Moerer, Ryan T.

Abstract Background Ischemic heart disease is the leading cause of death among women. Non-obstructive coronary disease (NOCAD), often identified by a positive stress test and negative coronary angiogram result, is linked to adverse outcomes, particularly among women. Purpose This study evaluated the impact of discordant Single Photon Emission Computed Tomography (SPECT) Myocardial Perfusion Imaging (MPI) stress test and coronary angiogram results on repeat invasive angiography and survival, while assessing sex-related differences. Methods Data were extracted from a single health system for patients who underwent a SPECT MPI stress test, and invasive coronary angiography performed within 3 months from September 2002 to July 2018. Discordance was defined as: Profile A – a positive stress test with negative angiography (epicardial coronary vessel stenosis <50%); Profile B – a negative stress test with positive angiography (at least one epicardial coronary vessel stenosis >=50%). To assess the association between discordance and all-cause mortality, Cox-proportional hazards regression was used to analyze the most recent stress/angiogram pair (adjusting for race, age, and number of prior angiograms). For repeat invasive angiography, where mortality was considered a competing event, the Fine-Gray proportional hazards model for the sub-distribution of a competing risk was used to analyze the first stress/angiogram pair (adjusting for race and age). Hazard ratios (HRs), sub-distribution hazard ratios (SHRs), and corresponding 95% confidence intervals (CIs) were reported. Results 5,179 were included in the final analysis, median age was 67.9 years and 32.7% were female. Approximately 15% and 24% were classified as Profile A and B respectively. Patients with a negative stress/negative angiogram were designated as the reference group. Profile A was not significantly associated with mortality or repeat invasive testing in both sexes. Profile B was associated with the highest risk of death (female aHR: 1.58, P<.001; male aHR: 1.54, P<.001) followed by those with a positive stress/positive angiogram (female aHR: 1.39, P=.009; male aHR: 1.25, P=.05) compared to the reference group. Profile B was significantly associated with repeat invasive testing and a stronger association was seen in females (female aSHR: 9.84, P< .001; male aSHR: 3.42, P<.001). A similar pattern was seen for those with a positive stress/positive angiogram. Conclusion Discordant Profile A showed no significant association with mortality or repeat invasive testing. Discordant Profile B was associated with the highest mortality risk in both sexes and showed a stronger association with repeat invasive testing among females. These findings underscore the importance of careful patient selection for stress testing, the need for improved stress testing options (especially in females), and prompt coronary evaluation in patients with a negative stress test and persistent symptoms or high-risk features.

Abstract Background: Chronic dry eye disease (CDED) is a condition of the ocular surface that causes discomfort, visual disturbance, conjunctival injection, and photophobia. A debilitating form of CDED in patients undergoing allogeneic bone marrow transplant results from ocular graft versus host disease (oGVHD). Autologous serum eye drops (ASED) have beneficial effects on the ocular surface. The aim of this study is to compare improvements in symptoms and function in a cohort of CDED patients with ocular GVHD treated with ASED and a cohort of CDED without GVHD (non-GVHD). We additionally report on some of the biologic characteristics of one specific ASED formulation. Materials and Methods: A total of 71 patients seen in a multi-specialty ophthalmology practice in a university hospital setting receiving ASEDs underwent ocular surface disease index (OSDI) and visual function questionnaire measurements at baseline, 3 months, and 6 months. Twenty-four ASED samples were studied for biomarkers. Results: Compared to baseline, OSDI scores significantly decreased after 3 and 6 months of ASED treatment in both oGVHD and non-GVHD CDED groups. Additionally, visual function questionnaire-25 (VFQ-25) subscales (ocular pain, distance activity, driving, role difficulties, dependency, and mental health) were significantly improved at 3 months and 6 months, and social functioning was improved at 6 months. The majority of patients in both groups had severe disease. Improvements in patient-reported outcomes were greater in the oGHD CDED group than in the non-GVHD CDED group There were no reported complications. Conclusion: ASED is safe and effective in patients with CDED due to oGVHD and non-GVHD. Those with oGVHD had greater improvements. These findings potentiate the wider adoption of this therapy in CDED patients and warrant additional studies into the biochemical makeup of ASED.

AbstractBackgroundHospital‐at‐home has become a more recognized way to care for patients requiring inpatient hospitalization. At times, these patients may require escalation of care (transfer from home back to the brick‐and‐mortar (BAM) hospital for ongoing hospitalization care needs), a process that has not been extensively studied.ObjectiveTo evaluate what patient factors contribute to escalations of care in the hospital‐at‐home delivery model.Designs, Settings, and ParticipantsWe conducted a retrospective review of all patients admitted to Mayo Clinic's Advanced Care at Home (ACH) program from January 1, 2022 to December 31, 2022.InterventionNone.Main Outcomes and MeasuresPatient information was collected via electronic health record including demographic, socioeconomic, and clinical status. The primary outcome was the of occurrence of an escalation.ResultsA total of 904 patients were included, of whom 80 (8.8%) required an escalation of care. In multivariable analysis, risk of an escalation was significantly higher for patients who were married or had a life partner (HR: 1.82, 95% CI: 1.05–3.23, p = .033) for patients admitted with procedure‐related disorders (HR: 2.61, 95% CI: 1.35–5.05, p = .005) and patients with an increased mortality risk score (HR [per each 1–category increase] = 1.86, 95% CI: 1.39–2.50, p < .001).