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van Apeldoorn JAN, Roozekrans AK, Harskamp RE, Richard E, Agyemang C, Moll van Charante EP. General practitioners' views on cardiovascular prevention for ethnic minorities-a qualitative study in the Netherlands. Fam Pract 2024; 41:340-348. [PMID: 36994852 PMCID: PMC11167987 DOI: 10.1093/fampra/cmad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES While ethnic minorities in Europe are disproportionally affected by cardiovascular disease (CVD), little is known about how general practitioners (GPs) perceive differences in risk or care needs across ethnic minority groups. Therefore, we explored GPs' views on whether ethnicity influences cardiovascular risk, whether a culturally sensitive approach is warranted, on potential barriers in the provision of such care, and to find potential opportunities to improve cardiovascular prevention for these groups. METHODS We conducted a qualitative study by interviewing GPs practising in The Netherlands. The interviews were semistructured, audio-recorded, and analysed by 2 researchers using thematic analysis. RESULTS We interviewed 24 Dutch GPs (50% male). GPs' views on the impact of ethnicity on CVD risk varied widely, yet it was generally recognized as a relevant factor in cardiovascular prevention for most minority groups, prompting earlier case-finding of high-risk patients. While GPs were aware of sociocultural differences, they emphasized an individualized approach. Perceived limitations were language barriers and unfamiliarity with sociocultural customs, leading to a need for continuing medical education on culturally sensitive care and reimbursement of telephone interpreting services. CONCLUSION Dutch GPs have differing views on the role of ethnicity in evaluating and treating cardiovascular risk. Despite these differences, they emphasized the importance of a personalized and culturally sensitive approach during patient consultations and expressed a need for continuing medical education. Additional research on how ethnicity influences CVD risk may strengthen cardiovascular prevention in increasingly diverse primary care populations.
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Affiliation(s)
- Joshua A N van Apeldoorn
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
- Department of General Practice, Amsterdam Public Health Research Institute and Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Alet K Roozekrans
- Department of General Practice, Amsterdam Public Health Research Institute and Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ralf E Harskamp
- Department of General Practice, Amsterdam Public Health Research Institute and Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Edo Richard
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Eric P Moll van Charante
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
- Department of General Practice, Amsterdam Public Health Research Institute and Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Dalmau Llorca MR, Aguilar Martín C, Carrasco-Querol N, Hernández Rojas Z, Rodríguez Cumplido D, Castro Blanco E, Queiroga Gonçalves A, Fernández-Sáez J, Pérez-Villacastín J. Clinical value of a tool for managing oral anticoagulation in nonvalvular atrial fibrillation in primary health care. Randomized clinical trial. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:471-480. [PMID: 38056770 DOI: 10.1016/j.rec.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES The management of atrial fibrillation is complex and requires improvement at strategic points, such as in the control of patients treated with vitamin K antagonists. The aim of this study was to evaluate the impact on health outcomes of a nonvalvular atrial fibrillation decision support tool based on visualization of the time in therapeutic range in primary care. METHODS The present randomized clinical trial was conducted in 2018 with a 1-year follow-up in 325 primary care centers in Catalonia. In the intervention centers, the decision support tool was installed to control the time in therapeutic range of patients treated with vitamin K antagonists. The tool was not visualized in the control group. RESULTS In total, 44 556 patients were studied. The intervention protected against admission for stroke (adjusted odds ratio [OR], 0.70; 95% confidence interval [95%CI], 0.55-0.88). The number needed to treat was 3502 (95%CI, 3305-3725) while the number of admissions for stroke avoided was 12.63 (95%CI, 11.88-13.38). The intervention also protected against mortality (adjusted OR, 0.78; 95%CI, 0.67-0.90), with a number needed to treat of 13 687 (95%CI, 10 789-18 714) and number of deaths avoided of 3.23 (95%CI, 2.36-4.10). CONCLUSIONS The decision support tool was associated with slight reductions in the numbers of admissions for ischemic stroke and mortality. Although the follow-up time was short and the effect of the intervention was small, the results are valuable and could improve implementation of the tool. This clinical trial was registered with ClinicalTrials.gov (NCT03367325).
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Affiliation(s)
- M Rosa Dalmau Llorca
- Servei Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain; Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Tortosa, Tarragona, Spain; Programa de Doctorat Biomedicina, Universitat Rovira i Virgili, Tortosa, Tarragona, Spain.
| | - Carina Aguilar Martín
- Servei Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain; Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Tortosa, Tarragona, Spain; Programa de Doctorat Biomedicina, Universitat Rovira i Virgili, Tortosa, Tarragona, Spain.
| | - Noèlia Carrasco-Querol
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Tortosa, Tarragona, Spain
| | - Zojaina Hernández Rojas
- Servei Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain; Programa de Doctorat Biomedicina, Universitat Rovira i Virgili, Tortosa, Tarragona, Spain
| | - Dolores Rodríguez Cumplido
- Departament de Farmacologia Clínica, Hospital Universitari Bellvitge, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Elisabet Castro Blanco
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Tortosa, Tarragona, Spain; Programa de Doctorat Biomedicina, Universitat Rovira i Virgili, Tortosa, Tarragona, Spain
| | - Alessandra Queiroga Gonçalves
- Servei Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain; Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Tortosa, Tarragona, Spain
| | - José Fernández-Sáez
- Servei Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain; Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Tortosa, Tarragona, Spain; Programa de Doctorat Biomedicina, Universitat Rovira i Virgili, Tortosa, Tarragona, Spain
| | - Julián Pérez-Villacastín
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Butala NM, Waldo SW, Secemsky EA, Kennedy KF, Spertus JA, Rymer JA, Rao SV, Messenger JC, Yeh RW. Use of Calcium Modification During Percutaneous Coronary Intervention After Introduction of Coronary Intravascular Lithotripsy. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101254. [PMID: 39132220 PMCID: PMC11308754 DOI: 10.1016/j.jscai.2023.101254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 11/21/2023] [Accepted: 11/21/2023] [Indexed: 08/13/2024]
Abstract
Background Calcified coronary lesions are a challenge for percutaneous coronary interventions (PCIs). Coronary intravascular lithotripsy (IVL) is a novel calcium modification technology approved for commercial use in February 2021, but little is known about its uptake in US clinical practice. Methods We described trends in use of calcium modification strategies, variation in use across hospitals, and predictors of calcium modification and IVL use in PCI. We included National Cardiovascular Data Registry CathPCI Registry patients who underwent PCI between April 1, 2018, and December 31, 2022. We examined trends and hospital variation in calcium modification and IVL use. We used multivariate hierarchical logistic regression to identify predictors of calcium modification and IVL use at hospitals in 2022. Results Of 2,733,494 PCIs across 1676 hospitals over 4.75 years, 11.4% were performed with calcium modification. Coronary IVL use increased rapidly from 0% of PCIs in Q4 2020 to 7.8% of PCIs in Q4 2022, which was accompanied by an overall increase in use of all calcium modification strategies (11.1%-16.0%) during this period with a slight corresponding decrease in coronary atherectomy use (5.4%-4.4%). In 2022, there was wide variation in IVL use across hospitals (median, 3.86%; IQR, 0%-8.19%), with IVL being the most common calcium modification strategy in 48% of hospitals. The treating hospital was the strongest predictor of calcium modification (median odds ratio [OR], 2.49; 95% CI, 2.40-2.57) and IVL use (median OR, 2.89; 95% CI, 2.74-3.04). Conclusions IVL has rapidly changed the landscape of calcium modification use for PCI, although there remains wide variation across hospitals.
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Affiliation(s)
- Neel M. Butala
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado
- University of Colorado School of Medicine, Aurora, Colorado
| | - Stephen W. Waldo
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado
- University of Colorado School of Medicine, Aurora, Colorado
- VA CART Program, Office of Quality and Patient Safety, Washington, DC
| | - Eric A. Secemsky
- Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kevin F. Kennedy
- University of Missouri—Kansas City’s Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - John A. Spertus
- University of Missouri—Kansas City’s Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | | | | | | | - Robert W. Yeh
- Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Lachar J, Avila CJ, Qayyum R. The Long-Term Effect of Financial Penalties on 30-Day Hospital Readmission Rates. Jt Comm J Qual Patient Saf 2023; 49:521-528. [PMID: 37394398 DOI: 10.1016/j.jcjq.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Although the immediate effect of financial penalties imposed by the Hospital Readmissions Reduction Program (HRRP) was a decrease in 30-day hospital readmission rates, the long-term effects are unclear. The authors studied 30-day readmissions before and immediately after HRRP penalties and during the most recent period before the COVID-19 pandemic and examined whether readmission trends differed between penalized and non-penalized hospitals. METHODS Centers for Medicare & Medicaid Services hospital archive data and US Census Bureau data were used to analyze hospital characteristics, including readmission penalty status, and hospital service area (HSA) demographic information, respectively. These two datasets were matched by HSA crosswalk files, available through the Dartmouth Atlas files. Using data from 2005-2008 as baseline, the authors examined hospital readmission trends before (2008-2011) and after penalties (during three periods: 2011-2014, 2014-2017, 2017-2019). Mixed linear models were used to examine readmission trends through periods, and differences by hospital penalty status without and with adjustment for hospital characteristics and HSA demographic information. RESULTS For all hospitals combined, rates for 2008-2011 vs. 2011-2014 were as follows: pneumonia, 18.6% vs. 17.0%; heart failure (HF), 24.8% vs. 22.0%; acute myocardial infarction (AMI), 19.7% vs. 17.0% (p < 0.001 for all three conditions). Rates for 2014-2017 vs. 2017-2019 were as follows: pneumonia, 16.8% vs. 16.8% (p = 0.87), HF, 21.7% vs. 21.9% (p < 0.001); AMI, 16.0% vs. 15.8% (p < 0.001). Compared to penalized hospitals, using difference-in-differences, non-penalized hospitals had a significantly greater increase for two conditions between the 2014-2017 and 2017-2019 periods: pneumonia 0.34%, p < 0.001; and HF 0.24%, p = 0.002. CONCLUSION Long-term readmission rates are lower than pre-HRRP rates, with recent trends decreasing further for AMI, stabilizing for pneumonia, and increasing for HF.
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Ferguson EL, Vittinghoff E, Zeki Al Hazzouri A, Allen N, Fitzpatrick A, Yaffe K. Contribution of life course cardiovascular risk factors to racial disparities in dementia incidence. FRONTIERS IN DEMENTIA 2023; 2:1215904. [PMID: 39081968 PMCID: PMC11285666 DOI: 10.3389/frdem.2023.1215904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/15/2023] [Indexed: 08/02/2024]
Abstract
Background Racial disparities in dementia outcomes persist in the United States. Targeting modifiable risk factors, including cardiovascular risk factors (CVRFs), is a conceivable way to reduce health disparities. Life course CVRFs are often higher in non-White adults and are associated with risk of dementia, but it is unknown whether they contribute to racial disparities in dementia and cognition. Methods Using a pooled cohort of 4,159 White and 939 Black participants aged 65-95 years, we conducted a mediation analysis to estimate the proportional effect of race on dementia that is explained by four CVRFs imputed over the life course (20-49, 50-69, and 70-89 years of age): body mass index, fasting glucose, systolic blood pressure, and low-density lipoprotein cholesterol. Results Compared to White participants, Black participants had greater risk of dementia (adjusted OR = 1.37; 95% CI: 1.17-1.60). BMI and fasting glucose over the life course were significant mediators of the effect of race on dementia risk, mediating 39.1% (95% CI: 10.5-67.8%) and 8.2% (95% CI: 0.1-16.2%) of the effect, adjusted for sex and age. All four CVRFs together were also significant mediators of the effect of race on scores on global cognition and processing speed, accounting for approximately 11% of the effect. Conclusions We found that CVRFs across the life course partially explain disparities in dementia risk and cognition in late-life. Improved prevention and treatment of CVRFs across the life course may be important to reduce health disparities for dementia.
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Affiliation(s)
- Erin L. Ferguson
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Adina Zeki Al Hazzouri
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Norrina Allen
- Department of Internal Medicine, Northwestern University, Chicago, IL, United States
| | - Annette Fitzpatrick
- Departments of Family Medicine, Epidemiology, and Global Health, School of Public Health, University of Washington, Seattle, Washington, DC, United States
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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Goitia JJ, Onwuzurike J, Chen A, Wu YL, Shen AYJ, Lee MS. Association between vehicle ownership and disparities in mortality after myocardial infarction. Am J Prev Cardiol 2023; 14:100500. [PMID: 37181802 PMCID: PMC10173400 DOI: 10.1016/j.ajpc.2023.100500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/12/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023] Open
Abstract
Background Access to reliable transportation is fundamental in the management of chronic disease. The purpose of this study was to investigate the association between vehicle ownership at the neighborhood-level and long-term mortality after myocardial infarction (MI). Methods This is a retrospective observational study evaluating adult patients admitted for MI between January 1st, 2006, and December 31st, 2016. Neighborhoods were defined by census tract and household vehicle ownership data was obtained from the American Community Survey courtesy of the University of California, Los Angeles Center for Neighborhood Knowledge. Patients were divided into 2 groups: those living in neighborhoods with higher vehicle ownership, and those living in neighborhoods with lower vehicle ownership. The cutoff of 4.34% of households reporting not owning a vehicle was used to define a neighborhood as one with "higher" vs "lower" vehicle ownership as this was the median value for the cohort. The association between vehicle ownership and all-cause mortality after MI was assessed using Cox proportional hazards regression models. Results A total of 30,126 patients were included (age 68.1 +/- 13.5 years, 63.2% male). After adjusting for age, sex, race/ethnicity, and medical comorbidities, lower vehicle ownership was associated with increased all-cause mortality after MI (hazard ratio [HR] 1.10; 95% confidence interval [CI] 1.06-1.14; p<0.001). This finding remained significant after adjusting for median household income (HR 1.06; 95% CI 1.02-1.10; p = 0.007). Upon comparison of White and Black patients living in neighborhoods with lower vehicle ownership; Black patients were found to have an increased all-cause mortality after MI (HR 1.21, 95% CI 1.13-1.30, p<0.001), a difference which remained significant after adjusting for income (HR 1.20; 95% CI 1.12-1.29; p<0.001). There was no significant difference in mortality between White and Black patients living in neighborhoods with higher vehicle ownership. Conclusion Lower vehicle ownership was associated with increased mortality after MI. Black patients living in neighborhoods with lower vehicle ownership had a higher mortality after MI than White patients living in similar neighborhoods but Black patients living in neighborhoods with higher vehicle ownership had no worse mortality than their White counterparts. This study highlights the importance of transportation in determining health status after MI.
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Affiliation(s)
- Jesse J Goitia
- Division of Cardiology, University of California, Irvine
- Corresponding author at: Division of Cardiology, University of California, Irvine, 333 City Blvd W, Ste 400, Orange, CA 92868, USA.
| | - James Onwuzurike
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Aiyu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Yi-Lin Wu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Albert Yuh-Jer Shen
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Ming-Sum Lee
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
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Masters RK, Tilstra AM, Simon DH, Coleman-Minahan K. Differences in Determinants: Racialized Obstetric Care and Increases in U.S. State Labor Induction Rates. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:174-191. [PMID: 37098856 PMCID: PMC10848243 DOI: 10.1177/00221465231165284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Induction of labor (IOL) rates in the United States have nearly tripled since 1990. We examine official U.S. birth records to document increases in states' IOL rates among pregnancies to Black, Latina, and White women. We test if the increases are associated with changes in demographic characteristics and risk factors among states' racial-ethnic childbearing populations. Among pregnancies to White women, increases in state IOL rates are strongly associated with changes in risk factors among White childbearing populations. However, the rising IOL rates among pregnancies to Black and Latina women are not due to changing factors in their own populations but are instead driven by changing factors among states' White childbearing populations. The results suggest systemic racism may be shaping U.S. obstetric care whereby care is not "centered at the margins" but is instead responsive to characteristics in states' White populations.
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Affiliation(s)
- Ryan K. Masters
- University of Colorado Boulder, Boulder, CO, USA
- University of Colorado Population Center, Boulder, CO, USA
| | - Andrea M. Tilstra
- University of Colorado Population Center, Boulder, CO, USA
- Oxford University, Oxford, UK
| | - Daniel H. Simon
- University of Colorado Boulder, Boulder, CO, USA
- University of Colorado Population Center, Boulder, CO, USA
| | - Kate Coleman-Minahan
- University of Colorado Population Center, Boulder, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Clinical Outcomes of Telehealth in Patients With Coronary Artery Disease and Heart Failure During the COVID-19 Pandemic. Am J Cardiol 2023; 187:171-178. [PMID: 36459742 PMCID: PMC9706495 DOI: 10.1016/j.amjcard.2022.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/21/2022] [Accepted: 10/17/2022] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic necessitated a rapid adoption of telehealth (TH); however, its safety in subspecialty clinical practice remains uncertain. To assess the clinical outcomes associated with TH use in patients with coronary artery disease and/or heart failure during the initial phase of the COVID-19 pandemic, eligible adult patients who saw cardiologists from March 1, 2020, to August 31, 2020 (TH period) were identified. Patients were divided into two 3-month subcohorts (TH1, TH2) and compared with corresponding 2019 prepandemic subcohorts. The primary outcome was cardiovascular (CV) events within 3 months after index visits. Secondary analysis was CV events in patients aged ≥75 years within 3-month follow-up associated with TH use. Multivariable logistic regression was used to evaluate the association between TH use and CV outcomes. The study cohort included 6,485 TH and 7,557 prepandemic patients. The mean age was 70 years, with 40% of patients aged ≥75 years and 35% women. TH visits accounted for 0% of visits during the prepandemic period, compared with 68% during the TH period. Telephone visits comprised ≥92% of all TH encounters. Compared with the prepandemic period, patients seen during the TH period had fewer overall CV events (adjusted odds ratio 0.78, 95% confidence interval 0.67 to 0.90). Patients aged ≥75 years had similar findings (adjusted odds ratio 0.70, 95% confidence interval 0.55 to 0.89). Additional analysis of CV outcome events within 6 months after index visits showed similar findings. In conclusion, TH largely by way of telephone encounters can be safely incorporated into the ambulatory cardiology practice regardless of age.
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Kobo O, Abramov D, Davies S, Ahmed SB, Sun LY, Mieres JH, Parwani P, Siudak Z, Van Spall HG, Mamas MA. CKD-Associated Cardiovascular Mortality in the United States: Temporal Trends From 1999 to 2020. Kidney Med 2022; 5:100597. [PMID: 36814454 PMCID: PMC9939730 DOI: 10.1016/j.xkme.2022.100597] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Rationale & Objective Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular (CV) mortality, but there are limited data on temporal trends disaggregated by sex, race, and urban/rural status in this population. Study Design Retrospective observational study. Setting & Participants The Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research database. Exposure & Predictors Patients with CKD and end-stage kidney disease (ESKD) stratified according to key demographic groups. Outcomes Etiologies of CKD- and ESKD-associated mortality between 1999 and 2000. Analytical Approach Presentation of age-adjusted mortality rates (per 100,000 people) characterized by CV categories, ethnicity, sex (male or female), age categories, state, and urban/rural status. Results Between 1999 and 2020, we identified 1,938,505 death certificates with CKD (and ESKD) as an associated cause of mortality. Of all CKD-associated mortality, the most common etiology was CV, with 31.2% of cases. Between 1999 and 2020, CKD-related age-adjusted mortality increased by 50.2%, which was attributed to an 86.6% increase in non-CV mortality but a 7.1% decrease in CV mortality. Black patients had a higher rate of CV mortality throughout the study period, although Black patients experienced a 38.6% reduction in mortality whereas White patients saw a 2.7% increase. Hispanic patients experienced a greater reduction in CV mortality over the study period (40% reduction) compared to non-Hispanic patients (3.6% reduction). CV mortality was higher in urban areas in 1999 but in rural areas in 2020. Limitations Reliance on accurate characterization of causes of mortality in a large dataset. Conclusions Among patients with CKD-related mortality in the United States between 1999 and 2020, there was an increase in all-cause mortality though a small decrease in CV-related mortality. Overall, temporal decreases in CV mortality were more prominent in Hispanic versus non-Hispanic patients and Black patients versus White patients.
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Affiliation(s)
- Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel,Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California
| | - Simon Davies
- Department of Renal Medicine, School of Medicine, Keele University, David Weatherall Building, Keele, United Kingdom
| | - Sofia B. Ahmed
- Department of Medicine, University of Calgary, Alberta, Canada,Libin Cardiovascular Institute of Alberta, Calgary, Canada,Alberta Kidney Disease Network, Calgary, Canada
| | - Louise Y. Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer H. Mieres
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Harriette G.C. Van Spall
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Population Health Research Institute, Hamilton, Ontario, Canada,Research Institute of St. Joseph’s, Hamilton, Ontario, Canada
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom,Address for Correspondence: Mamas A. Mamas, Professor of Cardiology, Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, UK.
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Andersen JA, Morrow JE, Gibbs L, Hernandez NI. Caregiver reports of physician risk counseling for adolescents with special health care needs. PATIENT EDUCATION AND COUNSELING 2022; 105:1581-1586. [PMID: 34742598 DOI: 10.1016/j.pec.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 09/28/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Research has indicated disagreement between physicians, caregivers, and adolescents with special health care needs regarding appropriate risk counseling. OBJECTIVE The study examines caregivers' perceptions of adolescent risk counseling. We hypothesize caregivers of adolescents with special healthcare needs will perceive a lower rate of risk counseling. METHODS Data come from the 2016 National Survey of Children's Health. The sample included 13,542 adolescents. Analysis completed using logistic regression with odds ratios. RESULTS The results indicate no difference in caregiver perceptions of risk counseling for adolescents with special healthcare needs. Gender, race/ethnicity, and relationship between caregiver and provider influenced perception of receipt of risk counseling, regardless of health status. CONCLUSIONS Although adolescents with special healthcare needs perceive their risk behavior counseling to be lacking in quantity/quality, caregivers perceive such counseling does occur. These results highlight the need for comprehensive risk counseling for groups at risk of known health disparities. PRACTICE IMPLICATIONS Physicians and providers should be provided with the training and resources needed to be comfortable to engage in risk counseling. Adolescents need the opportunity to see their provider privately, and education to advocate for information risky behaviors. Parents, providers, and adolescents should be included in future risk counseling intervention plans.
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Affiliation(s)
- Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA.
| | - Jess E Morrow
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Larry Gibbs
- Department of Sociology and Anthropology, Southern Oregon University, Ashland, OR, USA
| | - Nestor I Hernandez
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, NE, USA
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11
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Provance JB, Spertus JA, Jones PG, Hoffman MA, Bunte MC, Vogel TR, Mena-Hurtado C, Smolderen KG. Variability in 30-day major amputation rates following endovascular peripheral vascular intervention for critical limb ischemia. Vasc Med 2022; 27:350-357. [PMID: 35603755 DOI: 10.1177/1358863x221098097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Patients with critical limb ischemia (CLI) can undergo endovascular peripheral vascular intervention (PVI) to restore blood flow and decrease risk of amputation. As a potential indicator of quality for CLI care, we sought to describe 30-day major amputation rates following PVI. We also examined rate variability, and patient-level and site-level factors predicting amputations, using a national electronic health record (EHR) database. Methods: Using the Cerner Health Facts de-identified EHR database, patients with CLI diagnosis codes undergoing PVI were identified. The rate of amputation within 30 days of PVI was calculated. Risk ratios predicting amputation were derived using a mixed effects Poisson regression model adjusting for 16 patient and clinical factors. Median risk ratios (MRRs) were calculated to quantify site-level variability in amputations. Results: A total of 20,204 PVI procedures for CLI from 179 healthcare sites were identified. Mean age at procedure was 69.0 ± 12.6 years, 58.0% were male, and 29.6% were persons of color. Amputation within 30 days of PVI occurred after 570 (2.8%) procedures. Malnutrition, previous amputation, diabetes, and being of Black race were predictors of amputation. Amputation rates across sites ranged from 0.0% to 10.0%. The unadjusted MRR was 1.40 (95% CI 1.35-1.46), which was attenuated after adjusting for patient-level factors (MRR 1.30, 95% CI 1.26-1.34) and site characteristics (MRR 1.11, 95% CI 1.09-1.13). Conclusions: Among PVI procedures for CLI treatment, 30-day amputation rates varied across institutions. Although patient-level factors explained some variability, site-level factors explained most variation in the rates of these outcomes.
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Affiliation(s)
- Jeremy B Provance
- Vascular Medicine Outcomes (VAMOS) Research Group, Department of Internal Medicine, Cardiovascular Medicine Section, Yale University, New Haven, CT, USA
| | - John A Spertus
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Saint Luke's Mid-America Heart Institute, Kansas City, MO, USA
| | - Philip G Jones
- Saint Luke's Mid-America Heart Institute, Kansas City, MO, USA
| | - Mark A Hoffman
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, MO, USA
| | - Matthew C Bunte
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Saint Luke's Mid-America Heart Institute, Kansas City, MO, USA
| | - Todd R Vogel
- Division of Vascular Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Carlos Mena-Hurtado
- Vascular Medicine Outcomes (VAMOS) Research Group, Department of Internal Medicine, Cardiovascular Medicine Section, Yale University, New Haven, CT, USA
| | - Kim G Smolderen
- Vascular Medicine Outcomes (VAMOS) Research Group, Department of Internal Medicine, Cardiovascular Medicine Section, Yale University, New Haven, CT, USA.,Department of Psychiatry, Yale University, New Haven, CT, USA
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12
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Ghassemi M, Mohamed S. Machine learning and health need better values. NPJ Digit Med 2022; 5:51. [PMID: 35459793 PMCID: PMC9033858 DOI: 10.1038/s41746-022-00595-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Marzyeh Ghassemi
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA. .,Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA. .,CIFAR AI Chair, Vector Institute, Toronto, Ontario, M5G 1M1, Canada.
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13
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Gold R, Larson AE, Sperl-Hillen JM, Boston D, Sheppler CR, Heintzman J, McMullen C, Middendorf M, Appana D, Thirumalai V, Romer A, Bava J, Davis JV, Yosuf N, Hauschildt J, Scott K, Moore S, O’Connor PJ. Effect of Clinical Decision Support at Community Health Centers on the Risk of Cardiovascular Disease: A Cluster Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2146519. [PMID: 35119463 PMCID: PMC8817199 DOI: 10.1001/jamanetworkopen.2021.46519] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Management of cardiovascular disease (CVD) risk in socioeconomically vulnerable patients is suboptimal; better risk factor control could improve CVD outcomes. OBJECTIVE To evaluate the impact of a clinical decision support system (CDSS) targeting CVD risk in community health centers (CHCs). DESIGN, SETTING, AND PARTICIPANTS This cluster randomized clinical trial included 70 CHC clinics randomized to an intervention group (42 clinics; 8 organizations) or a control group that received no intervention (28 clinics; 7 organizations) from September 20, 2018, to March 15, 2020. Randomization was by CHC organization accounting for organization size. Patients aged 40 to 75 years with (1) diabetes or atherosclerotic CVD and at least 1 uncontrolled major risk factor for CVD or (2) total reversible CVD risk of at least 10% were the population targeted by the CDSS intervention. INTERVENTIONS A point-of-care CDSS displaying real-time CVD risk factor control data and personalized, prioritized evidence-based care recommendations. MAIN OUTCOMES AND MEASURES One-year change in total CVD risk and reversible CVD risk (ie, the reduction in 10-year CVD risk that was considered achievable if 6 key risk factors reached evidence-based levels of control). RESULTS Among the 18 578 eligible patients (9490 [51.1%] women; mean [SD] age, 58.7 [8.8] years), patients seen in control clinics (n = 7419) had higher mean (SD) baseline CVD risk (16.6% [12.8%]) than patients seen in intervention clinics (n = 11 159) (15.6% [12.3%]; P < .001); baseline reversible CVD risk was similarly higher among patients seen in control clinics. The CDSS was used at 19.8% of 91 988 eligible intervention clinic encounters. No population-level reduction in CVD risk was seen in patients in control or intervention clinics; mean reversible risk improved significantly more among patients in control (-0.1% [95% CI, -0.3% to -0.02%]) than intervention clinics (0.4% [95% CI, 0.3% to 0.5%]; P < .001). However, when the CDSS was used, both risk measures decreased more among patients with high baseline risk in intervention than control clinics; notably, mean reversible risk decreased by an absolute 4.4% (95% CI, -5.2% to -3.7%) among patients in intervention clinics compared with 2.7% (95% CI, -3.4% to -1.9%) among patients in control clinics (P = .001). CONCLUSIONS AND RELEVANCE The CDSS had low use rates and failed to improve CVD risk in the overall population but appeared to have a benefit on CVD risk when it was consistently used for patients with high baseline risk treated in CHCs. Despite some limitations, these results provide preliminary evidence that this technology has the potential to improve clinical care in socioeconomically vulnerable patients with high CVD risk. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03001713.
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Affiliation(s)
- Rachel Gold
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
- OCHIN Inc, Portland, Oregon
| | | | | | | | | | | | - Carmit McMullen
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | | | | | | | | | - James V. Davis
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Nadia Yosuf
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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14
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Prasitlumkum N, Chokesuwattanaskul R, Kaewput W, Thongprayoon C, Tokavanich N, Bathini T, Boonpheng B, Vallabhajosyula S, Cheungpasitporn W, Jongnarangsin K. Temporal trends and in-hospital complications of catheter ablation for atrial fibrillation among patients with moderate and advanced chronic kidney diseases: 2005-2018. J Cardiovasc Electrophysiol 2022; 33:401-411. [PMID: 35018675 DOI: 10.1111/jce.15354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/13/2021] [Accepted: 11/18/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Real-world data on atrial fibrillation (AF) ablation among moderate and advanced chronic kidney disease (CKD) patients have so far remained scarce, especially in-hospital AF ablation outcomes. METHODS We drew data from the US National Inpatient Sample to identify hospitalized patients who underwent AF ablation between 2005 and 2018, and further stratified by CKD classification. We assessed the trend of AF ablation, as well as its complications. RESULTS A total of 152 630 patients who were primarily hospitalized for AF and underwent ablation were estimated. Among these, CKD patients were found in a total of 1509 participants, with 978, 206, and 325 under CKD3, CKD4, and CKD5/ESKD, respectively. There was a significant increment in admission rates for AF ablation in the CKD population across all CKD classifications (p < .001). All CKD patients were statistically older, with higher coexisting comorbidities, while hypertension was found substantially lower than non-CKD patients (p ≤ .001). Importantly, CKD, especially CKD3 and CKD5/ESKD, was significantly associated with an increased risk of total complications, and total bleeding, Neurological complications were found statistically lower in CKD patients (p = .029), and no mortality rates were significantly different (p = .287). CONCLUSION Our study observed an increase in admission trends for AF ablation among moderate and advanced CKD patients from 2005 to 2018. CKD was strongly associated with higher procedure-related complications and bleeding, but neurological safety profiles and mortalities rates were nonsignificantly different.
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Affiliation(s)
- Narut Prasitlumkum
- Department of Cardiology, University of California Riverside, Riverside, California, USA
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiovascular Medicine, Department of Medicine, Cardiac Center, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Wisit Kaewput
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nithi Tokavanich
- Division of Cardiovascular Medicine, Department of Medicine, Cardiac Center, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA
| | - Boonphiphop Boonpheng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Saraschandra Vallabhajosyula
- Department of Medicine, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Krit Jongnarangsin
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
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15
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The association of race with CPR quality following out-of-hospital cardiac arrest. Resuscitation 2022; 170:194-200. [PMID: 34871755 PMCID: PMC8799526 DOI: 10.1016/j.resuscitation.2021.11.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Previous studies have shown racial disparities in outcomes after out-of-hospital cardiac arrest. Although several treatment factors may account for these differences, there is limited information regarding differences in CPR quality and its effect on survival in underrepresented racial populations. METHODS We conducted a secondary analysis of data from patients enrolled in the Pragmatic Airway Resuscitation Trial (PART). We calculated compliance rates with AHA 2015 high quality CPR metrics as well as compliance to intended CPR strategy (30:2 or continuous chest compression) based on the protocol in place for the first responding EMS agency. The primary analysis used general estimating equations logistic regression to examine differences between black and white patients based on EMS-assessed race after adjustment for potential confounders. Sensitivity analyses examined differences using alternate race definitions. RESULTS There were 3004 patients enrolled in PART of which 1734 had > 2 minutes of recorded CPR data and an EMS-assessed race (1003 white, 555 black, 176 other). Black patients had higher adjusted odds of compression rate compliance (OR: 1.36, 95% CI: 1.02-1.81) and lower adjusted odds of intended CPR strategy compliance (OR: 0.78, 95% CI: 0.63-0.98) compared to white patients. Of 974 transported to the hospital, there was no difference in compliance metric estimates based on ED-reported race. CONCLUSION Compression rate compliance was higher in black patients however compliance with intended strategy was lower based on EMS-assessed race. The remaining metrics showed no difference suggesting that CPR quality differences are not important contributors to the observed outcome disparities by race.
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16
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Ntusi NAB, Sliwa K. Associations of Race and Ethnicity With Presentation and Outcomes of Hypertrophic Cardiomyopathy: JACC Focus Seminar 6/9. J Am Coll Cardiol 2021; 78:2573-2579. [PMID: 34887143 DOI: 10.1016/j.jacc.2021.10.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 12/26/2022]
Abstract
Significant racial and ethnicity-based disparities in clinical presentation, management, and outcome of hypertrophic cardiomyopathy (HCM) are reported. Black patients with HCM are more likely to present with heart failure but are less commonly referred for symptom management, sudden cardiac death stratification, surgical septal myectomy, or for implantable cardioverter-defibrillators, all interventions that increase survival. Prevalence of bystander cardiopulmonary resuscitation is lower for Black patients than for White patients. Black patients with HCM have decreased survival after hospital discharge following out-of-hospital cardiac arrest. Biomedical and social interventions are urgently needed to reduce ethnicity-based disparities, which have an impact on outcomes in HCM and other cardiovascular diseases. There is also a need to focus on implementation science to support durable adoption of evidence-based therapies in Black patients and communities.
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Affiliation(s)
- Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Karen Sliwa
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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Delva S, Waligora Mendez KJ, Cajita M, Koirala B, Shan R, Wongvibulsin S, Vilarino V, Gilmore DR, Han HR. Efficacy of Mobile Health for Self-management of Cardiometabolic Risk Factors: A Theory-Guided Systematic Review. J Cardiovasc Nurs 2021; 36:34-55. [PMID: 32040072 PMCID: PMC7713761 DOI: 10.1097/jcn.0000000000000659] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although mobile health (mHealth) technologies are burgeoning in the research arena, there is a lack of mHealth interventions focused on improving self-management of individuals with cardiometabolic risk factors (CMRFs). OBJECTIVE The purpose of this article was to critically and systematically review the efficacy of mHealth interventions for self-management of CMRF while evaluating quality, limitations, and issues with disparities using the technology acceptance model as a guiding framework. METHODS PubMed, CINAHL, EMBASE, and Lilacs were searched to identify research articles published between January 2008 and November 2018. Articles were included if they were published in English, included adults, were conducted in the United States, and used mHealth to promote self-care or self-management of CMRFs. A total of 28 articles were included in this review. RESULTS Studies incorporating mHealth have been linked to positive outcomes in self-management of diabetes, physical activity, diet, and weight loss. Most mHealth interventions included modalities such as text messaging, mobile applications, and wearable technologies. There was a lack of studies that are (1) in resource-poor settings, (2) theoretically driven, (3) community-engaged research, (4) measuring digital/health literacy, (5) measuring and evaluating engagement, (6) measuring outcomes related to disease self-management, and (7) focused on vulnerable populations, especially immigrants. CONCLUSION There is still a lack of mHealth interventions created specifically for immigrant populations, especially within the Latino community-the largest growing minority group in the United States. In an effort to meet this challenge, more culturally tailored mHealth interventions are needed.
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18
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Mendoza CE. Impact of health inequity on transcatheter mitral valve repair: An urgent call for improvement. J Card Surg 2021; 36:3230-3231. [PMID: 34143512 DOI: 10.1111/jocs.15734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Cesar E Mendoza
- Division of Cardiovascular Disease, Jackson Memorial Hospital, Miami, Florida, USA
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19
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Fitzsimmons E, Arany Z, Howell EA, Lewey J. Differential Outcomes for African-American Women with Cardiovascular Complications of Pregnancy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00863-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Loring Z, Holmes DN, Matsouaka RA, Curtis AB, Day JD, Desai N, Ellenbogen KA, Feld GK, Fonarow GC, Frankel DS, Hurwitz JL, Knight BP, Joglar JA, Russo AM, Sidhu MS, Turakhia MP, Lewis WR, Piccini JP. Procedural Patterns and Safety of Atrial Fibrillation Ablation: Findings From Get With The Guidelines-Atrial Fibrillation. Circ Arrhythm Electrophysiol 2020; 13:e007944. [PMID: 32703018 PMCID: PMC7502261 DOI: 10.1161/circep.119.007944] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/23/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Catheter ablation is an increasingly used treatment for symptomatic atrial fibrillation (AF). However, there are limited prospective, nationwide data on patient selection and procedural characteristics. This study describes patient characteristics, techniques, treatment patterns, and safety outcomes of patients undergoing AF ablation. METHODS A total of 3139 patients undergoing AF ablation between 2016 and 2018 in the Get With The Guidelines-Atrial Fibrillation registry from 24 US centers were included. Patient demographics, medical history, procedural details, and complications were abstracted. Differences between paroxysmal and patients with persistent AF were compared using Pearson χ2 and Wilcoxon rank-sum tests. RESULTS Patients undergoing AF ablation were predominantly male (63.9%) and White (93.2%) with a median age of 65. Hypertension was the most common comorbidity (67.6%), and patients with persistent AF had more comorbidities than patients with paroxysmal AF. Drug refractory, paroxysmal AF was the most common ablation indication (class I, 53.6%) followed by drug refractory, persistent AF (class I, 41.8%). Radiofrequency ablation with contact force sensing was the most common ablation modality (70.5%); 23.7% of patients underwent cryoballoon ablation. Pulmonary vein isolation was performed in 94.6% of de novo ablations; the most common adjunctive lesions included left atrial roof or posterior/inferior lines, and cavotricuspid isthmus ablation. Complications were uncommon (5.1%) and were life-threatening in 0.7% of cases. CONCLUSIONS More than 98% of AF ablations among participating sites are performed for class I or class IIA indications. Contact force-guided radiofrequency ablation is the dominant technique and pulmonary vein isolation the principal lesion set. In-hospital complications are uncommon and rarely life-threatening.
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Affiliation(s)
- Zak Loring
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
- Division of Cardiology, Duke University Medical Center, Durham, NC
| | | | - Roland A. Matsouaka
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Anne B. Curtis
- Department of Medicine, University at Buffalo, Buffalo, NY
| | - John D. Day
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT
| | - Nihar Desai
- Cardiovascular Medicine Section, Yale University, New Haven, CT
| | | | - Gregory K. Feld
- Department of Medicine, University of California San Diego, San Diego, CA
| | - Gregg C. Fonarow
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - David S. Frankel
- Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | - Jose A. Joglar
- Department of Cardiology, University of Texas, Southwestern Medical Center, Dallas, TX
| | | | | | - Mintu P. Turakhia
- VA Palo Alto Health Care System, Palo Alto, CA; Center for Digital Health, Stanford University, Stanford, CA
| | - William R. Lewis
- MetroHealth System Campus, Case Western Reserve University, Cleveland, OH
| | - Jonathan P. Piccini
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
- Division of Cardiology, Duke University Medical Center, Durham, NC
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21
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Hammond G, Luke AA, Elson L, Towfighi A, Joynt Maddox KE. Urban-Rural Inequities in Acute Stroke Care and In-Hospital Mortality. Stroke 2020; 51:2131-2138. [PMID: 32833593 DOI: 10.1161/strokeaha.120.029318] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The rural-urban life-expectancy gap is widening, but underlying causes are incompletely understood. Prior studies suggest stroke care may be worse for individuals in more rural areas, and technological advancements in stroke care may disproportionately impact individuals in more rural areas. We sought to examine differences and 5-year trends in the care and outcomes of patients hospitalized for stroke across rural-urban strata. METHODS Retrospective cohort study using National Inpatient Sample data from 2012 to 2017. Rurality was classified by county of residence according to the 6-strata National Center for Health Statistics classification scheme. RESULTS There were 792 054 hospitalizations for acute stroke in our sample. Rural patients were more often white (78% versus 49%), older than 75 (44% versus 40%), and in the lowest quartile of income (59% versus 32%) compared with urban patients. Among patients with acute ischemic stroke, intravenous thrombolysis and endovascular therapy use were lower for rural compared with urban patients (intravenous thrombolysis: 4.2% versus 9.2%, adjusted odds ratio, 0.55 [95% CI, 0.51-0.59], P<0.001; endovascular therapy: 1.63% versus 2.41%, adjusted odds ratio, 0.64 [0.57-0.73], P<0.001). Urban-rural gaps in both therapies persisted from 2012 to 2017. Overall, stroke mortality was higher in rural than urban areas (6.87% versus 5.82%, P<0.001). Adjusted in-patient mortality rates increased across categories of increasing rurality (suburban, 0.97 [0.94-1.0], P=0.086; large towns, 1.05 [1.01-1.09], P=0.009; small towns, 1.10 [1.06-1.15], P<0.001; micropolitan rural, 1.16 [1.11-1.21], P<0.001; and remote rural 1.21 [1.15-1.27], P<0.001 compared with urban patients. Mortality for rural patients compared with urban patients did not improve from 2012 (adjusted odds ratio, 1.12 [1.00-1.26], P<0.001) to 2017 (adjusted odds ratio, 1.27 [1.13-1.42], P<0.001). CONCLUSIONS Rural patients with stroke were less likely to receive intravenous thrombolysis or endovascular therapy and had higher in-hospital mortality than their urban counterparts. These gaps did not improve over time. Enhancing access to evidence-based stroke care may be a target for reducing rural-urban disparities.
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Affiliation(s)
| | - Alina A Luke
- Washington University School of Medicine, St Louis, MO (A.A.L., L.E.)
| | - Lauren Elson
- Washington University School of Medicine, St Louis, MO (A.A.L., L.E.)
| | - Amytis Towfighi
- Department of Neurology, University of Southern California Keck School of Medicine (A.T.)
| | - Karen E Joynt Maddox
- Division of Cardiology (G.H., K.E.J.M.).,Institute for Public Health at Washington University, St Louis, MO (K.E.J.M.)
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22
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Loring Z, Shrader P, Allen LA, Blanco R, Chan PS, Ezekowitz MD, Fonarow GC, Freeman JV, Gersh BJ, Mahaffey KW, Naccarelli GV, Pieper K, Reiffel JA, Singer DE, Steinberg BA, Thomas LE, Peterson ED, Piccini JP. Guideline-directed therapies for comorbidities and clinical outcomes among individuals with atrial fibrillation. Am Heart J 2020; 219:21-30. [PMID: 31710841 PMCID: PMC7285625 DOI: 10.1016/j.ahj.2019.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/18/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Comorbidities are common in patients with atrial fibrillation (AF) and affect prognosis, yet are often undertreated. However, contemporary rates of use of guideline-directed therapies (GDT) for non-AF comorbidities and their association with outcomes are not well described. METHODS We used the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF) to test the association between GDT for non-AF comorbidities and major adverse cardiac or neurovascular events (MACNE; cardiovascular death, myocardial infarction, stroke/thromboembolism, or new-onset heart failure), all-cause mortality, new-onset heart failure, and AF progression. Adjustment was performed using Cox proportional hazards models and logistic regression. RESULTS Only 6,782 (33%) of the 20,434 patients eligible for 1 or more GDT for non-AF comorbidities received all indicated therapies. Use of all comorbidity-specific GDT was highest for patients with hyperlipidemia (75.6%) and lowest for those with diabetes mellitus (43.1%). Use of "all eligible" GDT was associated with a nonsignificant trend toward lower rates of MACNE (HR 0.90 [0.79-1.02]) and all-cause mortality (HR 0.90 [0.80-1.01]). Use of GDT for heart failure was associated with a lower risk of all-cause mortality (HR 0.77 [0.67-0.89]), and treatment of obstructive sleep apnea was associated with a lower risk of AF progression (OR 0.75 [0.62-0.90]). CONCLUSIONS In AF patients, there is underuse of GDT for non-AF comorbidities. The association between GDT use and outcomes was strongest in heart failure and obstructive sleep apnea patients where use of GDT was associated with lower mortality and less AF progression.
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Affiliation(s)
- Zak Loring
- Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
| | | | - Larry A Allen
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO
| | | | - Paul S Chan
- Department of Cardiovascular Research, St Luke's Mid America Institute, Kansas City, MO
| | | | - Gregg C Fonarow
- Department of Medicine, University of California, Los Angeles, CA
| | - James V Freeman
- Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Bernard J Gersh
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford University, Stanford, CA
| | | | | | - James A Reiffel
- Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY
| | - Daniel E Singer
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | | | | | - Eric D Peterson
- Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Jonathan P Piccini
- Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC
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Abdelmessih E, Simpson MD, Cox J, Guisard Y. Exploring the Health Care Challenges and Health Care Needs of Arabic-Speaking Immigrants with Cardiovascular Disease in Australia. PHARMACY (BASEL, SWITZERLAND) 2019; 7:pharmacy7040151. [PMID: 31717927 PMCID: PMC6958385 DOI: 10.3390/pharmacy7040151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 12/18/2022]
Abstract
The Arabic-speaking immigrant group, which makes up the fourth largest language group in Australia, has a high prevalence of cardiovascular disease. The objective of this study was to explore the health care challenges and needs of Arabic-speaking immigrants with cardiovascular disease (CVD), using a comparative approach with English-speaking patients with CVD as the comparable group. Methods: Participants were recruited from community settings in Melbourne, Australia. Face-to-face semi-structured individual interviews were conducted at the recruitment sites. All interviews were audio-taped, transcribed, and coded thematically. Results: 29 participants with CVD were recruited; 15 Arabic-speaking and 14 English-speaking. Arabic-speaking immigrants, and to a lesser extent English-speaking patients with CVD may have specific health care challenges and needs. Arabic-speaking immigrants’ health care needs include: effective health care provider (HCP)-patient communication, accessible care, participation in decision-making, and empowerment. English-speaking participants viewed these needs as important for CVD management. However, only a few English-speaking participants cited these needs as unmet health care needs. Conclusion: This study suggests that Arabic-speaking immigrants with CVD may have unique needs including the need for privacy, effective HCP-patient communication that takes into account patients’ limited English proficiency, and pharmacist-physician collaboration. Therefore, there may be a need to identify a health care model that can address these patients’ health care challenges and needs. This, in turn, may improve their disease management and health outcomes.
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Affiliation(s)
- Erini Abdelmessih
- School of Biomedical Sciences, Charles Sturt University, Leeds Parade, Orange 2800, Australia; (M.-D.S.); (J.C.)
- Correspondence:
| | - Maree-Donna Simpson
- School of Biomedical Sciences, Charles Sturt University, Leeds Parade, Orange 2800, Australia; (M.-D.S.); (J.C.)
| | - Jennifer Cox
- School of Biomedical Sciences, Charles Sturt University, Leeds Parade, Orange 2800, Australia; (M.-D.S.); (J.C.)
| | - Yann Guisard
- School of Science, Charles Sturt University, Leeds Parade, Orange 2800, Australia;
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24
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Lewey J, Levine LD, Elovitz MA, Irizarry OC, Arany Z. Importance of Early Diagnosis in Peripartum Cardiomyopathy. Hypertension 2019; 75:91-97. [PMID: 31707840 DOI: 10.1161/hypertensionaha.119.13291] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Peripartum cardiomyopathy (PPCM) can lead to long-term systolic dysfunction, especially among black women. Hypertensive disorders of pregnancy (HDP) are the strongest risk factor for PPCM, but controversy remains on whether HDP predict a favorable outcome. Women with HDP are also often diagnosed with PPCM earlier than those without HDP. Our objective is to determine recovery of systolic function in patients with PPCM stratified by HDP, timing of diagnosis, and race. We conducted a retrospective cohort study of 220 patients (55% black) diagnosed with PPCM. Patients with PPCM and HDP were diagnosed earlier postpartum than patients without HDP (P=0.013), an effect that was most pronounced in nonblack patients. Rates of left ventricular ejection fraction (LVEF) recovery were similar among PPCM patients with and without HDP (68.4% versus 62.6%, P=0.425). In contrast, patients with PPCM diagnosed after 1-month postpartum had lower rates of LVEF recovery than patients diagnosed <1-month postpartum (53.7% versus 69.9%, P=0.035). LVEF at time of diagnosis is a strong predictor of LVEF recovery, and patients with PPCM diagnosed after 1-month postpartum had lower baseline LVEF compared to patients presenting earlier (P=0.041). The presence of HDP does not correlate with LVEF recovery in our racially diverse PPCM cohort. In contrast, early diagnosis portends a favorable outcome. Early diagnosis is associated with higher LVEF at presentation, likely explaining the improved outcomes in these women. These findings underscore the need for early monitoring and diagnosis, especially in at-risk and underserved populations.
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Affiliation(s)
- Jennifer Lewey
- From the Division of Cardiology (J.L., Z.A.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Lisa D Levine
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology (L.D.L., M.A.E., O.C.I.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Michal A Elovitz
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology (L.D.L., M.A.E., O.C.I.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Olga C Irizarry
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology (L.D.L., M.A.E., O.C.I.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Zoltan Arany
- From the Division of Cardiology (J.L., Z.A.), University of Pennsylvania Perelman School of Medicine, Philadelphia
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25
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Nee R, Yan G, Yuan CM, Agodoa LY, Norris KC. Use of Percutaneous Coronary Intervention Among Black and White Patients With End-Stage Renal Disease in the United States. J Am Heart Assoc 2019; 8:e012101. [PMID: 31331221 PMCID: PMC6761629 DOI: 10.1161/jaha.119.012101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Racial disparities in invasive cardiac procedures such as percutaneous coronary intervention (PCI) in the general population are well documented; however, national-level data on such disparities in the end-stage renal disease (ESRD) population are lacking. We assessed racial differences in PCI between black and white patients with ESRD on maintenance dialysis. Methods and Results Using the US Renal Data System database, we abstracted Medicare inpatient procedure claims for PCI in a cohort of 268 575 Medicare-primary patients who initiated treatment on maintenance dialysis from January 1, 2009, through June 1, 2013. We conducted Cox regression analyses with PCI being the event, adjusted for demographic characteristics, Hispanic ethnicity, cause of ESRD, comorbidities, and socioeconomic factors. We also assessed the probability of PCI, accounting for death or transplant in competing risk regression models. The crude incidence rate of PCI among white patients was 25.8 per 1000 patient-years versus 15.5 per 1000 patient-years among black patients. Cox regression analyses demonstrated that black patients were significantly less likely to undergo PCI compared with white patients (adjusted hazard ratio: 0.64; 95% CI, 0.62-0.67; P<0.001). In the competing risk models, the racial gap for PCI among black and white patients remained significant with death (subdistribution hazard ratio: 0.81; 95% CI, 0.76-0.85; P<0.001) or transplant as a competing event (subdistribution hazard ratio: 0.67; 95% CI, 0.64-0.70; P<0.001). Conclusions A racial gap exists in PCI use among dialysis patients despite having comprehensive coverage with Medicare. These findings persisted despite accounting for demographic, clinical, socioeconomic factors, and death or transplant as competing events.
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Affiliation(s)
- Robert Nee
- Nephrology Service Walter Reed National Military Medical Center Bethesda MD.,Uniformed Services University Bethesda MD
| | - Guofen Yan
- Department of Public Health Sciences University of Virginia School of Medicine Charlottesville VA
| | - Christina M Yuan
- Nephrology Service Walter Reed National Military Medical Center Bethesda MD.,Uniformed Services University Bethesda MD
| | | | - Keith C Norris
- Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA
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26
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Tabaei BP, Chamany S, Perlman S, Thorpe L, Bartley K, Wu WY. Heart Age, Cardiovascular Disease Risk, and Disparities by Sex and Race/Ethnicity Among New York City Adults. Public Health Rep 2019; 134:404-416. [PMID: 31095441 DOI: 10.1177/0033354919849881] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Cardiovascular disease (CVD) is the leading cause of mortality in the United States. The risk for developing CVD is usually calculated and communicated to patients as a percentage. The calculation of heart age-defined as the predicted age of a person's vascular system based on the person's CVD risk factor profile-is an alternative method for expressing CVD risk. We estimated heart age among adults aged 30-74 in New York City and examined disparities in excess heart age by race/ethnicity and sex. METHODS We applied data from the 2011, 2013, and 2015 New York State Behavioral Risk Factor Surveillance System to the non-laboratory-based Framingham risk score functions to calculate 10-year CVD risk and heart age by sex, race/ethnicity, and selected sociodemographic groups and risk factors. RESULTS Of 6117 men and women in the study sample, the average heart age was 5.7 years higher than the chronological age, and 2631 (43%) adults had a predicted heart age ≥5 years older than their chronological age. Mean excess heart age increased with age (from 0.7 year among adults aged 30-39 to 11.2 years among adults aged 60-74) and body mass index (from 1.1 year among adults with normal weight to 11.8 years among adults with obesity). Non-Latino white women had the lowest mean excess heart age (2.3 years), and non-Latino black men and women had the highest excess heart age (8.4 years). CONCLUSIONS Racial/ethnic and sex disparities in CVD risk persist among adults in New York City. Use of heart age at the population level can support public awareness and inform targeted programs and interventions for population subgroups most at risk for CVD.
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Affiliation(s)
- Bahman P Tabaei
- 1 New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Shadi Chamany
- 1 New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Sharon Perlman
- 1 New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Lorna Thorpe
- 2 New York University School of Medicine, New York, NY, USA
| | - Katherine Bartley
- 1 New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Winfred Y Wu
- 1 New York City Department of Health and Mental Hygiene, Queens, NY, USA
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27
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Alkhouli M, Holmes DR, Carroll JD, Li Z, Inohara T, Kosinski AS, Szerlip M, Thourani VH, Mack MJ, Vemulapalli S. Racial Disparities in the Utilization and Outcomes of TAVR. JACC Cardiovasc Interv 2019; 12:936-948. [DOI: 10.1016/j.jcin.2019.03.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/25/2019] [Accepted: 03/05/2019] [Indexed: 12/20/2022]
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28
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Relation of Sex and Race to Outcomes in Patients Undergoing Percutaneous Intervention With Drug-Eluting Stents. Am J Cardiol 2019; 123:913-918. [PMID: 30595392 DOI: 10.1016/j.amjcard.2018.12.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/04/2018] [Accepted: 12/13/2018] [Indexed: 12/14/2022]
Abstract
Cardiovascular disease is the leading cause of death in men and women, black and white. However, there exists limited outcomes data for women and blacks after percutaneous coronary intervention (PCI). The aim of this study was to evaluate the 1-year major cardiovascular events in patients who underwent PCI based on gender and race. We retrospectively analyzed data that were prospectively collected over 13 years at a large tertiary hospital in the United States. There were 12,050 patients who underwent PCI for both stable disease and acute coronary syndrome from 2003 to 2016. Of those, 1,952 were black men, 6,013 white men, 1,619 black women, and 2,466 white women. Major cardiovascular events at 1 year were assessed, and proportional Cox hazard model analyses were performed to assess outcome adjusted for confounding factors (i.e., age, body mass index, presentation with acute myocardial infarction, diabetes, smoking, history of coronary artery disease, family history of coronary artery disease, hyperlipidemia, hypertension, previous cardiovascular intervention, and chronic kidney disease). At 1 year, white men had significantly lower major cardiovascular events driven by lower rate of death compared with the other groups. Adjusted for confounders, major cardiovascular events were 1.3 to 1.5 times more likely to occur in black men and women and white women than in white men. There was a significant race by gender interaction (p <0.001).
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29
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Pegus C, Duncan I, Greener J, Granada JF, Ahmed T. Achieving Health Equity by Normalizing Cardiac Care. Health Equity 2018; 2:404-411. [PMID: 30623169 PMCID: PMC6323589 DOI: 10.1089/heq.2018.0067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose: It is well known that minority patients, and particularly African Americans undergo lower rates of cardiac procedures than the white population, even when covered by equivalent insurance. Methods: We analyzed the rates of percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI) and for intermediate coronary syndrome (ICS), and rates of transcatheter aortic valve replacement for aortic stenosis in the 2012–2013 Medicare Limited Data Set (5% sample) file. Results: Although blacks have similar prevalence rates for AMI and ICS, they experience lower PTCA rates when compared with that of white patients (10.57 vs. 19.40, −46%). “Normalizing” procedure rates in the African American community to match their disease prevalence will require education and participation of all stakeholders: patients, providers, manufacturers, insurers, and advocacy organizations. Beyond improved clinical outcomes, financial incentives to “normalize care” exist. We estimate “lost” revenue within the Medicare population as a result of the lower procedure rates, at ∼$90 million annually ($22.0 million AMI, $9.4 million ICS and $68.7 million aortic valve disease). Conclusions: Providing evidence-based care to all patients improves health equity and can lower downstream high-cost conditions such as heart failure and multiple repeat inpatient admissions. As we move toward value-based care, the opportunity to normalize treatment for everyone seeking care is within our data analytics, innovative and collective reach.
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Affiliation(s)
| | - Ian Duncan
- Department of Statistics and Applied Probability, University of California, Santa Barbara, Santa Barbara, California
| | | | - Juan F Granada
- Cardiovascular Research Foundation, Columbia University Medical Center, New York, New York
| | - Tamim Ahmed
- Santa Barbara Actuaries, Inc., Santa Barbara, California
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30
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Gender and Race Disparities in Cardiovascular Disease Risk Factors among New York City Adults: New York City Health and Nutrition Examination Survey (NYC HANES) 2013-2014. J Urban Health 2018; 95:801-812. [PMID: 29987772 PMCID: PMC6286284 DOI: 10.1007/s11524-018-0287-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
While gender and racial/ethnic disparities in cardiovascular disease (CVD) risk factors have each been well characterized, few studies have comprehensively examined how patterns of major CVD risk factors vary and intersect across gender and major racial/ethnic groups, considered together. Using data from New York City Health and Nutrition Examination Survey 2013-2014-a population-based, cross-sectional survey of NYC residents ages 20 years and older-we measured prevalence of obesity, hypertension, hypercholesterolemia, smoking, and diabetes across gender and race/ethnicity groups for 1527 individuals. We used logistic regression with predicted marginal to estimate age-adjusted prevalence ratio by gender and race/ethnicity groups and assess for potential additive and multiplicative interaction. Overall, women had lower prevalence of CVD risk factors than men, with less hypertension (p = 0.040), lower triglycerides (p < 0.001), higher HDL (p < 0.001), and a greater likelihood of a heart healthy lifestyle, more likely not to smoke and to follow a healthy diet (p < 0.05). When further stratified by race/ethnicity, however, the female advantage was largely restricted to non-Latino white women. Non-Latino black women had significantly higher risk of being overweight or obese, having hypertension, and having diabetes than non-Latino white men or women, or than non-Latino black men (p < 0.05). Non-Latino black women also had higher total cholesterol compared to non-Latino black men (184.4 vs 170.5 mg/dL, p = 0.010). Despite efforts to improve cardiovascular health and narrow disparities, non-Latino black women continue to have a higher burden of CVD risk factors than other gender and racial/ethnic groups. This study highlights the importance of assessing for intersectionality between gender and race/ethnicity groups when examining CVD risk factors.
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31
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Graham GN, Jones PG, Chan PS, Arnold SV, Krumholz HM, Spertus JA. Racial Disparities in Patient Characteristics and Survival After Acute Myocardial Infarction. JAMA Netw Open 2018; 1:e184240. [PMID: 30646346 PMCID: PMC6324589 DOI: 10.1001/jamanetworkopen.2018.4240] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Black patients experience worse outcomes than white patients following acute myocardial infarction (AMI). OBJECTIVE To examine the degree to which nonrace characteristics explain observed survival differences between white patients and black patients following AMI. DESIGN, SETTING, AND PARTICIPANTS This cohort study used the extensive socioeconomic and clinical characteristics from patients recovering from an AMI that were prospectively collected at 31 hospitals across the contiguous United States between 2003 and 2008 for the Prospective Registry Evaluating Myocardial Infarction: Events and Recovery registry and the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status registry. Survival was assessed using data from the National Death Index. Data were analyzed from December 2016 to July 2018. MAIN OUTCOMES AND MEASURES Patient characteristics were categorized into 8 domains, and the degree to which each domain discriminated self-identified black patients from white patients was determined by calculating propensity scores associated with black race for each domain as well as cumulatively across all domains. The final propensity score was associated with 1- and 5-year mortality rates. RESULTS Among 6402 patients (mean [SD] age, 60 [13] years; 2127 [33.2%] female; 1648 [25.7%] black individuals), the 5-year mortality rate following AMI was 28.9% (476 of 1648) for black patients and 18.0% (856 of 4754) for white patients (hazard ratio, 1.72; 95% CI, 1.54-1.92; P < .001). Most categories of patient characteristics differed substantially between black patients and white patients. The cumulative propensity score discriminated race, with a C statistic of 0.89, and the propensity scores were associated with 1- and 5-year mortality rates (hazard ratio for the 75th percentile of the propensity score vs 25th percentile, 1.72; 95% CI, 1.43-2.08; P < .001). Patients in the lowest propensity score quintile associated with being a black individual (regardless of whether they were of white or black race) had a 5-year mortality rate of 15.5%, while those in the highest quintile had a 5-year mortality rate of 31.0% (P < .001). After adjusting for the propensity associated with being a black patient, there was no significant mortality rate difference by race (adjusted hazard ratio, 1.09; 95% CI, 0.93-1.26; P = .37) and no statistical interaction between race and propensity score (P = .42). CONCLUSIONS AND RELEVANCE Characteristics of black patients and white patients differed significantly at the time of admission for AMI. Those characteristics were associated with an approximately 3-fold difference in 5-year mortality rate following AMI and mediated most of the observed mortality rate difference between the races.
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Affiliation(s)
- Garth N Graham
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Kansas City
| | - Philip G Jones
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Kansas City
| | - Paul S Chan
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Kansas City
| | - Suzanne V Arnold
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Kansas City
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - John A Spertus
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Kansas City
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Sussman JB, Heisler M. Of Barbershops and Churches. Circ Cardiovasc Qual Outcomes 2018; 11:e005149. [PMID: 30354585 DOI: 10.1161/circoutcomes.118.005149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jeremy B Sussman
- Department of Internal Medicine, University of Michigan, Ann Arbor (J.B.S., M.H.).,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (J.B.S., M.H.).,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, MI (J.B.S., M.H.)
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor (J.B.S., M.H.).,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (J.B.S., M.H.).,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, MI (J.B.S., M.H.)
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33
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Pino EC, Zuo Y, Borba CP, Henderson DC, Kalesan B. Clinical depression and anxiety among ST-elevation myocardial infarction hospitalizations: Results from Nationwide Inpatient Sample 2004-2013. Psychiatry Res 2018; 266:291-300. [PMID: 29615266 DOI: 10.1016/j.psychres.2018.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/13/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
Abstract
Depression and anxiety are common among patients who have a major cardiovascular event. However, despite their frequency, there is a lack of evidence regarding the relationship between depression and/or anxiety and receiving revascularization in ST-elevation myocardial infarction (STEMI) hospitalizations. Using data from the Nationwide Inpatient Sample (NIS) from the years 2004 to 2013, we assessed whether a clinical co-diagnosis of depression and/or anxiety decreases the likelihood of revascularization among STEMI hospitalizations. Our central finding is that, paradoxically, the odds of in-hospital mortality were lower among STEMI hospitalizations with a clinical co-diagnosis of depression and/or anxiety as compared to those without. We further discovered that clinical diagnoses of depression and/or anxiety were less prevalent among revascularized as compared to non-revascularized STEMI hospitalizations. However, the percentage of clinical diagnoses of depression and/or anxiety among STEMI hospitalizations increased at a similar rate over a 10-year period irrespective of revascularization status. In conclusion, these results are suggestive of the potentially underdiagnosed mental health issues surrounding major cardiovascular events, and indeed, chronic disease as a whole. To our knowledge, this is the first study to document and examine the "depression paradox" among a population of cardiac patients.
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Affiliation(s)
- Elizabeth C Pino
- Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Yi Zuo
- Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Christina Pc Borba
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - David C Henderson
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Bindu Kalesan
- Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Department of Medicine, Boston University School of Medicine, Boston, MA, United States.
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Sauerbier A, Aris A, Lim EW, Bhattacharya K, Ray Chaudhuri K. Impact of ethnicity on the natural history of Parkinson disease. Med J Aust 2018; 208:410-414. [DOI: 10.5694/mja17.01074] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 05/16/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Anna Sauerbier
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
| | - Azman Aris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
| | - Ee Wei Lim
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
- National Neuroscience Institute, Singapore
| | | | - K Ray Chaudhuri
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
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Yuyun MF, Squire IB, Ng GA, Samani NJ. Evidence for reduced susceptibility to cardiac bradycardias in South Asians compared with Caucasians. Heart 2018; 104:1350-1355. [DOI: 10.1136/heartjnl-2017-312374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 01/11/2023] Open
Abstract
ObjectivesTo investigate ethnic differences in susceptibility to bradycardias in South Asian and white European patients in the UK by determining rates of permanent pacemaker (PPM) implantation for sinus node dysfunction (SND) and atrioventricular block (AVB) in each ethnic group.MethodsWe carried out a retrospective cohort study into new PPM implantation during the period from 1 May 2006 to 31 March 2014, in patients of South Asian and Caucasian ethnicity resident in Leicestershire, UK. Numbers of individuals at risk in each ethnic group were derived from UK National Census data of 2011. Crude, and age-standardised incidence rates and risk ratios per 1000 population of PPM implantation were calculated for Caucasians and South Asians.ResultsDuring the study period, 4883 individuals from the Leicestershire population of 980 328 underwent PPM implantation, a cumulative implantation rate of 4.98/1000 population. The population cumulative PPM implantation rate for SND was 1.74/1000, AVB 2.83/1000 and other indications 0.38/1000 population. The crude incidence in Caucasians (6.15/1000 population) was higher than in South Asians (1.07/1000 population) and remained higher after age standardisation (5.60/1000 vs 2.03/1000, P<0.001). The age-standardised cumulative PPM implantation rates were lower in South Asians for both SND (0.53/1000 in South Asians; 1.97/1000 in Caucasians, P<0.001) and AVB (1.30/1000 in South Asians; 3.17/1000 in Caucasians, P<0.001). Standardised risk ratios (95% CI) for PPM implantation in South Asians compared with Caucasians for all pacing indications, SND and AVB were 0.36 (95% CI 0.36 to 0.37), 0.27 (95% CI 0.27 to 0.28) and 0.41 (95% CI 0.41 to 0.42), respectively.ConclusionsRates of PPM implantation are lower in South Asians residing in the UK, compared with Caucasians. This observation raises the possibility of lower inherent susceptibility to bradycardias in South Asians compared with Caucasians. Studies aimed at identifying underlying mechanisms, including possible genetic differences, are warranted.
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Webb Hooper M, Antoni MH, Okuyemi K, Dietz NA, Resnicow K. Randomized Controlled Trial of Group-Based Culturally Specific Cognitive Behavioral Therapy Among African American Smokers. Nicotine Tob Res 2017; 19:333-341. [PMID: 27613941 DOI: 10.1093/ntr/ntw181] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/07/2016] [Indexed: 01/04/2023]
Abstract
Introduction This study tested the efficacy of group-based culturally specific cognitive behavioral therapy (CBT) for smoking cessation among low-income African Americans. Methods Participants (N = 342; 63.8% male; M = 49.5 years old; M cigarettes per day = 18) were randomly assigned to eight sessions of group-based culturally specific or standard CBT, plus 8 weeks of transdermal nicotine patches. Biochemically verified 7-day point prevalence abstinence (ppa) was assessed at the end-of-therapy (ie, CBT) (EOT), and 3-, 6-, and 12-month follow-ups. Primary outcomes were the longitudinal intervention effect over the 12-month follow-up period, and 7-day ppa at the 6-month follow-up. Secondary outcomes included 7-day ppa at the EOT and 12-month follow-up, and intervention ratings. Generalized linear mixed modeling tested the longitudinal effect and logistic regression tested effects at specific timepoints. Results Generalized linear mixed modeling demonstrated a longitudinal effect of intervention condition. Specifically, 7-day ppa was two times (P = .02) greater following culturally specific CBT versus standard CBT when tested across all timepoints. Analyses by timepoint found no significant difference at 6 or 12 months, yet culturally specific CBT was efficacious at the EOT (62.5% vs. 51.5% abstinence, P = .05) and the 3-month follow-up (36.4% vs. 22.9% abstinence, P = .007). Finally, intervention ratings in both conditions were high, with no significant differences. Conclusions Culturally specific CBT had a positive longitudinal effect on smoking cessation compared to a standard approach; however, the effects were driven by short-term successes. We recommend the use of group-based culturally specific CBT in this population when possible, and future research on methods to prevent long-term relapse. Implications Culturally specific interventions are one approach to address smoking-related health disparities; however, evidence for their efficacy in African Americans is equivocal. Moreover, the methodological limitations of the existing literature preclude an answer to this fundamental question. We found a positive longitudinal effect of culturally specific CBT versus standard CBT for smoking cessation across the follow-up period. Analyses by assessment point revealed that the overall effect was driven by early successes. Best practices for treating tobacco use in this population should attend to ethnocultural factors, but when this is not possible, standard CBT is an alternative approach for facilitating long-term abstinence.
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Affiliation(s)
- Monica Webb Hooper
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Michael H Antoni
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Kolawole Okuyemi
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - Noella A Dietz
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL
| | - Ken Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
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Garcia RM, Yoon S, Cage T, Potts MB, Lawton MT. Ethnicity, Race, and Postoperative Stroke Risk Among 53,593 Patients with Asymptomatic Carotid Stenosis Undergoing Revascularization. World Neurosurg 2017; 108:246-253. [PMID: 28890012 DOI: 10.1016/j.wneu.2017.08.184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/29/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The incidence of postoperative stroke after carotid endarterectomy is an uncommon event, and differences by racial and ethnic subgroups are not described fully in the literature. OBJECTIVE To investigate the impact of race and ethnicity on postoperative stroke risk among patients with asymptomatic carotid stenosis undergoing carotid endarterectomy. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was searched for patients between the dates 2008 and 2015 to identify patients undergoing carotid endarterectomy with no history of stroke. Four racial and ethnic subgroups were included: non-Hispanic white, Hispanic white, non-Hispanic back, and non-Hispanic Asian. In addition to a descriptive statistical analysis, univariate and multivariate regression models were created to adjust for cardiovascular and perioperative risk factors and corrected for multiple comparisons. RESULTS Among the 53,593 patients identified meeting the inclusion criteria, 788 (1.45%) patients experienced a stroke within 30 days. The non-Hispanic white group compared with the minority subgroups had a lower risk of postoperative stroke (1.43% vs. 1.67%, P = 0.18). The greatest difference was between the non-Hispanic white and Hispanic white groups, but this was not significant on multivariable analysis (odds ratio 1.40, 95% confidence interval 0.97-2.02, P = 0.08) after adjustment for risk stroke factors. The strongest predictors of postoperative stroke were perioperative blood transfusion, dependent functional status, and longer operative time. CONCLUSIONS There was no difference between the racial and ethnic groups and the proportion of postoperative stroke among patients undergoing revascularization for asymptomatic carotid stenosis.
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Affiliation(s)
- Roxanna M Garcia
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA.
| | - Seungwon Yoon
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Tene Cage
- Department of Neurosurgery, University of California, San Francisco, California, USA
| | - Matthew B Potts
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA; Department of Neurosurgery, University of California, San Francisco, California, USA
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Dong L, Fakeye OA, Graham G, Gaskin DJ. Racial/Ethnic Disparities in Quality of Care for Cardiovascular Disease in Ambulatory Settings: A Review. Med Care Res Rev 2017; 75:263-291. [DOI: 10.1177/1077558717725884] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Racial and ethnic disparities in cardiovascular disease (CVD) outcomes are widely reported, but research has largely focused on differences in quality of inpatient and urgent care to explain these disparate outcomes. The objective of this review is to synthesize recent evidence on racial and ethnic disparities in management of CVD in the ambulatory setting. Database searches yielded 550 articles of which 25 studies met the inclusion criteria. Reviewed studies were categorized into non-interventional studies examining the association between race and receipt of ambulatory CVD services with observational designs, and interventional studies evaluating specific clinical courses of action intended to ameliorate disparities. Based on the Donabedian framework, this review demonstrates that significant racial/ethnic disparities persist in process and outcome measures of quality of ambulatory CVD care. Multimodal interventions were most effective in reducing disparities in CVD outcomes.
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Affiliation(s)
- Liming Dong
- University of Michigan School of Public Health, Ann Arbor, MI, USA
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Kressin NR, Chapman SE, Magnani JW. A Tale of Two Patients: Patient-Centered Approaches to Adherence as a Gateway to Reducing Disparities. Circulation 2017; 133:2583-92. [PMID: 27297350 DOI: 10.1161/circulationaha.116.015361] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The disparate effects of social determinants of health on cardiovascular health status and health care have been extensively documented by epidemiology. Yet, very little attention has been paid to how understanding and addressing social determinants of health might improve the quality of clinical interactions, especially by improving patients' adherence to recommended therapies. We present a case and suggested approach to illustrate how cardiovascular clinicians can use patient-centered approaches to identify and address social determinants of health barriers to adherence and reduce the impact of unconscious clinician biases. We propose that cardiovascular clinicians (1) recognize that patients may have different belief systems about illnesses' cause and treatment, which may influence their actions, and not assume they share one's experiences or explanatory model; (2) Endeavor to understand the individual patient before you; (3) based on that understanding, tailor your approach to that individual. We suggest a previously-developed mnemonic for an approach to RESPECT the patient: First, show Respect; then elicit patients' understandings of their illness by asking about their Explanatory model. Ask about the patient's Social context, share Power in the interaction, show Empathy, ask about Concerns or fears, and work to develop Trust by building the relationship over time. We provide additional clinical resources to support these efforts, including lay descriptions of cardiovascular conditions, challenges to adherence, and suggested strategies to address them.
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Affiliation(s)
- Nancy R Kressin
- From VA Boston Healthcare System, Jamaica Plain, MA (N.R.K.); Department of Medicine, Boston University School of Medicine and Boston Medical Center, MA (N.R.K., S.E.C.); and Department of Medicine, Division of Cardiology, UPMC Heart & Vascular Institute, University of Pittsburgh, PA (J.W.M.).
| | - Sheila E Chapman
- From VA Boston Healthcare System, Jamaica Plain, MA (N.R.K.); Department of Medicine, Boston University School of Medicine and Boston Medical Center, MA (N.R.K., S.E.C.); and Department of Medicine, Division of Cardiology, UPMC Heart & Vascular Institute, University of Pittsburgh, PA (J.W.M.)
| | - Jared W Magnani
- From VA Boston Healthcare System, Jamaica Plain, MA (N.R.K.); Department of Medicine, Boston University School of Medicine and Boston Medical Center, MA (N.R.K., S.E.C.); and Department of Medicine, Division of Cardiology, UPMC Heart & Vascular Institute, University of Pittsburgh, PA (J.W.M.)
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Lee JH, Han D, Park HE, Choi SY, Sung J, Park SH, Han HW, Jung HO, Chun EJ, Chang HJ. Coronary Artery Calcification in the Asian Population: An Overview of the Results from the Korea Initiatives on Coronary Artery Calcification Registry. ACTA ACUST UNITED AC 2017. [DOI: 10.22468/cvia.2016.00150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ji Hyun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Donghee Han
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Hyo Eun Park
- Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Su-Yeon Choi
- Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Jidong Sung
- Division of Cardiology, Heart Stroke & Vascular Institute, Samsung Medical Center, Seoul, Korea
| | - Sung Hak Park
- Department of Radiology, Gangnam Heartscan Clinic, Seoul, Korea
| | - Hae-Won Han
- Department of Internal Medicine, Gangnam Heartscan Clinic, Seoul, Korea
| | - Hae Ok Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Ju Chun
- Division of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
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Patterson F, Zaslav DS, Kolman-Taddeo D, Cuesta H, Morrison M, Leone FT, Satti A. Smoking Cessation in Pulmonary Care Subjects: A Mixed Methods Analysis of Treatment-Seeking Participation and Preferences. Respir Care 2016; 62:179-192. [PMID: 27729398 DOI: 10.4187/respcare.04958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND African-American smokers experience disproportionate COPD morbidity. As a front-line COPD behavioral management strategy, smoking cessation is less prevalent among African-American smokers. Identifying barriers and predictors to smoking cessation in this population is important to bridging this disparity. METHODS In this study, the predictors of enrollment and attendance to a 3-session urban hospital smoking cessation program were examined. A retrospective chart review was conducted for all pulmonary clinic patients who smoked and were referred to the cessation program between June 2013 and May 2014. Demographic, smoking behavior, cardiopulmonary, and health status variables were extracted (N = 253). Second, a qualitative assessment of the beliefs and barriers for smoking cessation and physical activity were examined in a sub-sample of the population (n = 41). RESULTS One-hundred forty-seven of the pulmonary subjects (58%) enrolled in the cessation program, and 40 attended all sessions (16% of the total sample). Participants with COPD (odds ratio = 4.65, P = .030), or had a mother who had cancer (odds ratio = 4.49, P = .027), were more likely to attend the program. Qualitatively, pulmonary care patients who wanted to quit smoking and be more physically active cited: strong beliefs about the inability to engage in these behaviors, belief that quitting and increased activity might exacerbate poor health, and an inability to obtain pharmacotherapy as barriers to adopting these behaviors. CONCLUSIONS Smoking cessation program attendance in this sample of mostly African-American smokers was poor. Increased knowledge about cessation benefits and access to full-course pharmacotherapy, particularly in those without a COPD diagnosis and who do not have a maternal history of cancer, may be high-priority targets to promote cessation program uptake in this population. Increased knowledge and access to safe forms of physical activity may also be beneficial.
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Affiliation(s)
- Freda Patterson
- Center of Biomedical Research Excellence (COBRE) in Cardiovascular Health and the Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware.
| | - David S Zaslav
- Treatment Research Institute, Philadelphia, Pennsylvania
| | - Diana Kolman-Taddeo
- Temple University Lung Center, Temple University Health System, Ambulatory Care Center, Philadelphia, Pennsylvania
| | - Hillary Cuesta
- Department of Epidemiology and Biostatistics, College of Health Sciences, Temple University, Philadelphia, Pennsylvania
| | - Mary Morrison
- Department of Psychiatry and Behavioral Sciences, Temple University School of Medicine Episcopal Campus, Philadelphia, Pennsylvania
| | - Frank T Leone
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Aditi Satti
- Temple University Lung Center, Temple University Health System, Ambulatory Care Center, Philadelphia, Pennsylvania
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Graham G. Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes. Clin Cardiol 2016; 39:299-306. [PMID: 27028198 DOI: 10.1002/clc.22524] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/13/2016] [Indexed: 01/01/2023] Open
Abstract
In the United States, different races, ethnicities, and their subgroups experience disparities regarding acute coronary syndrome (ACS) and myocardial infarction (MI). This review highlights these differences across 4 stages that comprise the ACS/MI narrative: (1) patient demographics, (2) patient comorbidities and health risks, (3) treatments and their delays, and (4) outcomes. Overall, black and Hispanic ACS/MI patients are more likely to present with comorbidities, experience longer delays before treatment, and suffer worse outcomes when compared with non-Hispanic white patients. More specifically, across the studies analyzed, black and Hispanic ACS/MI patients were consistently more likely to be younger or female, or to have hypertension or diabetes, than non-Hispanic white patients. ACS/MI disparities also exist among Asian populations, and these are briefly outlined. However, black, Hispanic, and non-Hispanic white ACS/MI patients were the 3 most-studied racial and ethnic groups, indicating that additional studies of other minority groups, such as Native Americans, Asian populations, and black and Hispanic subgroups, are needed for their utility in reducing disparities. Despite notable improvement in ACS/MI treatment quality measures over recent decades, disparities persist. Causes are complex and extend beyond the healthcare system to culture and patients' personal characteristics; sophisticated solutions will be required. Continued research has the potential to further reduce or eliminate disparities in the comorbidities, delays, and treatments surrounding ACS and MI, extending healthy lifespans of many underserved and minority populations, while reducing healthcare costs.
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Affiliation(s)
- Garth Graham
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut.,Aetna Foundation, Aetna Inc., Hartford, Connecticut
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Graham G, Xiao YYK, Rappoport D, Siddiqi S. Population-level differences in revascularization treatment and outcomes among various United States subpopulations. World J Cardiol 2016; 8:24-40. [PMID: 26839655 PMCID: PMC4728105 DOI: 10.4330/wjc.v8.i1.24] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/29/2015] [Accepted: 11/04/2015] [Indexed: 02/06/2023] Open
Abstract
Despite recent general improvements in health care, significant disparities persist in the cardiovascular care of women and racial/ethnic minorities. This is true even when income, education level, and site of care are taken into consideration. Possible explanations for these disparities include socioeconomic considerations, elements of discrimination and racism that affect socioeconomic status, and access to adequate medical care. Coronary revascularization has become the accepted and recommended treatment for myocardial infarction (MI) today and is one of the most common major medical interventions in the United States, with more than 1 million procedures each year. This review discusses recent data on disparities in co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in revascularization as treatment for acute coronary syndrome, looking especially at women and minority populations in the United States. The data show that revascularization is used less in both female and minority patients. We summarize recent data on disparities in co-morbidities and presentation symptoms related to MI; access to care, medical resources, and treatments; and outcomes in women, blacks, and Hispanics. The picture is complicated among the last group by the many Hispanic/Latino subgroups in the United States. Some differences in outcomes are partially explained by presentation symptoms and co-morbidities and external conditions such as local hospital capacity. Of particular note is the striking differential in both presentation co-morbidities and mortality rates seen in women, compared to men, especially in women ≤ 55 years of age. Surveillance data on other groups in the United States such as American Indians/Alaska Natives and the many Asian subpopulations show disparities in risk factors and co-morbidities, but revascularization as treatment for MI in these populations has not been adequately studied. Significant research is required to understand the extent of disparities in treatment in these subpopulations.
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Lee JH, Ó Hartaigh B, Han D, Park HE, Choi SY, Sung J, Chang HJ. Reassessing the Usefulness of Coronary Artery Calcium Score among Varying Racial and Ethnic Groups by Geographic Locations: Relevance of the Korea Initiatives on Coronary Artery Calcification Registry. J Cardiovasc Ultrasound 2015; 23:195-203. [PMID: 26755926 PMCID: PMC4707303 DOI: 10.4250/jcu.2015.23.4.195] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/24/2015] [Accepted: 11/25/2015] [Indexed: 01/09/2023] Open
Abstract
There is some disparity in the morbidity and mortality rates of cardiovascular disease (CVD) according to race, ethnicity, and geographic regions. Although prediction algorithms that evaluate risk of cardiovascular events have been established using traditional risk factors, they have also demonstrated a number of differences along with race and ethnicity. Of various risk assessment modalities, coronary artery calcium (CAC) score is a sensitive marker of calcific atherosclerosis and correlates well with atherosclerotic plaque burden. Although CAC score is now utilized as a useful tool for early detection of coronary artery disease, prior studies have suggested some variability in the presence and severity of coronary calcification according to race, ethnicity, and/or geographic regions. Among Asian populations, it would appear necessary to reappraise the utility of CAC score and whether it remains superior over and above established clinical risk prediction algorithms. To this end, the Korea initiatives on coronary artery calcification (KOICA) registry has been designed to identify the effectiveness of CAC score for primary prevention of CVD in asymptomatic Korean adults. This review discusses the important role of CAC score for prognostication, while also describing the design and rationale of the KOICA registry.
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Affiliation(s)
- Ji Hyun Lee
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University Health System, Seoul, Korea.; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Bríain Ó Hartaigh
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Donghee Han
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University Health System, Seoul, Korea.; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Hyo Eun Park
- Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Su-Yeon Choi
- Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Jidong Sung
- Division of Cardiology, Heart Stroke & Vascular Institute, Samsung Medical Center, Seoul, Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University Health System, Seoul, Korea
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