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  1. Article: Electronic Health Records and Heart Failure.

    Kao, David P

    Heart failure clinics

    2022  Volume 18, Issue 2, Page(s) 201–211

    Abstract: Increasing the global adoption of electronic health records (EHRs) is transforming the delivery of clinical care. EHRs offer tools that are useful in the care of heart failure ranging from individualized risk stratification and decision support to ... ...

    Abstract Increasing the global adoption of electronic health records (EHRs) is transforming the delivery of clinical care. EHRs offer tools that are useful in the care of heart failure ranging from individualized risk stratification and decision support to population management. EHR tools can be combined to target specific areas of need such as the standardization of care, improved quality of care, and resource management. Leveraging EHR functionality has been shown to improve select outcomes including guideline-based therapies, reduction in adverse clinical outcomes, and improved cost-efficiency. Central to success is participation by clinicians and patients in the design and feedback of EHR tools.
    MeSH term(s) Electronic Health Records ; Heart Failure/therapy ; Humans
    Language English
    Publishing date 2022-03-04
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2212019-1
    ISSN 1551-7136
    ISSN 1551-7136
    DOI 10.1016/j.hfc.2021.12.004
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  2. Article ; Online: Intelligent Artificial Intelligence: Present Considerations and Future Implications of Machine Learning Applied to Electrocardiogram Interpretation.

    Kao, David P

    Circulation. Cardiovascular quality and outcomes

    2019  Volume 12, Issue 9, Page(s) e006021

    MeSH term(s) Artificial Intelligence ; Electrocardiography ; Forecasting ; Humans ; Machine Learning
    Language English
    Publishing date 2019-09-05
    Publishing country United States
    Document type Editorial ; Research Support, N.I.H., Extramural ; Comment
    ZDB-ID 2483197-9
    ISSN 1941-7705 ; 1941-7713
    ISSN (online) 1941-7705
    ISSN 1941-7713
    DOI 10.1161/CIRCOUTCOMES.119.006021
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  3. Article ; Online: Extracting Vocal Biomarkers for Pulmonary Congestion With a Smartphone App.

    Ravindra, Neal G / Kao, David P

    JACC. Heart failure

    2021  Volume 10, Issue 1, Page(s) 50–51

    MeSH term(s) Biomarkers ; Heart Failure ; Humans ; Mobile Applications ; Pulmonary Edema/diagnostic imaging ; Pulmonary Edema/etiology ; Smartphone ; Speech
    Chemical Substances Biomarkers
    Language English
    Publishing date 2021-12-08
    Publishing country United States
    Document type Editorial ; Research Support, N.I.H., Extramural ; Comment
    ZDB-ID 2705621-1
    ISSN 2213-1787 ; 2213-1779
    ISSN (online) 2213-1787
    ISSN 2213-1779
    DOI 10.1016/j.jchf.2021.10.007
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  4. Article ; Online: Reply: Loperamide-Associated Ventricular Arrhythmias.

    Krantz, Mori J / Stockbridge, Norman / Kao, David P / Klein, Michael G / Haigney, Mark C P

    Journal of the American College of Cardiology

    2023  Volume 82, Issue 17, Page(s) e159

    MeSH term(s) Humans ; Loperamide/adverse effects ; Arrhythmias, Cardiac/chemically induced ; Drug Overdose
    Chemical Substances Loperamide (6X9OC3H4II)
    Language English
    Publishing date 2023-10-16
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 605507-2
    ISSN 1558-3597 ; 0735-1097
    ISSN (online) 1558-3597
    ISSN 0735-1097
    DOI 10.1016/j.jacc.2023.07.033
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  5. Article: Patient-Level Exposure to Actionable Pharmacogenomic Medications in a Nationally Representative Insurance Claims Database.

    Bianchini, Monica L / Aquilante, Christina L / Kao, David P / Martin, James L / Anderson, Heather D

    Journal of personalized medicine

    2023  Volume 13, Issue 11

    Abstract: Background: The prevalence of exposure to pharmacogenomic medications is well established but little is known about how long patients are exposed to these medications.: Aim: Our objective was to describe the amount of exposure to actionable ... ...

    Abstract Background: The prevalence of exposure to pharmacogenomic medications is well established but little is known about how long patients are exposed to these medications.
    Aim: Our objective was to describe the amount of exposure to actionable pharmacogenomic medications using patient-level measures among a large nationally representative population using an insurance claims database.
    Methods: Our retrospective cohort study included adults (18+ years) from the IQVIA PharMetrics
    Results: Over 1 million fills of pharmacogenetic medications were identified for 605,355 unique patients. The mean PDC for all medications was 0.21 (SD 0.3), suggesting patients were exposed 21% (77 days) of the year. Medications with the highest PDC (0.55-0.89) included ivacaftor, tamoxifen, clopidogrel, HIV medications, transplant medications, and statins; with the exception of statins, these medications were initiated by fewer patients. Pharmacogenomic medications were filled an average of 2.8 times (SD 3.0, range 1-81) during the year following the medication's initiation, and the average days supplied for each fill was 22.3 days (SD 22.4, range 1-180 days).
    Conclusion: Patient characteristics associated with more medication exposure were male sex, older age, and comorbid chronic conditions. Prescription fill data provide patient-level exposure metrics that can further our understanding of pharmacogenomic medication utilization and help inform opportunities for pharmacogenomic testing.
    Language English
    Publishing date 2023-11-03
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662248-8
    ISSN 2075-4426
    ISSN 2075-4426
    DOI 10.3390/jpm13111574
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  6. Article ; Online: Heart Failure Management Innovation Enabled by Electronic Health Records.

    Kao, David P / Trinkley, Katy E / Lin, Chen-Tan

    JACC. Heart failure

    2020  Volume 8, Issue 3, Page(s) 223–233

    Abstract: Patients with congestive heart failure (CHF) require complex medical management across the continuum of care. Electronic health records (EHR) are currently used for traditional tasks of documentation, reviewing and managing test results, computerized ... ...

    Abstract Patients with congestive heart failure (CHF) require complex medical management across the continuum of care. Electronic health records (EHR) are currently used for traditional tasks of documentation, reviewing and managing test results, computerized order entry, and billing. Unfortunately many clinicians view EHR as merely digitized versions of paper charts, which create additional work and cognitive burden without improving quality or efficiency of care. In fact, EHR are revolutionizing the care of chronic diseases such as CHF. This review describes how appropriate use of technologies offered by EHR can help standardize CHF care, promote adherence to evidence-based guidelines, optimize workflow efficiency, improve performance metrics, and facilitate patient engagement. This review discusses a number of tools including documentation templates, telehealth and telemedicine, health information exchange, order sets, clinical decision support, registries, and analytics. Where available, evidence of their potential utility in management of CHF is presented. Together these EHR tools can also be used to enhance quality improvement, patient management, and clinical research as part of a learning health care system model. This review describes how existing EHR tools can support patients, cardiologists, and care teams to deliver consistent, high-quality, coordinated, patient-centered, and guideline-concordant care of CHF.
    MeSH term(s) Disease Management ; Electronic Health Records/standards ; Heart Failure/therapy ; Humans ; Quality Improvement ; Registries ; Telemedicine/methods
    Language English
    Publishing date 2020-01-08
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2705621-1
    ISSN 2213-1787 ; 2213-1779
    ISSN (online) 2213-1787
    ISSN 2213-1779
    DOI 10.1016/j.jchf.2019.09.008
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  7. Article ; Online: Ventricular Arrhythmias Associated With Over-the-Counter and Recreational Opioids.

    Krantz, Mori J / Rudo, Todd J / Haigney, Mark C P / Stockbridge, Norman / Kleiman, Robert B / Klein, Michael / Kao, David P

    Journal of the American College of Cardiology

    2023  Volume 81, Issue 23, Page(s) 2258–2268

    Abstract: Background: Epidemic increases in opioid deaths prompted policies limiting access to prescription opioids in North America. Consequently, the over-the-counter opioids loperamide (Imodium A-D) and mitragynine, the herbal ingredient in kratom, are ... ...

    Abstract Background: Epidemic increases in opioid deaths prompted policies limiting access to prescription opioids in North America. Consequently, the over-the-counter opioids loperamide (Imodium A-D) and mitragynine, the herbal ingredient in kratom, are increasingly used to avert withdrawal or induce euphoria. Arrhythmia events related to these nonscheduled drugs have not been systematically studied.
    Objectives: In this study, we sought to explore opioid-associated arrhythmia reporting in North America.
    Methods: The U.S. Food and Drug Administration Adverse Event Reporting System (FAERS), Center for Food Safety and Applied Nutrition Adverse Event Reporting System (CAERS), and Canada Vigilance Adverse Reaction (CVAR) databases were searched (2015-2021). Reports involving nonprescription drugs (loperamide, mitragynine) and diphenoxylate/atropine (Lomotil) were identified. Methadone, a prescription opioid (full agonist), served as a positive control owing to its established arrhythmia risk. Buprenorphine (partial agonist) and naltrexone (pure antagonist), served as negative controls. Reports were classified according to Medical Dictionary for Regulatory Activities terminology. Significant disproportionate reporting required a proportional reporting ratio (PRR) of ≥2, ≥3 cases, and chi-square ≥4. Primary analysis used FAERS data, whereas CAERS and CVAR data were confirmatory.
    Results: Methadone was disproportionately associated with ventricular arrhythmia reports (PRR: 6.6; 95% CI: 6.2-7.0; n = 1,163; chi-square = 5,456), including 852 (73%) fatalities. Loperamide was also significantly associated with arrhythmia (PRR: 3.2; 95% CI: 3.0-3.4; n = 1,008; chi-square = 1,537), including 371 (37%) deaths. Mitragynine demonstrated the highest signal (PRR: 8.9; 95% CI: 6.7-11.7; n = 46; chi-square = 315), with 42 (91%) deaths. Buprenorphine, diphenoxylate, and naltrexone were not associated with arrhythmia. Signals were similar in CVAR and CAERS.
    Conclusions: The nonprescription drugs loperamide and mitragynine are associated with disproportionate reports of life-threatening ventricular arrhythmia in North America.
    MeSH term(s) Humans ; Analgesics, Opioid/adverse effects ; Diphenoxylate ; Loperamide/adverse effects ; Naltrexone ; Arrhythmias, Cardiac/chemically induced ; Arrhythmias, Cardiac/epidemiology ; Buprenorphine/adverse effects ; Methadone/adverse effects ; Nonprescription Drugs/adverse effects
    Chemical Substances Analgesics, Opioid ; Diphenoxylate (73312P173G) ; Loperamide (6X9OC3H4II) ; Naltrexone (5S6W795CQM) ; Buprenorphine (40D3SCR4GZ) ; Methadone (UC6VBE7V1Z) ; Nonprescription Drugs
    Language English
    Publishing date 2023-06-03
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 605507-2
    ISSN 1558-3597 ; 0735-1097
    ISSN (online) 1558-3597
    ISSN 0735-1097
    DOI 10.1016/j.jacc.2023.04.009
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  8. Article ; Online: Association Between Coffee Intake and Incident Heart Failure Risk: A Machine Learning Analysis of the FHS, the ARIC Study, and the CHS.

    Stevens, Laura M / Linstead, Erik / Hall, Jennifer L / Kao, David P

    Circulation. Heart failure

    2021  Volume 14, Issue 2, Page(s) e006799

    Abstract: Background: Coronary heart disease, heart failure (HF), and stroke are complex diseases with multiple phenotypes. While many risk factors for these diseases are well known, investigation of as-yet unidentified risk factors may improve risk assessment ... ...

    Abstract Background: Coronary heart disease, heart failure (HF), and stroke are complex diseases with multiple phenotypes. While many risk factors for these diseases are well known, investigation of as-yet unidentified risk factors may improve risk assessment and patient adherence to prevention guidelines. We investigated the diet domain in FHS (Framingham Heart Study), CHS (Cardiovascular Heart Study), and the ARIC study (Atherosclerosis Risk in Communities) to identify potential lifestyle and behavioral factors associated with coronary heart disease, HF, and stroke.
    Methods: We used machine learning feature selection based on random forest analysis to identify potential risk factors associated with coronary heart disease, stroke, and HF in FHS. We evaluated the significance of selected variables using univariable and multivariable Cox proportional hazards analysis adjusted for known cardiovascular risks. Findings from FHS were then validated using CHS and ARIC.
    Results: We identified multiple dietary and behavioral risk factors for cardiovascular disease outcomes including marital status, red meat consumption, whole milk consumption, and coffee consumption. Among these dietary variables, increasing coffee consumption was associated with decreasing long-term risk of HF congruently in FHS, ARIC, and CHS.
    Conclusions: Higher coffee intake was found to be associated with reduced risk of HF in all three studies. Further study is warranted to better define the role, possible causality, and potential mechanism of coffee consumption as a potential modifiable risk factor for HF.
    MeSH term(s) Aged ; Animals ; Cardiovascular Diseases/epidemiology ; Coffee ; Coronary Disease/epidemiology ; Diet/statistics & numerical data ; Female ; Heart Disease Risk Factors ; Heart Failure/epidemiology ; Humans ; Incidence ; Machine Learning ; Male ; Middle Aged ; Milk ; Proportional Hazards Models ; Protective Factors ; Red Meat ; Stroke/epidemiology
    Chemical Substances Coffee
    Language English
    Publishing date 2021-02-09
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2429459-7
    ISSN 1941-3297 ; 1941-3289
    ISSN (online) 1941-3297
    ISSN 1941-3289
    DOI 10.1161/CIRCHEARTFAILURE.119.006799
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  9. Article ; Online: The Rate of Medial Ulnar Collateral Ligament Repair Is Increasing While Reconstruction Remains the Most Common Procedure Overall Among Early-Career Orthopaedic Surgeons.

    Spivey, Matthew G / Constantinescu, David S / Costello, Joseph P / Kao, Davis S / O'Connell, Robert S / Vap, Alexander R

    Arthroscopy, sports medicine, and rehabilitation

    2023  Volume 5, Issue 3, Page(s) e549–e557

    Abstract: Purpose: To determine the practice patterns and complication rates in medial ulnar collateral ligament (MUCL) repair versus reconstruction procedures performed by early-career orthopaedic surgeons each year between 2010 and 2020, stratified by ... ...

    Abstract Purpose: To determine the practice patterns and complication rates in medial ulnar collateral ligament (MUCL) repair versus reconstruction procedures performed by early-career orthopaedic surgeons each year between 2010 and 2020, stratified by fellowship training and concomitant procedures performed, during their 6-month American Board of Orthopaedic Surgery (ABOS) Case List collection period.
    Methods: The ABOS database was queried for MUCL reconstruction and MUCL repair procedures reported by ABOS Part II Oral Examination examinees from 2010 to 2020. Surgeon fellowship training background, patient demographics, procedural diagnosis codes, complications, and concomitant procedures were recorded for each case. Differences between overall procedure rates and the associated complications reported were examined. Data regarding the specific injury pathology and other patient-specific characteristics for each case were not available.
    Results: In total, 187 primary procedures performed to address isolated MUCL injuries were reported. Of those, 83% (n = 155) were reconstructions and 17% (n = 32) were repairs. The annual percentage of MUCL repair increased from 10% (1/10) in 2010 to 38% (8/21) in 2020 (linear regression; R
    Conclusions: Among cases reported by ABOS Part II Oral Examination examinees from 2010 to 2020, there was an increasing rate of MUCL repair whereas MUCL reconstruction remained more common overall. Interestingly, the overall complication rates were significantly lower for MUCL reconstruction than for MUCL repair both in isolation and when concurrent procedures were performed.
    Level of evidence: Level III, retrospective cohort study.
    Language English
    Publishing date 2023-03-31
    Publishing country United States
    Document type Journal Article
    ISSN 2666-061X
    ISSN (online) 2666-061X
    DOI 10.1016/j.asmr.2023.02.007
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  10. Article ; Online: Implementation of clopidogrel pharmacogenetic clinical decision support for a preemptive return of results program.

    Aquilante, Christina L / Trinkley, Katy E / Lee, Yee Ming / Crooks, Kristy R / Hearst, Emily C / Heckman, Simeon M / Hess, Kaitlyn W / Kudron, Elizabeth L / Martin, James L / Swartz, Carolyn T / Kao, David P

    American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

    2024  

    Abstract: Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and ...

    Abstract Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
    Purpose: To describe our experiences implementing and iterating CYP2C19 genotype-guided clopidogrel pharmacogenetic clinical decision support (CDS) tools over time in the setting of a large health system-wide, preemptive pharmacogenomics program.
    Summary: Clopidogrel-treated patients who are genetically predicted cytochrome P450 isozyme 2C19 intermediate or poor metabolizers have an increased risk of atherothrombotic events, some of which can be life-threatening. The Clinical Pharmacogenetics Implementation Consortium provides guidance for the use of clopidogrel based on CYP2C19 genotype in patients with cardiovascular and cerebrovascular diseases. Our multidisciplinary team implemented an automated, interruptive alert that fires when clopidogrel is ordered or refilled for biobank participants with structured CYP2C19 intermediate or poor metabolizer genomic indicators in the electronic health record. The implementation began with a narrow cardiovascular indication and setting and was then scaled in 4 primary dimensions: (1) clinical indication; (2) availability across health-system locations; (3) care venue (e.g., inpatient vs outpatient); and (4) provider groups (eg, cardiology and neurology). We iterated our approach over time based on evolving clinical evidence and proactive strategies to optimize CDS maintenance and sustainability. A key facilitator of expansion was socialization of the broader pharmacogenomics initiative among our academic medical center community, accompanied by clinician acceptance of pharmacogenetic alerts in practice.
    Conclusion: A multidisciplinary collaboration is recommended to facilitate the use of CYP2C19 genotype-guided antiplatelet therapy in patients with cardiovascular and cerebrovascular diseases. Evolving clopidogrel pharmacogenetic evidence necessitates thoughtful iteration of implementation efforts and strategies to optimize long-term maintenance and sustainability.
    Language English
    Publishing date 2024-01-22
    Publishing country England
    Document type Journal Article
    ZDB-ID 1224627-x
    ISSN 1535-2900 ; 1079-2082
    ISSN (online) 1535-2900
    ISSN 1079-2082
    DOI 10.1093/ajhp/zxae008
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