César Caraballo-Cordovez

Yale-New Haven Hospital | YNHH · Internal Medicine

Introduction Despite evidence supporting the benefits of marriage on cardiovascular health, the impact of marital/partner status on the long-term readmission of young acute myocardial infarction (AMI) survivors is less clear. We examined the association between marital/partner status and 1-year all-cause readmission and explored sex differences amo...

Background: Long COVID contributes to the global burden of disease. Proposed root cause hypotheses include the persistence of SARS-CoV-2 viral reservoir, autoimmunity, and reactivation of latent herpesviruses. Patients have reported various changes in Long COVID symptoms after COVID-19 vaccinations, leaving uncertainty about whether vaccine-induced...

Objectives To describe the experiences of patients who have postacute sequelae SARS-CoV-2 infection with internal vibrations and tremors as a prominent component, we leveraged the efforts by Survivor Corps, a grassroots COVID-19 patient advocacy group, to gather information from individuals belonging to its Facebook group with a history of COVID-19...

Background Studies show that digoxin use is declining but is still prevalent. Recent data on digoxin prescription and characteristics of digoxin prescribers are unknown, which can help understand its contemporary use. Methods Using Medicare Part D data from 2013 to 2019, we studied the change in number and proportion of digoxin prescriptions and d...

Importance Despite efforts to improve the quality of care for patients with atherosclerotic cardiovascular disease (ASCVD), it is unclear whether the US has made progress in reducing racial and ethnic differences in utilization of guideline-recommended therapies for secondary prevention. Objective To evaluate 21-year trends in racial and ethnic di...

Aims Current guidelines suggest calcium channel blockers (CCBs) as the second or third option for blood pressure management in patients with left ventricular assist device (LVAD). However, the clinical outcomes of patients with LVAD who receive CCBs remain unclear. Our study aims to analyse the association of CCBs with clinical outcomes in patients...

Introduction: A chronic post-vaccination syndrome (PVS) after covid-19 vaccination has been reported but has yet to be well characterized. Methods: We included 241 individuals aged 18 and older who self-reported PVS after covid-19 vaccination and who joined the online Yale Listen to Immune, Symptom and Treatment Experiences Now (LISTEN) Study from...

Introduction: Studies suggest hospitalizations for acute myocardial infarction (AMI) declined early in the COVID-19 pandemic, but national patterns during the entire pandemic are not well characterized. This study aims to characterize the changes in AMI hospitalizations and 30-day mortality rates among Medicare Fee-For-Service (FFS) beneficiaries d...

Introduction: International Classification of Diseases 10 th revision (ICD-10) discharge diagnosis codes are widely used for research studies that use electronic databases. The accuracy of the codes for identifying patients with isolated sub-segmental pulmonary embolism (issPE) is unknown. Methods: We used data from the Mass General Brigham (MGB) h...

Introduction: The International Classification of Diseases, 10 th revision (ICD-10) codes were updated in 2015 to include designation of pulmonary embolism (PE) with cor pulmonale . These codes can be advantageous to identify higher-risk patients with PE for research or quality improvement. However, the validity of these codes is unknown. Methods:...

Background: Many research studies from electronic databases and even the American Heart Association annual statistics for pulmonary embolism (PE) rely on the International Classification of Disease, 10 th modification (ICD-10) codes. However, the validity of ICD-10 codes for PE remains uncertain. Methods: Using a pre-specified protocol, we identifi...

Background Age and sex-differences exist in presentation of adults with pulmonary embolism (PE). However, it remains unclear if these differences influence the accuracy of International Classification of Diseases, Tenth Revision (ICD-10) codes used for identification of PE. Methods: Using multicenter data from Mass General-Brigham Health System (20...

Background Stress experienced in a marriage or committed relationship may be associated with worse patient‐reported outcomes after acute myocardial infarction (AMI), but little is known about this association in young adults (≤55 years) with AMI. Methods and Results We used data from VIRGO (Variation in Recovery: Role of Gender on Outcomes of Youn...

Introduction: Despite evidence supporting the benefits of marriage on cardiovascular health, the impact of marital/partner status on the long-term readmission of young acute myocardial infarction (AMI) survivors is less clear. We aimed to examine the association between marital/partner status and 1-year all-cause readmission, and explore sex differ...

Background Internal tremors and vibrations symptoms have been described as part of neurologic disorders but have not been fully described as a part of long COVID. We compared demographics, socioeconomic characteristics, pre-pandemic comorbidities, and new-onset conditions between people with internal tremors and vibrations as part of their long COV...

Importance: Amid efforts in the US to promote health equity, there is a need to assess recent progress in reducing excess deaths and years of potential life lost among the Black population compared with the White population. Objective: To evaluate trends in excess mortality and years of potential life lost among the Black population compared wit...

Background: Younger women experience worse health status than men after their index episode of acute myocardial infarction (AMI). However, whether women have a higher risk for cardiovascular and noncardiovascular hospitalizations in the year after discharge is unknown. Objectives: The aim of this study was to determine sex differences in causes...

Introduction: International Classification of Diseases 10 th revision (ICD-10) discharge diagnosis codes are widely used for research studies that use electronic databases. The accuracy of the codes for identifying patients with isolated sub-segmental pulmonary embolism (issPE) is unknown. Methods: We used data from the Mass General Brigham (MGB) h...

Background: Marital stress is associated with worse cardiac outcomes in young adults (≤55 years) with acute myocardial infarction (AMI), but whether psychosocial factors mediate this association remains largely unknown. We conducted a mediation analysis to investigate whether marital stress worsened quality of life (QoL) after AMI by increasing the...

Background: Contemporary pulmonary embolism (PE) research relies on data from electronic health records (EHRs) and administrative databases that use International Classification of Diseases (ICD) codes. Natural language processing (NLP) tools can be used for automated chart review and patient identification. However, there remains uncertainty with...

Background: The digital transformation of medical data presents opportunities for novel approaches to manage patients with persistent hypertension. We sought to develop an actionable taxonomy of patients with persistent hypertension (defined as 5 or more consecutive measurements of blood pressure ≥160/100 mmHg over time) based on data from the ele...

This study describes the degree to which blood draws occurred among hospitalized patients during traditional sleep hours and investigates trends over time.

Importance: In the US, nearly all medical devices progress to market under the 510(k) pathway, which uses previously authorized devices (predicates) to support new authorizations. Current regulations permit manufacturers to use devices subject to a Class I recall-the FDA's most serious designation indicating a high probability of adverse health co...

Background: There is scarce information on recent trends in excess deaths and years of potential life lost among Black populations compared with White populations in the United States. Methods: We used death certificates data from the Centers for Disease Control and Prevention WONDER from 1999-2020 and evaluated trends in excess age-adjusted mortal...

Introduction: Nationally representative data evaluating recent trends in racial and ethnic differences in prevalence and treatment of metabolic syndrome (MetS) are sparse. Methods: We evaluated 21-year trends in the prevalence and treatment of MetS and individual components in 21,602 adults, using data from the National Health and Nutrition Examina...

Background: Psychosocial stress is associated with worse cardiac outcomes, but little is known about the prognostic impact of marital stress in young adults (≤55 years) with acute myocardial infarction (AMI). We investigated the association between marital stress and 1-year health outcomes in young AMI survivors. Methods: We used data from the VIRG...

Introduction: Digital transformation of medical data present opportunities for novel approaches to manage patients with persistent hypertension (HTN). Methods: This qualitative study was a thematic analysis of clinician notes in the electronic health records of patients in the Yale New Haven Health System. Eligible patients were 18 to 85 years and...

Background: The digital transformation of medical data presents opportunities for novel approaches to manage patients with persistent hypertension (defined as multiple measurements of elevated BP over 6 months). We sought to develop an actionable taxonomy of patients with persistent hypertension based on clinical data from the electronic health rec...

Importance: Racial and ethnic disparities in delayed medical care for reasons that are not directly associated with the cost of care remain understudied. Objective: To describe trends in racial and ethnic disparities in barriers to timely medical care among adults during a recent 20-year period. Design, setting, and participants: This was a se...

Background: Younger women have higher recurrent hospitalization rates and worse health status than men after their index episode of acute myocardial infarction (AMI). However, whether women have a higher risk of cardiovascular events in the year after discharge is unknown. Methods: We used data from the VIRGO (Variation in Recovery: Role of Gender...

Importance: Insufficient data exist about the clinical presentation, short-term, and long-term outcomes of patients with isolated distal deep vein thrombosis (IDDVT), that is, thrombosis in infrapopliteal veins without proximal extension or pulmonary embolism (PE). Objective: To determine the clinical characteristics, short-term, and 1-year outc...

Importance Early morning blood draws disrupt patients’ sleep and adversely affect patient experience. Objective To describe the trends in non-urgent early morning blood draws in a large health care system. Design This cross-sectional study analyzed trends in non-urgent early morning (04:00–06:59) blood draws using the electronic medical records o...

Background Whether there are sex differences in hemodynamic profiles among people with elevated blood pressure is not well understood and could guide personalization of treatment. Methods and results We described the clinical and hemodynamic characteristics of adults with elevated blood pressure in China using impedance cardiography. We included 4...

Importance: Historically marginalized racial and ethnic groups are generally more likely to experience sleep deficiencies. It is unclear how these sleep duration disparities have changed during recent years. Objective: To evaluate 15-year trends in racial and ethnic differences in self-reported sleep duration among adults in the US. Design, set...

Background Disparities in multimorbidity prevalence indicate health inequalities, as the risk of morbidity does not intrinsically differ by race/ethnicity. This study aimed to determine if multimorbidity differences by race/ethnicity are decreasing over time. Methods Serial cross-sectional analysis of the National Health Interview Survey, 1999–201...

Objective To evaluate medication guideline adherence among ambulatory patients with markedly elevated blood pressure (BP), overall and by patient characteristics. Design Population-based, retrospective cohort study. Setting Yale New Haven Health System. Participants Adult patients aged 18-85 years with markedly elevated BP (defined as two consec...

Background Racial and ethnic disparities in delayed medical care due to reasons not related to cost of care remain understudied. We aimed to describe recent 20-year trends in such disparities. Methods The study used data from the National Health Interview Survey from 1999–2018 and included individuals ≥18 years of age. Respondents were categorized...

OBJECTIVE Health-related expenditures resulting from diabetes are rising in the U.S. Medication nonadherence is associated with worse health outcomes among adults with diabetes. We sought to examine the extent of reported cost-related medication nonadherence (CRN) in individuals with diabetes in the U.S. RESEARCH DESIGN AND METHODS We studied adul...

Background: Health-related expenditures due to diabetes mellitus (DM) are rising in the US. Medication nonadherence is associated with worse health outcomes, particularly among individuals with DM who require uninterrupted treatment. We sought to determine whether patients with DM in the US report cost-related nonadherence (CRN), a potential conseq...

Introduction: Reducing overall rates of and the racial/ethnic differences in obesity is a public health priority in the US. However, it is unknown how the racial/ethnic differences in different adiposity measures changed in the US population over recent decades Methods: Using data from the National Health and Nutrition Examination Survey 1999-2018,...

Introduction: Black and Hispanic adults have poorer hypertension control compared with White adults in the US. Less is known about the country’s progress in eliminating disparities in awareness and treatment of hypertension and whether these differences explain the difference in hypertension control. Methods: We assessed 20-year trends in racial/et...

Poor hypertension awareness and underuse of guideline-recommended medications are critical factors contributing to poor hypertension control. Using data from 8095 hypertensive people aged ≥18 years from the National Health and Nutrition Examination Survey (2011–2018), we examined recent trends in racial and ethnic differences in awareness and antih...

Importance: Minoritized racial and ethnic groups are generally more likely to experience sleep deficiencies. It is unclear how these sleep duration disparities have changed over recent years. Objective: To determine 15–year trends in the racial and ethnic differences in self–reported sleep duration among adults in the US. Design: Serial cross–secti...

Background New methods such as machine learning techniques have been increasingly used to enhance the performance of risk predictions for clinical decision-making. However, commonly reported performance metrics may not be sufficient to capture the advantages of these newly proposed models for their adoption by health care professionals to improve c...

Background: Multimorbidity, an important health indicator, is a contributor to and result of health inequity. We sought to determine if gaps in multimorbidity by race and ethnicity are decreasing over time. Methods: Serial cross-sectional analysis of the National Health Interview Survey, 1999 to 2018. The study included individuals older than 18 ye...

Background Racial and ethnic disparities contribute to differences in access and outcomes for patients undergoing heart transplantation. We evaluated contemporary outcomes for heart transplantation stratified by race and ethnicity as well as the new 2018 allocation system. Methods and Results Adult heart recipients from 2011 to 2020 were identifie...

Objective: To examine United States (US) trends in racial/ethnic differences in hypertension awareness and antihypertensive medication use, and whether these differences help explain racial/ethnic differences in hypertension control among adults from 2011 to 2018. Design: Population-based study. Setting: National Health and Nutrition Examination Su...

Importance The elimination of racial and ethnic differences in health status and health care access is a US goal, but it is unclear whether the country has made progress over the last 2 decades. Objective To determine 20-year trends in the racial and ethnic differences in self-reported measures of health status and health care access and affordabi...

Background: It remains unclear why depression is associated with adverse outcomes in heart failure (HF) patients. We examine the relationship between depression and clinical outcomes among patients with HF and reduced ejection fraction (HFrEF) managed with guideline directed medical therapy (GDMT). Methods: Using the GUIDE-IT trial, 894 patients wi...

Aims Improved cancer survivorship has led to a higher number of anthracycline‐induced cardiomyopathy patients with end‐stage heart failure. We hypothesize that outcomes following continuous‐flow LVAD (CF‐LVAD) implantation in those with anthracycline‐induced cardiomyopathy are comparable with other aetiologies of cardiomyopathy. Methods and result...

Objectives The aim of this study was to examine patterns of care and clinical outcomes among patients with heart failure with reduced ejection fraction (HFrEF) in the United States and Canada. Background In the GUIDE-IT (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment) trial, the use of N-terminal pro–B-type natriuretic peptid...

BACKGROUND Harnessing health-related data posted on social media in real-time has the potential to offer insights into how the pandemic impacts the mental health and general well-being of individuals and populations over time. OBJECTIVE The aim of this study was to obtain information on symptoms and medical conditions self-reported by non-Twitter...

Background: Harnessing health-related data posted on social media in real-time has the potential to offer insights into how the pandemic impacts the mental health and general well-being of individuals and populations over time. Objective: The aim of this study was to obtain information on symptoms and medical conditions self-reported by non-Twit...

Objective To evaluate effects of atrial fibrillation (AF) on cardiac biomarkers and outcomes in a trial population of patients with heart failure (HF) with reduced ejection fraction treated with optimal guideline-directed medical therapy. Methods We performed a secondary analysis of 894 patients in the Guiding Evidence-Based Therapy Using Biomarke...

Background: Whether there are sex differences in hemodynamic profiles among people with elevated blood pressure is not well understood and could guide personalization of treatment. Methods and results: We described the clinical and hemodynamic characteristics of adults with elevated blood pressure in China using impedance cardiography. We included...

Hospitalizations for acute cardiac conditions have markedly declined during the coronavirus disease 2019 (COVID-19) pandemic, yet the cause of this decline is not clear. Using remote monitoring data of 4,029 patients with implantable cardiac defibrillators (ICDs) living in New York City and Minneapolis/Saint Paul, we assessed changes in markers of...

Nationwide public health restrictions due to the coronavirus disease 2019 (COVID-19) pandemic have disrupted people’s routine physical activities, yet little objective information is available on the extent to which physical activity has changed among patients with pre-existing cardiac diseases. Using remote monitoring data of 9,924 patients with p...

Background: The coronavirus disease 2019 (COVID-19) has continued to spread in the US and globally. Closely monitoring public engagement and perception of COVID-19 and preventive measures using social media data could provide important information for understanding the progress of current interventions and planning future programs. Objective: To me...

Background Infection fatality rate and infection hospitalization rate, defined as the proportion of deaths and hospitalizations, respectively, of the total infected individuals, can estimate the actual toll of COVID-19 on a community as the denominator is ideally based on a representative sample of a population, which captures the full spectrum of...

BACKGROUND The coronavirus disease 2019 (COVID-19) has continued to spread in the US and globally. Closely monitoring public engagement and perception of COVID-19 and preventive measures using social media data could provide important information for understanding the progress of current interventions and planning future programs. OBJECTIVE To mea...

Background: The coronavirus disease 2019 (COVID-19) has continued to spread in the US and globally. Closely monitoring public engagement and perception of COVID-19 and preventive measures using social media data could provide important information for understanding the progress of current interventions and planning future programs. Objective: To...

ImportancePatient outcomes in heart failure clinical trials are generally better than those observed in real-world settings. This may be related to stricter inclusion and exclusion criteria in clinical trials.Objective We study sought to characterize the clinical implications of differences between patients in clinical trials and those in a real-wo...

Machine learning (ML) techniques have become ubiquitous and indispensable for solving intricate problems in most disciplines. To determine the extent of funding for clinical research projects applying ML techniques by the National Institutes of Health (NIH) in 2017, we searched the NIH Research Portfolio Online Reporting Tools Expenditures and Resu...

Background Community engagement and rapid translation of findings for the benefit of patients has been noted as a major criterion for NIH decisions regarding allocation of funds for research priorities. We aimed to examine whether the presence of top NIH-funded institutions resulted in a benefit on the cardiovascular and cancer mortality of their l...

Background Scaling SARS-CoV-2 testing to meet demands of safe reopenings continues to be plagued by assay costs and supply chain shortages. In response, we developed SalivaDirect, which received Emergency Use Authorization (EUA) from the U.S. FDA. Methods We simplified our saliva-based diagnostic test by (1) not requiring collection tubes with pre...

While normal gestation is characterized by an increase in lipid production during the second and third trimesters to support healthy fetal development, maternal dyslipidemia during early gestation is associated with greater risk of preeclampsia, preterm birth, and other adverse pregnancy outcomes, as well as an increased risk of cardiovascular dise...

Introduction: Anthracycline-induced cardiomyopathy (AC-CM) presenting as end-stage heart failure may require mechanical circulatory support. Hypothesis: We hypothesize that there is no difference in outcomes after LVAD placement in those with AC-CM compared to other forms of cardiomyopathy. Methods: Interagency Registry for Mechanically Assisted Ci...

Background: Isolated distal deep vein thrombosis (IDDVT) is a common form of venous thromboembolism (VTE). Limited data exist about the clinical characteristics, initial treatment, and short-term outcomes of these patients. Methods: Using the data from the RIETE registry (05/2001-02/2019), we identified patients with IDDVT without pulmonary embolis...

Introduction: Combination therapy with two or more antihypertensive agents is recommended for management of patients with markedly elevated blood pressure (systolic blood pressure [SBP] ≥160 mmHg or diastolic blood pressure [DBP] ≥100 mmHg) by the 2017 AHA/ACC hypertension guideline. Using electronic health records (EHR) data from a large health sy...

Importance COVID-19 case fatality and hospitalization rates, calculated using the number of confirmed cases of COVID-19, have been described widely in the literature. However, the number of infections confirmed by testing underestimates the total infections as it is biased based on the availability of testing and because asymptomatic individuals ma...

Importance Racial and ethnic disparities plague the US health care system despite efforts to eliminate them. To understand what has been achieved amid these efforts, a comprehensive study from the population perspective is needed. Objectives To determine trends in rates and racial/ethnic disparities of key access to care measures among adults in t...

Importance Thirty-five years ago, the Heckler Report described health disparities among minority populations in the US. Since then, policies have been implemented to address these disparities. However, a recent evaluation of progress towards improving the health and health equity among US adults is lacking. Objectives To evaluate racial/ethnic dis...

Introducción: las dermatosis infecciosas y no infecciosas tienen una alta prevalencia en pacientes con infección por el virus de la inmunodeficiencia humana (VIH) y son importantes para su diagnóstico y seguimiento clínico. A pesar de que hay extensa documentación de dichas dermatosis en otras poblaciones y especialmente en países desarrollados, la...

Background Patients with comorbid conditions have a higher risk of mortality with SARS-CoV-2 (COVID-19) infection, but the impact on heart failure patients living near a disease hotspot is unknown. Therefore, we sought to characterize the prevalence and outcomes of COVID-19 in a live registry of heart failure patients across an integrated health ca...

Background/aims Non-inferiority trials are increasing in cardiovascular medicine, with approval of many drugs and devices on the basis of such studies. Surrogate markers as primary endpoints have been also more frequently used for efficient assessment of cardiovascular interventions. However, there is uncertainty about their concordance with clinic...

Objectives This study sought to use INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) results to evaluate sex differences in the use and clinical outcomes of left ventricular assist devices (LVAD). Background Despite a similar incidence of heart failure in men and women, prior studies have highlighted potential underus...

Background Many clinical investigations depend on participant self-report as a principal method of identifying health care events. If self-report is used as the trigger to collect and adjudicate medical records, any event that is not reported by the patient will be missed by the investigators, reducing the power of the study and misrepresenting the...

Background Psychiatric comorbidities play a key role in patient selection for left ventricular assist devices (LVADs), but their impact on clinical outcomes is unknown. Objectives The goal of this study was to examine the clinical impact of psychiatric illness on outcomes in patients receiving LVADs for end-stage heart failure (HF). Methods The s...

Background Atherosclerotic cardiovascular disease ( ASCVD ) has a strong association with diabetes mellitus ( DM ), accounting for approximately two thirds of deaths in this patient population. Many individuals with ASCVD and DM are vulnerable to financial hardship associated with treatment‐related expenses. Therefore, we examined the burden of fin...

Background: Patients with comorbid conditions have a higher risk of mortality with SARS-CoV-2 (COVID-19) infection, but the impact on heart failure patients living near a disease hotspot is unknown. Therefore, we sought to characterize the prevalence and outcomes of COVID-19 in a live registry of heart failure patients across an integrated health c...

Background: Non-inferiority trials are increasing in cardiovascular medicine, with approval of many drugs and devices on the basis of such studies. Surrogate endpoints have been also increasingly used for efficient assessment of cardiovascular interventions, but there is uncertainty about their concordance with clinical outcomes. Non-inferiority de...

Objectives Tricuspid regurgitation (TR) is common in end stage heart failure patients receiving left ventricular assist devices (LVADs), but the benefit of concomitant tricuspid valve procedures (TVP) remains uncertain. This study examined the impact of TVP at time of LVAD implantation on clinical outcomes and quality of life metrics. Methods We i...

Purpose Aortic insufficiency (AI) is a common problem in advanced heart failure and progression after left ventricular assist device implantation is well described. Patterns of care for AVP at the time of LVAD implantation and the associated outcomes remain poorly described. Methods We included all patients in the INTERMACS (Interagency Registry f...

Purpose The clinical impact of mitral valve procedures (MVP) at time of left ventricular assist device (LVAD) is not well understood. We examined the association of MVP, according to severity of MR, with long term survival and quality of life metrics. Methods Continuous-flow LVAD recipients with MR from the 2008-2017 INTERMACS registry were includ...

Purpose Tricuspid regurgitation (TR) is common in end stage heart failure patients receiving left ventricular assist devices (LVADs), but the value of intervention is uncertain. This study examined the impact of tricuspid valve procedures (TVP) at time of LVAD implantation on clinical outcomes and quality of life metrics. Methods We included patie...

We propose a novel reinforcement learning-based approach for adaptive and iterative feature selection. Given a masked vector of input features, a reinforcement learning agent iteratively selects certain features to be unmasked, and uses them to predict an outcome when it is sufficiently confident. The algorithm makes use of a novel environment sett...