Hemolysis in Patients Supported with Durable, Long-Term Left Ventricular Assist Device Therapy
|
|
- Corey Baker
- 7 years ago
- Views:
Transcription
1 Hemolysis in Patients Supported with Durable, Long-Term Left Ventricular Assist Device Therapy Jason N. Katz, MD,MHS; Brian C. Jensen, MD; Patricia P. Chang, MD, MHS; Susan L. Myers, BBA; Francis D. Pagani, MD, PhD; James K. Kirklin, MD
2 None DISCLOSURES
3 BACKGROUND Despite the beneficial effects of LVAD therapy, most patients will suffer an adverse event after device implantation Hemolysis is a known complication of MCS 1 out of 10 in patients with short-term support 1 Rare early after durable LVAD placement? 2 1 Bennett M, et al. Perfusion Genovese EA, et al. Ann Thorac Surg 2009.
4 BACKGROUND HeartMate II Destination Trial 1 Hemolysis incidence 4% (0.02 events/pt-yr) HeartMate II Bridge-to-Transplant Trial 2 Hemolysis incidence 4% (0.06 events/pt-yr) 1 Slaughter MS, et al. NEJM Pagani FD, et al. JACC 2009.
5 BACKGROUND Hemocompatibility with LVAD impacted by: Blood-surface interactions Alterations in flow-dynamics Changes in coagulation Abnormalities of host immunity Not only is epidemiology of hemolysis in contemporary LVAD populations unclear, but so too are the clinical consequences
6 METHODS Data obtained from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) represents 117 centers All adult patients with a primary, intracorporeal, CF-LVAD between Jun Mar 2012 Descriptive statistics, χ 2, Fisher s exact test, t- test, and Wilcoxon rank-sum test
7 METHODS Hemolysis Event Plasma-free hemoglobin >40 mg/dl, in association with clinical signs of hemolysis, when occurring at least 72 hours following LVAD implantation
8 METHODS Survival analysis performed using Kaplan- Meier method, with censoring for heart transplantation or cardiac recovery Stratified time-to-event curves compared using the log-rank test
9 DERIVATION OF STUDY POPULATION
10 BASELINE CHARACTERISTICS VARIABLE NO HEMOLYSIS HEMOLYSIS P-VALUE Age (yrs) < Male sex 79.4% 72.3% 0.01 White race 70.2% 67.7% 0.39 BMI (kg/m2) INTERMACS % 14.2% 0.99 INTERMACS % 44.2% 0.21 INTERMACS % 22.3% 0.18 INTERMACS % 13.1% 0.91 INTERMACS 5 3.3% 3.1% 0.84 INTERMACS 6 1.9% 1.2% 0.39 INTERMACS 7 0.9% 1.9% 0.11
11 BASELINE CHARACTERISTICS VARIABLE NO HEMOLYSIS HEMOLYSIS P-VALUE Destination Therapy 29.0% 28.5% 0.85 Diabetes 39.2% 41.5% 0.46 CVD 7.9% 8.7% 0.68 Prior CABG 22.9% 17.7% 0.05 Prior Valve Surgery 7.3% 5.4% 0.24 Concomitant Rx Inotrope 80.2% 82.7% 0.32 IABP 31.6% 33.1% 0.62 ECMO 2.0% 2.7% 0.20 No differences in baseline lab values, baseline hemodynamics, or other evaluable characteristics prior to implant
12 Younger age (<60yrs) independently associated with hemolysis, p=0.01
13
14
15 CAUSE OF DEATH PRIMARY CAUSE OF DEATH NO HEMOLYSIS (N=863) HEMOLYSIS (N=80) CVA 10.2% 16.3% Infection 10.3% 3.8% Right Ventricular Failure 4.6%% 7.5% Hepatic Failure 1.0% 6.3% Renal Failure 2.0% 2.5% Device Malfunction 1.6% 3.8% Hemorrhage 9.4% 5.0% Unknown/Undocumented 12.2% 22.5% Other 22.9% 21.3%
16 Device Malfunction Due to Suspected or Confirmed Thrombosis
17 Patients, N=260 Device malfunction due to thrombus, N=27
18 Need for Device Exchange
19 20% chance of needing device exchange early after event
20 Events Stratified by Year
21 Adult Primary Continuous Flow LVADs, n=4850 Time to 1 st Hemolysis Event by Implant Year Freedom from Hemolysis P(overall) =.005 % freedom post Implant Year n events implant at 3 months % % % % 2012 (March) % Months post implant
22 STUDY LIMITATIONS Retrospective study design Candidate variables limited to those collected routinely in INTERMACS no reliable data on pump speed, cannula position Limited data on concomitant meds (esp. antiplatelet & antithrombotic therapies) More contemporary INTERMACS hemolysis definition (employing LDH & risk stratifying minor and major events) not used
23 CONCLUSIONS Hemolysis is relatively common in realworld CF-LVAD populations Survival is significantly reduced following a hemolytic event and device exchange is common Need to develop consistent definitions for hemolysis, particularly ones that are reliable despite evolving technologies, patient characteristics, and indications
24 CONCLUSIONS These findings should not temper our enthusiasm for VAD therapy, but rather should compel us to focus on key care processes and best practice principles which will allow our patients to reap greater benefits from the technology Future evaluation should focus on device and implant characteristics leading to hemolysis, as well as appropriate strategies for optimally defining, detecting and managing these events
25 THANK YOU.
Elevated heart rate at twelve months after heart transplantation is an independent predictor of long term mortality
Elevated heart rate at twelve months after heart transplantation is an independent predictor of long term mortality C. Tomas, MA Castel, E Roig, I. Vallejos, C. Plata, F. Pérez-Villa Cardiology Department,
More informationFunctional Improvement for Heart Failure Patients After Left Ventricular Assistive Device Placement in a Free Standing Rehabilitation Hospital
Functional Improvement for Heart Failure Patients After Left Ventricular Assistive Device Placement in a Free Standing Rehabilitation Hospital Vittal R. Nagar, M.D, PhDc PGY II Mentor: Robert Nickerson,
More informationBerlin Heart EXCOR Ventricular Assist Device
First transportation on a Berlin Heart LVAD as a bridge to transplantation to Arkansas Children s Hospital Dorothy Garbin, CCP Berlin Heart EXCOR Ventricular Assist Device Pediatric pulsatile assist device
More informationObjectives. Preoperative Cardiac Risk Stratification for Noncardiac Surgery. History
Preoperative Cardiac Risk Stratification for Noncardiac Surgery Kimberly Boddicker, MD FACC Essentia Health Heart and Vascular Center 27 th Heart and Vascular Conference May 13, 2011 Objectives Summarize
More informationMechanical Circulatory Support and End of Life Care. 10 th Annual Interdisciplinary Transplant Symposium 24 September 2015
Mechanical Circulatory Support and End of Life Care 10 th Annual Interdisciplinary Transplant Symposium 24 September 2015 Nicole Huhn, APRN VAD Coordinator Center for Advanced Heart Failure & Transplant
More informationNew in Atrial Fibrillation
New in Atrial Fibrillation September 2011 Stroke prevention more options Rhythm Control -drugs - alternatives to drugs; ablation Rate Control - pace + ablate A-FIB Dell Stroke Risk AFib Two Principles
More informationClinical Commissioning Policy Statement: Percutaneous mitral valve leaflet repair for mitral regurgitation April 2013. Reference: NHSCB/A09/PS/b
Clinical Commissioning Policy Statement: Percutaneous mitral valve leaflet repair for mitral regurgitation April 2013 Reference: NHS Commissioning Board Clinical Commissioning Policy Statement: Percutaneous
More information2/20/2015. KPNW Region. NW Service Delivery History
KPNW Region Service area=17 counties in 2 states; approximately 504,400 members Building an Integrated Heart Failure Transplant Program The KPNW Experience Kathy A. Crispell, MD, FACC, Department of Cardiology
More informationListen to your heart: Good Cardiovascular Health for Life
Listen to your heart: Good Cardiovascular Health for Life Luis R. Castellanos MD, MPH Assistant Clinical Professor of Medicine University of California San Diego School of Medicine Sulpizio Family Cardiovascular
More informationHeart Failure in Quebec - A Case Study of Interrelated Value
Summary Evaluation of the evidence on the HeartMate II and HeartWare ventricular assist devices for the treatment of chronic end-stage heart failure September 2012 A production of the Institut national
More informationHeart transplantation
Heart transplantation A patient s guide 1 Heart transplantation Heart transplantation has the potential to significantly improve the length and quality of life for patients with severe heart failure.
More information*6816* 6816 CONSENT FOR DECEASED KIDNEY DONOR ORGAN OPTIONS
The shortage of kidney donors and the ever-increasing waiting list has prompted the transplant community to look at different types of organ donors to meet the needs of our patients on the waiting list.
More informationSection III. Heart Mate II (2 nd Generation) III.41.1 EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC A Ventricular Assist Device, or VAD, is a mechanical device used to substantially support circulation in a patient with significant cardiac ventricular dysfunction.
More information嘉 義 長 庚 醫 院 藥 劑 科 Speaker : 翁 玟 雯
The Clinical Efficacy and Safety of Sodium Glucose Cotransporter-2 (SGLT2) Inhibitors in Adults with Type 2 Diabetes Mellitus 嘉 義 長 庚 醫 院 藥 劑 科 Speaker : 翁 玟 雯 Diabetes Mellitus : A group of diseases characterized
More informationGUIDELINES IN ANTIPLATELET AND ANTICOAGULATION RX IN CARDIAC SURGERY
BLOOD CONSERVATION STRATEGIES IN CARDIAC SURGERY: MORE IS BETTER GUIDELINES IN ANTIPLATELET AND ANTICOAGULATION RX IN CARDIAC SURGERY DIMITRIOS V. AVGERINOS MD, PhD, FACS, FACC Department of Cardiac Surgery,
More informationManagement of Pacing Wires After Cardiac Surgery
Management of Pacing Wires After Cardiac Surgery David E. Lizotte, Jr. PA C, MPAS, FAPACVS President, Association of Physician Assistants in Cardiovascular Surgery Conflicts: None Indications 2008 Journal
More informationInpatient Heart Failure Management: Risks & Benefits
Inpatient Heart Failure Management: Risks & Benefits Dr. Kenneth L. Baughman Professor of Medicine Harvard Medical School Director, Advanced Heart Disease Section Brigham & Women's Hospital Harvard Medical
More informationImpact of Diabetes on Treatment Outcomes among Maryland Tuberculosis Cases, 2004-2005. Tania Tang PHASE Symposium May 12, 2007
Impact of Diabetes on Treatment Outcomes among Maryland Tuberculosis Cases, 2004-2005 Tania Tang PHASE Symposium May 12, 2007 Presentation Outline Background Research Questions Methods Results Discussion
More informationMEDICAL POLICY SUBJECT: VENTRICULAR ASSIST DEVICES. POLICY NUMBER: 7.01.07 CATEGORY: Technology Assessment
MEDICAL POLICY SUBJECT: VENTRICULAR ASSIST DEVICES PAGE: 1 OF: 7 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product, including
More informationSteven J. Yakubov, MD FACC For the CoreValve US Clinical Investigators
Long-Term Outcomes Using a Self- Expanding Bioprosthesis in Patients With Severe Aortic Stenosis Deemed Extreme Risk for Surgery: Two-Year Results From the CoreValve US Pivotal Trial Steven J. Yakubov,
More informationCope Sample Small. Jeffrey T. Cope, M.D., Susan L. Sample, MSN, CRNP, and Roy S. Small, M.D.
Mechanical Cardiac Assist in a Community Hospital without Transplantation Cope Sample Small Jeffrey T. Cope, M.D., Susan L. Sample, MSN, CRNP, and Roy S. Small, M.D. Cardiothoracic Surgery and Cardiology
More informationSepsis: Identification and Treatment
Sepsis: Identification and Treatment Daniel Z. Uslan, MD Associate Clinical Professor Division of Infectious Diseases Medical Director, UCLA Sepsis Task Force Severe Sepsis: A Significant Healthcare Challenge
More informationUse of Nucleic Acid Amplification Tests in TB patients in California 2010-2012
Use of Nucleic Acid Amplification Tests in TB patients in California 2010-2012 Lisa Pascopella, PhD, MPH Pennan Barry, MD, MPH Tuberculosis Control Branch, Division of Communicable Disease Control, Center
More informationJames F. Kravec, M.D., F.A.C.P
James F. Kravec, M.D., F.A.C.P Chairman, Department of Internal Medicine, St. Elizabeth Health Center Chair, General Internal Medicine, Northeast Ohio Medical University Associate Medical Director, Hospice
More informationEarly mortality rate (EMR) in Acute Myeloid Leukemia (AML)
Early mortality rate (EMR) in Acute Myeloid Leukemia (AML) George Yaghmour, MD Hematology Oncology Fellow PGY5 UTHSC/West cancer Center, Memphis, TN May,1st,2015 Off-Label Use Disclosure(s) I do not intend
More informationThe author has no disclosures
Mary Bradbury, PharmD, BCPS Clinical Pharmacy Specialist, Cardiac Surgery September 18, 2012 Mary.bradbury@inova.org This presentation will discuss unlabeled and investigational use of products The author
More informationThromboembolic stroke in patients with a HeartMate-II left ventricular assist device the role of anticoagulation
van den Bergh et al. Journal of Cardiothoracic Surgery (2015) 10:128 DOI 10.1186/s13019-015-0333-7 RESEARCH ARTICLE Open Access Thromboembolic stroke in patients with a HeartMate-II left ventricular assist
More informationNone. Dual Antiplatelet Therapy Plus Systemic Anticoagulation: Bleeding Risk and Management. 76 year old male LINGO 1/5/2015
Financial Disclosure Information Dual Antiplatelet Therapy Plus Systemic Anticoagulation: Bleeding Risk and Management Robert D. McBane, M.D. Division of Cardiology Mayo Clinic Rochester Dual Antiplatelet
More informationSupplementary Online Content
Supplementary Online Content Arterburn DE, Olsen MK, Smith VA, Livingston EH, Van Scoyoc L, Yancy WS, Jr. Association Between Bariatric Surgery and Long-Term Survival. JAMA. doi:10.1001/jama.2014.16968.
More informationAtrial Fibrillation The Basics
Atrial Fibrillation The Basics Family Practice Symposium Tim McAveney, M.D. 10/23/09 Objectives Review the fundamentals of managing afib Discuss the risks for stroke and the indications for anticoagulation
More informationCirrhosis and HCV. Jonathan Israel M.D.
Cirrhosis and HCV Jonathan Israel M.D. Outline Relationship of fibrosis and cirrhosisprevalence and epidemiology. Sequelae of cirrhosis Diagnosis of cirrhosis Effect of cirrhosis on efficacy of treatment
More informationAppendix G - Identification and Selection of Studies
FINAL Emergency framework for rationing of blood for massively bleeding patients during a red phase of a Appendix G - Identification and Selection of Studies Inclusion/Exclusion Criteria We included studies
More informationDVT/PE Management with Rivaroxaban (Xarelto)
DVT/PE Management with Rivaroxaban (Xarelto) Rivaroxaban is FDA approved for the acute treatment of DVT and PE and reduction in risk of recurrence of DVT and PE. FDA approved indications: Non valvular
More informationUtilizing the Cath Lab for Cardiac Arrest
Utilizing the Cath Lab for Cardiac Arrest Khaled M. Ziada, MD Director, Cardiovascular Catheterization Laboratories Gill Heart Institute, University of Kentucky UK/AHA Strive to Revive Symposium May 2013
More informationDevice Therapy: the future is now.
Device Therapy: the future is now. Mariell Jessup MD FAHA, FACC, FESC Professor of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA Disclosure: Mariell Jessup MD University of Pennsylvania
More informationSurgeons Role in Atrial Fibrillation
Atrial Fibrillation Surgeons Role in Atrial Fibrillation Steven J Feldhaus, MD, FACS 2015 Cardiac Symposium September 18, 2015 Stages of Atrial Fibrillation Paroxysmal (Intermittent) Persistent (Continuous)
More informationAdvanced Heart Failure & Transplantation Fellowship Program
Advanced Heart Failure & Transplantation Fellowship Program Curriculum I. Patient Care When on the inpatient Heart Failure and Transplant Cardiology service, the cardiology fellow will hold primary responsibility
More informationFDA Considerations Regarding Frequent Plasma Collection Procedures
FDA Considerations Regarding Frequent Plasma Collection Procedures Alan E. Williams, Ph.D. Office of Blood Research and Review Center for Biologics Evaluation and Research US Food and Drug Administration
More informationINTRAPERITONEAL HYPERTHERMIC CHEMOTHERAPY (IPHC) FOR PERITONEAL CARCINOMATOSIS AND MALIGNANT ASCITES. INFORMATION FOR PATIENTS AND FAMILY MEMBERS
INTRAPERITONEAL HYPERTHERMIC CHEMOTHERAPY (IPHC) FOR PERITONEAL CARCINOMATOSIS AND MALIGNANT ASCITES. INFORMATION FOR PATIENTS AND FAMILY MEMBERS Description of Treatment A major difficulty in treating
More informationAnticoagulation For Atrial Fibrillation
Anticoagulation For Atrial Fibrillation New Agents In A New Era Arjun V Gururaj, MD Arrhythmia and Electrophysiology Nevada Heart and Vascular Center Disclosures Biotronik Speaker Clinical investigator
More informationELSO GUIDELINES FOR TRAINING AND CONTINUING EDUCATION OF ECMO SPECIALISTS
ELSO GUIDELINES FOR TRAINING AND CONTINUING EDUCATION OF ECMO SPECIALISTS PURPOSE The "" is a document developed by the Extracorporeal Life Support Organization (ELSO) as a reference for current and future
More informationGuidance for Industry
Guidance for Industry Cancer Drug and Biological Products Clinical Data in Marketing Applications U.S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and
More informationHydrodynamic characteristics of prosthetic heart valves Cardiamed
Hydrodynamic characteristics of prosthetic heart valves Cardiamed Hydrodynamic characteristics of blood flow passing through a prosthetic heart valve have profound effect on the activation of thrombus
More informationA Patient s Guide to Primary and Secondary Prevention of Cardiovascular Disease Using Blood-Thinning (Anticoagulant) Drugs
A Patient s Guide to Primary and Secondary Prevention of PATIENT EDUCATION GUIDE What Is Cardiovascular Disease? Cardiovascular disease (CVD) is a broad term that covers any disease of the heart and circulatory
More informationSTROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE
STROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE CASE REPORT: ACUTE STROKE MANAGEMENT 90 YEAR OLD WOMAN, PREVIOUSLY ACTIVE AND INDEPENDENT, CHRONIC ATRIAL FIBRILLATION,
More informationChristopher M. Wright, MD, MBA Pioneer Cardiovascular Consultants Tempe, Arizona
Christopher M. Wright, MD, MBA Pioneer Cardiovascular Consultants Tempe, Arizona Areas to be covered Historical, current, and future treatments for various cardiovascular disease: Atherosclerosis (Coronary
More informationDEVICE RECALLS: The Era of Regulation and Outcome Metrics: Optimizing Benefits and Managing Risks
DEVICE RECALLS: The Era of Regulation and Outcome Metrics: Optimizing Benefits and Managing Risks Kenneth A. Ellenbogen, MD Kontos Professor & Chairman Virginia Commonwealth University School of Medicine
More informationNovember 15, 2013. Ann Laramee MS ANP-BC ACNS-BC CHFN FletcherAllen.org
Advance Care Planning with Heart Failure: Results of a Primary Care Practitioners Needs Survey 5 th Annual Nursing Research and Evidence Based Practice Symposium November 15, 2013 Ann Laramee MS ANP-BC
More informationStroke Risk Scores. CHA 2 DS 2 -VASc. CHA 2 DS 2 -VASc Scoring Table 2
Bleeding/Clotting Risk Evaluation Tools for Atrial Fibrillation Patients Before prescribing anticoagulants, providers should weigh the risk of thrombosis against the risk of bleeding. The tools below can
More informationMedical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South
Medical management of CHF: A New Class of Medication Al Timothy, M.D. Cardiovascular Institute of the South Disclosures Speakers Bureau for Amgen Background Chronic systolic congestive heart failure remains
More informationListen to Your Heart. What Everyone Needs To Know About Atrial Fibrillation & Stroke. The S-ICD System. The protection you need
Listen to Your Heart The S-ICD System What Everyone Needs To Know About Atrial Fibrillation & Stroke The protection you need without Stroke. touching Are you your at heart risk? Increase your knowledge.
More informationSubstandard Underwriting Structured Settlements
Substandard Underwriting Structured Settlements Structures 101-Back to Basics February 20-22, 2013 Las Vegas, Nevada Rosemary Brindamour BSN CSSC Chief Medical Underwriter Structured Settlement Underwriting
More informationAnticoagulants in Atrial Fibrillation
Anticoagulants in Atrial Fibrillation Starting and Stopping Them Safely Carmine D Amico, D.O. Overview Learning objectives Introduction Basic concepts Treatment strategy & options Summary 1 Learning objectives
More informationStage IV Renal Cell Carcinoma. Changing Management in A Comprehensive Community Cancer Center. Susquehanna Health Cancer Center
Stage IV Renal Cell Carcinoma Changing Management in A Comprehensive Community Cancer Center Susquehanna Health Cancer Center 2000 2009 Warren L. Robinson, MD, FACP January 27, 2014 Introduction 65,150
More informationrenal transplantation: A single-center comparative study
Impact of posterior urethral valves on pediatric renal transplantation: A single-center comparative study BY Mohamed Kamal Gheith, MD Oberarzt die Urologie, Universitätsmedizin Mainz Ass. Prof. of Urology,
More informationPRACTICE PROBLEMS FOR BIOSTATISTICS
PRACTICE PROBLEMS FOR BIOSTATISTICS BIOSTATISTICS DESCRIBING DATA, THE NORMAL DISTRIBUTION 1. The duration of time from first exposure to HIV infection to AIDS diagnosis is called the incubation period.
More informationSt Lucia Diabetes and Hypertension Screening and Disease Management Programs
St Lucia Diabetes and Hypertension Screening and Disease Management Programs Michael Graven, MD, MSc,, MPH, FAAP Health Informatics and Neonatal Pediatrics Dalhousie University Halifax, Nova Scotia CANADA
More informationAntiplatelet and Antithrombotics From clinical trials to guidelines
Antiplatelet and Antithrombotics From clinical trials to guidelines Ashraf Reda, MD, FESC Prof and head of Cardiology Dep. Menofiya University Preisedent of EGYBAC Chairman of WGLVR One of the big stories
More informationMitral Valve Repair versus Replacement for Severe Ischemic Mitral Regurgitation. Michael Acker, MD For the CTSN Investigators AHA November 2013
Mitral Valve Repair versus Replacement for Severe Ischemic Mitral Regurgitation Michael Acker, MD For the CTSN Investigators AHA November 2013 Acknowledgements Supported by U01 HL088942 Cardiothoracic
More informationPHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES.
PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES. Hossam Bahy, MD (1992 2012), 19 tools have been identified 11 stroke scores 1
More informationDenominator Statement: Cardiac surgery patients with no evidence of prior infection.
Last Updated: Version 4.3b NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE Measure Information Form CMS/The Joint Commission: Suspended (Effective immediately beginning with July 1, 2014 discharges)
More informationCurrent Renal Replacement Therapy in Korea - Insan Memorial Dialysis Registry, 2011 - ESRD Registry Committee, Korean Society of Nephrology*
Current Renal Replacement Therapy in Korea - Insan Memorial Dialysis Registry, 2011 - ESRD Registry Committee, Korean Society of Nephrology* =Abstracts= Registry committee of Korean Society of Nephrology
More informationThe State of the Liver in the Adult Patient after Fontan Palliation
The State of the Liver in the Adult Patient after Fontan Palliation Fred Wu, M.D. Boston Adult Congenital Heart Service Boston Children s Hospital/Brigham & Women s Hospital 7 th National Adult Congenital
More informationClinical Research on Lifestyle Interventions to Treat Obesity and Asthma in Primary Care Jun Ma, M.D., Ph.D.
Clinical Research on Lifestyle Interventions to Treat Obesity and Asthma in Primary Care Jun Ma, M.D., Ph.D. Associate Investigator Palo Alto Medical Foundation Research Institute Consulting Assistant
More informationScottish Diabetes Survey 2014. Scottish Diabetes Survey Monitoring Group
Scottish Diabetes Survey 2014 Scottish Diabetes Survey Monitoring Group Contents Table of Contents Contents... 2 Foreword... 4 Executive Summary... 6 Prevalence... 8 Undiagnosed diabetes... 21 Duration
More informationEvidence-Based Secondary Stroke Prevention and Adherence to Guidelines
Evidence-Based Secondary Stroke Prevention and Adherence to Guidelines Mitchell S.V. Elkind, MD, MS Associate Professor of Neurology Columbia University New York, NY Presenter Disclosure Information Mitchell
More information4/8/13. Pre-test Audience Response. Prostate Cancer 2012. Screening and Treatment of Prostate Cancer: The 2013 Perspective
Pre-test Audience Response Screening and Treatment of Prostate Cancer: The 2013 Perspective 1. I do not offer routine PSA screening, and the USPSTF D recommendation will not change my practice. 2. In light
More informationPRECOMBAT Trial. Seung-Whan Lee, MD, PhD On behalf of the PRECOMBAT Investigators
Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease PRECOMBAT Trial Seung-Whan Lee, MD, PhD On behalf
More informationDH Cardiac Rehabilitation Commissioning Pack: highlights and process. Prof Patrick Doherty BACR conference Liverpool 2010
DH Cardiac Rehabilitation Commissioning Pack: highlights and process Prof Patrick Doherty BACR conference Liverpool 2010 CR commissioning pack working groups: led by SCDU and NHS Improvement 1. A reference
More informationThe Arguments: T2DM - tremendous economic burden globally Lifestyle / Pharm Rx:
James Cromie The Arguments: T2DM - tremendous economic burden globally Lifestyle / Pharm Rx: INEFFECTIVE and UNSUSTAINED Bariatric surgery is an Effective and Durable treatment option Well established
More informationNew Anticoagulants and GI bleeding
New Anticoagulants and GI bleeding DR DANNY MYERS MD FRCP(C) CLINICAL ASSISTANT PROFESSOR OF MEDICINE, UBC Conflicts of Interest None I am unbiased in the use of NOAC s vs Warfarin based on risk benefit
More informationUsing Clinical Registries to Create Evidence-based Health Care Policy : Experiences from Ontario, Canada
Using Clinical Registries to Create Evidence-based Health Care Policy : Experiences from Ontario, Canada April 2009 Jack V. Tu, MD PhD FRCPC CANADA RESEARCH CHAIR IN HEALTH SERVICES RESEARCH Institute
More informationKidneys. Kidney Failure4. Transplantation
Kidneys & Kidney Failure4 Transplantation This booklet helps you understand the process of transplantation. It defines the criteria for a donor and the recipient. It also clearly explains the concepts
More informationHeartWare Ventricular Assist System Instructions for Use
HeartWare Ventricular Assist System Instructions for Use Caution: Federal law restricts this device to sale by or on the order of a physician. TABLE OF CONTENTS 1.0 INTRODUCTION... 1 2.0 INDICATIONS FOR
More informationInterpretation of Laboratory Values
Interpretation of Laboratory Values Konrad J. Dias PT, DPT, CCS Overview Electrolyte imbalances Renal Function Tests Complete Blood Count Coagulation Profile Fluid imbalance Sodium Electrolyte Imbalances
More informationSponsor. Novartis Generic Drug Name. Vildagliptin. Therapeutic Area of Trial. Type 2 diabetes. Approved Indication. Investigational.
Clinical Trial Results Database Page 1 Sponsor Novartis Generic Drug Name Vildagliptin Therapeutic Area of Trial Type 2 diabetes Approved Indication Investigational Study Number CLAF237A2386 Title A single-center,
More informationContegra Pulmonary Valved Conduit Humanitarian Device Exemption (HDE) H020003
Presentation to the Pediatric Advisory Committee September 16, 2015 Contegra Pulmonary Valved Conduit Humanitarian Device Exemption (HDE) H020003 George Aggrey, MD, MPH Epidemiologist Division of Epidemiology
More informationTestosterone Treatment in Older Men
Testosterone Treatment in Older Men J. Bruce Redmon, M.D. Professor Division of Endocrinology Departments of Medicine and Urologic Surgery Disclosure Information I have no financial relationships to disclose.
More informationUniversity of Ulsan College of Medicine, Asan Medical Center on behalf of the REAL-LATE and the ZEST-LATE trial
Duration of Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation A Pooled Analysis of the REAL-LATE and the ZEST-LATE Trial Seung-Jung Park MD PhD Seung-Jung Park, MD, PhD, University of Ulsan
More informationPrognostic impact of uric acid in patients with stable coronary artery disease
Prognostic impact of uric acid in patients with stable coronary artery disease Gjin Ndrepepa, Siegmund Braun, Martin Hadamitzky, Massimiliano Fusaro, Hans-Ullrich Haase, Kathrin A. Birkmeier, Albert Schomig,
More informationDabigatran (Pradaxa) Guidelines
Dabigatran (Pradaxa) Guidelines Dabigatran is a new anticoagulant for reducing the risk of stroke in patients with atrial fibrillation. Dabigatran is a direct thrombin inhibitor, similar to warfarin, without
More information4/9/2015. Risk Stratify Our Patients. Stroke Risk in AF: CHADS2 Scoring system JAMA 2001; 285: 2864-71
Anticoagulation in the 21 st Century Adam Karpman, D.O. Saint Francis Medical Center/Oklahoma State University Medical Center Disclosures: None Atrial Fibrillation Most common arrhythmia in clinical practice.
More informationSaint Francis Kidney Transplant Program Issue Date: 6/9/15
Kidney Transplant Candidate Informed Consent Education Here are educational materials about Kidney Transplant. Please review and read these before your evaluation visit. The RN Transplant Coordinator will
More informationType II Pulmonary Hypertension: Pulmonary Hypertension due to Left Heart Disease
Heart Failure Center Hadassah University Hospital Type II Pulmonary Hypertension: Pulmonary Hypertension due to Left Heart Disease Israel Gotsman MD The Heart Failure Center, Heart Institute Hadassah University
More informationMaintenance Steroid Avoidance in Pediatric Heart Transplantation is Associated with Excellent Graft Survival
Maintenance Steroid Avoidance in Pediatric Heart Transplantation is Associated with Excellent Graft Survival Scott Auerbach, MD, Jane Gralla, PhD, Shelley Miyamoto, MD, David Campbell, MD, and Biagio Pietra,
More informationThe Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy
The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy Cindy Goodrich RN, MS, CCRN Content Description Sepsis is caused by widespread tissue injury and systemic inflammation resulting
More informationDescription of the OECD Health Care Quality Indicators as well as indicator-specific information
Appendix 1. Description of the OECD Health Care Quality Indicators as well as indicator-specific information The numbers after the indicator name refer to the report(s) by OECD and/or THL where the data
More informationWorldwide Experience with S-ICD: Early results from the EFFORTLESS Registry
Worldwide Experience with S-ICD: Early results from the EFFORTLESS Registry Results published in European Heart Journal (March 2014) Pier D. Lambiase, Craig Barr, Dominic A.M.J. Theuns, Reinoud Knops,
More informationStatins and Risk for Diabetes Mellitus. Background
Statins and Risk for Diabetes Mellitus Kevin C. Maki, PhD, FNLA Midwest Center for Metabolic & Cardiovascular Research and DePaul University, Chicago, IL 1 Background In 2012 the US Food and Drug Administration
More informationSystolic Blood Pressure Intervention Trial (SPRINT) Principal Results
Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results Paul K. Whelton, MB, MD, MSc Chair, SPRINT Steering Committee Tulane University School of Public Health and Tropical Medicine, and
More informationEnvironmental Health Science. Brian S. Schwartz, MD, MS
Environmental Health Science Data Streams Health Data Brian S. Schwartz, MD, MS January 10, 2013 When is a data stream not a data stream? When it is health data. EHR data = PHI of health system Data stream
More informationResearch Skills for Non-Researchers: Using Electronic Health Data and Other Existing Data Resources
Research Skills for Non-Researchers: Using Electronic Health Data and Other Existing Data Resources James Floyd, MD, MS Sep 17, 2015 UW Hospital Medicine Faculty Development Program Objectives Become more
More informationJUL 2 2008. Ms. Kendra Basler Regulatory Affairs Associate Abbott Vascular Cardiac Therapies 3200 Lakeside Drive Santa Clara, CA 95054-2807
DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service JUL 2 2008 Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850 Ms. Kendra Basler Regulatory Affairs Associate Abbott Vascular
More informationAccording to the American Heart Association, approximately 5.7 million persons more than
Feature Destination to Nowhere: A New Look at Aggressive Treatment for Heart Failure A Case Study BRIAN J. O NEILL, DNP, APRN, ANP-BC, CCRN-CSC MEREDITH W. KAZER, PhD, CNL, APRN, A/GNP-BC Approximately
More informationAtrial Fibrillation: A Different Perspective. Michael Heffernan MD PhD FRCPC FACC Staff Cardiologist Oakville Hospital
Atrial Fibrillation: A Different Perspective Michael Heffernan MD PhD FRCPC FACC Staff Cardiologist Oakville Hospital Faculty/Presenter Disclosure Faculty: Dr. Michael Heffernan Relationships with commercial
More informationIC 3 : Improving Continuous Cardiac Care Quality Improvement in Practice
IC 3 : Improving Continuous Cardiac Care Quality Improvement in Practice Presenter Disclosure Information Paul Chan, MD FINANCIAL DISCLOSURE: None FUNDING FOR THE IC3 PROGRAM: Bristol-Myers Squibb / Sanofi
More informationElectrocardiographic Issues in Williams Syndrome
Electrocardiographic Issues in Williams Syndrome R. Thomas Collins II, MD Assistant Professor, Pediatrics and Internal Medicine University of Arkansas for Medical Sciences Arkansas Children s Hospital
More informationTYSABRI Risk Management Plan. Carmen Bozic, MD Vice President Drug Safety and Risk Management Biogen Idec Inc
76 TYSABRI Risk Management Plan Carmen Bozic, MD Vice President Drug Safety and Risk Management Biogen Idec Inc 77 Presentation Outline Overview and Goals of Plan Risk Minimization Plan Risk Assessment
More informationTips for surviving the analysis of survival data. Philip Twumasi-Ankrah, PhD
Tips for surviving the analysis of survival data Philip Twumasi-Ankrah, PhD Big picture In medical research and many other areas of research, we often confront continuous, ordinal or dichotomous outcomes
More information9/4/2013. Medicare NCD for Qualifying Trials. Coverage Based on Medical Necessity. Medicare National Coverage Determinations (NCD) for Clinical Trials
DUHS Compliance Presentation Date: September 11, 2013 Medicare National Coverage Determinations (NCD) for Clinical Trials Presented by Jan Collins, Compliance Auditor for Clinical Trials Page 1 Medicare
More information