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Saeed H, Abdullah MBBS, Naeem I, Zafar A, Ahmad B, Islam TU, Rizvi SS, Kumari N, Kirmani SGA, Mansoor F, Hassan A, Raja A, Daoud M, Goyal A. Demographic trends and disparities in mortality related to coexisting heart failure and diabetes mellitus among older adults in the United States between 1999 and 2020: A retrospective population-based cohort study from the CDC WONDER database. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 23:200326. [PMID: 39282605 PMCID: PMC11395761 DOI: 10.1016/j.ijcrp.2024.200326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 08/03/2024] [Accepted: 08/22/2024] [Indexed: 09/19/2024]
Abstract
Background Heart Failure (HF) and Diabetes Mellitus (DM) often coexist, and each condition independently increases the likelihood of developing the other. While there has been concern regarding the increasing burden of disease for both conditions individually over the last decade, a comprehensive examination of mortality trends and demographic and regional disparities needs to be thoroughly explored in the United States (US). Methods This study analyzed death certificates from the CDC WONDER database, focusing on mortality caused by the co-occurrence of HF and DM in adults aged 75 and older from 1999 to 2020. Age-adjusted mortality rates (AAMRs) and annual percent changes (APCs) were computed and categorized by year, gender, race, census region, state, and metropolitan status. Results A total of 663,016 deaths were reported in patients with coexisting HF and DM. Overall, AAMR increased from 154.1 to 186.1 per 100,000 population between 1999 and 2020, with a notable significant increase from 2018 to 2020 (APC: 11.30). Older men had consistently higher AAMRs than older women (185 vs. 135.4). Furthermore, we found that AAMRs were highest among non-Hispanic (NH) American Indian or Alaskan natives and lowest in NH Asian or Pacific Islanders (214.4 vs. 104.1). Similarly, AAMRs were highest in the Midwestern region and among those dwelling in non-metropolitan areas. Conclusions Mortality from HF and DM has risen significantly in recent years, especially among older men, NH American Indian or Alaska Natives, and those in non-metropolitan areas. Urgent policies need to be developed to address these disparities and promote equitable healthcare access.
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Affiliation(s)
- Humza Saeed
- Rawalpindi Medical University, Rawalpindi, Punjab, Pakistan
| | | | - Irum Naeem
- King Edward Medical University, Lahore, Punjab, Pakistan
| | - Amna Zafar
- King Edward Medical University, Lahore, Punjab, Pakistan
| | - Bilal Ahmad
- DG Khan Medical College, Dera Ghazi Khan, Punjab, Pakistan
| | - Taimur Ul Islam
- Shifa college of medicine, Shifa Tameer e Millat University, Islamabad, Pakistan
| | - Syed Saaid Rizvi
- Sindh Medical College, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Nikita Kumari
- Sindh Medical College, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | | | | | - Adarsh Raja
- Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | | | - Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
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Luo H, Xiang C, Zeng L, Li S, Mei X, Xiong L, Liu Y, Wen C, Cui Y, Du L, Zhou Y, Wang K, Li L, Liu Z, Wu Q, Pu J, Yue R. SHAP based predictive modeling for 1 year all-cause readmission risk in elderly heart failure patients: feature selection and model interpretation. Sci Rep 2024; 14:17728. [PMID: 39085442 PMCID: PMC11291677 DOI: 10.1038/s41598-024-67844-7] [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: 04/17/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024] Open
Abstract
Heart failure (HF) is a significant global public health concern with a high readmission rate, posing a serious threat to the health of the elderly population. While several studies have used machine learning (ML) to develop all-cause readmission risk prediction models for elderly patients with HF, few have integrated ML-selected features with those chosen by human experts to assess HF patients readmission. A retrospective analysis of 8396 elderly HF patients hospitalized at the Affiliated Hospital of North Sichuan Medical College from January 1, 2018 to December 31, 2021 was conducted. Variables selected by XGBoost, LASSO regression, and random forest constituted the machine group, while the human expert group comprised variables chosen by two experienced cardiovascular professors. The variables selected by both groups were combined to form a human-machine collaboration group. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC). The SHapley Additive exPlanations (SHAP) method was used to elucidate the importance of each predictive feature, explain the impact of individual features on the model, and provide visual representation. A total of 73 features were included for model development. The human-machine collaboration model, utilizing CatBoost, achieved an AUC of 0.83617, an F1-score of 0.73521, and a Brier score of 0.16536 on the validation set. This model demonstrated superior predictive performance compared to those created solely by human experts or machine. The SHAP plot was then used to visually display the feature analysis of the human-machine collaboration model, revealing HGB, NT-proBNP, smoking history, NYHA classification, and LVEF as the 5 most important features. This study indicate that the human-machine collaboration model outperforms those relying solely on human expert selection or machine algorithm at predicting all-cause readmission in elderly HF patients. The application of the SHAP method enhanced the interpretability of the model outcomes, aiding clinicians in accurately pinpointing risk factors associated with HF readmission. This advancement enables the formulation of tailored treatment strategies, offering a more personalized approach to patient care.
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Affiliation(s)
- Hao Luo
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, No. 63, Wenhua Road, Nanchong, 637000, Sichuan Province, People's Republic of China
| | - Congyu Xiang
- Hubei Polytechnic University, Huangshi, 435003, Hubei, People's Republic of China
| | - Lang Zeng
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, No. 63, Wenhua Road, Nanchong, 637000, Sichuan Province, People's Republic of China
| | - Shikang Li
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, No. 63, Wenhua Road, Nanchong, 637000, Sichuan Province, People's Republic of China
| | - Xue Mei
- School of Pharmacy, Institute of Material Medica, North Sichuan Medical College, Nanchong, 637000, Sichuan, People's Republic of China
| | - Lijuan Xiong
- Department of Cardiology, People's Hospital of Guang'an District, Guang'an, 638550, Sichuan Province, People's Republic of China
| | - Yanxu Liu
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, No. 63, Wenhua Road, Nanchong, 637000, Sichuan Province, People's Republic of China
| | - Cong Wen
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, No. 63, Wenhua Road, Nanchong, 637000, Sichuan Province, People's Republic of China
| | - Yangyang Cui
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, No. 63, Wenhua Road, Nanchong, 637000, Sichuan Province, People's Republic of China
| | - Linqin Du
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, No. 63, Wenhua Road, Nanchong, 637000, Sichuan Province, People's Republic of China
| | - Yang Zhou
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, No. 63, Wenhua Road, Nanchong, 637000, Sichuan Province, People's Republic of China
| | - Kun Wang
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, No. 63, Wenhua Road, Nanchong, 637000, Sichuan Province, People's Republic of China
| | - Lan Li
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, No. 63, Wenhua Road, Nanchong, 637000, Sichuan Province, People's Republic of China
| | - Zonglian Liu
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, No. 63, Wenhua Road, Nanchong, 637000, Sichuan Province, People's Republic of China
| | - Qi Wu
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, People's Republic of China
| | - Jun Pu
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, No. 63, Wenhua Road, Nanchong, 637000, Sichuan Province, People's Republic of China.
| | - Rongchuan Yue
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, No. 63, Wenhua Road, Nanchong, 637000, Sichuan Province, People's Republic of China.
- Department of Cardiology, People's Hospital of Guang'an District, Guang'an, 638550, Sichuan Province, People's Republic of China.
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Piña IL, Allen LA, Desai NR. Policy and Payment Challenges in the Postpandemic Treatment of Heart Failure: Value-Based Care and Telehealth. J Card Fail 2021; 28:835-844. [PMID: 34520854 PMCID: PMC8434774 DOI: 10.1016/j.cardfail.2021.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022]
Abstract
Increasing patient and therapeutic complexity have created both challenges and opportunities for heart failure care. Within this background, the coronavirus disease-2019 pandemic has disrupted care as usual, accelerating the need for transition from volume-based to value-based care, and demanding a rapid expansion of telehealth and remote care for heart failure. Patients, clinicians, health systems, and payors have by necessity become more invested in these issues. Herein we review recent changes in health care policy related to the movement from volume to value-based payment and from in-person to remote care delivery.
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Affiliation(s)
- Ileana L Piña
- Central Michigan University, Mount Pleasant, Michigan.
| | - Larry A Allen
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Nihar R Desai
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
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Bahiru E, Ziaeian B, Moucheraud C, Agarwal A, Xu H, Matsouaka RA, DeVore AD, Heidenreich PA, Allen LA, Yancy CW, Fonarow GC. Association of Dual Eligibility for Medicare and Medicaid With Heart Failure Quality and Outcomes Among Get With The Guidelines-Heart Failure Hospitals. JAMA Cardiol 2021; 6:791-800. [PMID: 33825802 DOI: 10.1001/jamacardio.2021.0611] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The Centers for Medicare & Medicaid Services uses a new peer group-based payment system to compare hospital performance as part of its Hospital Readmissions Reduction Program, which classifies hospitals into quintiles based on their share of dual-eligible beneficiaries for Medicare and Medicaid. However, little is known about the association of a hospital's share of dual-eligible beneficiaries with the quality of care and outcomes for patients with heart failure (HF). Objective To evaluate the association between a hospital's proportion of patients with dual eligibility for Medicare and Medicaid and HF quality of care and outcomes. Design, Setting, and Participants This retrospective cohort study evaluated 436 196 patients hospitalized for HF using the Get With The Guidelines-Heart Failure registry from January 1, 2010, to December 31, 2017. The analysis included patients 65 years or older with available data on dual-eligibility status. Hospitals were divided into quintiles based on their share of dual-eligible patients. Quality and outcomes were analyzed using unadjusted and adjusted multivariable logistic regression models. Data analysis was performed from April 1, 2020, to January 1, 2021. Main Outcomes and Measures The primary outcome was 30-day all-cause readmission. The secondary outcomes included in-hospital mortality, 30-day HF readmissions, 30-day all-cause mortality, and HF process of care measures. Results A total of 436 196 hospitalized HF patients 65 years or older from 535 hospital sites were identified, with 258 995 hospitalized patients (median age, 81 years; interquartile range, 74-87 years) at 455 sites meeting the study criteria and included in the primary analysis. A total of 258 995 HF hospitalizations from 455 sites were included in the primary analysis of the study. Hospitals in the highest dual-eligibility quintile (quintile 5) tended to care for patients who were younger, were more likely to be female, belonged to racial minority groups, or were located in rural areas compared with quintile 1 sites. After multivariable adjustment, hospitals with the highest quintile of dual eligibility were associated with lower rates of key process measures, including evidence-based β-blocker prescription, measure of left ventricular function, and anticoagulation for atrial fibrillation or atrial flutter. Differences in clinical outcomes were seen with higher 30-day all-cause (adjusted odds ratio, 1.24; 95% CI, 1.14-1.35) and HF (adjusted odds ratio, 1.14; 95% CI, 1.03-1.27) readmissions in higher dual-eligible quintile 5 sites compared with quintile 1 sites. Risk-adjusted in-hospital and 30-day mortality did not significantly differ in quintile 1 vs quintile 5 hospitals. Conclusions and Relevance In this cohort study, hospitals with a higher share of dual-eligible patients provided care with lower rates of some of the key HF quality of care process measures and with higher 30-day all-cause or HF readmissions compared with lower dual-eligibility quintile hospitals.
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Affiliation(s)
- Ehete Bahiru
- Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles
| | - Boback Ziaeian
- Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles.,Division of Cardiology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | | | - Anubha Agarwal
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Haolin Xu
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Roland A Matsouaka
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Adam D DeVore
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Paul A Heidenreich
- Department of Medicine, Stanford School of Medicine, Palo Alto, California
| | - Larry A Allen
- Division of Cardiology, University of Colorado School of Medicine, Aurora
| | - Clyde W Yancy
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Deputy Editor, JAMA Cardiology
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles.,Ahmanson Cardiomyopathy Center, David Geffen School of Medicine, University of California, Los Angeles.,Associate Editor for Health Care Quality and Guidelines, JAMA Cardiology
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5
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Shirey TE, Hu Y, Ko YA, Nayak A, Udeshi E, Patel S, Morris AA. Relation of Neighborhood Disadvantage to Heart Failure Symptoms and Hospitalizations. Am J Cardiol 2021; 140:83-90. [PMID: 33144159 DOI: 10.1016/j.amjcard.2020.10.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/24/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
Residence in socioeconomically deprived neighborhoods may influence patient's health-related behaviors and overall health. We evaluated the association of neighborhood disadvantage on heart failure (HF) symptom burden and hospitalization rates. We characterized neighborhood deprivation in 359 HF subjects (age 56 ± 13 years, 52% black) in metropolitan Atlanta using the Area Deprivation Index (ADI). ANOVA was used to compare HF symptoms measured using the Kansas City Cardiomyopathy Questionnaire, and HF Self-Care Index across ADI tertiles. Zero-inflated Poisson regression was used to compare rates of recurrent HF hospitalization (HFH) across ADI tertiles. Subjects living in more deprived neighborhoods were more likely to be black, have Medicare or Medicaid insurance, and have a lower ejection fraction than those living in less deprived neighborhoods (all p ≤ 0.005). Subjects in more deprived neighborhoods had more severe HF symptoms (p < 0.001), but there was no difference in HF Self-Care Index scores across ADI tertiles. Subjects living in more deprived neighborhoods had a higher odds of being hospitalized for HF than subjects in less deprived neighborhoods. Once subjects had experienced a HFH, however, the association between ADI and the risk of recurrent HFH varied by racial group. In whites, increasing ADI was associated with a marginally decreased risk of recurrent HFH, while there was no association between ADI and recurrent HFH in blacks. In conclusion, patients with HF living in more deprived neighborhoods have greater symptom burden and are more likely to experience a HFH than those living in less deprived neighborhoods.
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Joury A, Bob-Manuel T, Sanchez A, Srinithya F, Sleem A, Nasir A, Noor A, Penfold D, Bober R, Morin DP, Krim SR. Leadless and Wireless Cardiac Devices: The Next Frontier in Remote Patient Monitoring. Curr Probl Cardiol 2021; 46:100800. [PMID: 33545511 DOI: 10.1016/j.cpcardiol.2021.100800] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/31/2022]
Abstract
In the last decade, advances in wireless and sensor technologies, and the implementation of telemedicine, have led to innovative digital health care for cardiac patients. Continuous monitoring of patients' biomedical signals, and acute changes in these signals, may result in timely, accurate diagnoses and implementation of early interventions. In this review, we discuss commonly used wireless and leadless cardiac devices including pulmonary artery pressure sensors, implantable loop recorders, leadless pacemakers and subcutaneous implantable cardioverter-defibrillators. We discuss the concept and function of each device, indications, methods of delivery, potential complications, consideration for implantation, and cost-effectiveness.
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Affiliation(s)
- Abdulaziz Joury
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA
| | | | - Alexandra Sanchez
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA
| | - Fnu Srinithya
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA
| | - Amber Sleem
- Division of Internal Medicine, Ochsner Medical Center, New Orleans, LA
| | - Ayman Nasir
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA
| | - Abdullah Noor
- Division of Internal Medicine, Ochsner Medical Center, New Orleans, LA
| | - Dana Penfold
- Division of Internal Medicine, Ochsner Medical Center, New Orleans, LA
| | - Robert Bober
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Daniel P Morin
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Selim R Krim
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
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