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The clinical sequalae of SARS-CoV-2 infection are in part dependent upon age and pre-existing health conditions. Although the use of tobacco products decreases cardiorespiratory fitness while increasing susceptibility to microbial infections, limited information is available on how smoking affects COVID-19 severity. Therefore, we examined whether smokers hospitalized for COVID-19 are at a greater risk for developing severe complications than non-smokers. Data were from all hospitalized adults with SARS-CoV-2 infection from the American Heart Association's Get-With-The-Guidelines COVID-19 Registry, from January 2020 to March 2021, which is a hospital-based voluntary national registry initiated in 2019 with 122 participating hospitals across the United States. Patients who reported smoking at the time of admission were classified as smokers. Severe outcome was defined as either death or the use of mechanical ventilation. Of the 31,545 patients in the cohort, 6,717 patients were 1:2 propensity matched (for age, sex, race, medical history, medications, and time-frame of hospital admission) and classified as current smokers or non-smokers according to admission data. In multivariable analyses, after adjusting for sociodemographic characteristics, medical history, medication use, and the time of hospital admission, patients self-identified as current smokers had higher adjusted odds of death (adjusted odds ratio [aOR], 1.41; 95% CI, 1.21-1.64), the use of mechanical ventilation (aOR 1.15; 95% CI 1.01-1.32), and increased risk of major adverse cardiovascular events (aOR, 1.27; 95% CI 1.05-1.52). Independent of sociodemographic characteristics and medical history, smoking was associated with a higher risk of severe COVID-19, including death.
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COVID-19 , Doenças Cardiovasculares , Adulto , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Hospitalização , Humanos , SARS-CoV-2 , Índice de Gravidade de Doença , Fumar/efeitos adversos , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Mood disorders (MDS) are a type of mental health illness that effects millions of people in the United States. Early prediction of MDS can give providers greater opportunity to treat these disorders. We hypothesized that longitudinal cardiovascular health (CVH) measurements would be informative for MDS prediction. METHODS: To test this hypothesis, the American Heart Association's Guideline Advantage (TGA) dataset was used, which contained longitudinal EHR from 70 outpatient clinics. The statistical analysis and machine learning models were employed to identify the associations of the MDS and the longitudinal CVH metrics and other confounding factors. RESULTS: Patients diagnosed with MDS consistently had a higher proportion of poor CVH compared to patients without MDS, with the largest difference between groups for Body mass index (BMI) and Smoking. Race and gender were associated with status of CVH metrics. Approximate 46% female patients with MDS had a poor hemoglobin A1C compared to 44% of those without MDS; 62% of those with MDS had poor BMI compared to 47% of those without MDS; 59% of those with MDS had poor blood pressure (BP) compared to 43% of those without MDS; and 43% of those with MDS were current smokers compared to 17% of those without MDS. CONCLUSIONS: Women and ethnoracial minorities with poor cardiovascular health measures were associated with a higher risk of development of MDS, which indicated the high utility for using routine medical records data collected in care to improve detection and treatment for MDS among patients with poor CVH.
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Doenças Cardiovasculares , Pressão Sanguínea , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Masculino , Transtornos do Humor , Fatores de Risco , Estados UnidosRESUMO
[Figure: see text].
Assuntos
COVID-19/epidemiologia , Hemorragia Cerebral/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Anticoagulantes/uso terapêutico , Proteína C-Reativa/metabolismo , COVID-19/metabolismo , COVID-19/terapia , Hemorragia Cerebral/metabolismo , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Feminino , Fatores de Risco de Doenças Cardíacas , Mortalidade Hospitalar , Hospitalização , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Interleucina-6/metabolismo , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Respiração Artificial/estatística & dados numéricos , Fatores de Risco , SARS-CoV-2 , Fatores Sexuais , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in the United States (US). Better cardiovascular health (CVH) is associated with CVD prevention. Predicting future CVH levels may help providers better manage patients' CVH. We hypothesized that CVH measures can be predicted based on previous measurements from longitudinal electronic health record (EHR) data. METHODS: The Guideline Advantage (TGA) dataset was used and contained EHR data from 70 outpatient clinics across the United States (US). We studied predictions of 5 CVH submetrics: smoking status (SMK), body mass index (BMI), blood pressure (BP), hemoglobin A1c (A1C), and low-density lipoprotein (LDL). We applied embedding techniques and long short-term memory (LSTM) networks - to predict future CVH category levels from all the previous CVH measurements of 216,445 unique patients for each CVH submetric. RESULTS: The LSTM model performance was evaluated by the area under the receiver operator curve (AUROC): the micro-average AUROC was 0.99 for SMK prediction; 0.97 for BMI; 0.84 for BP; 0.91 for A1C; and 0.93 for LDL prediction. Model performance was not improved by using all 5 submetric measures compared with using single submetric measures. CONCLUSIONS: We suggest that future CVH levels can be predicted using previous CVH measurements for each submetric, which has implications for population cardiovascular health management. Predicting patients' future CVH levels might directly increase patient CVH health and thus quality of life, while also indirectly decreasing the burden and cost for clinical health system caused by CVD and cancers.
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Doenças Cardiovasculares , Registros Eletrônicos de Saúde , Pressão Sanguínea , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Nível de Saúde , Humanos , Qualidade de Vida , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Cancer is the second leading cause of death in the United States. Cancer screenings can detect precancerous cells and allow for earlier diagnosis and treatment. Our purpose was to better understand risk factors for cancer screenings and assess the effect of cancer screenings on changes of Cardiovascular health (CVH) measures before and after cancer screenings among patients. METHODS: We used The Guideline Advantage (TGA)-American Heart Association ambulatory quality clinical data registry of electronic health record data (n = 362,533 patients) to investigate associations between time-series CVH measures and receipt of breast, cervical, and colon cancer screenings. Long short-term memory (LSTM) neural networks was employed to predict receipt of cancer screenings. We also compared the distributions of CVH factors between patients who received cancer screenings and those who did not. Finally, we examined and quantified changes in CVH measures among the screened and non-screened groups. RESULTS: Model performance was evaluated by the area under the receiver operator curve (AUROC): the average AUROC of 10 curves was 0.63 for breast, 0.70 for cervical, and 0.61 for colon cancer screening. Distribution comparison found that screened patients had a higher prevalence of poor CVH categories. CVH submetrics were improved for patients after cancer screenings. CONCLUSION: Deep learning algorithm could be used to investigate the associations between time-series CVH measures and cancer screenings in an ambulatory population. Patients with more adverse CVH profiles tend to be screened for cancers, and cancer screening may also prompt favorable changes in CVH. Cancer screenings may increase patient CVH health, thus potentially decreasing burden of disease and costs for the health system (e.g., cardiovascular diseases and cancers).
Assuntos
Neoplasias da Mama/diagnóstico , Doenças Cardiovasculares/diagnóstico , Neoplasias do Colo/diagnóstico , Aprendizado Profundo , Neoplasias do Colo do Útero/diagnóstico , Adulto , Área Sob a Curva , Detecção Precoce de Câncer , Feminino , Guias como Assunto , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Fatores de RiscoRESUMO
BACKGROUND: Electronic health record (EHR) data can measure cardiovascular health (CVH) of patient populations, but have limited generalizability when derived from one health care system. OBJECTIVE: We used The Guideline Advantage™ (TGA) data repository, comprising EHR data of patients from 8 diverse health care systems, to describe CVH of adult patients and progress towards the American Heart Association's (AHA's) 2020 Impact Goals. METHODS: Our analysis included 203,488 patients with 677,733 encounters recorded in TGA from 2012 to 2015. Five measures from EHRs [cigarette smoking status, body mass index (BMI), blood pressure (BP), cholesterol, and diabetes mellitus (DM)] were categorized as poor/intermediate/ideal according to AHA's Life's Simple 7 algorithm. We presented distributions and trends of CVH for each metric over time, first using all available data, and then in a subsample (n = 1,890) of patients with complete data on all metrics. RESULTS: Among all patients, the greatest stride towards ideal CVH attainment from 2012 to 2015 was for cigarette smoking (50.6 percent to 65 percent), followed by DM (17.3 percent to 20.7 percent) and BP (21.1 percent to 23.2 percent). Overall, prevalence of ideal CVH did not increase for any metric in the subsample. Males slightly improved in ideal CVH for BMI and cholesterol; meanwhile, females saw no improvement in ideal CVH for any metric. As ideal CVH for BP and cholesterol increased slightly among white patients, ideal CVH for BP, cholesterol, BMI, and DM worsened for non-whites. CONCLUSION: Despite improvements in some CVH metrics in the outpatient setting, more tangible progress is needed to meet AHA's 2020 Impact Goals.
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OBJECTIVE: To evaluate the use of inpatient pharmacy and administrative data to detect surgical site infections (SSIs) following hysterectomy and colorectal and vascular surgery. DESIGN: Retrospective cohort study. SETTING: Five hospitals affiliated with academic medical centers. PATIENTS: Adults who underwent abdominal or vaginal hysterectomy, colorectal surgery, or vascular surgery procedures between July 1, 2003, and June 30, 2005. METHODS: We reviewed the medical records of weighted, random samples drawn from 3,079 abdominal and vaginal hysterectomy, 4,748 colorectal surgery, and 3,332 vascular surgery procedures. We compared routine surveillance with screening of inpatient pharmacy data and diagnosis codes and then performed medical record review to confirm SSI status. RESULTS: Medical records from 823 hysterectomy, 736 colorectal surgery, and 680 vascular surgery procedures were reviewed. SSI rates determined by antimicrobial- and/or diagnosis code-based screening followed by medical record review (enhanced surveillance) were substantially higher than rates determined by routine surveillance (4.3% [95% confidence interval, 3.6%-5.1%] vs 2.7% for hysterectomies, 7.1% [95% confidence interval, 6.7%-8.2%] vs 2.0% for colorectal procedures, and 2.3% [95% confidence interval, 1.9%-2.9%] vs 1.4% for vascular procedures). Enhanced surveillance had substantially higher sensitivity than did routine surveillance to detect SSI (92% vs 59% for hysterectomies, 88% vs 22% for colorectal procedures, and 72% vs 43% for vascular procedures). A review of medical records confirmed SSI for 31% of hysterectomies, 20% of colorectal procedures, and 31% of vascular procedures that met the enhanced screening criteria. CONCLUSION: Antimicrobial- and diagnosis code-based screening may be a useful method for enhancing and streamlining SSI surveillance for a variety of surgical procedures, including those procedures targeted by the Centers for Medicare and Medicaid Services.
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Classificação Internacional de Doenças , Prontuários Médicos , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Vigilância da População/métodos , Infecção da Ferida Cirúrgica/epidemiologia , Anti-Infecciosos/uso terapêutico , Doenças do Colo/cirurgia , Intervalos de Confiança , Humanos , Histerectomia/efeitos adversos , Histerectomia/estatística & dados numéricos , Valor Preditivo dos Testes , Curva ROC , Doenças Retais/cirurgia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/tratamento farmacológico , Doenças Vasculares/cirurgiaRESUMO
OBJECTIVE: To evaluate the use of routinely collected electronic health data in Medicare claims to identify surgical site infections (SSIs) following hip arthroplasty, knee arthroplasty, and vascular surgery. DESIGN: Retrospective cohort study. SETTING: Four academic hospitals that perform prospective SSI surveillance. METHODS: We developed lists of International Classification of Diseases, Ninth Revision, and Current Procedural Terminology diagnosis and procedure codes to identify potential SSIs. We then screened for these codes in Medicare claims submitted by each hospital on patients older than 65 years of age who had undergone 1 of the study procedures during 2007. Each site reviewed medical records of patients identified by either claims codes or traditional infection control surveillance to confirm SSI using Centers for Disease Control and Prevention/National Healthcare Safety Network criteria. We assessed the performance of both methods against all chart-confirmed SSIs identified by either method. RESULTS: Claims-based surveillance detected 1.8-4.7-fold more SSIs than traditional surveillance, including detection of all previously identified cases. For hip and vascular surgery, there was a 5-fold and 1.6-fold increase in detection of deep and organ/space infections, respectively, with no increased detection of deep and organ/space infections following knee surgery. Use of claims to trigger chart review led to confirmation of SSI in 1 out of 3 charts for hip arthroplasty, 1 out of 5 charts for knee arthroplasty, and 1 out of 2 charts for vascular surgery. CONCLUSION: Claims-based SSI surveillance markedly increased the number of SSIs detected following hip arthroplasty, knee arthroplasty, and vascular surgery. It deserves consideration as a more effective approach to target chart reviews for identifying SSIs.
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Classificação Internacional de Doenças , Medicare , Vigilância da População/métodos , Infecção da Ferida Cirúrgica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Feminino , Humanos , Masculino , Prontuários Médicos , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Estados Unidos , Procedimentos Cirúrgicos Vasculares/efeitos adversosRESUMO
OBJECTIVE: To evaluate whether longitudinal insurer claims data allow reliable identification of elevated hospital surgical site infection (SSI) rates. DESIGN: We conducted a retrospective cohort study of Medicare beneficiaries who underwent coronary artery bypass grafting (CABG) in US hospitals performing at least 80 procedures in 2005. Hospitals were assigned to deciles by using case mix-adjusted probabilities of having an SSI-related inpatient or outpatient claim code within 60 days of surgery. We then reviewed medical records of randomly selected patients to assess whether chart-confirmed SSI risk was higher in hospitals in the worst deciles compared with the best deciles. PARTICIPANTS: Fee-for-service Medicare beneficiaries who underwent CABG in these hospitals in 2005. RESULTS: We evaluated 114,673 patients who underwent CABG in 671 hospitals. In the best decile, 7.8% (958/12,307) of patients had an SSI-related code, compared with 24.8% (2,747/11,068) in the worst decile ([Formula: see text]). Medical record review confirmed SSI in 40% (388/980) of those with SSI-related codes. In the best decile, the chart-confirmed annual SSI rate was 3.2%, compared with 9.4% in the worst decile, with an adjusted odds ratio of SSI of 2.7 (confidence interval, 2.2-3.3; [Formula: see text]) for CABG performed in a worst-decile hospital compared with a best-decile hospital. CONCLUSIONS: Claims data can identify groups of hospitals with unusually high or low post-CABG SSI rates. Assessment of claims is more reproducible and efficient than current surveillance methods. This example of secondary use of routinely recorded electronic health information to assess quality of care can identify hospitals that may benefit from prevention programs.
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Ponte de Artéria Coronária , Infecção Hospitalar/epidemiologia , Hospitais/estatística & dados numéricos , Medicare/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/métodos , Infecção da Ferida Cirúrgica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Hospitais/normas , Humanos , Formulário de Reclamação de Seguro/estatística & dados numéricos , Modelos Logísticos , Masculino , Estudos Retrospectivos , Medição de Risco/métodos , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To explore the disparities in colorectal cancer (CRC) screening based on health insurance status. METHOD: We reviewed 382 medical records of asymptomatic patients aged 50-80 years, who completed their screening colonoscopies between January 2000 and May 2007. Medical records were abstracted from a private primary-care clinic and a university hospital primary-care clinic. Patients with private or public health insurance were included. General linear model and t-test were performed for statistical analysis. RESULTS: We found that the average waiting time for screening colonoscopy among privately insured patients was significantly lower than for publicly insured patients (33 vs 200 days; P < 0.001). There was no statistical difference in gender or age between the two groups. CONCLUSION: There is an urgent need for state-wide health-care policy reform to help reduce some of the observed causes of health-care disparities based on the insurance status of individuals.
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Colonoscopia , Neoplasias Colorretais/diagnóstico , Diagnóstico Tardio , Disparidades em Assistência à Saúde/economia , Seguro Médico Ampliado , Assistência Médica , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: The objective of this study was to determine if providers asked patients about tobacco and assisted tobacco users with cessation. METHODS: The data source is the 2001-2004 National Ambulatory Medical Care Survey, which is an annual survey of outpatient visits. The prevalence of "asking" about tobacco use, providing "assistance" with tobacco cessation, and prescription of pharmacotherapy for cessation were estimated. A logistic regression model was fit to the data to determine if any variables were related to "asking" about tobacco use and providing "assistance" with cessation. RESULTS: Overall, 32% of patient charts did not include information about tobacco use, 81% of smokers did not receive assistance and less than 2% received a prescription for pharmacotherapy. Asking about tobacco use varied with presence of chronic disease, cardiovascular disease counseling, geographical region, whether the physician was the patient's primary provider, time spent with physician, age, and gender. Providing assistance with cessation varied with the presence of chronic diseases, cardiovascular disease counseling, region of the country, provider type, insurance type, and time spent with the physician. CONCLUSIONS: Methods for improving adherence to the Clinical Practice Guideline for cessation, such as medical school curricula or educational programs for practicing providers, should be examined.
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Assistência Ambulatorial/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Educação de Pacientes como Assunto/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Prevenção do Hábito de Fumar , Adulto , Idoso , Aconselhamento/estatística & dados numéricos , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/normas , Guias de Prática Clínica como Assunto , Prevalência , Fumar/epidemiologia , Abandono do Hábito de Fumar/métodos , Estados Unidos/epidemiologiaRESUMO
Coronary artery perforation is a rare, but dreaded, complication of percutaneous coronary intervention. Conventional treatment, including reversal of anticoagulation and prolonged balloon inflation, is associated with a high incidence of death, Q-wave myocardial infarction, and emergency coronary bypass surgery. Although a number of case reports have demonstrated the feasibility of sealing coronary perforations with synthetic material-covered stent grafts, the efficacy of this treatment has not been reported in a large, multicenter series. We used a retrospective international registry to examine the outcomes of the polytetrafluoroethylene-coated JOSTENT coronary stent graft (CSG) in 41 cases of coronary perforations. Perforations were relatively severe: 16.7% Ellis grade 1, 54.2% grade 2, and 29.1% grade 3. Of the 41 patients, > 1/3 (n = 14) experienced life-threatening complications before stent graft implantation, including pericardial tamponade (12.2%), cardiogenic shock (9.8%), and cardiac arrest (2.4%). A total of 52 CSGs were used to treat the 41 perforations (mean 1.3 per lesion). All CSGs were placed successfully, with 92.9% of the perforations sealed completely and 7.1% partially. One patient developed abrupt vessel closure after CSG deployment, resulting in an overall procedure success rate of 96.4%. No in-hospital Q-wave myocardial infarctions, emergency coronary bypass surgeries, or deaths resulted. The CSG may be a reliable and highly effective treatment option for sealing coronary perforations complicating percutaneous coronary interventions.