Publications

BACKGROUND

Pacemakers and implantable cardioverter-defibrillators (ICDs) are increasingly implanted in adults with congenital heart disease (CHD), but little is known about implant-related complications and mortality.

OBJECTIVE

The purpose of this study was to compare pacemaker and ICD implantation complication rates between adults with and those without CHD using a comprehensive, statewide database.

METHODS

We used the Healthcare Cost and Utilization Project database to identify initial transvenous pacemaker and ICD implantations and implant-related complications in California hospitals from January 1, 2005, to December 31, 2011. We calculated relative risks of implant-related complications by comparing those with and those without CHD using Poisson regression with robust standard errors, adjusting for age and medical comorbidities.

RESULTS

We identified 105,852 patients undergoing pacemaker implantation, 1465 with noncomplex CHD and 66 with complex CHD. CHD was not associated with increased risk of pacemaker implant-related complications: adjusted risk ratio (aRR) 0.92, 95% confidence interval (CI) 0.74-1.14, P = .45. We identified 32,948 patients undergoing ICD implantation, 815 with noncomplex CHD and 87 with complex CHD. Patients with CHD had increased risk of ICD implant-related complications: aRR 1.36, 95% CI 1.05-1.76, P = .02. Patients with complex CHD had greater increased risk of ICD implant-related complications: aRR 2.14, 95% CI 1.16-3.95, P = .02. In patients receiving devices, CHD was associated with a trend toward lower 30-day in-hospital mortality after pacemaker (P = .07) and ICD (P = .19) implantation.

CONCLUSION

Among adult patients undergoing device implantation in California, CHD was associated with increased risk of ICD implant-related complications, but not pacemaker implant-related complications or higher 30-day in-hospital mortality.

BACKGROUND

Heightened immune activation among human immunodeficiency virus (HIV)-infected persons may contribute to atherosclerosis. We assessed associations of serologic markers of monocyte activation, soluble CD163 (sCD163) and soluble CD14 (sCD14), and monocyte chemoattractant protein 1 (CCL2) with subclinical atherosclerosis among men with and those without HIV infection in the Multicenter AIDS Cohort Study.

METHODS

We performed noncontrast computed tomography on 906 men (566 HIV-infected men and 340 HIV-uninfected men), 709 of whom also underwent coronary computed tomographic angiography. Associations between each biomarker and the prevalence of coronary plaque, the prevalence of stenosis of ≥50%, and the extent of plaque were assessed by logistic and linear regression, adjusting for age, race, HIV serostatus, and cardiovascular risk factors.

RESULTS

Levels of all biomarkers were higher among HIV-infected men, of whom 81% had undetectable HIV RNA, and were associated with lower CD4(+) T-cell counts. In the entire population and among HIV-infected men, higher biomarker levels were associated with a greater prevalence of coronary artery stenosis of ≥50%. Higher sCD163 levels were also associated with greater prevalences of coronary artery calcium, mixed plaque, and calcified plaque; higher CCL2 levels were associated with a greater extent of noncalcified plaque.

CONCLUSIONS

sCD163, sCD14, and CCL2 levels were elevated in treated HIV-infected men and associated with atherosclerosis. Monocyte activation may increase the risk for cardiovascular disease in individuals with HIV infection.

In alignment with a major shift toward patient-centered care as the model for improving care in our health system, informatics is transforming patient-provider relationships and overall care delivery. AMIA's 2013 Health Policy Invitational was focused on examining existing challenges surrounding full engagement of the patient and crafting a research agenda and policy framework encouraging the use of informatics solutions to achieve this goal. The group tackled this challenge from educational, technical, and research perspectives. Recommendations include the need for consumer education regarding rights to data access, the need for consumers to access their health information in real time, and further research on effective methods to engage patients. This paper summarizes the meeting as well as the research agenda and policy recommendations prioritized among the invited experts and stakeholders.

OBJECTIVE

While flavoured cigarettes were prohibited in the USA in 2009, flavoured little cigars and cigarillos (LCCs) remain on the market. We describe the evolving strategies used by tobacco companies to encourage uptake of flavoured LCCs and industry research findings on consumer perceptions of flavoured LCC products.

METHODS

Analysis of internal tobacco industry documents was triangulated with data from tobacco advertisement archives, national newspapers, trade press and the internet.

RESULTS

Flavoured LCC products were associated with young and inexperienced tobacco users, women and African-Americans. Internal industry studies confirmed that menthol and candy-like flavours (eg, vanilla and cherry) increased LCC appeal to starters by masking the heavy cigar taste, reducing throat irritation and making LCC smoke easier to inhale. To appeal to new users, manufacturers also reduced the size of cigars to make them more cigarette-like, introduced filters and flavoured filter tips, emphasised mildness and ease of draw in advertising, and featured actors using little cigars in television commercials. RJ Reynolds tried to capitalise on the popularity of menthol cigarettes among African-Americans and marketed a menthol little cigar to African-Americans.

CONCLUSIONS

Tobacco companies engaged in a calculated effort to blur the line between LCCs to increase the appeal to cigarette smokers, and the use of flavours facilitated these efforts. Bans on flavoured cigarettes should be expanded to include flavoured LCCs, and tobacco use prevention initiatives should include LCCs.