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Lewis KO, Popov V, Fatima SS. From static web to metaverse: reinventing medical education in the post-pandemic era. Ann Med 2024; 56:2305694. [PMID: 38261592 PMCID: PMC10810636 DOI: 10.1080/07853890.2024.2305694] [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: 09/01/2023] [Accepted: 01/06/2024] [Indexed: 01/25/2024] Open
Abstract
The World Wide Web and the advancement of computer technology in the 1960s and 1990s respectively set the ground for a substantial and simultaneous change in many facets of our life, including medicine, health care, and medical education. The traditional didactic approach has shifted towards more dynamic and interactive methods, leveraging technologies such as simulation tools, virtual reality, and online platforms. At the forefront is the remarkable evolution that has revolutionized how medical knowledge is accessed, disseminated, and integrated into pedagogical practices. The COVID-19 pandemic also led to rapid and large-scale adoption of e-learning and digital resources in medical education because of widespread lockdowns, social distancing measures, and the closure of medical schools and healthcare training programs. This review paper examines the evolution of medical education from the Flexnerian era to the modern digital age, closely examining the influence of the evolving WWW and its shift from Education 1.0 to Education 4.0. This evolution has been further accentuated by the transition from the static landscapes of Web 2D to the immersive realms of Web 3D, especially considering the growing notion of the metaverse. The application of the metaverse is an interconnected, virtual shared space that includes virtual reality (VR), augmented reality (AR), and mixed reality (MR) to create a fertile ground for simulation-based training, collaborative learning, and experiential skill acquisition for competency development. This review includes the multifaceted applications of the metaverse in medical education, outlining both its benefits and challenges. Through insightful case studies and examples, it highlights the innovative potential of the metaverse as a platform for immersive learning experiences. Moreover, the review addresses the role of emerging technologies in shaping the post-pandemic future of medical education, ultimately culminating in a series of recommendations tailored for medical institutions aiming to successfully capitalize on revolutionary changes.
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Affiliation(s)
- Kadriye O. Lewis
- Children’s Mercy Kansas City, Department of Pediatrics, UMKC School of Medicine, Kansas City, MO, USA
| | - Vitaliy Popov
- Department of Learning Health Sciences, University of MI Medical School, Ann Arbor, MI, USA
| | - Syeda Sadia Fatima
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
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Zaidi SSB, Adnan U, Lewis KO, Fatima SS. Metaverse-powered basic sciences medical education: bridging the gaps for lower middle-income countries. Ann Med 2024; 56:2356637. [PMID: 38794846 PMCID: PMC11132556 DOI: 10.1080/07853890.2024.2356637] [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: 09/27/2023] [Accepted: 04/27/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Traditional medical education often lacks contextual experience, hindering students' ability to effectively apply theoretical knowledge in real-world scenarios. The integration of the metaverse into medical education holds great enormous promise for addressing educational disparities, particularly in lower-middle-income countries (LMICs) accompanied by rapid technological advancements. This commentary paper aimed to address the potential of the metaverse in enhancing basic sciences education within the constraints faced by universities in LMICs. We also addressed learning design challenges by proposing fundamental design elements and a suggested conceptual framework for developing metaverse-based teaching methods.The goal is to assist educators and medical practitioners in comprehensivley understanding key factors in immersive teaching and learning. DISCUSSION By immersing medical students in virtual scenarios mimicking real medical settings and patient interactions, the metaverse enables practice in clinical decision-making, interpersonal skills, and exposure to complex medical situations in a controlled environment. These simulations can be customized to reflect local healthcare challenges, preparing medical students to tackle specific community needs. Various disciplines, including anatomy, physiology, pharmacy, dentistry, and pathology, have begun leveraging the metaverse to offer immersive learning experiences, foster interdisciplinary collaborations, and facilitate authentic assessments. However, financial constraints pose a significant barrier to widespread adoption, particularly in resource-limited settings like LMICs. Addressing these challenges is crucial to realizing the full potential of metaverse technology in medical education. CONCLUSION The metaverse offers a promising solution for enhancing medical education by providing immersive, context-rich learning experiences. This paper proposes a conceptual framework and fundamental design elements to aid faculty educators and medical practitioners in effectively incorporating metaverse technology into their teaching methods, thus improving educational outcomes in LMICs.
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Affiliation(s)
| | - Umer Adnan
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Kadriye O. Lewis
- Children’s Mercy Kansas City, Department of Pediatrics, UMKC School of Medicine, Kansas City, MO, USA
| | - Syeda Sadia Fatima
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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Brown L, Cambron C, Post WS, Brandt EJ. The Role of Social Determinants of Health in Atherosclerotic Cardiovascular Disease. Curr Atheroscler Rep 2024; 26:451-461. [PMID: 38980573 DOI: 10.1007/s11883-024-01226-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE OF REVIEW This review seeks to provide important information on each of the major domains of social determinants of health (SDOH) in the context of atherosclerotic cardiovascular disease. RECENT FINDINGS SDOH can be classified into five domains: social and community context, health care access and quality, neighborhood and built environment, economic stability, and education access and quality. SDOH are major drivers for cardiovascular health outcomes that exceed the impact from traditional risk factors, and explain inequities in health outcomes observed across different groups of individuals. SDOH profoundly impacts healthcare's receipt, delivery, and outcomes. Many patients fall within various disenfranchised groups (e.g., identify with minority race, low socioeconomic status, low educational attainment, LGBTQ+), which impact overall health status and care. Learning to understand, recognize, and address SDOH as the driving force of disparities are critical for achieving health equity in the prevention and adequate treatment of ASCVD.
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Affiliation(s)
- Logan Brown
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric J Brandt
- Institute for Healthcare Policy and Innovation, University of Michigan, 24 Frank Lloyd Wright Dr, Lobby A, Ann Arbor, MI, 48103, USA.
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 24 Frank Lloyd Wright Dr, Lobby A, Ann Arbor, MI, 48103, USA.
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Buus SMØ, Behrndtz AB, Schmitz ML, Hedegaard JN, Cordsen P, Johnsen SP, Phan T, Andersen G, Simonsen CZ. Urban-rural inequalities in IV thrombolysis for acute ischemic stroke: A nationwide study. Eur Stroke J 2024; 9:722-731. [PMID: 38600682 DOI: 10.1177/23969873241244591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION Rural residency has been associated with lower reperfusion treatment rates for acute ischemic stroke in many countries. We aimed to explore urban-rural differences in IV thrombolysis rates in a small country with universal health care, and short transport times to stroke units. PATIENTS AND METHODS In this nationwide cohort study, adult ischemic stroke patients registered in the Danish Stroke Registry (DSR) between 2015 and 2020 were included. The exposure was defined by residence rurality. Data from the DSR, Statistics Denmark, and the Danish Health Data Authority, were linked on the individual level using the Civil Registration Number. Adjusted treatment rates were calculated by balancing baseline characteristics using inverse probability of treatment weights. RESULTS Among the included 56,175 patients, prehospital delays were shortest for patients residing in capital municipalities (median 4.7 h), and longest for large town residents (median 7.1 h). Large town residents were predominantly admitted directly to a comprehensive stroke center (98.5%), whereas 30.9% of capital residents were admitted to a hospital with no reperfusion therapy available (non-RT unit). Treatment rates were similar among all non-rural residents (18.5%-18.7%), but slightly lower among rural residents (17.2% [95% CI 16.5-17.8]). After adjusting for age, sex, immigrant status, and educational attainment, rural residents reached treatment rates comparable to capital and large town residents at 18.5% (95% CI 17.7-19.4). DISCUSSION AND CONCLUSION While treatment rates varied minimally by urban-rural residency, substantial differences in median prehospital delay and admission to non-RT units underscored marked urban-rural differences in potential obstacles to reperfusion therapies.
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Affiliation(s)
| | | | | | | | - Pia Cordsen
- Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Thanh Phan
- Department of Medicine, School of Clinical Sciences at Monash health, Monash University, Melbourne, VIC, Australia
| | - Grethe Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Claus Ziegler Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Sekkarie A, Woodruff RC, Casper M, Paul AT, Vaughan AS. Rural-urban disparities in cardiovascular disease mortality vary by poverty level and region. J Rural Health 2024. [PMID: 39152622 DOI: 10.1111/jrh.12874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 06/18/2024] [Accepted: 08/04/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE To examine rural and urban disparities in cardiovascular disease (CVD) death rates by poverty level and region. METHODS Using 2021 county-level population and mortality data for CVD deaths listed as the underlying cause among adults aged 35-64 years, we calculated age-standardized CVD death rates and rate ratios (RR) for 4 categories of counties: high-poverty rural, high-poverty urban, low-poverty rural, and low-poverty urban (referent). Results are presented nationally and by US Census region. FINDINGS Rural and urban disparities in CVD mortality varied markedly by poverty and region. Nationally, the CVD death rate was highest among high-poverty rural areas (191 deaths per 100,000, RR: 1.76, CI: 1.73-1.78). By region, Southern high-poverty rural areas had the highest CVD death rate (256 deaths per 100,000) and largest disparity relative to low-poverty urban areas (RR: 2.05; CI: 2.01-2.09). In the Midwest and West, CVD death rates among high-poverty areas were higher than low-poverty areas, regardless of rural or urban classification. CONCLUSIONS Results reinforce the importance of prioritizing high-poverty rural areas, especially in the South, in efforts to reduce CVD mortality. These efforts may need to consider socioeconomic conditions and region, in addition to rural and urban disparities.
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Affiliation(s)
- Ahlia Sekkarie
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rebecca C Woodruff
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michele Casper
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Angela-Thompson Paul
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Adam S Vaughan
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Stinehart KR, Hyer JM, Joshi S, Brummel NE. Healthcare Use and Expenditures in Rural Survivors of Hospitalization for Sepsis. Crit Care Med 2024:00003246-990000000-00363. [PMID: 39137035 DOI: 10.1097/ccm.0000000000006397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
OBJECTIVES Sepsis survivors have greater healthcare use than those surviving hospitalizations for other reasons, yet factors associated with greater healthcare use in this population remain ill-defined. Rural Americans are older, have more chronic illnesses, and face unique barriers to healthcare access, which could affect postsepsis healthcare use. Therefore, we compared healthcare use and expenditures among rural and urban sepsis survivors. We hypothesized that rural survivors would have greater healthcare use and expenditures. DESIGN, SETTING, AND PATIENTS To test this hypothesis, we used data from 106,189 adult survivors of a sepsis hospitalization included in the IBM MarketScan Commercial Claims and Encounters database and Medicare Supplemental database between 2013 and 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We identified hospitalizations for severe sepsis and septic shock using the International Classification of Diseases, 9th Edition (ICD-9) or 1CD-10 codes. We used Metropolitan Statistical Area classifications to categorize rurality. We measured emergency department (ED) visits, inpatient hospitalizations, skilled nursing facility admissions, primary care visits, physical therapy visits, occupational therapy visits, and home healthcare visits for the year following sepsis hospitalizations. We calculated the total expenditures for each of these categories. We compared outcomes between rural and urban patients using multivariable regression and adjusted for covariates. After adjusting for age, sex, comorbidities, admission type, insurance type, U.S. Census Bureau region, employment status, and sepsis severity, those living in rural areas had 17% greater odds of having an ED visit (odds ratio [OR] 1.17; 95% CI, 1.13-1.22; p < 0.001), 9% lower odds of having a primary care visit (OR 0.91; 95% CI, 0.87-0.94; p < 0.001), and 12% lower odds of receiving home healthcare (OR 0.88; 95% CI, 0.84-0.93; p < 0.001). Despite higher levels of ED use and equivalent levels of hospital readmissions, expenditures in these areas were 14% (OR 0.86; 95% CI, 0.80-0.91; p < 0.001) and 9% (OR 0.91; 95% CI, 0.87-0.96; p < 0.001) lower among rural survivors, respectively, suggesting these services may be used for lower-acuity conditions. CONCLUSIONS In this large cohort study, we report important differences in healthcare use and expenditures between rural and urban sepsis survivors. Future research and policy work is needed to understand how best to optimize sepsis survivorship across the urban-rural continuum.
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Affiliation(s)
- Kyle R Stinehart
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
- Department of Internal Medicine, Center for Health Outcomes in Medicine Scholarship and Service (HOMES), The Ohio State University Wexner Medical Center, Columbus, OH
| | - J Madison Hyer
- Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH
- Secondary Data Core, The Ohio State University Center for Clinical and Translational Science, Columbus, OH
| | - Shivam Joshi
- Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH
- Secondary Data Core, The Ohio State University Center for Clinical and Translational Science, Columbus, OH
| | - Nathan E Brummel
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
- Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University College of Medicine, Columbus, OH
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University College of Medicine, Columbus, OH
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Agrons K, Nambi V, Salas R, Minhas AMK. Suicide-related mortality in cardiovascular disease in the United States from 1999 to 2019. J Natl Med Assoc 2024; 116:378-389. [PMID: 39098558 DOI: 10.1016/j.jnma.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/13/2024] [Accepted: 07/02/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION Research has shown chronic diseases can be associated with suicide but there is limited data on suicide in cardiovascular disease (CVD). Given the substantial psychosocial, financial, quality of life, and health impact of CVD, we aimed to study suicide-related mortality in CVD. METHODS We used Center for Disease Control Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access Multiple Cause of Death data from 1999 to 2019. Suicide and CVD related deaths in patients ≥ 25 years were identified. Proportionate suicide-related mortality (PSrM) was calculated as suicide-related deaths (listed with CVD) divided by all CVD-related deaths (irrespective of suicide) and reported as PSrM per 100,000 CVD-related deaths. Joinpoint regression was used to examine trend changes using annual percentage change (APC) overall and by sex, race/ethnicity, disease subtype, and age. RESULTS Overall, PSrM in CVD increased from 62.8 in 1999 to 90.5 in 2019. The PSrM increased from 1999 to 2002 with an associated APC of 6.2 (95 % CI, 0.0 to 12.7), remained stable from 2002 to 2005, increased from 2005 to 2013 with an APC of 4.8 (95 % CI, 3.4 to 6.3), and decreased from 2013 to 2019 with an APC of -2.1 (95 % CI, -3.6 to -0.5). Among racial/ethnic groups, PSrM was highest in non-hispanic (NH) White (103.8), then Hispanic or Latino (63.6), and then NH Black or African American individuals (29.2). PSrM was highest in the 25-39 years age group (858), then 40-54 years (382.8), 55-69 years (146.2), 70-84 years (55.9), and then 85+ (17). PSrM initially increased in men with APC (3.1 until 2013), women (4.1 until 2014), NH White individuals (3.9 until 2013), Hispanic or Latino (3.5 until 2014), ages 40-54 years (2.9 until 2013), 55-69 years (6.0 until 2013), then stabilized or decreased. AAMR increased in NH Black or AA individuals APC (1.0) and 25-39 years APC (1.4) from 1999 to 2019. CONCLUSION PSrM in CVD peaked in the early 2010s, with varying differences across sex, racial/ethnic, and age groups. Further research is needed to understand disparities and develop preventive strategies.
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Affiliation(s)
- Kenyon Agrons
- Department of Medical Education, Baylor College of Medicine, Houston, TX, USA.
| | - Vijay Nambi
- Section of Cardiovascular Research, Department of Medicine, Baylor college of Medicine, Houston, TX, USA; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ramiro Salas
- Department of Psychiatry Research, Baylor College of Medicine, Houston, TX, USA
| | - Abdul Mannan Khan Minhas
- Section of Cardiovascular Research, Department of Medicine, Baylor college of Medicine, Houston, TX, USA
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Boakye E, Oyeka CP, Kwapong YA, Metlock FE, Khan SS, Mamas MA, Perak AM, Douglas PS, Honigberg MC, Nasir K, Blaha MJ, Sharma G. Cardiovascular Risk Profile Among Reproductive-Aged Women in the U.S.: The Behavioral Risk Factor Surveillance System, 2015-2020. AJPM FOCUS 2024; 3:100210. [PMID: 38766464 PMCID: PMC11096844 DOI: 10.1016/j.focus.2024.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Introduction Suboptimal cardiovascular health is associated with adverse pregnancy outcomes and long-term cardiovascular risk. The authors examined trends in cardiovascular risk factors and correlates of suboptimal cardiovascular risk profiles among reproductive-aged U.S. women. Methods With data from 335,959 women in the Behavioral Risk Factor Surveillance System (2015-2020), the authors conducted serial cross-sectional analysis among nonpregnant reproductive-aged women (18-44 years) without cardiovascular disease who self-reported information on 8 cardiovascular risk factors selected on the basis of Life's Essential 8 metrics. The authors estimated the prevalence of each risk factor and suboptimal cardiovascular risk profile (≥2 risk factors) and examined trends overall and by age and race/ethnicity. Using multivariable Poisson regression, the authors assessed the sociodemographic correlates of suboptimal cardiovascular risk profile. Results The weighted prevalence of women aged <35 years was approximately 64% in each survey year. The prevalence of suboptimal cardiovascular risk profile increased modestly from 72.4% (71.6%-73.3%) in 2015 to 75.9% (75.0%-76.7%) in 2019 (p<0.001). This increase was mainly driven by increases in overweight/obesity (53.1%-58.4%; p<0.001). Between 2015 and 2019, significant increases in suboptimal cardiovascular risk profile were observed among non-Hispanic White (69.8%-72.6%; p<0.001) and Hispanic (75.1%-80.3%; p<0.001) women but not among non-Hispanic Black (82.7%-83.7%; p=0.48) or Asian (68.1%-73.2%; p=0.09) women. Older age, rural residence, and non-Hispanic Black and Hispanic race and ethnicity were associated with a higher prevalence of suboptimal cardiovascular risk profile. Conclusions There has been a modest but significant increase in suboptimal cardiovascular risk profile among U.S. women of reproductive age. Urgent preventive efforts are needed to reverse this trend and improve cardiovascular health, particularly among subgroups at increased risk, to mitigate its implications.
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Affiliation(s)
- Ellen Boakye
- Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins Medicine, Baltimore, Maryland
| | - Chigolum P. Oyeka
- Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins Medicine, Baltimore, Maryland
| | - Yaa A. Kwapong
- Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins Medicine, Baltimore, Maryland
| | | | - Sadiya S. Khan
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mamas A. Mamas
- Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Staffordshire, United Kingdom
| | - Amanda M. Perak
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Pamela S. Douglas
- Division of Cardiology, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Michael C. Honigberg
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Khurram Nasir
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist, Houston, Texas
| | - Michael J. Blaha
- Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins Medicine, Baltimore, Maryland
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins Medicine, Baltimore, Maryland
- Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, Virginia
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Longenecker CT, Brant L, Okello E, Beaton A. More With Less: Diffusing Innovations in Cardiovascular Service Delivery. Circ Cardiovasc Qual Outcomes 2024; 17:e010601. [PMID: 39167768 DOI: 10.1161/circoutcomes.124.010601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Affiliation(s)
- Chris T Longenecker
- Division of Cardiology and Department of Global Health, University of Washington, Seattle (C.T.L.)
| | - Luisa Brant
- Faculty of Medicine and Hospital das Clínicas Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (L.B.)
| | - Emmy Okello
- Uganda Heart Institute, Kampala, Uganda (E.O.)
| | - Andrea Beaton
- Department of Pediatrics, University of Cincinnati and The Heart Institute at Cincinnati Children's Hospital, OH (A.B.)
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Pham HN, Sainbayar E, Ibrahim R, Lee JZ. Intracerebral hemorrhage mortality in individuals with atrial fibrillation: a nationwide analysis of mortality trends in the United States. J Interv Card Electrophysiol 2024; 67:1117-1125. [PMID: 37861964 DOI: 10.1007/s10840-023-01674-x] [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: 08/04/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is a risk factor for intracerebral hemorrhage (ICH), both with and without use of anticoagulation. Limited data exists on mortality trends and disparities related to this phenomenon. We aimed to assess ICH mortality trends and disparities based on demographic factors in individuals with atrial fibrillation in the United States (US). METHODS Our cross-sectional analysis utilized mortality data from the CDC database through death certificate queries from the years 1999 to 2020 in the US. We queried for all deaths with ICH as the underlying cause of death and atrial fibrillation as the multiple causes of death. Mortality data was obtained for overall population and demographic subpopulations based on sex, race and ethnicity, and geographic region. Trend analysis and average annual-mortality percentage change (AAPC) were completed using log-linear regression models. RESULTS ICH age-adjusted mortality rate (AAMR) in patients with AF increased from 0.27 (95% CI 0.25-0.29) in 1999 to 0.30 (95% CI 0.29-0.32) in 2020. A higher mortality rate was observed in males (AAMR 0.33) than in females (AAMR 0.26). The highest mortality was found in Asian/Pacific Islander (AAMR: 0.32) populations, followed by White (AAMR: 0.30), Black (AAMR: 0.15), and American Indian/Alaska Native (AAMR: 0.11) populations. Southern (AAPC: 1.3%) and non-metropolitan US regions (AAPC: + 1.9%) had the highest increase in annual mortality change. CONCLUSION Our findings highlight the disparities in ICH mortality in patients with AF. Further investigation is warranted to confirm these findings and evaluate for contributors to the observed disparities.
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Affiliation(s)
- Hoang Nhat Pham
- Department of Medicine, University of Arizona Tucson, Tucson, Arizona, USA
| | | | - Ramzi Ibrahim
- Department of Medicine, University of Arizona Tucson, Tucson, Arizona, USA
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue J2-2, Cleveland, Ohio, USA.
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Fasolino T, Mayfield ME, Valentine K, Rosa WE, Koci A. Palliative Care in Rural Communities. Am J Nurs 2024; 124:50-55. [PMID: 39051815 DOI: 10.1097/01.naj.0001027716.70431.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
ABSTRACT Rural communities in the United States are frequently marginalized and misrepresented. These communities face unique challenges, such as limited access to health care, nutritious food, and clean water, that contribute to persistent health disparities. This article presents the CARE (Complex, Access, Resourceful, Extraordinary) framework, which illustrates the dichotomy of rurality-its negative and positive aspects-in order to inform the development of palliative care delivery in rural settings. Various palliative care models are described that address access gaps, bolster provider capacity, and increase the provision of specialty palliative care. However, workforce shortages and reimbursement structures restrict the expansion of these services. Nurses, the largest segment of the health care workforce and the most trusted professionals, must partner with interdisciplinary colleagues and rural communities to advocate for equitable and inclusive care.
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Affiliation(s)
- Tracy Fasolino
- Tracy Fasolino is a professor and Distinguished Palliative Care Leader at the Clemson University School of Nursing in Clemson, SC, where Kathleen Valentine is a professor. Megan E. Mayfield is a doctoral student at Emory University in Atlanta. William E. Rosa is assistant attending behavioral scientist, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York City. Anne Koci is professor emerita of nursing at Texas Woman's University in Denton. Contact author: Tracy Fasolino, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Joynt Maddox KE, Elkind MSV, Aparicio HJ, Commodore-Mensah Y, de Ferranti SD, Dowd WN, Hernandez AF, Khavjou O, Michos ED, Palaniappan L, Penko J, Poudel R, Roger VL, Kazi DS. Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050-Prevalence of Risk Factors and Disease: A Presidential Advisory From the American Heart Association. Circulation 2024; 150:e65-e88. [PMID: 38832505 DOI: 10.1161/cir.0000000000001256] [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] [Indexed: 06/05/2024]
Abstract
BACKGROUND Cardiovascular disease and stroke are common and costly, and their prevalence is rising. Forecasts on the prevalence of risk factors and clinical events are crucial. METHODS Using the 2015 to March 2020 National Health and Nutrition Examination Survey and 2015 to 2019 Medical Expenditure Panel Survey, we estimated trends in prevalence for cardiovascular risk factors based on adverse levels of Life's Essential 8 and clinical cardiovascular disease and stroke. We projected through 2050, overall and by age and race and ethnicity, accounting for changes in disease prevalence and demographics. RESULTS We estimate that among adults, prevalence of hypertension will increase from 51.2% in 2020 to 61.0% in 2050. Diabetes (16.3% to 26.8%) and obesity (43.1% to 60.6%) will increase, whereas hypercholesterolemia will decline (45.8% to 24.0%). The prevalences of poor diet, inadequate physical activity, and smoking are estimated to improve over time, whereas inadequate sleep will worsen. Prevalences of coronary disease (7.8% to 9.2%), heart failure (2.7% to 3.8%), stroke (3.9% to 6.4%), atrial fibrillation (1.7% to 2.4%), and total cardiovascular disease (11.3% to 15.0%) will rise. Clinical CVD will affect 45 million adults, and CVD including hypertension will affect more than 184 million adults by 2050 (>61%). Similar trends are projected in children. Most adverse trends are projected to be worse among people identifying as American Indian/Alaska Native or multiracial, Black, or Hispanic. CONCLUSIONS The prevalence of many cardiovascular risk factors and most established diseases will increase over the next 30 years. Clinical and public health interventions are needed to effectively manage, stem, and even reverse these adverse trends.
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Kim JH, Cisneros T, Nguyen A, van Meijgaard J, Warraich HJ. Geographic Disparities in Access to Cardiologists in the United States. J Am Coll Cardiol 2024; 84:315-316. [PMID: 38986673 DOI: 10.1016/j.jacc.2024.04.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/25/2024] [Accepted: 04/26/2024] [Indexed: 07/12/2024]
Affiliation(s)
- Jeong Hwan Kim
- Brigham and Women's Hospital, Boston, Massachusetts, USA; VA Boston Healthcare System, Boston, Massachusetts, USA
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Rajagopalan N, Leung SW, Craft RS, Bailey AL. Improving Cardiovascular Health in Rural United States: Role of Academic Medical Centers. JACC. ADVANCES 2024; 3:100950. [PMID: 39129998 PMCID: PMC11312348 DOI: 10.1016/j.jacadv.2024.100950] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Affiliation(s)
- Navin Rajagopalan
- Division of Cardiology, University of Kentucky, Lexington, Kentucky, USA
| | - Steve W. Leung
- Division of Cardiology, University of Kentucky, Lexington, Kentucky, USA
| | - Rebecca S. Craft
- Division of Cardiology, University of Kentucky, Lexington, Kentucky, USA
| | - Alison L. Bailey
- Center for Heart, Lung and Vascular Health, Parkridge Medical Center, Chattanooga, Tennessee, USA
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15
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Mentias A, Keshvani N, Sumarsono A, Desai R, Khan MS, Menon V, Hsich E, Bress AP, Jacobs J, Vasan RS, Fonarow GC, Pandey A. Patterns, Prognostic Implications, and Rural-Urban Disparities in Optimal GDMT Following HFrEF Diagnosis Among Medicare Beneficiaries. JACC. HEART FAILURE 2024; 12:1044-1055. [PMID: 37943222 DOI: 10.1016/j.jchf.2023.08.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Patterns and disparities in guideline-directed medical therapy (GDMT) uptake for heart failure with reduced ejection fraction (HFrEF) across rural vs urban regions are not well described. OBJECTIVES This study aims to evaluate patterns, prognostic implications, and rural-urban differences in GDMT use among Medicare beneficiaries following new-onset HFrEF. METHODS Patients with a diagnosis of new-onset HFrEF in a 5% Medicare sample with available data for Part D medication use were identified from January 2015 through December 2020. The primary exposure was residence in rural vs urban zip codes. Optimal triple GDMT was defined as ≥50% of the target daily dose of beta-blockers, ≥50% of the target daily dose of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker or any dose of sacubitril/valsartan, and any dose of mineralocorticoid receptor antagonist. The association between the achievement of optimal GDMT over time following new-onset HFrEF diagnosis and risk of all-cause mortality and subsequent HF hospitalization was also evaluated using adjusted Cox models. The association between living in rural vs urban location and time to optimal GDMT achievement over a 12-month follow-up was assessed using cumulative incidence curves and adjusted Fine-Gray subdistribution hazard models. RESULTS A total of 41,296 patients (age: 76.7 years; 15.0% Black; 27.6% rural) were included. Optimal GDMT use over the 12-month follow-up was low, with 22.5% initiated on any dose of triple GDMT and 9.1% on optimal GDMT doses. Optimal GDMT on follow-up was significantly associated with a lower risk of death (HR: 0.89 [95% CI: 0.85-0.94]; P < 0.001) and subsequent HF hospitalization (HR: 0.93 [95% CI: 0.87-0.98]; P = 0.02). Optimal GDMT use at 12 months was significantly lower among patients living in rural (vs urban) areas (8.4% vs 9.3%; P = 0.02). In adjusted analysis, living in rural (vs urban) locations was associated with a significantly lower probability of achieving optimal GDMT (HR: 0.92 [95% CI: 0.86-0.98]; P = 0.01 Differences in optimal GDMT use following HFrEF diagnosis accounted for 16% of excess mortality risk among patients living in rural (vs urban) areas. CONCLUSIONS Use of optimal GDMT following new-onset HFrEF diagnosis is low, with substantially lower use noted among patients living in rural vs urban locations. Suboptimal GDMT use following new-onset HFrEF was associated with an increased risk of mortality and subsequent HF hospitalization.
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Affiliation(s)
- Amgad Mentias
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Andrew Sumarsono
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | - Venu Menon
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eileen Hsich
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Adam P Bress
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Joshua Jacobs
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Ramachandran S Vasan
- School of Public Health, Department of Population Health, and Division of Cardiology, Long School of Medicine, University of Texas San Antonio, San Antonio, Texas, USA
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center, Los Angeles, California, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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Mszar R, Hagan K, Lahan S, Parekh T. Cost and non-cost factors associated with delays in receiving medical care in adults with atherosclerotic cardiovascular disease. J R Coll Physicians Edinb 2024; 54:127-132. [PMID: 38804568 DOI: 10.1177/14782715241256693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The study aims to compare cost and non-cost factors associated with delays in receiving medical care in adults with atherosclerotic cardiovascular disease (ASCVD). METHODS Using 2014-2018 data from the Centers for Disease Control and Prevention (CDC) Behaviour Risk Factor Surveillance System (BRFSS) survey (N = 508,203), multivariate logistic regression models were developed to compute the adjusted odds ratio of reasons for delays in medical care in adults with ASCVD. RESULTS Our study population of 61,227 adults with ASCVD (9.1%) had higher odds of any medical care delay (aOR 1.50, 95% CI 1.43-1.57), delay due to cost (aOR 1.55, 95% CI 1.45-1.65), long clinic wait times (aOR 1.21, 95% CI 1.04-1.39) and lack of transportation (aOR 1.64, 95% CI 1.47-1.84) than those without ASCVD. CONCLUSION Novel public health and health policy approaches are urgently needed to reduce the cost- and non-cost-related barriers that adults with ASCVD encounter when accessing healthcare services.
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Affiliation(s)
- Reed Mszar
- Department of Chronic Disease Epidemiology, Yale University, New Haven, CT, USA
| | - Kobina Hagan
- Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Shubham Lahan
- Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Tarang Parekh
- Epidemiology Program, College of Health Sciences, University of Delaware, Newark, DE, USA
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17
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Ma C. The mediating effect of uncertainty in illness between heart failure symptoms and health-related quality of life among rural patients with heart failure: A multi-center cross-sectional study. Heart Lung 2024; 66:71-77. [PMID: 38593676 DOI: 10.1016/j.hrtlng.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The health-related quality of life (HRQoL) of patients with heart failure (HF) in rural settings in China remains unclear. Limited studies explored the mediating effect of uncertainty in illness between heart failure symptoms and HRQoL in this population. OBJECTIVES To explore the status of HRQoL in rural patients with HF; assess the impact of HF symptoms and uncertainty in illness on HRQoL; and examine the mediating effect of uncertainty in illness on the relationship between symptoms and HRQoL in rural patients with HF. METHODS Overall, 298 rural patients with HF were recruited from five township hospitals of Taishan and Jinzhong City in China between November 2021 and August 2022. Three variables, namely HF symptoms, uncertainty in illness, and HRQoL were measured using three validated scales. RESULTS The average score of HRQoL in rural patients with HF was 43.19. Of the participants, 60.4 %, 35.23 %, and 4.37 % exhibited poor, moderate, and good HRQoL, respectively. The HF symptoms (β = -0.47) and uncertainty in illness (β = -0.34) directly influenced HRQoL. Moreover, the HF symptoms also indirectly affected HRQoL through uncertainty in illness (β = -0.07). The indirect effect accounted for 12.96 % of the total effect of HF symptoms on HRQoL. CONCLUSION Rural patients with HF exhibited poor HRQoL. In this population, HF symptoms and uncertainty in illness were negatively associated with HRQoL. Uncertainty in illness mediated the relationship between HF symptoms and HRQoL. Tailored healthcare services should be developed for the rural population to alleviate HF symptoms, reduce uncertainty in illness, and enhance their HRQoL.
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Affiliation(s)
- Chunhua Ma
- School of Nursing, Guangzhou Medical University, 195 Dongfengxi Rd., Guangzhou, Guangdong 510180, China.
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18
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Mehta A, Spitz J, Sharma S, Bonomo J, Brewer LC, Mehta LS, Sharma G. Addressing Social Determinants of Health in Maternal Cardiovascular Health. Can J Cardiol 2024; 40:1031-1042. [PMID: 38387722 DOI: 10.1016/j.cjca.2024.02.010] [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: 11/09/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024] Open
Abstract
Cardiovascular diseases (CVDs) remain the number-one cause of maternal mortality, with over two-thirds of cases being preventable. Social determinants of health (SDoH) encompass the nonmedical social and environmental factors that an individual experiences that have a significant impact on their health. These stressors disproportionately affect socially disadvantaged and minority populations. Pregnancy is a physiologically stressful state that can unmask underlying CVD risk factors and lead to adverse pregnancy outcomes (APOs). Disparities in APOs are particularly pronounced among individuals of color and those from economically disadvantaged backgrounds. This variation underscores healthcare inequity and access, a failure of the healthcare system. Besides short-term negative effects, APOs also are associated strongly with long-term CVDs. APOs therefore must be identified as a cue for early intervention, for the prevention and management of CVD risk factors. This review explores the intricate relationship among maternal morbidity and mortality, SDoH, and cardiovascular health, and the implementation of health policy efforts to reduce the negative impact of SDoH in this patient population. The review emphasizes the importance of comprehensive strategies to improve maternal health outcomes.
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Affiliation(s)
- Adhya Mehta
- Department of Internal Medicine, Albert Einstein College of Medicine and Jacobi Medical Center, Bronx, New York, USA
| | - Jared Spitz
- Department of Cardiovascular Medicine, Inova Health System, Falls Church, Virginia, USA
| | - Sneha Sharma
- Department of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jason Bonomo
- Department of Cardiovascular Medicine, Inova Health System, Falls Church, Virginia, USA
| | - LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Laxmi S Mehta
- Department of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Garima Sharma
- Department of Cardiovascular Medicine, Inova Health System, Falls Church, Virginia, USA.
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Bucci T, Romiti GF, Corica B, Shantsila A, Teo WS, Park HW, Shimizu W, Tse HF, Proietti M, Chao TF, Lip GYH. Educational status and the risk of adverse outcomes in Asian patients with atrial fibrillation: a report from the prospective APHRS-AF Registry. Minerva Med 2024; 115:308-319. [PMID: 38727706 DOI: 10.23736/s0026-4806.24.09159-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of educational status (ES) on the clinical course of Asian patients with atrial fibrillation (AF). METHODS We used data from the prospective APHRS-AF Registry. ES was classified as follows: low (primary school), medium (secondary), and high (University). The primary outcome was a composite of all-cause death, thromboembolic events, acute coronary syndrome, and heart failure. Secondary outcomes were each component of the primary outcome, cardiovascular death, and major bleeding. The one-year risk of primary and secondary outcomes was assessed through Cox-regressions. Adherence to the Atrial fibrillation Better Care (ABC) pathway was assessed. RESULTS Among 2697 AF patients (69±12 years, 34.8% females), 34.6% had low ES; 37.3% had medium ES; and 28.1% had high ES. Compared to patients with medium-high ES, patients with low ES were older, more often females, with a higher prevalence of cardiovascular risk factors, and a lower ABC pathway adherence (30.4% vs. 40.2%, P<0.001). On multivariable analysis, low ES was associated with a higher risk for the primary outcome (HR 1.52,95%CI 1.11-2.06) and all-cause death (HR 1.76,95%CI 1.10-2.83) than medium-high ES. A significant interaction was found for the risk of composite outcome among the different age strata, with the higher risk in the elderly (P for int=0.008), whereas the beneficial effect of the ABC pathway was irrespective of ES (P for int=0.691). CONCLUSIONS In Asian AF patients, low ES is associated with high mortality. Efforts to improve education and include ES evaluation in the integrated care approach for AF are necessary to reduce the cardiovascular burden in these patients.
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Affiliation(s)
- Tommaso Bucci
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of General and Specialized Surgery, Sapienza University, Rome, Italy
| | - Giulio F Romiti
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Bernadette Corica
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Alena Shantsila
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Wee-Siong Teo
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Hyung-Wook Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, School of Clinical Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Marco Proietti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Subacute Care, IRCCS Maugeri Scientific Clinical Institutes, Milan, Italy
| | - Tze-Fan Chao
- Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan (R.O.C.)
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (R.O.C.)
| | - Gregory Y H Lip
- Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK -
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Kaur G, Masket D, Reddy T, Revankar S, Satish P, Paquin A, Mulvagh S, O'Donoghue ML, Zieroth S, Farkouh M, Gulati M. Socioeconomic Disparities in Women's Cardiovascular Health in the United States and Canada. Can J Cardiol 2024; 40:1056-1068. [PMID: 38593915 DOI: 10.1016/j.cjca.2024.04.001] [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: 12/21/2023] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024] Open
Abstract
Cardiovascular disease has been the leading cause of death in the United States and Canada for decades. Although it affects millions of people across a multitude of backgrounds, notable disparities in cardiovascular health are observed among women and become more apparent when accounting for race and socioeconomic status. Although intrinsic sex-specific physiologic differences predispose women to poorer outcomes, social determinants of health (SDOH) and biases at both the individual provider and the larger health care system levels play an equal, if not greater, role. This review examines socioeconomic disparities in women compared with men regarding cardiovascular risk factors, treatments, and outcomes. Although various at-risk subpopulations exist, we highlight the impact of SDOH in specific populations, including patients with disabilities, transgender persons, and South Asian and Indigenous populations. These groups are underrepresented in studies and experience poorer health outcomes owing to structural barriers to care. These findings emphasise the significance of understanding the interplay of different socioeconomic factors and how their stacking can negatively affect women's cardiovascular health. To address these disparities, we propose a multipronged approach to augment culturally sensitive and patient-centred care. This includes increased cardiovascular workforce diversity, inclusion of underrepresented populations into analyses of cardiovascular metrics, and greater utilisation of technology and telemedicine to improve access to health care. Achieving this goal will necessitate active participation from patients, health care administrators, physicians, and policy makers, and is imperative in closing the cardiovascular health gap for women over the coming decades.
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Affiliation(s)
- Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Diane Masket
- Rowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Tina Reddy
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Shruti Revankar
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Priyanka Satish
- Ascension Texas Cardiovascular, University of Texas at Austin Dell School of Medicine, Austin, Texas, USA
| | - Amelie Paquin
- Barbra Streisand Women's Heart Center, Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Sharon Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michelle L O'Donoghue
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shelley Zieroth
- Division of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Farkouh
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Martha Gulati
- Barbra Streisand Women's Heart Center, Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA.
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Meng Y, Yu R, Bai H, Han J. Evidence From the China Family Panel Studies Survey on the Effect of Integrating the Basic Medical Insurance System for Urban and Rural Residents on the Health Equity of Residents: Difference-in-Differences Analysis. JMIR Public Health Surveill 2024; 10:e50622. [PMID: 38815256 PMCID: PMC11176868 DOI: 10.2196/50622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/22/2023] [Accepted: 03/31/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND The fragmentation of the medical insurance system is a major challenge to achieving health equity. In response to this problem, the Chinese government is pushing to establish the unified Urban and Rural Resident Basic Medical Insurance (URRBMI) system by integrating the New Rural Cooperative Medical Scheme and the Urban Resident Basic Medical Insurance. By the end of 2020, URRBMI had been implemented almost entirely across China. Has URRBMI integration promoted health equity for urban and rural residents? OBJECTIVE This study aims to examine the effect of URRBMI integration on the health level of residents and whether the integration can contribute to reducing health disparities and promoting health equity. METHODS We used the staggered difference-in-differences method based on the China Family Panel Studies survey from 2014 to 2018. Our study had a nationally representative sample of 27,408 individuals from 98 cities. We chose self-rated health as the measurement of health status. In order to more accurately discern whether the sample was covered by URRBMI, we obtained the exact integration time of URRBMI according to the official documents issued by local governments. Finally, we grouped the sample by urban and rural areas, regions, and household income to examine the impact of the integration on health equity. RESULTS We found that overall, the URRBMI integration has improved the health level of Chinese residents (B=0.066, 95% CI 0.014-0.123; P=.01). In terms of health equity, the results showed that first, the integration has improved the health level of rural residents (B=0.070, 95% CI 0.012-0.128; P=.02), residents in western China (B=0.159, 95% CI 0.064-0.255; P<.001), and lower-middle-income groups (B=0.113, 95% CI 0.004-0.222, P=.04), so the integration has played a certain role in narrowing the health gap between urban and rural areas, different regions, and different income levels. Through further mechanism analysis, we found that the URRBMI integration reduced health inequity in China by facilitating access to higher-rated hospitals and increasing reimbursement rates for medical expenses. However, the integration did not improve the health of the central region and low-income groups, and the lack of access to health care for low-income groups was not effectively reduced. CONCLUSIONS The role of URRBMI integration in promoting health equity among urban and rural residents was significant (P=.02), but in different regions and income groups, it was limited. Focusing on the rational allocation of medical resources between regions and increasing the policy tilt toward low-income groups could help improve the equity of health insurance integration.
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Affiliation(s)
- Yingying Meng
- School of Political Science and Public Administration, Center for Social Security Studies, Wuhan University, Wuhan, China
| | - Ran Yu
- School of Political Science and Public Administration, Center for Social Security Studies, Wuhan University, Wuhan, China
| | - Huixin Bai
- School of Political Science and Public Administration, Center for Social Security Studies, Wuhan University, Wuhan, China
| | - Junqiang Han
- School of Public Management, South-Central Minzu University, Wuhan, China
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22
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Cheng R, Kittleson MM, Wechalekar AD, Alvarez-Cardona J, Mitchell JD, Scarlatelli Macedo AV, Dutra JPP, Campbell CM, Liu JE, Landau HJ, Davis MK, Morrissey S, Casselli S, Lousada I, Seabra-Garcez JD, Szor RS, Ganatra S, Trachtenberg B, Maurer MS, Stockerl-Goldstein K, Lenihan D. Moving towards establishing centres of excellence in cardiac amyloidosis: an International Cardio-Oncology Society statement. Heart 2024; 110:823-830. [PMID: 38267197 DOI: 10.1136/heartjnl-2023-323502] [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: 09/23/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024] Open
Abstract
The prevalence of amyloidosis has been increasing, driven by a combination of improved awareness, evolution of diagnostic pathways, and effective treatment options for both transthyretin and light chain amyloidosis. Due to the complexity of amyloidosis, centralised expert providers with experience in delineating the nuances of confirmatory diagnosis and management may be beneficial. There are many potential benefits of a centre of excellence designation for the treatment of amyloidosis including recognition of institutions that have been leading the way for the optimal treatment of this condition, establishing the expectations for any centre who is engaging in the treatment of amyloidosis and developing cooperative groups to allow more effective research in this disease space. Standardising the expectations and criteria for these centres is essential for ensuring the highest quality of clinical care and community education. In order to define what components are necessary for an effective centre of excellence for the treatment of amyloidosis, we prepared a survey in cooperation with a multidisciplinary panel of amyloidosis experts representing an international consortium. The purpose of this position statement is to identify the essential elements necessary for highly effective clinical care and to develop a general standard with which practices or institutions could be recognised as a centre of excellence.
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Affiliation(s)
- Richard Cheng
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | | | - Ashutosh D Wechalekar
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Jose Alvarez-Cardona
- Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Joshua D Mitchell
- Cardiology/IM, Washington University in St Louis, St Louis, Missouri, USA
| | | | - Joao Pedro Passos Dutra
- Center for Oncological Research (CEPON) and SOS Cardio Hospital in Florianópolis, Santa Catarina, Brazil
| | - Courtney M Campbell
- Baylor Scott and White Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas, USA
| | - Jennifer E Liu
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Heather J Landau
- Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Margot K Davis
- Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Sarju Ganatra
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | | | - Mathew S Maurer
- Center for Advanced Cardiac Care, Columbia University Medical Center, New York, New York, USA
| | | | - Daniel Lenihan
- Cardiology, International Cardio-Oncology Society and St Frances Healthcare, Cape Girardeau, Missouri, USA
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23
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Johnson EA, Hellem TL. Working From Within: The Rural Community Participatory Design Framework. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024:19375867241250323. [PMID: 38738946 DOI: 10.1177/19375867241250323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
OBJECTIVE This article describes the development of the rural community-based participatory design framework to guide healthcare design teams in their integration of rural community and clinical voice during the planning, design, and construction of a healthcare facility. BACKGROUND Rural communities are facing an alarming rate of healthcare facility closures, provider shortages, and dwindling resources, which are negatively impacting population health outcomes. A prioritized focus on rural care access and delivery requires design teams to have a deeper understanding of the contextual considerations necessary for a successful healthcare facility project, made possible through engagement and partnership with rural dwelling community members and healthcare teams. METHOD The rural community participatory design framework is adapted from the rural participatory research model, selected due to its capture of key concepts and characteristics of rural communities. Underpinning theories included rural nursing theory and theory of the built environment. RESULTS The framework encompasses healthcare facility project phases, key translational concepts, and common traits across rural communities and cultures. As a middle-range theoretical framework, it is being tested in a current healthcare project with a Critical Access Hospital in Montana to facilitate design team and stakeholder collaboration. CONCLUSION The rural community participatory design framework may be utilized by design teams as a means of familiarization with rural cultures, norms, values, and critical needs, which relate to meaningful design. The framework further enables design teams to critically appraise best practices of stakeholder engagement throughout the project lifecycle.
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Affiliation(s)
- Elizabeth A Johnson
- Mark & Robyn Jones College of Nursing, Montana State University, Bozeman, MT, USA
| | - Tracy L Hellem
- Mark & Robyn Jones College of Nursing, Montana State University, Missoula, MT, USA
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Bikomeye JC, Awoyinka I, Kwarteng JL, Beyer AM, Rine S, Beyer KMM. Disparities in Cardiovascular Disease-Related Outcomes Among Cancer Survivors in the United States: A Systematic Review of the Literature. Heart Lung Circ 2024; 33:576-604. [PMID: 38184426 PMCID: PMC11144115 DOI: 10.1016/j.hlc.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Cancer and cardiovascular disease (CVD) are major causes of morbidity and mortality in the United States (US). Cancer survivors have increased risks for CVD and CVD-related mortality due to multiple factors including cancer treatment-related cardiotoxicity. Disparities are rooted in differential exposure to risk factors and social determinants of health (SDOH), including systemic racism. This review aimed to assess SDOH's role in disparities, document CVD-related disparities among US cancer survivors, and identify literature gaps for future research. METHODS Following the Peer Review of Electronic Search Strategies (PRESS) guidelines, MEDLINE, PsycINFO, and Scopus were searched on March 15, 2021, with an update conducted on September 26, 2023. Articles screening was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, a pre-defined Population, Exposure, Comparison, Outcomes, and Settings (PECOS) framework, and the Rayyan platform. A modified version of the Newcastle-Ottawa Scale was used to assess the risk of bias, and RAW Graphs for alluvial charts. This review is registered with PROSPERO under ID #CRD42021236460. RESULTS Out of 7,719 retrieved articles, 24 were included, and discussed diverse SDOH that contribute to CVD-related disparities among cancer survivors. The 24 included studies had a large combined total sample size (n=7,704,645; median=19,707). While various disparities have been investigated, including rural-urban, sex, socioeconomic status, and age, a notable observation is that non-Hispanic Black cancer survivors experience disproportionately adverse CVD outcomes when compared to non-Hispanic White survivors. This underscores historical racism and discrimination against non-Hispanic Black individuals as fundamental drivers of CVD-related disparities. CONCLUSIONS Stakeholders should work to eliminate the root causes of disparities. Clinicians should increase screening for risk factors that exacerbate CVD-related disparities among cancer survivors. Researchers should prioritise the investigation of systemic factors driving disparities in cancer and CVD and develop innovative interventions to mitigate risk in cancer survivors.
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Affiliation(s)
- Jean C Bikomeye
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; PhD Program in Public and Community Health, Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Iwalola Awoyinka
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; PhD Program in Public and Community Health, Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jamila L Kwarteng
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andreas M Beyer
- Department of Medicine and Physiology, Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sarah Rine
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; PhD Program in Public and Community Health, Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kirsten M M Beyer
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; PhD Program in Public and Community Health, Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA; MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
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Mullen MT. Location, Location, Location: Geographic Factors Drive Differential Receipt of Neurologist Evaluation After Stroke. Neurology 2024; 102:e209288. [PMID: 38484208 DOI: 10.1212/wnl.0000000000209288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/23/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
- Michael T Mullen
- From the Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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Accetta-Rojas G, McCulloch CE, Whelan AM, Copeland TP, Grimes BA, Ku E. Rurality of patient residence and access to transplantation among children with kidney failure in the United States. Pediatr Nephrol 2024; 39:1239-1244. [PMID: 37768419 PMCID: PMC10899312 DOI: 10.1007/s00467-023-06148-w] [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: 06/21/2023] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Residence in rural areas is often a barrier to health care access. To date, differences in access to kidney transplantation among children who reside in rural and micropolitan areas of the US have not been explored. METHODS A retrospective cohort study of children < 18 years who developed kidney failure between 2000 and 2019 according to the United States Renal Data System (USRDS). We examined the association between rurality of patient residence and time to living and/or deceased donor kidney transplantation (primary outcomes) and waitlist registration (secondary outcome) using Fine-Gray models. RESULTS We included 18,530 children, of whom 14,175 (76.5%) received a kidney transplant (39.8% from a living and 60.2% from a deceased donor). Residence in micropolitan (subhazard ratio (SHR) 1.16; 95% CI 1.06-1.27) and rural (SHR 1.18; 95% CI 1.06-1.3) areas was associated with better access to living donor transplantation compared with residence in metropolitan areas. There was no statistically significant association between residence in micropolitan (SHR, 0.95; 95%CI 0.88-1.03) and rural (SHR, 0.94; 95%CI 0.86-1.03) areas compared with metropolitan areas in the access of children to deceased donor transplantation. There was also no difference in the time to waitlist registration comparing micropolitan (SHR 1.04; 95%CI 0.98-1.10) and rural (SHR 1.05; 95% CI 0.98-1.13) versus metropolitan areas. CONCLUSIONS In children with kidney failure, residence in rural and micropolitan areas was associated with better access to living donor transplantation and similar access to deceased donor transplantation compared with residence in metropolitan areas.
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Affiliation(s)
- Gabriela Accetta-Rojas
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
- Department of Medicine, Division of Nephrology, University of California, 500 Parnassus Avenue MBU-E 414 SF, San Francisco, CA, 94143-0532, USA.
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Adrian M Whelan
- Division of Nephrology, Department of Medicine, University of California, San Francisco, CA , USA
| | - Timothy P Copeland
- Division of Nephrology, Department of Medicine, University of California, San Francisco, CA , USA
| | - Barbara A Grimes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Elaine Ku
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Division of Nephrology, Department of Medicine, University of California, San Francisco, CA , USA
- Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, CA, USA
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Ashraf H, Nadeem ZA, Ashfaq H, Ahmed S, Ashraf A, Nashwan AJ. Mortality patterns in older adults with infective endocarditis in the US: A retrospective analysis. Curr Probl Cardiol 2024; 49:102455. [PMID: 38342352 DOI: 10.1016/j.cpcardiol.2024.102455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/08/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Infective Endocarditis (IE) has become a significant cause of morbidity and mortality over the last two decades. Despite management advancements, mortality trends in the USA's geriatric population are unexplored. The aim of this study was to assess the trends and regional differences in IE related mortality among geriatric patients in the USA. METHODS We analyzed death certificates sourced from the CDC WONDER database spanning 1999 to 2020. The research targeted individuals aged 65 and older. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent change (APC), along with 95% CI, were calculated through joinpoint regression analysis. RESULTS From 1999 to 2020, infective endocarditis caused 222,573 deaths, showing a declining trend (APC: -0.8361). Males had higher AAMR (26.8) than females (22.2). NH White had the highest AAMR (25.8), followed by NH American Indians or Alaska Natives (19.6). Geographically, the Midwest had the highest AAMR (27.4), followed by the Northeast (25.8). Rural areas consistently had higher AAMRs (26.6) than urban areas (23.6), while 80.16% of deaths occurring in urban settings. North Dakota, Nebraska, and Montana had the highest state AAMRs, approximately double than the states with the lowest mortality rates: Mississippi, Hawaii, California, and Massachusetts. Those aged 85 and above accounted for 42.9% of deaths. CONCLUSION IE mortality exhibited a clear pattern: rising till 2004, declining from 2004 to 2018, and increasing again till 2020. Key risk factors were male gender, Midwest residence, NH White ethnicity, and age ≥85.Targeted interventions are essential to reduce IE mortality, especially among vulnerable older populations.
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Affiliation(s)
- Hamza Ashraf
- Department of Cardiology, Allama Iqbal Medical College, Pakistan
| | - Zain Ali Nadeem
- Department of Medicine, Allama Iqbal Medical College, Pakistan
| | - Haider Ashfaq
- Department of Medicine, Allama Iqbal Medical College, Pakistan
| | - Sophia Ahmed
- Department of Medicine, Allama Iqbal Medical College, Pakistan
| | - Ali Ashraf
- Department of Medicine, Punjab Medical College, Pakistan
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Shah LM, Patel H, Faisaluddin M, Kwapong YA, Patel BA, Choi E, Satti DI, Oyeka CP, Hegde S, Dani SS, Sharma G. Rural/urban disparities in the trends and outcomes of peripartum cardiomyopathy in delivery hospitalizations. Curr Probl Cardiol 2024; 49:102433. [PMID: 38301915 DOI: 10.1016/j.cpcardiol.2024.102433] [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: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Rural-urban disparities in peripartum cardiomyopathy (PPCM) are not well known. We examined rural-urban differences in maternal, fetal, and cardiovascular outcomes in PPCM during delivery hospitalizations. METHODS We used 2003-2020 data from the National Inpatient Sample for delivery hospitalizations in individuals with PPCM. The 9th and 10th editions of the International Classification of Diseases were used to identify PPCM and cardiovascular, maternal, and fetal outcomes. Rural and urban hospitalizations for PPCM were 1:1 propensity score-matched using relevant clinical and sociodemographic variables. Odds of in-hospital mortality were assessed using logistic regression. RESULTS Among 72,880 delivery hospitalizations with PPCM, 4,571 occurred in rural locations, while 68,309 occurred in urban locations. After propensity matching, there were a total of 4,571 rural-urban pairs. There was significantly higher in-hospital mortality in urban compared to rural hospitalizations (adjusted OR 1.54, 95% CI 1.10-1.89). Urban PPCM hospitalizations had significantly higher cardiogenic shock (2.9% vs. 1.3%), mechanical circulatory support (1.0% vs. 0.6%), cardiac arrest (2.3% vs. 0.9%), and VT/VF (4.5% vs. 2.1%, all p <.05). Additionally, urban PPCM hospitalizations had worse maternal and fetal outcomes as compared to rural hospitalizations, including higher preterm delivery, gestational diabetes, and fetal death (all p<.05). Notably, significantly more rural individuals were transferred to a short-term hospital (including tertiary care centers) compared to urban individuals (13.5% vs. 3.2%, p<.0001). CONCLUSIONS There are significant rural-urban disparities in delivery hospitalizations with PPCM. Worse outcomes were associated with urban hospitalizations, while rural PPCM hospitalizations were associated with increased transfers, suggesting inadequate resources and advanced sickness.
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Affiliation(s)
- Lochan M Shah
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, MD, United States
| | - Harsh Patel
- Department of Cardiology, Southern Illinois University, Springfield, IL, United States
| | | | - Yaa A Kwapong
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, MD, United States
| | - Bhavin A Patel
- Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI, United States
| | - Eunjung Choi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, MD, United States
| | - Danish Iltaf Satti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, MD, United States
| | - Chigolum P Oyeka
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, MD, United States
| | - Shruti Hegde
- Department of Cardiology, Southern Illinois University, Springfield, IL, United States
| | - Sourbha S Dani
- Lahey Hospital & Medical Center, Boston, MA, United States
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, MD, United States; Inova Schar Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA, United States.
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Griesemer I, Palmer JA, MacLaren RZ, Harvey KLL, Li M, Garikipati A, Linsky AM, Mohr DC, Gurewich D. Rural Veterans' Experiences with Social Risk Factors: Impacts, Challenges, and Care System Recommendations. J Gen Intern Med 2024; 39:782-789. [PMID: 38010459 PMCID: PMC11043235 DOI: 10.1007/s11606-023-08530-8] [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: 04/20/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Social risk factors, such as food insecurity and financial needs, are associated with increased risk of cardiovascular diseases, health conditions that are highly prevalent in rural populations. A better understanding of rural Veterans' experiences with social risk factors can inform expansion of Veterans Health Administration (VHA) efforts to address social needs. OBJECTIVE To examine social risk and need from rural Veterans' lived experiences and develop recommendations for VHA to address social needs. DESIGN We conducted semi-structured interviews with participants purposively sampled for racial diversity. The interview guide was informed by Andersen's Behavioral Model of Health Services Use and the Outcomes from Addressing Social Determinants of Health in Systems framework. PARTICIPANTS Rural Veterans with or at risk of cardiovascular disease who participated in a parent survey and agreed to be recontacted. APPROACH Interviews were recorded and transcribed. We analyzed transcripts using directed qualitative content analysis to identify themes. KEY RESULTS Interviews (n = 29) took place from March to June 2022. We identified four themes: (1) Social needs can impact access to healthcare, (2) Structural factors can make it difficult to get help for social needs, (3) Some Veterans are reluctant to seek help, and (4) Veterans recommended enhancing resource dissemination and navigation support. CONCLUSIONS VHA interventions should include active dissemination of information on social needs resources and navigation support to help Veterans access resources. Community-based organizations (e.g., Veteran Service Organizations) could be key partners in the design and implementation of future social need interventions.
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Affiliation(s)
- Ida Griesemer
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA.
| | - Jennifer A Palmer
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Risette Z MacLaren
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
| | - Kimberly L L Harvey
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
| | - Mingfei Li
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Mathematical Sciences, Bentley University, Waltham, MA, USA
| | | | - Amy M Linsky
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - David C Mohr
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, MA, USA
| | - Deborah Gurewich
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Chang A, Wu X, Liu K. Deep learning from latent spatiotemporal information of the heart: Identifying advanced bioimaging markers from echocardiograms. BIOPHYSICS REVIEWS 2024; 5:011304. [PMID: 38559589 PMCID: PMC10978053 DOI: 10.1063/5.0176850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024]
Abstract
A key strength of echocardiography lies in its integration of comprehensive spatiotemporal cardiac imaging data in real-time, to aid frontline or bedside patient risk stratification and management. Nonetheless, its acquisition, processing, and interpretation are known to all be subject to heterogeneity from its reliance on manual and subjective human tracings, which challenges workflow and protocol standardization and final interpretation accuracy. In the era of advanced computational power, utilization of machine learning algorithms for big data analytics in echocardiography promises reduction in cost, cognitive errors, and intra- and inter-observer variability. Novel spatiotemporal deep learning (DL) models allow the integration of temporal arm information based on unlabeled pixel echocardiographic data for convolution of an adaptive semantic spatiotemporal calibration to construct personalized 4D heart meshes, assess global and regional cardiac function, detect early valve pathology, and differentiate uncommon cardiovascular disorders. Meanwhile, data visualization on spatiotemporal DL prediction models helps extract latent temporal imaging features to develop advanced imaging biomarkers in early disease stages and advance our understanding of pathophysiology to support the development of personalized prevention or treatment strategies. Since portable echocardiograms have been increasingly used as point-of-care imaging tools to aid rural care delivery, the application of these new spatiotemporal DL techniques show the potentials in streamlining echocardiographic acquisition, processing, and data analysis to improve workflow standardization and efficiencies, and provide risk stratification and decision supporting tools in real-time, to prompt the building of new imaging diagnostic networks to enhance rural healthcare engagement.
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Affiliation(s)
- Amanda Chang
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa 52242, USA
| | - Xiaodong Wu
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, Iowa 52242, USA
| | - Kan Liu
- Division of Cardiology, Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri 63110, USA
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Zeitler EP, Joly J, Leggett CG, Wong SL, O’Malley AJ, Kraft SA, Mackwood MB, Jones ST, Skinner JS. The role of comorbidities, medications, and social determinants of health in understanding urban-rural outcome differences among patients with heart failure. J Rural Health 2024; 40:386-393. [PMID: 37867249 PMCID: PMC10954420 DOI: 10.1111/jrh.12803] [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: 06/24/2022] [Revised: 08/18/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE There is now a 20% disparity in all-cause, excess deaths between urban and rural areas, much of which is driven by disparities in cardiovascular death. We sought to explain the sources of these disparities for Medicare beneficiaries with heart failure with reduced ejection fraction (HFrEF). METHODS Using a sample of Medicare Parts A, B, and D, we created a cohort of 389,528 fee-for-service beneficiaries with at least 1 heart failure hospitalization from 2008 to 2017. The primary outcome was 30-day mortality after discharge; 1-year mortality, readmissions, and return emergency room (ER) admissions were secondary outcomes. We used hierarchical, logistic regression modeling to determine the contribution of comorbidities, guideline-directed medical therapy (GDMT), and social determinants of health (SDOH) to outcomes. RESULTS Thirty-day mortality rates after hospital discharge were 6.3% in rural areas compared to 5.7% in urban regions (P < .001); after adjusting for patient health and GDMT receipt, the 30-day mortality odds ratio for rural residence was 1.201 (95% CI 1.164-1.239). Adding the SDOH measure reduced the odds ratio somewhat (1.140, 95% CI 1.103-1.178) but a gap remained. Readmission rates in rural areas were consistently lower for all model specifications, while ER admissions were consistently higher. CONCLUSIONS Among patients with HFrEF, living in a rural area is associated with an increased risk of death and return ER visits within 30 days of discharge from HF hospitalization. Differences in SDOH appear to partially explain mortality differences but the remaining gap may be the consequence of rural-urban differences in HF treatment.
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Affiliation(s)
- Emily P. Zeitler
- Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Joanna Joly
- University of Alabama at Birmingham, Division of Cardiovascular Disease, Birmingham, AL
| | | | - Sandra L. Wong
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Lebanon, NH
| | - A. James O’Malley
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Sally A. Kraft
- Dartmouth-Hitchcock Medical Center, Center for Population Health, Lebanon, NH
| | - Matthew B. Mackwood
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH
- Dartmouth-Hitchcock Medical Center, Department of General Internal Medicine, Lebanon, NH
| | - Sarah T. Jones
- Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Jonathan S. Skinner
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH
- Dartmouth College, Department of Economics, Hanover, NH
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Zègre-Hemsey JK, Cheskes S, Johnson AM, Rosamond WD, Cunningham CJ, Arnold E, Schierbeck S, Claesson A. Challenges & barriers for real-time integration of drones in emergency cardiac care: Lessons from the United States, Sweden, & Canada. Resusc Plus 2024; 17:100554. [PMID: 38317722 PMCID: PMC10838948 DOI: 10.1016/j.resplu.2024.100554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
Importance Out-of-hospital cardiac arrest (OHCA) is a leading cause of morbidity and mortality in the US and Europe (∼600,000 incident events annually) and around the world (∼3.8 million). With every minute that passes without cardiopulmonary resuscitation or defibrillation, the probability of survival decreases by 10%. Preliminary studies suggest that uncrewed aircraft systems, also known as drones, can deliver automated external defibrillators (AEDs) to OHCA victims faster than ground transport and potentially save lives. Objective To date, the United States (US), Sweden, and Canada have made significant contributions to the knowledge base regarding AED-equipped drones. The purpose of this Special Communication is to explore the challenges and facilitators impacting the progress of AED-equipped drone integration into emergency medicine research and applications in the US, Sweden, and Canada. We also explore opportunities to propel this innovative and important research forward. Evidence review In this narrative review, we summarize the AED-drone research to date from the US, Sweden, and Canada, including the first drone-assisted delivery of an AED to an OHCA. Further, we compare the research environment, emergency medical systems, and aviation regulatory environment in each country as they apply to OHCA, AEDs, and drones. Finally, we provide recommendations for advancing research and implementation of AED-drone technology into emergency care. Findings The rates that drone technologies have been integrated into both research and real-life emergency care in each country varies considerably. Based on current research, there is significant potential in incorporating AED-equipped drones into the chain of survival for OHCA emergency response. Comparing the different environments and systems in each country revealed ways that each can serve as a facilitator or barrier to future AED-drone research. Conclusions and relevance The US, Sweden, and Canada each offers different challenges and opportunities in this field of research. Together, the international community can learn from one another to optimize integration of AED-equipped drones into emergency systems of care.
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Affiliation(s)
| | - Sheldon Cheskes
- Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada
| | - Anna M. Johnson
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, United States
| | - Wayne D. Rosamond
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, United States
| | | | - Evan Arnold
- North Carolina State University, Institute for Transportation Research and Education, United States
| | - Sofia Schierbeck
- Centre for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Claesson
- Centre for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Hashem A, Goldsweig AM. Funny things are everywhere: Combatting geographic disparities in aortic stenosis care. Catheter Cardiovasc Interv 2024; 103:678-679. [PMID: 38407542 DOI: 10.1002/ccd.30971] [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: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 02/27/2024]
Abstract
Key points
Only 25%–35% of geographic variation in the use of surgical and transcatheter aortic valve replacement can be attributed to differing patient and hospital characteristics.
To address geographic disparities, the cardiovascular community must address modifiable cardiovascular risk factors, social determinants of health, and healthcare delivery models.
Governmental and professional organizations must study and actively address geographic disparities in access to care for aortic valve disease.
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Affiliation(s)
- Anas Hashem
- Department of Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Andrew M Goldsweig
- Department of Cardiovascular Diseases, Baystate Medical Center, Springfield, Massachusetts, USA
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Borlaug BA, Koepp KE, Reddy YNV, Obokata M, Sorimachi H, Freund M, Haberman D, Sweere K, Weber KL, Overholt EA, Safe BA, Omote K, Omar M, Popovic D, Acker NG, Gladwin MT, Olson TP, Carter RE. Inorganic Nitrite to Amplify the Benefits and Tolerability of Exercise Training in Heart Failure With Preserved Ejection Fraction: The INABLE-Training Trial. Mayo Clin Proc 2024; 99:206-217. [PMID: 38127015 PMCID: PMC10872737 DOI: 10.1016/j.mayocp.2023.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To determine whether nitrite can enhance exercise training (ET) effects in heart failure with preserved ejection fraction (HFpEF). METHODS In this multicenter, double-blind, placebo-controlled, randomized trial conducted at 1 urban and 9 rural outreach centers between November 22, 2016, and December 9, 2021, patients with HFpEF underwent ET along with inorganic nitrite 40 mg or placebo 3 times daily. The primary end point was peak oxygen consumption (VO2). Secondary end points included Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OSS, range 0 to 100; higher scores reflect better health status), 6-minute walk distance, and actigraphy. RESULTS Of 92 patients randomized, 73 completed the trial because of protocol modifications necessitated by loss of drug availability. Most patients were older than 65 years (80%), were obese (75%), and lived in rural settings (63%). At baseline, median peak VO2 (14.1 mL·kg-1·min-1) and KCCQ-OSS (63.7) were severely reduced. Exercise training improved peak VO2 (+0.8 mL·kg-1·min-1; 95% CI, 0.3 to 1.2; P<.001) and KCCQ-OSS (+5.5; 95% CI, 2.5 to 8.6; P<.001). Nitrite was well tolerated, but treatment with nitrite did not affect the change in peak VO2 with ET (nitrite effect, -0.13; 95% CI, -1.03 to 0.76; P=.77) or KCCQ-OSS (-1.2; 95% CI, -7.2 to 4.9; P=.71). This pattern was consistent across other secondary outcomes. CONCLUSION For patients with HFpEF, ET administered for 12 weeks in a predominantly rural setting improved exercise capacity and health status, but compared with placebo, treatment with inorganic nitrite did not enhance the benefit from ET. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02713126.
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Affiliation(s)
- Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - Katlyn E Koepp
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Yogesh N V Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Hidemi Sorimachi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Monique Freund
- Mayo Clinic Community Cardiology Southwest Wisconsin, La Crosse
| | - Doug Haberman
- Mayo Clinic Community Cardiology Southwest Wisconsin, La Crosse
| | - Kara Sweere
- Mayo Clinic Community Cardiology Southeast Minnesota, Albert Lea
| | - Kari L Weber
- Mayo Clinic Community Cardiology Southeast Minnesota, Austin
| | | | - Bethany A Safe
- Mayo Clinic Community Cardiology Southeast Minnesota, Red Wing
| | - Kazunori Omote
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Massar Omar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Dejana Popovic
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Nancy G Acker
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Mark T Gladwin
- Department of Medicine, Maryland School of Medicine, Baltimore
| | - Thomas P Olson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
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Baig MFA. Analysis of the Weekend Effect on Mortality, Diagnostic Coronary Angiography, and Percutaneous Coronary Intervention in Acute Myocardial Infarction Across Rural US Hospitals. Cureus 2024; 16:e53751. [PMID: 38465191 PMCID: PMC10921120 DOI: 10.7759/cureus.53751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Rural hospitals face several unique challenges in delivering healthcare to an underserved population. Achieving time-sensitive goals in a resource-scarce facility is often a difficult task without the right team at hand. Resources are further depleted on the weekends, exposing understaffed hospitals to poorer outcomes. Acute myocardial infarction (AMI) mortality depends on timely diagnosis and intervention. It is unknown to what extent resource shortages impact rural hospitals during weekends and how they affect AMI mortality. METHODS This cross-sectional study was performed on patients admitted on weekends with AMI using the National Inpatient Sample (NIS) 2019. Patients with type II non-ST-elevation myocardial infarction (NSTEMI) and missing information were excluded. The rates and timing of in-hospital diagnostic coronary angiograms, PCIs (percutaneous coronary interventions), and in-hospital mortality were studied. Regression models were used for data analyses. RESULTS A total of 161,625 patients met the inclusion criteria (58,690 females (36%), 114,830 Caucasians (71%), 17,910 African American (11%), 13,920 Hispanic (8.6%); mean (SD) age, 66.5 (0.5) years), including 47,665 (29.5%) ST-elevation myocardial infarction (STEMI) and 113,960 (70.5%) NSTEMI. Patients admitted to rural hospitals were less likely to undergo diagnostic coronary angiogram (adjusted odds ratio (aOR), 0.69; CI, 0.57-0.83; p<0.001) and PCI (aOR, 0.83; CI, 0.72-0.96; p 0.012). Rural hospitals had lesser odds of early diagnostic angiograms (aOR, 0.79; CI, 0.67-0.95; p<0.05) and PCI (aOR, 0.78; CI, 0.66-0.92; p<0.05) within 24 hours. The mortality difference between rural and urban hospitals was not significant (aOR, 1.08; CI, 0.85-1.4; p 0.52). CONCLUSIONS Diagnostic coronary angiograms and PCI are performed at a lesser rate in rural hospitals during weekends. This trend did not affect rural AMI mortality.
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Fazlalizadeh H, Khan MS, Fox ER, Douglas PS, Adams D, Blaha MJ, Daubert MA, Dunn G, van den Heuvel E, Kelsey MD, Martin RP, Thomas JD, Thomas Y, Judd SE, Vasan RS, Budoff MJ, Bloomfield GS. Closing the Last Mile Gap in Access to Multimodality Imaging in Rural Settings: Design of the Imaging Core of the Risk Underlying Rural Areas Longitudinal Study. Circ Cardiovasc Imaging 2024; 17:e015496. [PMID: 38377236 PMCID: PMC10883604 DOI: 10.1161/circimaging.123.015496] [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] [Indexed: 02/22/2024]
Abstract
Achieving optimal cardiovascular health in rural populations can be challenging for several reasons including decreased access to care with limited availability of imaging modalities, specialist physicians, and other important health care team members. Therefore, innovative solutions are needed to optimize health care and address cardiovascular health disparities in rural areas. Mobile examination units can bring imaging technology to underserved or remote communities with limited access to health care services. Mobile examination units can be equipped with a wide array of assessment tools and multiple imaging modalities such as computed tomography scanning and echocardiography. The detailed structural assessment of cardiovascular and lung pathology, as well as the detection of extracardiac pathology afforded by computed tomography imaging combined with the functional and hemodynamic assessments acquired by echocardiography, yield deep phenotyping of heart and lung disease for populations historically underrepresented in epidemiological studies. Moreover, by bringing the mobile examination unit to local communities, innovative approaches are now possible including engagement with local professionals to perform these imaging assessments, thereby augmenting local expertise and experience. However, several challenges exist before mobile examination unit-based examinations can be effectively integrated into the rural health care setting including standardizing acquisition protocols, maintaining consistent image quality, and addressing ethical and privacy considerations. Herein, we discuss the potential importance of cardiac multimodality imaging to improve cardiovascular health in rural regions, outline the emerging experience in this field, highlight important current challenges, and offer solutions based on our experience in the RURAL (Risk Underlying Rural Areas Longitudinal) cohort study.
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Affiliation(s)
- Hooman Fazlalizadeh
- Lundquist Institute, Harbor-University of California Los Angeles Medical Center, Torrance (H.F., M.J.B.)
| | - Muhammad Shahzeb Khan
- Division of Cardiology, Department of Medicine (M.S.K., P.S.D., M.A.D., M.D.K., G.S.B.), Duke University, Durham, NC
| | - Ervin R Fox
- Division of Cardiology, Department of Medicine University of Mississippi Medical Center, Jackson, MS (E.R.F.)
| | - Pamela S Douglas
- Division of Cardiology, Department of Medicine (M.S.K., P.S.D., M.A.D., M.D.K., G.S.B.), Duke University, Durham, NC
- Duke Clinical Research Institute (P.S.D., M.A.D., G.D., M.D.K., G.S.B.), Duke University, Durham, NC
| | - David Adams
- Caption Health, Inc, San Francisco, CA (D.A., R.P.M., Y.T.)
| | - Michael J Blaha
- Lundquist Institute, Harbor-University of California Los Angeles Medical Center, Torrance (H.F., M.J.B.)
| | - Melissa A Daubert
- Division of Cardiology, Department of Medicine (M.S.K., P.S.D., M.A.D., M.D.K., G.S.B.), Duke University, Durham, NC
- Duke Clinical Research Institute (P.S.D., M.A.D., G.D., M.D.K., G.S.B.), Duke University, Durham, NC
| | - Gary Dunn
- Duke Clinical Research Institute (P.S.D., M.A.D., G.D., M.D.K., G.S.B.), Duke University, Durham, NC
| | - Edwin van den Heuvel
- Department of Mathematics and Computer Science, Eindhoven University of Technology, The Netherlands (E.v.d.H.)
| | - Michelle D Kelsey
- Division of Cardiology, Department of Medicine (M.S.K., P.S.D., M.A.D., M.D.K., G.S.B.), Duke University, Durham, NC
- Duke Clinical Research Institute (P.S.D., M.A.D., G.D., M.D.K., G.S.B.), Duke University, Durham, NC
| | | | - James D Thomas
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.D.T.)
- Center for Artificial Intelligence, Northwestern Medicine Bluhm Cardiovascular Institute, Chicago, IL (J.D.T.)
| | - Yngvil Thomas
- Caption Health, Inc, San Francisco, CA (D.A., R.P.M., Y.T.)
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham (S.E.J.)
| | - Ramachandran S Vasan
- University of Texas Health Sciences Center, University of Texas School of Public Health, San Antonio (R.S.V.)
| | - Matthew J Budoff
- Division of Cardiology, John Hopkins University School of Medicine, Baltimore, MD (M.J.B.)
| | - Gerald S Bloomfield
- Division of Cardiology, Department of Medicine (M.S.K., P.S.D., M.A.D., M.D.K., G.S.B.), Duke University, Durham, NC
- Duke Clinical Research Institute (P.S.D., M.A.D., G.D., M.D.K., G.S.B.), Duke University, Durham, NC
- Duke Global Health Institute (G.S.B.), Duke University, Durham, NC
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Conners KM, Avery CL, Syed FF. Advancing Cardiovascular Risk Assessment with Artificial Intelligence: Opportunities and Implications in North Carolina. N C Med J 2024; 85:10.18043/001c.91424. [PMID: 38938760 PMCID: PMC11208038 DOI: 10.18043/001c.91424] [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] [Indexed: 06/29/2024]
Abstract
Cardiovascular disease mortality is increasing in North Carolina with persistent inequality by race, income, and location. Artificial intelligence (AI) can repurpose the widely available electrocardiogram (ECG) for enhanced assessment of cardiac dysfunction. By identifying accelerated cardiac aging from the ECG, AI offers novel insights into risk assessment and prevention.
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Affiliation(s)
- Katherine M Conners
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christy L Avery
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Faisal F Syed
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Aitken AV, Minassa VS, Batista TJ, Oliveira JKDS, Sant'Anna KDO, Felippe ISA, Paton JFR, Coitinho JB, Bissoli NS, Sampaio KN. Acute poisoning by chlorpyrifos differentially impacts survival and cardiorespiratory function in normotensive and hypertensive rats. Chem Biol Interact 2024; 387:110821. [PMID: 38042398 DOI: 10.1016/j.cbi.2023.110821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Abstract
Hypertension is the most important and well-known risk factor for cardiovascular disease (CVD). Recently, acute organophosphate (OP) poisoning has also been pointed as a CVD risk factor. Despite this evidence, no studies have contrasted the acute toxicosis and cardiovascular (CV) effects of OP poisoning under conditions of normotension and hypertension. In this work, adult male normotensive Wistar and Spontaneously Hypertensive rats (SHR) were intraperitoneally injected with saline or chlorpyrifos (CPF), an OP compound, monitored for acute toxicosis signs and 24-h survival. After poisoning, blood pressure, heart rate and ventilation were recorded, the Bezold-Jarisch Reflex (BJR), the Chemoreflex (CR) were chemically activated, as well as the cardiac autonomic tone (AUT) was assessed. Erythrocyte and brainstem acetylcholinesterase and plasmatic butyrylcholinesterase (BuChE) activities were measured as well as lipid peroxidation, advanced oxidation protein products (AOPP), nitrite/nitrate levels, expression of catalase, TNFα and angiotensin-I converting enzyme (ACE-1) within the brainstem. CPF induced a much more pronounced acute toxicosis and 33 % lethality in SHR. CPF poisoning impaired ventilation in SHR, the BJR reflex responses in Wistar rats, and the chemoreflex tachypneic response in both strains. CPF inhibited activity of cholinesterases in both strains, increased AOPP and nitrite/nitrate levels and expression of TNFα and ACE-1 in the brainstem of Wistar rats. Interestingly, SHR presented a reduced intrinsic BuChE activity, an important bioscavenger. Our findings show that, CPF at sublethal doses in normotensive rats lead to lethality and much more pronounced acute toxicity signs in the SHR. We also showed that cardiorespiratory reflexes were differentially impacted after CPF poisoning in both strains and that the cardiorespiratory disfunction seems to be associated with interference in cholinergic transmission, oxidative stress and inflammation. These results points to an increased susceptibility to acute toxicosis in hypertension, which may impose a significant risk to vulnerable populations.
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Affiliation(s)
- Andrew Vieira Aitken
- Postgraduate Program in Pharmaceutical Sciences, Department of Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil; Department of Anatomy, Physiology, and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, 36849, USA
| | - Vítor Sampaio Minassa
- Postgraduate Program in Pharmaceutical Sciences, Department of Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil; Postgraduate Program in Physiological Sciences, Department of Physiology, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Thatiany Jardim Batista
- Postgraduate Program in Physiological Sciences, Department of Physiology, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Janne Ketly da Silva Oliveira
- Postgraduate Program in Pharmaceutical Sciences, Department of Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Karoline de Oliveira Sant'Anna
- Postgraduate Program in Pharmaceutical Sciences, Department of Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Igor Simões Assunção Felippe
- The Centre for Heart Research - Manaaki Mānawa, Department of Physiology, Faculty of Health & Medical Sciences, University of Auckland, Grafton Campus, Auckland, 1023, New Zealand
| | - Julian Francis Richmond Paton
- The Centre for Heart Research - Manaaki Mānawa, Department of Physiology, Faculty of Health & Medical Sciences, University of Auckland, Grafton Campus, Auckland, 1023, New Zealand
| | - Juliana Barbosa Coitinho
- Postgraduate Program in Pharmaceutical Sciences, Department of Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil; Postgraduate Program in Biochemistry, Department of Physiology, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Nazaré Souza Bissoli
- Postgraduate Program in Physiological Sciences, Department of Physiology, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Karla Nívea Sampaio
- Postgraduate Program in Pharmaceutical Sciences, Department of Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil.
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Kotit S. Rurality and race in heart failure risk: Insights from the Southern Community Cohort Study. Glob Cardiol Sci Pract 2024; 2024:e202404. [PMID: 38404655 PMCID: PMC10886951 DOI: 10.21542/gcsp.2024.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/11/2023] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION Rural-urban health disparities are apparent in the burden of disease and health outcomes, including cardiovascular disease (CVD), specifically heart failure (HF). However, the factors influencing these disparities are not fully understood. Study and results: Among 27,115 participants in the Southern Community Cohort Study (SCCS) (mean age: 54 years (47-65)), 18,647 (68.8%) were black, 8,468 (32.3%) were white, and 20% resided in rural areas. Over a median 13-year follow-up period, 7,542 HF events occurred (rural = 1,865 vs. urban = 5,677). The age-adjusted HF incidence was 29.6 (95% CI, 28.9-30.5) and 36.5 (95% CI, 34.9-38.3) per 1,000 person-years for urban and rural participants, respectively (P < .001). The risk of HF associated with rurality varied by race and sex. Rural black men had the highest risk across all groups (HR, 1.34; 95% CI, 1.19-1.51) (age-adjusted incidence rate: 40.4/1000 person-years (95% CI, 36.8-44.3)) followed by black women (HR, 1.18; 95% CI, 1.08-1.28) and white women (HR, 1.22; 95% CI, 1.07-1.39). Rurality was not associated with HF risk among white men (HR, 0.97; 95% CI, 0.81-1.16). LESSONS LEARNED This large study shows that rural populations have an increased incidence of HF, which is particularly striking among women and black men, independent of individual-level biological, behavioral, and sociocultural risk factors. It also shows the need for further investigation into the rurality-associated risk of HF, the impact of preventive care utilization on the risk of HF and interpersonal, community, or societal factors that could contribute to rural-urban disparities. This will help to guide public health efforts aimed at HF prevention among rural populations.
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1-e156. [PMID: 38033089 PMCID: PMC11095842 DOI: 10.1161/cir.0000000000001193] [Citation(s) in RCA: 231] [Impact Index Per Article: 231.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines liaison
| | | | | | | | | | - Paul L Hess
- ACC/AHA Joint Committee on Performance Measures liaison
| | | | | | | | | | - Kazuhiko Kido
- American College of Clinical Pharmacy representative
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41
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:109-279. [PMID: 38043043 PMCID: PMC11104284 DOI: 10.1016/j.jacc.2023.08.017] [Citation(s) in RCA: 66] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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Pichan C, DeVore AD. Rural and urban hospitals in the United States: does location affect care and outcomes of patients with heart failure? Expert Rev Cardiovasc Ther 2024; 22:1-3. [PMID: 38533791 DOI: 10.1080/14779072.2024.2325015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 02/26/2024] [Indexed: 03/28/2024]
Affiliation(s)
- Cayla Pichan
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Adam D DeVore
- Department of Medicine and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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Minhas AMK, Cullen MW, Mamas MA, Fudim M, Virani SS, Khan SS, Misra A, Ballantyne CM, Nambi V, Abramov D. Association Between Cardiologist Density and Mortality in Urban and Rural Counties in the United States. Am J Cardiol 2024; 210:279-282. [PMID: 37844717 DOI: 10.1016/j.amjcard.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Abdul Mannan Khan Minhas
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas
| | - Michael W Cullen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Marat Fudim
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina
| | - Salim S Virani
- Aga Khan University, Karachi, Pakistan; Baylor College of Medicine and Texas Heart Institute, Houston, Texas
| | - Sadiya S Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Arunima Misra
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Christie M Ballantyne
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas
| | - Vijay Nambi
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas
| | - Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, Loma Linda, California.
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Patel R, Peesay T, Krishnan V, Wilcox J, Wilsbacher L, Khan SS. Prioritizing the primary prevention of heart failure: Measuring, modifying and monitoring risk. Prog Cardiovasc Dis 2024; 82:2-14. [PMID: 38272339 PMCID: PMC10947831 DOI: 10.1016/j.pcad.2024.01.001] [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: 01/07/2024] [Accepted: 01/07/2024] [Indexed: 01/27/2024]
Abstract
With the rising incidence of heart failure (HF) and increasing burden of morbidity, mortality, and healthcare expenditures, primary prevention of HF targeting individuals in at-risk HF (Stage A) and pre-HF (Stage B) Stages has become increasingly important with the goal to decrease progression to symptomatic (Stage C) HF. Identification of risk based on traditional risk factors (e.g., cardiovascular health which can be assessed with the American Heart Association's Life's Essential 8 framework), adverse social determinants of health, inherited risk of cardiomyopathies, and identification of risk-enhancing factors, such as patients with viral disease, exposure to cardiotoxic chemotherapy, and history of adverse pregnancy outcomes should be the first step in evaluation for HF risk. Next, use of guideline-endorsed risk prediction tools such as Pooled Cohort Equations to Prevent Heart Failure provide quantification of absolute risk of HF based in traditional risk factors. Risk reduction through counseling on traditional risk factors is a core focus of implementation of prevention and may include the use of novel therapeutics that target specific pathways to reduce risk of HF, such as mineralocorticoid receptor agonists (e.g., fineronone), angiotensin-receptor/neprolysin inhibitors, and sodium glucose co-transporter-2 inhibitors. These interventions may be limited in at-risk populations who experience adverse social determinants and/or individuals who reside in rural areas. Thus, strategies like telemedicine may improve access to preventive care. Gaps in the current knowledge base for risk-based prevention of HF are highlighted to outline future research that may target approaches for risk assessment and risk-based prevention with the use of artificial intelligence, genomics-enhanced strategies, and pragmatic trials to develop a guideline-directed medical therapy approach to reduce risk among individuals with Stage A and Stage B HF.
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Affiliation(s)
- Ruchi Patel
- Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Tejasvi Peesay
- Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Vaishnavi Krishnan
- Department of Medicine, Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jane Wilcox
- Department of Medicine, Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lisa Wilsbacher
- Department of Medicine, Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sadiya S Khan
- Department of Medicine, Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Venkatesh KK, Huang X, Cameron NA, Petito LC, Joseph J, Landon MB, Grobman WA, Khan SS. Rural-urban disparities in pregestational and gestational diabetes in pregnancy: Serial, cross-sectional analysis of over 12 million pregnancies. BJOG 2024; 131:26-35. [PMID: 37366023 PMCID: PMC10751384 DOI: 10.1111/1471-0528.17587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/24/2023] [Accepted: 06/10/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To compare trends in pregestational (DM) and gestational diabetes (GDM) in pregnancy in rural and urban areas in the USA, because pregnant women living in rural areas face unique challenges that contribute to rural-urban disparities in adverse pregnancy outcomes. DESIGN Serial, cross-sectional analysis. SETTING US National Center for Health Statistics (NCHS) Natality Files from 2011 to 2019. POPULATION A total of 12 401 888 singleton live births to nulliparous women aged 15-44 years. METHODS We calculated the frequency (95% confidence interval [CI]) per 1000 live births, the mean annual percentage change (APC), and unadjusted and age-adjusted rate ratios (aRR) of DM and GDM in rural compared with urban maternal residence (reference) per the NCHS Urban-Rural Classification Scheme overall, and by delivery year, reported race and ethnicity, and US region (effect measure modification). MAIN OUTCOME MEASURES The outcomes (modelled separately) were diagnoses of DM and GDM. RESULTS From 2011 to 2019, there were increases in both the frequency (per 1000 live births; mean APC, 95% CI per year) of DM and GDM in rural areas (DM: 7.6 to 10.4 per 1000 live births; APC 2.8%, 95% CI 2.2%-3.4%; and GDM: 41.4 to 58.7 per 1000 live births; APC 3.1%, 95% CI 2.6%-3.6%) and urban areas (DM: 6.1 to 8.4 per 1000 live births; APC 3.3%, 95% CI 2.2%-4.4%; and GDM: 40.8 to 61.2 per 1000 live births; APC 3.9%, 95% CI 3.3%-4.6%). Individuals living in rural areas were at higher risk of DM (aRR 1.48, 95% CI 1.45%-1.51%) and GDM versus those in urban areas (aRR 1.17, 95% CI 1.16%-1.18%). The increased risk was similar each year for DM (interaction p = 0.8), but widened over time for GDM (interaction p < 0.01). The rural-urban disparity for DM was wider for individuals who identified as Hispanic race/ethnicity and in the South and West (interaction p < 0.01 for all); and for GDM the rural-urban disparity was generally wider for similar factors (i.e. Hispanic race/ethnicity, and in the South; interaction p < 0.05 for all). CONCLUSIONS The frequency of DM and GDM increased in both rural and urban areas of the USA from 2011 to 2019 among nulliparous pregnant women. Significant rural-urban disparities existed for DM and GDM, and increased over time for GDM. These rural-urban disparities were generally worse among those of Hispanic race/ethnicity and in women who lived in the South. These findings have implications for delivering equitable diabetes care in pregnancy in rural US communities.
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Affiliation(s)
- Kartik K. Venkatesh
- The Ohio State University College of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine (Columbus, OH)
| | - Xiaoning Huang
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine (Chicago, IL)
| | - Natalie A. Cameron
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics (Chicago, IL)
| | - Lucia C. Petito
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine (Chicago, IL)
| | - Joshua Joseph
- The Ohio State University College of Medicine, Department of Medicine (Columbus, OH)
| | - Mark B. Landon
- The Ohio State University College of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine (Columbus, OH)
| | - William A. Grobman
- The Ohio State University College of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine (Columbus, OH)
| | - Sadiya S. Khan
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine (Chicago, IL)
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of Cardiology (Chicago, IL)
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Patel L, Dhruve R, Keshvani N, Pandey A. Role of exercise therapy and cardiac rehabilitation in heart failure. Prog Cardiovasc Dis 2024; 82:26-33. [PMID: 38199321 DOI: 10.1016/j.pcad.2024.01.002] [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: 01/07/2024] [Accepted: 01/07/2024] [Indexed: 01/12/2024]
Abstract
Heart failure (HF) is a common cause of hospitalization and death, and the hallmark symptoms of HF, including dyspnea, fatigue, and exercise intolerance, contribute to poor patient quality of life (QoL). Cardiac rehabilitation (CR) is a comprehensive disease management program incorporating exercise training, cardiovascular risk factor management, and psychosocial support. CR has been demonstrated to effectively improve patient functional status and QoL among patients with HF. However, CR participation among patients with HF is poor. This review details the mechanisms of dyspnea and exercise intolerance among patients with HF, the physiologic and clinical improvements observed with CR, and the key components of a CR program for patients with HF. Furthermore, unmet needs and future strategies to improve patient participation and engagement in CR for HF are reviewed.
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Affiliation(s)
- Lajjaben Patel
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ritika Dhruve
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
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Carson DB, Messmer R, Leuf Fjällberg E. Creating 'good' hospital to home transfers in the rural north of Sweden: informal workarounds and opportunities for improvement. Home Health Care Serv Q 2024; 43:18-38. [PMID: 37439524 DOI: 10.1080/01621424.2023.2235321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Hospital to home transfers for older people require effective communication, coordination and collaboration across multiple service settings. Rural Nursing Theory and the Beyond Periphery model explain why this is particularly difficult in rural areas, but there are few examples of how rural services respond. This paper presents a case study of the district of Tärnaby in the inland north of Sweden. Data are drawn from interviews with health and care staff in Tärnaby, observations, and experiences of the researchers. Data were analyzed thematically, with four main themes emerging - role clarity, communication, geography, and understanding of the rural context. Responses to challenges included increasing opportunities for communication between service providers and improving documentation. The paper concludes that informal "workarounds" run the risk of further disconnecting rural service settings from "the city". Rather, the aim needs to be to improve contextual understanding through formally incorporating "the rural" in service design.
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Affiliation(s)
| | - Ronja Messmer
- Department of Nursing, Umeå University, Umea, Sweden
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Sharma P, Tranby B, Kamath C, Brockman T, Roche A, Hammond C, Brewer LC, Sinicrope P, Lenhart N, Quade B, Abuan N, Halom M, Staples J, Patten C. A Christian Faith-Based Facebook Intervention for Smoking Cessation in Rural Communities (FAITH-CORE): Protocol for a Community Participatory Development Study. JMIR Res Protoc 2023; 12:e52398. [PMID: 38090799 PMCID: PMC10753420 DOI: 10.2196/52398] [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: 09/01/2023] [Revised: 11/02/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Tobacco smoking remains the leading cause of preventable morbidity and mortality in the United States, with significant rural-urban disparities. Adults who live in rural areas of the United States have among the highest tobacco smoking rates in the nation and experience a higher prevalence of smoking-related deaths and deaths due to chronic diseases for which smoking is a causal risk factor. Barriers to accessing tobacco use cessation treatments are a major contributing factor to these disparities. Adults living in rural areas experience difficulty accessing tobacco cessation services due to geographical challenges, lack of insurance coverage, and lack of health care providers who treat tobacco use disorders. The use of digital technology could be a practical answer to these barriers. OBJECTIVE This report describes a protocol for a study whose main objectives are to develop and beta test an innovative intervention that uses a private, moderated Facebook group platform to deliver peer support and faith-based cessation messaging to enhance the reach and uptake of existing evidence-based smoking cessation treatment (EBCT) resources (eg, state quitline coaching programs) for rural adults who smoke. METHODS We will use the Integrated Theory of Health Behavior Change, surface or deep structure frameworks to guide intervention development, and the community-based participatory research (CBPR) approach to identify and engage with community stakeholders. The initial content library of moderator postings (videos and text or image postings) will be developed using existing EBCT material from the Centers for Disease Control and Prevention Tips from Former Smokers Campaign. The content library will feature topics related to quitting smoking, such as coping with cravings and withdrawal and using EBCTs with faith-based message integration (eg, Bible quotes). A community advisory board and a community engagement studio will provide feedback to refine the content library. We will also conduct a beta test of the intervention with 15 rural adults who smoke to assess the recruitment feasibility and preliminary intervention uptake such as engagement, ease of use, usefulness, and satisfaction to further refine the intervention based on participant feedback. RESULTS The result of this study will create an intervention prototype that will be used for a future randomized controlled trial. CONCLUSIONS Our CBPR project will create a prototype of a Facebook-delivered faith-based messaging and peer support intervention that may assist rural adults who smoke to use EBCT. This study is crucial in establishing a self-sufficient smoking cessation program for the rural community. The project is unique in using a moderated social media platform providing peer support and culturally relevant faith-based content to encourage adult people who smoke to seek treatment and quit smoking. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52398.
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Affiliation(s)
- Pravesh Sharma
- Psychiatry and Psychology, Mayo Clinic Health System, Mayo Clinic, Eau Claire, WI, United States
| | - Brianna Tranby
- Behavioral Psychology, Mayo Clinic, Rochester, MN, United States
| | - Celia Kamath
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Tabetha Brockman
- Health Equity and Community Engagement in Research, Mayo Clinic, Rochester, MN, United States
| | - Anne Roche
- Psychology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Pamela Sinicrope
- Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Ned Lenhart
- Living Water Church, Cameron, WI, United States
| | - Brian Quade
- Bethesda Lutheran Church, Eau Claire, WI, United States
| | - Nate Abuan
- Valleybrook Church, Eau Claire, WI, United States
| | - Martin Halom
- St John's Lutheran Church, Bloomer, WI, United States
| | | | - Christi Patten
- Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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Bailey RR, Miner N. Differences in health characteristics and health behaviors between rural and non-rural community-dwelling stroke survivors aged ≥65 years in the USA. BRAIN IMPAIR 2023; 24:521-528. [PMID: 38167358 DOI: 10.1017/brimp.2022.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To examine differences in health characteristics and health behaviors between rural and non-rural stroke survivors in the USA. METHODS Data were extracted from the 2017 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) to compare prevalences of health characteristics (i.e., diabetes, disability, poor health, high cholesterol, hypertension, no health care coverage, weight status) and health behaviors (i.e., fruit consumption, vegetable consumption, physical inactivity, high alcohol consumption, smoking) among community-dwelling stroke survivors, stratified by rural status (i.e., rural vs. non-rural). Logistic regression was used to calculate odds ratios (ORs) for health characteristics and health behaviors to examine the association of rural status with each variable of interest (reference group=non-rural). RESULTS Data from 14,599 respondents (rural: n = 5,039; non-rural: n = 9,560) were available for analysis. The majority of respondents were female (61.4%), non-Hispanic white (83.2%), previously married (56.1%), had at least some college education (55.2%), and had an annual household income ≥USD $25,000 (56.9%). Prevalences of disability, poor health, weekly aerobic exercise, and smoking were higher among rural respondents compared to non-rural respondents. Logistic regression showed increased odds (odds ratio range: 1.1-1.2) for these variables among rural respondents; however, odds ratios were attenuated after controlling for sociodemographic and health characteristics. CONCLUSIONS We did not find evidence of differences in the investigated health characteristics and health behaviors between rural and non-rural community-dwelling stroke survivors in the USA. Additional research is needed to confirm these findings and to identify alternative sociodemographic and health factors that may differ between rural and non-rural community-dwelling stroke survivors.
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Affiliation(s)
- Ryan R Bailey
- Department of Occupational and Recreational Therapies, College of Health, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Natalie Miner
- Department of Occupational and Recreational Therapies, College of Health, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA
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50
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Chaganty SS, Abramov D, Van Spall HG, Bullock-Palmer RP, Vassiliou V, Myint PK, Bang V, Kobo O, Mamas MA. Rural and urban disparities in cardiovascular disease-related mortality in the USA over 20 years; have the trends been reversed by COVID-19? INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 19:200202. [PMID: 37675096 PMCID: PMC10477062 DOI: 10.1016/j.ijcrp.2023.200202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/14/2023] [Accepted: 07/26/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Saisunder S. Chaganty
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke- on-Trent, UK
| | - Dmitry Abramov
- International Heart Institute, Loma Linda University, Loma Linda, CA, USA
| | - Harriette G.C. Van Spall
- Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada
| | | | - Vassilios Vassiliou
- Norwich Medical School, University of East Anglia, 2.06 Bob Champion Research and Education Building, And Norfolk and Norwich Hospital, NR4 7TJ, UK
| | - Phyo Kyaw Myint
- Aberdeen Cardiovascular and Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
| | - Vijay Bang
- Oriion Citicare Hospital, Aurangabad, India
| | - Ofer Kobo
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke- on-Trent, UK
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke- on-Trent, UK
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