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Li W, Wang Z, Hua C, Zhang H, Liu X, Zheng S, Lv Q, Jiang C, Dong J, Ma C, Du X. Body mass index, frailty, and outcomes in heart failure with preserved ejection fraction. ESC Heart Fail 2024; 11:709-718. [PMID: 38131256 DOI: 10.1002/ehf2.14595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/10/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023] Open
Abstract
AIMS Relationship between body mass index (BMI), frailty, and clinical adverse events remains unclear in patients with heart failure (HF) with preserved ejection fraction (HFpEF) in different patient populations. We aimed to compare the association of BMI, frailty, and clinical adverse events between a US cohort from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study and a Chinese cohort from the Heart Failure Registry of Patient Outcomes (HERO) study. METHODS AND RESULTS We used data of 1715 participants enrolled from America in the TOPCAT study and 1487 patients with HFpEF in the Chinese registry study, the HERO. We evaluated the relationship between BMI and frailty using multivariate restricted cubic spline logistic regression. Association between frailty and BMI categories and primary outcomes including HF hospitalization, aborted sudden death, and cardiovascular death, all-cause mortality, and HF hospitalization were analysed by Cox proportional hazards models. The patients' mean age was 72 ± 11 years for both study populations, with 50% and 46% female for the TOPCAT study and the HERO study, respectively. Patients in the TOPCAT study had a higher mean BMI (33.9 vs. 24 kg/m2), with 72.3% vs. 52.9% defined as moderately to severely frail (frailty index > 0.3). In the TOPCAT study, risk of frailty rose as BMI increased, but not in the HERO study. Patients with frailty were at significant higher risk for the primary composite outcomes [hazard ratio (HR) 1.84 (95% confidence interval: 1.46-2.32)], all-cause mortality [HR 1.73 (1.34-2.25)], and HF hospitalization [HR 1.83 (1.40-2.40)] in the TOPCAT study. The corresponding numbers in the HERO study were 1.26 (1.01-1.57), 2.21 (1.45-3.35), and 1.15 (0.81-1.37), respectively. The association of frailty with clinical outcomes did not vary with BMI categories in the two studies. CONCLUSIONS BMI distribution and association between BMI and frailty risk were different between the two study populations. Frailty was associated with clinical adverse events and this association was consistent across different BMI categories in both studies.
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Affiliation(s)
- Wenjie Li
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Zhiyan Wang
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Chang Hua
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Hao Zhang
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Xinru Liu
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Shiyue Zheng
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Qiang Lv
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Chao Jiang
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Anzhen Hospital, Beijing, China
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Changsheng Ma
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Xin Du
- Department of Cardiology, Anzhen Hospital, Beijing, China
- Heart Health Research Center (HHRC), Beijing, China
- The George Institute for Global Health (Australia), The University of New South Wales, Sydney, Australia
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2
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Norris CM, Mullen KA, Foulds HJ, Jaffer S, Nerenberg K, Gulati M, Parast N, Tegg N, Gonsalves CA, Grewal J, Hart D, Levinsson AL, Mulvagh SL. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 7: Sex, Gender, and the Social Determinants of Health. CJC Open 2024; 6:205-219. [PMID: 38487069 PMCID: PMC10935698 DOI: 10.1016/j.cjco.2023.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/31/2023] [Indexed: 03/17/2024] Open
Abstract
Women vs men have major differences in terms of risk-factor profiles, social and environmental factors, clinical presentation, diagnosis, and treatment of cardiovascular disease. Women are more likely than men to experience health issues that are complex and multifactorial, often relating to disparities in access to care, risk-factor prevalence, sex-based biological differences, gender-related factors, and sociocultural factors. Furthermore, awareness of the intersectional nature and relationship of sociocultural determinants of health, including sex and gender factors, that influence access to care and health outcomes for women with cardiovascular disease remains elusive. This review summarizes literature that reports on under-recognized sex- and gender-related risk factors that intersect with psychosocial, economic, and cultural factors in the diagnosis, treatment, and outcomes of women's cardiovascular health.
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Affiliation(s)
- Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kerri-Anne Mullen
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather J.A. Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shahin Jaffer
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kara Nerenberg
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Martha Gulati
- Barbra Streisand Women’s Heart Centre, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Nazli Parast
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Nicole Tegg
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jasmine Grewal
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna Hart
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | | | - Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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3
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Yeung AM, Huang J, Pandey A, Hashim IA, Kerr D, Pop-Busui R, Rhee CM, Shah VN, Bally L, Bayes-Genis A, Bee YM, Bergenstal R, Butler J, Fleming GA, Gilbert G, Greene SJ, Kosiborod MN, Leiter LA, Mankovsky B, Martens TW, Mathieu C, Mohan V, Patel KV, Peters A, Rhee EJ, Rosano GMC, Sacks DB, Sandoval Y, Seley JJ, Schnell O, Umpierrez G, Waki K, Wright EE, Wu AHB, Klonoff DC. Biomarkers for the Diagnosis of Heart Failure in People with Diabetes: A Consensus Report from Diabetes Technology Society. Prog Cardiovasc Dis 2023; 79:65-79. [PMID: 37178991 DOI: 10.1016/j.pcad.2023.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023]
Abstract
Diabetes Technology Society assembled a panel of clinician experts in diabetology, cardiology, clinical chemistry, nephrology, and primary care to review the current evidence on biomarker screening of people with diabetes (PWD) for heart failure (HF), who are, by definition, at risk for HF (Stage A HF). This consensus report reviews features of HF in PWD from the perspectives of 1) epidemiology, 2) classification of stages, 3) pathophysiology, 4) biomarkers for diagnosing, 5) biomarker assays, 6) diagnostic accuracy of biomarkers, 7) benefits of biomarker screening, 8) consensus recommendations for biomarker screening, 9) stratification of Stage B HF, 10) echocardiographic screening, 11) management of Stage A and Stage B HF, and 12) future directions. The Diabetes Technology Society panel recommends 1) biomarker screening with one of two circulating natriuretic peptides (B-type natriuretic peptide or N-terminal prohormone of B-type natriuretic peptide), 2) beginning screening five years following diagnosis of type 1 diabetes (T1D) and at the diagnosis of type 2 diabetes (T2D), 3) beginning routine screening no earlier than at age 30 years for T1D (irrespective of age of diagnosis) and at any age for T2D, 4) screening annually, and 5) testing any time of day. The panel also recommends that an abnormal biomarker test defines asymptomatic preclinical HF (Stage B HF). This diagnosis requires follow-up using transthoracic echocardiography for classification into one of four subcategories of Stage B HF, corresponding to risk of progression to symptomatic clinical HF (Stage C HF). These recommendations will allow identification and management of Stage A and Stage B HF in PWD to prevent progression to Stage C HF or advanced HF (Stage D HF).
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Affiliation(s)
- Andrea M Yeung
- Diabetes Technology Society, Burlingame, CA, United States of America
| | - Jingtong Huang
- Diabetes Technology Society, Burlingame, CA, United States of America
| | - Ambarish Pandey
- UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Ibrahim A Hashim
- UT Southwestern Medical Center, Dallas, TX, United States of America
| | - David Kerr
- Diabetes Technology Society, Burlingame, CA, United States of America
| | | | - Connie M Rhee
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA, United States of America
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Lia Bally
- Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Antoni Bayes-Genis
- Hospital Universitari Germans Trias I Pujol, CIBERCV, Universitat Autonoma Barcelona, Spain
| | | | - Richard Bergenstal
- International Diabetes Center, HealthPartners Institute, Minneapolis, MN, United States of America
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX and University of Mississippi, Jackson, MS, United States of America
| | | | - Gregory Gilbert
- Mills-Peninsula Medical Center, Burlingame, CA, United States of America
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC, United States of America
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States of America
| | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | | | - Thomas W Martens
- International Diabetes Center and Park Nicollet Clinic, Minneapolis, MN, United States of America
| | | | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Kershaw V Patel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States of America
| | - Anne Peters
- University of Southern California Keck School of Medicine, Los Angeles, CA, United States of America
| | - Eun-Jung Rhee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - David B Sacks
- National Institutes of Health, Bethesda, MD, United States of America
| | - Yader Sandoval
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, MN, United States of America
| | | | - Oliver Schnell
- Forschergruppe Diabetes e.V., Munich-, Neuherberg, Germany
| | | | - Kayo Waki
- The University of Tokyo, Tokyo, Japan
| | - Eugene E Wright
- Charlotte Area Health Education Center, Charlotte, NC, United States of America
| | - Alan H B Wu
- University of California, San Francisco, San Francisco, CA, United States of America
| | - David C Klonoff
- Mills-Peninsula Medical Center, San Mateo, CA, United States of America.
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4
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Wang C, Che H, Zhou Y, Wang R, Zhu D, Cheng L, Rao C, Zhong Q, Li Z, Duan Y, Xu J, Dong W, Bai Y, He K. Joint association of hyperuricemia and chronic kidney disease with mortality in patients with chronic heart failure. Front Endocrinol (Lausanne) 2023; 14:1131566. [PMID: 37091841 PMCID: PMC10113528 DOI: 10.3389/fendo.2023.1131566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/24/2023] [Indexed: 04/08/2023] Open
Abstract
Background The joint association of hyperuricemia and chronic kidney disease (CKD) with mortality in patients with chronic heart failure (CHF) is not conclusive. Methods This retrospective cohort study was conducted in Chinese People's Liberation Army General Hospital, Beijing, China. We included 9,367 patients with CHF, who were hospitalized between January 2011 and June 2019. The definitions of hyperuricemia and CKD were based on laboratory test, medication use, and medical record. We categorized patients with CHF into 4 groups according to the absence (-) or presence (+) of hyperuricemia and CKD. The primary outcomes included in-hospital mortality and long-term mortality. We used multivariate logistic regression and Cox proportional hazards regression to estimate the mortality risk according to the hyperuricemia/CKD groups. Results We identified 275 cases of in-hospital mortality and 2,883 cases of long-term mortality in a mean follow-up of 4.81 years. After adjusting for potential confounders, we found that compared with the hyperuricemia-/CKD- group, the risks of in-hospital mortality were higher in the hyperuricemia+/CKD- group (odds ratio [OR], 95% confidence interval [CI]: 1.58 [1.01-2.46]), hyperuricemia-/CKD+ group (OR, 95% CI: 1.67 [1.10-2.55]), and hyperuricemia+/CKD+ group (OR, 95% CI: 2.12 [1.46-3.08]). Similar results were also found in long-term mortality analysis. Compared with the hyperuricemia-/CKD- group, the adjusted hazard ratios and 95% CI for long-term mortality were 1.25 (1.11-1.41) for hyperuricemia+/CKD- group, 1.37 (1.22-1.53) for hyperuricemia-/CKD+ group, and 1.59 (1.43-1.76) for hyperuricemia+/CKD+ group. The results remained robust in the sensitivity analysis. Conclusions Hyperuricemia and CKD, both individually and cumulatively, are associated with increased mortality risk in patients with CHF. These results highlighted the importance of the combined control of hyperuricemia and CKD in the management of heart failure.
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Affiliation(s)
- Chi Wang
- Graduate School of People's Liberation Army General Hospital, Beijing, China
- Medical Big Data Research Center, Medical Innovation Research Department of People's Liberation Army General Hospital, Beijing, China
| | - Hebin Che
- Medical Big Data Research Center, Medical Innovation Research Department of People's Liberation Army General Hospital, Beijing, China
| | - You Zhou
- School of Medicine, Nankai University, Tianjin, China
| | - Ruiqing Wang
- Graduate School of People's Liberation Army General Hospital, Beijing, China
| | - Di Zhu
- Graduate School of People's Liberation Army General Hospital, Beijing, China
| | - Liting Cheng
- School of Medicine, Nankai University, Tianjin, China
| | - Chongyou Rao
- Graduate School of People's Liberation Army General Hospital, Beijing, China
| | - Qin Zhong
- Graduate School of People's Liberation Army General Hospital, Beijing, China
| | - Zongren Li
- Medical Big Data Research Center, Medical Innovation Research Department of People's Liberation Army General Hospital, Beijing, China
| | - Yongjie Duan
- Graduate School of People's Liberation Army General Hospital, Beijing, China
| | - Jiayu Xu
- Graduate School of People's Liberation Army General Hospital, Beijing, China
| | - Wei Dong
- Department of Cardiology, Sixth Medical Center of People's Liberation Army General Hospital, Beijing, China
| | - Yongyi Bai
- Department of Cardiology, Second Medical Center of People's Liberation Army General Hospital, Beijing, China
| | - Kunlun He
- Medical Big Data Research Center, Medical Innovation Research Department of People's Liberation Army General Hospital, Beijing, China
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5
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The Morphology of Coronary Artery Disease in South Asians versus White Caucasians and its Implications. Can J Cardiol 2022; 38:1570-1579. [PMID: 35568268 DOI: 10.1016/j.cjca.2022.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 01/09/2023] Open
Abstract
South Asians (SAs) experience a higher prevalence and earlier onset of coronary artery disease and have worse outcomes relative to White Caucasians (WCs) following invasive revascularization procedures, a mainstay of coronary artery disease (CAD) management. We sought to review the differences in the CAD pattern and risk factors between SA and WC patients and discuss their potential impact on the development of coronary disease, acute coronary syndrome and revascularization outcomes. SAs have a more diffuse pattern with multi-vessel involvement compared to WCs. However, less is known about other morphological characteristics such as calcification of atherosclerotic plaque and coronary diameter in SA populations. Despite a similar coronary calcification burden, higher non-calcified plaque composition, elevated thrombosis and inflammatory markers likely contribute to the disease pattern. While the current evidence on the role of coronary vessel size remains inconsistent, smaller coronary diameters in SAs could play a potential role in the higher disease prevalence. This is especially important given the impact of coronary artery diameter on revascularization outcomes. In conclusion, SAs have a unique CAD risk profile comprised of traditional and novel risk factors. Our findings highlight the need for additional awareness of healthcare professionals of this specific risk profile and potential therapeutic targets, as well as the need for further research in this vulnerable population.
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6
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Jaffer S, Foulds HJA, Parry M, Gonsalves CA, Pacheco C, Clavel MA, Mullen KA, Yip CYY, Mulvagh SL, Norris CM. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women-Chapter 2: Scope of the Problem. CJC Open 2021; 3:1-11. [PMID: 33458627 PMCID: PMC7801195 DOI: 10.1016/j.cjco.2020.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
Background This Atlas chapter summarizes the epidemiology of cardiovascular disease (CVD) in women in Canada, discusses sex and gender disparities, and examines the intersectionality between sex and other factors that play a prominent role in CVD outcomes in women, including gender, indigenous identity, ethnic variation, disability, and socioeconomic status. Methods CVD is the leading cause of premature death in Canadian women. Coronary artery disease, including myocardial infarction, and followed by stroke, accounts for the majority of CVD-related deaths in Canadian women. The majority of emergency department visits and hospitalizations by women are due to coronary artery disease, heart failure, and stroke. The effect of traditional cardiovascular risk factors and their association with increasing cardiovascular morbidity is unique in this group. Results Indigenous women in Canada experience increased CVD, linked to colonization and subsequent social, economic, and political challenges. Women from particular racial and ethnic backgrounds (ie, South Asian, Afro-Caribbean, Hispanic, and Chinese North American women) have greater CVD risk factors, and CVD risk in East Asian women increases with duration of stay in Canada. Conclusions Canadians living in northern, rural, remote, and on-reserve residences experience greater CVD morbidity, mortality, and risk factors. An increase in CVD risk among Canadian women has been linked with a background of lower socioeconomic status, and women with disabilities have an increased risk of adverse cardiac events.
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Affiliation(s)
- Shahin Jaffer
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather J A Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Christine Pacheco
- Pierre-Boucher Hospital, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Marie-Annick Clavel
- Laval University, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Ville de Québec, Québec, Canada
| | - Kerri A Mullen
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Cindy Y Y Yip
- HeartLife Foundation of Canada, Toronto, Ontario, Canada
| | - Sharon L Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Colleen M Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,Cardiovascular Health and Stroke Strategic Clinical Network, Alberta Health Services, Alberta, Canada
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7
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Martinez-Amezcua P, Haque W, Khera R, Kanaya AM, Sattar N, Lam CSP, Harikrishnan S, Shah SJ, Kandula NR, Jose PO, Narayan KMV, Agyemang C, Misra A, Jenum AK, Bilal U, Nasir K, Cainzos-Achirica M. The Upcoming Epidemic of Heart Failure in South Asia. Circ Heart Fail 2020; 13:e007218. [PMID: 32962410 DOI: 10.1161/circheartfailure.120.007218] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Currently, South Asia accounts for a quarter of the world population, yet it already claims ≈60% of the global burden of heart disease. Besides the epidemics of type 2 diabetes mellitus and coronary heart disease already faced by South Asian countries, recent studies suggest that South Asians may also be at an increased risk of heart failure (HF), and that it presents at earlier ages than in most other racial/ethnic groups. Although a frequently underrecognized threat, an eventual HF epidemic in the densely populated South Asian nations could have dramatic health, social and economic consequences, and urgent interventions are needed to flatten the curve of HF in South Asia. In this review, we discuss recent studies portraying these trends, and describe the mechanisms that may explain an increased risk of premature HF in South Asians compared with other groups, with a special focus on highly relevant features in South Asian populations including premature coronary heart disease, early type 2 diabetes mellitus, ubiquitous abdominal obesity, exposure to the world's highest levels of air pollution, highly prevalent pretransition forms of HF such as rheumatic heart disease, and underdevelopment of healthcare systems. Other rising lifestyle-related risk factors such as use of tobacco products, hypertension, and general obesity are also discussed. We evaluate the prognosis of HF in South Asian countries and the implications of an anticipated HF epidemic. Finally, we discuss proposed interventions aimed at curbing these adverse trends, management approaches that can improve the prognosis of prevalent HF in South Asian countries, and research gaps in this important field.
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Affiliation(s)
- Pablo Martinez-Amezcua
- Johns Hopkins Bloomberg School of Public Health (P.M.-A., W.H.), Johns Hopkins University, Baltimore, MD
| | - Waqas Haque
- Johns Hopkins Bloomberg School of Public Health (P.M.-A., W.H.), Johns Hopkins University, Baltimore, MD.,Ciccarone Center for the Prevention of Cardiovascular Disease (W.H., K.N., M.C.-A.), Johns Hopkins University, Baltimore, MD
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (R.K.).,Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (R.K.)
| | | | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, United Kingdom (N.S.)
| | - Carolyn S P Lam
- National Heart Centre Singapore (C.S.P.L.).,Duke-National University of Singapore (C.S.P.L.).,University Medical Centre, Groningen, the Netherlands (C.S.P.L.)
| | - Sivadasanpillai Harikrishnan
- Heart Failure Association of India (S.H.).,National Center of Research and Excellence in Heart Failure, ICMR (S.H.).,Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum (S.H.)
| | - Sanjiv J Shah
- Bluhm Cardiovascular Institute and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Namratha R Kandula
- Northwestern University, Feinberg School of Medicine, Chicago, IL (N.R.K.)
| | - Powell O Jose
- Sutter Davis Hospital, Sutter Medical Center, Sacramento, CA (P.O.J.)
| | - K M Venkat Narayan
- Rollins School of Public Health, Emory University and Emory University School of Medicine, Atlanta, GA (K.M.V.N.)
| | - Charles Agyemang
- Department of Public Health, Amsterdam UMC, University of Amsterdam, the Netherlands (C.A.)
| | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India (A.M.).,National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India (A.M.).,Diabetes Foundation India, New Delhi, India (A.M.)
| | - Anne K Jenum
- General Practice Research Unit (AFE), Department of General Practice, University of Oslo, Institute of Health and Society, Norway (A.K.J.)
| | - Usama Bilal
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA (U.B.)
| | - Khurram Nasir
- Ciccarone Center for the Prevention of Cardiovascular Disease (W.H., K.N., M.C.-A.), Johns Hopkins University, Baltimore, MD.,Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX (K.N., M.C.-A.).,Center for Outcomes Research, Houston Methodist, Houston, TX (K.N., M.C.-A.)
| | - Miguel Cainzos-Achirica
- Ciccarone Center for the Prevention of Cardiovascular Disease (W.H., K.N., M.C.-A.), Johns Hopkins University, Baltimore, MD.,Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX (K.N., M.C.-A.).,Center for Outcomes Research, Houston Methodist, Houston, TX (K.N., M.C.-A.)
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8
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Karnati SA, Wee A, Shirke MM, Harky A. Racial disparities and cardiovascular disease: One size fits all approach? J Card Surg 2020; 35:3530-3538. [PMID: 32949061 DOI: 10.1111/jocs.15047] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite recent advancements in prevention, treatment, and management options, cardiovascular diseases contribute to one of the leading causes of morbidity and mortality. Several studies highlight the compelling evidence for the existence of healthcare inequities and disparities in the treatment and management control of cardiovascular diseases. AIMS To explore the role of racial disparities in the treatment of various cardiovascular diseases, highlighting the role of socioeconomic and cultural factors, and ultimately postulate solutions to eliminate the disparities. METHODS A comprehensive review of the literature was conducted using appropriate keywords on search engines of SCOPUS, Wiley, PubMed, and SAGE Journals. CONCLUSION By continued research to eliminate healthcare inequalities, there exists a potential to improve health-related outcomes in minority populations.
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Affiliation(s)
- Santoshi A Karnati
- Department of Medicine, Queen's University Belfast School of Medicine, Belfast, UK
| | - Alexandra Wee
- Department of Medicine, Queen's University Belfast School of Medicine, Belfast, UK
| | - Manasi M Shirke
- Department of Medicine, Queen's University Belfast School of Medicine, Belfast, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
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9
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Sun LY, Kimmoun A, Takagi K, Liu PP, Bader Eddeen A, Mebazaa A. Ethnic differences in acute heart failure outcomes in Ontario. Int J Cardiol 2019; 291:177-182. [PMID: 31153653 DOI: 10.1016/j.ijcard.2019.05.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Previous studies have identified ethnic differences in outcomes after episodes of acute heart failure in natives of Asia as compared to those of Europe. Whether these ethnic differences in outcomes would still exist, years after migration to a different geographical and cultural setting remain unclear. We investigated the one-year mortality after an episode of acute heart failure admission in Ontario residents of South Asian and Chinese descent as compared to the General Population. METHODS We conducted a population-based, retrospective cohort study of adult Ontarions who were hospitalized for AHF between April 1, 2010 and March 31, 2016. Ethnicity was categorized using validated surname-based algorithms. The primary outcome was all-cause one-year mortality. Mortality rates were calculated using the Kaplan-Meier method. The relative hazard of death was assessed using a multivariable Cox proportional hazard model. RESULTS Of 82,125 patients, 1287 (1.6%) were Chinese, 1662 (2.0%) were South Asians, and the remaining 79,176 (96.4%) were of the General Population. The risk of mortality was markedly lower amongst South Asians (adjusted HR 0.81, 95% CI [0.73-0.89]) relative to the General Population. There was no statistically significant difference in the risk of mortality between Chinese and the General Population (adjusted HR 1.00 [0.91-1.10]). In addition, guideline-directed medical therapies were associated with similar survival benefit in patients of all three ethnic origins. CONCLUSIONS We found a lower risk of one-year mortality after acute heart failure hospitalization amongst South Asians compared to Chinese and the General Population, and similar benefit of medical therapy in all three groups. Further studies are needed to explore the etiologies of these ethnic disparities to truly improve outcomes at the population level.
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Affiliation(s)
- Louise Y Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada.
| | - Antoine Kimmoun
- Medical Intensive Care Unit Brabois, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, Vandoeuvre-les-Nancy, France; Inserm U942, Lariboisière University Hospital, Paris, France
| | - Koji Takagi
- Inserm U942, Lariboisière University Hospital, Paris, France
| | - Peter P Liu
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Alexandre Mebazaa
- Department of Anaesthesia, Burn, and Critical Care, Saint-Louis Lariboisière University Hospital, Paris, France; Université de Paris, France
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10
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Pekmezaris R, Nouryan CN, Schwartz R, Castillo S, Makaryus AN, Ahern D, Akerman MB, Lesser ML, Bauer L, Murray L, Pecinka K, Zeltser R, Zhang M, DiMarzio P. A Randomized Controlled Trial Comparing Telehealth Self-Management to Standard Outpatient Management in Underserved Black and Hispanic Patients Living with Heart Failure. Telemed J E Health 2018; 25:917-925. [PMID: 30418101 PMCID: PMC6784489 DOI: 10.1089/tmj.2018.0219] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Although the American Heart Association promotes telehealth models to improve care access, there is limited literature on its use in underserved populations. This study is the first to compare utilization and quality of life (QoL) for underserved black and Hispanic heart failure (HF) patients assigned to telehealth self-monitoring (TSM) or comprehensive outpatient management (COM) over 90 days. Methods: This randomized controlled trial enrolled 104 patients. Outcomes included emergency department (ED) visits, hospitalizations, QoL, depression, and anxiety. Binary outcomes for utilization were analyzed using chi-square or Fisher's exact test. Poisson or negative binomial regression, repeated-measures analysis of variance, or generalized estimating equations were also used as appropriate. Results: Of 104 patients, 31% were Hispanic, 69% black, 41% women, and 72% reported incomes of <$10,000/year. Groups did not differ regarding binary ED visits (relative risk [RR] = 1.37, confidence interval [CI] = 0.83–2.27), hospitalization (RR = 0.92, CI = 0.57–1.48), or length of stay in days (TSM = 0.54 vs. COM = 0.91). Number of all-cause hospitalizations was significantly lower for COM (TSM = 0.78 vs. COM = 0.55; p = 0.03). COM patients reported greater anxiety reduction from baseline to 90 days (TSM = 50–28%; COM = 57–13%; p = 0.05). Conclusions: These findings suggest that TSM is not effective in reducing utilization or improving QoL for underserved patients with HF. Future studies are needed to determine whether TSM can be effective for populations facing health care access issues.
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Affiliation(s)
- Renee Pekmezaris
- Department of Medicine, Northwell Health, Manhasset, New York.,Department of Medicine and Department of Community Health, Zucker School of Medicine, Hempstead, New York.,Department of Occupational Medicine Epidemiology and Prevention, Northwell Health, Great Neck, New York.,Department of Biostatistics, The Feinstein Institute of Medical Research, Manhasset, New York
| | - Christian N Nouryan
- Department of Medicine, Northwell Health, Manhasset, New York.,Department of Medicine and Department of Community Health, Zucker School of Medicine, Hempstead, New York.,Department of Biostatistics, The Feinstein Institute of Medical Research, Manhasset, New York
| | - Rebecca Schwartz
- Department of Occupational Medicine Epidemiology and Prevention, Northwell Health, Great Neck, New York
| | - Stacy Castillo
- Department of Cardiology, Heart Failure Center, Nassau University Medical Center, East Meadow, New York
| | - Amgad N Makaryus
- Department of Medicine, Northwell Health, Manhasset, New York.,Department of Cardiology, Heart Failure Center, Nassau University Medical Center, East Meadow, New York
| | - Deborah Ahern
- Department of Cardiology, Heart Failure Center, Nassau University Medical Center, East Meadow, New York
| | - Meredith B Akerman
- Department of Biostatistics, The Feinstein Institute of Medical Research, Manhasset, New York
| | - Martin L Lesser
- Department of Medicine, Northwell Health, Manhasset, New York.,Department of Medicine and Department of Community Health, Zucker School of Medicine, Hempstead, New York.,Department of Biostatistics, The Feinstein Institute of Medical Research, Manhasset, New York
| | - Lorinda Bauer
- Department of Cardiology, Heart Failure Center, Nassau University Medical Center, East Meadow, New York
| | - Lawrence Murray
- Community Advisory Board, Northwell Health, Manhasset, New York
| | - Kathleen Pecinka
- Nursing Department, Queensborough Community College, Bayside, New York
| | - Roman Zeltser
- Department of Medicine, Northwell Health, Manhasset, New York.,Department of Cardiology, Heart Failure Center, Nassau University Medical Center, East Meadow, New York
| | - Meng Zhang
- Department of Medicine, Northwell Health, Manhasset, New York.,Department of Biostatistics, The Feinstein Institute of Medical Research, Manhasset, New York
| | - Paola DiMarzio
- Department of Medicine, Northwell Health, Manhasset, New York.,Department of Medicine and Department of Community Health, Zucker School of Medicine, Hempstead, New York.,Department of Occupational Medicine Epidemiology and Prevention, Northwell Health, Great Neck, New York.,Department of Biostatistics, The Feinstein Institute of Medical Research, Manhasset, New York
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11
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Kim J, Shin MS, Hwang SY, Park E, Lim YH, Shim JL, Kim SH, Kim YH, An M. Memory loss and decreased executive function are associated with limited functional capacity in patients with heart failure compared to patients with other medical conditions. Heart Lung 2018; 47:61-67. [DOI: 10.1016/j.hrtlng.2017.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 12/28/2022]
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12
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Mentz RJ, Roessig L, Greenberg BH, Sato N, Shinagawa K, Yeo D, Kwok BWK, Reyes EB, Krum H, Pieske B, Greene SJ, Ambrosy AP, Kelly JP, Zannad F, Pitt B, Lam CSP. Heart Failure Clinical Trials in East and Southeast Asia: Understanding the Importance and Defining the Next Steps. JACC-HEART FAILURE 2017; 4:419-27. [PMID: 27256745 DOI: 10.1016/j.jchf.2016.01.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 12/22/2015] [Accepted: 01/08/2016] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) is a major and increasing global public health problem. In Asia, aging populations and recent increases in cardiovascular risk factors have contributed to a particularly high burden of HF, with outcomes that are poorer than those in the rest of the world. Representation of Asians in landmark HF trials has been variable. In addition, HF patients from Asia demonstrate clinical differences from patients in other geographic regions. Thus, the generalizability of some clinical trial results to the Asian population remains uncertain. In this article, we review differences in HF phenotype, HF management, and outcomes in patients from East and Southeast Asia. We describe lessons learned in Asia from recent HF registries and clinical trial databases and outline strategies to improve the potential for success in future trials. This review is based on discussions among scientists, clinical trialists, industry representatives, and regulatory representatives at the CardioVascular Clinical Trialist Asia Forum in Singapore on July 4, 2014.
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Affiliation(s)
- Robert J Mentz
- Duke Clinical Research Institute and the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
| | | | - Barry H Greenberg
- Division of Cardiology, University of California San Diego, San Diego, California
| | - Naoki Sato
- Internal Medicine, Cardiology, and Intensive Care Medicine, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Kaori Shinagawa
- Office of New Drug II, Pharmaceuticals and Medical Devices Agency, Chiyoda-ku, Tokyo, Japan
| | | | | | | | - Henry Krum
- Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Burkert Pieske
- Department of Cardiology, Charité University Medicine, Campus Virchow Klinikum, and German Heart Center Berlin, Berlin, Germany
| | - Stephen J Greene
- Duke Clinical Research Institute and the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Andrew P Ambrosy
- Duke Clinical Research Institute and the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Jacob P Kelly
- Duke Clinical Research Institute and the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Faiez Zannad
- INSERM, Centre d'Investigations Cliniques-Plurithématique 1433, Vandoeuvre-lès-Nancy, France; INSERM U1116, Nancy, France; Université de Lorraine, Nancy, France; CHU Nancy, Pôle de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre-lès-Nancy, France; F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Bertram Pitt
- University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
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13
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Das A, Ambale-Venkatesh B, Lima JAC, Freedman JE, Spahillari A, Das R, Das S, Shah RV, Murthy VL. Cardiometabolic disease in South Asians: A global health concern in an expanding population. Nutr Metab Cardiovasc Dis 2017; 27:32-40. [PMID: 27612985 DOI: 10.1016/j.numecd.2016.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/30/2016] [Accepted: 08/01/2016] [Indexed: 12/27/2022]
Abstract
Cardiovascular disease (CVD) is one of the main causes of mortality and morbidity worldwide. As an emerging population, South Asians (SAs) bear a disproportionately high burden of CVD relative to underlying classical risk factors, partly attributable to a greater prevalence of insulin resistance and diabetes and distinct genetic and epigenetic influences. While the phenotypic distinctions between SAs and other ethnicities in CVD risk are becoming increasingly clear, the biology of these conditions remains an area of active investigation, with emerging studies involving metabolism, genetic variation and epigenetic modifiers (e.g., extracellular RNA). In this review, we describe the current literature on prevalence, prognosis and CVD risk in SAs, and provide a landscape of translational research in this field toward ameliorating CVD risk in SAs.
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Affiliation(s)
- A Das
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - B Ambale-Venkatesh
- Department of Medicine and Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, USA
| | - J A C Lima
- Department of Medicine and Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, USA
| | - J E Freedman
- Department of Cardiology, UMass Memorial Health Care, MA, USA
| | - A Spahillari
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - R Das
- The John Hopkins University, Baltimore, USA
| | - S Das
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - R V Shah
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - V L Murthy
- Cardiovascular Medicine Division, Department of Medicine, University of Michigan, Ann Arbor, USA.
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14
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Krittanawong C, Namath A, Lanfear DE, Tang WHW. Practical Pharmacogenomic Approaches to Heart Failure Therapeutics. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:60. [PMID: 27566707 DOI: 10.1007/s11936-016-0483-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OPINION STATEMENT The major challenge in applying pharmacogenomics to everyday clinical practice in heart failure (HF) is based on (1) a lack of robust clinical evidence for the differential utilization of neurohormonal antagonists in the management of HF in different subgroups, (2) inconsistent results regarding appropriate subgroups that may potentially benefit from an alternative strategy based on pharmacogenomic analyses, and (3) a lack of clinical trials that focused on testing gene-guided treatment in HF. To date, all pharmacogenomic analyses in HF have been conducted as post hoc retrospective analyses of clinical trial data or of observational patient series studies. This is in direct contrast with the guideline-directed HF therapies that have demonstrated their safety and efficacy in the absence of pharmacogenomic guidance. Therefore, the future of clinical applications of pharmacogenomic testing will largely depend on our ability to incorporate gene-drug interactions into the prescribing process, requiring that preemptive and cost-effective testing be paired with decision-support tools in a value-based care approach.
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Affiliation(s)
- Chayakrit Krittanawong
- Department of Cardiovascular Medicine, Heart and Vascular Institute, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA
| | - Amalia Namath
- Center for Clinical Genomics, Cleveland Clinic, Cleveland, OH, USA
| | - David E Lanfear
- Advanced Heart Failure and Cardiac Transplantation, Research Scientist, Center for Health Services Research, Henry Ford Hospital, Detroit, MI, USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA. .,Center for Clinical Genomics, Cleveland Clinic, Cleveland, OH, USA.
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15
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Park J, Johantgen ME. A Cross-Cultural Comparison of Symptom Reporting and Symptom Clusters in Heart Failure. J Transcult Nurs 2016; 28:372-380. [DOI: 10.1177/1043659616651673] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
An understanding of symptoms in heart failure (HF) among different cultural groups has become increasingly important. The purpose of this study was to compare symptom reporting and symptom clusters in HF patients between a Western (the United States) and an Eastern Asian sample (China and Taiwan). A secondary analysis of a cross-sectional observational study was conducted. The data were obtained from a matched HF patient sample from the United States and China/Taiwan ( N = 240 in each). Eight selective items related to HF symptoms from the Minnesota Living with Heart Failure Questionnaire were analyzed. Compared with the U.S. sample, HF patients from China/Taiwan reported a lower level of symptom distress. Analysis of two different regional groups did not result in the same number of clusters using latent class approach: the United States (four classes) and China/Taiwan (three classes). The study demonstrated that symptom reporting and identification of symptom clusters might be influenced by cultural factors.
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Affiliation(s)
- Jumin Park
- National Institutes of Health Clinical Center, Bethesda, MD, USA
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16
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Panduranga P, Al-Zakwani I, Sulaiman K, Al-Habib K, Alsheikh-Ali A, Al-Suwaidi J, Al-Mahmeed W, Al-Faleh H, Elasfar A, Ridha M, Bulbanat B, Al-Jarallah M, Asaad N, Bazargani N, Al-Motarreb A, Amin H. Comparison of Indian subcontinent and Middle East acute heart failure patients: Results from the Gulf Acute Heart Failure Registry. Indian Heart J 2015; 68 Suppl 1:S36-44. [PMID: 27056651 PMCID: PMC4824330 DOI: 10.1016/j.ihj.2015.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/05/2015] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To compare Middle East Arabs and Indian subcontinent acute heart failure (AHF) patients. METHODS AHF patients admitted from February 14, 2012 to November 14, 2012 in 47 hospitals among 7 Middle East countries. RESULTS The Middle Eastern Arab group (4157) was older (60 vs. 54 years), with high prevalence of coronary artery disease (48% vs. 37%), valvular heart disease (14% vs. 7%), atrial fibrillation (12% vs. 7%), and khat chewing (21% vs. 1%). Indian subcontinent patients (382) were more likely to be smokers (36% vs. 21%), alcohol consumers (11% vs. 2%), diabetic (56% vs. 49%) with high prevalence of AHF with reduced ejection fraction (76% vs. 65%), and with acute coronary syndrome (46% vs. 26%). In-hospital mortality was 6.5% with no difference, but 3-month and 12-month mortalities were significantly high among Middle East Arabs, (13.7% vs. 7.6%) and (22.8% vs. 17.1%), respectively. CONCLUSIONS AHF patients from this region are a decade younger than Western patients with high prevalence of ischemic heart disease, diabetes mellitus, and AHF with reduced ejection fraction. There is an urgent need to control risk factors among both groups, as well as the need for setting up heart failure clinics for better postdischarge management.
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Affiliation(s)
| | - Ibrahim Al-Zakwani
- Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Oman
| | | | - Khalid Al-Habib
- Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Alawi Alsheikh-Ali
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Jassim Al-Suwaidi
- Adult Cardiology, Hamad Medical Corporation and Qatar Cardiovascular Research Center, Doha, Qatar
| | - Wael Al-Mahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - Hussam Al-Faleh
- Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Abdelfatah Elasfar
- Adult Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia; Tanta University, Egypt
| | | | | | | | - Nidal Asaad
- Adult Cardiology, Hamad Medical Corporation and Qatar Cardiovascular Research Center, Doha, Qatar
| | | | - Ahmed Al-Motarreb
- Internal Medicine, Faculty of Medicine, Sana'a University, Sana'a, Yemen
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17
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Colvin M, Sweitzer NK, Albert NM, Krishnamani R, Rich MW, Stough WG, Walsh MN, Westlake Canary CA, Allen LA, Bonnell MR, Carson PE, Chan MC, Dickinson MG, Dries DL, Ewald GA, Fang JC, Hernandez AF, Hershberger RE, Katz SD, Moore S, Rodgers JE, Rogers JG, Vest AR, Whellan DJ, Givertz MM. Heart Failure in Non-Caucasians, Women, and Older Adults: A White Paper on Special Populations From the Heart Failure Society of America Guideline Committee. J Card Fail 2015; 21:674-93. [DOI: 10.1016/j.cardfail.2015.05.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/21/2015] [Accepted: 05/26/2015] [Indexed: 01/11/2023]
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18
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Qian F, Fonarow GC, Krim SR, Vivo RP, Cox M, Hannan EL, Shaw BA, Hernandez AF, Eapen ZJ, Yancy CW, Bhatt DL. Characteristics, quality of care, and in-hospital outcomes of Asian-American heart failure patients: Findings from the American Heart Association Get With The Guidelines-Heart Failure Program. Int J Cardiol 2015; 189:141-7. [PMID: 25889445 DOI: 10.1016/j.ijcard.2015.03.400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 03/26/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Because little was previously known about Asian-American patients with heart failure (HF), we compared clinical profiles, quality of care, and outcomes between Asian-American and non-Hispanic white HF patients using data from the American Heart Association Get With The Guidelines-Heart Failure (GWTG-HF) program. METHODS We analyzed 153,023 HF patients (149,249 whites, 97.5%; 3774 Asian-Americans, 2.5%) from 356 U.S. centers participating in the GWTG-HF program (2005-2012). Baseline characteristics, quality of care metrics, in-hospital mortality, discharge to home, and length of stay were examined. RESULTS Relative to white patients, Asian-American HF patients were younger, more likely to be male, uninsured or covered by Medicaid, and recruited in the western region. They had higher prevalence of diabetes, hypertension, and renal insufficiency, but similar ejection fraction. Overall, Asian-American HF patients had comparable quality of care except that they were less likely to receive aldosterone antagonists at discharge (relative risk <RR>, 0.88; 95% confidence interval <CI>, 0.78-0.99), and anticoagulation for atrial fibrillation (RR, 0.91; 95% CI, 0.85-0.97) even after risk adjustment. Compared with white patients, Asian-American patients had comparable risk adjusted in-hospital mortality (RR, 1.11; 95% CI, 0.91-1.35), length of stay>4 days (RR, 1.01; 95% CI, 0.95-1.08), and were more likely to be discharged to home (RR, 1.08; 95% CI, 1.06-1.11). CONCLUSIONS Despite some differences in clinical profiles, Asian-American patients hospitalized with HF receive very similar quality of care and have comparable health outcomes to their white counterparts.
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Affiliation(s)
- Feng Qian
- University at Albany-State University of New York, Albany, United States.
| | - Gregg C Fonarow
- Ronald Reagan-UCLA Medical Center, Los Angeles, CA, United States
| | - Selim R Krim
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States
| | - Rey P Vivo
- Ronald Reagan-UCLA Medical Center, Los Angeles, CA, United States
| | | | - Edward L Hannan
- University at Albany-State University of New York, Albany, United States
| | - Benjamin A Shaw
- University at Albany-State University of New York, Albany, United States
| | | | | | | | - Deepak L Bhatt
- VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, United States
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19
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Racial and Ethnic Differences in Heart Failure Etiology, Prognosis, and Management. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0426-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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