About

Kun Shan Carolyn Lee is a Professor of the Practice of Asian and Middle Eastern Studies at Duke University, a position she has held since 2014. Her research interests include content-based instruction (CBI), second language acquisition, experiential learning, sociocultural theory, study abroad education, and intercultural competence. Since joining Duke in 1995, she has worked to develop a dual-track curriculum that serves both traditional foreign language learners and bilingual learners, while also strengthening connections between the on-campus curriculum and the Duke Study in China program, which she was involved with from 1982 to 2021. Her recent publications focus on collaborative program development and creating teaching materials that promote cross-cultural communication through the study of cultural values and critical incidents. Currently, she is developing courses in classical Chinese philosophy, exploring Confucian and Daoist traditions, along with instructional resources for second-language learners, informed by the Cultures and Languages Across the Curriculum (CLAC) model and community-engaged learning.

Research topics

• Cardiology
• Internal medicine
• Medicine
• Surgery
• Pharmacology

Selected publications

• Prognostic Impact of Sinus Rhythm in Atrial Fibrillation Patients: Separating Rhythm Outcomes From Randomized Strategy Findings From the CABANA Trial

  Circulation Arrhythmia and Electrophysiology · 2024-04-17 · 16 citations

  article

  BACKGROUND: Clinically detected atrial fibrillation (AF) is associated with a significant increase in mortality and other adverse cardiovascular events. Since the advent of effective methods for AF rhythm control, investigators have attempted to determine how much these adverse prognostic AF effects could be mitigated by the restoration of sinus rhythm (SR) and whether the method used mattered. METHODS: The CABANA trial (Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation) randomized 2204 AF patients to ablation versus drug therapy, of which 1240 patients were monitored in follow-up using the CABANA ECG rhythm monitoring system. To assess the prognostic benefits of SR, we performed a prespecified analysis using Cox survival modeling with heart rhythm as a time-dependent variable and randomized treatment group as a stratification factor. RESULTS: In the 1240 patient study cohort, 883 (71.2%) had documented AF at some point during their postblanking follow-up. Among the 883 patients, 671 (76.0%) experienced AF within the first year of postblanking follow-up, and 212 (24.0%) experienced their first AF after ≥1 year of postblanking follow-up. The primary CABANA end point (death, disabling stroke, serious bleeding, or cardiac arrest) occurred in 95 (10.8%) of the 883 patients with documented AF and in 29 (8.1%) of the 357 patients with no AF recorded during follow-up. In multivariable time-dependent analysis, the presence of SR (compared with non-SR) was associated with a significantly reduced risk of the primary end point (adjusted hazard ratio, 0.57 [95% CI, 0.38–0.85]; P =0.006; independent of treatment strategy [ablation versus drugs]). Corresponding results for all-cause mortality were adjusted hazard ratio of 0.59 [95% CI, 0.35–1.01]; P =0.053). CONCLUSIONS: In patients in the CABANA trial with detailed long-term rhythm follow-up, increased time in SR was associated with a clinically consequential decrease in mortality and other adverse prognostic events. The predictive value of SR was independent of the therapeutic approach responsible for reducing the burden of detectable AF. REGISTRATION: URL: https://clinicaltrials.gov ; Unique Identifier: NCT00911508

  PublisherDOI

• Regional differences in outcomes with ablation versus drug therapy for atrial fibrillation: Results from the CABANA trial

  American Heart Journal · 2024-02-01 · 1 citations

  articleOpen access
  PublisherOA PDFDOI

• PO-02-118 A PRELIMINARY REPORT OF A LARGE DATAMART PILOT STUDY DETAILING OUTCOMES OF ATRIAL FIBRILLATION ABLATION IN HFPEF PATIENTS

  Heart Rhythm · 2024-05-01

  articleOpen access
  PublisherOA PDFDOI

• Effects of Ablation Versus Drug Therapy on Quality of Life by Sex in Atrial Fibrillation: Results From the CABANA Trial

  Journal of the American Heart Association · 2023-01-23 · 17 citations

  articleOpen access

  Background Women with atrial fibrillation (AF) demonstrate more AF-related symptoms and worse quality of life (QOL). Whether increased use of ablation in women reduces sex-related QOL differences is unknown. Sex-related outcomes for ablation versus drug therapy was a prespecified analysis in the CABANA (Catheter Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation) trial. Methods and Results Symptoms were assessed periodically over 60 months with the Mayo AF-Specific Symptom Inventory (MAFSI) frequency score, and QOL was assessed with the Atrial Fibrillation Effect on Quality of Life (AFEQT) summary and component scores. Women had lower baseline QOL scores than men (mean AFEQT scores 55.9 and 65.6, respectively). Ablation patients improved more than drug therapy patients with similar treatment effect by sex: AFEQT 12-month mean adjusted treatment difference in women 6.1 points (95% CI, 3.5-8.6) and men 4.9 points (95% CI, 3.0-6.9). Participants with baseline AFEQT summary scores <70 had greater QOL improvement, with a mean treatment difference at 12 months of 7.6 points for women (95% CI, 4.3-10.9) and 6.4 points for men (95% CI, 3.3-9.4). The mean adjusted difference in MAFSI frequency score between women randomized to ablation versus drug therapy at 12 months was -2.5 (95% CI, -3.4 to -1.6); for men, the difference was -1.3 (95% CI, -2.0 to -0.6). Conclusions Compared with drug therapy for AF, ablation resulted in more QOL improvement in both sexes, primarily driven by improvements in those with lower baseline QOL. Ablation did not eliminate the AF-related QOL gap between women and men. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00911508.

  PublisherOA PDFDOI

• Influence of atrial fibrillation type on outcomes of ablation vs. drug therapy: results from CABANA

  EP Europace · 2022-04-15 · 35 citations

  articleOpen access

  AIMS: Influence of atrial fibrillation (AF) type on outcomes seen with catheter ablation vs. drug therapy is incompletely understood. This study assesses the impact of AF type on treatment outcomes in the Catheter Ablation vs. Antiarrhythmic Drug Therapy for Atrial Fibrillation Trial (CABANA). METHODS AND RESULTS: CABANA randomized 2204 patients ≥65 years old or <65 with at least one risk factor for stroke to catheter ablation or drug therapy. Of these, 946 (42.9%) had paroxysmal AF (PAF), 1042 (47.3%) had persistent AF (PersAF), and 215 (9.8%) had long-standing persistent AF (LSPAF) at baseline. The primary endpoint was a composite of death, disabling stroke, serious bleeding, or cardiac arrest. Symptoms were measured with the Mayo AF-Specific Symptom Inventory (MAFSI), and quality of life was measured with the Atrial Fibrillation Effect on Quality of Life (AFEQT). Comparisons are reported by intention to treat. Compared with drug therapy alone, catheter ablation produced a 19% relative risk reduction in the primary endpoint for PAF {adjusted hazard ratio [aHR]: 0.81 [95% confidence interval (CI): 0.50, 1.30]}, and a 17% relative reduction for PersAF (aHR: 0.83, 95% CI: 0.56, 1.22). For LSPAF, the ablation relative effect was a 7% reduction (aHR: 0.93, 95% CI: 0.36, 2.44). Ablation was more effective than drug therapy at reducing first AF recurrence in all AF types: by 51% for PAF (aHR: 0.49, 95% CI: 0.39, 0.62), by 47% for PersAF (aHR: 0.53, 95% CI: 0.43,0.65), and by 36% for LSPAF (aHR 0.64, 95% CI 0.41,1.00). Ablation was associated with greater improvement in symptoms, with the mean difference between groups in the MAFSI frequency score favouring ablation over 5 years of follow-up in all subgroups: PAF had a clinically significant -1.9-point difference (95% CI: -1.2 to -2.6); PersAF a -0.9 difference (95% CI: -0.2 to -1.6); LSPAF a clinically significant difference of -1.6 points (95% CI: -0.1 to -3.1). Ablation was also associated with greater improvement in quality of life in all subgroups, with the AFEQT overall score in PAF patients showing a clinically significant 5.3-point improvement (95% CI: 3.3 to 7.3) over drug therapy alone over 5 years of follow-up, PersAF a 1.7-point difference (95% CI: 0.0 to 3.7), and LSPAF a 3.1-point difference (95% CI: -1.6 to 7.8). CONCLUSION: Prognostic treatment effects of catheter ablation compared with drug therapy on the primary and major secondary clinical endpoints did not differ consequentially by AF subtype. With regard to decreases in AF recurrence and improving quality of life, ablation was more effective than drug therapy in all three AF type subgroups. CLINICALTRIALS.GOV IDENTIFIER: NCT00911508.

  PublisherOA PDFDOI

• Cost-Effectiveness of Catheter Ablation Versus Antiarrhythmic Drug Therapy in Atrial Fibrillation: The CABANA Randomized Clinical Trial

  Circulation · 2022 · 69 citations

  • Medicine
  • Cardiology
  • Internal medicine

  BACKGROUND: In the CABANA trial (Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation), catheter ablation did not significantly reduce the primary end point of death, disabling stroke, serious bleeding, or cardiac arrest compared with drug therapy by intention-to-treat, but did improve the quality of life and freedom from atrial fibrillation recurrence. In the heart failure subgroup, ablation improved both survival and quality of life. Cost-effectiveness was a prespecified CABANA secondary end point. METHODS: Medical resource use data were collected for all CABANA patients (N=2204). Costs for hospital-based care were assigned using prospectively collected bills from US patients (n=1171); physician and medication costs were assigned using the Medicare Fee Schedule and National Average Drug Acquisition Costs, respectively. Extrapolated life expectancies were estimated using age-based survival models. Quality-of-life adjustments were based on EQ-5D-based utilities measured during the trial. The primary outcome was the incremental cost-effectiveness ratio, comparing ablation with drug therapy on the basis of intention-to-treat, and assessed from the US health care sector perspective. RESULTS: $100 000 per QALY gained. With no quality-of-life/utility adjustments, the incremental cost-effectiveness ratio was $183 318 per LY gained. CONCLUSIONS: Catheter ablation of atrial fibrillation was economically attractive compared with drug therapy in the CABANA Trial overall at present benchmarks for health care value in the United States on the basis of projected incremental QALYs but not LYs alone.

  PublisherOA PDFDOI

• CABANA: underpowered and with detrimental protocol changes: is ‘ablation salvation’?—Reply by the authors of the CABANA trial

  EP Europace · 2021-09-08

  letterSenior author

  We thank Drs Providencia, Papoila, and Adragao for their interest in the important CABANA trial. We briefly respond to each of their points.1 (1) The authors argue that ‘the ITT analysis in CABANA should have been reported as inconclusive to assess its primary endpoint’. They evidently overlooked the description of the study results in the first paragraph of the Discussion section of the CABANA publication,2 which uses the exact language being advocated, namely ‘the trial primary ITT statistical comparison is inconclusive’. (2) The authors argue that the secondary endpoint of all-cause mortality or cardiovascular hospitalization should be given more emphasis. We agree that this is an important and clinically relevant outcome. We provided detailed data for the comparison of the randomized treatment groups with respect to that endpoint in the text of the primary CABANA publication2 (both in the Results section and Discussion section) as well as...

  PublisherDOI

• Renal function and coronary bypass surgery in patients with ischemic heart failure

  Journal of Thoracic and Cardiovascular Surgery · 2020-04-03 · 11 citations

  articleOpen access
  PublisherOA PDFDOI

• Differential Outcomes With Edetate Disodium-Based Treatment Among Stable Post Anterior vs. Non-Anterior Myocardial Infarction Patients

  Cardiovascular revascularization medicine · 2020-04-07 · 3 citations

  articleSenior author
  PublisherDOI

• Possible differential benefits of edetate disodium in post-myocardial infarction patients with diabetes treated with different hypoglycemic strategies in the Trial to Assess Chelation Therapy (TACT)

  Journal of Diabetes and its Complications · 2020-05-07 · 6 citations

  articleOpen access
  PublisherOA PDFDOI

Recent grants

• NIH Grant U01HL089786

  NIH · $10.7M · 2017

• NIH Grant U01HL084904

  NIH · $19.8M · 2012

• NIH Grant U01HL055297

  NIH · $5.1M · 2005

• NIH Grant U01HL053973

  NIH · $3.4M · 2001

• NIH Grant R01HL098236

  NIH · $5.0M · 2015

Frequent coauthors

• Daniel B. Mark

  1067 shared

• Alfred E. Buxton

  Beth Israel Deaconess Medical Center

  666 shared

• Gail E. Hafley

  575 shared

• Gust H. Bardy

  571 shared

• Anne S. Hellkamp

  Clinical Research Institute

  518 shared

• Eric J. Topol

  Scripps Clinic

  506 shared

• Jill Anderson

  Inspire Institute

  490 shared

• Jeanne E. Poole

  University of Washington

  485 shared

Awards & honors

• Department of Defense Project GO: ROTC Chinese Language Init…