Publications by authors named "Stephen W Waldo"
Evaluation of Peer Review of Percutaneous Coronary Intervention Operator Performance.
Circ Cardiovasc Qual Outcomes
January 2025
Background: Case-based peer review of percutaneous coronary intervention (PCI) is used by many hospitals for quality improvement and to make decisions regarding physician competency. However, there are no studies testing the reliability or validity of peer review for PCI performance evaluation.
Methods: We recruited interventional cardiologists from 12 Veterans Affairs Health System facilities throughout the United States to provide PCI cases for review.
Delays in initiation of targeted temperature management (TTM) have been observed in randomized trials evaluating immediate or delayed coronary angiography among survivors of ventricular tachycardia (VT) or ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA), but whether delays are associated with adverse clinical outcomes is unknown. Resuscitated survivors of VT/VF OHCA who received TTM between April 2011 and June 2015 were identified and time to TTM initiation was described. The association between TTM initiation <2 versus ≥2 hours, neurologically favorable, and overall survival to hospital discharge was assessed.
View Article and Find Full Text PDFBackground: Previous work has demonstrated disparities in the management of cardiovascular disease among men and women. We sought to evaluate these disparities and their associations with clinical outcomes among patients admitted with acute coronary syndromes to the Veterans Affairs Healthcare System.
Methods And Results: We identified all patients that were discharged with acute coronary syndromes within the Veterans Affairs Healthcare System from October 1, 2015 to September 30, 2022.
Use of Calcium Modification During Percutaneous Coronary Intervention After Introduction of Coronary Intravascular Lithotripsy.
J Soc Cardiovasc Angiogr Interv
February 2024
Background: Calcified coronary lesions are a challenge for percutaneous coronary interventions (PCIs). Coronary intravascular lithotripsy (IVL) is a novel calcium modification technology approved for commercial use in February 2021, but little is known about its uptake in US clinical practice.
Methods: We described trends in use of calcium modification strategies, variation in use across hospitals, and predictors of calcium modification and IVL use in PCI.
Article Synopsis
- ULM PCI patients were typically older and presented with more complex health issues, utilizing radial access more often and having a higher likelihood of needing mechanical support.
- At one year, ULM PCI showed significantly worse outcomes compared to PLM PCI, with higher rates of major adverse cardiovascular events (22% vs 16%) and all-cause mortality (16% vs 10%), despite similar low rates of myocardial infarction and revascularization across both groups.
Article Synopsis
- The Veterans Health Administration is striving to create supportive learning environments within healthcare teams to reduce burnout and improve care consistency but struggles with reliable implementation of these strategies.
- The authors conducted a mixed-methods study involving 81 VA cardiac catheterization labs, leading to the development of a Relational Playbook focusing on evidence-based interventions to enhance team dynamics and learning.
- The Playbook includes 50 interventions organized into categories like teamwork and communication, aimed at helping healthcare managers integrate these practices into their current training and meetings to foster employee well-being and enhance patient safety.
Background: Portopulmonary hypertension (PoPH), associated with increased mortality, can limit treatment options for liver diseases. Data on the continuum of clinical risk related to cardiopulmonary hemodynamics in PoPH are lacking.
Methods And Results: As part of the United States national Veterans Affairs Clinical Assessment, Reporting, and Tracking database, we performed a retrospective cohort study of adults with cirrhosis undergoing right heart catheterization between October 1, 2017, and September 30, 2022.
Article Synopsis
- The study investigates the branching pattern of coronary arteries in humans, known as coronary dominance, and aims to understand its genetic regulation, which has been poorly understood due to challenges in studying human heart development.
- By analyzing data from 61,043 participants in the VA Million Veteran Program, researchers identified a moderate heritability of 27.7% for coronary dominance and discovered ten significant genetic loci, particularly near a chemokine-related region.
- The findings suggest that the gene in question plays a crucial role in the development of coronary artery patterns, as experiments in mice showed altered artery development when this gene was reduced, indicating potential targets for future medical treatments related to coronary artery conditions.
Article Synopsis
- Loss-of-function (LOF) alleles may reduce the effectiveness of clopidogrel, a medication used after PCI in patients with acute coronary syndrome (ACS) or stable ischemic heart disease (SIHD), but their impact on these conditions remains uncertain.
- A study involving 4,461 Veterans indicated that while LOF allele carriers had a slightly higher risk of major adverse cardiac events (MACE) after PCI for ACS, the difference wasn't statistically significant; the risk for SIHD patients with LOF alleles remained unchanged.
- The findings suggest that while LOF allele carriers with ACS treated with clopidogrel may face increased MACE risk, this genetic factor does not appear to
Background: Practice patterns and outcomes of protected left main (PLM) and unprotected left main (ULM) percutaneous coronary intervention (PCI), as well as the differences between these types of PCI, are not well defined in real-world clinical practice.
Methods: Data collected from all Veteran Affairs (VA) catheterization laboratories participating in the Clinical Assessment Reporting and Tracking Program between 2009 and 2019. The analysis included 4,351 patients undergoing left main PCI, of which 1,306 pairs of PLM and ULM PCI were included in a propensity matched cohort.
Article Synopsis
- A study analyzed the use of new cardiovascular medications among US Veterans, specifically focusing on ARNI, SGLT2i, and GLP-1 RA across 114 VA hospitals for patients with heart failure (HF) and coronary artery disease with diabetes (CAD+T2D).
- Results showed significant increases in medication use from 2017 to 2021, with ARNI and SGLT2i prescribed for HF rising to about 20% and CAD+T2D medications increasing to 30%, but there were still issues with low overall utilization.
- The research indicated considerable variations in medication usage among the hospitals, influenced by factors like patient volume and hospital complexity, highlighting the need for improved practices to boost medication
Article Synopsis
- * Researchers analyzed data from 56,357 Veteran Affairs patients from 2012 to 2018, finding that 20.7% were non-adherent before PCI, with this group more likely to be younger and present non-electively.
- * Findings indicate that past non-adherence adversely affects future medication adherence and increases mortality risk, suggesting that tracking pharmacy data can help identify high-risk patients and enhance adherence interventions.
Article Synopsis
- A significant number of patients with coronary artery disease (CAD) fail to meet recommended low-density lipoprotein cholesterol (LDL-C) targets, prompting the need for improved treatment strategies.* -
- This study evaluated the potential benefits of enhanced statin therapy, either alone or combined with ezetimibe, in reducing adverse outcomes like death and heart attacks among US military veterans with CAD.* -
- Results showed that although statin usage increased over time, many patients remained on suboptimal therapy, with only a small percentage using ezetimibe, highlighting the need for better management of LDL-C levels in this population.*
Socioeconomic status, biologics and all-cause mortality in the VA healthcare system.
J Eur Acad Dermatol Venereol
November 2023
Trends and Outcomes in Patients With Coronary Artery Disease Undergoing TAVR: Insights From VA CART.
J Soc Cardiovasc Angiogr Interv
June 2023
Background: Obstructive coronary artery disease (CAD) is common in patients with severe symptomatic aortic stenosis. The management and impact of obstructive CAD in patients undergoing transcatheter aortic valve replacement (TAVR) have not been fully evaluated. We aimed to determine the patient characteristics and clinical outcomes among veterans undergoing TAVR with and without obstructive CAD and to determine temporal trends and association of pre-TAVR percutaneous coronary intervention (PCI) with clinical outcomes.
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- The study aims to identify clinical markers and therapeutic targets that can predict survival in patients with pulmonary hypertension (PH) using data from U.S. Veterans Affairs and Vanderbilt University, focusing on those with elevated mean pulmonary artery pressure (mPAP).
- Analysis of 4,737 patients revealed 21 distinct subgroups based on pulmonary arterial compliance (PAC), with higher PAC levels correlating with better survival rates, especially in patients with precapillary PH.
- The findings suggest that maintaining PAC levels at or above 3.0 ml/mm Hg is associated with significantly improved survival rates in both discovery and validation cohorts, indicating its potential as a critical biomarker in managing PH.
Article Synopsis
- The study compared the clinical characteristics and outcomes of people living with HIV (PLWH) undergoing percutaneous coronary intervention (PCI) to uninfected individuals, using data from the Veterans Affairs Clinical Assessment Program from 2009 to 2019.
- It found that while treatment strategies for coronary artery disease were similar between PLWH and controls, PLWH were younger, had fewer traditional risk factors, and less extensive heart disease, but faced a higher mortality risk.
- By 5 years post-PCI, PLWH had a 21% increased risk of mortality compared to controls, highlighting that better control of HIV does not negate poorer long-term survival outcomes.
Background: Up to 14% of patients in the United States undergoing cardiac catheterization each year experience AKI. Consistent use of risk minimization preventive strategies may improve outcomes. We hypothesized that team-based coaching in a Virtual Learning Collaborative (Collaborative) would reduce postprocedural AKI compared with Technical Assistance (Assistance), both with and without Automated Surveillance Reporting (Surveillance).
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- The study aimed to investigate how often patients undergoing coronary artery chronic total occlusion (CTO) percutaneous coronary intervention (PCI) received recommended antianginal therapy and stress testing in the months prior to the procedure within the Veterans Affairs Healthcare System.
- Among 4250 patients analyzed, 40% were prescribed two or more antianginal medications, and only 24% underwent stress testing before the PCI, with the trends showing variable practice over time and across different hospitals and operators.
- The research highlighted a notable inconsistency in the adherence to guidelines, indicating that less than half of the patients received the optimal preprocedural management, which varied significantly between healthcare sites and operators.