José B. Cruz Rodríguez

University of California, San Diego

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Marcus A. Urey

University of California, San Diego

Khan O. Mohammad

The University of Texas at Austin

Debabrata Mukherjee

Texas Tech University

José Tallaj

University of Alabama at Birmingham

Renato Papa‐Vettorazzi

Instituto de Microcirugía Ocular

Haider Alkhateeb

Texas Tech University Health Sciences Center

Charles W. Hoopes

University of Alabama at Birmingham

Victor Pretorius

University of California, San Diego

Salpy V. Pamboukian

University of Washington

Indranee Rajapreyar

Tufts Medical Center

Cooperative Institutions

University of California, San Diego

UC San Diego Health System

Texas Tech University

Texas Tech University Health Sciences Center

University of Alabama at Birmingham

Brigham and Women's Hospital

Harvard University

The University of Texas at El Paso

Stanford University

Instituto de Salud Carlos III

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Patient Adapted Paternalism for Endomyocardial Biopsy Policy Changes in Heart Transplant Patients: A Mixed-Methods Study

medRxiv (Cold Spring Harbor Laboratory) (2024)

H Y Kim Vincenzo Cusi Melissa McLenon Rebecca Fielding‐Miller José B. Cruz Rodríguez

Abstract Endomyocardial biopsies (EMB) are invasive procedures performed in heart transplant (HTx) patients for surveillance of acute rejection. However, patient preferences for replacing EMBs with noninvasive assays in the context of potential institutional policy changes are unknown. A mixed-methods design was used with 28 semi-structured patient interviews and 123 self-administered online survey questionnaires in English and Spanish between January to June 2023. Additionally, we performed semi-structured interviews with 18 HTx team members. Three dominant themes were identified: alleviating patient anxiety and distress, consistent patient-provider communication, and strong interpersonal trust with the HTx team. We found that strong interpersonal trust with the HTx team by the patients was more highly prioritized than their own opinions on whether to replace EMBs with noninvasive assays. Thus, HTx patients often considered surveillance EMBs important to their care (93%), based on the recommendations provided by their HTx team. HTx faculty physicians stated that more multicenter trials are needed prior to replacing EMBs with noninvasive assays. In conclusion, patients identified strong interpersonal trust with HTx team members to justify patient adapted paternalism, where the provider decides in accordance with the patient’s situation, as their preferred shared decision-making paradigm when considering institutional policy on surveillance EMBs.

Paternalism

Endomyocardial Biopsy

10.1101/2024.12.29.24319749

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Beta-Blockers, Calcium Channel Blockers, and Mortality in Stable Coronary Artery Disease

Current Cardiology Reports (2020)

José B. Cruz Rodríguez Haider Alkhateeb

BETA (programming language)

Adrenergic beta-Antagonists

10.1007/s11886-020-1262-1

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Risk Factors for 30-Day Readmissions after Acute Myocardial Infarction

International Cardiovascular Forum Journal (2015)

José B. Cruz Rodríguez Priyanka Acharya Edwin Olson Leslie Cler

BackgroundThe hospital readmission rate has been thought to reflect the quality of patient care. Understanding the risk factors for these can guide strategies to reduce them.MethodsRetrospective cohort design that included all the admissions for AMI from October 2011 to September 2014. Primary outcome was 30-day readmission rate. Secondary outcomes were 7-day readmission rate, reasons for readmission and cardiac-related readmission rate. Univariate and multivariate logistic regression were conducted with Hosmer-Lemeshow goodness-of-fit statistics for model calibration and ROC curve for model discrimination.ResultsWe identified 2958 cases of AMI and 334 readmissions (11.3%). The final sample for analysis included 310 readmitted and 652 non-readmitted patients. The principal causes of readmission were cardiac related (42%), followed by respiratory (15%) and gastrointestinal (11%). Separate analysis for the early readmissions showed the same pattern. 42% of the readmissions happened during the first week and 68% in the first 2 weeks after discharge. Median time for readmission was 10 days. Older age, days from admission to catheterization, complete medical therapy at discharge, diabetes, hypertension, stroke, major psychiatric disorders, insurance status, chronic kidney disease and congestive heart failure were independently associated with 30-day readmission. The final multivariate model discriminated well with a ROC of 0.753 (95% CI 0.72-0.79).ConclusionReasons for readmission found in our study were consistent with previous studies. Absolute readmission rates reported in this study were lower than in some prior publications. We present novel and addressable patient risk factors derived from the index admission that can be used to predict readmission.

Univariate analysis

Stroke

10.17987/icfj.v4i0.155

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Dairy Intake and Risk of Cardiovascular Disease

Current Cardiology Reports (2020)

Vivek Bhupathi Mónica Mazariegos José B. Cruz Rodríguez Abhizith Deoker

Narrative review

Consumption

10.1007/s11886-020-1263-0

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Citations (52)

Beyond Left Ventricular Ejection Fraction Improvement in the Optimization of Cardiac Resynchronization Therapy

Angiology (2021)

José B. Cruz Rodríguez

10.1177/00033197211015551

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Citations (1)

Cost-effectiveness of a Contact Intervention and a Psychotherapeutic Program for Post-discharge Suicide Prevention

The Canadian Journal of Psychiatry (2020)

Gonzalo Martínez‐Alés José B. Cruz Rodríguez Pablo Lázaro Arce Domingo‐Relloso María Luisa Barrigón

To determine the cost-effectiveness of 2 strategies for post-discharge suicide prevention, an Enhanced Contact intervention based on repeated in-person and telephone contacts, and an individual 2-month long problem-solving Psychotherapy program, in comparison to facilitated access to outpatient care following a suicide attempt.We conducted a cost-effectiveness analysis based on a decision tree between January and December 2019. Comparative effectiveness estimates were obtained from an observational study conducted between 2013 and 2017 in Madrid, Spain. Electronic health care records documented resource use (including extra-hospital emergency care, mortality, inpatient admission, and disability leave). Direct cost data were derived from Madrid's official list of public health care prices. Indirect cost data were derived from Spain's National Institute of Statistics.Both augmentation strategies were more cost-effective than a single priority outpatient appointment considering reasonable thresholds of willingness to pay. Under the base-case scenario, Enhanced Contact and Psychotherapy incurred, respectively, €2,340 and 6,260 per averted attempt, compared to a single priority appointment. Deterministic and probabilistic sensitivity analyses showed both augmentation strategies to remain cost-effective under several scenarios. Enhanced Contact was slightly cost minimizing in comparison to Psychotherapy (base-case scenario: €-196 per averted attempt).Two post-discharge suicide prevention strategies based on Enhanced Contact and Psychotherapy were cost-effective in comparison to a single priority appointment. Increasing contacts between suicide attempters and mental health-care providers was slightly cost minimizing compared to psychotherapy.

10.1177/0706743720980135

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Comparison of Frequency of Referral to Cardiothoracic Surgery for Aortic Valve Disease in Blacks, Hispanics, and Whites

The American Journal of Cardiology (2017)

José B. Cruz Rodríguez Priyanka Acharya Christopher Salazar-Fields Aaron Horne

10.1016/j.amjcard.2017.04.048

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Citations (51)

(747) Incidence, Predictors and Outcomes of Acute Cardiac Conduction Abnormalities after Orthotopic Heart Transplant

The Journal of Heart and Lung Transplantation (2023)

L.K. Keyt A. Lin M. Begur Q. Bui A. Duran

Conduction abnormalities

10.1016/j.healun.2023.02.761

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Normal Geriatric Nutritional Risk Index is Associated with Rehospitalization After Orthotopic Heart Transplant

The Journal of Heart and Lung Transplantation (2022)

J Lipinski Gourisree Dharmavaram José B. Cruz Rodríguez Marcus A. Urey Victor Pretorius

10.1016/j.healun.2022.01.1675

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Antithrombotic / Antiplatelet Therapy in Patients with Stable Coronary Artery Disease and After Acute Coronary Syndrome

Cardiovascular & Hematological Agents in Medicinal Chemistry (2020)

José B. Cruz Rodríguez Kunal Mishra Tariq Siddiqui

The major physiopathological mechanism underlying Acute Coronary Syndromes (ACS) is atherosclerotic plaque rupture with resultant coronary thrombosis, posing a big burden in health care systems. Dual anti-platelet therapy (DAPT) can improve CV outcome with a prolonged regimen, albeit at the cost of increased bleeding rates. We performed a narrative literature review on the topic, in which we explored databases through April 15th, 2020, with no restrictions on language. Keywords related to antiplatelet therapy, P2Y12 inhibitor, aspirin and DAPT were utilized. Randomized clinical trials, large prospective studies, systematic reviews and meta-analysis were included. We hand-searched the reference lists of included articles and relevant reviews. The review revealed that when choosing antiplatelet agents, the decision should be driven by pharmacodynamic properties as well as demonstrated efficacy and safety. Additionally, it was noted that in patients undergoing percutaneous coronary intervention, prasugrel and ticagrelor are preferred. In patients with a high risk of bleeds or receiving thrombolysis, or when cost or specific patient issues exist, clopidogrel is considered though it is a second-line therapy. Due to an elevated risk of bleeds, triple therapy should be avoided, as evidence shows effectiveness and safety with regimens without ASA. Furthermore, multiple studies have also shown that regimens shorter than 12 months of DAPT could be adequate for many patients, and newer guidelines are likely to reflect it. There are specific recommendations for switching among antiplatelets, mostly based on registries and pharmacodynamic studies.

Regimen

10.2174/1871525718666201207201552

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