Chest
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Multicenter Study
Association of Cardiopulmonary Hemodynamics and Outcomes in Pulmonary Hypertension Following Kidney Transplant: A Multicenter Retrospective Cohort Study.
Pulmonary hypertension (PH) frequently complicates the evaluation of kidney transplantation (KT) candidates, and is associated with increased adverse outcomes (mortality, delayed graft function [DGF], and major adverse cardiovascular event) following KT. ⋯ Precapillary pulmonary hypertension and an mPAP of ≥ 30 mm Hg on RHC, but not echocardiographic evidence of PH, was associated with mortality and major adverse cardiovascular event following KT. These data suggest that RHC hemodynamics are superior to echocardiographic measures of PH in association with outcomes following KT, and RHC-derived mPAP in particular may have value in predicting major adverse cardiovascular event and mortality post-KT.
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Multiple listing (ML) is a practice used to increase the potential for transplant but is controversial due to concerns that it disproportionately benefits patients with greater access to health care resources. ⋯ ML is an uncommon practice with disparities existing between ML and SL patients based on several factors including social deprivation. ML patients are more likely to be transplanted, but only if they have ML status early in their transplant candidacy. With changing allocation guidelines, it is yet to be seen how ML will change with the implementation of continuous distribution.
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Comparative Study
Differences in Healthcare and Palliative Care Utilization at the End of Life: a Comparison Study Between Lung Cancer, COPD, and IPF.
Patients with lung cancer, idiopathic pulmonary fibrosis (IPF), and COPD have high symptom burden, poor quality of life, and high health care use at the end of life. Although proactive integration of palliative care in lung cancer can improve outcomes, it is unclear whether similar practices have been adopted in COPD and IPF care. ⋯ This study showed that patients with COPD and IPF are less likely to receive outpatient palliative care and opioid prescriptions and are more likely to use end-of-life intensive care than patients with lung cancer. Further research should explore health system barriers contributing to differences in care patterns to optimize quality of life and to align with patient goals of care.
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Multiple biomarkers are equivalent to clinical pulmonary arterial hypertension survival risk models.
Risk assessment in pulmonary arterial hypertension (PAH) is fundamental to guiding treatment and improved outcomes. Clinical models are excellent at identifying high-risk patients, but leave uncertainty amongst moderate-risk patients. ⋯ In this study, a multibiomarker model alone was equivalent to current PAH clinical mortality risk prediction models and improved performance when combined and added to NT-proBNP. Clinical risk scores offer excellent predictive models, but require multiple tests; adding blood biomarkers to models can improve prediction or can enable more frequent, noninvasive monitoring of risk in PAH to support therapeutic decision-making.