Peaks Identified in Time of Year, Day of Week for Assault-Related Injury Visits to Emergency Departments

Violence is the third leading cause of death in the U.S. and preventing assault-related injuries is a priority in public health and clinical medicine. A study led by investigators at the Brigham examined variations in month and day of the week of injuries that led to Emergency Department visits nationally. Over 13 years, there were more than 21 million injury visits due to assault. Assault-related visits peaked on late Saturday or early Sunday. Visits peaked in the spring and winter for interpersonal violence.

“We aimed to fill in a gap in our knowledge about assault patterns by using a nationally representative dataset of ED visits for assaults across the entire country,” said corresponding author Bharti Khurana, MD, of the Department of Radiology. “We hope that these findings will help to inform resource planning for management and prevention strategies.”

Read more in the The Journal of Biological and Medical Rhythm Research.

Hypertensive Pregnancy Disorders Linked to Higher Risk of Cardiac Events Later in Life

Women with hypertensive disorders of pregnancy (HDP), such as gestational hypertension or preeclampsia, are at a higher risk for developing cardiovascular disease (CVD) later in life. Although these conditions are recognized as risk factors by the American Heart Association and American College of Cardiology, the extent of the relationship and how to intervene to reduce risk has remained unclear. To investigate the relationship between a hypertensive pregnancy and the onset of CVD, researchers at the Brigham followed 60,739 mothers for incident CVD after their first birth using data from the Nurses’ Health Study II. In doing so, they discovered that women with HDP had a 63 percent higher rate of CVD events compared to women who had normal blood pressure during pregnancy. The increased risk of CVD was not explained by shared risk factors, including pre-pregnancy body mass index, smoking, and parental history of CVD. The researchers also found that the majority of the increased risk (64 percent) was jointly accounted for by the subsequent development of chronic hypertension, hypercholesterolemia, type 2 diabetes, and/or weight gain after first birth. These established CVD risk factors accounted for an even higher proportion of the CVD risk among women with gestational hypertension (84 percent) than among those with preeclampsia (57 percent). Researchers also found that the overall relationship between HDP and CVD appeared to be driven by underlying relationships between preeclampsia and coronary heart disease, and between gestational hypertension and stroke.

“Women with a history of gestational hypertension or preeclampsia should be informed that they are at increased risk for cardiovascular disease events. Screening and prevention efforts in those with a history of gestational hypertension or preeclampsia should target the established cardiovascular disease risk factors of chronic hypertension, hypercholesterolemia, type 2 diabetes mellitus, and overweight/obesity,” said study author Jennifer J. Stuart, ScD, of the Division of Women’s Health. “We are eager to continue investigating strategies to reduce long-term cardiovascular risk following hypertensive pregnancy and to empower and equip these patients to improve their cardiovascular health in the years and decades after delivery.”

Read more in Journal of the American College of Cardiology.

Study Finds Markups in Prices of Cancer Therapies, Lack of Price Transparency Across Cancer Centers

U.S. spending on cancer therapies has risen sharply in recent years. Researchers from Brigham and Women’s Hospital analyzed data on drug pricing from 61 National Cancer Institute-designated cancer centers to determine how much U.S. hospitals mark up the price of cancer therapies for patients with private health insurance. The team conducted a cross-sectional study of the 25 most common injectable or infusible cancer therapies. The researchers report more than half of cancer centers did not publicly disclose payer-specific prices, despite federal regulation requirements. Among those that did, many substantially marked up drug prices for patients with private insurance, and markups ranged from approximately 120 percent to 630 percent of the cost for the hospital to acquire the drug. They also found that negotiated prices varied between payers even at the same cancer center.

“Our study indicates that there is both significant markup and variation in negotiated prices for cancer therapies. Policy changes may be helpful to prevent excessive hospital price markups and reduce the financial burden of cancer treatment for patients,” said corresponding author Roy Xiao, MD, MS, a resident in the Harvard Medical School/Mass Eye and Ear/Mass General Brigham Residency Program in Otolaryngology–Head & Neck Surgery.

Read more in JAMA Internal Medicine.

Physicians Working in Physician-Owned Practices More Likely to Be Satisfied with Their Electronic Health Records

Despite having benefits for information exchange and patient safety, electronic health records (EHR) have had drawbacks for daily practice and the physician experience. Some studies suggest that physicians practicing in solo or physician-owned practices have lower burnout, but it’s not clear how practice ownership influences doctors’ experiences with the EHR. To answer this question, researchers from Brigham and Women’s Hospital and collaborators used data from the National Electronic Health Records Survey to examine the relationship between physician ownership of their practices and satisfaction with the EHR.

Using a sample representing 301,603 physicians, they found that physicians working in physician-owned practices were significantly more likely to be satisfied with their EHRs (68.1 percent of those in physician-owned practices reported being satisfied vs. 58.5 percent of those in non-physician-owned practices). Those in physician-owned practices were significantly more likely to say that they had staff support for documentation (36.0 percent vs. 26.7 percent) and that time spent on documentation was appropriate (44.8 percent vs. 32.4 percent). These differences partially, but not completely, explained differences in EHR satisfaction for doctors practicing in physician versus non-physician owned practices.

“Our study suggests that multiple factors associated with physician ownership likely play a role in the greater EHR satisfaction seen among those practicing in physician-owned practices. Future work should examine the other cultural, practice structure, and EHR design factors that influence the differences in satisfaction we have identified,” said Lisa S. Rotenstein, MD MBA, of the Division of General Internal Medicine. “This is particularly important given data showing a relationship between time on the EHR and burnout and evidence that fewer doctors across the U.S. are working in physician-owned practices.”

Read more in JAMA Network Open.

New Targets Uncovered for Treating Hypertension-Related Fibrosis

Elevated blood pressure can cause a condition known as perivascular fibrosis, where the outside wall of a blood vessel thickens due to connective tissue build-up. Although recent data has suggested that the thickening is due to the activation of T-cells, the defenders of our immune system, the underlying mechanisms are not well known. To further investigate how fibrosis develops, researchers at the Brigham profiled the peripheral blood mononuclear immune cells from patients with high blood pressure. In doing so, they discovered two relevant mediators of fibrosis and potential therapeutic targets: a transcription factor, KLF10, and a cytokine, IL-9. When researchers injected mice with IL-9 neutralizing antibodies, they observed a reversal of the fibrosis and prevention of organ dysfunction, building a stronger case for targeting this pathway.

“Given that hypertension contributes to a considerable number of cardiovascular-related deaths globally, we wanted to look into the depths of perivascular fibrosis for potential drug targets,” said senior author Mark W. Feinberg, MD, of the Division of Cardiovascular Medicine. “We are eager to continue investigating KLF10-IL-9 signaling to hopefully create effective treatments for vascular diseases.”

Read more in Circulation Research.