Featured Publications
Institutional solutions addressing disparities in compensation and advancement of emergency medicine physicians: A critical appraisal of gaps and associated recommendations
Madsen TE, Heron S, Lall MD, Blomkalns A, Arbelaez C, Lopez B, Lin M, Rounds K, Sethuraman KN, Safdar B. Institutional solutions addressing disparities in compensation and advancement of emergency medicine physicians: A critical appraisal of gaps and associated recommendations. Academic Emergency Medicine 2022, 29: 710-718. PMID: 35064998, DOI: 10.1111/acem.14452.Peer-Reviewed Original ResearchEmergency MedicineEmergency Service, HospitalFaculty, MedicalFemaleHumansPhysiciansSalaries and Fringe BenefitsUnited StatesWorkforcePrevalence and characteristics of coronary microvascular dysfunction among chest pain patients in the emergency department
Safdar B, D’Onofrio G, Dziura J, Russell RR, Johnson C, Sinusas AJ. Prevalence and characteristics of coronary microvascular dysfunction among chest pain patients in the emergency department. European Heart Journal Acute Cardiovascular Care 2018, 9: 5-13. PMID: 29543037, DOI: 10.1177/2048872618764418.Peer-Reviewed Original ResearchConceptsCoronary microvascular dysfunctionCoronary artery diseaseCardiac positron emission tomography/Positron emission tomography/Chest pain patientsArtery diseaseAcute myocardial infarctionEmission tomography/Chest painMyocardial infarctionMicrovascular dysfunctionPain patientsEmergency departmentTomography/General emergency department populationLower coronary flow reserveNon-obstructive coronary arteriesPrior emergency department visitsTraditional cardiac risk factorsCardiac risk factorsModerate-risk patientsEmergency department visitsEmergency department patientsCoronary flow reserveEmergency department populationIdentifying Myocardial Ischemia due to Coronary Microvascular Dysfunction in the Emergency Department: Introducing a New Paradigm in Acute Chest Pain Evaluation
Safdar B, Ong P, Camici PG. Identifying Myocardial Ischemia due to Coronary Microvascular Dysfunction in the Emergency Department: Introducing a New Paradigm in Acute Chest Pain Evaluation. Clinical Therapeutics 2018, 40: 1920-1930. PMID: 30458932, DOI: 10.1016/j.clinthera.2018.09.010.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAlgorithmsBiomarkersChest PainCoronary Artery DiseaseEmergency Service, HospitalEuropeFemaleHumansMaleMyocardial InfarctionMyocardial IschemiaConceptsAcute myocardial infarctionRecurrent chest painCoronary microvascular dysfunctionChest painEmergency departmentHs-TnTMicrovascular dysfunctionMyocardial ischemiaAcute chest pain evaluationHigh-sensitivity troponin TDiagnosis of AMIType 2 acute myocardial infarctionElevated hs-TnTIschemia/necrosisChest pain evaluationGroup of patientsAssessment of symptomsIdentification of patientsAppropriate medical treatmentSex-specific thresholdsPulmonary embolismVasomotor disordersAortic dissectionPain evaluationEpicardial coronaries
2024
Interim Effectiveness of Updated 2023–2024 (Monovalent XBB.1.5) COVID-19 Vaccines Against COVID-19–Associated Emergency Department and Urgent Care Encounters and Hospitalization Among Immunocompetent Adults Aged ≥18 Years — VISION and IVY Networks, September 2023–January 2024
DeCuir J, Payne A, Self W, Rowley E, Dascomb K, DeSilva M, Irving S, Grannis S, Ong T, Klein N, Weber Z, Reese S, Ball S, Barron M, Naleway A, Dixon B, Essien I, Bride D, Natarajan K, Fireman B, Shah A, Okwuazi E, Wiegand R, Zhu Y, Lauring A, Martin E, Gaglani M, Peltan I, Brown S, Ginde A, Mohr N, Gibbs K, Hager D, Prekker M, Mohamed A, Srinivasan V, Steingrub J, Khan A, Busse L, Duggal A, Wilson J, Chang S, Mallow C, Kwon J, Exline M, Columbus C, Vaughn I, Safdar B, Mosier J, Harris E, Casey J, Chappell J, Grijalva C, Swan S, Johnson C, Lewis N, Ellington S, Adams K, Tenforde M, Paden C, Dawood F, Fleming-Dutra K, Surie D, Link-Gelles R, Collaborators C, Collaborators C, Ghamande S, Gottlieb R, McNeal T, Raver C, Bender W, Fletcher L, Heaton P, Kane S, McEvoy C, Thapa S, Vazquez-Benitez G, Frosch A, Lamerato L, Ramesh M, Arnofer J, Ali H, Hopkins J, Crane B, Dandamudi P, Goddard K, Hansen J, Timbol J, Zerbo O, Allen K, Duszynski T, Fadel W, Rogerson C, Qadir N, Chavez C, Doyle B, Mayer D, Rao S, Rivas C, Johnson N, Baughman A, Lwin C, Rhoads J, Womack K, Dunne M, Ciesla A, Mak J, Najdowski M, Ray C. Interim Effectiveness of Updated 2023–2024 (Monovalent XBB.1.5) COVID-19 Vaccines Against COVID-19–Associated Emergency Department and Urgent Care Encounters and Hospitalization Among Immunocompetent Adults Aged ≥18 Years — VISION and IVY Networks, September 2023–January 2024. MMWR Morbidity And Mortality Weekly Report 2024, 73: 180-188. PMID: 38421945, PMCID: PMC10907041, DOI: 10.15585/mmwr.mm7308a5.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAdvisory CommitteesCOVID-19COVID-19 VaccinesEmergency Service, HospitalHospitalizationHumansConceptsVaccine effectivenessEmergency departmentCOVID-19 vaccineCDC's Advisory CommitteeCOVID-19-associated hospitalizationUrgent careCOVID-19 vaccine dosesImmunocompetent adultsMedian intervalCase-control designVE estimatesVaccine doseImmunization PracticesTest-negativeSevere diseaseCDC recommendationsDoseVaccineHospitalVE networkCOVID-19CDCMonthsAdvisory CommitteeDays
2023
Women in pediatric emergency medicine: Trends in gender from 2000 to 2020
Kayani J, Reed J, Safdar B, Langhan M. Women in pediatric emergency medicine: Trends in gender from 2000 to 2020. Academic Emergency Medicine 2023, 30: 675-677. PMID: 36545838, DOI: 10.1111/acem.14644.Peer-Reviewed Original Research
2022
Sex and Race Differences in the Evaluation and Treatment of Young Adults Presenting to the Emergency Department With Chest Pain
Banco D, Chang J, Talmor N, Wadhera P, Mukhopadhyay A, Lu X, Dong S, Lu Y, Betensky RA, Blecker S, Safdar B, Reynolds HR. Sex and Race Differences in the Evaluation and Treatment of Young Adults Presenting to the Emergency Department With Chest Pain. Journal Of The American Heart Association 2022, 11: e024199. PMID: 35506534, PMCID: PMC9238573, DOI: 10.1161/jaha.121.024199.Peer-Reviewed Original ResearchMeSH KeywordsChest PainEmergency Service, HospitalFemaleHumansMaleMyocardial InfarctionRace FactorsTriageYoung AdultConceptsChest painAcute myocardial infarctionEmergency departmentMultivariable adjustmentYoung adultsMyocardial infarctionBackground Acute myocardial infarctionRacial differencesCardiac biomarker testingHospital admissionClinical featuresConclusions WomenPhysician evaluationTriage levelBiomarker testingCardiac biomarkersWhite adultsNational estimatesObservation unitCP managementAdultsSurvey 2014WomenPainInfarction
2020
National Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015
Pendyal A, Rothenberg C, Scofi JE, Krumholz HM, Safdar B, Dreyer RP, Venkatesh AK. National Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015. Journal Of The American Heart Association 2020, 9: e017208. PMID: 33047624, PMCID: PMC7763391, DOI: 10.1161/jaha.120.017208.Peer-Reviewed Original ResearchConceptsST-segment elevation myocardial infarctionAcute myocardial infarctionMedian ED lengthUS emergency departmentsEmergency departmentED visitsMyocardial infarctionED administrationED lengthAMI careNational Hospital Ambulatory Medical Care SurveyCare processesAmbulatory Medical Care SurveyEvidence-based medicationsNonaspirin antiplatelet agentsEarly invasive strategyAnnual ED visitsRegionalization of careED care processesReal-world trendsAntiplatelet therapyAnnual incidenceAntiplatelet agentsYearly incidenceCare Survey
2019
Inclusion of Sex and Gender in Emergency Medicine Research—A 2018 Update
Safdar B, Ayala K, Ali SS, Seifer BJ, Hong M, Greenberg MR, Choo EK, McGregor AJ. Inclusion of Sex and Gender in Emergency Medicine Research—A 2018 Update. Academic Emergency Medicine 2019, 26: 293-302. PMID: 30637897, DOI: 10.1111/acem.13688.Peer-Reviewed Original Research
2017
Ranolazine and Microvascular Angina by PET in the Emergency Department: Results From a Pilot Randomized Controlled Trial
Safdar B, D’Onofrio G, Dziura J, Russell RR, Johnson C, Sinusas AJ. Ranolazine and Microvascular Angina by PET in the Emergency Department: Results From a Pilot Randomized Controlled Trial. Clinical Therapeutics 2017, 39: 55-63. PMID: 28081848, PMCID: PMC10345862, DOI: 10.1016/j.clinthera.2016.12.002.Peer-Reviewed Original ResearchConceptsCoronary microvascular dysfunctionCoronary flow reserveCoronary artery diseaseChest painSymptomatic patientsArtery diseasePrimary outcomeEmergency departmentNonobstructive coronary artery diseaseRb-82 positron emission tomographyEffect of ranolazineRate-pressure productEmergency department patientsQTc-prolonging drugsRobust clinical trialsPositron emission tomographyHypertensive urgencyMicrovascular anginaMicrovascular dysfunctionUnderdiagnosed causeControlled TrialsDepartment patientsHeart failureAcute symptomsPressure product
2016
Women and Chest Pain: Recognizing the Different Faces of Angina in the Emergency Department.
Safdar B, D'Onofrio G. Women and Chest Pain: Recognizing the Different Faces of Angina in the Emergency Department. The Yale Journal Of Biology And Medicine 2016, 89: 227-38. PMID: 27354848, PMCID: PMC4918863.Peer-Reviewed Original ResearchMeSH KeywordsAcute Coronary SyndromeAdultAgedChest PainCoronary Artery DiseaseEmergency Service, HospitalFemaleHumansMiddle AgedQuality of LifeConceptsCoronary artery diseaseAcute coronary syndromeChest painEmergency departmentMicrovascular dysfunctionED patientsCoronary artery endothelial dysfunctionCause of anginaCoronary artery dissectionCoronary artery spasmPersistent chest painRecurrent chest painSex-specific causesQuality of lifeArtery spasmArtery dissectionCoronary syndromeEndothelial dysfunctionMyocardial bridgingArtery diseasePoor functionCardinal symptomsAnginaPainPatientsMicrovascular Dysfunction as Opposed to Conduit Artery Disease Explains Sex-specific Chest Pain in Emergency Department Patients With Low to Moderate Cardiac Risk
Safdar B, Ali A, D’Onofrio G, Katz SD. Microvascular Dysfunction as Opposed to Conduit Artery Disease Explains Sex-specific Chest Pain in Emergency Department Patients With Low to Moderate Cardiac Risk. Clinical Therapeutics 2016, 38: 240-255.e1. PMID: 26778090, DOI: 10.1016/j.clinthera.2015.12.010.Peer-Reviewed Original ResearchConceptsChest painControl subjectsMicrovascular dysfunctionArtery diseaseObstructive coronary artery diseaseCommon emergency department presentationConduit vessel functionCoronary artery vasomotionTransient forearm ischemiaAcute chest painCardiac risk factorsPersistent chest painAcute coronary syndromeBrachial artery diameterFramingham risk scoreProspective cohort studyChest pain centerSystolic blood pressureAsymptomatic healthy volunteersCoronary artery diseaseEmergency department presentationsBrachial artery reactivityPeripheral microvascular dysfunctionHigh-resolution ultrasoundArtery dysfunction
2014
Elevated CK-MB with a Normal Troponin Does Not Predict 30-Day Adverse Cardiac Events in Emergency Department Chest Pain Observation Unit Patients
Safdar B, Bezek SK, Sinusas AJ, Russell RR, Klein MR, Dziura JD, D’onofrio G. Elevated CK-MB with a Normal Troponin Does Not Predict 30-Day Adverse Cardiac Events in Emergency Department Chest Pain Observation Unit Patients. Critical Pathways In Cardiology A Journal Of Evidence-Based Medicine 2014, 13: 14-19. PMID: 24526146, DOI: 10.1097/hpc.0000000000000001.Peer-Reviewed Original ResearchConceptsAdverse cardiac eventsCPU patientsNormal troponinAdverse eventsCardiac eventsMultiple logistic regression modelComposite adverse eventsElevated creatinine kinaseObservation unit patientsSerial troponin testingStandardized chart reviewRetrospective cohort studyAcute coronary syndromeNational Death RegistryCoronary artery diseaseLogistic regression modelsPositive troponinPrior CADRenal insufficientCoronary syndromeHemodynamic instabilityChart reviewCohort studyDeath RegistryIschemic electrocardiogram
2012
Diagnostic accuracy of a point-of-care troponin I assay for acute myocardial infarction within 3 hours after presentation in early presenters to the emergency department with chest pain
Diercks DB, Peacock WF, Hollander JE, Singer AJ, Birkhahn R, Shapiro N, Glynn T, Nowack R, Safdar B, Miller CD, Lewandrowski E, Nagurney JT. Diagnostic accuracy of a point-of-care troponin I assay for acute myocardial infarction within 3 hours after presentation in early presenters to the emergency department with chest pain. American Heart Journal 2012, 163: 74-80.e4. PMID: 22172439, DOI: 10.1016/j.ahj.2011.09.028.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionCare troponin IAcute coronary syndromeSymptom onsetMyocardial infarctionDiagnostic accuracyCoronary syndromeEmergency departmentSerial testingAmerican Heart Association/American CollegeTroponin ICriterion standard diagnosisInitial blood drawAvailable medical recordsCardiac marker testingPositive likelihood ratioSimilar diagnostic accuracyNegative likelihood ratioInvestigational markersIschemia evaluationCardiology criteriaChest painLikelihood ratioMedian ageMedian time
2011
Myeloperoxidase in the diagnosis of acute coronary syndromes: The importance of spectrum
Peacock WF, Nagurney J, Birkhahn R, Singer A, Shapiro N, Hollander J, Glynn T, Nowak R, Safdar B, Miller C, Peberdy M, Counselman F, Chandra A, Kosowsky J, Neuenschwander J, Schrock J, Plantholt S, Lewandrowski E, Wong V, Kupfer K, Diercks D. Myeloperoxidase in the diagnosis of acute coronary syndromes: The importance of spectrum. American Heart Journal 2011, 162: 893-899. PMID: 22093206, DOI: 10.1016/j.ahj.2011.08.017.Peer-Reviewed Original ResearchConceptsAcute coronary syndromeNoncardiac chest painCoronary syndromeMyocardial infarctionPredictive valueTroponin ISerial cardiac markersEmergency department patientsNegative predictive valuePositive predictive valuePositive likelihood ratioNegative likelihood ratioChest painLikelihood ratioSymptom onsetUnstable anginaDepartment patientsProspective studyRisk stratificationMean agePerfusion testingC-statisticFinal diagnosisPatientsCardiac markers
2010
Depression as Modifiable Coronary Risk Factor in the Emergency Department Chest Pain Observation Unit
Safdar B, Foody JM, D'Onofrio G. Depression as Modifiable Coronary Risk Factor in the Emergency Department Chest Pain Observation Unit. Critical Pathways In Cardiology A Journal Of Evidence-Based Medicine 2010, 9: 82-87. PMID: 20520215, DOI: 10.1097/hpc.0b013e3181db06ef.Peer-Reviewed Original ResearchConceptsCoronary risk factorsModifiable coronary risk factorsRisk factorsUrban tertiary care hospital EDChest pain observation unitTertiary care hospital EDEmergency department observation unitFramingham risk scoreObservation unitProspective observational studyHealth service utilizationSeverity of depressionBehavioral health referralsCPC patientsChest painNonprivate insuranceED visitsStudy nursesCardiac symptomsHigher obesityHospital EDSpecialty referralsFuture trialsHealth referralsQuick InventoryPhysician Race/Ethnicity Predicts Successful Emergency Department Analgesia
Heins A, Homel P, Safdar B, Todd K. Physician Race/Ethnicity Predicts Successful Emergency Department Analgesia. Journal Of Pain 2010, 11: 692-697. PMID: 20382572, DOI: 10.1016/j.jpain.2009.10.017.Peer-Reviewed Original ResearchConceptsBetter pain reliefPain intensityNonwhite physiciansPain reliefPain treatmentPrimary outcomeProvider raceConcordance of patientRace of providersBetter pain controlEmergency department patientsEmergency department analgesiaRace of patientsPhysician race/ethnicityAnalysis of predictorsRace/ethnicityCanadian EDsED analgesiaLess analgesiaMore analgesicsPain controlPain scoresSevere painDepartment patientsMulticenter study
2009
Improvements in Time to Reperfusion
Rao V, Safdar B, Parkosewich J, Lee LV, D'Onofrio G, Foody JM. Improvements in Time to Reperfusion. Critical Pathways In Cardiology A Journal Of Evidence-Based Medicine 2009, 8: 38-42. PMID: 19258837, DOI: 10.1097/hpc.0b013e318194e443.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAngioplasty, Balloon, CoronaryCohort StudiesElectrocardiographyEmergency Service, HospitalEmergency TreatmentFemaleHospitals, TeachingHumansIncidenceMaleMiddle AgedMyocardial InfarctionPrognosisRetrospective StudiesRisk AssessmentSeverity of Illness IndexSex FactorsSurvival AnalysisTime FactorsTreatment OutcomeUrban HealthConceptsPrimary percutaneous coronary interventionST-elevation myocardial infarctionYale-New Haven HospitalPrimary PCIChart-abstracted dataPercutaneous coronary interventionUrban teaching hospitalQuality of carePhysician-level interventionsSingle-site studyChest painCoronary interventionHospital-wide systemPhysician awarenessEmergency departmentMyocardial infarctionHeart diseaseSTEMI careImproved outcomesTeaching hospitalEarly presentationReperfusionTimely managementClinical initiativesWomen