Publications by authors named "Sarah Goldstein"

Cardiovascular disease is the leading cause of maternal mortality in the United States. Pregnancy is associated with increased risk of acute myocardial infarction (AMI) and outcomes of pregnancy-associated AMI (PAMI) are poor. Spontaneous coronary artery dissection is the most common cause of PAMI.

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  • Congenital heart disease (CHD) is a wide range of structural heart issues and is the leading cause of serious birth defects.
  • Advances in pediatric care have resulted in more adults surviving with CHD than there are children currently living with the condition.
  • Adults with CHD face significant health risks from their heart conditions and previous surgeries, necessitating regular check-ups and targeted care plans for better health outcomes.
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  • The study aimed to evaluate the prevalence of maternal chronic hypertension (MCH) among Veterans and assess blood pressure control before pregnancy as well as medication management during pregnancy.
  • About 8% of Veterans with documented pregnancies had MCH, with a significant portion showing uncontrolled blood pressure, particularly in those with chronic kidney disease and diabetes.
  • The findings suggest a need for improved interventions to manage MCH and preconception blood pressure to ensure better health outcomes during pregnancy.*
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  • Improved survival rates after heart transplantation (HT) have led more recipients to consider pregnancy, but there is limited data on the associated outcomes.
  • In a study analyzing over 19 million deliveries in the U.S., HT recipients were found to have significantly higher risks for severe maternal morbidity (SMM), preterm birth, and readmission within one year after delivery compared to non-HT recipients.
  • The findings indicate that women with a history of HT face 16 to 38 times greater odds of suffering from various complications during and after pregnancy, highlighting the need for careful counseling for these patients.
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  • There is ongoing uncertainty regarding the use of primary prevention implantable cardioverter-defibrillators (ICDs) in older patients with hypertrophic cardiomyopathy, emphasizing the need for clarity in treatment options.
  • A study analyzed data from patients who received ICDs between 2010 and 2016, noting an overall increase in ICD utilization across age groups, including those aged 65 and older.
  • Key risk factors for postdischarge mortality and hospitalization after ICD implantation in older patients included older age, severe heart failure symptoms, and low left ventricular ejection fraction, while a history of nonsustained ventricular tachycardia was particularly associated with hospitalizations for cardiac issues.*
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Although the potential for participant selection bias is readily acknowledged in the momentary data collection literature, very little is known about uptake rates in these studies or about differences in the people that participate versus those who do not. This study analyzed data from an existing Internet panel of older people (age 50 and greater) who were offered participation into a momentary study (n = 3,169), which made it possible to compute uptake and to compare many characteristics of participation status. Momentary studies present participants with brief surveys multiple times a day over several days; these surveys ask about immediate or recent experiences.

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  • * Many antihypertensive medications are considered safe for pregnant individuals when monitored carefully for fetal growth and amniotic fluid levels.
  • * The article outlines guidelines for diagnosing and treating hypertension during pregnancy, offering detailed information on the safety and effectiveness of various antihypertensives both during and after pregnancy.
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  • The study investigates how pre-existing ischemic heart disease (IHD) affects pregnancy outcomes compared to women without cardiac issues and those with other cardiac diagnoses.
  • It analyzes data from the Nationwide Readmissions Database, focusing on severe maternal morbidity (SMM) and mortality during delivery hospitalizations from 2015 to 2018.
  • Findings reveal that women with isolated IHD face significantly worse maternal outcomes than those without cardiac disease, with risks similar to those with World Health Organization (WHO) class I-II conditions.
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  • * Fontan circulation is associated with heightened risks during pregnancy, such as maternal cardiovascular issues, high blood pressure, preterm birth, and fetal growth problems.
  • * This case series discusses the placental health and pregnancy outcomes of three individuals with Fontan circulation who delivered at a specialized medical center in the Southeastern U.S.
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Background: Nonadherence to diet and medical therapies in heart failure (HF) contributes to poor HF outcomes. Mobile apps may be a promising way to improve adherence because they increase knowledge and behavior change via education and monitoring. Well-designed apps with input from health care providers (HCPs) can lead to successful adoption of such apps in practice.

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Objective: N-terminal pro-brain natriuretic peptide (NT-proBNP), a marker of ventricular dysfunction, varies by body mass index (BMI) outside of pregnancy. This study aimed to determine whether obesity affects NT-proBNP levels in pregnancy.

Study Design: This was a prospective observational study of healthy pregnant people in the third trimester (3TM) and postpartum (PP).

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  • * The field of cardio-obstetrics focuses on managing women with or at high risk for heart disease related to pregnancy, highlighting the need for more specialists with this expertise.
  • * Proposed specialized training pathways for cardiovascular fellows are aimed at filling knowledge gaps and preparing healthcare providers to better care for women with cardiovascular issues throughout the pregnancy journey.
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  • Women with congenital heart disease (CHD) have a higher prevalence of hypertensive disorders of pregnancy (HDP) compared to those without CHD, with rates of 11.2% vs 8.1% respectively.
  • Chronic hypertension and diabetes mellitus are significant risk factors for HDP in women with CHD, along with coarctation of the aorta as a specific condition linked to increased risk.
  • HDP was found to be more strongly associated with complications like difficult deliveries and preterm births, indicating that HDP poses more substantial risks than the presence of CHD itself.
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  • The study compares rates of severe maternal morbidity (SMM) in pregnant patients with cardiac diagnoses using the modified World Health Organization (mWHO) classification, against those without cardiac issues.
  • An analysis of over 14 million delivery admissions from 2015-2019 found that patients with moderate-to-high-risk cardiac conditions (mWHO II/III-IV) had significantly higher rates of SMM (22.8%) and death (0.3%) during hospitalization compared to those without cardiac diagnoses.
  • The findings emphasize that the risk of SMM and mortality remains elevated for these patients even up to 11 months after delivery, highlighting the need for better pregnancy counseling and monitoring for those with moderate-to
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Purpose Of Review: To review the data on hypertensive disorders of pregnancy (HDP) and heart failure (HF) risk.

Recent Findings: Hypertensive disorders are the most common medical condition affecting women during pregnancy and are associated with future HF risk, including peripartum cardiomyopathy, pregnancy-associated HF with preserved ejection fraction, and new-onset HF later in life. HF related to HDP can occur during pregnancy and persist long term, as can be the case with peri-partum cardiomyopathy, or can develop years after delivery through mechanisms that have yet to be clearly defined.

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  • Pulmonary arterial hypertension related to congenital heart disease (PAH-CHD) affects 5-10% of adults with congenital heart disease and is linked to serious health risks.
  • It develops due to abnormal blood flow between the heart and lungs, leading to harmful changes in pulmonary blood vessels, similar to other types of PAH.
  • The most extreme form, called Eisenmenger syndrome, results in high pulmonary pressure and can cause serious symptoms like low oxygen levels; treatment usually involves medication, with surgery considered for some patients.
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Emotions and symptoms are often overestimated in retrospective ratings, a phenomenon referred to as the "memory-experience gap." Some research has shown that this gap is less pronounced among older compared to younger adults for self-reported negative affect, but it is not known whether these age differences are evident consistently across domains of well-being and why these age differences emerge. In this study, we examined age differences in the memory-experience gap for emotional (positive and negative affect), social (loneliness), and physical (pain, fatigue) well-being.

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  • - Peripartum cardiomyopathy is a rare type of heart failure that can occur in women during the later stages of pregnancy or after childbirth, making it challenging to diagnose due to overlapping symptoms with normal pregnancy changes.
  • - The causes are not well understood, but factors like genetics, inflammation, and certain risk factors (such as age and race) may play a role; those with the condition face serious complications, including a higher risk of cardiac issues and death.
  • - Effective management relies on quick diagnosis and treatment by a diverse healthcare team to improve patient outcomes and is centered around medication and monitoring the mother’s condition, especially regarding delivery.
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  • - Women experience a greater benefit from cardiac resynchronization therapy (CRT) compared to men, even when men have more risk factors for nonresponse, possibly due to differences in left ventricular (LV) electrical dyssynchrony.
  • - The study found that while the mean QRS duration was the same for both sexes, women had a significantly greater QRS area (QRSA), particularly in those with less severe LBBB, suggesting women may be underrepresented in standard assessments.
  • - After adjusting for QRSA differences, female sex was less predictive of long-term outcomes, which indicates that these sex-specific differences in LV dyssynchrony play a significant role in the observed benefits of CRT for women.
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Background: Ecological momentary assessment (EMA) has the potential to minimize recall bias by having people report on their experiences in the moment (momentary model) or over short periods (coverage model). This potential hinges on the assumption that participants provide their ratings based on the reporting time frame instructions prescribed in the EMA items. However, it is unclear what time frames participants actually use when answering the EMA questions and whether participant training improves participants' adherence to the reporting instructions.

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  • Congenital heart disease (CHD) refers to various structural heart defects present at birth, and advancements in treatment have allowed many affected individuals to survive into adulthood.
  • Adults with CHD face various neurological complications, including a higher risk of stroke, cognitive and psychiatric disorders, and epilepsy, influenced by both their congenital condition and age-related health issues.
  • To ensure the best care for adults with CHD, a collaborative approach involving both neurologists and cardiologists specialized in adult CHD is essential for managing their complex health needs.
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Actinobacteria belonging to the genus have evolved a close relationship with multiple species of fungus-growing ants, where these bacteria produce diverse secondary metabolites that protect the ants and their fungal mutualists from disease. Recent research has charted the phylogenetic diversity of this symbiosis, revealing multiple instances where the ants and have formed stable relationships in which these bacteria are housed on specific regions of the ant's cuticle. Parallel chemical and genomic analyses have also revealed that symbiotic produce diverse secondary metabolites with antifungal and antibacterial bioactivities, and highlighted the importance of plasmid recombination and horizontal gene transfer for maintaining these symbiotic traits.

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