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Wändell P, Li X, Carlsson AC, Sundquist J, Sundquist K. Heart failure in first- and second-generation immigrants aged 18-54 years in Sweden: A national study. ESC Heart Fail 2024. [PMID: 39049515 DOI: 10.1002/ehf2.14998] [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: 04/03/2024] [Revised: 06/17/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024] Open
Abstract
PURPOSE We aimed at analysing the risk of congestive heart failure (CHF) among first- and second-generation immigrants in younger age groups. METHODS All individuals aged 18-54 years, n = 3 973 454 in the first-generation study and n = 3 817 560 in the second-generation study, were included. CHF was defined as at least one registered diagnosis in the National Patient Register between 1 January 1998 and 31 December 2018. Cox regression analysis was used to estimate the relative risk [hazard ratios (HRs) with 99% confidence intervals (CIs)] of incident CHF with adjustments for age, co-morbidities and socio-demographics. RESULTS In the first-generation study, a total of 85 719 cases of CHF were registered, 54 369 men and 31 350 women, where fully adjusted models showed HRs for all foreign-born men of 1.12 (99% CI 1.06-1.17) and for women of 0.99 (0.92-1.05). Groups with higher risk included men from Eastern Europe, Central Europe, Africa and Asia and women from Africa and Asia, and a lower risk was found among Latin American women. In the second-generation study, a total of 88 999 cases of CHF were registered, 58 403 men and 30 596 women, where fully adjusted models showed HRs for second-generation men of 1.04 (0.99-1.09) and women of 0.97 (0.90-1.04). CONCLUSIONS The higher risk in some foreign-born groups needs to be paid attention to in clinical practice. The fact that almost all increased risks were attenuated and absent in second-generation immigrants suggests that lifestyle and environmental factors are more important than genetic differences in the risk of CHF.
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Affiliation(s)
- Per Wändell
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Xinjun Li
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Axel C Carlsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Stockholm Region, Stockholm, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Skåne, Sweden
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
- Department of Family and Community Medicine, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Skåne, Sweden
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
- Department of Family and Community Medicine, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
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Gavin JR, Rodbard HW, Battelino T, Brosius F, Ceriello A, Cosentino F, Giorgino F, Green J, Ji L, Kellerer M, Koob S, Kosiborod M, Lalic N, Marx N, Prashant Nedungadi T, Parkin CG, Topsever P, Rydén L, Huey-Herng Sheu W, Standl E, Olav Vandvik P, Schnell O. Disparities in prevalence and treatment of diabetes, cardiovascular and chronic kidney diseases - Recommendations from the taskforce of the guideline workshop. Diabetes Res Clin Pract 2024; 211:111666. [PMID: 38616041 DOI: 10.1016/j.diabres.2024.111666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
There is a mounting clinical, psychosocial, and socioeconomic burden worldwide as the prevalence of diabetes, cardiovascular disease (CVD), and chronic kidney disease (CKD) continues to rise. Despite the introduction of therapeutic interventions with demonstrated efficacy to prevent the development or progression of these common chronic diseases, many individuals have limited access to these innovations due to their race/ethnicity, and/or socioeconomic status (SES). However, practical guidance to providers and healthcare systems for addressing these disparities is often lacking. In this article, we review the prevalence and impact of healthcare disparities derived from the above-mentioned chronic conditions and present broad-based recommendations for improving access to quality care and health outcomes within the most vulnerable populations.
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Affiliation(s)
- James R Gavin
- Emory University School of Medicine, Atlanta, GA, USA
| | - Helena W Rodbard
- Endocrine and Metabolic Consultants, 3200 Tower Oaks Blvd., Suite 250, Rockville, MD 20852, USA.
| | - Tadej Battelino
- University Medical Center Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Frank Brosius
- University of Arizona College of Medicine, 1501 N. Campbell Ave, Tucson, AZ 85724-5022, USA.
| | - Antonio Ceriello
- IRCCS MultiMedica, Via Milanese 300, Sesto San Giovanni MI 20099, Italy.
| | - Francesco Cosentino
- Cardiology Unit, Department of Medicine, Karolinska Institute and Karolinska University Hospital, Solna, Stockholm, Sweden.
| | - Francesco Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Jennifer Green
- Duke University Medical Center, Duke Clinical Research Institute, 641 Durham Centre, Box 17969, Durham, NC 27715, USA.
| | - Linong Ji
- Peking University People's Hospital, 11 Xizhimen S St, Xicheng District, Beijing, China.
| | - Monika Kellerer
- Marienhospital Stuttgart, Böheimstraße 37, Stuttgart 70199, Germany.
| | - Susan Koob
- PCNA National Office, 613 Williamson Street, Suite 200, Madison, WI 53703, USA.
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, 4401 Wornall Rd, Kansas City, MO 64111, USA; The George Institute for Global Health and University of New South Wales, Sydney, Australia.
| | - Nebojsa Lalic
- University Clinical Center of Serbia, University of Belgrade, Pasterova 2, Beograd 11000, Serbia
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University Pauwelsstraße 30, 52074 Aachen, Germany.
| | | | - Christopher G Parkin
- CGParkin Communications, Inc., 2675 Windmill Pkwy, Suite 2721, Henderson, NV 89074, USA
| | - Pinar Topsever
- Department of Family Medicine, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İçerenköy, Kayışdağı Cd. No: 32, Ataşehir/İstanbul 34752, Türkiye.
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden.
| | - Wayne Huey-Herng Sheu
- Institute of Molecular and Genomic Medicine, National Research Health Institutes, Zhunan, Miaoli 350, Taiwan.
| | - Eberhard Standl
- Forschergruppe Diabetes e. V., Ingolstaedter Landstraße 1, Neuherberg, Munich, Germany.
| | - Per Olav Vandvik
- Department of Medicine, Lovisenberg Diaconal Hospital, Institute of Health and Society, University of Oslo, Lovisenberggata 17, Oslo 0456, Norway
| | - Oliver Schnell
- Forschergruppe Diabetes e. V., Ingolstaedter Landstraße 1, Neuherberg, Munich, Germany.
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Sun G, Liu Y, Rong D, Liang X. Association between serum uric acid levels and the prevalence of heart failure due to acute coronary syndrome in Chinese hospitalized patients: A cross-sectional study. Nutr Metab Cardiovasc Dis 2023; 33:308-314. [PMID: 36586774 DOI: 10.1016/j.numecd.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/11/2022] [Accepted: 11/01/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND AIMS Serum uric acid (SUA) may play a role in heart failure (HF). Our study was to find relationships between SUA and the prevalence of HF due to acute coronary syndrome (ACS), and the ethnic-specific relationship between them in an inpatient population. METHODS AND RESULTS We analyzed 1075 Chinese ACS patients. SUA levels were cut to four groups as Q1 to Q4, according to quartiles. Binary logistic regression models were used to assess associations of SUA with HF due to ACS. Subgroup analysis was performed to find ethnic-specific association between SUA and HF due to ACS. We also performed univariate and multivariate logistic regression analyses taking into account an Italian's cut-off for SUA for HF prognosis stratification. After adjustment for all potential confounders, compared to the lowest quartile, quartiles 2, 3 and 4 had a prevalence OR of 0.69 (0.44-1.08), 1.06 (0.67-1.67) and 2.19 (1.35-3.56), respectively, for the HF due to ACS (p for trend <0.001). Subgroup analyses didn't reveal an ethnic-specific differences between SUA and HF due to ACS. In Han, the highest SUA level was significantly associated with the risk of HF due to ACS. OR with 95%CI for Q4 was 1.85 (1.02-3.37), Q1 as a reference. For Mongolians, the OR with 95%CI for Q4 was 6.82 (1.90-24.50), Q1 as a reference. CONCLUSION We found positive associations between SUA and the prevalence of HF due to ACS among Chinese patients. No differences exist regarding ethnicity.
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Affiliation(s)
- Guotong Sun
- Suzhou Medical College of Soochow University, Soochow University, Suzhou, 215000, Jiangsu, China; Department of Cardiology, Hulunbuir People's Hospital, Hulunbuir, 021000, Inner Mongolia, China; Department of Cardiology, Shouguang Hospital of T.C.M, Weifang, 262700, Shandong, China
| | - Yu Liu
- Department of Cardiology, Hulunbuir People's Hospital, Hulunbuir, 021000, Inner Mongolia, China; Medical College, Inner Mongolia Minzu University, Tongliao, 028000, Inner Mongolia, China
| | - Di Rong
- Suzhou Medical College of Soochow University, Soochow University, Suzhou, 215000, Jiangsu, China; Department of Geriatric, Hulunbuir People's Hospital, Hulunbuir, 021000, Inner Mongolia, China
| | - Xiuwen Liang
- Suzhou Medical College of Soochow University, Soochow University, Suzhou, 215000, Jiangsu, China; Medical College, Inner Mongolia Minzu University, Tongliao, 028000, Inner Mongolia, China; Department of Cardiology, Hulunbeir China Mongolia Hospital, Hulunbuir, 021000, Inner Mongolia, China.
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Zou P, Stinson J, Parry M, Dennis CL, Yang Y, Lu Z. A Smartphone App (mDASHNa-CC) to Support Healthy Diet and Hypertension Control for Chinese Canadian Seniors: Protocol for Design, Usability and Feasibility Testing. JMIR Res Protoc 2020; 9:e15545. [PMID: 32238343 PMCID: PMC7316441 DOI: 10.2196/15545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/12/2019] [Accepted: 12/09/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This proposed study aims to translate the Dietary Approach to Stop Hypertension with Sodium (Na) Reduction for Chinese Canadians (DASHNa-CC), a classroom-based, antihypertensive, dietary educational intervention, to an innovative smartphone app (mDASHNa-CC). This study will enable Chinese Canadian seniors to access antihypertensive dietary interventions anytime, regardless of where they are. It is hypothesized that senior Chinese Canadians will be satisfied with their experiences using the mDASHNa-CC app and that the use of this app could lead to a decrease in their blood pressure and improvement in their health-related quality of life. OBJECTIVE The goal of this study is to design and test the usability and feasibility of a smartphone-based dietary educational app to support a healthy diet and hypertension control for Chinese Canadian seniors. METHODS A mixed-method two-phase design will be used. The study will be conducted in a Chinese immigrant community in Toronto, Ontario, Canada. Chinese Canadian seniors, who are at least 65 years old, self-identified as Chinese, living in Canada, and with elevated blood pressure, will be recruited. In Phase I, we will design and test the usability of the app using a user-centered approach. In Phase II, we will test the feasibility of the app, including implementation (primary outcomes of accrual and attrition rates, technical issues, acceptability of the app, and adherence to the intervention) and preliminary effectiveness (secondary outcomes of systolic and diastolic blood pressure, weight, waist circumference, health-related quality of life, and health service utilization), using a pilot, two-group, randomized controlled trial with a sample size of 60 participants in a Chinese Canadian community. RESULTS The study is supported by the Startup Research Grant from Nipissing University, Canada. The research ethics application is under review by a university research ethics review board. CONCLUSIONS The study results will make several contributions to the existing literature, including illustrating the rigorous design and testing of smartphone app technology for hypertension self-management in the community, exploring an approach to incorporating traditional medicine into chronic illness management in minority communities and promoting equal access to current technology among minority immigrant senior groups. TRIAL REGISTRATION Clinicaltrials.gov NCT03988894; https://clinicaltrials.gov/ct2/show/NCT03988894. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/15545.
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Affiliation(s)
- Ping Zou
- School of Nursing, Nipissing University, Toronto, ON, Canada
| | - Jennifer Stinson
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Hospital for Sick Children, Toronto, ON, Canada
| | - Monica Parry
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Cindy-Lee Dennis
- Lawrence Bloomberg Faculty of Nursing and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yeqin Yang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Zhongqiu Lu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
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Wändell P, Carlsson AC, Li X, Gasevic D, Ärnlöv J, Holzmann MJ, Sundquist J, Sundquist K. Heart failure in immigrant groups: a cohort study of adults aged 45 years and over in Sweden. SCAND CARDIOVASC J 2018; 52:292-300. [PMID: 30445882 DOI: 10.1080/14017431.2018.1546892] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE An increased risk of being diagnosed with coronary heart disease or atrial fibrillation has been shown among different immigrant groups. However, less is known on the risk of being diagnosed with congestive heart failure (CHF). DESIGN We studied CHF in immigrants including all adults ≥45 years in Sweden (n = 3,274,119) from 1998 to 2012. CHF was defined as at the first event registered in the National Patient Register. Risk of incident CHF in immigrant groups compared to the Swedish-born population was assessed by Cox regression, stratified by sex, adjusting for age, socio-demographic status, and co-morbidities. RESULTS During a mean follow-up of 14 years in total, a total of 302,340 (9.2%) events of CHF were registered. We found the following: higher incidence in men from Bosnia, Iraq, Lebanon, Russia and Africa; among women from Bosnia, Iraq, Lebanon, Turkey, Central Europe and Finland; lower incidence in men from Iceland, Latin America, Southern Europe, Norway and Western Europe; and among women from Iceland, Southern Europe, Norway, Denmark and Western Europe. CONCLUSION It is important to be aware of the increased incidence of CHF in some immigrant groups, especially from countries and areas where the immigrants have been refugees, in order to enable for a timely diagnosis, treatment of and prevention of CHF and its debilitating complications.
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Affiliation(s)
- Per Wändell
- a Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society , Karolinska Institutet , Huddinge , Sweden
| | - Axel C Carlsson
- a Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society , Karolinska Institutet , Huddinge , Sweden
| | - Xinjun Li
- b Center for Primary Health Care Research , Lund University , Malmö , Sweden
| | - Danijela Gasevic
- c Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine , University of Edinburgh , Edinburgh , UK.,d School of Public Health and Preventive Medicine , Monash University , Melbourne , Australia
| | - Johan Ärnlöv
- a Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society , Karolinska Institutet , Huddinge , Sweden.,e School of Health and Social Studies , Dalarna University , Falun , Sweden
| | - Martin J Holzmann
- f Functional Area of Emergency Medicine , Karolinska University Hospital , Stockholm , Sweden.,g Department of Internal Medicine Solna , Karolinska Institutet , Stockholm , Sweden
| | - Jan Sundquist
- b Center for Primary Health Care Research , Lund University , Malmö , Sweden.,h Department of Family Medicine and Community Health, Department of Population Health Science and Policy , Icahn School of Medicine at Mount Sinai , New York , NY , USA.,i Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine , Shimane University , Matsue , Japan
| | - Kristina Sundquist
- b Center for Primary Health Care Research , Lund University , Malmö , Sweden.,h Department of Family Medicine and Community Health, Department of Population Health Science and Policy , Icahn School of Medicine at Mount Sinai , New York , NY , USA.,i Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine , Shimane University , Matsue , Japan
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Wierenga KL. Emotion Regulation and Perceptions of Illness Coherence and Controllability on Regimen Adherence and Negative Cardiac Health Events in African American Women With Heart Failure. J Cardiovasc Nurs 2018; 32:594-602. [PMID: 28398917 PMCID: PMC5633482 DOI: 10.1097/jcn.0000000000000403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND African American women with heart failure (HF) have stressors that negatively impact HF self-management adherence and heighten the occurrence of negative cardiac health events. Perceptions of illness coherence and controllability and emotion regulation are known to facilitate self-management in the face of stressors. OBJECTIVE The aim of this study was to determine whether difficulties with emotion regulation and negative perceptions of illness coherence and controllability are detrimental to adherence and increase negative cardiac health events in this patient population. METHODS African American women (n = 54) with HF, aged 49 to 84 years, participated in this longitudinal descriptive correlational study. Using convenience sampling, we recruited patients from hospitals and HF clinics. They completed interviews at intake and 30 days, and their medical records were reviewed at 90 days. Linear and logistic regression models were used to assess predictors of general adherence and negative cardiac health events. RESULTS Of 54 patients who participated in the study, 28 experienced a negative health event during 90 days, and 57% of these events were cardiac related. The only clear predictor of these events was greater New York Heart Association functional classification (β = 1.47, P = .027). No associations were found between predictors (emotion regulation, controllability, coherence, age, education) and general adherence. CONCLUSIONS Emotion regulation showed a possible greater impact on negative cardiac health events than on general adherence. Perceived illness coherence showed less impact on negative cardiac health events than on general adherence.
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Affiliation(s)
- Kelly L Wierenga
- Kelly L. Wierenga, PhD, RN Postdoctoral Fellow, Case Western Reserve University, Cleveland, Ohio
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Zou P, Dennis CL, Lee R, Parry M. Dietary Approach to Stop Hypertension with Sodium Reduction for Chinese Canadians (DASHNa-CC): A Pilot Randomized Controlled Trial. J Nutr Health Aging 2017; 21:1225-1232. [PMID: 29188883 DOI: 10.1007/s12603-016-0861-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is a lack of culturally sensitive dietary interventions targeting Chinese Canadians despite unhealthy dietary behaviours being identified as the most important modifiable risk factor for hypertension in the Chinese population. AIMS To determine the feasibility of a culturally sensitive dietary intervention for hypertension control; to examine the potential effects of the intervention on blood pressure and health-related quality of life among Chinese Canadians in community. METHODS This study was a two-group pilot randomized controlled trial with 8 weeks follow up. Sixty self-identified Chinese Canadians, older than 45 years old and with grade one hypertension but not on antihypertensive medications were recruited in community. The control group received usual care and the intervention group received usual care plus newly developed DASHNa-CC intervention. The DASHNa-CC intervention consisted of a written manual, two classroom sessions, and one telephone booster call to provide healthy dietary and sodium reduction advice, integrated with Traditional Chinese Medicine food therapy recommendations for hypertension control. RESULTS 618 Chinese Canadians participated in blood pressure screening, and 60 eligible participants recruited. Participants were highly satisfied with the intervention and adhered to the trial protocol. The lost to follow-up rate was 5%. At 8 weeks post-randomization, those in the intervention group had greater reductions in systolic blood pressure [3.8mmHg, t (55) = -1.58, p = 0.12] and higher physical health scores [t (55) = 2.13, p = 0.04] compared to those of the control group. There were no group differences in health care utilization. CONCLUSIONS It is feasible to deliver the DASHNa-CC intervention in a Chinese Canadian community. The DASHNa-CC intervention may decrease blood pressure and improve health-related quality of life for Chinese Canadians.
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Affiliation(s)
- P Zou
- Dr. Ping Zou, Assistant Professor, School of Nursing, Nipissing University, 750 Dundas Street West, Toronto, Ontario, Canada, M6J 3S3, Phone: 416-642-7003,
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Zou P, Dennis CL, Lee R, Parry M. Hypertension Prevalence, Health Service Utilization, and Participant Satisfaction: Findings From a Pilot Randomized Controlled Trial in Aged Chinese Canadians. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2017; 54:46958017724942. [PMID: 28853303 PMCID: PMC5798669 DOI: 10.1177/0046958017724942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Responding to high prevalence of hypertension and patients' preference of integrating traditional Chinese medicine for blood pressure control, the Dietary Approach to Stop Hypertension With Sodium Reduction for Chinese Canadian (DASHNa-CC) intervention was newly designed as a culturally sensitive dietary educational intervention to facilitate middle-aged and senior Chinese Canadians' blood pressure control in community. The aim of this study was to report the hypertension prevalence rate according to the data from blood pressure screening events, to describe the characteristics of health service utilization among aged Chinese Canadians, and to report the evaluation of participant satisfaction to the DASHNa-CC intervention. This study was designed as a pilot randomized controlled trial with a sample size of 60. Among 618 Chinese Canadians participated in blood pressure screening events, 54.5% (n = 337) having various levels of hypertension. Across 2 months, 38 (63.3%) participants made a total of 47 visits to see their family physicians; 20 (33.3%) participants consulted their family members 224 times for lifestyle modifications and hypertension self-management. Various forms of Chinese media were frequently used as sources of health care information, and English media were rarely accessed. Participants highly satisfied with the contents, delivery approaches, and integration of traditional Chinese medicine in the intervention. Results indicated that middle-aged and senior Chinese Canadians have high hypertension prevalence and specific characteristics of health service utilization. It is important to implement interventions, which are culturally tailored, language appropriate, using proper technology and incorporating traditional Chinese medicine, in Chinese Canadian community for hypertension control.
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Affiliation(s)
- Ping Zou
- Nipissing University, Toronto, Ontario, Canada
- Ping Zou, Assistant Professor, School of Nursing, Nipissing University, 750 Dundas Street West, Toronto, Ontario, Canada M6J 3S3.
| | | | - Ruth Lee
- McMaster University, Hamilton, Ontario, Canada
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Iyngkaran P, Kangaharan N, Zimmet H, Arstall M, Minson R, Thomas MC, Bergin P, Atherton J, MacDonald P, Hare DL, Horowitz JD, Ilton M. Heart Failure in Minority Populations - Impediments to Optimal Treatment in Australian Aborigines. Curr Cardiol Rev 2016; 12:166-79. [PMID: 27280307 PMCID: PMC5011191 DOI: 10.2174/1573403x12666160606115034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/18/2015] [Accepted: 01/11/2016] [Indexed: 01/30/2023] Open
Abstract
Chronic heart failure (CHF) among Aboriginal/Indigenous Australians is endemic. There are also grave concerns for outcomes once acquired. This point is compounded by a lack of prospective and objective studies to plan care. To capture the essence of the presented topic it is essential to broadly understand Indigenous health. Key words such as ‘worsening’, ‘gaps’, ‘need to do more’, ‘poorly studied’, or ‘future studies should inform’ occur frequently in contrast to CHF research for almost all other groups. This narrative styled opinion piece attempts to discuss future directions for CHF care for Indigenous Australians. We provide a synopsis of the problem, highlight the treatment gaps, and define the impediments that present hurdles in optimising CHF care for Indigenous Australians.
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Affiliation(s)
- Pupalan Iyngkaran
- Cardiologist and Senior Lecturer NT Medical School, Flinders University, Tiwi, NT 0811, Australia.
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Yeboah J, Rodriguez CJ, Qureshi W, Liu S, Carr JJ, Lima JA, Hundley WG, Herrington DM. Prognosis of Low Normal Left Ventricular Ejection Fraction in an Asymptomatic Population-Based Adult Cohort: The Multiethnic Study of Atherosclerosis. J Card Fail 2016; 22:763-8. [PMID: 27038640 DOI: 10.1016/j.cardfail.2016.03.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/07/2016] [Accepted: 03/25/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Reduced left ventricular systolic function predicts worse outcomes. However, the optimal threshold for "normal" left ventricular ejection fraction (LVEF) is uncertain. In general, LVEF ≥ 55% is considered to be "normal" by guidelines, with a low normal designation for LVEF being 50%-55%. We assessed the prognosis of participants with low normal LVEF in the Multiethnic Study of Atherosclerosis. All participants were asymptomatic and had no known clinical cardiovascular disease at baseline. METHODS AND RESULTS A total of 4926 out of 6814 had LVEF assessed with the use of cardiac magnetic resonance imaging (MRI), had no significant valvular disease, did not have myocardial infarction during follow-up, had complete data, and were included in this analysis. A total of 83/4926 (1.7%) had LVEF < 50% (low LVEF) and 101/4926 (2.1%) had low normal LVEF. Cox proportional hazard and cubic spline analyses were used to evaluate the association between LVEF category and 10 years of adjudicated incident congestive heart failure (CHF) and all-cause mortality adjusting for (model 1) age, sex, and race and (model 2) model 1 and diabetes mellitus, smoking, systolic blood pressure (BP), BP medications, body mass index, estimated glomerular filtration rate, low-density lipoprotein, family history of coronary heart disease, educational status, and LV mass. Mean age was 61 ± 10 years, 47% were men, 35% were on BP medications, 9% had diabetes. After 10.2 years of follow-up, 109 (2.2%) had CHF and 427 (8.7%) died. Compared with normal LVEF (≥55%), low normal LVEF and low LVEF were associated with an increased risk for incident CHF during follow-up in our multivariable Cox models: hazard ratios (HRs) 3.64 (95% CI 1.76-7.52) and 9.52 (5.63-17.52), respectively. Unlike low LVEF, low normal LVEF was not associated with increased risk of death compared with normal LVEF in our fully adjusted models: HRs 3.03 (1.94-4.73) and 1.32 (0.72-2.41), respectively. In the adjusted spline analysis HR of LVEF 55% as reference, LVEF had a U-shape association of future CHF risk and LVEF. CONCLUSION Low normal LVEF is as prevalent as low LVEF in asymptomatic community-dwelling adults. We observed a gradient-response association between the 3 categories of LVEF (low, low normal, and normal) and incident CHF but not for all-cause death.
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Affiliation(s)
- Joseph Yeboah
- Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Carlos J Rodriguez
- Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Waqas Qureshi
- Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Songtao Liu
- National Institutes of Health, Bethesda, Maryland
| | - J Jeffrey Carr
- Cardiology and Radiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Joao A Lima
- Cardiology and Radiology, Johns Hopkins University, Baltimore, Maryland
| | - W Gregory Hundley
- Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - David M Herrington
- Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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11
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Mansour IN, Bress AP, Groo V, Ismail S, Wu G, Patel SR, Duarte JD, Kittles RA, Stamos TD, Cavallari LH. Circulating Procollagen Type III N-Terminal Peptide and Mortality Risk in African Americans With Heart Failure. J Card Fail 2015; 22:692-9. [PMID: 26721774 DOI: 10.1016/j.cardfail.2015.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 12/08/2015] [Accepted: 12/14/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Procollagen type III N-terminal peptide (PIIINP) is a biomarker of cardiac fibrosis that is associated with heart failure prognosis in whites. Its prognostic significance in African Americans is unknown. We sought to determine whether PIIINP is associated with outcomes in African Americans with heart failure. METHODS AND RESULTS Blood was collected from 138 African Americans with heart failure for determining PIIINP and genetic ancestry, and patients were followed prospectively for death or hospitalization for heart failure. PIIINP was inversely correlated with West African ancestry (R(2) = 0.061; P = .010). PIIINP > 4.88 ng/mL was associated with all-cause mortality on univariate (hazard ratio [HR] 4.9, 95% confidence interval [CI] 2.2-11.0; P < .001) and multivariate (HR 5.8; 95% CI 1.9-17.3; P = .002) analyses over a median follow-up period of 3 years. We also observed an increased risk for the combined outcome of all-cause mortality or hospitalization for heart failure with PIIINP > 4.88 ng/mL on univariate (HR 2.6, 95% CI 1.6-5.0; P < .001) and multivariate (HR 2.4, 95% CI 1.2-4.7; P = .016) analyses. CONCLUSIONS High circulating PIIINP is associated with poor outcomes in African Americans with chronic heart failure, suggesting that PIIINP may be useful in identifying African Americans who may benefit from additional therapy to combat fibrosis as a means of improving prognosis.
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Affiliation(s)
- Ibrahim N Mansour
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Adam P Bress
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois
| | - Vicki Groo
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois
| | - Sahar Ismail
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Grace Wu
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Shitalben R Patel
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois
| | - Julio D Duarte
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois
| | - Rick A Kittles
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Thomas D Stamos
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Larisa H Cavallari
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois.
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12
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Predictors of heart failure self-care in patients who screened positive for mild cognitive impairment. J Cardiovasc Nurs 2015; 30:152-60. [PMID: 24434832 DOI: 10.1097/jcn.0000000000000130] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Heart failure (HF) is associated with cognitive impairment, which could negatively affect a patient's abilities to carry out self-care, potentially resulting in higher hospital readmission rates. Factors associated with self-care in patients experiencing mild cognitive impairment (MCI) are not known. OBJECTIVE This descriptive correlation study aimed to assess levels of HF self-care and knowledge and to determine the predictors of self-care in HF patients who screen positive for MCI. METHODS The Montreal Cognitive Assessment was used to screen for MCI. In 125 patients with MCI hospitalized with HF, self-care (Self-care of Heart Failure Index) and HF knowledge (Dutch Heart Failure Knowledge Scale) were assessed. We used multiple regression analysis to test a model of variables hypothesized to predict self-care maintenance, management, and confidence. RESULTS Mean (SD) HF knowledge scores (11.24 [1.84]) were above the level considered to be adequate (defined as >10). Mean (SD) scores for self-care maintenance (63.57 [19.12]), management (68.35 [20.24]), and confidence (64.99 [16.06]) were consistent with inadequate self-care (defined as scores <70). In multivariate analysis, HF knowledge, race, greater disease severity, and social support explained 22% of the variance in self-care maintenance (P < .001); age, education level, and greater disease severity explained 19% of the variance in self-care management (P < .001); and younger age and higher social support explained 20% of the variance in self-care confidence scores (P < .001). Blacks, on average, scored significantly lower in self-care maintenance (P = .03). CONCLUSION In this sample, patients who screened positive for MCI, on average, had adequate HF knowledge yet inadequate self-care scores. These models show the influence of modifiable and nonmodifiable predictors for patients who screened positive for MCI across the domains of self-care. Health professionals should consider screening for MCI and identifying interventions that address HF knowledge and social support. Further research is needed to explain the racial differences in self-care.
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Iyngkaran P, Thomas M. Bedside-to-Bench Translational Research for Chronic Heart Failure: Creating an Agenda for Clients Who Do Not Meet Trial Enrollment Criteria. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 9:121-32. [PMID: 26309418 PMCID: PMC4527366 DOI: 10.4137/cmc.s18737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/09/2015] [Accepted: 03/25/2015] [Indexed: 01/09/2023]
Abstract
Congestive heart failure (CHF) is a chronic condition usually without cure. Significant developments, particularly those addressing pathophysiology, mainly started at the bench. This approach has seen many clinical observations initially explored at the bench, subsequently being trialed at the bedside, and eventually translated into clinical practice. This evidence, however, has several limitations, importantly the generalizability or external validity. We now acknowledge that clinical management of CHF is more complicated than merely translating bench-to-bedside evidence in a linear fashion. This review aims to help explore this evolving area from an Australian perspective. We describe the continuation of research once core evidence is established and describe how clinician-scientist collaboration with a bedside-to-bench view can help enhance evidence translation and generalizability. We describe why an extension of the available evidence or generating new evidence is occasionally needed to address the increasingly diverse cohort of patients. Finally, we explore some of the tools used by basic scientists and clinicians to develop evidence and describe the ones we feel may be most beneficial.
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Affiliation(s)
- P Iyngkaran
- Flinders University, NT Medical School, Darwin, Australia
| | - M Thomas
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
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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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15
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Progression of left ventricular diastolic dysfunction in ethnic minorities. High Blood Press Cardiovasc Prev 2015; 21:205-11. [PMID: 24235072 DOI: 10.1007/s40292-013-0031-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Approximately 50 % of heart failure cases are due to diastolic failure. Generally, it is thought that asymptomatic diastolic dysfunction precedes the development of diastolic heart failure, representing an ideal time for intervention. Previous studies have examined progression rates in non-minority populations only. OBJECTIVE To determine the rate of diastolic dysfunction progression and the associated risk factors in a predominately ethnic minority population. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of participants drawn from the echocardiogram database and Electronic Health Record (EHR) for an academic medical center. Individuals with 2 or more echocardiograms showing diastolic dysfunction during a six year study period (2006–2012) were selected. MAIN OUTCOME MEASURES Change in diastolic function grade over time and risk factors associated with this change. RESULTS During the six-year retrospective study period, 154 patients with 2 or more echocardiograms demonstrating diastolic dysfunction were reviewed; these represented 496 echocardiograms. The mean time between echocardiograms was 1.9 years. Mean age was 64.6 (±10.1) years,81 % were female, and average BMI was 30.5(±7.4). The majority of subjects had Grade I diastolic dysfunction at the initial examination (87.7 % (n = 135)); 9 % (n = 14) had Grade II, and 3 % (n = 5) had Grade III. Approximately 27.9 % (n = 43) of the study cohort demonstrated overall worsening grade of diastolic dysfunction over time. Diastolic dysfunction grade was unchanged in 62 %(n = 96), improved in 9.7 % (n = 14), and worsened then improved in 0.7 % (n = 1). CONCLUSIONS Our study showed a slightly higher rate of diastolic dysfunction progression in this predominately ethnic minority population. This is consistent with a previous study in a non-minority population demonstrating the progressive nature of diastolic dysfunction over time.Understanding the role of cardiovascular disease risk factors in accelerating progression rates from asymptomatic diastolic dysfunction to symptomatic stages is paramount to optimize intervention strategies.
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Bresan D, Bastos JL, Leite MS. Epidemiology of high blood pressure among the Kaingang people on the Xapecó Indigenous Land in Santa Catarina State, Brazil, 2013. CAD SAUDE PUBLICA 2015; 31:331-44. [DOI: 10.1590/0102-311x00058714] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/28/2014] [Indexed: 11/21/2022] Open
Abstract
This cross-sectional study describes the prevalence of high blood pressure (HBP; measured at one setting, and suggestive of a clinical diagnosis of arterial hypertension) and mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) and their associations with socio-demographic and anthropometric variables among 355 Kaingang adults (≥ 20 years) on the Xapecó Indigenous Land in Brazil. Weight, height, waist circumference (WC), SBP, and DBP were measured and socio-demographic data were collected. Prevalence of HBP was 53.2% (95%CI: 45.3; 61.1) in men and 40.7% (95%CI: 33.8; 47.6) in women. In women, age and WC were directly associated with HBP; age was associated with SBP and schooling with DBP. In men, HBP was statistically associated with high body mass index (BMI) and tile floor in the home (as a socioeconomic proxy); BMI and WC were associated with SBP; BMI and WC were associated with DBP. The study highlights the need for measures to control risk factors for HBP, especially due to its relevance for cardiovascular diseases and their consequences.
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Affiliation(s)
- Deise Bresan
- Universidade Federal de Mato Grosso do Sul, Brasil
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Russo V, Santarelli S, Magrini L, Moscatelli P, Altomonte F, Cremonesi G, Battista S, Maggiorotto M, Pinto N, Maroccia A, Glorioso N, Sircana A, Moro M, Pugliese FR, Revello A, Di Somma S. Multicentre Italian analysis on cardiovascular diseases: impact of immigrants' referral to emergency department. J Cardiovasc Med (Hagerstown) 2014; 18:136-143. [PMID: 25333377 DOI: 10.2459/jcm.0000000000000221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
During the recent years, immigration in Italy has increased. There are few data on the health status of immigrants and there is a need to improve their healthcare. Cardiovascular disorders account for 7.6% of immigrants' diseases and cause 3.6% of the total deaths. Lack of healthcare services to general medicine support and prescriptions leads immigrants to contact the Emergency Department (ED) to receive medical assistance. Primary endpoints of this study were to assess the use of national healthcare system by immigrants and to determine the incidence of cardiovascular diseases, and the frequency and type of risk factors for cardiovascular diseases in these patients. A no-profit, observational, multicentre study was conducted from April to September 2012. We studied 642 foreign patients referring to the ED for various symptoms/signs. One hundred and fourteen patients referred for suspected cardiovascular disease and 105 had a confirmed final diagnosis of cardiovascular disease. The more represented ethnic origin was Caucasian (59%), whereas the most represented country was Romania (24%). The main symptom recorded at ED arrival was chest pain (37.1%). Final cardiovascular diagnoses were represented by: hypertensive crisis (28.5%), acute coronary syndrome (20%), acute heart failure (12.3%), atrial fibrillation (10.4%) and chest pain (10.4%). Past medical history of cardiovascular disease, hypertension, obesity and male sex showed independent significant predictive value for cardiovascular disease diagnosis.Our study provides support for the development of specific primary prevention of cardiovascular risk factors in immigrants with the important role of culturally competent education of individuals and families. Better outpatient management seems to be needed in order to limit the need for emergency room referral.
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Affiliation(s)
- Veronica Russo
- aEmergency Department, Sant'Andrea Hospital, School of Medicine and Psychology 'Sapienza' University, Rome bEmergency Medicine Department, San Martino Teaching Hospital, Genova University, Genoa cEmergency Medicine Department, Città della Scienza e della Salute Hospital, Turin dEmergency Medicine Department, Bari Teaching Hospital, Bari eEmergency Medicine Department, Sassari Teaching Hospital, Sassari fEmergency Medicine Department, Sandro Pertini Hospital, Rome, Italy
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Choi D, Nemi E, Fernando C, Gupta M, Moe GW. Differences in the Clinical Characteristics of Ethnic Minority Groups With Heart Failure Managed in Specialized Heart Failure Clinics. JACC-HEART FAILURE 2014; 2:392-9. [DOI: 10.1016/j.jchf.2014.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/04/2014] [Accepted: 02/08/2014] [Indexed: 11/25/2022]
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Piña IL, Ventura HO. Heart Failure in Ethnic Minorities. JACC-HEART FAILURE 2014; 2:400-2. [DOI: 10.1016/j.jchf.2014.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 03/28/2014] [Indexed: 11/15/2022]
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20
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Yeung DF, Van Dyke NK, Maclagan LC, Moe GW, Shah BR, Chiu M, Lee DS, Ko DT, Lau C, Tu JV. A comparison of Chinese and non-Chinese Canadian patients hospitalized with heart failure. BMC Cardiovasc Disord 2013; 13:114. [PMID: 24325765 PMCID: PMC4029301 DOI: 10.1186/1471-2261-13-114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 12/01/2013] [Indexed: 11/10/2022] Open
Abstract
Background Canadians of Chinese descent, represent one of the fastest growing visible minority groups in Canada, (as well as the second largest), but relatively little is known about the clinical features of heart failure (HF) in Chinese-Canadian versus non-Chinese Canadian patients. Methods We conducted a population-based analysis of urban patients hospitalized in Ontario, Canada for the first time with a most responsible diagnosis of HF between April 1, 1995 and March 31, 2008. Among the 99,278 patients, 1,339 (1.3%) were classified as Chinese using a previously validated list of Chinese surnames. Through linkage to other administrative databases, we compared the clinical characteristics, pharmacological management, and outcomes of Chinese versus non-Chinese HF patients. Results Ischemic heart disease was identified as the possible etiology of HF in a greater proportion of non-Chinese patients (47.7% vs. 35.3%; p < 0.001) whereas hypertension (26.1% vs. 16.1%; p < 0.001) and valvular heart disease (11.6% vs. 7.2%; p < 0.001) were relatively more common in Chinese patients. Chinese patients were prescribed angiotensin-converting enzyme (ACE) inhibitors less frequently (57.5% vs. 66.4%, p < 0.001) and angiotensin receptor blockers (ARBs) more frequently (17.4% vs. 8.9%, p < 0.001) compared to non-Chinese patients. They were also less likely to be adherent to ACE inhibitors over a 1-year follow up period. However, the 1-year case-fatality rates were comparable between the Chinese (31.7%) and non-Chinese (30.2%) subjects (p = 0.24). Conclusion There are important differences in the causes and medical management of HF in Chinese and non-Chinese patients residing in Canada. Despite these differences, the long-term outcomes of HF patients were similar.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jack V Tu
- Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue G250, Toronto ON, Canada.
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Huang Y, Lian J, Huang RS, Wang F, Xu L, Le Y, Yang X, Xu W, Huang X, Ye M, Zhou J, Duan S. Positive association between rs10918859 of the NOS1AP gene and coronary heart disease in male Han Chinese. Genet Test Mol Biomarkers 2012; 17:25-9. [PMID: 23171141 DOI: 10.1089/gtmb.2012.0254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Westaway et al. have revealed a significant association between common variants of calsequestrin-2 (CASQ2) and nitric oxide synthase 1 (neuronal) adaptor protein (NOS1AP) and the risk of sudden death in patients of coronary heart disease (CHD). In light of the findings, we aim to explore the association between variants of the two genes and CHD risk in Han Chinese. Our results show a significant contribution of rs10918859 of the NOS1AP gene to CHD in Han Chinese (genotype: χ(2)=8.33, df=2, p=0.015; allele: χ(2)=4.00, df=1, p=0.047, odds ratio [OR]=1.44, 95% confidence interval [CI]=1.00-2.05). The association of rs10918859 with CHD is seen only in men (genotype: χ(2)=7.81, df=2, p=0.02; allele: χ(2)=4.49, df=1, p=0.03, OR=1.66, 95% CI=1.03-2.66). Moreover, rs10918859 is likely to exert its effect under a dominant model in men (χ(2)=7.6, df=1, p=0.005, OR=2.46, 95% CI=1.29-4.71). No association is observed between CASQ2 variants and CHD risk. The frequencies of rs12084280-C and rs10918859-A are higher in Han Chinese (36.7% and 41.6%) than those in Europeans (11% and 19.4%, respectively). These ethnic differences imply that further validation of NOS1AP in the susceptibility of CHD in other populations is warranted. We confirm that rs10918859 of the NOS1AP gene is associated with CHD in Han Chinese. In addition, here we report a gender effect in the association between rs10918859 of the NOS1AP gene and CHD.
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Affiliation(s)
- Yi Huang
- The Affiliated Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
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Disparities in healthcare utilisation rates for Aboriginal and non-Aboriginal Albertan residents, 1997-2006: a population database study. PLoS One 2012; 7:e48355. [PMID: 23152770 PMCID: PMC3495946 DOI: 10.1371/journal.pone.0048355] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 09/24/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is widely recognised that significant discrepancies exist between the health of indigenous and non-indigenous populations. Whilst the reasons are incompletely defined, one potential cause is that indigenous communities do not access healthcare to the same extent. We investigated healthcare utilisation rates in the Canadian Aboriginal population to elucidate the contribution of this fundamental social determinant for health to such disparities. METHODS Healthcare utilisation data over a nine-year period were analysed for a cohort of nearly two million individuals to determine the rates at which Aboriginal and non-Aboriginal populations utilised two specialties (Cardiology and Ophthalmology) in Alberta, Canada. Unadjusted and adjusted healthcare utilisation rates obtained by mixed linear and Poisson regressions, respectively, were compared amongst three population groups - federally registered Aboriginals, individuals receiving welfare, and other Albertans. RESULTS Healthcare utilisation rates for Aboriginals were substantially lower than those of non-Aboriginals and welfare recipients at each time point and subspecialty studied [e.g. During 2005/06, unadjusted Cardiology utilisation rates were 0.28% (Aboriginal, n = 97,080), 0.93% (non-Aboriginal, n = 1,720,041) and 1.37% (Welfare, n = 52,514), p = <0.001]. The age distribution of the Aboriginal population was markedly different [2.7%≥65 years of age, non-Aboriginal 10.7%], and comparable utilisation rates were obtained after adjustment for fiscal year and estimated life expectancy [Cardiology: Incidence Rate Ratio 0.66, Ophthalmology: IRR 0.85]. DISCUSSION The analysis revealed that Aboriginal people utilised subspecialty healthcare at a consistently lower rate than either comparatively economically disadvantaged groups or the general population. Notably, the differences were relatively invariant between the major provincial centres and over a nine year period. Addressing the causes of these discrepancies is essential for reducing marked health disparities, and so improving the health of Aboriginal people.
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Eaton CB, Abdulbaki AM, Margolis KL, Manson JE, Limacher M, Klein L, Allison MA, Robinson JG, Curb JD, Martin LA, Liu S, Howard BV. Racial and ethnic differences in incident hospitalized heart failure in postmenopausal women: the Women's Health Initiative. Circulation 2012; 126:688-96. [PMID: 22753306 DOI: 10.1161/circulationaha.111.066688] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The differences in the incidence of heart failure by race/ethnicity and the potential mechanisms for these differences are largely unexplored in women. METHODS AND RESULTS A total of 156 143 postmenopausal women free of self-reported heart failure enrolled from 1993 to 1998 at 40 clinical centers throughout the United States as part of the Women's Health Initiative and were followed up until 2005, for an average of 7.8 years, for incident hospitalized heart failure. Incident rates, hazard ratios (HRs), and 95% confidence intervals were determined by use of the Cox proportional hazard model comparing racial/ethnic groups, and population-attributable risk percentages were calculated for each racial/ethnic group. Blacks had the highest age-adjusted incidence of heart failure (380 in 100 000 person-years), followed by whites (274), Hispanics (193), and Asian/Pacific Islanders (103). The excess risk in blacks compared with whites (age-adjusted HR=1.45) was significantly attenuated by adjustment for household income (HR=0.97) and diabetes mellitus (HR=0.89), but the lower risk in Hispanics (age-adjusted HR=0.72) and Asian/Pacific Islanders (age-adjusted HR=0.44) remained despite adjustment for traditional risk factors, socioeconomic status, lifestyle, and access-to-care variables. The effect of adjustment for interim coronary heart disease on nonwhite versus white HRs for heart failure differed by race/ethnic group. CONCLUSIONS Asian/Pacific Islander and Hispanic women have a lower incidence of heart failure and black women have higher rates of heart failure compared with white women. The excess risk of incident heart failure in black women is explained largely by adjustment for lower household incomes and diabetes mellitus in black women, whereas the lower rates of heart failure in Asian/Pacific Islanders and Hispanics are largely unexplained by the risk factors measured in this study. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000611.
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Affiliation(s)
- Charles B Eaton
- Alpert Medical School of Brown University, Director, Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, 111 Brewster St, Pawtucket, RI 02860, USA.
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Cardiac rehabilitation participation in underserved populations. Minorities, low socioeconomic, and rural residents. J Cardiopulm Rehabil Prev 2011; 31:203-10. [PMID: 21705915 DOI: 10.1097/hcr.0b013e318220a7da] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cardiac rehabilitation (CR) services in the United States are underutilized and participation is particularly low for racial and ethnic minorities, low socioeconomic status patients, and rural residents. Reduced participation may not only indicate a failure in transitional cardiac care during the in hospital referral process but also could be due to barriers attributed to patients, providers, employers, or medical systems. In-depth analysis of this problem is impeded by difficulties with the identification of underserved groups in clinical settings. Disparities in CR participation certainly contribute to poor medical outcomes in these populations that stand to benefit greatly from lifestyle modifications. It is critical that CR providers survey their communities for underserved populations and coordinate creative efforts aimed at overcoming barriers to participation. Moreover, it is likely that referral to, and participation in, CR will soon be considered a quality indicator, providing further incentive for programs to optimize CR utilization among all eligible patients.
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Savage PD, Sanderson BK, Brown TM, Berra K, Ades PA. Clinical research in cardiac rehabilitation and secondary prevention: looking back and moving forward. J Cardiopulm Rehabil Prev 2011; 31:333-41. [PMID: 21946418 PMCID: PMC3219833 DOI: 10.1097/hcr.0b013e31822f0f79] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Cardiac rehabilitation/secondary prevention (CR/SP) programs are considered standard of care and provide critically important resources for optimizing the care of cardiac patients. The objective of this article is to briefly review the evolution of CR/SP programs from a singular exercise intervention to its current, more comprehensive multifaceted approach. In addition, we offer perspective on critical concerns and suggest future research considerations to optimize the effectiveness and utilization of CR/SP program interventions.
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Affiliation(s)
- Patrick D. Savage
- Division of Cardiology, Cardiac Rehabilitation & Prevention, University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, VT
| | | | - Todd M. Brown
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL
| | - Kathy Berra
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA
| | - Philip A. Ades
- Division of Cardiology, Cardiac Rehabilitation & Prevention, University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, VT
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