Harlan Krumholz Profile picture
Apr 27 7 tweets 14 min read Twitter logo Read on Twitter
We have been doing a series of studies, led by @jeb1426, on sex differences in symptom complexity & phenotypes in acute myocardial infarction (AMI) and their impact on diagnosis & treatment. Some imp findings. #Cardiology #MedTwitter @YaleMed @YaleCardiology @yuan_lu1 Image
@jeb1426 @YaleMed @YaleCardiology @yuan_lu1 In one study, we found 'Women had more variation in unique symptom phenotypes than men' greater symptom complexity & longer door-to-balloon times. Non-chest pain symptoms are more frequent in women, potentially delaying STEMI recognition. @CircOutcomes ahajournals.org/doi/full/10.11… Image
@jeb1426 @YaleMed @YaleCardiology @yuan_lu1 @CircOutcomes In another study, that focused on older patients... ' Women reported more symptoms and had significantly more symptom phenotypes than men.' @amjmed sciencedirect.com/science/articl… @YaleCardiology @YaleMed Image
@jeb1426 @YaleMed @YaleCardiology @yuan_lu1 @CircOutcomes @amjmed In a third study, we found 'more symptom phenotypes in young women were assoc w/prolonged D2B time or no PCI...greater frequency of nonchest pain symptoms in young women may have also slowed the recognition of STEMI and D2B times.' @AmJCardio sciencedirect.com/science/articl… Image
@jeb1426 @YaleMed @YaleCardiology @yuan_lu1 @CircOutcomes @amjmed @AmJCardio Implications: These studies emphasize the need for increased clinicians' awareness of the sex differences in symptom presentation during heart attacks. Recognizing this diversity may reduce diagnostic delays & improve treatment outcomes for women. @AHAScience
@jeb1426 @YaleMed @YaleCardiology @yuan_lu1 @CircOutcomes @amjmed @AmJCardio @AHAScience Future research: Further exploration of symptom clusters & targeted education can help improve recognition of diverse AMI symptoms in women, ultimately reducing missed diagnoses & enhancing patient care. And looking at how symptoms cluster is important. #MedEd #Research
@jeb1426 @YaleMed @YaleCardiology @yuan_lu1 @CircOutcomes @amjmed @AmJCardio @AHAScience Acknowledgments: Shoutout to contributors: @jeb1426, @yuan_lu1, @RachelDreyerPhD, Sarwat Chaudhry, Erich Greene, and Alexandra Hadjuk Gail D'Onofrio. And to @nih_nhlbi for funding. #CardioTwitter #MedTwitter

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More from @hmkyale

Mar 9
One of most important articles I’ve done… showing the noise in clinic BP measurement is large & makes it impossible to track Rx effects; almost useless in evaluating change from 2 clinic visits. Let me explain… ahajournals.org/doi/abs/10.116… @YaleMed @YaleCardiology @CircOutcomes Image
@YaleMed @YaleCardiology @CircOutcomes But first, kudos to the team @yuan_lu1 @shiwani_mahajan @rohan_khera @SpatzErica @GCLinderman #yuntianliu @jbmortazavi #chenxihuang - great team that persisted on this challenging project. And thanks @CircOutcomes @bnallamo for your support and reviews.
@YaleMed @YaleCardiology @CircOutcomes @yuan_lu1 @shiwani_mahajan @rohan_khera @SpatzErica @GCLinderman @jbmortazavi @bnallamo Now, we often see a patient with hypertension & change the meds and have them return to evaluate Rx effect. If everything goes right, drugs and changing doses may affect BP by ~5 mm Hg. Maybe a little less. We wondered how much natural variability there is between visits.
Read 9 tweets
Feb 3
Why do people have persistent hypertension? Turns out there are many reasons; we developed a taxonomy to classify them so they can be addressed, based on #EHR data. @yuan_lu1 @CircOutcomes @SpatzErica @YaleMed @YaleCardiology #bloodpressure @AHAScience ahajournals.org/doi/abs/10.116…
@yuan_lu1 @CircOutcomes @SpatzErica @YaleMed @YaleCardiology @AHAScience Several years ago @yuan_lu1 and I introduced the concept of persistent hypertension to describe people with many measures of elevated #bloodpressure; a more encompassing term than resistant hypertension, which was about not responding to drugs. @amjmed sciencedirect.com/science/articl…
@yuan_lu1 @CircOutcomes @SpatzErica @YaleMed @YaleCardiology @AHAScience @amjmed We wrote that persistent hypertension was a condition of repetitive measures of above-goal elevated blood pressure over a period of time (eg, 6 mos), and drug resistance was just one of many causes. And many causes were related to missed opportunities in the care pathways.
Read 6 tweets
Jan 22
Sleep as medicine... On behalf of hospitalized patients, what is we simply stopped ordering routine lab draws before 7am. What is we wrote an order, do not disturb before 7am except for an urgent need. Or an order for 7 hrs of peace and quiet. @FutureDocs nam12.safelinks.protection.outlook.com/?url=https%3A%…
@FutureDocs I strongly believe that rest and sleep are essential to recovery from acute illness...and yet everything we do in the hospital seems to ignore the role of sleep in treatment. We need to put people in a position to help their bodies heal and recovery... not make it more difficult.
@FutureDocs In our study we found it was normal operating procedures to draw bloods from 4-6am on hospitalized patients...the unintended effect, in my view, is to slow recovery and add stress... and impede healing. Shouldn't the hospital be where people can be treated, healed and recover?
Read 6 tweets
May 20, 2022
Is Omicron benign? No. In our @JAMA_current study, led by @jeremyfaust, more all-cause excess mortality occurred in MA during the first 8 wks of Omicron period than during the entire 23-week Delta period. @YaleMed @harvardmed @YaleCardiology @EMRES_MGHBWH jamanetwork.com/journals/jama/…
@JAMA_current @jeremyfaust @YaleMed @harvardmed @YaleCardiology @EMRES_MGHBWH We believe excess mortality is the best metric of the burden of the pandemic… how many excess deaths compared with a pre-pandemic steady state period. And so not about labeling deaths… but a broader view of mortality.
@JAMA_current @jeremyfaust @YaleMed @harvardmed @YaleCardiology @EMRES_MGHBWH And we are showing here that in a highly vaccinated state… omicron exactly a high mortality toll; and make no mistake, would have been worse w/o vaccination. But this crossed all age groups.
Read 5 tweets
Apr 3, 2022
Hey #ACC22 presenters, especially late breaking studies of consequence. If you don't have simultaneous peer-reviewed pub, consider #preprint what you presented so it's archived & accessible. Let’s make it normative. @medrxivpreprint @yaleHFdoc #LBCT @EricTopol @CMichaelGibson
@medrxivpreprint @yaleHFdoc @EricTopol @CMichaelGibson For all #ACC22 presenters, preprinting is easy; we accept scientific studies, screen rapidly, post quickly. Non-profit. It is of the community-available throughout the world, understood as pre-peer reviewed, and citable. Almost all reputable journals are fine with it, incl @NEJM.
@medrxivpreprint @yaleHFdoc @EricTopol @CMichaelGibson @NEJM In the pandemic @medrxivpreprint stimulated discussions about research in progress, & many examples of advancing research. Cardiology has not yet fully embraced it, yet is this work any less important? All fields should accelerate public scientific communication & #openscience.
Read 6 tweets
Apr 3, 2022
Great piece @FrancesSSellers ...'How #LongCovid is accelerating a revolution in medical research...Patients, who have typically been only subjects in the research process, are becoming partners in it.’ @washingtonpost @limitlessliza @dianaberrent @VirusesImmunity @YaleMed @PCORI
@FrancesSSellers @washingtonpost @limitlessliza @dianaberrent @VirusesImmunity @YaleMed @PCORI “The people who had the wisdom [about #LongCovid were the people experiencing it.” And that Krumholz, said “opened a lot of people’s eyes to a different way of doing research.” [and this approach should become normative…not more subjects in studies, just authentic partners]
@FrancesSSellers @washingtonpost @limitlessliza @dianaberrent @VirusesImmunity @YaleMed @PCORI People participating in research as partners, and w/agency over their data, & w/an approach of 'nothing about me, without me’ has great promise, yet threatens a status quo… but about time. Will enable better, faster, more efficient, more relevant, and less burdensome research.
Read 7 tweets

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