Browsing by Author "Chew, Derek S"

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    ItemOpen Access
    2023 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic.
    (Journal of arrhythmia, 2023-06) Ferrick, Aileen M; Raj, Satish R; Deneke, Thomas; Kojodjojo, Pipin; Lopez-Cabanillas, Nestor; Abe, Haruhiko; Boveda, Serge; Chew, Derek S; Choi, Jong-Il; Dagres, Nikolaos; Dalal, Aarti S; Dechert, Brynn E; Frazier-Mills, Camille G; Gilbert, Olivia; Han, Janet K; Hewit, Sherri; Kneeland, Christine; Mirza, Starr DeEllen; Mittal, Suneet; Ricci, Renato Pietro; Runte, Mary; Sinclair, Susan; Alkmim-Teixeira, Ricardo; Vandenberk, Bert; Varma, Niraj; Document Reviewers; Davenport, Elizabeth; Freedenberg, Vicki; Glotzer, Taya V; Huang, Jin-Long; Ikeda, Takanori; Kramer, Daniel B; Lin, David; Rojel-Martínez, Ulises; Stühlinger, Markus; Varosy, Paul D
    Remote monitoring is beneficial for the management of patients with cardiovascular implantable electronic devices by impacting morbidity and mortality. With increasing numbers of patients using remote monitoring, keeping up with higher volume of remote monitoring transmissions creates challenges for device clinic staff. This international multidisciplinary document is intended to guide cardiac electrophysiologists, allied professionals, and hospital administrators in managing remote monitoring clinics. This includes guidance for remote monitoring clinic staffing, appropriate clinic workflows, patient education, and alert management. This expert consensus statement also addresses other topics such as communication of transmission results, use of third-party resources, manufacturer responsibilities, and programming concerns. The goal is to provide evidence-based recommendations impacting all aspects of remote monitoring services. Gaps in current knowledge and guidance for future research directions are also identified.
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    ItemOpen Access
    2023 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic.
    (Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2023-05) Ferrick, Aileen M; Raj, Satish R; Deneke, Thomas; Kojodjojo, Pipin; Lopez-Cabanillas, Nestor; Abe, Haruhiko; Boveda, Serge; Chew, Derek S; Choi, Jong-Il; Dagres, Nikolaos; Dalal, Aarti S; Dechert, Brynn E; Frazier-Mills, Camille G; Gilbert, Olivia; Han, Janet K; Hewit, Sherri; Kneeland, Christine; Mirza, Starr DeEllen; Mittal, Suneet; Ricci, Renato Pietro; Runte, Mary; Sinclair, Susan; Alkmim-Teixeira, Ricardo; Vandenberk, Bert; Varma, Niraj; Davenport, Elizabeth; Freedenberg, Vicki; Glotzer, Taya V; Huang, Jin-Long; Ikeda, Takanori; Kramer, Daniel B; Lin, David; Rojel-Martínez, Ulises; Stühlinger, Markus; Varosy, Paul D
    Remote monitoring is beneficial for the management of patients with cardiovascular implantable electronic devices by impacting morbidity and mortality. With increasing numbers of patients using remote monitoring, keeping up with higher volume of remote monitoring transmissions creates challenges for device clinic staff. This international multidisciplinary document is intended to guide cardiac electrophysiologists, allied professionals, and hospital administrators in managing remote monitoring clinics. This includes guidance for remote monitoring clinic staffing, appropriate clinic workflows, patient education, and alert management. This expert consensus statement also addresses other topics such as communication of transmission results, use of third-party resources, manufacturer responsibilities, and programming concerns. The goal is to provide evidence-based recommendations impacting all aspects of remote monitoring services. Gaps in current knowledge and guidance for future research directions are also identified.
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    ItemOpen Access
    Diagnosis-to-ablation time predicts recurrent atrial fibrillation and rehospitalization following catheter ablation.
    (Heart rhythm O2, 2022-02) Chew, Derek S; Jones, Kelley A; Loring, Zak; Black-Maier, Eric; Noseworthy, Peter A; Exner, Derek V; Packer, Douglas L; Grant, Jennifer; Mark, Daniel B; Piccini, Jonathan P

    Background

    Wait times for catheter ablation in patients with symptomatic atrial fibrillation (AF) may influence clinical outcomes.

    Objective

    This study examined the relationship between the duration from AF diagnosis to ablation, or diagnosis-to-ablation time (DAT), on the clinical response to catheter ablation in a large nationwide cohort of patients.

    Methods

    We identified patients with new AF who underwent catheter ablation between January 2014 and December 2017 using the IBM MarketScan databases. Cox proportional hazard models were used to estimate the strength of the association between DAT and the outcomes of AF recurrence and hospitalization at 1 year postablation.

    Results

    Among 11,143 AF patients who underwent ablation, the median age was 59 years, 31% were female, and the median CHA2DS2-VASc score was 2. Median DAT was 5.5 (2.6, 13.1) months. At 1 year postablation, 10.0% (n = 1116) developed recurrent AF. For each year increase in DAT, the risk of AF recurrence increased by 20% after adjustment for baseline comorbidities and medications (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.11-1.30). A longer DAT was associated with an increased risk of hospitalization (HR 1.08 per DAT year, 95% CI 1.02-1.15). DAT was a stronger predictor of AF recurrence postablation than traditional clinical risk factors, including age, prior heart failure, or renal failure.

    Conclusion

    Increasing duration between AF diagnosis and catheter ablation is associated with higher AF recurrence rates and all-cause hospitalization. Our findings are consistent with a growing body of evidence supporting the benefits of prioritizing early restoration of sinus rhythm.
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    ItemOpen Access
    Left Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation : A Decision Analysis.
    (Annals of internal medicine, 2022-08) Chew, Derek S; Zhou, Ke; Pokorney, Sean D; Matchar, David B; Vemulapalli, Sreekanth; Allen, Larry A; Jackson, Kevin P; Samad, Zainab; Patel, Manesh R; Freeman, James V; Piccini, Jonathan P

    Background

    Left atrial appendage occlusion (LAAO) is a potential alternative to oral anticoagulants in selected patients with atrial fibrillation (AF). Compared with anticoagulants, LAAO decreases major bleeding risk, but there is uncertainty regarding the risk for ischemic stroke compared with anticoagulation.

    Objective

    To determine the optimal strategy for stroke prevention conditional on a patient's individual risks for ischemic stroke and bleeding.

    Design

    Decision analysis with a Markov model.

    Data sources

    Evidence from the published literature informed model inputs.

    Target population

    Women and men with nonvalvular AF and without prior stroke.

    Time horizon

    Lifetime.

    Perspective

    Clinical.

    Intervention

    LAAO versus warfarin or direct oral anticoagulants (DOACs).

    Outcome measures

    The primary end point was clinical benefit measured in quality-adjusted life-years.

    Results of base-case analysis

    The baseline risks for stroke and bleeding determined whether LAAO was preferred over anticoagulants in patients with AF. The combined risks favored LAAO for higher bleeding risk, but that benefit became less certain at higher stroke risks. For example, at a HAS-BLED score of 5, LAAO was favored in more than 80% of model simulations for CHA2DS2-VASc scores between 2 and 5. The probability of LAAO benefit in QALYs (>80%) at lower bleeding risks (HAS-BLED score of 0 to 1) was limited to patients with lower stroke risks (CHA2DS2-VASc score of 2). Because DOACs carry lower bleeding risks than warfarin, the net benefit of LAAO is less certain than that of DOACs.

    Results of sensitivity analysis

    Results were consistent using the ORBIT bleeding score instead of the HAS-BLED score, as well as alternative sources for LAAO clinical effectiveness data.

    Limitation

    Clinical effectiveness data were drawn primarily from studies on the Watchman device.

    Conclusion

    Although LAAO could be an alternative to anticoagulants for stroke prevention in patients with AF and high bleeding risk, the overall benefit from LAAO depends on the combination of stroke and bleeding risks in individual patients. These results suggest the need for a sufficiently low stroke risk for LAAO to be beneficial. The authors believe that these results could improve shared decision making when selecting patients for LAAO.

    Primary funding source

    None.