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Malla G, Long DL, Cherrington A, Goyal P, Guo B, Safford MM, Khodneva Y, Cummings DM, McAlexander TP, DeSilva S, Judd SE, Hidalgo B, Levitan EB, Carson AP. Neighborhood Disadvantage and Risk of Heart Failure: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Circ Cardiovasc Qual Outcomes 2024; 17:e009867. [PMID: 38328917 PMCID: PMC10950536 DOI: 10.1161/circoutcomes.123.009867] [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: 01/05/2023] [Accepted: 11/14/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Heart failure (HF) affects >6 million US adults, with recent increases in HF hospitalizations. We aimed to investigate the association between neighborhood disadvantage and incident HF events and potential differences by diabetes status. METHODS We included 23 645 participants from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), a prospective cohort of Black and White adults aged ≥45 years living in the continental United States (baseline 2005-2007). Neighborhood disadvantage was assessed using a Z score of 6 census tract variables (2000 US Census) and categorized as quartiles. Incident HF hospitalizations or HF-related deaths through 2017 were adjudicated. Multivariable-adjusted Cox regression was used to examine the association between neighborhood disadvantage and incident HF. Heterogeneity by diabetes was assessed using an interaction term. RESULTS The mean age was 64.4 years, 39.5% were Black adults, 54.9% females, and 18.8% had diabetes. During a median follow-up of 10.7 years, there were 1125 incident HF events with an incidence rate of 3.3 (quartile 1), 4.7 (quartile 2), 5.2 (quartile 3), and 6.0 (quartile 4) per 1000 person-years. Compared to adults living in the most advantaged neighborhoods (quartile 1), those living in neighborhoods in quartiles 2, 3, and 4 (most disadvantaged) had 1.30 (95% CI, 1.06-1.60), 1.36 (95% CI, 1.11-1.66), and 1.45 (95% CI, 1.18-1.79) times greater hazard of incident HF even after accounting for known confounders. This association did not significantly differ by diabetes status (interaction P=0.59). For adults with diabetes, the adjusted incident HF hazards comparing those in quartile 4 versus quartile 1 was 1.34 (95% CI, 0.92-1.96), and it was 1.50 (95% CI, 1.16-1.94) for adults without diabetes. CONCLUSIONS In this large contemporaneous prospective cohort, neighborhood disadvantage was associated with an increased risk of incident HF events. This increase in HF risk did not differ by diabetes status. Addressing social, economic, and structural factors at the neighborhood level may impact HF prevention.
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Affiliation(s)
- Gargya Malla
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - D. Leann Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrea Cherrington
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Boyi Guo
- Departments of Family Medicine and Public Health, East Carolina University, Greenville, North Carolina, USA
| | - Monika M. Safford
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Yulia Khodneva
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Doyle M. Cummings
- Departments of Family Medicine and Public Health, East Carolina University, Greenville, North Carolina, USA
| | - Tara P. McAlexander
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Shanika DeSilva
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Suzanne E. Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bertha Hidalgo
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emily B. Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - April P. Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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Suzuki T, Mizuno A, Yasui H, Noma S, Ohmori T, Rewley J, Kawai F, Nakayama T, Kondo N, Tsukada YT. Scoping Review of Screening and Assessment Tools for Social Determinants of Health in the Field of Cardiovascular Disease. Circ J 2024; 88:390-407. [PMID: 38072415 DOI: 10.1253/circj.cj-23-0443] [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: 02/23/2024]
Abstract
BACKGROUND Despite the importance of implementing the concept of social determinants of health (SDOH) in the clinical practice of cardiovascular disease (CVD), the tools available to assess SDOH have not been systematically investigated. We conducted a scoping review for tools to assess SDOH and comprehensively evaluated how these tools could be applied in the field of CVD. METHODS AND RESULTS We conducted a systematic literature search of PubMed and Embase databases on July 25, 2023. Studies that evaluated an SDOH screening tool with CVD as an outcome or those that explicitly sampled or included participants based on their having CVD were eligible for inclusion. In addition, studies had to have focused on at least one SDOH domain defined by Healthy People 2030. After screening 1984 articles, 58 articles that evaluated 41 distinct screening tools were selected. Of the 58 articles, 39 (67.2%) targeted populations with CVD, whereas 16 (27.6%) evaluated CVD outcome in non-CVD populations. Three (5.2%) compared SDOH differences between CVD and non-CVD populations. Of 41 screening tools, 24 evaluated multiple SDOH domains and 17 evaluated only 1 domain. CONCLUSIONS Our review revealed recent interest in SDOH in the field of CVD, with many useful screening tools that can evaluate SDOH. Future studies are needed to clarify the importance of the intervention in SDOH regarding CVD.
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Affiliation(s)
- Takahiro Suzuki
- Department of Cardiovascular Medicine, St. Luke's International Hospital
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke's International Hospital
- Leonard Davis Institute for Health Economics, University of Pennsylvania
| | - Haruyo Yasui
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Satsuki Noma
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Jeffrey Rewley
- Leonard Davis Institute for Health Economics, University of Pennsylvania
- The MITRE Corporation
| | - Fujimi Kawai
- Department of Academic Resources, St. Luke's International University
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University
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Amin K, Bethel G, Jackson LR, Essien UR, Sloan CE. Eliminating Health Disparities in Atrial Fibrillation, Heart Failure, and Dyslipidemia: A Path Toward Achieving Pharmacoequity. Curr Atheroscler Rep 2023; 25:1113-1127. [PMID: 38108997 PMCID: PMC11044811 DOI: 10.1007/s11883-023-01180-5] [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: 11/25/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE OF REVIEW Pharmacoequity refers to the goal of ensuring that all patients have access to high-quality medications, regardless of their race, ethnicity, gender, or other characteristics. The goal of this article is to review current evidence on disparities in access to cardiovascular drug therapies across sociodemographic subgroups, with a focus on heart failure, atrial fibrillation, and dyslipidemia. RECENT FINDINGS Considerable and consistent disparities to life-prolonging heart failure, atrial fibrillation, and dyslipidemia medications exist in clinical trial representation, access to specialist care, prescription of guideline-based therapy, drug affordability, and pharmacy accessibility across racial, ethnic, gender, and other sociodemographic subgroups. Researchers, health systems, and policy makers can take steps to improve pharmacoequity by diversifying clinical trial enrollment, increasing access to inpatient and outpatient cardiology care, nudging clinicians to increase prescription of guideline-directed medical therapy, and pursuing system-level reforms to improve drug access and affordability.
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Affiliation(s)
- Krunal Amin
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Garrett Bethel
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Larry R Jackson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Utibe R Essien
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Center for the Study of Healthcare Innovation, Implementation & Policy, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
| | - Caroline E Sloan
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.
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Minhas AMK, Fudim M, Garan AR, Davis JD, Fonarow GC, Antoine SM, Fedson S, Nambi V, Abramov D. Socioeconomic status and in-hospital outcomes for patients undergoing heart transplantation or ventricular assist device implantation. Clin Transplant 2023; 37:e15093. [PMID: 37548056 DOI: 10.1111/ctr.15093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/19/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Although lower socioeconomic status (SES) has been associated with worse in-hospital outcomes among patients with heart failure, the in-hospital outcomes for patients undergoing durable Left Ventricular Assist Device (LVAD) implantation or Heart Transplantation (HT) based on SES have not been well characterized. METHODS We analyzed data from the National Inpatient Sample of hospitalizations between January 2016 and December 2020 of patients aged 18 and over who underwent a HT or newly implanted LVAD. Quartile classification of the median household income of the patient's residential zip code was used to estimate SES. Multivariable analyses with logistic and linear regression were used to evaluate the effects of SES on inpatient outcomes including inpatient mortality, length of stay, and key inpatient complications. RESULTS A total of 16,265 weighted hospitalizations for new LVAD implantation and 14,320 weighted hospitalizations for HT were identified. In multivariable analysis, among patients undergoing HT or LVAD implantation respectively, there were no significant differences between the lowest and highest SES quartiles among important in-hospital outcomes including length of stay (adj B-coeff .56, (-3.59)-(4.71), p = .79 and adj B-coeff 2.40, (-.21)-(5.02), p = .07) and mortality (aOR 1.02, .61-1.70, p = .94 and aOR 1.08, .72-1.62, p = .73). There were also no differences based on SES quartile in important inpatient complications including stroke and cardiac arrest. CONCLUSION In this analysis from the National Inpatient Sample, we demonstrate that SES, evaluated by median zip code income, was not associated with important in-hospital metrics including mortality and length of stay among patients undergoing LVAD or HT.
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Affiliation(s)
| | - Marat Fudim
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - A Reshad Garan
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jonathan D Davis
- Department of Medicine, Division of Cardiology, University of San Francisco, San Francisco, California, USA
| | - Gregg C Fonarow
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Steve M Antoine
- Michael E DeBakey Veterans Affairs Hospital and Baylor College of Medicine, Center for Cardiovascular Disease Prevention, Houston, Texas, USA
| | - Savitri Fedson
- Michael E DeBakey Veterans Affairs Hospital and Baylor College of Medicine, Center for Cardiovascular Disease Prevention, Houston, Texas, USA
| | - Vijay Nambi
- Michael E DeBakey Veterans Affairs Hospital and Baylor College of Medicine, Center for Cardiovascular Disease Prevention, Houston, Texas, USA
| | - Dmitry Abramov
- Department of Medicine, Division of Cardiology, Loma Linda Medical Center, Loma Linda, California, USA
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Anderson KM, Yearwood E, Weintraub WS, Xia Y, Scally R, Groninger H, Rao A, Ahn J. Determinants of Health and Outcomes in Medicare Recipients With Heart Disease: A Population Study. J Pain Symptom Manage 2023; 66:561-569.e2. [PMID: 37544553 DOI: 10.1016/j.jpainsymman.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
CONTEXT Heart disease (HD) is a primary cause of mortality and morbidity in the United States. While there is a growing body of evidence demonstrating the contribution of social determinants of health (SDoH) to HD outcomes, the impact of combined or individual SDoH on health-related quality of life (HRQoL) in patients with HD is not well understood. OBJECTIVES To analyze the National Health and Aging Trends Study (NHATS) to explore the relationship of SDoH with HRQoL, advance care planning, and treatment preferences in Medicare beneficiaries with HD. METHODS The study design was a secondary data analysis using latent class analysis (LCA) and multivariable analysis of NHATS participants with HD, Round 8, that included End of Life Plans and Care questions. RESULTS 1202 participants, median age 81 years, 57% female, 70% non-Hispanic White, 20% non-Hispanic Black, 10% Other. LCA identified two SDoH risk profiles (low/high), using 12 measures within the NHATS Economic and Social Consequences key concept area. The high-risk SDoH profile participants were more likely to have fair/poor HRQoL, and identify as female, non-White (P < 0.0001); and less likely to have completed advance care planning (P < 0.0001). High-risk SDoH participants were more likely to want life-prolonging treatments (P < 0.0001), however, this association was not significant after adjusting for age, sex, and race (P = 0.344). CONCLUSION Higher risk SDoH profiles are associated with reduced HRQoL, reduced advance care planning completion, female sex, and non-White race in a cohort of Medicare beneficiaries. These findings provide opportunities to improve SDoH-related care practices in older patients with HD.
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Affiliation(s)
- Kelley M Anderson
- Georgetown University School of Nursing (K.M.A., E.Y., R.S.), Washington, District of Columbia.
| | - Edilma Yearwood
- Georgetown University School of Nursing (K.M.A., E.Y., R.S.), Washington, District of Columbia
| | - William S Weintraub
- MedStar Health Research Institute (W.S.W.), Hyattsville, Maryland; Georgetown University School of Medicine (W.S.W., H.G., A.R.), Washington, District of Columbia
| | - Yi Xia
- Department of Biostatistics, Bioinformatics, and Biomathematics (Y.X., J.A.), Georgetown University, Washington, District of Columbia
| | - Rebecca Scally
- Georgetown University School of Nursing (K.M.A., E.Y., R.S.), Washington, District of Columbia
| | - Hunter Groninger
- Georgetown University School of Medicine (W.S.W., H.G., A.R.), Washington, District of Columbia; Section of Palliative Care (H.G., A.R.), MedStar Washington Hospital Center, Washington, District of Columbia
| | - Anirudh Rao
- Georgetown University School of Medicine (W.S.W., H.G., A.R.), Washington, District of Columbia; Section of Palliative Care (H.G., A.R.), MedStar Washington Hospital Center, Washington, District of Columbia
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics (Y.X., J.A.), Georgetown University, Washington, District of Columbia
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Li Y, Gray A, Xue L, Farb MG, Ayalon N, Andersson C, Ko D, Benjamin EJ, Levy D, Vasan RS, Larson MG, Rong J, Xanthakis V, Liu C, Fetterman JL, Gopal DM. Metabolomic Profiles, Ideal Cardiovascular Health, and Risk of Heart Failure and Atrial Fibrillation: Insights From the Framingham Heart Study. J Am Heart Assoc 2023; 12:e028022. [PMID: 37301766 PMCID: PMC10356055 DOI: 10.1161/jaha.122.028022] [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: 11/26/2022] [Accepted: 04/13/2023] [Indexed: 06/12/2023]
Abstract
Background The American Heart Association's framework "ideal cardiovascular health" (CVH) focuses on modifiable risk factors to reduce cardiovascular disease (CVD). Metabolomics provides important pathobiological insights into risk factors and CVD development. We hypothesized that metabolomic signatures associate with CVH status, and that metabolites, at least partially, mediate the association of CVH score with atrial fibrillation (AF) and heart failure (HF). Methods and Results We studied 3056 adults in the FHS (Framingham Heart Study) cohort to evaluate CVH score and incident outcomes of AF and HF. Metabolomics data were available in 2059 participants; mediation analysis was performed to evaluate the mediation of metabolites in the association of CVH score and incident AF and HF. In the smaller cohort (mean age, 54 years; 53% women), CVH score was associated with 144 metabolites, with 64 metabolites shared across key cardiometabolic components (body mass index, blood pressure, and fasting blood glucose) of the CVH score. In mediation analyses, 3 metabolites (glycerol, cholesterol ester 16:1, and phosphatidylcholine 32:1) mediated the association of CVH score with incident AF. Seven metabolites (glycerol, isocitrate, asparagine, glutamine, indole-3-proprionate, phosphatidylcholine C36:4, and lysophosphatidylcholine 18:2), partly mediated the association between CVH score and incident HF in multivariable-adjusted models. Conclusions Most metabolites that associated with CVH score were shared the most among 3 cardiometabolic components. Three main pathways: (1) alanine, glutamine, and glutamate metabolism; (2) citric acid cycle metabolism; and (3) glycerolipid metabolism mediated CVH score with HF. Metabolomics provides insights into how ideal CVH status contributes to the development of AF and HF.
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Affiliation(s)
- Yi Li
- Department of Biostatistics, School of Public HealthBoston UniversityBostonMAUSA
| | | | - Liying Xue
- Evans Department of Medicine and Whitaker Cardiovascular InstituteBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Melissa G. Farb
- Evans Department of Medicine and Whitaker Cardiovascular InstituteBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Nir Ayalon
- Section of Cardiovascular Medicine, Department of MedicineBoston University Chobanian & Avedisian School of Medicine/Boston Medical CenterBostonMAUSA
| | - Charlotte Andersson
- Section of Cardiovascular Medicine, Department of MedicineBoston University Chobanian & Avedisian School of Medicine/Boston Medical CenterBostonMAUSA
| | - Darae Ko
- Section of Cardiovascular Medicine, Department of MedicineBoston University Chobanian & Avedisian School of Medicine/Boston Medical CenterBostonMAUSA
| | - Emelia J. Benjamin
- Section of Cardiovascular Medicine, Department of MedicineBoston University Chobanian & Avedisian School of Medicine/Boston Medical CenterBostonMAUSA
- Evans Department of Medicine, Section of Cardiovascular Medicine and Department of EpidemiologyBoston UniversityBostonMAUSA
- Framingham Heart StudyFraminghamMAUSA
| | - Daniel Levy
- Population Sciences Branch, Division of Intramural ResearchNational Heart, Lung, and Blood Institute, National Institutes of HealthBethesdaMDUSA
- Framingham Heart StudyFraminghamMAUSA
| | - Ramachandran S. Vasan
- Section of Cardiovascular Medicine, Department of MedicineBoston University Chobanian & Avedisian School of Medicine/Boston Medical CenterBostonMAUSA
- Evans Department of Medicine, Section of Cardiovascular Medicine and Department of EpidemiologyBoston UniversityBostonMAUSA
- Section of Preventive Medicine and Epidemiology, Department of MedicineBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Framingham Heart StudyFraminghamMAUSA
| | - Martin G. Larson
- Department of BiostatisticsBoston University School of Public HealthBostonMAUSA
- Framingham Heart StudyFraminghamMAUSA
| | - Jian Rong
- Department of BiostatisticsBoston University School of Public HealthBostonMAUSA
| | - Vanessa Xanthakis
- Section of Preventive Medicine and Epidemiology, Department of MedicineBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of BiostatisticsBoston University School of Public HealthBostonMAUSA
- Framingham Heart StudyFraminghamMAUSA
| | - Chunyu Liu
- Department of BiostatisticsBoston University School of Public HealthBostonMAUSA
- Framingham Heart StudyFraminghamMAUSA
| | - Jessica L. Fetterman
- Evans Department of Medicine and Whitaker Cardiovascular InstituteBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Deepa M. Gopal
- Evans Department of Medicine and Whitaker Cardiovascular InstituteBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Section of Cardiovascular Medicine, Department of MedicineBoston University Chobanian & Avedisian School of Medicine/Boston Medical CenterBostonMAUSA
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Hall JL, Jhund PS. Novel Methods of the Precision Medicine Platform: A Path to Tackling Heart Disease. Circ Heart Fail 2022; 15:e010024. [PMID: 36378757 DOI: 10.1161/circheartfailure.122.010024] [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] [Indexed: 11/16/2022]
Affiliation(s)
| | - Pardeep S Jhund
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom (P.S.J.)
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Allen LA, Yancy CW, Fonarow GC. Heart Failure Data Challenge: Democratizing Data, Modernizing Methods, and Interpreting Inequity. Circ Heart Fail 2022; 15:e010025. [PMID: 36378755 DOI: 10.1161/circheartfailure.122.010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Larry A Allen
- University of Colorado School of Medicine, Aurora (L.A.A.)
| | - Clyde W Yancy
- Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.)
| | - Gregg C Fonarow
- UCLA David Geffen School of Medicine, University of California, Los Angeles (G.C.F.)
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Lewsey SC. Social Constructs and the Making of Social Determinants of Health: A Pathway for Equity Interventions to Change Heart Failure Outcomes. Circ Heart Fail 2022; 15:e010023. [PMID: 36378753 DOI: 10.1161/circheartfailure.122.010023] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Sabra C Lewsey
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
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Kittleson MM. Social Determinants of Health and Heart Failure: Clinical Takeaways From 5 Pivotal Analyses of the GWTG-HF Registry. Circ Heart Fail 2022; 15:e010022. [PMID: 36378754 DOI: 10.1161/circheartfailure.122.010022] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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