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Article ; Online: Defining Rural in Rural-Urban Differences in Myocardial Infarction Management-Reply.

Ziada, Khaled M / Hillerson, Dustin

JAMA cardiology

2023 Volume 8, Issue 3, Page(s) 301–302

MeSH term(s)	Humans ; Myocardial Infarction/epidemiology ; Myocardial Infarction/therapy ; Rural Health Services
Language	English
Publishing date	2023-01-25
Publishing country	United States
Document type	Journal Article ; Comment
ISSN	2380-6591
ISSN (online)	2380-6591
DOI	10.1001/jamacardio.2022.5221
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Article ; Online: Prognostic Implication of Pre-Cannulation Cardiac Arrest in Patients Undergoing Extracorporeal Membrane Oxygenation for the Management of Cardiogenic Shock.

Whiteside, Hoyle L / Hillerson, Dustin / Abdel-Latif, Ahmed / Gupta, Vedant A

Journal of intensive care medicine

2022 Volume 38, Issue 2, Page(s) 202–207

Abstract: Background: The application of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in contemporary management of cardiogenic shock (CS) has dramatically increased. Despite increased utilization, few predictive models exist to estimate patient ... ...

Abstract	Background: The application of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in contemporary management of cardiogenic shock (CS) has dramatically increased. Despite increased utilization, few predictive models exist to estimate patient survival based on pre-ECMO characteristics. Furthermore, the prognostic implications of pre-ECMO cardiac arrest are not well defined. Methods: Utilizing an institutional VA-ECMO database, all consecutive patients undergoing VA-ECMO for the management of CS from January 1, 2014, to July 1, 2019, were identified. Survival to hospital discharge was analyzed based on cannulation indication in patients with and without pre-ECMO cardiac arrest. Patients who received extracorporeal cardiopulmonary resuscitation (eCPR) were analyzed separately. Results: Of the 214 patients identified, 110 did not suffer a cardiac arrest prior to cannulation (cohort 1), 57 patients had a cardiac arrest with sustained ROSC (cohort 2), and 47 were cannulated as a component of eCPR (cohort 3). Despite sustained ROSC (cohort 2), the presence of pre-ECMO cardiac arrest was associated with a significant reduction in survival to hospital discharge (22.8% vs. 55.5% in cohort 1; p < 0.001). Comparatively, survival to discharge was similar in patients undergoing eCPR (22.8% vs. 17.0%; p = 0.464). Finally, patients with a cardiac arrest were significantly more likely to have a neurological etiology death with VA-ECMO than patients supported prior to hemodynamic collapse (18.3% vs. 2.7%; p < 0.001). This result is seen in those with sustained ROSC (21.1% vs. 2.7%; p < 0.001) and those with eCPR (14.9% vs. 2.7%; p = 0.004). Conclusion: In our cohort, pre-ECMO cardiac arrest carries a negative prognostic value across all indications and is associated with an increased prevalence of neurological-etiology death. This finding is true in patients with sustained ROSC as well as those resuscitated with eCPR. Cardiac arrest can inform survival probability with VA-ECMO as early implementation of VA-ECMO may mitigate adverse outcomes in patients at the highest risk of hemodynamic collapse.
MeSH term(s)	Humans ; Shock, Cardiogenic/etiology ; Shock, Cardiogenic/therapy ; Extracorporeal Membrane Oxygenation ; Prognosis ; Heart Arrest/therapy
Language	English
Publishing date	2022-07-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	632828-3
ISSN	1525-1489 ; 0885-0666
ISSN (online)	1525-1489
ISSN	0885-0666
DOI	10.1177/08850666221115606
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Article ; Online: Continuity of Critical Care: Establishing a Cardiac Intensive Care Unit Recovery Clinic.

Hillerson, Dustin / Whiteside, Hoyle L / Gupta, Vedant A

JACC. Case reports

2021 Volume 3, Issue 18, Page(s) 1932–1935

Language	English
Publishing date	2021-12-15
Publishing country	Netherlands
Document type	Editorial
ISSN	2666-0849
ISSN (online)	2666-0849
DOI	10.1016/j.jaccas.2021.09.009
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Article ; Online: Contemporary targeted temperature management: Clinical evidence and controversies.

Hillerson, Dustin B / Laine, Melanie E / Bissell, Brittany D / Mefford, Breanne

Perfusion

2022 Volume 38, Issue 4, Page(s) 666–680

Abstract: Advancements in cardiac arrest and post-cardiac arrest care have led to improved survival to hospital discharge. While survival to hospital discharge is an important clinical outcome, neurologic recovery is also a priority. With the advancement of ... ...

Abstract	Advancements in cardiac arrest and post-cardiac arrest care have led to improved survival to hospital discharge. While survival to hospital discharge is an important clinical outcome, neurologic recovery is also a priority. With the advancement of targeted temperature management (TTM), the American Heart Association guidelines for post-cardiac arrest care recommend TTM in patients who remain comatose after return of spontaneous circulation (ROSC). Recently, the TTM2 randomized controlled trial found no significant difference in neurologic function and mortality at 6-months between traditional hypothermia to 33°C versus 37.5°C. While TTM has been evaluated for decades, current literature suggests that the use of TTM to 33° when compared to a protocol of targeted normothermia does not result in improved outcomes. Instead, perhaps active avoidance of fever may be most beneficial. Extracorporeal cardiopulmonary resuscitation and membrane oxygenation can provide a means of both hemodynamic support and TTM after ROSC. This review aims to describe the pathophysiology, physiologic aspects, clinical trial evidence, changes in post-cardiac arrest care, potential risks, as well as controversies of TTM.
MeSH term(s)	Humans ; Temperature ; Hypothermia, Induced/methods ; Body Temperature ; Heart Arrest/therapy ; Cardiopulmonary Resuscitation/methods ; Treatment Outcome
Language	English
Publishing date	2022-05-07
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	645038-6
ISSN	1477-111X ; 0267-6591
ISSN (online)	1477-111X
ISSN	0267-6591
DOI	10.1177/02676591221076286
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Zs.A 2424: Show issues

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Article ; Online: ST-Segment Elevation in a Patient With Nausea, Vomiting, and Intracerebral Hemorrhage.

Banerjee, Ranjan / Hillerson, Dustin / Leung, Steve W / Sorrell, Vincent L

JACC. Case reports

2021 Volume 3, Issue 16, Page(s) 1727–1729

Abstract: A 60-year-old man who presented with nausea, vomiting, and intracerebral hemorrhage developed inferior ST-segment elevation and angina. Coronary angiography showed no coronary obstruction. The patient was found to have a small bowel obstruction causing ... ...

Abstract	A 60-year-old man who presented with nausea, vomiting, and intracerebral hemorrhage developed inferior ST-segment elevation and angina. Coronary angiography showed no coronary obstruction. The patient was found to have a small bowel obstruction causing superior translocation of the heart. Relief of obstruction caused immediate resolution of electrocardiographic changes and symptoms. (
Language	English
Publishing date	2021-11-17
Publishing country	Netherlands
Document type	Journal Article
ISSN	2666-0849
ISSN (online)	2666-0849
DOI	10.1016/j.jaccas.2021.09.010
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Article ; Online: Establishing a Cardiac ICU Recovery Clinic: Characterizing a Model for Continuity of Cardiac Critical Care.

Whiteside, Hoyle L / Hillerson, Dustin / Buescher, Victoria / Kreft, Kayla / Mayer, Kirby P / Montgomery-Yates, Ashley / Gupta, Vedant A

Critical pathways in cardiology

2022 Volume 21, Issue 3, Page(s) 135–140

Abstract: Background: Care in the cardiovascular intensive care unit (CICU) has become increasingly intricate due to a temporal rise in noncardiac diagnoses and overall clinical complexity with high risk for short-term rehospitalization and mortality. Survivors ... ...

Abstract	Background: Care in the cardiovascular intensive care unit (CICU) has become increasingly intricate due to a temporal rise in noncardiac diagnoses and overall clinical complexity with high risk for short-term rehospitalization and mortality. Survivors of critical illness are often faced with debility and limitations extending beyond the index hospitalization. Comprehensive ICU recovery programs have demonstrated some efficacy but have primarily targeted survivors of acute respiratory distress syndrome or sepsis. The efficacy of dedicated ICU recovery programs on the CICU population is not defined. Methods: We aim to describe the design and initial experience of a novel CICU-recovery clinic (CICURC). The primary outcome was death or rehospitalization in the first 30 days following hospital discharge. Self-reported outcome measures were performed to assess symptom burden and independence in activities of daily living. Results: Using standardized criteria, 41 patients were referred to CICURC of which 78.1% established care and were followed for a median of 88 (56-122) days. On intake, patients reported a high burden of heart failure symptoms (KCCQ overall summary score 29.8 [18.0-47.5]), and nearly half (46.4%) were dependent on caretakers for activities of daily living. Thirty days postdischarge, no deaths were observed and the rate of rehospitalization for any cause was 12.2%. Conclusions: CICU survivors are faced with significant residual symptom burden, dependence upon caretakers, and impairments in mental health. Dedicated CICURCs may help prioritize treatment of ICU related illness, reduce symptom burden, and improve outcomes. Interventions delivered in ICU recovery clinic for patients surviving the CICU warrant further investigation.
MeSH term(s)	Activities of Daily Living ; Aftercare ; Critical Care ; Heart Diseases/therapy ; Hospital Mortality ; Humans ; Intensive Care Units ; Patient Discharge
Language	English
Publishing date	2022-08-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2079676-6
ISSN	1535-2811 ; 1535-282X
ISSN (online)	1535-2811
ISSN	1535-282X
DOI	10.1097/HPC.0000000000000294
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Article ; Online: Characteristics, Process Metrics, and Outcomes Among Patients With ST-Elevation Myocardial Infarction in Rural vs Urban Areas in the US: A Report From the US National Cardiovascular Data Registry.

Hillerson, Dustin / Li, Shuang / Misumida, Naoki / Wegermann, Zachary K / Abdel-Latif, Ahmed / Ogunbayo, Gbolahan O / Wang, Tracy Y / Ziada, Khaled M

JAMA cardiology

2022 Volume 7, Issue 10, Page(s) 1016–1024

Abstract: Importance: Patients with ST-segment elevation myocardial infarction (STEMI) living in rural settings often have worse clinical outcomes compared with their urban counterparts. Whether this discrepancy is due to clinical characteristics or delays in ... ...

Abstract	Importance: Patients with ST-segment elevation myocardial infarction (STEMI) living in rural settings often have worse clinical outcomes compared with their urban counterparts. Whether this discrepancy is due to clinical characteristics or delays in timely reperfusion with primary percutaneous coronary intervention (PPCI) or fibrinolysis is unclear. Objective: To assess process metrics and outcomes among patients with STEMI in rural and urban settings across the US. Design, setting, and participants: This cross-sectional multicenter study analyzed data for 70 424 adult patients with STEMI from the National Cardiovascular Data Registry Chest Pain-MI Registry in 686 participating US hospitals between January 1, 2019, and June 30, 2020. Patients without a valid zip code were excluded, and those transferred to a different hospital during the course of the study were excluded from outcome analysis. Main outcomes and measures: In-hospital mortality and time-to-reperfusion metrics. Results: This study included 70 424 patients with STEMI (median [IQR] age, 63 [54-73] years; 49 850 [70.8%] male and 20 574 [29.2%] female; patient self-reported race: 6753 [9.6%] Black, 60 114 [85.4%] White, and 2096 [3.0%] of another race [including American Indian, Alaskan Native, Native Hawaiian, and Pacific Islander]; 5281 [7.5%] individuals of Hispanic or Latino ethnicity) in 686 hospitals (50 702 [72.0%] living in urban zip codes and 19 722 [28.0%] in rural zip codes). Patients from rural settings were less likely to undergo PPCI compared with patients from urban settings (14 443 [73.2%] vs 43 142 [85.1%], respectively; P < .001) and more often received fibrinolytics (2848 [19.7%] vs 937 [2.7%]; P < .001). Compared with patients from urban settings, those in rural settings undergoing PPCI had longer median (IQR) time from first medical contact to catheterization laboratory activation (30 [12-42] minutes vs 22 [15-59] minutes; P < .001) and longer median (IQR) time from first medical contact to device (99 minutes [75-131] vs 81 [66-103] minutes; P < .001), including those who arrived directly at PPCI centers (83 [66-107] minutes vs 78 [64-97] minutes; P < .001) and those who transferred to PPCI centers from another treatment center (125 [102-163] minutes vs 103 [85-135] minutes; P < .001). Among those who transferred in, median (IQR) door-in-door-out time was longer in patients from rural settings (63 [41-100] minutes vs 50 [35-80] minutes; P < .001). Out-of-hospital cardiac arrest was more common in patients from urban vs rural settings (3099 [6.1%] vs 958 [4.9%]; P < .001), and patients from urban settings were more likely to present with heart failure (4112 [8.1%] vs 1314 [6.7%]; P < .001). After multivariable adjustment, there was no significant difference in in-hospital mortality between rural and urban groups (adjusted odds ratio, 0.97; 95% CI, 0.89-1.06). Conclusions and relevance: In this large cohort of patients with STEMI from US hospitals participating in the National Cardiovascular Data Registry Chest Pain-MI Registry, patients living in rural settings had longer times to reperfusion, were less likely to receive PPCI or meet guideline-recommended time to reperfusion, and more frequently received fibrinolytics than patients living in urban settings. However, there was no difference in adjusted in-hospital mortality between patients with STEMI from urban and rural settings.
MeSH term(s)	Adult ; Chest Pain ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/drug therapy ; Myocardial Infarction/therapy ; Registries ; ST Elevation Myocardial Infarction/therapy ; Time Factors
Language	English
Publishing date	2022-08-31
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2380-6591
ISSN (online)	2380-6591
DOI	10.1001/jamacardio.2022.2774
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Article ; Online: Incidental Coronary Artery Calcification and Stroke Risk in Patients With Atrial Fibrillation.

Hillerson, Dustin / Wool, Thomas / Ogunbayo, Gbolahan O / Sorrell, Vincent L / Leung, Steve W

AJR. American journal of roentgenology

2020 Volume 215, Issue 2, Page(s) 344–350

Abstract: OBJECTIVE. ...

Abstract	OBJECTIVE.
MeSH term(s)	Aged ; Atrial Fibrillation/complications ; Atrial Fibrillation/diagnostic imaging ; Coronary Artery Disease/complications ; Coronary Artery Disease/diagnostic imaging ; Female ; Humans ; Incidental Findings ; Male ; Middle Aged ; Retrospective Studies ; Risk Assessment ; Stroke/epidemiology ; Stroke/etiology ; Tomography, X-Ray Computed ; Vascular Calcification/complications ; Vascular Calcification/diagnostic imaging
Language	English
Publishing date	2020-04-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	82076-3
ISSN	1546-3141 ; 0361-803X ; 0092-5381
ISSN (online)	1546-3141
ISSN	0361-803X ; 0092-5381
DOI	10.2214/AJR.19.22298
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Article ; Online: Modes of Death in Patients with Cardiogenic Shock in the Cardiac Intensive Care Unit: A Report from the Critical Care Cardiology Trials Network.

Journal of cardiac failure

2024

Abstract: Background: There are limited data on how patients with cardiogenic shock (CS) die.: Methods: The Critical Care Cardiology Trials Network is a research network of cardiac intensive care units coordinated by the Thrombolysis In Myocardial Infarction ( ... ...

Abstract	Background: There are limited data on how patients with cardiogenic shock (CS) die. Methods: The Critical Care Cardiology Trials Network is a research network of cardiac intensive care units coordinated by the Thrombolysis In Myocardial Infarction (TIMI) Study Group (Boston, MA). Using standardized definitions, site investigators classified direct modes of in-hospital death for CS admissions (October 2021 to September 2022). Mutually exclusive categories included 4 modes of cardiovascular death and 4 modes of noncardiovascular death. Subgroups defined by CS type, preceding cardiac arrest (CA), use of temporary mechanical circulatory support (tMCS), and transition to comfort measures were evaluated. Results: Among 1068 CS cases, 337 (31.6%) died during the index hospitalization. Overall, the mode of death was cardiovascular in 82.2%. Persistent CS was the dominant specific mode of death (66.5%), followed by arrhythmia (12.8%), anoxic brain injury (6.2%), and respiratory failure (4.5%). Patients with preceding CA were more likely to die from anoxic brain injury (17.1% vs 0.9%; P < .001) or arrhythmia (21.6% vs 8.4%; P < .001). Patients managed with tMCS were more likely to die from persistent shock (P < .01), both cardiogenic (73.5% vs 62.0%) and noncardiogenic (6.1% vs 2.9%). Conclusions: Most deaths in CS are related to direct cardiovascular causes, particularly persistent CS. However, there is important heterogeneity across subgroups defined by preceding CA and the use of tMCS.
Language	English
Publishing date	2024-02-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	1281194-4
ISSN	1532-8414 ; 1071-9164
ISSN (online)	1532-8414
ISSN	1071-9164
DOI	10.1016/j.cardfail.2024.01.012
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Article ; Online: Variation in risk-adjusted cardiac intensive care unit (CICU) length of stay and the association with in-hospital mortality: An analysis from the Critical Care Cardiology Trials Network (CCCTN) registry.

Koerber, Daniel M / Katz, Jason N / Bohula, Erin / Park, Jeong-Gun / Dodson, Mark W / Gerber, Daniel A / Hillerson, Dustin / Liu, Shuangbo / Pierce, Matthew J / Prasad, Rajnish / Rose, Scott W / Sanchez, Pablo A / Shaw, Jeffrey / Wang, Jeffrey / Jentzer, Jacob C / Kristin Newby, L / Daniels, Lori B / Morrow, David A / van Diepen, Sean

American heart journal

2024 Volume 271, Page(s) 28–37

Abstract: Background: Previous studies have suggested that there is wide variability in cardiac intensive care unit (CICU) length of stay (LOS); however, these studies are limited by the absence of detailed risk assessment at the time of admission. Thus, we ... ...

Abstract	Background: Previous studies have suggested that there is wide variability in cardiac intensive care unit (CICU) length of stay (LOS); however, these studies are limited by the absence of detailed risk assessment at the time of admission. Thus, we evaluated inter-hospital differences in CICU LOS, and the association between LOS and in-hospital mortality. Methods: Using data from the Critical Care Cardiology Trials Network (CCCTN) registry, we included 22,862 admissions between 2017 and 2022 from 35 primarily tertiary and quaternary CICUs that captured consecutive admissions in annual 2-month snapshots. The primary analysis compared inter-hospital differences in CICU LOS, as well as the association between CICU LOS and all-cause in-hospital mortality using a Fine and Gray competing risk model. Results: The overall median CICU LOS was 2.2 (1.1-4.8) days, and the median hospital LOS was 5.9 (2.8-12.3) days. Admissions in the longest tertile of LOS tended to be younger with higher rates of pre-existing comorbidities, and had higher Sequential Organ Failure Assessment (SOFA) scores, as well as higher rates of mechanical ventilation, intravenous vasopressor use, mechanical circulatory support, and renal replacement therapy. Unadjusted all-cause in-hospital mortality was 9.3%, 6.7%, and 13.4% in the lowest, intermediate, and highest CICU LOS tertiles. In a competing risk analysis, individual patient CICU LOS was correlated (r Conclusions: In a large registry of academic CICUs, we observed significant variation in CICU LOS and report that LOS is independently associated with all-cause in-hospital mortality. These findings could potentially be used to improve CICU resource utilization planning and refine risk prognostication in critically ill cardiovascular patients.
MeSH term(s)	Humans ; Hospital Mortality/trends ; Male ; Registries ; Female ; Length of Stay/statistics & numerical data ; Aged ; Middle Aged ; Coronary Care Units/statistics & numerical data ; Risk Assessment/methods ; Critical Care/statistics & numerical data ; United States/epidemiology
Language	English
Publishing date	2024-02-16
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	80026-0
ISSN	1097-6744 ; 0002-8703
ISSN (online)	1097-6744
ISSN	0002-8703
DOI	10.1016/j.ahj.2024.02.010
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