The Experts below are selected from a list of 13182 Experts worldwide ranked by ideXlab platform
Robert W Yeh - One of the best experts on this subject based on the ideXlab platform.
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conscious sedation versus general anesthesia for transcatheter aortic valve replacement variation in practice and outcomes
Jacc-cardiovascular Interventions, 2020Co-Authors: Neel M Butala, Sreekanth Vemulapalli, Mabel Chung, Eric A Secemsky, Pratik Manandhar, Guillaume Marquisgravel, Andrzej S Kosinski, Robert W Yeh, David J CohenAbstract:Abstract Objectives The aims of this study were to examine variation in the use of conscious sedation (CS) for transcatheter aortic valve replacement (TAVR) across hospitals and over time and to evaluate outcomes of CS compared with general anesthesia (GA) using Instrumental Variable Analysis, a quasi-experimental method to control for unmeasured confounding. Background Despite increasing use of CS for TAVR, contemporary data on utilization patterns are lacking, and existing studies evaluating the impact of sedation choice on outcomes may suffer from unmeasured confounding. Methods Among 120,080 patients in the TVT (Transcatheter Valve Therapy) Registry who underwent transfemoral TAVR between January 2016 and March 2019, the relationship between anesthesia choice and TAVR outcomes was evaluated using hospital proportional use of CS as an Instrumental Variable. Results Over the study period, the proportion of TAVR performed using CS increased from 33% to 64%, and CS was used in a median of 0% and 91% of cases in the lowest and highest quartiles of hospital CS use, respectively. On the basis of Instrumental Variable Analysis, CS was associated with decreases in in-hospital mortality (adjusted risk difference: 0.2%; p = 0.010) and 30-day mortality (adjusted risk difference: 0.5%; p Conclusions In contemporary U.S. practice, the use of CS for TAVR continues to increase, although there remains wide variation across hospitals. The use of CS for TAVR is associated with improved outcomes (including reduced mortality) compared with GA, although the magnitude of benefit appears to be less than in previous studies.
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conscious sedation versus general anesthesia for transcatheter aortic valve replacement results of an Instrumental Variable Analysis
Journal of the American College of Cardiology, 2020Co-Authors: Neel M Butala, Sreekanth Vemulapalli, Mabel Chung, Eric A Secemsky, Pratik Manandhar, Guillaume Marquisgravel, Andrzej S Kosinski, Robert W Yeh, David CohenAbstract:Although observational studies have suggested that conscious sedation (CS) for transcatheter aortic valve replacement (TAVR) is associated with reduced mortality compared with general anesthesia (GA), these findings may reflect unmeasured confounding. Instrumental Variable (IV) Analysis is a
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effectiveness of arterial closure devices for preventing complications with percutaneous coronary intervention an Instrumental Variable Analysis
Circulation-cardiovascular Interventions, 2016Co-Authors: Neil J Wimmer, Eric A Secemsky, Laura Mauri, Matthew T Roe, Paramita Sahachaudhuri, David Dai, James M Mccabe, Frederic S Resnic, Hitinder S Gurm, Robert W YehAbstract:Background— Bleeding is associated with poor outcomes after percutaneous coronary intervention (PCI). Although arterial closure devices (ACDs) are widely used in clinical practice, whether they are effective in reducing bleeding complications during transfemoral PCI is uncertain. The objective of this study was to evaluate the effectiveness of ACDs for the prevention of vascular access site complications in patients undergoing transfemoral PCI using an Instrumental Variable approach. Methods and Results— We performed a retrospective Analysis of the CathPCI Registry from 2009 to 2013 at 1470 sites across the United States. Variation in the proportion of ACDs used by each individual physician operator was used as an Instrumental Variable to address potential confounding. A 2-stage Instrumental Variable Analysis was used as the primary approach. The main outcome measure was vascular access site complications, and nonaccess site bleeding was used as a falsification end point (negative control) to evaluate for potential confounding. A total of 1 053 155 ACDs were used during 2 056 585 PCIs during the study period. The vascular access site complication rate was 1.5%. In the Instrumental Variable Analysis, the use of ACDs was associated with a 0.40% absolute risk reduction in vascular access site complications (95% confidence interval, 0.31–0.42; number needed to treat=250). Absolute differences in nonaccess site bleeding were negligible (risk difference, 0.04%; 95% confidence interval, 0.01–0.07), suggesting acceptable control of confounding in the comparison. Conclusions— ACDs are associated with a modest reduction in major bleeding after PCI. The number needed to treat with ACDs to prevent 1 major bleeding event is high.
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Instrumental Variable Analysis to compare effectiveness of stents in the extremely elderly
Circulation-cardiovascular Quality and Outcomes, 2014Co-Authors: Robert W Yeh, Samip Vasaiwala, Daniel E Forman, Treacy S Silbaugh, Katya Zelevinski, Ann Lovett, Sharonlise T Normand, Laura MauriAbstract:Background—Evaluating novel therapies is challenging in the extremely elderly. Instrumental Variable methods identify Variables associated with treatment allocation to perform adjusted comparisons that may overcome limitations of more traditional approaches. Methods and Results—Among all patients aged ≥85 years undergoing percutaneous coronary intervention in nonfederal hospitals in Massachusetts between 2003 and 2009 (n=2690), we identified quarterly drug-eluting stent (DES) use rates as an Instrumental Variable. We estimated risk-adjusted differences in outcomes for DES versus bare metal stents using a 2-stage least squares Instrumental Variable Analysis method. Quarterly DES use ranged from 15% to 88%. Unadjusted 1-year mortality rates were 14.5% for DES versus 23.0% for bare metal stents (risk difference, −8.5%; P<0.001), an implausible finding compared with randomized trial results. Using Instrumental Variable Analysis, DES were associated with no difference in 1-year mortality (risk difference, −0.8...
Neel M Butala - One of the best experts on this subject based on the ideXlab platform.
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conscious sedation versus general anesthesia for transcatheter aortic valve replacement variation in practice and outcomes
Jacc-cardiovascular Interventions, 2020Co-Authors: Neel M Butala, Sreekanth Vemulapalli, Mabel Chung, Eric A Secemsky, Pratik Manandhar, Guillaume Marquisgravel, Andrzej S Kosinski, Robert W Yeh, David J CohenAbstract:Abstract Objectives The aims of this study were to examine variation in the use of conscious sedation (CS) for transcatheter aortic valve replacement (TAVR) across hospitals and over time and to evaluate outcomes of CS compared with general anesthesia (GA) using Instrumental Variable Analysis, a quasi-experimental method to control for unmeasured confounding. Background Despite increasing use of CS for TAVR, contemporary data on utilization patterns are lacking, and existing studies evaluating the impact of sedation choice on outcomes may suffer from unmeasured confounding. Methods Among 120,080 patients in the TVT (Transcatheter Valve Therapy) Registry who underwent transfemoral TAVR between January 2016 and March 2019, the relationship between anesthesia choice and TAVR outcomes was evaluated using hospital proportional use of CS as an Instrumental Variable. Results Over the study period, the proportion of TAVR performed using CS increased from 33% to 64%, and CS was used in a median of 0% and 91% of cases in the lowest and highest quartiles of hospital CS use, respectively. On the basis of Instrumental Variable Analysis, CS was associated with decreases in in-hospital mortality (adjusted risk difference: 0.2%; p = 0.010) and 30-day mortality (adjusted risk difference: 0.5%; p Conclusions In contemporary U.S. practice, the use of CS for TAVR continues to increase, although there remains wide variation across hospitals. The use of CS for TAVR is associated with improved outcomes (including reduced mortality) compared with GA, although the magnitude of benefit appears to be less than in previous studies.
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conscious sedation versus general anesthesia for transcatheter aortic valve replacement results of an Instrumental Variable Analysis
Journal of the American College of Cardiology, 2020Co-Authors: Neel M Butala, Sreekanth Vemulapalli, Mabel Chung, Eric A Secemsky, Pratik Manandhar, Guillaume Marquisgravel, Andrzej S Kosinski, Robert W Yeh, David CohenAbstract:Although observational studies have suggested that conscious sedation (CS) for transcatheter aortic valve replacement (TAVR) is associated with reduced mortality compared with general anesthesia (GA), these findings may reflect unmeasured confounding. Instrumental Variable (IV) Analysis is a
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is delayed graft function causally associated with long term outcomes after kidney transplantation Instrumental Variable Analysis
Transplantation, 2013Co-Authors: Neel M Butala, Mona D Doshi, Peter P Reese, Chirag R ParikhAbstract:Background While some studies have found an association between delayed graft function (DGF) after kidney transplantation and worse long-term outcomes, a causal relationship remains controversial. We investigated this relationship using an Instrumental Variables model (IVM), a quasi-randomization technique for drawing causal inferences.
Eric A Secemsky - One of the best experts on this subject based on the ideXlab platform.
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conscious sedation versus general anesthesia for transcatheter aortic valve replacement variation in practice and outcomes
Jacc-cardiovascular Interventions, 2020Co-Authors: Neel M Butala, Sreekanth Vemulapalli, Mabel Chung, Eric A Secemsky, Pratik Manandhar, Guillaume Marquisgravel, Andrzej S Kosinski, Robert W Yeh, David J CohenAbstract:Abstract Objectives The aims of this study were to examine variation in the use of conscious sedation (CS) for transcatheter aortic valve replacement (TAVR) across hospitals and over time and to evaluate outcomes of CS compared with general anesthesia (GA) using Instrumental Variable Analysis, a quasi-experimental method to control for unmeasured confounding. Background Despite increasing use of CS for TAVR, contemporary data on utilization patterns are lacking, and existing studies evaluating the impact of sedation choice on outcomes may suffer from unmeasured confounding. Methods Among 120,080 patients in the TVT (Transcatheter Valve Therapy) Registry who underwent transfemoral TAVR between January 2016 and March 2019, the relationship between anesthesia choice and TAVR outcomes was evaluated using hospital proportional use of CS as an Instrumental Variable. Results Over the study period, the proportion of TAVR performed using CS increased from 33% to 64%, and CS was used in a median of 0% and 91% of cases in the lowest and highest quartiles of hospital CS use, respectively. On the basis of Instrumental Variable Analysis, CS was associated with decreases in in-hospital mortality (adjusted risk difference: 0.2%; p = 0.010) and 30-day mortality (adjusted risk difference: 0.5%; p Conclusions In contemporary U.S. practice, the use of CS for TAVR continues to increase, although there remains wide variation across hospitals. The use of CS for TAVR is associated with improved outcomes (including reduced mortality) compared with GA, although the magnitude of benefit appears to be less than in previous studies.
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conscious sedation versus general anesthesia for transcatheter aortic valve replacement results of an Instrumental Variable Analysis
Journal of the American College of Cardiology, 2020Co-Authors: Neel M Butala, Sreekanth Vemulapalli, Mabel Chung, Eric A Secemsky, Pratik Manandhar, Guillaume Marquisgravel, Andrzej S Kosinski, Robert W Yeh, David CohenAbstract:Although observational studies have suggested that conscious sedation (CS) for transcatheter aortic valve replacement (TAVR) is associated with reduced mortality compared with general anesthesia (GA), these findings may reflect unmeasured confounding. Instrumental Variable (IV) Analysis is a
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effectiveness of arterial closure devices for preventing complications with percutaneous coronary intervention an Instrumental Variable Analysis
Circulation-cardiovascular Interventions, 2016Co-Authors: Neil J Wimmer, Eric A Secemsky, Laura Mauri, Matthew T Roe, Paramita Sahachaudhuri, David Dai, James M Mccabe, Frederic S Resnic, Hitinder S Gurm, Robert W YehAbstract:Background— Bleeding is associated with poor outcomes after percutaneous coronary intervention (PCI). Although arterial closure devices (ACDs) are widely used in clinical practice, whether they are effective in reducing bleeding complications during transfemoral PCI is uncertain. The objective of this study was to evaluate the effectiveness of ACDs for the prevention of vascular access site complications in patients undergoing transfemoral PCI using an Instrumental Variable approach. Methods and Results— We performed a retrospective Analysis of the CathPCI Registry from 2009 to 2013 at 1470 sites across the United States. Variation in the proportion of ACDs used by each individual physician operator was used as an Instrumental Variable to address potential confounding. A 2-stage Instrumental Variable Analysis was used as the primary approach. The main outcome measure was vascular access site complications, and nonaccess site bleeding was used as a falsification end point (negative control) to evaluate for potential confounding. A total of 1 053 155 ACDs were used during 2 056 585 PCIs during the study period. The vascular access site complication rate was 1.5%. In the Instrumental Variable Analysis, the use of ACDs was associated with a 0.40% absolute risk reduction in vascular access site complications (95% confidence interval, 0.31–0.42; number needed to treat=250). Absolute differences in nonaccess site bleeding were negligible (risk difference, 0.04%; 95% confidence interval, 0.01–0.07), suggesting acceptable control of confounding in the comparison. Conclusions— ACDs are associated with a modest reduction in major bleeding after PCI. The number needed to treat with ACDs to prevent 1 major bleeding event is high.
Emmanuel Stamatakis - One of the best experts on this subject based on the ideXlab platform.
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childhood obesity and device measured sedentary behavior an Instrumental Variable Analysis of 3 864 mother offspring pairs
Obesity, 2021Co-Authors: Mark Hamer, Sebastien F M Chastin, Russell M Viner, Emmanuel StamatakisAbstract:OBJECTIVE Intergenerational data on mother-offspring pairs were utilized in an Instrumental Variable Analysis to examine the longitudinal association between BMI and sedentary behavior. METHODS The sample included 3,864 mother-offspring pairs from the 1970 British Cohort Study. Height and weight were recorded in mothers (age 31 [5.4] years) and offspring (age 10 years) and repeated in offspring during adulthood. Offspring provided objective data on sedentary behavior (7-day thigh-worn activPAL) in adulthood at age 46 to 47 years. RESULTS Maternal BMI, the Instrumental Variable, was associated with offspring BMI at age 10 (change per kg/m2 , β = 0.11; 95% CI: 0.09 to 0.12), satisfying a key assumption of Instrumental Variable analyses. Offspring (change per kg/m2 , β = 0.010; 95% CI: -0.02 to 0.03 h/d) and maternal BMI (β = 0.017; 95% CI: 0.001 to 0.03 h/d) was related to offspring sedentary time, suggestive of a causal impact of BMI on sedentary behavior (two-stage least squares Analysis, β = 0.18 [SE 0.08], P = 0.015). For moderate-vigorous physical activity, there were associations with offspring BMI (β = -0.010; 95% CI: -0.017 to -0.004) and maternal BMI (β = -0.007; 95% CI: -0.010 to -0.003), with evidence for causality (two-stage least squares Analysis, β = -0.060 [SE 0.02], P = 0.001). CONCLUSIONS There is strong evidence for a causal pathway linking childhood obesity to greater sedentary behavior.
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childhood obesity and device measured sedentary behavior an Instrumental Variable Analysis of 3 864 mother offspring pairs
Obesity, 2021Co-Authors: Mark Hamer, Sebastien F M Chastin, Russell M Viner, Emmanuel StamatakisAbstract:Objective Intergenerational data on mother-offspring pairs were utilized in an Instrumental Variable Analysis to examine the longitudinal association between BMI and sedentary behavior. Methods The sample included 3,864 mother-offspring pairs from the 1970 British Cohort Study. Height and weight were recorded in mothers (age 31 [5.4] years) and offspring (age 10 years) and repeated in offspring during adulthood. Offspring provided objective data on sedentary behavior (7-day thigh-worn activPAL) in adulthood at age 46 to 47 years. Results Maternal BMI, the Instrumental Variable, was associated with offspring BMI at age 10 (change per kg/m(2), beta = 0.11; 95% CI: 0.09 to 0.12), satisfying a key assumption of Instrumental Variable analyses. Offspring (change per kg/m(2), beta = 0.010; 95% CI: -0.02 to 0.03 h/d) and maternal BMI (beta = 0.017; 95% CI: 0.001 to 0.03 h/d) was related to offspring sedentary time, suggestive of a causal impact of BMI on sedentary behavior (two-stage least squares Analysis, beta = 0.18 [SE 0.08], P = 0.015). For moderate-vigorous physical activity, there were associations with offspring BMI (beta = -0.010; 95% CI: -0.017 to -0.004) and maternal BMI (beta = -0.007; 95% CI: -0.010 to -0.003), with evidence for causality (two-stage least squares Analysis, beta = -0.060 [SE 0.02], P = 0.001). Conclusions There is strong evidence for a causal pathway linking childhood obesity to greater sedentary behavior.
Sebastien F M Chastin - One of the best experts on this subject based on the ideXlab platform.
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childhood obesity and device measured sedentary behavior an Instrumental Variable Analysis of 3 864 mother offspring pairs
Obesity, 2021Co-Authors: Mark Hamer, Sebastien F M Chastin, Russell M Viner, Emmanuel StamatakisAbstract:OBJECTIVE Intergenerational data on mother-offspring pairs were utilized in an Instrumental Variable Analysis to examine the longitudinal association between BMI and sedentary behavior. METHODS The sample included 3,864 mother-offspring pairs from the 1970 British Cohort Study. Height and weight were recorded in mothers (age 31 [5.4] years) and offspring (age 10 years) and repeated in offspring during adulthood. Offspring provided objective data on sedentary behavior (7-day thigh-worn activPAL) in adulthood at age 46 to 47 years. RESULTS Maternal BMI, the Instrumental Variable, was associated with offspring BMI at age 10 (change per kg/m2 , β = 0.11; 95% CI: 0.09 to 0.12), satisfying a key assumption of Instrumental Variable analyses. Offspring (change per kg/m2 , β = 0.010; 95% CI: -0.02 to 0.03 h/d) and maternal BMI (β = 0.017; 95% CI: 0.001 to 0.03 h/d) was related to offspring sedentary time, suggestive of a causal impact of BMI on sedentary behavior (two-stage least squares Analysis, β = 0.18 [SE 0.08], P = 0.015). For moderate-vigorous physical activity, there were associations with offspring BMI (β = -0.010; 95% CI: -0.017 to -0.004) and maternal BMI (β = -0.007; 95% CI: -0.010 to -0.003), with evidence for causality (two-stage least squares Analysis, β = -0.060 [SE 0.02], P = 0.001). CONCLUSIONS There is strong evidence for a causal pathway linking childhood obesity to greater sedentary behavior.
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childhood obesity and device measured sedentary behavior an Instrumental Variable Analysis of 3 864 mother offspring pairs
Obesity, 2021Co-Authors: Mark Hamer, Sebastien F M Chastin, Russell M Viner, Emmanuel StamatakisAbstract:Objective Intergenerational data on mother-offspring pairs were utilized in an Instrumental Variable Analysis to examine the longitudinal association between BMI and sedentary behavior. Methods The sample included 3,864 mother-offspring pairs from the 1970 British Cohort Study. Height and weight were recorded in mothers (age 31 [5.4] years) and offspring (age 10 years) and repeated in offspring during adulthood. Offspring provided objective data on sedentary behavior (7-day thigh-worn activPAL) in adulthood at age 46 to 47 years. Results Maternal BMI, the Instrumental Variable, was associated with offspring BMI at age 10 (change per kg/m(2), beta = 0.11; 95% CI: 0.09 to 0.12), satisfying a key assumption of Instrumental Variable analyses. Offspring (change per kg/m(2), beta = 0.010; 95% CI: -0.02 to 0.03 h/d) and maternal BMI (beta = 0.017; 95% CI: 0.001 to 0.03 h/d) was related to offspring sedentary time, suggestive of a causal impact of BMI on sedentary behavior (two-stage least squares Analysis, beta = 0.18 [SE 0.08], P = 0.015). For moderate-vigorous physical activity, there were associations with offspring BMI (beta = -0.010; 95% CI: -0.017 to -0.004) and maternal BMI (beta = -0.007; 95% CI: -0.010 to -0.003), with evidence for causality (two-stage least squares Analysis, beta = -0.060 [SE 0.02], P = 0.001). Conclusions There is strong evidence for a causal pathway linking childhood obesity to greater sedentary behavior.