Amgad Makaryus - Academia.edu (original) (raw)
Papers by Amgad Makaryus
Journal of Cardiovascular Medicine, Aug 1, 2008
Background Normal or near normal myocardial perfusion stress imaging (MPI) suggests the absence o... more Background Normal or near normal myocardial perfusion stress imaging (MPI) suggests the absence of lifethreatening coronary artery disease (CAD). Nevertheless, there are instances where severe left main or three-vessel CAD may be present despite no significant perfusion abnormalities on MPI. Methods Review of Tl-201 or Tc-99m sestamibi MPI over a period of 5 years to ascertain the features that may prevent misdiagnosis. Out of 9171 tests, 3992 (44%) were interpreted as normal or near normal. For clinical reasons, 98 (2%) of these patients underwent coronary angiography within 6 months. Results A total of 3992 patients were interpreted as normal or near normal. Seventy (22 men/48 women; 58 W 13 years) did not have obstructive CAD. Nine (six men/three women; 64 W 8 years) had either left main (n U 3), three-vessel CAD with or without left main (n U 3) or severe proximal left anterior descending (n U 3) disease. Although both normal patients and patients with CAD had similar proportions of imaging artifacts, those with severe CAD had significantly more markers of CAD (increased lung Tl-201 uptake, transient ischemic cavity dilatation, stress-induced STsegment depression, chest pain, and/or hypotension with exercise; P < 0.01; no CAD vs. severe CAD; two-tail Fisher's Exact Test). Similarly, patients with moderate CAD by coronary angiography (n U 19), and a random sample of 250 patients (82 men/168 women; 62 W 14 years) with normal or near normal MPI who did not undergo coronary angiography, had similar proportions of imaging artifacts but significantly fewer markers of CAD. Conclusion When dealing with individual patients, the referring physician and the interpreter of MPI studies should consider severe CAD when there are markers of CAD despite normal or near normal perfusion images.
Journal of the American College of Cardiology, Mar 1, 2020
Background: Acutely decompensated heart failure (ADHF) is one of the leading causes of hospitaliz... more Background: Acutely decompensated heart failure (ADHF) is one of the leading causes of hospitalization in the USA contributing to more than 11% of all deaths. Management of ADHF hinges on IV diuresis, the adjustment of which is primarily guided by clinical experience and anecdotal evidence. The DOSE trial showed that higher doses of IV diuretics produce favorable outcomes without significant detriment, but appropriate duration of IV diuresis remains a question. We aimed to identify if guidance by biochemical analysis (BA) or clinical assessment (CA) alone altered length of stay (LOS), inpatient mortality or 30-day readmission. Methods: Retrospective chart review was performed on patients admitted with ADHF and treated with IV diuresis for a minimum of 2 doses from 2015-2017. Patients requiring invasive hemodynamic support, coronary intervention, or inotropic/vasopressor support were excluded. IV diuresis was discontinued in the BA group based upon increased creatinine and in the CA group by symptoms and physical exam alone. Endpoints of LOS, inpatient mortality, and 30-day readmission rates were evaluated. Results: CA group included 357 patients, mean age 71, 59% male and 43.1% white. BA group included 131 patients, mean age 74, 50% male and 43.5% white. Coronary artery disease, hypertension, chronic kidney disease (CKD) and diabetes were equivalent between groups. LOS in the BA group was 2.45 days longer than in the CA group (p < 0.001). There was no statistically significant difference in inpatient mortality (p = 0.676) or readmission (p = 0.224) in the CA versus BA group. CKD prolonged LOS by 1.42 days, but did not affect mortality or readmission. Sex, race, and co-morbidities outside CKD had no effect on LOS, mortality or readmission. Conclusion: In our study, LOS was prolonged by nearly 2.5 days by utilization of Cr to discontinue IV diuresis, but there was no impact on hospital re-admission or inpatient mortality. The use of CA alone rather than BA to guide discontinuation of IV diuresis in ADHF may equate to average health care savings of $6000 without sacrificing outcomes. Optimizing management of ADHF necessitates further study to standardize the assessment of euvolemia and adequacy of IV diuresis.
Clinical Cardiology, Apr 1, 2006
Aspirin is the most widely used medication in patients with cardiovascular disease. It has had a ... more Aspirin is the most widely used medication in patients with cardiovascular disease. It has had a greater effect on patients with cardiovascular disease than any other drug. With the importance of aspirin now known for decades, it is recently becoming clearer that some patients do not derive as great a benefit from this "wonder drug" secondary to their resistance to its effects. Aspirin resistance, its prevalence, its identification, and how to overcome or avert it with other medications then becomes a central topic of discussion as important, if not more so, than the importance of aspirin itself as a cornerstone in the treatment of patients with cardiovascular disease. This review explores the current understanding of the mechanism of aspirin resistance with regard to its prevalence and the magnitude of its clinical significance. It also examines the therapeutic implications of a diagnosis of aspirin resistance.
Expert Review of Cardiovascular Therapy, Mar 1, 2007
PubMed, 2004
Background: Initiation of antiarrhythmic therapy for atrial fibrillation is a key step in the tre... more Background: Initiation of antiarrhythmic therapy for atrial fibrillation is a key step in the treatment of this disorder. Much controversy remains as to the risks and benefits of initiating therapy as an inpatient versus an outpatient. Objective: To explore the various issues of debate and to determine the importance and validity of these various issues when it comes to the evaluation of patients for in- versus out-of-hospital initiation of antiarrhythmic therapy for atrial fibrillation. Methods: A MEDLINE search of English language journal articles since 1966 and a hand search of bibliographies included in pertinent retrieved articles was undertaken. Articles used included review articles, retrospective studies, and meta-analyses. Results: The literature is full of articles for and against outpatient initiation of antiarrhythmic therapy. One side feels that the risks of antiarrhythmic therapy initiation are serious enough in all patients and easy enough to reverse or ameliorate if the patient is in the safety of the monitored hospital setting. The other side argues that these complications are infrequent enough except in certain commonly identifiable patients, that not all need hospitalization during antiarrhythmic initiation. The issues at the heart of the dispute include: the presence or absence of underlying heart disease; the period of monitoring after initiation of therapy; the choice of antiarrhythmic agent used; and even the seriousness and prevalence of the arrhythmia which can be induced. Conclusions: The issue of in versus out-of-hospital initiation of antiarrhythmic therapy for atrial fibrillation remains a widely disputed topic. Many factors come under consideration when this topic is studied. At present, we recommend that patients with significant structural heart disease, conduction disease, and/or QT prolongation be strongly considered for in-hospital initiation of antiarrhythmic medications. Further prospective studies are necessary to assess the magnitude of the difference of initiating antiarrhythmic therapy as an inpatient versus as an outpatient.
InTech eBooks, Nov 18, 2015
Cardiovascular disease is the leading cause of morbidity and mortality among people with diabetes... more Cardiovascular disease is the leading cause of morbidity and mortality among people with diabetes worldwide, accounting for 60% of all deaths in diabetics. Despite advances in our pathophysiologic understanding of diabetic co-morbidities and measures to help counter these, diabetics still remain at increased risk for cardiovascular disease complicating our overall approach to management. Diabetics, in particularly type 2, are often fraught with additional risk factors contributing to their overall propensity for developing cardiovascular disease. These include, but are not limited to, obesity, dyslipidemia, poor glycemic control, lack of physical activity, and hypertension. In response to this, research driven guidelines focusing on primary prevention have continued to arise with new clinical targets and goals substantially changing our approach with the diabetic population. It is important to note early on, type 1 diabetics carry a higher risk of cardiovascular disease for which the pathophysiology is only recently being elucidated. The underlying relationship between cardiovascular events and risk factors is, however, not well understood. For this reason, management approaches to risk reduction have been extrapolated from experience in type 2 diabetes mellitus. The purpose of this chapter is to present the conclusions of current literature pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the new guidelines, and clinical targets, including preventative measures for subclinical cardiovascular disease for the contemporary management of patients with diabetes mellitus.
Journal of Psychiatric Practice, Mar 1, 2022
OBJECTIVE Antipsychotics are frequently used for managing both acute and chronic neuropsychiatric... more OBJECTIVE Antipsychotics are frequently used for managing both acute and chronic neuropsychiatric disorders. While antipsychotics are known to be associated with increased mortality due to cardiac arrhythmia, there is a lack of consensus on the timing and frequency of electrocardiogram (ECG) monitoring. The goal of this study was to examine current ECG monitoring practices for adults receiving antipsychotics, specifically during hospital admission. METHODS The study involved a multisite retrospective chart review of adults admitted across 8 hospitals between January 2010 and December 2015 who received antipsychotics during hospitalization. The primary outcome was the presence of an ECG after receiving an antipsychotic. RESULTS During the study period, there were 26,353 hospitalizations during which adults received antipsychotic medication; the average age of the patients was 61.4 years, 50.1% were female, and 64.8% were white. The average comorbidity score was 1.4 with a median length of stay of 8.3 days. Of the 26,353 patients who were hospitalized, 60.6% (n=15,977) of patients in the sample had an ECG during their hospitalization, and 41.2% (n=10,865) had the ECG following antipsychotic administration. Patients who received a follow-up ECG had a longer length of stay (median: 11.3 d) compared with those who did not receive a follow-up ECG (median: 7.0 d). Follow-up ECGs were more likely among patients who had a history of heart failure [odds ratio (OR)=1.17, 95% confidence interval (CI): 1.06-1.30, P=0.002], who were receiving multiple antipsychotics (OR=1.3, 95% CI: 1.24-1.36, P<0.001) or other QT-prolonging medications (OR=1.09, 95% CI: 1.07-1.1, P<0.001), who were receiving risperidone (OR=1.12, 95% CI: 1.004-1.25, P=0.04), and who showed an increase in QTc duration (OR per 10 ms increase=1.02, 95% CI: 1.01-1.04, P=0.003). Follow-up ECGs were less likely to be administered to patients who were receiving antipsychotics before admission (OR=0.93, 95% CI: 0.87-0.997, P=0.04). CONCLUSIONS This study demonstrated that, in a large health system, ECG monitoring is not routinely practiced for hospitalized patients receiving antipsychotics. Further studies are needed to identify patients who would most benefit from ECG monitoring in the acute care setting.
Diabetes Spectrum, Feb 8, 2022
Telehealth has emerged as an evolving care management strategy that is playing an increasingly vi... more Telehealth has emerged as an evolving care management strategy that is playing an increasingly vital role, particularly with the onset of the coronavirus disease 2019 pandemic. A meta-analysis of 20 randomized controlled trials was conducted to test the effectiveness of home telemonitoring (HTM) in patients with type 2 diabetes in reducing A1C, blood pressure, and BMI over a median 180-day study duration. HTM was associated with a significant reduction in A1C by 0.42% (P 5 0.0084). Although we found statistically significant changes in both systolic and diastolic blood pressure (À0.10 mmHg [P 5 0.0041], and À0.07 mmHg [P 5 0.044], respectively), we regard this as clinically nonsignificant in the context of HTM. Comparisons across different methods of transmitting vital signs suggest that patients logging into systems with moderate interaction with the technology platform had significantly higher reductions in A1C than those using fully automatic transmission methods or fully manual uploading methods. A1C did not vary significantly by study duration (from 84 days to 5 years). HTM has the potential to provide patients and their providers with timely, up-to-date information while simultaneously improving A1C.
Heart & Lung, Nov 1, 2016
Background: The Modified Early Warning Score (MEWS) helps identify patients experiencing a declin... more Background: The Modified Early Warning Score (MEWS) helps identify patients experiencing a decline in physiological parameters that indicate risk for cardiac arrest (CA). Objectives: To assess the association between MEWS values and patient survival following in-hospital CA. Methods: Retrospective cohort study of patients who experienced in-hospital CA. The relationship between CA survival and MEWS values as well as other risk factors such as age, gender and type of electrographic cardiac rhythms was analyzed using logistic regression. Results: Survival rate to hospital discharge was 21%. Strong predictors for survival were MEWS values at hospital admission (p < .002), younger age (p < .005), ventricular fibrillation (p < .0001), and ventricular tachycardia (p < .0001). Gender and MEWS 4 hours prior to CA were not significantly associated with survival. Conclusions: Survival following CA was significantly associated with MEWS at hospital admission but not 4 hours prior to CA. The type of cardiac rhythm and age were also predictive of survival.
Frontiers in Clinical Diabetes and Healthcare
Background and aimDuring the early stages of the COVID-19 pandemic, nationwide lockdowns caused d... more Background and aimDuring the early stages of the COVID-19 pandemic, nationwide lockdowns caused disruption in the diets, physical activities, and lifestyles of patients with type 2 diabetes. Previous reports on the possible association between race/ethnicity, COVID-19, and mortality have shown that Hispanic/Latino patients with type 2 diabetes who are socioeconomically disadvantaged are disproportionately affected by this novel virus. The aim of this study was to explore stressors associated with changes in diabetes self-management behaviors. Our goal was to highlight the health disparities in these vulnerable racial/ethnic minority communities and underscore the need for effective interventions.Methods and participantsParticipants were enrolled in part of a larger randomized controlled trial to compare diabetes telehealth management (DTM) with comprehensive outpatient management (COM) in terms of critical patient-centered outcomes among Hispanic/Latino patients with type 2 diabetes...
Journal of the American College of Cardiology
Heart, Lung and Circulation
Journal of the American College of Cardiology
Journal of the American College of Cardiology
StatPearls Publishing, Sep 28, 2021
Journal of the American College of Cardiology, 2022
Journal of the American College of Cardiology, 2022
Case Reports in Radiology, 2022
Dynamic imaging of heart valves and specifically prosthetic valves is a central benefit of echoca... more Dynamic imaging of heart valves and specifically prosthetic valves is a central benefit of echocardiography. Most bioprosthetic heart valves degenerate over a given time and hence require repeat valve replacement which carries a significant risk of morbidity and mortality. Reoperation is the standard of care and may still be required after the first successful surgery due to complications disrupting either mechanical or bioprosthetic valves. Such complications can be delayed or even prevented if optimal prosthesis selection is individualized according to patients' medical and postimplantation follow-up. We present the case of an 84-year-old woman where an open-heart valve-in-valve approach, implanting a mechanical valve in a failed bioprosthetic valve, produced a unique image on transthoracic echocardiography which needs to be recognized by imagers for appropriate patient diagnosis and management.
The Frank-Starling relationship is based on the link between the initial length of myocardial fib... more The Frank-Starling relationship is based on the link between the initial length of myocardial fibers and the force generated by contraction. There is a predictable relationship between the length between sarcomeres and the tension of the muscle fibers. There is an optimal length between sarcomeres at which the tension in the muscle fiber is greatest, resulting in the greatest force of contraction. If sarcomeres are closer together or further apart compared to this optimal length, there will be a decrease in the tension and strength of contraction.The greater the ventricular diastolic volume, the more the myocardial fibers are stretched during diastole. Within a normal physiologic range, the more the myocardial fibers are stretched, the greater the tension in the muscle fibers, and the greater force of contraction of the ventricle when stimulated. The Frank-Starling relationship is the observation that ventricular output increases as preload (end-diastolic pressure) increase.
Journal of Cardiovascular Medicine, Aug 1, 2008
Background Normal or near normal myocardial perfusion stress imaging (MPI) suggests the absence o... more Background Normal or near normal myocardial perfusion stress imaging (MPI) suggests the absence of lifethreatening coronary artery disease (CAD). Nevertheless, there are instances where severe left main or three-vessel CAD may be present despite no significant perfusion abnormalities on MPI. Methods Review of Tl-201 or Tc-99m sestamibi MPI over a period of 5 years to ascertain the features that may prevent misdiagnosis. Out of 9171 tests, 3992 (44%) were interpreted as normal or near normal. For clinical reasons, 98 (2%) of these patients underwent coronary angiography within 6 months. Results A total of 3992 patients were interpreted as normal or near normal. Seventy (22 men/48 women; 58 W 13 years) did not have obstructive CAD. Nine (six men/three women; 64 W 8 years) had either left main (n U 3), three-vessel CAD with or without left main (n U 3) or severe proximal left anterior descending (n U 3) disease. Although both normal patients and patients with CAD had similar proportions of imaging artifacts, those with severe CAD had significantly more markers of CAD (increased lung Tl-201 uptake, transient ischemic cavity dilatation, stress-induced STsegment depression, chest pain, and/or hypotension with exercise; P < 0.01; no CAD vs. severe CAD; two-tail Fisher's Exact Test). Similarly, patients with moderate CAD by coronary angiography (n U 19), and a random sample of 250 patients (82 men/168 women; 62 W 14 years) with normal or near normal MPI who did not undergo coronary angiography, had similar proportions of imaging artifacts but significantly fewer markers of CAD. Conclusion When dealing with individual patients, the referring physician and the interpreter of MPI studies should consider severe CAD when there are markers of CAD despite normal or near normal perfusion images.
Journal of the American College of Cardiology, Mar 1, 2020
Background: Acutely decompensated heart failure (ADHF) is one of the leading causes of hospitaliz... more Background: Acutely decompensated heart failure (ADHF) is one of the leading causes of hospitalization in the USA contributing to more than 11% of all deaths. Management of ADHF hinges on IV diuresis, the adjustment of which is primarily guided by clinical experience and anecdotal evidence. The DOSE trial showed that higher doses of IV diuretics produce favorable outcomes without significant detriment, but appropriate duration of IV diuresis remains a question. We aimed to identify if guidance by biochemical analysis (BA) or clinical assessment (CA) alone altered length of stay (LOS), inpatient mortality or 30-day readmission. Methods: Retrospective chart review was performed on patients admitted with ADHF and treated with IV diuresis for a minimum of 2 doses from 2015-2017. Patients requiring invasive hemodynamic support, coronary intervention, or inotropic/vasopressor support were excluded. IV diuresis was discontinued in the BA group based upon increased creatinine and in the CA group by symptoms and physical exam alone. Endpoints of LOS, inpatient mortality, and 30-day readmission rates were evaluated. Results: CA group included 357 patients, mean age 71, 59% male and 43.1% white. BA group included 131 patients, mean age 74, 50% male and 43.5% white. Coronary artery disease, hypertension, chronic kidney disease (CKD) and diabetes were equivalent between groups. LOS in the BA group was 2.45 days longer than in the CA group (p < 0.001). There was no statistically significant difference in inpatient mortality (p = 0.676) or readmission (p = 0.224) in the CA versus BA group. CKD prolonged LOS by 1.42 days, but did not affect mortality or readmission. Sex, race, and co-morbidities outside CKD had no effect on LOS, mortality or readmission. Conclusion: In our study, LOS was prolonged by nearly 2.5 days by utilization of Cr to discontinue IV diuresis, but there was no impact on hospital re-admission or inpatient mortality. The use of CA alone rather than BA to guide discontinuation of IV diuresis in ADHF may equate to average health care savings of $6000 without sacrificing outcomes. Optimizing management of ADHF necessitates further study to standardize the assessment of euvolemia and adequacy of IV diuresis.
Clinical Cardiology, Apr 1, 2006
Aspirin is the most widely used medication in patients with cardiovascular disease. It has had a ... more Aspirin is the most widely used medication in patients with cardiovascular disease. It has had a greater effect on patients with cardiovascular disease than any other drug. With the importance of aspirin now known for decades, it is recently becoming clearer that some patients do not derive as great a benefit from this "wonder drug" secondary to their resistance to its effects. Aspirin resistance, its prevalence, its identification, and how to overcome or avert it with other medications then becomes a central topic of discussion as important, if not more so, than the importance of aspirin itself as a cornerstone in the treatment of patients with cardiovascular disease. This review explores the current understanding of the mechanism of aspirin resistance with regard to its prevalence and the magnitude of its clinical significance. It also examines the therapeutic implications of a diagnosis of aspirin resistance.
Expert Review of Cardiovascular Therapy, Mar 1, 2007
PubMed, 2004
Background: Initiation of antiarrhythmic therapy for atrial fibrillation is a key step in the tre... more Background: Initiation of antiarrhythmic therapy for atrial fibrillation is a key step in the treatment of this disorder. Much controversy remains as to the risks and benefits of initiating therapy as an inpatient versus an outpatient. Objective: To explore the various issues of debate and to determine the importance and validity of these various issues when it comes to the evaluation of patients for in- versus out-of-hospital initiation of antiarrhythmic therapy for atrial fibrillation. Methods: A MEDLINE search of English language journal articles since 1966 and a hand search of bibliographies included in pertinent retrieved articles was undertaken. Articles used included review articles, retrospective studies, and meta-analyses. Results: The literature is full of articles for and against outpatient initiation of antiarrhythmic therapy. One side feels that the risks of antiarrhythmic therapy initiation are serious enough in all patients and easy enough to reverse or ameliorate if the patient is in the safety of the monitored hospital setting. The other side argues that these complications are infrequent enough except in certain commonly identifiable patients, that not all need hospitalization during antiarrhythmic initiation. The issues at the heart of the dispute include: the presence or absence of underlying heart disease; the period of monitoring after initiation of therapy; the choice of antiarrhythmic agent used; and even the seriousness and prevalence of the arrhythmia which can be induced. Conclusions: The issue of in versus out-of-hospital initiation of antiarrhythmic therapy for atrial fibrillation remains a widely disputed topic. Many factors come under consideration when this topic is studied. At present, we recommend that patients with significant structural heart disease, conduction disease, and/or QT prolongation be strongly considered for in-hospital initiation of antiarrhythmic medications. Further prospective studies are necessary to assess the magnitude of the difference of initiating antiarrhythmic therapy as an inpatient versus as an outpatient.
InTech eBooks, Nov 18, 2015
Cardiovascular disease is the leading cause of morbidity and mortality among people with diabetes... more Cardiovascular disease is the leading cause of morbidity and mortality among people with diabetes worldwide, accounting for 60% of all deaths in diabetics. Despite advances in our pathophysiologic understanding of diabetic co-morbidities and measures to help counter these, diabetics still remain at increased risk for cardiovascular disease complicating our overall approach to management. Diabetics, in particularly type 2, are often fraught with additional risk factors contributing to their overall propensity for developing cardiovascular disease. These include, but are not limited to, obesity, dyslipidemia, poor glycemic control, lack of physical activity, and hypertension. In response to this, research driven guidelines focusing on primary prevention have continued to arise with new clinical targets and goals substantially changing our approach with the diabetic population. It is important to note early on, type 1 diabetics carry a higher risk of cardiovascular disease for which the pathophysiology is only recently being elucidated. The underlying relationship between cardiovascular events and risk factors is, however, not well understood. For this reason, management approaches to risk reduction have been extrapolated from experience in type 2 diabetes mellitus. The purpose of this chapter is to present the conclusions of current literature pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the new guidelines, and clinical targets, including preventative measures for subclinical cardiovascular disease for the contemporary management of patients with diabetes mellitus.
Journal of Psychiatric Practice, Mar 1, 2022
OBJECTIVE Antipsychotics are frequently used for managing both acute and chronic neuropsychiatric... more OBJECTIVE Antipsychotics are frequently used for managing both acute and chronic neuropsychiatric disorders. While antipsychotics are known to be associated with increased mortality due to cardiac arrhythmia, there is a lack of consensus on the timing and frequency of electrocardiogram (ECG) monitoring. The goal of this study was to examine current ECG monitoring practices for adults receiving antipsychotics, specifically during hospital admission. METHODS The study involved a multisite retrospective chart review of adults admitted across 8 hospitals between January 2010 and December 2015 who received antipsychotics during hospitalization. The primary outcome was the presence of an ECG after receiving an antipsychotic. RESULTS During the study period, there were 26,353 hospitalizations during which adults received antipsychotic medication; the average age of the patients was 61.4 years, 50.1% were female, and 64.8% were white. The average comorbidity score was 1.4 with a median length of stay of 8.3 days. Of the 26,353 patients who were hospitalized, 60.6% (n=15,977) of patients in the sample had an ECG during their hospitalization, and 41.2% (n=10,865) had the ECG following antipsychotic administration. Patients who received a follow-up ECG had a longer length of stay (median: 11.3 d) compared with those who did not receive a follow-up ECG (median: 7.0 d). Follow-up ECGs were more likely among patients who had a history of heart failure [odds ratio (OR)=1.17, 95% confidence interval (CI): 1.06-1.30, P=0.002], who were receiving multiple antipsychotics (OR=1.3, 95% CI: 1.24-1.36, P<0.001) or other QT-prolonging medications (OR=1.09, 95% CI: 1.07-1.1, P<0.001), who were receiving risperidone (OR=1.12, 95% CI: 1.004-1.25, P=0.04), and who showed an increase in QTc duration (OR per 10 ms increase=1.02, 95% CI: 1.01-1.04, P=0.003). Follow-up ECGs were less likely to be administered to patients who were receiving antipsychotics before admission (OR=0.93, 95% CI: 0.87-0.997, P=0.04). CONCLUSIONS This study demonstrated that, in a large health system, ECG monitoring is not routinely practiced for hospitalized patients receiving antipsychotics. Further studies are needed to identify patients who would most benefit from ECG monitoring in the acute care setting.
Diabetes Spectrum, Feb 8, 2022
Telehealth has emerged as an evolving care management strategy that is playing an increasingly vi... more Telehealth has emerged as an evolving care management strategy that is playing an increasingly vital role, particularly with the onset of the coronavirus disease 2019 pandemic. A meta-analysis of 20 randomized controlled trials was conducted to test the effectiveness of home telemonitoring (HTM) in patients with type 2 diabetes in reducing A1C, blood pressure, and BMI over a median 180-day study duration. HTM was associated with a significant reduction in A1C by 0.42% (P 5 0.0084). Although we found statistically significant changes in both systolic and diastolic blood pressure (À0.10 mmHg [P 5 0.0041], and À0.07 mmHg [P 5 0.044], respectively), we regard this as clinically nonsignificant in the context of HTM. Comparisons across different methods of transmitting vital signs suggest that patients logging into systems with moderate interaction with the technology platform had significantly higher reductions in A1C than those using fully automatic transmission methods or fully manual uploading methods. A1C did not vary significantly by study duration (from 84 days to 5 years). HTM has the potential to provide patients and their providers with timely, up-to-date information while simultaneously improving A1C.
Heart & Lung, Nov 1, 2016
Background: The Modified Early Warning Score (MEWS) helps identify patients experiencing a declin... more Background: The Modified Early Warning Score (MEWS) helps identify patients experiencing a decline in physiological parameters that indicate risk for cardiac arrest (CA). Objectives: To assess the association between MEWS values and patient survival following in-hospital CA. Methods: Retrospective cohort study of patients who experienced in-hospital CA. The relationship between CA survival and MEWS values as well as other risk factors such as age, gender and type of electrographic cardiac rhythms was analyzed using logistic regression. Results: Survival rate to hospital discharge was 21%. Strong predictors for survival were MEWS values at hospital admission (p < .002), younger age (p < .005), ventricular fibrillation (p < .0001), and ventricular tachycardia (p < .0001). Gender and MEWS 4 hours prior to CA were not significantly associated with survival. Conclusions: Survival following CA was significantly associated with MEWS at hospital admission but not 4 hours prior to CA. The type of cardiac rhythm and age were also predictive of survival.
Frontiers in Clinical Diabetes and Healthcare
Background and aimDuring the early stages of the COVID-19 pandemic, nationwide lockdowns caused d... more Background and aimDuring the early stages of the COVID-19 pandemic, nationwide lockdowns caused disruption in the diets, physical activities, and lifestyles of patients with type 2 diabetes. Previous reports on the possible association between race/ethnicity, COVID-19, and mortality have shown that Hispanic/Latino patients with type 2 diabetes who are socioeconomically disadvantaged are disproportionately affected by this novel virus. The aim of this study was to explore stressors associated with changes in diabetes self-management behaviors. Our goal was to highlight the health disparities in these vulnerable racial/ethnic minority communities and underscore the need for effective interventions.Methods and participantsParticipants were enrolled in part of a larger randomized controlled trial to compare diabetes telehealth management (DTM) with comprehensive outpatient management (COM) in terms of critical patient-centered outcomes among Hispanic/Latino patients with type 2 diabetes...
Journal of the American College of Cardiology
Heart, Lung and Circulation
Journal of the American College of Cardiology
Journal of the American College of Cardiology
StatPearls Publishing, Sep 28, 2021
Journal of the American College of Cardiology, 2022
Journal of the American College of Cardiology, 2022
Case Reports in Radiology, 2022
Dynamic imaging of heart valves and specifically prosthetic valves is a central benefit of echoca... more Dynamic imaging of heart valves and specifically prosthetic valves is a central benefit of echocardiography. Most bioprosthetic heart valves degenerate over a given time and hence require repeat valve replacement which carries a significant risk of morbidity and mortality. Reoperation is the standard of care and may still be required after the first successful surgery due to complications disrupting either mechanical or bioprosthetic valves. Such complications can be delayed or even prevented if optimal prosthesis selection is individualized according to patients' medical and postimplantation follow-up. We present the case of an 84-year-old woman where an open-heart valve-in-valve approach, implanting a mechanical valve in a failed bioprosthetic valve, produced a unique image on transthoracic echocardiography which needs to be recognized by imagers for appropriate patient diagnosis and management.
The Frank-Starling relationship is based on the link between the initial length of myocardial fib... more The Frank-Starling relationship is based on the link between the initial length of myocardial fibers and the force generated by contraction. There is a predictable relationship between the length between sarcomeres and the tension of the muscle fibers. There is an optimal length between sarcomeres at which the tension in the muscle fiber is greatest, resulting in the greatest force of contraction. If sarcomeres are closer together or further apart compared to this optimal length, there will be a decrease in the tension and strength of contraction.The greater the ventricular diastolic volume, the more the myocardial fibers are stretched during diastole. Within a normal physiologic range, the more the myocardial fibers are stretched, the greater the tension in the muscle fibers, and the greater force of contraction of the ventricle when stimulated. The Frank-Starling relationship is the observation that ventricular output increases as preload (end-diastolic pressure) increase.