Validation of ICD-10 Diagnosis Codes for Identification of Acute Myocardial Infarction From a US Integrated Healthcare System.

Purpose: Contemporary epidemiologic research on acute myocardial infarction (AMI) using electronic health records (EHR) relies on International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes, but limited studies have been conducted to validate these codes in the United States. Therefore, this study aimed to validate AMI events identified by ICD-10-CM diagnosis codes.

Methods: The study was conducted as part of a hepatitis B vaccine safety study.

Association of Rate-Control and Antiarrhythmic Medication Use and Risk of Ischemic Stroke and Death in Patients on Dialysis With Atrial Fibrillation.

Background: Incident atrial fibrillation (AF) is common among adults with kidney failure treated with maintenance dialysis and is associated with poor clinical outcomes. Limited data exist informing treatment of AF among patients on dialysis. We aimed to describe the use of rate-control and antiarrhythmic medications for AF among patients on dialysis and associations of these medication use strategies with stroke and all-cause death.

Clinical and socioeconomic factors associated with recurrent atrial fibrillation after catheter ablation or antiarrhythmic drug therapy.

Background: Maintaining sinus rhythm after initiating rhythm control strategies in atrial fibrillation (AF) remains challenging.

Objective: The study sought to investigate risk factors associated with AF recurrence among patients with incident AF who underwent catheter ablation or received antiarrhythmic drugs (AADs).

Methods: We identified adults with incident AF from 2010 to 2017 who underwent catheter ablation or initiated AAD therapy from 2 U.

Cost-effectiveness of early noninvasive cardiac testing for suspected acute coronary syndrome.

Background: Early noninvasive cardiac testing (NIT) is often performed in the initial workup of patients who present to the emergency department (ED) with suspected acute coronary syndrome (ACS). Our study objective was to calculate the cost-effectiveness of adopting early NIT for risk stratification to avoid future nonfatal acute myocardial infarction (MI) or death.

Methods: To obtain the incremental difference in cost and clinical outcomes, we first conducted a multicenter retrospective cohort study within the member population of the Kaiser Permanente Southern California integrated health care delivery system.

Association of Early Noninvasive Cardiac Stress Testing With Acute Myocardial Infarction and Mortality.

Study Objective: The evaluation for suspected acute coronary syndrome is a common and high-risk presentation in emergency departments (EDs). After exclusion of acute myocardial infarction (MI), patients often undergo early (within 72 hours) noninvasive cardiac testing. We evaluated the association between early noninvasive testing and death/acute MI in ED patients suspected of acute coronary syndrome.

Novel Use of a Catheter-Based Device Retrieval System for Percutaneous Treatment of Recurrent Atrial Myxoma.

Surgical resection is standard of care for the treatment of atrial myxoma. However, the optimal management strategy for recurrent cardiac tumors is less clear. Here we report the novel use of a catheter-based device retrieval system for the removal of a recurrent cardiac myxoma.

Cardiovascular Adaptation in Normal Pregnancy With 2D and 3D Echocardiography, Speckle Tracking, and Radial Artery Tonometry.

Background: Comprehensive cardiovascular assessment in normal pregnancy using advanced techniques has limited data.

Objectives: The aim of the study was to evaluate cardiovascular changes in normal pregnancy using two-dimensional/three-dimensional (3D) echo and applanation tonometry in healthy pregnant women.

Methods: Two-dimensional/Doppler, speckle tracking strain, 3D echocardiography, and vascular compliance by applanation tonometry were performed during the first, second, and third trimesters and postpartum.

Impact of California's naloxone co-prescription law on emergency department visits, 30-day mortality, and prescription patterns.

Objective: Opioid overdose is a public health epidemic adversely impacting individuals and communities. To combat this, California passed a law mandating that prescribers offer a naloxone prescription in certain circumstances. Our objective was to evaluate associations with California's naloxone prescription mandate and emergency department (ED) overdose visits/hospitalizations, opioid and naloxone prescribing, and 30-day mortality.

Pretransplant cardiac stress testing and transplant wait time in kidney transplantation candidates.

Objective: Routine screening for cardiovascular disease before kidney transplantation remains controversial. This study aims to compare cardiac testing rates in patients with end-stage renal disease, referred and not referred for transplantation, and assess the impact of testing on transplant wait times.

Methods: This is a retrospective cohort study of 22 687 end-stage renal disease patients from 2011 to 2022, within an integrated health system.

Rule-based natural language processing to examine variation in worsening heart failure hospitalizations by age, sex, race and ethnicity, and left ventricular ejection fraction.

Background: Prior studies characterizing worsening heart failure events (WHFE) have been limited in using structured healthcare data from hospitalizations, and with little exploration of sociodemographic variation. The current study examined the impact of incorporating unstructured data to identify WHFE, describing age-, sex-, race and ethnicity-, and left ventricular ejection fraction (LVEF)-specific rates.

Methods: Adult members of Kaiser Permanente Southern California (KPSC) with a HF diagnosis between 2014 and 2018 were followed through 2019 to identify hospitalized WHFE.

Racial and Ethnic Differences in the Prevalence of Severe Aortic Stenosis by Echocardiography.

Background: Understanding the burden of aortic stenosis (AS) across diverse racial and ethnic populations is important to ensure equitable resource allocation. This study explored whether severe AS rate varies by race and ethnicity.

Methods: The rates of severe AS, stratified by race and ethnicity, were calculated among 615,038 adults with a transthoracic echocardiogram.

Gender and Age Differences in the Evaluation and Clinical Outcomes of Patients with Palpitations.

Background: Palpitations represent a common clinic complaint.

Objective: To explore gender and age differences in the evaluation and outcomes of patients with palpitations in outpatient settings.

Design/participants: This is a retrospective observational study of 58,543 patients with no known structural cardiac disease or arrythmias presenting to primary care and cardiology clinics in an integrated health system in California with palpitations between January 2017 and December 2021.

Prognostic Value of Stress Myocardial Perfusion Imaging Across the Spectrum of Cardiovascular Risk.

Background: Single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is widely used to identify ischemia. There is limited research to evaluate if there is a risk threshold below which SPECT-MPI may not add significant prognostic value.

Methods: Between January 1, 2012, and December 31, 2018, individuals who underwent SPECT-MPI were stratified into 4 risk groups.

Effectiveness and safety of early treatment with spironolactone for new-onset acute heart failure.

Background: The effectiveness and safety of mineralocorticoid receptor antagonists (MRA) in acute heart failure (HF) is uncertain. We sought to describe the prescription of spironolactone during acute HF and whether early treatment is effective and safe in a real-world setting.

Methods: We performed a retrospective cohort study of adult (≥18 years) nonpregnant patients hospitalized with new-onset HF with reduced ejection fraction (HFrEF, defined by ejection fraction ≤40%) within 15 Kaiser Permanente Southern California medical centers between 2016 and 2021.

Effectiveness and safety of Dabigatran 110 mg versus 150 mg for Stroke Prevention in Patients with Atrial Fibrillation at High Bleeding Risk.

Purpose: The effectiveness and tolerability of a reduced dose (110 mg) of dabigatran versus the standard dose (150 mg) were evaluated in subgroups of patients with atrial fibrillation (AF) at high bleeding risk.

Methods: Eligible patients were adults with AF and a creatinine clearance rate ≥30 mL/min who were initiated on treatment with dabigatran (index) between 2016 and 2018. High-bleeding-risk subgroups were identified: (1) age ≥80 years; (2) moderate renal impairment (creatinine clearance rate 30-<50 mL/min); and (3) recent bleeding or a HAS-BLED score of ≥3.