Enhanced Detection of Heart Valve Disease Using Integrated Artificial Intelligence at Scale.

BACKGROUND: Undertreatment of heart valve disease creates unnecessary patient risk. Poorly integrated healthcare data systems are unequipped to solve this problem. A software program using a rules-based algorithm to search the electronic health record for heart valve disease among patients treated by healthcare systems in the United States may provide a solution. METHODS: A software interface allowed concurrent access to picture archiving communication systems, the electronic health record, and other sources. The software platform was created to programmatically run a rules engine to search structured and unstructured data for identification of moderate or severe heart valve disease using guideline-reported values. Incidence and progression of disease as well as compliance with a care pathway were assessed. RESULTS: In 2 health institutions in the United States 60,145 patients had 77,215 echocardiograms. Moderate or severe aortic stenosis (AS) was identified at a rate of 9.1% of patients (5474 and 6910 echocardiograms) in this population. The precision and accuracy of the algorithm for the detection of moderate or severe AS was 92.9% and 98.6%, respectively. Thirty-five percent of patients (441/1265) with moderate stenosis and a subsequent echocardiogram progressed to severe stenosis (mean interval, 358 days). In 1 sample 70.3% of moderate AS patients lacked a 6-month echocardiogram or appointment. The platform enabled 100% accountability for all patients with severe AS. CONCLUSIONS: A rules-based software program enhances detection of heart valve disease and can be used to measures disease progression and care pathway compliance.

Effects of Continuous Irrigation During Burring on Thermal Necrosis and Fusion Strength in a Rabbit Arthrodesis Model.

BACKGROUND: High-speed burring used to prepare bony surfaces during arthrodesis procedures can increase heat generation that may impede healing and fusion. Irrigation during burring has the potential to improve early healing of burred bone surfaces and result in a stronger fusion mass. The purpose of this study was to determine the effects of continuous irrigation during burring on thermal necrosis and fusion strength in an in vivo arthrodesis animal model. METHODS: A small joint rabbit ulnohumeral arthrodesis model was developed and utilized in 16 New Zealand white rabbits. Joints were prepared and contoured using a high-speed cutting burr and fixed in compression with crossed screws to obtain fusion. Prepared bony surfaces were either irrigated (n = 8) with chilled 6°C (43°F) saline or not irrigated (n = 8). Specimens were harvested, radiographed, mechanically tested for torque to failure and stiffness, and evaluated for histology. RESULTS: Fusion rate was 100% (8/8) when joints were irrigated during burring and 75% (6/8) when joints were not irrigated (P = .45). Mechanical testing showed a mean torque to failure of 0.85 Nm and 0.72 Nm in irrigated and nonirrigated specimens, respectively (P = .57). Histology showed evidence of less mature osseous formation in nonirrigated specimens compared to irrigated specimens. CONCLUSION: There was an overall trend toward decreased fusion rate and lower fusion mass strength in nonirrigated fusion specimens compared with those treated with chilled irrigation during bone preparation. CLINICAL RELEVANCE: Continuous chilled irrigation during bone preparation with burring may have a positive effect on fusion rate and fusion mass strength for arthrodesis procedures.