417 results on '"Gregory M Marcus"'
Search Results
2. Email-Based Recruitment Into the Health eHeart Study: Cohort Analysis of Invited Eligible Patients
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Madelena Y Ng, Jeffrey E Olgin, Gregory M Marcus, Courtney R Lyles, and Mark J Pletcher
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Public aspects of medicine ,RA1-1270 - Abstract
BackgroundWeb- or app-based digital health studies allow for more efficient collection of health data for research. However, remote recruitment into digital health studies can enroll nonrepresentative study samples, hindering the robustness and generalizability of findings. Through the comprehensive evaluation of an email-based campaign on recruitment into the Health eHeart Study, we aim to uncover key sociodemographic and clinical factors that contribute to enrollment. ObjectiveThis study sought to understand the factors related to participation, specifically regarding enrollment, in the Health eHeart Study as a result of a large-scale remote email recruitment campaign. MethodsWe conducted a cohort analysis on all invited University of California, San Francisco (UCSF) patients to identify sociodemographic and clinical predictors of enrollment into the Health eHeart Study. The primary outcome was enrollment, defined by account registration and consent into the Health eHeart Study. The email recruitment campaign was carried out from August 2015 to February 2016, with electronic health record data extracted between September 2019 and December 2019. ResultsThe email recruitment campaign delivered at least 1 email invitation to 93.5% (193,606/206,983) of all invited patients and yielded a 3.6% (7012/193,606) registration rate among contacted patients and an 84.1% (5899/7012) consent rate among registered patients. Adjusted multivariate logistic regression models analyzed independent sociodemographic and clinical predictors of (1) registration among contacted participants and (2) consent among registered participants. Odds of registration were higher among patients who are older, women, non-Hispanic White, active patients with commercial insurance or Medicare, with a higher comorbidity burden, with congestive heart failure, and randomized to receive up to 2 recruitment emails. The odds of registration were lower among those with medical conditions such as dementia, chronic pulmonary disease, moderate or severe liver disease, paraplegia or hemiplegia, renal disease, or cancer. Odds of subsequent consent after initial registration were different, with an inverse trend of being lower among patients who are older and women. The odds of consent were also lower among those with peripheral vascular disease. However, the odds of consent remained higher among patients who were non-Hispanic White and those with commercial insurance. ConclusionsThis study provides important insights into the potential returns on participant enrollment when digital health study teams invest resources in using email for recruitment. The findings show that participant enrollment was driven more strongly by sociodemographic factors than clinical factors. Overall, email is an extremely efficient means of recruiting participants from a large list into the Health eHeart Study. Despite some improvements in representation, the formulation of truly diverse studies will require additional resources and strategies to overcome persistent participation barriers.
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- 2023
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3. Digital Tool-Assisted Hospitalization Detection in the Tailored Antiplatelet Initiation to Lessen Outcomes due to Decreased Clopidogrel Response After Percutaneous Coronary Intervention Study Compared to Traditional Site-Coordinator Ascertainment: Intervention Study
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Robert Avram, Julia Byrne, Derek So, Erin Iturriaga, Ryan Lennon, Vishakantha Murthy, Nancy Geller, Shaun Goodman, Charanjit Rihal, Yves Rosenberg, Kent Bailey, Michael Farkouh, Malcolm Bell, Charles Cagin, Ivan Chavez, Mohammad El-Hajjar, Wilson Ginete, Amir Lerman, Justin Levisay, Kevin Marzo, Tamim Nazif, Jean-Francois Tanguay, Mark Pletcher, Gregory M Marcus, Naveen L Pereira, and Jeffrey Olgin
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Public aspects of medicine ,RA1-1270 - Abstract
BackgroundAccurate, timely ascertainment of clinical end points, particularly hospitalizations, is crucial for clinical trials. The Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response after Percutaneous Coronary Intervention (TAILOR-PCI) Digital Study extended the main TAILOR-PCI trial's follow-up to 2 years, using a smartphone-based research app featuring geofencing-triggered surveys and routine monthly mobile phone surveys to detect cardiovascular (CV) hospitalizations. This pilot study compared these digital tools to conventional site-coordinator ascertainment of CV hospitalizations. ObjectiveThe objectives were to evaluate geofencing-triggered notifications and routine monthly mobile phone surveys' performance in detecting CV hospitalizations compared to telephone visits and health record reviews by study coordinators at each site. MethodsUS and Canadian participants from the TAILOR-PCI Digital Follow-Up Study were invited to download the Eureka Research Platform mobile app, opting in for location tracking using geofencing, triggering a smartphone-based survey if near a hospital for ≥4 hours. Participants were sent monthly notifications for CV hospitalization surveys. ResultsFrom 85 participants who consented to the Digital Study, downloaded the mobile app, and had not previously completed their final follow-up visit, 73 (85.8%) initially opted in and consented to geofencing. There were 9 CV hospitalizations ascertained by study coordinators among 5 patients, whereas 8 out of 9 (88.9%) were detected by routine monthly hospitalization surveys. One CV hospitalization went undetected by the survey as it occurred within two weeks of the previous event, and the survey only allowed reporting of a single hospitalization. Among these, 3 were also detected by the geofencing algorithm, but 6 out of 9 (66.7%) were missed by geofencing: 1 occurred in a participant who never consented to geofencing, while 5 hospitalizations occurred among participants who had subsequently turned off geofencing prior to their hospitalization. Geofencing-detected hospitalizations were ascertained within a median of 2 (IQR 1-3) days, monthly surveys within 11 (IQR 6.5-25) days, and site coordinator methods within 38 (IQR 9-105) days. The geofencing algorithm triggered 245 notifications among 39 participants, with 128 (52.2%) from true hospital presence and 117 (47.8%) from nonhospital health care facility visits. Additional geofencing iterative improvements to reduce hospital misidentification were made to the algorithm at months 7 and 12, elevating the rate of true alerts from 35.4% (55 true alerts/155 total alerts before month 7) to 78.7% (59 true alerts/75 total alerts in months 7-12) and ultimately to 93.3% (14 true alerts/5 total alerts in months 13-21), respectively. ConclusionsThe monthly digital survey detected most CV hospitalizations, while the geofencing survey enabled earlier detection but did not offer incremental value beyond traditional tools. Digital tools could potentially reduce the burden on study coordinators in ascertaining CV hospitalizations. The advantages of timely reporting via geofencing should be weighed against the issue of false notifications, which can be mitigated through algorithmic refinements.
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- 2023
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4. Individuals’ willingness to provide geospatial global positioning system (GPS) data from their smartphone during the COVID-19 pandemic
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Yulin Hswen, Ulrich Nguemdjo, Elad Yom-Tov, Gregory M Marcus, and Bruno Ventelou
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History of scholarship and learning. The humanities ,AZ20-999 ,Social Sciences - Abstract
Abstract This study aims to evaluate people’s willingness to provide their geospatial global positioning system (GPS) data from their smartphones during the COVID-19 pandemic. Based on the self-determination theory, the addition of monetary incentives to encourage data provision may have an adverse effect on spontaneous donation. Therefore, we tested if a crowding-out effect exists between financial and altruistic motivations. Participants were randomized to different frames of motivational messages regarding the provision of their GPS data based on (1) self-interest, (2) pro-social benefit, and (3) monetary compensation. We also sought to examine the use of a negative versus positive valence in the framing of the different armed messages. 1055 participants were recruited from 41 countries with a mean age of 34 years on Amazon Mechanical Turk (MTurk), an online crowdsourcing platform. Participants living in India or in Brazil were more willing to provide their GPS data compared to those living in the United States. No significant differences were seen between positive and negative valence framing messages. Monetary incentives of $5 significantly increased participants’ willingness to provide GPS data. Half of the participants in the self-interest and pro-social arms agreed to provide their GPS data and almost two-thirds of participants were willing to provide their data in exchange for $5. If participants refused the first framing proposal, they were followed up with a “Vickrey auction” (a sealed-bid second-priced auction, SPSBA). An average of $17 bid was accepted in the self-interest condition to provide their GPS data, and the average “bid” of $21 was for the pro-social benefit experimental condition. These results revealed that a crowding-out effect between intrinsic and extrinsic motivations did not take place in our sample of internet users. Framing and incentivization can be used in combination to influence the acquisition of private GPS smartphone data. Financial incentives can increase data provision to a greater degree with no losses on these intrinsic motivations, to fight the COVID-19 pandemic.
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- 2022
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5. Associations between tobacco and cannabis use and anxiety and depression among adults in the United States: Findings from the COVID-19 citizen science study.
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Nhung Nguyen, Noah D Peyser, Jeffrey E Olgin, Mark J Pletcher, Alexis L Beatty, Madelaine F Modrow, Thomas W Carton, Rasha Khatib, Djeneba Audrey Djibo, Pamela M Ling, and Gregory M Marcus
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Medicine ,Science - Abstract
BackgroundLittle is known about whether people who use both tobacco and cannabis (co-use) are more or less likely to have mental health disorders than single substance users or non-users. We aimed to examine associations between use of tobacco and/or cannabis with anxiety and depression.MethodsWe analyzed data from the COVID-19 Citizen Science Study, a digital cohort study, collected via online surveys during 2020-2022 from a convenience sample of 53,843 US adults (≥ 18 years old) nationwide. Past 30-day use of tobacco and cannabis was self-reported at baseline and categorized into four exclusive patterns: tobacco-only use, cannabis-only use, co-use of both substances, and non-use. Anxiety and depression were repeatedly measured in monthly surveys. To account for multiple assessments of mental health outcomes within a participant, we used Generalized Estimating Equations to examine associations between the patterns of tobacco and cannabis use with each outcome.ResultsIn the total sample (mean age 51.0 years old, 67.9% female), 4.9% reported tobacco-only use, 6.9% cannabis-only use, 1.6% co-use, and 86.6% non-use. Proportions of reporting anxiety and depression were highest for the co-use group (26.5% and 28.3%, respectively) and lowest for the non-use group (10.6% and 11.2%, respectively). Compared to non-use, the adjusted odds of mental health disorders were highest for co-use (Anxiety: OR = 1.89, 95%CI = 1.64-2.18; Depression: OR = 1.77, 95%CI = 1.46-2.16), followed by cannabis-only use, and tobacco-only use. Compared to tobacco-only use, co-use (OR = 1.35, 95%CI = 1.08-1.69) and cannabis-only use (OR = 1.17, 95%CI = 1.00-1.37) were associated with higher adjusted odds for anxiety, but not for depression. Daily use (vs. non-daily use) of cigarettes, e-cigarettes, and cannabis were associated with higher adjusted odds for anxiety and depression.ConclusionsUse of tobacco and/or cannabis, particularly co-use of both substances, were associated with poor mental health. Integrating mental health support with tobacco and cannabis cessation may address this co-morbidity.
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- 2023
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6. Worldwide physical activity trends since COVID-19 onset
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Geoffrey H Tison, Joshua Barrios, Robert Avram, Peter Kuhar, Bojan Bostjancic, Gregory M Marcus, Mark J Pletcher, and Jeffrey E Olgin
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Public aspects of medicine ,RA1-1270 - Published
- 2022
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7. Remote Assessment of Cardiovascular Risk Factors and Cognition in Middle-Aged and Older Adults: Proof-of-Concept Study
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Jennifer A Eastman, Allison R Kaup, Amber L Bahorik, Xochitl Butcher, Mouna Attarha, Gregory M Marcus, Mark J Pletcher, Jeffrey E Olgin, Deborah E Barnes, and Kristine Yaffe
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Medicine - Abstract
BackgroundAdults with cardiovascular disease risk factors (CVRFs) are also at increased risk of developing cognitive decline and dementia. However, it is often difficult to study the relationships between CVRFs and cognitive function because cognitive assessment typically requires time-consuming in-person neuropsychological evaluations that may not be feasible for real-world situations. ObjectiveWe conducted a proof-of-concept study to determine if the association between CVRFs and cognitive function could be detected using web-based, self-administered cognitive tasks and CVRF assessment. MethodsWe recruited 239 participants aged ≥50 years (mean age 62.7 years, SD 8.8; 42.7% [n=102] female, 88.7% [n=212] White) who were enrolled in the Health eHeart Study, a web-based platform focused on cardiac disease. The participants self-reported CVRFs (hypertension, high cholesterol, diabetes, and atrial fibrillation) using web-based health surveys between August 2016 and July 2018. After an average of 3 years of follow-up, we remotely evaluated episodic memory, working memory, and executive function via the web-based Posit Science platform, BrainHQ. Raw data were normalized and averaged into 3 domain scores. We used linear regression models to examine the association between CVRFs and cognitive function. ResultsCVRF prevalence was 62.8% (n=150) for high cholesterol, 45.2% (n=108) for hypertension, 10.9% (n=26) for atrial fibrillation, and 7.5% (n=18) for diabetes. In multivariable models, atrial fibrillation was associated with worse working memory (β=-.51, 95% CI -0.91 to -0.11) and worse episodic memory (β=-.31, 95% CI -0.59 to -0.04); hypertension was associated with worse episodic memory (β=-.27, 95% CI -0.44 to -0.11). Diabetes and high cholesterol were not associated with cognitive performance. ConclusionsSelf-administered web-based tools can be used to detect both CVRFs and cognitive health. We observed that atrial fibrillation and hypertension were associated with worse cognitive function even in those in their 60s and 70s. The potential of mobile assessments to detect risk factors for cognitive aging merits further investigation.
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- 2022
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8. Prospective arrhythmia surveillance after a COVID-19 diagnosis
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Lekshmi Santhosh, Thomas A Dewland, Mark J Pletcher, Jeffrey E Olgin, Gregory M Marcus, David Wen, Uday Kumar, José M Sánchez, Sithu Win, Noah Peyser, Sean Joyce, Vivian Yang, Janet Hwang, Xochitl Butcher, Cathy Horner, Isaac R Whitman, and Kelsey Ogomori
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2022
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9. Author Correction: Individuals’ willingness to provide geospatial global positioning system (GPS) data from their smartphone during the COVID-19 pandemic
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Yulin Hswen, Ulrich Nguemdjo, Elad Yom-Tov, Gregory M Marcus, and Bruno Ventelou
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History of scholarship and learning. The humanities ,AZ20-999 ,Social Sciences - Published
- 2022
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10. Predictors of incident SARS-CoV-2 infections in an international prospective cohort study
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Gregory Nah, Eric Vittinghoff, Gregory M Marcus, David Wen, Anthony Lin, Jeffrey Olgin, Noah Peyser, Sidney Aung, Sean Joyce, Vivian Yang, Janet Hwang, Robert Avram, Geoffrey H Tison, Alexis Beatty, Ryan Runge, Xochitl Butcher, Cathy Horner, Helena Eitel, and Mark Pletcher
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Medicine - Published
- 2021
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11. The COVID-19 Citizen Science Study: Protocol for a Longitudinal Digital Health Cohort Study
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Alexis L Beatty, Noah D Peyser, Xochitl E Butcher, Thomas W Carton, Jeffrey E Olgin, Mark J Pletcher, and Gregory M Marcus
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Medicine ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
BackgroundThe COVID-19 pandemic has catalyzed a global public response and innovation in clinical study methods. ObjectiveThe COVID-19 Citizen Science study was designed to generate knowledge about participant-reported COVID-19 symptoms, behaviors, and disease occurrence. MethodsCOVID-19 Citizen Science is a longitudinal cohort study launched on March 26, 2020, on the Eureka Research Platform. This study illustrates important advances in digital clinical studies, including entirely digital study participation, targeted recruitment strategies, electronic consent, recurrent and time-updated assessments, integration with smartphone-based measurements, analytics for recruitment and engagement, connection with partner studies, novel engagement strategies such as participant-proposed questions, and feedback in the form of real-time results to participants. ResultsAs of February 2021, the study has enrolled over 50,000 participants. Study enrollment and participation are ongoing. Over the lifetime of the study, an average of 59% of participants have completed at least one survey in the past 4 weeks. ConclusionsInsights about COVID-19 symptoms, behaviors, and disease occurrence can be drawn through digital clinical studies. Continued innovation in digital clinical study methods represents the future of clinical research. International Registered Report Identifier (IRRID)DERR1-10.2196/28169
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- 2021
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12. Predictors of incident viral symptoms ascertained in the era of COVID-19.
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Gregory M Marcus, Jeffrey E Olgin, Noah D Peyser, Eric Vittinghoff, Vivian Yang, Sean Joyce, Robert Avram, Geoffrey H Tison, David Wen, Xochitl Butcher, Helena Eitel, and Mark J Pletcher
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Medicine ,Science - Abstract
BackgroundIn the absence of universal testing, effective therapies, or vaccines, identifying risk factors for viral infection, particularly readily modifiable exposures and behaviors, is required to identify effective strategies against viral infection and transmission.MethodsWe conducted a world-wide mobile application-based prospective cohort study available to English speaking adults with a smartphone. We collected self-reported characteristics, exposures, and behaviors, as well as smartphone-based geolocation data. Our main outcome was incident symptoms of viral infection, defined as fevers and chills plus one other symptom previously shown to occur with SARS-CoV-2 infection, determined by daily surveys.FindingsAmong 14, 335 participants residing in all 50 US states and 93 different countries followed for a median 21 days (IQR 10-26 days), 424 (3%) developed incident viral symptoms. In pooled multivariable logistic regression models, female biological sex (odds ratio [OR] 1.75, 95% CI 1.39-2.20, pInterpretationWhile several immutable characteristics were associated with the risk of developing viral symptoms, multiple immediately modifiable exposures and habits that influence risk were also observed, potentially identifying readily accessible strategies to mitigate risk in the COVID-19 era.
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- 2021
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13. Diagnostic and prognostic significance of premature ventricular complexes in community and hospital-based participants: A scoping review.
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Sukardi Suba, Kirsten E Fleischmann, Hildy Schell-Chaple, Priya Prasad, Gregory M Marcus, Xiao Hu, and Michele M Pelter
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Medicine ,Science - Abstract
BackgroundWhile there are published studies that have examined premature ventricular complexes (PVCs) among patients with and without cardiac disease, there has not been a comprehensive review of the literature examining the diagnostic and prognostic significance of PVCs. This could help guide both community and hospital-based research and clinical practice.MethodsScoping review frameworks by Arksey and O'Malley and the Joanna Briggs Institute (JBI) were used. A systematic search of the literature using four databases (CINAHL, Embase, PubMed, and Web of Science) was conducted. The review was prepared adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR).ResultsA total of 71 relevant articles were identified, 66 (93%) were observational, and five (7%) were secondary analyses from randomized clinical trials. Three studies (4%) examined the diagnostic importance of PVC origin (left/right ventricle) and QRS morphology in the diagnosis of acute myocardial ischemia (MI). The majority of the studies examined prognostic outcomes including left ventricular dysfunction, heart failure, arrhythmias, ischemic heart diseases, and mortality by PVCs frequency, burden, and QRS morphology.ConclusionsVery few studies have evaluated the diagnostic significance of PVCs and all are decades old. No hospital setting only studies were identified. Community-based longitudinal studies, which make up most of the literature, show that PVCs are associated with structural and coronary heart disease, lethal arrhythmias, atrial fibrillation, stroke, all-cause and cardiac mortality. However, a causal association between PVCs and these outcomes cannot be established due to the purely observational study designs employed.
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- 2021
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14. Cigarette and e-cigarette dual use and risk of cardiopulmonary symptoms in the Health eHeart Study.
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Julie B Wang, Jeffrey E Olgin, Gregory Nah, Eric Vittinghoff, Janine K Cataldo, Mark J Pletcher, and Gregory M Marcus
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Medicine ,Science - Abstract
E-cigarettes are promoted as healthier alternatives to conventional cigarettes. Many cigarette smokers use both products. It is unknown whether the additional use of e-cigarettes among cigarette smokers (dual users) is associated with reduced exposure to tobacco-related health risks. Cross-sectional analysis was performed using baseline data from the Health eHeart Study, among English-speaking adults, mostly from the United States. Cigarette use (# cigarettes/day) and/or e-cigarette use (# days, # cartridges, and # puffs) were compared between cigarette only users vs. dual users. Additionally, we examined cardiopulmonary symptoms/ conditions across product use: no product (neither), e-cigarettes only, cigarettes only, and dual use. Among 39,747 participants, 573 (1.4%) reported e-cigarette only use, 1,693 (4.3%) reported cigarette only use, and 514 (1.3%) dual use. Dual users, compared to cigarette only users, reported a greater median (IQR) number of cigarettes per day, 10.0 (4.0-20.0) vs. 9.0 (3.0-15.0) (p < .0001), a lower (worse) median (IQR) SF-12 general health score, 3.3 (2.8-3.8) vs. 3.5 (2.8-3.9) (p = .0014), and a higher (worse) median (IQR) breathing difficulty score in the past month, 2.0 (1.0-2.0) vs. 1.0 (1.0-2.0) (p = .001). Of the 19 cardiopulmonary symptoms/ conditions, having a history of arrhythmia was significantly different between cigarette only users (14.2%) and dual users (17.8%) (p = .02). In this sample, dual use was not associated with reduced exposure to either (i) cigarettes, compared to cigarette only users or (ii) e-cigarettes, compared to e-cigarette only users. E-cigarette only use, compared to no product use, was associated with lower general health scores, higher breathing difficulty scores (typically and past month), and greater proportions of those who responded 'yes' to having chest pain, palpitations, coronary heart disease, arrhythmia, COPD, and asthma. These data suggest the added use of e-cigarettes alone may have contributed to cardiopulmonary health risks particularly respiratory health risks.
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- 2018
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15. Past alcohol consumption and incident atrial fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study.
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Shalini Dixit, Alvaro Alonso, Eric Vittinghoff, Elsayed Z Soliman, Lin Y Chen, and Gregory M Marcus
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Medicine ,Science - Abstract
BackgroundAlthough current alcohol consumption is a risk factor for incident atrial fibrillation (AF), the more clinically relevant question may be whether alcohol cessation is associated with a reduced risk.Methods and resultsWe studied participants enrolled in the Atherosclerosis Risk in Communities Study (ARIC) between 1987 and 1989 without prevalent AF. Past and current alcohol consumption were ascertained at baseline and at 3 subsequent visits. Incident AF was ascertained via study ECGs, hospital discharge ICD-9 codes, and death certificates. Of 15,222 participants, 2,886 (19.0%) were former drinkers. During a median follow-up of 19.7 years, there were 1,631 cases of incident AF, 370 occurring in former consumers. Former drinkers had a higher rate of AF compared to lifetime abstainers and current drinkers. After adjustment for potential confounders, every decade abstinent from alcohol was associated with an approximate 20% (95% CI 11-28%) lower rate of incident AF; every additional decade of past alcohol consumption was associated with a 13% (95% CI 3-25%) higher rate of AF; and every additional drink per day during former drinking was associated with a 4% (95% CI 0-8%) higher rate of AF.ConclusionsAmong former drinkers, the number of years of drinking and the amount of alcohol consumed may each confer an increased risk of AF. Given that a longer duration of abstinence was associated with a decreased risk of AF, earlier modification of alcohol use may have a greater influence on AF prevention.
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- 2017
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16. Correction: Past alcohol consumption and incident atrial fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study.
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Shalini Dixit, Alvaro Alonso, Eric Vittinghoff, Elsayed Z Soliman, Lin Y Chen, and Gregory M Marcus
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Medicine ,Science - Abstract
[This corrects the article DOI: 10.1371/journal.pone.0185228.].
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- 2017
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17. Racial Differences in Left Atrial Size: Results from the Coronary Artery Risk Development in Young Adults (CARDIA) Study.
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Thomas A Dewland, Kirsten Bibbins-Domingo, Feng Lin, Eric Vittinghoff, Elyse Foster, Kofo O Ogunyankin, Joao A Lima, David R Jacobs, Donglei Hu, Esteban G Burchard, and Gregory M Marcus
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Medicine ,Science - Abstract
Whites have an increased risk of atrial fibrillation (AF) compared to Blacks. The mechanism underlying this association is unknown. Left atrial (LA) size is an important AF risk factor, and studies in older adults suggest Whites have larger LA diameters. However, because AF itself causes LA dilation, LA size differences may be due to greater subclinical AF among older Whites. We therefore assessed for racial differences in LA size among young adults at low AF risk. The Coronary Artery Risk Development in Young Adults (CARDIA) study enrolled White and Black participants between 18 and 30 years of age. LA diameter was measured in a subset of participants using echocardiography at Year 5 (n = 4,201) and Year 25 (n = 3,373) of follow up. LA volume was also assessed at Year 5 (n = 2,489). Multivariate linear regression models were used to determine the adjusted association between race and LA size. In unadjusted analyses, mean LA diameter was significantly larger among Blacks compared to Whites both at Year 5 (35.5 ± 4.8 mm versus 35.1 ± 4.5 mm, p = 0.01) and Year 25 (37.4 ± 5.1 mm versus 36.8 ± 4.9 mm, p = 0.002). After adjusting for demographics, comorbidities, and echocardiographic parameters, Whites demonstrated an increased LA diameter (0.7 mm larger at Year 5, 95% CI 0.3-1.1, p
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- 2016
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18. Direct Measurements of Smartphone Screen-Time: Relationships with Demographics and Sleep.
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Matthew A Christensen, Laura Bettencourt, Leanne Kaye, Sai T Moturu, Kaylin T Nguyen, Jeffrey E Olgin, Mark J Pletcher, and Gregory M Marcus
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Medicine ,Science - Abstract
BACKGROUND:Smartphones are increasingly integrated into everyday life, but frequency of use has not yet been objectively measured and compared to demographics, health information, and in particular, sleep quality. AIMS:The aim of this study was to characterize smartphone use by measuring screen-time directly, determine factors that are associated with increased screen-time, and to test the hypothesis that increased screen-time is associated with poor sleep. METHODS:We performed a cross-sectional analysis in a subset of 653 participants enrolled in the Health eHeart Study, an internet-based longitudinal cohort study open to any interested adult (≥ 18 years). Smartphone screen-time (the number of minutes in each hour the screen was on) was measured continuously via smartphone application. For each participant, total and average screen-time were computed over 30-day windows. Average screen-time specifically during self-reported bedtime hours and sleeping period was also computed. Demographics, medical information, and sleep habits (Pittsburgh Sleep Quality Index-PSQI) were obtained by survey. Linear regression was used to obtain effect estimates. RESULTS:Total screen-time over 30 days was a median 38.4 hours (IQR 21.4 to 61.3) and average screen-time over 30 days was a median 3.7 minutes per hour (IQR 2.2 to 5.5). Younger age, self-reported race/ethnicity of Black and "Other" were associated with longer average screen-time after adjustment for potential confounders. Longer average screen-time was associated with shorter sleep duration and worse sleep-efficiency. Longer average screen-times during bedtime and the sleeping period were associated with poor sleep quality, decreased sleep efficiency, and longer sleep onset latency. CONCLUSIONS:These findings on actual smartphone screen-time build upon prior work based on self-report and confirm that adults spend a substantial amount of time using their smartphones. Screen-time differs across age and race, but is similar across socio-economic strata suggesting that cultural factors may drive smartphone use. Screen-time is associated with poor sleep. These findings cannot support conclusions on causation. Effect-cause remains a possibility: poor sleep may lead to increased screen-time. However, exposure to smartphone screens, particularly around bedtime, may negatively impact sleep.
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- 2016
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19. Healthcare utilization and clinical outcomes after catheter ablation of atrial flutter.
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Thomas A Dewland, David V Glidden, and Gregory M Marcus
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Medicine ,Science - Abstract
Atrial flutter ablation is associated with a high rate of acute procedural success and symptom improvement. The relationship between ablation and other clinical outcomes has been limited to small studies primarily conducted at academic centers. We sought to determine if catheter ablation of atrial flutter is associated with reductions in healthcare utilization, atrial fibrillation, or stroke in a large, real world population. California Healthcare Cost and Utilization Project databases were used to identify patients undergoing atrial flutter ablation between 2005 and 2009. The adjusted association between atrial flutter ablation and healthcare utilization, atrial fibrillation, or stroke was investigated using Cox proportional hazards models. Among 33,004 patients with a diagnosis of atrial flutter observed for a median of 2.1 years, 2,733 (8.2%) underwent catheter ablation. Atrial flutter ablation significantly lowered the adjusted risk of inpatient hospitalization (HR 0.88, 95% CI 0.84-0.92, p
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- 2014
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20. DeepHeart: Semi-Supervised Sequence Learning for Cardiovascular Risk Prediction.
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Brandon Ballinger, Johnson Hsieh, Avesh Singh, Nimit Sohoni, Jack Wang 0001, Geoffrey H. Tison, Gregory M. Marcus, Jose M. Sanchez, Carol Maguire, Jeffrey E. Olgin, and Mark J. Pletcher
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- 2018
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21. Randomized Comparison of a Radiofrequency Wire Versus a Radiofrequency Needle System for Transseptal Puncture
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Thomas A. Dewland, Edward P. Gerstenfeld, Joshua D. Moss, Adam C. Lee, Vasanth Vedantham, Randall J. Lee, Zian H. Tseng, Henry H. Hsia, Byron K. Lee, Grace C. Wall, Kathleen R. Chang, Michelle H. Yang, and Gregory M. Marcus
- Published
- 2023
22. Consumer-Led Screening for Atrial Fibrillation: Frontier Review of the AF-SCREEN International Collaboration
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Axel Brandes, Stavros Stavrakis, Ben Freedman, Sotiris Antoniou, Giuseppe Boriani, A. John Camm, Clara K. Chow, Eric Ding, Johan Engdahl, Michael M. Gibson, Gregory Golovchiner, Taya Glotzer, Yutao Guo, Jeff S. Healey, Mellanie T. Hills, Linda Johnson, Gregory Y. H. Lip, Trudie Lobban, Peter W. Macfarlane, Gregory M. Marcus, David D. McManus, Lis Neubeck, Jessica Orchard, Marco V. Perez, Renate B. Schnabel, Breda Smyth, Steven Steinhubl, and Mintu P. Turakhia
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Stroke ,Electrocardiography ,Risk Factors ,screening ,Physiology (medical) ,atrial fibrillation ,wearable electronic devices ,Atrial Fibrillation ,Humans ,Mass Screening ,Cardiology and Cardiovascular Medicine ,Aged - Abstract
The technological evolution and widespread availability of wearables and handheld ECG devices capable of screening for atrial fibrillation (AF), and their promotion directly to consumers, has focused attention of health care professionals and patient organizations on consumer-led AF screening. In this Frontiers review, members of the AF-SCREEN International Collaboration provide a critical appraisal of this rapidly evolving field to increase awareness of the complexities and uncertainties surrounding consumer-led AF screening. Although there are numerous commercially available devices directly marketed to consumers for AF monitoring and identification of unrecognized AF, health care professional–led randomized controlled studies using multiple ECG recordings or continuous ECG monitoring to detect AF have failed to demonstrate a significant reduction in stroke. Although it remains uncertain if consumer-led AF screening reduces stroke, it could increase early diagnosis of AF and facilitate an integrated approach, including appropriate anticoagulation, rate or rhythm management, and risk factor modification to reduce complications. Companies marketing AF screening devices should report the accuracy and performance of their products in high- and low-risk populations and avoid claims about clinical outcomes unless improvement is demonstrated in randomized clinical trials. Generally, the diagnostic yield of AF screening increases with the number, duration, and temporal dispersion of screening sessions, but the prognostic importance may be less than for AF detected by single–time point screening, which is largely permanent, persistent, or high-burden paroxysmal AF. Consumer-initiated ECG recordings suggesting possible AF always require confirmation by a health care professional experienced in ECG reading, whereas suspicion of AF on the basis of photoplethysmography must be confirmed with an ECG. Consumer-led AF screening is unlikely to be cost-effective for stroke prevention in the predominantly young, early adopters of this technology. Studies in older people at higher stroke risk are required to demonstrate both effectiveness and cost-effectiveness. The direct interaction between companies and consumers creates new regulatory gaps in relation to data privacy and the registration of consumer apps and devices. Although several barriers for optimal use of consumer-led screening exist, results of large, ongoing trials, powered to detect clinical outcomes, are required before health care professionals should support widespread adoption of consumer-led AF screening.
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- 2023
23. Machine learning prediction of blood alcohol concentration: a digital signature of smart-breathalyzer behavior.
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Kirstin Aschbacher, Christian S. Hendershot, Geoffrey H. Tison, Judith A. Hahn, Robert Avram, Jeffrey E. Olgin, and Gregory M. Marcus
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- 2021
- Full Text
- View/download PDF
24. Acute Effects of Coffee Consumption on Health among Ambulatory Adults
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Gregory M. Marcus, David G. Rosenthal, Gregory Nah, Eric Vittinghoff, Christina Fang, Kelsey Ogomori, Sean Joyce, Defne Yilmaz, Vivian Yang, Tara Kessedjian, Emily Wilson, Michelle Yang, Kathleen Chang, Grace Wall, and Jeffrey E. Olgin
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General Medicine - Published
- 2023
25. Initial Findings From the National Cardiovascular Data Registry of Atrial Fibrillation Ablation Procedures
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Jonathan C. Hsu, Douglas Darden, Chengan Du, Joseph E. Marine, Sheila Nichols, Gregory M. Marcus, Andrea Natale, Peter A. Noseworthy, Kimberly A. Selzman, Paul Varosy, Frederick Masoudi, James Freeman, Jeptha Curtis, Joseph Akar, and Peter R. Kowey
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Cardiology and Cardiovascular Medicine - Published
- 2023
26. The Value of Programmed Ventricular Extrastimuli From the Right Ventricular Basal Septum During Supraventricular Tachycardia
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Satoshi Higuchi, Hiroyuki Ito, Edward P. Gerstenfeld, Adam C. Lee, Byron K. Lee, Gregory M. Marcus, Henry H. Hsia, Joshua D. Moss, Randall J. Lee, Thomas A. Dewland, Vasanth Vedantham, Zian H. Tseng, Akash R. Patel, Ronn E. Tanel, Nitish Badhwar, Cara N. Pellegrini, Mitsuharu Kawamura, Morio Shoda, Chun Hwang, Marwan M. Refaat, and Melvin M. Scheinman
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- 2023
27. American Indians and atrial fibrillation
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José M. Sanchez and Gregory M. Marcus
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Stroke ,American Indians and Alaska Natives ,Heart Disease ,Good Health and Well Being ,Epidemiology ,Clinical Research ,Indigenous population ,Cardiovascular ,Cardiology and Cardiovascular Medicine ,Atrial fibrillation ,American Indian or Alaska Native ,Race and ethnicity - Abstract
The American Indian population is known to experience high rates of cardiovascular disease and have a heightened vulnerability to severe outcomes driven by an overall poor health status and lower access to quality health care. Our group has previously published an analysis demonstrating that American Indians have the highest risk of atrial fibrillation (AF), as well as of AF-related stroke, when compared with other races and ethnicities. Despite this, AF in this population has not been extensively studied and additional publications are scarce. Our review article provides an up-to-date summary of the relevant literature addressing the relationship between race, ethnicity, and AF by focusing on American Indians.
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- 2022
28. The Persistence of an Atrial Tachyarrhythmia Constrained to an Isolated Pulmonary Vein
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Christopher C. Cheung, Adam C.H. Lee, and Gregory M. Marcus
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Pulmonary Veins ,Tachycardia ,Atrial Fibrillation ,Catheter Ablation ,Humans ,Heart Atria - Published
- 2022
29. Cannabis, cocaine, methamphetamine, and opiates increase the risk of incident atrial fibrillation
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Anthony L Lin, Gregory Nah, Janet J Tang, Eric Vittinghoff, Thomas A Dewland, and Gregory M Marcus
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Adult ,Cocaine ,Risk Factors ,Opiate Alkaloids ,Incidence ,Atrial Fibrillation ,Humans ,Cardiology and Cardiovascular Medicine ,United States ,Cannabis ,Methamphetamine - Abstract
Aims Atrial fibrillation (AF) is now regarded as a preventable disease, requiring a search for modifiable risk factors. With legalization of cannabis and more lenient laws regarding the use of other illicit substances, investigation into the potential effects of methamphetamine, cocaine, opiate, and cannabis exposure on incident AF is needed. Methods and results Using Office of Statewide Health Planning and Development databases, a longitudinal analysis was performed of adult Californians ≥18 years of age who received care in an emergency department, outpatient surgery facility, or hospital from 1 January 2005 to 31 December 2015. Associations between healthcare coding for the use of each substance and a new AF diagnosis were assessed. Among 23,561,884 patients, 98 271 used methamphetamine, 48 701 used cocaine, 10 032 used opiates, and 132 834 used cannabis. Of the total population, 998 747 patients (4.2%) developed incident AF during the study period. After adjusting for potential confounders and mediators, use of methamphetamines, cocaine, opiates, and cannabis was each associated with increased incidence of AF: hazard ratios 1.86 [95% confidence interval (CI) 1.81–1.92], 1.61 (95% CI 1.55–1.68), 1.74 (95% CI 1.62–1.87), and 1.35 (95% CI 1.30–1.40), respectively. Negative control analyses in the same cohort failed to reveal similarly consistent positive relationships. Conclusion Methamphetamine, cocaine, opiate, and cannabis uses were each associated with increased risk of developing incident AF. Efforts to mitigate the use of these substances may represent a novel approach to AF prevention.
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- 2022
30. Association Between Intensive vs Standard Blood Pressure Control and Incident Left Ventricular Conduction Disease
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Emilie K. Frimodt-Møller, Eric Vittinghoff, Gurbani Kaur, Tor Biering-Sørensen, Elsayed Z. Soliman, and Gregory M. Marcus
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Cardiology and Cardiovascular Medicine - Abstract
ImportanceLeft ventricular conduction disease predicts heart failure and death, and the only strategies to mitigate its effects involve implantation of a permanent pacemaker. There are currently no proven preventive strategies for this common condition.ObjectiveTo determine the association between targeting intensive blood pressure (BP) control and the risk of developing left ventricular conduction disease.Design, Setting, and ParticipantsThis was a post hoc analysis of the 2-arm multicenter Systolic Blood Pressure Intervention Trial (SPRINT), which recruited participants from 102 sites in the US and Puerto Rico and was conducted from November 2010 until August 2015. Adults 50 years and older with hypertension and at least 1 other cardiovascular risk factor were included. Participants with baseline left ventricular conduction disease, ventricular pacing, or ventricular pre-excitation were excluded for the current analysis. Data were analyzed from November 2021 to November 2022.InterventionParticipants were randomly assigned to a systolic BP target of less than 140 mm Hg (standard treatment group) or less than 120 mm Hg (intensive treatment group).Main OutcomeThe primary outcome was incident left ventricular conduction disease, including any fascicular or left bundle-branch block, assessed by serial electrocardiography. Incident right bundle-branch block was examined as a negative control.ResultsAmong 3918 participants randomized to standard treatment and 3956 to intensive treatment (mean [SD] age, 67.6 [9.2] years; 2815 [36%] female) monitored for a median [IQR] 3.5 (0.02-5.2) years, 203 developed left ventricular conduction disease. Older age (hazard ratio per 10-year increase [HR], 1.42; 95% CI, 1.21-1.67; P P P = .02) were associated with a higher risk of left ventricular conduction disease. Assignment to intensive treatment was associated with a 26% lower risk of left ventricular conduction disease (HR, 0.74; 95% CI, 0.56-0.98; P = .04). These results persisted when incident ventricular pacing was included in the outcome and when considering all-cause death as a competing risk. In contrast, no association between randomization assignment and right bundle-branch block was observed (HR, 0.95; 95% CI, 0.71-1.27; P = .75).Conclusions and RelevanceIn this study, targeting intensive BP control was associated with lower risk of left ventricular conduction disease in a randomized clinical trial, suggesting that clinically relevant conduction disease may be preventable.Trial RegistrationClinicalTrials.gov Identifier: NCT01206062
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- 2023
31. Mechanically induced electrical storm as a complication of cardiac resynchronization therapy: A case report
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Zekun Feng, Gregory M. Marcus, and Nitish Badhwar
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
32. Evaluation of premature ventricular complexes during in‐hospital ECG monitoring as a predictor of ventricular tachycardia in an intensive care unit cohort
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Sukardi Suba, Thomas J. Hoffmann, Kirsten E. Fleischmann, Hildy Schell‐Chaple, Gregory M. Marcus, Priya Prasad, Xiao Hu, Fabio Badilini, and Michele M. Pelter
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General Nursing - Published
- 2023
33. Real-world heart rate norms in the Health eHeart study.
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Robert Avram, Geoffrey H. Tison, Kirstin Aschbacher, Peter Kuhar, Eric Vittinghoff, Michael Butzner, Ryan Runge, Nancy Wu, Mark J. Pletcher, Gregory M. Marcus, and Jeffrey E. Olgin
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- 2019
- Full Text
- View/download PDF
34. Association of Nirmatrelvir/Ritonavir Treatment with Long COVID Symptoms in an Online Cohort of Non-Hospitalized Individuals Experiencing Breakthrough SARS-CoV-2 Infection in the Omicron Era
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Matthew S. Durstenfeld, Michael J. Peluso, Feng Lin, Noah D. Peyser, Carmen Isasi, Thomas W. Carton, Timothy J. Henrich, Steven G. Deeks, Jeffrey E. Olgin, Mark J. Pletcher, Alexis L. Beatty, Gregory M. Marcus, and Priscilla Y. Hsue
- Abstract
BackgroundOral nirmatrelvir/ritonavir is a treatment for COVID-19, but whether treatment during the acute phase reduces the risk of developing Long COVID is unknown.MethodsUsing the Covid Citizen Science (CCS) online cohort, we surveyed individuals who reported their first SARS-CoV-2 positive test between March and August 2022 regarding Long COVID symptoms. We excluded those who were pregnant, unvaccinated, hospitalized for COVID-19, or received other antiviral therapy. The primary exposure was oral nirmatrelvir/ritonavir. The primary outcome was the presence of any Long COVID symptoms reported on cross-sectional surveys in November and December 2022. We used propensity-score models and inverse probability of treatment weighting to adjust for differences in treatment propensity. Our secondary question was whether symptom or test positivity rebound were associated with Long COVID.Results4684 individuals met the eligibility criteria, of whom 988 (21.1%) were treated and 3696 (78.9%) were untreated; 353/988 (35.7%) treated and 1258/3696 (34.0%) untreated responded to the survey. Median age was 55 years and 66% were female. We did not identify an association between nirmatrelvir/ritonavir treatment and Long COVID symptoms (OR 1.15; 95%CI 0.80-1.64). Among n=666 treated with nirmatrelvir/ritonavir who responded who responded to questions about rebound, rebound symptoms or test positivity were not associated with Long COVID symptoms (OR 1.34; 95%CI 0.74-2.41; p=0.33).ConclusionsWithin this cohort, treatment with nirmatrelvir/ritonavir among vaccinated, non-hospitalized individuals was not associated with lower prevalence of Long COVID symptoms or severity of Long COVID. Experiencing rebound symptoms or test positivity is not strongly associated with developing Long COVID.
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- 2023
35. A Randomized Trial of High vs Standard Power Radiofrequency Ablation for Pulmonary Vein Isolation
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Adam C. Lee, Alex Voskoboinik, Christopher C. Cheung, Sarah Yogi, Zian H. Tseng, Joshua D. Moss, Thomas A. Dewland, Byron K. Lee, Randall J. Lee, Henry H. Hsia, Gregory M. Marcus, Vasanth Vedantham, David Chieng, Peter M. Kistler, William Dillon, Eric Vittinghoff, and Edward P. Gerstenfeld
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- 2023
36. Back to the basics: A case of atrial flutter?
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Thomas A. Dewland, Melvin M. Scheinman, Maurice G. Marcus, and Gregory M. Marcus
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
37. PO-01-193 SMOKING CESSATION REDUCES THE RISK OF INCIDENT ATRIAL FIBRILLATION
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Justin Teraoka, Janet Tang, Francesca N. Delling, and Gregory M. Marcus
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
38. Population-level analyses of alcohol consumption as a predictor of acute atrial fibrillation episodes
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Sidney Aung, Gregory Nah, Eric Vittinghoff, Christopher A. Groh, Christina D. Fang, and Gregory M. Marcus
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- 2022
39. Human Immunodeficiency Virus Infection and Out-of-Hospital Cardiac Arrest
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Gregory M. Marcus, Priscilla Y. Hsue, Eric Vittinghoff, Mayank Sardana, Gregory Nah, Thomas A. Dewland, and Zian H. Tseng
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Adult ,Male ,medicine.medical_specialty ,Population ,HIV Infections ,Disease ,California ,Coronary artery disease ,Sex Factors ,Risk Factors ,Internal medicine ,medicine ,Humans ,Renal Insufficiency, Chronic ,Risk factor ,education ,Prospective cohort study ,Aged ,Heart Failure ,education.field_of_study ,business.industry ,Hazard ratio ,Age Factors ,Middle Aged ,medicine.disease ,Heart failure ,Hypertension ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Out-of-Hospital Cardiac Arrest ,Kidney disease - Abstract
Patients with human immunodeficiency virus (HIV) infection are at increased risk of cardiovascular disease, but studies on HIV as a risk factor for cardiac arrest in the general population are lacking. We aimed to examine the association of HIV infection with out-of-hospital cardiac arrests (OHCAs). We used the Office of Statewide Health Planning and Development data to evaluate HIV infection as a predictor of OHCA in all California emergency department encounters from 2005 to 2015, adjusting for age, gender, race, income, obesity, smoking, alcohol, substance abuse, hypertension (HTN), diabetes, coronary artery disease, congestive heart failure (CHF), atrial fibrillation, and chronic kidney disease (CKD). We also determined patient characteristics modifying these associations by including interaction terms in multivariable-adjusted models. In 18,542,761 patients (mean age 47 ± 20 years, 53% women, 43,849 with HIV) followed for a median 6.8 years, 133,983 new OHCA events occurred. Incidence rates in patients with HIV were higher than in patients without HIV (1.99 vs 1.16 OHCA events per 1,000-person-years follow-up). After multivariable adjustment, HIV was associated with a 2.5-fold higher risk of OHCA (hazard ratio 2.47, 95% confidence interval 2.29 to 2.66, p
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- 2022
40. Lifestyle habits associated with cardiac conduction disease
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Emilie K Frimodt-Møller, Elsayed Z Soliman, Jorge R Kizer, Eric Vittinghoff, Bruce M Psaty, Tor Biering-Sørensen, John S Gottdiener, and Gregory M Marcus
- Subjects
Adult ,Male ,Aging ,Conduction disease ,Bundle-Branch Block ,Clinical Sciences ,Cardiorespiratory Medicine and Haematology ,Cardiovascular ,Cohort Studies ,Electrocardiography ,Habits ,Cardiac Conduction System Disease ,Risk Factors ,Clinical Research ,Humans ,2.1 Biological and endogenous factors ,Aetiology ,Aged ,Nutrition ,Lifestyle habits ,Bundle branch block ,Physical activity ,Prevention ,Heart Disease ,Good Health and Well Being ,Cardiovascular System & Hematology ,Female ,Cardiology and Cardiovascular Medicine ,Atrioventricular block - Abstract
Aims Cardiac conduction disease can lead to syncope, heart failure, and death. The only available therapy is pacemaker implantation, with no established prevention strategies. Research to identify modifiable risk factors has been scant. Methods and results Data from the Cardiovascular Health Study, a population-based cohort study of adults ≥ 65 years with annual 12-lead electrocardiograms obtained over 10 years, were utilized to examine relationships between baseline characteristics, including lifestyle habits, and conduction disease. Of 5050 participants (mean age 73 ± 6 years; 52% women), prevalent conduction disease included 257 with first-degree atrioventricular block, 99 with left anterior fascicular block, 9 with left posterior fascicular block, 193 with right bundle branch block (BBB), 76 with left BBB, and 102 with intraventricular block at baseline. After multivariable adjustment, older age, male sex, a larger body mass index, hypertension, and coronary heart disease were associated with a higher prevalence of conduction disease, whereas White race and more physical activity were associated with a lower prevalence. Over a median follow-up on 7 (interquartile range 1–9) years, 1036 developed incident conduction disease. Older age, male sex, a larger BMI, and diabetes were each associated with incident conduction disease. Of lifestyle habits, more physical activity (hazard ratio 0.91, 95% confidence interval 0.84–0.98, P = 0.017) was associated with a reduced risk, while smoking and alcohol did not exhibit a significant association. Conclusion While some difficult to control comorbidities were associated with conduction disease as expected, a readily modifiable lifestyle factor, physical activity, was associated with a lower risk.
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- 2023
41. Inflammation and Incident Conduction Disease
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Emilie K. Frimodt‐Møller, John S. Gottdiener, Elsayed Z. Soliman, Jorge R. Kizer, Eric Vittinghoff, Bruce M. Psaty, Tor Biering‐Sørensen, and Gregory M. Marcus
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conduction disease ,inflammation ,atrioventricular block ,bundle‐branch block ,Cardiology and Cardiovascular Medicine ,CRP - Published
- 2023
42. Emergency activations for chest pain and ventricular arrhythmias related to regional COVID-19 across the US
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Sidney Aung, Eric Vittinghoff, Gregory Nah, Anthony Lin, Sean Joyce, N. Clay Mann, and Gregory M. Marcus
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Chest Pain ,Epidemiology ,Science ,Acute coronary syndromes ,Arrhythmias ,Cardiovascular ,Article ,Theoretical ,Models ,Clinical Research ,Humans ,Non-ST Elevated Myocardial Infarction ,Heart Disease - Coronary Heart Disease ,Multidisciplinary ,Prevention ,Pain Research ,COVID-19 ,Arrhythmias, Cardiac ,Models, Theoretical ,United States ,Heart Disease ,Good Health and Well Being ,Medicine ,Cardiac - Abstract
Evidence that patients may avoid healthcare facilities for fear of COVID-19 infection has heightened the concern that true rates of myocardial infarctions have been under-ascertained and left untreated. We analyzed data from the National Emergency Medical Services Information System (NEMSIS) and incident COVID-19 infections across the United States (US) between January 1, 2020 and April 30, 2020. Grouping events by US Census Division, multivariable adjusted negative binomial regression models were utilized to estimate the relationship between COVID-19 and EMS cardiovascular activations. After multivariable adjustment, increasing COVID-19 rates were associated with less activations for chest pain and non-ST-elevation myocardial infarctions. Simultaneously, increasing COVID-19 rates were associated with more activations for cardiac arrests, ventricular fibrillation, and ventricular tachycardia. Although direct effects of COVID-19 infections may explain these discordant observations, these findings may also arise from patients delaying or avoiding care for myocardial infarction, leading to potentially lethal consequences.
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- 2021
43. Acute Consumption of Alcohol and Discrete Atrial Fibrillation Events
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Christina D. Fang, Randall J. Lee, Rachel A. Gladstone, Kelsey Ogomori, Vivian Yang, Eric Vittinghoff, Byron K. Lee, Gregory M. Marcus, Emily Lee, Gregory Nah, Isaac R. Whitman, Edward P. Gerstenfeld, Shannon M Fan, Vasanth Vedantham, Henry H. Hsia, Jeffrey E. Olgin, Sean Joyce, Zian H. Tseng, Robin Fatch, Joshua D. Moss, Judith A. Hahn, and Melvin M. Scheinman
- Subjects
Male ,medicine.medical_specialty ,Alcohol Drinking ,Population ,Alcohol abuse ,Alcohol ,Odds ,chemistry.chemical_compound ,Internal medicine ,Atrial Fibrillation ,Internal Medicine ,Humans ,Medicine ,Prospective Studies ,education ,education.field_of_study ,Cross-Over Studies ,business.industry ,Area under the curve ,Atrial fibrillation ,General Medicine ,Odds ratio ,Middle Aged ,medicine.disease ,chemistry ,Ambulatory ,Electrocardiography, Ambulatory ,Blood Alcohol Content ,Female ,business - Abstract
BACKGROUND Patients' self-reports suggest that acute alcohol consumption may trigger a discrete atrial fibrillation (AF) event. OBJECTIVE To objectively ascertain whether alcohol consumption heightens risk for an AF episode. DESIGN A prospective, case-crossover analysis. SETTING Ambulatory persons in their natural environments. PARTICIPANTS Consenting patients with paroxysmal AF. MEASUREMENTS Participants were fitted with a continuous electrocardiogram (ECG) monitor and an ankle-worn transdermal ethanol sensor for 4 weeks. Real-time documentation of each alcoholic drink consumed was self-recorded using a button on the ECG recording device. Fingerstick blood tests for phosphatidylethanol (PEth) were used to corroborate ascertainments of drinking events. RESULTS Of 100 participants (mean age, 64 years [SD, 15]; 79% male; 85% White), 56 had at least 1 episode of AF. Results of PEth testing correlated with the number of real-time recorded drinks and with events detected by the transdermal alcohol sensor. An AF episode was associated with 2-fold higher odds of 1 alcoholic drink (odds ratio [OR], 2.02 [95% CI, 1.38 to 3.17]) and greater than 3-fold higher odds of at least 2 drinks (OR, 3.58 [CI, 1.63 to 7.89]) in the preceding 4 hours. Episodes of AF were also associated with higher odds of peak blood alcohol concentration (OR, 1.38 [CI, 1.04 to 1.83] per 0.1% increase in blood alcohol concentration) and the total area under the curve of alcohol exposure (OR, 1.14 [CI, 1.06 to 1.22] per 4.7% increase in alcohol exposure) inferred from the transdermal ethanol sensor in the preceding 12 hours. LIMITATION Confounding by other time-varying exposures that may accompany alcohol consumption cannot be excluded, and the findings from the current study of patients with AF consuming alcohol may not apply to the general population. CONCLUSION Individual AF episodes were associated with higher odds of recent alcohol consumption, providing objective evidence that a modifiable behavior may influence the probability that a discrete AF event will occur. PRIMARY FUNDING SOURCE National Institute on Alcohol Abuse and Alcoholism.
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- 2021
44. Association of daily physical activity with brain volumes and cervical spinal cord areas in multiple sclerosis
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Valerie J Block, Shuiting Cheng, Jeremy Juwono, Richard Cuneo, Gina Kirkish, Amber M Alexander, Mahir Khan, Amit Akula, Eduardo Caverzasi, Nico Papinutto, William A Stern, Mark J Pletcher, Gregory M Marcus, Jeffrey E Olgin, Stephen L Hauser, Jeffrey M Gelfand, Riley Bove, Bruce AC Cree, and Roland G Henry
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Adult ,Multiple Sclerosis ,brain MRI ,Physical Injury - Accidents and Adverse Effects ,Motor Disorders ,Clinical Sciences ,Walking ,Neurodegenerative ,Fitbit ,Autoimmune Disease ,Disability Evaluation ,spinal cord gray matter area ,Clinical Research ,Humans ,Disabled Persons ,Spinal Cord Injury ,remote monitoring ,Traumatic Head and Spine Injury ,Neurology & Neurosurgery ,Rehabilitation ,Neurosciences ,Brain ,Cervical Cord ,activity level ,Middle Aged ,Magnetic Resonance Imaging ,Brain Disorders ,Physical Rehabilitation ,Spinal Cord ,cervical MRI ,Neurology ,Neurological ,Biomedical Imaging ,Neurology (clinical) ,Atrophy - Abstract
Background: Remote activity monitoring has the potential to evaluate real-world, motor function, and disability at home. The relationships of daily physical activity with spinal cord white matter and gray matter (GM) areas, multiple sclerosis (MS) disability and leg function, are unknown. Objective: Evaluate the association of structural central nervous system pathology with ambulatory disability. Methods: Fifty adults with progressive or relapsing MS with motor disability who could walk >2 minutes were assessed using clinician-evaluated, patient-reported outcomes, and quantitative brain and spinal cord magnetic resonance imaging (MRI) measures. Fitbit Flex2, worn on the non-dominant wrist, remotely assessed activity over 30 days. Univariate and multivariate analyses were performed to assess correlations between physical activity and other disability metrics. Results: Mean age was 53.3 years and median Expanded Disability Status Scale (EDSS) was 4.0. Average daily step counts (STEPS) were highly correlated with EDSS and walking measures. Greater STEPS were significantly correlated with greater C2-C3 spinal cord GM areas (ρ = 0.39, p = 0.04), total cord area (TCA; ρ = 0.35, p = 0.04), and cortical GM volume (ρ = 0.32, p = 0.04). Conclusion These results provide preliminary evidence that spinal cord GM area is a neuroanatomical substrate associated with STEPS. STEPS could serve as a proxy to alert clinicians and researchers to possible changes in structural nervous system pathology.
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- 2022
45. Correction: Individuals’ willingness to provide geospatial global positioning system (GPS) data from their smartphone during the COVID-19 pandemic
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Yulin Hswen, Ulrich Nguemdjo, Elad Yom-Tov, Gregory M Marcus, and Bruno Ventelou
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General Arts and Humanities ,General Social Sciences ,General Economics, Econometrics and Finance ,General Business, Management and Accounting ,General Psychology - Published
- 2022
46. Factors Associated with Long Covid Symptoms in an Online Cohort Study
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Matthew S Durstenfeld, Michael J Peluso, Noah D Peyser, Feng Lin, Sara J Knight, Audrey Djibo, Rasha Khatib, Heather Kitzman, Emily O’Brien, Natasha Williams, Carmen Isasi, John Kornak, Thomas W Carton, Jeffrey E Olgin, Mark J Pletcher, Gregory M Marcus, and Alexis L Beatty
- Subjects
SARS-CoV-2 ,Depression ,Prevention ,COVID-19 ,Brain Disorders ,Post-Acute Sequelae of SARS-CoV-2 ,Mental Health ,Good Health and Well Being ,Infectious Diseases ,Oncology ,patient-reported outcomes ,Clinical Research ,Behavioral and Social Science ,long COVID ,Lung - Abstract
ImportanceProlonged symptoms following SARS-CoV-2 infection, or Long COVID, is common, but few prospective studies of Long COVID risk factors have been conducted.ObjectiveTo determine whether sociodemographic factors, lifestyle, or medical history preceding COVID-19 or characteristics of acute SARS-CoV-2 infection are associated with Long COVID.DesignCohort study with longitudinal assessment of symptoms before, during, and after SARS-CoV-2 infection, and cross-sectional assessment of Long COVID symptoms using data from the COVID-19 Citizen Science (CCS) study.SettingCCS is an online cohort study that began enrolling March 26, 2020. We included data collected between March 26, 2020, and May 18, 2022.ParticipantsAdult CCS participants who reported a positive SARS-CoV-2 test result (PCR, Antigen, or Antibody) more than 30 days prior to May 4, 2022, were surveyed.ExposuresAge, sex, race/ethnicity, education, employment, socioeconomic status/financial insecurity, self-reported medical history, vaccination status, time of infection (variant wave), number of acute symptoms, pre-COVID depression, anxiety, alcohol and drug use, sleep, exercise.Main OutcomePresence of at least 1 Long COVID symptom greater than 1 month after acute infection. Sensitivity analyses were performed considering only symptoms beyond 3 months and only severe symptoms.Results13,305 participants reported a SARS-CoV-2 positive test more than 30 days prior, 1480 (11.1% of eligible) responded to a survey about Long COVID symptoms, and 476 (32.2% of respondents) reported Long COVID symptoms (median 360 days after infection).Respondents’ mean age was 53 and 1017 (69%) were female. Common Long COVID symptoms included fatigue, reported by 230/476 (48.3%), shortness of breath (109, 22.9%), confusion/brain fog (108, 22.7%), headache (103, 21.6%), and altered taste or smell (98, 20.6%). In multivariable models, number of acute COVID-19 symptoms (OR 1.30 per symptom, 95%CI 1.20-1.40), lower socioeconomic status/financial insecurity (OR 1.62, 95%CI 1.02-2.63), pre-infection depression (OR 1.08, 95%CI 1.01-1.16), and earlier variants (OR 0.37 for Omicron compared to ancestral strain, 95%CI 0.15-0.90) were associated with Long COVID symptoms.Conclusions and RelevanceVariant wave, severity of acute infection, lower socioeconomic status and pre-existing depression are associated with Long COVID symptoms.Key PointsQuestionWhat are the patterns of symptoms and risk factors for Long COVID among SARS-CoV-2 infected individuals?FindingsPersistent symptoms were highly prevalent, especially fatigue, shortness of breath, headache, brain fog/confusion, and altered taste/smell, which persisted beyond 1 year among 56% of participants with symptoms; a minority of participants reported severe Long COVID symptoms. Number of acute symptoms during acute SARS-CoV-2 infection, financial insecurity, pre-existing depression, and infection with earlier variants are associated with prevalent Long COVID symptoms independent of vaccination, medical history, and other factors.MeaningSeverity of acute infection, SARS-CoV-2 variant, and financial insecurity and depression are associated with Long COVID symptoms.
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- 2022
47. Time to Get Moving
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Alexis L. Beatty and Gregory M. Marcus
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- 2023
48. Clinical Correlates and Outcomes of Methamphetamine‐Associated Cardiovascular Diseases in Hospitalized Patients in California
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Lara Curran, Gregory Nah, Gregory M. Marcus, Zian Tseng, Michael H. Crawford, and Nisha I. Parikh
- Subjects
Male ,Hypertension, Pulmonary ,Myocardial Infarction ,Cardiorespiratory Medicine and Haematology ,Cardiovascular ,Methamphetamine ,Alcohol Use and Health ,Substance Misuse ,Cocaine ,Clinical Research ,Risk Factors ,Behavioral and Social Science ,pulmonary hypertension ,Humans ,Renal Insufficiency ,Renal Insufficiency, Chronic ,Chronic ,Heart Failure ,MINOCA ,Prevention ,Pulmonary ,Health Services ,stroke ,Brain Disorders ,Alcoholism ,Heart Disease ,Good Health and Well Being ,congestive heart failure ,Cardiovascular Diseases ,Hypertension ,myocardial infarction without coronary artery obstruction ,Mental health ,Cardiology and Cardiovascular Medicine - Abstract
Background Methamphetamine misuse affects 27 million people worldwide and is associated with cardiovascular disease (CVD); however, risk factors for CVD among users have not been well studied. Methods and Results We studied hospitalized patients in California, captured by the Healthcare Cost and Utilization Project database, between 2005 and 2011. We studied the association between methamphetamine use and CVD (pulmonary hypertension, heart failure, stroke, and myocardial infarction). Among 20 249 026 persons in the Healthcare Cost and Utilization Project, 66 199 used methamphetamines (median follow‐up 4.58 years). Those who used were more likely younger (33 years versus 45 years), male (63.3% versus 44.4%), smoked, misused alcohol, and had depression and anxiety compared with nonusers. Methamphetamine use was associated with the development of heart failure (hazard ratio [HR], 1.53 [95% CI, 1.45–1.62]) and pulmonary hypertension (HR, 1.42 [95% CI, 1.26–1.60]). Among users, male sex (HR, 1.73 [95% CI, 1.37–2.18]) was associated with myocardial infarction. Chronic kidney disease (HR, 2.38 [95% CI, 1.74–3.25]) and hypertension (HR, 2.26 [95% CI, 2.03–2.51]) were strong risk factors for CVD among users. When compared with nonuse, methamphetamine use was associated with a 32% significant increase in CVD, alcohol abuse with a 28% increase, and cocaine use with a 47% increase in CVD. Conclusions Methamphetamine use has a similar magnitude of risk of CVD compared with alcohol and cocaine. Prevention and treatment could be focused on those with chronic kidney disease, hypertension, and mental health disorders.
- Published
- 2022
49. PO-01-136 SAFETY AND EFFICACY OF 375 MCG DOSE OF DOFETILIDE IN PATIENTS WITH ATRIAL FIBRILLATION
- Author
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Nitish Badhwar, Gerilynn M. Schott, Melvin M. Scheinman, and Gregory M. Marcus
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
50. PO-01-197 THE EPIDEMIOLOGY OF EXTRACRANIAL INFARCTS IN A POPULATION-BASED COHORT WITH ATRIAL FIBRILLATION
- Author
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Alexander P. Cabulong, Janet Tang, Thomas A. Dewland, and Gregory M. Marcus
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
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