2016 AHA/ACC Clinical Performance and Quality Measures for Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures

Al‐Khatib, Sana M.; Yancy, Clyde W.; Solis, Penelope; Becker, Lance B.; Benjamin, Emelia J.; Carrillo, Roger G.; Fonarow, Gregg C.; Kantharia, Bharat K.; Kleinman, Monica E.; Nichol, Graham; Varosy, Paul D.

doi:10.1161/hcq.0000000000000022

Cited by 16 publications

(16 citation statements)

References 137 publications

(127 reference statements)

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“…Current practice points emphasize quality-of-care measures (ie, appropriate candidate selection and minimization of procedural risks). 1 However, management downstream to implant has received less attention. This is important because devices introduce potential risks (eg, unnecessary ICD therapies) that may erode the survival benefit afforded by the implant.…”

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confidence: 99%

How Well Do Results From Randomized Clinical Trials and/or Recommendations for Implantable Cardioverter‐Defibrillator Programming Diffuse Into Clinical Practice?

Varma

Jones

Wold

et al. 2019

JAHA

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Background-Inappropriate implantable cardioverter-defibrillator programming can be detrimental. Whether trials/recommendations informing best implantable cardioverter-defibrillator programming (high-rate cutoff and/or extended duration of detection) influence practice is unknown. Methods and Results-We measured reaction to publication of MADIT-RIT (Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy; 2012) and the Consensus Statement (2015) providing generic programming parameters, in a national cohort of implantable cardioverter-defibrillator recipients, using the ALTITUDE database (Boston Scientific). Yearly changes in programmed parameters to either trial-specified or class 1 recommended parameters (≥185 beats per minute or delay ≥6 seconds) were assessed in parallel. From 2008 to 2017, 232 982 patients (aged 67AE13 years; 28% women) were analyzed. Prevalence of MADIT-RIT-specific settings before publication was <1%, increasing to 13.6% in the year following. Thereafter, this increased by <6% over 5 years. Among preexisting implants (91 171), most patients (58 739 [64.4%]) underwent at least 1 inperson device reprogramming after trial publication, but <2% were reprogrammed to MADIT-RIT settings. Notably, prevalence of programming to ≥185 beats per minute or delay ≥6 seconds was increased by MADIT-RIT (57.4% in 2013 versus 40.2% at baseline), but the following publication of recommendations had minor incremental effect (73.2% in 2016 versus 70.8% in 2015). High-rate cutoff programming was favored almost 2-fold compared with extended duration throughout the test period. Practice changes demonstrated large interhospital and interstate variations. Conclusions-Trial publication had an immediate effect during 1 year postpublication, but absolute penetration was low, and amplified little with time. Consensus recommendations had a negligible effect. However, generic programming was exercised more widely, and increased after trial publication, but not following recommendations.

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confidence: 99%

How Well Do Results From Randomized Clinical Trials and/or Recommendations for Implantable Cardioverter‐Defibrillator Programming Diffuse Into Clinical Practice?

Varma

Jones

Wold

et al. 2019

JAHA

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“…In the real world, however, consideration should be given to the fact that changing lifestyle factors is very difficult in practice and resisted by patients (recently it has been termed Sisyphus fatigue) . In particular, cigarette smoking is associated with a very high risk of sudden death, so much so that in the US guidelines, cigarette smoking abstention is placed first in the recommendations for preventing this mode of death . Worldwide, 25% of men and 5% of women are smokers (in Italy, 23% and 17%, respectively) .…”

Section: Discussionmentioning

confidence: 99%

“…25 In particular, cigarette smoking is associated with a very high risk of sudden death, so much so that in the US guidelines, cigarette smoking abstention is placed first in the recommendations for preventing this mode of death. 26 Worldwide, 25% of men and 5% of women are smokers (in Italy, 23% and 17%, respectively). 24 In our study, the majority of patients who experienced events were current smokers.…”

Section: Methodsmentioning

confidence: 99%

Stable atypical chest pain with negative anatomical or functional diagnostic test: Diagnosis no matter what or prevention at any cost?

Cosmi¹,

Mariottoni

Cosmi

2019

Clinical Cardiology

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Background Approximately 1% to 2% of patients with stable atypical chest pain (SACP) experienced a major coronary event, even after a negative functional or anatomical test. Methods Over the past 15 years, 1706 patients with SACP evaluated in our clinics underwent functional stress testing or coronary computed tomographic angiography (CTA). In these patients, we also assessed the presence of three major modifiable lifestyle‐related risk factors (cigarette smoking, low intake of fruit and vegetables, and physical inactivity). Patients were stratified according to the presence of at least one risky lifestyle factor or no risky lifestyle factors. Functional or anatomical tests were positive in 170 patients (10%). We followed the remaining 1536 patients with negative tests for 1 year to evaluate the incidence of major coronary events. Results The percentage of patients reporting major coronary events was 1.2% in the group with risky lifestyles and 0.2% in the non‐risky lifestyle group (P < .01). Events were more common in smokers. Conclusions Patients with SACP, when functional or anatomical tests are negative, have a residual risk of fatal and non‐fatal cardiovascular events of 1% at 1 year of follow‐up. People with incorrect lifestyles, especially smokers, have a higher risk of events. We think that in this population, a more effective intervention on lifestyles could be the key to reduce major cardiovascular events.

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“…Each concept was assigned a property in the form of a weight, a number in the (0,1) interval, reflecting the concept materiality with respect to the concept preceding on the tree (one level up), with the proviso that the sum of weights assigned to all successors (one level down along the tree paths) of a given concept is 1. The last stage of the construction consisted in defining instances of individual concept in the form of recognized SCD prognostic factors [1,12,14,26] corresponding to appropriate data set features. Selected risks are presented in Tables 2 and 3.…”

Section: Construction Of Ontologymentioning

confidence: 99%

Effective construction of classifiers with the k-NN method supported by a concept ontology

et al. 2019

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In analysing sensor data, it usually proves beneficial to use domain knowledge in the classification process in order to narrow down the search space of relevant features. However, it is often not effective when decision trees or the k-NN method is used. Therefore, the authors herein propose to build an appropriate concept ontology based on expert knowledge. The use of an ontology-based metric enables mutual similarity to be determined between objects covered by respective concept ontology, taking into consideration interrelations of features at various levels of abstraction. Using a set of medical data collected with the Holter method, it is shown that predicting coronary disease with the use of the approach proposed is much more accurate than in the case of not only the k-NN method using classical metrics, but also most other known classifiers. It is also proved in this paper that the expert determination of appropriate structure of ontology is of key importance, while subsequent selection of appropriate weights can be automated. Keywords k-nearest neighbour algorithm • Ontology similarity metrics • Holter measurement • Coronary disease B Jan Bazan

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2016 AHA/ACC Clinical Performance and Quality Measures for Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures

Cited by 16 publications

References 137 publications

How Well Do Results From Randomized Clinical Trials and/or Recommendations for Implantable Cardioverter‐Defibrillator Programming Diffuse Into Clinical Practice?

How Well Do Results From Randomized Clinical Trials and/or Recommendations for Implantable Cardioverter‐Defibrillator Programming Diffuse Into Clinical Practice?

Stable atypical chest pain with negative anatomical or functional diagnostic test: Diagnosis no matter what or prevention at any cost?

Effective construction of classifiers with the k-NN method supported by a concept ontology

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