Medical Specialties Commons^™

Incidence And Predictor Variables Of Pressure Injuries In Patients Undergoing Ventricular Assist Device And Total Artificial Heart Surgeries: An Eight-Year Retrospective Review, Christopher T. Brindle

Theses and Dissertations

BACKGROUND

Cardiac surgery patients have some of the highest reported incidence and prevalence of pressure injuries (PI). A growing subset of cardiac surgery include patients with end-stage heart failure who undergo ventricular assist device (VAD) or total artificial heart (TAH) surgery. The risk of PI and their natural history of development in this population are unknown and the specific risk factors for PI development remain unexplored.

OBJECTIVES

To perform a systematic review of the literature to identify the incidence and risk factors of PI development in patients undergoing VAD-TAH surgery and thereby inform study design and variables in an eight-year …

Therapeutic Targeting Of Relaxin Signaling In Ischemic Heart Disease, Siva Teja Vk Devarakonda

Theses and Dissertations

Ischemic heart disease is characterized by reduced perfusion of oxygenated blood to the myocardium, potentially resulting in infarction upon occlusion of coronary arteries. While prompt reperfusion and advances in in-hospital care have led to a decline in short term mortality, sustained damage to the ventricle, along with reperfusion injury, can lead to progressive deterioration in cardiac function. Limiting the extent of this initial ischemia-reperfusion injury and combating the course of adverse remodeling remains the scope of several preclinical studies geared towards improving cardiac health after MI. To this, relaxin-2 – the peptide hormone that regulates maternal hemodynamic function during pregnancy …

Frailty In Patients Undergoing Left Ventricular Assist Device Implantation, Candice Falls

Theses and Dissertations--Nursing

Heart failure is a progressive condition that affects over 5.7 million Americans and costs associated with heart failure account for 2-3 % of the national health care budget. The high rates of morbidity and mortality along with increased costs from readmissions associated with advanced heart failure have led to the exploration of advanced treatments such as left ventricular assist devices (LVADs). LVADS have demonstrated morbidity and mortality benefit but cost remains extensive with costs per quality-adjusted years > $400,000. With this in mind, it is important to identify those who are most likely to benefit from an LVAD to avoid unfavorable …

Elderly Bleeding Risk Of Direct Oral Anticoagulants In Nonvalvular Atrial Fibrillation: A Systematic Review And Meta-Analysis Of Cohort Studies, Jessika Lobraico-Fernandez, Salma Baksh, Eric C. Nemec

Physician Associate Studies Faculty Publications

Introduction The 2014 American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Rhythm Society (HRS) guidelines recommend anticoagulation to reduce clot formation and the risk of thromboembolic events in patients with atrial fibrillation but does not specify guidelines for the elderly population. Direct oral anticoagulants (DOACs) are newer US FDA-approved alternatives to warfarin and include dabigatran, rivaroxaban, apixaban and edoxaban. The efficacy of DOACs is heavily researched, but few studies have evaluated their bleeding risk. Objectives This systematic review and meta-analysis investigates which DOAC has the lowest bleeding risk in elderly patients with nonvalvular atrial fibrillation (NVAF). Methods CINAHL and MEDLINE …

Long-Term Use Of Beta-Blocker Medication In Pediatric Long Qt Syndrome Patients: Neuropsychological Profiles, Kara J. Rudisill

PCOM Psychology Dissertations

Long QT syndrome (LQTS) is a heart rhythm disorder characterized by a disruption of the heart’s electrical activity that may cause accelerated and uncontrolled heartbeats referred to as ventricular fibrillation. LQTS is primarily treated with beta-blocker medications, which reduce the risk of experiencing an arrhythmia through regulating the heart rate. However, the potential neuropsychological side-effects associated with the use of beta-blocker medication may impact the executive functioning skills, mental health, and behavior of the affected pediatric population at home. As a result, a child’s academic performance and emotional regulation etiology may be misunderstood by his or her parents, caregivers, and …

Development Of A Cardio-Oncology Program In A Community Hospital, Deborah W. Sundlof Do, Brijesh D. Patel Md, Kelly C. Schadler Msn, Crnp, Ross G. Biggs Do, Cheri A. Silverstein Fadlon Md, Mscr, Paul S. Corotto Md, Sameer Tolay Md, Ahmed J. Nadeem Do, Ranju Gupta Md, Nadeem V. Ahmad Md

Department of Medicine

No abstract provided.

Does Stem Cell Injection Improve Quality Of Life In Patients With Cardiopathy Patients?, Shoua Shue Casillas

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not stem cell injections improve the quality of life in patients with cardiopathy.

STUDY DESIGN: Review of three randomized controlled trial (RCT) articles. All articles were published between 2012 – 2017 and were all printed in the English language.

DATA SOURCES: All three RCT articles were found through PubMed.

OUTCOMES MEASURED: One of the outcomes measured in each of the articles were improvement in quality of life in patients with cardiopathy. Among the three review articles, quality of life was measured using either the Kansas City Cardiomyopathy …

Evaluation Of The Effect Of Milner-Fenwick Video-Based Education And Teach-Back On Knowledge Acquisition In Atrial Fibrillation Patients, Melissa Czarapata

DNP Projects

PURPOSE: The purpose of this study was to evaluate if video education impacts knowledge acquisition and health literacy in patients with atrial fibrillation. METHODS: This study employed a descriptive, pretest-posttest single site comparative design. Baseline health literacy was assessed before video education was completed using the Atrial Fibrillation Knowledge scale. Health literacy regarding atrial fibrillation was again assessed for the same participants immediately after video education was completed and again in 7 to 10 days through the use of the Atrial Fibrillation Knowledge scale and teach-back questions. RESULTS: There was no statistical significance found when comparing scores before and after …

Implementation Of Stroke Pathways To Reduce Length Of Stay, Cost, Readmissions, And Mortality, Jayme Strauss, Daniel Hartnett, Jenny Ductant, Peter De Armas, Albert Fernandez, Andrew Waisbrot, Amy Starosciak, Felipe De Los Rios La Rosa

All Publications

No abstract provided.

Addressing Stroke Patient And Family Reasons For Not Calling 911, Maygret Ramirez, Rodney Bedgio, Virginia Ramos, Ivis Gonzalez, Yaima Miro Gonzalez, Amy Starosciak, Daniel D'Amour, Jayme Strauss, Felipe De Los Rios La Rosa

All Publications

No abstract provided.

Stroke Outcomes With Vorapaxar Versus Placebo In Patients With Acute Coronary Syndromes: Insights From The Tracer Trial, Leo Ungar, Robert M. Clare, Fatima Rodriguez, Bradley J Kolls, Paul W. Armstrong, Philip Aylward, Claes Held, David J. Moliterno, John Strony, Frans Van De Werf, Lars Wallentin, Harvey D. White, Pierluigi Tricoci, Robert A. Harrington, Kenneth W. Mahaffey, Chiara Melloni

Gill Heart & Vascular Institute Faculty Publications

Background—Vorapaxar, a protease‐activated receptor‐1 antagonist, is approved for secondary prevention of cardiovascular events but is associated with increased intracranial hemorrhage.

Methods and Results—TRACER (Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome) was a trial of vorapaxar versus placebo among patients with acute coronary syndrome. Strokes were adjudicated by a central events committee. Of 12 944 patients, 199 (1.5%) had ≥1 stroke during the study period (median follow‐up, 477 days). Four patients had a single stroke of unknown type; 195 patients had ≥1 stroke classified as hemorrhagic or nonhemorrhagic (165 nonhemorrhagic, 28 hemorrhagic, and 2 both). …

Evidence For Minimal Cardiogenic Potential Of Stem Cell Antigen 1-Positive Cells In The Adult Mouse Heart., Lauren E Neidig, Florian Weinberger, Nathan J Palpant, John Mignone, Amy M Martinson, Daniel W Sorensen, Ingrid Bender, Natsumi Nemoto, Hans Reinecke, Lil Pabon, Jeffery D Molkentin, Charles E Murry, Jop H Van Berlo

Articles, Abstracts, and Reports

No abstract provided.

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted DRG …

Are Patients Living With Hiv Infection At Risk For Not Receiving Statin Medications For Cardiovascular Disease Risk Reduction?, Nick Hastain, Pharmd Candidate, Roshni S. Patel, Pharmd, Bcps, Jason J. Schafer, Pharmd, Mph, Bcps, Aahivp

College of Pharmacy Posters

Objective

To determine the prevalence of appropriate statin prescribing for ASCVD risk reduction in PLWH

Coarctation Of Aorta In Children., Arpan R. Doshi, Sathish Chikkabyrappa

Manuscripts, Articles, Book Chapters and Other Papers

Coarctation of aorta (CoA) is a discrete narrowing in aorta causing obstruction to the flow of blood. It accounts for 6-8% of all congenital heart diseases. With advances in fetal echocardiography rate of prenatal diagnosis of coarctation of aorta has improved but it still remains a challenging diagnosis to make prenatally. Transthoracic echocardiography is mainstay of making initial diagnosis and routine follow-up. Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) are great advanced imaging tools for two-dimensional and three-dimensional imaging of aortic arch in complex cases. Based on type of coarctation, size of patient, severity of lesion, and associated …

Innocent Heart Murmur., Arpan R. Doshi

Manuscripts, Articles, Book Chapters and Other Papers

Heart murmur is the most common reason for a referral to a pediatric cardiologist. Virtually all children have a heart murmur during their childhood. Less than 1% of murmurs are pathological in children. Innocent/functional heart murmur is the most common type of heart murmur. There are multiple theories proposed to identify etiology of innocent heart murmur with varying consensus, but everybody agrees that innocent heart murmur does not carry any morbidity or mortality risk. Even today, heart murmur is associated with high physician uncertainty and parental anxiety. Extensive cardiac evaluation for such a benign finding is also associated with high …

Ongoing Evaluation Of The Impact Of A Post-Operative Atrial Fibrillation Prevention Protocol For Patients Undergoing Cardiothoracic Surgery, Kamarena Sankar, Jonatha Kline, Heidi Clarke, Radhan Gopalani, Faaria Quadri

All Publications

No abstract provided.

Implementing Evidence-Based Dietary Instruction Strategies In A Specialty Care Clinic, Jacobie Landers

Doctor of Nursing Practice

Cardiovascular disease is a significant health concern that increases risks for stroke, escalates the development of renal disease, and significantly increases morbidity and mortality risk. Dietary changes can significantly reduce complications in patients with heart and vascular disease. This project was designed to effectively implement and sustain provider and cardiovascular staff instructions on dietary modifications to improve hypertension control and lower cholesterol in patients with cardiac disease using staff support. The project facilitated provider evaluation of patients’ dietary habits to promote wellness in a patient population which was not receiving dietary education. Project interventions included establishing structured methods of providing …

Clopidogrel Versus Newer P2y12 Antagonists For Percutaneous Coronary Intervention In Patients With Out-Of-Hospital Cardiac Arrest Managed With Therapeutic Hypothermia: A Meta-Analysis, Ayman Elbadawi, Islam Y. Elgendy, Ahmed H. Mohamed, Kirolos Barssoum, Erfan Alotaki, Gbolahan O. Ogunbayo, Khaled M. Ziada

Internal Medicine Faculty Publications

Introduction: The impact of therapeutic hypothermia (TH) on outcomes of percutaneous coronary intervention (PCI) and the optimal antiplatelet treatment remains debatable.

Methods: Electronic databases were searched for randomized trials and observational studies to evaluate the available clinical evidence comparing the use of clopidogrel versus newer P2Y12 antagonists in cases of TH after PCI. The primary outcome was in-hospital definite stent thrombosis while the secondary outcomes were in-hospital mortality and major bleeding. Fixed-effects risk ratios (RRs) were estimated using Mantel–Haenszel method.

Results: The final analysis included five studies with a total of 290 patients. There was no difference in the incidence …

Perioperative Aspirin And Long-Term Survival In Patients Undergoing Coronary Artery Bypass Graft., Qian Ding, Hong Liu, Zugui Zhang, Jordan E. Goldhammer, Eric Yuen, Zhongmin Li, Linong Yao, Nilas Young, Douglas Boyd, William Weintraub, Rohinton Morris, Jianzhong Sun

Department of Anesthesiology Faculty Papers

This study aimed to examine association between perioperative uses of aspirin and long-term survival in patients undergoing CABG. A retrospective cohort study was performed in 9,584 consecutive patients receiving cardiac surgery from three tertiary hospitals. Of all the patients, 4,132 patients undergoing CABG met inclusion criteria and were divided into four groups: with or without preoperative or postoperative aspirin respectively. 30-day postoperative and long-term mortality were compared with the use of propensity scores and inverse probability weighting adjustment to reduce the treatment-selection bias. The patients taking preoperative aspirin presented significantly more with comorbidities. However, the results of this study showed …

Drug-Coated Balloon Treatment Of Femoropopliteal Lesions Typically Excluded From Clinical Trials: 12-Month Findings From The In.Pact Global Study., Gary M Ansel, Marianne Brodmann, Koen Keirse, Antonio Micari, Michael R Jaff, Krishna Rocha-Singh, Eric J Fernandez, Hong Wang, Thomas Zeller, In.Pact Global Study Investigators

Heart and Vascular Articles

PURPOSE: To report a post hoc analysis comparing outcomes between subjects who would have been included in the IN.PACT SFA randomized controlled trial vs those who would have been excluded.

METHODS: The 1406 subjects enrolled in the IN.PACT Global Study ( ClinicalTrials.gov identifier NCT01609296) were retrospectively assigned to a standard-use group (n=281) based on the inclusion and exclusion criteria from the randomized IN.PACT SFA trial; the remaining 1125 patients were assigned to the broader-use group. Freedom from clinically-driven target lesion revascularization (CD-TLR) was evaluated at 12 months. The composite primary safety endpoint was freedom from 30-day device- and procedure-related death …

Clinical Outcomes Of Successful Revascularization Of Chronic Total Coronary Occlusions With Bioresorbable Vascular Scaffolds: A Systematic Review., Roman Marchenko, Salik Nazir, Shelina Malla, Anthony Donato

Reading Hospital Internal Medicine Residency

Revascularization of chronic total occlusions (CTO) with percutaneous coronary intervention is associated with favorable long-term clinical and echocardiographic outcomes. Whether bioresorbable vascular scaffolds (BVS) would be advantageous in the treatment of CTO is unknown as patients with these lesions were generally excluded from large BVS randomized trials. We performed a systematic review, which sought to summarize known data on mid- to long-term clinical outcomes for BVS in CTO. We searched MEDLINE, EMBASE, clinicaltrials.gov, and the Cochrane Library through April 2018 to look for studies on implantation of BVS in CTO. Outcomes of interest included myocardial infarction, cardiac death, all-cause mortality, …

Macrophage-Derived Netrin-1 Promotes Abdominal Aortic Aneurysm Formation By Activating Mmp3 In Vascular Smooth Muscle Cells, Tarik Hadi, Ludovic Boytard, Michele Silvestro, Dornazsadat Alebrahim, Samson Jacob, Jordyn Feinstein, Krista Barone, Wes Spiro, Susan Hutchison, Russell Simon, Debra L. Rateri, Florence Pinet, David Fenyo, Mark Adelman, Kathryn J. Moore, Holger K. Eltzschig, Alan Daugherty, Bhama Ramkhelawon

Physiology Faculty Publications

Abdominal aortic aneurysms (AAA) are characterized by extensive extracellular matrix (ECM) fragmentation and inflammation. However, the mechanisms by which these events are coupled thereby fueling focal vascular damage are undefined. Here we report through single-cell RNA-sequencing of diseased aorta that the neuronal guidance cue netrin-1 can act at the interface of macrophage-driven injury and ECM degradation. Netrin-1 expression peaks in human and murine aneurysmal macrophages. Targeted deletion of netrin-1 in macrophages protects mice from developing AAA. Through its receptor neogenin-1, netrin-1 induces a robust intracellular calcium flux necessary for the transcriptional regulation and persistent catalytic activation of matrix metalloproteinase-3 (MMP3) …

Equalization Of Four Cardiovascular Risk Algorithms After Systematic Recalibration: Individual-Participant Meta-Analysis Of 86 Prospective Studies, Lisa Pennells, Stephen Kaptoge, Angela Wood, Mike Sweeting, Xiaohui Zhao, Ian White, Stephen Burgess, Peter Willeit, Thomas Bolton, Karel G. M. Moons, Yvonne T. Van Der Schouw, Randi Selmer, Kay-Tee Khaw, Vilmundur Gudnason, Gerd Assman, Philippe Amouyel, Veikko Salomaa, Mika Kivimaki, Borge G. Nordestgaard, Michael J. Blaha, Lewis H. Kuller, Hermann Brenner, Richard F. Gillum, Christa Meisinger, Ian Ford, Matthew W. Knuiman, Annika Rosengren, Debbie A. Lawlor, Henry Volzke, Cyrus Cooper, Alejandro Marin Ibañez, Edoardo Casiglia, Jussi Kauhanen, Jackie A. Cooper, Beatriz Rodriguez, Johan Sundstrom, Elizabeth Barrett-Connor, Rachel Dankner, Paul J. Nietert, Karina W. Davidson, Robert B. Wallace, Dan G. Blazer, Cecilia Bjorkelund, Chiara Donfrancesco, Harlan M. Krumholz, Aulikki Nissinen, Barry R. Davis, Sean Coady, Peter H. Whincup, Torben Jorgensen, Pierre Ducimetiere, Maurizo Trevisan, Gunnar Engstrom, Carlos J. Crespo, Tom W. Meade, Marjolein Visser, Daan Kromhout, Stefan Kiechl, Makoto Daimon, Jackie F. Price, Agustin Gomez De La Camara, J. Wouter Jukema, Benoit Lamarche, Altan Onat, Leon A. Simons, Maryam Kavousi, Yoav Ben-Shlomo, John Gallacher, Jacqueline M. Dekker, Hisatomi Arima, Nawar Shara, Robert W. Tipping, Ronan Roussel, Eric J. Brunner, Wolfgang Koenig, Masaru Sakurai, Jelena Pavlovic, Ron T. Gansevoort, Dorothea Nagel, Uri Goldbourt, Elizabeth L. M. Barr, Luigi Palmieri, Inger Njolstad, Shinichi Sato, W. M. Monique Verschuren, Cherian V. Varghese, Ian Graham, Oyere Onuma, Philip Greenland, Mark Woodward, Majid Ezzati, Bruce M. Psaty, Naveed Sattar, Rod Jackson, Paul M. Ridker, Nancy R. Cook, Ralph B. D'Agostino Sr., Simone G. Thompson, John Danesh, Emanuele Di Angelantonio

Publications and Research

Aims: There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after ‘recalibration’, a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied.

Methods & Results: Using individual-participant data on 360737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination and calibration, and …

Characteristics Of Traumatic Out-Of-Hospital Cardiac Arrest Patients Presenting To Major Centers In Karachi, Pakistan-A Longitudinal Cohort Study, Minaz Mawani, Muhammad Masood Kadir, Iqbal Azam Syed, Junaid Abdul Razzak

Section of Cardiology

Background: Trauma is the leading cause of death for adults under 44 years of age. Survival after traumatic out-of-hospital cardiac arrest (OHCA) has been reported to be poor, and its epidemiology is not well defined. A few studies have reported better survival in response to pre-hospital life-saving interventions. Currently, no published data on traumatic cardiac arrests in the field exist from low- and lower middle-income countries. We aimed to explore the epidemiology and outcomes of traumatic OHCA patients from Karachi, Pakistan. We conducted a longitudinal cohort study at emergency departments (ED) of five major public and private hospitals of the …

Platelet Cd36 Signaling Through Erk5 Promotes Caspase-Dependent Procoagulant Activity And Fibrin Deposition In Vivo, Moua Yang, Andaleb Kholmukhamedov, Marie L. Schulte, Brian C. Cooley, Na'il O. Scoggins, Jeremy P. Wood, Scott J. Cameron, Craig N. Morrell, Shawn M. Jobe, Roy L. Silverstein

Saha Cardiovascular Research Center Faculty Publications

Dyslipidemia is a risk factor for clinically significant thrombotic events. In this condition, scavenger receptor CD36 potentiates platelet reactivity through recognition of circulating oxidized lipids. CD36 promotes thrombosis by activating redox-sensitive signaling molecules, such as the MAPK extracellular signal-regulated kinase 5 (ERK5). However, the events downstream of platelet ERK5 are not clear. In this study, we report that oxidized low-density lipoprotein (oxLDL) promotes exposure of procoagulant phosphatidylserine (PSer) on platelet surfaces. Studies using pharmacologic inhibitors indicate that oxLDL-CD36 interaction–induced PSer exposure requires apoptotic caspases in addition to the downstream CD36-signaling molecules Src kinases, hydrogen peroxide, and ERK5. Caspases promote PSer …

Chemo-Coronaries: A Rare Form Of Coronary Vasospasm Following 5-Fu Infusion, George Prousi Md, Joseph Moran Do, Ross Biggs Do, John Mannisi Md

Department of Medicine

No abstract provided.

Restoration Of Left Ventricular Function Following Lvad Implantation – Remission Or Recovery? A Case Series., Shiksha Joshi, Mariah Barlow, Maya Guglin

The VAD Journal

Background

A wide range of left ventricular (LV) recovery rates on left ventricular assist device (LVAD) support have been reported. In this case series, we summarize our experience with LVAD explantation for presumed LV recovery.

Case series

Out of 240 patients who received an LVAD implant in our program since its inception, we explanted/inactivated the pump for presumed LV recovery in only three patients. All three of these patients had relapse of cardiomyopathy within 6 months of explantation.

Conclusion

Our experience does not support the existence of LV recovery following LVAD implantation as a common phenomenon. Improvement in LV function …

Designing Tailored Patient Education On Atrial Fibrillation, Tammy Toscos, R Ahmed, Romisa Rohani Ghahari, Elizabeth Martin, Shauna Wagner, Michelle Drouin, Michael J. Mirro

Presentations and Events

Background & Hypothesis: Research has revealed a high prevalence of depression, anxiety, and burnout among medical students accompanied by widespread lack of treatment. We hypothesize that by leveraging our study findings examining the use of telemental health(TMH) among youth (ages 14-24) alongside results from existing research focused on the mental health needs of medical students (median age at start 22-24 years old), we will gain valuable insight into the potential for TMH to address the needs of this high-risk population.

Methods: Using the Delphi method, a sample of 25 experts were surveyed anonymously, thus avoiding group pressure for conformity while …

A Real World Experience Of The Fast-Ed Based Pre-Hospital Stroke Triage System To Detect Large Vessel Occlusions, Ned Shashoua, Amy Starosciak, Jayme Strauss, Felipe De Los Rios La Rosa

All Publications

No abstract provided.