Scholars@Duke
Robert William Harrison

Robert William Harrison

Associate Professor of Medicine
Medicine, Cardiology
robert.w.harrison@duke.edu
2301 Erwin Rd, DUMC 7th Floor, Rm 7403A, Durham, NC 27710
2301 Erwin Rd, DUMC 7th Floor, Rm 7403A, Durham, NC 27710

Selected Publications

Participant Engagement and Preference Study for Clinical Outcomes Associated With Atrial Fibrillation: The PEARL-AF Study.

Journal Article JACC Adv · December 2024 BACKGROUND: Quantifying patients' preferences for health outcomes associated with atrial fibrillation (AF) and its treatments offers a replicable approach to considering the patient perspective in regulatory decision-making. OBJECTIVE: The authors conducte ... Full text Link to item Cite

Remote Follow-up in a Heart Failure Pragmatic Trial: Insights From the CONNECT-HF.

Journal Article J Card Fail · November 2024 BACKGROUND: Randomized controlled trials typically require study-specific visits, which can burden participants and sites. Remote follow-up, such as centralized call centers for participant-reported or site-reported, holds promise for reducing costs and en ... Full text Link to item Cite

Characteristics and Outcomes of Adults With Congenital Heart Disease in the Cardiac Intensive Care Unit.

Journal Article JACC Adv · August 2024 BACKGROUND: Little is known regarding the characteristics, treatment patterns, and outcomes in patients with adult congenital heart disease (ACHD) admitted to cardiac intensive care units (CICUs). OBJECTIVES: The authors sought to better define the contemp ... Full text Link to item Cite

Mobile Application-Based Communication Facilitation Platform for Family Members of Critically Ill Patients: A Randomized Clinical Trial.

Journal Article JAMA Netw Open · January 2, 2024 IMPORTANCE: Unmet and racially disparate palliative care needs are common in intensive care unit (ICU) settings. OBJECTIVE: To test the effect of a primary palliative care intervention vs usual care control both overall and by family member race. DESIGN, S ... Full text Link to item Cite

Characteristics, therapies, and outcomes of In-Hospital vs Out-of-Hospital cardiac arrest in patients presenting to cardiac intensive care units: From the critical care Cardiology trials network (CCCTN).

Journal Article Resuscitation · February 2023 BACKGROUND: Cardiac arrest (CA) is a common reason for admission to the cardiac intensive care unit (CICU), though the relative burden of morbidity, mortality, and resource use between admissions with in-hospital (IH) and out-of-hospital (OH) CA is unknown ... Full text Link to item Cite

Trajectories of Palliative Care Needs in the ICU and Long-Term Psychological Distress Symptoms.

Journal Article Crit Care Med · January 1, 2023 OBJECTIVES: While palliative care needs are assumed to improve during ICU care, few empiric data exist on need trajectories or their impact on long-term outcomes. We aimed to describe trajectories of palliative care needs during ICU care and to determine i ... Full text Link to item Cite

Addressing Unmet Needs Among Family Members of Critically Ill Patients: The ICUconnect Randomized Clinical Trial

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · 2023 Cite

Palliative care phenotypes among critically ill patients and family members: intensive care unit prospective cohort study.

Journal Article BMJ Support Palliat Care · September 27, 2022 OBJECTIVE: Because the heterogeneity of patients in intensive care units (ICUs) and family members represents a challenge to palliative care delivery, we aimed to determine if distinct phenotypes of palliative care needs exist. METHODS: Prospective cohort ... Full text Link to item Cite

Assessment of Clinical Palliative Care Trigger Status vs Actual Needs Among Critically Ill Patients and Their Family Members.

Journal Article JAMA Netw Open · January 4, 2022 IMPORTANCE: Palliative care consultations in intensive care units (ICUs) are increasingly prompted by clinical characteristics associated with mortality or resource utilization. However, it is not known whether these triggers reflect actual palliative care ... Full text Link to item Cite

Effect of a Hospital and Postdischarge Quality Improvement Intervention on Clinical Outcomes and Quality of Care for Patients With Heart Failure With Reduced Ejection Fraction: The CONNECT-HF Randomized Clinical Trial.

Journal Article JAMA · July 27, 2021 IMPORTANCE: Adoption of guideline-directed medical therapy for patients with heart failure is variable. Interventions to improve guideline-directed medical therapy have failed to consistently achieve target metrics, and limited data exist to inform efforts ... Full text Link to item Cite

Improving racial disparities in unmet palliative care needs among intensive care unit family members with a needs-targeted app intervention: The ICUconnect randomized clinical trial.

Journal Article Contemp Clin Trials · April 2021 INTRODUCTION: The technologies used to treat the millions who receive care in intensive care unit (ICUs) each year have steadily advanced. However, the quality of ICU-based communication has remained suboptimal, particularly concerning for Black patients a ... Full text Link to item Cite

Cardiac Myosin Activation with Omecamtiv Mecarbil in Systolic Heart Failure.

Journal Article N Engl J Med · January 14, 2021 BACKGROUND: The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS: We randomly assigne ... Full text Link to item Cite

Palliative Care Triggers vs Actual Unmet Needs Among ICU Patients and Family Members

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · 2021 Cite

Care Optimization Through Patient and Hospital Engagement Clinical Trial for Heart Failure: Rationale and design of CONNECT-HF.

Journal Article Am Heart J · February 2020 Many therapies have been shown to improve outcomes for patients with heart failure (HF) in controlled settings, but there are limited data available to inform best practices for hospital and post-discharge quality improvement initiatives. The CONNECT-HF st ... Full text Link to item Cite

Risk Categorization Using New American College of Cardiology/American Heart Association Guidelines for Cholesterol Management and Its Relation to Alirocumab Treatment Following Acute Coronary Syndromes.

Journal Article Circulation · November 5, 2019 BACKGROUND: The 2018 US cholesterol management guidelines recommend additional lipid-lowering therapies for secondary prevention in patients with low-density lipoprotein cholesterol ≥70 mg/dL or non-high-density lipoprotein cholesterol ≥100 mg/dL despite m ... Full text Link to item Cite

Alirocumab Reduces Total Hospitalizations and Increases Days Alive and Out of Hospital in the ODYSSEY OUTCOMES Trial.

Journal Article Circ Cardiovasc Qual Outcomes · November 2019 BACKGROUND: In ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab), alirocumab was compared with placebo, added to high-intensity or maximum tolerated statin treatment after acute coron ... Full text Link to item Cite

Alirocumab in Patients With Polyvascular Disease and Recent Acute Coronary Syndrome: ODYSSEY OUTCOMES Trial.

Journal Article J Am Coll Cardiol · September 3, 2019 BACKGROUND: Patients with acute coronary syndrome (ACS) and concomitant noncoronary atherosclerosis have a high risk of major adverse cardiovascular events (MACEs) and death. The impact of lipid lowering by proprotein convertase subtilisin-kexin type 9 inh ... Full text Link to item Cite

Effects of alirocumab on cardiovascular and metabolic outcomes after acute coronary syndrome in patients with or without diabetes: a prespecified analysis of the ODYSSEY OUTCOMES randomised controlled trial.

Journal Article Lancet Diabetes Endocrinol · August 2019 BACKGROUND: After acute coronary syndrome, diabetes conveys an excess risk of ischaemic cardiovascular events. A reduction in mean LDL cholesterol to 1·4-1·8 mmol/L with ezetimibe or statins reduces cardiovascular events in patients with an acute coronary ... Full text Link to item Cite

Effect of Alirocumab on Mortality After Acute Coronary Syndromes.

Journal Article Circulation · July 9, 2019 BACKGROUND: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrom ... Full text Link to item Cite

Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation.

Journal Article N Engl J Med · April 18, 2019 BACKGROUND: Appropriate antithrombotic regimens for patients with atrial fibrillation who have an acute coronary syndrome or have undergone percutaneous coronary intervention (PCI) are unclear. METHODS: In an international trial with a two-by-two factorial ... Full text Link to item Cite

Rivaroxaban in Acute Coronary Syndromes: We Have a Compass and an Atlas, But Where Are We Headed?

Journal Article J Am Heart Assoc · March 5, 2019 See Article by Gibson et al. ... Full text Link to item Cite

Frequency, Regional Variation, and Predictors of Undetermined Cause of Death in Cardiometabolic Clinical Trials: A Pooled Analysis of 9259 Deaths in 9 Trials.

Journal Article Circulation · February 12, 2019 BACKGROUND: Modern cardiometabolic clinical trials often include cardiovascular death as a component of a composite primary outcome, requiring central adjudication by a clinical events committee to classify cause of death. However, sometimes the cause of d ... Full text Link to item Cite

Alirocumab Reduces Total Nonfatal Cardiovascular and Fatal Events: The ODYSSEY OUTCOMES Trial.

Journal Article J Am Coll Cardiol · February 5, 2019 BACKGROUND: The ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial compared alirocumab with placebo, added to high-intensity or maximum-tolerated statin treatment, after acute co ... Full text Link to item Cite

The East-West late lumen loss study: Comparison of angiographic late lumen loss between Eastern and Western drug-eluting stent study cohorts.

Journal Article Am Heart J · December 2018 BACKGROUND: Regulatory decisions approving new coronary drug-eluting stent (DES) require mechanistic observations of angiographic late lumen loss (LLL). Patient safety and device approval times could be enhanced if angiographic follow-up data were found to ... Full text Link to item Cite

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial.

Journal Article Lancet · October 27, 2018 BACKGROUND: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine t ... Full text Link to item Cite

UNDETERMINED CAUSE OF DEATH: A POOLED ANALYSIS OF 9,307 DEATHS ACROSS 9 CARDIOVASCULAR TRIALS

Conference Journal of the American College of Cardiology · March 2018 Full text Cite

Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial.

Journal Article Lancet · January 20, 2018 BACKGROUND: Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications. METHODS: This was a multicentre, double-blind, randomised placebo-contr ... Full text Link to item Cite

Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial.

Journal Article Lancet · January 20, 2018 BACKGROUND: Coronary artery disease is a major cause of morbidity and mortality worldwide, and is a consequence of acute thrombotic events involving activation of platelets and coagulation proteins. Factor Xa inhibitors and aspirin each reduce thrombotic e ... Full text Link to item Cite

Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease.

Journal Article N Engl J Med · October 5, 2017 BACKGROUND: We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. METHODS: In this double-blind trial, we randomly assigned 27,395 participants with stable ... Full text Link to item Cite

Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes.

Journal Article N Engl J Med · September 28, 2017 BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, ... Full text Open Access Link to item Cite

Levosimendan in Patients with Left Ventricular Dysfunction Undergoing Cardiac Surgery.

Journal Article N Engl J Med · May 25, 2017 BACKGROUND: Levosimendan is an inotropic agent that has been shown in small studies to prevent or treat the low cardiac output syndrome after cardiac surgery. METHODS: In a multicenter, randomized, placebo-controlled, phase 3 trial, we evaluated the effica ... Full text Link to item Cite

Levosimendan in patients with left ventricular systolic dysfunction undergoing cardiac surgery on cardiopulmonary bypass: Rationale and study design of the Levosimendan in Patients with Left Ventricular Systolic Dysfunction Undergoing Cardiac Surgery Requiring Cardiopulmonary Bypass (LEVO-CTS) trial.

Journal Article Am Heart J · December 2016 BACKGROUND: Low cardiac output syndrome is associated with increased mortality and occurs in 3% to 14% of patients undergoing cardiac surgery on cardiopulmonary bypass (CPB). Levosimendan, a novel calcium sensitizer and KATP channel activator with inotropi ... Full text Link to item Cite

Rationale and design of the East-West late lumen loss study: Comparison of late lumen loss between Eastern and Western drug-eluting stent study cohorts.

Journal Article Am Heart J · December 2016 BACKGROUND: The contemporary evaluation of novel drug-eluting stents (DES) includes mechanistic observations that characterize postdeployment stent behavior. Quantification of late lumen loss due to neointimal hyperplasia 8-13 months after stent implantati ... Full text Link to item Cite

Trends in Bare-Metal Stent Use in the United States in Patients Aged ≥65 Years (from the CathPCI Registry).

Journal Article Am J Cardiol · October 1, 2016 In 2006, the United States (US) Food and Drug Administration published advisory highlighting concerns for late drug-eluting stent thrombosis; its impact on US bare-metal stent (BMS) utilization is unknown. We examined rates of BMS use among Medicare patien ... Full text Link to item Cite

Association of hospital myocardial infarction volume with adherence to American College of Cardiology/American Heart Association performance measures: Insights from the National Cardiovascular Data Registry.

Journal Article Am Heart J · August 2016 BACKGROUND: Adherence to guideline-based therapy improves patient outcomes after acute myocardial infarction (AMI) and hospital AMI volume is associated with reperfusion care, but the extent hospital AMI volume is associated with overall guideline adherenc ... Full text Link to item Cite

Lost to Follow-up and Withdrawal of Consent in Contemporary Global Cardiovascular Randomized Clinical Trials.

Journal Article Crit Pathw Cardiol · December 2015 BACKGROUND: High rates of lost to follow-up (LTFU) and withdrawal of consent (WDC) may introduce uncertainty around the validity of the results of clinical trials. We sought to better understand published proportions of LTFU and WDC in large contemporary c ... Full text Link to item Cite

A randomized, double-blind, placebo-controlled trial to evaluate the safety and effectiveness of intracoronary application of a novel bioabsorbable cardiac matrix for the prevention of ventricular remodeling after large ST-segment elevation myocardial infarction: Rationale and design of the PRESERVATION I trial.

Journal Article Am Heart J · November 2015 Postinfarction left ventricular (LV) remodeling can result in chronic heart failure and functional impairment. Although pharmacological strategies for established heart failure can be beneficial, preventing remodeling remains a challenge. Injectable bioabs ... Full text Link to item Cite

Effect of Sitagliptin on Cardiovascular Outcomes in Type 2 Diabetes.

Journal Article N Engl J Med · July 16, 2015 BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind st ... Full text Link to item Cite

Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study.

Journal Article Am Heart J · April 2015 BACKGROUND: Mental stress-induced myocardial ischemia (MSIMI) is common in patients with ischemic heart disease (IHD) and associated with a poorer cardiovascular prognosis. Platelet hyperactivity is an important factor in acute coronary syndrome. This stud ... Full text Open Access Link to item Cite

Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study

Journal Article American Heart Journal · April 1, 2015 Background Mental stress-induced myocardial ischemia (MSIMI) is common in patients with ischemic heart disease (IHD) and associated with a poorer cardiovascular prognosis. Platelet hyperactivity is an important factor in acute coronary syndrome. This study ... Full text Cite

Effect of levosimendan on survival and adverse events after cardiac surgery: a meta-analysis.

Journal Article J Cardiothorac Vasc Anesth · December 2013 OBJECTIVE: Left ventricular systolic dysfunction is associated with increased morbidity and mortality in patients undergoing cardiac surgery. The authors performed a meta-analysis investigating the effects of levosimendan in cardiac surgery patients with a ... Full text Link to item Cite

Incidence and outcomes of no-reflow phenomenon during percutaneous coronary intervention among patients with acute myocardial infarction.

Journal Article Am J Cardiol · January 15, 2013 Previous studies describing the no-reflow phenomenon in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) were largely confined to single-center studies or small registries. To better characterize the incid ... Full text Link to item Cite

To bridge or not to bridge: these are the questions.

Journal Article J Thromb Thrombolysis · July 2012 Full text Link to item Cite

Dynamic denitrosylation via S-nitrosoglutathione reductase regulates cardiovascular function.

Journal Article Proc Natl Acad Sci U S A · March 13, 2012 Although protein S-nitrosylation is increasingly recognized as mediating nitric oxide (NO) signaling, roles for protein denitrosylation in physiology remain unknown. Here, we show that S-nitrosoglutathione reductase (GSNOR), an enzyme that governs levels o ... Full text Link to item Cite

Clopidogrel and PPI interaction: clinically relevant or not?

Journal Article Curr Cardiol Rep · February 2012 Proton pump inhibitors and clopidogrel are commonly prescribed medications, both alone and in combination. In January of 2009 the US Food and Drug Administration and the European Medicines Agency issued warnings with regard to the concomitant use of clopid ... Full text Link to item Cite

Simulated microgravity produces attenuated baroreflex-mediated pressor, chronotropic, and inotropic responses in mice.

Journal Article Am J Physiol Heart Circ Physiol · August 2005 Whether myocardial contractile impairment contributes to orthostatic intolerance (OI) is controversial. Accordingly, we used transient bilateral carotid occlusion (TBCO) to compare the in vivo pressor, chronotropic, and inotropic responses (parts 1 and 2) ... Full text Link to item Cite

Critical role for the alpha-1B adrenergic receptor at the sympathetic neuroeffector junction.

Journal Article Hypertension · November 2004 The alpha-1 adrenergic receptors (alpha(1)ARs) are critical in sympathetically mediated vasoconstriction. The specific role of each alpha(1)AR subtype in regulating vasoconstriction remains highly controversial. Limited pharmacological studies suggest that ... Full text Link to item Cite

Disruption of leptin signaling contributes to cardiac hypertrophy independently of body weight in mice.

Journal Article Circulation · August 12, 2003 BACKGROUND: Whether left ventricular hypertrophy (LVH) in obesity results from increased hemodynamic load or altered neurohormonal signaling remains controversial. Dysregulation of leptin, a neurohormone essential to energy homeostasis, is implicated in th ... Full text Link to item Cite

Nitric oxide regulation of myocardial contractility and calcium cycling: independent impact of neuronal and endothelial nitric oxide synthases.

Journal Article Circ Res · June 27, 2003 The mechanisms by which nitric oxide (NO) influences myocardial Ca2+ cycling remain controversial. Because NO synthases (NOS) have specific spatial localization in cardiac myocytes, we hypothesized that neuronal NOS (NOS1) found in cardiac sarcoplasmic ret ... Full text Link to item Cite

Combined loss of neuronal and endothelial nitric oxide synthase causes premature mortality and age-related hypertrophic cardiac remodeling in mice.

Journal Article J Mol Cell Cardiol · June 2003 Deficiency of either neuronal nitric oxide synthase (NOS1) or endothelial nitric oxide synthase (NOS3) leads to cardiac hypertrophy in mice. Loss of both produces concentric left ventricular (LV) remodeling, in which increased wall thickness is accompanied ... Full text Link to item Cite

Nitric oxide regulates the heart by spatial confinement of nitric oxide synthase isoforms.

Journal Article Nature · March 21, 2002 Subcellular localization of nitric oxide (NO) synthases with effector molecules is an important regulatory mechanism for NO signalling. In the heart, NO inhibits L-type Ca2+ channels but stimulates sarcoplasmic reticulum (SR) Ca2+ release, leading to varia ... Full text Link to item Cite

Imbalance between xanthine oxidase and nitric oxide synthase signaling pathways underlies mechanoenergetic uncoupling in the failing heart.

Journal Article Circ Res · February 22, 2002 Inhibition of xanthine oxidase (XO) in failing hearts improves cardiac efficiency by an unknown mechanism. We hypothesized that this energetic effect is due to reduced oxidative stress and critically depends on nitric oxide synthase (NOS) activity, reflect ... Full text Link to item Cite

cGMP-independent inotropic effects of nitric oxide and peroxynitrite donors: potential role for nitrosylation.

Journal Article Am J Physiol Heart Circ Physiol · October 2000 Nitric oxide (NO) has concentration-dependent biphasic myocardial contractile effects. We tested the hypothesis, in isolated rat hearts, that NO cardiostimulation is primarily non-cGMP dependent. Infusion of 3-morpholinosydnonimine (SIN-1, 10(-5) M), which ... Full text Link to item Cite

beta(3)-adrenoceptor deficiency blocks nitric oxide-dependent inhibition of myocardial contractility.

Journal Article J Clin Invest · September 2000 The cardiac beta-adrenergic pathway potently stimulates myocardial performance, thereby providing a mechanism for myocardial contractile reserve. beta-Adrenergic activation also increases cardiac nitric oxide (NO) production, which attenuates positive inot ... Full text Link to item Cite

Relative contribution of preload and afterload to the reduction in cardiac output caused by nitric oxide synthase inhibition with L-N(G)-methylarginine hydrochloride 546C88.

Journal Article Crit Care Med · May 2000 OBJECTIVE: The nitric oxide synthase inhibitor L-N(G)-methylarginine hydrochloride (L-NMMA HC1 546C88) causes reductions in cardiac output (CO), a potential limitation to clinical application. This drop in CO exceeds that from phenylephrine at matched syst ... Full text Link to item Cite

Intravenous allopurinol decreases myocardial oxygen consumption and increases mechanical efficiency in dogs with pacing-induced heart failure.

Journal Article Circ Res · September 3, 1999 Allopurinol, an inhibitor of xanthine oxidase, increases myofilament calcium responsiveness and blunts calcium cycling in isolated cardiac muscle. We sought to extend these observations to conscious dogs with and without pacing-induced heart failure and te ... Full text Link to item Cite