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Article ; Online: Management of perioperative acute coronary syndromes by mechanism: a practical approach.

Tabit, Corey E / Nathan, Sandeep

2020 Volume 59, Issue 1, Page(s) 61–65

MeSH term(s)	Acute Coronary Syndrome/therapy ; Humans ; Perioperative Care
Language	English
Publishing date	2020-11-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	210757-0
ISSN	1537-1913 ; 0020-5907
ISSN (online)	1537-1913
ISSN	0020-5907
DOI	10.1097/AIA.0000000000000310
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Article ; Online: Social determinants of health and hospital readmissions: can the HOSPITAL risk score be improved by the inclusion of social factors?

Obuobi, Shirlene / Chua, Rhys F M / Besser, Stephanie A / Tabit, Corey E

BMC health services research

2021 Volume 21, Issue 1, Page(s) 5

Abstract: Background: The HOSPITAL Risk Score (HRS) predicts 30-day hospital readmissions and is internationally validated. Social determinants of health (SDOH) such as low socioeconomic status (SES) affect health outcomes and have been postulated to affect ... ...

Abstract	Background: The HOSPITAL Risk Score (HRS) predicts 30-day hospital readmissions and is internationally validated. Social determinants of health (SDOH) such as low socioeconomic status (SES) affect health outcomes and have been postulated to affect readmission rates. We hypothesized that adding SDOH to the HRS could improve its predictive accuracy. Methods: Records of 37,105 inpatient admissions at the University of Chicago Medical Center were reviewed. HRS was calculated for each patient. Census tract-level SDOH then were combined with the HRS and the performance of the resultant "Social HRS" was compared against the HRS. Patients then were assigned to 1 of 7 typologies defined by their SDOH and a balanced dataset of 14,235 admissions was sampled from the larger dataset to avoid over-representation by any 1 sociodemographic group. Principal component analysis and multivariable linear regression then were performed to determine the effect of SDOH on the HRS. Results: The c-statistic for the HRS predicting 30-day readmission was 0.74, consistent with published values. However, the addition of SDOH to the HRS did not improve the c-statistic (0.71). Patients with unfavorable SDOH (no high-school, limited English, crowded housing, disabilities, and age > 65 yrs) had significantly higher HRS (p < 0.05 for all). Overall, SDOH explained 0.2% of the HRS. Conclusion: At an urban tertiary care center, the addition of census tract-level SDOH to the HRS did not improve its predictive power. Rather, the effects of SDOH are already reflected in the HRS.
MeSH term(s)	Aged ; Hospitals ; Humans ; Patient Readmission ; Risk Factors ; Social Determinants of Health ; Social Factors
Language	English
Publishing date	2021-01-04
Publishing country	England
Document type	Journal Article
ISSN	1472-6963
ISSN (online)	1472-6963
DOI	10.1186/s12913-020-05989-7
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Article ; Online: Social determinants of health and hospital readmissions

Shirlene Obuobi / Rhys F. M. Chua / Stephanie A. Besser / Corey E. Tabit

BMC Health Services Research, Vol 21, Iss 1, Pp 1-

can the HOSPITAL risk score be improved by the inclusion of social factors?

2021 Volume 8

Abstract: Abstract Background The HOSPITAL Risk Score (HRS) predicts 30-day hospital readmissions and is internationally validated. Social determinants of health (SDOH) such as low socioeconomic status (SES) affect health outcomes and have been postulated to ... ...

Abstract	Abstract Background The HOSPITAL Risk Score (HRS) predicts 30-day hospital readmissions and is internationally validated. Social determinants of health (SDOH) such as low socioeconomic status (SES) affect health outcomes and have been postulated to affect readmission rates. We hypothesized that adding SDOH to the HRS could improve its predictive accuracy. Methods Records of 37,105 inpatient admissions at the University of Chicago Medical Center were reviewed. HRS was calculated for each patient. Census tract-level SDOH then were combined with the HRS and the performance of the resultant “Social HRS” was compared against the HRS. Patients then were assigned to 1 of 7 typologies defined by their SDOH and a balanced dataset of 14,235 admissions was sampled from the larger dataset to avoid over-representation by any 1 sociodemographic group. Principal component analysis and multivariable linear regression then were performed to determine the effect of SDOH on the HRS. Results The c-statistic for the HRS predicting 30-day readmission was 0.74, consistent with published values. However, the addition of SDOH to the HRS did not improve the c-statistic (0.71). Patients with unfavorable SDOH (no high-school, limited English, crowded housing, disabilities, and age > 65 yrs) had significantly higher HRS (p < 0.05 for all). Overall, SDOH explained 0.2% of the HRS. Conclusion At an urban tertiary care center, the addition of census tract-level SDOH to the HRS did not improve its predictive power. Rather, the effects of SDOH are already reflected in the HRS.
Keywords	Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
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Article ; Online: Association Between Acute Exposure to Crime and Individual Systolic Blood Pressure.

Wilson, W Wyatt / Chua, Rhys F M / Wei, Peng / Besser, Stephanie A / Tung, Elizabeth L / Kolak, Marynia / Tabit, Corey E

American journal of preventive medicine

2021 Volume 62, Issue 1, Page(s) 87–94

Abstract: Introduction: Hypertension is associated with adverse cardiovascular outcomes and is geographically concentrated in urban underserved neighborhoods. This study examines the temporal-spatial association between individual exposure to violent crime and ... ...

Abstract	Introduction: Hypertension is associated with adverse cardiovascular outcomes and is geographically concentrated in urban underserved neighborhoods. This study examines the temporal-spatial association between individual exposure to violent crime and blood pressure. Methods: A retrospective observational cohort study analyzed 39,211 patients with 227,595 blood pressure measurements from 2014 to 2016 at 3 outpatient clinics at an academic medical center in Chicago. Patients were included in the study if they had documentation of blood pressure in the medical record and resided in census tracts with >1,000 observations. Geocoded violent crime events were obtained from the Chicago Police Department. Individual-level exposure was defined on the basis of spatial and temporal buffers around each patient's home. Spatial buffers included 100-, 250-, 500-, and 1,000-meter disc radii, and temporal buffers included 7, 30, and 60 days preceding each outpatient appointment. Systolic blood pressure measurements (mmHg) were abstracted from the electronic health record. Analysis was performed in 2019-2020. Results: For each violent crime event within 100 meters from home, systolic blood pressure increased by 0.14 mmHg within 7 days of exposure compared with 0.08 mmHg at 30 days of exposure. In analyses stratified by neighborhood cluster, systolic blood pressure increased by 0.37 mmHg among patients in the suburban affluent cluster relative to that among those in an extreme poverty cluster for the same spatial and temporal buffer. Conclusions: Exposure to a violent crime event was associated with increased blood pressure, with gradient effects by both distance and time from exposure.
MeSH term(s)	Blood Pressure ; Census Tract ; Crime ; Humans ; Residence Characteristics ; Retrospective Studies ; Risk Factors ; Violence
Language	English
Publishing date	2021-09-15
Publishing country	Netherlands
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	632646-8
ISSN	1873-2607 ; 0749-3797
ISSN (online)	1873-2607
ISSN	0749-3797
DOI	10.1016/j.amepre.2021.06.017
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Article ; Online: SALAD-BAAR: A numerical risk score for hospital admission or emergency department presentation in ambulatory patients with cardiovascular disease.

Anyanwu, Emeka C / Chua, Rhys F M / Besser, Stephanie A / Sun, Deyu / Liao, James K / Tabit, Corey E

Clinical cardiology

2020 Volume 44, Issue 2, Page(s) 193–199

Abstract: Background: While many interventions to reduce hospital admissions and emergency department (ED) visits for patients with cardiovascular disease have been developed, identifying ambulatory cardiac patients at high risk for admission can be challenging.!# ...

Abstract	Background: While many interventions to reduce hospital admissions and emergency department (ED) visits for patients with cardiovascular disease have been developed, identifying ambulatory cardiac patients at high risk for admission can be challenging. Hypothesis: A computational model based on readily accessible clinical data can identify patients at risk for admission. Methods: Electronic health record (EHR) data from a tertiary referral center were used to generate decision tree and logistic regression models. International Classification of Disease (ICD) codes, labs, admissions, medications, vital signs, and socioenvironmental variables were used to model risk for ED presentation or hospital admission within 90 days following a cardiology clinic visit. Model training and testing were performed with a 70:30 data split. The final model was then prospectively validated. Results: A total of 9326 patients and 46 465 clinic visits were analyzed. A decision tree model using 75 patient characteristics achieved an area under the curve (AUC) of 0.75 and a logistic regression model achieved an AUC of 0.73. A simplified 9-feature model based on logistic regression odds ratios achieved an AUC of 0.72. A further simplified numerical score assigning 1 or 2 points to each variable achieved an AUC of 0.66, specificity of 0.75, and sensitivity of 0.58. Prospectively, this final model maintained its predictive performance (AUC 0.63-0.60). Conclusion: Nine patient characteristics from routine EHR data can be used to inform a highly specific model for hospital admission or ED presentation in cardiac patients. This model can be simplified to a risk score that is easily calculated and retains predictive performance.
MeSH term(s)	Cardiovascular Diseases ; Emergency Service, Hospital ; Humans ; Patient Admission ; Risk Factors ; Salads ; Tertiary Care Centers
Language	English
Publishing date	2020-10-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	391935-3
ISSN	1932-8737 ; 0160-9289
ISSN (online)	1932-8737
ISSN	0160-9289
DOI	10.1002/clc.23525
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Article ; Online: A retrospective analysis of high sensitivity cardiac troponin-T ranges in non-myocardial infarction emergency department visits.

Kong, Nathan / Chua, Rhys F M / Besser, Stephanie A / Heelan, Louise / Nathan, Sandeep / Spiegel, Thomas F / van Wijk, Xander M R / Tabit, Corey E

BMC cardiovascular disorders

2021 Volume 21, Issue 1, Page(s) 283

Abstract: Introduction: Current evidence suggests that high sensitivity cardiac troponin-T (hs-cTnT) values differ based on sex, race, age, and kidney function. However, most studies examining the relationship of hs-cTnT and these individual factors are in ... ...

Abstract	Introduction: Current evidence suggests that high sensitivity cardiac troponin-T (hs-cTnT) values differ based on sex, race, age, and kidney function. However, most studies examining the relationship of hs-cTnT and these individual factors are in healthy participants, leading to difficulty in interpreting hs-cTnT values in the Emergency Department (ED) setting. We seek to examine the relationship between hs-cTnT values and sex, race, age, and kidney function in a contemporary, urban academic setting. Methods: ED visits from June 2018 through April 2019 with at least 1 hs-cTnT and no diagnosis of acute myocardial infarction (AMI) at an academic medical center in the south side of Chicago were retrospectively analyzed. Median hs-cTnT values were stratified by sex (male or female), race (African American or Caucasian), age, estimated glomerular filtration rate (eGFR), and stage of chronic kidney disease. Results: 9679 encounters, representing 7989 distinct patients, were included for analysis (age 58 ± 18 years, 59% female, 85% black). Males had significantly higher median hs-cTnT values than females (16 [8-34] vs. 9 [6-22] ng/L, p < 0.001), African Americans had a significantly lower median value than Caucasians (10 [6-24] vs. 15 [6-29] ng/L, p < 0.001), and those with atrial fibrillation (27 [16-48] vs. 9 [6-19] ng/L, p < 0.001) and heart failure (28 [14-48] vs. 8 [6-15] ng/L, p < 0.001) had higher median values than those without. Median hs-cTnT values increased significantly with increased age and decreased eGFR. All relationships continued to be significant even after multivariable regression of sex, age, race, eGFR, presence of atrial fibrillation, and presence of heart failure (p < 0.01). Conclusions: Analysis of hs-cTnT in non-AMI patients during ED encounters showed that males have higher values than females, African Americans have lower values than Caucasians, those with atrial fibrillation and heart failure have higher values than those without, and that older age and lower eGFR were associated with higher median values.
MeSH term(s)	Academic Medical Centers ; Adult ; Age Factors ; Aged ; Atrial Fibrillation/blood ; Atrial Fibrillation/ethnology ; Atrial Fibrillation/physiopathology ; Biomarkers/blood ; Chicago/epidemiology ; Emergency Service, Hospital ; Female ; Glomerular Filtration Rate ; Heart Failure/blood ; Heart Failure/ethnology ; Heart Failure/physiopathology ; Humans ; Kidney/physiopathology ; Male ; Middle Aged ; Predictive Value of Tests ; Race Factors ; Renal Insufficiency, Chronic/blood ; Renal Insufficiency, Chronic/ethnology ; Renal Insufficiency, Chronic/physiopathology ; Retrospective Studies ; Sex Factors ; Troponin T/blood
Chemical Substances	Biomarkers ; Troponin T
Language	English
Publishing date	2021-06-07
Publishing country	England
Document type	Comparative Study ; Journal Article
ZDB-ID	2059859-2
ISSN	1471-2261 ; 1471-2261
ISSN (online)	1471-2261
ISSN	1471-2261
DOI	10.1186/s12872-021-02089-0
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Article ; Online: Association of Rising Violent Crime With Blood Pressure and Cardiovascular Risk: Longitudinal Evidence From Chicago, 2014-2016.

Tung, Elizabeth L / Chua, Rhys F M / Besser, Stephanie A / Lindau, Stacy Tessler / Kolak, Marynia / Anyanwu, Emeka C / Liao, James K / Tabit, Corey E

American journal of hypertension

2019 Volume 32, Issue 12, Page(s) 1192–1198

Abstract: Background: The purpose of this study was to examine the longitudinal association between rising violent crime and elevated blood pressure (BP).: Methods: We analyzed 217,816 BP measurements from 17,783 adults during a temporal surge in violent crime ...

Abstract	Background: The purpose of this study was to examine the longitudinal association between rising violent crime and elevated blood pressure (BP). Methods: We analyzed 217,816 BP measurements from 17,783 adults during a temporal surge in violent crime in Chicago (2014-2016). Serial observations were abstracted from the electronic health record at an academic medical center and paired to the City of Chicago Police Data Portal. The violent crime rate (VCR) was calculated as the number of violent crimes per 1,000 population per year for each census tract. Longitudinal multilevel regression models were implemented to assess elevated BP (systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg) as a function of the VCR, adjusting for patient characteristics, neighborhood characteristics, and time effects. Secondary dependent measures included elevated heart rate, obesity, missed outpatient appointments, all-cause hospital admissions, and cardiovascular hospital admissions. Results: At baseline, the median VCR was 41.3 (interquartile range: 15.2-66.8), with a maximum rise in VCR of 59.1 over the 3-year surge period. A 20-unit rise in the VCR was associated with 3% higher adjusted odds of having elevated BP (95% confidence interval [CI]: 1.01-1.06), 8% higher adjusted odds of missing an outpatient appointment (95% CI: 1.03-1.13), and 6% higher adjusted odds of having a cardiovascular-related hospital admission (95% CI: 1.01-1.12); associations were not significant for elevated heart rate and obesity. Conclusion: Rising violent crime was associated with increased BP during a temporal crime surge.
MeSH term(s)	Adolescent ; Adult ; Aged ; Blood Pressure ; Chicago/epidemiology ; Female ; Humans ; Hypertension/diagnosis ; Hypertension/epidemiology ; Hypertension/physiopathology ; Longitudinal Studies ; Male ; Middle Aged ; Risk Assessment ; Risk Factors ; Social Determinants of Health/trends ; Time Factors ; Violence/trends ; Young Adult
Language	English
Publishing date	2019-08-07
Publishing country	United States
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	639383-4
ISSN	1941-7225 ; 1879-1905 ; 0895-7061
ISSN (online)	1941-7225 ; 1879-1905
ISSN	0895-7061
DOI	10.1093/ajh/hpz134
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Article ; Online: Tumor necrosis factor-α levels and non-surgical bleeding in continuous-flow left ventricular assist devices.

Tabit, Corey E / Coplan, Mitchell J / Chen, Phetcharat / Jeevanandam, Valluvan / Uriel, Nir / Liao, James K

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

2017 Volume 37, Issue 1, Page(s) 107–115

Abstract: Background: Non-surgical bleeding (NSB) due to angiodysplasia is common in left ventricular assist device (LVAD) patients. Thrombin-induced angiopoietin-2 (Ang-2) expression in LVAD patients leads to altered angiogenesis and is associated with lower ... ...

Abstract	Background: Non-surgical bleeding (NSB) due to angiodysplasia is common in left ventricular assist device (LVAD) patients. Thrombin-induced angiopoietin-2 (Ang-2) expression in LVAD patients leads to altered angiogenesis and is associated with lower angiopoietin-1 (Ang-1) and increased NSB. However, the mechanism for decreased Ang-1, made by pericytes, is unknown and the origin of thrombin in LVAD patients is unclear. We hypothesized that high tumor necrosis factor-α (TNF-α) levels in LVAD patients induce pericyte apoptosis, tissue factor (TF) expression and vascular instability. Methods: We incubated cultured pericytes with serum from patients with heart failure (HF), LVAD or orthotopic heart transplantation (OHT), with or without TNF-α blockade. We performed several measurements: Ang-1 expression was assessed by reverse transcript-polymerase chain reaction (RT-PCR) and pericyte death fluorescently; TF expression was assessed by RT-PCR in cultured endothelial cells incubated with patient plasma with or without TNF-α blockade; and TF expression was assessed in endothelial biopsy samples from these patients by immunofluorescence. We incubated cultured endothelial cells on Matrigel with patient serum with or without TNF-α blockade and determined tube formation by microscopy. Results: Serum from LVAD patients had higher levels of TNF-α, suppressed Ang-1 expression in pericytes, and induced pericyte death, and there was accelerated endothelial tube formation compared with serum from patients without LVADs. TF was higher in both plasma and endothelial cells from LVAD patients, and plasma from LVAD patients induced more endothelial TF expression. All of these effects were reversed or reduced with TNF-α blockade. High levels of TNF-α were associated with increased risk of NSB. Conclusions: Elevated TNF-α in LVAD patients is a central regulator of altered angiogenesis, pericyte apoptosis and expression of TF and Ang-1.
MeSH term(s)	Aged ; Female ; Heart-Assist Devices/adverse effects ; Hemorrhage/blood ; Hemorrhage/etiology ; Humans ; Male ; Middle Aged ; Postoperative Complications/blood ; Postoperative Complications/etiology ; Tumor Necrosis Factor-alpha/blood
Chemical Substances	Tumor Necrosis Factor-alpha
Language	English
Publishing date	2017-06-08
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1062522-7
ISSN	1557-3117 ; 1053-2498
ISSN (online)	1557-3117
ISSN	1053-2498
DOI	10.1016/j.healun.2017.06.001
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Article ; Online: Community Health Workers Reduce Rehospitalizations and Emergency Department Visits for Low-Socioeconomic Urban Patients With Heart Failure.

Vohra, Adam S / Chua, Rhys F M / Besser, Stephanie A / Alcain, Charina F / Basnet, Sweta / Battle, Brenda / Coplan, Mitchell J / Liao, James K / Tabit, Corey E

Critical pathways in cardiology

2020 Volume 19, Issue 3, Page(s) 139–145

Abstract: Background: Low-socioeconomic, urban, minority patients with heart failure (HF) often have unique barriers to care. Community health workers (CHWs) are specially trained laypeople who serve as liaisons between underserved communities and the health ... ...

Abstract	Background: Low-socioeconomic, urban, minority patients with heart failure (HF) often have unique barriers to care. Community health workers (CHWs) are specially trained laypeople who serve as liaisons between underserved communities and the health system. It is not known whether CHWs improve outcomes in low-socioeconomic, urban, minority patients with HF. Hypothesis: CHWs reduce rehospitalizations, emergency department (ED) visits, and healthcare costs for low-socioeconomic urban patients with HF. Methods: Patients admitted with acute decompensated HF were assigned to receive weekly visits by CHW after discharge. Patients were propensity score matched with controls who received usual care. HF-related rehospitalizations, ED visits, and inpatient costs were compared for 12 months following index admission versus the same period before. Results: Twenty-eight patients who received weekly visits from a CHW for 12 months after discharge were matched with 28 control patients who did not receive CHWs. Patients who received a CHW had a 75% decrease in HF-related ED visits (0.71 vs. 0.18 visits per patient, P < 0.001), an 89% decrease in HF-related readmissions (0.64 vs. 0.07 admissions per patient, P < 0.005), and a significant decrease in inpatient cost for HF-related visits. In controls receiving usual care, there was no significant change in hospitalizations, ED visits, or costs. Conclusions: In conclusion, CHWs are associated with reduced rehospitalizations, ED visits, and inpatient costs in low-socioeconomic, urban, minority patients with HF. CHWs may be a cost-effective method to reduce health care utilization and improve outcomes for this population.
MeSH term(s)	Adult ; Aged ; Community Health Workers/statistics & numerical data ; Emergency Service, Hospital/statistics & numerical data ; Female ; Heart Failure/economics ; Heart Failure/epidemiology ; Heart Failure/therapy ; Humans ; Illinois/epidemiology ; Incidence ; Male ; Middle Aged ; Office Visits/trends ; Patient Readmission/trends ; Retrospective Studies ; Socioeconomic Factors ; Urban Population
Language	English
Publishing date	2020-03-24
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2079676-6
ISSN	1535-2811 ; 1535-282X
ISSN (online)	1535-2811
ISSN	1535-282X
DOI	10.1097/HPC.0000000000000220
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Article ; Online: Positional obstruction of the superior mesenteric artery by an intra-aortic balloon pump placed through subclavian artery approach.

Tabit, Corey E / Onsager, David R / Kim, Gene H / Jeevanandam, Valluvan / Fedson, Savitri E

Circulation. Heart failure

2014 Volume 7, Issue 5, Page(s) 864–867

MeSH term(s)	Arterial Occlusive Diseases/diagnosis ; Arterial Occlusive Diseases/etiology ; Catheterization, Peripheral/adverse effects ; Catheterization, Peripheral/methods ; Diagnosis, Differential ; Heart Failure/therapy ; Humans ; Intra-Aortic Balloon Pumping/adverse effects ; Intra-Aortic Balloon Pumping/instrumentation ; Male ; Mesenteric Artery, Superior ; Middle Aged ; Patient Positioning/adverse effects ; Posture ; Radiography, Abdominal ; Subclavian Artery ; Tomography, X-Ray Computed ; Ultrasonography, Doppler
Language	English
Publishing date	2014-09
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2429459-7
ISSN	1941-3297 ; 1941-3289
ISSN (online)	1941-3297
ISSN	1941-3289
DOI	10.1161/CIRCHEARTFAILURE.114.001463
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