Assessment of early anthracycline-induced cardiotoxicity using segmental strain of cardiac magnetic resonance compared with global strain and functional parameters: an animal study.

Background: The identification of anthracycline-induced cardiotoxicity holds significant importance in guiding subsequent treatment strategies, and recent research has demonstrated the efficacy of cardiac magnetic resonance (CMR) global strain analysis for its diagnosis. On the other hand, it is noteworthy that abnormal global myocardial strain may exhibit a temporal delay due to different cardiac movement in each segment of the left ventricle. To address this concern, this study aims to assess the diagnostic utility of CMR segmental strain analysis as an early detection method for cardiotoxicity. Methods: A serials of CMR scans were performed in 18 adult males New Zealand rabbits at baseline time (n=15), followed by scans at week 2 (n=15), week 4 (n=9), week 6 (n=6), and week 8 (n=5) after each week's anthracycline injection. Additionally, following each CMR scan, two to three rabbits were euthanized for pathological comparison. Cardiac functional parameters, global peak strain parameters, segmental peak strain parameters of the left ventricle, and the presence of myocardial cells damage were obtained. A mixed linear model was employed to obtain the earliest CMR diagnostic time. Receiver operating characteristic (ROC) analysis was performed to get the parameter threshold indicative of cardiotoxicity. Results: The left ventricular ejection fraction decreased at week 8 (P=0.002). There were no statistical differences in global strain throughout the experiment period (P>0.05). Regarding segmental strain analysis, the peak segmental radial strain of the apical lateral wall exhibited a decrease starting from week 2 and reached its lowest point at this week (P=0.011). Conversely, peak segmental circumferential strain of the apical anterior wall showed an increase at week 2 and reached its peak at week 6 (P=0.026). The cutoff strain value by ROC analysis for these two walls were 46.285 and -16.920, with the respective areas under the curve (AUC) 0.593 [specificity =0.267, sensitivity =1.000, 95% confidence interval (CI): 0.471-0.777] and 0.764 (specificity =0.733, sensitivity =0.784, 95% CI: 0.511-0.816). Peak segmental longitudinal strain of the apical anterior and apical lateral wall showed relatively delayed changes, occurring in the 4th week (P=0.030 and P=0.048), the cutoff values for these strains were -12.415 and -15.960, with corresponding AUCs of 0.645 (specificity =0.333, sensitivity =0.955, 95% CI: 0.495-0.795) and 0.717 (specificity =0.433, sensitivity =0.955, 95% CI: 0.566-0.902), respectively. Notably, the myocardial injury was also observed at the corresponding periods. Conclusions: Based on experimental evidence, the peak segmental strain of the apical lateral and anterior wall, as determined by CMR, demonstrated an earlier detection of anthracycline-induced cardiotoxicity compared to peak global strain and cardiac function.

The Future of Process Industry: A Cyber-Physical-Social System Perspective.

The process industry is an industrial field of interdisciplinary nature involving electrical engineering, energy, petroleum, chemical, and metallurgy, which play a key role in the sustainable development. As a main source of CO 2 emissions, the process industry will undertake a large part of the emission reduction task. In order to incorporate the impact of social factors, such as environment, society, and human to support the future process industry, the cyber-physical-social system (CPSS) framework should be considered as a promising way to enhance the transformation of the process industry. The development of CPSS technologies will fundamentally change the infrastructure of conventional industrial systems, offering a great opportunity for the greenization, high-value, and digitalization in the process industry. This article first presents the current status of the process industry. Through a CPSS framework, the current developments of the process industry as well as the main challenges and opportunities are discussed. A vision for the future process industry based on CPSS is described by focusing on three aspects, namely, the greenization and low carbon, high-value and high-end, digitalization, and intellectualization in process manufacturing. Finally, the advanced technologies and approaches in CPSS driven by artificial intelligence and industrial digitalization, which are important in achieving the sustainable development of the process industry, are outlined. The development of the comprehensive digital technologies, such as virtual reality, digital twin, blockchain, and big data, will stimulate the implementation of a ground-breaking concept formed in the CPSS framework called industrial metaverse.

Green, General and Low-cost Synthesis of Porous Organic Polymers in Sub-kilogram Scale for Catalysis and CO2 Capture.

Porous organic polymers (POPs) with high porosity and tunable functionalities have been widely studied for use in gas separation, catalysis, energy conversion and energy storage. However, the high cost of organic monomers, and the use of toxic solvents and high temperatures during synthesis pose obstacles for large-scale production. Herein, we report the synthesis of imine and aminal-linked POPs using inexpensive diamine and dialdehyde monomers in green solvents. Theoretical calculations and control experiments show that using meta-diamines is crucial for forming aminal linkages and branching porous networks from [2+2] polycondensation reactions. The method demonstrates good generality in that 6 POPs were successfully synthesized from different monomers. Additionally, we scaled up the synthesis in ethanol at room temperature, resulting in the production of POPs in sub-kilogram quantities at a relatively low cost. Proof-of-concept studies demonstrate that the POPs can be used as high-performance sorbents for CO2 separation and as porous substrates for efficient heterogeneous catalysis. This method provides an environmentally friendly and cost-effective approach for large-scale synthesis of various POPs.

The price, efficacy, and safety of within-class targeted anticancer medicines between domestic and imported drugs in China: a comparative analysis.

Background: Affordability to novel anticancer drugs has become a major health issue in China. It is encouraging to note that China initiated its drug regulatory reform and national price negotiation policies since 2015. As a growing number of domestic within-class targeted anticancer drugs are approved in China, it is expected that this may reduce the price of novel anticancer drugs and improve the affordability of anticancer drugs. This study aimed to evaluate the price, efficacy, and safety of the within-class anticancer drugs between domestic and imported drugs approved in China from 2010 to 2022. Methods: The domestic and imported within-class targeted drugs for solid cancers approved in China between 2010 and 2022 were extracted. We classified it as a class of anticancer drugs based on the same indication and similar biological mechanism. The published literature derived from pivotal clinical trials of these domestic and imported drugs was identified based on the review report and the latest labels issued by the China National Medical Products Administration. We evaluated the monthly treatment price at launch and the latest (2022), primary efficacy endpoint and safety between domestic and imported anticancer drugs. Meta-analyses were further employed to evaluate the efficacy and safety of the domestic and imported anticancer drugs, including pooled hazard ratios (HR) for progression-free survival (PFS), overall survival (OS), objective response rates (ORR) for solid cancers, and relative risk for serious adverse events (SAE) and Grade ≥3 adverse events (AEs). Findings: In our cohort study, 12 within-class anticancer drugs with 7 cancer diseases were analyzed, including 18 domestic (21 indications; 21 pivotal trials) and 18 imported (21 indications; 27 pivotal trials) novel anticancer drugs, respectively. The median monthly treatment price of domestic and imported drugs from the years of launch to 2022 had significantly decreased by 71% and 62%, respectively. Moreover, the median monthly treatment price of domestic targeted anticancer drugs on the market at launch ($3786 vs. $5393, P = 0.007) and the latest ($1222 vs. $2077, P = 0.011) was significantly lower than that of imported drugs. No significant differences in median PFS gains (9.0 vs. 11.0 months; P = 0.24), OS gains (9.3 vs 10.6 months; P = 0.66), and ORR (57% vs 62%, P = 0.77) of targeted anticancer drugs in their pivotal trials were observed between the domestic and imported drugs. Additionally, there was no significant difference between domestic and imported drugs in the incidence of SAE (23% vs. 24%; P = 0.41) and Grade ≥3 AEs (59% vs. 57%; P = 0.45). These findings were also further confirmed in the meta-analyses for primary efficacy endpoints and safety outcomes. Interpretation: The prices of both domestic and imported anticancer drugs significantly decreased after market entry mainly due to the role of national price negotiations. The median monthly treatment price of domestic within-class targeted anticancer drugs was significantly lower than that of imported drugs. Furthermore, the efficacy and safety of domestic anticancer drugs were comparable to that of imported drugs. This evidence implicated that the development of within-class anticancer drugs with national price negotiations in China significantly improved the affordability for patients. Funding: This study was supported by postdoctoral fellowship from Tsinghua-Peking Joint Centers for Life Sciences (CLS).

Social Determinants, Cardiovascular Disease, and Health Care Cost: A Nationwide Study in the United States Using Machine Learning.

Background Existing studies on cardiovascular diseases (CVDs) often focus on individual-level behavioral risk factors, but research examining social determinants is limited. This study applies a novel machine learning approach to identify the key predictors of county-level care costs and prevalence of CVDs (including atrial fibrillation, acute myocardial infarction, congestive heart failure, and ischemic heart disease). Methods and Results We applied the extreme gradient boosting machine learning approach to a total of 3137 counties. Data are from the Interactive Atlas of Heart Disease and Stroke and a variety of national data sets. We found that although demographic composition (eg, percentages of Black people and older adults) and risk factors (eg, smoking and physical inactivity) are among the most important predictors for inpatient care costs and CVD prevalence, contextual factors such as social vulnerability and racial and ethnic segregation are particularly important for the total and outpatient care costs. Poverty and income inequality are the major contributors to the total care costs for counties that are in nonmetro areas or have high segregation or social vulnerability levels. Racial and ethnic segregation is particularly important in shaping the total care costs for counties with low poverty rates or social vulnerability level. Demographic composition, education, and social vulnerability are consistently important across different scenarios. Conclusions The findings highlight the differences in predictors for different types of CVD cost outcomes and the importance of social determinants. Interventions directed toward areas that have been economically and socially marginalized may aid in reducing the impact of CVDs.

Assessment of hepatic fat content and prediction of myocardial fibrosis in athletes by using proton density fat fraction sequence.

PURPOSE: To explore the characteristics of the hepatic fat content in athletes, and predict late gadolinium enhancement (LGE) based on magnetic resonance imaging-proton density fat fraction (MRI-PDFF). MATERIAL AND METHODS: From March 2020 to March 2021, 233 amateur athletes and 42 healthy sedentary controls were prospectively recruited. The liver fat content of four regions of interest (ROIs 1-4), the mean liver fat fraction (FF), cardiac function, and myocardium LGE were recorded, respectively. The values of ROIs 1-4 and FF were compared between athletes and controls. According to the liver fat content threshold for distinguishing athletes and controls, the cutoff total exercise time that induced a change in liver fat was obtained. The correlations among the liver fat content, cardiac function, and other parameters were analyzed. Moreover, the liver fat content was used to predict myocardium LGE by logistic regression. RESULTS: There were significant differences for the values of ROI 1, ROI 3, ROI 4, and FF between athletes and controls (allp< 0.05). The cutoff total exercise time for inducing a change in the liver fat content was 1680 h (area under the curve [AUC] = 0.593, specificity = 83.3,p< 0.05). Blood indexes, cardiac function, and basic clinical parameters were related to liver fat content (allp< 0.05). The prediction model for LGE had an AUC value of 0.829 for the receiver operator characteristic curve. CONCLUSION: MRI-PDFF could assess liver fat content and predict cardiac fibrosis in athletes for risk stratification and follow-up.

Utilization Trends and Short-Term Outcomes for Transcatheter and Surgical Aortic Valve Replacement Surgery in New York.

BACKGROUND: Population-based utilization trends and outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) remain unknown. OBJECTIVES: To examine the utilization trends and outcomes of TAVR and SAVR in New York using all-inclusive aggregated statewide cardiac registries. METHODS: We described the utilization trends, compared baseline characteristics, and evaluated short-term outcomes of TAVR vs SAVR during 2011-2018 in New York. We applied Cox proportional hazards models to analyze changes in 30-day postoperative mortality for TAVR and SAVR. RESULTS: Of a total 37,566 aortic valve replacement (AVR) patients, 50.8% underwent TAVR and 49.2% received SAVR. TAVR's annual volume increased from 715 in 2012 to 4849 in 2018 (578.18% increase) whereas SAVR's annual volume decreased from 2619 in 2012 to 1855 in 2018 (29.17% decrease). TAVR patients were older, more likely to be female and white, and less likely to be Hispanic. Younger patients (<65 years) and Medicare managed-care patients received TAVR (vs SAVR) a lower percentage of the time relative to older patients (≥65 years) and Medicare fee-for-service patients, respectively. In 2018, the unadjusted 30-day mortality rate was 2.37% for TAVR whereas the rate was 0.97% for SAVR. There was significant annual improvement in 30-day mortality for TAVR (annual adjusted hazard ratio, 0.84, 95% confidence interval, 0.80-0.88) but not for SAVR (annual adjusted hazard ratio, 0.96; 95% confidence interval, 0.91-1.01). CONCLUSION: TAVR and AVR experienced massive growth whereas SAVR decreased in New York. Younger and Medicare managed-care patients had unique utilization trends. TAVR was associated with continuous improvement in 30-day postoperative mortality.

Assessment of the Delay in Novel Anticancer Drugs between China and the United States: A Comparative Study of Drugs Approved between 2010 and 2021.

Access to anticancer drugs has been a critical health issue in China for many years. We retrospectively analyzed the novel anticancer drugs approved in the United States (US) between 2010 and 2021 to assess the evolving landscape of the drug lags in China by taking Japan and the European Union (EU) as comparisons. The absolute and relative lags of drug initial approval (DIA) and indication approval were calculated between China (or Japan/European Union) and the US based on the US approval date of novel agents, the duration was divided into 2010-2015 and 2016-2021. Overall, 123 (244 indications) new molecular entities (NMEs) approved in the United States were included, of which 58 (94 indications), 72 (128 indications), and 99 (170 indications) NMEs were also approved in China, Japan, and the European Union, respectively. The absolute lags of DIA and indications for approval in China improved dramatically in 2016-2021 compared with 2010-2015. Similarly, the relative DIA and indication approval lags in China decreased significantly in 2016-2021. The median review lags for DIA of China in 2016-2021 were comparable to Japan but dramatically lower than that of the European Union. Nevertheless, China had significantly longer median submission lags for DIA (28 months) in 2016-2021 than that of Japan (6 months) and the European Union (1 month). Although the absolute and relative lags of anticancer drugs in China had been initially addressed, 53% of NMEs and 61% of indications were still not approved for cancers in China compared with the United States. Therefore, China should adopt steps to further reduce drug lags.

Assessment of the breakthrough-therapy-designated drugs granted in China: A pooled analysis 2020-2022.

The implementation of China's breakthrough therapy designation (BTD) program in 2020 to accelerate drug development for serious or life-threatening diseases has attracted widespread attention. Here, we review the characteristics of BTD and its implementation in China. Overall, 78 drugs with 82 BTDs were collected from the program's inception to April 2022. The time to obtain BTD for imported new drugs was significantly faster than for domestic ones. The BTDs granted for domestic new drugs were highly concentrated in oncology. The BTD drugs can reduce clinical trial and review times compared with non-BTD drugs. The implementation of BTD is expected to expedite the development of new drugs to address unmet clinical needs in China.

Life Cycle Assessment and Multiobjective Optimization for Steam Cracking Process in Ethylene Plant.

With energy savings and emission reduction becoming national policies in recent years, the environmental impacts of industrial production are more and more critical. Most of the studies have concentrated on the environmental effects of the industrial production process. Little attention has been paid to the energy consumption and pollution emission in extracting, processing, and transporting the feedstock and other secondary materials. An integrated multiobjective optimization framework is proposed for the steam cracking process on the basis of a life cycle assessment and data-driven modeling methods. A multiobjective economic-environmental optimization model is developed on the basis of industrial and simulated data. A multiobjective optimization model combined with energy cost is also developed for comparative study. The nondominated sorting genetic algorithm-II is utilized to solve the problems, and the Pareto front is obtained. An industrial case study is carried out to indicate the effectiveness of the proposed method. The results show that the LCA-based method can better represent the environmental impacts in comparison with the standard energy cost model. Therefore, the proposed method can achieve a better tradeoff between economic benefits and environmental impacts for guiding ethylene production.

Analysis of Patent and Regulatory Exclusivity for Novel Agents in China and the United States: A Cohort Study of Drugs Approved Between 2018 and 2021.

Patent and regulatory exclusivity shall constitute incentives for pharmaceutical companies to develop new drugs. This study aims to investigate the differences in the patent term extension (PTE) and regulatory exclusivity between China and the United States, and to evaluate their potential impact on the market exclusivity period of novel drugs. Small-molecule novel drugs with their first indication approved in China and the United States between 2018 and 2021 were evaluated regarding their PTE and regulatory exclusivity. The PTE length of the China-approved drugs was calculated by simulation, whereas that of the US-approved drugs was extracted from the United States Patent and Trademark Office. Thirty-two and 107 novel drugs approved in China and the United States, respectively, were included in the study. The PTE length of the US-approved drugs calculated by the China-PTE method was significantly longer than that calculated by the US-PTE method. Patent extensions should be granted for 91% of new drugs in China and 82% in the United States. The simulated median PTE length of novel drugs approved in China was significantly higher than that of the United States (5.0 vs. 2.9 years, P < 0.05). It can be expected that the implementation of the PTE policy in China would significantly extend the period of market exclusivity for novel drugs similar to that of the United States. China should fully evaluate the potential impact of the PTE policy on the market exclusivity of novel drugs and provide better incentives to the development of novel drugs in addressing unmet clinical needs when developing its regulatory exclusivity policy.

Rapid, sensitive and cost-effective determination of immune checkpoint inhibitor activity using a magnetic bead-based binding assay.

Immune checkpoint Inhibitors (ICIs) are effective immunno-therapeutic agents for cancer. Rapid and sensitive determination of the blocking activity of ICIs is important for ICIs development and immunological research. Among various immune checkpoint (IC) binding assays, cell-based binding assays are widely regarded, and the functional ELISA is a convenient alternative. However, these methodologies are limited by time-consuming preparation of cell lines stably expressing IC molecules, or long turnaround time with high cost. In this study, two magnetic bead based binding assays were developed to evaluate activity of ICIs, which was determined by a soluble ligand/bead immobilized receptor based binding assay (sL/bR binding assay) that assessed efficacy to block binding of one soluble IC ligand on its cognate receptor immobilized beads, or by a soluble receptor/bead immobilized ligand based binding assay (sR/bL binding assay) that assessed efficacy to block binding of soluble IC receptor on its cognate ligand immobilized beads. Half maximal inhibitory concentration (IC50) values of ICIs were calculated to determine ICIs activity. The sL/bR binding assay accurately determined the activity of two TIGIT blocking antibodies, since the relative blocking activity of two TIGIT antibodies determined by the sL/bR binding assay established in this study and that by the cell based binding assay were almost identical. In contrast, the sR/bL binding assay showed significantly improved sensitivity to determine activity of two PD-1 blocking antibodies than the sL/bR binding assay that was tested in this study and previous reports. Moreover, both amount of the used recombinant protein of ICI receptor/ligand and turnaround time of the two binding assays were more than 10 times less than those of the functional ELISA. These data indicate that the two magnetic bead based binding assays are sensitive, rapid and cost-effective methods to determine blocking activity of ICIs.

Benefits, Cost, and Activities of Patient Navigation (PN) Program for Colorectal Cancer Screening at the Charles B. Wang Community Health Center (CBWCHC).

To evaluate the benefits of a PN program for colorectal cancer (CRC) screening at Charles B. Wang Community Health Center (CBWCHC) in New York City from June 2012 to May 2015, estimate the cost of implementation, and describe time allocation patterns of PN activities. Semi-structured interviews were conducted with key informants of the CBWCHC in 2015. The electronic PN database was used to evaluate the program's effectiveness. New York State Department of Health budgeting and cost data were used to estimate the implementation cost. Self-reported activities of PNs were used to analyze time allocation patterns. A total of 3723 screen-eligible patients were contacted by PNs and 2552 (68.5%) completed at least one CRC screening test. Of these, 266 (10.4%) patients were diagnosed with precancerous polyps and two patients were diagnosed with CRC. The CRC screening rate at CBWCHC increased from 56% to 60% during the program period. The total cost was estimated to be $295,296.51 (in 2014 dollar terms). Overall, this relatively inexpensive CRC screening PN program was effective in increasing CRC screening in a low-income Asian-American community.

Insight into removal of dissolved organic matter in post pharmaceutical wastewater by coagulation-UV/H2O2.

The removal of four dissolved organic matter (DOM) fractions, non-acid hydrophobics, hydrophobic acids, hydrophilics and transphilics, was achieved by coagulation-UV/H2O2 oxidation in post-pharmaceutical wastewater (PhWW). Coagulation with Polyferric chloride (PFC), Polymeric ferric sulfate (PFS) and Polymeric aluminum ferric chloride (PAFC) was studied separately to evaluate the effects of the initial pH and coagulant dosage. The coagulation-UV/H2O2 oxidation method resulted in much higher reduction rates for dissolved organic carbon (DOC) (by 75%) and UV254 (by 92%) than coagulation or UV/H2O2 oxidation alone. The proportion of non-acid hydrophobics, hydrophobic acids, transphilics and hydrophilics removed by coagulation was 54%, 49%, 27% and 12 %, while the combined treatment removed 92%, 87%, 70% and 39%, respectively. Parallel factor analysis (PARAFAC) of fluorescence measurements revealed that the humic-like fluorescent component C4 showed the highest removal (by 44%) during the coagulation stage. After coagulation-UV/H2O2 treatment, the humic-like fluorescent component C3 had the highest removal (by 72%), whereas xenobiotic organic fluorescent components C1 and C4 remained recalcitrant to decomposition. Significant correlations (R2 > 0.8) between C1 and the hydrophobic acids and non-acid hydrophobics suggested the possibility of using fluorescence spectroscopy as an effective tool to assess variations in DOM fraction treatment efficacy in coagulation-UV/H2O2 systems. After the combined treatment, toxic inhibition of cellular activity by post PhWW decreased from 88% to 47% and biodegradability increased from 0.1 to 0.52.

Novel insights into the coagulation process for pharmaceutical wastewater treatment with fluorescence EEMs-PARAFAC.

In this study, coagulation process was applied to treat the effluent of pharmaceutical wastewater using polymeric ferric sulfate as a coagulant. Three-dimensional excitation-emission matrix fluorescence spectroscopy coupled with parallel factor analysis (EEMs-PARAFAC) was applied to investigate the fluorescent characteristics of dissolved organic matter (DOM) from pharmaceutical wastewater and the reduction of contaminant and fluorescent variations in the coagulation process. It shows that coagulation was effective to remove contaminants in the effluent of pharmaceutical wastewater, and the optimum coagulate dosage was 0.5 g/L, where the removal efficiency of total organic matter (TOC), UV254, turbidity and NH4+-N were achieved 44.2%, 43.3%, 87.0% and 10.27%, respectively. Five fluorescence components were identified by EEMs-PARAFAC, including one fulvic-like component (C1), one xenobiotic-like component (C2), two humic-like components (C3 and C5) and one protein-like component (C4); DOM of pharmaceutical wastewater was dominated by C3, C4 and C2. Under the optimum coagulation condition, the decreasing order of removal efficiencies was C5 (49.92%), C3 (40.95%), C4 (10.58%), C2 (9.68%) and C1 (5.05%). Principal component analysis (PCA) showed C3, C5 had remarkable correlations with TOC and UV254, suggesting that C3 and C5 may be a good indicator for the reduction of TOC and UV254. PCA indicated that the EEM-PARAFAC could be successfully applied to the evaluation of the coagulation efficiency for pharmaceutical wastewater treatment.

Cost Analysis and Performance Assessment of Partner Services for Human Immunodeficiency Virus and Sexually Transmitted Diseases, New York State, 2014.

OBJECTIVE: To estimate the programmatic costs of partner services for HIV, syphilis, gonorrhea, and chlamydial infection. STUDY SETTING: New York State and local health departments conducting partner services activities in 2014. STUDY DESIGN: A cost analysis estimated, from the state perspective, total program costs and cost per case assignment, patient interview, partner notification, and disease-specific key performance indicator. DATA COLLECTION: Data came from contracts, a time study of staff effort, and statewide surveillance systems. PRINCIPAL FINDINGS: Disease-specific costs per case assignment (mean: $580; range: $502-$1,111), patient interview ($703; $608-$1,609), partner notification ($1,169; $950-$1,936), and key performance indicator ($2,697; $1,666-$20,255) varied across diseases. Most costs (79 percent) were devoted to gonorrhea and chlamydial infection investigations. CONCLUSIONS: Cost analysis complements cost-effectiveness analysis in evaluating program performance and guiding improvements.

Comparing the economic burden of ischemic stroke patients with and without atrial fibrillation: a retrospective study in Beijing, China.

BACKGROUND: Little is known about the economic burden for ischemic stroke (IS) patients with atrial fibrillation (AF) in China. AIM: We aimed to compare the economic burden of treatment-related costs in IS patients with AF vs. without AF in China. METHODS: This retrospective analysis used economic burden data from the Beijing urban health insurance database. Using a random sampling method, 10% of the patients diagnosed with IS from 1 January through 31 December 2012 were enrolled. First hospitalization was considered as the index event and hospital utilization after the index event was followed up until September 2013. Overall healthcare cost during the study period was analyzed. RESULTS: In 4061 patients with IS (mean ± SD age, 68.45 ± 13.95 years; AF: 992; without AF: 3069), the AF group had a higher percentage of patients with co-morbidities at baseline. Compared with the non-AF group, the AF group had significantly greater hospitalization at the index event (p < .001). Overall inpatient cost per patient during the observational period (Renminbi (RMB) 141,875.9 ± 121,071.8 vs. RMB 53,834.03 ± 63,535.72, in 2012 terms), total healthcare cost per patient (RMB 163,550.4 ± 131,103.5 vs. RMB 64,735.41 ± 67,584.95), total healthcare cost covered by health insurance, and annualized total healthcare cost per patient were higher in the AF group than in the non-AF group (p < .001). Treatment costs were significantly associated with old age, male gender, AF, and frequency of outpatient visits and hospitalization. CONCLUSIONS: AF increased the use of healthcare resources, treatment cost, and economic burden in patients with IS. Therefore, prevention of cardio-embolic events in patients with AF by anticoagulants may decrease the economic burden in patients with IS.

Racial Differences in Heart Failure Outcomes: Evidence From the Tele-HF Trial (Telemonitoring to Improve Heart Failure Outcomes).

OBJECTIVES: The purpose of this study was to determine whether there are racial differences in patient-reported health status as well as mortality and rehospitalization after hospitalization for heart failure (HF). BACKGROUND: Little is known about whether racial differences exist in patient-reported outcomes after HF hospitalization. METHODS: We analyzed data from 1,427 patients (636 non-Hispanic African Americans [45%]; 791 non-Hispanic whites [55%]) enrolled in the Tele-HF (Telemonitoring to Improve Heart Failure Outcomes) trial. Health status was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) at baseline and then at 3 and 6 months. Generalized linear mixed models and propensity score methods were used to adjust for clustering within sites and differences between races. RESULTS: Although black patients reported better adjusted health status at baseline (black vs. white difference in KCCQ summary scores was 6.22; 95% confidence interval [CI]: 2.98 to 9.46; p < 0.001), after adjusting for patient demographics, comorbidities, clinical laboratory values, and baseline KCCQ score, we detected no significant racial differences in patient-reported health status at 3 months (black vs. white difference in KCCQ score: 2.28; 95% CI: -0.84 to 5.41; p = 0.15) or 6 months (black vs. white difference in KCCQ score: 1.91; 95% CI: -1.31 to 5.13; p = 0.24). CONCLUSIONS: Compared with white patients, black patients with HF had better patient-reported health status shortly after HF admission but not at 3 or 6 months. Our study failed to show that black patients were disadvantaged with regard to health status after HF hospitalization. (Tele-HF: Yale Heart Failure Telemonitoring Study; NCT00303212).

Racial disparities in the use of blood transfusion in major surgery.

BACKGROUND: Racial disparities in healthcare in the United States are widespread and have been well documented. However, it is unknown whether racial disparities exist in the use of blood transfusion for patients undergoing major surgery. METHODS: We used the University HealthSystem Consortium database (2009-2011) to examine racial disparities in perioperative red blood cells (RBCs) transfusion in patients undergoing coronary artery bypass surgery (CABG), total hip replacement (THR), and colectomy. We estimated multivariable logistic regressions to examine whether black patients are more likely than white patients to receive perioperative RBC transfusion, and to investigate potential sources of racial disparities. RESULTS: After adjusting for patient-level factors, black patients were more likely to receive RBC transfusions for CABG (AOR = 1.41, 95% CI: [1.13, 1.76], p = 0.002) and THR (AOR = 1.39, 95% CI: [1.20, 1.62], p < 0.001), but not for colectomy (AOR = 1.08, 95% CI: [0.90, 1.30], p = 0.40). Black-white disparities in blood transfusion persisted after controlling for patient insurance and hospital effects (CABG: AOR = 1.42, 95% CI: [1.30, 1.56], p < 0.001; THR: AOR = 1.43, 95% CI: [1.29, 1.58], p < 0.001). CONCLUSIONS: We detected racial disparities in the use of blood transfusion for CABG and THR (black patients tended to receive more transfusions compared with whites), but not for colectomy. Reporting racial disparities in contemporary transfusion practices may help reduce potentially unnecessary blood transfusions in minority patients.

Racial and ethnic differences in outcomes in older patients with acute ischemic stroke.

BACKGROUND: Little is known as to whether long-term outcomes of acute ischemic stroke (AIS) vary by race/ethnicity. Using the American Heart Association Get With The Guidelines-Stroke registry linked with Medicare claims data set, we examined whether 30-day and 1-year outcomes differed by race/ethnicity among older patients with AIS. METHODS AND RESULTS: We analyzed 200 900 patients with AIS >65 years of age (170 694 non-Hispanic whites, 85.0%; 20 514 non-Hispanic blacks, 10.2%; 6632 Hispanics, 3.3%; 3060 non-Hispanic Asian Americans, 1.5%) from 926 US centers participating in the Get With The Guidelines-Stroke program from April 2003 through December 2008. Compared with whites, other racial and ethnic groups were on average younger and had a higher median score on the National Institutes of Health Stroke Scale. Whites had higher 30-day unadjusted mortality than other groups (white versus black versus Hispanic versus Asian=15.0% versus 9.9% versus 11.9% versus 11.1%, respectively). Whites also had higher 1-year unadjusted mortality (31.7% versus 28.6% versus 28.1% versus 23.9%, respectively) but lower 1-year unadjusted all-cause rehospitalization (54.7% versus 62.5% versus 60.0% versus 48.6%, respectively). After risk adjustment, Asian American patients with AIS had lower 30-day and 1-year mortality than white, black, and Hispanic patients. Relative to whites, black and Hispanic patients had higher adjusted 1-year all-cause rehospitalization (black: adjusted odds ratio, 1.28 [95% confidence interval, 1.21-1.37]; Hispanic: adjusted odds ratio, 1.22 [95% confidence interval, 1.11-1.35]), whereas Asian patients had lower odds (adjusted odds ratio, 0.83 [95% confidence interval, 0.74-0.94]). CONCLUSIONS: Among older Medicare beneficiaries with AIS, there were significant differences in long-term outcomes by race/ethnicity, even after adjustment for stroke severity, other prognostic variables, and hospital characteristics.