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Orkin S, Zhao X, Setchell KDR, Carr E, Arce-Clachar AC, Bramlage K, Huang R, Fei L, Beck AF, Fawaz R, Valentino PL, Xanthakos SA, Mouzaki M. Food Insecurity and Pediatric Nonalcoholic Fatty Liver Disease Severity. J Pediatr 2024; 265:113818. [PMID: 37931698 PMCID: PMC11108653 DOI: 10.1016/j.jpeds.2023.113818] [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] [Received: 06/13/2023] [Revised: 10/03/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE To determine the association between food insecurity and pediatric nonalcoholic fatty liver disease (NAFLD). METHODS Cross-sectional study of patients < 21 years of age with histologically confirmed NAFLD. The Household Food Security Survey Module was administered to determine food insecurity status. Skin lipidomics were performed to explore pathophysiologic mechanisms. RESULTS Seventy-three patients with histologically confirmed NAFLD completed the Household Food Security Survey Module. Of these, the majority were male (81%) and non-Hispanic (53%), with a mean age at biopsy of 13 ± 3 years. Food insecurity was seen in 42% (n = 31). Comparison of features between food insecure and food secure subgroups revealed no differences in sex, ethnicity, BMI z-score, aminotransferases, or histologic severity. However, children experiencing food insecurity presented on average 2 years before their food secure counterparts (12.3 ± 3.0 vs 14.4 ± 3.6 years, P = .015). A subset of 31 patients provided skin samples. Skin lipidomics revealed that food insecurity was associated with down-regulated features from the lipoamino acid class of lipids, previously linked to inflammation and adipocyte differentiation. CONCLUSIONS Food insecurity is highly prevalent in children with NAFLD and is associated with earlier presentation. Lipidomic analyses suggest a possible pathophysiologic link that warrants further exploration.
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Affiliation(s)
- Sarah Orkin
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Xueheng Zhao
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kenneth D R Setchell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Emily Carr
- Division of Pediatric Gastroenterology and Hepatology, Yale New Haven Children's Hospital, New Haven, CT
| | - Ana Catalina Arce-Clachar
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kristin Bramlage
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Rong Huang
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lin Fei
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Andrew F Beck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Rima Fawaz
- Division of Pediatric Gastroenterology and Hepatology, Yale New Haven Children's Hospital, New Haven, CT; Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Pamela L Valentino
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Division of Pediatric Gastroenterology and Hepatology, Seattle Children's Hospital, Seattle, WA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Stavra A Xanthakos
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Marialena Mouzaki
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
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Khadanga S, Savage PD, Ades PA, Yant B, Anair B, Kromer L, Gaalema DE. Lower-Socioeconomic Status Patients Have Extremely High-Risk Factor Profiles on Entry to Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2024; 44:26-32. [PMID: 37820180 PMCID: PMC10843557 DOI: 10.1097/hcr.0000000000000826] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
PURPOSE Patients with lower socioeconomic status (SES) have higher rates of cardiovascular events, yet are less likely to engage in secondary prevention such as cardiac rehabilitation (CR). Given the low number of lower-SES patients entering CR, characterization of this population has been difficult. Our CR program specifically increased recruitment of lower-SES patients, allowing for careful comparison of medical, psychosocial, and behavioral risk factors between lower- and higher-SES patients eligible for secondary prevention. METHODS Demographic and clinical characteristics were prospectively gathered on consecutive individuals entering phase 2 CR from January 2014 to December 2022. Patients were classified as lower SES if they had Medicaid insurance. Statistical methods included chi-square and nonpaired t tests. A P value of <.01 was used to determine significance. RESULTS The entire cohort consisted of 3131 individuals. Compared with higher-SES patients, lower-SES individuals (n = 405; 13%) were a decade younger (57.1 ± 10.4 vs 67.2 ± 11.2 yr), 5.8 times more likely to be current smokers (29 vs 5%), 1.7 times more likely to have elevated depressive symptoms, and significantly higher body mass index, waist circumference, and glycated hemoglobin A 1c , with more abnormal lipid profiles (all P s < .001). Despite being a decade younger, lower-SES patients had lower measures of cardiorespiratory fitness and self-reported physical function (both P s < .001). CONCLUSION Lower-SES patients have a remarkably prominent high-risk cardiovascular disease profile, resulting in a substantially higher risk for a recurrent coronary event than higher-SES patients. Accordingly, efforts must be made to engage this high-risk population in CR. It is incumbent on CR programs to ensure that they are appropriately equipped to intervene on modifiable risk factors such as low cardiorespiratory fitness, obesity, depression, and smoking.
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Affiliation(s)
| | | | | | | | - Bradley Anair
- University of Vermont Medical Center, Burlington, VT
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3
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Akioyamen LE, Abdel-Qadir H, Han L, Sud M, Mistry N, Alter DA, Atzema CL, Austin PC, Bhatia RS, Booth GL, Dhalla I, Ha ACT, Jackevicius CA, Kapral MK, Krumholz HM, Lee DS, McNaughton CD, Roifman I, Schull MJ, Sivaswamy A, Tu K, Udell JA, Wijeysundera HC, Ko DT. Association of Neighborhood-Level Marginalization With Health Care Use and Clinical Outcomes Following Hospital Discharge in Patients Who Underwent Coronary Catheterization for Acute Myocardial Infarction in a Single-Payer Health Care System. Circ Cardiovasc Qual Outcomes 2023; 16:e010063. [PMID: 38050754 DOI: 10.1161/circoutcomes.123.010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/06/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Canadian data suggest that patients of lower socioeconomic status with acute myocardial infarction receive less beneficial therapy and have worse clinical outcomes, raising questions regarding care disparities even in universal health care systems. We assessed the contemporary association of marginalization with clinical outcomes and health services use. METHODS Using clinical and administrative databases in Ontario, Canada, we conducted a population-based study of patients aged ≥65 years hospitalized for their first acute myocardial infarction between April 1, 2010 and March 1, 2019. Patients receiving cardiac catheterization and surviving 7 days postdischarge were included. Our primary exposure was neighborhood-level marginalization, a multidimensional socioeconomic status metric. Neighborhoods were categorized by quintile from Q1 (least marginalized) to Q5 (most marginalized). Our primary outcome was all-cause mortality. A proportional hazards regression model with a robust variance estimator was used to quantify the association of marginalization with outcomes, adjusting for risk factors, comorbidities, disease severity, and regional cardiologist supply. RESULTS Among 53 841 patients (median age, 75 years; 39.1% female) from 20 640 neighborhoods, crude 1- and 3-year mortality rates were 7.7% and 17.2%, respectively. Patients in Q5 had no significant difference in 1-year mortality (hazard ratio [HR], 1.08 [95% CI, 0.95-1.22]), but greater mortality over 3 years (HR, 1.13 [95% CI, 1.03-1.22]) compared with Q1. Over 1 year, we observed differences between Q1 and Q5 in visits to primary care physicians (Q1, 96.7%; Q5, 93.7%) and cardiologists (Q1, 82.6%; Q5, 72.6%), as well as diagnostic testing. There were no differences in secondary prevention medications dispensed or medication adherence at 1 year. CONCLUSIONS In older patients with acute myocardial infarction who survived to hospital discharge, those residing in the most marginalized neighborhoods had a greater long-term risk of mortality, less specialist care, and fewer diagnostic tests. Yet, there were no differences across socioeconomic status in prescription medication use and adherence.
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Affiliation(s)
- Leo E Akioyamen
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
| | - Husam Abdel-Qadir
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- University Health Network, Toronto, ON, Canada (H.A.-Q., D.A.A., R.S.B., A.C.T.H., M.K.K., D.S.L., J.A.U.)
- Women's College Hospital, Toronto, ON, Canada (H.A.-Q., J.A.U.)
| | - Lu Han
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
| | - Maneesh Sud
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada (M.S., C.L.A., C.D.M., I.R., M.J.S., H.C.W., D.T.K.)
| | - Nikhil Mistry
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
| | - David A Alter
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- University Health Network, Toronto, ON, Canada (H.A.-Q., D.A.A., R.S.B., A.C.T.H., M.K.K., D.S.L., J.A.U.)
| | - Clare L Atzema
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada (M.S., C.L.A., C.D.M., I.R., M.J.S., H.C.W., D.T.K.)
| | - Peter C Austin
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
| | - R Sacha Bhatia
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada (H.A.-Q., D.A.A., R.S.B., A.C.T.H., M.K.K., D.S.L., J.A.U.)
| | - Gillian L Booth
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada (G.L.B., I.R.,)
| | - Irfan Dhalla
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
| | - Andrew C T Ha
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada (H.A.-Q., D.A.A., R.S.B., A.C.T.H., M.K.K., D.S.L., J.A.U.)
| | - Cynthia A Jackevicius
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Western University of Health Sciences, Pomona, CA (C.A.J.)
| | - Moira K Kapral
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada (H.A.-Q., D.A.A., R.S.B., A.C.T.H., M.K.K., D.S.L., J.A.U.)
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (H.M.K.)
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (H.M.K.)
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Douglas S Lee
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- University Health Network, Toronto, ON, Canada (H.A.-Q., D.A.A., R.S.B., A.C.T.H., M.K.K., D.S.L., J.A.U.)
| | - Candace D McNaughton
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada (M.S., C.L.A., C.D.M., I.R., M.J.S., H.C.W., D.T.K.)
| | - Idan Roifman
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada (M.S., C.L.A., C.D.M., I.R., M.J.S., H.C.W., D.T.K.)
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada (G.L.B., I.R.,)
| | - Michael J Schull
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada (M.S., C.L.A., C.D.M., I.R., M.J.S., H.C.W., D.T.K.)
| | - Atul Sivaswamy
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
| | - Karen Tu
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Department of Family and Community Medicine, (K.T.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- North York General Hospital, Toronto, ON, Canada (K.T.)
| | - Jacob A Udell
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- University Health Network, Toronto, ON, Canada (H.A.-Q., D.A.A., R.S.B., A.C.T.H., M.K.K., D.S.L., J.A.U.)
- Women's College Hospital, Toronto, ON, Canada (H.A.-Q., J.A.U.)
| | - Harindra C Wijeysundera
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada (M.S., C.L.A., C.D.M., I.R., M.J.S., H.C.W., D.T.K.)
| | - Dennis T Ko
- Department of Medicine (L.E.A., H.A.-Q., D.A.A., C.L.A., R.S.B., I.D., A.C.T.H., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (H.A.-Q., M.S., D.A.A., C.L.A., P.C.A., G.L.B., I.D., C.A.J., M.K.K., D.S.L., I.R., M.J.S., K.T., J.A.U., H.C.W., D.T.K.), University of Toronto, ON, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada (H.A.-Q., L.H., M.S., N.M., D.A.A., C.L.A., P.C.A., G.L.B., C.A.J., M.K.K., D.S.L., C.D.M., I.R., M.J.S., A.S., K.T., J.A.U., H.C.W., D.T.K.)
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada (M.S., C.L.A., C.D.M., I.R., M.J.S., H.C.W., D.T.K.)
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Chalabaev A, Cheval B, Maltagliati S, Saoudi I, Sniehotta FF. Beyond Individual Cognitions: Time for Intervention Science to Focus on Health Context and Audience. J Phys Act Health 2023; 20:465-470. [PMID: 37076243 DOI: 10.1123/jpah.2023-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 04/21/2023]
Abstract
Intervention science faces a hazardous paradox: on the one hand, vulnerable populations (eg, patients, people from low socioeconomic background, older adults) are those for whom adoption of healthy behaviors is most urgent; on the other hand, behavior change models are less predictive, and interventions less successful, in these populations. This commentary presents 4 reasons that may explain this issue: (1) research mostly focuses on what causes behavior and how to change it, at the expense of investigating among whom and under what conditions models are valid; (2) models put an undue emphasis on individual cognitions; (3) most studies are not conducted on vulnerable populations; and (4) most researchers are from high-income countries. Several avenues are proposed to address this issue: (1) providing a central place to the context and audience in health behavior change modelization, through collaborations with researchers from other disciplines and countries, and with members of the targeted audience; (2) better reporting samples' sociodemographic characteristics and increasing samples' diversity; and (3) using more rigorous and innovative designs (eg, powered randomized controlled trials, N-of-1 trials, intensive longitudinal studies). In conclusion, it becomes urgent to change the way we do research: the social utility and credibility of intervention science depend on it.
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Affiliation(s)
| | - Boris Cheval
- Swiss Center for Affective Sciences, University of Geneva, Geneva,Switzerland
- Department of Psychology, Switzerland Department of Public Health, Social and Environmental Determinants of Health, Laboratory for the Study of Emotion Elicitation and Expression (E3Lab), University of Geneva, Geneva,Switzerland
| | | | | | - Falko F Sniehotta
- Department of Public Health, Social and Preventive Medicine, CPD, Medical Faculty Mannheim, University of Heidelberg, Mannheim,Germany
- NIHR Policy Research Unit Behavioural Science, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne,United Kingdom
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Gaalema DE, Savage PD, O'Neill S, Bolívar HA, Denkmann D, Priest JS, Khadanga S, Ades PA. The Association of Patient Educational Attainment With Cardiac Rehabilitation Adherence and Health Outcomes. J Cardiopulm Rehabil Prev 2022; 42:227-234. [PMID: 34840247 PMCID: PMC9127001 DOI: 10.1097/hcr.0000000000000646] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Participating in cardiac rehabilitation (CR) after a cardiac event provides many clinical benefits. Patients of lower socioeconomic status (SES) are less likely to attend CR. It is unclear whether they attain similar clinical benefits as patients with higher SES. This study examines how educational attainment (one measure of SES) predicts both adherence to and improvements during CR. METHODS This was a prospective observational study of 1407 patients enrolled between January 2016 and December 2019 in a CR program located in Burlington, VT. Years of education, smoking status (self-reported and objectively measured), depression symptom level (Patient Health Questionnaire), self-reported physical function (Medical Outcomes Survey), level of fitness (peak metabolic equivalent, peak oxygen uptake, and handgrip strength), and body composition (body mass index and waist circumference) were obtained at entry to, and for a subset (n = 917), at exit from CR. Associations of educational attainment with baseline characteristics were examined using Kruskal-Wallis or Pearson's χ 2 tests as appropriate. Associations of educational attainment with improvements during CR were examined using analysis of covariance or logistic regression as appropriate. RESULTS Educational attainment was significantly associated with most patient characteristics examined at intake and was a significant predictor of the number of CR sessions completed. Lower educational attainment was associated with less improvement in cardiorespiratory fitness, even when controlling for other variables. CONCLUSIONS Patients with lower SES attend fewer sessions of CR than their higher SES counterparts and may not attain the same level of benefit from attending. Programs need to increase attendance within this population and consider program modifications that further support behavioral changes during CR.
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Affiliation(s)
- Diann E Gaalema
- Larner College of Medicine at the University of Vermont, Burlington (Drs Gaalema, O'Neill, and Bolívar and Ms Denkmann); Department of Medicine, Division of Cardiology, University of Vermont Medical Center, Burlington (Mr Savage and Drs Khadanga and Ades); and Department of Biostatistics, University of Vermont, Burlington (Dr Priest)
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6
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Factors influencing kinesiophobia during the "blanking period" after radiofrequency catheter ablation in patients with atrial fibrillation by the fear-avoidance model. Int J Cardiol 2022; 363:49-55. [PMID: 35716943 DOI: 10.1016/j.ijcard.2022.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/31/2022] [Accepted: 06/10/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The influencing factors of kinesiophobia (fear of movement) in patients with atrial fibrillation(AF)during the post-operative "Blanking Period" are not known. The aims were to investigate the status of kinesiophobia in patients with AF during the post-operative "Blanking Period", then further describe the occurrence and analyze the influencing factors of patients' kinesiophobia by the Fear-Avoidance Model. MATERIALS AND METHODS In total,400 patients diagnosed with atrial fibrillation, during the post-operative "Blanking Period" from the selected hospital were included in this study. The Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), the Self-efficacy for Exercise (SEE) scale, and the Geriatric Locomotive Function Scale (GLFS) were used to assess kinesiophobia, exercise self-efficacy, and physical function. The study adopted a cross-sectional design. RESULTS The score of kinesiophobia during the "Blanking Period" after operation in patients with atrial fibrillation was (44.06 ± 10.77), and the rate of high kinesiophobia was 71.61%.Logistic regression results showed that age, education, household monthly income, resting heart rate, EHRA symptom classification, exercise self-efficacy, and physical function influenced the kinesiophobia of patients during the post-operative "Blanking Period"(p<0.05, p<0.01). CONCLUSIONS Kinesiophobia is common in patients with atrial fibrillation during the postoperative "Blanking Period", and the fear of movement is related to age, education, household monthly income, resting heart rate, EHRA symptom classification, exercise self-efficacy, and physical function. Clinical and nursing staff should pay close attention to the psychological problems in the post-operation "Blanking Period" of exercise rehabilitation in patients with atrial fibrillation, make timely interventions to reduce patients' fear of movement, and improve patients' compliance with exercise rehabilitation.
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7
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Lovatt S, Wong CW, Holroyd E, Butler R, Phan T, Patwala A, Loke YK, Mallen CD, Kwok CS. Smoking cessation after acute coronary syndrome: A systematic review and meta-analysis. Int J Clin Pract 2021; 75:e14894. [PMID: 34541754 DOI: 10.1111/ijcp.14894] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/02/2021] [Accepted: 09/17/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Smoking cessation is an effective secondary prevention measure after acute coronary syndrome (ACS). We conducted a systematic review with the aim to better understand which patients have a greater propensity to quit smoking and the risk factors for continued smoking after ACS. METHODS We searched MEDLINE and EMBASE for studies that evaluated smoking cessation after ACS. The pooled rate of smoking cessation across included studies was performed. Random effects meta-analysis for different variables and their association with smoking cessation was conducted. RESULTS A total of 39 studies with 11 228 patients were included in this review. The pooled rate of smoking cessation following ACS across 38 studies was 45.0%. Factors associated with greater likelihood of smoking cessation were attendance at cardiac rehabilitation (OR 1.90 95% CI 1.44-2.51), married/not alone (OR 1.68 95% CI 1.32-2.13), intention/attempt to quit smoking (OR 1.27 95% CI 1.11-1.46), diabetes mellitus (OR 1.24 95% CI 1.03-1.51) and hospitalised duration (OR 1.09 95% CI 1.02-1.15). Variables associated with a lower likelihood of smoking cessation were depression (OR 0.57 95% CI 0.43-0.75), chronic obstructive pulmonary disease/lung disease (OR 0.73 95% CI 0.57-0.93), previous admission with acute myocardial infarction/cardiac admission (OR 0.61 95% CI 0.47-0.80), cerebrovascular disease/transient ischaemic attack (OR 0.42 95% CI 0.30-0.58) and unemployment (OR 0.37 95% CI 0.17-0.80). CONCLUSIONS The majority of smokers with an ACS continue to smoke after admission. Patients attending cardiac rehabilitation show increased odds of quitting while people who are depressed and those with chronic lung disease were less likely to quit smoking and should be targeted for intensive smoking cessation interventions.
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Affiliation(s)
- Saul Lovatt
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Chun Wai Wong
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Eric Holroyd
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Rob Butler
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Thanh Phan
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Ashish Patwala
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Chun Shing Kwok
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
- School of Medicine, Keele University, Stoke-on-Trent, UK
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8
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Nari F, Jeong W, Jang BN, Lee HJ, Park EC. Association between healthy lifestyle score changes and quality of life and health-related quality of life: a longitudinal analysis of South Korean panel data. BMJ Open 2021; 11:e047933. [PMID: 34675011 PMCID: PMC8532554 DOI: 10.1136/bmjopen-2020-047933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES We aimed to determine the influence of changes in the aggregate score of healthy lifestyle factors on health-related quality of life (HRQOL) and overall quality of life (QOL) in the Korean older adult population. DESIGN This study used a longitudinal design. SETTING AND PARTICIPANTS Data on 9474 participants aged 45 years or older were extracted from the Korean Longitudinal Study on Aging for the period 2006-2016. A composite score of four lifestyle factors (smoking, drinking, physical activity and body mass index) was calculated, and biennial changes in aggregate score were computed. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were HRQOL and QOL. RESULTS Generalised estimating equation analysis results showed that those with healthy lifestyle score changes from 'Low-High' (β =-0.987, p=0.002; β =-1.288, p<0.0001), 'High-Low' (β =-1.281, p<0.0001; β =-1.952, p<0.0001) and 'Low-Low' (β =-1.552, p<0.0001; β =-2.398, p<0.0001) groups were more likely to be have lower HRQOL and QOL estimates than those in 'High-High' group. Female gender, older age and depression had a more negative impact on HRQOL, while male gender and younger age had a more negative impact on QOL, especially in the Low-Low group. The relationship between changes in scores and HRQOL and QOL varied across different elements of healthy lifestyle scores. Changes in physical activity, drinking and smoking status were significantly associated with lower HRQOL and QOL. CONCLUSION The findings suggest an association between a low healthy lifestyle score and poor quality of life, in both general and health-related aspects. Strategies targeting the Korean ageing demographic to promote a healthier lifestyle should be encouraged.
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Affiliation(s)
- Fatima Nari
- Department of Public Health, Graduate School, Yonsei University, Seodaemun-gu, Korea (the Republic of)
- Yonsei University Institute of Health Services Research, Seodaemun-gu, Korea (the Republic of)
| | - Wonjeong Jeong
- Department of Public Health, Graduate School, Yonsei University, Seodaemun-gu, Korea (the Republic of)
- Yonsei University Institute of Health Services Research, Seodaemun-gu, Korea (the Republic of)
| | - Bich Na Jang
- Department of Public Health, Graduate School, Yonsei University, Seodaemun-gu, Korea (the Republic of)
- Yonsei University Institute of Health Services Research, Seodaemun-gu, Korea (the Republic of)
| | - Hyeon Ji Lee
- Department of Public Health, Graduate School, Yonsei University, Seodaemun-gu, Korea (the Republic of)
- Yonsei University Institute of Health Services Research, Seodaemun-gu, Korea (the Republic of)
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
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Moledina A, Tang KL. Socioeconomic Status, Mortality, and Access to Cardiac Services After Acute Myocardial Infarction in Canada: A Systematic Review and Meta-analysis. CJC Open 2021; 3:950-964. [PMID: 34401702 PMCID: PMC8347872 DOI: 10.1016/j.cjco.2021.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background Low socioeconomic status (SES) is an important prognosticator for those with acute myocardial infarction (AMI), having previously been described to be associated with increased short-term mortality. Whether this effect persists over time, and whether access to cardiac interventions is equitable within Canada’s universal health care system, remains unknown. Methods We conducted a systematic review to determine the associations of SES with mortality and access to a spectrum of interventions including cardiac catheterization, revascularization, and cardiac rehabilitation. Electronic databases (EMBASE and MEDLINE) were searched in March 2019 and December 2019. Original studies from Canada examining associations between SES and any of the above outcomes in AMI patients were included. Meta-analyses were conducted using random effects models. Results Nineteen studies were included, 11 of which could be meta-analyzed. Low SES was associated with a 48% and 34% increase in short-term and intermediate-term mortality, respectively. There was a trend toward increased long-term mortality more than 1-year post-event (pooled odds ratio [OR] 1.34 [95% confidence interval {CI} 0.95-1.88]). Low SES was also associated with lower rates of cardiac catheterization (pooled OR 0.80 [95% CI 0.65-0.99]) and revascularization (pooled OR 0.76 [95% CI 0.63-0.90]) post-AMI. Studies on cardiac rehabilitation showed reduced access and participation in low-SES groups. Conclusions Low SES is associated with not only increased mortality post-AMI, but also reduced access to cardiac interventions that have demonstrated benefits for mortality and morbidity. Interventions that improve access to catheterization, revascularization, and cardiac rehabilitation for low-SES populations are needed if true equitable care in Canada is desired.
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Affiliation(s)
- Aliza Moledina
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Karen L Tang
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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10
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McCullough JM, Curwick K. Local Health and Social Services Spending to Reduce Preventable Hospitalizations. Popul Health Manag 2020; 23:453-458. [PMID: 31930933 DOI: 10.1089/pop.2019.0195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Upstream spending on social determinants of health can lead to improved downstream population health outcomes but intermediate steps between these end points are unclear. The purpose of this study was to determine the longitudinal impacts of government spending on hospital visits for potentially preventable conditions. The authors used secondary data sets from 2007-2014 to measure county-level Prevention Quality Indicator (PQI) rates, local government health and social services spending, hospital-provided community health services, and other sociodemographics. Mixed effects models regressed county PQI rates on deviation from mean local government spending from 4 years previously to account for lag between spending and outcomes. Thirty-two states reported PQI data; complete data were available for 1660 counties. Controlling for baseline spending levels, a 1-time $10 per capita increase in social services spending was associated with 1.9 fewer preventable hospitalizations (per 100,000) within 4 years (P < 0.001); $10 increases in public health or education were associated with 1.8 and 2.2 fewer preventable hospitalizations (per 100,000), respectively (P < 0.001). The association between change in spending and change in PQI was larger for acute than for chronic conditions. Additional health and social services spending by local governments can prevent hospitalizations for conditions for which quality outpatient care can potentially prevent the need for hospitalization or for which early intervention can prevent complications or progression of disease. Upstream spending can affect health care utilization and may offer a way to improve health outcomes or reshape the health care cost curve.
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Affiliation(s)
- J Mac McCullough
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Kevin Curwick
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
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Sakalaki M, Barywani S, Rosengren A, Björck L, Fu M. Determinants of suboptimal long-term secondary prevention of acute myocardial infarction: the structural interview method and physical examinations. BMC Cardiovasc Disord 2019; 19:243. [PMID: 31694556 PMCID: PMC6833166 DOI: 10.1186/s12872-019-1238-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 10/24/2019] [Indexed: 11/19/2022] Open
Abstract
Background Secondary prevention after an acute myocardial infarction (AMI) reduces morbidity and mortality, but suboptimal secondary prevention of cardiovascular disease is common. Therefore, the present study aimed to identify potential underlying factors for suboptimal secondary prevention 2 years after an AMI event. Methods Patients aged 18–85 years at the time of their index AMI and hospitalized between July 2010 and December 2011, were identified retrospectively and consecutively from hospital discharge records. All patients who agreed to participate underwent a structured interview, physical examinations and laboratory analysis 2 years after their index AMI. The secondary preventive goals included are; blood pressure < 140/90 mmHg, LDL < 1.8 mmol/L, HbA1c < 48 mmol/mol, regular physical activity that causes sweating at least twice a week, non-smoking and BMI < 25 kg/m2. Multivariable and univariable logistic regression models were applied to identify independent predictors of different secondary prevention achievements. Results Of the 200 patients (mean age 63.3 ± 9.7 years) included in the study, 159 (80%) were men. No common determinants were found in patients who failed to achieve at least six secondary prevention guideline-directed goals. For individual secondary prevention goals, several determinants were defined. Patients born in Sweden were less likely to achieve optimal lipid control [odds ratio (OR) 0.28 (95% confidence interval, CI 0.12–0.63)]. Younger (≤ 65 years) [OR 0.24 (95% CI 0.07–0.74)] and unemployed patients [OR 0.23 (95% CI 0.06–0.82)] were less likely to be non-smokers. Patients with diabetes mellitus [OR 0.21 (95% CI 0.04–0.98)] or with a walking aid [OR 0.23 (95% CI 0.07–0.71)] were less likely to achieve an optimal body mass index (BMI < 25). Living alone was an independent predictor of achieving regular physical activity [OR 1.94 (95% CI 1.02–3.69)]. Conclusion Long-term secondary prevention remained suboptimal 2 years after an AMI. Causes are likely multifactorial, with no single determinant for all six guideline-recommended preventive goals. Therefore a tailored comprehensive assessment should be requested and updated and treatment of risk factors should be applied.
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Affiliation(s)
- Maria Sakalaki
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Region Västra Götaland, Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
| | - Salim Barywani
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Lena Björck
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
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12
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Højskov IE, Thygesen LC, Moons P, Egerod I, Olsen PS, Berg SK. The challenge of non-adherence to early rehabilitation after coronary artery bypass surgery: Secondary results from the SheppHeartCABG trial. Eur J Cardiovasc Nurs 2019; 19:238-247. [PMID: 31630532 DOI: 10.1177/1474515119883454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Attending and maintaining a cardiac rehabilitation programme is a challenge. AIMS The purpose of this study was to explore associations between non-adherence to early coronary artery bypass graft rehabilitation and sociodemographic and clinical baseline data. METHODS Coronary artery bypass graft patients were randomised 1:1 to either four weeks of comprehensive early rehabilitation or usual care. Outcomes were assessed at three time-points points: baseline, discharge and four weeks post-coronary artery bypass graft. Differences in sociodemographic and clinical baseline data in adherent versus non-adherent patients were tested using the Pearson χ2 test for categorical variables. To test associations between non-adherence to exercise training and sociodemographic and clinical baseline data, multivariate logistic regression was used to estimate the odds ratio for in-hospital training and post-discharge training adjusted for age, sex and left ventricular ejection fraction. RESULTS Non-adherence to in-hospital versus post-discharge exercise training was 31% (n=48) versus 53% (n=81). Female non-adherence was 20% versus 70%. Non-adherence to in-hospital versus post-discharge mindfulness was 87% versus 70%. Male non-adherence to mindfulness was 85% versus 70%. Non-adherence to psycho-educational consultations was 3%, most of whom were men. Patients with university level education were more adherent to in-hospital exercise training than patients with lower educational level (odds ratio=3.14 (95% confidence interval; 1.16-8.51), p=0.02). Diabetic patients were more non-adherent to exercise training after discharge (3.74 (1.54-9.08), p=0.004) as were overweight patients (0.37 (0.17-0.80), p=0.01). CONCLUSIONS This study demonstrated wide acceptance of psycho-educational consultations in post-coronary artery bypass graft patients. Adherence to physical rehabilitation was low especially after discharge from hospital and the opportunity to attend a mindfulness programme was not used.
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Affiliation(s)
- Ida E Højskov
- The Heart Centre, University of Copenhagen, Denmark.,Department of Nursing and Nutrition Education. The Faculty of Health Sciences, University College, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Philip Moons
- Department of Public Health and Primary Care, University of Leuven, Belgium.,Department of Pediatrics and Child Health, University of Cape Town, South Africa
| | - Ingrid Egerod
- Department of Intensive Care Unit, Rigshospitalet, University of Copenhagen, Denmark
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Hald K, Larsen FB, Nielsen KM, Meillier LK, Johansen MB, Larsen ML, Christensen B, Nielsen CV. Medication adherence, biological and lifestyle risk factors in patients with myocardial infarction: a ten-year follow-up on socially differentiated cardiac rehabilitation. Scand J Prim Health Care 2019; 37:182-190. [PMID: 31122102 PMCID: PMC6566981 DOI: 10.1080/02813432.2019.1608046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: There is strong evidence that medication adherence and lifestyle changes are essential in patients undergoing secondary cardiovascular disease prevention. Cardiac rehabilitation (CR) increases medication adherence and improves lifestyle changes. Patients with cardiac diseases and a low educational level and patients with little social support are less responsive to improve medication adherence and to adapt lifestyle changes. The aim of the present study was to investigate the long-term effects of a socially differentiated CR intervention on medication adherence as well as changes in biological and lifestyle risk factors at two- five- and ten-year follow-up. Design: A prospective cohort study. Setting: The cardiac ward at Aarhus University Hospital, Denmark. Intervention: A socially differentiated CR intervention in addition to the standard CR program. Subjects: Patients admitted with first-episode myocardial infarction between 2000 and 2004, N = 379. Patients were defined as socially vulnerable or non-socially vulnerable according to their educational level and extent of social network. Main outcome measures: Primary outcome was medication adherence to antithrombotics, beta-blockers, statins and angiotensin-converting enzyme inhibitors. Secondary outcomes were biological and lifestyle risk factors defined as; total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, glycated hemoglobin, blood pressure and smoking status. Results: No significant long-term effect of the intervention was found. Conclusions: The results indicate a non-significant effect of the intervention. However, it was found that equality in health was improved in the study population except concerning smoking. General practitioners manage to support the long-term secondary cardiovascular disease prevention in all patients regardless of social status. Key points The socially differentiated intervention did not significantly improve medication adherence or biological and lifestyle risk factors. Despite the non-significant effect of the intervention, equality in health was improved except concerning smoking. General practitioners managed to support the long-term secondary cardiovascular disease prevention in all patients regardless of social status.
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Affiliation(s)
- Kathrine Hald
- Section for Clinical Social Medicine and Rehabilitation Department of Public Health, Aarhus University, Aarhus, Denmark;
- CONTACT Kathrine Hald Section for Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, P. P. Oerums Gade 9-11, Building 1B, 8000Aarhus C, Denmark
| | - Finn Breinholt Larsen
- DEFACTUM, Social and Health Services and Labour Market, Central Denmark Region, Aarhus, Denmark;
| | | | - Lucette Kirsten Meillier
- DEFACTUM, Social and Health Services and Labour Market, Central Denmark Region, Aarhus, Denmark;
| | | | - Mogens Lytken Larsen
- Danish Centre for Inequality in Health, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark;
| | - Bo Christensen
- Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Claus Vinther Nielsen
- Section for Clinical Social Medicine and Rehabilitation Department of Public Health, Aarhus University, Aarhus, Denmark;
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Wolf A, Vella R, Fors A. The impact of person-centred care on patients’ care experiences in relation to educational level after acute coronary syndrome: secondary outcome analysis of a randomised controlled trial. Eur J Cardiovasc Nurs 2019; 18:299-308. [DOI: 10.1177/1474515118821242] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Research supporting the benefits of person-centred care is growing, still knowledge about patients’ experiences of person-centred care is limited. Aim: To evaluate the effects of person-centred care on patients’ experiences of care, and also in relation to educational level, after an acute coronary syndrome. Method: A total of 199 patients aged less than 75 years, hospitalised for acute coronary syndrome, were randomly assigned to either standard cardiac care ( n=105) or person-centred care plus standard cardiac care ( n=94). Experience of care was assessed at three healthcare settings (hospital, outpatient and primary care) using the 15-item Picker patient experience questionnaire plus two questions concerning information and documentation. Results: No significant difference was found at the three healthcare settings between the two study groups in the Picker patient experience questionnaire total score. Item level analysis showed that the person-centred care group significantly improved at all three healthcare settings on information received and in documentation of care compared with the standard cardiac care group ( P<0.05). In outpatient care, the person-centred care group reported significantly better family–physician communication ( P=0.004) and information for the family ( P=0.007) compared with the standard cardiac care group. In patients without postsecondary education, the corresponding figures were even more in favour of the person-centred care group ( P=0.0005 and P=0.0049, respectively), and they also reported higher involvement in care decisions ( P=0.023). Conclusion: A person-centred care approach after an event of acute coronary syndrome improves patients’ care experiences for information, shared documentation and involvement of family and friends. This effect was especially prominent in patients with a low educational level, who were also more involved in care decisions. Trial registration: Swedish registry, Researchweb.org , ID NR 65 791
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Affiliation(s)
- Axel Wolf
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital Östra, Gothenburg, Sweden
| | - Rebecca Vella
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
- Närhälsan Research and Development Primary Health Care, Sweden
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Livitckaia K, Koutkias V, Maglaveras N, Kouidi E, van Gils M, Chouvarda I. Adherence to Physical Activity in Patients with Heart Disease: Types, Settings and Evaluation Instruments. PRECISION MEDICINE POWERED BY PHEALTH AND CONNECTED HEALTH 2018. [DOI: 10.1007/978-981-10-7419-6_42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Abstract
PURPOSE Cardiac rehabilitation (CR) is a program of structured exercise and interventions for coronary risk factor reduction that reduces morbidity and mortality rates following a major cardiac event. Although a dose-response relationship between the number of CR sessions completed and health outcomes has been demonstrated, adherence with CR is not high. In this study, we examined associations between the number of sessions completed within CR and patient demographics, clinical characteristics, smoking status, and socioeconomic status (SES). METHODS Multiple logistic regression and classification and regression tree (CART) modeling were used to examine associations between participant characteristics measured at CR intake and the number of sessions completed in a prospectively collected CR clinical database (n = 1658). RESULTS Current smoking, lower SES, nonsurgical diagnosis, exercise-limiting comorbidities, and lower age independently predicted fewer sessions completed. The CART analysis illustrates how combinations of these characteristics (ie, risk profiles) predict the number of sessions completed. Those with the highest-risk profile for nonadherence (<65 years old, current smoker, lower SES) completed on average 9 sessions while those with the lowest-risk profile (>72 years old, not current smoker, higher SES, surgical diagnosis) completed 27 sessions on average. CONCLUSIONS Younger individuals, as well as those who report smoking or economic challenges or have a nonsurgical diagnosis, may require additional support to maintain CR session attendance.
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Fors A, Swedberg K, Ulin K, Wolf A, Ekman I. Effects of person-centred care after an event of acute coronary syndrome: Two-year follow-up of a randomised controlled trial. Int J Cardiol 2017; 249:42-47. [PMID: 28893432 DOI: 10.1016/j.ijcard.2017.08.069] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
Abstract
AIM To assess the long-term effect of person-centred care (PCC) in patients with acute coronary syndrome (ACS). METHOD Patients with ACS were randomly assigned to treatment as usual (control group) or an added PCC intervention for six months. The primary endpoint was a composite score of changes in general self-efficacy≥five units, return to work or to a prior activity level and re-hospitalisation or death. RESULTS The composite score improved in the PCC intervention group (n=94) at a two-year follow-up compared with the control group (n=105) (18.1%, n=17 vs. 10.5%, n=11; P=0.127). In the per-protocol analysis (n=183) the improvement was significant in favour of the PCC intervention (n=78) compared with usual care (n=105) (21.8%, n=17 vs. 10.5%, n=11; P=0.039). This effect was driven by the finding that more patients in the PCC group improved their general self-efficacy score≥5units (32.2%, n=19 vs. 17.3%, n=14; P=0.046). The composite score improvement was significantly higher in the PCC intervention group without post-secondary education (n=33) in comparison with corresponding patients in the control group (n=50) (30.3%, n=10 vs. 10.0%, n=5; P=0.024). CONCLUSION Implementation of PCC results in sustained improvements in health outcome in patients with ACS. PCC can be incorporated into conventional cardiac prevention programmes to improve equity in uptake and patient health outcomes. TRIAL REGISTRATION Swedish registry, Researchweb.org, ID NR 65791.
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Affiliation(s)
- Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Sweden.
| | - Karl Swedberg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Kerstin Ulin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Axel Wolf
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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Klitkou ST, Wangen KR. Educational attainment and differences in relative survival after acute myocardial infarction in Norway: a registry-based population study. BMJ Open 2017; 7:e014787. [PMID: 28851768 PMCID: PMC5724085 DOI: 10.1136/bmjopen-2016-014787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although there is a broad societal interest in socioeconomic differences in survival after an acute myocardial infarction, only a few studies have investigated how such differences relate to the survival in general population groups. We aimed to investigate education-specific survival after acute myocardial infarction and to compare this with the survival of corresponding groups in the general population. METHODS Our study included the entire population of Norwegian patients admitted to hospitals for acute myocardial infarction during 2008-2010, with a 6- year follow-up period. Patient survival was measured relative to the expected survival in the general population for three educational groups: primary, secondary and tertiary. Education, sex, age and calendar year-specific expected survival were obtained from population life tables and adjusted for the presence of infarction-related mortality. RESULTS Six-year patient survivals were 56.3% (55.3-57.2) and 65.5% (65.6-69.3) for the primary and tertiary educational groups (95% CIs), respectively. Also 6-year relative survival was markedly lower for the primary educational group: 70.2% (68.6-71.8) versus 81.2% (77.4-84.4). Throughout the follow-up period, patient survival tended to remain lower than the survival in the general population with the same educational background. CONCLUSION Both patient survival and relative survival after acute myocardial infarction are positively associated with educational level. Our findings may suggest that secondary prevention has been more effective for the highly educated.
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Affiliation(s)
- Søren Toksvig Klitkou
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Knut R Wangen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
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Hill VA, Vickrey BG, Cheng EM, Valle NP, Ayala-Rivera M, Moreno L, Munoz C, Dombish H, Espinosa A, Wang D, Ochoa D, Chu A, Heymann R, Towfighi A. A Pilot Trial of a Lifestyle Intervention for Stroke Survivors: Design of Healthy Eating and Lifestyle after Stroke (HEALS). J Stroke Cerebrovasc Dis 2017; 26:2806-2813. [PMID: 28823491 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 05/04/2017] [Accepted: 06/30/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Stroke survivors have high rates of subsequent cardiovascular and recurrent cerebrovascular events, and mortality. While healthy lifestyle practices - including a diet rich in fruits and vegetables, limited alcohol intake, and regular physical activity - can mitigate these outcomes, few stroke survivors adhere to them. Minorities from socioeconomically disadvantaged communities who obtain care in safety-net health systems experience the most barriers to implementing healthy lifestyle changes after stroke. PURPOSE To report the design of Healthy Eating and Lifestyle After Stroke (HEALS), a randomized controlled trial (RCT) was designed to test the feasibility of using a manualized, lifestyle management intervention in a safety-net setting to improve lifestyle practices among ethnically diverse individuals with stroke or transient ischemic attack (TIA). METHODS Design: Pilot RCT. PARTICIPANTS Inclusion criteria: 1) Adults (≥40 years) with ischemic stroke or TIA (≥ 90 days prior); 2) English- or Spanish-speaking. SETTING Outpatient clinic, safety-net setting. INTERVENTION Weekly two-hour small group sessions led by an occupational therapist for six weeks. The sessions focused on implementing nutrition, physical activity, and self-management strategies tailored to each participant's goals. MAIN OUTCOME MEASURES Body mass index, diet, and physical activity. CONCLUSIONS Recruitment for this study is complete. If the HEALS intervention study is feasible and effective, it will serve as a platform for a large-scale RCT that will investigate the efficacy and cost-effectiveness of life management interventions for racially and ethnically diverse, low-income individuals with a history of stroke or TIA who seek healthcare in the safety-net system.
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Affiliation(s)
- Valerie A Hill
- Herman Ostrow School of Dentistry, T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California; Rancho Research Institute, Downey, California.
| | | | - Eric M Cheng
- Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | | | | | | | | | - Heidi Dombish
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | | | - Debbie Wang
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Dina Ochoa
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Allison Chu
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Rebecca Heymann
- Herman Ostrow School of Dentistry, T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Amytis Towfighi
- Rancho Los Amigos National Rehabilitation Center, Downey, California; Department of Neurology, University of Southern California, Los Angeles, California
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Gaalema DE, Elliott RJ, Morford ZH, Higgins ST, Ades PA. Effect of Socioeconomic Status on Propensity to Change Risk Behaviors Following Myocardial Infarction: Implications for Healthy Lifestyle Medicine. Prog Cardiovasc Dis 2017; 60:159-168. [PMID: 28063785 PMCID: PMC5498261 DOI: 10.1016/j.pcad.2017.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/02/2017] [Indexed: 01/04/2023]
Abstract
Failure to change risk behaviors following myocardial infarction (MI) increases the likelihood of recurrent MI and death. Lower-socioeconomic status (SES) patients are more likely to engage in high-risk behaviors prior to MI. Less well known is whether propensity to change risk behaviors after MI also varies inversely with SES. We performed a systematized literature review addressing changes in risk behaviors following MI as a function of SES. 2160 abstracts were reviewed and 44 met eligibility criteria. Behaviors included smoking cessation, cardiac rehabilitation (CR), medication adherence, diet, and physical activity (PA). For each behavior, lower-SES patients were less likely to change after MI. Overall, lower-SES patients were 2 to 4 times less likely to make needed behavior changes (OR's 0.25-0.56). Lower-SES populations are less successful at changing risk behaviors post-MI. Increasing their participation in CR/secondary prevention programs, which address multiple risk behaviors, including increasing PA and exercise, should be a priority of healthy lifestyle medicine (HLM).
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Affiliation(s)
- Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT; Department of Psychiatry, University of Vermont, Burlington, VT; Department of Psychological Science, University of Vermont, Burlington, VT.
| | - Rebecca J Elliott
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT; Department of Psychiatry, University of Vermont, Burlington, VT
| | - Zachary H Morford
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT; Department of Psychiatry, University of Vermont, Burlington, VT; Department of Psychological Science, University of Vermont, Burlington, VT
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT; Department of Psychiatry, University of Vermont, Burlington, VT; Department of Psychological Science, University of Vermont, Burlington, VT
| | - Philip A Ades
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT; Department of Medicine, Division of Cardiology, University of Vermont Medical Center, Burlington, VT
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Cafagna G, Seghieri C. Educational level and 30-day outcomes after hospitalization for acute myocardial infarction in Italy. BMC Health Serv Res 2017; 17:18. [PMID: 28069004 PMCID: PMC5220616 DOI: 10.1186/s12913-016-1966-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 12/21/2016] [Indexed: 12/01/2022] Open
Abstract
Background There is a growing interest in the factors that influence short-term mortality and readmission after hospitalization for acute myocardial infarction (AMI) since such outcomes are commonly considered as hospital performance measures. Socioeconomic status (SES) is one of the factors contributing to healthcare outcomes after hospitalization for AMI. However, no study has been published on education and 30-day readmission in Europe. The objective of this study is to examine the association between educational level and 30-day mortality and readmission among patients hospitalized for AMI in Tuscany (Italy). Methods A retrospective cohort study using data from hospital discharge records was conducted. The analysis included all patients discharged with a principal diagnosis of AMI between January 1, 2011, and November 30, 2014, from all hospitals in Tuscany. Educational level was categorized as low (no middle school diploma), mid (middle school diploma) and high (high school diploma or more). Three multilevel models were developed, sequentially controlling for patient-level socio-demographic and clinical variables and hospital-level variables. Patients were stratified by age (≤75 and >75 years). Results Mortality analysis included 23,402 patients, readmission analysis included 22,181 patients. In both unadjusted and full-adjusted models, patients with a high education had lower odds of 30-day mortality compared to those patients with low education (OR age ≤ 75 years 0.67, 95% CI:0.47–0.94; OR age > 75 years 0.72, 95% CI:0.54–0.95). With regard to 30-day readmission, only patients aged over 75 years with a high education had lower odds of short-term readmission compared to those patients with low education (OR age > 75 0.73, 95% CI:0.58–0.93). Conclusions Among patients hospitalized in Tuscany for AMI, low levels of education were associated with increased odds of 30-day mortality for both age groups and increased odds of 30-day readmission only for patients aged over 75 years. Our findings suggest that the educational component should not be underestimated in order to improve short-term outcomes, which are considered as performance measures at the hospital level. Hospital managers might consider strategies that are sensitive to patients with low SES, such as providing post-hospitalization support to less-educated patients and promoting a healthier lifestyle, to improve both health equity and performance outcomes.
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Affiliation(s)
- Gianluca Cafagna
- Health and Management Laboratory (MeS Lab), Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 24, Pisa, Italy.
| | - Chiara Seghieri
- Health and Management Laboratory (MeS Lab), Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 24, Pisa, Italy
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Vehko T, Arffman M, Manderbacka K, Pukkala E, Keskimäki I. Differences in mortality among women with breast cancer by income – a register-based study in Finland. Scand J Public Health 2016; 44:630-637. [DOI: 10.1177/1403494816660455] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: The aim was to assess all-cause and breast cancer mortality by income among women with incident breast cancer and the effect of cancer stage at diagnosis and comorbidity on the differences. Methods: The 43,439 women (age ⩾30) diagnosed with breast cancer in 1998–2008 in Finland were monitored using individual-level Cancer Registry data supplemented with data from Finnish health care registers and sociodemographic data. Results: Overall mortality was greater among breast cancer patients of the lowest income group than in the highest one; the hazard ratio (HR) for age and incidence year adjusted all-cause mortality was 1.9 (95% CI 1.8–2.1) and for breast cancer mortality 2.0 (95% CI 1.8–2.2). The women from the lowest income group were over-represented in the breast cancer stage ‘distant’ (10.1% vs. 3.5% among the highest income group). The presence of comorbidities was more common in patients with the lowest income (at least one comorbidity in 54%) than in the highest (24%). The HR adjusted with stage at presentation and comorbidities was 1.6 (95% CI 1.4–1.7) for all-cause mortality and 1.6 (95% CI 1.4–1.7) for breast cancer mortality. Conclusions: Tumour stage at diagnosis was more severe among lower income groups, and the presence of comorbidities was more common, although this only accounted for a part of the higher breast cancer mortality in these groups. More information is needed about recognition, diagnosis and treatment of breast cancer to examine whether the socioeconomic differences of breast cancer mortality are related to care.
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Affiliation(s)
- Tuulikki Vehko
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Martti Arffman
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | | | - Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Ilmo Keskimäki
- National Institute for Health and Welfare (THL), Helsinki, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
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Fors A, Gyllensten H, Swedberg K, Ekman I. Effectiveness of person-centred care after acute coronary syndrome in relation to educational level: Subgroup analysis of a two-armed randomised controlled trial. Int J Cardiol 2016; 221:957-62. [PMID: 27441475 DOI: 10.1016/j.ijcard.2016.07.060] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/04/2016] [Indexed: 11/24/2022]
Abstract
AIM The aim of this study was to evaluate the effects of person-centred care (PCC) after acute coronary syndrome (ACS) in relation to educational level of participants. METHOD 199 Patients <75years with ACS were randomised to PCC plus usual care or usual care alone and followed for 6months from hospital to outpatient care and primary care. For the PCC group, patients and health care professionals co-created a PCC health plan reflecting both perspectives, which induced a continued collaboration in person-centred teams at each health care level. A composite score of changes that included general self-efficacy assessment, return to work or previous activity level, re-hospitalisation or death was used as outcome measure. RESULTS In the group of patients without postsecondary education (n=90) the composite score showed a significant improvement in favour of the PCC intervention (n=40) vs. usual care (n=50) at six months (35.0%, n=14 vs. 16.0%, n=8; odds ratio (OR)=2.8, 95% confidence interval (CI): 1.0-7.7, P=0.041). In patients with postsecondary education (n=109), a non-significant difference in favour of the PCC intervention (n=54) vs. usual care (n=55) was observed in the composite score (13.0%, n=7 vs 3.6%, n=2; OR=3.9, 95% CI: 0.8-19.9, P=0.097). CONCLUSION A PCC approach, which stresses the necessity of a patient-health care professional partnership, is beneficial in patients with low education after an ACS event. Because these patients have been identified as a vulnerable group in cardiac rehabilitation, we suggest that PCC can be integrated into conventional cardiac rehabilitation programmes to improve both equity in uptake and health outcomes. TRIAL REGISTRATION Swedish registry, Researchweb.org, ID NR 65 791.
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Affiliation(s)
- Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Närhälsan Research and Development, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. http://www.gpcc.gu.se
| | - Karl Swedberg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; National Heart and Lung Institute, Imperial College, London, United Kingdom. http://www.gpcc.gu.se
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden. http://www.gpcc.gu.se
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Fang JY, Li JL, Li ZH, Xu DM, Chen C, Xie B, Chen H, Au WW. Attitudes towards acceptance of an innovative home-based and remote sensing rehabilitation protocol among cardiovascular patients in Shantou, China. J Geriatr Cardiol 2016; 13:326-32. [PMID: 27403142 PMCID: PMC4921545 DOI: 10.11909/j.issn.1671-5411.2016.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/18/2016] [Accepted: 03/15/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) protocols have diversified to include home-based cardiac tele-rehabilitation (HBCTR) as an alternative to hospital-based or center-based CR. To adopt the use of home-based cardiac tele-rehabilitation, it is necessary to assess cardiac patients' attitudes towards acceptance of such e-health technology, especially in China where knowledge of such technology is deficient. METHODS Interviews were conducted in the First Affiliated Hospital of Shantou University Medical College, Shantou, China. After percutaneous coronary interventional (PCI) surgery, patients completed the survey. RESULTS Among the 150 patients, only 13% had ever heard of HBCTR. After an introduction of our HBCTR program, 60% of patients were willing to participate in the program. From our multivariate analysis of questionnaire data, age (OR: 0.92, 95% CI: 0.86-0.98; P = 0.007), average family monthly income (OR: 0.13, 95% CI: 0.05-0.34; P < 0.001), education level (OR: 0.24, 95% CI: 0.10-0.59; P = 0.002) and physical exercise time (OR: 0.19, 95% CI: 0.06-0.56; P = 0.003) were independent predictors for acceptance of HBCTR. From the reasons for participation, patients selected: enhanced safety and independence (28.3%), ability to self-monitor physical conditions daily (25.4%), and having automatic and emergency alert (23.1%). Reasons for refusal were: too cumbersome operation (34.3%) and unnecessary protocol (19.4%). CONCLUSIONS Most patients lacked knowledge about HBCTR but volunteered to participate after they have learned about the program. Several personal and life-style factors influenced their acceptance of the program. These indicate that both improvement of technology and better understanding of the program will enhance active participation.
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Affiliation(s)
- Jia-Ying Fang
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Ji-Lin Li
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zhong-Han Li
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Duan-Min Xu
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Chang Chen
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Bin Xie
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Helen Chen
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - William W Au
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
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Manderbacka K, Arffman M, Lumme S, Keskimäki I. Are there socioeconomic differences in outcomes of coronary revascularizations--a register-based cohort study. Eur J Public Health 2015; 25:984-9. [PMID: 25958240 DOI: 10.1093/eurpub/ckv086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Earlier studies have reported socioeconomic differences in coronary heart disease incidence and mortality and in coronary treatment, but less is known about outcomes of care. We examined trends in income group differences in outcomes of coronary revascularizations among Finnish residents in 1998-2010. METHODS First revascularizations for 45-84-year-old Finns were extracted from the Hospital Discharge Register in 1998-2009 and followed until 31 December 2010. Income was individually linked to them and adjusted for family size. We examined the risk of major adverse cardiac events (MACEs), coronary mortality and re-revascularization. We calculated age-standardized rates with direct method and Cox regression models. RESULTS Altogether 69 076 men and 27 498 women underwent revascularization during the study period. Among men [women] in the 1998 cohort, 41% [35%] suffered MACE during 29 days after the operation and 30% [28%] in the 2009 cohort. Myocardial infarction mortality within 1 year was 2% among both genders in both cohorts. Among men [women] 9% [14%] underwent revascularization within 1 year after the operation in 1998 and 12% [12%] in 2009. Controlling for age, co-morbidities, year, previous infarction and disease severity, an inverse income gradient was found in MACE incidence within 29 days and in coronary mortality. The excess MACE risk was 1.39 and excess mortality risk over 1.70 among both genders in the lowest income quintile. All income group differences remained stable from 1998 to 2010. CONCLUSIONS In health care, more attention should be paid to prevention of adverse outcomes among persons with low socioeconomic position undergoing revascularization.
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Affiliation(s)
- Kristiina Manderbacka
- 1 Health and Social Systems Research Unit, Department of Health and Social Care Systems, National Institute for Health and Welfare, P. O. Box 30, 00271 Helsinki, Finland
| | - Martti Arffman
- 1 Health and Social Systems Research Unit, Department of Health and Social Care Systems, National Institute for Health and Welfare, P. O. Box 30, 00271 Helsinki, Finland
| | - Sonja Lumme
- 1 Health and Social Systems Research Unit, Department of Health and Social Care Systems, National Institute for Health and Welfare, P. O. Box 30, 00271 Helsinki, Finland
| | - Ilmo Keskimäki
- 1 Health and Social Systems Research Unit, Department of Health and Social Care Systems, National Institute for Health and Welfare, P. O. Box 30, 00271 Helsinki, Finland School of Health Sciences, University of Tampere, 33014 Tampere, Finland
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The role of health behaviours across the life course in the socioeconomic patterning of all-cause mortality: the west of Scotland twenty-07 prospective cohort study. Ann Behav Med 2014; 47:148-57. [PMID: 24072618 PMCID: PMC3964290 DOI: 10.1007/s12160-013-9539-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Socioeconomic differentials in mortality are increasing in many industrialised countries. Purpose This study aims to examine the role of behaviours (smoking, alcohol, exercise, and diet) in explaining socioeconomic differentials in mortality and whether this varies over the life course, between cohorts and by gender. Methods Analysis of two representative population cohorts of men and women, born in the 1950s and 1930s, were performed. Health behaviours were assessed on five occasions over 20 years. Results Health behaviours explained a substantial part of the socioeconomic differentials in mortality. Cumulative behaviours and those that were more strongly associated with socioeconomic status had the greatest impact. For example, in the 1950s cohort, the age-sex adjusted hazard ratio comparing respondents with manual versus non-manual occupational status was 1.80 (1.25, 2.58); adjustment for cumulative smoking over 20 years attenuated the association by 49 %, diet by 43 %, drinking by 13 % and inactivity by only 1%. Conclusions Health behaviours have an important role in explaining socioeconomic differentials in mortality.
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Ehrenthal DB, Goldstein ND, Wu P, Rogers S, Townsend RR, Edwards DG. Arterial stiffness and wave reflection 1 year after a pregnancy complicated by hypertension. J Clin Hypertens (Greenwich) 2014; 16:695-9. [PMID: 25116457 DOI: 10.1111/jch.12398] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 01/24/2023]
Abstract
Hypertensive disorders of pregnancy (HDP) are associated with cardiovascular disease (CVD) later in life. The authors investigated the association of HDP with blood pressure (BP) and arterial stiffness 1-year postpartum. Seventy-four participants, 33 with an HDP and 41 with uncomplicated pregnancies, were examined using applanation tonometry to measure BP, carotid-femoral pulse wave velocity (cfPWV), and augmentation index (AIx). On average, women with HDP had a 9 mm higher systolic BP (P<.01), 0.8 m/s faster cfPWV (P=.09), and 5.4% greater AIx (P=.09) at the 1-year examination. After adjustment for covariates, there was no significant difference in cfPWV between groups, while a 7.3% greater AIx (P<.05) remained. These findings suggest that reduced endothelial function may be detected 1 year after HDP. Large prospective studies are needed to further understand the contribution of arterial stiffness and endothelial dysfunction in the evolution of CVD after these complicated pregnancies.
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Affiliation(s)
- Deborah B Ehrenthal
- Christiana Care Health System, Newark, DE; Thomas Jefferson University, Philadelphia, PA
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Coady SA, Johnson NJ, Hakes JK, Sorlie PD. Individual education, area income, and mortality and recurrence of myocardial infarction in a Medicare cohort: the National Longitudinal Mortality Study. BMC Public Health 2014; 14:705. [PMID: 25011538 PMCID: PMC4227052 DOI: 10.1186/1471-2458-14-705] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 06/09/2014] [Indexed: 11/25/2022] Open
Abstract
Background The Medicare program provides universal access to hospital care for the elderly; however, mortality disparities may still persist in this population. The association of individual education and area income with survival and recurrence post Myocardial Infarction (MI) was assessed in a national sample. Methods Individual level education from the National Longitudinal Mortality Study was linked to Medicare and National Death Index records over the period of 1991-2001 to test the association of individual education and zip code tabulation area median income with survival and recurrence post-MI. Survival was partitioned into 3 periods: in-hospital, discharge to 1 year, and 1 year to 5 years and recurrence was partitioned into two periods: 28 day to 1 year, and 1 year to 5 years. Results First MIs were found in 8,043 women and 7,929 men. In women and men 66-79 years of age, less than a high school education compared with a college degree or more was associated with 1-5 year mortality in both women (HRR 1.61, 95% confidence interval 1.03-2.50) and men (HRR 1.37, 1.06-1.76). Education was also associated with 1-5 year recurrence in men (HRR 1.68, 1.18-2.41, < High School compared with college degree or more), but not women. Across the spectrum of survival and recurrence periods median zip code level income was inconsistently associated with outcomes. Associations were limited to discharge-1 year survival (RR lowest versus highest quintile 1.31, 95% confidence interval 1.03-1.67) and 28 day-1 year recurrence (RR lowest versus highest quintile 1.72, 95% confidence interval 1.14-2.57) in older men. Conclusions Despite the Medicare entitlement program, disparities related to individual socioeconomic status remain. Additional research is needed to elucidate the barriers and mechanisms to eliminating health disparities among the elderly.
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Affiliation(s)
- Sean A Coady
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, 2 Rockledge Ctr, 6701 Rockledge Dr,, Rm10200 MSC 7936, Bethesda 20817 MD, USA.
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Jin H, Wei Q, Chen L, Sun Q, Zhang Y, Wu J, Ma G, Liu N. Obstacles and alternative options for cardiac rehabilitation in Nanjing, China: an exploratory study. BMC Cardiovasc Disord 2014; 14:20. [PMID: 24533661 PMCID: PMC3930547 DOI: 10.1186/1471-2261-14-20] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/12/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Coronary heart disease (CHD) is a major cause of morbidity and mortality, and cardiac rehabilitation (CR) is still not well developed in mainland China. The objective of this study is to investigate the barriers associated with those seeking cardiac rehabilitation (CR) and to explore appropriate secondary prevention modalities tailored to the needs of Chinese patients with coronary heart disease (CHD). METHODS A consecutive series of eligible patients was recruited from the cardiac department of a teaching hospital in Nanjing, located in southeast China. Structured face-to-face interviews were conducted with 328 patients prior to hospital discharge. Patient preferences for seeking an outpatient CR program or an alternative outpatient self-choice, minimal-cost educational program were evaluated. Socio-demographic characteristics and clinical data were assessed. Additionally, patients were asked to provide the reasons affecting their choice. RESULTS Overall, only 14.3% patients preferred the standard CR program. Factors associated with non-participating were female gender (odds ratios [ORs], 6.05, 95% CI, 1.30-28.19), older age (ORs, 1.11, 95% CI, 1.04-1.19, per year), less education (ORs, 8.13, 95% CI, 2.83-23.38), low income (ORs, 3.26, 95% CI, 1.24-8.54), and having either basic medical care or a lack of health insurance (ORs, 10.01, 95% CI, 3.90-25.68). The most common reason for refusing to participate in CR was that patients could not afford it. Of the remaining patients, 65.8% patients chose self-choice educational programs, especially for female (ORs, 5.84, 95% CI, 2.67-12.79), older (ORs, 1.06, 95% CI, 1.02-1.11, per year), and low income (ORs, 2.14, 95% CI, 1.12-4.10) patients. The main reasons for their preferences were their desires for more information about disease and risk factors, the low cost, feasibility, and saving time. CONCLUSIONS Multiple barriers, which may occur at the patient, health system, and societal levels, have prevented eligible patients from participating in CR programs. Self-choice educational programs, an alternative model incorporating more information, would strongly meet the needs of most patients. A feasible delivery format for secondary prevention should be provided for all CHD patients.
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Affiliation(s)
- Hong Jin
- Department of Cardiology, Zhongda Hospital, Medical School of Southeast University, 210009 Nanjing, Jiangsu, China.
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Dumas A, Savage M, Stuart S. Anti-normative lifestyles in cardiac rehabilitation: Underprivileged men’s post-heart incident lives. Health (London) 2013; 18:458-75. [DOI: 10.1177/1363459313507587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiovascular diseases are leading causes of premature mortality and disability. Although health institutions have developed and promoted cardiac rehabilitation programs, they have not attained their desired outcomes, especially among the most vulnerable groups of the population. This study qualitatively examines socially and materially deprived men’s (n = 20) noncompliance with cardiovascular health guidelines following a medical intervention to the heart. By drawing on Pierre Bourdieu’s sociocultural theory of practice, results indicate that precarious living conditions obstruct long-term physical recovery and illness prevention by underemphasizing the value of “health capital” and reducing the capacity to sustain lifestyle change. This study calls into question health policies that have little to no consideration of embodied practical knowledge and lived experiences.
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Savage M, Dumas A, Stuart SA. Fatalism and short-termism as cultural barriers to cardiac rehabilitation among underprivileged men. SOCIOLOGY OF HEALTH & ILLNESS 2013; 35:1211-1226. [PMID: 24266752 DOI: 10.1111/1467-9566.12040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Cardiovascular diseases are a leading cause of death and disability in Canada, and individuals of low socioeconomic status appear particularly vulnerable to such disorders. Although many health-related institutions have promoted cardiovascular health and have created cardiac rehabilitation programmes, they have not attained their desired outcomes, especially amongst socioeconomically deprived men. Drawing on Pierre Bourdieu's sociocultural theory, this qualitative study aims to understand the social mechanisms underpinning the lifestyles and health practices of men who had suffered a cardiovascular incident requiring hospitalisation. In all, 20 interviews were conducted with francophone men aged 40 to 65 years living in the province of Québec, Canada. The analysis strongly suggests that the respondents' living conditions and disease were significant obstacles to their adoption of a healthy lifestyle. Their despair and pessimism, apparently originating in the harshness of their financial realities, physical limitations and social networks, led them to believe that they could do little to control their lives, thereby limiting the fulfillment of any long-term ambitions. Therefore, the adoption of a habitus characterised by fatalistic and short-term perceptions of health influenced their lifestyle choices, leading them to maintain lives that were in stark contrast with the recommendations made by health promotion experts.
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Affiliation(s)
- Mathieu Savage
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Canada
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Zeng W, Stason WB, Fournier S, Razavi M, Ritter G, Strickler GK, Bhalotra SM, Shepard DS. Benefits and costs of intensive lifestyle modification programs for symptomatic coronary disease in Medicare beneficiaries. Am Heart J 2013; 165:785-92. [PMID: 23622916 DOI: 10.1016/j.ahj.2013.01.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 01/28/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND This study reports outcomes of a Medicare-sponsored demonstration of two intensive lifestyle modification programs (LMPs) in patients with symptomatic coronary heart disease: the Cardiac Wellness Program of the Benson-Henry Mind Body Institute (MBMI) and the Dr Dean Ornish Program for Reversing Heart Disease® (Ornish). METHODS This multisite demonstration, conducted between 2000 and 2008, enrolled Medicare beneficiaries who had had an acute myocardial infarction or a cardiac procedure within the preceding 12 months or had stable angina pectoris. Health and economic outcomes are compared with matched controls who had received either traditional or no cardiac rehabilitation following similar cardiac events. Each program included a 1-year active intervention of exercise, diet, small-group support, and stress reduction. Medicare claims were used to examine 3-year outcomes. The analysis includes 461 elderly, fee-for-service, Medicare participants and 1,795 controls. RESULTS Cardiac and non-cardiac hospitalization rates were lower in participants than controls in each program and were statistically significant in MBMI (P < .01). Program costs of $3,801 and $4,441 per participant for the MBMI and Ornish Programs, respectively, were offset by reduced health care costs yielding non-significant three-year net savings per participant of about $3,500 in MBMI and $1,000 in Ornish. A trend towards lower mortality compared with controls was observed in MBMI participants (P = .07). CONCLUSIONS Intensive, year-long LMPs reduced hospitalization rates and suggest reduced Medicare costs in elderly beneficiaries with symptomatic coronary heart disease.
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Affiliation(s)
- Wu Zeng
- Brandeis University, Heller School, Schneider Institutes for Health Policy, Waltham, MA 02454–9110, USA
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Cheville AL, Kollasch J, Vandenberg J, Shen T, Grothey A, Gamble G, Basford JR. A home-based exercise program to improve function, fatigue, and sleep quality in patients with Stage IV lung and colorectal cancer: a randomized controlled trial. J Pain Symptom Manage 2013; 45:811-21. [PMID: 23017624 PMCID: PMC4524515 DOI: 10.1016/j.jpainsymman.2012.05.006] [Citation(s) in RCA: 184] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 05/13/2012] [Accepted: 05/18/2012] [Indexed: 12/15/2022]
Abstract
CONTEXT Exercise benefits patients with cancer, but studies of home-based approaches, particularly among those with Stage IV disease, remain small and exploratory. OBJECTIVES To conduct an adequately powered trial of a home-based exercise intervention that can be facilely integrated into established delivery and reimbursement structures. METHODS Sixty-six adults with Stage IV lung or colorectal cancer were randomized, in an eight-week trial, to usual care or incremental walking and home-based strength training. The exercising participants were instructed during a single physiotherapy visit and subsequently exercised four days or more per week; training and step-count goals were advanced during bimonthly telephone calls. The primary outcome measure was mobility assessed with the Ambulatory Post Acute Care Basic Mobility Short Form. Secondary outcomes included ratings of pain and sleep quality as well as the ability to perform daily activities (Ambulatory Post Acute Care Daily Activities Short Form), quality of life (Functional Assessment of Cancer Therapy-General), and fatigue (Functional Assessment of Cancer Therapy-Fatigue). RESULTS Three participants dropped out and seven died (five in the intervention and two in the control group, P=0.28). At Week 8, the intervention group reported improved mobility (P=0.01), fatigue (P=0.02), and sleep quality (P=0.05) compared with the usual care group, but did not differ on the other measures. CONCLUSION A home-based exercise program seems capable of improving the mobility, fatigue, and sleep quality of patients with Stage IV lung and colorectal cancer.
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Affiliation(s)
- Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.
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Mayer-Berger W, Simic D, Mahmoodzad J, Burtscher R, Kohlmeyer M, Schwitalla B, Redaèlli M. Efficacy of a long-term secondary prevention programme following inpatient cardiovascular rehabilitation on risk and health-related quality of life in a low-education cohort: a randomized controlled study. Eur J Prev Cardiol 2012; 21:145-52. [DOI: 10.1177/2047487312465526] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gravely S, Ginsburg L, Stewart DE, Mak S, Grace SL. Referral and use of heart failure clinics: what factors are related to use? Can J Cardiol 2012; 28:483-9. [PMID: 22366509 PMCID: PMC4494832 DOI: 10.1016/j.cjca.2011.11.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 11/29/2011] [Accepted: 11/29/2011] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Heart failure (HF) clinics have been shown to reduce hospital readmissions and generally have favourable effects on quality of life, survival, and care costs. This study investigated the rates of referral and use of HF clinics and examined factors related to program use. METHODS This study represents a secondary analysis of a larger prospective cohort study conducted in Ontario. In hospital, 474 HF inpatients from 11 hospitals across Ontario completed a survey that examined predisposing, enabling, and need factors affecting HF clinic use. Then 1 year later, 271 HF patients completed a mailed survey that assessed referral to and use of HF clinics. RESULTS Forty-one patients (15.2%) self-reported referral, and 35 (13%) self-reported attending an HF clinic. Generalized estimating equations showed that factors related to greater program use were having an HF clinic at the site of hospital recruitment (odds ratio [OR] = 8.40; P = 0.04), referral to other disease management programs (OR = 4.87; P = 0.04), higher education (OR = 4.61; P = 0.02), lower stress (OR = 0.93; P = 0.03), and lower functional status (OR = 0.97; P = 0.03). CONCLUSION Similar to previous research, only one-seventh of HF patients were referred to and used an HF clinic. Both patient-level and health-system factors were related to HF clinic use. Given the benefits of HF clinics, more research examining how equitable access can be increased is needed. Also, the appropriateness and cost repercussions of use of multiple disease management programs should be investigated.
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Affiliation(s)
- Shannon Gravely
- York University, Faculty of Health, Toronto, Ontario, Canada
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Gravely S, Reid RD, Oh P, Ross H, Stewart DE, Grace SL. A prospective examination of disease management program use by complex cardiac outpatients. Can J Cardiol 2012; 28:490-6. [PMID: 22424663 DOI: 10.1016/j.cjca.2012.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 01/12/2012] [Accepted: 01/13/2012] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The use of disease management programs (DMPs) by patients with cardiovascular disease (CVD) is associated with improved outcomes. Although rates of cardiac rehabilitation (CR) use are well established, less is known about other DMPs. The objectives of this study were to describe the degree of DMP utilization by CVD outpatients, and examine factors related to use. METHODS This study represents a secondary analysis of a larger prospective cohort study. In hospital, 2635 CVD inpatients from 11 hospitals in Ontario Canada completed a survey that assessed factors affecting DMP utilization. One year later, 1803 participants completed a mailed survey that assessed DMP utilization. RESULTS One thousand seventy-three (59.5%) participants reported using at least 1 DMP. Overall, 951 (52.7%) reported participating in cardiac rehabilitation, and among participants with a comorbid indication, 212 (41.2%) reported attending a diabetes education centre, 28 (25.9%) attended stroke rehabilitation, 35 (12.9%) used a heart failure clinic, and 13 (11.7%) attended a smoking cessation program. A multinomial logistic regression analysis showed that compared with no DMP use, participants that attended 1 or multiple programs were younger, married, diagnosed with a myocardial infarction, less likely to have had a percutaneous coronary intervention and had higher perceptions of personal control over their heart condition. There were few differences between participants that used 1 vs multiple DMPs, however, having diabetes or comorbid stroke significantly increased the likelihood of multiple DMP use. CONCLUSIONS Approximately 40% of CVD outpatients do not access DMPs. An integrated approach to vascular disease management appears warranted.
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Cardiac rehabilitation participation in underserved populations. Minorities, low socioeconomic, and rural residents. J Cardiopulm Rehabil Prev 2011; 31:203-10. [PMID: 21705915 DOI: 10.1097/hcr.0b013e318220a7da] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cardiac rehabilitation (CR) services in the United States are underutilized and participation is particularly low for racial and ethnic minorities, low socioeconomic status patients, and rural residents. Reduced participation may not only indicate a failure in transitional cardiac care during the in hospital referral process but also could be due to barriers attributed to patients, providers, employers, or medical systems. In-depth analysis of this problem is impeded by difficulties with the identification of underserved groups in clinical settings. Disparities in CR participation certainly contribute to poor medical outcomes in these populations that stand to benefit greatly from lifestyle modifications. It is critical that CR providers survey their communities for underserved populations and coordinate creative efforts aimed at overcoming barriers to participation. Moreover, it is likely that referral to, and participation in, CR will soon be considered a quality indicator, providing further incentive for programs to optimize CR utilization among all eligible patients.
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Steptoe A, Molloy GJ, Messerly-Bürgy N, Wikman A, Randall G, Perkins-Porras L, Kaski JC. Emotional triggering and low socio-economic status as determinants of depression following acute coronary syndrome. Psychol Med 2011; 41:1857-1866. [PMID: 21211098 DOI: 10.1017/s0033291710002588] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The determinants of depression following acute coronary syndrome (ACS) are poorly understood. Triggering of ACS by emotional stress and low socio-economic status (SES) are predictors of adverse outcomes. We therefore investigated whether emotional triggering and low SES predict depression and anxiety following ACS. METHOD This prospective observational clinical cohort study involved 298 patients with clinically verified ACS. Emotional stress was assessed for the 2 h before symptom onset and compared with the equivalent period 24 h earlier using case-crossover methods. SES was defined by household income and education. Depression was measured with the Beck Depression Inventory and the Hamilton Rating Scale for Depression and anxiety with the Hospital Anxiety and Depression Scale 3 weeks after ACS and again at 6 and 12 months. Age, gender, ethnicity, marital status, the Global Registry of Acute Coronary Events risk score, duration of hospital stay and history of depression were included as covariates. RESULTS Emotional stress during the 2-h hazard period was associated with increased risk of ACS (odds ratio 1.88, 95% confidence interval 1.01-3.61). Both low income and emotional triggering predicted depression and anxiety at 3 weeks and 6/12 months independently of covariates. The two factors interacted, with the greatest depression and anxiety in lower income patients who experienced acute emotional stress. Education was not related to depression. CONCLUSIONS Patients who experience acute emotional stress during their ACS and are lower SES as defined by current affluence and access to resources are particularly vulnerable to subsequent depression and anxiety.
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Affiliation(s)
- A Steptoe
- Department of Epidemiology and Public Health, University College London, London, UK.
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Eshah NF. Jordanian acute coronary syndrome patients' learning needs: Implications for cardiac rehabilitation and secondary prevention programs. Nurs Health Sci 2011; 13:238-45. [PMID: 21615656 DOI: 10.1111/j.1442-2018.2011.00608.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The identification of patients' learning needs is an essential step for nurses in order to facilitate the recovery of acute coronary syndrome survivors. This study aimed to identify and prioritize the actual learning needs of these patients and to explore the differences in learning needs on the basis of sociodemographic and clinical variables. Descriptive comparative design was used, and patients' learning needs data were collected through the Patient Learning Needs Scale. The results showed that patients need a high amount of information after this syndrome. The 10 most needed educational topics belonged to the medications and treatment and activities of daily living categories. Older patients and those from lower socioeconomic backgrounds requested less information than others did. In conclusion, topics perceived by patients as important and sociodemographic variables should be considered in preparing and providing cardiac rehabilitation and secondary prevention programs. Furthermore, these programs should be redesigned considering patients' actual learning needs rather than the expected needs, and they should incorporate medications, treatment and activities of daily living, complications and symptoms, illness-related concerns, and support in the community.
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Affiliation(s)
- Nidal F Eshah
- Faculty of Nursing, Zarqa University, Zarqa, Jordan.
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Brinks J, Franklin BA. Suboptimal Exercise Compliance: Common Barriers to an Active Lifestyle and Counseling Strategies to Overcome Them. Am J Lifestyle Med 2011. [DOI: 10.1177/1559827610391971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Adherence to a structured exercise program provides numerous health benefits, including reductions in body weight, fat stores, and blood pressure, improved blood glucose management and lipid/lipoprotein profiles, increased cardiorespiratory fitness, decreased cardiovascular risk, and enhanced psychosocial well-being. Despite these benefits, many individuals find it difficult to comply with a regular exercise program, predisposing them to an increased risk of chronic diseases and other medical conditions. Several barriers to participation in structured exercise, including time and financial constraints, psychosocial factors, and physical limitations, contribute to low adherence rates. Accordingly, health care professionals should use varied counseling strategies to assist their patients in overcoming habitual physical inactivity and our increasingly hypokinetic lifestyle. Motivational interviewing, goal setting, using stages of readiness to change, and identifying physical/psychosocial limitations are effective ways for helping patients to achieve the health and fitness benefits of structured exercise, increased lifestyle physical activity, or both.
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Affiliation(s)
- Jenna Brinks
- Department of Medicine, Division of Cardiology, Cardiac Rehabilitation and Exercise Laboratories, William Beaumont Hospital, Royal Oak, Michigan,
| | - Barry A. Franklin
- Department of Medicine, Division of Cardiology, Cardiac Rehabilitation and Exercise Laboratories, William Beaumont Hospital, Royal Oak, Michigan
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L J, N B, O R, J-Y W, R LB, J L, J-P M. [Acute myocardial infarction in young smokers treated by coronary angioplasty. In-hospital prognosis and long-term outcome in a consecutive series of 93 patients]. Ann Cardiol Angeiol (Paris) 2010; 59:119-24. [PMID: 20511119 DOI: 10.1016/j.ancard.2010.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 04/06/2010] [Indexed: 11/16/2022]
Abstract
AIMS OF THE STUDY The study evaluated in-hospital and long-term outcome of patients less than 50 years old with myocardial infarction within 12 hours after symptom onset treated by coronary angioplasty. PATIENTS AND METHOD This is a retrospective study with survival analysis by Kaplan-Meier method in patients included from December 2003 to February 2008. RESULTS We included 93 patients aged 42,8+/-5,2 years old with smoking estimated at 27,7+/-12,7 pack-years. Thirty-one patients (33,3%) were dyslipidemic and 36 patients had family history of coronary artery disease. Thirty patients (32,3%) had an anterior myocardial infarction and four patients (4.4%) had Killip greater than 2. Coronary angioplasty was performed within 4.5+/-3.0 hours after symptom onset with TIMI 3 final flow in the culprit vessel in 96.8%. One patient died from cardiogenic shock. With a follow-up of 85 patients during 20.0+/-15.6 months, the survival without death was 98.2% and survival without major cardiac complication was 87.9% at 24 months. Seventy-two patients (85.7%) were taking a betablocker, 81 patients (96.4%) aspirin, 75 patients (89.3%) a statin and 64 patients (76.2%) an angiotensin-converting inhibitor. Only 50 patients (58.8%) were nonsmokers. CONCLUSION Thus, young smokers with acute MI treated by coronary angioplasty have a good prognosis during in-hospital stay and long-term outcome. Secondary medical treatment prevention is well followed but there is a low rate of smoking cessation.
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Affiliation(s)
- Jacquemin L
- Service de cardiologie, centre hospitalier Emile-Muller, 20, rue du Docteur Laennec, Mulhouse, France.
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Stringhini S, Sabia S, Shipley M, Brunner E, Nabi H, Kivimaki M, Singh-Manoux A. Association of socioeconomic position with health behaviors and mortality. JAMA 2010; 303:1159-66. [PMID: 20332401 PMCID: PMC2918905 DOI: 10.1001/jama.2010.297] [Citation(s) in RCA: 707] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Previous studies may have underestimated the contribution of health behaviors to social inequalities in mortality because health behaviors were assessed only at the baseline of the study. OBJECTIVE To examine the role of health behaviors in the association between socioeconomic position and mortality and compare whether their contribution differs when assessed at only 1 point in time with that assessed longitudinally through the follow-up period. DESIGN, SETTING, AND PARTICIPANTS Established in 1985, the British Whitehall II longitudinal cohort study includes 10 308 civil servants, aged 35 to 55 years, living in London, England. Analyses are based on 9590 men and women followed up for mortality until April 30, 2009. Socioeconomic position was derived from civil service employment grade (high, intermediate, and low) at baseline. Smoking, alcohol consumption, diet, and physical activity were assessed 4 times during the follow-up period. MAIN OUTCOME MEASURES All-cause and cause-specific mortality. RESULTS A total of 654 participants died during the follow-up period. In the analyses adjusted for sex and year of birth, those with the lowest socioeconomic position had 1.60 times higher risk of death from all causes than those with the highest socioeconomic position (a rate difference of 1.94/1000 person-years). This association was attenuated by 42% (95% confidence interval [CI], 21%-94%) when health behaviors assessed at baseline were entered into the model and by 72% (95% CI, 42%-154%) when they were entered as time-dependent covariates. The corresponding attenuations were 29% (95% CI, 11%-54%) and 45% (95% CI, 24%-79%) for cardiovascular mortality and 61% (95% CI, 16%-425%) and 94% (95% CI, 35%-595%) for noncancer and noncardiovascular mortality. The difference between the baseline only and repeated assessments of health behaviors was mostly due to an increased explanatory power of diet (from 7% to 17% for all-cause mortality, respectively), physical activity (from 5% to 21% for all-cause mortality), and alcohol consumption (from 3% to 12% for all-cause mortality). The role of smoking, the strongest mediator in these analyses, did not change when using baseline or repeat assessments (from 32% to 35% for all-cause mortality). CONCLUSION In a civil service population in London, England, there was an association between socioeconomic position and mortality that was substantially accounted for by adjustment for health behaviors, particularly when the behaviors were assessed repeatedly.
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Affiliation(s)
- Silvia Stringhini
- INSERM U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France.
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