Department of Medicine

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Integrating Artificial Intelligence Support in Patient Care While Respecting Ethical Principles.
Sharko, M.; Cole, C.L. (American Medical Association, 2025-03-03)
The Significance of Premature Ventricular Contractions in the Normal Heart.
Raizada, A.; Parikh, M.A.; Mihatov, N.; Frishman, W.H.; Peterson, S.J. (Lippincott, Williams & Wilkins, 2025-03-10)
The incidence of premature ventricular contractions (PVCs) in a structurally normal heart can result in clinically significant consequences, including PVC-induced cardiomyopathy. It is essential to consider the electrophysiologic characteristics of the PVCs to determine the patient's susceptibility. In an asymptomatic patient with no other structural heart disease and with PVCs, it is crucial to understand both the prognostic significance of the PVCs and when to initiate treatment with the appropriate modality. This review aims to review the clinical significance of PVCs in a normal heart and discuss the appropriate timing of treatment and first-line therapy.
Renal Denervation: A New Therapy for Resistant Hypertension.
Trivedi, D.B.; Parikh, M.A.; Turitto, G.; Frishman, W.H.; Peterson, S.J. (Lippincott, Williams & Wilkins, 2025-02-27)
The Food and Drug Administration (FDA) recently approved renal denervation to treat resistant hypertension. This procedure is a minimally invasive procedure that starts by placing a catheter in the renal artery. This catheter is used to send either radiofrequency heat or ultrasound waves to burn the superficial nerves surrounding the renal arteries while making certain no damage happens to the renal arteries themselves. This procedure is done after a renal angiogram to ensure patency of the renal artery. Each radiofrequency ablation will take 1-2 minutes, depending on the device used. The radiofrequency balloon generator requires one single application of the radiofrequency pulse. The radiofrequency generator that uses a catheter tube will need more than one pulse. The second approved option uses ultrasound to generate an electrical signal that is converted into ultrasound vibration, that occurs at the distal end of the catheter. This vibration heats the system around the nerves, disrupting the superficial nerves that communicate with the central nervous system. This will result in lowering the blood pressure. We will review the studies that led to FDA approval, and the current guidelines for use. The FDA now approves both devices.
Adverse Events Associated with Devices for Incisional Glaucoma Surgery Performed with Implants as Reported to the FDA MAUDE Database.
Chen, K.; Pendri, P.; Kovacs, K.; Van Tassel, S.H. (Springer, 2025-02-21)
PURPOSE: Incisional glaucoma surgery is indicated in advanced glaucoma or glaucoma refractory to less invasive therapies, and can be performed with implants to lower IOP including glaucoma drainage or filtration devices. The Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) represents the largest U.S. publicly-available repository of device-related incisional glaucoma surgery complications, enabling insight into complications experienced with incisional glaucoma surgery in real-world practice to develop a risk profile for the use of each device. METHODS: MAUDE database was searched between January-2012 and December-2021 for Brand Name: Ahmed ClearPath, Ahmed Glaucoma Valve, Baerveldt, Ex-PRESS, and Molteno. Reports were categorized by complication;when multiple were present, multiple categories were attributed. Reports with identical text and dates were counted as duplicate and excluded. Literature reports comparing multiple devices without clear device specification per complication were excluded. RESULTS: The search yielded 1538 reports, of which 1379 reports describing 2429 adverse events met inclusion criteria. The most common events for were hypotony/hypotony maculopathy (284), device-iris touch (282), device occlusion (213), elevated IOP (210), and device explanted due to possible exclusion (176). Delivery system failures occurred (166). Patients also experienced flat/shallow anterior chambers (147) and corneal edema/bullous keratopathy/endothelial cell count reduction/corneal decompensation/Descemet's membrane tears (128). CONCLUSION: By drawing on the real-world complications collected in the MAUDE database, this study identifies adverse events of greatest clinical pertinence for device-related incisional glaucoma surgery overall and by brand. Understanding the most common adverse events may support surgeons in counseling patients and preparing for device implantation.
Leaving Against Medical Advice: What's a Nurse to Do?
Walker, J.M.; de Melo-Martín, I. (Lippincott, Williams & Wilkins, 2025-02-20)
Each year approximately 1% to 2% of patient acute care discharges in United States hospitals are described as against medical advice (AMA). AMA discharges are associated with higher patient morbidity, increased risk of readmission, and higher mortality. Most discussions dealing with AMA discharge tend to focus on physicians. However, nurses have a pivotal role in the care process and in ensuring the safety of patients. The aim of this paper is to increase awareness regarding nurses' ethical responsibilities when confronting AMA discharges. We highlight nurses' leadership role in discharge planning and argue that they have moral obligations to promote as safe a discharge as possible. Such obligations are consistent with nursing codes of ethics, according to which nurses have a primary moral duty to promote patients' well-being. Moreover, nurses' training, expertise, and scope of practice place them in an ideal situation to address problems related to AMA discharges. We also offer suggestions that can contribute to helping nurses to fulfill their ethical responsibilities in this context.
Hospital Safety-Net Burden is Associated with Perioperative Outcomes in Primary Total Hip Arthroplasty: A Multistate Retrospective Analysis, 2015-2020.
Darko, M.; Tangel, V.E.; Gilman, A.; Cumbermack, M.; Kelleher, D.C.; Tedore, T.; White, R.S. (Mary Ann Liebert, 2025-01-21)
Total hip arthroplasty (THA) is a widely performed surgical procedure in the United States, but disparities in THA outcomes related to hospital-level factors, such as safety-net burden, are underexplored. This study expands on previous research by analyzing multicenter, multistate data from 2015 to 2020 to investigate the impact of hospital safety-net burden-defined as the proportion of services billed to Medicaid and uninsured patients-on THA outcomes. This study is a retrospective analysis using data from the State Inpatient Databases for Florida, Kentucky, Maryland, New York, Washington, New Jersey, and North Carolina. The study cohort included 543,814 inpatient primary THA admissions, with patient demographics, comorbidities, and hospital characteristics analyzed across 3 categories of hospital safety-net burden (low, medium, and high). Generalized linear mixed models assessed the association between safety-net burden and in-hospital mortality and postoperative complications, whereas multilevel negative binomial regression evaluated the impact on hospital length of stay. The study findings indicate that patients undergoing THA at hospitals with high safety-net burden had significantly higher odds of in-hospital mortality (adjusted odds ratio [aOR]: 1.20, 95% confidence interval [CI]: 1.02-1.42), postoperative complications (aOR 1.33, 95% CI 1.20-1.48), and longer hospital stays (adjusted incidence rate ratio 1.15, 95% CI 1.10-1.21) compared with those at low-burden hospitals. These results suggest that hospitals with higher safety-net burden, often serving more vulnerable populations, may have suboptimal perioperative processes and protocols, leading to poorer outcomes. The study underscores the need for targeted interventions to improve THA outcomes in these hospitals.
Aldosterone Synthase Inhibitor BI 690517: Specificity for Mineralocorticoid Receptor.
Treihaft, A.M.; Parikh, M.A.; Jackson, K.A.; Frishman, W.H.; Peterson, S.J. (Lippincott, Williams & Wilkins, 2025-02-12)
Aldosterone plays a critical role in maintaining volume and blood pressure control. It also plays a highly negative role in vascular diseases such as systemic hypertension, congestive heart failure, and cardiorenal syndrome due to the critical role that the renin-angiotensin-aldosterone system plays in these diseases from oxidative stress, vasoconstriction, and vascular remodeling caused by angiotensin II. Controlling aldosterone involves drugs such as angiotensin-converting enzyme inhibitor/angiotensin receptor blockers and mineralocorticoid receptor antagonists (MRAs). Recent guidelines suggest that the MRAs were more beneficial than angiotensin-converting enzyme inhibitor/angiotensin receptor blockers and diuretics in resistant hypertension. It is also essential to understand the role of both mineralocorticoid receptors (MRs) and glucocorticoid receptors (GRs) because they are present in many of the same tissues, and the balance of these 2 receptors is critical for homeostasis. Glucocorticoids activate MRs at basal levels and GRs at stress levels. During oxidative stress, MR activation can negatively affect the balance of MRs/GRs interactions, cognition, and memory. The older drugs in this category were less effective than MRAs in controlling blood pressure. A new class of drugs to consider are the aldosterone synthase inhibitors, which inhibit salt and water reabsorption and decrease sympathetic stimulation. The ideal candidate drug must be capable of inhibiting the MR while sparing the glucocorticoid receptor, a challenge given the 95% homology of these receptors.
Exit Mapping to Characterize Sites of Residual Pulmonary Vein Conduction After Failed First-Pass Isolation With Radiofrequency Ablation of Atrial Fibrillation.
Li, H.A.; Zhang, R.; Mandler, A.G.; Markowitz, S.M.; Ip, J.E.; Liu, C.F.; Thomas, G.; Lerman, B.B.; Cheung, J.W. (Wiley, 2025-02-03)
Cardiovascular Disease Multimorbidity and Decreased Health-Related Quality of Life in Haiti: A Cross-Sectional Study.
Sabwa, S.; Rouzier, V.; Sufra, R.; St. Sauveur, R.; Mourra, N.; Rasul, R.; Inddy, J.; Yan, L.D.; Sterling, M.; Pinheiro, L.; Deschamps, M.; Pape, J.W.; McNairy, M.L. (Wiley, 2025-01-27)
BACKGROUND: Multimorbidity is increasingly prevalent in lower- and middle-income countries. Health-related quality of life (HRQOL) has been inversely associated with multimorbidity but is understudied in lower- and middle-income countries. We report cardiovascular disease (CVD) multimorbidity in Haiti and its association with HRQOL. METHODS AND RESULTS: We used data from the Haiti CVD Cohort, a population-based longitudinal cohort of adults. CVD multimorbidity was 2+ CVD risk factors/diseases at enrollment. HRQOL was measured using the Short Form-12, yielding physical component summary/mental component summary scores between 0 and 100, with higher scores indicating better HRQOL. We used linear regressions to assess the association between CVD multimorbidity and HRQOL and individual CVD comorbidities and HRQOL. Additionally, we examined sex and education as potential effect modifiers. Among 2,996 participants, the median age was 40 years (interquartile range [IQR], 27-55), 58.0% were women, and 70.3% earned <1 US dollar per day. CVD multimorbidity prevalence was 24.1%; compared with those without CVD multimorbidity, those with CVD multimorbidity were older (median age, 56.0 years [IQR, 47.0-53.0]) and women (70.5%). Adjusted models revealed CVD multimorbidity was inversely related to physical component summary (-2.7 [95% CI, -3.8 to -1.6]) and mental component summary (-1.0 [95% CI, -1.8 to -0.2]). Heart failure and hypertension showed the strongest CVD morbidities associated with poor HRQOL. In the interaction analysis, among men, CVD multimorbidity was associated with a 4.3-point lower physical component summary score. Among those with less education, CVD multimorbidity was associated with a 4.6-point lower physical component summary score than no CVD multimorbidity. CONCLUSIONS: Our data are among the first to describe HRQOL data with high CVD multimorbidity in a young population in urban Haiti, and CVD multimorbidity was associated with decreased HRQOL. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03892265.
Predictors of Post-Acute Sequelae of COVID-19 in a Diverse Urban Population.
Gonzalez, C.J.; Lau, J.D.; Rajan, M.; Jabri, A.; Phillips, E. (Springer, 2025-01-27)
BACKGROUND: Post-acute sequelae of SARS-CoV-2 infection (PASC) are ongoing, relapsing, or new symptoms present at least 3 months after infection. Predictors of PASC, particularly across diverse racial and ethnic groups, remain unclear. OBJECTIVES: Assess the prevalence of PASC 1 year after infection, examining differences in PASC prevalence by the social construct of race. DESIGN: Retrospective observational cohort study. PARTICIPANTS: In total, 863 adults aged 18 years or older, who were assessed for COVID-19 at two hospitals in New York City during the first two waves of the pandemic (March to July 2020 and January to March 2021). MAIN MEASURES: Prevalence of self-reported PASC, including its respiratory and neurological phenotypes. Data were gathered via telephone surveys conducted 11-15 months following diagnosis. Logistic regression models were used to identify predictors of PASC. KEY RESULTS: In total, 54.1% of those diagnosed with COVID-19 reported PASC symptoms 1 year after infection. Racial and ethnic disparities in the prevalence of PASC varied by PASC phenotype and by the time of initial diagnosis (Wave 1 versus Wave 2). Asian adults had significantly lower odds of reporting any PASC compared to White adults (AOR = 0.55, p=0.02), particularly for neurological symptoms (AOR = 0.5, p=0.01). Black adults had significantly higher odds of reporting respiratory PASC (AOR = 2.67, p<0.001) and lower odds of neurological PASC (AOR = 0.54, p=0.02). Females had higher odds of respiratory (AOR = 1.45, p=0.04) and neurological PASC (AOR = 1.45, p=0.02). Loneliness was consistently associated with higher odds of all PASC categories. CONCLUSIONS: This study reveals a high prevalence of PASC 1 year post-infection, with notable racial and ethnic disparities. The results underscore the need for long-term monitoring of those infected with COVID-19 during the initial waves, with a focus on identifying and addressing yet unmeasured social determinants of health that contribute to these disparities.

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