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253. Reply

Author

Glaser, Ruchira, primary, Glick, Henry A., additional, Herrmann, Howard C., additional, and Kimmel, Stephen E., additional

Published
2007
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255. Factors affecting time to maintenance dose in patients initiating warfarin.

Author

Finkelman, Brian S., French, Benjamin, Bershaw, Luanne, and Kimmel, Stephen E.

Abstract

Purpose Patients starting warfarin often experience lengthy dose-titration periods, when they are at high risk for bleeding and thromboembolism. However, relatively little is known about why some patients take longer than others to reach maintenance dose. Thus, we sought to identify social, clinical, and genetic factors associated with prolonged time to maintenance dose (TTM). Methods We conducted a time-to-event analysis, using a prospective cohort of patients initiating warfarin ( N = 390). Additionally, we examined whether changes in post-initiation factors were associated with TTM. Finally, we performed a secondary analysis in a subcohort ( N = 156) assessing the effect of adherence on TTM. Results No genetic or post-initiation factors were significantly associated with TTM. However, previous use of warfarin [hazard ratio (HR) = 0.64; 95% confidence interval (CI) 0.46, 0.88], current smoking status (HR = 0.61; 95%CI 0.39, 0.96), fewer than four doctor's visits in the previous year (HR = 0.63 vs 4-12 visits; 95%CI 0.46, 0.88), and worse general health status (HR = 0.63; 95%CI 0.47, 0.84) were significantly associated with longer TTM. Use of illegal injectable drugs (HR = 2.51; 95%CI 1.17, 5.39) was associated with shorter TTM. On secondary analysis, the HR for better adherence and TTM was 1.70 (95%CI 0.88, 3.27). Conclusions Time to maintenance dose was associated with pre-existing behavioral factors, health care utilization, and health quality but not clinical comorbidities or genetic factors in patients initiating warfarin. Future studies are needed to determine whether warfarin patients with prolonged TTM would have better outcomes on alternative agents. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Published
2015
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257. Comparison of Cool Tip Versus 8-mm Tip Catheter in Achieving Electrical Isolation of Pulmonary Veins for Long-Term Control of Atrial Fibrillation: A Prospective Randomized Pilot Study

Author

DIXIT, SANJAY, primary, GERSTENFELD, EDWARD P., additional, CALLANS, DAVID J., additional, COOPER, JOSHUA M., additional, LIN, DAVID, additional, RUSSO, ANDREA M., additional, VERDINO, RALPH J., additional, PATEL, VICKAS V., additional, KIMMEL, STEPHEN E., additional, RATCLIFFE, SARAH J., additional, HSIA, HENRY H., additional, NAYAK, HEMAL M., additional, ZADO, ERICA, additional, REN, JIAN-FANG, additional, and MARCHLINSKI, FRANCIS E., additional

Published
2006
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259. ORIGINAL RESEARCH—ED PHARMACOTHERAPY: Can Atorvastatin Improve the Response to Sildenafil in Men with Erectile Dysfunction Not Initially Responsive to Sildenafil? Hypothesis and Pilot Trial Results

Author

Herrmann, Howard C., primary, Levine, Laurence A., additional, Macaluso, Joseph, additional, Walsh, Michelle, additional, Bradbury, Danielle, additional, Schwartz, Stanley, additional, Mohler, Emile R., additional, and Kimmel, Stephen E., additional

Published
2006
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285. Abstract 11294: Rates of Testing in Syncope Patients in the United States Using a National Database

Author

Smoot, Madeline, Bai, Chen, Edwards, Emily S, Dasa, Osama, Petersen, John W, Kimmel, Stephen E, Mardini, Mamoun T, and Ruzieh, Mohammed

Abstract

Introduction:Syncope is a prevalent health problem. Most causes of syncope are benign and can be diagnosed based on history and physical examinations. Nonetheless, overtesting for syncope is a major healthcare problem associated with increased costs. In this study, we sought to assess the testing trends for the evaluation of syncope.Methods:We used data from the IBM MarketScan Research Database, which captures deidentified, individual-level information in the United States from approximately 100 commercial payers and self-insured corporations, not including Medicaid claims. We identified patients with the first diagnosis of syncope from 2010-2020 using ICD-9 and ICD-10 codes. Patients were followed up for three months to determine the rate of testing for syncope.Results:We identified 2,500,850 patients (57.9% women) with a mean age of 48.5 years. The overall rate of anatomical neurological testing was higher than cardiac anatomical testing (43.3% vs. 25.5%, p<0.001). The rate of the following tests decreased over time: cardiac stress testing (17.4% to 11.4%, p<0.001, figure 1A), carotid ultrasound (13.1% to 7.2%, p<0.001, figure 1C) and EEG (7.3% to 5.7%, p<0.001, figure 1C). The rate of CT chest angiography increased significantly (3.6% to 6.1%, p<0.001, figure 1B). The rates of long-term ECG monitoring, echocardiogram, chest x-ray, and neck and brain imaging remained the same (Figures 1A-C).Conclusion:Although prior studies demonstrated low yield for most cardiac and neurological evaluations for syncope and the reduction of testing over time (stress testing, carotid doppler, EEG), high rates of testing remained prevalent in syncope patients. Efforts are needed to reduce the use of low-yield diagnostic studies in syncope patients.

Published
2022
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289. Racial differences in the prevalence of cardiac sources of embolism in subjects with unexplained stroke or transient ischemic attack evaluated by transesophageal echocardiography

Author

Kizer, Jorge R, primary, Silvestry, Frank E, additional, Kimmel, Stephen E, additional, Kasner, Scott E, additional, Wiegers, Susan E, additional, Erwin, Michael B, additional, Schwalm, Stephanie A, additional, Viswanathan, Mohan N, additional, Pollard, John R, additional, Keane, Martin G, additional, and St. John Sutton, Martin G, additional

Published
2002
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300. Efficacy and safety of catheter ablation in octogenarians

Author

Zado, Erica S, primary, Callans, David J, additional, Gottlieb, Charles D, additional, Kutalek, Steven P, additional, Wilbur, Sabrina L, additional, Samuels, Fania L, additional, Hessen, Scott E, additional, Movsowitz, Colin M, additional, Fontaine, John M, additional, Kimmel, Stephen E, additional, and Marchlinski, Francis E, additional

Published
2000
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