In Emergency Settings, Neal W. Dickert, Victoria A. Mah, Michellle H. Biros, Deneil M. Harney, Robert Silbergleit, Jeremy Sugarman, Emir Veledar, Kevin P. Weinfurt, David W. Wright, Rebecca D. Pentz

Emir Veledar

No abstract provided.

Circulating Cd34+ Progenitor Cells And Risk Of Mortality In A Population With Coronary Artery Disease, Riyaz S. Patel, Qunna Li, Nima Ghasemzadeh, Danny J. Eapen, Lauren D. Moss, A. Umair Janjua, Pankaj Manocha, Hatem Al Kassem, Emir Veledar, Habib Samady, W. Robert Taylor, A. Maziar Zafari, Laurence Sperling, Viola Vaccarino, Edmund Waller, Arshed A. Quyyumi

Emir Veledar

No abstract provided.

Economic Evaluation Of Pcsk9 Inhibitors In Reducing Cardiovascular Risk From Health System And Private Payer Perspectives, Alejandro Arrieta, Timothy Page, Emir Veledar, Khurram Nasir

Emir Veledar

The introduction of Proprotein covertase subtilisin/kexin type 9 (PCSK9) inhibitors has been heralded as a major advancement in reducing low-density lipoprotein cholesterol levels by nearly 50%. However, concerns have been raised on the added value to the health care system in terms of their costs and benefits. We assess the cost-effectiveness of PCSK9 inhibitors based on a decision-analytic model with existing clinical evidence. The model compares a lipid-lowering therapy based on statin plus PCSK9 inhibitor treatment with statin treatment only (standard therapy). From health system perspective, incremental cost per quality adjusted life years (QALYs) gained are presented. From a private …

Cigarette Smoking Worsens Systemic Inflammation In Persons With Metabolic Syndrome, Omar Jamal, Ehimen C. Aneni, Sameer Shaharyar, Shozab S. Ali, Don Parris, John W. Mcevoy, Emir Veledar, Michael J. Blaha, Roger S. Blumenthal, Arthur Agatston, Raquel D. Conceicao, Theodore Feldman, Jose A. Carvalho, Raul D. Santos, Khurram Nasir

Emir Veledar

Background

Emerging data suggests that the combination of smoking and metabolic syndrome (MetS) markedly increases cardiovascular disease risk well beyond that of either condition. In this study we assess if this interaction can be explained by an additive increase in the risk of systemic inflammation by MetS and cigarette smoking.

Methods

We evaluated 5,503 healthy non-diabetic Brazilian subjects (mean age of 43 ± 10 years, 79% males). Participants were divided into sub-groups of smokers and non-smokers with or without MetS. High-sensitivity C reactive protein (hs-CRP) was measured to assess degree of underlying inflammation.

Results

Overall (19%) had hs-CRP > 3 mg/L. …

Circadian Variation In Vascular Function And Regenerative Capacity In Healthy Humans, Ibhar Al Mheid, Frank Corrigan, Farheen Shirazi, Emir Veledar, Qunna Li, Wayne R. Alexander, W. Robert Taylor, Edmund K. Waller, Arshed A. Quyyumi

Emir Veledar

Background Progenitor cells (PCs) are mobilized in response to vascular injury to effect regeneration and repair. Recruitment of PCs requires intact nitric oxide (NO) synthesis by endothelial cells, and their number and activity correlate with cardiovascular disease risk burden and future outcomes. Whereas cardiovascular vulnerability exhibits a robust circadian rhythm, the 24-hour variation of PCs and their inter-relation with vascular function remain unknown. We investigated the circadian variation of PCs and vascular function with the hypothesis that this will parallel the pattern observed for cardiovascular events (CVEs).

Methods and Results In 15 healthy subjects (9 men, 37±16 years), circulating PCs …

Association Of Subjective And Objective Sleep Duration As Well As Sleep Quality With Non-Invasive Markers Of Sub-Clinical Cardiovascular Disease (Cvd): A Systematic Review, Muhammad Aziz, Shozab S. Ali, Sankalp Das, Adnan Younus, Rehan Malik, Muhammad A. Latif, Choudhry Humayun, Dixitha Anugula, Ghulam Abbas, Joseph Salami, Javier Valero Elizondo, Emir Veledar, Khurram Nasir

Emir Veledar

Aim: Abnormal daily sleep duration and quality have been linked to hypertension, diabetes, stroke, and overall cardiovascular disease (CVD) morbidity& mortality. However, the relationship between daily sleep duration and quality with subclinical measures of CVD remains less well studied. This systematic review evaluated how daily sleep duration and quality affect burden of subclinical CVD in subjects free of symptomatic CVD.

Methods: Literature search was done via MEDLINE, EMBASE, Web of Science until June 2016 and 32 studies met the inclusion criteria. Sleep duration and quality were measured either via subjective methods, as self-reported questionnaires or Pittsburg Sleep Quality …

Association Between Posttraumatic Stress Disorder And Inflammation: A Twin Study, Laura Plantinga, J. Douglas Bremner, Andrew A. Miller, Dean P. Jones, Emir Veledar, Jack Goldberg, Viola Vaccarino

Emir Veledar

The association of posttraumatic stress disorder (PTSD) with cardiovascular disease risk may be mediated by inflammation. Our objective was to examine the association between PTSD and measures of inflammation and to determine whether these associations are due to shared familial or genetic factors. We measured lifetime history of PTSD using the Structured Clinical Interview for DSM-IV in 238 male middle-aged military veteran twin pairs (476 individuals), selected from the Vietnam Era Twins Registry, who were free of cardiovascular disease at baseline. We assessed inflammation using levels of high-sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), fibrinogen, white blood cells, vascular cell …

Association Between Modifiable Risk Factors And Pharmaceutical Expenditures Among Adults With Atherosclerotic Cardiovascular Disease In The United States: 2012–2013 Medical Expenditures Panel Survey, Joseph A. Salami, Javier Valero‐Elizondo, Oluseye Ogunmoroti, Erica S. Spatz, Jamal S. Rana, Salim S. Virani, Ron Blankenstein, Adnan Younus, Alejandro Arrieta, Michael J. Blaha, Emir Veledar, Khurram Nasir

Emir Veledar

Background Atherosclerotic cardiovascular disease (ASCVD) causes most deaths in the United States and accounts for the highest healthcare spending. The association between the modifiable risk factors (MRFs) of ASCVD and pharmaceutical expenditures are largely unknown. Methods and Results We examined the association between MRFs and pharmaceutical expenditures among adults with ASCVD using the 2012 and 2013 Medical Expenditure Panel Survey. A 2‐part model was used while accounting for the survey's complex design to obtain nationally representative results. All costs were adjusted to 2013 US dollars using the gross domestic product deflator. The annual total pharmaceutical expenditure among those with ASCVD …

Association Between Life's Simple 7 And Noncardiovascular Disease: The Multi‐Ethnic Study Of Atherosclerosis, Oluseye Ogunmoroti, Norrina B. Allen, Mary Cushman, Erin D. Michos, Tatjana Rundek, Jamal S. Rana, Ron Blankenstein, Roger S. Blumenthal, Michael J. Blaha, Emir Veledar, Khurram Nasir

Emir Veledar

Background The American Heart Association introduced the Life's Simple 7 (LS7) metrics to assess and promote cardiovascular health. We examined the association between the LS7 metrics and noncardiovascular disease. Methods and Results We studied 6506 men and women aged between 45 and 84 years, enrolled in the Multi‐Ethnic Study of Atherosclerosis. Median follow‐up time was 10.2 years. Each component of the LS7 metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, and blood glucose) was assigned points, 0 indicates “poor” category; 1, “intermediate,” and 2, “ideal.” The LS7 score, ranged from 0 to 14, was created from …

Aggregate Risk Score Based On Markers Of Inflammation, Cell Stress, And Coagulation Is An Independent Predictor Of Adverse Cardiovascular Outcomes, Danny J. Eapen, Pankaj Manocha, Riyaz S. Patel, Muhammad Hammadah, Emir Veledar, Christina Wassel, Ravi A. Nanjundappa, Sergey Sikora, Dylan Malayter, Peter W.F. Wilson, Laurence Sperling, Arshed A. Quyyumi, Stephen E. Epstein

Emir Veledar

No abstract provided.

Association Between Ideal Cardiovascular Health And Carotid Intima-Media Thickness: A Twin Study, Ambar Kulshreshtha, Abhinav Goyal, Emir Veledar, William Mcclellan, Suzanne Judd, Silvia C. Eufinger, J. Douglas Bremner, Jack Goldberg, Viola Vaccarino

Emir Veledar

Background The American Heart Association (AHA) recently developed the Cardiovascular Health Index (CVHI), a health metric consisting of 7 modifiable risk factors. The relationship of the CVHI with preclinical markers, such as carotid intima-media thickness (CIMT) has not been assessed.

Methods We examined 490 male monozygotic and dizygotic twins without overt cardiovascular disease. CIMT was measured using B-mode ultrasonography. Each of the 7 CVHI components (blood pressure, fasting glucose, total cholesterol, body mass index, physical activity, healthy diet, and smoking) was given a point score of 0, 1, or 2 to represent poor, intermediate, or ideal health, respectively. A CVHI …

Waterpipe A Gateway To Cigarette Smoking Initiation Among Adolescents In Irbid, Jordan: A Longitudinal Study, Rana Jaber, Purnima Madhivanan, Emir Veledar, Y. Khader, F. Mzayek, Wasim Maziak

Emir Veledar

No abstract provided.

Response To Letter Regarding Article By Patel Et Al: A Novel Biomarker Of Oxidative Stress Is Associated With Risk Of Death In Patients With Coronary Artery Disease, Riyaz S. Patel, Nima Ghasemzadeh, Danny J. Eapen, Salman Sher, Shawn Arshad, Yian Ko, Emir Veledar, Habib Samady, A. Maziar Zafari, Laurence Sperling, Viola Vaccarino, Dean P. Jones, Arshed A. Quyyumi

Emir Veledar

No abstract provided.

The Benefits Of Inositol-Stabilized Arginine Silicate As A Workout Ingredient, S. Rood-Ojalvo, D. Sandler, Emir Veledar, J. Komorowski

Emir Veledar

No abstract provided.

The Tongue Enables Computer And Wheelchair Control For People With Spinal Cord Injury, Jeonghee Kim, Hangue Park, Joy Bruce, Erica Sutton, Diane Rowles, Deborah Pucci, Jaimee Holbrook, Julia Minocha, Beatrice Nardone, Dennis West, Anne Laumann, Eliot Roth, Mike Jones, Emir Veledar, Maysam Ghovanloo

Emir Veledar

The Tongue Drive System (TDS) is a wireless and wearable assistive technology, designed to allow individuals with severe motor impairments such as tetraplegia to access their environment using voluntary tongue motion. Previous TDS trials used a magnetic tracer temporarily attached to the top surface of the tongue with tissue adhesive. We investigated TDS efficacy for controlling a computer and driving a powered wheelchair in two groups of able-bodied subjects and a group of volunteers with spinal cord injury (SCI) at C6 or above. All participants received a magnetic tongue barbell and used the TDS for five to six consecutive sessions. …

Soluble Urokinase Plasminogen Activator Receptor Level Is An Independent Predictor Of The Presence And Severity Of Coronary Artery Disease And Of Future Adverse Events, Danny J. Eapen, Pankaj Manocha, Nima Ghasemzadeh, Riyaz S. Patel, Hatem Al Kassem, Muhammad Hammadah, Emir Veledar, Ngoc-Anh Le, Tomasz Pielak, Christian W. Thorball, Aristea Velegraki, Dimitrios T. Kremastinos, Stamatios Lerakis, Laurence Sperling, Arshed A. Quyyumi

Emir Veledar

Introduction Soluble urokinase plasminogen activator receptor (suPAR) is an emerging inflammatory and immune biomarker. Whether suPAR level predicts the presence and the severity of coronary artery disease (CAD), and of incident death and myocardial infarction (MI) in subjects with suspected CAD, is unknown.

Methods and Results We measured plasma suPAR levels in 3367 subjects (67% with CAD) recruited in the Emory Cardiovascular Biobank and followed them for adverse cardiovascular (CV) outcomes of death and MI over a mean 2.1±1.1 years. Presence of angiographic CAD (≥50% stenosis in ≥1 coronary artery) and its severity were quantitated using the Gensini score. Cox's …

Plasmodium Falciparum And Soil-Transmitted Helminth Co-Infections Among Children In Sub-Saharan Africa: A Systematic Review And Meta-Analysis, Abraham Degarege, Emir Veledar, Dawit Degarege, Berhanu Erko, Mathieu Nacher, Purnima Madhivanan

Emir Veledar

The epidemiology of soil-transmitted helminth (STH) and Plasmodium co-infections need better understanding. The findings of the individual studies are inconclusive. A systematic review was conducted to synthesize evidence on the association of STH infection with the prevalence and density of Plasmodium falciparum infection, and its effect on anaemia among children in sub-Saharan Africa (SSA).

Posttraumatic Stress Disorder And Impaired Autonomic Modulation In Male Twins, Amit J. Shah, Rachel Lampert, Jack Goldberg, Emir Veledar, J. Douglas Bremner, Viola Vaccarino

Emir Veledar

No abstract provided.

Prognostic Value Of Stress Myocardial Perfusion Positron Emission Tomography: Results From A Multicenter Observational Registry, Sharmila Dorbala, Marcelo F. Di Carli, Rob S. Beanlands, Micheal E. Merhinge, Brent A. Williams, Emir Veledar, Benjamin Jw Chow, James K. Min, Michael J. Pencina, Daniel S. Berman, Leslee J. Shaw

Emir Veledar

No abstract provided.

Posttraumatic Stress Disorder And Incidence Of Coronary Heart Disease: A Twin Study, Viola Vaccarino, Jack Goldberg, Cherie Rooks, Amit J. Shah, Emir Veledar, Tracy L. Faber, John R. Votaw, Christopher W. Forsberg, J. Douglas Bremner

Emir Veledar

No abstract provided.