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

Striking the Right Chord DOI Creative Commons
Aishat Mustapha, Modele O. Ogunniyi, Neal W. Dickert

et al.

JACC Advances, Journal Year: 2024, Volume and Issue: 3(7), P. 100954 - 100954

Published: May 1, 2024

Language: Английский

Citations

1
The effect of down-titration and discontinuation of heart failure pharmacotherapy in older people: a systematic review and meta-analysis DOI Open Access
Mai Duong, Danijela Gnjidic, Andrew J. McLachlan

et al.

Authorea (Authorea), Journal Year: 2024, Volume and Issue: unknown

Published: May 16, 2024

Aim: To investigate if interventions to discontinue or down-titrate heart failure (HF)-pharmacotherapy are feasible and associated with risks in older people. Methods: A systematic review meta-analysis were conducted according PRISMA 2020 guidelines. Electronic databases searched from inception March 8th 2023. Randomised controlled trials (RCTs) observational studies included people HF, aged >50 years who discontinued down-titrated HF-pharmacotherapy. Outcomes feasibility (whether discontinuation down-titration of HF-pharmacotherapy was sustained at follow-up) (mortality, hospitalisation, adverse drug withdrawal effects [ADWE]). Random-effects performed when heterogeneity not substantial (Higgins I2<70%). Sub-analysis by frailty status conducted. Results: Six RCTs (536-participants) 27 (810,499-participants) across six therapeutic classes included, for 3-260 weeks follow-up. patients presenting stable HF. Down-titrating a renin-angiotensin system inhibitor (RASI) chronic kidney disease 76% likely than continuation (Risk Ratio [RR] 1.76, 95%CI 1.14-2.73), no difference mortality (RR 0.64, 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 hospitalisation continuation. Worsening HF the commonest ADWE. One study measured but did report outcomes status. Conclusions: The appropriateness down-titrating discontinuing >75 is uncertain. Evaluation necessitates investigation.

Language: Английский

Citations

0
Racial disparities in cutaneous T-cell lymphoma clinical trial enrollment and reporting: A systematic review DOI Creative Commons

Leore Lavin,

Anna Chen,

Céline Soudant

et al.

JAAD reviews., Journal Year: 2024, Volume and Issue: 2, P. 100 - 106

Published: Oct. 2, 2024

Language: Английский

Citations

0
Measuring Hospital Inpatient Procedure Access Inequality in the United States DOI Creative Commons
Alon Bergman, Guy David, Ashwin S. Nathan

et al.

Health Affairs Scholar, Journal Year: 2024, Volume and Issue: 2(11)

Published: Oct. 29, 2024

Abstract Geographic disparities in access to inpatient procedures are a significant issue within the US healthcare system. This study introduces Procedure Access Inequality (PAI) index, standardized metric quantify these while adjusting for disease prevalence. Using data from Healthcare Cost and Utilization Project State Inpatient Databases, we analyzed procedure 18 states between 2016 2019. The PAI index reveals notable variability inequality across different procedures, with minimally invasive newer exhibiting higher inequality. Key findings indicate that such as skin grafts gastrectomy have highest scores, cesarean sections percutaneous coronary interventions lowest. highlights is associated greater market concentration particular, fewer hospitals offering procedures. These emphasize need targeted policy address procedural promote more equitable delivery United States.

Language: Английский

Citations

0
Transcatheter or Surgical Aortic Valve Replacement in Patients with Severe Aortic Stenosis and Small Aortic Annulus: A Randomized Clinical Trial DOI Open Access
Josep Rodés‐Cabau, Henrique Barbosa Ribeiro, Siamak Mohammadi

et al.

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

Published: Sept. 29, 2023

ABSTRACT BACKGROUND The optimal treatment in patients with severe aortic stenosis (AS) and small annulus (SAA) remains to be determined. objectives of this study were compare the hemodynamic clinical outcomes between transcatheter valve replacement (TAVR) surgical (SAVR) a SAA. METHODS Prospective multicenter international randomized trial performed 15 university hospitals. Participants 151 AS SAA (mean diameter <23 mm) (1:1) TAVR (n=77) vs SAVR (n=74), primary outcome was impaired hemodynamics (i.e. prosthesis patient mismatch [PPM] or moderate-severe regurgitation [AR]) at 60 days as evaluated by Doppler-echocardiography analyzed central echocardiography core laboratory. Clinical events secondary outcomes. RESULTS mean age participants 75±5 years, 93 women, median STS 2.5 (1.7-3.3)%, 21.1±1.2 mm. CONCLUSIONS This will provide clinicians scientific evidence determine if population smaller anatomy setting maybe better suited compared SAVR. TRIAL REGISTRATION Clinicaltrials.gov : NCT03383445

Language: Английский

Citations

1
Editorial: Disparity persists: The continued need to address racial differences in TAVR and SAVR DOI
Brian C. Case, Andrew G. Hill

Cardiovascular revascularization medicine, Journal Year: 2023, Volume and Issue: 59, P. 91 - 92

Published: Oct. 20, 2023

Language: Английский

Citations

0
Temporal Trends of Enrollment by Sex and Race in Major Cardiovascular Randomized Clinical Trials DOI Creative Commons
Hassan Sheikh,

Nicole Walczak,

Haaris Rana

et al.

CJC Open, Journal Year: 2023, Volume and Issue: 6(2), P. 454 - 462

Published: Nov. 2, 2023

Women and racialized minorities continue to be underrepresented in cardiovascular (CV) trial outcomes data, despite comprising a significant global burden of CV disease. This study evaluated the impact characteristics on temporal enrollment women prominent trials published period 1986-2023.

Language: Английский

Citations

0
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

Citations

0