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Léveillé N, Provost H, Keutcha Kamani C, Chen M, Deghan Manshadi S, Ades M, Shanahan K, Nauche B, Drudi LM. Exploring Prognostic Implications of Race and Ethnicity in Patients With Peripheral Arterial Disease. J Surg Res 2024; 302:739-754. [PMID: 39216457 DOI: 10.1016/j.jss.2024.07.120] [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: 03/26/2024] [Revised: 06/07/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Significant health inequalities in major adverse limb events exist. Ethnically minoritized groups are more prone to have a major adverse event following peripheral vascular interventions. This systematic review and meta-analysis aimed to describe the postoperative implications of racial and ethnic status on clinical outcomes following vascular interventions for claudication and chronic limb-threatening ischemia. METHODS Searches were conducted across seven databases from inception to June 2021 and were updated in October 2022 to identify studies reporting claudication or chronic limb-threatening ischemia in patients who underwent open, endovascular, or hybrid procedures. Studies with documented racial and ethnic status and associated clinical outcomes were selected. Extracted data included demographic and clinical characteristics, vascular interventions, and measured outcomes associated with race or ethnicity. Meta-analyses were performed using random-effect models to report pooled odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS Seventeen studies evaluating the impact of Black versus White patients undergoing amputation as a primary intervention were combined in a meta-analysis, revealing that Black patients had a higher incidence of amputations as a primary intervention than White patients (OR: 1.91, 95% CI: 1.61-2.27). Another meta-analysis demonstrated that Black patients had significantly higher rates of amputation after revascularization (OR: 1.56, 95% CI: 1.28-1.89). Furthermore, multiple trends were demonstrated in the secondary outcomes evaluated. CONCLUSIONS Our findings suggest that Black patients undergo primary major amputation at a significantly higher rate than White patients, with similar trends seen among Hispanic and First Nations patients. Black patients are also significantly more likely to be subjected to amputation following attempts at revascularization when compared to White patients.
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Affiliation(s)
- Nayla Léveillé
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Hubert Provost
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Cedric Keutcha Kamani
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mia Chen
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Shaidah Deghan Manshadi
- Department of Vascular Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Ades
- Division of General Internal Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Kristina Shanahan
- Innovation Hub, Centre de recherche du Centre Hospitalier de L'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Bénédicte Nauche
- Bibliothèque du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Laura M Drudi
- Innovation Hub, Centre de recherche du Centre Hospitalier de L'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Division of Vascular Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
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Wang TN, An BW, Wang TX, Tamer R, Yuce TK, Hassanein RT, Haisley KR, Perry KA, Sweigert PJ. Assessing the effects of smoking status on outcomes of elective minimally invasive paraesophageal hernia repair. Surg Endosc 2023; 37:7238-7246. [PMID: 37400691 DOI: 10.1007/s00464-023-10185-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/30/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Patients are often advised on smoking cessation prior to elective surgical interventions, but the impact of active smoking on paraesophageal hernia repair (PEHR) outcomes is unclear. The objective of this cohort study was to evaluate the impact of active smoking on short-term outcomes following PEHR. METHODS Patients who underwent elective PEHR at an academic institution between 2011 and 2022 were retrospectively reviewed. The National Surgical Quality Improvement Program (NSQIP) database from 2010 to 2021 was queried for PEHR. Patient demographics, comorbidities, and 30-day post-operative data were collected and maintained in an IRB-approved database. Cohorts were stratified by active smoking status. Primary outcomes included rates of death or serious morbidity (DSM) and radiographically identified recurrence. Bivariate and multivariable regressions were performed, and p value < 0.05 was considered statistically significant. RESULTS 538 patients underwent elective PEHR in the single-institution cohort, of whom 5.8% (n = 31) were smokers. 77.7% (n = 394) were female, median age was 67 [IQR 59, 74] years, and median follow-up was 25.3 [IQR 3.2, 53.6] months. Rates of DSM (non-smoker 4.5% vs smoker 6.5%, p = 0.62) and hernia recurrence (33.3% vs 48.4%, p = 0.09) did not differ significantly. On multivariable analysis, smoking status was not associated with any outcome (p > 0.2). On NSQIP analysis, 38,284 PEHRs were identified, of whom 8.6% (n = 3584) were smokers. Increased DSM was observed among smokers (non-smoker 5.1%, smoker 6.2%, p = 0.004). Smoking status was independently associated with increased risk of DSM (OR 1.36, p < 0.001), respiratory complications (OR 1.94, p < 0.001), 30-day readmission (OR 1.21, p = 0.01), and discharge to higher level of care (OR 1.59, p = 0.01). No difference was seen in 30-day mortality or wound complications. CONCLUSION Smoking status confers a small increased risk of short-term morbidity following elective PEHR without increased risk of mortality or hernia recurrence. While smoking cessation should be encouraged for all active smokers, minimally invasive PEHR in symptomatic patients should not be delayed on account of patient smoking status.
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Affiliation(s)
- Theresa N Wang
- Center for Minimally Invasive Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43210, USA.
| | - Bryan W An
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Tina X Wang
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Robert Tamer
- Center for Minimally Invasive Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43210, USA
| | - Tarik K Yuce
- Center for Minimally Invasive Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43210, USA
| | - Roukaya T Hassanein
- Center for Minimally Invasive Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43210, USA
| | - Kelly R Haisley
- Center for Minimally Invasive Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43210, USA
| | - Kyle A Perry
- Center for Minimally Invasive Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43210, USA
| | - Patrick J Sweigert
- Center for Minimally Invasive Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43210, USA
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Eslami MH, Semaan DB. Increased Medicaid eligibility of Affordable Care Act: Evidence of improved outcomes for patients with peripheral artery disease. Semin Vasc Surg 2023; 36:58-63. [PMID: 36958898 DOI: 10.1053/j.semvascsurg.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023]
Abstract
Peripheral artery disease (PAD) is a debilitating disease that disproportionately affects people of low socioeconomic status and racial minority individuals. These groups also tend to have lower rates of revascularization and worse outcomes, including higher rates of major amputation. In 2010, the Affordable Care Act (ACA) was signed into law, providing better opportunities for health care access to millions of uninsured Americans, although the implementation of different components started at a later date. Political issues led to uneven adaptation by states of the different ACA components. In states that adopted Medicaid expansion under the ACA, similar to that under the Massachusetts Health Care Reform Law of 2006, patients of low socioeconomic status and racial minority patients gained better access to health care. This review article will examine the disparities that exist in peripheral artery disease outcomes, as well as the effects of the ACA and Medicaid expansion on revascularization, limb salvage, and major amputation rates.
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Affiliation(s)
- Mohammad H Eslami
- Division of Vascular Surgery, UPMC, Heart and Vascular Institute, South Tower, 200 Lothrop Street, Pittsburgh, PA 15213.
| | - Dana B Semaan
- Division of Vascular Surgery, UPMC, Heart and Vascular Institute, South Tower, 200 Lothrop Street, Pittsburgh, PA 15213
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Coy T, Brinza E, DeLozier S, Gornik HL, Webel AR, Longenecker CT, White Solaru KT. Black men's awareness of peripheral artery disease and acceptability of screening in barbershops: a qualitative analysis. BMC Public Health 2023; 23:46. [PMID: 36609297 PMCID: PMC9821364 DOI: 10.1186/s12889-022-14648-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/16/2022] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Peripheral artery disease (PAD) disproportionately burdens Black Americans, particularly Black men. Despite the significant prevalence and high rate of associated morbidity and mortality, awareness of and treatment initiation for PAD remains low in this demographic group. Given the well-established social cohesion among barbershops frequently attended by Black men, barbershops may be ideal settings for health screening and education to improve awareness, early detection, and treatment initiation of PAD among Black men. METHODS A qualitative study involving 1:1 participant interviews in Cleveland, Ohio assessed perspectives of Black men about barbershop-based screening and education about PAD. Inductive thematic analysis was performed to derive themes directly from the data to reflect perceived PAD awareness and acceptability of screening in a barbershop setting. RESULTS Twenty-eight African American/Black, non-Hispanic men completed a qualitative interview for this analysis. Mean age was 59.3 ± 11.2 years and 93% of participants resided in socioeconomically disadvantaged zip codes. Several themes emerged indicating increased awareness of PAD and acceptability of barbershop-based screenings for PAD, advocacy for systemic changes to improve the health of the community, and a desire among participants to increase knowledge about cardiovascular disease. CONCLUSIONS Participants were overwhelmingly accepting of PAD screenings and reported increased awareness of PAD and propensity to seek healthcare due to engagement in the study. Participants provided insight into barriers and facilitators of health and healthcare-seeking behavior, as well as into the community and the barbershop as an institution. Additional research is needed to explore the perspectives of additional stakeholders and to translate community-based screenings into treatment initiation.
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Affiliation(s)
- Tyler Coy
- Division of Cardiovascular Medicine and Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Ellen Brinza
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Internal Medicine, University of Colorado, Aurora, CO, USA
| | - Sarah DeLozier
- Clinical Research Center, University Hospitals, Cleveland, OH, USA
| | - Heather L Gornik
- Division of Cardiovascular Medicine and Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA.
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Allison R Webel
- University of Washington School of Nursing, Seattle, WA, USA
| | - Christopher T Longenecker
- Division of Cardiovascular Medicine and Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
- School of Medicine and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Khendi T White Solaru
- Division of Cardiovascular Medicine and Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
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White Solaru KT, Coy T, DeLozier S, Brinza E, Ravenell J, Longenecker CT, Wright JT, Gornik HL. Findings of a Novel Barbershop-Based Peripheral Artery Disease Screening Program for Black Men. J Am Heart Assoc 2022; 11:e026347. [PMID: 36250671 DOI: 10.1161/jaha.122.026347] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Peripheral artery disease (PAD) increases the risk of cardiovascular events and limb events including amputations. PAD is twice as prevalent in Black compared with non-Hispanic White individuals, especially among men. Screening for PAD using the ankle-brachial index in community settings, such as the barbershop, could lead to earlier diagnosis and treatment. Methods and Results A pilot study was conducted at 2 barbershops in Cleveland, OH from June to December 2020 to assess the feasibility of screening for PAD in the barbershop setting and the effect of an educational intervention on PAD awareness. After screening with both automated and Doppler ankle-brachial index, PAD was identified in 5/31 (16.1%) of participants. Baseline systolic blood pressure, low-density lipoprotein cholesterol, and random blood glucose were higher in participants who screened positive for PAD (P<0.001). PAD awareness was low overall. There was a significant improvement in PAD awareness assessment scores obtained at the initial and exit visits (9.93±4.23 to 12.50±4.41, P=0.004). An association was found between PAD awareness at baseline and highest education level achieved: compared with those with some college/associate's degree or higher, non-high school graduates scored lower on PAD awareness (P=0.022), as did those who only had a high school diploma or tests of General Educational Development (P=0.049). Conclusions In a pilot study, barbershop-based screening for PAD among Black men revealed a higher than expected PAD prevalence and low PAD awareness. An educational video was effective at increasing PAD awareness. Ankle-brachial index screening and educational outreach in the barbershop may be a feasible and effective tool to diagnose PAD and reduce PAD disparities among Black men at highest risk.
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Affiliation(s)
- Khendi T White Solaru
- Department of Cardiovascular Medicine University Hospitals Harrington Heart and Vascular Institute Cleveland OH.,Department of Medicine Case Western Reserve University School of Medicine Cleveland OH
| | - Tyler Coy
- Department of Cardiovascular Medicine University Hospitals Harrington Heart and Vascular Institute Cleveland OH
| | - Sarah DeLozier
- Clinical Research Center University Hospitals Cleveland OH
| | - Ellen Brinza
- Department of Medicine Case Western Reserve University School of Medicine Cleveland OH
| | - Joseph Ravenell
- Langone's Departments of Population Health and Medicine New York University School of Medicine New York NY
| | - Christopher T Longenecker
- Department of Cardiovascular Medicine University Hospitals Harrington Heart and Vascular Institute Cleveland OH.,Department of Medicine Case Western Reserve University School of Medicine Cleveland OH
| | - Jackson T Wright
- Department of Cardiovascular Medicine University Hospitals Harrington Heart and Vascular Institute Cleveland OH.,Department of Medicine Case Western Reserve University School of Medicine Cleveland OH
| | - Heather L Gornik
- Department of Cardiovascular Medicine University Hospitals Harrington Heart and Vascular Institute Cleveland OH.,Department of Medicine Case Western Reserve University School of Medicine Cleveland OH
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Demsas F, Joiner MM, Telma K, Flores AM, Teklu S, Ross EG. Disparities in peripheral artery disease care: A review and call for action. Semin Vasc Surg 2022; 35:141-154. [PMID: 35672104 PMCID: PMC9254894 DOI: 10.1053/j.semvascsurg.2022.05.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022]
Abstract
Peripheral artery disease (PAD), the pathophysiologic narrowing of arterial blood vessels of the lower leg due to atherosclerosis, is a highly prevalent disease that affects more than 6 million individuals 40 years and older in the United States, with sharp increases in prevalence with age. Morbidity and mortality rates in patients with PAD range from 30% to 70% during the 5- to 15-year period after diagnosis and PAD is associated with poor health outcomes and reduced functionality and quality of life. Despite advances in medical, endovascular, and open surgical techniques, there is striking variation in care among population subgroups defined by sex, race and ethnicity, and socioeconomic status, with concomitant differences in preoperative medication optimization, amputation risk, and overall health outcomes. We reviewed studies from 1995 to 2021 to provide a comprehensive analysis of the current impact of disparities on the treatment and management of PAD and offer action items that require strategic partnership with primary care providers, researchers, patients, and their communities. With new technologies and collaborative approaches, optimal management across all population subgroups is possible.
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Affiliation(s)
- Falen Demsas
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | | | - Kate Telma
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Alyssa M Flores
- Department of Surgery, Division of Vascular Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Elsie Gyang Ross
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA; Center for Biomedical Informatics Research, Stanford University, Stanford, CA; Stanford Cardiovascular Institute, 780 Welch Road, CJ350, Palo Alto, CA 94304.
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Lim M, Qureshi MM, Boyd G, Hirsch AE. Effect of Radiation Treatment at a High-Volume Center on Outcomes in Intermediate-Risk Prostate Cancer: An Analysis of the National Cancer Database. Urology 2022; 165:242-249. [PMID: 35182584 DOI: 10.1016/j.urology.2022.01.045] [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: 10/18/2021] [Revised: 12/21/2021] [Accepted: 01/09/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the effect of radiation treatment at a high-volume center on overall survival in men with intermediate-risk prostate cancer. METHODS From 2004-2015, 430,347 patients with intermediate-risk prostate cancer were identified in the NCDB. Radiation case volume (RCV) of each hospital was calculated based on number of patients treated. After excluding certain patients including those with metastatic disease, our final analysis population included 116,091 intermediate-risk prostate cancer patients receiving radiation therapy (RT) or radiation with androgen deprivation therapy (RT+ADT). Characteristics analyzed include age, race, distance to treatment facility, Charlson-Deyo Score (CDS), and socioeconomic factors. Primary outcome was overall survival (OS). 5-year survival rates were estimated using the Kaplan-Meier method. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) were computed using multivariate analysis (MVA). Cox regression and propensity score-matched (PSM) analysis was performed. RESULTS Median follow up was 63.5 months and estimated 5-year OS was 90.1% at high RCV centers and 88.2% at low RCV centers (p<0.0001). Treatment at high RCV facility was associated with significantly lower mortality compared to treatment at a low RCV facility on MVA and PSM analysis. The survival benefit of treatment at a high RCV facility remained when high RCV facilities were defined as those above the 80th, 90th, and 95th percentile in patient volume (p<0.05). CONCLUSIONS Treatment at a high radiation case volume facility is associated with improved OS in patients with radiation-treated intermediate-risk prostate cancer. This survival benefit is important to consider when choosing a treatment center for radiation therapy.
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Affiliation(s)
- Mir Lim
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA.
| | - Muhammad M Qureshi
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Graham Boyd
- Harvard Radiation Oncology Program, Boston, MA
| | - Ariel E Hirsch
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA
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Social Deprivation and Peripheral Artery Disease. Can J Cardiol 2021; 38:612-622. [PMID: 34971734 DOI: 10.1016/j.cjca.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/08/2021] [Accepted: 12/22/2021] [Indexed: 12/24/2022] Open
Abstract
The link between peripheral artery disease and socioeconomic status is complex. The objective of this narrative review is to explore this relationship in detail, including how social factors impact the development, management, and outcomes of peripheral artery disease. Although the current literature on this topic is limited, some patterns do emerge. Populations of low socioeconomic status appear to be at increased risk for the development of peripheral artery disease, due to factors such as increased prevalence of cardiovascular risk factors (i.e. cigarette smoking) and decreased access to care. However, variables that are more difficult to quantify, such as chronic stress and health literacy, also likely play a significant role. Among those who are living with peripheral artery disease, socioeconomic status can also affect disease management. Secondary prevention strategies, such as medication use, smoking cessation, and exercise therapy, are underutilized in socially deprived populations. This underutilization of evidence-based management leads to adverse outcomes in these groups, including increased rates of amputation and decreased post-operative survival. The recognition of the importance of social factors in prognosis is an important first step towards addressing this health disparity. Moving forward, interventions that help to identify those who are at high risk and help to improve access to care in populations of low socioeconomic status, will be critical to improving outcomes.
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Abstract
Peripheral artery disease is an obstructive, atherosclerotic disease of the lower extremities causing significant morbidity and mortality. Black Americans are disproportionately affected by this disease while they are also less likely to be diagnosed and promptly treated. The consequences of this disparity can be grim as Black Americans bear the burden of lower extremity amputation resulting from severe peripheral artery disease. The risk factors of peripheral artery disease and how they differentially affect certain groups are discussed in addition to a review of pharmacological and nonpharmacological treatment modalities. The purpose of this review is to highlight health care inequities and provide a review and resource of available recommendations for clinical management of all patients with peripheral artery disease.
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Affiliation(s)
- Eddie L Hackler
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH (E.L.H., K.W.S.)
| | - Naomi M Hamburg
- Cardiology, Boston University School of Medicine, Medicine, MA (N.M.H.)
| | - Khendi T White Solaru
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH (E.L.H., K.W.S.)
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Dedov II, Shestakova MV, Mayorov AY, Shamkhalova MS, Nikonova TV, Sukhareva OY, Pekareva EV, Ibragimova LI, Mikhina MS, Galstyan GR, Tokmakova AY, Surkova EV, Laptev DN, Kononenko IV, Egorova DN, Klefortova II, Sklyanik IA, Yarek-Martynova IY, Severina AS, Martynov SA, Vikulova OK, Kalashnikov VY, Gomova IS, Lipatov DV, Starostina EG, Ametov AS, Antsiferov MB, Bardymova TP, Bondar IA, Valeeva FV, Demidova TY, Klimontov VV, Mkrtumyan AM, Petunina NA, Suplotova LA, Ushakova OV, Khalimov YS, Ruyatkina LA. Diabetes mellitus type 1 in adults. DIABETES MELLITUS 2020. [DOI: 10.14341/dm12505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tatiana P. Bardymova
- Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education
| | | | | | | | - Vadim V. Klimontov
- Research Institute of Clinical and Experimental Lymphology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences
| | - Ashot M. Mkrtumyan
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
| | - Nina A. Petunina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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Dedov II, Shestakova MV, Mayorov AY, Shamkhalova MS, Sukhareva OY, Galstyan GR, Tokmakova AY, Nikonova TV, Surkova EV, Kononenko IV, Egorova DN, Ibragimova LI, Shestakova EA, Klefortova II, Sklyanik IA, Yarek-Martynova IY, Severina AS, Martynov SA, Vikulova OK, Kalashnikov VY, Bondarenko IZ, Gomova IS, Starostina EG, Ametov AS, Antsiferov MB, Bardymova TP, Bondar IA, Valeeva FV, Demidova TY, Mkrtumyan AM, Petunina NA, Ruyatkina LA, Suplotova LA, Ushakova OV, Khalimov YS. Diabetes mellitus type 2 in adults. DIABETES MELLITUS 2020. [DOI: 10.14341/dm12507] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tatiana P. Bardymova
- Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education
| | | | | | | | - Ashot M. Mkrtumyan
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
| | - Nina A. Petunina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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Bevan GH, White Solaru KT. Evidence-Based Medical Management of Peripheral Artery Disease. Arterioscler Thromb Vasc Biol 2020; 40:541-553. [PMID: 31996023 DOI: 10.1161/atvbaha.119.312142] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Peripheral artery disease is an atherosclerotic disease of the lower extremities associated with high cardiovascular mortality. Management of this condition may include lifestyle modifications, medical management, endovascular repair, or surgery. The medical approach to peripheral artery disease is multifaceted and includes cholesterol reduction, antiplatelet therapy, anticoagulation, peripheral vasodilators, blood pressure management, exercise therapy, and smoking cessation. Adherence to this regimen can reduce limb-related complications like critical limb ischemia and amputation, as well as systemic complications of atherosclerosis like stroke and myocardial infarction. Relative to coronary artery disease, peripheral artery disease is an undertreated condition. In this article, we explore the evidence behind medical therapies for the management of peripheral artery disease.
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Affiliation(s)
- Graham H Bevan
- From the Department of Medicine (G.H.B., K.T.W.S.), University Hospitals Cleveland Medical Center, OH.,Case Western Reserve University School of Medicine, Cleveland, OH (G.H.B., K.T.W.S.)
| | - Khendi T White Solaru
- From the Department of Medicine (G.H.B., K.T.W.S.), University Hospitals Cleveland Medical Center, OH.,Harrington Heart and Vascular Institute (K.T.W.S.), University Hospitals Cleveland Medical Center, OH.,Case Western Reserve University School of Medicine, Cleveland, OH (G.H.B., K.T.W.S.)
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Peripheral Artery Disease and African Americans: Review of the Literature. CURRENT CARDIOVASCULAR RISK REPORTS 2019. [DOI: 10.1007/s12170-019-0621-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Affiliation(s)
- Steven D Shapiro
- Department of Medicine, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, Pennsylvania, USA
| | - Ata Murat Kaynar
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, Pennsylvania, USA.,The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, Pennsylvania, USA
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Halle TR, Benarroch-Gampel J, Teodorescu VJ, Rajani RR. Surgical Intervention for Peripheral Artery Disease Does Not Improve Patient Compliance with Recommended Medical Therapy. Ann Vasc Surg 2018; 46:104-111. [DOI: 10.1016/j.avsg.2017.06.152] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/09/2017] [Accepted: 06/16/2017] [Indexed: 10/19/2022]
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Moses DA, Mehaffey JH, Strider DV, Tracci MC, Kern JA, Upchurch GR. Smoking Cessation Counseling Improves Quality of Care and Surgical Outcomes with Financial Gain for a Vascular Practice. Ann Vasc Surg 2017; 42:214-221. [PMID: 28389293 DOI: 10.1016/j.avsg.2016.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 11/22/2016] [Accepted: 12/05/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cigarette smoking is strongly associated with atherosclerotic disease. It is incumbent on vascular surgeons to provide smoking cessation counseling (SCC) to their patients. The objective of this study was to determine the association of SCC and improvement in quality of care. METHODS As a quality project using retrospective data, the study received institutional review board exemption status. A retrospective review of prospectively maintained database from April 2014 through March 2015 of outpatient encounters in a vascular surgery clinic was performed of current smokers. Through the quality support team, providers were encouraged to counsel smokers to quit, document the discussion, and bill specific Evaluate and Management codes (99406 and 99407). The number of outpatients by smoking status, documentation and billing of SCC, demographics of current smokers, and monetary collections were collected. Data were compared using a correlation coefficient calculated and tested for statistical significant using two-tailed t-test. RESULTS A sample of 1,077 visits by 612 currently smoking patients accounted for 24% of all outpatient vascular surgery visits. The average age was 61 years, and 64% were male. Comorbidities included 77% with hypertension, 32% with diabetes mellitus, and 14% with chronic kidney disease. Medically, 72% were on aspirin, 71% on statin, and 48% on beta blocker. A total of 208 (34%) never underwent a vascular intervention, and 183 (30%) had an intervention during the study period (44% for peripheral artery disease, 10% for carotid stenosis, 14% amputations, and 10% abdominal aortic aneurysm). Documentation improved from 65% of encounters during the first month to 89% in the peak month and 79% of total encounters. All-cause mortality rate was 2%, and this cohort demonstrated 75% SCC for 28 encounters. Fifty-five patients (9%) quit smoking for more than 30 days at the end of the study period, and this cohort had 69% of their 97 encounters with documented SCC. Increased SCC was correlated with decreased 30-day readmissions during the concurrent month (r = -0.711, P = 0.009) and the following month (r = -0.719, P = 0.008). There was a weak correlation with decreased amputations the following month (r = -0.5, P = 0.08). From a financial perspective, $1,373 was collected for 33 patients with a potential for collection of $7,460 predicted for minimum Medicare payment of 1 visit per patient. CONCLUSIONS Advising vascular patients in the arduous process of smoking cessation benefits both the patient and the health system. Proper documentation and billing decreases costs of early readmissions and increases departmental revenue.
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Affiliation(s)
- D A Moses
- Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville, VA.
| | - J H Mehaffey
- Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville, VA
| | - D V Strider
- Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville, VA
| | - M C Tracci
- Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville, VA
| | - J A Kern
- Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville, VA
| | - G R Upchurch
- Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville, VA
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Effect of Gaining Insurance Coverage on Smoking Cessation in Community Health Centers: A Cohort Study. J Gen Intern Med 2016; 31:1198-205. [PMID: 27329121 PMCID: PMC5023615 DOI: 10.1007/s11606-016-3781-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/27/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Community health center (CHC) patients have high rates of smoking. Insurance coverage for smoking cessation assistance, such as that mandated by the Affordable Care Act, may aid in smoking cessation in this vulnerable population. OBJECTIVE We aimed to determine if uninsured CHC patients who gain Medicaid coverage experience greater primary care utilization, receive more cessation medication orders, and achieve higher quit rates, compared to continuously uninsured smokers. DESIGN Longitudinal observational cohort study using electronic health record data from a network of Oregon CHCs linked to Oregon Medicaid enrollment data. PATIENTS Cohort of patients who smoke and who gained Medicaid coverage in 2008-2011 after ≥ 6 months of being uninsured and with ≥ 1 smoking assessment in the 24-month follow-up period from the baseline smoking status date. This group was propensity score matched to a cohort of continuously uninsured CHC patients who smoke (n = 4140 matched pairs; 8280 patients). INTERVENTION Gaining Medicaid after being uninsured for ≥ 6 months. MAIN MEASURES 'Quit' smoking status (baseline smoking status was 'current every day' or 'some day' and status change to 'former smoker' at a subsequent visit), smoking cessation medication order, and ≥ 6 documented visits (yes/no variables) at ≥ 1 smoking status assessment within the 24-month follow-up period. KEY RESULTS The newly insured had 40 % increased odds of quitting smoking (aOR = 1.40, 95 % CI:1.24, 1.58), nearly triple the odds of having a medication ordered (aOR = 2.94, 95 % CI:2.61, 3.32), and over twice the odds of having ≥ 6 follow-up visits (aOR = 2.12, 95 % CI:1.94, 2.32) compared to their uninsured counterparts. CONCLUSIONS Newly insured patients had increased odds of quit smoking status over 24 months of follow-up than those who remained uninsured. Providing insurance coverage to vulnerable populations may have a significant impact on smoking cessation.
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Intermittent Claudication due to Peripheral Artery Disease: Best Modern Medical and Endovascular Therapeutic Approaches. Curr Cardiol Rep 2015; 17:86. [DOI: 10.1007/s11886-015-0643-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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