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JOURNAL ARTICLE
Long COVID Characteristics and Experience: A Descriptive Study from the Yale LISTEN Research Cohort.
Mitsuaki Sawano, Yilun Wu, Rishi M Shah, Tianna Zhou, Adith S Arun, Pavan Khosla, Shayaan Kaleem, Anushree Vashist, Bornali Bhattacharjee, Qinglan Ding, Yuan Lu, César Caraballo, Frederick Warner, Chenxi Huang, Jeph Herrin, David Putrino, Teresa Michelsen, Liza Fisher, Cynthia Adinig, Akiko Iwasaki, Harlan M Krumholz
OBJECTIVE: To describe the experience of people with long COVID symptomatology and characterize the psychological, social, and financial challenges they experience. BACKGROUND: The experience of people with long COVID needs further amplification, especially with a comprehensive focus on symptomatology, treatments, and impact on daily life and finances. METHODS: We collected data from individuals aged 18 and older reporting long COVID as participants in the Yale Listen to Immune, Symptom and Treatment Experiences Now (LISTEN) Study...
April 23, 2024: American Journal of Medicine
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JOURNAL ARTICLE
Katelyn F McNamara, Alexander E Merkler, James V Freeman, Harlan M Krumholz, Tariq Ahmad, Richa Sharma
Reduced left ventricular ejection fraction ≤40%, a known risk factor for adverse cardiac outcomes and recurrent acute ischemic stroke, may be detected during an acute ischemic stroke hospitalization. A multidisciplinary care paradigm informed by neurology and cardiology expertise may facilitate the timely implementation of an array of proven heart failure-specific therapies and procedures in a nuanced manner to optimize brain and cardiac health.
April 25, 2024: Stroke; a Journal of Cerebral Circulation
#3
JOURNAL ARTICLE
Kavya M Shah, Rishi M Shah, Mitsuaki Sawano, Yixuan Wu, Pamela Bishop, Akiko Iwasaki, Harlan M Krumholz
BACKGROUND: While factors associated with long COVID (LC) continue to be illuminated, little is known about recovery. This study used national survey data to assess differences between adults in the United States with LC and those who recovered. METHODS: We used COVID-19 and LC data from the 2022 National Health Interview Survey, a cross-sectional sample of non-institutionalized US adults. Survey analysis was used to account for oversampling and nonresponse bias and to obtain nationally representative estimates...
April 20, 2024: American Journal of Medicine
#4
Lovedeep S Dhingra, Arya Aminorroaya, Veer Sangha, Aline Pedroso Camargos, Folkert W Asselbergs, Luisa Cc Brant, Sandhi M Barreto, Antonio Luiz P Ribeiro, Harlan M Krumholz, Evangelos K Oikonomou, Rohan Khera
BACKGROUND: Current risk stratification strategies for heart failure (HF) risk require either specific blood-based biomarkers or comprehensive clinical evaluation. In this study, we evaluated the use of artificial intelligence (AI) applied to images of electrocardiograms (ECGs) to predict HF risk. METHODS: Across multinational longitudinal cohorts in the integrated Yale New Haven Health System (YNHHS) and in population-based UK Biobank (UKB) and Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), we identified individuals without HF at baseline...
April 3, 2024: medRxiv
#5
Philip Adejumo, Phyllis Thangaraj, Lovedeep Singh Dhingra, Arya Aminorroaya, Xinyu Zhou, Cynthia Brandt, Hua Xu, Harlan M Krumholz, Rohan Khera
INTRODUCTION: Serial functional status assessments are critical to heart failure (HF) management but are often described narratively in documentation, limiting their use in quality improvement or patient selection for clinical trials. We developed and validated a deep learning-based natural language processing (NLP) strategy to extract functional status assessments from unstructured clinical notes. METHODS: We identified 26,577 HF patients across outpatient services at Yale New Haven Hospital (YNHH), Greenwich Hospital (GH), and Northeast Medical Group (NMG) (mean age 76...
April 1, 2024: medRxiv
#6
JOURNAL ARTICLE
Evangelos K Oikonomou, Gregory Holste, Neal Yuan, Andreas Coppi, Robert L McNamara, Norrisa A Haynes, Amit N Vora, Eric J Velazquez, Fan Li, Venu Menon, Samir R Kapadia, Thomas M Gill, Girish N Nadkarni, Harlan M Krumholz, Zhangyang Wang, David Ouyang, Rohan Khera
IMPORTANCE: Aortic stenosis (AS) is a major public health challenge with a growing therapeutic landscape, but current biomarkers do not inform personalized screening and follow-up. A video-based artificial intelligence (AI) biomarker (Digital AS Severity index [DASSi]) can detect severe AS using single-view long-axis echocardiography without Doppler characterization. OBJECTIVE: To deploy DASSi to patients with no AS or with mild or moderate AS at baseline to identify AS development and progression...
April 6, 2024: JAMA Cardiology
#7
Evangelos K Oikonomou, Veer Sangha, Lovedeep S Dhingra, Arya Aminorroaya, Andreas Coppi, Harlan M Krumholz, Lauren A Baldassarre, Rohan Khera
BACKGROUND: Risk stratification strategies for cancer therapeutics-related cardiac dysfunction (CTRCD) rely on serial monitoring by specialized imaging, limiting their scalability. OBJECTIVES: To examine an artificial intelligence (AI)-enhanced electrocardiographic (AI-ECG) surrogate for imaging risk biomarkers, and its association with CTRCD. METHODS: Across a five-hospital U.S.-based health system (2013-2023), we identified patients with breast cancer or non-Hodgkin lymphoma (NHL) who received anthracyclines (AC) and/or trastuzumab (TZM), and a control cohort receiving immune checkpoint inhibitors (ICI)...
March 19, 2024: medRxiv
#8
Evangelos K Oikonomou, Gregory Holste, Andreas Coppi, Robert L McNamara, Girish N Nadkarni, Cristiana Baloescu, Harlan M Krumholz, Zhangyang Wang, Rohan Khera
BACKGROUND: Point-of-care ultrasonography (POCUS) enables access to cardiac imaging directly at the bedside but is limited by brief acquisition, variation in acquisition quality, and lack of advanced protocols. OBJECTIVE: To develop and validate deep learning models for detecting underdiagnosed cardiomyopathies on cardiac POCUS, leveraging a novel acquisition quality-adapted modeling strategy. METHODS: To develop the models, we identified transthoracic echocardiograms (TTEs) of patients across five hospitals in a large U...
March 15, 2024: medRxiv
#9
JOURNAL ARTICLE
Daniel Wang, Satoko Ito, Christina Waldron, Ayesha Butt, Ellen Zhang, Harlan Krumholz, Hanny Al-Samkari, George Goshua
No FDA or EMA approved therapies exist for bleeding due to hereditary hemorrhagic telangiectasia (HHT), the second-most-common inherited bleeding disorder worldwide. The current standard-of-care (SOC) includes iron and red cell supplementation, alongside the necessary hemostatic procedures, none of which target underlying disease pathogenesis. Recent evidence has demonstrated that bleeding pathophysiology is amenable to systemic antiangiogenic therapy with the anti-VEGF bevacizumab. Despite its high cost, the addition of longitudinal bevacizumab to the current SOC may reduce overall healthcare resource utilization and improve patient quality-of-life...
March 27, 2024: Blood Advances
#10
REVIEW
Azita H Talasaz, Parham Sadeghipour, Luis Ortega-Paz, Hessam Kakavand, Maryam Aghakouchakzadeh, Craig Beavers, John Fanikos, John W Eikelboom, Deborah M Siegal, Manuel Monreal, David Jimenez, Muthiah Vaduganathan, Lana A Castellucci, Adam Cuker, Geoffrey D Barnes, Jean M Connors, Eric A Secemsky, Benjamin W Van Tassell, Raffaele De Caterina, Jacob E Kurlander, Ali Aminian, Gregory Piazza, Samuel Z Goldhaber, Lisa Moores, Saskia Middeldorp, Ajay J Kirtane, Mitchell S V Elkind, Dominick J Angiolillo, Stavros Konstantinides, Gregory Y H Lip, Gregg W Stone, Mary Cushman, Harlan M Krumholz, Roxana Mehran, Deepak L Bhatt, Behnood Bikdeli
Balancing the safety and efficacy of antithrombotic agents in patients with gastrointestinal disorders is challenging because of the potential for interference with the absorption of antithrombotic drugs and for an increased risk of bleeding. In this Review, we address considerations for enteral antithrombotic therapy in patients with cardiovascular disease and gastrointestinal comorbidities. For those with gastrointestinal bleeding (GIB), we summarize a general scheme for risk stratification and clinical evidence on risk reduction approaches, such as limiting the use of concomitant medications that increase the risk of GIB and the potential utility of gastrointestinal protection strategies (such as proton pump inhibitors or histamine type 2 receptor antagonists)...
March 20, 2024: Nature Reviews. Cardiology
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JOURNAL ARTICLE
Cecily Allen, Satoko Ito, Ayesha Butt, Adriana Purcell, Rhys Richmond, Christopher A Tormey, Harlan Krumholz, Adam Cuker, George Goshua
While awaiting confirmatory results, empiric therapy for patients suspected to have immune thrombotic thrombocytopenic purpura (iTTP) provides benefits and also accrues risks and costs. Rapid assays for ADAMTS13 may be able to avoid the cost and risk exposure associated with empiric treatment. We conducted the first cost-effectiveness evaluation of testing strategies with rapid versus traditional ADAMTS13 assays in patients with intermediate to high-risk PLASMIC scores, with and without caplacizumab use. We built a Markov cohort simulation with four clinical base-case analyses: 1) Intermediate-risk PLASMIC score with caplacizumab, 2) Intermediate-risk PLASMIC score without caplacizumab, 3) High-risk PLASMIC score with caplacizumab, 4) High-risk PLASMIC score without caplacizumab...
March 19, 2024: Blood Advances
#12
Julio Silva, Takehiro Takahashi, Jamie Wood, Peiwen Lu, Alexandra Tabachnikova, Jeff R Gehlhausen, Kerrie Greene, Bornali Bhattacharjee, Valter Silva Monteiro, Carolina Lucas, Rahul M Dhodapkar, Laura Tabacof, Mario Peña-Hernandez, Kathy Kamath, Tianyang Mao, Dayna Mccarthy, Ruslan Medzhitov, David van Dijk, Harlan M Krumholz, Leying Guan, David Putrino, Akiko Iwasaki
Strong sex differences in the frequencies and manifestations of Long COVID (LC) have been reported with females significantly more likely than males to present with LC after acute SARS-CoV-2 infection 1-7 . However, whether immunological traits underlying LC differ between sexes, and whether such differences explain the differential manifestations of LC symptomology is currently unknown. Here, we performed sex-based multi-dimensional immune-endocrine profiling of 165 individuals 8 with and without LC in an exploratory, cross-sectional study to identify key immunological traits underlying biological sex differences in LC...
March 4, 2024: medRxiv
#13
JOURNAL ARTICLE
Yixuan Wu, Mitsuaki Sawano, Yilun Wu, Rishi M Shah, Pamela Bishop, Akiko Iwasaki, Harlan M Krumholz
BACKGROUND: Long COVID is a multisystemic condition that affects the lives of millions of people globally, yet factors associated with it are poorly defined. Our purpose in this study was to identify factors associated with long COVID. METHODS: This cross-sectional study used data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) and the 2022 National Health Interview Survey (NHIS). We restricted the sample to individuals aged 18 and older who reported a positive COVID-19 test or doctor's diagnosis...
March 13, 2024: American Journal of Medicine
#14
JOURNAL ARTICLE
Daniela Renedo, Julian N Acosta, Audrey C Leasure, Richa Sharma, Harlan M Krumholz, Adam de Havenon, Fares Alahdab, Aleksandr Y Aravkin, Zahra Aryan, Till Winfried Bärnighausen, Sanjay Basu, Katrin Burkart, Kaleb Coberly, Michael H Criqui, Xiaochen Dai, Rupak Desai, Samath Dhamminda Dharmaratne, Rajkumar Doshi, Islam Y Elgendy, Valery L Feigin, Irina Filip, Mohamed M Gad, Sherief Ghozy, Nima Hafezi-Nejad, Rizwan Kalani, Ibraheem M Karaye, Adnan Kisa, Vijay Krishnamoorthy, Warren Lo, Tomislav Mestrovic, Ted R Miller, Awoke Misganaw, Ali H Mokdad, Christopher J L Murray, Zuhair S Natto, Amir Radfar, Pradhum Ram, Gregory A Roth, Allen Seylani, Nilay S Shah, Purva Sharma, Aziz Sheikh, Jasvinder A Singh, Suhang Song, Houman Sotoudeh, Dominique Vervoort, Cong Wang, Hong Xiao, Suowen Xu, Ramin Zand, Guido J Falcone, Kevin N Sheth
IMPORTANCE: Stroke is a leading cause of death and disability in the US. Accurate and updated measures of stroke burden are needed to guide public health policies. OBJECTIVE: To present burden estimates of ischemic and hemorrhagic stroke in the US in 2019 and describe trends from 1990 to 2019 by age, sex, and geographic location. DESIGN, SETTING, AND PARTICIPANTS: An in-depth cross-sectional analysis of the 2019 Global Burden of Disease study was conducted...
March 4, 2024: JAMA Neurology
#15
JOURNAL ARTICLE
Sina Rashedi, Christie M Greason, Parham Sadeghipour, Azita H Talasaz, Michelle L O'Donoghue, David Jimenez, Manuel Monreal, Christopher D Anderson, Mitchell S V Elkind, Lisa M Baumann Kreuziger, Irene M Lang, Samuel Z Goldhaber, Stavros V Konstantinides, Gregory Piazza, Harlan M Krumholz, Eugene Braunwald, Behnood Bikdeli
Fibrinolytic agents catalyze the conversion of the inactive proenzyme plasminogen into the active protease plasmin, degrading fibrin within the thrombus and recanalizing occluded vessels. The history of these medications dates to the discovery of the first fibrinolytic compound, streptokinase, from bacterial cultures in 1933. Over time, researchers identified two other plasminogen activators in human samples, namely urokinase and tissue plasminogen activator (tPA). Subsequently, tPA was cloned using recombinant DNA methods to produce alteplase...
March 1, 2024: Seminars in Thrombosis and Hemostasis
#16
Yuan Lu, Ellen C Keeley, Eric Barrette, Rhonda M Cooper-DeHoff, Sanket S Dhruva, Jenny Gaffney, Ginger Gamble, Bonnie Handke, Chenxi Huang, Harlan Krumholz, Caitrin Rowe, Wade Schulz, Kathryn Shaw, Myra Smith, Jennifer Woodard, Patrick Young, Keondae Ervin, Joseph Ross
Background Improving hypertension control is a public health priority. However, consistent identification of uncontrolled hypertension using computable definitions in electronic health records (EHR) across health systems remains uncertain. Methods In this retrospective cohort study, we applied two computable definitions to the EHR data to identify patients with controlled and uncontrolled hypertension and to evaluate differences in characteristics, treatment, and clinical outcomes between these patient populations...
February 15, 2024: Research Square
#17
Akshay Khunte, Veer Sangha, Evangelos K Oikonomou, Lovedeep Singh Dhingra, Arya Aminorroaya, Andreas Coppi, Sumukh Vasisht Shankar, Bobak J Mortazavi, Deepak L Bhatt, Harlan M Krumholz, Girish Nadkarni, Akhil Vaid, Rohan Khera
Timely and accurate assessment of electrocardiograms (ECGs) is crucial for diagnosing, triaging, and clinically managing patients. Current workflows rely on a computerized ECG interpretation using rule-based tools built into the ECG signal acquisition systems with limited accuracy and flexibility. In low-resource settings, specialists must review every single ECG for such decisions, as these computerized interpretations are not available. Additionally, high-quality interpretations are even more essential in such low-resource settings as there is a higher burden of accuracy for automated reads when access to experts is limited...
February 18, 2024: medRxiv
#18
JOURNAL ARTICLE
Jiun-Ruey Hu, Karthik Murugiah, Xin Xin, Mitsuaki Sawano, Yuan Lu, F Perry Wilson, Frederick A Masoudi, John C Messenger, Harlan M Krumholz, Chenxi Huang
No abstract text is available yet for this article.
February 23, 2024: Journal of the American Heart Association
#19
JOURNAL ARTICLE
Sarah Krumholz, Molly Hurd, Wendy Memishian
No abstract text is available yet for this article.
February 21, 2024: Medical Education
#20
JOURNAL ARTICLE
Thomas A Pearson, Debbie Vitalis, Charlotte Pratt, Rebecca Campo, Antonis A Armoundas, David Au, Bettina Beech, Olga Brazhnik, Christopher G Chute, Karina W Davidson, Ana V Diez-Roux, Lawrence J Fine, Davera Gabriel, Peter Groenveld, Jaclyn Hall, Alison B Hamilton, Hui Hu, Heng Ji, Amy Kind, William E Kraus, Harlan Krumholz, George A Mensah, Raina M Merchant, Dariush Mozaffarian, David M Murray, Dianne Neumark-Sztainer, Maya Petersen, David Goff
Precision prevention embraces personalized prevention but includes broader factors such as social determinants of health to improve cardiovascular health. The quality, quantity, precision, and diversity of data relatable to individuals and communities continue to expand. New analytical methods can be applied to these data to create tools to attribute risk, which may allow a better understanding of cardiovascular health disparities. Interventions using these analytic tools should be evaluated to establish feasibility and efficacy for addressing cardiovascular disease disparities in diverse individuals and communities...
January 2024: JACC Adv
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