Publications by authors named "Dharam J Kumbhani"
Article Synopsis
- The IMPACT SDM study evaluates the effectiveness of patient decision aids and clinician training in shared decision-making for severe aortic stenosis patients choosing between TAVR and SAVR.
- The study employs a hybrid effectiveness-implementation design across 8 US sites, surveying patients and clinicians to track the reach of decision aids and training adoption.
- It aims to identify barriers and facilitators to SDM implementation, providing insights for future efforts to enhance patient-centered care.
Background: Hospitals and health systems must balance the demand for transcatheter aortic valve replacement (TAVR) against financial sustainability. Patients may be eligible for both TAVR and surgical aortic valve replacement (SAVR), but financial realities for hospitals may affect differential access to those therapies. We sought to understand the landscape of costs and reimbursement for TAVR and SAVR in the US and to understand the association of procedural reimbursement with receipt of either.
View Article and Find Full Text PDFArticle Synopsis
- The study investigates the link between hospital volumes for aortic valve replacement (AVR) surgeries—either transcatheter (TAVR) or surgical (SAVR)—and patient outcomes, specifically in-hospital mortality and 30-day readmission rates.
- It classified hospitals based on their procedural volumes and analyzed data from over 72,000 patients across 400 U.S. hospitals, finding that higher hospital volumes are associated with lower in-hospital mortality but do not affect 30-day readmissions.
- The conclusions suggest that patients with aortic stenosis have better outcomes when treated in high-volume hospitals that perform both TAVR and SAVR procedures frequently.
Article Synopsis
- Research on peripheral artery disease (PAD) is hindered by the absence of a national registry and insufficient diagnostic coding in electronic health records.
- A new natural language processing (NLP) system helped establish a registry of over 103,000 new PAD patients within the Veterans Health Administration, revealing high rates of comorbidities and significant clinical outcomes over a year.
- The study found notable one-year mortality (9.4%) and incidences of cardiovascular (5.6 per 100 patient-years) and limb events (4.5 per 100 patient-years), highlighting the urgent need for better care strategies for this high-risk population.
Renal denervation as an option for difficult to treat hypertension has been a concept for several decades, with recent U.S. FDA approval of new, minimally invasive devices.
View Article and Find Full Text PDFIntroduction: Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic cause of myocardial infarction. Migraine headache has been reported to be common among patients with SCAD, but the degree of migraine-related disability has not been quantified.
Methods: Clinical data and headache variables were obtained from the baseline assessment of the prospective, multicenter iSCAD Registry.
Article Synopsis
- Cardiogenic shock after acute myocardial infarction remains highly lethal, prompting researchers to analyze data from 16,337 cases across 440 centers to identify characteristics linked to lower mortality.
- The study found that centers with lower risk-adjusted in-hospital mortality rates typically had patients with fewer co-morbidities, performed more revascularizations, and showed better adherence to clinical processes.
- Despite the presence of some beneficial factors, not all low-mortality centers demonstrated these characteristics, indicating the complexity of treating cardiogenic shock and the challenges in evaluating outcomes in such cases.
Article Synopsis
- Myocardial infarction from spontaneous coronary artery dissection (SCAD) can lead to significant psychological issues, including posttraumatic stress disorder (PTSD), affecting many patients' quality of life.
- In a study involving 1,156 SCAD patients, nearly 35% had experienced probable PTSD at some point, but a significant portion had not sought treatment for their symptoms.
- Factors such as younger age at first SCAD, being single, and having a history of anxiety were linked to higher PTSD symptom severity, highlighting the need for better screening and treatment connections for affected individuals.
Background: A single, multitiered valve center designation has been proposed to publicly identify centers with expertise for all valve therapies. The correlation between transcatheter aortic valve replacement (TAVR) and mitral transcatheter edge-to-edge repair (MTEER) procedures is unknown.
Objectives: The authors sought to examine the relationship between site-level volumes and outcomes for TAVR and MTEER.
Article Synopsis
- Frailty linked to worse outcomes post-transcatheter aortic valve replacement (TAVR) and is often underpinned by sarcopenia, which includes muscle mass, strength, and performance, though their impact on TAVR outcomes hasn't been fully studied.
- In a study of 445 patients with severe aortic stenosis, significant percentages were found to have slow gait (56%), weak grip (59%), and low muscle mass (42%); only slower gait speed showed a clear link to increased mortality after TAVR.
- The research indicates that while overall body fat measurements and sarcopenia criteria influence mortality risk, lower visceral fat and slow gait speed are main factors affecting post-TAVR death rates.
Percutaneous Coronary Intervention for Heart Failure: Worth the Cost?
Circ Cardiovasc Qual Outcomes
January 2024
Article Synopsis
- There is limited data on current trends in the use of advanced therapies for pulmonary embolism (PE) in the U.S. and patient outcomes for acute PE.
- A study analyzed data from the Nationwide Readmissions Database (2016-2020), finding increased use of advanced therapies, especially systemic thrombolytics and catheter-directed treatments, alongside a rise in high-risk PE diagnoses.
- Although the use of certain treatments like inferior vena cava filters decreased, overall mortality rates remained stable, and the rate of 90-day unplanned readmissions showed improvement.
Background: Depression and cognitive dysfunction (CD) are not routinely screened for in patients before transcatheter aortic valve replacement (TAVR) and their association with postprocedural outcomes is poorly understood. The objectives of this study are to determine the prevalence of depression and CD in patients with aortic stenosis undergoing TAVR and evaluate their association with mortality and quality of life.
Methods: We analyzed a prospective, multicenter TAVR registry that systematically screened patients for preexisting depression and CD with the Patient Health Questionnaire-2 and Mini-Cog, respectively.
Transcatheter edge-to-edge repair for mitral regurgitation using PASCAL or MitraClip.
Catheter Cardiovasc Interv
September 2023
Background: There is a paucity of data regarding the comparative efficacy and safety of Mitral valve transcatheter edge-to-edge repair (MTEER) using the PASCAL or MitraClip systems for patients with mitral regurgitation (MR).
Methods: An electronic search was conducted for MEDLINE, COCHRANE, and EMBASE, through February 2023, for studies comparing the clinical outcomes of MTEER using PASCAL versus MitraClip systems among patients with severe MR. The primary study outcome was residual MR ≤ 2 at discharge.
Aim: The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease."
Methods: A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.
Article Synopsis
- The study analyzed trends and outcomes of transcatheter aortic valve implant (TAVI) in patients with prior coronary artery bypass graft (CABG) surgery using data from the Nationwide Readmissions Database between 2016 and 2019.
- It found that the percentage of patients with previous CABG undergoing TAVI decreased from 21% in 2016 to 15.5% in 2019, without significant changes in in-hospital mortality rates.
- Key findings included that patients with prior CABG had lower in-hospital mortality and similar rates of complications compared to those without CABG, while factors like female gender and advanced kidney disease were linked to higher mortality in this group.
Aim: The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease."
Methods: A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.