Suzanne V. Arnold
University of Missouri–Kansas City
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Featured researches published by Suzanne V. Arnold.
Circulation | 2010
Elizabeth M. Mahoney; Kaijun Wang; Suzanne V. Arnold; Irina Proskorovsky; Stephen D. Wiviott; Elliott M. Antman; Eugene Braunwald; David J. Cohen
Background— In patients with acute coronary syndromes and planned percutaneous coronary intervention, the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel–Thrombolysis in Myocardial Infarction 38 (TRITON-TIMI 38) demonstrated that treatment with prasugrel versus clopidogrel was associated with reduced rates of cardiovascular death, MI, or stroke and an increased risk of major bleeding. We evaluated the cost-effectiveness of prasugrel versus clopidogrel from the perspective of the US healthcare system by using data from TRITON-TIMI 38. Methods and Results— Detailed resource use data were prospectively collected for all patients recruited from 8 countries (United States, Australia, Canada, Germany, Italy, Spain, United Kingdom, and France; n=3373 prasugrel, n=3332 clopidogrel). Hospitalization costs were estimated on the basis of diagnosis-related group and in-hospital complications. Cardiovascular medication costs were estimated by using net wholesale prices (clopidogrel=
Journal of the American College of Cardiology | 2013
Mikhail Kosiborod; Suzanne V. Arnold; John A. Spertus; Darren K. McGuire; Yan Li; Patrick Yue; Ori Ben-Yehuda; Amos Katz; Philip G. Jones; Ann Olmsted; Luiz Belardinelli; Bernard R. Chaitman
4.62/d; prasugrel=
Circulation | 2014
Suzanne V. Arnold; Matthew R. Reynolds; Yang Lei; Elizabeth A. Magnuson; Ajay J. Kirtane; Susheel Kodali; Alan Zajarias; Vinod H. Thourani; Philip Green; Josep Rodés-Cabau; Nirat Beohar; Michael J. Mack; Martin B. Leon; David J. Cohen
5.45/d). Life expectancy was estimated from in-trial cardiovascular and bleeding events with the use of statistical models of long-term survival from a similar population from the Saskatchewan Health Database. Over a median follow-up of 14.7 months, average total costs (including study drug) were
Circulation-cardiovascular Quality and Outcomes | 2008
Suzanne V. Arnold; Carole Decker; Homaa Ahmad; Olawale Olabiyi; Surya Mundluru; Kimberly J. Reid; Gabriel E. Soto; Sarah Gansert; John A. Spertus
221 per patient lower with prasugrel (95% confidence interval, −759 to 299), largely because of a lower rate of rehospitalization involving percutaneous coronary intervention. Prasugrel was associated with life expectancy gains of 0.102 years (95% confidence interval, 0.030 to 0.180), primarily because of the decreased rate of nonfatal MI. Thus, compared with clopidogrel, prasugrel was an economically dominant treatment strategy. If a hypothetical generic cost for clopidogrel of
Circulation-cardiovascular Quality and Outcomes | 2011
Suzanne V. Arnold; Paul S. Chan; Philip G. Jones; Carole Decker; Donna M. Buchanan; Harlan M. Krumholz; P. Michael Ho; John A. Spertus
1/d is used, the incremental net cost with prasugrel was
Circulation-cardiovascular Quality and Outcomes | 2009
Suzanne V. Arnold; David A. Morrow; Yang Lei; David J. Cohen; Elizabeth M. Mahoney; Eugene Braunwald; Paul S. Chan
996 per patient, yielding an incremental cost-effectiveness ratio of
Journal of the American College of Cardiology | 2013
Suzanne V. Arnold; John A. Spertus; Frederick A. Masoudi; Stacie L. Daugherty; Thomas M. Maddox; Yan Li; John A. Dodson; Paul S. Chan
9727 per life-year gained. Conclusion— Among acute coronary syndrome patients with planned percutaneous coronary intervention, treatment with prasugrel versus clopidogrel for up to 15 months is an economically attractive treatment strategy. Clinical Trial Registration— clinicaltrials.gov. Unique identifier: NCT00097591.
Circulation-heart Failure | 2013
Suzanne V. Arnold; John A. Spertus; Yang Lei; Keith B. Allen; Adnan K. Chhatriwalla; Martin B. Leon; Craig R. Smith; Matthew R. Reynolds; John G. Webb; Lars G. Svensson; David J. Cohen
OBJECTIVES This study sought to examine the efficacy of ranolazine versus placebo on weekly angina frequency and sublingual nitroglycerin use in subjects with type 2 diabetes mellitus, coronary artery disease (CAD), and chronic stable angina who remain symptomatic despite treatment with up to 2 antianginal agents. BACKGROUND Patients with diabetes have more extensive CAD than those without diabetes, and a high burden of angina. Ranolazine is not only effective in treating angina but also may improve glycemic control, thus providing several potential benefits in this high-risk group. We conducted a randomized trial to test the antianginal benefit of ranolazine in patients with diabetes and stable angina. METHODS TERISA (Type 2 Diabetes Evaluation of Ranolazine in Subjects With Chronic Stable Angina) was an international, randomized, double-blind trial of ranolazine versus placebo in patients with diabetes, CAD, and stable angina treated with 1 to 2 antianginals. After a single-blind, 4-week placebo run-in, patients were randomized to 8 weeks of double-blind ranolazine (target dose 1000 mg bid) or placebo. Anginal episodes and nitroglycerin use were recorded with daily entry into a novel electronic diary. Primary outcome was the average weekly number of anginal episodes over the last 6 weeks of the study. RESULTS A total of 949 patients were randomized across 104 centers in 14 countries. Mean age was 64 years, 61% were men, mean diabetes duration was 7.5 years, and mean baseline HbA1c was 7.3%. Electronic diary data capture was 98% in both groups. Weekly angina frequency was significantly lower with ranolazine versus placebo (3.8 [95% confidence interval (CI): 3.6 to 4.1] episodes vs. 4.3 [95% CI: 4.0 to 4.5] episodes, p = 0.008), as was the weekly sublingual nitroglycerin use (1.7 [95% CI: 1.6 to 1.9] doses vs. 2.1 [95% CI: 1.9 to 2.3] doses, p = 0.003). There was no difference in the incidence of serious adverse events between groups. CONCLUSIONS Among patients with diabetes and chronic angina despite treatment with up to 2 agents, ranolazine reduced angina and sublingual nitroglycerin use and was well tolerated. (Type 2 Diabetes Evaluation of Ranolazine in Subjects With Chronic Stable Angina [TERISA]; NCT01425359).
Circulation-cardiovascular Quality and Outcomes | 2011
Suzanne V. Arnold; Paul S. Chan; Philip G. Jones; Carole Decker; Donna M. Buchanan; Harlan M. Krumholz; P. Michael Ho; John A. Spertus
Background— Transcatheter aortic valve replacement (TAVR) is a less invasive option for treatment of high-risk patients with severe aortic stenosis. We sought to identify patients at high risk for poor outcome after TAVR using a novel definition of outcome that integrates quality of life with mortality. Methods and Results— Among 2137 patients who underwent TAVR in the PARTNER (Placement of Aortic Transcatheter Valve) trial or its associated continued access registry, quality of life was assessed with the Kansas City Cardiomyopathy Questionnaire–Overall Summary Scale (KCCQ-OS; range 0–100, where a higher score equates to a better quality of life) at baseline and at 1, 6, and 12 months after TAVR. A poor 6-month outcome (defined as death, KCCQ-OS score <45, or ≥10-point decrease in KCCQ-OS score compared with baseline) occurred in 704 patients (33%). Using a split-sample design, we developed a multivariable model to identify a parsimonious set of covariates to identify patients at high risk for poor outcome. The model demonstrated moderate discrimination (c-index=0.66) and good calibration with the observed data, performed similarly in the separate validation cohort (c-index=0.64), and identified 211 patients (10% of the population) with a ≥50% likelihood of a poor outcome after TAVR. A second model that explored predictors of poor outcome at 1 year identified 1102 patients (52%) with ≥50% likelihood and 178 (8%) with ≥70% likelihood of a poor 1-year outcome after TAVR. Conclusions— Using a large, multicenter cohort, we have developed and validated predictive models that can identify patients at high risk for a poor outcome after TAVR. Although model discrimination was moderate, these models may help guide treatment choices and offer patients realistic expectations of outcomes based on their presenting characteristics. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894.Background— Transcatheter aortic valve replacement (TAVR) is a less invasive option for treatment of high-risk patients with severe aortic stenosis. We sought to identify patients at high risk for poor outcome after TAVR using a novel definition of outcome that integrates quality of life with mortality. Methods and Results— Among 2137 patients who underwent TAVR in the PARTNER (Placement of Aortic Transcatheter Valve) trial or its associated continued access registry, quality of life was assessed with the Kansas City Cardiomyopathy Questionnaire–Overall Summary Scale (KCCQ-OS; range 0–100, where a higher score equates to a better quality of life) at baseline and at 1, 6, and 12 months after TAVR. A poor 6-month outcome (defined as death, KCCQ-OS score <45, or ≥10-point decrease in KCCQ-OS score compared with baseline) occurred in 704 patients (33%). Using a split-sample design, we developed a multivariable model to identify a parsimonious set of covariates to identify patients at high risk for poor outcome. The model demonstrated moderate discrimination ( c -index=0.66) and good calibration with the observed data, performed similarly in the separate validation cohort ( c -index=0.64), and identified 211 patients (10% of the population) with a ≥50% likelihood of a poor outcome after TAVR. A second model that explored predictors of poor outcome at 1 year identified 1102 patients (52%) with ≥50% likelihood and 178 (8%) with ≥70% likelihood of a poor 1-year outcome after TAVR. Conclusions— Using a large, multicenter cohort, we have developed and validated predictive models that can identify patients at high risk for a poor outcome after TAVR. Although model discrimination was moderate, these models may help guide treatment choices and offer patients realistic expectations of outcomes based on their presenting characteristics. Clinical Trial Registration— URL: . Unique identifier: [NCT00530894][1]. # CLINICAL PERSPECTIVE {#article-title-31} [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00530894&atom=%2Fcirculationaha%2F129%2F25%2F2682.atom
Journal of the American College of Cardiology | 2013
Suzanne V. Arnold; John A. Spertus; Frederick A. Masoudi; Stacie L. Daugherty; Thomas M. Maddox; Yan Li; John A. Dodson; Paul S. Chan
Background—Standard consent forms result in highly variable communication between patients and physicians. To enhance the consent process and facilitate shared decision making, we developed a World Wide Web–based program, PREDICT (Patient Refined Expectations for Deciding Invasive Cardiac Treatments), to systematically embed patient-specific estimates of death, bleeding, and restenosis into individualized percutaneous coronary intervention informed consent documents. We then compared patients’ experiences with informed consent before and after implementation of PREDICT. Methods and Results—Between August 2006 and May 2007, patients undergoing nonemergent cardiac catheterization who received the original consent form (n=142) were interviewed and compared with those who received the PREDICT consent form (n=193). Hierarchical modified Poisson regression models were used to adjust for clustering of patients within physicians. Compared with the original consent group, those in the PREDICT group reported higher rates of reading the consent form (72% versus 44%, relative risk [RR] 1.64, 95% confidence interval [CI] 1.24 to 2.16), increased perception of shared decision making (67% versus 45%, RR 1.48, 95% CI 0.99 to 2.22), and decreased anxiety (35% versus 55%, RR 0.70, 95% CI 0.53 to 0.91). Although there were no differences between groups in patients’ ability to name complications of percutaneous coronary intervention, among patients who identified either death or bleeding as a potential complication, more patients in the PREDICT group recalled being informed of their estimated risk of that complication (death: 85% versus 62%, RR 1.37, 95% CI 1.03 to 1.82; bleeding: 92% versus 71%, RR 1.28, 95% CI 1.06 to 1.56). Conclusions—In this preliminary, single-center experience, individualized consent forms with patient-specific risks were associated with improved participation in the consent process, reduced anxiety, and better risk recall. PREDICT is one potential strategy for improving the current practice of obtaining informed consent for percutaneous coronary intervention.