Publications by authors named "Mintu Turakhia"
Background: There have been limited data examining the temporal relationship between device-derived daily activity and ventricular arrhythmias (VAs).
Objective: We aimed to assess whether activity predicted VAs or VAs predicted changes in activity.
Methods: The CERTITUDE registry includes over 55,000 implanted devices active on Home Monitoring.
Background: Despite clear associations between arrhythmia burden and cardiovascular risk, clinical risk scores that predict cardiovascular events do not incorporate individual-level arrhythmia characteristics from long-term continuous monitoring (LTCM).
Objectives: This study evaluated the performance of risk models that use data from LTCM and patient claims for prediction of heart failure (HF) and ischemic stroke.
Methods: We retrospectively analyzed features extracted from up to 14 days of LTCM electrocardiogram (ECG) data linked to patient-level claims data for 320,974 Medicare beneficiaries who underwent ZioXT ambulatory monitoring.
The rapid growth in consumer-facing mobile and sensor technologies has created tremendous opportunities for patient-driven personalized health management. The diagnosis and management of cardiac arrhythmias are particularly well suited to benefit from these easily accessible consumer health technologies. In particular, smartphone-based and wrist-worn wearable electrocardiogram (ECG) and photoplethysmography (PPG) technology can facilitate relatively inexpensive, long-term rhythm monitoring.
View Article and Find Full Text PDFArticle Synopsis
- Catheter ablation for atrial fibrillation (AF) is widely researched, and this expert opinion aims to enhance future studies by applying lessons from past research and promoting consistency in methodologies.
- The effectiveness of these studies can improve with clearly defined endpoints and a thorough understanding of emerging technologies, as well as a need to revisit some current research methods.
- A panel of clinical experts has produced recommendations highlighting essential elements such as documenting clinical details, managing medications during trials, and assessing outcomes to aid in the standardization and quality of AF catheter ablation studies.
Background: In hypertrophic cardiomyopathy (HCM), 48-hour ambulatory monitoring has been standard practice to detect nonsustained ventricular tachycardia (NSVT), a sudden death risk marker. Extended-wear ambulatory electrocardiographic (ECG) devices have more recently used for monitoring patients with HCM.
Objective: We aimed to evaluate NSVT burden identified with continuous ambulatory monitoring for up to 2 weeks compared with initial 48 hours.
Article Synopsis
- Hypertension is a major risk factor for serious health conditions, and there’s potential for artificial intelligence (AI) to improve how it's diagnosed and managed.* -
- AI technologies, particularly machine learning, could personalize treatment and enhance blood pressure monitoring, but effective collaboration among health professionals and data scientists is crucial.* -
- A workshop by the National Heart, Lung, and Blood Institute highlighted communication gaps in healthcare, innovative methods for managing hypertension, and challenges to implementing AI in real-world settings.*
Article Synopsis
- There are currently no direct comparisons of the effectiveness and safety of the two most common oral anticoagulants, apixaban and rivaroxaban, for older patients with atrial fibrillation (AF), creating uncertainty regarding which drug is better.
- This study examined older adults (66 and older) in Ontario, Canada, comparing the incidence of major bleeding and thromboembolic events in patients treated with either apixaban or rivaroxaban from 2011 to 2020.
- The findings revealed that apixaban was associated with a significantly lower risk of major and any bleeding compared to rivaroxaban, while both drugs had similar risks for thromboembolic events.
Article Synopsis
- Over the past 21 years, there has been a concerning rise in heart failure (HF)-related deaths among patients with atrial fibrillation (AF) in the U.S., with a total of 916,685 deaths recorded between 1999 and 2020.
- The study revealed that age-adjusted mortality rates increased significantly, particularly after 2011, affecting men, White individuals, and those under 65 the most.
- A notable spike in HF-related deaths was also seen during the first year of the COVID-19 pandemic, especially among patients with AF aged over 65.
Article Synopsis
- * A hypertension management platform was developed through careful analysis of clinician workflows and needs, incorporating input from 5 Stanford clinicians and a team of 15 specialists across various fields.
- * The platform aims to enhance chronic disease management by integrating digital health tools, offering a model that can be adapted for other cardiovascular digital health solutions.
Early identification of atrial fibrillation (AF) can reduce the risk of stroke, heart failure, and other serious cardiovascular outcomes. However, paroxysmal AF may not be detected even after a two-week continuous monitoring period. We developed a model to quantify the risk of near-term AF in a two-week period, based on AF-free ECG intervals of up to 24 h from 459,889 patch-based ambulatory single-lead ECG (modified lead II) recordings of up to 14 days.
View Article and Find Full Text PDFBackground: Objective data comparing the diagnostic performance of different ambulatory cardiac monitors (ACMs) are lacking.
Objectives: To assess variation in monitoring strategy, clinical outcomes and healthcare utilization in patients undergoing ambulatory monitoring without a pre-existing arrhythmia diagnosis.
Methods: Using the full sample (100%) of Medicare claims data, we performed a retrospective cohort study of diagnostic-naïve patients who received first-time ACM in 2017 to 2018 and evaluated arrhythmia encounter diagnosis at 3-months, repeat ACM testing at 6 months, all-cause 90-day emergency department (ED) and inpatient utilization, and cost of different strategies: Holter; long-term continuous monitor (LTCM); non-continuous, event-based external ambulatory event monitor (AEM); and mobile cardiac telemetry (MCT).
Background: Wearable devices may be useful for identification, quantification and characterization, and management of atrial fibrillation (AF). To date, consumer wrist-worn devices for AF detection using photoplethysmography-based algorithms perform only periodic checks when the user is stationary and are US Food and Drug Administration cleared for prediagnostic uses without intended use for clinical decision-making. There is an unmet need for medical-grade diagnostic wrist-worn devices that provide long-term, continuous AF monitoring.
View Article and Find Full Text PDFArticle Synopsis
- - Clinical trials, considered the "gold standard" for medical evidence, are evolving to include real-world data, which enhances their applicability and effectiveness in practical settings.
- - Three case studies show how different data sources, like wearables and electronic health records, impact the role and responsibilities of Data and Safety Monitoring Boards (DSMBs).
- - While real-world trials can improve findings' relevance and efficiency, they require strong data management systems and adapted monitoring practices to maintain the rigor of traditional clinical trials.
Dronedarone Versus Sotalol in Antiarrhythmic Drug-Naive Veterans With Atrial Fibrillation.
Circ Arrhythm Electrophysiol
August 2023
Background: Sotalol and dronedarone are both used for maintenance of sinus rhythm for patients with atrial fibrillation. However, while sotalol requires initial monitoring for QT prolongation and proarrhythmia, dronedarone does not. These treatments can be used in comparable patients, but their safety and effectiveness have not been compared head to head.
View Article and Find Full Text PDFBackground Cardiovascular procedural treatments were deferred at scale during the COVID-19 pandemic, with unclear impact on patients presenting with non-ST-segment-elevation myocardial infarction (NSTEMI). Methods and Results In a retrospective cohort study of all patients diagnosed with NSTEMI in the US Veterans Affairs Healthcare System from January 1, 2019 to October 30, 2022 (n=67 125), procedural treatments and outcomes were compared between the prepandemic period and 6 unique pandemic phases: (1) acute phase, (2) community spread, (3) first peak, (4) post vaccine, (5) second peak, and (6) recovery. Multivariable regression analysis was performed to assess the association between pandemic phases and 30-day mortality.
View Article and Find Full Text PDFBackground: There are limited comparative data on safety and efficacy within commonly used Vaughan-Williams (VW) class III antiarrhythmic drugs (AADs) for maintenance of sinus rhythm in adults with atrial fibrillation (AF).
Hypothesis: We hypothesized that dronedarone and sotalol, two commonly prescribed VW class III AADs with class II properties, have different safety and efficacy effects in patients with nonpermanent AF.
Methods: A systematic literature review was conducted searching MEDLINE®, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) up to June 15, 2021 (NCT05279833).
Background: Morbidity and mortality associated with high CHADS-VASc and HAS-BLED scores is not specific to atrial fibrillation (AF). Frailty could be an important contributor to this morbidity and mortality while being mechanistically independent from AF. We sought to evaluate the association of stroke and bleeding risk to noncardiovascular frail events and the association of stroke prevention therapy to outcomes in frail patients with AF.
View Article and Find Full Text PDFBackground: Atrial fibrillation (AF) prevalence estimates vary and have been based on cohorts with clinically established or diagnosed disease. Undiagnosed AF prevalence estimates are less certain as they are based on nongeneralizable convenience samples.
Hypothesis: Because AF is often asymptomatic, it my remain undiagnosed until the development of complications such as stroke or heart failure.
Article Synopsis
- Atrial fibrillation (AF) is a major contributor to ischemic stroke, which greatly impacts health and mortality rates, especially as the aging population grows.
- There are various stroke prevention methods available, yet significant questions persist regarding the best strategies for both broader populations and individual patients in managing AF.
- The National Heart, Lung, and Blood Institute workshop highlighted research areas for improvement, including risk assessment tools, challenges related to oral anticoagulants, and the effectiveness of different left atrial appendage closure techniques in stroke prevention for AF patients.
Introduction: Atrial fibrillation (AF) disproportionally affects persons on maintenance hemodialysis (HD). Associations of serum and dialysate potassium concentrations [K] with AF incidence are poorly understood.
Methods: We conducted a cohort study using Medicare claims merged with clinical data from a dialysis provider to determine whether serum-[K] and/or dialysate-[K] independently associated with AF incidence.
The evidence of direct oral anticoagulants (DOACs) usage for venous thromboembolism (VTE) in patients at extremes of body weight or mass index is limited. In such situations, warfarin may be more frequently used. We investigated warfarin time in the therapeutic international normalized ratio range (TTR) and DOAC adherence based on the calculated proportion of days covered (PDC) by pill coverage from a DOAC prescription in patients with VTE across all body sizes.
View Article and Find Full Text PDFArticle Synopsis
- The Heartline Study is a large-scale trial aimed at evaluating the effectiveness of wearable devices, like the Apple Watch, for early detection of atrial fibrillation (AF) in older adults (65+) who either have no history of AF or are already diagnosed and on anticoagulant treatment.
- Participants are randomly assigned to either use the Apple Watch with features for detecting irregular heart rhythms and ECG monitoring or to just engage with a digital health program through an iPhone app, while all assessments are completed via the app.
- The main goal is to determine if using the Apple Watch can reduce the time it takes to get a clinical diagnosis of AF, alongside gathering data on various health outcomes related to AF management.