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Article ; Online: Serious mental illness is associated with elevated risk of hospital readmission in veterans with heart failure.

Browne, Julia / Rudolph, James L / Jiang, Lan / Bayer, Thomas A / Kunicki, Zachary J / De Vito, Alyssa N / Bozzay, Melanie L / McGeary, John E / Kelso, Catherine M / Wu, Wen-Chih

Journal of psychosomatic research

2024 Volume 178, Page(s) 111604

Abstract: Objective: Adults with serious mental illness (SMI) have high rates of cardiovascular disease, particularly heart failure, which contribute to premature mortality. The aims were to examine 90- and 365-day all-cause medical or surgical hospital ... ...

Abstract	Objective: Adults with serious mental illness (SMI) have high rates of cardiovascular disease, particularly heart failure, which contribute to premature mortality. The aims were to examine 90- and 365-day all-cause medical or surgical hospital readmission in Veterans with SMI discharged from a heart failure hospitalization. The exploratory aim was to evaluate 180-day post-discharge engagement in cardiac rehabilitation, an effective intervention for heart failure. Methods: This study used administrative data from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services between 2011 and 2019. SMI status and medical comorbidity were assessed in the year prior to hospitalization. Cox proportional hazards models (competing risk of death) were used to evaluate the relationship between SMI status and outcomes. Models were adjusted for VHA hospital site, demographics, and medical characteristics. Results: The sample comprised 189,767 Veterans of which 23,671 (12.5%) had SMI. Compared to those without SMI, Veterans with SMI had significantly higher readmission rates at 90 (16.1% vs. 13.9%) and 365 (42.6% vs. 37.1%) days. After adjustment, risk of readmission remained significant (90 days: HR: 1.07, 95% CI: 1.03, 1.11; 365 days: HR: 1.10, 95% CI: 1.07, 1.12). SMI status was not significantly associated with 180-day cardiac rehabilitation engagement (HR: 0.98, 95% CI: 0.91, 1.07). Conclusions: Veterans with SMI and heart failure have higher 90- and 365-day hospital readmission rates even after adjustment. There were no differences in cardiac rehabilitation engagement based on SMI status. Future work should consider a broader range of post-discharge interventions to understand contributors to readmission.
MeSH term(s)	Aged ; Adult ; Humans ; United States/epidemiology ; Patient Readmission ; Veterans ; Aftercare ; Patient Discharge ; Medicare ; Heart Failure/epidemiology ; Heart Failure/therapy ; Mental Disorders/epidemiology
Language	English
Publishing date	2024-02-01
Publishing country	England
Document type	Journal Article
ZDB-ID	80166-5
ISSN	1879-1360 ; 0022-3999
ISSN (online)	1879-1360
ISSN	0022-3999
DOI	10.1016/j.jpsychores.2024.111604
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Article ; Online: Lower odds of successful community discharge after medical hospitalization for Veterans with schizophrenia: A retrospective cohort study of national data.

Browne, Julia / Wu, Wen-Chih / Jiang, Lan / Singh, Mriganka / Bozzay, Melanie L / Kunicki, Zachary J / Bayer, Thomas A / De Vito, Alyssa N / Primack, Jennifer M / McGeary, John E / Kelso, Catherine M / Rudolph, James L

Journal of psychiatric research

2024 Volume 173, Page(s) 58–63

Abstract: Medical comorbidity, particularly cardiovascular diseases, contributes to high rates of hospital admission and early mortality in people with schizophrenia. The 30 days following hospital discharge represents a critical period for mitigating adverse ... ...

Abstract	Medical comorbidity, particularly cardiovascular diseases, contributes to high rates of hospital admission and early mortality in people with schizophrenia. The 30 days following hospital discharge represents a critical period for mitigating adverse outcomes. This study examined the odds of successful community discharge among Veterans with schizophrenia compared to those with major affective disorders and those without serious mental illness (SMI) after a heart failure hospital admission. Data for Veterans hospitalized for heart failure were obtained from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services between 2011 and 2019. Psychiatric diagnoses and medical comorbidities were assessed in the year prior to hospitalization. Successful community discharge was defined as remaining in the community without hospital readmission, death, or hospice for 30 days after hospital discharge. Logistic regression analyses adjusting for relevant factors were used to examine whether individuals with a schizophrenia diagnosis showed lower odds of successful community discharge versus both comparison groups. Out of 309,750 total Veterans in the sample, 7377 (2.4%) had schizophrenia or schizoaffective disorder and 32,472 (10.5%) had major affective disorders (bipolar disorder or recurrent major depressive disorder). Results from adjusted logistic regression analyses demonstrated significantly lower odds of successful community discharge for Veterans with schizophrenia compared to the non-SMI (Odds Ratio [OR]: 0.63; 95% Confidence Interval [CI]: 0.60, 0.66) and major affective disorders (OR: 0.65, 95%; CI: 0.62, 0.69) groups. Intervention efforts should target the transition from hospital to home in the subgroup of Veterans with schizophrenia.
MeSH term(s)	Aged ; Humans ; United States/epidemiology ; Schizophrenia/epidemiology ; Schizophrenia/therapy ; Patient Discharge ; Veterans/psychology ; Depressive Disorder, Major/epidemiology ; Depressive Disorder, Major/therapy ; Retrospective Studies ; Medicare ; Mental Disorders/epidemiology ; Mental Disorders/therapy ; Mental Disorders/psychology ; Hospitalization ; Heart Failure
Language	English
Publishing date	2024-03-11
Publishing country	England
Document type	Journal Article
ZDB-ID	3148-3
ISSN	1879-1379 ; 0022-3956
ISSN (online)	1879-1379
ISSN	0022-3956
DOI	10.1016/j.jpsychires.2024.03.004
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Article ; Online: Identifying Alzheimer's disease and related disorders via diagnostic codes in Veterans with heart failure.

Bayer, Thomas A / Jiang, Lan / Kunicki, Zachary J / Quinn, McKenzie / De Vito, Alyssa N / Kelso, Catherine M / Rudolph, James L / Sullivan, Jennifer L

Journal of the American Geriatrics Society

2023 Volume 72, Issue 3, Page(s) 949–952

MeSH term(s)	Humans ; Alzheimer Disease/diagnosis ; Veterans ; Heart Failure/diagnosis ; Heart Failure/epidemiology
Language	English
Publishing date	2023-12-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.18701
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Book: Platelet immunobiology

Kunicki, Thomas J.

molecular and clinical aspects

1989

Author's details	ed. by Thomas J. Kunicki
Keywords	Blood Platelets / immunology ; Glycoproteins / physiology ; Thrombozyt ; Immunbiologie
Subject	Immunobiologie ; Blutplättchen ; Platelet ; Thrombozyten
Size	XII, 498 S. : Ill., graph. Darst.
Edition	1. [Dr.]
Publisher	Lippincott
Publishing place	Philadelphia u.a.
Publishing country	United States
Document type	Book
HBZ-ID	HT003335430
ISBN	0-397-50872-7 ; 978-0-397-50872-3
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1989 A 3759	order for loan	Magazin

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Article ; Online: A mischief of mice.

Kunicki, Thomas J

Blood

2009 Volume 114, Issue 26, Page(s) 5249–5250

Language	English
Publishing date	2009-12-16
Publishing country	United States
Document type	Comment ; Journal Article
ZDB-ID	80069-7
ISSN	1528-0020 ; 0006-4971
ISSN (online)	1528-0020
ISSN	0006-4971
DOI	10.1182/blood-2009-10-247544
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Article ; Online: CLEC ... too!

Kunicki, Thomas J

Blood

2009 Volume 114, Issue 16, Page(s) 3364–3365

Language	English
Publishing date	2009-10-15
Publishing country	United States
Document type	Comment ; Journal Article
ZDB-ID	80069-7
ISSN	1528-0020 ; 0006-4971
ISSN (online)	1528-0020
ISSN	0006-4971
DOI	10.1182/blood-2009-08-236802
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Article ; Online: Incidence of New Dementia Diagnosis in Veterans Admitted to Nursing Homes After Heart Failure Hospitalization.

Bayer, Thomas A / Jiang, Lan / Erqou, Sebhat / Kunicki, Zachary J / Singh, Mriganka / Duprey, Matthew / Bozzay, Melanie / McGeary, John E / Zullo, Andrew R / Wu, Wen-Chih / Gravenstein, Stefan / Rudolph, James L

Journal of Alzheimer's disease : JAD

2023 Volume 94, Issue 4, Page(s) 1397–1404

Abstract: Background: Hospitalization with heart failure (HF) may signal an increased risk of Alzheimer's disease and related dementias (ADRD). Nursing homes routinely assess cognition but the association of these results with new ADRD diagnosis in a population ... ...

Abstract	Background: Hospitalization with heart failure (HF) may signal an increased risk of Alzheimer's disease and related dementias (ADRD). Nursing homes routinely assess cognition but the association of these results with new ADRD diagnosis in a population at high risk of ADRD is not known. Objective: To determine the association between nursing home cognitive assessment results and new diagnosis of dementia after heart failure hospitalization. Methods: This retrospective cohort study included Veterans hospitalized for HF and discharged to nursing homes, from 2010 to 2015, without a prior diagnosis of ADRD. We determined mild, moderate, or severe cognitive impairment using multiple items of the nursing home admission assessment. We used Cox regression to determine the association of cognitive impairment with new ADRD diagnosis during 365 days of follow-up. Results: The cohort included 7,472 residents, new diagnosis of ADRD occurred in 4,182 (56%). The adjusted hazard ratio of ADRD diagnosis was 4.5 (95% CI 4.2, 4.8) for the mild impairment group, 5.4 (95% CI 4.8, 5.9) for moderate impairment, and 4.0 (95% CI 3.2, 5.0) for severe impairment compared to the cognitively intact group. Conclusion: New ADRD diagnoses occurred in more than half of Veterans with HF admitted to nursing homes for post-acute care.
MeSH term(s)	Humans ; United States/epidemiology ; Retrospective Studies ; Incidence ; Veterans ; Alzheimer Disease/diagnosis ; Hospitalization ; Nursing Homes ; Heart Failure/diagnosis ; Heart Failure/epidemiology
Language	English
Publishing date	2023-07-07
Publishing country	Netherlands
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural
ZDB-ID	1440127-7
ISSN	1875-8908 ; 1387-2877
ISSN (online)	1875-8908
ISSN	1387-2877
DOI	10.3233/JAD-221300
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Article ; Online: Prevalence of Comorbid Depression and Insomnia Among Veterans Hospitalized for Heart Failure with Alzheimer Disease and Related Disorders.

Kunicki, Zachary J / Frietchen, Rachel / McGeary, John E / Jiang, Lan / Duprey, Matthew S / Bayer, Thomas / Singh, Mriganka / Primack, Jennifer M / Kelso, Catherine M / Wu, Wen-Chih / Rudolph, James L / Bozzay, Melanie L

The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry

2023 Volume 31, Issue 6, Page(s) 428–437

Abstract: Objective: To examine prevalence of Alzheimer Disease and related dementias (ADRD) and patient characteristics as a function of comorbid insomnia and/or depression among heart failure (HF) patients discharged from hospitals.: Design: Retrospective ... ...

Abstract	Objective: To examine prevalence of Alzheimer Disease and related dementias (ADRD) and patient characteristics as a function of comorbid insomnia and/or depression among heart failure (HF) patients discharged from hospitals. Design: Retrospective cohort descriptive epidemiology study. Setting: VA Hospitals. Participants: N = 373,897 Veterans hospitalized with heart failure from October 1, 2011 until September 30, 2020. Measurements: We examined VA and Center for Medicare & Medicaid Services (CMS) coding in the year prior to admission using published ICD-9/10 codes for dementia, insomnia, and depression. The primary outcome was the prevalence of ADRD and the secondary outcomes were 30-day and 365-day mortality. Results: The cohort were predominantly older adults (mean age = 72 years, SD = 11), male (97%), and White (73%). Dementia prevalence in participants without insomnia or depression was 12%. In those with both insomnia and depression, dementia prevalence was 34%. For insomnia alone and depression alone, dementia prevalence was 21% and 24%, respectively. Mortality followed a similar pattern with highest 30-day and 365-day mortality higher in those with both insomnia and depression. Conclusions: These results suggest that persons with both insomnia and depression are at an increased risk of ADRD and mortality compared to persons with one or neither condition. Screening for both insomnia and depression, especially in patients with other ADRD risk factors, could lead to earlier identification of ADRD. Understanding comorbid conditions which may represent earlier signs of ADRD may be critical in the identification of ADRD risk.
MeSH term(s)	Humans ; Male ; Aged ; United States/epidemiology ; Alzheimer Disease/complications ; Veterans ; Prevalence ; Retrospective Studies ; Depression/epidemiology ; Sleep Initiation and Maintenance Disorders/epidemiology ; Sleep Initiation and Maintenance Disorders/complications ; Medicare ; Heart Failure/epidemiology ; Heart Failure/complications
Language	English
Publishing date	2023-02-08
Publishing country	England
Document type	Journal Article
ZDB-ID	1278145-9
ISSN	1545-7214 ; 1064-7481
ISSN (online)	1545-7214
ISSN	1064-7481
DOI	10.1016/j.jagp.2023.01.026
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Article ; Online: Six-Year Cognitive Trajectory in Older Adults Following Major Surgery and Delirium.

Kunicki, Zachary J / Ngo, Long H / Marcantonio, Edward R / Tommet, Douglas / Feng, Yi / Fong, Tamara G / Schmitt, Eva M / Travison, Thomas G / Jones, Richard N / Inouye, Sharon K

JAMA internal medicine

2023 Volume 183, Issue 5, Page(s) 442–450

Abstract: Importance: The study results suggest that delirium is the most common postoperative complication in older adults and is associated with poor outcomes, including long-term cognitive decline and incident dementia.: Objective: To examine the patterns ... ...

Abstract	Importance: The study results suggest that delirium is the most common postoperative complication in older adults and is associated with poor outcomes, including long-term cognitive decline and incident dementia. Objective: To examine the patterns and pace of cognitive decline up to 72 months (6 years) in a cohort of older adults following delirium. Design, setting, and participants: This was a prospective, observational cohort study with long-term follow-up including 560 community-dwelling older adults (older than 70 years) in the ongoing Successful Aging after Elective Surgery study that began in 2010. The data were analyzed from 2021 to 2022. Exposure: Development of incident delirium following major elective surgery. Main outcomes and measures: Delirium was assessed daily during hospitalization using the Confusion Assessment Method, which was supplemented with medical record review. Cognitive performance using a comprehensive battery of neuropsychological tests was assessed preoperatively and across multiple points postoperatively to 72 months of follow-up. We evaluated longitudinal cognitive change using a composite measure of neuropsychological performance called the general cognitive performance (GCP), which is scaled so that 10 points on the GCP is equivalent to 1 population SD. Retest effects were adjusted using cognitive test results in a nonsurgical comparison group. Results: The 560 participants (326 women [58%]; mean [SD] age, 76.7 [5.2] years) provided a total of 2637 person-years of follow-up. One hundred thirty-four participants (24%) developed postoperative delirium. Cognitive change following surgery was complex: we found evidence for differences in acute, post-short-term, intermediate, and longer-term change from the time of surgery that were associated with the development of postoperative delirium. Long-term cognitive change, which was adjusted for practice and recovery effects, occurred at a pace of about -1.0 GCP units (95% CI, -1.1 to -0.9) per year (about 0.10 population SD units per year). Participants with delirium showed significantly faster long-term cognitive change with an additional -0.4 GCP units (95% CI, -0.1 to -0.7) or -1.4 units per year (about 0.14 population SD units per year). Conclusions and relevance: This cohort study found that delirium was associated with a 40% acceleration in the slope of cognitive decline out to 72 months following elective surgery. Because this is an observational study, we cannot be sure whether delirium directly causes subsequent cognitive decline, or whether patients with preclinical brain disease are more likely to develop delirium. Future research is needed to understand the causal pathway between delirium and cognitive decline.
MeSH term(s)	Humans ; Female ; Aged ; Cohort Studies ; Emergence Delirium/complications ; Delirium/etiology ; Prospective Studies ; Cognitive Dysfunction/etiology ; Postoperative Complications/etiology ; Cognition
Language	English
Publishing date	2023-03-20
Publishing country	United States
Document type	Observational Study ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2699338-7
ISSN	2168-6114 ; 2168-6106
ISSN (online)	2168-6114
ISSN	2168-6106
DOI	10.1001/jamainternmed.2023.0144
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Article ; Online: Comparing Lookback Periods to Ascertain Alzheimer's Disease and Related Dementias.

Kunicki, Zachary J / Bayer, Thomas / Jiang, Lan / Bozzay, Melanie L / Quinn, McKenzie J / De Vito, Alyssa N / Emrani, Sheina / Erqou, Sebhat / McGeary, John E / Zullo, Andrew R / Duprey, Matthew S / Singh, Mriganka / Primack, Jennifer M / Kelso, Catherine M / Wu, Wen-Chih / Rudolph, James L

American journal of Alzheimer's disease and other dementias

2023 Volume 38, Page(s) 15333175231199566

Abstract: Claims data are a valuable resource for studying Alzheimer's disease and related dementias (ADRD). Alzheimer's disease and related dementias is often identified using a list of claims codes and a fixed lookback period of 3 years of data. However, a 1- ... ...

Abstract	Claims data are a valuable resource for studying Alzheimer's disease and related dementias (ADRD). Alzheimer's disease and related dementias is often identified using a list of claims codes and a fixed lookback period of 3 years of data. However, a 1-year lookback or an approach using all-available lookback data could be beneficial based on different research questions. Thus, the purpose of this study was to compare 1-year and all-available lookback approaches to ascertaining ADRD compared to the standard 3-year approach. Using a cohort of Veterans hospitalized for heart failure (N = 373, 897), our results suggested high agreement (93% or greater) between the lookback periods. The 1-year lookback period had lower sensitivity (60%) and underestimated the prevalence of ADRD. These results suggest that 1-year and all-available lookback periods are viable approaches when using claims data.
MeSH term(s)	Humans ; Alzheimer Disease/diagnosis ; Alzheimer Disease/epidemiology ; Prevalence
Language	English
Publishing date	2023-08-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	1283069-0
ISSN	1938-2731 ; 0895-5336 ; 1082-5207 ; 1533-3175
ISSN (online)	1938-2731
ISSN	0895-5336 ; 1082-5207 ; 1533-3175
DOI	10.1177/15333175231199566
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