Featured Publications
Survival of the Fittest: Impact of Cardiorespiratory Fitness on Outcomes in Men and Women with Cardiovascular Disease
Safdar B, Mangi AA. Survival of the Fittest: Impact of Cardiorespiratory Fitness on Outcomes in Men and Women with Cardiovascular Disease. Clinical Therapeutics 2020, 42: 385-392. PMID: 32088022, DOI: 10.1016/j.clinthera.2020.01.014.Peer-Reviewed Original ResearchConceptsPeak cardiorespiratory fitnessCardiorespiratory fitnessCardiovascular diseaseCardiac rehabilitationPhysical inactivityMyocardial infarctionImpact of CRFOnset of CVDPeak exercise capacityCardiac rehabilitation programModifiable risk factorsRecurrent myocardial infarctionPoor functional outcomeCause of mortalitySex differencesImpact of sexCVD outcomesExercise capacityImproved survivalLow referralMale patientsFemale patientsExercise prescriptionFunctional outcomeRisk factorsSex Differences in the Presentation and Perception of Symptoms Among Young Patients With Myocardial Infarction
Lichtman JH, Leifheit EC, Safdar B, Bao H, Krumholz HM, Lorenze NP, Daneshvar M, Spertus JA, D'Onofrio G. Sex Differences in the Presentation and Perception of Symptoms Among Young Patients With Myocardial Infarction. Circulation 2018, 137: 781-790. PMID: 29459463, PMCID: PMC5822747, DOI: 10.1161/circulationaha.117.031650.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionPerception of symptomsChest painCare-seeking behaviorSymptom presentationYounger patientsMyocardial infarctionST-segment elevation acute myocardial infarctionMultivariable hierarchical logistic regressionIndex AMI hospitalizationMajority of womenHierarchical logistic regressionStress/anxietyVIRGO StudyMuscle painPatient characteristicsPredominant symptomAMI symptomsPerceive symptomsProdromal symptomsPatient interviewsHeart diseasePainAMI hospitalizationUS hospitalsPrevalence 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 populationPresentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study
Safdar B, Spatz ES, Dreyer RP, Beltrame JF, Lichtman JH, Spertus JA, Reynolds HR, Geda M, Bueno H, Dziura JD, Krumholz HM, D'Onofrio G. Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study. Journal Of The American Heart Association 2018, 7: e009174. PMID: 29954744, PMCID: PMC6064896, DOI: 10.1161/jaha.118.009174.Peer-Reviewed Original ResearchConceptsMI-CAD patientsNonobstructive coronary arteriesMI-CADYounger patientsClinical profileCoronary arteryMyocardial infarctionTraditional cardiac risk factorsAcute myocardial infarction patientsCardiac risk factorsGestational diabetes mellitusMyocardial infarction patientsTimes higher oddsMINOCA patientsSAQ qualityVIRGO StudyClinical characteristicsHypercoaguable stateDiabetes mellitusObstructive diseaseClinical outcomesInfarction patientsRisk factorsMINOCAPsychosocial status
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 ResearchConceptsChest painAcute myocardial infarctionEmergency departmentMultivariable adjustmentYoung adultsMyocardial infarctionBackground Acute myocardial infarctionRacial differencesCardiac biomarker testingHospital admissionClinical featuresConclusions WomenPhysician evaluationTriage levelBiomarker testingCardiac biomarkersWhite adultsNational estimatesObservation unitCP managementAdultsSurvey 2014WomenPainInfarctionDepression and Perceived Stress After Spontaneous Coronary Artery Dissection and Comparison With Other Acute Myocardial Infarction (the VIRGO Experience)
Murugiah K, Chen L, Dreyer RP, Bouras G, Safdar B, Lu Y, Spatz ES, Gupta A, Khera R, Ng VG, Bueno H, Tweet MS, Spertus JA, Hayes SN, Lansky A, Krumholz HM. Depression and Perceived Stress After Spontaneous Coronary Artery Dissection and Comparison With Other Acute Myocardial Infarction (the VIRGO Experience). The American Journal Of Cardiology 2022, 173: 33-38. PMID: 35365290, PMCID: PMC9133198, DOI: 10.1016/j.amjcard.2022.03.005.Peer-Reviewed Original ResearchConceptsSpontaneous coronary artery dissectionPatient Health Questionnaire-9Coronary artery dissectionPSS-14 scoreArtery dissectionBaseline PHQ-9 scoreAcute myocardial infarction patientsCardiovascular risk factorsPHQ-9 scoresAcute myocardial infarctionMyocardial infarction patientsYears of agePerceived Stress Scale scoresStress Scale scoresLinear mixed-effects analysisSCAD casesVIRGO StudyQuestionnaire-9Infarction patientsMixed-effects analysisMyocardial infarctionSubgroup analysisRisk factorsRoutine screeningClinical acuityHealth status outcomes after spontaneous coronary artery dissection and comparison with other acute myocardial infarction: The VIRGO experience
Murugiah K, Chen L, Dreyer RP, Bouras G, Safdar B, Khera R, Lu Y, Spatz ES, Ng VG, Gupta A, Bueno H, Tweet MS, Spertus JA, Hayes SN, Lansky A, Krumholz HM. Health status outcomes after spontaneous coronary artery dissection and comparison with other acute myocardial infarction: The VIRGO experience. PLOS ONE 2022, 17: e0265624. PMID: 35320296, PMCID: PMC8942215, DOI: 10.1371/journal.pone.0265624.Peer-Reviewed Original ResearchConceptsSpontaneous coronary artery dissectionAcute myocardial infarctionAMI patientsCoronary artery dissectionYoung AMI patientsHealth status outcomesHealth status instrumentsSCAD patientsArtery dissectionMyocardial infarctionStatus outcomesPatientsOutcomesHousehold incomeCollege educationInfarction
2021
Mild cognitive impairment in middle-aged adults with coronary microvascular dysfunction
Nowroozpoor A, Sharp E, Gordon R, Malicki C, Hwang U, Dziura J, D'Onofrio' G, Safdar B. Mild cognitive impairment in middle-aged adults with coronary microvascular dysfunction. European Heart Journal 2021, 42: ehab724.2744. DOI: 10.1093/eurheartj/ehab724.2744.Peer-Reviewed Original ResearchCoronary microvascular dysfunctionCoronary flow reservePerfusion defectsCognitive impairmentMean ageCMD patientsCardiac positron emission tomography/Chest pain observation unitPositron emission tomography/Coronary artery diseaseSmall vessel diseaseEmission tomography/Montreal Cognitive AssessmentChest discomfortHypertensive urgencyMicrovascular dysfunctionArtery diseaseHeart failureVessel diseaseMyocardial infarctionTomography/Odds ratioFlow reserveNormal groupYears of education
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 SurveyCardiovascular Considerations in Caring for Pregnant Patients: A Scientific Statement From the American Heart Association
Mehta LS, Warnes CA, Bradley E, Burton T, Economy K, Mehran R, Safdar B, Sharma G, Wood M, Valente AM, Volgman A, Council O. Cardiovascular Considerations in Caring for Pregnant Patients: A Scientific Statement From the American Heart Association. Circulation 2020, 141: e884-e903. PMID: 32362133, DOI: 10.1161/cir.0000000000000772.Peer-Reviewed Original ResearchConceptsCardio-obstetrics teamCardiovascular diseaseCardiac conditionsMultidisciplinary cardio-obstetrics teamHistory of preeclampsiaPregnancy-related mortalityPrimary care cliniciansAmerican Heart AssociationScientific statementHypertensive disordersMaternal morbidityPregnant patientsPreconception counselingValvular diseaseCare cliniciansComorbid conditionsThromboembolic diseaseAortic diseaseCardiovascular ConsiderationsCerebrovascular diseaseYear postpartumHeart AssociationMaternal mortalityMaternal ageMyocardial infarctionUtility of discovery approach using proteomics to create a biomarker profile for coronary microvascular dysfunction
Nowroozpoor A, Gutterman D, Safdar B. Utility of discovery approach using proteomics to create a biomarker profile for coronary microvascular dysfunction. Microvascular Research 2020, 129: 103985. PMID: 32007502, PMCID: PMC10291513, DOI: 10.1016/j.mvr.2020.103985.Peer-Reviewed Original ResearchConceptsCoronary microvascular dysfunctionCoronary flow reserveMicrovascular dysfunctionNormal coronary flow reservePositron emission tomography/Beta-blocker useAcute myocardial infarctionEmission tomography/Regional perfusion defectsSerum proteinsBaseline characteristicsCoronary calcificationMyocardial infarctionTomography/Perfusion defectsCMD patientsFlow reserveSerial measurementsBiomarker profilesAdvanced imagingPatientsPotential biomarkersPotential protein biomarkersSerum samplesObservation unit
2015
Sex Differences in Reperfusion in Young Patients With ST-Segment–Elevation Myocardial Infarction
D'Onofrio G, Safdar B, Lichtman JH, Strait KM, Dreyer RP, Geda M, Spertus JA, Krumholz HM. Sex Differences in Reperfusion in Young Patients With ST-Segment–Elevation Myocardial Infarction. Circulation 2015, 131: 1324-1332. PMID: 25792558, PMCID: PMC4652789, DOI: 10.1161/circulationaha.114.012293.Peer-Reviewed Original ResearchConceptsST-segment elevation myocardial infarctionMyocardial infarctionReperfusion therapyAcute ST-segment elevation myocardial infarctionProspective observational cohort studyYoung AMI Patients (VIRGO) studyTime guidelinesYoung womenObservational cohort studyProportion of patientsElevation myocardial infarctionPercutaneous coronary interventionYears of ageSex differencesPatients 18Reperfusion strategyCohort studyCoronary interventionFibrinolytic therapyNeedle timeYounger patientsReperfusion delayRatio of womenReperfusion guidelinesSex disparities
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
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