Publications by authors named "Paul S. Chan"
Background: Although they are fast-growing populations in the United States, little is known about survival outcomes of Hispanic and Asian patients after in-hospital cardiac arrest.
Methods And Results: In Get With The Guidelines-Resuscitation, we identified Asian, Hispanic, and White adults with in-hospital cardiac arrest during 2005 to 2023. Using multivariable models, we compared rates of survival to discharge separately for Asian and Hispanic patients versus White patients, as well as rates of sustained return of spontaneous circulation for ≥20 minutes and favorable neurologic survival as secondary outcomes.
High prevalence of long COVID symptoms has emerged as a significant public health concern. This study investigated the associations between three doses of COVID-19 vaccines and the presence of any and ≥3 types of long COVID symptoms among people with a history of SARS-CoV-2 infection in Hong Kong, China. This is a secondary analysis of a cross-sectional online survey among Hong Kong adult residents conducted between June and August 2022.
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- 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: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are the first therapy shown to improve clinical outcomes for patients with heart failure (HF) and a left ventricular ejection fraction (LVEF) greater than 40%. Nationwide adoption of SGLT2is in the US since publication of the Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved Ejection Fraction (EMPEROR-Preserved) in August 2021 is unknown.
Objective: To examine trends and hospital-level variation in SGLT2i adoption.
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 focused on understanding the rates of implantable cardioverter-defibrillator (ICD) placement among survivors of out-of-hospital cardiac arrest, specifically in patients aged 65 and older with shockable rhythms.
- Out of 3226 patients analyzed, only 30.9% received an ICD before discharge, and factors like older age, being female, and a history of diabetes were linked to lower chances of obtaining one, but race/ethnicity showed no significant differences in ICD placement.
- The research highlighted substantial variability in ICD implantation rates among different hospitals, with some facilities providing them to nearly 50% of survivors, while others offered them to only 20%, indicating a need for more uniform practices in
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.
Pneumococcal vaccination (PV) is effective in preventing vaccine-type pneumococcal diseases. This study investigated the changes in PV uptake and its determinants before, during, and after the Coronavirus Disease 2019 (COVID-19) pandemic among community-living older adults aged ≥65 years in Hong Kong, China. Three rounds of random telephone surveys were conducted every two years from May 2019 to October 2023.
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- Survival rates for in-hospital cardiac arrest (IHCA) have decreased since the COVID-19 pandemic, raising concerns about the consistency of top-performing hospitals.
- A study analyzed 243 hospitals with at least two years of data from before and after the pandemic, finding a mean risk-standardized survival rate (RSSR) drop from 26.8% to 21.7%.
- Despite variations in patient demographics, the correlation between pre- and post-pandemic survival rates was relatively strong (0.55), indicating that better-performing hospitals before the pandemic generally maintained their status afterwards.
Article Synopsis
- This study investigates the impact of bystander CPR on survival rates for out-of-hospital cardiac arrests, analyzing data from over 623,000 cases between 2013 and 2022 in the US.
- It finds that bystander CPR significantly improves survival chances across different racial and ethnic groups, but the effect is strongest in White and Native American individuals, and weakest in Black individuals.
- Additionally, the positive association of bystander CPR with survival rates is higher in men compared to women, indicating a potential disparity in outcomes based on sex and race/ethnicity.
Article Synopsis
- The study investigates the relationship between CPR duration and survival outcomes in hospitalized children who experience cardiac arrest and do not achieve return of circulation (ROC).
- It involved two analyses: a patient-level examination of CPR duration factors and a hospital-level analysis looking at the association between hospital median CPR duration and survival rates among patients without ROC.
- Results indicated that among 13,899 CPR events, 3,859 patients did not achieve ROC, with a longer median CPR duration observed in those who did not survive, highlighting the significance of CPR duration in cardiac arrest survival.
Background: How frequently out-of-hospital cardiac arrest (OHCA) occurs within a reasonable walking distance to the nearest public automated external defibrillator (AED) has not been well studied.
Methods: As Kansas City, Missouri has a comprehensive city-wide public AED registry, we identified adults with an OHCA in Kansas City during 2019-2022 in the Cardiac Arrest Registry to Enhance Survival. Using AED location data from the registry, we computed walking times between OHCAs and the nearest registered AED using the Haversine formula, a mapping algorithm to calculate walking distance in miles from one location to another.
Article Synopsis
- This study aimed to evaluate the relationship between hospitals' risk-standardized survival rates (RSSR) for in-hospital cardiac arrest (IHCA) at discharge and their long-term survival rates.
- Researchers analyzed data from over 56,000 Medicare beneficiaries, finding that while many survived to discharge, survival declined significantly over time (only 7.6% survived to 3 years post-discharge).
- Strong correlations were found between a hospital's discharge RSSR and 30-day survival rates, indicating that the discharge rate could serve as an effective benchmark for assessing hospital performance without needing additional long-term survival data.
This systematic review and meta-analysis analyzed and summarized the growing literature on the effectiveness of chatbot-delivered interventions in increasing uptake, intention, and attitudes related to any type of vaccination. We identified randomized controlled studies (RCTs), quasi-experimental studies, and non-experimental studies from the following platforms: PubMed, Web of Science, MEDLINE, Global Health, APA PsycInfo, and EMBASE databases. A total of 12 eligible studies published from 2019 to 2023 were analyzed and summarized.
View Article and Find Full Text PDFImportance: Survival for out-of-hospital cardiac arrest (OHCA) varies widely across emergency medical service (EMS) agencies in the US. However, little is known about which EMS practices are associated with higher agency-level survival.
Objective: To identify resuscitation practices associated with favorable neurological survival for OHCA at EMS agencies.
Article Synopsis
- The Kansas City Medical Optimization (KCMO) score was developed to more accurately quantify the intensity of guideline-directed medical therapy (GDMT) for heart failure patients by averaging daily doses compared to target doses.
- In a study with over 4,500 patients, baseline scores showed low average KCMO (38.8), indicating underutilization of optimal therapy, while a 1-year follow-up revealed slight declines in scores, suggesting challenges in improving GDMT intensity.
- KCMO demonstrated the highest variability among scoring methods, implying it provides a clearer picture of differences in GDMT intensity among patients, but further research is needed to determine its impact on patient outcomes and quality of care.
Background: Alcohol screening and brief intervention (SBI) is an evidence-based intervention recommended by the World Health Organization. This study applied the Consolidated Framework for Implementation Research (CFIR) to understand facilitators and barriers of SBI implementation in primary care settings in Hong Kong, China.
Methods: This was a sequential mixed-method study.
Background: Cardiac arrest is 1 of the leading causes of morbidity and mortality, with an estimated 340 000 out-of-hospital and 292 000 in-hospital cardiac arrest events per year in the United States. Survival rates are lower in certain racial and socioeconomic groups.
Methods And Results: We performed a county-level cross-sectional longitudinal study using the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research multiple causes of death data set between 2016 and 2020 among individuals of all ages whose death was attributed to cardiac arrest.
Article Synopsis
- - Cardiac arrest is a prevalent issue that leads to high rates of death and ongoing health problems for those who survive
- - Cardiac arrest registries in the U.S. reveal significant disparities in patient care and survival based on race, ethnicity, and sex
- - These findings highlight the need for more research to explore the reasons behind these disparities and to develop strategies for improving survival rates among all patient groups
Objectives: Contrary to advanced cardiac life support guidelines that recommend immediate defibrillation for shockable in-hospital cardiac arrest (IHCA), epinephrine administration before first defibrillation is common and associated with lower survival at a "patient-level." Whether this practice varies across hospitals and its association with "hospital-level" IHCA survival remains unknown. The purpose of this study was to determine hospital variation in rates of epinephrine administration before defibrillation for shockable IHCA and its association with IHCA survival.
View Article and Find Full Text PDFImportance: A primary objective in managing atrial fibrillation (AF) is to optimize patients' health status, which can be done only if physicians accurately quantify the outcomes associated with AF in patients' lives.
Objective: To explore physicians' estimation of the health status of patients with AF and its association with subsequent care and outcomes.
Design, Setting, And Participants: A multicenter, prospective cohort study was conducted in 2 outpatient practices in Tokyo, Japan.