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LaMonte MJ, Manson JE, Anderson GL, Baker LD, Bea JW, Eaton CB, Follis S, Hayden KM, Kooperberg C, LaCroix AZ, Limacher MC, Neuhouser ML, Odegaard A, Perez MV, Prentice RL, Reiner AP, Stefanick ML, Van Horn L, Wells GL, Whitsel EA, Rossouw JE. Contributions of the Women's Health Initiative to Cardiovascular Research: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:256-275. [PMID: 35835498 DOI: 10.1016/j.jacc.2022.05.016] [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: 03/11/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/25/2022]
Abstract
The WHI (Women's Health Initiative) enrolled 161,808 racially and ethnically diverse postmenopausal women, ages 50-79 years, from 1993 to 1998 at 40 clinical centers across the United States. In its clinical trial component, WHI evaluated 3 randomized interventions (menopausal hormone therapy; diet modification; and calcium/vitamin D supplementation) for the primary prevention of major chronic diseases, including cardiovascular disease, in older women. In the WHI observational study, numerous clinical, behavioral, and social factors have been evaluated as predictors of incident chronic disease and mortality. Although the original interventions have been completed, the WHI data and biomarker resources continue to be leveraged and expanded through ancillary studies to yield novel insights regarding cardiovascular disease prevention and healthy aging in women.
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Affiliation(s)
- Michael J LaMonte
- Department of Epidemiology and Environmental Health, University at Buffalo-SUNY, Buffalo, New York, USA.
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Garnet L Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Laura D Baker
- Department of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer W Bea
- Department of Health Promotion Science, University of Arizona, Tucson, Arizona, USA
| | - Charles B Eaton
- Department of Family Medicine and Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Shawna Follis
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California, USA
| | - Kathleen M Hayden
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Andrea Z LaCroix
- Division of Epidemiology, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, California, USA
| | - Marian C Limacher
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Andrew Odegaard
- Department of Epidemiology, University of California, Irvine, California, USA
| | - Marco V Perez
- Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Alexander P Reiner
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Marcia L Stefanick
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | - Gretchen L Wells
- Department of Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jacques E Rossouw
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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Racial Disparities in Cardiovascular Risk and Cardiovascular Care in Women. Curr Cardiol Rep 2022; 24:1197-1208. [PMID: 35802234 DOI: 10.1007/s11886-022-01738-w] [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] [Accepted: 06/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Research on sex and gender aspects cardiovascular disease has contributed to a reduction in cardiovascular mortality in women. However, cardiovascular disease remains the leading cause of death of women in the United States. Disparities in cardiovascular risk and outcomes among women overall persist and are amplified for women of certain ethnic and racial subgroups. We review the evidence of racial and ethnic differences in cardiovascular risk and care among women and describe a path forward to achieve equitable cardiovascular care for women of racial and ethnic minority groups. RECENT FINDINGS There is a disproportionate effect on cardiovascular outcomes in women and certain racial and ethnic groups in part due to disparities in triage, diagnosis, treatment, which lead to amplification of inequalities in women of minority racial and ethnic background. Data suggest gender and racial bias, underappreciation of nontraditional risk factors, underrepresentation of women in clinical trials and undertreatment of disease contributes to persistent differences in cardiovascular disease outcomes in women of color. Understanding the myriad of factors that contribute to increased cardiovascular risk, and disparities in treatment and outcomes among women from racial/ethnic minority backgrounds is imperative to improving cardiovascular care for this patient population.
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Cené CW, Leng XI, Faraz K, Allison M, Breathett K, Bird C, Coday M, Corbie‐Smith G, Foraker R, Ijioma NN, Rosal MC, Sealy‐Jefferson S, Shippee TP, Kroenke CH. Social Isolation and Incident Heart Failure Hospitalization in Older Women: Women's Health Initiative Study Findings. J Am Heart Assoc 2022; 11:e022907. [PMID: 35189692 PMCID: PMC9075097 DOI: 10.1161/jaha.120.022907] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/30/2021] [Indexed: 01/27/2023]
Abstract
Background The association of social isolation or lack of social network ties in older adults is unknown. This knowledge gap is important since the risk of heart failure (HF) and social isolation increase with age. The study examines whether social isolation is associated with incident HF in older women, and examines depressive symptoms as a potential mediator and age and race and ethnicity as effect modifiers. Methods and Results This study included 44 174 postmenopausal women of diverse race and ethnicity from the WHI (Women's Health Initiative) study who underwent annual assessment for HF adjudication from baseline enrollment (1993-1998) through 2018. We conducted a mediation analysis to examine depressive symptoms as a potential mediator and further examined effect modification by age and race and ethnicity. Incident HF requiring hospitalization was the main outcome. Social isolation was a composite variable based on marital/partner status, religious ties, and community ties. Depressive symptoms were assessed using CES-D (Center for Epidemiology Studies-Depression). Over a median follow-up of 15.0 years, we analyzed data from 36 457 women, and 2364 (6.5%) incident HF cases occurred; 2510 (6.9%) participants were socially isolated. In multivariable analyses adjusted for sociodemographic, behavioral, clinical, and general health/functioning; socially isolated women had a higher risk of incident HF than nonisolated women (HR, 1.23; 95% CI, 1.08-1.41). Adding depressive symptoms in the model did not change this association (HR, 1.22; 95% CI, 1.07-1.40). Neither race and ethnicity nor age moderated the association between social isolation and incident HF. Conclusions Socially isolated older women are at increased risk for developing HF, independent of traditional HF risk factors. Registration URL: http://www.clinicaltrials.gov; Unique identifier: NCT00000611.
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Affiliation(s)
- Crystal W. Cené
- University of North Carolina at Chapel HillNC
- now with University of California, San DiegoLa JollaCA
| | | | | | | | | | | | - Mace Coday
- University of Tennessee Health Science CenterMemphisTN
| | | | - Randi Foraker
- Washington University in St. Louis School of MedicineSt. LouisMO
| | | | | | | | - Tetyana P. Shippee
- Division of Health Policy and ManagementUniversity of MinnesotaMinneapolisMN
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Miremad M, Lin X, Rasla S, El Meligy A, Roberts MB, Laddu D, Allison M, Martin LW, Shadyab AH, Manson JAE, Chlebowski R, Panjrath G, LaMonte MJ, Liu S, Eaton CB. The association of walking pace and incident heart failure and subtypes among postmenopausal women. J Am Geriatr Soc 2022; 70:1405-1417. [PMID: 35048361 DOI: 10.1111/jgs.17657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/30/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND To investigate the association between walking pace and the risk of heart failure (HF) and HF sub-types. METHODS We examined associations of self-reported walking pace with risk of incident HF and HF subtypes of preserved (HFpEF) and reduced (HFrEF) ejection fractions, among 25,183 postmenopausal women, ages 50-79 years. At enrollment into the Women's Health Initiative cohort in 1993-1998, this subset of women was free of HF, cancer, or the inability to walk one block, with self-reported information on walking pace and walking duration. Multivariable Cox regression was used to examine associations of walking pace (casual <2 mph [referent], average 2-3 mph, and fast >3 mph) with incident HF. We also examined the joint association of walking pace and duration with incident HF. RESULTS There were 1455 incident adjudicated acute decompensated HF hospitalization cases during a median of 16.9 years of follow-up. There was a strong inverse association between walking pace and overall risk of HF (HR = 0.73, 95% CI [0.65, 0.83] for average vs. casual walking; HR = 0.66, 95%CI [0.56, 0.78] for fast vs. casual walking). There were similar associations of walking pace with HFpEF (HR = 0.73, 95%CI [0.62, 0.86] average vs. casual; HR = 0.63, 95%CI [0.50, 0.80] for fast vs. casual) and with HFrEF (HR = 0.72, 95%CI [0.57, 0.91] for average vs. casual; HR = 0.74, 95%CI [0.54, 0.99] for fast vs. casual). The risk of HF associated with fast walking with less than 1 h/week walking duration was comparable with the risk of HF among casual and average walkers with more than 2 h/week walking duration. CONCLUSION Walking pace was inversely associated with risks of overall HF, HFpEF, and HFrEF in postmenopausal women. Whether interventions to increase the walking pace in older adults will reduce HF risk and whether fast pace will compensate for the short duration of walking warrants further study.
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Affiliation(s)
| | - Xiaochen Lin
- Department of Epidemiology Brown University Providence Rhode Island USA
- Center for Global Cardio‐metabolic Health Brown University Providence Rhode Island USA
| | - Somwail Rasla
- Division of General Internal Medicine Brown University Providence Rhode Island USA
| | - Amr El Meligy
- Division of General Internal Medicine Brown University Providence Rhode Island USA
| | - Mary B. Roberts
- Center for Primary Care and Prevention Care New England Medical Group/Primary Care and Specialty Services Pawtucket Rhode Island USA
| | - Deepika Laddu
- Department of Physical Therapy University of Illinois at Chicago Chicago Illinois USA
| | - Matthew Allison
- Department of Family Medicine and Public Health University of California San Diego La Jolla California USA
| | - Lisa W. Martin
- Department of Medicine George Washington University Washington District of Columbia USA
| | - Aladdin H. Shadyab
- Department of Family Medicine and Public Health University of California San Diego La Jolla California USA
| | - Jo Ann E. Manson
- Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts USA
- Department of Epidemiology Harvard T.H. Chan School of Public Health Boston Massachusetts USA
| | - Rowan Chlebowski
- Division of Medical Oncology and Hematology University of California Los Angeles Los Angeles California USA
| | - Gurusher Panjrath
- Department of Medicine George Washington University Washington District of Columbia USA
| | - Michael J. LaMonte
- Department of Epidemiology and Environmental Health University of Buffalo Buffalo New York USA
| | - Simin Liu
- Department of Epidemiology Brown University Providence Rhode Island USA
- Center for Global Cardio‐metabolic Health Brown University Providence Rhode Island USA
- Division of Endocrinology, Warren Alpert Medical School Brown University Providence Rhode Island USA
- Department of Endocrinology Guangdong General Hospital Guangzhou China
| | - Charles B. Eaton
- Department of Epidemiology Brown University Providence Rhode Island USA
- Department of Family Medicine Warren Alpert Medical School of Brown University Providence Rhode Island USA
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Piña IL, Jimenez S, Lewis EF, Morris AA, Onwuanyi A, Tam E, Ventura HO. Race and Ethnicity in Heart Failure: JACC Focus Seminar 8/9. J Am Coll Cardiol 2021; 78:2589-2598. [PMID: 34887145 DOI: 10.1016/j.jacc.2021.06.058] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/15/2022]
Abstract
Heart failure (HF) affects >6 million Americans, with variations in incidence, prevalence, and clinical outcomes by race/ethnicity. Black adults have the highest risk for HF, with earlier age of onset and the highest risk of death and hospitalizations. The risk of hospitalizations for Hispanic patients is higher than White patients. Data on HF in Asian individuals are more limited. However, the higher burden of traditional cardiovascular risk factors, particularly among South Asian adults, is associated with increased risk of HF. The role of environmental, socioeconomic, and other social determinants of health, more likely for Black and Hispanic patients, are increasingly recognized as independent risk factors for HF and worse outcomes. Structural racism and implicit bias are drivers of health care disparities in the United States. This paper will review the clinical, physiological, and social determinants of HF risk, unique for race/ethnic minorities, and offer solutions to address systems of inequality that need to be recognized and dismantled/eradicated.
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Affiliation(s)
| | | | | | - Alanna A Morris
- Emory University, Atlanta, Georgia, USA. https://twitter.com/morrismd
| | | | - Edlira Tam
- Montefiore Medical Center, Bronx, New York, USA
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Bellettiere J, Nguyen S, Eaton CB, Liles S, Laddu-Patel D, Di C, Stefanick ML, LaCroix AZ, LaMonte MJ. The short physical performance battery and incident heart failure among older women: the OPACH study. Am J Prev Cardiol 2021; 8:100247. [PMID: 34553186 PMCID: PMC8441145 DOI: 10.1016/j.ajpc.2021.100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Reduced functional capacity is a hallmark of early pre-clinical stages of heart failure (HF). The Short Physical Performance Battery (SPPB) is a valid measure of lower extremity physical function, has relatively low implementation burden, and is associated with cardiovascular disease and mortality. However, the SPPB-HF association is understudied in older women among whom HF burden is high. METHODS Women (n = 5325; mean age 79 ± 7 years; 34% Black, 18% Hispanic, and 49% White) without prior HF completed the SPPB consisting of standing balance, strength, and walking tests that were summarized as a composite score from 0 (lowest) to 12 (highest), categorized as very low (0-3), low (4-6), medium (7-9), or high (10-12). Participants were followed for up to 8 years for incident HF (306 cases identified). Cox proportional hazards regression estimated hazard ratios (HR) adjusting for age, race/ethnicity, education, smoking, alcohol, diabetes, hypertension, COPD, osteoarthritis, depression, BMI, systolic blood pressure, lipids, glucose, and accelerometer-measured moderate-vigorous physical activity (MVPA) and sedentary time. RESULTS Incident HF cases (crude rate per 1000 person-years) in the four SPPB categories (very low to high) were 34 (26.0), 79 (14.5), 128 (9.3), and 65 (5.6). Corresponding multivariable-adjusted HRs (95% CIs) were 2.22 (1.34-3.66), 1.63 (1.11-2.38), 1.39 (1.00-1.94), and 1.00 (referent; P-trend<0.001). Higher HF risk was associated with lower SPPB in women with major modifiable HF risk factors including obesity (HR per 3-unit SPPB decrement: present HR = 1.41, absent HR = 1.41), hypertension (present HR = 1.45, absent HR = 1.30), diabetes (present HR = 1.32, absent HR = 1.44), and lower accelerometer-measured MVPA (<45 min/day HR = 1.29, ≥45 min/day HR = 1.60); all P-interaction>0.10. CONCLUSION Lower SPPB scores were associated with greater risk of incident HF in older women even after accounting for differences in HF risk factors and objectively measured PA. Implementing the SPPB in clinical settings could potentially enhance individual-level HF risk assessment, which should be further explored.
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Affiliation(s)
- John Bellettiere
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla CA, USA
- Center for Behavioral Epidemiology and Community Health (C-BEACH), School of Public Health, San Diego State University, San Diego, CA, USA
| | - Steve Nguyen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla CA, USA
| | - Charles B. Eaton
- Departments of Family Medicine and Epidemiology, Schools of Medicine and Public Health, Brown University, Providence, RI, USA
| | - Sandy Liles
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla CA, USA
- Center for Behavioral Epidemiology and Community Health (C-BEACH), School of Public Health, San Diego State University, San Diego, CA, USA
| | - Deepika Laddu-Patel
- College of Applied Health Sciences, University of Illinois, Chicago, IL, USA
| | - Chongzhi Di
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marcia L. Stefanick
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Andrea Z. LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla CA, USA
| | - Michael J. LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, SUNY, Buffalo, NY, USA
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Abstract
ABSTRACT Heart failure (HF) is a complex clinical syndrome hallmarked by an inability to match cardiac output with metabolic demand, resulting in exercise intolerance. HF is increasingly prevalent in an aging population and accounts for substantial burden of health care costs and morbidity. Because many of the central and peripheral mechanisms of HF respond favorably to exercise training, its role in HF treatment is becoming established. The role of habitual physical activity in the primary prevention of HF is less clear; however, available evidence is supportive. This article reviews recently published studies on exercise training and usual physical activity in HF treatment and prevention, discusses potential mechanisms, and suggests areas where further research is needed.
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Affiliation(s)
- Michael J. LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo – SUNY, Buffalo, NY, USA
| | - Charles B. Eaton
- Departments of Family Medicine and Epidemiology, Warren Alpert Medical School, Director, Center for Primary Care and Prevention, Brown University, Providence, RI, USA
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Cordola Hsu AR, Xie B, Peterson DV, LaMonte MJ, Garcia L, Eaton CB, Going SB, Phillips LS, Manson JE, Anton-Culver H, Wong ND. Metabolically Healthy/Unhealthy Overweight/Obesity Associations With Incident Heart Failure in Postmenopausal Women: The Women's Health Initiative. Circ Heart Fail 2021; 14:e007297. [PMID: 33775111 DOI: 10.1161/circheartfailure.120.007297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Obesity is associated with an increased risk of heart failure (HF); however, how metabolic weight groups relate to HF risk, especially in postmenopausal women, has not been demonstrated. METHODS We included 19 412 postmenopausal women ages 50 to 79 without cardiovascular disease from the Women's Health Initiative. Normal weight was defined as a body mass index ≥18.5 and <25 kg/m2 and waist circumference <88 cm and overweight/obesity as a body mass index ≥25 kg/m2 or waist circumference ≥88 cm. Metabolically healthy was based on <2 and unhealthy ≥2 cardiometabolic traits: triglycerides ≥150 mg/dL, systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥85 mm Hg or blood pressure medication, fasting glucose ≥100 mg/dL or diabetes medication, and HDL-C (high-density lipoprotein cholesterol) <50 mg/dL. Risk factor-adjusted Cox regression examined the hazard ratios (HRs) for incident hospitalized HF among metabolically healthy normal weight (reference), metabolically unhealthy normal weight, metabolically healthy overweight/obese, and metabolically unhealthy overweight/obese. RESULTS Among our sample, 455 (2.34%) participants experienced HF hospitalizations over a mean follow-up time of 11.3±1.1 years. Compared with metabolically healthy normal weight individuals, HF risk was greater in metabolically unhealthy normal weight (HR, 1.66 [95% CI, 1.01-2.72], P=0.045) and metabolically unhealthy overweight/obese individuals (HR, 1.95 [95% CI, 1.35-2.80], P=0.0004), but not metabolically healthy overweight/obese individuals (HR, 1.15 [95% CI, 0.78-1.71], P=0.48). Subdividing the overweight/obese into separate groups showed HRs for metabolically unhealthy obese of 2.62 (95% CI, 1.80-3.83; P<0.0001) and metabolically healthy obese of 1.52 (95% CI, 0.98-2.35; P=0.06). CONCLUSIONS Metabolically unhealthy overweight/obese and metabolically unhealthy normal weight are associated with an increased risk of HF in postmenopausal women.
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Affiliation(s)
- Amber R Cordola Hsu
- Heart Disease Prevention Program, Division of Cardiology, Department of Medicine (A.R.C.H., N.D.W.), UC Irvine School of Medicine, University of California.,School of Community and Global Health, Claremont Graduate University, The Claremont Colleges, CA (A.R.C.H., B.X., D.V.P.)
| | - Bin Xie
- School of Community and Global Health, Claremont Graduate University, The Claremont Colleges, CA (A.R.C.H., B.X., D.V.P.)
| | - Darleen V Peterson
- School of Community and Global Health, Claremont Graduate University, The Claremont Colleges, CA (A.R.C.H., B.X., D.V.P.)
| | - Michael J LaMonte
- School of Public Health and Health Professions, University of Buffalo, NY (M.J.L.)
| | - Lorena Garcia
- Division of Epidemiology, Department of Public Health Sciences, UC Davis School of Medicine, CA (L.G.)
| | - Charles B Eaton
- Departments of Family Medicine and Epidemiology, Alpert Medical School and School of Public Health, Brown University, Pawtucket, RI (C.B.E.)
| | - Scott B Going
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson (S.B.G.)
| | - Lawrence S Phillips
- Atlanta VA Medical Center and Division of Endocrinology, Department of Medicine, Emory University, GA (L.S.P.)
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.)
| | - Hoda Anton-Culver
- Department of Medicine (H.A.-C.), UC Irvine School of Medicine, University of California
| | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, Department of Medicine (A.R.C.H., N.D.W.), UC Irvine School of Medicine, University of California
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Breathett K, Kohler LN, Eaton CB, Franceschini N, Garcia L, Klein L, Martin LW, Ochs-Balcom HM, Shadyab AH, Cené CW. When the At-Risk Do Not Develop Heart Failure: Understanding Positive Deviance Among Postmenopausal African American and Hispanic Women. J Card Fail 2021; 27:217-223. [PMID: 33232822 PMCID: PMC7880886 DOI: 10.1016/j.cardfail.2020.11.009] [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: 06/24/2020] [Revised: 10/29/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND African American and Hispanic postmenopausal women have the highest risk for heart failure compared with other races, but heart failure prevalence is lower than expected in some national cohorts. It is unknown whether psychosocial factors are associated with lower risk of incident heart failure hospitalization among high-risk postmenopausal minority women. METHODS AND RESULTS Using the Women's Health Initiative Study, African American and US Hispanic women were classified as high-risk for incident heart failure hospitalization with 1 or more traditional heart failure risk factors and the highest tertile heart failure genetic risk scores. Positive psychosocial factors (optimism, social support, religion) and negative psychosocial factors (living alone, social strain, depressive symptoms) were measured using validated survey instruments at baseline. Adjusted subdistribution hazard ratios of developing heart failure hospitalization were determined with death as a competing risk. Positive deviance indicated not developing incident heart failure hospitalization with 1 or more risk factors and the highest tertile for genetic risk. Among 7986 African American women (mean follow-up of 16 years), 27.0% demonstrated positive deviance. Among high-risk African American women, optimism was associated with modestly reduced risk of heart failure hospitalization (subdistribution hazard ratio 0.94, 95% confidence interval 0.91-0.99), and social strain was associated with modestly increased risk of heart failure hospitalization (subdistribution hazard ratio 1.07, 95% confidence interval 1.02-1.12) in the initial models; however, no psychosocial factors were associated with heart failure hospitalization in fully adjusted analyses. Among 3341 Hispanic women, 25.1% demonstrated positive deviance. Among high-risk Hispanic women, living alone was associated with increased risk of heart failure hospitalization (subdistribution hazard ratio 1.97, 95% confidence interval 1.06-3.63) in unadjusted analyses; however, no psychosocial factors were associated with heart failure hospitalization in fully adjusted analyses. CONCLUSIONS Among postmenopausal African American and Hispanic women, a significant proportion remained free from heart failure hospitalization despite having the highest genetic risk profile and 1 or more traditional risk factors. No observed psychosocial factors were associated with incident heart failure hospitalization in high-risk African Americans and Hispanics. Additional investigation is needed to understand protective factors among high-risk African American and Hispanic women.
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Affiliation(s)
- Khadijah Breathett
- Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson, Arizona.
| | - Lindsay N Kohler
- Department of Health Promotion Sciences and Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona
| | - Charles B Eaton
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nora Franceschini
- Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Lorena Garcia
- Department of Public Health Sciences, University of California, Davis, California
| | - Liviu Klein
- Division of Cardiovascular Medicine, University of California, San Francisco, California
| | - Lisa W Martin
- Division of Cardiovascular Medicine, George Washington University, Washington, DC
| | - Heather M Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Aladdin H Shadyab
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Crystal W Cené
- Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, North Carolina
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10
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Shetty S, Malik AH, Ali A, Yang YC, Briasoulis A, Alvarez P. Characteristics, trends, outcomes, and costs of stimulant-related acute heart failure hospitalizations in the United States. Int J Cardiol 2021; 331:158-163. [PMID: 33535075 DOI: 10.1016/j.ijcard.2021.01.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/03/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Heart failure (HF) hospitalizations remains a significant burden on the health care system. Stimulants including cocaine, amphetamine and its derivatives are amongst the most used illegal substances in the United States. The information regarding stimulant-related HF hospitalizations is scarce. We sought to evaluate the characteristics and trends of stimulant-related HF hospitalizations in the United States and their associated outcomes and resource utilization. METHODS Using the National Inpatient Sample (NIS), we identified patients with a primary diagnosis of HF hospitalization. These hospitalizations were further divided into those with and without a concomitant diagnosis of stimulant (cocaine or amphetamine) dependence or abuse. Survey specific techniques were employed to compare trends in baseline characteristics, complications, procedures, outcomes and resource utilization between the two cohorts. RESULTS We identified 9,932,753 hospitalizations (weighted) with a primary diagnosis of heart failure, of those 138,438 (1.39%) had a diagnosis of active stimulant use. The proportion of stimulant-related HF hospitalization is on the rise (1.1% to 1.9%). Stimulant-related HF hospitalization was highest amongst age group 30-39 years and 7.9% of HF hospitalizations in this age group were due to stimulant use. The proportion of stimulant-related HF hospitalization for the White and Hispanic race has doubled from 2008 to 2017. Stimulant-related HF hospitalization is associated with increased incidence of in-hospital complications like cardiogenic shock, acute kidney injury and ventricular tachycardia. These patients have more than 7-fold higher discharge against medical advice. CONCLUSIONS Stimulant-related HF hospitalizations have been increasing. It is associate with significant morbidity burden and health care utilization.
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Affiliation(s)
- Suchith Shetty
- Department of Cardiology, University of Iowa Health Care, Carver College of Medicine, Iowa City, Iowa, USA.
| | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Abbas Ali
- Department of Cardiology, University of Iowa Health Care, Carver College of Medicine, Iowa City, Iowa, USA
| | - Ying Chi Yang
- Department of Cardiology, University of Iowa Health Care, Carver College of Medicine, Iowa City, Iowa, USA
| | - Alexandros Briasoulis
- Department of Cardiology, University of Iowa Health Care, Carver College of Medicine, Iowa City, Iowa, USA
| | - Paulino Alvarez
- Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA
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11
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LaMonte MJ, Larson JC, Manson JE, Bellettiere J, Lewis CE, LaCroix AZ, Bea JW, Johnson KC, Klein L, Noel CA, Stefanick ML, Wactawski-Wende J, Eaton CB. Association of Sedentary Time and Incident Heart Failure Hospitalization in Postmenopausal Women. Circ Heart Fail 2020; 13:e007508. [PMID: 33228398 PMCID: PMC7738397 DOI: 10.1161/circheartfailure.120.007508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The 2018 US Physical Activity Guidelines recommend reducing sedentary behavior (SB) for cardiovascular health. SB's role in heart failure (HF) is unclear. METHODS We studied 80 982 women in the Women's Health Initiative Observational Study, aged 50 to 79 years, who were without known HF and reported ability to walk ≥1 block unassisted at baseline. Mean follow-up was 9 years for physician-adjudicated incident HF hospitalization (1402 cases). SB was assessed repeatedly by questionnaire. Time-varying total SB was categorized according to awake time spent sitting or lying down (≤6.5, 6.6-9.5, >9.5 h/d); sitting time (≤4.5, 4.6-8.5, >8.5 h/d) was also evaluated. Hazard ratios and 95% CI were estimated using Cox regression. RESULTS Controlling for age, race/ethnicity, education, income, smoking, alcohol, menopausal hormone therapy, and hysterectomy status, higher HF risk was observed across incremental tertiles of time-varying total SB (hazard ratios [95% CI], 1.00 [referent], 1.15 [1.01-1.31], 1.42 [1.25-1.61], trend P<0.001) and sitting time (1.00 [referent], 1.14 [1.01-1.28], 1.54 [1.34-1.78], trend P<0.001). The inverse trends remained significant after further controlling for comorbidities including time-varying myocardial infarction and coronary revascularization (hazard ratios: SB, 1.00, 1.11, 1.27; sitting, 1.00, 1.09, 1.37, trend P<0.001 each) and for baseline physical activity (hazard ratios: SB 1.00, 1.10, 1.24; sitting 1.00, 1.08, 1.33, trend P<0.001 each). Associations with SB exposures were not different according to categories of baseline age, race/ethnicity, body mass index, physical activity, physical functioning, diabetes, hypertension, or coronary heart disease. CONCLUSIONS SB was associated with increased risk of incident HF hospitalization in postmenopausal women. Targeted efforts to reduce SB could enhance HF prevention in later life.
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Affiliation(s)
- Michael J. LaMonte
- University at Buffalo, Department of Epidemiology and Environmental Health, Buffalo, NY
| | | | - JoAnn E. Manson
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - John Bellettiere
- University of California San Diego, Department of Family Medicine and Public Health, San Diego, CA
| | - Cora E. Lewis
- University of Alabama Birmingham, Department of Epidemiology, Birmingham, AL
| | - Andrea Z. LaCroix
- University of California San Diego, Department of Family Medicine and Public Health, San Diego, CA
| | | | | | - Liviu Klein
- University of California San Francisco School of Medicine, San Francisco, CA
| | - Corinna A. Noel
- Brown University Warren Alpert School of Medicine, and School of Public Health, Providence, RI
| | - Marcia L. Stefanick
- Stanford University School of Medicine and Prevention Research Center, Palo Alto, CA
| | - Jean Wactawski-Wende
- University at Buffalo, Department of Epidemiology and Environmental Health, Buffalo, NY
| | - Charles B. Eaton
- Brown University Warren Alpert School of Medicine, and School of Public Health, Providence, RI
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12
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Temporal Associations and Outcomes of Breast Cancer and Heart Failure in Postmenopausal Women. JACC: CARDIOONCOLOGY 2020; 2:567-577. [PMID: 34396268 PMCID: PMC8352239 DOI: 10.1016/j.jaccao.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/28/2020] [Accepted: 09/03/2020] [Indexed: 01/01/2023]
Abstract
Background Heart failure (HF) and breast cancer are 2 of the leading causes of death in postmenopausal women. The temporal association between HF and breast cancer in postmenopausal women has not been described. Objectives This study sought to examine the temporal association between HF and breast cancer. Methods Postmenopausal women within the WHI (Women's Health Initiative) cohort were studied. All prevalent HF and prevalent breast cancer at enrollment were self-reported. Incident hospitalized HF and breast cancer diagnoses were adjudicated through 2017. Results Among a cohort of 44,174 women (mean age 63 ± 7 years), 2,188 developed incident invasive breast cancer and 2,416 developed incident hospitalized HF over a median follow-up of 14 and 15 years, respectively. When compared with a breast cancer- and HF-free cohort, there was no association between prevalent HF and incident invasive breast cancer and similarly, there was no association between prevalent breast cancer and incident hospitalized HF. Across the entire cohort, the median survival after incident hospitalized HF was worse compared with an incident invasive breast cancer diagnosis (5 and 19 years, respectively). In women with incident invasive breast cancer, prevalent HF was associated with an increased risk of mortality (hazard ratio: 2.28; 95% confidence interval: 1.31 to 3.95). In women with incident hospitalized HF, prevalent breast cancer was associated with an increased risk of mortality (hazard ratio: 1.66; 95% confidence interval: 1.03 to 2.68). Cause of death after incident HF was different only in women with prevalent and interim breast cancer compared with those without prevalent and interim breast cancer. Conclusions In postmenopausal women, prevalent HF was not associated with a higher incidence of breast cancer and vice versa. However, the presence of incident invasive breast cancer or incident HF in those with prevalent HF or prevalent breast cancer, respectively, was associated with increased mortality.
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13
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Healthy lifestyle and risk of incident heart failure with preserved and reduced ejection fraction among post-menopausal women: The Women's Health Initiative study. Prev Med 2020; 138:106155. [PMID: 32473271 DOI: 10.1016/j.ypmed.2020.106155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/16/2020] [Accepted: 05/22/2020] [Indexed: 01/09/2023]
Abstract
We examined associations of diet, physical activity, cigarette smoking, and body mass index (BMI), separately and as a cumulative lifestyle score, with incident hospitalized HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). This analysis included 40,095 postmenopausal women in the Women's Health Initiative clinical trial and observational studies, aged 50-79 years and without self-reported HF at baseline. A healthy lifestyle score (HLS) was developed, in which women received 1 point for each healthy lifestyle. A weighted HLS was also created to examine the independent magnitude of each of the lifestyle factors in HF subtypes. Trained adjudicators determined cases of incident hospitalized HF, HFpEF, HFrEF through March 2018. Multiple variable Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI). During a mean follow-up period of 14.5 years, 659 incident HFrEF and 1276 HFpEF cases were documented. Across unweighted HLS of 0 (referent), 1, 2, 3, and 4, multivariable adjusted HRs (95% CI) for HFrEF were 1.00, 0.52 (0.38, 0.71), 0.40 (0.29, 0.56), 0.33 (0.23, 0.48), and 0.33 (0.19, 0.56) (P-trend = 0.03) and for HFpEF were 1.00, 0.47 (0.37, 0.59), 0.39 (0.30, 0.49), 0.26 (0.20, 0.34), and 0.23 (0.15, 0.35) (P-trend < 0.001). Results were similar for the weighted HLS. Our findings suggest that following a healthy lifestyle pattern is associated with lower risks of HFpEF and HFrEF among postmenopausal women.
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14
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Dzhioeva O, Belyavskiy E. Diagnosis and Management of Patients with Heart Failure with Preserved Ejection Fraction (HFpEF): Current Perspectives and Recommendations. Ther Clin Risk Manag 2020; 16:769-785. [PMID: 32904123 PMCID: PMC7450524 DOI: 10.2147/tcrm.s207117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a major global public health problem. Diagnosis of HFpEF is still challenging and built based on the comprehensive echocardiographic analysis. Currently, there are no universally accepted therapies that alter the clinical course of HFpEF. This review attempts to summarize the current advances in the diagnosis of HFpEF and provide future directions of the patients´ management with this very widespread, heterogeneous clinical syndrome.
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Affiliation(s)
- Olga Dzhioeva
- Department of Fundamental and Applied Aspects of Obesity, National Medical Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Evgeny Belyavskiy
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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15
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Reding KW, Aragaki AK, Cheng RK, Barac A, Wassertheil-Smoller S, Chubak J, Limacher MC, Hundley WG, D'Agostino R, Vitolins MZ, Brasky TM, Habel LA, Chow EJ, Jackson RD, Chen C, Morgenroth A, Barrington WE, Banegas M, Barnhart M, Chlebowski RT. Cardiovascular Outcomes in Relation to Antihypertensive Medication Use in Women with and Without Cancer: Results from the Women's Health Initiative. Oncologist 2020; 25:712-721. [PMID: 32250503 DOI: 10.1634/theoncologist.2019-0977] [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: 12/19/2019] [Accepted: 02/14/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Recent clinical trials have evaluated angiotensin-converting enzyme (ACE) inhibitors (ACEis), angiotensin receptor blockers (ARBs), and beta blockers (BBs) in relation to cardiotoxicity in patients with cancer, typically defined by ejection fraction declines. However, these trials have not examined long-term, hard clinical endpoints. Within a prospective study, we examined the risk of heart failure (HF) and coronary heart disease (CHD) events in relation to use of commonly used antihypertensive medications, including ACEis/ARBs, BBs, calcium channel blockers (CCB), and diuretics, comparing women with and without cancer. MATERIALS AND METHODS In a cohort of 56,997 Women's Health Initiative study participants free of cardiovascular disease who received antihypertensive treatment, we used multivariable-adjusted Cox regression models to calculate the hazard ratios (HRs) of developing CHD, HF, and a composite outcome of cardiac events (combining CHD and HF) in relation to use of ACEis/ARBs, CCBs, or diuretics versus BBs, separately in women with and without cancer. RESULTS Whereas there was no difference in risk of cardiac events comparing ACEi/ARB with BB use among cancer-free women (HR = 0.99 [0.88-1.12]), among cancer survivors ACEi/ARB users were at a 2.24-fold risk of total cardiac events (1.18-4.24); p-interaction = .06). When investigated in relation to CHD only, an increased risk was similarly observed in ACEi/ARB versus BB use for cancer survivors (HR = 1.87 [0.88-3.95]) but not in cancer-free women (HR = 0.91 [0.79-1.06]; p-interaction = .04). A similar pattern was also seen in relation to HF but did not reach statistical significance (p-interaction = .23). CONCLUSION These results from this observational study suggest differing risks of cardiac events in relation to antihypertensive medications depending on history of cancer. Although these results require replication before becoming actionable in a clinical setting, they suggest the need for more rigorous examination of the effect of antihypertensive choice on long-term cardiac outcomes in cancer survivors. IMPLICATIONS FOR PRACTICE Although additional research is needed to replicate these findings, these data from a large, nationally representative sample of postmenopausal women indicate that beta blockers are favorable to angiotensin-converting enzyme inhibitors in reducing the risk of cardiac events among cancer survivors. This differs from the patterns observed in a noncancer cohort, which largely mirrors what is found in the randomized clinical trials in the general population.
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Affiliation(s)
- Kerryn W Reding
- University of Washington School of Nursing, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington, USA
| | - Aaron K Aragaki
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington, USA
| | - Richard K Cheng
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Ana Barac
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Marian C Limacher
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - W Gregory Hundley
- Virginia Commonwealth University Pauley Heart Center, Richmond, Virginia, USA
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ralph D'Agostino
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mara Z Vitolins
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Laurel A Habel
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Eric J Chow
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Rebecca D Jackson
- The Ohio State University Department of Medicine, Columbus, Ohio, USA
| | - Chu Chen
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington, USA
| | - April Morgenroth
- Seattle Pacific University College of Nursing, Seattle, Washington, USA
| | - Wendy E Barrington
- University of Washington School of Nursing, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington, USA
| | - Matthew Banegas
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Matthew Barnhart
- Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Rowan T Chlebowski
- Harbor-University of California Los Angeles Medical Center, Los Angeles, California, USA
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16
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Pandey A, Keshvani N, Ayers C, Correa A, Drazner MH, Lewis A, Rodriguez CJ, Hall ME, Fox ER, Mentz RJ, deFilippi C, Seliger SL, Ballantyne CM, Neeland IJ, de Lemos JA, Berry JD. Association of Cardiac Injury and Malignant Left Ventricular Hypertrophy With Risk of Heart Failure in African Americans: The Jackson Heart Study. JAMA Cardiol 2020; 4:51-58. [PMID: 30566191 DOI: 10.1001/jamacardio.2018.4300] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance African Americans have a higher burden of heart failure (HF) risk factors and clinical HF than other racial/ethnic groups. However, the factors underlying the transition from at-risk to clinical HF in African Americans are not well understood. Objective To evaluate the contributions of left ventricular hypertrophy (LVH) and subclinical myocardial injury as determined by abnormal high-sensitivity cardiac troponin-I (hs-cTnI) measurements toward HF risk among African Americans. Design, Setting, and Participants This prospective, community-based cohort study was conducted between July 2016 and September 2018 and included African American participants from Jackson, Mississippi enrolled in the Jackson Heart Study without prevalent HF who had hs-cTnI measurements and an echocardiographic examination at baseline. Participants were stratified into categories based on the presence or absence of LVH and subclinical myocardial injury (category 1: hs-cTnI <4 ng/L in women and <6 ng/L in men; category 2: 4-10 ng/L in women and 6-12 ng/L in men; category 3: >10 ng/L in women and >12 ng/L in men). Main Outcomes and Measures Adjusted associations between LVH, subclinical myocardial injury, and the risk of incident HF hospitalization were assessed using Cox proportional hazards models. Results The study included 3987 participants (2552 women [64%]; 240 (6.0%) with LVH; 1003 (25.1%) with myocardial injury) with 285 incident HF events over a median follow-up of 9.8 years (interquartile range, 8.9-10.6 years). In adjusted analyses, higher LV mass and subclinical myocardial injury were independently associated with the risk of HF with a significant interaction between the 2 (Pint < 0.001). The highest risk of HF was noted among individuals with both LVH and myocardial injury (absolute incidence, 35%; adjusted hazard ratio [aHR; vs no LVH and no myocardial injury], 5.35; 95% CI, 3.66-7.83). A significant interaction by sex was also observed. Men with LVH and subclinical myocardial injury had an almost 15-fold higher risk of HF (aHR, 14.62; 95% CI, 7.61-28.10) vs those with neither LVH nor injuries. By contrast, women with this phenotype had a nearly 4-fold higher risk of HF (aHR, 3.81; 95% CI, 2.40-6.85). Conclusions and Relevance The combination of LVH and subclinical myocardial injury identifies a malignant, preclinical HF phenotype in African Americans with a very high risk of HF, particularly among men. This finding could have implications for future screening strategies that are designed to prevent HF in the population.
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Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Mark H Drazner
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Alana Lewis
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Carlos J Rodriguez
- Division of Cardiology, Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Michael E Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Ervin R Fox
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Robert J Mentz
- Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina
| | | | - Stephen L Seliger
- Division of Nephrology, University of Maryland School of Medicine, Baltimore
| | - Christie M Ballantyne
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ian J Neeland
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - James A de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Jarett D Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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17
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Mayfield JJ, Papolos A, Vasti E, De Marco T, Tison GH. Pulmonary arterial capacitance predicts outcomes in patients with pulmonary hypertension independent of race/ethnicity, sex, and etiology. Respir Med 2020; 163:105891. [PMID: 32056840 DOI: 10.1016/j.rmed.2020.105891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pulmonary arterial capacitance (PAC) is a strong hemodynamic predictor of outcomes in patients with pulmonary hypertension (PH). Its value across subgroups of race/ethnicity, sex, and PH etiologies is unclear. We hypothesized that the association of PAC with outcomes would not vary across World Health Organization (WHO) PH group, race/ethnicity, or sex. METHODS We performed a retrospective study in patients with PH diagnosed and managed at the Pulmonary Hypertension Comprehensive Care Center of a tertiary care hospital (n = 270). Demographic, diagnostic, treatment, and outcome data were extracted from the electronic medical record. Cox proportional hazards models were used to model time from right heart catheterization to event in univariate and multivariable models. Our primary outcome was all-cause mortality and our secondary outcome was PH hospitalization. RESULTS The median age of the cohort was 56 years (±14.6), and 67% were female. In multivariable Cox models adjusted for significant covariates, decreased PAC remained independently and significantly associated with both all-cause mortality (p = 0.029) and hospitalization for PH (p = 0.010). No significant interactions were observed between PAC and race, sex, or WHO group. Hispanic patients exhibited a significant independent association with increased hospitalizations (p = 0.030), and there was a trend toward increased all-cause mortality in African Americans. WHO group 2 PH was associated with more frequent hospitalization (p = 0.004). CONCLUSIONS Decreased PAC is significantly associated with mortality and hospitalization in PH patients independent of race, sex, and PH subgroups. Further investigation is required to characterize the effects and determinants of racial disparities in PH.
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Affiliation(s)
- Jacob J Mayfield
- Department of Medicine, University of California, San Francisco, USA
| | - Alexander Papolos
- Department of Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Elena Vasti
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Teresa De Marco
- Department of Medicine, University of California, San Francisco, USA; Division of Cardiology, University of California, San Francisco, USA
| | - Geoffrey H Tison
- Department of Medicine, University of California, San Francisco, USA; Division of Cardiology, University of California, San Francisco, USA; Bakar Institute of Computational Health Sciences, University of California, San Francisco, USA; Cardiovascular Research Institute, University of California, San Francisco, USA.
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18
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Liu L, Klein L, Eaton C, Panjrath G, Martin LW, Chae CU, Greenland P, Lloyd-Jones DM, Wactawski-Wende J, Manson JE. Menopausal Hormone Therapy and Risks of First Hospitalized Heart Failure and its Subtypes During the Intervention and Extended Postintervention Follow-up of the Women's Health Initiative Randomized Trials. J Card Fail 2020; 26:2-12. [DOI: 10.1016/j.cardfail.2019.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/24/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022]
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19
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Franceschini N, Kopp JB, Barac A, Martin LW, Li Y, Qian H, Reiner AP, Pollak M, Wallace RB, Rosamond WD, Winkler CA. Association of APOL1 With Heart Failure With Preserved Ejection Fraction in Postmenopausal African American Women. JAMA Cardiol 2019; 3:712-720. [PMID: 29971324 DOI: 10.1001/jamacardio.2018.1827] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance APOL1 genotypes are associated with kidney diseases in African American individuals and may influence cardiovascular disease and mortality risk, but findings have been inconsistent. Objective To discern whether high-risk APOL1 genotypes are associated with cardiovascular disease and stroke in postmenopausal African American women, who are at high risk for these outcomes. Design, Setting, and Participants The Women's Health Initiative is a prospective cohort that enrolled 161 838 postmenopausal women into clinical trials and an observational study between 1993 and 1998. This study includes 11 137 African American women participants who had a clinical event from enrollment to June 2014. Data analyses were completed from January 2017 to August 2017. Exposures The variants of APOL1 were genotyped or imputed from whole-exome sequencing. Main Outcomes and Measures Incident coronary heart disease, stroke and heart failure subtypes, and overall and cause-specific mortality were adjudicated from hospital records and death certificates. Estimated incidence rates were determined for each outcome and hazard ratios (HR) and 95% CIs for the associations of APOL1 groups with outcomes. Results The mean (SD) age of participants was 61.7 (7.1) years. Carriers of high-risk APOL1 variants (n = 1370; 12.3%) had higher prevalence of hypertension, use of cholesterol-lowering medications, and reduced estimated glomerular filtration rate (eGFR). After a mean (SD) of 11.0 (3.6) years, carriers of high-risk APOL1 variants had a higher incidence rate of hospitalized heart failure with preserved ejection fraction (HFpEF) than low-risk carriers did but showed no differences for other outcomes. In adjusted models, there was a significant 58% increased hazard of hospitalized HFpEF (HR, 1.58 [95% CI, 1.03-2.41]) among carriers of high-risk APOL1 variants compared with carriers of low-risk APOL1 variants. The association with HFpEF was attenuated (HR = 1.50 [95% CI, 0.98-2.30]) and no longer significant when adjusting for baseline eGFR. Conclusions and Relevance Status as a carrier of a high-risk APOL1 genotype was associated with HFpEF hospitalization among postmenopausal women, which is partly accounted for by baseline kidney function. These findings do not support an association of high-risk APOL1 genotypes with coronary heart disease, stroke, or mortality in postmenopausal African American women.
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Affiliation(s)
- Nora Franceschini
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Jeffrey B Kopp
- Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Ana Barac
- MedStar Heart and Vascular Institute, Washington, DC
| | - Lisa W Martin
- Cardiology Division, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Yun Li
- Department of Statistics and Operations Research, University of North Carolina, Chapel Hill
| | - Huijun Qian
- Department of Statistics and Operations Research, University of North Carolina, Chapel Hill
| | - Alex P Reiner
- University of Washington School of Public Health, Seattle
| | - Martin Pollak
- Division of Nephrology, Harvard Medical School, Boston, Massachusetts
| | - Robert B Wallace
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Wayne D Rosamond
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Cheryl A Winkler
- Molecular Genetic Epidemiology Section, Basic Research Laboratory, Basic Science Program, National Cancer Institute Leidos Biomedical Research, Frederick National Laboratory, Frederick, Maryland
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20
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Pandey A, Kondamudi N, Patel KV, Ayers C, Simek S, Hall ME, Musani SK, Blackshear C, Mentz RJ, Khan H, Terry JG, Correa A, Butler J, Neeland IJ, Berry JD. Association Between Regional Adipose Tissue Distribution and Risk of Heart Failure Among Blacks. Circ Heart Fail 2019; 11:e005629. [PMID: 30571193 DOI: 10.1161/circheartfailure.118.005629] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Obesity is highly prevalent among blacks and is associated with a greater risk of heart failure (HF). However, the contribution of regional adiposity depots such as visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue toward risk of HF in blacks is unknown. METHODS AND RESULTS We included 2602 participants (mean age: 59 years, 35% men) from the Jackson Heart Study without prevalent HF who underwent computed tomography quantification of VAT and subcutaneous adipose tissue during the second visit (2005-2009). The associations between different adiposity measures and HF were evaluated using adjusted Cox models. There were 122 incident HF events over a median follow-up of 7.1 years. Higher amounts of VAT were associated with greater risk of HF in age- and sex-adjusted analyses (hazard ratio [95% CI] per 1-SD higher VAT: 1.29 [1.09-1.52]). This association was attenuated and not significant after additional adjustment for traditional HF risk factors and body mass index. Overall obesity, represented by body mass index, was associated with higher risk of HF independent of risk factors and VAT (hazard ratio [95% CI] per 1-kg/m2 higher body mass index: 1.06 [1.02-1.11]). Subcutaneous adipose tissue was not associated with risk of HF in adjusted analyses. CONCLUSIONS In a community-dwelling black population, higher amounts of overall and visceral adiposity are associated with higher risk of HF. The association between VAT and HF risk in blacks may reflect differences in traditional HF risk factor burden. Future studies are needed to confirm this observation and clarify the independent role of different measures of adiposity on HF outcomes.
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Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UTSW Medical Center, Dallas, TX (A.P., N.K., K.V.P., C.A., S.S., I.J.N., J.D.B.)
| | - Nitin Kondamudi
- Division of Cardiology, Department of Internal Medicine, UTSW Medical Center, Dallas, TX (A.P., N.K., K.V.P., C.A., S.S., I.J.N., J.D.B.)
| | - Kershaw V Patel
- Division of Cardiology, Department of Internal Medicine, UTSW Medical Center, Dallas, TX (A.P., N.K., K.V.P., C.A., S.S., I.J.N., J.D.B.)
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, UTSW Medical Center, Dallas, TX (A.P., N.K., K.V.P., C.A., S.S., I.J.N., J.D.B.)
| | - Shawn Simek
- Division of Cardiology, Department of Internal Medicine, UTSW Medical Center, Dallas, TX (A.P., N.K., K.V.P., C.A., S.S., I.J.N., J.D.B.)
| | - Michael E Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson (M.E.H., S.K.M., C.B., A.C., J.B.)
| | - Solomon K Musani
- Department of Medicine, University of Mississippi Medical Center, Jackson (M.E.H., S.K.M., C.B., A.C., J.B.)
| | - Chad Blackshear
- Department of Medicine, University of Mississippi Medical Center, Jackson (M.E.H., S.K.M., C.B., A.C., J.B.)
| | - Robert J Mentz
- Division of Cardiology, Duke Clinical Research Institute, Durham, NC (R.J.M.)
| | - Hassan Khan
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (H.K.)
| | - James G Terry
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.G.T.)
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson (M.E.H., S.K.M., C.B., A.C., J.B.)
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson (M.E.H., S.K.M., C.B., A.C., J.B.)
| | - Ian J Neeland
- Division of Cardiology, Department of Internal Medicine, UTSW Medical Center, Dallas, TX (A.P., N.K., K.V.P., C.A., S.S., I.J.N., J.D.B.)
| | - Jarett D Berry
- Division of Cardiology, Department of Internal Medicine, UTSW Medical Center, Dallas, TX (A.P., N.K., K.V.P., C.A., S.S., I.J.N., J.D.B.)
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Abstract
Approximately half of the patients with signs and symptoms of heart failure have a left ventricular ejection fraction that is not markedly abnormal. Despite the historically initial surprise, heightened risks for heart failure specific major adverse events occur across the broad range of ejection fraction, including normal. The recognition of the magnitude of the problem of heart failure with preserved ejection fraction in the past 20 years has spurred an explosion of clinical investigation and growing intensity of informative outcome trials. This article addresses the historic development of this component of the heart failure syndrome, including the epidemiology, pathophysiology, and existing and planned therapeutic studies. Looking forward, more specific phenotyping and even genotyping of subpopulations should lead to improvements in outcomes from future trials.
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Affiliation(s)
- Marc A. Pfeffer
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amil M. Shah
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Barry A. Borlaug
- Cardiovascular Medicine Division, Mayo Clinic, Rochester, Minnesota
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22
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Lundberg G, Walsh MN, Mehta LS. Sex-Specific Differences in Risk Factors for Development of Heart Failure in Women. Heart Fail Clin 2019; 15:1-8. [DOI: 10.1016/j.hfc.2018.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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23
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LaMonte MJ, Manson JE, Chomistek AK, Larson JC, Lewis CE, Bea JW, Johnson KC, Li W, Klein L, LaCroix AZ, Stefanick ML, Wactawski-Wende J, Eaton CB. Physical Activity and Incidence of Heart Failure in Postmenopausal Women. JACC. HEART FAILURE 2018; 6:983-995. [PMID: 30196073 PMCID: PMC6275092 DOI: 10.1016/j.jchf.2018.06.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/06/2018] [Accepted: 06/14/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study prospectively examined physical activity levels and the incidence of heart failure (HF) in 137,303 women, ages 50 to 79 years, and examined a subset of 35,272 women who, it was determined, had HF with preserved ejection fraction (HFpEF) and HF with reduced EF (HFrEF). BACKGROUND The role of physical activity in HF risk among older women is unclear, particularly for incidence of HFpEF or HFrEF. METHODS Women were free of HF and reported ability to walk at least 1 block without assistance at baseline. Recreational physical activity was self-reported. The study documented 2,523 cases of total HF, and 451 and 734 cases of HFrEF and HFpEF, respectively, during a mean 14-year follow-up. RESULTS After controlling for age, race, education, income, smoking, alcohol, hormone therapy, and hysterectomy status, compared with women who reported no physical activity (reference group), inverse associations were observed across incremental tertiles of total physical activity for overall HF (hazard ratio [HR]: Tertile 1 = 0.89, Tertile 2 = 0.74, Tertile 3 = 0.65; trend p < 0.001), HFpEF (HR: 0.93, 0.70, 0.68; p < 0.001), and HFrEF (HR: 0.81, 0.59, 0.68; p = 0.01). Additional controlling for potential mediating factors included attenuated time-varying coronary heart disease (CHD) (nonfatal myocardial infarction, coronary revascularization) diagnosis but did not eliminate the inverse associations. Walking, the most common form of physical activity in older women, was also inversely associated with HF risks (overall: 1.00, 0.98, 0.93, 0.72; p < 0.001; HFpEF: 1.00, 0.98, 0.87, 0.67; p < 0.001; HFrEF: 1.00, 0.75, 0.78, 0.67; p = 0.01). Associations between total physical activity and HF were consistent across subgroups, defined by age, body mass index, diabetes, hypertension, physical function, and CHD diagnosis. Analysis of physical activity as a time-varying exposure yielded findings comparable to those of baseline physical activity. CONCLUSIONS Higher levels of recreational physical activity, including walking, are associated with significantly reduced HF risk in community-dwelling older women.
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Affiliation(s)
- Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York.
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrea K Chomistek
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana
| | | | - Cora E Lewis
- Department of Preventive Medicine, University of Alabama at Birmingham Medical School, Birmingham, Alabama
| | - Jennifer W Bea
- Departments of Medicine and Nutritional Sciences, University of Arizona Cancer Center, Tucson, Arizona
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Wenjun Li
- Department of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Liviu Klein
- Department of Cardiology, University of San Francisco School of Medicine, San Francisco, California
| | - Andrea Z LaCroix
- Department of Epidemiology, University of California, San Diego, California
| | - Marcia L Stefanick
- Department of Medicine Stanford University Medical School, Stanford, California; Department of Gynecology Obstetrics, Stanford University Medical School, Stanford, California
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Charles B Eaton
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Epidemiology, Brown University School of Public Health, Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Providence, Rhode Island
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24
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Breathett K, Leng I, Foraker RE, Abraham WT, Coker L, Whitfield KE, Shumaker S, Manson JE, Eaton CB, Howard BV, Ijioma N, Cené CW, Martin LW, Johnson KC, Klein L. Risk Factor Burden, Heart Failure, and Survival in Women of Different Ethnic Groups: Insights From the Women's Health Initiative. Circ Heart Fail 2018; 11:e004642. [PMID: 29716899 PMCID: PMC5935135 DOI: 10.1161/circheartfailure.117.004642] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/30/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The higher risk of heart failure (HF) in African-American and Hispanic women compared with white women is related to the higher burden of risk factors (RFs) in minorities. However, it is unclear if there are differences in the association between the number of RFs for HF and the risk of development of HF and death within racial/ethnic groups. METHODS AND RESULTS In the WHI (Women's Health Initiative; 1993-2010), African-American (n=11 996), white (n=18 479), and Hispanic (n=5096) women with 1, 2, or 3+ baseline RFs were compared with women with 0 RF within their respective racial/ethnic groups to assess risk of developing HF or all-cause mortality before and after HF, using survival analyses. After adjusting for age, socioeconomic status, and hormone therapy, the subdistribution hazard ratio (95% confidence interval) of developing HF increased as number of RFs increased (P<0.0001, interaction of race/ethnicity and RF number P=0.18)-African-Americans 1 RF: 1.80 (1.01-3.20), 2 RFs: 3.19 (1.84-5.54), 3+ RFs: 7.31 (4.26-12.56); Whites 1 RF: 1.27 (1.04-1.54), 2 RFs: 1.95 (1.60-2.36), 3+ RFs: 4.07 (3.36-4.93); Hispanics 1 RF: 1.72 (0.68-4.34), 2 RFs: 3.87 (1.60-9.37), 3+ RFs: 8.80 (3.62-21.42). Risk of death before developing HF increased with subsequent RFs (P<0.0001) but differed by racial/ethnic group (interaction P=0.001). The number of RFs was not associated with the risk of death after developing HF in any group (P=0.25; interaction P=0.48). CONCLUSIONS Among diverse racial/ethnic groups, an increase in the number of baseline RFs was associated with higher risk of HF and death before HF but was not associated with death after HF. Early RF prevention may reduce the burden of HF across multiple racial/ethnic groups.
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Affiliation(s)
- Khadijah Breathett
- Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson (K.B.).
| | - Iris Leng
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (I.L.)
| | - Randi E Foraker
- Institute for Informatics, Washington University in St Louis School of Medicine, MO (R.E.F.)
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus (W.T.A.)
| | - Laura Coker
- Division of Public Health Sciences, Wake Forest School of Medicine, Social Sciences and Health Policy, Winston-Salem, NC (L.C., S.S.)
| | | | - Sally Shumaker
- Division of Public Health Sciences, Wake Forest School of Medicine, Social Sciences and Health Policy, Winston-Salem, NC (L.C., S.S.)
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.)
| | - Charles B Eaton
- Department of Family Medicine, Alpert Medical School of Brown University and Department of Epidemiology, School of Public Health of Brown University, Center for Primary Care and Prevention, Pawtucket, RI (C.B.E.)
| | - Barbara V Howard
- MedStar Health Research Institute and Georgetown/Howard Universities Center for Clinical and Translational Science, Washington, DC (B.V.H.)
| | | | - Crystal W Cené
- Division of General Internal Medicine, University of North Carolina-Chapel Hill (C.W.C.)
| | - Lisa W Martin
- Division of Cardiology, George Washington University, Washington, DC (L.W.M.)
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.)
| | - Liviu Klein
- Division of Cardiology, University of California San Francisco (L.K.)
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25
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Tee Lu H, Nordin RB, Abdul Rahim AAB. Influence of Race in the Association of Diabetes and Heart Failure. US CARDIOLOGY REVIEW 2018. [DOI: 10.15420/usc.2017:24:2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Heart failure is a global public health problem with high mortality and readmission rates. Race and ethnicity are useful concepts when attempting to understand differential health risks and health disparities. With cardiovascular diseases accounting for most deaths globally, eliminating racial disparities in cardiac care has become a new challenge in cardiology. Significant racial differences exist in patients with heart failure. African American patients in the US have a significantly higher incidence of heart failure, lower ejection fraction and are younger at presentation compared to White, Hispanic and Chinese American patients. These findings are explained by a higher burden of risk factors such as diabetes mellitus, hypertension, obesity and lower household incomes among African Americans. The authors believe that these findings are applicable to other racial groups across the globe. The prevalence of predisposing risk factors probably has a stronger influence on the incidence of heart failure than the racial factor alone. The interaction between race and diabetes mellitus has important public health implications for the management and prevention of heart failure.
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26
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Nuti SV, Wang Y, Masoudi FA, Nunez-Smith M, Normand SLT, Murugiah K, Rodríguez-Vilá O, Ross JS, Krumholz HM. Quality of Care in the United States Territories, 1999-2012. Med Care 2017; 55:886-892. [PMID: 28906314 PMCID: PMC6482857 DOI: 10.1097/mlr.0000000000000797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Millions of Americans live in the US territories, but health outcomes and payments among Medicare beneficiaries in these territories are not well characterized. METHODS Among Fee-for-Service Medicare beneficiaries aged 65 years and older hospitalized between 1999 and 2012 for acute myocardial infarction (AMI), heart failure (HF), and pneumonia, we compared hospitalization rates, patient outcomes, and inpatient payments in the territories and states. RESULTS Over 14 years, there were 4,350,813 unique beneficiaries in the territories and 402,902,615 in the states. Hospitalization rates for AMI, HF, and pneumonia declined overall and did not differ significantly. However, 30-day mortality rates were higher in the territories for all 3 conditions: in the most recent time period (2008-2012), the adjusted odds of 30-day mortality were 1.34 [95% confidence interval (CI), 1.21-1.48], 1.24 (95% CI, 1.12-1.37), and 1.85 (95% CI, 1.71-2.00) for AMI, HF, and pneumonia, respectively; adjusted odds of 1-year mortality were also higher. In the most recent study period, inflation-adjusted Medicare in-patient payments, in 2012 dollars, were lower in the territories than the states, at $9234 less (61% lower than states), $4479 less (50% lower), and $4403 less (39% lower) for AMI, HF, and pneumonia hospitalizations, respectively (P<0.001 for all). CONCLUSIONS AND RELEVANCE Among Medicare Fee-for-Service beneficiaries, in 2008-2012 mortality rates were higher, or not significantly different, and hospital reimbursements were lower for patients hospitalized with AMI, HF, and pneumonia in the territories. Improvement of health care and policies in the territories is critical to ensure health equity for all Americans.
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Affiliation(s)
| | - Yun Wang
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Frederick A. Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marcella Nunez-Smith
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine
- Section of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Sharon-Lise T. Normand
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Karthik Murugiah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Orlando Rodríguez-Vilá
- Cardiology Section and the Medical Service, VA Caribbean Healthcare System, San Juan, Puerto Rico
| | - Joseph S. Ross
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine
- Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
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27
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Ziaeian B, Kominski GF, Ong MK, Mays VM, Brook RH, Fonarow GC. National Differences in Trends for Heart Failure Hospitalizations by Sex and Race/Ethnicity. Circ Cardiovasc Qual Outcomes 2017; 10:e003552. [PMID: 28655709 PMCID: PMC5540644 DOI: 10.1161/circoutcomes.116.003552] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND National heart failure (HF) hospitalization rates have not been appropriately age standardized by sex or race/ethnicity. Reporting hospital utilization trends by subgroup is important for monitoring population health and developing interventions to eliminate disparities. METHODS AND RESULTS The National Inpatient Sample (NIS) was used to estimate the crude and age-standardized rates of HF hospitalization between 2002 and 2013 by sex and race/ethnicity. Direct standardization was used to age-standardize rates to the 2000 US standard population. Relative differences between subgroups were reported. The national age-adjusted HF hospitalization rate decreased 30.8% from 526.86 to 364.66 per 100 000 between 2002 and 2013. Although hospitalizations decreased for all subgroups, the ratio of the age-standardized rate for men compared with women increased from 20% greater to 39% (P trend=0.002) between 2002 and 2013. Black men had a rate that was 229% (P trend=0.141) and black women, 240% (P trend=0.725) with reference to whites in 2013 with no significant change between 2002 and 2013. Hispanic men had a rate that was 32% greater in 2002 and the difference narrowed to 4% (P trend=0.047) greater in 2013 relative to whites. For Hispanic women, the rate was 55% greater in 2002 and narrowed to 8% greater (P trend=0.004) in 2013 relative to whites. Asian/Pacific Islander men had a 27% lower rate in 2002 that improved to 43% (P trend=0.040) lower in 2013 relative to whites. For Asian/Pacific Islander women, the hospitalization rate was 24% lower in 2002 and improved to 43% (P trend=0.021) lower in 2013 relative to whites. CONCLUSIONS National HF hospitalization rates have decreased steadily during the recent decade. Disparities in HF burden and hospital utilization by sex and race/ethnicity persist. Significant population health interventions are needed to reduce the HF hospitalization burden among blacks. An evaluation of factors explaining the improvements in the HF hospitalization rates among Hispanics and Asian/Pacific Islanders is needed.
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Affiliation(s)
- Boback Ziaeian
- From the Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA (B.Z., G.F.K., V.M.M., R.H.B.); Division of Cardiology (B.Z.) and Department of Internal Medicine (M.K.O.), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; Division of General Internal Medicine and Health Services Research (M.K.O., R.H.B.) and Division of Cardiology (B.Z., G.C.F.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Psychology, University of California, Los Angeles (V.M.M.); and Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Gerald F Kominski
- From the Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA (B.Z., G.F.K., V.M.M., R.H.B.); Division of Cardiology (B.Z.) and Department of Internal Medicine (M.K.O.), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; Division of General Internal Medicine and Health Services Research (M.K.O., R.H.B.) and Division of Cardiology (B.Z., G.C.F.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Psychology, University of California, Los Angeles (V.M.M.); and Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Michael K Ong
- From the Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA (B.Z., G.F.K., V.M.M., R.H.B.); Division of Cardiology (B.Z.) and Department of Internal Medicine (M.K.O.), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; Division of General Internal Medicine and Health Services Research (M.K.O., R.H.B.) and Division of Cardiology (B.Z., G.C.F.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Psychology, University of California, Los Angeles (V.M.M.); and Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Vickie M Mays
- From the Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA (B.Z., G.F.K., V.M.M., R.H.B.); Division of Cardiology (B.Z.) and Department of Internal Medicine (M.K.O.), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; Division of General Internal Medicine and Health Services Research (M.K.O., R.H.B.) and Division of Cardiology (B.Z., G.C.F.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Psychology, University of California, Los Angeles (V.M.M.); and Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Robert H Brook
- From the Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA (B.Z., G.F.K., V.M.M., R.H.B.); Division of Cardiology (B.Z.) and Department of Internal Medicine (M.K.O.), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; Division of General Internal Medicine and Health Services Research (M.K.O., R.H.B.) and Division of Cardiology (B.Z., G.C.F.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Psychology, University of California, Los Angeles (V.M.M.); and Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Gregg C Fonarow
- From the Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA (B.Z., G.F.K., V.M.M., R.H.B.); Division of Cardiology (B.Z.) and Department of Internal Medicine (M.K.O.), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; Division of General Internal Medicine and Health Services Research (M.K.O., R.H.B.) and Division of Cardiology (B.Z., G.C.F.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Psychology, University of California, Los Angeles (V.M.M.); and Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.).
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28
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Eaton CB, Pettinger M, Rossouw J, Martin LW, Foraker R, Quddus A, Liu S, Wampler NS, Hank Wu WC, Manson JE, Margolis K, Johnson KC, Allison M, Corbie-Smith G, Rosamond W, Breathett K, Klein L. Risk Factors for Incident Hospitalized Heart Failure With Preserved Versus Reduced Ejection Fraction in a Multiracial Cohort of Postmenopausal Women. Circ Heart Fail 2016; 9:e002883. [PMID: 27682440 PMCID: PMC5111360 DOI: 10.1161/circheartfailure.115.002883] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 08/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Heart failure is an important and growing public health problem in women. Risk factors for incident hospitalized heart failure with preserved ejection fraction (HFpEF) compared with heart failure with reduced ejection fraction (HFrEF) in women and differences by race/ethnicity are not well characterized. METHODS AND RESULTS We prospectively evaluated the risk factors for incident hospitalized HFpEF and HFrEF in a multiracial cohort of 42 170 postmenopausal women followed up for a mean of 13.2 years. Cox regression models with time-dependent covariate adjustment were used to define risk factors for HFpEF and HFrEF. Differences by race/ethnicity about incidence rates, baseline risk factors, and their population-attributable risk percentage were analyzed. Risk factors for both HFpEF and HFrEF were as follows: older age, white race, diabetes mellitus, cigarette smoking, and hypertension. Obesity, history of coronary heart disease (other than myocardial infarction), anemia, atrial fibrillation, and more than one comorbidity were associated with HFpEF but not with HFrEF. History of myocardial infarction was associated with HFrEF but not with HFpEF. Obesity was found to be a more potent risk factor for African American women compared with white women for HFpEF (P for interaction=0.007). For HFpEF, the population-attributable risk percentage was greatest for hypertension (40.9%) followed by obesity (25.8%), with the highest population-attributable risk percentage found in African Americans for these risk factors. CONCLUSIONS In this multiracial cohort of postmenopausal women, obesity stands out as a significant risk factor for HFpEF, with the strongest association in African American women. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000611.
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Affiliation(s)
- Charles B Eaton
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.).
| | - Mary Pettinger
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Jacques Rossouw
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Lisa Warsinger Martin
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Randi Foraker
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Abdullah Quddus
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Simin Liu
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Nina S Wampler
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Wen-Chih Hank Wu
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - JoAnn E Manson
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Karen Margolis
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Karen C Johnson
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Matthew Allison
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Giselle Corbie-Smith
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Wayne Rosamond
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Khadijah Breathett
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
| | - Liviu Klein
- From the Center of Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (C.B.E., A.Q.); School of Public Health, Alpert Medical School, Brown University, Providence, RI (C.B.E., S.L.); Fred Hutchinson Cancer Research Center, Seattle, WA (M.P.); Women's Health Initiative Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.R.); George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.); Division of Epidemiology, College of Public Health, The Ohio State University Columbus (R.F.); The University of Arizona Cancer Center, Phoenix, AZ (N.S.W.); Providence VA Medical Center, RI (W.-C.H.W.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.); HealthPartners Institute for Research and Education, Minneapolis, MN (K.M.); University of Tennessee Health Science Center, Memphis, TN (K.C.J.); University of California San Diego (M.A.); The University of North Carolina, Chapel Hill (G.C.-S., W.R.); The Ohio State University Wexner Medical Center, Columbus (K.B.); The Ohio State University Davis Heart and Lung Research Institute, Columbus (K.B.); and University of California San Francisco (L.K.)
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Sangaralingham LR, Shah ND, Yao X, Roger VL, Dunlay SM. Incidence and Early Outcomes of Heart Failure in Commercially Insured and Medicare Advantage Patients, 2006 to 2014. Circ Cardiovasc Qual Outcomes 2016; 9:332-7. [PMID: 27166206 DOI: 10.1161/circoutcomes.116.002653] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/13/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Lindsey R Sangaralingham
- From the Department of Health Sciences Research (L.R.S., N.D.S., X.Y., V.L.R., S.M.D.), Division of Cardiovascular Diseases, Department of Medicine (V.L.R., S.M.D.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery ((L.R.S., N.D.S., X.Y., V.L.R., S.M.D), Mayo Clinic, Rochester, MN; and OptumLabs, Cambridge, MA (N.D.S.)
| | - Nilay D Shah
- From the Department of Health Sciences Research (L.R.S., N.D.S., X.Y., V.L.R., S.M.D.), Division of Cardiovascular Diseases, Department of Medicine (V.L.R., S.M.D.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery ((L.R.S., N.D.S., X.Y., V.L.R., S.M.D), Mayo Clinic, Rochester, MN; and OptumLabs, Cambridge, MA (N.D.S.)
| | - Xiaoxi Yao
- From the Department of Health Sciences Research (L.R.S., N.D.S., X.Y., V.L.R., S.M.D.), Division of Cardiovascular Diseases, Department of Medicine (V.L.R., S.M.D.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery ((L.R.S., N.D.S., X.Y., V.L.R., S.M.D), Mayo Clinic, Rochester, MN; and OptumLabs, Cambridge, MA (N.D.S.)
| | - Véronique L Roger
- From the Department of Health Sciences Research (L.R.S., N.D.S., X.Y., V.L.R., S.M.D.), Division of Cardiovascular Diseases, Department of Medicine (V.L.R., S.M.D.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery ((L.R.S., N.D.S., X.Y., V.L.R., S.M.D), Mayo Clinic, Rochester, MN; and OptumLabs, Cambridge, MA (N.D.S.)
| | - Shannon M Dunlay
- From the Department of Health Sciences Research (L.R.S., N.D.S., X.Y., V.L.R., S.M.D.), Division of Cardiovascular Diseases, Department of Medicine (V.L.R., S.M.D.), and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery ((L.R.S., N.D.S., X.Y., V.L.R., S.M.D), Mayo Clinic, Rochester, MN; and OptumLabs, Cambridge, MA (N.D.S.).
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Clark AP, McDougall G, Riegel B, Joiner-Rogers G, Innerarity S, Meraviglia M, Delville C, Davila A. Health Status and Self-care Outcomes After an Education-Support Intervention for People With Chronic Heart Failure. J Cardiovasc Nurs 2015; 30:S3-13. [PMID: 24978157 PMCID: PMC4276559 DOI: 10.1097/jcn.0000000000000169] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The rising cost of hospitalizations for heart failure (HF) care mandates intervention models to address education for self-care success. The effectiveness of memory enhancement strategies to improve self-care and learning needs further examination. OBJECTIVE The objective of this study was to examine the effects of an education-support intervention delivered in the home setting, using strategies to improve health status and self-care in adults/older adults with class I to III HF. Our secondary purpose was to explore participants' subjective perceptions of the intervention. METHODS This study used a randomized, 2-group design. Fifty people were enrolled for 9 months and tested at 4 time points-baseline; after a 3-month education-support intervention; at 6 months, after 3 months of telephone/e-mail support; and 9 months, after a 3-month period of no contact. Advanced practice registered nurses delivered the intervention. Memory enhancement methods were built into the teaching materials and delivery of the intervention. We measured the intervention's effectiveness on health status outcomes (functional status, self-efficacy, quality of life, emotional state/depressive symptoms, and metamemory) and self-care outcomes (knowledge/knowledge retention, self-care ability). Subjects evaluated the usefulness of the intervention at the end of the study. RESULTS The mean age of the sample was 62.4 years, with a slight majority of female participants. Participants were well educated and had other concomitant diseases, including diabetes (48%) and an unexpected degree of obesity. The intervention group showed significant improvements in functional status, self-efficacy, and quality of life (Kansas City Cardiomyopathy Questionnaire); metamemory Change and Capacity subscales (Metamemory in Adulthood Questionnaire); self-care knowledge (HF Knowledge Test); and self-care (Self-care in Heart Failure Index). Participants in both groups improved in depressive scores (Geriatric Depression Scale). CONCLUSIONS An in-home intervention delivered by advanced practice registered nurses was successful in several health status and self-care outcomes, including functional status, self-efficacy, quality of life, metamemory, self-care status, and HF knowledge.
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Affiliation(s)
- Angela P Clark
- Angela P. Clark, PhD, RN, ACNS-BC, FAAN, FAHA Associate Professor of Nursing Emerita, The University of Texas at Austin. Graham McDougall, PhD, RN, FAAN, FGSA Professor of Nursing, The University of Alabama at Tuscaloosa. Barbara Riegel, PhD, RN, FAHA, FAAN Professor of Nursing, School of Nursing, The University of Pennsylvania, Philadelphia. Glenda Joiner-Rogers, PhD, RN, ACNS-BC Assistant Professor of Clinical Nursing, The University of Texas at Austin. Sheri Innerarity, PhD, RN, ACNS-BC, FNP Associate Professor of Clinical Nursing, The University of Texas at Austin. Martha Meraviglia, PhD, RN, ACNS-BC Associate Professor of Clinical Nursing, The University of Texas at Austin. Carol Delville, PhD, RN, ACNS-BC Assistant Professor of Clinical Nursing, The University of Texas at Austin. Ashley Davila, MSN, ACNS-BC Clinical Nurse Specialist, Texas Diabetes and Endocrinology, Austin
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Racial Differences in Heart Failure Outcomes. JACC-HEART FAILURE 2015; 3:531-538. [DOI: 10.1016/j.jchf.2015.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 03/12/2015] [Accepted: 03/18/2015] [Indexed: 11/18/2022]
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Comparison of biopsychosocial functioning of women of different nationalities in the perimenopausal period. MENOPAUSE REVIEW 2014; 13:339-43. [PMID: 26327876 PMCID: PMC4352915 DOI: 10.5114/pm.2014.47987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 11/10/2014] [Accepted: 11/18/2014] [Indexed: 11/17/2022]
Abstract
Introduction The perimenopausal age is a time of many changes in women's health. Changes in women's health affect all spheres of life, because health is not merely the absence of disease or infirmity but full psychological, physical and social well-being. Presentation and comparison of the biopsychosocial functioning of women of different races and nationalities in perimenopause, identification of the most common menopause symptoms occurring among women and their needs. Material and methods Work supported with research examples. Using the PubMed database, the medical literature was searched for works that contain the key words menopause and race or ethnicity published between 1996 and 2013 and available in English. Literature in Polish is a supplementary issue. Results Various demographic processes taking place in the countries of Africa, North and South America, Asia and Europe are the basis for observing the situation in perimenopausal women in these countries. Caucasian women living in North America and Europe most often experience the negative symptoms of menopause, hindering daily functioning, and women living in urbanized countries in Asia best assess their health condition, both psychosocial and physical. Conclusions Biopsychosocial functioning of women varies among countries. Developing countries should be given the necessary support and financial information to ensure the health and quality of life in perimenopausal women. In most countries of the world there has been observed the need to promote women's health, particularly research aimed at prevention, increasing physical activity and attention to nutrition.
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Agha G, Loucks EB, Tinker LF, Waring ME, Michaud DS, Foraker RE, Li W, Martin LW, Greenland P, Manson JE, Eaton CB. Healthy lifestyle and decreasing risk of heart failure in women: the Women's Health Initiative observational study. J Am Coll Cardiol 2014; 64:1777-85. [PMID: 25443698 PMCID: PMC4254927 DOI: 10.1016/j.jacc.2014.07.981] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/28/2014] [Accepted: 07/08/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The impact of a healthy lifestyle on risk of heart failure (HF) is not well known. OBJECTIVES The objectives of this study were to evaluate the effect of a combination of lifestyle factors on incident HF and to further investigate whether weighting each lifestyle factor has additional impact. METHODS Participants were 84,537 post-menopausal women from the WHI (Women's Health Initiative) observational study, free of self-reported HF at baseline. A healthy lifestyle score (HL score) was created wherein women received 1 point for each healthy criterion met: high-scoring Alternative Healthy Eating Index, physically active, healthy body mass index, and currently not smoking. A weighted score (wHL score) was also created in which each lifestyle factor was weighted according to its independent magnitude of effect on HF. The incidence of hospitalized HF was determined by trained adjudicators using standardized methodology. RESULTS There were 1,826 HF cases over a mean follow-up of 11 years. HL score was strongly associated with risk of HF (multivariable-adjusted hazard ratio [HR] [95% confidence interval (CI)] 0.49 [95% CI: 0.38 to 0.62], 0.36 [95% CI: 0.28 to 0.46], 0.24 [95% CI: 0.19 to 0.31], and 0.23 [95% CI: 0.17 to 0.30] for HL score of 1, 2, 3, and 4 vs. 0, respectively). The HL score and wHL score were similarly associated with HF risk (HR: 0.46 [95% CI: 0.41 to 0.52] for HL score; HR: 0.48 [95% CI: 0.42 to 0.55] for wHL score, comparing the highest tertile to the lowest). The HL score was also strongly associated with HF risk among women without antecedent coronary heart disease, diabetes, or hypertension. CONCLUSIONS An increasingly healthy lifestyle was associated with decreasing HF risk among post-menopausal women, even in the absence of antecedent coronary heart disease, hypertension, and diabetes. Weighting the lifestyle factors had minimal impact.
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Affiliation(s)
- Golareh Agha
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts.
| | - Eric B Loucks
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | | | - Molly E Waring
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Dominique S Michaud
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Randi E Foraker
- Ohio State University, College of Public Health, Columbus, Ohio
| | - Wenjun Li
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Lisa W Martin
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Philip Greenland
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - JoAnn E Manson
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Charles B Eaton
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island; Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
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Halter JB, Musi N, McFarland Horne F, Crandall JP, Goldberg A, Harkless L, Hazzard WR, Huang ES, Kirkman MS, Plutzky J, Schmader KE, Zieman S, High KP. Diabetes and cardiovascular disease in older adults: current status and future directions. Diabetes 2014; 63:2578-89. [PMID: 25060886 PMCID: PMC4113072 DOI: 10.2337/db14-0020] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The prevalence of diabetes increases with age, driven in part by an absolute increase in incidence among adults aged 65 years and older. Individuals with diabetes are at higher risk for cardiovascular disease, and age strongly predicts cardiovascular complications. Inflammation and oxidative stress appear to play some role in the mechanisms underlying aging, diabetes, cardiovascular disease, and other complications of diabetes. However, the mechanisms underlying the age-associated increase in risk for diabetes and diabetes-related cardiovascular disease remain poorly understood. Moreover, because of the heterogeneity of the older population, a lack of understanding of the biology of aging, and inadequate study of the effects of treatments on traditional complications and geriatric conditions associated with diabetes, no consensus exists on the optimal interventions for older diabetic adults. The Association of Specialty Professors, along with the National Institute on Aging, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Heart, Lung, and Blood Institute, and the American Diabetes Association, held a workshop, summarized in this Perspective, to discuss current knowledge regarding diabetes and cardiovascular disease in older adults, identify gaps, and propose questions to guide future research.
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Affiliation(s)
- Jeffrey B Halter
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Nicolas Musi
- Geriatric Research, Education and Clinical Center, University of Texas Health Sciences Center at San Antonio and South Texas Veterans Health Care System, San Antonio, TX
| | | | - Jill P Crandall
- Department of Medicine, Division of Endocrinology, Albert Einstein College of Medicine, Bronx, NY
| | - Andrew Goldberg
- University of Maryland School of Medicine and Baltimore VA Medical Center Geriatric Research Education and Clinical Center, Baltimore, MD
| | | | - William R Hazzard
- Department of Medicine, University of Washington, Puget Sound VA Health Care System, Seattle, WA
| | - Elbert S Huang
- Department of Medicine, Division of General Internal Medicine, University of Chicago, Chicago, IL
| | - M Sue Kirkman
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, NC
| | - Jorge Plutzky
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Kenneth E Schmader
- Geriatric Research, Education and Clinical Center, Duke University School of Medicine and Durham VA Medical Center, Durham, NC
| | | | - Kevin P High
- Department of Internal Medicine, Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC
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Santen RJ, Stuenkel CA, Burger HG, Manson JE. Competency in Menopause Management: Whither Goest the Internist? J Womens Health (Larchmt) 2014; 23:281-5. [DOI: 10.1089/jwh.2014.4746] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Richard J. Santen
- Division of Endocrinology and Metabolism, University of Virginia Health Sciences System, Charlottesville, Virginia
| | - Cynthia A. Stuenkel
- Division of Endocrinology, Diabetes and Metabolism, University of California at San Diego, La Jolla, California
| | - Henry G. Burger
- Prince Henry's Institute for Medical Research, Monash University, Melbourne, Australia
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Lyons KJ, Ezekowitz JA, Liu W, McAlister FA, Kaul P. Mortality outcomes among status Aboriginals and whites with heart failure. Can J Cardiol 2014; 30:619-26. [PMID: 24882532 DOI: 10.1016/j.cjca.2014.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Aboriginals have more cardiovascular risk factors than do non-Aboriginals that predispose them to the development of heart failure (HF). Whether long-term mortality outcomes and health care use differ between Aboriginals and whites with HF is unknown. METHODS The population consisted of all Albertans aged ≥ 20 years with an incident HF hospitalization between 2000 and 2008. Aboriginal status is recorded in the Alberta Health Care Insurance Registry and white ethnicity was determined using previously validated surname analysis algorithms. Cox and logistic regression was used to examine mortality outcomes after adjustment for key variables. RESULTS Compared with whites (n = 42,288), status aboriginal patients with HF (n = 1158) were significantly younger (mean age, 62.6 vs 75.4 years; P < 0.0001) and had higher rates of diabetes (45% vs 29%; P < 0.0001) and chronic obstructive pulmonary disease (40% vs 36%; P < 0.0001) but lower rates of most other comorbidities. Although crude mortality rates were lower in status Aboriginals than in whites at 1 year (22% vs 31%; P < 0.0001) and at 5 years (48% vs 59%; P < 0.0001), after adjustment, status Aboriginals exhibited increased mortality at 1 year (adjusted odds ratio [OR], 1.18; 95% confidence interval [CI], 1.01-1.38) and 5 years (adjusted OR, 1.39; 95% CI, 1.16-1.67). Compared with whites, status Aboriginals used more health care resources in the years before and after an incident HF hospitalization but less specialist care. CONCLUSIONS Although status Aboriginals hospitalized for the first time with HF are > 10 years younger, they use more health care resources and have increased short- and long-term mortality compared with their white counterparts.
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Affiliation(s)
- Kristin J Lyons
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Justin A Ezekowitz
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada.
| | - Wei Liu
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
| | - Finlay A McAlister
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada; Division of General Internal Medicine and Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Padma Kaul
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
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Zhang ZM, Rautaharju PM, Soliman EZ, Manson JE, Martin LW, Perez M, Vitolins M, Prineas RJ. Different patterns of bundle-branch blocks and the risk of incident heart failure in the Women's Health Initiative (WHI) study. Circ Heart Fail 2013; 6:655-61. [PMID: 23729198 PMCID: PMC3969232 DOI: 10.1161/circheartfailure.113.000217] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 05/15/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND We evaluated the risk of incident heart failure (HF) associated with bundle-branch blocks (BBBs) in postmenopausal women. METHODS AND RESULTS Cox's regression was used to evaluate hazard ratios with 95% confidence intervals for HF among 65975 participants of the Women's Health Initiative (WHI) study during an average follow-up of 14 years. BBBs observed in 1676 women at baseline were categorized into left, right, and indetermined-type BBBs (LBBB, RBBB, and intraventricular conduction defect, respectively). Compared with women with no BBB, LBBB, and intraventricular conduction defect were strong predictors of incident HF in multivariable-adjusted risk models (hazard ratio, 3.79; confidence interval, 2.95-4.87 for LBBB and hazard ratio, 3.53; confidence interval, 2.14-5.81 for intraventricular conduction defect). RBBB was not a significant predictor of incident HF in multivariable-adjusted risk model, but the combination of RBBB and left anterior fascicular block was a strong predictor (hazard ratio, 2.96; confidence interval, 1.77-4.93). QRS duration was an independent predictor of incident HF only in LBBB, with more pronounced risk at QRS ≥ 140 ms than at <140 ms. QRS nondipolar voltage (RNDPV) was an independent predictor in both RBBB and LBBB and, in addition, in LBBB, QRS/STT angle and ST J-point depression in aVL were independent predictors. CONCLUSIONS LBBB, intraventricular conduction defect, and RBBB combined with left anterior fascicular block are strong predictors of incident HF in multivariable-adjusted risk models, but RBBB is not a significant predictor. QRS duration ≥ 140 ms may warrant consideration in LBBB as an indication for further diagnostic evaluation for possible therapeutic and preventive action. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000611.
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Affiliation(s)
- Zhu-ming Zhang
- Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
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