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Ariane J Marelli - One of the best experts on this subject based on the ideXlab platform.
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exposure to low dose ionizing radiation from Cardiac Procedures and malignancy risk in adults with congenital heart disease
Circulation, 2017Co-Authors: Sarah Cohen, Michelle Gurvitz, Judith Therrien, Claudie Laprise, Jay S Kaufman, Michal Abrahamowicz, Ariane J MarelliAbstract:Background: Adults with congenital heart disease (CHD) are exposed to increasing amounts of low-dose ionizing radiation (LDIR) from Cardiac Procedures. Cancer prevalence in this population is higher than in the general population. This study estimates the association between LDIR exposure from Cardiac Procedures and incident cancer in adult patients with CHD. Methods: The study population derived from the Quebec Congenital Heart Disease Database. We measured cumulative numbers of LDIR-related Cardiac Procedures for each patient until 1 year before the time of cancer diagnosis or administrative censoring. To assess the association between LDIR exposure and cancer risk, we conducted a nested case-control study and matched cancer cases with controls on sex, CHD severity, birth year, and age. Results: The study included 24 833 adult patients with CHD aged 18 to 64 years from 1995 to 2009. In >250 791 person-years of follow-up, 602 cancer cases were observed (median age, 55.4 years). The cumulative incidence of cancer estimated up to 64 years of age was 15.3% (95% confidence interval [CI], 14.2–16.5). Cases had more LDIR-related Cardiac Procedures than controls (1410 versus 921 per 1000 adult patients with CHD, P Conclusions: To our knowledge, this is the first large population-based study to analyze and document the association between LDIR-related Cardiac Procedures and incident cancer in the population of adults with CHD. Confirmations of these findings by prospective studies are needed to reinforce policy recommendations for radiation surveillance in patients with CHD where no regulation currently exists. Physicians ordering and performing Cardiac imaging should ensure that exposure is as low as reasonably achievable without sacrificing quality of care.
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abstract 20252 exposure to low dose ionizing radiation from Cardiac Procedures and risk of malignancy in adults with congenital heart disease
Circulation, 2016Co-Authors: Sarah Cohen, Michelle Gurvitz, Judith Therrien, Eva Goossens, Ariane J MarelliAbstract:Introduction: We showed that congenital heart disease (CHD) patients were exposed to increasing number of low-dose ionizing radiation (LDIR) from Cardiac Procedures between 1990 and 2005. We also s...
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exposure to low dose ionizing radiation from Cardiac Procedures in patients with congenital heart disease 15 year data from a population based longitudinal cohort
Circulation, 2016Co-Authors: Virginie Beausejour Ladouceur, Michelle Gurvitz, Louise Pilote, Mark J. Eisenberg, Patrick R Lawler, Raluca Ionescuittu, Ariane J MarelliAbstract:BACKGROUND: The burden of low-dose ionizing radiation (LDIR) exposure from medical Procedures among individuals with congenital heart disease (CHD) is unknown. In this longitudinal population-based study, we sought to determine exposure to LDIR-related Cardiac imaging and therapeutic Procedures in children and adults with CHD. METHODS AND RESULTS: In an analysis of the Quebec CHD database, exposure to the following LDIR-related Cardiac Procedures was recorded: catheter-based diagnostic Procedures, structural heart interventions, coronary interventions, computed tomography scans of the chest, nuclear Procedures, and pacemaker/implantable cardioverter-defibrillator insertion and repair. From 1990 to 2005, there were 16 253 LDIR-exposed patients with CHD with 317 988 patient-years of available follow-up. The total number of LDIR-related Procedures increased from 18.5 to 51.9 per 1000 CHD patients per year (P<0.0001). This increase was attributable to increases in rates per 1000 CHD patients in diagnostic Cardiac catheterizations (11.7 to 13.7 per 1000), structural heart interventions (1.0 to 5.2 per 1000), coronary interventions (1.0 to 2.4 per 1000), pacemaker/implantable cardioverter-defibrillator insertions (1.6 to 4.4 per 1000), nuclear Procedures (4.2 to 13.8 per 1000), and computed tomography scans of the chest (2.5 to 12.3 per 1000). Over time, among children with CHD, the median age at first LDIR procedure decreased from 5.0 years to 9.6 months. Severity of CHD significantly predicted extent of exposure. CONCLUSIONS: From 1990 to 2005, patients with CHD were exposed to increasing numbers of LDIR-emitting Cardiac Procedures. This exposure occurred at progressively younger ages. These findings provide an important perspective on longitudinal LDIR exposure in this at-risk population.
Jack V Tu - One of the best experts on this subject based on the ideXlab platform.
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Administrative hospitalization database validation of Cardiac procedure codes.
Medical care, 2020Co-Authors: Audra Stitt, Peter C Austin, Xuesong Wang, Jeffery S. Yu, Yana Gurevich, Kori J. Kingsbury, Jack V TuAbstract:Although Cardiac Procedures are commonly used to treat cardiovascular disease, they are costly. Administrative data sources could be used to track Cardiac Procedures, but sources of such data have not been validated against clinical registries. To examine accuracy of Cardiac procedure coding in administrative databases versus a prospective clinical registry. We examined a total of 182,018 common Cardiac Procedures including percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery, valve surgery, and Cardiac catheterization Procedures during fiscal years 2005 and 2006 across 18 Cardiac centers in Ontario, Canada. Accuracy of codes in the Canadian Institute for Health Information (CIHI) administrative databases were compared with the clinical registry of the Cardiac Care Network. Comparing 17,511 CIHI and 17,404 registry Procedures for CABG surgery, the positive predictive value (PPV) of CIHI-coded CABG surgery was 97%. In 6229 CIHI-coded and 5885 registry-coded valve surgery Procedures, the PPV of the administrative data source was 96%. Comparing 38,527 PCI Procedures in CIHI to 38,601 in the registry, the PPV of CIHI was 94%. Among 119,751 CIHI-coded and 111,725 registry-coded Cardiac catheterization Procedures, the PPV of administrative data was 94%. When the procedure date window was expanded from the same day to ±1 days, the PPV was 96% (PCI) and exceeded 98% (CABG surgery), 97% (valve surgery), and 95% (Cardiac catheterization). Using a clinical registry as the gold standard, the coding accuracy of common Cardiac Procedures in the CIHI administrative database was high.
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Administrative hospitalization database validation of Cardiac procedure codes.
Medical Care, 2013Co-Authors: Audra Stitt, Peter C Austin, Xuesong Wang, Jeffery S. Yu, Yana Gurevich, Kori J. Kingsbury, Jack V TuAbstract:Background:Although Cardiac Procedures are commonly used to treat cardiovascular disease, they are costly. Administrative data sources could be used to track Cardiac Procedures, but sources of such data have not been validated against clinical registries.Objectives:To examine accuracy of Cardiac pro
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effects of socioeconomic status on access to invasive Cardiac Procedures and on mortality after acute myocardial infarction
The New England Journal of Medicine, 1999Co-Authors: D A Alter, C D Naylor, Peter C Austin, Jack V TuAbstract:Background Universal health care systems seek to ensure access to care on the basis of need rather than income and to improve the health status of all citizens. We examined the performance of the Canadian health system with respect to these goals in the province of Ontario by assessing the effects of neighborhood income on access to invasive Cardiac Procedures and on mortality one year after acute myocardial infarction. Methods We linked claims for payment for physicians' services, hospital-discharge abstracts, and vital-status data for all patients with acute myocardial infarction who were admitted to hospitals in Ontario between April 1994 and March 1997. Patients' income levels were imputed from the median incomes of their residential neighborhoods as determined in Canada's 1996 census. We determined rates of use and waiting times for coronary angiography and revascularization Procedures after the index admission for acute myocardial infarction and determined death rates at one year. In multivariate an...
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use of Cardiac Procedures and outcomes in elderly patients with myocardial infarction in the united states and canada
The New England Journal of Medicine, 1997Co-Authors: Jack V Tu, Chris L Pashos, C D Naylor, E Chen, S L Normand, Joseph P Newhouse, Barbara J McneilAbstract:Background Acute myocardial infarction is a leading cause of morbidity and mortality in the United States and Canada. We performed a population-based study to compare the use of Cardiac Procedures and outcomes after acute myocardial infarction in elderly patients in the two countries. Methods We compared the use of invasive Cardiac Procedures and the mortality rates among 224,258 elderly Medicare beneficiaries in the United States and 9444 elderly patients in Ontario, Canada, each of whom had a new acute myocardial infarction in 1991. Results The U.S. patients were significantly more likely than the Canadian patients to undergo coronary angiography (34.9 percent vs. 6.7 percent, P< 0.001), percutaneous transluminal coronary angioplasty (11.7 percent vs. 1.5 percent, P<0.001), and coronary-artery bypass surgery (10.6 percent vs. 1.4 percent, P<0.001) during the first 30 days after the index infarction. These differences in the use of Cardiac Procedures narrowed but persisted through 180 days of follow-up. ...
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Use of Cardiac Procedures and outcomes in elderly patients with myocardial infarction in the United States and Canada
The New England Journal of Medicine, 1997Co-Authors: Jack V Tu, Chris L Pashos, Joseph P Newhouse, Naylor Cd, Chen E, Normand Sl, Barbara J McneilAbstract:Background Acute myocardial infarction is a leading cause of morbidity and mortality in the United States and Canada. We performed a population-based study to compare the use of Cardiac Procedures and outcomes after acute myocardial infarction in elderly patients in the two countries. Methods We compared the use of invasive Cardiac Procedures and the mortality rates among 224,258 elderly Medicare beneficiaries in the United States and 9444 elderly patients in Ontario, Canada, each of whom had a new acute myocardial infarction in 1991. Results The U.S. patients were significantly more likely than the Canadian patients to undergo coronary angiography (34.9 percent vs. 6.7 percent, P< 0.001), percutaneous transluminal coronary angioplasty (11.7 percent vs. 1.5 percent, P
Barbara J Mcneil - One of the best experts on this subject based on the ideXlab platform.
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use of Cardiac Procedures and outcomes in elderly patients with myocardial infarction in the united states and canada
The New England Journal of Medicine, 1997Co-Authors: Jack V Tu, Chris L Pashos, C D Naylor, E Chen, S L Normand, Joseph P Newhouse, Barbara J McneilAbstract:Background Acute myocardial infarction is a leading cause of morbidity and mortality in the United States and Canada. We performed a population-based study to compare the use of Cardiac Procedures and outcomes after acute myocardial infarction in elderly patients in the two countries. Methods We compared the use of invasive Cardiac Procedures and the mortality rates among 224,258 elderly Medicare beneficiaries in the United States and 9444 elderly patients in Ontario, Canada, each of whom had a new acute myocardial infarction in 1991. Results The U.S. patients were significantly more likely than the Canadian patients to undergo coronary angiography (34.9 percent vs. 6.7 percent, P< 0.001), percutaneous transluminal coronary angioplasty (11.7 percent vs. 1.5 percent, P<0.001), and coronary-artery bypass surgery (10.6 percent vs. 1.4 percent, P<0.001) during the first 30 days after the index infarction. These differences in the use of Cardiac Procedures narrowed but persisted through 180 days of follow-up. ...
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Use of Cardiac Procedures and outcomes in elderly patients with myocardial infarction in the United States and Canada
The New England Journal of Medicine, 1997Co-Authors: Jack V Tu, Chris L Pashos, Joseph P Newhouse, Naylor Cd, Chen E, Normand Sl, Barbara J McneilAbstract:Background Acute myocardial infarction is a leading cause of morbidity and mortality in the United States and Canada. We performed a population-based study to compare the use of Cardiac Procedures and outcomes after acute myocardial infarction in elderly patients in the two countries. Methods We compared the use of invasive Cardiac Procedures and the mortality rates among 224,258 elderly Medicare beneficiaries in the United States and 9444 elderly patients in Ontario, Canada, each of whom had a new acute myocardial infarction in 1991. Results The U.S. patients were significantly more likely than the Canadian patients to undergo coronary angiography (34.9 percent vs. 6.7 percent, P< 0.001), percutaneous transluminal coronary angioplasty (11.7 percent vs. 1.5 percent, P
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variation in the use of Cardiac Procedures after acute myocardial infarction
The New England Journal of Medicine, 1995Co-Authors: Edward Guadagnoli, Chris L Pashos, Barbara J Mcneil, Paul J Hauptman, John Z Ayanian, Paul D ClearyAbstract:Background There are large geographic differences in the frequency with which coronary angiography and revascularization are performed. We attempted to assess whether differences in case mix or in the treatment of specific groups of patients may explain this variability. We also assessed the consequences of various patterns of treatment. Methods We studied patients covered by Medicare who were 65 to 79 years of age and were admitted to 478 hospitals with acute myocardial infarctions during 1990 in New York (1852 patients), where the rate of use of Cardiac Procedures is low, and in Texas (1837 patients), where the rate of use of such Procedures is high. We compared the patterns of treatment of clinically similar groups of patients in the two states. We also compared mortality rates and measures of the health-related quality of life. Results Coronary angiography was performed more often in Texas than in New York (45 percent vs. 30 percent, P<0.001). The frequency of use in Texas was significantly higher tha...
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Variation in the Use of Cardiac Procedures after Acute Myocardial Infarction
The New England Journal of Medicine, 1995Co-Authors: Edward Guadagnoli, Chris L Pashos, Barbara J Mcneil, Paul J Hauptman, John Z Ayanian, Paul D ClearyAbstract:Background There are large geographic differences in the frequency with which coronary angiography and revascularization are performed. We attempted to assess whether differences in case mix or in the treatment of specific groups of patients may explain this variability. We also assessed the consequences of various patterns of treatment. Methods We studied patients covered by Medicare who were 65 to 79 years of age and were admitted to 478 hospitals with acute myocardial infarctions during 1990 in New York (1852 patients), where the rate of use of Cardiac Procedures is low, and in Texas (1837 patients), where the rate of use of such Procedures is high. We compared the patterns of treatment of clinically similar groups of patients in the two states. We also compared mortality rates and measures of the health-related quality of life. Results Coronary angiography was performed more often in Texas than in New York (45 percent vs. 30 percent, P
Carmelo A Milano - One of the best experts on this subject based on the ideXlab platform.
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low operative mortality with implantation of a continuous flow left ventricular assist device and impact of concurrent Cardiac Procedures
Circulation, 2009Co-Authors: Charles T Klodell, Ranjit John, Francis D Pagani, Joseph G Rogers, David J Farrar, Carmelo A MilanoAbstract:Background— The objective of this study was to determine the impact of concurrent Cardiac Procedures (CCP) on patient outcomes after HeartMate II (HMII) left ventricular assist device implantation. Methods and Results— Two hundred eighty-one patients underwent implantation of a HMII as a bridge to transplantation from March 2005 to March 2007. One hundred seventy patients had an HMII implanted only, and 81 patients underwent concurrent Cardiac Procedures in conjunction with HMII implantation (HMII+CCP). Of these, 47 patients had concurrent valvular Procedures, 15 patients had simultaneous closure of patent foramen ovale, and 19 patients had other various Cardiac Procedures. Patients requiring right ventricular assist device support or nonCardiac Procedures were excluded. Preoperative characteristics were similar for patients with and without concurrent Cardiac Procedures. Overall 30-day mortality was 5.8% for the HMII group and 11.3% for the HMII+CCP group. Subgroup analysis demonstrated that simultaneous patent foramen ovale closure was not associated with an increased 30-day mortality rate, but concurrent valvular Procedures increased the risk to 8.5%. Patients who underwent an aortic valve procedure had a 30-day mortality rate of 25%, higher than for isolated concurrent mitral (0%) or tricuspid repair (3.3%). Survival at 180 days was 87% for HMII alone and 80% for HMII+CCP. The hazard ratio for concurrent Cardiac Procedures adjusted for baseline parameters was 1.82 (95% CI, 1.07 to 3.10, P =0.026). Conclusions— There is a low 5.8% operative mortality rate for patients requiring uncomplicated HMII implantation, with no apparent increased risk for concurrent patent foramen ovale closure or mitral or tricuspid repair. However, concurrent aortic valve and other Cardiac Procedures are associated with significantly decreased perioperative and long-term survival.
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Low operative mortality with implantation of a continuous-flow left ventricular assist device and impact of concurrent Cardiac Procedures.
Circulation, 2009Co-Authors: Charles T Klodell, Ranjit John, Francis D Pagani, Joseph G Rogers, David J Farrar, Carmelo A MilanoAbstract:The objective of this study was to determine the impact of concurrent Cardiac Procedures (CCP) on patient outcomes after HeartMate II (HMII) left ventricular assist device implantation. Two hundred eighty-one patients underwent implantation of a HMII as a bridge to transplantation from March 2005 to March 2007. One hundred seventy patients had an HMII implanted only, and 81 patients underwent concurrent Cardiac Procedures in conjunction with HMII implantation (HMII+CCP). Of these, 47 patients had concurrent valvular Procedures, 15 patients had simultaneous closure of patent foramen ovale, and 19 patients had other various Cardiac Procedures. Patients requiring right ventricular assist device support or nonCardiac Procedures were excluded. Preoperative characteristics were similar for patients with and without concurrent Cardiac Procedures. Overall 30-day mortality was 5.8% for the HMII group and 11.3% for the HMII+CCP group. Subgroup analysis demonstrated that simultaneous patent foramen ovale closure was not associated with an increased 30-day mortality rate, but concurrent valvular Procedures increased the risk to 8.5%. Patients who underwent an aortic valve procedure had a 30-day mortality rate of 25%, higher than for isolated concurrent mitral (0%) or tricuspid repair (3.3%). Survival at 180 days was 87% for HMII alone and 80% for HMII+CCP. The hazard ratio for concurrent Cardiac Procedures adjusted for baseline parameters was 1.82 (95% CI, 1.07 to 3.10, P=0.026). There is a low 5.8% operative mortality rate for patients requiring uncomplicated HMII implantation, with no apparent increased risk for concurrent patent foramen ovale closure or mitral or tricuspid repair. However, concurrent aortic valve and other Cardiac Procedures are associated with significantly decreased perioperative and long-term survival.
Michelle Gurvitz - One of the best experts on this subject based on the ideXlab platform.
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exposure to low dose ionizing radiation from Cardiac Procedures and malignancy risk in adults with congenital heart disease
Circulation, 2017Co-Authors: Sarah Cohen, Michelle Gurvitz, Judith Therrien, Claudie Laprise, Jay S Kaufman, Michal Abrahamowicz, Ariane J MarelliAbstract:Background: Adults with congenital heart disease (CHD) are exposed to increasing amounts of low-dose ionizing radiation (LDIR) from Cardiac Procedures. Cancer prevalence in this population is higher than in the general population. This study estimates the association between LDIR exposure from Cardiac Procedures and incident cancer in adult patients with CHD. Methods: The study population derived from the Quebec Congenital Heart Disease Database. We measured cumulative numbers of LDIR-related Cardiac Procedures for each patient until 1 year before the time of cancer diagnosis or administrative censoring. To assess the association between LDIR exposure and cancer risk, we conducted a nested case-control study and matched cancer cases with controls on sex, CHD severity, birth year, and age. Results: The study included 24 833 adult patients with CHD aged 18 to 64 years from 1995 to 2009. In >250 791 person-years of follow-up, 602 cancer cases were observed (median age, 55.4 years). The cumulative incidence of cancer estimated up to 64 years of age was 15.3% (95% confidence interval [CI], 14.2–16.5). Cases had more LDIR-related Cardiac Procedures than controls (1410 versus 921 per 1000 adult patients with CHD, P Conclusions: To our knowledge, this is the first large population-based study to analyze and document the association between LDIR-related Cardiac Procedures and incident cancer in the population of adults with CHD. Confirmations of these findings by prospective studies are needed to reinforce policy recommendations for radiation surveillance in patients with CHD where no regulation currently exists. Physicians ordering and performing Cardiac imaging should ensure that exposure is as low as reasonably achievable without sacrificing quality of care.
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abstract 20252 exposure to low dose ionizing radiation from Cardiac Procedures and risk of malignancy in adults with congenital heart disease
Circulation, 2016Co-Authors: Sarah Cohen, Michelle Gurvitz, Judith Therrien, Eva Goossens, Ariane J MarelliAbstract:Introduction: We showed that congenital heart disease (CHD) patients were exposed to increasing number of low-dose ionizing radiation (LDIR) from Cardiac Procedures between 1990 and 2005. We also s...
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exposure to low dose ionizing radiation from Cardiac Procedures in patients with congenital heart disease 15 year data from a population based longitudinal cohort
Circulation, 2016Co-Authors: Virginie Beausejour Ladouceur, Michelle Gurvitz, Louise Pilote, Mark J. Eisenberg, Patrick R Lawler, Raluca Ionescuittu, Ariane J MarelliAbstract:BACKGROUND: The burden of low-dose ionizing radiation (LDIR) exposure from medical Procedures among individuals with congenital heart disease (CHD) is unknown. In this longitudinal population-based study, we sought to determine exposure to LDIR-related Cardiac imaging and therapeutic Procedures in children and adults with CHD. METHODS AND RESULTS: In an analysis of the Quebec CHD database, exposure to the following LDIR-related Cardiac Procedures was recorded: catheter-based diagnostic Procedures, structural heart interventions, coronary interventions, computed tomography scans of the chest, nuclear Procedures, and pacemaker/implantable cardioverter-defibrillator insertion and repair. From 1990 to 2005, there were 16 253 LDIR-exposed patients with CHD with 317 988 patient-years of available follow-up. The total number of LDIR-related Procedures increased from 18.5 to 51.9 per 1000 CHD patients per year (P<0.0001). This increase was attributable to increases in rates per 1000 CHD patients in diagnostic Cardiac catheterizations (11.7 to 13.7 per 1000), structural heart interventions (1.0 to 5.2 per 1000), coronary interventions (1.0 to 2.4 per 1000), pacemaker/implantable cardioverter-defibrillator insertions (1.6 to 4.4 per 1000), nuclear Procedures (4.2 to 13.8 per 1000), and computed tomography scans of the chest (2.5 to 12.3 per 1000). Over time, among children with CHD, the median age at first LDIR procedure decreased from 5.0 years to 9.6 months. Severity of CHD significantly predicted extent of exposure. CONCLUSIONS: From 1990 to 2005, patients with CHD were exposed to increasing numbers of LDIR-emitting Cardiac Procedures. This exposure occurred at progressively younger ages. These findings provide an important perspective on longitudinal LDIR exposure in this at-risk population.