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Longenecker CT, Brant L, Okello E, Beaton A. More With Less: Diffusing Innovations in Cardiovascular Service Delivery. Circ Cardiovasc Qual Outcomes 2024; 17:e010601. [PMID: 39167768 DOI: 10.1161/circoutcomes.124.010601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Affiliation(s)
- Chris T Longenecker
- Division of Cardiology and Department of Global Health, University of Washington, Seattle (C.T.L.)
| | - Luisa Brant
- Faculty of Medicine and Hospital das Clínicas Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (L.B.)
| | - Emmy Okello
- Uganda Heart Institute, Kampala, Uganda (E.O.)
| | - Andrea Beaton
- Department of Pediatrics, University of Cincinnati and The Heart Institute at Cincinnati Children's Hospital, OH (A.B.)
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2
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Sims KD, Wei PC, Penko JM, Hennessy S, Coxson PG, Mukand NH, Bellows BK, Kazi DS, Zhang Y, Boylan R, Moran AE, Bibbins-Domingo K. Projected Impact of Nonpharmacologic Management of Stage 1 Hypertension Among Lower-Risk US Adults. Hypertension 2024; 81:1758-1765. [PMID: 38881463 PMCID: PMC11254541 DOI: 10.1161/hypertensionaha.124.22704] [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: 01/07/2024] [Accepted: 05/28/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND The 2017 American College of Cardiology/American Heart Association blood pressure guideline classified 31 million US adults as having stage 1 hypertension and recommended clinicians provide counseling on behavioral change to the low-risk portion of this group. However, nationwide reductions in cardiovascular disease (CVD) and associated health care expenditures achievable by nonpharmacologic therapy remain unquantified. METHODS We simulated interventions on a target population of US adults aged 35 to 64 years, identified from the 2015-2018 National Health and Nutrition Examination Survey, with low-risk stage 1 systolic hypertension: that is, untreated systolic blood pressure 130 to 139 mm Hg with diastolic BP <90 mm Hg; no history of CVD, diabetes, or chronic kidney disease; and a low 10-year risk of CVD. We used meta-analyses and trials to estimate the effects of population-level behavior modification on systolic blood pressure. We assessed the extent to which restricting intervention to those in regular contact with clinicians might prevent the delivery of nonpharmacologic therapy. RESULTS Controlling systolic blood pressure to <130 mm Hg among the 8.8 million low-risk US adults with stage 1 hypertension could prevent 26 100 CVD events, avoid 2900 deaths, and save $1.7 billion in total direct health care costs over 10 years. Adoption of the Dietary Approaches to Stop Hypertension diet could prevent 28 000 CVD events. Other nonpharmacologic interventions could avert between 3800 and 19 500 CVD events. However, only 51% of men and 75% of women regularly interacted with clinicians for counseling opportunities. CONCLUSIONS Among low-risk adults with stage 1 hypertension, substantial benefits to cardiovascular health could be achieved through public policy that promotes the adoption of nonpharmacologic therapy.
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Affiliation(s)
- Kendra D. Sims
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Pengxiao Carol Wei
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Joanne M. Penko
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Susan Hennessy
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Pamela G. Coxson
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Nita H. Mukand
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Brandon K. Bellows
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Dhruv S. Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts
| | - Yiyi Zhang
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Ross Boylan
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Andrew E. Moran
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California
- Editorial Board, Journal of the American Medical Association, Chicago, Illinois
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Ionescu R, Magnani JW. The barbershop paradigm: Community engagement for cardiovascular prevention. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 44:100414. [PMID: 39021620 PMCID: PMC11252612 DOI: 10.1016/j.ahjo.2024.100414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024]
Abstract
Barbershops and beauty salons provide community-specific opportunities to engage in cardiovascular disease screening and prevention. This editorial articulates the advantages of what is termed the "barbershop paradigm," the community-engaged endeavor that leverages familiarity, trust, and stakeholder engagement to advance cardiovascular health. The authors summarize the neighborhood-based factors that contribute to cardiovascular health, and then identify the strategies implemented by ShopTalk and their specific advantages.
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Affiliation(s)
- Ruxandra Ionescu
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jared W. Magnani
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Khosla P, Amin K, Doshi R. Combating Chronic Disease with Barbershop Health Interventions: A Review of Current Knowledge and Potential for Big Data. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2024; 97:239-245. [PMID: 38947107 PMCID: PMC11202109 DOI: 10.59249/otfp5065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Community-based participatory research (CBPR) using barbershop interventions is an emerging approach to address health disparities and promote health equity. Barbershops serve as trusted community settings for health education, screening services, and referrals. This narrative mini-review provides an overview of the current state of knowledge regarding CBPR employing barbershop interventions and explores the potential for big data involvement to enhance the impact and reach of this approach in combating chronic disease. CBPR using barbershop interventions has shown promising results in reducing blood pressure among Black men and improving diabetes awareness and self-management. By increasing testing rates and promoting preventive behaviors, barbershop interventions have been successful in addressing infectious diseases, including HIV and COVID-19. Barbershops have also played roles in promoting cancer screening and increasing awareness of cancer risks, namely prostate cancer and colorectal cancer. Further, leveraging the trusted relationships between barbers and their clients, mental health promotion and prevention efforts have been successful in barbershops. The potential for big data involvement in barbershop interventions for chronic disease management offers new opportunities for targeted programs, real-time monitoring, and personalized approaches. However, ethical considerations regarding privacy, confidentiality, and data ownership need to be carefully addressed. To maximize the impact of barbershop interventions, challenges such as training and resource provision for barbers, cultural appropriateness of interventions, sustainability, and scalability must be addressed. Further research is needed to evaluate long-term impact, cost-effectiveness, and best practices for implementation. Overall, barbershops have the potential to serve as key partners in addressing chronic health disparities and promoting health equity.
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Affiliation(s)
- Pavan Khosla
- Yale University School of Medicine, New Haven, CT,
USA
| | | | - Rushabh Doshi
- Yale University School of Medicine, New Haven, CT,
USA
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5
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Kohrman N, Rashid M, Flores R, Blyler C, Barragan NC, Kuo T, Inkelas M, Chen S, Rader F, Cheng S, Albert C, Bello NA, Ebinger J. A qualitative analysis of post-hoc interviews with multilevel participants of a randomized controlled trial of a community-based intervention. PLoS One 2024; 19:e0303075. [PMID: 38723012 PMCID: PMC11081230 DOI: 10.1371/journal.pone.0303075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Community-based health interventions often demonstrate efficacy in clinical trial settings but fail to be implemented in the real-world. We sought to identify the key operational and contextual elements of the Los Angeles Barbershop Blood Pressure Study (LABBPS), an objectively successful community-based health intervention primed for real-world implementation. LABBPS was a cluster randomized control trial that paired the barbers of Black-owned barbershops with clinical pharmacists to manage uncontrolled hypertension in Black male patrons, demonstrating a substantial 21.6 mmHg reduction in systolic blood pressure. Despite this success, the LABBPS intervention has not expanded beyond the original clinical trial setting. The aim of this study was to determine the facilitating and limiting factors to expansion of the LABBPS intervention. METHODS We undertook a qualitative assessment of semi-structured interviews with study participants performed after trial completion. Interviews included a total of 31 participants including 20 (6%) of the 319 LABBPS program participants ("patrons"), 10 (19%) barbers, and one (50%) clinical pharmacist. The semi-structured interviews were focused on perceptions of the medical system, study intervention, and influence of social factors on health. RESULTS Several common themes emerged from thematic analysis of interview responses including: importance of care provided in a convenient and safe environment, individual responsibility for health and health-related behaviors, and engagement of trusted community members. In particular, patrons reported that receiving the intervention from their barber in a familiar environment positively influenced the formation of relationships with clinical pharmacists around shared efforts to improve medication adherence and healthy habits. All interviewee groups identified the trust diad, comprising the familiar environment and respected community member, as instrumental in increasing health-related behaviors to a degree not usually achieved by traditional healthcare providers. DISCUSSION In conclusion, participants of an objectively successful community-based intervention trial consistently identified key features that could facilitate wider implementation and efficacy: social trust relationships, soliciting insights of trust bearers, and consistent engagement in a familiar community setting. These findings can help to inform the design and operations of future community-based studies and programs aiming to achieve a broad and sustainable impact.
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Affiliation(s)
- Nathan Kohrman
- Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Mohamad Rashid
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Roxana Flores
- Los Angeles County Department of Public Health, Division of Chronic Disease and Injury Prevention, Los Angeles, California, United States of America
| | - Ciantel Blyler
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Noel C. Barragan
- Los Angeles County Department of Public Health, Division of Chronic Disease and Injury Prevention, Los Angeles, California, United States of America
| | - Tony Kuo
- Department of Epidemiology, Los Angeles (UCLA) Fielding School of Public Health, University of California, Los Angeles, California, United States of America
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- UCLA Clinical and Translational Science Institute, Population Health Program, Los Angeles, California, United States of America
| | - Moira Inkelas
- UCLA Clinical and Translational Science Institute, Population Health Program, Los Angeles, California, United States of America
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Steven Chen
- Associate Dean for Clinical Affairs, University of Southern California Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, Los Angeles, California, United States of America
| | - Florian Rader
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Christine Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Natalie A. Bello
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Joseph Ebinger
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
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Doshi U, Chaiken S, Hersh A, Gibbins KJ, Caughey AB. Treating Mild Chronic Hypertension During Pregnancy: A Cost-Effectiveness Analysis. Obstet Gynecol 2024; 143:562-569. [PMID: 38387029 DOI: 10.1097/aog.0000000000005531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/07/2023] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To assess the cost effectiveness of targeting a blood pressure of less than 140/90 mm Hg compared with 160/105 mm Hg. METHODS A decision-analytic model was constructed to compare the treatment of chronic hypertension in pregnancy at mild-range blood pressures (140/90 mm Hg) with the treatment of chronic hypertension before 20 weeks of gestation at severe-range blood pressures (160/105 mm Hg) in a theoretical cohort of 180,000 patients with mild chronic hypertension. Probabilities, costs, and utilities were derived from literature and varied in sensitivity analyses. Primary outcomes included incremental cost per quality-adjusted life-year (QALY), cases of preeclampsia, preeclampsia with severe features, severe maternal morbidity (SMM), preterm birth, maternal death, neonatal death, and neurodevelopmental delay. The cost-effectiveness threshold was $100,000 per QALY. RESULTS Treating chronic hypertension in a population of 180,000 pregnant persons at mild-range blood pressures, compared with severe-range blood pressures, resulted in 14,177 fewer cases of preeclampsia (43,953 vs 58,130), 11,835 of which were cases of preeclampsia with severe features (40,530 vs 52,365). This led to 817 fewer cases of SMM (4,375 vs 5,192), and 18 fewer cases of maternal death (102 vs 120). Treating at a lower threshold also resulted in 8,078 fewer cases of preterm birth (22,000 vs 30,078), which led to 26 fewer neonatal deaths (276 vs 302) and 157 fewer cases of neurodevelopmental delay (661 vs 818). Overall, treating chronic hypertension at a lower threshold was a dominant strategy that resulted in decreased costs of $600 million and increased effectiveness of 12,852 QALYs. CONCLUSION Treating chronic hypertension at a threshold of mild-range blood pressures is a dominant (lower costs, better outcomes) and cost-effective strategy that results in fewer neonatal and maternal deaths compared with the standard treatment of treating at severe range blood pressures.
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Affiliation(s)
- Uma Doshi
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
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Zhang Y, Dron JS, Bellows BK, Khera AV, Liu J, Balte PP, Oelsner EC, Amr SS, Lebo MS, Nagy A, Peloso GM, Natarajan P, Rotter JI, Willer C, Boerwinkle E, Ballantyne CM, Lutsey PL, Fornage M, Lloyd-Jones DM, Hou L, Psaty BM, Bis JC, Floyd JS, Vasan RS, Heard-Costa NL, Carson AP, Hall ME, Rich SS, Guo X, Kazi DS, de Ferranti SD, Moran AE. Familial Hypercholesterolemia Variant and Cardiovascular Risk in Individuals With Elevated Cholesterol. JAMA Cardiol 2024; 9:263-271. [PMID: 38294787 PMCID: PMC10831623 DOI: 10.1001/jamacardio.2023.5366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/22/2023] [Indexed: 02/01/2024]
Abstract
Importance Familial hypercholesterolemia (FH) is a genetic disorder that often results in severely high low-density lipoprotein cholesterol (LDL-C) and high risk of premature coronary heart disease (CHD). However, the impact of FH variants on CHD risk among individuals with moderately elevated LDL-C is not well quantified. Objective To assess CHD risk associated with FH variants among individuals with moderately (130-189 mg/dL) and severely (≥190 mg/dL) elevated LDL-C and to quantify excess CHD deaths attributable to FH variants in US adults. Design, Setting, and Participants A total of 21 426 individuals without preexisting CHD from 6 US cohort studies (Atherosclerosis Risk in Communities study, Coronary Artery Risk Development in Young Adults study, Cardiovascular Health Study, Framingham Heart Study Offspring cohort, Jackson Heart Study, and Multi-Ethnic Study of Atherosclerosis) were included, 63 of whom had an FH variant. Data were collected from 1971 to 2018, and the median (IQR) follow-up was 18 (13-28) years. Data were analyzed from March to May 2023. Exposures LDL-C, cumulative past LDL-C, FH variant status. Main Outcomes and Measures Cox proportional hazards models estimated associations between FH variants and incident CHD. The Cardiovascular Disease Policy Model projected excess CHD deaths associated with FH variants in US adults. Results Of the 21 426 individuals without preexisting CHD (mean [SD] age 52.1 [15.5] years; 12 041 [56.2%] female), an FH variant was found in 22 individuals with moderately elevated LDL-C (0.3%) and in 33 individuals with severely elevated LDL-C (2.5%). The adjusted hazard ratios for incident CHD comparing those with and without FH variants were 2.9 (95% CI, 1.4-6.0) and 2.6 (95% CI, 1.4-4.9) among individuals with moderately and severely elevated LDL-C, respectively. The association between FH variants and CHD was slightly attenuated when further adjusting for baseline LDL-C level, whereas the association was no longer statistically significant after adjusting for cumulative past LDL-C exposure. Among US adults 20 years and older with no history of CHD and LDL-C 130 mg/dL or higher, more than 417 000 carry an FH variant and were projected to experience more than 12 000 excess CHD deaths in those with moderately elevated LDL-C and 15 000 in those with severely elevated LDL-C compared with individuals without an FH variant. Conclusions and Relevance In this pooled cohort study, the presence of FH variants was associated with a 2-fold higher CHD risk, even when LDL-C was only moderately elevated. The increased CHD risk appeared to be largely explained by the higher cumulative LDL-C exposure in individuals with an FH variant compared to those without. Further research is needed to assess the value of adding genetic testing to traditional phenotypic FH screening.
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Affiliation(s)
- Yiyi Zhang
- Division of General Medicine, Columbia University, New York, New York
| | - Jacqueline S. Dron
- Cardiovascular Disease Initiative, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge
- Center for Genomic Medicine, Massachusetts General Hospital, Boston
| | | | - Amit V. Khera
- Cardiovascular Disease Initiative, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Cardiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Junxiu Liu
- Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai, New York, New York
| | - Pallavi P. Balte
- Division of General Medicine, Columbia University, New York, New York
| | | | - Sami Samir Amr
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Laboratory for Molecular Medicine, Personalized Medicine, Mass General Brigham, Cambridge, Massachusetts
| | - Matthew S. Lebo
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Laboratory for Molecular Medicine, Personalized Medicine, Mass General Brigham, Cambridge, Massachusetts
| | - Anna Nagy
- Laboratory for Molecular Medicine, Personalized Medicine, Mass General Brigham, Cambridge, Massachusetts
| | - Gina M. Peloso
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Pradeep Natarajan
- Cardiovascular Disease Initiative, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Cristen Willer
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Department of Human Genetics, University of Michigan, Ann Arbor
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston
| | | | - Pamela L. Lutsey
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Myriam Fornage
- The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston
| | | | - Lifang Hou
- Northwestern University, Chicago, Illinois
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Joshua C. Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle
| | - James S. Floyd
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | - Ramachandran S. Vasan
- The Framingham Heart Study, Framingham, Massachusetts
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Nancy L. Heard-Costa
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - April P. Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Michael E. Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Dhruv S. Kazi
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sarah D. de Ferranti
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Andrew E. Moran
- Division of General Medicine, Columbia University, New York, New York
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Zhang F, Bryant KB, Moran AE, Zhang Y, Cohen JB, Bress AP, Sheppard JP, King JB, Derington CG, Weintraub WS, Kronish IM, Shea S, Bellows BK. Effectiveness of Hypertension Management Strategies in SPRINT-Eligible US Adults: A Simulation Study. J Am Heart Assoc 2024; 13:e032370. [PMID: 38214272 PMCID: PMC10926802 DOI: 10.1161/jaha.123.032370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Despite reducing cardiovascular disease (CVD) events and death in SPRINT (Systolic Blood Pressure Intervention Trial), intensive systolic blood pressure goals have not been adopted in the United States. This study aimed to simulate the potential long-term impact of 4 hypertension management strategies in SPRINT-eligible US adults. METHODS AND RESULTS The validated Blood Pressure Control-Cardiovascular Disease Policy Model, a discrete event simulation of hypertension care processes (ie, visit frequency, blood pressure [BP] measurement accuracy, medication intensification, and medication adherence) and CVD outcomes, was populated with 25 000 SPRINT-eligible US adults. Four hypertension management strategies were simulated: (1) usual care targeting BP <140/90 mm Hg (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care), (2) intensive care per the SPRINT protocol targeting BP <120/90 mm Hg (SPRINT intensive), (3) usual care targeting guideline-recommended BP <130/80 mm Hg (American College of Cardiology/American Heart Association usual care), and (4) team-based care added to usual care and targeting BP <130/80 mm Hg. Relative to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care, among the 18.1 million SPRINT-eligible US adults, an estimated 138 100 total CVD events could be prevented per year with SPRINT intensive, 33 900 with American College of Cardiology/American Heart Association usual care, and 89 100 with team-based care. Compared with the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care, SPRINT intensive care was projected to increase treatment-related serious adverse events by 77 600 per year, American College of Cardiology/American Heart Association usual care by 33 300, and team-based care by 27 200. CONCLUSIONS As BP control has declined in recent years, health systems must prioritize hypertension management and invest in effective strategies. Adding team-based care to usual care may be a pragmatic way to manage risk in this high-CVD-risk population.
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Affiliation(s)
- Fengdi Zhang
- Department of MedicineColumbia UniversityNew YorkNYUSA
| | | | | | - Yiyi Zhang
- Department of MedicineColumbia UniversityNew YorkNYUSA
| | - Jordana B. Cohen
- Department of Medicine and Department of Biostatistics, Epidemiology, and InformaticsUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Adam P. Bress
- Intermountain Healthcare Department of Population Health SciencesUniversity of UtahSalt Lake CityUTUSA
| | - James P. Sheppard
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordUK
| | - Jordan B. King
- Intermountain Healthcare Department of Population Health SciencesUniversity of UtahSalt Lake CityUTUSA
- Institute for Health ResearchKaiser Permanente ColoradoAuroraCOUSA
| | - Catherine G. Derington
- Intermountain Healthcare Department of Population Health SciencesUniversity of UtahSalt Lake CityUTUSA
| | - William S. Weintraub
- Department of MedicineGeorgetown UniversityWashingtonDCUSA
- MedStar Health Research InstituteWashingtonDCUSA
| | | | - Steven Shea
- Department of MedicineColumbia UniversityNew YorkNYUSA
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Rifkin DE. Lost in Translation: Why Are Rates of Hypertension Control Getting Worse Over Time? Am J Kidney Dis 2024; 83:101-107. [PMID: 37714284 DOI: 10.1053/j.ajkd.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 09/17/2023]
Abstract
Treatment of hypertension to decrease rates of cardiovascular disease is the most well studied and most broadly applicable treatment in cardiovascular prevention. Blood pressure can be measured anywhere, not just in a physician's office; medications are readily available, inexpensive, and have highly favorable benefit/harm ratios with relatively minimal side effects; and stepped medication regimens can be prescribed in algorithmic fashion by a variety of practitioners. Yet overall hypertension control rates in the United States have never exceeded 60%, and the last 5-10 years have seen decreased, rather than increased, rates of control. Here, I describe the scale of this massive failure to deliver on the promise of preventive hypertension care; outline the populations most affected and the contemporaneous events that have impacted hypertension control; discuss the disparate paths of hypertension science and health care delivery; and highlight novel interventions, approaches, and future opportunities to bend the curve back toward improvements in hypertension control.
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Affiliation(s)
- Dena E Rifkin
- Division of Nephrology, Department of Medicine, VA Healthcare System, and University of California, San Diego, San Diego, California.
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10
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Chong S, Huynh B, Wong S, Woldeyesus T, Faulks M, El-Amin K, Thibeaux J, Lewis J, Harlin R, Carter M, Shatara R, Zhou C, Oni-Orisan A. Preferences and Perspectives of Black Male Barbershop Patrons on Receiving Health Care in Nontraditional Settings. Health Equity 2023; 7:835-842. [PMID: 38145054 PMCID: PMC10739686 DOI: 10.1089/heq.2023.0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Non-Hispanic Black men experience a disproportionate rate of morbidity and mortality from hypertension, cardiovascular disease, and other chronic conditions in the United States. Studies have demonstrated the efficacy of community-based health outreach in settings not traditionally utilized for health care. Understanding how potential future participants view health care services in nontraditional settings is a necessary step to ascertain the success of these interventions in the real world. Our study objective was to explore the preferences of Black male barbershop patrons regarding health care-provided services in these nontraditional settings. Methods We recruited patrons of a Black-owned barbershop in the San Francisco Bay Area. Study participants were asked to complete a survey assessing individual attitudes and preferences toward the idea of receiving health care services in traditional and nontraditional settings. Results Among non-Hispanic Black males (n=17), 81% agreed or strongly agreed that they would prefer to receive health care in traditional clinics. Receiving care at the pharmacy (56% agreed or strongly agreed) and the patient's own home (53% agreed or strongly agreed) were the next most preferred locations. A minority of participants agreed or strongly agreed that they preferred to receive health care in nontraditional settings: 47% for barbershops, 19% for churches, and 6% for grocery stores. Discussion Participants expressed preference for traditional over nontraditional settings, despite listing barriers that may be addressed, in part, by nontraditional settings. One potential reason for this is simply a lack of familiarity. Establishing and normalizing nontraditional clinical settings may allow for enhanced acceptance within Black communities, ultimately increasing health care access.
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Affiliation(s)
- Sarah Chong
- Department of Clinical Pharmacy, University of Maryland, Baltimore, Maryland, USA
| | - Brittany Huynh
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Stephanie Wong
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Temesgen Woldeyesus
- Department of Medicine, Stanford University, Palo Alto, California, USA
- Department of Clinical Programs, Roots Community Health Center, Oakland, California, USA
| | - Melvin Faulks
- Department of Clinical Programs, Roots Community Health Center, Oakland, California, USA
| | | | | | - Joseph Lewis
- Chicago 2 Barbershop, San Francisco, California, USA
| | - Robert Harlin
- Chicago 2 Barbershop, San Francisco, California, USA
| | - Mario Carter
- Chicago 2 Barbershop, San Francisco, California, USA
| | - Ramy Shatara
- Chicago 2 Barbershop, San Francisco, California, USA
| | - Crystal Zhou
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Akinyemi Oni-Orisan
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
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11
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Bryan AS, Moran AE, Mobley CM, Derington CG, Rodgers A, Zhang Y, Fontil V, Shea S, Bellows BK. Cost-effectiveness analysis of initial treatment with single-pill combination antihypertensive medications. J Hum Hypertens 2023; 37:985-992. [PMID: 36792728 PMCID: PMC10425570 DOI: 10.1038/s41371-023-00811-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 02/17/2023]
Abstract
Hypertension guidelines recommend initiating treatment with single pill combination (SPC) antihypertensive medications, but SPCs are used by only one-third of treated hypertensive US adults. This analysis estimated the cost-effectiveness of initial treatment with SPC dual antihypertensive medications compared with usual care monotherapy in hypertensive US adults.The validated BP Control Model-Cardiovascular Disease (CVD) Policy Model simulated initial SPC dual therapy (two half-standard doses in a single pill) compared with initial usual care monotherapy (half-standard dose when baseline systolic BP < 20 mmHg above goal and one standard dose when ≥20 mmHg above goal). Secondary analyses examined equivalent dose monotherapy (one standard dose) and equivalent dose dual therapy as separate pills (two half-standard doses). The primary outcomes were direct healthcare costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) over 10 years from a US healthcare sector perspective.At 10 years, initial dual drug SPC was projected to yield 0.028 (95%UI 0.008 to 0.051) more QALYs at no greater cost ($73, 95%UI -$1 983 to $1 629) than usual care monotherapy. In secondary analysis, SPC dual therapy was cost-effective vs. equivalent dose monotherapy (ICER $8 000/QALY gained) and equivalent dose dual therapy as separate pills (ICER $57 000/QALY gained). At average drug prices, initiating antihypertensive treatment with SPC dual therapy is more effective at no greater cost than usual care initial monotherapy and has the potential to improve BP control rates and reduce the burden of CVD in the US.
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12
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Affiliation(s)
- Michelle N. Johnson
- Cardiology Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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13
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Bryant KB, Rao AS, Cohen LP, DanDan N, Kronish IM, Barai N, Fontil V, Zhang Y, Moran AE, Bellows BK. Effectiveness and Cost-Effectiveness of Team-Based Care for Hypertension: A Meta-Analysis and Simulation Study. Hypertension 2023; 80:1199-1208. [PMID: 36883454 PMCID: PMC10987007 DOI: 10.1161/hypertensionaha.122.20292] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/16/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Team-based care (TBC), a team of ≥2 healthcare professionals working collaboratively toward a shared clinical goal, is a recommended strategy to manage blood pressure (BP). However, the most effective and cost-effective TBC strategy is unknown. METHODS A meta-analysis of clinical trials in US adults (aged ≥20 years) with uncontrolled hypertension (≥140/90 mm Hg) was performed to estimate the systolic BP reduction for TBC strategies versus usual care at 12 months. TBC strategies were stratified by the inclusion of a nonphysician team member who could titrate antihypertensive medications. The validated BP Control Model-Cardiovascular Disease Policy Model was used to project the expected BP reductions out to 10 years and simulate cardiovascular disease events, direct healthcare costs, quality-adjusted life years, and cost-effectiveness of TBC with physician and nonphysician titration. RESULTS Among 19 studies comprising 5993 participants, the 12-month systolic BP change versus usual care was -5.0 (95% CI, -7.9 to -2.2) mm Hg for TBC with physician titration and -10.5 (-16.2 to -4.8) mm Hg for TBC with nonphysician titration. Relative to usual care at 10 years, TBC with nonphysician titration was estimated to cost $95 (95% uncertainty interval, -$563 to $664) more per patient and gain 0.022 (0.003-0.042) quality-adjusted life years, costing $4400/quality-adjusted life year gained. TBC with physician titration was estimated to cost more and gain fewer quality-adjusted life years than TBC with nonphysician titration. CONCLUSIONS TBC with nonphysician titration yields superior hypertension outcomes compared with other strategies and is a cost-effective way to reduce hypertension-related morbidity and mortality in the United States.
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Affiliation(s)
| | - Aditi S. Rao
- Vagelos College of Physician and Surgeons, Columbia University, New York, NY
| | - Laura P. Cohen
- Vagelos College of Physician and Surgeons, Columbia University, New York, NY
| | - Nadine DanDan
- New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Ian M. Kronish
- Vagelos College of Physician and Surgeons, Columbia University, New York, NY
| | - Nikita Barai
- Icahn School of Medicine, Mount Sinai, New York, NY
| | - Valy Fontil
- Grossman School of Medicine, New York University, New York, NY
| | - Yiyi Zhang
- Vagelos College of Physician and Surgeons, Columbia University, New York, NY
| | - Andrew E. Moran
- Vagelos College of Physician and Surgeons, Columbia University, New York, NY
| | - Brandon K. Bellows
- Vagelos College of Physician and Surgeons, Columbia University, New York, NY
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14
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Cohen LP, Isaza N, Hernandez I, Lewis GD, Ho JE, Fonarow GC, Kazi DS, Bellows BK. Cost-effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors for the Treatment of Heart Failure With Preserved Ejection Fraction. JAMA Cardiol 2023; 8:419-428. [PMID: 36870047 PMCID: PMC9985815 DOI: 10.1001/jamacardio.2023.0077] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/19/2022] [Indexed: 03/05/2023]
Abstract
Importance Adding a sodium-glucose cotransporter-2 inhibitor (SGLT2-I) to standard-of-care treatment in patients with heart failure with preserved ejection fraction (HFpEF) reduces the risk of a composite outcome of worsening heart failure or cardiovascular mortality, but the cost-effectiveness in US patients with HFpEF is uncertain. Objective To evaluate the lifetime cost-effectiveness of standard therapy plus an SGLT2-I compared with standard therapy in individuals with HFpEF. Design, Setting, and Participants In this economic evaluation conducted from September 8, 2021, to December 12, 2022, a state-transition Markov model simulated monthly health outcomes and direct medical costs. Input parameters including hospitalization rates, mortality rates, costs, and utilities were extracted from HFpEF trials, published literature, and publicly available data sets. The base-case annual cost of SGLT2-I was $4506. A simulated cohort with similar characteristics as participants of the Empagliflozin in Heart Failure With a Preserved Ejection Fraction (EMPEROR-Preserved) and Dapagliflozin in Heart Failure With Mildly Reduced or Preserved Ejection Fraction (DELIVER) trials was used. Exposures Standard of care plus SGLT2-I vs standard of care. Main Outcomes and Measures The model simulated hospitalizations, urgent care visits, and cardiovascular and noncardiovascular death. Future medical costs and benefits were discounted by 3% per year. Main outcomes were quality-adjusted life-years (QALYs), direct medical costs (2022 US dollars), and incremental cost-effectiveness ratio (ICER) of SGLT2-I therapy from a US health care sector perspective. The ICER of SGLT2-I therapy was evaluated according to the American College of Cardiology/American Heart Association value framework (high value: <$50 000; intermediate value: $50 000 to <$150 000; and low value: ≥$150 000). Results The simulated cohort had a mean (SD) age of 71.7 (9.5) years and 6828 of 12 251 participants (55.7%) were male. Standard of care plus SGLT2-I increased quality-adjusted survival by 0.19 QALYs at an increased cost of $26 300 compared with standard of care. The resulting ICER was $141 200 per QALY gained, with 59.1% of 1000 probabilistic iterations indicating intermediate value and 40.9% indicating low value. The ICER was most sensitive to SGLT2-I costs and effect of SGLT2-I therapy on cardiovascular death (eg, increasing to $373 400 per QALY gained if SGLT2-I therapy was assumed to have no effect on mortality). Conclusions and Relevance Results of this economic evaluation suggest that at 2022 drug prices, adding an SGLT2-I to standard of care was of intermediate or low economic value compared with standard of care in US adults with HFpEF. Efforts to expand access to SGLT2-I for individuals with HFpEF should be coupled with efforts to lower the cost of SGLT2-I therapy.
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Affiliation(s)
- Laura P. Cohen
- Division of Cardiology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Nicolas Isaza
- Harvard Medical School, Boston, Massachusetts
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Inmaculada Hernandez
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego
| | - Gregory D. Lewis
- Division of Cardiology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Jennifer E. Ho
- Harvard Medical School, Boston, Massachusetts
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Gregg C. Fonarow
- Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, California
- Associate Section Editor, JAMA Cardiology
| | - Dhruv S. Kazi
- Harvard Medical School, Boston, Massachusetts
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Brandon K. Bellows
- Division of General Medicine, Columbia University Irving Medical Center, New York, New York
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15
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Spruill TM, Muntner P, Popp CJ, Shimbo D, Cooper LA, Moran AE, Penko J, Bibbins-Domingo K, Ibe C, Nnodim Opara I, Howard G, Bellows BK, Spoer BR, Ravenell J, Cherrington AL, Levy P, Commodore-Mensah Y, Juraschek SP, Molello N, Dietz KB, Brown D, Bartelloni A, Ogedegbe G. AddREssing Social Determinants TO pRevent hypErtension (The RESTORE Network): Overview of the Health Equity Research Network to Prevent Hypertension. Am J Hypertens 2023; 36:232-239. [PMID: 37061798 PMCID: PMC10306079 DOI: 10.1093/ajh/hpad010] [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: 12/19/2022] [Accepted: 01/13/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND The American Heart Association funded a Health Equity Research Network on the prevention of hypertension, the RESTORE Network, as part of its commitment to achieving health equity in all communities. This article provides an overview of the RESTORE Network. METHODS The RESTORE Network includes five independent, randomized trials testing approaches to implement non-pharmacological interventions that have been proven to lower blood pressure (BP). The trials are community-based, taking place in churches in rural Alabama, mobile health units in Michigan, barbershops in New York, community health centers in Maryland, and food deserts in Massachusetts. Each trial employs a hybrid effectiveness-implementation research design to test scalable and sustainable strategies that mitigate social determinants of health (SDOH) that contribute to hypertension in Black communities. The primary outcome in each trial is change in systolic BP. The RESTORE Network Coordinating Center has five cores: BP measurement, statistics, intervention, community engagement, and training that support the trials. Standardized protocols, data elements and analysis plans were adopted in each trial to facilitate cross-trial comparisons of the implementation strategies, and application of a standard costing instrument for health economic evaluations, scale up, and policy analysis. Herein, we discuss future RESTORE Network research plans and policy outreach activities designed to advance health equity by preventing hypertension. CONCLUSIONS The RESTORE Network was designed to promote health equity in the US by testing effective and sustainable implementation strategies focused on addressing SDOH to prevent hypertension among Black adults.
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Affiliation(s)
- Tanya M Spruill
- Department of Population Health, NYU Grossman School of Medicine and Institute for Excellence in Health Equity, NYU Langone Health; New York, New York, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Collin J Popp
- Department of Population Health, NYU Grossman School of Medicine and Institute for Excellence in Health Equity, NYU Langone Health; New York, New York, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, Maryland, USA
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Andrew E Moran
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Joanne Penko
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Chidinma Ibe
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ijeoma Nnodim Opara
- Department of Internal Medicine, Internal-Medicine-Pediatrics Section, Wayne State University, Detroit, Michigan, USA
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Brandon K Bellows
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Ben R Spoer
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health; New York, New York, USA
| | - Joseph Ravenell
- Department of Population Health, NYU Grossman School of Medicine and Institute for Excellence in Health Equity, NYU Langone Health; New York, New York, USA
| | - Andrea L Cherrington
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Phillip Levy
- Departments of Emergency Medicine and Physiology, Wayne State University, Detroit, Michigan, USA
| | | | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Nancy Molello
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Katherine B Dietz
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deven Brown
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alexis Bartelloni
- Department of Population Health, NYU Grossman School of Medicine and Institute for Excellence in Health Equity, NYU Langone Health; New York, New York, USA
| | - Gbenga Ogedegbe
- Department of Population Health, NYU Grossman School of Medicine and Institute for Excellence in Health Equity, NYU Langone Health; New York, New York, USA
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16
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Harrison TN, Zhou H, Wei R, Brettler J, Muntner P, An J, Ong-Su AL, Reynolds K. Blood Pressure Control Among Black and White Adults Following a Quality Improvement Program in a Large Integrated Health System. JAMA Netw Open 2023; 6:e2249930. [PMID: 36607636 PMCID: PMC9856959 DOI: 10.1001/jamanetworkopen.2022.49930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE A higher percentage of non-Hispanic Black (hereinafter, Black) adults vs non-Hispanic White (hereinafter, White) adults with hypertension have uncontrolled blood pressure (BP) contributing to racial and ethnic disparities in cardiovascular disease. In 2010, Kaiser Permanente Southern California began implementing quality improvement (QI) strategies aimed at reducing this disparity. OBJECTIVE To examine the change in BP control between Black and White patients before and after the implementation of a QI program. DESIGN, SETTING, AND PARTICIPANTS A QI quasi-experimental, difference-in-difference analysis was conducted of Kaiser Permanente Southern California patients 18 years or older included in the population care management hypertension registry. The study was conducted from December 31, 2008, to December 31, 2019. Data analysis was performed from November 20, 2020, to November 7, 2022. INTERVENTIONS Quality improvement program implementation began in 2010. MAIN OUTCOMES AND MEASURES Blood pressure control (systolic BP <140 mm Hg and diastolic BP <90 mm Hg) was assessed using the last outpatient BP measurement in each calendar year. Changes in BP control between Black and White patients from before (2008-2009) to after (2016-2019) implementation of the QI program were examined using a difference-in-difference analysis. Blood pressure control disparities from 2008 through 2019 by age, sex, race and ethnicity, and factors associated with BP control were examined. RESULTS The number of patients with hypertension increased from 624 094 in 2008 (mean [SD] age, 61.8 [13.5] years; 330 551 [53.0%] female patients; 89 407 [14.3%] Black and 284 116 [45.5%] White patients) to 855 257 in 2019 (mean [SD] age, 64.5 [13.6] years; 444 422 [52.0%] female patients; 107 054 [12.5%] Black and 331 932 [38.8%] White patients). Blood pressure control increased an absolute 4.6% (95% CI, 4.3%-4.8%) among Black patients and 2.1% (95% CI, 2.0%-2.2%) among White patients from before to after the QI program implementation (difference-in-difference: 2.5%; 95% CI, 2.2%-2.8%). The largest reduction in BP control disparity between Black and White female patients was for those aged 50 to 64 years (difference-in-difference: 3.8%; 95% CI, 3.2%-4.4%) and for those aged 18 to 49 years between Black and White male patients (difference-in-difference: 4.2%; 95% CI, 3.0%-5.5%). The proportion of BP control among Black male patients aged 18 to 49 years was the lowest throughout 2008-2019 compared with male and female patients in other age and racial and ethnic groups. In 2019, uncontrolled BP was more common among Black vs White patients (prevalence ratio: 1.13; 95% CI, 1.12-1.14). CONCLUSIONS AND RELEVANCE This QI program noted that disparities in BP control between Black and White patients were decreased but not eliminated following implementation of QI strategies aimed at reducing disparities in BP control. These findings suggest that more focused interventions may be needed to increase BP control among Black individuals.
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Affiliation(s)
- Teresa N. Harrison
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Hui Zhou
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Rong Wei
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Jeffrey Brettler
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
- Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham
| | - Jaejin An
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Angeline L. Ong-Su
- Kaiser Permanente Panorama City Medical Center, Panorama City, California
| | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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18
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Green MB, Shimbo D, Schwartz JE, Bress AP, King JB, Muntner P, Sheppard JP, McManus RJ, Kohli-Lynch CN, Zhang Y, Shea S, Moran AE, Bellows BK. Cost-Effectiveness of Masked Hypertension Screening and Treatment in US Adults With Suspected Masked Hypertension: A Simulation Study. Am J Hypertens 2022; 35:752-762. [PMID: 35665802 PMCID: PMC9340638 DOI: 10.1093/ajh/hpac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/25/2022] [Accepted: 06/01/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Recent US blood pressure (BP) guidelines recommend using ambulatory BP monitoring (ABPM) or home BP monitoring (HBPM) to screen adults for masked hypertension. However, limited evidence exists of the expected long-term effects of screening for and treating masked hypertension. METHODS We estimated the lifetime health and economic outcomes of screening for and treating masked hypertension using the Cardiovascular Disease (CVD) Policy Model, a validated microsimulation model. We simulated a cohort of 100,000 US adults aged ≥20 years with suspected masked hypertension (i.e., office BP 120-129/<80 mm Hg, not taking antihypertensive medications, without CVD history). We compared usual care only (i.e., no screening), usual care plus ABPM, and usual care plus HBPM. We projected total direct healthcare costs (2021 USD), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios. Future costs and QALYs were discounted 3% annually. Secondary outcomes included CVD events and serious adverse events. RESULTS Relative to usual care, adding masked hypertension screening and treatment with ABPM and HBPM was projected to prevent 14.3 and 20.5 CVD events per 100,000 person-years, increase the proportion experiencing any treatment-related serious adverse events by 2.7 and 5.1 percentage points, and increase mean total costs by $1,076 and $1,046, respectively. Compared with usual care, adding ABPM was estimated to cost $85,164/QALY gained. HBPM resulted in lower QALYs than usual care due to increased treatment-related adverse events and pill-taking disutility. CONCLUSIONS The results from our simulation study suggest screening with ABPM and treating masked hypertension is cost-effective in US adults with suspected masked hypertension.
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Affiliation(s)
- Matthew B Green
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Joseph E Schwartz
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA,Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, New York, USA
| | - Adam P Bress
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Jordan B King
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James P Sheppard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ciaran N Kohli-Lynch
- Center for Health Services and Outcomes Research, Institute of Public Health and Medicine, Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Illinois,USA
| | - Yiyi Zhang
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Steven Shea
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Andrew E Moran
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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Colvin CL, Kalejaiye A, Ogedegbe G, Commodore-Mensah Y. Advancing Equity in Blood Pressure Control: A Response to the Surgeon General's Call-to-Action. Am J Hypertens 2022; 35:217-224. [PMID: 35259236 PMCID: PMC8903884 DOI: 10.1093/ajh/hpab187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/06/2021] [Indexed: 12/13/2022] Open
Abstract
Hypertension is an established risk factor for cardiovascular disease. Although controlling blood pressure reduces cardiovascular and stroke mortality and target organ damage, poor blood pressure control remains a clinical and public health challenge. Furthermore, racial and ethnic disparities in the outcomes of hypertension are well documented. In October of 2020, the U.S. Department of Health and Human Services published The Surgeon General's Call to Action to Control Hypertension. The Call to Action emphasized, among other priorities, the need to eliminate disparities in the treatment and control of high blood pressure and to address social determinants as root causes of inequities in blood pressure control and treatment. In support of the goals set in the Call to Action, this review summarizes contemporary research on racial, ethnic, and socioeconomic disparities in hypertension and blood pressure control; describes interventions and policies that have improved blood pressure control in minoritized populations by addressing the social determinants of health; and proposes next steps for achieving equity in hypertension and blood pressure control.
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Affiliation(s)
- Calvin L Colvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ayoola Kalejaiye
- Department of Medicine, Montefiore Health System, New York, New York, USA
| | - Gbenga Ogedegbe
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, New York, USA
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Tajeu GS, Tsipas S, Rakotz M, Wozniak G. Cost-Effectiveness of Recommendations From the Surgeon General's Call-to-Action to Control Hypertension. Am J Hypertens 2022; 35:225-231. [PMID: 34661634 DOI: 10.1093/ajh/hpab162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/08/2021] [Indexed: 12/15/2022] Open
Abstract
In response to high prevalence of hypertension and suboptimal rates of blood pressure (BP) control in the United States, the Surgeon General released a Call-to-Action to Control Hypertension (Call-to-Action) in the fall of 2020 to address the negative consequences of uncontrolled BP. In addition to morbidity and mortality associated with hypertension, hypertension has an annual cost to the US healthcare system of $71 billion. The Call-to-Action makes recommendations for improving BP control, and the purpose of this review was to summarize the literature on the cost-effectiveness of these strategies. We identified a number of studies that demonstrate the cost saving or cost-effectiveness of recommendations in the Call-to-Action including strategies to promote access to and availability of physical activity opportunities and healthy food options within communities, advance the use of standardized treatment approaches and guideline-recommended care, to promote the use of healthcare teams to manage hypertension, and to empower and equip patients to use self-measured BP monitoring and medication adherence strategies. While the current review identified numerous cost-effective methods to achieve the Surgeon General's recommendations for improving BP control, future work should determine the cost-effectiveness of the 2017 American College of Cardiology and American Heart Association Hypertension guidelines, interventions to lower therapeutic inertia, and optimal team-based care strategies, among other areas of research. Economic evaluation studies should also be prioritized to generate more comprehensive data on how to provide efficient and high value care to improve BP control.
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Affiliation(s)
- Gabriel S Tajeu
- Department of Health Services Administration and Policy, Temple University, Philadelphia, Pennsylvania, USA
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21
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Fontil V, Pacca L, Bellows BK, Khoong E, McCulloch CE, Pletcher M, Bibbins-Domingo K. Association of Differences in Treatment Intensification, Missed Visits, and Scheduled Follow-up Interval With Racial or Ethnic Disparities in Blood Pressure Control. JAMA Cardiol 2022; 7:204-212. [PMID: 34878499 PMCID: PMC8655666 DOI: 10.1001/jamacardio.2021.4996] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/15/2021] [Indexed: 11/14/2022]
Abstract
Importance Black patients with hypertension often have the lowest rates of blood pressure (BP) control in clinical settings. It is unknown to what extent variation in health care processes explains this disparity. Objective To assess whether and to what extent treatment intensification, scheduled follow-up interval, and missed visits are associated with racial and ethnic disparities in BP control. Design, Setting, and Participants In this cohort study, nested logistic regression models were used to estimate the likelihood of BP control (defined as a systolic BP [SBP] level <140 mm Hg) by race and ethnicity, and a structural equation model was used to assess the association of treatment intensification, scheduled follow-up interval, and missed visits with racial and ethnic disparities in BP control. The study included 16 114 adults aged 20 years or older with hypertension and elevated BP (defined as an SBP level ≥140 mm Hg) during at least 1 clinic visit between January 1, 2015, and November 15, 2017. A total of 11 safety-net clinics within the San Francisco Health Network participated in the study. Data were analyzed from November 2019 to October 2020. Main Outcomes and Measures Blood pressure control was assessed using the patient's most recent BP measurement as of November 15, 2017. Treatment intensification was calculated using the standard-based method, scored on a scale from -1.0 to 1.0, with -1.0 being the least amount of intensification and 1.0 being the most. Scheduled follow-up interval was defined as the mean number of days to the next scheduled visit after an elevated BP measurement. Missed visits measured the number of patients who did not show up for visits during the 4 weeks after an elevated BP measurement. Results Among 16 114 adults with hypertension, the mean (SD) age was 58.6 (12.1) years, and 8098 patients (50.3%) were female. A total of 4658 patients (28.9%) were Asian, 3743 (23.2%) were Black, 3694 (22.9%) were Latinx, 2906 (18.0%) were White, and 1113 (6.9%) were of other races or ethnicities (including American Indian or Alaska Native [77 patients (0.4%)], Native Hawaiian or Pacific Islander [217 patients (1.3%)], and unknown [819 patients (5.1%)]). Compared with patients from all racial and ethnic groups, Black patients had lower treatment intensification scores (mean [SD], -0.33 [0.26] vs -0.29 [0.25]; β = -0.03, P < .001) and missed more visits (mean [SD], 0.8 [1.5] visits vs 0.4 [1.1] visits; β = 0.35; P < .001). In contrast, Asian patients had higher treatment intensification scores (mean [SD], -0.26 [0.23]; β = 0.02; P < .001) and fewer missed visits (mean [SD], 0.2 [0.7] visits; β = -0.20; P < .001). Black patients were less likely (odds ratio [OR], 0.82; 95% CI, 0.75-0.89; P < .001) and Asian patients were more likely (OR, 1.13; 95% CI, 1.02-1.25; P < .001) to achieve BP control than patients from all racial or ethnic groups. Treatment intensification and missed visits accounted for 21% and 14%, respectively, of the total difference in BP control among Black patients and 26% and 13% of the difference among Asian patients. Conclusions and Relevance This study's findings suggest that racial and ethnic inequities in treatment intensification may be associated with more than 20% of observed racial or ethnic disparities in BP control, and racial and ethnic differences in visit attendance may also play a role. Ensuring more equitable provision of treatment intensification could be a beneficial health care strategy to reduce racial and ethnic disparities in BP control.
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Affiliation(s)
- Valy Fontil
- Division of General Internal Medicine, University of California, San Francisco, San Francisco
- UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California
| | - Lucia Pacca
- Division of General Internal Medicine, University of California, San Francisco, San Francisco
- UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California
| | - Brandon K. Bellows
- Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Elaine Khoong
- Division of General Internal Medicine, University of California, San Francisco, San Francisco
- UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Mark Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Kirsten Bibbins-Domingo
- Division of General Internal Medicine, University of California, San Francisco, San Francisco
- UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
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22
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Lauren BN, Lim F, Krikhely A, Taveras EM, Woo Baidal JA, Bellows BK, Hur C. Estimated Cost-effectiveness of Medical Therapy, Sleeve Gastrectomy, and Gastric Bypass in Patients With Severe Obesity and Type 2 Diabetes. JAMA Netw Open 2022; 5:e2148317. [PMID: 35157054 PMCID: PMC8845022 DOI: 10.1001/jamanetworkopen.2021.48317] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/21/2021] [Indexed: 12/16/2022] Open
Abstract
Importance Bariatric surgery is recommended for patients with severe obesity (body mass index ≥40) and type 2 diabetes (T2D). However, the most cost-effective treatment remains unclear and may depend on the patient's T2D severity. Objective To estimate the cost-effectiveness of medical therapy, sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB) among patients with severe obesity and T2D, stratified by T2D severity. Design, Setting, and Participants This economic evaluation used a microsimulation model to project health and cost outcomes of medical therapy, SG, and RYGB over 5 years. Time horizons varied between 10 and 30 years in sensitivity analyses. Model inputs were derived from clinical trials, large cohort studies, national databases, and published literature. Probabilistic sampling of model inputs accounted for parameter uncertainty. Estimates of US adults with severe obesity and T2D were derived from the National Health and Nutrition Examination Survey. Data analysis was performed from January 2020 to August 2021. Exposures Medical therapy, SG, and RYGB. Main Outcomes and Measures Quality-adjusted life-years (QALYs), costs (in 2020 US dollars), and incremental cost-effectiveness ratios (ICERs) were projected, with future cost and QALYs discounted 3.0% annually. A strategy was deemed cost-effective if the ICER was less than $100 000 per QALY. The preferred strategy resulted in the greatest number of QALYs gained while being cost-effective. Results The model simulated 1000 cohorts of 10 000 patients, of whom 16% had mild T2D, 56% had moderate T2D, and 28% had severe T2D at baseline. The mean age of simulated patients was 54.6 years (95% CI, 54.2-55.0 years), 61.6% (95% CI, 60.1%-63.4%) were female, and 65.1% (95% CI, 63.6%-66.7%) were non-Hispanic White. Compared with medical therapy over 5 years, RYGB was associated with the most QALYs gained in the overall population (mean, 0.44 QALY; 95% CI, 0.21-0.86 QALY) and when stratified by baseline T2D severity: mild (mean, 0.59 QALY; 95% CI, 0.35-0.98 QALY), moderate (mean, 0.50 QALY; 95% CI, 0.25-0.88 QALY), and severe (mean, 0.30 QALY; 95% CI, 0.07-0.79 QALY). RYGB was the preferred strategy in the overall population (ICER, $46 877 per QALY; 83.0% probability preferred) and when stratified by baseline T2D severity: mild (ICER, $36 479 per QALY; 73.7% probability preferred), moderate (ICER, $37 056 per QALY; 85.6% probability preferred), and severe (ICER, $98 940 per QALY; 40.2% probability preferred). The cost-effectiveness of RYGB improved over a longer time horizon. Conclusions and Relevance These findings suggest that the effectiveness and cost-effectiveness of bariatric surgery vary by baseline severity of T2D. Over a 5-year time horizon, RYGB is projected to be the preferred treatment strategy for patients with severe obesity regardless of baseline T2D severity.
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Affiliation(s)
- Brianna N. Lauren
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Francesca Lim
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Abraham Krikhely
- Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston
| | | | - Brandon K. Bellows
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Chin Hur
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Aggarwal R, Chiu N, Wadhera RK, Moran AE, Raber I, Shen C, Yeh RW, Kazi DS. Racial/Ethnic Disparities in Hypertension Prevalence, Awareness, Treatment, and Control in the United States, 2013 to 2018. Hypertension 2021; 78:1719-1726. [PMID: 34365809 PMCID: PMC10861176 DOI: 10.1161/hypertensionaha.121.17570] [Citation(s) in RCA: 135] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/02/2021] [Indexed: 01/13/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Rahul Aggarwal
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Nicholas Chiu
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Rishi K. Wadhera
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Andrew E. Moran
- Division of General Medicine, Columbia University, New York, NY
| | - Inbar Raber
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Robert W. Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Dhruv S. Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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24
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Dixon DL, Baker WL, Buckley LF, Salgado TM, Van Tassell BW, Carter BL. Effect of a Physician/Pharmacist Collaborative Care Model on Time in Target Range for Systolic Blood Pressure: Post Hoc Analysis of the CAPTION Trial. Hypertension 2021; 78:966-972. [PMID: 34397278 PMCID: PMC8415522 DOI: 10.1161/hypertensionaha.121.17873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Supplemental Digital Content is available in the text. Longer time in target range (TTR) for systolic blood pressure (SBP) is associated with a lower risk of cardiovascular events. Team-based care improves SBP control but its effect on the consistency of SBP control over time is unknown. This post hoc analysis used data from a cluster-randomized trial of a physician/pharmacist collaborative model that randomized medical offices to either a 9- or 24-month pharmacist intervention or control group. TTR for SBP was calculated using linear interpolation and an SBP range of 110 to 130 mm Hg. TTR is reported as median values and group comparisons assessed using the Kruskal-Wallis test. Of the 625 participants enrolled, 524 had 9-month and 366 had 24-month SBP data. Participants were a median 59 years old, 59% female, and 52% minority. After 24 months, the median TTR for SBP was 31.9% and 29.8% for the 9- and 24-month intervention groups, respectively, compared with 19% in the control group (P=0.0068). This observation persisted in the subgroup of participants with diabetes or chronic kidney disease and minorities. A longer TTR was not associated with an increased risk of adverse drug events. Time to first observed SBP in the target range was shorter in the intervention group compared with control (270 versus 365 days; P=0.0047). A physician/pharmacist collaborative care model achieved longer TTR for SBP compared with control (usual care).
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Affiliation(s)
- Dave L Dixon
- Center for Pharmacy Practice Innovation (D.L.D., T.M.S.), Virginia Commonwealth University School of Pharmacy, Richmond, VA.,Department of Pharmacotherapy and Outcomes Science (D.L.D., T.M.S., B.W.V.T.), Virginia Commonwealth University School of Pharmacy, Richmond, VA
| | - William L Baker
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT (W.L.B.)
| | - Leo F Buckley
- Department of Pharmacy, Brigham and Women's Hospital, Boston, MA (L.F.B.)
| | - Teresa M Salgado
- Center for Pharmacy Practice Innovation (D.L.D., T.M.S.), Virginia Commonwealth University School of Pharmacy, Richmond, VA.,Department of Pharmacotherapy and Outcomes Science (D.L.D., T.M.S., B.W.V.T.), Virginia Commonwealth University School of Pharmacy, Richmond, VA
| | - Benjamin W Van Tassell
- Department of Pharmacotherapy and Outcomes Science (D.L.D., T.M.S., B.W.V.T.), Virginia Commonwealth University School of Pharmacy, Richmond, VA
| | - Barry L Carter
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA (B.L.C.)
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25
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Kazi DS, Ogedegbe O, Bibbins-Domingo K. Addressing the Last-Mile Problem in Blood Pressure Control—Scaling Up Community-Based Interventions. JAMA HEALTH FORUM 2021; 2:e212022. [DOI: 10.1001/jamahealthforum.2021.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Dhruv S. Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Olugbenga Ogedegbe
- Institute for Excellence in Health Equity, New York University Langone Health, New York, New York
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26
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Affiliation(s)
- Michelle A Albert
- Department of Medicine (Cardiology), University of California, San Francisco (M.A.A.)
| | - Mercedes R Carnethon
- Department of Preventive Medicine and Medicine (Pulmonary and Critical Care), Northwestern University, Chicago, IL (M.R.C.)
| | - Karol E Watson
- Department of Medicine (Cardiology), University of California, Los Angeles (K.E.W.)
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