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Article ; Online: Sustainable Approach to Justice, Equity, Diversity, and Inclusion Through Better Quality Measurement.

Okeke, Nkem / Hennessey, Kerrilynn C / Sitapati, Amy M / Weisshaar, Dana / Shah, Nishant P / Alicki, Rebecca / Haft, Howard

Circulation. Cardiovascular quality and outcomes

2024 , Page(s) e010791

Abstract: The US health care industry has broadly adopted performance and quality measures that are extracted from electronic health records and connected to payment incentives that hope to improve declining life expectancy and health status and reduce costs. ... ...

Abstract	The US health care industry has broadly adopted performance and quality measures that are extracted from electronic health records and connected to payment incentives that hope to improve declining life expectancy and health status and reduce costs. While the development of a quality measurement infrastructure based on electronic health record data was an important first step in addressing US health outcomes, these metrics, reflecting the average performance across diverse populations, do not adequately adjust for population demographic differences, social determinants of health, or ecosystem vulnerability. Like society as a whole, health care must confront the powerful impact that social determinants of health, race, ethnicity, and other demographic variations have on key health care performance indicators and quality metrics. Tools that are currently available to capture and report the health status of Americans lack the granularity, complexity, and standardization needed to improve health and address disparities at the local level. In this article, we discuss the current and future state of electronic clinical quality measures through a lens of equity.
Language	English
Publishing date	2024-04-15
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2483197-9
ISSN	1941-7705 ; 1941-7713
ISSN (online)	1941-7705
ISSN	1941-7713
DOI	10.1161/CIRCOUTCOMES.123.010791
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Article ; Online: Response to "Comments on sirolimus use and risk of cutaneous squamous cell carcinoma (SCC) in solid organ transplant recipients" (SOTRs).

Asgari, Maryam M / Arron, Sarah / Warton, E Margaret / Quesenberry, Charles P / Weisshaar, Dana

Journal of the American Academy of Dermatology

2022 Volume 86, Issue 5, Page(s) e205–e206

Language	English
Publishing date	2022-04-16
Publishing country	United States
Document type	Letter ; Research Support, N.I.H., Extramural ; Comment
ZDB-ID	603641-7
ISSN	1097-6787 ; 0190-9622
ISSN (online)	1097-6787
ISSN	0190-9622
DOI	10.1016/j.jaad.2016.01.063
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Article ; Online: Amyloid cardiomyopathy in a large integrated health care system.

Czobor, Peter / Hung, Yun-Yi / Baer, David / McGlothlin, Dana / Weisshaar, Dana / Zaroff, Jonathan

American heart journal

2019 Volume 216, Page(s) 42–52

Abstract: Background: Light Chain (AL) and transthyretin (ATTR) amyloidosis are the most common forms of amyloid cardiomyopathy. Population based studies describing the epidemiology and clinical features of amyloid cardiomyopathy are often based in tertiary ... ...

Abstract	Background: Light Chain (AL) and transthyretin (ATTR) amyloidosis are the most common forms of amyloid cardiomyopathy. Population based studies describing the epidemiology and clinical features of amyloid cardiomyopathy are often based in tertiary medical centers and thus may be limited by referral bias. Methods and results: We performed a cohort study of 198 patients diagnosed and treated in the Kaiser Permanente Northern California health care system who had a confirmed diagnosis of cardiac amyloidosis between 2001 and 2016. Associations between demographic, clinical, laboratory and imaging data and patient outcomes were quantified using multivariable Cox proportional hazard models for both the AL and ATTR groups. The average length of follow up was 2.8 years (SD 2.9 years) and overall survival was 69.1 percent at one year and 35.4 percent at five years. In the AL group, lower left ventricular ejection fraction (HR 1.33 per 5-point decrease, P < .001), coronary artery disease (HR 3.56, P < .001), and diabetes mellitus (HR 3.19, P < .001) were associated with all-cause mortality. Increasing age at the time of diagnosis with associated with higher all-cause mortality in both the AL and ATTR groups. Higher levels of B-type natriuretic peptide were associated with all-cause mortality in both groups: Top quartile BNP HR 6.17, P < .001 for AL and HR 8.16, P = .002 for ATTR. Conclusions: This study describes a large cohort of patients with amyloid cardiomyopathy derived from a community based, integrated healthcare system and describes demographic, clinical, and laboratory characteristics associated with mortality and heart failure hospitalization. In this population, coronary artery disease, diabetes mellitus, and high BNP levels were strongly associated with mortality.
MeSH term(s)	Age Factors ; Aged ; Aged, 80 and over ; Amyloid Neuropathies, Familial/blood ; Amyloid Neuropathies, Familial/mortality ; Amyloid Neuropathies, Familial/physiopathology ; California ; Cardiomyopathies/blood ; Cardiomyopathies/mortality ; Cardiomyopathies/physiopathology ; Cause of Death ; Cohort Studies ; Coronary Artery Disease/mortality ; Delivery of Health Care, Integrated ; Diabetes Mellitus/mortality ; Echocardiography ; Female ; Heart Failure/etiology ; Heart Failure/mortality ; Hospitalization ; Humans ; Immunoglobulin Light-chain Amyloidosis/blood ; Immunoglobulin Light-chain Amyloidosis/mortality ; Immunoglobulin Light-chain Amyloidosis/physiopathology ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Natriuretic Peptide, Brain/blood ; Proportional Hazards Models ; Stroke Volume ; Treatment Outcome
Chemical Substances	Natriuretic Peptide, Brain (114471-18-0)
Language	English
Publishing date	2019-06-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	80026-0
ISSN	1097-6744 ; 0002-8703
ISSN (online)	1097-6744
ISSN	0002-8703
DOI	10.1016/j.ahj.2019.06.008
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Ui IV Zs.15: Show issues

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Article ; Online: Association between the chance locus of control belief with self-reported occasional nonadherence after heart transplantation: a pilot study.

Epstein, Flavio R / Kale, Parag P / Weisshaar, Dana M

Transplantation

2014 Volume 98, Issue 1, Page(s) e4

MeSH term(s)	Cross-Sectional Studies ; Female ; Graft Rejection/immunology ; Graft Rejection/prevention & control ; Graft Survival/drug effects ; Health Knowledge, Attitudes, Practice ; Heart Transplantation/adverse effects ; Heart Transplantation/psychology ; Humans ; Immunosuppressive Agents/therapeutic use ; Internal-External Control ; Male ; Medication Adherence ; Middle Aged ; Pilot Projects ; Risk Factors ; Self Report ; Time Factors ; Treatment Outcome
Chemical Substances	Immunosuppressive Agents
Language	English
Publishing date	2014-07-15
Publishing country	United States
Document type	Letter
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000000196
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Zs.A 488: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 509: Show issues

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Article ; Online: Outcomes in Patients With Cardiac Amyloidosis Undergoing Heart Transplantation.

Barrett, Christopher D / Alexander, Kevin M / Zhao, Hongyu / Haddad, Francois / Cheng, Paul / Liao, Ronglih / Wheeler, Matthew T / Liedtke, Michaela / Schrier, Stanley / Arai, Sally / Weisshaar, Dana / Witteles, Ronald M

JACC. Heart failure

2020 Volume 8, Issue 6, Page(s) 461–468

Abstract: Objectives: The purpose of this study is to report outcomes after heart transplantation in patients with cardiac amyloidosis based on a large single-center experience.: Background: Cardiac amyloidosis causes significant morbidity and mortality, often ...

Abstract	Objectives: The purpose of this study is to report outcomes after heart transplantation in patients with cardiac amyloidosis based on a large single-center experience. Background: Cardiac amyloidosis causes significant morbidity and mortality, often leading to restrictive cardiomyopathy, progressive heart failure, and death. Historically, heart transplantation outcomes have been worse in patients with cardiac amyloidosis compared with other heart failure populations, in part due to the systemic nature of the disease. However, several case series have suggested that transplantation outcomes may be better in the contemporary era, likely in part due to the availability of more effective light chain suppressive therapies for light chain amyloidosis. Methods: This study examined all patients seen between 2004 and 2017, either at the Stanford University Medical Center or the Kaiser Permanente Santa Clara Medical Center, who were diagnosed with cardiac amyloidosis and ultimately underwent heart transplantation. This study examined pre-transplantation characteristics and post-transplantation outcomes in this group compared with the overall transplantation population at our center. Results: During the study period, 31 patients (13 with light chain amyloidosis and 18 with transthyretin [ATTR] amyloidosis) underwent heart transplantation. Patients with ATTR amyloidosis were older, were more likely to be male, had worse baseline renal function, and had longer waitlist times compared with both patients with light chain amyloidosis and the overall transplantation population. Post-transplantation, there were no differences in post-operative bleeding, renal failure, infection, rejection, or malignancy. There was no significant difference in mortality between patients who underwent heart transplantation for amyloid cardiomyopathy and patients who underwent heart transplantation for all other indications. Conclusions: In carefully selected patients with cardiac amyloidosis, heart transplantation can be an effective therapeutic option with outcomes similar to those transplanted for other causes of heart failure.
MeSH term(s)	Aged ; Amyloidosis/complications ; Amyloidosis/diagnosis ; Amyloidosis/surgery ; Cardiomyopathies/complications ; Cardiomyopathies/diagnosis ; Cardiomyopathies/surgery ; Female ; Heart Failure/diagnosis ; Heart Failure/etiology ; Heart Failure/surgery ; Heart Transplantation ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Waiting Lists
Language	English
Publishing date	2020-05-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2705621-1
ISSN	2213-1787 ; 2213-1779
ISSN (online)	2213-1787
ISSN	2213-1779
DOI	10.1016/j.jchf.2019.12.013
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Article ; Online: Sirolimus use and risk of cutaneous squamous cell carcinoma (SCC) in solid organ transplant recipients (SOTRs).

Asgari, Maryam M / Arron, Sarah T / Warton, E Margaret / Quesenberry, Charles P / Weisshaar, Dana

Journal of the American Academy of Dermatology

2015 Volume 73, Issue 3, Page(s) 444–450

Abstract: Background: Little is known about the use of sirolimus for primary prevention of cutaneous squamous cell carcinoma (SCC) among solid organ transplant recipients (SOTRs).: Objective: We examined the association between sirolimus exposure and incident ... ...

Abstract	Background: Little is known about the use of sirolimus for primary prevention of cutaneous squamous cell carcinoma (SCC) among solid organ transplant recipients (SOTRs). Objective: We examined the association between sirolimus exposure and incident SCC risk among SOTRs within Kaiser Permanente Northern California. Methods: Using a retrospective cohort of all Kaiser Permanente Northern California members given a diagnosis of SOTR from 2000 through 2010, we evaluated incident posttransplantation SCC risk in relation to sirolimus exposure. Sirolimus use was determined from electronic pharmacy records, and incident posttransplantation SCCs were identified from health plan electronic pathology records. We used extended Cox regression to examine the independent association between receipt of sirolimus and risk of SCC. Results: Among 3539 SOTRs, 488 were exposed to sirolimus and 47 developed an incident SCC. SCC risk was not associated with ever use of sirolimus (adjusted hazard ratio 1.18, 95% confidence interval 0.84-1.16) or cumulative duration of sirolimus exposure (adjusted hazard ratio 2.75, 95% confidence interval 0.84-9.04, comparing long-term users with nonusers). Limitations: No information was available for some known SCC risk factors, such as skin type and sun exposure. Conclusions: Among a large cohort of SOTRs, sirolimus exposure was not associated with a reduction in incident posttransplantation SCC risk.
MeSH term(s)	Adult ; Aged ; Carcinoma, Squamous Cell/epidemiology ; Carcinoma, Squamous Cell/etiology ; Carcinoma, Squamous Cell/physiopathology ; Cohort Studies ; Confidence Intervals ; Female ; Follow-Up Studies ; Humans ; Immunosuppressive Agents/administration & dosage ; Incidence ; Male ; Middle Aged ; Organ Transplantation/adverse effects ; Organ Transplantation/methods ; Proportional Hazards Models ; Reference Values ; Retrospective Studies ; Risk Assessment ; Sensitivity and Specificity ; Sirolimus/administration & dosage ; Skin Neoplasms/epidemiology ; Skin Neoplasms/etiology ; Skin Neoplasms/physiopathology ; Transplant Recipients/statistics & numerical data ; Treatment Outcome
Chemical Substances	Immunosuppressive Agents ; Sirolimus (W36ZG6FT64)
Language	English
Publishing date	2015-06-30
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	603641-7
ISSN	1097-6787 ; 0190-9622
ISSN (online)	1097-6787
ISSN	0190-9622
DOI	10.1016/j.jaad.2015.05.029
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Article ; Online: The Incremental Value of Right Ventricular Size and Strain in the Risk Assessment of Right Heart Failure Post - Left Ventricular Assist Device Implantation.

Aymami, Marie / Amsallem, Myriam / Adams, Jackson / Sallam, Karim / Moneghetti, Kegan / Wheeler, Matthew / Hiesinger, William / Teuteberg, Jeffrey / Weisshaar, Dana / Verhoye, Jean-Philippe / Woo, Y Joseph / Ha, Richard / Haddad, François / Banerjee, Dipanjan

Journal of cardiac failure

2018 Volume 24, Issue 12, Page(s) 823–832

Abstract: Background: Right heart failure (RHF) after left ventricular assist device (LVAD) implantation is associated with high morbidity and mortality. Existing risk scores include semiquantitative evaluation of right ventricular (RV) dysfunction. This study ... ...

Abstract	Background: Right heart failure (RHF) after left ventricular assist device (LVAD) implantation is associated with high morbidity and mortality. Existing risk scores include semiquantitative evaluation of right ventricular (RV) dysfunction. This study aimed to determine whether quantitative evaluation of both RV size and function improve risk stratification for RHF after LVAD implantation beyond validated scores. Methods and results: From 2009 to 2015, 158 patients who underwent implantation of continuous-flow devices who had complete echocardiographic and hemodynamic data were included. Quantitative RV parameters included RV end-diastolic (RVEDAI) and end-systolic area index, RV free-wall longitudinal strain (RVLS), fractional area change, tricuspid annular plane systolic excursion, and right atrial area and pressure. Independent correlates of early RHF (<30 days) were determined with the use of logistic regression analysis. Mean age was 56 ± 13 years, with 79% male; 49% had INTERMACS profiles ≤2. RHF occurred in 60 patients (38%), with 20 (13%) requiring right ventricular assist device. On multivariate analysis, INTERMACS profiles (adjusted odds ratio 2.38 [95% confidence interval [CI] 1.47-3.85]), RVEDAI (1.61 [1.08-2.32]), and RVLS (2.72 [1.65-4.51]) were independent correlates of RHF (all P < .05). Both RVLS and RVEDAI were incremental to validated risk scores (including the EUROMACS score) for early RHF after LVAD (all P < .01). Conclusions: RV end-diastolic and strain are complementary prognostic markers of RHF after LVAD implantation.
MeSH term(s)	California/epidemiology ; Disease Progression ; Echocardiography ; Female ; Follow-Up Studies ; Heart Failure/diagnosis ; Heart Failure/epidemiology ; Heart Failure/physiopathology ; Heart Ventricles/diagnostic imaging ; Heart Ventricles/physiopathology ; Heart-Assist Devices ; Humans ; Incidence ; Male ; Middle Aged ; Organ Size ; Retrospective Studies ; Risk Assessment/methods ; Ventricular Function, Left/physiology ; Ventricular Function, Right/physiology
Language	English
Publishing date	2018-10-26
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.2018.10.012
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Article ; Online: Circulating cell-free DNA enables noninvasive diagnosis of heart transplant rejection.

De Vlaminck, Iwijn / Valantine, Hannah A / Snyder, Thomas M / Strehl, Calvin / Cohen, Garrett / Luikart, Helen / Neff, Norma F / Okamoto, Jennifer / Bernstein, Daniel / Weisshaar, Dana / Quake, Stephen R / Khush, Kiran K

Science translational medicine

2014 Volume 6, Issue 241, Page(s) 241ra77

Abstract: Monitoring allograft health is an important component of posttransplant therapy. Endomyocardial biopsy is the current gold standard for cardiac allograft monitoring but is an expensive and invasive procedure. Proof of principle of a universal, ... ...

Abstract	Monitoring allograft health is an important component of posttransplant therapy. Endomyocardial biopsy is the current gold standard for cardiac allograft monitoring but is an expensive and invasive procedure. Proof of principle of a universal, noninvasive diagnostic method based on high-throughput screening of circulating cell-free donor-derived DNA (cfdDNA) was recently demonstrated in a small retrospective cohort. We present the results of a prospective cohort study (65 patients, 565 samples) that tested the utility of cfdDNA in measuring acute rejection after heart transplantation. Circulating cell-free DNA was purified from plasma and sequenced (mean depth, 1.2 giga-base pairs) to quantify the fraction of cfdDNA. Through a comparison with endomyocardial biopsy results, we demonstrate that cfdDNA enables diagnosis of acute rejection after heart transplantation, with an area under the receiver operating characteristic curve of 0.83 and sensitivity and specificity that are comparable to the intrinsic performance of the biopsy itself. This noninvasive genome transplant dynamics approach is a powerful and informative method for routine monitoring of allograft health without incurring the risk, discomfort, and expense of an invasive biopsy.
MeSH term(s)	DNA/blood ; Early Diagnosis ; Graft Rejection/diagnosis ; Heart Transplantation ; Humans ; Retrospective Studies
Chemical Substances	DNA (9007-49-2)
Language	English
Publishing date	2014-06-18
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2518854-9
ISSN	1946-6242 ; 1946-6234
ISSN (online)	1946-6242
ISSN	1946-6234
DOI	10.1126/scitranslmed.3007803
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Zs.A 6941: Show issues

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Article: Primary cardiac angiosarcoma: case report and review of the literature.

Kurian, Kizhake C / Weisshaar, Dana / Parekh, Hemal / Berry, Gerald J / Reitz, Bruce

Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology

2006 Volume 15, Issue 2, Page(s) 110–112

Abstract: We report of a young man who was referred for evaluation of the right atrial mass. He had presented outside the hospital with shortness of breath. A transthoracic echocardiogram (TTE) done there showed a bright echodensity in the right atrium with ... ...

Abstract	We report of a young man who was referred for evaluation of the right atrial mass. He had presented outside the hospital with shortness of breath. A transthoracic echocardiogram (TTE) done there showed a bright echodensity in the right atrium with moderate pericardial effusion. He was treated for presumed viral pericarditis. Pericardiocentesis showed a bloody effusion. Four weeks after this initial presentation, a repeat TTE was done to evaluate for recurrent pericardial effusion due to shortness of breath. The right atrial mass had increased in size and no effusion was noted. He was referred to us for further evaluation. The tumor was successfully resected during surgery, and the pathological examination revealed primary cardiac angiosarcoma. The case highlights the misdiagnosis in initial clinical presentation, current diagnostic modalities, and treatment options for cardiac angiosarcoma.
MeSH term(s)	Adult ; Heart Atria ; Heart Neoplasms/diagnosis ; Heart Neoplasms/pathology ; Heart Neoplasms/therapy ; Hemangiosarcoma/diagnosis ; Hemangiosarcoma/pathology ; Hemangiosarcoma/therapy ; Humans ; Male
Language	English
Publishing date	2006-03
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	1134600-0
ISSN	1054-8807
ISSN	1054-8807
DOI	10.1016/j.carpath.2005.10.003
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Article ; Online: COVID-19 in hospitalized lung and non-lung solid organ transplant recipients: A comparative analysis from a multicenter study.

Heldman, Madeleine R / Kates, Olivia S / Safa, Kassem / Kotton, Camille N / Georgia, Sarah J / Steinbrink, Julie M / Alexander, Barbara D / Hemmersbach-Miller, Marion / Blumberg, Emily A / Crespo, Maria M / Multani, Ashrit / Lewis, Angelica V / Eugene Beaird, Omer / Haydel, Brandy / La Hoz, Ricardo M / Moni, Lisset / Condor, Yesabeli / Flores, Sandra / Munoz, Carlos G /

Guitierrez, Juan / Diaz, Esther I / Diaz, Daniela / Vianna, Rodrigo / Guerra, Giselle / Loebe, Matthias / Rakita, Robert M / Malinis, Maricar / Azar, Marwan M / Hemmige, Vagish / McCort, Margaret E / Chaudhry, Zohra S / Singh, Pooja / Hughes, Kailey / Velioglu, Arzu / Yabu, Julie M / Morillis, Jose A / Mehta, Sapna A / Tanna, Sajal D / Ison, Michael G / Tomic, Rade / Candace Derenge, Ariella / van Duin, David / Maximin, Adrienne / Gilbert, Carlene / Goldman, Jason D / Sehgal, Sameep / Weisshaar, Dana / Girgis, Reda E / Nelson, Joanna / Lease, Erika D / Limaye, Ajit P / Fisher, Cynthia E

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

2021 Volume 21, Issue 8, Page(s) 2774–2784

Abstract: Lung transplant recipients (LTR) with coronavirus disease 2019 (COVID-19) may have higher mortality than non-lung solid organ transplant recipients (SOTR), but direct comparisons are limited. Risk factors for mortality specifically in LTR have not been ... ...

Abstract	Lung transplant recipients (LTR) with coronavirus disease 2019 (COVID-19) may have higher mortality than non-lung solid organ transplant recipients (SOTR), but direct comparisons are limited. Risk factors for mortality specifically in LTR have not been explored. We performed a multicenter cohort study of adult SOTR with COVID-19 to compare mortality by 28 days between hospitalized LTR and non-lung SOTR. Multivariable logistic regression models were used to assess comorbidity-adjusted mortality among LTR vs. non-lung SOTR and to determine risk factors for death in LTR. Of 1,616 SOTR with COVID-19, 1,081 (66%) were hospitalized including 120/159 (75%) LTR and 961/1457 (66%) non-lung SOTR (p = .02). Mortality was higher among LTR compared to non-lung SOTR (24% vs. 16%, respectively, p = .032), and lung transplant was independently associated with death after adjusting for age and comorbidities (aOR 1.7, 95% CI 1.0-2.6, p = .04). Among LTR, chronic lung allograft dysfunction (aOR 3.3, 95% CI 1.0-11.3, p = .05) was the only independent risk factor for mortality and age >65 years, heart failure and obesity were not independently associated with death. Among SOTR hospitalized for COVID-19, LTR had higher mortality than non-lung SOTR. In LTR, chronic allograft dysfunction was independently associated with mortality.
MeSH term(s)	Adult ; Aged ; COVID-19 ; Cohort Studies ; Humans ; Lung ; Organ Transplantation/adverse effects ; SARS-CoV-2 ; Transplant Recipients
Language	English
Publishing date	2021-07-24
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, N.I.H., Extramural
ZDB-ID	2060594-8
ISSN	1600-6143 ; 1600-6135
ISSN (online)	1600-6143
ISSN	1600-6135
DOI	10.1111/ajt.16692
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