125 results on '"Horne, Benjamin D."'
Search Results
2. PO-01-018 ASCVD BUT NOT AN ELEVATED LP(A) WAS ASSOCIATED WITH ATRIAL FIBRILLATION INCIDENCE IN AN INTEGRATED HEALTHCARE SYSTEM.
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Le, Viet, May, Heidi, Bair, Tami L., Knight, Stacey, Horne, Benjamin D., Cutler, Michael J., Packer, Douglas L., Knowlton, Kirk U., and Anderson, Jeffrey L.
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- 2024
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3. International consensus on fasting terminology.
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Koppold, Daniela A., Breinlinger, Carolin, Hanslian, Etienne, Kessler, Christian, Cramer, Holger, Khokhar, Anika Rajput, Peterson, Courtney M., Tinsley, Grant, Vernieri, Claudio, Bloomer, Richard J., Boschmann, Michael, Bragazzi, Nicola L., Brandhorst, Sebastian, Gabel, Kelsey, Goldhamer, Alan C., Grajower, Martin M., Harvie, Michelle, Heilbronn, Leonie, Horne, Benjamin D., and Karras, Spyridon N.
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Although fasting is increasingly applied for disease prevention and treatment, consensus on terminology is lacking. Using Delphi methodology, an international, multidisciplinary panel of researchers and clinicians standardized definitions of various fasting approaches in humans. Five online surveys and a live online conference were conducted with 38 experts, 25 of whom completed all 5 surveys. Consensus was achieved for the following terms: "fasting" (voluntary abstinence from some or all foods or foods and beverages), "modified fasting" (restriction of energy intake to max. 25% of energy needs), "fluid-only fasting," "alternate-day fasting," "short-term fasting" (lasting 2–3 days), "prolonged fasting" (≥4 consecutive days), and "religious fasting." "Intermittent fasting" (repetitive fasting periods lasting ≤48 h), "time-restricted eating," and "fasting-mimicking diet" were discussed most. This study provides expert recommendations on fasting terminology for future research and clinical applications, facilitating communication and cross-referencing in the field. [Display omitted] • Thirty-eight panelists from five continents participated in this consensus process • First panel uniting experimental and clinical experts in medical and religious fasts • Twenty-four terms were defined in five online surveys and one live conference • Fasting defined as voluntary abstinence from some or all foods or foods and beverages Although fasting is being studied extensively around the world, there was no common definition of basic terms until now. This publication presents an international consensus process on such terms, including fasting, intermittent fasting, time-restricted eating, long-term and short-term fasting, as well as fasting-mimicking diets. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Intermittent fasting and changes in Galectin-3: A secondary analysis of a randomized controlled trial of disease-free subjects.
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Horne, Benjamin D., Anderson, Jeffrey L., May, Heidi T., Le, Viet T., Galenko, Oxana, Drakos, Stavros G., Bair, Tami L., Knowlton, Kirk U., and Muhlestein, Joseph B.
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Background and Aims: Intermittent fasting reduces risk of interrelated cardiometabolic diseases, including type 2 diabetes and heart failure (HF). Previously, we reported that intermittent fasting reduced homeostasis model assessment of insulin resistance (HOMA-IR) and Metabolic Syndrome Score (MSS) in the WONDERFUL Trial. Galectin-3 may act to reduce insulin resistance. This post hoc evaluation assessed whether intermittent fasting increased galectin-3.Methods and Results: The WONDERFUL Trial enrolled adults ages 21-70 years with ≥1 metabolic syndrome features or type 2 diabetes who were not taking anti-diabetic medication, were free of statins, and had elevated LDL-C. Subjects were randomized to water-only 24-h intermittent fasting conducted twice-per-week for 4 weeks and once-per-week for 22 weeks or to a parallel control arm with ad libitum energy intake. The study evaluated 26-week change scores of galectin-3 and other biomarkers. Overall, n = 67 subjects (intermittent fasting: n = 36; control: n = 31) completed the trial and had galectin-3 results. At 26-weeks, the galectin-3 change score was increased by intermittent fasting (median: 0.793 ng/mL, IQR: -0.538, 2.245) versus control (median: -0.332 ng/mL, IQR: -0.992, 0.776; p = 0.021). Galectin-3 changes correlated inversely with 26-week change scores of HOMA-IR (r = -0.288, p = 0.018) and MSS (r = -0.238, p = 0.052). Other HF biomarkers were unchanged by fasting.Conclusion: A 24-h water-only intermittent fasting regimen increased galectin-3. The fasting-triggered galectin-3 elevation was inversely correlated with declines in HOMA-IR and MSS. This may be an evolutionary adaptive survival response that protects human health by modifying disease risks, including by reducing inflammation and insulin resistance.Trial Registration: Clinicaltrials.gov, NCT02770313 (registered on May 12, 2016; first subject enrolled: November 30, 2016; final subject's 26-week study visit: February 19, 2020). [ABSTRACT FROM AUTHOR]- Published
- 2022
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5. Insulin Growth Factor Phenotypes in Heart Failure With Preserved Ejection Fraction, an INSPIRE Registry and CATHGEN Study.
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Haddad, Francois, Ataam, Jennifer Arthur, Amsallem, Myriam, Cauwenberghs, Nicholas, Kuznetsova, Tatiana, Rosenberg-Hasson, Yael, Zamanian, Roham T., Karakikes, Ioannis, Horne, Benjamin D., Muhlestein, Joseph B., Kwee, Lydia, Shah, Svati, Maecker, Holden, Knight, Stacey, and Knowlton, Kirk
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Background: The insulin-like growth factor (IGF) axis emerged as an important pathway in heart failure with preserved ejection (HFpEF). We aimed to identify IGF phenotypes associated with HFpEF in the context of high-dimensional proteomic profiling.Methods: From the INtermountain Healthcare Biological Samples Collection Project and Investigational REgistry for the On-going Study of Disease Origin, Progression and Treatment (Intermountain INSPIRE Registry), we identified 96 patients with HFpEF and matched controls. We performed targeted proteomics, including IGF-1,2, IGF binding proteins (IGFBP) 1-7 and 111 other proteins (EMD Millipore and ELISA). We used partial least square discriminant analysis (PLS-DA) to identify a set of proteins associated with prevalent HFpEF, pulmonary hypertension and 5-year all-cause mortality. K-mean clustering was used to identify IGF phenotypes.Results: Patients with HFpEF had a high prevalence of systemic hypertension (95%) and coronary artery disease (74%). Using PLS-DA, we identified a set of biomarkers, including IGF1,2 and IGFBP 1,2,7, that provided a strong discrimination of HFpEF, pulmonary hypertension and mortality with an area under the curve of 0.91, 0.77 and 0.83, respectively. Using K mean clustering, we identified 3 IGF phenotypes that were independently associated with all-cause 5-year mortality after adjustment for age, NT-proBNP and kidney disease (P = 0.004). Multivariable analysis validated the prognostic value of IGFBP-1 and 2 in the CATHeterization GENetics (CATHGEN) biorepository.Conclusion: IGF phenotypes were associated with pulmonary hypertension and mortality in HFpEF. [ABSTRACT FROM AUTHOR]- Published
- 2022
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6. The Reasoning behind Fake News Assessments: A Linguistic Analysis.
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Manikonda, Lydia, Nevo, Dorit, Horne, Benjamin D., Arrington, Clare, and Adali, Sibel
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LINGUISTIC analysis ,FAKE news ,NEWS consumption ,NATURAL language processing - Abstract
This paper investigates how individuals reason about the authenticity of the news content they consume. While researchers have conducted much work on fake news detection and prevention, we know relatively less about how news readers reason about the content that they read. Using data collected through Amazon Mechanical Turk, we analyzed over 1,000 justifications that news readers provided about why they believe (or fail to believe) given news articles. We included both fake and credible articles in our analyses and examined the novelty of the news topic as a possible contingency factor that differentiated the reasoning provided. Based on our psycholinguistic analyses, we found that news readers employ both cognitive and motivated reasoning and that agreement with the ground truth impacts the reasoning more than a news topic's novelty. Our insights contribute to the literature on news consumption and reasoning in the context of evaluating fake news. Furthermore, this knowledge contribution has implications in areas such as news veracity intervention and tool design. Lastly, we offer a methodological contribution via using linguistic analysis in a novel way to assess the quality of open-ended survey questions. [ABSTRACT FROM AUTHOR]
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- 2022
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7. Cardiovascular morbidity and mortality following hypertensive disorders of pregnancy.
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Theilen, Lauren H., Varner, Michael W., Esplin, M. Sean, and Horne, Benjamin D.
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• HDP are associated with subsequent CVD or major CV risk factors within 20 years. • Women with HDP are twice as likely to have CAD on angiography vs those without. • OB history may be informative when deciding whether to do coronary angiography. To determine whether hypertensive disorders of pregnancy (HDP) are associated with maternal coronary artery disease (CAD) and other cardiovascular (CV) diseases within 10–20 years following delivery. Retrospective cohort including all women who delivered ≥ 1 pregnancy ≥ 20 weeks' gestation within a single health system from 1998 to 2008. We excluded those with CV risk factors preceding first delivery or with no follow-up after delivery. The exposure of interest was any HDP, determined by ICD coding. The primary outcome was a composite of ICD codes for CAD, peripheral vascular disease, and CV events (myocardial infarction, stroke, and death). Multivariable Cox proportional hazards estimated the association between exposure and outcomes. A nested cohort of women who underwent cardiac catheterization had a primary outcome of angiographic CAD, and multivariable logistic regression estimated the association between HDP and CAD. Of 33,959 women included, 2,385 women had HDP. HDP was associated with the composite outcome (adjusted HR 1.50, 95 % CI 1.11, 2.03). There was a significant difference in event-free survival between groups (p = 0.003) with a median follow-up of 17.3 years. 592 women (1.7 %) underwent cardiac catheterization: 20 of 90 women with HDP had CAD (22.2 %) on angiography vs 49 of 502 without HDP (9.8 %, p < 0.001). HDP was associated with angiographic CAD (adjusted OR 2.08, 95 % CI 1.05, 4.11). Women with HDP had twice the incidence of CAD on angiography compared to parous women without HDP. Obstetric history may inform the decision to perform cardiac catheterization in relatively young women. [ABSTRACT FROM AUTHOR]
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- 2024
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8. Behavioral Nudges as Patient Decision Support for Medication Adherence: The ENCOURAGE Randomized Controlled Trial.
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Horne, Benjamin D., Muhlestein, Joseph B., Lappé, Donald L., May, Heidi T., Le, Viet T., Bair, Tami L., Babcock, Daniel, Bride, Daniel, Knowlton, Kirk U., and Anderson, Jeffrey L.
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Background: Medication adherence is generally low and challenging to address because patient actions control healthcare delivery outside of medical environments. Behavioral nudging changes clinician behavior, but nudging patient decision-making requires further testing. This trial evaluated whether behavioral nudges can increase statin adherence, measured as the proportion of days covered (PDC).Methods: In a 12-month parallel-group, unblinded, randomized controlled trial, adult patients in Intermountain Healthcare cardiology clinics were enrolled. Inclusion required an indication for statins and membership in SelectHealth insurance. Subjects were randomized 1:1 to control or nudges. Nudge content, timing, frequency, and delivery route were personalized by CareCentra using machine learning of subject motivations and abilities from psychographic assessment, demographics, social determinants, and the Intermountain Mortality Risk Score. PDC calculation used SelectHealth claims data.Results: Among 182 subjects, age averaged 63.2±8.5 years, 25.8% were female, baseline LDL-C was 82.5±32.7 mg/dL, and 93.4% had coronary disease. Characteristics were balanced between nudge (n = 89) and control arms (n = 93). The statin PDC was greater at 12 months in the nudge group (PDC: 0.742±0.318) compared to controls (PDC: 0.639±0.358, P = 0.042). Adherent subjects (PDC ≥80%) were more concentrated in the nudge group (66.3% vs controls: 50.5%, P = 0.036) while a composite of death, myocardial infarction, stroke, and revascularization was non-significant (nudges: 6.7% vs control: 10.8%, P = 0.44).Conclusions: Persuasive behavioral nudges driven by artificial intelligence resulted in a clinically important increase in statin adherence in general cardiology patients. This precision patient decision support utilized computerized nudge design and delivery with minimal on-going human input. [ABSTRACT FROM AUTHOR]- Published
- 2022
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9. Simplifying the ISCHEMIA trial algorithm for clinical practice: Identifying left main coronary artery disease using coronary artery calcium scans.
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Money, Joel E., Muhlestein, Joseph B., Mason, Steve, Bair, Tami L., Knowlton, Kirk U., Horne, Benjamin D., and Anderson, Jeffrey L.
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Background: Several recent trials have evaluated invasive versus medical therapy for stable ischemic heart disease. Importantly, patients with significant left main coronary stenosis (LMCS) were excluded from these trials. In the ISCHEMIA trial, these patients were identified by a coronary CT angiogram (CCTA), which adds time, expense, and contrast exposure. We tested whether a coronary artery calcium scan (CACS), a simpler, less expensive test, could replace CCTA to exclude significant LMCS.Methods: We hypothesized that patients with ≥50% LMCS would have a LM CACS score > 0. As a corollary, we postulated that a LM CACS = 0 would exclude patients with LMCS. To test this, we searched Intermountain Healthcare's electronic medical records database for all adult patients who had undergone non-contrast cardiac CT for quantitative CACS scoring prior to invasive coronary angiography (ICA). Patients aged <50 and those with a heart transplant were excluded. Cases with incomplete (qualitative) angiographic reports for LMCS and those with incomplete or discrepant LM CACS results were reviewed and reassessed blinded to CACS or ICA findings, respectively.Results: Among 669 candidate patients with CACS followed by ICA, 36 qualifying patients were identified who had a quantitative CACS score and LMCS ≥ 50%. Their age averaged 71.8 years, and 81% were men. Angiographic LMCS averaged 72% (range 50%-99%). Median time between CACS and ICA was 6 days. Total CACS score averaged 2,383 Agatston Units (AU), range 571-6,636. LM CACS score averaged 197 AU, range 31-610. Importantly, no LMCS patient had a LM CACS score of 0 vs 57% (362/633) of non-LMCS controls (P < .00001).Conclusions: Our results support the hypothesis that an easily administered, inexpensive, low radiation CACS can identify a large subset of patients with a very low risk of LMCS who would not have the need for routine CCTA. Using CACS to exclude LMCS may efficiently allow for safe implementation of an initial medical therapy strategy of patients with stable ischemic heart disease in clinical practice. These promising results deserve validation in larger data sets. [ABSTRACT FROM AUTHOR]- Published
- 2021
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10. Association of periodic fasting lifestyles with survival and incident major adverse cardiovascular events in patients undergoing cardiac catheterization
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Bartholomew, Ciera L, Muhlestein, Joseph B, Anderson, Jeffrey L, May, Heidi T, Knowlton, Kirk U, Bair, Tami L, Le, Viet T, Bailey, Bruce W, and Horne, Benjamin D
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- 2021
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11. Cost-effectiveness of managing low-risk pulmonary embolism patients without hospitalization. The low-risk pulmonary embolism prospective management study.
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Bledsoe, Joseph R., Woller, Scott C., Stevens, Scott M., Aston, Valerie, Patten, Rich, Allen, Todd, Horne, Benjamin D., Dong, Lydia, Lloyd, James, Snow, Greg, Madsen, Troy, Fink, Patrick, and Elliott, C. Gregory
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Objective: Evaluate the cost-effectiveness and difference in length-of-stay when patients in the ED diagnosed with low-risk pulmonary embolism (PE) are managed with early discharge or observation.Methods: Single cohort prospective management study from January 2013 to October 2016 of patients with PE diagnosed in the ED and evaluated for a primary composite endpoint of mortality, recurrent venous thromboembolism, and/or major bleeding event at 90 days. Low-risk patients had a PE Severity Index score < 86, no evidence of proximal deep vein thrombosis on venous compression ultrasonography of both lower extremities, and no evidence of right heart strain on echocardiography. Patients were managed either in the ED or in the hospital on observation status. Primary outcomes were total length of stay, total encounter costs, and 30-day costs.Results: 213 patients were enrolled. 13 were excluded per the study protocol. Of the remaining 200, 122 were managed with emergency department observation (EDO) and 78 with hospital observation (HO). One patient managed with EDO met the composite outcome due to a major bleeding event on day 61. The mean length of stay for EDO was 793.4 min (SD -169.7, 95% CI:762-823) and for HO was 1170 (SD -211.4, 95% CI:1122-1218) with a difference of 376.8 (95% CI: 430-323, p < 0.0001). Total encounter mean costs for EDO were $1982.95 and $2759.59 for HO, with a difference of $776.64 (95% CI: 972-480, p > 0.0001). 30-day total mean costs for EDO were $2864.14 and $3441.52 for HO, with a difference of $577.38 (95% CI: -1372-217, p = 0.15).Conclusions: Patients with low-risk PE managed with ED-based observation have a shorter length of stay and lower total encounter costs than patients managed with Hospital-based observation. [ABSTRACT FROM AUTHOR]- Published
- 2021
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12. ASSOCIATION OF OZONE AND PM2.5AIR POLLUTION ON SHORT-TERM VENOUS THROMBOEMBOLISM RISK, INCLUDING 10861 VTE EVENTS IN AN INTEGRATED HEALTH SYSTEM: 17 YEARS OF LONGITUDINAL DATA
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WOLLER, SCOTT C, HORNE, BENJAMIN D, M. STEVENS, SCOTT, LLOYD, JAMES F, BRIDE, DANIEL, SNOW, GREGORY L, and BLEDSOE, JOSEPH
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- 2023
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13. Risk score-guided multidisciplinary team-based Care for Heart Failure Inpatients is associated with lower 30-day readmission and lower 30-day mortality.
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Horne, Benjamin D., Roberts, Colleen A., Rasmusson, Kismet D., Buckway, Jason, Alharethi, Rami, Cruz, Jalisa, Evans, R. Scott, Lloyd, James F., Bair, Tami L., Kfoury, Abdallah G., and Lappé, Donald L.
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Objective: Using augmented intelligence clinical decision tools and a risk score-guided multidisciplinary team-based care process (MTCP), this study evaluated the MTCP for heart failure (HF) patients' 30-day readmission and 30-day mortality across 20 Intermountain Healthcare hospitals.Background: HF inpatient care and 30-day post-discharge management require quality improvement to impact patient health, optimize utilization, and avoid readmissions.Methods: HF inpatients (N = 6182) were studied from January 2013 to November 2016. In February 2014, patients began receiving care via the MTCP based on a phased implementation in which the 8 largest Intermountain hospitals (accounting for 89.8% of HF inpatients) were crossed over sequentially in a stepped manner from control to MTCP over 2.5 years. After implementation, patient risk scores were calculated within 24 hours of admission and delivered electronically to clinicians. High-risk patients received MTCP care (n = 1221), while lower-risk patients received standard HF care (n = 1220). Controls had their readmission and mortality scores calculated retrospectively (high risk: n = 1791; lower risk: n = 1950).Results: High-risk MTCP recipients had 21% lower 30-day readmission compared to high-risk controls (adjusted P = .013, HR = 0.79, CI = 0.66, 0.95) and 52% lower 30-day mortality (adjusted P < .001, HR = 0.48, CI = 0.33, 0.69). Lower-risk patients did not experience increased readmission (adjusted HR = 0.88, P = .19) or mortality (adjusted HR = 0.88, P = .61). Some utilization was higher, such as prescription of home health, for MTCP recipients, with no changes in length of stay or overall costs.Conclusions: A risk score-guided MTCP was associated with lower 30-day readmission and 30-day mortality in high-risk HF inpatients. Further evaluation of this clinical management approach is required. [ABSTRACT FROM AUTHOR]- Published
- 2020
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14. Robust Fake News Detection Over Time and Attack
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Horne, Benjamin D., Nørregaard, Jeppe, and Adali, Sibel
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- 2020
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15. CHA2DS2-VASc scores and Intermountain Mortality Risk Scores for the joint risk stratification of dementia among patients with atrial fibrillation.
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Graves, Kevin G, May, Heidi T, Jacobs, Victoria, Knowlton, Kirk U, Muhlestein, Joseph B, Lappe, Donald L, Anderson, Jeffrey L, Horne, Benjamin D, and Bunch, T Jared
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Background: High CHA2DS2-VASc scores in atrial fibrillation (AF) patients are generally associated with increased risks of stroke and dementia. At lower CHA2DS2-VASc scores, there remains an unquantifiable cranial injury risk, necessitating an improved risk assessment method within these lower-risk groups.Objective: The purpose of this study was to determine whether sex-specific Intermountain Mortality Risk Scores (IMRS), a dynamic measures of systemic health that comprises commonly performed blood tests, can stratify dementia risk overall and among CHA2DS2-VASc score strata in AF patients.Methods: Female (n = 34,083) and male (n = 39,998) AF patients with no history of dementia were studied. CHA2DS2-VASc scores were assessed at the time of AF diagnosis and were stratified into scores of 0-1, 2, and ≥3. Within each CHA2DS2-VASc score stratum, patients were further stratified by IMRS categories of low, moderate, and high. Multivariable Cox hazard regression was used to determine dementia risk.Results: High-risk IMRS patients were generally older and had higher rates of hypertension, diabetes, heart failure, and prior stroke. Higher CHA2DS2-VASc score strata (≥3 vs ≤1: women, hazard ratio [HR] 7.77, 95% confidence interval [CI] 5.94-10.17, P < .001; men: HR 4.75, 95% CI 4.15-5.44, P < .001) and IMRS categories (high vs low: women, HR 3.09, 95% CI 2.71-3.51, P < .001; men, HR 2.70, 95% CI 2.39-3.06, P < .001) were predictive of dementia. When stratified by CHA2DS2-VASc scores, IMRS further identified risk in each stratum.Conclusion: Both CHA2DS2-VASc scores and IMRS were independently associated with dementia incidence among AF patients. IMRS further stratified dementia risk among CHA2DS2-VASc score strata, particularly among those with lower CHA2DS2-VASc scores. [ABSTRACT FROM AUTHOR]- Published
- 2019
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16. Intermittent fasting and changes in clinical risk scores: Secondary analysis of a randomized controlled trial
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Horne, Benjamin D., Anderson, Jeffrey L., May, Heidi T., Le, Viet T., Bair, Tami L., Bennett, Sterling T., Knowlton, Kirk U., and Muhlestein, Joseph B.
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Intermittent fasting may increase longevity and lower cardiometabolic risk. This study evaluated whether fasting modifies clinical risk scores for mortality [i.e., Intermountain Mortality Risk Score (IMRS)] or chronic diseases [e.g., Pooled Cohort Risk Equations (PCRE), Intermountain Chronic Disease score (ICHRON)].
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- 2023
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17. Cardiac Rotational Mechanics As a Predictor of Myocardial Recovery in Heart Failure Patients Undergoing Chronic Mechanical Circulatory Support: A Pilot Study.
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Bonios, Michael J., Koliopoulou, Antigone, Wever-Pinzon, Omar, Taleb, Iosif, Stehlik, Josef, Weining Xu, Wever-Pinzon, James, Catino, Anna, Kfoury, Abdallah G., Horne, Benjamin D., Nativi-Nicolau, Jose, Adamopoulos, Stamatis N., Fang, James C., Selzman, Craig H., Bax, Jeroen J., and Drakos, Stavros G.
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BACKGROUND: Impaired qualitative and quantitative left ventricular (LV) rotational mechanics predict cardiac remodeling progression and prognosis after myocardial infarction. We investigated whether cardiac rotational mechanics can predict cardiac recovery in chronic advanced cardiomyopathy patients. METHODS AND RESULTS: Sixty-three patients with advanced and chronic dilated cardiomyopathy undergoing implantation of LV assist device (LVAD) were prospectively investigated using speckle tracking echocardiography. Acute heart failure patients were prospectively excluded. We evaluated LV rotational mechanics (apical and basal LV twist, LV torsion) and deformational mechanics (circumferential and longitudinal strain) before LVAD implantation. Cardiac recovery post-LVAD implantation was defined as (1) final resulting LV ejection fraction ≥40%, (2) relative LV ejection fraction increase ≥50%, (iii) relative LV end-systolic volume decrease ≥50% (all 3 required). Twelve patients fulfilled the criteria for cardiac recovery (Rec Group). The Rec Group had significantly less impaired pre-LVAD peak LV torsion compared with the Non-Rec Group. Notably, both groups had similarly reduced pre-LVAD LV ejection fraction. By receiver operating characteristic curve analysis, pre-LVAD peak LV torsion of 0.35 degrees/cm had a 92% sensitivity and a 73% specificity in predicting cardiac recovery. Peak LV torsion before LVAD implantation was found to be an independent predictor of cardiac recovery after LVAD implantation (odds ratio, 0.65 per 0.1 degrees/cm [0.49-0.87]; P=0.014). CONCLUSIONS: LV rotational mechanics seem to be useful in selecting patients prone to cardiac recovery after mechanical unloading induced by LVADs. Future studies should investigate the utility of these markers in predicting durable cardiac recovery after the explantation of the cardiac assist device. [ABSTRACT FROM AUTHOR]
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- 2018
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18. Impact of Selection Bias on Estimation of Subsequent Event Risk.
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Yi-Juan Hu, Schmidt, Amand F., Dudbridge, Frank, Holmes, Michael V., Brophy, James M., Tragante, Vinicius, Ziyi Li, Peizhou Liao, Quyyumi, Arshed A., McCubrey, Raymond O., Horne, Benjamin D., Hingorani, Aroon D., Asselbergs, Folkert W., Patel, Riyaz S., and Qi Long
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Background--Studies of recurrent or subsequent disease events may be susceptible to bias caused by selection of subjects who both experience and survive the primary indexing event. Currently, the magnitude of any selection bias, particularly for subsequent time-to-event analysis in genetic association studies, is unknown. Methods and Results--We used empirically inspired simulation studies to explore the impact of selection bias on the marginal hazard ratio for risk of subsequent events among those with established coronary heart disease. The extent of selection bias was determined by the magnitudes of genetic and nongenetic effects on the indexing (first) coronary heart disease event. Unless the genetic hazard ratio was unrealistically large (>1.6 per allele) and assuming the sum of all nongenetic hazard ratios was <10, bias was usually <10% (downward toward the null). Despite the low bias, the probability that a confidence interval included the true effect decreased (undercoverage) with increasing sample size because of increasing precision. Importantly, false-positive rates were not affected by selection bias. Conclusions--In most empirical settings, selection bias is expected to have a limited impact on genetic effect estimates of subsequent event risk. Nevertheless, because of undercoverage increasing with sample size, most confidence intervals will be over precise (not wide enough). When there is no effect modification by history of coronary heart disease, the false-positive rates of association tests will be close to nominal. [ABSTRACT FROM AUTHOR]
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- 2017
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19. Clinical Decision Support to Efficiently Identify Patients Eligible for Advanced Heart Failure Therapies.
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Evans, R. Scott, Kfoury, Abdallah G., Horne, Benjamin D., Lloyd, James F., Benuzillo, Jose, Rasmusson, Kismet D., Roberts, Colleen, and Lappé, Donald L.
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Background: Patients who need and receive timely advanced heart failure (HF) therapies have better long-term survival. However, many of these patients are not identified and referred as soon as they should be.Methods: A clinical decision support (CDS) application sent secure email notifications to HF patients' providers when they transitioned to advanced disease. Patients identified with CDS in 2015 were compared with control patients from 2013 to 2014. Kaplan-Meier methods and Cox regression were used in this intention-to-treat analysis to compare differences between visits to specialized and survival.Results: Intervention patients were referred to specialized heart facilities significantly more often within 30 days (57% vs 34%; P < .001), 60 days (69% vs 44%; P < .0001), 90 days (73% vs 49%; P < .0001), and 180 days (79% vs 58%; P < .0001). Age and sex did not predict heart facility visits, but renal disease did and patients of nonwhite race were less likely to visit specialized heart facilities. Significantly more intervention patients were found to be alive at 30 (95% vs 92%; P = .036), 60 (95% vs 90%; P = .0013), 90 (94% vs 87%; P = .0002), and 180 days (92% vs 84%; P = .0001). Age, sex, and some comorbid diseases were also predictors of mortality, but race was not.Conclusions: We found that CDS can facilitate the early identification of patients needing advanced HF therapy and that its use was associated with significantly more patients visiting specialized heart facilities and longer survival. [ABSTRACT FROM AUTHOR]- Published
- 2017
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20. Prediction of Long-Term Incidence of Chronic Cardiovascular and Cardiopulmonary Diseases in Primary Care Patients for Population Health Monitoring: The Intermountain Chronic Disease Model (ICHRON)
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May, Heidi T., Lappé, Donald L., Knowlton, Kirk U., Muhlestein, Joseph B., Anderson, Jeffrey L., and Horne, Benjamin D.
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To apply the practical parsimonious modeling method of the Intermountain Mortality Risk Score in a primary care environment to predict chronic disease (ChrD) onset.
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- 2019
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21. Uncertainty-based False Information Propagation in Social Networks
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Cho, Jin-Hee, Rager, Scott, O’Donovan, John, Adali, Sibel, and Horne, Benjamin D.
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- 2019
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22. LP(A) MEASUREMENT IN PRIMARY PREVENTION POPULATION MAY LEAD TO INCREASED UTILIZATION OF STATIN THERAPY, A REAL-WORLD EXPERIENCE
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Le, Viet T, May, Heidi T, Anderson, Jeffrey L., Bair, Tami, Knight, Stacey, Horne, Benjamin D., and Knowlton, Kirk U
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ASCVD/CVD Risk Reduction
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- 2023
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23. Early inpatient calculation of laboratory-based 30-day readmission risk scores empowers clinical risk modification during index hospitalization.
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Horne, Benjamin D., Budge, Deborah, Masica, Andrew L., Savitz, Lucy A., Benuzillo, José, Cantu, Gabriela, Bradshaw, Alejandra, McCubrey, Raymond O., Bair, Tami L., Roberts, Colleen A., Rasmusson, Kismet D., Alharethi, Rami, Kfoury, Abdallah G., James, Brent C., and Lappé, Donald L.
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Improving 30-day readmission continues to be problematic for most hospitals. This study reports the creation and validation of sex-specific inpatient (i) heart failure (HF) risk scores using electronic data from the beginning of inpatient care for effective and efficient prediction of 30-day readmission risk.
Methods: HF patients hospitalized at Intermountain Healthcare from 2005 to 2012 (derivation: n=6079; validation: n=2663) and Baylor Scott & White Health (North Region) from 2005 to 2013 (validation: n=5162) were studied. Sex-specific iHF scores were derived to predict post-hospitalization 30-day readmission using common HF laboratory measures and age. Risk scores adding social, morbidity, and treatment factors were also evaluated.Results: The iHF model for females utilized potassium, bicarbonate, blood urea nitrogen, red blood cell count, white blood cell count, and mean corpuscular hemoglobin concentration; for males, components were B-type natriuretic peptide, sodium, creatinine, hematocrit, red cell distribution width, and mean platelet volume. Among females, odds ratios (OR) were OR=1.99 for iHF tertile 3 vs. 1 (95% confidence interval [CI]=1.28, 3.08) for Intermountain validation (P-trend across tertiles=0.002) and OR=1.29 (CI=1.01, 1.66) for Baylor patients (P-trend=0.049). Among males, iHF had OR=1.95 (CI=1.33, 2.85) for tertile 3 vs. 1 in Intermountain (P-trend <0.001) and OR=2.03 (CI=1.52, 2.71) in Baylor (P-trend < 0.001). Expanded models using 182-183 variables had predictive abilities similar to iHF.Conclusions: Sex-specific laboratory-based electronic health record-delivered iHF risk scores effectively predicted 30-day readmission among HF patients. Efficient to calculate and deliver to clinicians, recent clinical implementation of iHF scores suggest they are useful and useable for more precise clinical HF treatment. [ABSTRACT FROM AUTHOR]- Published
- 2017
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24. Management of Low-Risk Pulmonary Embolism Patients Without Hospitalization
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Bledsoe, Joseph R., Woller, Scott C., Stevens, Scott M., Aston, Valerie, Patten, Rich, Allen, Todd, Horne, Benjamin D., Dong, Lydia, Lloyd, James, Snow, Greg, Madsen, Troy, and Elliott, C. Gregory
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The efficacy and safety of managing patients with low-risk pulmonary embolism (PE) without hospitalization requires objective data from US medical centers. We sought to determine the 90-day composite rate of recurrent symptomatic VTE, major bleeding events, and all-cause mortality among consecutive patients diagnosed with acute low-risk PE managed without inpatient hospitalization; and to measure patient satisfaction.
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- 2018
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25. The association of depression at any time to the risk of death following coronary artery disease diagnosis.
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May, Heidi T, Horne, Benjamin D, Knight, Stacey, Knowlton, Kirk U, Bair, Tami L, Lappé, Donald L, Le, Viet T, and Muhlestein, Joseph B
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Depression is a risk factor for cardiovascular (CV) diseases, incident CV events, and mortality. Among individuals who experience a CV diagnosis or event, whether a subsequent diagnosis of depression is associated with a greater risk of mortality is unknown. Among patients with existing coronary artery disease (CAD), this study evaluated the association of a subsequent depression diagnosis with all-cause mortality.
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- 2017
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26. GNB3 C825T Polymorphism and Myocardial Recovery in Peripartum Cardiomyopathy.
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Sheppard, Richard, Hsich, Eileen, Damp, Julie, Elkayam, Uri, Kealey, Angela, Ramani, Gautam, Zucker, Mark, Alexis, Jeffrey D., Horne, Benjamin D., Hanley-Yanez, Karen, Pisarcik, Jessica, Halder, Indrani, Fett, James D., and McNamara, Dennis M.
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Background--Black women are at greater risk for peripartum cardiomyopathy (PPCM). The guanine nucleotide-binding proteins ß-3 subunit (GNB3) has a polymorphism C825T. The GNB3 TT genotype more prevalent in blacks is associated with poorer outcomes. We evaluated GNB3 genotype and myocardial recovery in PPCM. Methods and Results--A total of 97 women with PPCM were enrolled and genotyped for the GNB3 T/C polymorphism. Left ventricular ejection fraction (LVEF) was assessed by echocardiography at entry, 6 and 12 months postpartum. LVEF over time in subjects with the GNB3 TT genotype was compared with those with the C allele overall and in black and white subsets. The cohort was 30% black, age 30+6, LVEF 0.34+0.10 at entry 31+25 days postpartum. The % GNB3 genotype for TT/CT/CC=23/41/36 and differed markedly by race (blacks=52/38/10 versus whites=10/44/46, P<0.001). In subjects with the TT genotype, LVEF at entry was lower (TT=0.31+0.09; CT+CC=0.35+0.09, P=0.054) and this difference increased at 6 (TT=0.45+0.15; CT+CC=0.53+0.08, P=0.002) and 12 months (TT=0.45+0.15; CT+CC=0.56+0.07, P<0.001.). The difference in LVEF at 12 months by genotype was most pronounced in blacks (12 months LVEF for GNB3 TT=0.39+0.16; versus CT+CC=0.53+0.09, P=0.02) but evident in whites (TT=0.50++0.11; CT+CC=0.56+0.06, P=0.04). Conclusions--The GNB3 TT genotype was associated with lower LVEF at 6 and 12 months in women with PPCM, and this was particularly evident in blacks. Racial differences in the prevalence and impact of GNB3 TT may contribute to poorer outcomes in black women with PPCM. [ABSTRACT FROM AUTHOR]
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- 2016
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27. Shortened telomere length is associated with paroxysmal atrial fibrillation among cardiovascular patients enrolled in the Intermountain Heart Collaborative Study.
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Carlquist, John F., Knight, Stacey, Cawthon, Richard M., Le, Viet T., Bunch, T. Jared, Horne, Benjamin D., Rollo, Jeffrey S., Huntinghouse, John A., Muhlestein, J. Brent, Anderson, Jeffrey L., Jared Bunch, T, and Brent Muhlestein, J
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Background: Atrial fibrillation (AF) diminishes quality of life and accounts for approximately one-third of all strokes. Studies have associated mitochondrial dysfunction with both AF and telomere length (TL).Objective: The purpose of this study was to test the hypothesis of a relationship between AF and TL.Methods: Blood was collected from consenting participants in the Intermountain Heart Collaborative Study (n = 3576) and DNA extracted. TL was determined by multiplex quantitative polymerase chain reaction, normalized to a single copy gene, and reported as telomere/single gene ratio (t/s). Patient information was extracted from Intermountain Healthcare's electronic records database. Prevalent AF was determined by discharge ICD-9 code. AF subtype (paroxysmal [Px], persistent [Ps], long-standing persistent/permanent [Pm]) was determined by chart review.Results: The t/s decreased with age (P <.00001). Subjects with a history of AF (n = 379 [10.6%] had shorter telomeres (mean t/s ± SD = 0.87 ± 0.29) compared to subjects without AF (mean t/s 0.95 ± 0.32, P <.0001). The association remained after adjustment for age (P = .017) and cardiovascular risk factors (P = .016). AF subtype was determined for 277 subjects; 110 (39.7%) had Px AF, 65 (23.5%) Ps, and 102 (36.8%) Pm AF. Mean t/s did not differ between Ps, Pm, and subjects without AF (0.94 ± 0.40, 0.94 ± 0.27, and 0.95 ± 0.32, respectively). However, the mean t/s for Px (0.81 ± 0.22) was significantly shorter than for Ps (P = .026), Pm (P = .004), or subjects without AF (P <.0001).Conclusion: The present study supports an association between Px AF and TL. Short TL may be a previously unrecognized risk factor for AF with potential applications in diagnosis and therapy. [ABSTRACT FROM AUTHOR]- Published
- 2016
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28. Clinically Feasible Stratification of 3-Year Chronic Disease Risk in Primary Care: The Mental Health Integration Risk Score
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May, Heidi T., Reiss-Brennan, Brenda, Brunisholz, Kimberly D., and Horne, Benjamin D.
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Depression is a common illness that imposes a disproportionately large health burden. Depression is generally associated with a higher prevalence of chronic disease risk factors and may contribute to higher chronic disease risk.
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- 2017
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29. Relations between lipoprotein(a) concentrations, LPAgenetic variants, and the risk of mortality in patients with established coronary heart disease: a molecular and genetic association study
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Zewinger, Stephen, Kleber, Marcus E, Tragante, Vinicius, McCubrey, Raymond O, Schmidt, Amand F, Direk, Kenan, Laufs, Ulrich, Werner, Christian, Koenig, Wolfgang, Rothenbacher, Dietrich, Mons, Ute, Breitling, Lutz P, Brenner, Herrmann, Jennings, Richard T, Petrakis, Ioannis, Triem, Sarah, Klug, Mira, Filips, Alexandra, Blankenberg, Stefan, Waldeyer, Christoph, Sinning, Christoph, Schnabel, Renate B, Lackner, Karl J, Vlachopoulou, Efthymia, Nygård, Ottar, Svingen, Gard Frodahl Tveitevåg, Pedersen, Eva Ringdal, Tell, Grethe S, Sinisalo, Juha, Nieminen, Markku S, Laaksonen, Reijo, Trompet, Stella, Smit, Roelof A J, Sattar, Naveed, Jukema, J Wouter, Groesdonk, Heinrich V, Delgado, Graciela, Stojakovic, Tatjana, Pilbrow, Anna P, Cameron, Vicky A, Richards, A Mark, Doughty, Robert N, Gong, Yan, Cooper-DeHoff, Rhonda, Johnson, Julie, Scholz, Markus, Beutner, Frank, Thiery, Joachim, Smith, J Gustav, Vilmundarson, Ragnar O, McPherson, Ruth, Stewart, Alexandre F R, Cresci, Sharon, Lenzini, Petra A, Spertus, John A, Olivieri, Oliviero, Girelli, Domenico, Martinelli, Nicola I, Leiherer, Andreas, Saely, Christoph H, Drexel, Heinz, Mündlein, Axel, Braund, Peter S, Nelson, Christopher P, Samani, Nilesh J, Kofink, Daniel, Hoefer, Imo E, Pasterkamp, Gerard, Quyyumi, Arshed A, Ko, Yi-An, Hartiala, Jaana A, Allayee, Hooman, Tang, W H Wilson, Hazen, Stanley L, Eriksson, Niclas, Held, Claes, Hagström, Emil, Wallentin, Lars, Åkerblom, Axel, Siegbahn, Agneta, Karp, Igor, Labos, Christopher, Pilote, Louise, Engert, James C, Brophy, James M, Thanassoulis, George, Bogaty, Peter, Szczeklik, Wojciech, Kaczor, Marcin, Sanak, Marek, Virani, Salim S, Ballantyne, Christie M, Lee, Vei-Vei, Boerwinkle, Eric, Holmes, Michael V, Horne, Benjamin D, Hingorani, Aroon, Asselbergs, Folkert W, Patel, Riyaz S, Krämer, Bernhard K, Scharnagl, Hubert, Fliser, Danilo, März, Winfried, and Speer, Thimoteus
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Lipoprotein(a) concentrations in plasma are associated with cardiovascular risk in the general population. Whether lipoprotein(a) concentrations or LPAgenetic variants predict long-term mortality in patients with established coronary heart disease remains less clear.
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- 2017
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30. Abstract P179: Development and Implementation of a Large, Multi-Center Survey of Patients With Heart Failure
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Chamberlain, Alanna M, Hade, Erinn M, Haller, Irina V, Horne, Benjamin D, Benziger, Catherine P, Killian, Jill M, Weston, Susan A, Manemann, Sheila M, and Roger, Veronique L
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Background:Most patients with heart failure (HF) have multimorbidity which may cause difficulties with self-management. Understanding the determinants of successful self-management and the resources patients draw upon to effectively manage their health is fundamental to designing new practice models to improve outcomes in HF.Methods:We developed a survey guided by the Chronic Care Model to understand the distribution of patient-centric factors, including health literacy, social support, self-management, and functional and mental status in patients with HF. The survey was administered to HF patients from 4 health care systems participating in PCORnet® (the National Patient-Centered Clinical Research Network). Patients were identified utilizing data available in the PCORnet common data model on or after 1/1/2013 at 1 health system and on or after 1/1/2015 at 3 health systems: age ≥30 years, ≥2 HF diagnostic codes, and ≥1 HF-related prescription (positive predictive value of algorithm: 81%).Results:A total of 10,662 patients with HF were identified, 9684 were mailed a survey, and 3330 completed a survey (response rate: 35%). Responders were older than non-responders (74 vs. 71 years), less racially diverse (3% vs. 12% non-White), less likely to have reduced ejection fraction (EF; 22% vs. 27% with EF <40%), and had higher prevalence of most chronic conditions. Responders reported their health was generally good or fair, they frequently had cardiovascular comorbidities, more than half had difficulty climbing stairs, and more than 10% reported difficulties with bathing, preparing meals, and using transportation (Table). Nearly 80% of patients had family or friends sit with them during a doctor visit, and most (54%) manage their health by themselves.Conclusion:More than half of patients with HF manage their health by themselves even though most bring someone along to their health care appointments. Increased understanding of self-management resources may guide the development of interventions to improve HF outcomes.
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- 2023
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31. Abstract P584: The Impact of Multimorbidity and Functional Limitation on Mental Health and Quality of Life Among Patients With Heart Failure
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Manemann, Sheila M, Hade, Erinn M, Haller, Irina V, Horne, Benjamin D, Benziger, Catherine P, Roger, Veronique L, Weston, Susan A, Killian, Jill M, and Chamberlain, Alanna M
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Background:Multimorbidity (MM) and functional limitation (FL) are associated with poor outcomes in heart failure (HF). However, the individual and combined effect of these on mental health and quality of life in patients with HF is not well understood.Methods:Patients aged ≥ 30 years with 2 or more HF diagnostic codes and 1 or more HF-related prescription drugs from four US institutions were mailed a survey to measure functional status (activities of daily living [ADLs]), quality of life and mental health (PROMIS-29 Health Profile) and social support (PROMIS Informational Support, Instrumental Support, and Social Isolation Short Forms). The sampling frame was restricted to patients with a first ever-diagnosis of HF on or after 1/1/2013 at 1 of the participating sites and on or after 1/1/2015 for the other 3 participating sites. A total of 3330 patients returned the survey (response rate 35%); among these, 3020 completed the questions of interest for this analysis and were retained. MM was defined as the presence of ≥ 2 non-cardiovascular comorbidities, and FL was defined as reporting any limitation in at least 1 of 8 ADLs. Patients were categorized into 4 groups by MM (Yes/No) and FL (Yes/No). We dichotomized the subscale scores of the PROMIS-29 at the median and calculated odd ratios for the 4 MM/FL groups.Results:Among 3020 patients with HF (45% female; mean age 73±12 years), 29% had neither MM or FL, 24% had MM only, 22% had FL only, and 25% had both. After adjustment, having both MM and FL or only FL was associated with increased odds of higher anxiety, depression, fatigue, sleep, and pain scores compared to having neither (Figure); having MM only was associated with a higher pain score.Conclusions:Patients with both FL and MM and only FL have similar odds of poor mental health and quality of life scores, underscoring the importance of the role that FL plays in outcomes in patients with HF.
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- 2023
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32. Pulmonary-Specific Intermountain Risk Score Predicts All-Cause Mortality via Spirometry, the Red Cell Distribution Width, and Other Laboratory Parameters.
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Horne, Benjamin D., Hegewald, Matthew, Muhlestein, Joseph B., May, Heidi T., Huggins, Elizabeth J., Bair, Tami L., and Anderson, Jeffrey L.
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MORTALITY risk factors ,ERYTHROCYTES ,CHI-squared test ,CONFIDENCE intervals ,RESEARCH funding ,RESPIRATORY diseases ,RISK assessment ,STATISTICAL sampling ,SPIROMETRY ,SURVIVAL analysis (Biometry) ,T-test (Statistics) ,DATA analysis software ,DESCRIPTIVE statistics - Abstract
BACKGROUND: Pulmonary function testing parameters predict cardiovascular and mortality outcomes. Previously, risk scores were created using the basic metabolic profile and complete blood count, including the Intermountain Risk Score (IMRS). This study sought to develop similar pulmonary-specific risk scores for mortality prediction. METHODS: Subjects evaluated by spirometry at 5 Intermountain Healthcare hospitals (females: n = 2,943; males: n = 2,495) were randomly assigned to risk score derivation (70% of subjects) or an independent validation set (the remaining 30%). Sex-specific scores used spirometry, age, and metabolic and blood count laboratory data. Cox regression β-coefficients formed the basis of risk score weightings. RESULTS: Among females, pulmonary IMRS was strongly associated with 5-y mortality in the validation set (hazard ratio = 1.24 per +1 risk score, CI 1.16-1.33, P trend < .001), with C-statistics of C = 0.835 and C = 0.757 for derivation and validation, respectively. Among males, validation results were similarly significant (hazard ratio = 1.20 per +1 risk score value, CI 1.11-1.28, P trend < .001), with C = 0.755 and C = 0.699 in derivation and validation sets, respectively. Results were stronger for pulmonary basic metabolic profile risk score, with females having C = 0.815 (derivation) and C = 0.806 (validation), whereas males had C = 0.734 and C = 0.731. CONCLUSIONS: Pulmonary-specific IMRS and pulmonary-specific basic metabolic profile risk score provided excellent discrimination of mortality among pulmonary subjects. These risk stratification tools combine familiar, relatively inexpensive, commonly-measured, standardized laboratory parameters with spirometry data. They may be electronically calculated and delivered at the point of care, providing meaningful risk information to assist clinicians in patient evaluations. [ABSTRACT FROM AUTHOR]
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- 2015
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33. The intermountain risk score predicts mortality in trauma patients.
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Majercik, Sarah, Knight, Stacey, and Horne, Benjamin D.
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BLOOD cell count ,BONE morphogenetic proteins ,CRITICAL care medicine ,MEDICAL needs assessment ,MEDICAL technology ,WOUNDS & injuries ,DATA analysis - Published
- 2014
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34. Abstract 10714: Disparities in Cardiovascular Investigator-Initiated Research Studies
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Knight, Stacey, Le, Viet T, Horne, Benjamin D, Rasmusson, Kismet D, Anderson, Jeffrey L, Knowlton, Kirk U, May, Heidi T, and Muhlestein, Joseph B
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Introduction:Recently there has been a much-needed focus on disparity and inequity in cardiovascular disease (CVD) care. Race, ethnicity, sex, and geography are shown to impact CVD care and outcomes. Perhaps one of the reasons for this is the lack of diversity and representation in CVD research studies, especially in non-sponsored research studies. Here we examine three investigator-initiated clinical CVD trials to describe current enrollment patterns and compare them to the comparable populations.Methods:Three Intermountain Healthcare, internally funded, CVD clinical trials were examined. These studies include a pragmatic trial, a randomized unblinded treatment trial, and a biobanking registry. Basic study characteristics and the comparison populations are shown in Table 1.Results:Demographic comparisons are shown in Table 2. Females were equally or slightly more represented in the studies. Minority races were under-represented in the pragmatic trial and the biobank registry. Rural or frontier counties were under-represented in the pragmatic trial and randomized trial. Hispanic/Latino patients were under-represented in all studies.ConclusionsFemales were well represented in all studies, but other minority groups were under-represented. The largest under-representation was for Hispanic/Latino patients. The reasons and mechanisms that may lead to under-representation and the impact on research results are unknown and deserve further study. While addressing these disparities may increase research costs (e.g., translation costs), future studies will benefit from the development of new resources and processes, and ultimately could lead to better care.
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- 2022
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35. Abstract 10149: Clinical Predictors of Medical Therapy-Induced Improvement in Left Ventricular Function in Patients Diagnosed With Heart Failure With Reduced Ejection Fraction (HFrEF): The Intermountain Healthcare Experience
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Muhlestein, Joseph B, May, Heidi T, Bair, Tami L, Knight, Stacey, Le, Viet T, Horne, Benjamin D, Knowlton, Kirk U, and Anderson, Jeffrey L
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Introduction:When patients (pts) are diagnosed with HFrEF, it is hoped that medical therapy will improve their left ventricular ejection fraction (LVEF). However, which baseline clinical characteristics may predict an improvement in LVEF after medical treatment remains unclear.Methods:Pts with a baseline LVEF ≤35% and a follow-up LVEF ≥180 days later were categorized according to the change in LVEF identified between the baseline and follow-up LVEF’s (Increased [ΔLVEF ≥+10%]; No change [ΔLVEF=-9% to +9%]; Decreased [ΔLVEF ≥-10%]). Baseline characteristics and follow-up death rates were collected. Independent predictors of an improved LVEF were determined by logistic regression.Results:Qualifying HFrEF pts totaled 5,632 and were categorized by ΔLVEF as follows: Increased = 3,074 (54.6%); No change = 2,193 (38.9%); Decreased = 365 (6.5%). Baseline characteristics and independent predictors of an increase in LVEF are shown in the figure. During a median follow-up of 6.2 years, the death rate was 35.3%, 60.0%, and 72.6% (p<0.0001) in patients with an increase, no change, or decrease in LVEF, respectively.Conclusions:In patients diagnosed with HFrEF and initiated on medical therapy, an increase in LVEF predicted a lower death rate. The strongest predictors of an increase in LVEF included female gender, the absence of ASCVD, a low initial BNP, a narrow QRS duration, and the presence of atrial fibrillation, pulmonary hypertension, and statin use. Explanations for these findings remain to be determined.
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- 2022
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36. Abstract 10842: Progression of COVID-19 Severity Among SARS-CoV-2 Positive Patients Prescribed Selective Serotonin Reuptake Inhibitors
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May, Heidi T, Horne, Benjamin D, Knight, Stacey, Bair, Tami L, Anderson, Jeffrey L, Le, Viet T, Muhlestein, Joseph B, and Knowlton, Kirk U
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Introduction:The clinical spectrum of COVID-19 can range from asymptomatic to severe, with severe resulting in part from an intense inflammatory response. Selective serotonin reuptake inhibitor (SSRI) is the most commonly prescribed class of antidepressants and has anti-inflammatory and anti-platelet effects. Recent studies reported greater survival and lesser COVID severity in patients taking SSRIs, specifically fluoxetine/fluvoxamine. Recently, application was made to the FDA for emergency use of fluvoxamine to prevent severe COVID-19, but it was denied based on insufficient data.Methods:Patients (n=33,088) testing positive for SARS-CoV-2 between March 14, 2020-December 31, 2021 as outpatients were studied. Patients were matched 3:1 by SSRI prescription at the time of a positive test by propensity score (±0.001). Patients were evaluated for COVID-19 hospitalization within 14-days and death within 3-months of positive SARS-CoV-2 test.Results:A total of 8,272 SSRI patients were well-matched to 24,816 no SSRI patients (Table 1). Hospitalization and death were significantly greater in the SSRI group compared to the no SSRI group (Table 1). A total of 2,067 (25.0%) of SSRI patients were taking fluoxetine or fluvoxamine. While attenuated, no SSRI remained associated with a lower 14-day COVID-19 hospitalization risk when compared to fluoxetine or fluvoxamine use, but not with 3-month death (Table 2).Conclusion:This study did not find a lower risk of progression of COVID-19 severity with the use of any SSRI or fluoxetine/fluvoxamine alone. Results from this study support the FDA’s decision to not recommend their use at an early stage of a COVID-19 infection.
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- 2022
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37. Abstract 13393: Equity Model Evaluation of a Predictive Cardiac Positron-Emission Tomography (PET) Risk Score for 90-Day and One-Year Major Adverse Cardiac Events and Revascularization
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McCubrey, Raymond O, Mason, Steve M, Le, Viet T, Bride, Daniel L, Horne, Benjamin D, Meredith, Kent G, Sekaran, Nishant K, Anderson, Jeffrey L, Knowlton, Kirk U, Min, David B, and Knight, Stacey
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Introduction:Artificial Intelligence (AI) algorithms should be evaluated to discern differences in prediction amongst population groups. The Intermountain data science group has developed a software package iEAI, which performs a model evaluation (ME) analysis to detect such meaningful prediction differences. Here we apply this software package to a recently developed cardiac PET/CT stress test-based risk score that predicts 90-day and one-year major adverse cardiac events (including death and myocardial infarction) and revascularization (MACE-Revasc). The results of these analyses will reveal any discrepancies in prediction and help with equity.Methods:5049 patients who had a clinically indicated PET/CT study from January 1, 2018, to December 31, 2018, were considered. The ME analyses were done for gender, age, and race. Precision (or positive predictive value) and recall (or sensitivity) were measured and meaningful differences were those that were statistically significant and had a ratio < 0.85 or >1.25 in magnitude than the reference category (e.g., the largest category).Results:The ME analysis of the PET/CT risk score for MACE-Revasc are shown in the table. For the 90-day PET/CT risk score a recall bias existed for females compared to males (0.49 vs 0.62). There was also bias with improved recall for Native-Hawaiian/ Pacific Islanders compared to Whites (0.87 vs 0.58). For the one-year PET/CT risk score, recall (0.38 vs 0.52) and precision (0.34 vs 0.47) biases were found for females compared to males, and recall biases were found for those aged 50-59 compared to 60-69 (0.34 vs 0.50).Conclusion:Meaningful biases were found in both the PET/CT risk scores for 90-day and One-year MACE-Revasc. As the application of AI in healthcare grows, evaluations like the above should be carried out. Then any detected inequalities could be addressed by refining or redeveloping the risk score models to eliminate biases.
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- 2022
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38. Abstract 12122: Five-Year Serial Measurement of the Intermountain Mortality Risk Score for Population Health Assessment Reveals Personalized Temporal Trajectories of Differential Longevity Over Two Decades
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Horne, Benjamin D, Bledsoe, Joseph R, Muhlestein, Joseph B, Woller, Scott C, Knowlton, Kirk U, Majercik, Sarah, Bair, Tami L, Snow, Gregory L, Lloyd, James F, Le, Viet T, Bennett, Sterling T, Ronnow, Brianna S, May, Heidi T, and Anderson, Jeffrey L
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Introduction:Health, wellness, and healthcare are most effectively and efficiently managed when health status is quantitatively measured. The Intermountain Mortality Risk Score (IMRS) is a well-validated low-cost decision tool calculated from the complete blood count and basic metabolic profile that can be electronically deployed to inform clinician or patient actions. This study evaluated if 3 serial IMRS measurements improved mortality prediction.Methods:In 119,379 Intermountain Healthcare outpatients, inpatients, and emergency patients, baseline (BL) IMRS was calculated in 1999-2005. Of those, the following were excluded: 22,678 who died prior to having 3 IMRS measurements and 38,228 survivors who at 5 years (y) post-BL did not have 3 IMRS. In the study cohort of 58,473 patients, a 1stfollow-up (1F) IMRS was available 1.49±0.79 y post-BL (range 1-4 y), and a 2ndfollow-up (2F) IMRS at 3.75±0.80 y post-BL (range 2-5 y). Patients had 13.4±1.7 y of follow-up after 2F (range: 9.3-18.7 y), with total follow-up post-BL of 17.2±1.5 y (range: 14.3-20.7 y).Results:Overall, 26,693 patients died (45.7%) after 2F. In females, IMRS for decedents vs. survivors was, respectively, 11.3±3.9 vs 6.3±4.0 at BL, 11.1±3.9 vs 5.7±4.0 at 1F, and 12.2±4.2 vs 6.1±4.0 at 2F; differences in males were similar to those results (all p<0.001). Relative risks for IMRS categories are shown in the Table. C-statistics for females were c= 0.815, 0.834, 0.858 for BL, 1F, and 2F, with 0.872 for a sum of the 3 IMRS (results were similar for males, with absolute c 0.06-0.08 lower).Conclusions:IMRS predicted substantial risk differences at each of 3 timepoints, but the IMRS trajectory (including declines in IMRS) revealed by the sequence of IMRS measurements better personalized risk assessment. When risk level and direction are considered together, critical junctures in a person’s health journey may be revealed, empowering earlier or more intensive prevention, diagnostic testing, and interventions.
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- 2022
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39. Abstract 11652: What is the Relative Risk for Elevated Liver Function Tests of Single and Combined Statin and Alcohol Use and Implications for Management?
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Horne, Benjamin D, Le, Viet T, May, Heidi T, Knight, Stacey, Bair, Tami L, Muhlestein, Joseph B, Knowlton, Kirk U, and Anderson, Jeffrey L
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Introduction:Statins play a critical role in primary and secondary ASCVD prevention. Although uncommon, myalgias and abnormal liver function tests (LFTs) may limit statin use. Alcohol consumption also is a common cause of LFT elevations. It is unknown whether or to what extent concurrent alcohol and statin use may alter elevated LFT risk and impact management.Methods:Patients (pts) enrolled in the Intermountain INSPIRE registry who completed a health questionnaire for alcohol and other socioeconomic, dietary, and physical activity data were studied. Demographics, anthropometrics, cardiac risk factors, comorbidities, medication use, and laboratory results were obtained from electronic health records. Associations of alcohol and statin use with high ALT (females, >40 U/L; males, >55 U/L) were tested. Alcohol categories were: non-drinkers (ND; n=2797), moderate drinkers (MD; ≤7 drinks/week, n=980), and heavy drinkers (HD; >7 drinks/week, n=164).Results:High ALT was found in 18.9%, 12.6%, and 10.5% of HD, MD, and ND respectively (p=0.002) and in 11.3% of both statin (n=2154) and non-statin users (n=1787) (p=0.97). After adjustment, HD vs. ND had OR=2.19 (CI: 1.44, 3.33; p<0.001), and MD vs ND had OR=1.09 (CI: 0.86, 1.37; p=0.49). Pts not on statins had high ALT in 15.4% of HD (OR=1.47, CI: 0.73, 2.95; p=0.28) and 12.0% of MD (OR=1.10, CI: 0.79, 1.54; p=0.57) compared to 11.0% of ND. In parallel, pts on statins had high ALT in 21.2% of HD (OR=2.58, 95% CI: 1.52, 4.36; p<0.001) and 13.0% of MD (OR=1.16, CI: 0.85, 1.59; p=0.34) vs. 10.2% of ND. Despite these trends, no formal interaction was found between statin use with HD (p-interaction=0.27) or with MD (p-interaction=0.43). Results for high AST (>40 U/L) and low ALP (<40 U/L) were similar to the ALT findings.Conclusions:In this prospective database, statin use was not associated with abnormal LFT findings, whereas risk was higher with increasing alcohol consumption. Concurrent statin and alcohol use was associated with a modestly elevated risk of abnormal LFT, but the interaction was not significant. Reducing alcohol consumption rather than reducing or discontinuing statins may reverse abnormal LFT while preserving the preventive benefit of statins. This hypothesis deserves further prospective testing.
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- 2022
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40. Myocardial Structural and Functional Response After Long-Term Mechanical Unloading With Continuous Flow Left Ventricular Assist Device
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Al-Sarie, Mohammad, Rauf, Asad, Kfoury, Abdallah G., Catino, Anna, Wever-Pinzon, James, Bonios, Michael, Horne, Benjamin D., Diakos, Nikolaos A., Wever-Pinzon, Omar, McKellar, Stephen H., Kelkhoff, Aaron, McCreath, Lauren, Fang, James, Stehlik, Josef, Selzman, Craig H., and Drakos, Stavros G.
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The aim of this study was to assess the impact of continuous-flow left ventricular assist device (LVAD) type—axial flow (AX) versus centrifugal flow (CR)—on myocardial structural and functional response following mechanical unloading.
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- 2016
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41. The utility of the apolipoprotein A1 remnant ratio in predicting incidence coronary heart disease in a primary prevention cohort: The Jackson Heart Study
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May, Heidi T, Nelson, John R, Lirette, Seth T, Kulkarni, Krishnaji R, Anderson, Jeffrey L, Griswold, Michael E, Horne, Benjamin D, Correa, Adolfo, and Muhlestein, Joseph B
- Abstract
Background Dyslipidemia plays a significant role in the progression of cardiovascular disease. The apolipoprotein (apo) A1 remnant ratio (apo A1/VLDL3-C + IDL-C) has recently been shown to be a strong predictor of death/myocardial infarction risk among women >50 years undergoing angiography. However, whether this ratio is associated with coronary heart disease risk among other populations is unknown. We evaluated the apo A1 remnant ratio and its components for coronary heart disease incidence.Design Observational.Methods Participants (N= 4722) of the Jackson Heart Study were evaluated. Baseline clinical characteristics and lipoprotein subfractions (Vertical Auto Profile method) were collected. Cox hazard regression analysis, adjusted by standard cardiovascular risk factors, was utilized to determine associations of lipoproteins with coronary heart disease.Results Those with new-onset coronary heart disease were older, diabetic, smokers, had less education, used more lipid-lowering medication, and had a more atherogenic lipoprotein profile. After adjustment, the apo A1 remnant ratio (hazard ratio = 0.67 per 1-SD, p= 0.002) was strongly associated with coronary heart disease incidence. This association appears to be driven by the IDL-C denominator (hazard ratio = 1.23 per 1-SD, p= 0.007). Remnants (hazard ratio = 1.21 per 1-SD, p= 0.017), but not apo A1 (hazard ratio = 0.85 per 1-SD, p= 0.121) or VLDL3-C (hazard ratio = 1.13 per 1-SD, p= 0.120) were associated with coronary heart disease. Standard lipids were not associated with coronary heart disease incidence.Conclusion We found the apo A1 remnant ratio to be strongly associated with coronary heart disease. This ratio appears to better stratify risk than standard lipids, apo A1, and remnants among a primary prevention cohort of African Americans. Its utility requires further study as a lipoprotein management target for risk reduction.
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- 2016
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42. Hypothyroidism as a risk factor for statin intolerance.
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Robison, Craig D., Bair, Tami L., Horne, Benjamin D., McCubrey, Ray O., Lappe, Donald L., Muhlestein, Joseph B., and Anderson, Jeffrey L.
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CONFIDENCE intervals ,HYPOTHYROIDISM ,SEX distribution ,STATINS (Cardiovascular agents) ,DESCRIPTIVE statistics ,ODDS ratio ,DISEASE complications - Abstract
Background Three-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) are one of the most commonly prescribed classes of medications because of their proven cardiovascular benefits. However, statin intolerance occurs in 5% to 20% of patients. Understanding the basis for statin intolerance remains a key issue in preventive medicine. Objectives To evaluate the association of statin intolerance with hypothyroidism in a large integrated health care system, including its sex-specific relationship and subsequent statin rechallenge and prescription history. Methods The Intermountain Healthcare electronic medical record database identified patients (n = 2686; males = 1276, females = 1410) with a documentation of intolerance ("allergy") to at least 1 statin. Age and sex similar controls (n = 8103; males = 3892, females = 4211) were identified among patients prescribed statins without documented intolerance. Patients were evaluated for a history of hypothyroidism, development of hypothyroidism, and statin prescription history up to 5 years of follow-up. Results A total of 30.2% patients (210 males, 16.5%; 602 females, 42.7%) with statin intolerance had a history of hypothyroidism compared with 21.5% of statin-tolerant patients (475 males, 12.2%; 1266 females, 30.1%), for an odds ratio (OR) in the total population of 1.49 (95% confidence interval [CI] 1.34-1.65; P < .0001); in males, OR was 1.29 (CI 1.07-1.55; P = .001); in females, OR was 1.60 (CI 1.41-1.82; P < .0001). During follow-up, patients with statin intolerance and hypothyroidism were less likely to be on a statin than their statin-intolerant counterparts without hypothyroidism (hazard ratio 0.84; 95% CI 0.75-0.94; P = .002). Conclusions Hypothyroidism is more prevalent in those with statin intolerance, both in males and, especially, in females. People with hypothyroidism are less likely to have a prescription for a statin at follow-up than those without hypothyroidism. [ABSTRACT FROM AUTHOR]
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- 2014
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43. 118 Cardiovascular disease following hypertensive disorders of pregnancy.
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Theilen, Lauren, Varner, Michael W., Esplin, Michael S., and Horne, Benjamin D.
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CARDIOVASCULAR diseases ,PREGNANCY ,HYPERTENSION ,DISEASES ,LABOR (Obstetrics) - Published
- 2021
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44. Red cell distribution width is predictive of mortality in trauma patients.
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Majercik, Sarah, Fox, Jolene, Knight, Stacey, and Horne, Benjamin D
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- 2013
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45. The intermountain risk score predicts incremental age-specific long-term survival and life expectancy.
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Horne, Benjamin D., Muhlestein, Joseph B., Lappé, Donald L., Brunisholz, Kimberly D., May, Heidi T., Kfoury, Abdallah G., Carlquist, John F., Alharethi, Rami, Budge, Deborah, Whisenant, Brian K., Bunch, T. Jared, Ronnow, Brianna S., Rasmusson, Kismet D., Bair, Tami L., Jensen, Kurt R., and Anderson, Jeffrey L.
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The Intermountain Risk Score (IMRS) encapsulates the mortality risk information from all components of the complete blood count (CBC) and basic metabolic profile (BMP), along with age. To individualize the IMRS more clearly, this study evaluated whether IMRS weightings for 1-year mortality predict age-specific survival over more than a decade of follow-up. Sex-specific 1-year IMRS values were calculated for general medical patients with CBC and BMP laboratory tests drawn during 1999–2005. The population was divided randomly 60% (N = 71,921, examination sample) and 40% (N = 47,458, validation sample). Age-specific risk thresholds were established, and both survival and life expectancy were compared across low-, moderate-, and high-risk IMRS categories. During 7.3 ± 1.8 years of follow-up (range, 4.5–11.1 years), the average IMRS of decedents was higher than censored in all age/sex strata (all P < 0.001). For examination and validation samples, every age stratum had incrementally lower survival for higher risk IMRS, with hazard ratios of 2.5–8.5 (P < 0.001). Life expectancies were also significantly shorter for higher risk IMRS (all P < 0.001): For example, among 50–59 year-olds, life expectancy was 7.5, 6.8, and 5.9 years for women with low-, moderate-, and high-risk IMRS (with mortality in 5.7%, 16.3%, and 37.0% of patients, respectively). In Men, life expectancy was 7.3, 6.8, and 5.4 for low-, moderate-, and high-risk IMRS (with patients having 7.3%, 19.5%, and 40.0% mortality), respectively. IMRS significantly stratified survival and life expectancy within age-defined subgroups during more than a decade of follow-up. IMRS may be used to stratify age-specific risk of mortality in research, clinical/preventive, and quality improvement applications. A web calculator is located at http://intermountainhealthcare.org/IMRS. [Copyright &y& Elsevier]
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- 2011
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46. Trends in early and late mortality in patients undergoing coronary catheterization for myocardial infarction: implications on observation periods and risk factors to determine ICD candidacy.
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Bunch, T. Jared, May, Heidi T., Bair, Tami L., Crandall, Brian G., Weiss, J. Peter, Osborn, Jeffrey S., Anderson, Jeffrey L., Muhlestein, Joseph B., Horne, Benjamin D., Lappe, Donald L., and Day, John D.
- Abstract
Background: Survivors of acute myocardial infarction (MI) are at high risk for death from both sudden cardiac death and progressive heart failure. Objective: This study sought to determine mortality trends, identify markers of risk, and determine whether outcomes in high-risk patients are altered by revascularization during the implantable cardioverter-defibrillator candidacy observation period. Methods: We included 16,793 patients that presented to the catheterization laboratory for acute management of an MI. All patients had 3 years of follow-up to define short- and long-term mortality. Results: Across the demographics studied there were no significant differences in baseline characteristics over time, with exception of an observed decline in patients with an ejection fraction (EF) ≤0.35. Nonetheless, at study closure 16.3% of all cases had an EF ≤ 0.35. There was a gradual increase in use of percutaneous coronary intervention and coronary artery bypass graft; however, at the end of the study, the highest level of revascularization use was slightly >50%. For the composite, right and left bundle branch block or QRS > 120, the death rates at 1 and 5 years were 31.8% and 46.8%, respectively. These 1- and 5-year mortality rates were increased with an EF ≤ 0.35 (36.0%, 60.2%). Mortality in those with EF ≤ 0.35 exceeded 20% in all groups with conduction system disease at 90 days and was not significantly impacted by percutaneous coronary intervention. Conclusion: The highest risk for death after MI is in patients with an EF ≤ 0.35 and/or conduction system disease. The mortality risk is most pronounced in the early observation period after MI when patients must wait to be considered for an implantable cardioverter-defibrillator. [ABSTRACT FROM AUTHOR]
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- 2011
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47. Genome-Wide Significance and Replication of the Chromosome 12p11.22 Locus Near the PTHLH Gene for Peripartum Cardiomyopathy.
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Horne, Benjamin D., Rasmusson, Kismet D., Alharethi, Rami, Budge, Deborah, Brunisholz, Kimberly D., Metz, Torri, Carlquist, John F., Connolly, Jennifer J., Porter, T. Flint, Lappé, Donald L., Muhlestein, Joseph B., Silver, Robert, Stehlik, Josef, Park, James J., May, Heidi T., Bair, Tami L., Anderson, Jeffrey L., Renlund, Dale G., and Kfoury, Abdallah G.
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CARDIOMYOPATHIES ,GENETIC polymorphisms ,LOCUS (Genetics) ,REPLICATION (Experimental design) ,WOMEN patients - Abstract
The article presents a study which evaluates and replicates the genome-wide association of single nucleotide polymorphisms with peripartum cardiomyopathy (PPCM). The study analyzes the genome-wide single nucleotide polymorphisms in women diagnosed with PPCM and replication was verified for younger control subjects for PPCM2. Results indicate a function of genetic factors in PPCM and present a locus for clinical and pathophysiological investigation.
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- 2011
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48. Caution Against Overinterpreting Time-Restricted Eating Results
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Tinsley, Grant M., Peterson, Courtney M., and Horne, Benjamin D.
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- 2021
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49. Association of vitamin D levels with incident depression among a general cardiovascular population.
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May, Heidi T., Bair, Tami L., Lappé, Donald L., Anderson, Jeffrey L., Horne, Benjamin D., Carlquist, John F., and Muhlestein, Joseph B.
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Background: Depression is associated with cardiovascular (CV) disease, and it has been hypothesized that vitamin (vit)D deficiency may be associated with depression and a contributing factor to excess CV events. Therefore, we evaluated whether there is an association between vitD and incident depression among a CV population. Methods: Patients (N = 7,358) ≥50 years of age, with a CV diagnosis (coronary artery disease, myocardial infarction, congestive heart failure, cerebrovascular accident, transient ischemic accident, atrial fibrillation, or peripheral vascular disease), no prior depression diagnosis, and a measured vitD level were studied. Vitamin D (ng/mL) was stratified into 4 categories: >50 (optimal [O] n = 367), 31 to 50 (normal [N] n = 2,264), 16 to 30 (low [L] n = 3,402), and ≥15 (very low [VL] n = 1,325). Depression was defined by International Classification of Diseases, Ninth Edition, codes: 296.2 to 296.36, 311. VitD categories were evaluated by Cox hazard regression with adjustment by standard CV risk factors. Results: Age averaged 73.1 ± 10.2 years, and 58.8% were female. When compared to O, VL, L, and N were associated with depression (adjusted: VL, hazard ratio [HR] 2.70 [1.35-5.40], P = .005; L, HR 2.15 [1.10-4.21], P = .03; N, HR 1.95 [0.99-3.87], P = .06). This association remained even after adjustment by parathyroid hormone levels. Parathyroid hormone was significantly associated with depression, however, became nonsignificant after adjustment by vitD. Winter (December-February) enhanced this association. Significant associations remained when stratifications were made by age (<65, ≥65), sex, and diabetes, although the associations among those age ≥65 and male sex were enhanced. Conclusion: Among a CV population ≥50 years with no history of depression, vitD levels were shown to be associated with incident depression after vitD draw. This study strengthens the hypothesis of the association between vitD and depression. [Copyright &y& Elsevier]
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- 2010
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50. Atrial fibrillation is independently associated with senile, vascular, and Alzheimer's dementia.
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Bunch, T. Jared, Weiss, J. Peter, Crandall, Brian G., May, Heidi T., Bair, Tami L., Osborn, Jeffrey S., Anderson, Jeffrey L., Muhlestein, Joseph B., Horne, Benjamin D., Lappe, Donald L., and Day, John D.
- Abstract
Background: The aging population has resulted in more patients living with cardiovascular disease, such as atrial fibrillation (AF). Recent focus has been placed on understanding the long-term consequences of chronic cardiovascular disease, such as a potential increased risk of dementia. Objective: This study sought to determine whether there is an association between AF and dementia and whether their coexistence is an independent marker of risk. Methods: A total of 37,025 consecutive patients from the large ongoing prospective Intermountain Heart Collaborative Study database were evaluated and followed up for a mean of 5 years for the development of AF and dementia. Dementia was sub-typed into vascular (VD), senile (SD), Alzheimer''s (AD), and nonspecified (ND). Results: Of the 37,025 patients with a mean age of 60.6 ± 17.9 years, 10,161 (27%) developed AF and 1,535 (4.1%) developed dementia (179 VD, 321 SD, 347 AD, 688 ND) during the 5-year follow-up. Patients with dementia were older and had higher rates of hypertension, coronary artery disease, renal failure, heart failure, and prior strokes. In age-based analysis, AF independently was significantly associated with all dementia types. The highest risk was in the younger group (<70). After dementia diagnosis, the presence of AF was associated with a marked increased risk of mortality (VD: hazard ratio [HR] = 1.38, P = .01; SD: HR = 1.41, P = .001; AD: HR = 1.45; ND: HR = 1.38, P <.0001). Conclusion: AF was independently associated with all forms of dementia. Although dementia is strongly associated with aging, the highest risk of AD was in the younger group, in support of the observed association. The presence of AF also identified dementia patients at high risk of death. [Copyright &y& Elsevier]
- Published
- 2010
- Full Text
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