Sneha Shah Jain MD, MBA

All Publications

• Avoiding Financial Toxicity for Patients from Clinicians' Use of AI. The New England journal of medicine Jain, S. S., Mello, M. M., Shah, N. H. 2024

  View details for DOI 10.1056/NEJMp2406135

  View details for PubMedID 39348681

• Low-Density Lipoprotein Cholesterol Control as a Performance Measure: A National Analysis of the VHA. Journal of the American College of Cardiology Jain, S. S., Skye, M., Din, N., Furst, A., Maron, D. J., Heidenreich, P., Kalwani, N., Bhatt, A. S., Sandhu, A. T., Rodriguez, F. 2024; 84 (13): 1272-1275

  View details for DOI 10.1016/j.jacc.2024.07.025

  View details for PubMedID 39293887

• Democratizing Congenital Heart Disease Management: The Potential for AI-Enabled Care and Necessary Future Directions. Journal of the American College of Cardiology Jain, S. S., Elias, P., Clark, D. E. 2024; 84 (9): 829-831

  View details for DOI 10.1016/j.jacc.2024.06.019

  View details for PubMedID 39168569

• Milvexian vs apixaban for stroke prevention in atrial fibrillation: The LIBREXIA atrial fibrillation trial rationale and design. American heart journal Jain, S. S., Mahaffey, K. W., Pieper, K. S., Shimizu, W., Potpara, T., Ruff, C. T., Kamel, H., Lewis, B. S., Cornel, J. H., Kowey, P. R., Horrow, J., Strony, J., Plotnikov, A. N., Li, D., Weng, S., Donahue, J., Gibson, C. M., Steg, P. G., Mehran, R., Weitz, J. I., Johnston, S. C., Hankey, G. J., Harrington, R. A., Lam, C. S. 2024

  Abstract

  Direct oral anticoagulants are the standard of care for stroke prevention in eligible patients with atrial fibrillation and atrial flutter; however, bleeding remains a significant concern, limiting their use. Milvexian is an oral Factor XIa inhibitor that may offer similar anticoagulant efficacy with less bleeding risk.LIBREXIA AF (NCT05757869) is a global phase III, randomized, double-blind, parallel-group, event-driven trial to compare milvexian with apixaban in participants with atrial fibrillation or atrial flutter. Participants are randomly assigned to milvexian 100 mg or apixaban (5 mg or 2.5 mg per label indication) twice daily. The primary efficacy objective is to evaluate if milvexian is noninferior to apixaban for the prevention of stroke and systemic embolism. The principal safety objective is to evaluate if milvexian is superior to apixaban in reducing the endpoint of International Society of Thrombosis and Hemostasis (ISTH) major bleeding events and the composite endpoint of ISTH major and clinically relevant nonmajor (CRNM) bleeding events. In total, 15,500 participants from approximately 1,000 sites in over 30 countries are planned to be enrolled. They will be followed until both 430 primary efficacy outcome events and 530 principal safety events are observed, which is estimated to take approximately 4 years.The LIBREXIA AF study will determine the efficacy and safety of the oral Factor XIa inhibitor milvexian compared with apixaban in participants with either atrial fibrillation or atrial flutter.ClinicalTrials.gov NCT05757869.

  View details for DOI 10.1016/j.ahj.2024.08.011

  View details for PubMedID 39214801

• Milvexian: An Oral, Bioavailable Factor XIa Inhibitor. Cardiology and therapy Parsa, S., Jain, S. S., Akinrimisi, O., Lam, C. S., Mahaffey, K. W. 2024

  Abstract

  Direct oral anticoagulants have a dose-dependent increased bleeding risk which limits use in certain populations. Studies in both animals and humans with inherited variations in factor XI levels provide a theoretical basis for a drug target capable of addressing current unmet needs. Milvexian is an oral factor XIa inhibitor that has the potential to provide robust anticoagulant effect without increased bleeding compared with current standard of care. Several key studies in the preclinical, phase I, and phase II stages have reported promising safety data in venous thromboembolism and stroke prevention without compromising hemostasis. The planned phase III trials will examine the efficacy of milvexian for prevention of thrombotic events in patients with acute stroke, acute coronary syndrome, and atrial fibrillation.

  View details for DOI 10.1007/s40119-024-00379-0

  View details for PubMedID 39152241

  View details for PubMedCentralID 10248740

• Introduction to Wearable Technology in Arrhythmia Management. Heart rhythm Perez-Guerrero, E. J., Mehrotra, I., Jain, S. S., Perez, M. V. 2024

  View details for DOI 10.1016/j.hrthm.2024.07.098

  View details for PubMedID 39053750

• Large Language Models as Partners in Medical Literature. Heart rhythm Perez-Guerrero, E. J., Mehrotra, I., Jain, S. S., Perez, M. V. 2024

  View details for DOI 10.1016/j.hrthm.2024.07.097

  View details for PubMedID 39053754

• Artificial Intelligence in Cardiovascular Disease Prevention: Is it Ready for Prime Time? Current atherosclerosis reports Parsa, S., Somani, S., Dudum, R., Jain, S. S., Rodriguez, F. 2024

  Abstract

  PURPOSE OF REVIEW: This review evaluates how Artificial Intelligence (AI) enhances atherosclerotic cardiovascular disease (ASCVD) risk assessment, allows for opportunistic screening, and improves adherence to guidelines through the analysis of unstructured clinical data and patient-generated data. Additionally, it discusses strategies for integrating AI into clinical practice in preventive cardiology.RECENT FINDINGS: AI models have shown superior performance in personalized ASCVD risk evaluations compared to traditional risk scores. These models now support automated detection of ASCVD risk markers, including coronary artery calcium (CAC), across various imaging modalities such as dedicated ECG-gated CT scans, chest X-rays, mammograms, coronary angiography, and non-gated chest CT scans. Moreover, large language model (LLM) pipelines are effective in identifying and addressing gaps and disparities in ASCVD preventive care, and can also enhance patient education. AI applications are proving invaluable in preventing and managing ASCVD and are primed for clinical use, provided they are implemented within well-regulated, iterative clinical pathways.

  View details for DOI 10.1007/s11883-024-01210-w

  View details for PubMedID 38780665

• LOW-DENSITY LIPOPROTEIN CHOLESTEROL TESTING AND CONTROL AS PERFORMANCE METRICS: A NATIONAL ANALYSIS OF VETERANS AFFAIRS HEALTH CARE SYSTEMS Jain, S. S., Skye, M., Din, N., Maron, D., Heidenreich, P. A., Kalwani, N., Bhatt, A., Sandhu, A., Rodriguez, F. ELSEVIER SCIENCE INC. 2024: 2014

  View details for Web of Science ID 001324901502048

• Contemporary attitudes and beliefs on coronary artery calcium from social media using artificial intelligence. NPJ digital medicine Somani, S., Balla, S., Peng, A. W., Dudum, R., Jain, S., Nasir, K., Maron, D. J., Hernandez-Boussard, T., Rodriguez, F. 2024; 7 (1): 83

  Abstract

  Coronary artery calcium (CAC) is a powerful tool to refine atherosclerotic cardiovascular disease (ASCVD) risk assessment. Despite its growing interest, contemporary public attitudes around CAC are not well-described in literature and have important implications for shared decision-making around cardiovascular prevention. We used an artificial intelligence (AI) pipeline consisting of a semi-supervised natural language processing model and unsupervised machine learning techniques to analyze 5,606 CAC-related discussions on Reddit. A total of 91 discussion topics were identified and were classified into 14 overarching thematic groups. These included the strong impact of CAC on therapeutic decision-making, ongoing non-evidence-based use of CAC testing, and the patient perceived downsides of CAC testing (e.g., radiation risk). Sentiment analysis also revealed that most discussions had a neutral (49.5%) or negative (48.4%) sentiment. The results of this study demonstrate the potential of an AI-based approach to analyze large, publicly available social media data to generate insights into public perceptions about CAC, which may help guide strategies to improve shared decision-making around ASCVD management and public health interventions.

  View details for DOI 10.1038/s41746-024-01077-w

  View details for PubMedID 38555387

  View details for PubMedCentralID PMC10981728

• Artificial Intelligence for Cardiovascular Care - Part 1: Advances: JACC Review Topic of the Week. Journal of the American College of Cardiology Elias, P., Jain, S., Poterucha, T., Randazzo, M., Lopez Jimenez, F., Khera, R., Perez, M., Ouyang, D., Pirruccello, J., Salerno, M., Einstein, A., Avram, R., Tison, G., Nadkarni, G., Natarajan, V., Pierson, E., Beecy, A., Kumaraiah, D., Haggerty, C., Avari Silva, J. N., Maddox, T. M. 2024

  Abstract

  Recent AI advancements in cardiovascular care offer potential enhancements in diagnosis, treatment, and outcomes. Innovations to date focus on automating measurements, enhancing image quality, and detecting diseases using novel methods. Applications span wearables, electrocardiograms, echocardiography, angiography, genetics, and more. AI models detect diseases from electrocardiograms at accuracy not previously achieved by technology or human experts, including reduced ejection fraction, valvular heart disease, and other cardiomyopathies. However, AI's unique characteristics necessitates rigorous validation by addressing training methods, real-world efficacy, equity concerns, and long-term reliability. Despite an exponentially growing number of studies in cardiovascular AI, trials showing improvement in outcomes remain lacking. A number are currently underway. Embracing this rapidly evolving technology while setting a high evaluation benchmark will be crucial for cardiology to leverage AI to enhance patient care and the provider experience.

  View details for DOI 10.1016/j.jacc.2024.03.400

  View details for PubMedID 38593946

• Artificial Intelligence in Cardiovascular Care - Part 2: Applications: JACC Review Topic of the Week. Journal of the American College of Cardiology Jain, S., Elias, P., Poterucha, T., Randazzo, M., Lopez Jimenez, F., Khera, R., Perez, M., Ouyang, D., Pirruccello, J., Salerno, M., Einstein, A., Avram, R., Tison, G., Nadkarni, G., Natarajan, V., Pierson, E., Beecy, A., Kumaraiah, D., Haggerty, C., Avari Silva, J. N., Maddox, T. M. 2024

  Abstract

  Recent Artificial Intelligence (AI) advancements in cardiovascular care offer potential enhancements in effective diagnosis, treatment, and outcomes. Over 600 Food and Drug Administration (FDA)-approved clinical AI algorithms now exist, with 10% focusing on cardiovascular applications, highlighting the growing opportunities for AI to augment care. This review discusses the latest advancements in the field of AI, with a particular focus on the utilization of multimodal inputs and the field of generative AI. Further discussions in this review involve an approach to understanding the larger context in which AI-augmented care may exist, and include a discussion of the need for rigorous evaluation, appropriate infrastructure for deployment, ethics and equity assessments, regulatory oversight, and viable business cases for deployment. Embracing this rapidly evolving technology while setting an appropriately high evaluation benchmark with careful and patient-centered implementation will be crucial for cardiology to leverage AI to enhance patient care and the provider experience.

  View details for DOI 10.1016/j.jacc.2024.03.401

  View details for PubMedID 38593945

• Sociodemographic Differences Among Patients Receiving Coronary Artery Calcium Scoring vs. Non-Gated Chest CT Imaging Peng, A. W., Skye, M., Jain, S. S., Dudum, R., Maron, D. J., Sandhu, A. T., Rodriguez, F. LIPPINCOTT WILLIAMS & WILKINS. 2023

  View details for DOI 10.1161/circ.148.suppl_1.14402

  View details for Web of Science ID 001157891303370

• Novel Digital Strategy for Improving Diversity in Cardiovascular Clinical Trials Jain, S. S., Perez, M. V., Nguyen, K. T., Hernandez, A. F., Turakhia, M., Mahaffey, K. W. LIPPINCOTT WILLIAMS & WILKINS. 2023

  View details for DOI 10.1161/circ.148.suppl_1.12956

  View details for Web of Science ID 001157891302001

• Treatment effect of canagliflozin for patients on therapy for heart failure: Pooled analysis of the CANVAS program and CREDENCE trial. International journal of cardiology Jain, S. S., Yu, J., Arnott, C., Neal, B., Perkovic, V., Neuen, B. L., Jardine, M., Mahaffey, K. W. 2023: 131444

  Abstract

  Canagliflozin is a sodium-glucose cotransporter 2 inhibitor that has been shown to reduce cardiovascular events in diabetic patients with and without heart failure (HF). Whether the clinical benefits and safety profile of canagliflozin are different in those on a beta blocker and an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (BB + RAASi) is unknown.We pooled participants with HF at baseline from the CANVAS Program and CREDENCE trial and assessed major adverse cardiovascular events and its components; hospitalization for heart failure (HHF); HHF or CV death; all-cause mortality; a renal composite; and a combined renal and CV composite.Of 14,543 participants, 2113 had HF at baseline, and 1280 were on BB + RAASi. In those with a history of HF, participants on BB + RAASi therapy were more likely to have coronary atherosclerotic disease (82 vs 72%, p < 0.001), history of myocardial infarction (42 vs 29%, p < 0.001), higher mean body mass index (34 vs 32 kg/m2, p < 0.001), and lower mean estimated glomerular filtration rate (67 vs 70 mL/min/1.73 m2, p < 0.01). They were also more likely to be on insulin, a statin, antithrombotic agent, and a diuretic (all p < 0.001). In unadjusted analysis and when adjusted for selected baseline factors, there was no heterogeneity in canagliflozin treatment effect except for HHF/CV death in those on baseline BB + RAASi vs. those not on baseline BB + RAASi (Pheterogeneity = 0.02).Canagliflozin mostly improved CV and kidney outcomes in participants with a history of HF irrespective of use of BB + RAASi at baseline, with possible greater benefit on HHF/CV death in participants on BB + RAASi.

  View details for DOI 10.1016/j.ijcard.2023.131444

  View details for PubMedID 37844669

• Aortic Root Thrombosis in Patients with HeartMate 3 Left Ventricular Assist Device Support. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Carey, M. R., Marshall, D., Clerkin, K., Laracuente, R., Sanchez, J., Jain, S. S., Raikhelkar, J. K., Leb, J. S., Kaku, Y., Yuzefpolskaya, M., Naka, Y., Colombo, P. C., Sayer, G. T., Takeda, K., Uriel, N., Topkara, V. K., Fried, J. A. 2023

  Abstract

  BACKGROUND: Aortic root thrombus (ART) formation is a complication of continuous flow left ventricular assist device (LVAD) therapy. However, the incidence and related complications of ART in HeartMate 3 (HM3) patients remains unknown.METHODS: Patients who underwent HM3 implantation from November 2014 through August 2020 at a quaternary academic medical center were included. Demographics and outcomes were abstracted from the medical record. Echocardiograms and contrast-enhanced CT studies were reviewed to identify patients who developed ART and/or moderate or greater aortic insufficiency (AI) on HM3 support.RESULTS: The study cohort included 197 HM3 patients with a median post-implant follow-up of 17.5 months. Nineteen patients (9.6%) developed ART during HM3 support, and 15 patients (7.6%) developed moderate or greater AI. Baseline age, gender, race, implantation strategy, and INTERMACS classification were similar between the ART and no-ART groups. ART was associated with an increased risk of death, stroke, or AV intervention (subhazard ratio [SHR] 3.60 [95% CI 1.71-7.56]; p=0.001) and moderate or greater AI (SHR 11.1 [CI 3.60-34.1]; p<0.001) but was not associated with a statistically significantly increased risk of death or stroke on HM3 support (2.12 [0.86-5.22]; p=0.10). Of the 19 patients with ART, 6 (31.6%) developed moderate or greater AI, necessitating more frequent AV interventions (ART: 5 AV interventions [3 surgical repairs, 1 surgical replacement, 1 transcatheter replacement; 26.3%]; no-ART: 0).CONCLUSION: Nearly 10% of HM3 patients developed ART during device support. ART was associated with increased risk of a composite endpoint of death, stroke, or AV intervention as well as moderate or greater AI.

  View details for DOI 10.1016/j.healun.2023.08.023

  View details for PubMedID 37739242

• Association of Coronary Artery Calcium Detected by Routine Ungated CT Imaging With Cardiovascular Outcomes. Journal of the American College of Cardiology Peng, A. W., Dudum, R., Jain, S. S., Maron, D. J., Patel, B. N., Khandwala, N., Eng, D., Chaudhari, A. S., Sandhu, A. T., Rodriguez, F. 2023; 82 (12): 1192-1202

  Abstract

  Coronary artery calcium (CAC) is a strong predictor of cardiovascular events across all racial and ethnic groups. CAC can be quantified on nonelectrocardiography (ECG)-gated computed tomography (CT) performed for other reasons, allowing for opportunistic screening for subclinical atherosclerosis.The authors investigated whether incidental CAC quantified on routine non-ECG-gated CTs using a deep-learning (DL) algorithm provided cardiovascular risk stratification beyond traditional risk prediction methods.Incidental CAC was quantified using a DL algorithm (DL-CAC) on non-ECG-gated chest CTs performed for routine care in all settings at a large academic medical center from 2014 to 2019. We measured the association between DL-CAC (0, 1-99, or ≥100) with all-cause death (primary outcome), and the secondary composite outcomes of death/myocardial infarction (MI)/stroke and death/MI/stroke/revascularization using Cox regression. We adjusted for age, sex, race, ethnicity, comorbidities, systolic blood pressure, lipid levels, smoking status, and antihypertensive use. Ten-year atherosclerotic cardiovascular disease risk was calculated using the pooled cohort equations.Of 5,678 adults without ASCVD (51% women, 18% Asian, 13% Hispanic/Latinx), 52% had DL-CAC >0. Those with DL-CAC ≥100 had an average 10-year ASCVD risk of 24%; yet, only 26% were on statins. After adjustment, patients with DL-CAC ≥100 had increased risk of death (HR: 1.51; 95% CI: 1.28-1.79), death/MI/stroke (HR: 1.57; 95% CI: 1.33-1.84), and death/MI/stroke/revascularization (HR: 1.69; 95% CI: 1.45-1.98) compared with DL-CAC = 0.Incidental CAC ≥100 was associated with an increased risk of all-cause death and adverse cardiovascular outcomes, beyond traditional risk factors. DL-CAC from routine non-ECG-gated CTs identifies patients at increased cardiovascular risk and holds promise as a tool for opportunistic screening to facilitate earlier intervention.

  View details for DOI 10.1016/j.jacc.2023.06.040

  View details for PubMedID 37704309

• TREATMENT EFFECT OF CANAGLIFLOZIN FOR PATIENTS ON THERAPY FOR HEART FAILURE: POOLED ANALYSIS OF THE CANVAS PROGRAM AND CREDENCE TRIAL Jain, S. S., Yu, J., Arnott, C., Neal, B., Perkovic, V., Neuen, B., Jardine, M., Mahaffey, K. W. ELSEVIER SCIENCE INC. 2023: 283

  View details for Web of Science ID 000990866100284

• ANTIRACIST AI: A MACHINE LEARNING MODEL USING ELECTROCARDIOGRAMS AND ECHOCARDIOGRAMS CAN DETECT TRANSTHYRETIN CARDIAC AMYLOIDOSIS AND DECREASE RACIAL BIAS IN DIAGNOSTIC TESTING Jain, S. S., Sun, T., Brown, K., Ramlall, V., Tatonetti, N., Elhadad, N., Rodriguez, F., Witteles, R., Maurer, M. S., Poterucha, T., Elias, P. ELSEVIER SCIENCE INC. 2023: 338

  View details for Web of Science ID 000990866100339

• Impact of Periprocedural AdverseEventsAfter PCI and CABGon5-Year Mortality: The EXCEL Trial. JACC. Cardiovascular interventions Jain, S. S., Li, D., Dressler, O., Kotinkaduwa, L., Serruys, P. W., Kappetein, A. P., Sabik, J. F., Morice, M., Puskas, J., Kandzari, D. E., Karmpaliotis, D., Lembo, N. J., Brown, W. M., Banning, A. P., Stone, G. W. 2023; 16 (3): 303-313

  Abstract

  BACKGROUND: The relative risks for different periprocedural major adverse events (MAE) after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on subsequent mortality have not been described.OBJECTIVES: The aim of this study was to assess the association between periprocedural MAE occurring within 30days postprocedure and early and late mortality after left main coronary artery revascularization by PCI and CABG.METHODS: In the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, patients with left main disease were randomized to PCI vs CABG. The associations between 12 prespecified nonfatal MAE and subsequent 5-year all-cause and cardiovascular death in 1,858 patients were examined using logistic regression.RESULTS: One or more nonfatal MAE occurred in 111 of 935 patients (11.9%) after PCI and 419 of 923 patients (45.4%) after CABG (P< 0.0001). Patients with MAE were older and had more baseline comorbidities. Within 5 years, all-cause death occurred in 117 and 87 patients after PCI and CABG, respectively. Experiencing an MAE was a strong independent predictor of 5-year mortality after both PCI (adjusted OR: 4.61; 95%CI: 2.71-7.82) and CABG (adjusted OR: 3.25; 95%CI: 1.95-5.41). These associations were present within the first 30days and between 30days and 5 years postprocedure. Major or minor bleeding with blood transfusion≥2 U was an independent predictor of 5-year mortality after both procedures. Stroke, unplanned revascularization for ischemia, and renal failure were significantly associated with mortality only after CABG.CONCLUSIONS: In the EXCEL trial, nonfatal periprocedural MAE were strongly associated with early and late mortality after both PCI and CABG for left main disease.

  View details for DOI 10.1016/j.jcin.2022.10.011

  View details for PubMedID 36792254

• When Two Isn't Better Than One: Single Versus Multiple Angiographic Views for Quantitative Flow Ratio. Journal of the Society for Cardiovascular Angiography & Interventions Jain, S. S., Fearon, W. F. 2022; 1 (5): 100411

  View details for DOI 10.1016/j.jscai.2022.100411

  View details for PubMedID 39131468

  View details for PubMedCentralID PMC11307653

• Outflow Graft Narrowing of the HeartMate 3 Left Ventricular Assist Device. The Annals of thoracic surgery Jain, S. S., Clerkin, K. J., Anstey, D. E., Liu, Q., Fried, J. A., Raikhelkar, J., Griffin, J. M., Marshall, D., Colombo, P., Yuzefpolskaya, M., Topkara, V., Naka, Y., Takeda, K., Sayer, G., Uriel, N., Leb, J. 2022

  Abstract

  Outflow graft narrowing has been reported in patients with the HeartMate 3 (HM3) left ventricular assist device (LVAD) due to accumulation of biodebris either internal or external to the graft. This study describes the prevalence, imaging findings, and clinical outcomes associated with HM3 LVAD outflow graft narrowing.A single-center retrospective cohort study was performed among patients who received a HM3 LVAD between 11/2014-7/2019. All patients with a Computed Tomography (CT) Angiography or CT with IV contrast sufficient to evaluate the outflow graft lumen were included. A narrowing was defined as a hypodensity of ≥3mm.Of 165 HM3 LVAD patients, 46 (28%) had qualifying imaging. Outflow graft narrowing was present in 33% (15/46). One patient had complete obstruction requiring emergency surgery, while 14 had a median (interquartile range) hypodensity of 4.5 mm (3.3-5.8). The presence of outflow graft narrowing was significantly associated with longer duration of LVAD support (588.2±277.5 vs. 131.5±170.9 days, p<0.0001). One-year survival after identification of narrowing was 93%, with death occurring in one patient with complete obstruction. Left ventricular (LV) unloading (mean percent decrease in LV end diastolic diameter at time of CT imaging vs. pre-LVAD) was 16.7% vs 17.7% in patients with and without narrowing, respectively (p=0.86).Among patients with adequate imaging, one-third have evidence of narrowing. Outflow graft narrowing due to biodebris was more likely to be found in HM3 LVAD patients with longer duration of LVAD support. There was no significant difference in LV unloading between patients with and without narrowing.

  View details for DOI 10.1016/j.athoracsur.2021.12.014

  View details for PubMedID 34998738

• The Effect of Chaplain Patient Navigators and Multidisciplinary Family Meetings on Patient Outcomes in the ICU: The Critical Care Collaboration and Communication Project. Critical care explorations Alghanim, F., Furqan, M., Prichett, L., Landon, J., Tao, X., Selvam, P., Leslie, M., Hartman-Shea, K., Teague, P., Scott, W., Kraeuter, S., Hicks, H., Jain, S., York, S., Blanding, R., Zakaria, S. 2021; 3 (11): e0574

  Abstract

  OBJECTIVES: To assess the effectiveness of a chaplain patient navigator in improving outcomes and reducing costs in the ICU setting.DESIGN: A randomized controlled trial at a large, urban, academic community hospital in Baltimore, Maryland.SETTING/PATIENTS: All patients admitted to the Johns Hopkins Bayview Medical Center Cardiac and Medical ICUs between March 2015 and December 2015.INTERVENTIONS: Patients in the intervention group were assigned a chaplain patient navigator to facilitate communication, offer support, and setup multidisciplinary family meetings.MEASUREMENTS AND MAIN RESULTS: The primary outcomes were hospital and ICU length of stay. Secondary outcomes included total and ICU charges, 60- and 90-day readmission rates, and the number of palliative care consults. For all outcomes, patients were included in the intention-to-treat analyses only if they remained in the ICU greater than 24 hours. In total, 1,174 were randomly assigned to "usual care" (n = 573) or to the intervention (n = 601). In the intervention group, 44.8% (269/601) had meetings within 24 hours of admission and, of those patients, 32.8% (88/268) took part in the larger multidisciplinary family meeting 2-3 days later. The intervention group had longer mean adjusted hospital length of stay (7.78 vs 8.63 d; p ≤ 0.001) and mean ICU length of stay (3.65 vs 3.87 d; p = 0.029). In addition, they had greater total and ICU charges. There were no differences in other outcomes. Of note, only differences in total and ICU charges remained when controlling for case-mix index, which were greater in the intervention group.CONCLUSIONS: Although the chaplain patient navigator anecdotally enhanced communication, our study found an increase in hospital and ICU length of stay as well as cost. Since other studies have shown benefits in some clinical outcomes, projects focused on patient navigators may learn lessons from our study in order to better prioritize family meetings, gather indicators of communication quality, and identify the optimal patient navigator operational context.

  View details for DOI 10.1097/CCE.0000000000000574

  View details for PubMedID 34765982

• Prognostic Importance of Health Status Versus Functional Status in Heart Failure and Secondary Mitral Regurgitation JACC-HEART FAILURE Arnold, S. V., Stone, G. W., Jain, S. S., Mack, M. J., Saxon, J. T., Zhang, Z., Lindenfeld, J., Abraham, W. T., Cohen, D. J., COAPT Investigators 2021; 9 (9): 684-692

  Abstract

  This study sought to understand the extent to which health status and exercise capacity are independently associated with long-term outcomes in patients with heart failure (HF) and secondary mitral regurgitation (MR).Secondary MR in patients with HF leads to impaired health status (Kansas City Cardiomyopathy Questionnaire Overall Summary Score [KCCQ-OS]) and exercise capacity (6-minute walk distance [6MWD]), both of which improve after transcatheter mitral valve repair (TMVr).The study used data from the COAPT trial (N = 604) to examine the association of baseline KCCQ-OS and 6MWD with 2-year mortality and HF hospitalization, adjusting for treatment arm and patient factors. We also examined the association of change in KCCQ-OS and 6MWD from baseline to 1 month with risk of outcomes from 1 month to 2 years. Interactions of KCCQ-OS and 6MWD with treatment assignment were explored.Mean baseline KCCQ-OS was 53 ± 23 points, and 6MWD was 240 ± 125 meters. In models including both measures, greater baseline 6MWD (but not KCCQ-OS) was associated with reduced 2-year mortality (HR per 125 meters: 0.75, 95% CI: 0.61-0.92). When stratified by treatment group, both baseline KCCQ-OS and 6MWD were independently associated with HF hospitalization in patients treated with medical therapy, whereas only KCCQ-OS was associated with HF hospitalization in patients treated with TMVr. In separate analyses, 1-month improvements in KCCQ-OS and 6MWD were each associated with lower subsequent risk of mortality and HF hospitalization, independent of treatment group.Among patients with HF and severe secondary MR, assessment of both health status and exercise capacity provide complementary prognostic information for patients with HF and severe secondary MR-both before and after TMVr. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial]; NCT01626079).

  View details for DOI 10.1016/j.jchf.2021.04.012

  View details for Web of Science ID 000691471800011

  View details for PubMedID 34391740

• CLINICAL AND ECONOMIC BURDEN OF OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY IN THE UNITED STATES Jain, S. S., Li, S. S., Xie, J., Sutton, M. B., Fine, J. T., Edelberg, J. M., Gao, W., Spertus, J. A., Cohen, D. J. ELSEVIER SCIENCE INC. 2021: 668

  View details for Web of Science ID 000647487500667

• IMPACT OF PREOPERATIVE LYMPHOPENIA ON OUTCOMES AFTER HEART TRANSPLANT Jain, S. S., Clerkin, K. J., Roth, Z. B., Fried, J. A., Raikhelkar, J., Griffin, J. M., Colombo, P. C., Yuzefpolskaya, M., Latif, F., Topkara, V. K., Farr, M. A., Naka, Y., Takeda, K., Sayer, G., Uriel, N. ELSEVIER SCIENCE INC. 2021: 641

  View details for Web of Science ID 000647487500640

• AORTIC ROOT THROMBOSIS IS ASSOCIATED WITH INCREASED INCIDENCE OF AORTIC INSUFFICIENCY IN PATIENTS SUPPORTED WITH HEARTMATE 3 LEFT VENTRICULAR ASSIST DEVICE Marshall, D. P., Laracuente, R., Carey, M., Clerkin, K., Masoumi, A., Raikhelkar, J., Griffin, J., Leb, J. S., Kaku, Y., Jain, S., Sanchez, J. E., Takayama, H., Yuzefpolskaya, M., Colombo, P., Takeda, K., Sayer, G., Naka, Y., Uriel, N., Topkara, V., Fried, J. ELSEVIER SCIENCE INC. 2021: 823

  View details for Web of Science ID 000647487500822

• AORTIC ROOT THROMBOSIS IN PATIENTS WITH HEARTMATE 3 LEFT VENTRICULAR ASSIST DEVICES Marshall, D. P., Carey, M., Laracuente, R., Clerkin, K., Masoumi, A., Kaku, Y., Raikhelkar, J., Griffin, J., Leb, J. S., Jain, S., Sanchez, J. E., Takayama, H., Yuzefpolskaya, M., Colombo, P., Takeda, K., Sayer, G., Naka, Y., Uriel, N., Topkara, V., Fried, J. ELSEVIER SCIENCE INC. 2021: 834

  View details for Web of Science ID 000647487500833

• Defining a Clinically Important Change in 6-Minute Walk Distance in Patients With Heart Failure and Mitral Valve Disease CIRCULATION-HEART FAILURE Jain, S. S., Cohen, D. J., Zhang, Z., Uriel, N., Sayer, G., Lindenfeld, J., Abraham, W. T., Mack, M. J., Stone, G. W., Arnold, S. V. 2021; 14 (3): 405-407

  View details for DOI 10.1161/CIRCHEARTFAILURE.120.007564

  View details for Web of Science ID 000639303800007

  View details for PubMedID 33663234

• Admission Cardiac Diagnostic Testing with Electrocardiography and Troponin Measurement Prognosticates Increased 30-Day Mortality in COVID-19 JOURNAL OF THE AMERICAN HEART ASSOCIATION Poterucha, T. J., Elias, P., Jain, S. S., Sayer, G., Redfors, B., Burkhoff, D., Rosenblum, H., DeFilippis, E. M., Gupta, A., Lawlor, M., Madhavan, M. V., Griffin, J., Raikhelkar, J., Fried, J., Clerkin, K. J., Kim, A., Perotte, A., Maurer, M. S., Saluja, D., Dizon, J., Ehlert, F. A., Morrow, J. P., Yarmohammadi, H., Biviano, A. B., Garan, H., Rabbani, L., Leon, M. B., Schwartz, A., Uriel, N., Wan, E. Y. 2021; 10 (1): e018476

  Abstract

  Background Cardiovascular involvement in coronavirus disease 2019 (COVID-19) is common and leads to worsened mortality. Diagnostic cardiovascular studies may be helpful for resource appropriation and identifying patients at increased risk for death. Methods and Results We analyzed 887 patients (aged 64±17 years) admitted with COVID-19 from March 1 to April 3, 2020 in New York City with 12 lead electrocardiography within 2 days of diagnosis. Demographics, comorbidities, and laboratory testing, including high sensitivity cardiac troponin T (hs-cTnT), were abstracted. At 30 days follow-up, 556 patients (63%) were living without requiring mechanical ventilation, 123 (14%) were living and required mechanical ventilation, and 203 (23%) had expired. Electrocardiography findings included atrial fibrillation or atrial flutter (AF/AFL) in 46 (5%) and ST-T wave changes in 306 (38%). 27 (59%) patients with AF/AFL expired as compared to 181 (21%) of 841 with other non-life-threatening rhythms (P<0.001). Multivariable analysis incorporating age, comorbidities, AF/AFL, QRS abnormalities, and ST-T wave changes, and initial hs-cTnT ≥20 ng/L showed that increased age (HR 1.04/year), elevated hs-cTnT (HR 4.57), AF/AFL (HR 2.07), and a history of coronary artery disease (HR 1.56) and active cancer (HR 1.87) were associated with increased mortality. Conclusions Myocardial injury with hs-cTnT ≥20 ng/L, in addition to cardiac conduction perturbations, especially AF/AFL, upon hospital admission for COVID-19 infection is associated with markedly increased risk for mortality than either diagnostic abnormality alone.

  View details for DOI 10.1161/JAHA.120.018476

  View details for Web of Science ID 000607087000019

  View details for PubMedID 33169643

  View details for PubMedCentralID PMC7955502

• Clinical and economic burden of obstructive hypertrophic cardiomyopathy in the United States JOURNAL OF MEDICAL ECONOMICS Jain, S. S., Li, S. S., Xie, J., Sutton, M. B., Fine, J. T., Edelberg, J. M., Gao, W., Spertus, J. A., Cohen, D. J. 2021; 24 (1): 1115-1123

  Abstract

  Obstructive hypertrophic cardiomyopathy (oHCM) is a disease of the cardiomyocyte in which dynamic left ventricular outflow track obstruction may lead to heart failure, valvular disease, and sudden death. Little is known about healthcare resource utilization (HRU) and costs associated with oHCM. This study investigated the clinical and economic burden of oHCM in patients with or without symptoms associated with oHCM.We used the US IBM MarketScan Commercial and Medicare Supplemental database to identify patients with oHCM (January 2009-March 2019). Control patients without cardiomyopathy were matched to each patient with oHCM based on age, sex, region, and index year (3:1 ratio). One-year HRU and cost data were compared between all oHCM, symptomatic oHCM, and asymptomatic oHCM subgroups, and their respective controls.Among 11,401 eligible patients with oHCM (mean age 57 years, 42% female), 5,667 (50%) were symptomatic (23% chest pain, 57% dyspnea, 29% fatigue, 17% syncope). oHCM was associated with significant increases in all-cause hospitalizations, hospital days, outpatient visits, and total healthcare costs (mean ± standard deviation: $26,929 ± 77,720 vs. $6,808 ± 25,712, p<.001) compared with matched controls. These differences were driven mainly by the clinical and economic burden of symptomatic oHCM, which was associated with significant increases in 1-year hospitalization rates (38.0 vs. 6.9%), hospital days (3.7 ± 9.9 vs. 0.4 ± 3.0), and total healthcare costs ($43,586 ± 103,756 vs. $6,768 ± 27,618; all p<.001). Adjustment for comorbidities had minimal impact on these differences.The use of claims data relies on International Classification of Diseases (ICD-9 and ICD-10) diagnosis codes, which might be inaccurate. Only commercially insured patients were included.In a real-world population, oHCM was associated with substantial increases in HRU and incremental costs of ∼$20,000/year when compared with matched controls-a difference that increased to ∼$35,000/year among symptomatic patients. Further studies are warranted to understand the potential impact of specific therapies on HRU and the economic burden of oHCM.

  View details for DOI 10.1080/13696998.2021.1978242

  View details for Web of Science ID 000697876100001

  View details for PubMedID 34493144

• The Evolving Roles of Digital Health, Big Data and AI: "Tech-celeration" in CV Care Jain, S. S. Cardiology Magazine. 2021
• Prognostic Importance of Functional Status Versus Health Status in Patients With Heart Failure and Severe Secondary Mitral Regurgitation Arnold, S., Stone, G., Jain, S., Mack, M., Saxon, J., Ambrosy, A., Malik, U., Ku, I., Mishell, J., Zhang, Z., Lindenfeld, J., Abraham, W., Cohen, D. ELSEVIER SCIENCE INC. 2020: B152-B153

  View details for Web of Science ID 000597114500339

• An Evaluation of Biometric Monitoring Technologies for Vital Signs in the Era of COVID-19 CTS-CLINICAL AND TRANSLATIONAL SCIENCE Manta, C., Jain, S. S., Coravos, A., Mendelsohn, D., Izmailova, E. S. 2020; 13 (6): 1034-1044

  Abstract

  The novel coronavirus disease 2019 (COVID-19) global pandemic has shifted how many patients receive outpatient care. Telehealth and remote monitoring have become more prevalent, and measurements taken in a patient's home using biometric monitoring technologies (BioMeTs) offer convenient opportunities to collect vital sign data. Healthcare providers may lack prior experience using BioMeTs in remote patient care, and, therefore, may be unfamiliar with the many versions of BioMeTs, novel data collection protocols, and context of the values collected. To make informed patient care decisions based on the biometric data collected remotely, it is important to understand the engineering solutions embedded in the products, data collection protocols, form factors (physical size and shape), data quality considerations, and availability of validation information. This article provides an overview of BioMeTs available for collecting vital signs (temperature, heart rate, blood pressure, oxygen saturation, and respiratory rate) and discusses the strengths and limitations of continuous monitoring. We provide considerations for remote data collection and sources of validation information to guide BioMeT use in the era of COVID-19 and beyond.

  View details for DOI 10.1111/cts.12874

  View details for Web of Science ID 000579560400001

  View details for PubMedID 32866314

  View details for PubMedCentralID PMC7719373

• The Prognostic Value of Electrocardiogram at Presentation to Emergency Department in Patients With COVID-19 MAYO CLINIC PROCEEDINGS Elias, P., Poterucha, T. J., Jain, S. S., Sayer, G., Raikhelkar, J., Fried, J., Clerkin, K., Griffin, J., DeFilippis, E. M., Gupta, A., Lawlor, M., Madhavan, M., Rosenblum, H., Roth, Z. B., Natarajan, K., Hripcsak, G., Perotte, A., Wan, E. Y., Saluja, A., Dizon, J., Ehlert, F., Morrow, J. P., Yarmohammadi, H., Kumaraiah, D., Redford, B., Gavin, N., Kirtane, A., Rabbani, L., Burkhoff, D., Moses, J., Schwartz, A., Leon, M., Uriel, N. 2020; 95 (10): 2099-2109

  Abstract

  To study whether combining vital signs and electrocardiogram (ECG) analysis can improve early prognostication.This study analyzed 1258 adults with coronavirus disease 2019 who were seen at three hospitals in New York in March and April 2020. Electrocardiograms at presentation to the emergency department were systematically read by electrophysiologists. The primary outcome was a composite of mechanical ventilation or death 48 hours from diagnosis. The prognostic value of ECG abnormalities was assessed in a model adjusted for demographics, comorbidities, and vital signs.At 48 hours, 73 of 1258 patients (5.8%) had died and 174 of 1258 (13.8%) were alive but receiving mechanical ventilation with 277 of 1258 (22.0%) patients dying by 30 days. Early development of respiratory failure was common, with 53% of all intubations occurring within 48 hours of presentation. In a multivariable logistic regression, atrial fibrillation/flutter (odds ratio [OR], 2.5; 95% CI, 1.1 to 6.2), right ventricular strain (OR, 2.7; 95% CI, 1.3 to 6.1), and ST segment abnormalities (OR, 2.4; 95% CI, 1.5 to 3.8) were associated with death or mechanical ventilation at 48 hours. In 108 patients without these ECG abnormalities and with normal respiratory vitals (rate <20 breaths/min and saturation >95%), only 5 (4.6%) died or required mechanical ventilation by 48 hours versus 68 of 216 patients (31.5%) having both ECG and respiratory vital sign abnormalities.The combination of abnormal respiratory vital signs and ECG findings of atrial fibrillation/flutter, right ventricular strain, or ST segment abnormalities accurately prognosticates early deterioration in patients with coronavirus disease 2019 and may assist with patient triage.

  View details for DOI 10.1016/j.mayocp.2020.07.028

  View details for Web of Science ID 000581142500014

  View details for PubMedID 33012341

  View details for PubMedCentralID PMC7428764

• Indications for and Findings on Transthoracic Echocardiography in COVID-19 JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY Jain, S. S., Liu, Q., Raikhelkar, J., Fried, J., Elias, P., Poterucha, T. J., DeFilippis, E. M., Rosenblum, H., Wang, E. Y., Redfors, B., Clerkin, K., Griffin, J. M., Abdalla, M., Bello, N. A., Hahn, R. T., Shimbo, D., Weiner, S. D., Kirtane, A. J., Kodali, S. K., Burkhoff, D., Rabbani, L. E., Schwartz, A., Leon, M. B., Homma, S., Di Tullio, M. R., Sayer, G., Uriel, N., Anstey, D. 2020; 33 (10): 1278-1284

  Abstract

  Despite growing evidence of cardiovascular complications associated with coronavirus disease 2019 (COVID-19), there are few data regarding the performance of transthoracic echocardiography (TTE) and the spectrum of echocardiographic findings in this disease.A retrospective analysis was performed among adult patients admitted to a quaternary care center in New York City between March 1 and April 3, 2020. Patients were included if they underwent TTE during the hospitalization after a known positive diagnosis for COVID-19. Demographic and clinical data were obtained using chart abstraction from the electronic medical record.Of 749 patients, 72 (9.6%) underwent TTE following positive results on severe acute respiratory syndrome coronavirus-2 polymerase chain reaction testing. The most common clinical indications for TTE were concern for a major acute cardiovascular event (45.8%) and hemodynamic instability (29.2%). Although most patients had preserved biventricular function, 34.7% were found to have left ventricular ejection fractions ≤ 50%, and 13.9% had at least moderately reduced right ventricular function. Four patients had wall motion abnormalities suggestive of stress-induced cardiomyopathy. Using Spearman rank correlation, there was an inverse relationship between high-sensitivity troponin T and left ventricular ejection fraction (ρ = -0.34, P = .006). Among 20 patients with prior echocardiograms, only two (10%) had new reductions in LVEF of >10%. Clinical management was changed in eight individuals (24.2%) in whom TTE was ordered for concern for acute major cardiovascular events and three (14.3%) in whom TTE was ordered for hemodynamic evaluation.This study describes the clinical indications for use and diagnostic performance of TTE, as well as findings seen on TTE, in hospitalized patients with COVID-19. In appropriately selected patients, TTE can be an invaluable tool for guiding COVID-19 clinical management.

  View details for DOI 10.1016/j.echo.2020.06.009

  View details for Web of Science ID 000576958500018

  View details for PubMedID 32782131

  View details for PubMedCentralID PMC7298489

• The Variety of Cardiovascular Presentations of COVID-19 CIRCULATION Fried, J. A., Ramasubbu, K., Bhatt, R., Topkara, V. K., Clerkin, K. J., Horn, E., Rabbani, L., Brodie, D., Jain, S. S., Kirtane, A. J., Masoumi, A., Takeda, K., Kumaraiah, D., Burkhoff, D., Leon, M., Schwartz, A., Uriel, N., Sayer, G. 2020; 141 (23): 1930-1936

  View details for DOI 10.1161/CIRCULATIONAHA.120.047164

  View details for Web of Science ID 000545970000018

  View details for PubMedID 32243205

  View details for PubMedCentralID PMC7314498

• COVID-19 and Cardiovascular Disease CIRCULATION Clerkin, K. J., Fried, J. A., Raikhelkar, J., Sayer, G., Griffin, J. M., Masoumi, A., Jain, S. S., Burkhoff, D., Kumaraiah, D., Rabbani, L., Schwartz, A., Uriel, N. 2020; 141 (20): 1648-1655

  Abstract

  Coronavirus disease 2019 (COVID-19) is a global pandemic affecting 185 countries and >3 000 000 patients worldwide as of April 28, 2020. COVID-19 is caused by severe acute respiratory syndrome coronavirus 2, which invades cells through the angiotensin-converting enzyme 2 receptor. Among patients with COVID-19, there is a high prevalence of cardiovascular disease, and >7% of patients experience myocardial injury from the infection (22% of critically ill patients). Although angiotensin-converting enzyme 2 serves as the portal for infection, the role of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers requires further investigation. COVID-19 poses a challenge for heart transplantation, affecting donor selection, immunosuppression, and posttransplant management. There are a number of promising therapies under active investigation to treat and prevent COVID-19.

  View details for DOI 10.1161/CIRCULATIONAHA.120.046941

  View details for Web of Science ID 000536791300012

  View details for PubMedID 32200663

• IMPACT OF THE REVERSAL OF ELEVATED PULMONARY VASCULAR RESISTANCE WITH LEFT VENTRICULAR ASSIST DEVICE OR CHRONIC VASODILATORS ON POST HEART TRANSPLANT CLINICAL OUTCOMES Jain, S., Roth, Z., Clerkin, K., Fried, J., Raikhelkar, J., Colombo, P., Farr, M. A., Topkara, V., Yuzefpolskaya, M., Naka, Y., Takeda, K., Uriel, N., Sayer, G. ELSEVIER SCIENCE INC. 2020: 1016

  View details for Web of Science ID 000522979101004

• Impact of Periprocedural Major Adverse Events After PCI and CABG on Long-Term Outcomes in Patients With Left Main Disease: The EXCEL Trial Jain, S., Dressler, O., Serruys, P., Kappetein, A., Sabik, J., Leon, M., Taggart, D., Morice, M., Puskas, J., Kandzari, D., Lembo, N., Brown, W., Banning, A., Stone, G. ELSEVIER SCIENCE INC. 2019: B306

  View details for DOI 10.1016/j.jacc.2019.08.385

  View details for Web of Science ID 000487306300307

• Diagnostic Capability of Three-Dimensional Macular Parameters for Glaucoma Using Optical Coherence Tomography Volume Scans INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Vercellin, A., Jassim, F., Poon, L., Tsikata, E., Braaf, B., Shah, S., Ben-David, G., Shieh, E., Lee, R., Simavli, H., Que, C. J., Papadogeorgou, G., Guo, R., Vakoc, B. J., Bouma, B. E., de Boer, J. F., Chen, T. C. 2018; 59 (12): 4998-5010

  Abstract

  To compare the diagnostic capability of three-dimensional (3D) macular parameters against traditional two-dimensional (2D) retinal nerve fiber layer (RNFL) thickness using spectral domain optical coherence tomography. To determine if manual correction and interpolation of B-scans improve the ability of 3D macular parameters to diagnose glaucoma.A total of 101 open angle glaucoma patients (29 with early glaucoma) and 57 healthy subjects had peripapillary 2D RNFL thickness and 3D macular volume scans. Four parameters were calculated for six different-sized annuli: total macular thickness (M-thickness), total macular volume (M-volume), ganglion cell complex (GCC) thickness, and GCC volume of the innermost 3 macular layers (retinal nerve fiber layer + ganglion cell layer + inner plexiform layer). All macular parameters were calculated with and without correction and interpolation of frames with artifacts. The areas under the receiver operating characteristic curves (AUROC) were calculated for all the parameters.The 3D macular parameter with the best diagnostic performance was GCC-volume-34, with an inner diameter of 3 mm and an outer of 4 mm. The AUROC for RNFL thickness and GCC-volume-34 were statistically similar for all regions (global: RNFL thickness 0.956, GCC-volume-34 0.939, P value = 0.3827), except for the temporal GCC-volume-34, which was significantly better than temporal RNFL thickness (P value = 0.0067). Correction of artifacts did not significantly change the AUROC of macular parameters (P values between 0.8452 and 1.0000).The diagnostic performance of best macular parameters (GCC-volume-34 and GCC-thickness-34) were similar to or better than 2D RNFL thickness. Manual correction of artifacts with data interpolation is unnecessary in the clinical setting.

  View details for DOI 10.1167/iovs.18-23813

  View details for Web of Science ID 000447614900007

  View details for PubMedID 30326067

  View details for PubMedCentralID PMC6188465

• Leading Change – A National Survey of Chief Innovation Officers in Health Systems Health Management, Policy & Innovation Shah, S. P., McCourt, L., Jakobson, K., Saddington, A., Harvey, K., Schulman, K. A. 2018; 3 (1)
• Committing To Transformation: Chief Innovation Officers And The Role Of Organizational Redesign Jain, S. S., Schulman, K. a. Health Affairs Forefront. 2018
• Why are patients being readmitted after surgery for esophageal cancer? JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Shah, S. P., Xu, T., Hooker, C. M., Hulbert, A., Battafarano, R. J., Brock, M. V., Mungo, B., Molena, D., Yang, S. C. 2015; 149 (5): 1384-1389

  Abstract

  Readmission after surgery is an unwanted adverse event that is costly to the healthcare system. We sought to evaluate factors associated with increased risk of readmission and to characterize the nature of these readmissions in patients who have esophageal cancer.A retrospective cohort study was performed in 306 patients with esophageal carcinoma who underwent neoadjuvant chemoradiation followed by esophagectomy at Johns Hopkins Hospital between 1993 and 2011. Logistic regression was used to identify factors associated with 30-day readmission. Readmissions were defined as inpatient admissions to our institution within 30 days of discharge.The median age at surgery was 61 years; the median postoperative length of stay was 9 days; and 48% of patients had ≥1 postoperative complication (POC). The 30-day readmission rate was 13.7% (42 of 306). In univariate analysis, length of stay and having ≥1 POC were significantly associated with readmission. In multivariate analysis, having ≥1 POC was significantly associated with a >2-fold increase in risk for 30-day readmission (odds ratio 2.35, with 95% confidence interval [1.08-5.09], P = .031) when controlling for age at diagnosis and length of stay. Of the 42 patients who were readmitted, 67% experienced POCs after surgery; 50% of patients who experienced POCs were readmitted for reasons related to their postoperative complication. The most common reasons for readmission were pulmonary issues (29%), anastomotic complications (20%), gastrointestinal concerns (17%), and venous thromboembolism (14%).Complications not adequately managed before discharge may lead to readmission. Quality improvement efforts surrounding venous thromboembolism prophylaxis, and discharging patients nothing-by-mouth, may be warranted.

  View details for DOI 10.1016/j.jtcvs.2015.01.064

  View details for Web of Science ID 000354567100038

  View details for PubMedID 25983251

• IMPROVING THE ICU PATIENT EXPERIENCE: THE C4 (CRITICAL CARE COLLABORATION AND COMMUNICATION) PROJECT Landon, J., York, S., Shah, S., Hartman-Shea, K., Teague, P., Wilkerson, H., Kraeuter, S., Zakaria, S. LIPPINCOTT WILLIAMS & WILKINS. 2014

  View details for Web of Science ID 000346211800565

• Notch-1 and Notch-4 Receptors as Prognostic Markers in Breast Cancer INTERNATIONAL JOURNAL OF SURGICAL PATHOLOGY Yao, K., Rizzo, P., Rajan, P., Albain, K., Rychlik, K., Shah, S., Miele, L. 2011; 19 (5): 607-613

  Abstract

  Studies looking at immunohistochemical (IHC) staining of Notch receptors in breast cancer and correlation with known prognostic factors are sparse.IHC staining for nuclear, cytoplasmic, and membrane Notch-1 (N1), Notch-4 (N4), and Jagged-1 (JAG1) was performed and correlated with known prognostic factors.Of 48 breast cancers, 36 (67%) were invasive, mean age was 50 years (range 43-86 years), 37 (77%) were estrogen receptor (ERα) positive, and 13 (27%) node positive. There was significantly more marked N1 membranous staining in ERα-positive tumors (P < .05). On univariate analysis, cytoplasmic N1 was significantly correlated with node status and tumor grade (P < .05); both cytoplasmic and membranous N4 significantly correlated with Ki67 (P < .05); and membranous JAG1 significantly correlated with Ki67 (P < .05). On multivariate analysis, only cytoplasmic N1 significantly correlated with node status.IHC of Notch markers is feasible and correlates with known prognostic factors consistent with a biological role of Notch signaling in breast cancer progression.

  View details for DOI 10.1177/1066896910362080

  View details for Web of Science ID 000297077900008

  View details for PubMedID 20444726

• The 2.5 angstrom Structure of CD1c in Complex with a Mycobacterial Lipid Reveals an Open Groove Ideally Suited for Diverse Antigen Presentation IMMUNITY Scharf, L., Li, N., Hawk, A. J., Garzon, D., Zhang, T., Fox, L. M., Kazen, A. R., Shah, S., Haddadian, E. J., Gumperz, J. E., Saghatelian, A., Faraldo-Gomez, J. D., Meredith, S. C., Piccirilli, J. A., Adams, E. J. 2010; 33 (6): 853-862

  Abstract

  CD1 molecules function to present lipid-based antigens to T cells. Here we present the crystal structure of CD1c at 2.5 Å resolution, in complex with the pathogenic Mycobacterium tuberculosis antigen mannosyl-β1-phosphomycoketide (MPM). CD1c accommodated MPM's methylated alkyl chain exclusively in the A' pocket, aided by a unique exit portal underneath the α1 helix. Most striking was an open F' pocket architecture lacking the closed cavity structure of other CD1 molecules, reminiscent of peptide binding grooves of classical major histocompatibility complex molecules. This feature, combined with tryptophan-fluorescence quenching during loading of a dodecameric lipopeptide antigen, provides a compelling model by which both the lipid and peptide moieties of the lipopeptide are involved in CD1c presentation of lipopeptides.

  View details for DOI 10.1016/j.immuni.2010.11.026

  View details for Web of Science ID 000286293900007

  View details for PubMedID 21167756

  View details for PubMedCentralID PMC3010391