Publications by authors named "Steven Bradley"
The Next Era of Quality Improvement: Owning the Challenge.
Circ Cardiovasc Qual Outcomes
November 2024
Background: Lipoprotein (a) is an independent risk factor for atherosclerotic cardiovascular disease. However, lipoprotein (a) testing remains variable and it is unclear what factors influence testing and if testing changes clinical management.
Methods And Results: A retrospective study using electronic medical record data from 5 health systems identified an atherosclerotic cardiovascular disease cohort divided into those with and without a lipoprotein (a) test between 2019 and 2021.
Background: Understanding ascending aortic aneurysm growth and associated risk factors is critical to advising appropriate echocardiographic follow-up intervals for patients. The aim of this study was to identify aortic aneurysm growth rate on serial echocardiography as well as the clinical and demographic variables that contribute to baseline aortic size and subsequent aortic growth.
Methods: Patients identified with ascending aortic aneurysms and undergoing serial echocardiograms within 5 years were evaluated.
Background: Although guidelines recommend low-density lipoprotein cholesterol (LDL-C) to be < 70 mg/dL in patients with atherosclerotic cardiovascular disease (ASCVD), the rate of achieving this goal remains suboptimal. We sought to understand real world contemporary practice patterns of LDL-C management in patients with ASCVD, and whether LDL-C testing influenced management across US health systems.
Methods: A retrospective cohort study utilizing electronic medical record data from five health systems participating in the CardioHealth Alliance was performed on patients with an LDL-C measurement in 2021 and prior ASCVD.
There has been little progress in reducing health care disparities since the 2003 landmark Institute of Medicine's report Unequal Treatment. Despite the higher burden of cardiovascular disease in underrepresented racial and ethnic groups, they have less access to cardiologists and cardiothoracic surgeons, and have higher rates of morbidity and mortality with cardiac surgical interventions. This review summarizes existing literature and highlights disparities in cardiovascular perioperative health care.
View Article and Find Full Text PDFNavigating ethical dilemmas in trauma, resuscitation, and critical care.
Int Anesthesiol Clin
October 2023
Background: Apparent resistant hypertension (aRH) carries excess cardiovascular risk beyond nonresistant forms of hypertension; however, our understanding of this at-risk population, as defined by current US practice guidelines, is limited. Accordingly, we sought to evaluate the prevalence, clinical characteristics, and pharmacotherapeutic patterns of patients with aRH using contemporary blood pressure guidance.
Methods: We classified patients at 3 large healthcare systems by hypertensive status using contemporary hypertension guidelines.
Article Synopsis
- - The ADAPTABLE trial examined the effects of different doses of aspirin (81 mg vs 325 mg daily) on cardiovascular events and bleeding rates in patients with existing cardiovascular disease, finding no significant differences between the two doses.
- - In a secondary analysis focusing on patients with chronic kidney disease (CKD), results showed that CKD patients had a higher risk of adverse cardiovascular outcomes and major bleeding, regardless of the aspirin dose they were taking.
- - The study concluded that while CKD increased the risk for complications, the dosing of aspirin did not affect the risk of adverse events or bleeding in these patients.
Article Synopsis
- A study explored how different doses of aspirin (81 mg vs 325 mg) affected health outcomes in patients with peripheral artery disease (PAD) and examined their involvement in a clinical trial.
- Results indicated that participants with PAD experienced significantly higher rates of serious health events like heart attacks and strokes, but higher aspirin doses did not offer any additional benefits.
- Additionally, patients with PAD showed lower rates of enrollment and internet engagement in the study, highlighting the need for tailored research and strategies to better involve these patients in clinical trials.
Background: The COVID-19 pandemic has evolved through multiple phases characterized by new viral variants, vaccine development, and changes in therapies. It is unknown whether rates of cardiovascular disease (CVD) risk factor profiles and complications have changed over time.
Methods: We analyzed the American Heart Association COVID-19 CVD registry, a national multicenter registry of hospitalized adults with active COVID-19 infection.
Background: Same day discharge (SDD) following chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.
Methods: We evaluated the clinical, angiographic, and procedural characteristics of patients discharged the same day versus those kept for overnight observation in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO, NCT02061436).
Results: Of the 7181 patients who underwent CTO PCI, 943 (13%) had SDD.
Importance: Although peer review is an important component of publication for new research, the viability of this process has been questioned, particularly with the added stressors of the COVID-19 pandemic.
Objective: To characterize rates of peer reviewer acceptance of invitations to review manuscripts, reviewer turnaround times, and editor-assessed quality of reviews before and after the start of the COVID-19 pandemic at a large, open-access general medical journal.
Design, Setting, And Participants: This retrospective, pre-post cohort study examined all research manuscripts submitted to JAMA Network Open between January 1, 2019, and June 29, 2021, either directly or via transfer from other JAMA Network journals, for which at least 1 peer review of manuscript content was solicited.
Objectives: To assess the characteristics and prognosis of ST-elevation myocardial infarction (STEMI) patients, presenting between 12 and 24 h after symptom onset, in contemporary regional STEMI systems of care in the United States.
Background: Previous observational studies have been inconsistent regarding the benefit of primary percutaneous coronary intervention (PCI) compared with conservative management for late-presenting STEMI patients and the majority of randomized trials are from the fibrinolytic era.
Methods: Using a two-center registry-based cohort from March 2003 to December 2020, we evaluated the frequency, clinical characteristics, and outcomes of STEMI patients, stratified by symptom onset to balloon time: <3, 3-6, 6-12, and 12-24 h (late presenters).
Identifying and Addressing Gaps in the Care of Patients With Severe Valve Disease.
Circ Cardiovasc Qual Outcomes
December 2022
Importance: Up to 60% of patients in the US receive a stress test within 2 years of percutaneous coronary intervention (PCI), prompting concerns about the possible overuse of stress testing.
Objective: To examine the proportion of patients who underwent stress testing within 2 years of elective PCI, proportion of patients who had symptoms that were consistent with coronary artery disease (CAD), timing of stress testing, and site-level variation in stress testing among symptomatic and asymptomatic patients.
Design, Setting, And Participants: This cohort study used administrative claims data and clinical records from the US Department of Veterans Affairs (VA) Clinical Assessment, Reporting, and Tracking program.
The National Cardiovascular Data Registry is a group of registries maintained by the American College of Cardiology Foundation. These registries are used by a diverse constituency to improve the quality and outcomes of cardiovascular care, to assess the safety and effectiveness of new therapies, and for research. To achieve these goals, registry data must be complete and reliable.
View Article and Find Full Text PDFArticle Synopsis
- Obesity is often stigmatized, leading individuals with a higher BMI to experience negative situations in healthcare settings, which may cause them to avoid seeking care or switch doctors.
- A study surveyed 2,380 primary care patients to investigate how these stigmatizing experiences and communication issues mediate the relationship between BMI and healthcare utilization.
- Findings suggest that people with higher BMIs are more likely to delay care and seek new doctors due to feelings of disrespect and negative experiences, potentially worsening their health issues if they ignore symptoms.