Browsing by Author "Li, Yanhong"
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Item Open Access Effects of Ablation Versus Drug Therapy on Quality of Life by Sex in Atrial Fibrillation: Results From the CABANA Trial.(Journal of the American Heart Association, 2023-02) Zeitler, Emily P; Li, Yanhong; Silverstein, Adam P; Russo, Andrea M; Poole, Jeanne E; Daniels, Melanie R; Al-Khalidi, Hussein R; Lee, Kerry L; Bahnson, Tristram D; Anstrom, Kevin J; Packer, Douglas L; Mark, Daniel B; CABANA InvestigatorsBackground Women with atrial fibrillation (AF) demonstrate more AF-related symptoms and worse quality of life (QOL). Whether increased use of ablation in women reduces sex-related QOL differences is unknown. Sex-related outcomes for ablation versus drug therapy was a prespecified analysis in the CABANA (Catheter Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation) trial. Methods and Results Symptoms were assessed periodically over 60 months with the Mayo AF-Specific Symptom Inventory (MAFSI) frequency score, and QOL was assessed with the Atrial Fibrillation Effect on Quality of Life (AFEQT) summary and component scores. Women had lower baseline QOL scores than men (mean AFEQT scores 55.9 and 65.6, respectively). Ablation patients improved more than drug therapy patients with similar treatment effect by sex: AFEQT 12-month mean adjusted treatment difference in women 6.1 points (95% CI, 3.5-8.6) and men 4.9 points (95% CI, 3.0-6.9). Participants with baseline AFEQT summary scores <70 had greater QOL improvement, with a mean treatment difference at 12 months of 7.6 points for women (95% CI, 4.3-10.9) and 6.4 points for men (95% CI, 3.3-9.4). The mean adjusted difference in MAFSI frequency score between women randomized to ablation versus drug therapy at 12 months was -2.5 (95% CI, -3.4 to -1.6); for men, the difference was -1.3 (95% CI, -2.0 to -0.6). Conclusions Compared with drug therapy for AF, ablation resulted in more QOL improvement in both sexes, primarily driven by improvements in those with lower baseline QOL. Ablation did not eliminate the AF-related QOL gap between women and men. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00911508.Item Open Access Increased Costs with Multidrug Resistant Gram Negative Bloodstream Infections Are Primarily Due to Patients with Hospital-Acquired Infections.(Antimicrob Agents Chemother, 2016-12-19) Thaden, Joshua T; Li, Yanhong; Ruffin, Felicia; Maskarinec, Stacey A; Hill-Rorie, Jonathan M; Wanda, Lisa C; Reed, Shelby D; Fowler, Vance GThe clinical and economic impact of bloodstream infections (BSI) due to multidrug resistant (MDR) Gram negative bacteria is incompletely understood. From 2009-2015, all adult inpatients with Gram negative BSI at our institution were prospectively enrolled. MDR status was defined as resistance to ≥3 antibiotic classes. Clinical outcomes and inpatient costs associated with the MDR phenotype were identified. Among 891 unique patients with Gram negative BSI, 292 (33%) were infected with MDR bacteria. In an adjusted analysis, only history of Gram negative infection was associated with MDR BSI versus non-MDR BSI (odds ratio 1.60; 95% confidence interval [CI] 1.19-2.16; P=0.002). Patients with MDR BSI had increased BSI recurrence (1.7% [5/292] vs 0.2% [1/599]; P=0.02) and longer hospital length of stay (median 10.0 vs.8.0 days; P=0.0005). Unadjusted in-hospital mortality did not significantly differ between MDR (26.4% [77/292]) and non-MDR (21.7% [130/599]) groups (P=0.12). Unadjusted mean costs were 1.62 times higher in MDR versus non-MDR BSI ($59,266 vs. $36,452; P=0.003). This finding persisted after adjustment for patient factors and appropriate empiric antibiotic therapy (means ratio 1.18; 95% CI 1.03-1.36; P=0.01). Adjusted analysis of patient sub-populations revealed that increased cost of MDR BSI occurred primarily among patients with hospital-acquired infections (MDR means ratio 1.41, 95% CI 1.10-1.82, P=0.008). MDR Gram negative BSI are associated with recurrent BSI, longer hospital length of stay, and increased mean inpatient costs. MDR BSI in patients with hospital-acquired infections primarily account for the increased cost.Item Open Access Potential Cost-effectiveness of Early Identification of Hospital-acquired Infection in Critically Ill Patients.(Ann Am Thorac Soc, 2016-03) Tsalik, Ephraim L; Li, Yanhong; Hudson, Lori L; Chu, Vivian H; Himmel, Tiffany; Limkakeng, Alex T; Katz, Jason N; Glickman, Seth W; McClain, Micah T; Welty-Wolf, Karen E; Fowler, Vance G; Ginsburg, Geoffrey S; Woods, Christopher W; Reed, Shelby DRATIONALE: Limitations in methods for the rapid diagnosis of hospital-acquired infections often delay initiation of effective antimicrobial therapy. New diagnostic approaches offer potential clinical and cost-related improvements in the management of these infections. OBJECTIVES: We developed a decision modeling framework to assess the potential cost-effectiveness of a rapid biomarker assay to identify hospital-acquired infection in high-risk patients earlier than standard diagnostic testing. METHODS: The framework includes parameters representing rates of infection, rates of delayed appropriate therapy, and impact of delayed therapy on mortality, along with assumptions about diagnostic test characteristics and their impact on delayed therapy and length of stay. Parameter estimates were based on contemporary, published studies and supplemented with data from a four-site, observational, clinical study. Extensive sensitivity analyses were performed. The base-case analysis assumed 17.6% of ventilated patients and 11.2% of nonventilated patients develop hospital-acquired infection and that 28.7% of patients with hospital-acquired infection experience delays in appropriate antibiotic therapy with standard care. We assumed this percentage decreased by 50% (to 14.4%) among patients with true-positive results and increased by 50% (to 43.1%) among patients with false-negative results using a hypothetical biomarker assay. Cost of testing was set at $110/d. MEASUREMENTS AND MAIN RESULTS: In the base-case analysis, among ventilated patients, daily diagnostic testing starting on admission reduced inpatient mortality from 12.3 to 11.9% and increased mean costs by $1,640 per patient, resulting in an incremental cost-effectiveness ratio of $21,389 per life-year saved. Among nonventilated patients, inpatient mortality decreased from 7.3 to 7.1% and costs increased by $1,381 with diagnostic testing. The resulting incremental cost-effectiveness ratio was $42,325 per life-year saved. Threshold analyses revealed the probabilities of developing hospital-acquired infection in ventilated and nonventilated patients could be as low as 8.4 and 9.8%, respectively, to maintain incremental cost-effectiveness ratios less than $50,000 per life-year saved. CONCLUSIONS: Development and use of serial diagnostic testing that reduces the proportion of patients with delays in appropriate antibiotic therapy for hospital-acquired infections could reduce inpatient mortality. The model presented here offers a cost-effectiveness framework for future test development.