Publications by authors named "John A Spertus"
Background: The relationship between the extent and severity of stress-induced ischemia and the extent and severity of anatomic coronary artery disease (CAD) in patients with obstructive CAD is multifactorial and includes the intensity of stress achieved, type of testing used, presence and extent of prior infarction, collateral blood flow, plaque characteristics, microvascular disease, coronary vasomotor tone, and genetic factors. Among chronic coronary disease participants with site-determined moderate or severe ischemia, we investigated associations between ischemia severity on stress testing and the extent of CAD on coronary computed tomography angiography.
Methods: Clinically indicated stress testing included nuclear imaging, echocardiography, cardiac magnetic resonance imaging, or nonimaging exercise tolerance test.
Article Synopsis
- A study examined patients with acute myocardial infarction (AMI) who lack standard modifiable risk factors (SMuRFs) to see how it affects their health status over time.
- Out of 4,076 patients studied, those without SMuRFs showed initially better health status scores but their long-term improvements were similar to those with SMuRFs.
- Findings suggest that AMI patients without SMuRFs can achieve comparable health status after 12 months, indicating less need for aggressive secondary prevention measures.
Importance: The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a commonly used outcome in heart failure trials. While comparing means between treatment groups improves statistical power, mean treatment effects do not necessarily reflect the clinical benefit experienced by individual patients.
Objective: To evaluate the association between mean KCCQ treatment effects and the proportions of patients experiencing clinically important improvements across a range of clinical trials and heart failure etiologies.
Article Synopsis
- The study examines the use and outcomes of P2Y inhibitor pretreatment in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in the U.S. from 2013 to 2023.
- P2Y inhibitor pretreatment rates decreased significantly from 24.8% to 12.4% over the study period, with only 15.9% in a recent cohort showing such treatment.
- There was notable variability in pretreatment rates among different operators and institutions, with no significant difference in in-hospital mortality between those who received pretreatment and those who did not.
Importance: Improving patients' health status is a key goal of treating tricuspid regurgitation (TR). The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a heart failure disease-specific health status measure used to capture the health status impact of TR and the benefit of transcatheter tricuspid valve intervention (TTVI), but its validity in this clinical setting is unknown.
Objective: To evaluate the psychometric properties of the KCCQ in patients with TR.
Background: Whether revascularisation (REV) improves outcomes in patients with three-vessel coronary artery disease (3V-CAD) is uncertain.
Aims: Our objective was to evaluate outcomes with REV (percutaneous coronary intervention [PCI] or coronary artery bypass graft surgery [CABG]) versus medical therapy in patients with 3V-CAD.
Methods: ISCHEMIA participants with 3V-CAD on coronary computed tomography angiography without prior CABG were included.
Background/objective: To address the opioid epidemic in Kansas City, Missouri, local health systems sought to implement a referral to peer recovery coaches (PRCs) for clients presenting with opioid use disorder. Client referrals were made primarily through health system emergency departments, where PRCs met clients to facilitate linkages to recovery support for up to twelve months. This study aimed to evaluate and improve program implementation with process mapping at three local health systems.
View Article and Find Full Text PDFBackground: Aficamten is a cardiac myosin inhibitor that mitigates left ventricular outflow gradients in obstructive hypertrophic cardiomyopathy (oHCM). The clinical efficacy of aficamten across multiple outcome domains in oHCM has not been fully defined.
Objectives: This responder analysis from the SEQUOIA-HCM (Phase 3 Trial to Evaluate the Efficacy and Safety of Aficamten Compared to Placebo in Adults With Symptomatic oHCM) trial characterizes the clinical impact of aficamten.
Background: A primary goal of treating patients with obstructive hypertrophic cardiomyopathy (oHCM) is to improve their symptoms, function and quality of life. Although the psychometric properties of the 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ-23) have been described in oHCM, they have not been assessed for the shorter 12-item version (KCCQ-12), which is used increasingly in clinical practice.
Methods And Results: Using data from the EXPLORER-HCM trial, the psychometric properties of the KCCQ-12 were evaluated.
Background: In order to identify candidacy and treatment response for patients with obstructive hypertrophic cardiomyopathy (oHCM), clinicians need an accurate means of assessing symptoms, function, and quality of life. While the New York Heart Association (NYHA) Classification is most often used for this purpose, the Kansas City Cardiomyopathy Questionnaire (KCCQ-23) is more accurate and sensitive to change, although less familiar to practicing clinicians. To support interpreting the KCCQ-23, we describe cross-sectional and longitudinal changes in KCCQ scores in the context of the NYHA.
View Article and Find Full Text PDFBackground: Healthcare utilization for patients with peripheral artery disease (PAD) is high, but stratifying patients' risk of hospitalization at initial evaluation is challenging. We examined the association between health status at PAD presentation and risk of (1) combined all-cause hospital admissions and emergency department (ED) visits and (2) all-cause hospital admissions.
Methods: Patients with claudication enrolled at US sites in the PORTRAIT registry were included.
Background: The ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) demonstrated greater health status benefits with an initial invasive strategy, as compared with a conservative one, for patients with chronic coronary disease and moderate or severe ischemia. Whether these benefits vary globally is important to understand to support global adoption of the results.
Methods: We analyzed participants' disease-specific health status using the validated 7-item Seattle Angina Questionnaire (SAQ: >5-point differences are clinically important) at baseline and over 1-year follow-up across 37 countries in 6 international regions.
Article Synopsis
- The study aimed to create a patient decision aid (PDA) to help patients with chronic coronary disease (CCD) understand their options for invasive vs. conservative management, drawing on data from the ISCHEMIA trial.
- Through focus groups with patients, caregivers, and healthcare professionals, researchers identified key patient priorities, emphasizing the importance of survival and quality of life in treatment decisions, as well as a preference for visual tools to illustrate outcomes.
- Participants valued shared decision-making but often relied on clinicians for guidance, expressing a desire to use the PDA collaboratively during consultations to facilitate informed choices.
Article Synopsis
- The study explores how incorporating patient-reported outcomes (PROs) can enhance the prediction of hospitalization and mortality risks in patients with heart failure (HF).
- The research involved 1165 patients with heart failure with reduced ejection fraction (HFrEF) and 456 with preserved ejection fraction (HFpEF), utilizing advanced statistical methods to analyze risk over time.
- Findings indicated that models including PROs significantly improved risk prediction, demonstrating their value alongside traditional clinical assessments in managing outpatient heart failure.
Future of Patient-Reported Outcomes: Bringing Patients' Voices Into Health Care.
Circ Cardiovasc Qual Outcomes
September 2024
Article Synopsis
- The review highlights a lack of evidence in coronary revascularization decisions specifically for women and minorities and introduces the RECHARGE trial program aimed at addressing this gap.
- The RECHARGE program includes two trials: one focused on women and the other on Black or Hispanic patients, comparing CABG and PCI treatments over a follow-up period of up to 10 years.
- Key outcomes will assess quality of life and mortality, with a focus on patient-centered measures, making these trials unique in their approach to these underrepresented populations.
Background: A primary goal in treating obstructive hypertrophic cardiomyopathy (oHCM) is to improve patients' health status: their symptoms, function, and quality of life. The health status benefits of aficamten, a novel cardiac myosin inhibitor, have not been comprehensively described.
Objectives: This study sought to determine the effect of aficamten on patient-reported health status, including symptoms of fatigue, shortness of breath, chest pain, physical and social limitations, and quality of life.
Article Synopsis
- Tricuspid regurgitation (TR) is linked to poorer health outcomes after procedures like TAVR and M-TEER, emphasizing the need to understand its impact on patient health status.
- The study analyzed data from a large registry to explore the relationship between levels of baseline TR and health status, measured through KCCQ-OS scores, as well as clinical outcomes post-procedure.
- Results indicated that patients with moderate to severe TR before intervention had significantly lower health scores and higher risks for mortality and readmission after 1 year compared to those with none to mild TR.