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Ramirez JL, Wang K, Sung E, Hernandez S, Le M, Avra TD, Talutis S, Iannuzzi JC, Ulloa JG. Readability of Spanish-Language Online Patient Educational Materials for Peripheral Artery Disease Do Not Meet Recommended Standards and Represent a Literacy Barrier to Care. Ann Vasc Surg 2024; 101:157-163. [PMID: 38154492 DOI: 10.1016/j.avsg.2023.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/28/2023] [Accepted: 10/21/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Online resources are a valuable source of information for patients and have been reported to improve engagement and adherence to medical care. However, readability of online patient educational materials (OPEMs) is crucial for them to serve their intended purpose. The American Medical Association (AMA) recommends that OPEM be written at or below the sixth grade reading level. To avoid disparities in access to comprehensible health information on peripheral artery disease (PAD), it is imperative that the readability of PAD OPEM is appropriate for both English-speaking and Spanish-speaking patients. The aim of this study is to evaluate the readability of PAD OPEM in Spanish and compare to English-language OPEM. METHODS We conducted a Google search in English and Spanish using "peripheral arterial disease" and "enfermedad arterial periferica", respectively, and the top 25 patient-accessible articles were collected for each. Articles were categorized by source type: hospital, professional society, or other. Readability of English-language OPEM was measured using the Flesch Reading Ease Readability Formula, Automated Readability Index, Coleman-Liau Index, Flesch-Kincaid Grade Level, Gunning Fog, Linsear Write Formula, and the Simple Measure of Gobbledygook Index. Readability of Spanish OPEM was measured using the Fernández-Huerta Index and Índice Flesch-Szigriszt Scale. Readability of the articles was compared to the AMA recommendation, between English- and Spanish-language, and across sources using statistical tests appropriate to the data. RESULTS OPEM from professional societies represented the fewest number of English- (n = 7, 28%) and Spanish-language (n = 6, 24%) articles. Most English-speaking (n = 18, 72%) and Spanish-language (n = 20, 80%) OPEM were considered difficult as measured by the Flesch Reading Ease Readability Formula and Fernández-Huerta Index, respectively, but did not significantly differ between languages (P = 0.59). There were no significant differences in the average readability of all readability measurements across sources (hospital, professional society, or other). All the average readability grade levels for English-speaking and Spanish-language OPEM was significantly higher than the sixth grade reading level (P < 0.01). Only 3 (6%) OPEM met the AMA recommended reading level and there was no significant difference between English-language and Spanish-language OPEM (P = 1.0). CONCLUSIONS Nearly all Spanish-language and English-language PAD OPEM assessed were written at a reading grade level higher than recommended by the AMA. There was no significant difference in the readability of materials from hospitals or professional societies. To prevent further widening of health disparities related to literacy, health content creators, particularly hospitals and professional societies, should prioritize, develop, and ensure that English-language and Spanish-language patient education materials are written at a level appropriate for the public.
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Affiliation(s)
- Joel L Ramirez
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA; Chan Zuckerberg Biohub, San Francisco, CA
| | - Karissa Wang
- David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Eric Sung
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | | | - Monica Le
- David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Tucker D Avra
- David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Stephanie Talutis
- David Geffen School of Medicine, University of California, Los Angeles, CA
| | - James C Iannuzzi
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Jesus G Ulloa
- David Geffen School of Medicine, University of California, Los Angeles, CA; West Los Angeles Veterans Health Administration, Los Angeles, CA.
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Alhuneafat L, Omar YA, Naser A, Jagdish B, Alameh A, Al-Ahmad M, Abdouh AA, Mhanna M, Hammad N, Khalid U, Yousaf A, Madanat L, Al-Amer M, Gharaibeh A, Siraj A, Nasser F, Jabri A. Racial and Ethnic Disparities in Peripheral Vascular Disease Admissions Using a Nationally Representative Sample. Am J Cardiol 2023; 202:74-80. [PMID: 37421733 DOI: 10.1016/j.amjcard.2023.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/05/2023] [Accepted: 06/11/2023] [Indexed: 07/10/2023]
Abstract
Our study aimed to identify clinical outcomes and resource utilization associated with race and ethnicity in patients admitted with peripheral vascular disease (PVD) across the United States. We queried the National Inpatient Sample database from 2015 to 2019 and identified 622,820 patients admitted with PVD. Patients across 3 major race and ethnic categories were compared in terms of baseline characteristics, inpatient outcomes, and resource utilization. Black and Hispanic patients were more likely to be younger and of the lowest median income but incur higher total hospital costs. Black race predicted higher rates of acute kidney injury, need for blood transfusion, and need for vasopressor but lower rates of circulatory shock, and mortality. Black and Hispanic patients were less likely to undergo limb-salvaging procedures and more likely to undergo amputation than White patients. In conclusion, our findings indicate that Black and Hispanic patients experience health disparities in resource utilization and inpatient outcomes for PVD admissions.
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Affiliation(s)
- Laith Alhuneafat
- Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Yazan Abu Omar
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Abdallah Naser
- Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Balaji Jagdish
- Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Anas Alameh
- Department of Cardiology, MetroHealth Medical Center, Cleveland, Ohio
| | - Majd Al-Ahmad
- Department of Geriatrics Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ahmad Al Abdouh
- Division of Hospital Medicine, University of Kentucky, Lexington, Kentucky
| | - Mohammed Mhanna
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Nour Hammad
- Department of Nephrology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Umar Khalid
- Department of Vascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Adnan Yousaf
- Department of Cardiology, MetroHealth Medical Center, Cleveland, Ohio
| | - Luai Madanat
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, Michigan
| | | | | | - Aisha Siraj
- Department of Cardiology, MetroHealth Medical Center, Cleveland, Ohio
| | - Farhan Nasser
- Department of Cardiology, MetroHealth Medical Center, Cleveland, Ohio
| | - Ahmad Jabri
- Department of Cardiovascular Disease, Henry Ford, Detroit, Michigan.
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Luna P, Harris K, Castro-Dominguez Y, Algara M, Severiche-Mena C, Smolderen KG, Mena-Hurtado C. Risk profiles, access to care, and outcomes in Hispanics hospitalized for lower extremity peripheral artery disease. J Vasc Surg 2023; 77:216-224.e15. [PMID: 36037965 DOI: 10.1016/j.jvs.2022.08.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Previous studies have shown that Hispanics have worse clinical outcomes for lower extremity peripheral artery disease (PAD) than non-Hispanic White (NHWs). Using a national database, this study aimed to document the contemporary burden of PAD in Hispanics by evaluating their risk profiles, access to care, and outcomes compared with NHWs. METHODS Hospitalizations of Hispanics and NHWs with a primary diagnosis of PAD were identified using 2011-2017 National Inpatient Sample data. Patient sociodemographic characteristics, comorbidities, whether the admission was through the emergency department (ED) or elective, length of stay, and costs accrued were compared by ethnicity. Temporal trends in revascularizations, amputations, and ED admissions by year were evaluated with the Cochran-Mantel-Haenszel test and stratified by ethnicity. Data were combined across years and multivariable logistic regression was used to evaluate the association of ethnicity with inpatient revascularization, amputation, and mortality, adjusting for sociodemographic and cardiovascular risk factors. RESULTS From 2011 to 2017, there were a total of 1,018,220 PAD hospitalizations among Hispanics (13.9%) and NHWs (86.1%) between 2011 and 2017. Hispanics were more often low income and uninsured and presented with higher burden of comorbidities including diabetes, renal failure, prior amputations, and chronic limb-threatening ischemia compared with NHWs. Most Hispanics were admitted via the ED compared with NHWs (58.0% vs 36.7%; d = 0.48), and median length of stay was almost a day longer (4.5 days vs 3.7 days). Hispanic ethnicity was associated with lower odds of surgical (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.57-0.67) and endovascular revascularization (OR, 0.94; 95% CI, 0.89-0.996) and mortality (OR, 0.83; 95% CI, 0.75-0.93), but higher odds of minor (OR, 1.25; 95% CI, 1.20-1.31) and major (OR, 1.08; 95% CI, 1.03-1.14) amputation. CONCLUSIONS Two tiers of health care consumption for inpatient PAD care and outcomes manifested among Hispanics and NHWs. First, Hispanics with PAD had a more vulnerable socioeconomic profile and presented with more severe PAD than NHWs. Second, they sought care more disproportionately through the ED and underwent more amputations than NHWs. To eradicate these inequities in PAD care and risk, strategies that improve access to outpatient care and expand health care coverage, as well as targeted management of risk factors in these vulnerable minority groups are needed.
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Affiliation(s)
- Paulina Luna
- Yale University School of Medicine, New Haven, CT; Weill Cornell Medicine, New York, NY
| | | | - Yulanka Castro-Dominguez
- Yale University School of Medicine, New Haven, CT; Case Western Reserve University, Cleveland, OH
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Zuercher MD, Harvey DJ, Au LE, Shadyab AH, Nassir R, Robbins JA, Seldin MF, Garcia L. Genetic admixture and cardiovascular disease risk in postmenopausal Hispanic women. Int J Cardiol 2022; 367:99-104. [PMID: 35961613 PMCID: PMC10639166 DOI: 10.1016/j.ijcard.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/20/2022] [Accepted: 08/08/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hispanics are a heterogeneous population with differences in the prevalence of cardiovascular disease (CVD) and its related risk factors among ethnic sub-groups. This study evaluated the association of genetic admixture and CVD in self-identified Hispanic women from the Women's Health Initiative (WHI). METHODS Data came from the WHI Observational Study and the Clinical Trial Components conducted among postmenopausal women. The CVD outcomes included coronary heart disease (CHD) and stroke. The proportions of European (EUR), sub-Saharan African (AFR), and Amerindian (AMI) admixture were estimated using 92 ancestry-informative markers. Cox regression models were used to assess the relationship between genetic admixture and CVD adjusting for age, lifestyle risk factors, known risk factors, and neighborhood socioeconomic status. RESULTS Among 5195 participants EUR ancestry was associated with a lower CHD risk after adjusting for age (HR 0.41, p = 0.02), and in the fully adjusted model (HR 0.40, p = 0.03). AFR ancestry was associated with a higher CHD risk after adjusting for age (HR 2.91, p = 0.03), but it only showed a trend in in the fully adjusted model (HR 2.46, p = 0.10). AMI ancestry was not statistically significantly associated with CHD and none of the genetic admixture proportions were statistically significantly associated with stroke (p > 0.05). CONCLUSION EUR ancestry was associated with a lower risk of CHD in Hispanic women. This highlights the need to account for genetic admixture in future CVD studies to consider different heritage groups to understand the role that genetic, neighborhood socioeconomic status, and environmental factors contribute to CVD health disparities in Hispanic women.
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Affiliation(s)
| | | | - Lauren E Au
- University of California Davis, Davis, CA, United States
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States
| | - Rami Nassir
- Department of Pathology, School of Medicine, Umm Al-Quraa University, Saudi Arabia
| | - John A Robbins
- University of California Davis, Davis, CA, United States
| | | | - Lorena Garcia
- University of California Davis, Davis, CA, United States.
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Ramadan OI, Santos T, Stoecker JB, Belkin N, Jackson BM, Schneider DB, Rice J, Wang GJ. The Differential Impact of Medicaid Expansion on Disparities in Outcomes Following Peripheral Vascular Intervention. Ann Vasc Surg 2022; 86:135-143. [PMID: 35460861 DOI: 10.1016/j.avsg.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) disproportionately affects nonwhite, Hispanic/Latino, and low socioeconomic status patients, who are less likely to have insurance and routine healthcare visits. Medicaid expansion (ME) has improved insurance rates and access to care, potentially benefitting these patients. We sought to assess the impact of ME on disparities in outcomes after peripheral vascular intervention (PVI) for PAD. METHODS A retrospective analysis of prospectively-collected Vascular Quality Initiative PVI procedures between 2011 and 2019 was conducted. The sample was restricted to first-record procedures in adults under the age 65 in states that expanded Medicaid on January 1, 2014 (ME group) or had not expanded before January 1, 2019 (non-expansion [NE] group). ME and NE groups were compared between pre-expansion (2011-2013) and post-expansion (2014- 2019) time periods to assess baseline demographic and operative differences. We used difference-in-differences multivariable logistic regression adjusted for patient factors and clinical center and year fixed effects. Our primary outcome was 1-year major amputation. Secondary outcomes included trends in presentation, 30-day mortality, 1-year mortality, and 1-year primary and secondary patency. Outcomes were stratified by race and ethnicity. RESULTS We examined 34,313 PVI procedures, including 20,378 with follow-up data. Rates of Medicaid insurance increased post-expansion in ME and NE states (ME 16.7% to 23.0%, P < 0.001; NE 10.0% to 11.9%, P = 0.013) while rates of self-pay decreased in ME states only (ME 4.6% to 1.8%, P < 0.001; NE 8.1% to 8.4%, P = 0.620). Adjusted difference-in-differences analysis revealed lower odds of urgent/emergent PVI among all patients and all nonwhite patients in ME states post-expansion compared to NE states (all: odds ratio [OR] 0.53 [95% confidence interval 0.33-0.87], P = 0.011; nonwhite: OR 0.41 [0.19-0.88], P = 0.023). No differences were observed for 1-year major amputation (OR 0.70 [0.43-1.14], P = 0.152), primary patency (OR 0.93 [0.63-1.38], P = 0.726), or secondary patency (OR 1.29 [0.69-2.41], P = 0.431). Odds of 1-year mortality were higher in ME states post-expansion compared to NE states (OR 2.50 [1.07-5.87], P = 0.035), although 30-day mortality was not different (OR 2.04 [0.60-6.90], P = 0.253). Notably, odds of 1-year major amputation among Hispanic/Latino patients decreased in ME states post-expansion compared to NE states (OR 0.11 [0.01-0.86], P = 0.036). CONCLUSIONS ME was associated with lower odds of 1-year major amputation among Hispanic/Latino patients who underwent PVI for PAD. ME was also associated with lower odds of urgent/emergent procedures among patients overall and nonwhite patients specifically. However, 1-year mortality increased in the overall cohort. Further study is needed to corroborate our findings that ME may have benefits for certain underserved populations with PAD.
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Affiliation(s)
- Omar I Ramadan
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
| | - Tatiane Santos
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; The Wharton School at the University of Pennsylvania, Philadelphia, PA
| | - Jordan B Stoecker
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Nathan Belkin
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Benjamin M Jackson
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Darren B Schneider
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jayne Rice
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Grace J Wang
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Role of Lipid-Lowering Therapy in Peripheral Artery Disease. J Clin Med 2022; 11:jcm11164872. [PMID: 36013107 PMCID: PMC9410277 DOI: 10.3390/jcm11164872] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/05/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Atherosclerosis is a multifactorial, lipoprotein-driven condition that leads to plaque formation within the arterial tree, leading to subsequent arterial stenosis and thrombosis that accounts for a large burden of cardiovascular morbidity and mortality globally. Atherosclerosis of the lower extremities is called peripheral artery disease and is a major cause of loss in mobility, amputation, and critical limb ischemia. Peripheral artery disease is a common condition with a gamut of clinical manifestations that affects an estimated 10 million people in the United States of America and 200 million people worldwide. The role of apolipoprotein B-containing lipoproteins, such as LDL and remnant lipoproteins in the development and progression of atherosclerosis, is well-established. The focus of this paper is to review existing data on lipid-lowering therapies in lower extremity atherosclerotic peripheral artery disease.
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Application of OpenArray RT-qPCR for identification of microRNA expression signatures of lower extremity artery disease. J Appl Genet 2022; 63:497-512. [DOI: 10.1007/s13353-022-00692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/19/2022] [Accepted: 03/24/2022] [Indexed: 12/24/2022]
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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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Chang WC, Wang CY, Cheng Y, Hung YP, Lin TH, Chen WJ, Su CS, Hsu CY, Liu TJ, Lee WL. Plantar thermography predicts freedom from major amputation after endovascular therapy in critical limb ischemic patients. Medicine (Baltimore) 2020; 99:e22391. [PMID: 33181638 PMCID: PMC7668514 DOI: 10.1097/md.0000000000022391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Although plantar thermography can evaluate the immediate perfusion result after an endovascular therapy (EVT) has been performed, a relevant wound outcome study is still lacking.This study was to investigate whether angiosome-based plantar thermography could predict wound healing and freedom from major amputation after EVT in patients with critical limb ischemia (CLI).All 124 patients with CLI (Rutherford category 5 and 6) who underwent EVT from January 2017 to February 2019 were prospectively enrolled. All patients received thermography both before and after EVT. Both wound healing and freedom from major amputation at the 6-month follow-up period were recorded. There were 61 patients in the healing group and 63 patients in the non-healing group, whereas the major amputation total was 14 patients. The mean pre- and post-EVT temperature of the foot was significantly higher in the healing group than in the non-healing group (30.78 °C vs 29.42 °C, P = .015; and 32.34 °C vs 30.96 °C, P = .004, respectively). DIFF2 was significantly lower in the non-healing group (-1.38 vs -0.90, P = .009). DIFF1 and DIFF2 were significantly lower in the amputation group (-1.85 °C vs -1.11 °C, P = .026; and -1.82 °C vs -1.08 °C, P = .004). Multivariate analysis showed that DIFF2 stood out as an independent predictor for freedom from major amputation (hazard ratio 0.51, P = .045). Receiver operating characteristic curve analysis showed a DIFF2 cut-off value of -1.30 °C, which best predicts freedom from major amputation.Plantar thermography is associated with wound healing and helps predict freedom from major amputation in CLI patients undergoing EVT.
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Affiliation(s)
- Wei-Chun Chang
- Cardiovascular Center, Taichung Veterans General Hospital
- Department of Life Science, Tunghai University
| | - Chi-Yen Wang
- Cardiovascular Center, Taichung Veterans General Hospital
| | - Yutsung Cheng
- Cardiovascular Center, Taichung Veterans General Hospital
- Department of Life Science, Tunghai University
| | - Yu-Po Hung
- Cardiovascular Center, Taichung Veterans General Hospital
| | - Tzu-Hsiang Lin
- Cardiovascular Center, Taichung Veterans General Hospital
| | - Wei-Jhong Chen
- Cardiovascular Center, Taichung Veterans General Hospital
| | - Chieh-Shou Su
- Cardiovascular Center, Taichung Veterans General Hospital
- Biostatistics Task Force of Taichung Veterans General Hospital, Taichung
| | - Chiann-yi Hsu
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tsun-Jui Liu
- Cardiovascular Center, Taichung Veterans General Hospital
- Biostatistics Task Force of Taichung Veterans General Hospital, Taichung
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital
- Biostatistics Task Force of Taichung Veterans General Hospital, Taichung
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Jung CH, Cho YY, Choi D, Kim BY, Kim CH, Mok JO. Relationship of Sarcopenia with Microcirculation Measured by Skin Perfusion Pressure in Patients with Type 2 Diabetes. Endocrinol Metab (Seoul) 2020; 35:578-586. [PMID: 32981300 PMCID: PMC7520593 DOI: 10.3803/enm.2020.679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/16/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Few studies have examined the relationship of sarcopenia with the microcirculation. The current study investigated the relationship of sarcopenia with microcirculatory function, as assessed by skin perfusion pressure (SPP), in type 2 diabetes mellitus (T2DM) patients. METHODS In total, 102 T2DM patients who underwent SPP measurements and bioelectrical impedance analysis (BIA) were enrolled in this cross-sectional study. SPP was assessed using the laser Doppler technique. Sarcopenia was defined as low height-adjusted appendicular muscle mass (men, <7 kg/m2; women, <5.7 kg/m2) using BIA. We divided the participants into two groups based on SPP (≤50 and >50 mm Hg), and an SPP below 50 mm Hg was considered to reflect impaired microcirculation. RESULTS Fourteen patients (13.7%) were diagnosed with impaired microcirculatory function of the lower limb based on SPP. The prevalence of sarcopenia in all subjects was 11.8%, but the percentage of patients with an SPP ≤50 mm Hg who had sarcopenia was more than triple that of patients with an SPP >50 mm Hg (28.6% vs. 9.1%, P=0.036). A significant positive correlation was found between SPP and appendicular muscle mass adjusted for height (P=0.041 for right-sided SPP). Multiple logistic regression analysis showed that patients with sarcopenia had an odds ratio of 4.1 (95% confidence interval, 1.01 to 24.9) for having an SPP ≤50 mm Hg even after adjustment for confounding factors. CONCLUSION These results suggest that sarcopenia may be significantly associated with impaired microcirculation in patients with T2DM. Nonetheless, the small number of patients and wide CI require cautious interpretation of the results.
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Affiliation(s)
- Chan-Hee Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Yoon Young Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Dughyun Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Bo-Yeon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Chul-Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ji-Oh Mok
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Hurwitz M, Fuentes M. Healthcare Disparities in Dysvascular Lower Extremity Amputations. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00281-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tanious A, Karunathilake N, Toro J, Abu-Hanna A, Boitano LT, Fawcett T, Graves B, Nelson P. Racial Disparities in Endovascular Aortic Aneurysm Repair. Ann Vasc Surg 2018; 56:46-51. [PMID: 30476598 DOI: 10.1016/j.avsg.2018.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/25/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Racial and ethnic disparities are a critical issue in access to care within all fields of medicine. We hypothesized that analysis of a statewide administrative dataset would demonstrate disparities based on race with respect to access to this latest technology and the associated outcomes following endovascular aortic aneurysm repair (EVAR). METHODS Utilizing de-identified data from the Florida State Agency for Health Care Administration, we identified patients based on International Classification of Diseases Ninth Revision procedure codes who underwent EVAR between the years 2000 and 2014. We then assigned these procedures with the specialty of the operating physician and then analyzed outcomes based on the race of the patient. RESULTS We identified 36,601 EVAR procedures during the study period. The average age of the total sample was 73.38 (±9.87), with the majority of the cohort being male (n = 29,034, 81.2%). Breakdown of patients within each race category was as follows: 17,056 (47.7%) non-Hispanic Whites, 1,630 (4.6%) non-Hispanic African Americans, 16,431 (46.0%) Hispanics, and 632 (1.8%) patients identified as "other." Data analysis showed significant differences among age at presentation, sex of patient, and comorbidity score of patients at presentation. There were significant differences in outcomes based on race with respect to total hospital charges, length of stay, disposition, and payer status. CONCLUSIONS Racial disparities were discovered with respect to EVAR treatment. African Americans present at younger ages, have the highest percentage of females requiring intervention, have the longest hospital stays, have the highest Medicaid payer source, have the highest in-hospital total charges of any racial group, and are more likely to be treated by academic practitioners. Hispanics present with the highest comorbidity scores compared to their counterparts and, along with African Americans, are more likely to be treated by nonvascular surgeons.
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Affiliation(s)
- Adam Tanious
- Department of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
| | - Nirmani Karunathilake
- Department of Vascular and Endovascular Surgery, University of South Florida, Morsani College of Medicine, Tampa, FL
| | - Joel Toro
- Department of Vascular and Endovascular Surgery, University of South Florida, Morsani College of Medicine, Tampa, FL
| | - Afif Abu-Hanna
- Department of Vascular and Endovascular Surgery, University of South Florida, Morsani College of Medicine, Tampa, FL
| | - Laura T Boitano
- Department of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Timothy Fawcett
- Department of Vascular and Endovascular Surgery, University of South Florida, Morsani College of Medicine, Tampa, FL
| | - Brian Graves
- Department of Nursing, Tampa General Hospital, Tampa, FL
| | - Peter Nelson
- Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, OK
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Chung J, Modrall JG, Knowles M, Xiang Q, Lavery LA, Timaran CH, Valentine RJ. Arteriographic Patterns of Atherosclerosis and the Association between Diabetes Mellitus and Ethnicity in Chronic Critical Limb Ischemia. Ann Vasc Surg 2017; 40:198-205. [DOI: 10.1016/j.avsg.2016.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/09/2016] [Indexed: 11/29/2022]
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Kim BH, Cho KI, Spertus J, Park YH, Je HG, Shin MS, Lee JH, Jang JS. Peripheral artery questionnaire improves ankle brachial index screening in symptomatic patients with peripheral artery disease. Int J Clin Pract 2014; 68:1488-95. [PMID: 25358955 DOI: 10.1111/ijcp.12494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/15/2014] [Indexed: 11/30/2022] Open
Abstract
AIM The peripheral artery questionnaire (PAQ) is a disease-specific health status measure of patients with peripheral artery disease (PAD). Whether the PAQ scores are associated with a PAD diagnosis among patients with symptoms suspicious for PAD is unknown and could help increase the pretest probability of ankle brachial index (ABI) screening among patients with suspicious symptoms. METHODS The PAQ was completed by 567 patients evaluated for potential intermittent claudication at six tertiary centres. Demographics, medical history, physical examination findings and the PAQ domain scores were compared with ABI. A diagnostic threshold < 0.90 for a PAD diagnosis was assessed with a ROC of PAQ scores. The correlation between the PAQ Summary Score and ABI was also calculated. RESULTS The PAQ Summary Score was significantly lower in patients with low ABI as compared with those having a normal ABI (37.6 ± 19.0 vs. 70.1 ± 22.7, p < 0.001). The PAQ Summary Score and ABI were highly correlated (r = 0.56, p < 0.001) and the optimal PAQ Summary Score for predicting low ABI was 50.3 (AUC = 0.86, sensitivity 80.3%, specificity 78.3%). CONCLUSIONS The PAQ Summary Score was associated with an increased likelihood of PAD in patients with suspected PAD symptoms, and a low summary score (≤ 50.3) was an optimal threshold for predicting PAD among patients referred for ABI.
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Affiliation(s)
- B-H Kim
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Forbang NI, Hughes-Austin JM, Allison MA, Criqui MH. Peripheral artery disease and non-coronary atherosclerosis in Hispanics: another paradox? Prog Cardiovasc Dis 2014; 57:237-43. [PMID: 25443822 PMCID: PMC4254403 DOI: 10.1016/j.pcad.2014.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hispanic Americans (HA) are a significant and increasing segment of the population who must be considered in future health planning. HA, compared to European Americans (EA), have a lower prevalence of coronary artery disease, but higher burden of cardiovascular disease risk factors. It remains unclear if this observation termed the 'Hispanic Paradox' also exists for vascular beds outside the heart. We present a review of the literature which suggests that this paradox may also exist for arteries in the extremities and neck.
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Affiliation(s)
- Nketi I Forbang
- Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA.
| | - Jan M Hughes-Austin
- Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA
| | - Matthew A Allison
- Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA
| | - Michael H Criqui
- Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA
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Collins TC, Dong F, Ablah E, Parra-Medina D, Cupertino P, Rogers N, Ahlers-Schmidt CR. Text messaging to motivate exercise among Latino adults at risk for vascular disease: a pilot study, 2013. Prev Chronic Dis 2014; 11:E192. [PMID: 25357260 PMCID: PMC4215572 DOI: 10.5888/pcd11.140219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In 2013, we administered a 15-item survey to determine the extent of text message usage among Latino adults in Kansas; for a subset of the survey participants, we also conducted a 6-week pilot trial to determine the effect of text messaging on exercise behaviors. Among the 82 survey participants, 78% had unlimited text messaging. At baseline, all trial participants were at the stage of contemplation; at 6 weeks, one (9%) trial participant remained at the contemplation stage and the other 10 (91%) participants progressed to the action/maintenance/termination stage. Use of text messaging to motivate exercise is feasible and potentially efficacious among Latinos.
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Affiliation(s)
- Tracie C Collins
- Preventive Medicine and Public Health, University of Kansas School of Medicine - Wichita, 1010 N. Kansas, Ste 1410, Wichita, KS 67214. Telephone: 316-293-2630. E-mail:
| | - Frank Dong
- University of Kansas School of Medicine, Wichita, Kansas
| | | | - Deborah Parra-Medina
- University of Texas Health Science Center, San Antonio Institute for Health Promotion Research, San Antonio, Texas
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Abstract
Non-healing wounds represent a challenging problem for physicians and patients alike. Although treatment strategies are aimed at specific causes, there are basic management principles that apply to all wounds. The purpose of this article is to review these core management principles as they apply to lower extremity wounds. Key points include a multidisciplinary approach and individualized plans of care as per specific patient needs. A comprehensive treatment plan will lead to faster healing and improved outcomes.
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Affiliation(s)
- Kelly Bumpus
- Orthopedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
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Liao KC, Weng SF, Hsing CH, Liu C, Wang JJ, Huang KF, Chu CC. The amputation and mortality rates of diabetic patients with critical limb ischemia: A nationwide population-based follow-up study in Taiwan. FORMOSAN JOURNAL OF SURGERY 2013. [DOI: 10.1016/j.fjs.2013.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Spångéus A, Wijkman M, Lindström T, Engvall JE, Östgren CJ, Nystrom FH, Länne T. Toe brachial index in middle aged patients with diabetes mellitus type 2: not just a peripheral issue. Diabetes Res Clin Pract 2013; 100:195-202. [PMID: 23522916 DOI: 10.1016/j.diabres.2013.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/19/2013] [Accepted: 03/01/2013] [Indexed: 11/18/2022]
Abstract
AIM To explore risk factors for peripheral arterial disease (PAD) as well as the association between toe blood pressure and subclinical and clinical central vascular disease in patients with type 2 diabetes. METHOD Toe brachial index (TBI) was cross-sectionally analyzed in 742 middle-aged (54-66 years) patients with type 2 diabetes as well as non-diabetic controls and related to other vascular measures (e.g. carotid intima media thickness (IMT), presence of carotid plaque, central arterial stiffness and left ventricular mass index) and previous cardiovascular events. RESULTS A TBI ≤ 0.7 was seen in 22% of the patients but only one patient had severe TBI reduction (TBI ≤ 0.3). The corresponding figures in the controls were 13% and 0%, respectively. Mean TBI was significantly lower in patients with type 2 diabetes than in controls (0.81 ± 0.14 vs. 0.87 ± 0.15, p<0.001). In patients with diabetes, a lower TBI was associated with increased central arterial stiffness (p<0.001), IMT (p<0.001) and carotid plaque (p<0.001) as well as with decreasing glomerular filtration rate (p<0.001). Lower TBI was found in patients with previous macrovascular ischemic events. Furthermore, TBI was negatively correlated with age (p<0.001), diabetes duration (p<0.001) and HbA1c (p=0.01). CONCLUSION PAD, assessed with TBI, is common in a Swedish middle-aged diabetes type 2 cohort, affecting about one-fifth. As ankle pressure may be confounded by falsely high values in patients with diabetes due to media calcification we conclude that information about TBI may improve the risk evaluation regarding arteriosclerotic disease in both small and large vessels in type 2 diabetes.
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Affiliation(s)
- Anna Spångéus
- Department of Endocrinology, County council of Östergötland, Linköping, Sweden.
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Ghidei W, Collins TC. African Americans and Peripheral Arterial Disease: A Review Article. ACTA ACUST UNITED AC 2012. [DOI: 10.5402/2012/165653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Peripheral arterial disease (PAD)—atherosclerosis of the abdominal aorta and arteries of the lower extremities—affects 12 million Americans. African Americans (AAs) are more than twice as likely as non-Hispanic whites to suffer from PAD. When compared to non-Hispanic whites with PAD, AAs with PAD have more severe disease and a greater reduction in walking distance, speed, and/or stair climbing. AAs with PAD are at increased risk for disease progression and worsening lower limb function. Reasons for the higher risk for disease progression have not been defined. One potential modifiable risk is a lower level of physical activity. Lower levels of physical activity are more common among African American seniors. Walking is a common type of physical activity. The benefits of walking therapy are only realized if the patient adheres to such therapy. Efforts are needed to increase walking in AAs with PAD. Additionally, risk factor management is key to reducing adverse events in AAs with PAD-yet few studies have targeted this high-risk group. In this paper, we discuss the management of PAD in AAs. Identifying current gaps will help to inform clinicians, researchers, and policy makers on next steps in identifying innovative approaches to increase home-based walking and reduce walking impairment in AAs with PAD.
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Affiliation(s)
- Winta Ghidei
- Center for Health Equity, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Tracie C. Collins
- Department of Preventive Medicine and Public Health, University of Kansas Medical School, 1010 N. Kansas St., Suite 1406, Wichita, KS 67214-3199, USA
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Abstract
Peripheral arterial disease (PAD) has a substantial impact on individual quality of life and is a significant financial burden to society. It is underdiagnosed, and therefore, undertreated. Early detection and treatment is essential to prevent increases in morbidity and mortality. The purpose of this article is to review evidence-based articles regarding prevalence, screening, diagnosis, and management of PAD.
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