Natural Language Processing to Identify Racial and Ethnic Disparities in Aortic Stenosis DOI Creative Commons
Dhruva Biswas,

Jack Wu,

Apurva Bharucha

et al.

medRxiv (Cold Spring Harbor Laboratory), Journal Year: 2023, Volume and Issue: unknown

Published: Dec. 17, 2023

Abstract IMPORTANCE This study uses artificial intelligence (AI) technologies to augment quality measurement and improvement in the setting of aortic stenosis (AS). We characterise racial ethnic disparities diagnosis, management, outcome AS within a universal healthcare system. OBJECTIVE To use natural language processing (NLP) AI methods applied electronic health records (EHR) identify while correcting for effects socioeconomic deprivation. DESIGN Retrospective cohort study. SETTING King’s College Hospital NHS Foundation Trust, multi-site tertiary care hospital London, UK PARTICIPANTS Adult patients with diagnosis between 2010-2020. MAIN OUTCOMES AND MEASURES Key outcomes were all-cause mortality, frequency intervention (TAVI or surgical valve replacement [AVR]) time from severe intervention. All analyses adjusted age, sex RESULTS 5859 identified, self-reported race ethnicity labels as 4.5% Asian, 7.5% Black, 88.0% White. For those AS, TAVI was performed 19.6% Asian patients, 17.6% Black 24.9% White patients; AVR 39.2% 27.9% 32.8% patients. The mean 0.69 years 1.03 0.62 (P=n.s.). longer (1.35 years) compared (0.49 (0.41 years, P<0.001). Survival overall did not associate ethnicity. However, independently associated increased mortality (hazard ratio=1.42, 95% CI=1.05-1.92, P=0.02). CONCLUSIONS RELEVANCE In experience lower rates TAVI, higher despite correction These data exhibit how may be leveraged shed light on inequities, here showing that persist system, should stimulate strategies address inequity. points Question Do (AS) exist system? Finding this retrospective using enabled analysis record stenosis, we identified transcatheter implantation (TAVI), times (AVR) mortality. Meaning Natural used inequities. Here, find even setting.

Language: Английский

Transcatheter or Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis and Small Aortic Annulus: A Randomized Clinical Trial DOI
Josep Rodés‐Cabau, Henrique Barbosa Ribeiro, Siamak Mohammadi

et al.

Circulation, Journal Year: 2023, Volume and Issue: 149(9), P. 644 - 655

Published: Oct. 26, 2023

The optimal treatment in patients with severe aortic stenosis and small annulus (SAA) remains to be determined. This study aimed compare the hemodynamic clinical outcomes between transcatheter valve replacement (TAVR) surgical (SAVR) a SAA.

Language: Английский

Citations

40
Measuring Representativeness in Clinical Trials DOI
Allen Sanyi, Samuel Byiringiro, Sanaz Dabiri

et al.

Circulation, Journal Year: 2025, Volume and Issue: 151(5), P. 318 - 330

Published: Feb. 3, 2025

Representativeness in randomized clinical trials remains a critical concern, affecting the external validity of trial results, equitable access to risks and benefits research participation, public trust research. Although representative participation by members groups traditionally underrepresented is just surrogate for true diversity, equity, inclusion, belonging trials, it can be quantified, allowing stakeholders add empirical rigor efforts. Multiple ways measure representativeness have been proposed, including participation-to-prevalence ratio, raw proportions or numbers relevant subgroups, enrollment fraction subgroups. These methods strengths weaknesses may appropriate report certain circumstances, depending on why seek assess representativeness. Stakeholders—including regulatory agencies, journal editors, investigators, sponsors—may use quantitative measures establish standards, monitor ongoing condition funding drug device approval achieving specific targets. However, using this way could unintended consequences, researchers “gaming” recruitment strategies meet target numbers, overlooking nuanced variations within communities, potentially incentivizing problematic exploitative strategies. no single method measuring offers comprehensive solution increasing all carefully designed, multifaceted approach provide with useful perspectives progress diversity participation. For seeking number enrolling patients disease state well-delineated demographics, ratio ideal; however, more view representativeness, combination subgroups relevance plus full demographics approached appropriate.

Language: Английский

Citations

1
Cardiovascular Disease in the Older Adult DOI Creative Commons
Farshad Forouzandeh, Karen P. Alexander, Daniel E. Forman

et al.

JACC Advances, Journal Year: 2024, Volume and Issue: 3(2), P. 100820 - 100820

Published: Jan. 11, 2024

The 1986 Bethesda Conference on Cardiovascular Disease (CVD) in the Elderly, co-chaired by Drs Nanette Wenger, Frank Marcus, and Robert O'Rourke delineated anticipated social, political, ethical, economic, technological impact of an aging population incidence, prevalence, management CVD United States worldwide. In ensuing 4 decades, older patients have come to comprise increasingly large proportion population, there has been explosion research all aspects affecting adults. Correspondingly, geriatric cardiology is now established field within cardiovascular medicine. this communication, we provide a focused update intersections between geriatrics from basic science clinical practice, review major advances diagnosis treatment adults with CVD, preview future directions still-evolving cardiology.

Language: Английский

Citations

4
Sex Disparities in Cardiovascular Disease DOI Creative Commons
Madeline Mahowald, Khadeeja Esmail, Fatima M. Ezzeddine

et al.

Methodist DeBakey Cardiovascular Journal, Journal Year: 2024, Volume and Issue: 20(2), P. 107 - 119

Published: Jan. 1, 2024

Cardiovascular disease is the leading cause of death in women. It remains underdiagnosed, undertreated, and portends worse outcomes women than men. Disparities exist every stage science, from bench research to editorial board major journals cardiovascular subspecialty. This review summarizes differences risk factors disparities management ischemic heart disease, failure, aortic stenosis, atrial fibrillation. also provides an overview female representation as participants leaders clinical trials, boards, academic institutions. Strategies overcome these are proposed with examples successful programs.

Language: Английский

Citations

4
Racial Disparities Among Patients Undergoing Balloon-Expandable Transcatheter Aortic Valve Replacement DOI Creative Commons

Karthik Vedantam,

Christian Torres, Sammy Elmariah

et al.

Journal of the Society for Cardiovascular Angiography & Interventions, Journal Year: 2025, Volume and Issue: unknown, P. 102495 - 102495

Published: Jan. 1, 2025

Language: Английский

Citations

0
Advancing Health Equity in the Cardiovascular Device Life Cycle DOI

Andre Small,

Nathan Watson, Rishi K. Wadhera

et al.

Circulation Cardiovascular Quality and Outcomes, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 3, 2025

Despite advancements in diagnostics and therapeutics for cardiovascular disease, significant health disparities persist among patients from historically marginalized racial ethnic groups, women, individuals who are socioeconomically under-resourced or underinsured, those living rural communities. While transcatheter interventions have revolutionized the treatment landscape cardiology, populations bearing greatest burden of disease continue to face inequitable access poorer outcomes. A notable gap literature concerns role modern approaches device innovation shaping perpetuating disparities. Health equity has been declared one top strategic initiatives 2022 2025 by Food Drug Administration Center Devices Radiological Health, underscoring need greater attention, dialogue, targeted this space. This narrative review uses life cycle as a conceptual framework enhance understanding guide future efforts mitigate field interventional cardiology. Drawing on illustrative examples we examine current practices regulation approval, clinical trial evaluation, adoption patterns, postprocedural outcomes with aim uncovering potential mechanisms identifying opportunities interventions.

Language: Английский

Citations

0
A series of randomized trials of behavioral economic interventions to increase racial and ethnic diversity of research participants:Rationale and design of ITERATE DOI Creative Commons

Nirali Patel,

Casey Whitman,

Allyson Lieberman

et al.

American Heart Journal, Journal Year: 2025, Volume and Issue: unknown

Published: March 1, 2025

Prospective clinical research studies are essential for determining the effectiveness and safety of drugs, medical devices, healthcare delivery interventions. However, low enrollment, particularly among Black Hispanic patients, challenges generalizability results fairness research. Leveraging insights from behavioral economics to modify content messages recruiting patients join may increase enrollment representativeness trial populations. Method outreach, source message framing, financial incentives will have important effects on fraction electronically approached participation in a prospective study. ITERATE (NCT05827718) is series four randomized trials (RCTs) designed rigorously, systematically, iteratively test different messaging strategies informed by economic theory individuals into Penn Medicine BioBank (PMBB), registry. For all RCTs, we identify eligible PMBB (those with ≥ 1 encounter University Pennsylvania Health System past 3 months, phone number able receive text or valid email address file, no history consenting declining PMBB, provide their own consent) randomly assign them outreach messages. RCT method (email vs. + message); 2, (research team team); 3, framing (appeal altruism appeal social proof control); 4, incentive (none medium guarantee small lottery large lottery). In each RCT, at least 50% participants be Hispanic. The primary outcome fraction, defined as who enroll divided total received an message, compared between arms both patients. Secondary outcomes include overall White "winning" earlier RCTs incorporated "standard care" subsequent RCTs.

Language: Английский

Citations

0
Engineering advanced in vitro models of endothelial dysfunction DOI
Jasneil Singh, Alexander M. Ruhoff,

Deepu Ashok

et al.

Trends in biotechnology, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Language: Английский

Citations

0
The effect of down‐titration and discontinuation of heart failure pharmacotherapy in older people: A systematic review and meta‐analysis DOI Creative Commons
Mai Duong, Danijela Gnjidic, Andrew J. McLachlan

et al.

British Journal of Clinical Pharmacology, Journal Year: 2024, Volume and Issue: unknown

Published: Sept. 16, 2024

The aim of this study was to investigate whether interventions discontinue or down‐titrate heart failure (HF) pharmacotherapy are feasible and associated with risks in older people. A systematic review meta‐analysis were conducted according PRISMA 2020 guidelines. Electronic databases searched from inception 8 March 2023. Randomized controlled trials (RCTs) observational studies included people HF, aged ≥50 years who discontinued down‐titrated HF pharmacotherapy. Outcomes feasibility (whether discontinuation down‐titration sustained at follow‐up) (mortality, hospitalization, adverse drug withdrawal effects [ADWE]). Random‐effects performed when heterogeneity not substantial (Higgins I 2 < 70%). Sub‐analysis by frailty status conducted. Six RCTs (536 participants) 27 (810 499 across six therapeutic classes included, for 3–260 weeks follow‐up. patients presenting stable chronic HF. Down‐titrating a renin‐angiotensin system inhibitor (RASI) kidney disease 76% more likely than continuation (risk ratio [RR] 1.76, 95% confidence interval [CI] 1.14–2.73), no difference mortality (RR 0.64, CI 0.30–1.64). Discontinuation beta‐blockers compared preserved ejection fraction 1.00, 0.68–1.47). Participants 25% re‐initiate diuretics 0.75, 0.66–0.86). Digoxin 5.5‐fold risk hospitalization continuation. Worsening the most common ADWE. One measured but did report outcomes status. appropriateness down‐titrating discontinuing ≥75 is uncertain. Evaluation necessitates investigation.

Language: Английский

Citations

3
Diversity in Clinical Trial Enrollment and Reporting—Where We Are and the Road Ahead DOI

Andrew Farb,

Charles J. Viviano, Michelle E. Tarver

et al.

JAMA Cardiology, Journal Year: 2023, Volume and Issue: 8(9), P. 803 - 803

Published: July 26, 2023

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Language: Английский

Citations

5