A5000351033- Cardiac, Anesthesia and Surgical Outcomes
- Cardiac Imaging and Diagnostics
- Health Systems, Economic Evaluations, Quality of Life
- Heart Failure Treatment and Management
- Blood Pressure and Hypertension Studies
- Cardiac Valve Diseases and Treatments
- Coronary Interventions and Diagnostics
- Acute Myocardial Infarction Research
- Cardiovascular Function and Risk Factors
- Frailty in Older Adults
- Cardiac Health and Mental Health
- Pharmaceutical Practices and Patient Outcomes
- Cardiovascular Disease and Adiposity
- Chronic Disease Management Strategies
- Cardiac Structural Anomalies and Repair
- Renal and Vascular Pathologies
- Infective Endocarditis Diagnosis and Management
- Cardiac pacing and defibrillation studies
- Venous Thromboembolism Diagnosis and Management
- Antiplatelet Therapy and Cardiovascular Diseases
- Palliative Care and End-of-Life Issues
- Aortic Disease and Treatment Approaches
- Intensive Care Unit Cognitive Disorders
- Blood properties and coagulation
- HIV-related health complications and treatments
Kaiser Permanente San Jose Medical Center
2015-2024
Stanford University
2022-2024
VA Palo Alto Health Care System
2022-2024
Geriatric Research Education and Clinical Center
2022-2024
United States Department of Veterans Affairs
2022-2024
Kaiser Permanente
2011-2024
University of Pennsylvania
2024
The University of Texas Southwestern Medical Center
2024
Circle Solutions
2023
Stanford Medicine
2022
Cardiovascular multidisciplinary heart teams (MDHTs) have evolved significantly over the past decade. These play a central role in treatment of wide array cardiovascular diseases affecting interventional cardiology, cardiac surgery, imaging, advanced failure, adult congenital disease, cardio-oncology, and cardio-obstetrics. To meet specific needs both patients programs, composition function MDHTs had to adapt evolve. Although lessons been learned from cancer care, best practices for...
BACKGROUND This study was designed to test the hypothesis that endogenously produced nitric oxide protects against platelet aggregation and cyclic flow variations in stenosed endothelium-injured arteries of mongrel dogs. METHODS AND RESULTS NG-Monomethyl-L-arginine (L-NMMA), an inhibitor formation, administered at 5 mg/kg 15 dogs after left anterior descending coronary artery mechanically injured narrowed by external constrictors nine before endothelial injury femoral moderate arterial...
Older adults with cardiovascular disease (CVD) contend deficits across multiple domains of health due to age-related physiological changes and the impact CVD. Multimorbidity, polypharmacy, cognitive changes, diminished functional capacity, along in social environment, result complexity that makes provision CVD care older challenging. In this review, we first describe history geriatric cardiology, an orientation acknowledges unique needs Then, introduce 5 essential principles for meeting CVD:...
As the older adult population expands, an increasing number of patients affected by geriatric syndromes are seen cardiovascular clinicians. One such syndrome that has been associated with poor outcomes is cognitive frailty: simultaneous presence impairment, without evidence dementia, and physical frailty, which results in decreased reserve. Driven common pathophysiologic underpinnings (eg, inflammation neurohormonal dysregulation), disease, frailty also share following risk factors:...
Guideline-based management of cardiovascular disease often involves prescribing multiple medications, which contributes to polypharmacy and risk for adverse drug events in older adults. Deprescribing is a potential strategy mitigate these risks. We sought characterize compare clinician perspectives regarding deprescribing medications across three specialties. National cross-sectional survey. Ambulatory. Random sample geriatricians, general internists, cardiologists from the American College...
Calcific aortic stenosis can be considered a model for geriatric cardiovascular conditions due to confluence of factors. The remarkable technological development transcatheter valve replacement was studied initially on older adult populations with prohibitive or high-risk surgical replacement. Through these trials, the community has recognized that stratification chronologically adults improved incrementally by invoking concept frailty and other risks. Given complexity aging process,...
Background— Effects were compared in patients the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial of mechanistically different strategies for treatment hyperglycemia, insulin-sensitizing and insulin-providing strategies, on biomarker profiles reflecting balance between fibrinolysis thrombosis intensity inflammation implicated diabetic vasculopathy. Methods Results— A total 2368 with type diabetes mellitus clinically stable, angiographically documented coronary...
As the population ages, older adults represent an increasing proportion of patients referred to cardiac catheterization laboratory. Older are highest-risk group for morbidity and mortality, particularly after complex, high-risk percutaneous coronary interventions. Structured risk assessment plays a key role in differentiating who likely derive net benefit vs those have disproportionate risks harm. Conventional tools from national cardiovascular societies typically rely on 3 pillars: 1) risk;...
A canine model with cyclic flow variations (CFVs) in stenosed and endothelium-injured coronary arteries was used to examine the role of active oxygen species platelet aggregation vivo. We studied 90 anesthetized dogs which pericardial cavity opened heart exposed. The velocity blood left anterior descending artery (LAD) monitored by a pulsed Doppler probe. In 67 dogs, LADs were applying external constrictors at site where endothelium mechanically injured. CFVs developed all dogs. Treatment...
A large number of cardiology clinical trials have mortality as an endpoint unless adequate surrogate endpoints are available. Although there nine classes agents used in the treatment diabetes mellitus, none shown a benefit trials. The United Kingdom Prospective Diabetic Study was first to suggest that metformin given for mellitus had trend toward lowering mortality. accidental discovery peroxisome proliferator-activated receptors (PPARs) led introduction thiazolidinediones (TZD), PPAR agent...
We review a comprehensive risk assessment approach for percutaneous coronary interventions in older adults and highlight the relevance of geriatric syndromes within that broader perspective to optimize patient-centered outcomes interventional cardiology practice. Reflecting influence principles undergoing interventions, we propose "geriatric" heart team incorporate expertise specialists addition traditional members, facilitate uptake into preprocedural assessment, address ways mitigate these...
The population worldwide is getting older as a result of advances in public health, medicine, and technology. Older individuals are living longer with higher prevalence subclinical clinical cardiovascular disease (CVD). In 2010, the American Heart Association introduced list key prevention targets, known "Life's Simple 7'' to increase CVD-free survival, longevity, quality life. 2022, sleep health was added expand recommendations Essential 8'' (eat better, be more active, stop smoking, get...
Importance Older patients using many prescription drugs (hyperpolypharmacy) may be at increased risk of adverse drug effects. Objective To test the effectiveness and safety a quality intervention intended to reduce hyperpolypharmacy. Design, Setting, Participants This randomized clinical trial allocated 76 years or older who used 10 more medications deprescribing usual care (1:1 ratio) an integrated health system with multiple preexisting workflows. Data were collected from October 15, 2020,...
To determine the relative risks of long-term mortality between coronary artery bypass grafting (CABG) and percutaneous intervention (PCI) among patients with end-stage renal disease (ESRD). We identified 1015 ESRD who underwent revascularization 1996 2008 within Kaiser Permanente Northern California. obtained clinical variables from health plan databases, state death certificates social security administration files. Our primary secondary outcomes, respectively, were all-cause repeat...
The optimal coronary revascularization strategy to maximize the patient-centered outcome of days alive and out hospital (DAOH), in multimorbid older (≥65-years) adults after an acute syndrome (ACS) is incompletely understood.Using Kaiser Permanente Northern California Health Plan databases, we identified 3871 patients ≥65-years presenting with ACS between 1/1/2010-3/1/2018 who underwent either artery bypass grafting (CABG, N = 1575) or multivessel percutaneous intervention (PCI, 2296)....
Rapid laboratory markers that correlate with patient risk would facilitate the decision making regarding admission of patients chest pain (CP). Platelet contractile force (PCF) and clot elastic modulus (CEM) are elevated in undergoing coronary bypass grafting. This study assessed PCF, CEM, platelet aggregation presenting to emergency department Results were compared fifty normal controls. Both total group CP (n = 100) subset 36) documented artery disease (CAD) had significantly PCF decreased...