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Graham HL, Asakura Y, Kirby J, Prue-Owens K, Ma J. Exercise Adherence in Older and Middle-Aged Adults With Coronary Artery Disease Before and During COVID-19. J Cardiovasc Nurs 2024; 39:379-389. [PMID: 37249539 DOI: 10.1097/jcn.0000000000001009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Regular exercise is advised for individuals given a diagnosis of cardiovascular disease. COVID-19 presented challenges to exercise adherence. OBJECTIVE The objective of this study was to determine long-term exercise adherence and whether individuals with cardiovascular disease adhered to American Heart Association/American College of Cardiology Foundation guidelines before and during the COVID-19 pandemic. METHODS This is an observational cross-sectional study in which men (73%) and women discharged from a multiwide hospital system after an acute coronary event were enrolled. Participants completed 3 questionnaires, including the Exercise Adherence Rating Scale. RESULTS Five hundred eighty-two individuals (mean [SD] age, 67 [9.8] years) completed the survey. Fifty-three percent of participants met minimum exercise guidelines during COVID-19. Exercise days per week decreased significantly during COVID-19 in women ( P = .013) but not significant for men ( P = .301). Categorized by age, the decrease was significant for middle-aged women ( P = .002), not older women ( P = .336). Men exercised more minutes per session ( P = .034), and had greater exercise adherence ( P = .003) and greater exercise intensity ( P < .001). Overall, women participated less in cardiac rehabilitation ( P = .046) and reported the greatest disparity in exercise adherence and intensity. CONCLUSION Exercise after an acute event is beneficial, and the percentage of individuals meeting recommended guidelines should be higher considering the relationship between exercise and the possibility of future cardiac events. On the basis of the many physical and mental benefits of maintaining exercise, healthcare practitioners are encouraged to screen all patients for exercise adherence with a major emphasis on educating women and older adults.
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Tracy M, Mancusi C, Salzano A. Editorial: Reviews in cardiac rehabilitation. Front Cardiovasc Med 2024; 11:1371750. [PMID: 38803666 PMCID: PMC11129823 DOI: 10.3389/fcvm.2024.1371750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/06/2024] [Indexed: 05/29/2024] Open
Affiliation(s)
- Melissa Tracy
- Rush University Medical Center, Chicago, IL, United States
| | - Costantino Mancusi
- Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
| | - Andrea Salzano
- Cardiology Unit, AORN A Cardarelli, Naples, Italy
- Cardiology, Glenfield Hospital, University Hospital of Leicester, Leicester, United Kingdom
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Whitler C, Varkoly KS, Patel H, Assaf AD, Hoose J, Brannan GD, Miller R, Zughaib M. Improved Cardiac Rehabilitation Referral Rate Utilizing a Multidisciplinary Quality Improvement Team. Cureus 2024; 16:e61157. [PMID: 38933616 PMCID: PMC11200930 DOI: 10.7759/cureus.61157] [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: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Cardiac rehabilitation (CR) is an underutilized resource in patients with ischemic heart disease, despite being a Class IA recommendation. In this study, a multidisciplinary quality improvement (QI) team aimed to improve CR referrals by standardizing the ordering process at our hospital system. Method By using a collaborative approach involving the electronic medical record (EMR), medical provider education, and hospital protocols, our two-hospital healthcare system was able to successfully identify barriers to CR referral rates and implement interventions for these barriers. All physicians and medical providers, including ancillary staff, were educated on the EMR order sets to improve compliance by using automated order sets in the EMR. The CR referral order in the EMR included a statement regarding the application of evidence-based medicine, and a computerized provider order entry was included as a reminder to the ordering provider. The use of EMR was monitored monthly by the QI committee. Chi-square test and odds ratios were obtained for statistical analysis. Results Through provider-EMR education and patient education on discharge, CR referral rates significantly improved from 51.2 to 87.1% (p = 0.0001) in a 12-month period. The study included 1,499 patients in total. The improvement was statistically significant regardless of patient gender, race, or insurance coverage. Additionally, subgroup analysis in this study found that prior to standardization of the ordering process, African American patients were significantly less likely to be referred to CR compared to Caucasian patients. (51.2% vs. 41.0%, p=0.01). There was no statistically significant difference in the likelihood of CR referral between Caucasian and African American patients following the intervention (84.0% vs. 78.0%, p = 0.166). Conclusion This study shows that CR is an underutilized resource and that effective QI initiatives may not only increase CR referral rates but also close the gap between racial inequities in referral rates. Future research with multi-center randomized control trials is needed to further enhance its external generalizability to other institutions.
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Affiliation(s)
- Cameron Whitler
- Department of Cardiovascular Medicine, Ascension Providence Hospital, Southfield, USA
| | - Kyle S Varkoly
- Department of Internal Medicine, McLaren Macomb Hospital, Mount Clemens, USA
| | - Harshil Patel
- Department of Cardiovascular Medicine, Ascension Providence Hospital, Southfield, USA
| | - Andrew D Assaf
- Department of Cardiovascular Medicine, Ascension Providence Hospital, Southfield, USA
| | - Jennifer Hoose
- Department of Cardiovascular Medicine, Ascension Providence Hospital, Southfield, USA
| | - Grace D Brannan
- Department of Research, GDB Research and Statistical Consulting, Athens, USA
| | - Ronald Miller
- Department of Cardiovascular Medicine, Ascension Providence Hospital, Southfield, USA
| | - Marcel Zughaib
- Department of Cardiovascular Medicine, Ascension Providence Hospital, Southfield, USA
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Tang WL, Rodriguez F. Racial and Ethnic Disparities in the Management of Chronic Coronary Disease. Med Clin North Am 2024; 108:595-607. [PMID: 38548466 PMCID: PMC10979033 DOI: 10.1016/j.mcna.2023.11.008] [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] [Indexed: 04/02/2024]
Abstract
Chronic coronary disease (CCD) comprises a continuum of conditions that include obstructive and non-obstructive coronary artery disease with or without prior acute coronary syndrome. Racial and ethnic representation disparities are pervasive in CCD guideline-informing clinical trials and evidence-based management. These disparities manifest across the entire spectrum of CCD management, spanning from non-pharmacological lifestyle changes to guideline-directed medical therapy, and cardiac rehabilitation to invasive procedures. Recognizing and addressing the historical factors underlying these disparities is crucial for enhancing the quality and equity of CCD management within an increasingly diverse population.
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Affiliation(s)
- Wilson Lay Tang
- Department of Medicine, Stanford University, 300 Pasteur Drive, L154, Stanford, CA 94305-5133, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and Cardiovascular Institute, Department of Medicine, Center for Academic Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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Garfein J, Chen Y, Swabe G, Guhl E, Forman DE, Magnani JW. Race or ethnicity and education in cardiac rehabilitation enrollment. J Cardiol 2024; 83:280-283. [PMID: 37562543 PMCID: PMC10850430 DOI: 10.1016/j.jjcc.2023.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Although cardiac rehabilitation (CR) has established benefits for cardiovascular health, it remains significantly underutilized, with substantial differences in participation related to factors such as educational attainment (EA), race, and ethnicity. We studied a geographically and racially diverse cohort of insured individuals in a health claims database to (1) evaluate differences in CR participation by EA and race or ethnicity and (2) assess how EA modifies associations between race or ethnicity and CR participation. METHODS We conducted a retrospective cohort study of individuals identified in Optum's de-identified Clinformatics® database between 1/1/2016 and 12/31/2019. Eligible individuals included those aged ≥18 years with a hospitalization for an incident CR-qualifying diagnosis. We calculated incidence rates of CR enrollment by EA and race or ethnicity, as well as associations of EA and race or ethnicity with CR enrollment, and evaluated interaction between EA and race or ethnicity with respect to CR participation. RESULTS We identified 171,297 individuals eligible for CR with a mean ± SD age of 70.4 ± 11.6 years; 37.4 % were female, and 68.3 % had >high school education. We observed a dose-response association between EA and rate of participation in CR. After adjustment, compared to White individuals, the odds of attending CR was 24 % lower for Asian individuals [95 % confidence interval (CI): 17 %, 30 %], 13 % lower for Black individuals (95 % CI: 9 %, 17 %), and 32 % lower for Hispanic individuals (95 % CI: 28 %, 35 %), all p < 0.0001. However, Black individuals with ≥bachelor's degree had a similar odds of CR enrollment as White individuals with ≥bachelor's degree (odds ratio 1.01, 95 % CI: 0.85, 1.20, p = 0.95). CONCLUSIONS EA was positively associated with CR enrollment across racial and ethnic groups. Higher EA might partially attenuate racial and ethnic differences in CR participation, but significant disparities persist. Our findings support increased attention to individuals with limited education to improve CR enrollment.
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Affiliation(s)
- Joshua Garfein
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yimin Chen
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gretchen Swabe
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emily Guhl
- Division of Cardiology, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel E Forman
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Division of Cardiology, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jared W Magnani
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Division of Cardiology, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Hall WL. Long chain n-3 polyunsaturated fatty acid intake across the life span for cardiovascular disease prevention in women. Proc Nutr Soc 2024:1-12. [PMID: 38444046 DOI: 10.1017/s0029665124000181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Cardiovascular diseases (CVDs) are a major health concern for women. Historically there has been a misconception that men are at greater risk because CVD tends to occur earlier in life compared to women. Clinical guidelines for prevention of heart disease are currently the same for both sexes, but accumulating evidence demonstrates that risk profiles diverge. In fact, several CVD risk factors confer an even greater risk in women relative to men, including high blood pressure, obesity, diabetes and raised triglycerides. Furthermore, many female-specific CVD risk factors exist, including early menarche, pregnancy complications, polycystic ovary syndrome, reproductive hormonal treatments and menopause. Little is known about how diet interacts with CVD risk factors at various stages of a woman’s life. Long chain (LC) n-3 polyunsaturated fatty acid (PUFA) intakes are a key dietary factor that may impact risk of CVD throughout the life course differentially in men and women. Oestrogen enhances conversion of the plant n-3 PUFA, alpha-linolenic acid, to LCn-3 PUFA. Increasing the frequency of oily fish consumption or LCn-3 PUFA supplementation may be important for reducing coronary risk during the menopausal transition, during which time oestrogen levels decline and the increase in CVD risk factors is accelerated. Women are under-represented in the evidence base for CVD prevention following LC n-3 PUFA supplementation. Therefore it is not clear whether there are sex differences in response to treatment. Furthermore, there is a lack of evidence on optimal intakes of LC n-3 PUFA across the lifespan for CVD prevention in women.
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Affiliation(s)
- Wendy Louise Hall
- Department of Nutritional Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Duscha BD, Ross LM, Hoselton AL, Piner LW, Pieper CF, Kraus WE. A Detailed Analysis of Cardiac Rehabilitation on 180-Day All-Cause Hospital Readmission and Mortality. J Cardiopulm Rehabil Prev 2024; 44:99-106. [PMID: 38113355 PMCID: PMC10913862 DOI: 10.1097/hcr.0000000000000835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
PURPOSE Cardiac rehabilitation (CR) is endorsed for coronary artery disease (CAD), but studies report inconsistent findings regarding efficacy. The objective of this study was to determine whether confounding factors, potentially contributing to these heterogeneous findings, impact the effect of CR on all-cause readmission and mortality. METHODS Patients (n = 2641) with CAD, CR eligible, and physically able were identified. Electronic medical records were inspected individually for each patient to extract demographic, clinical characteristic, readmission, and mortality information. Patients (n = 214) attended ≥1 CR session (CR group). Survival was considered free from: all-cause readmission; or composite outcome of all-cause readmission or death. Cox proportional hazards models, adjusting for demographics, comorbidities, and discharge criteria, were used to determine HR with 95% CI and to compare 180-d survival rates between the CR and no-CR groups. RESULTS During 180 d of follow-up, 12.1% and 18.7% of the CR and non-CR patients were readmitted to the hospital. There was one death (0.5%) in the CR group, while 98 deaths (4.0%) occurred in the non-CR group. After adjustment for age, sex, race, depression, anxiety, dyslipidemia, hypertension, obesity, smoking, type 2 diabetes, and discharge criteria, the final model revealed a significant 42.7% reduction in readmission or mortality risk for patients who attended CR (HR = 0.57: 95% CI, 0.33-0.98; P = .043). CONCLUSIONS Regardless of demographic characteristics, comorbidities, and cardiovascular discharge criteria, the risk of 180-d all-cause readmission or death was markedly decreased in patients who attended CR compared with those who did not.
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Affiliation(s)
- Brian D. Duscha
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - Leanna M. Ross
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - Andrew L. Hoselton
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - Lucy W. Piner
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - Carl F. Pieper
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
| | - William E. Kraus
- Duke University School of Medicine, Division of Cardiology and Duke Molecular Physiology Institute, Durham, North Carolina (Messrs Duscha and Hoselton, Drs Ross and Kraus, and Ms Piner); and Center for Aging and Human Development, Duke University School of Medicine Center, Durham, and Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina (Dr Pieper)
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Hollings M, Zhao E, Weddell J, Naismith S, Tofler G, Bauman A, Gallagher R. Lower cardiac rehabilitation enrolment occurs in acute coronary syndrome patients who report low levels of physical activity at four weeks post-event: A prospective observational study using physical activity tracker data. Heart Lung 2024; 64:143-148. [PMID: 38215534 DOI: 10.1016/j.hrtlng.2023.12.007] [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: 09/21/2023] [Revised: 12/19/2023] [Accepted: 12/31/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Physical activity (PA) and cardiac rehabilitation (CR) attendance are important for recovery and prognosis following acute coronary syndrome (ACS). However, PA patterns early post-ACS are not well known. OBJECTIVES Investigate the level of PA at 4-weeks post-ACS and any potential associations with CR enrolment. METHODS We recruited patients admitted for ACS from cardiac wards and clinics at two hospital sites in Sydney, Australia. PA data were collected using wearable activity trackers worn at 4-weeks post-ACS, and CR enrolment was self-reported. RESULTS Participants (n = 61) were aged 66.7 ± 10.3 years, 74 % male, 61 % were married or partnered, and 33 % were diagnosed with ST-elevation myocardial infarction. Patients engaged in 7514±3355 steps per day and 44.6 ± 37.5 min of moderate-to-vigorous physical activity (MVPA). Patients who enrolled in CR exhibited higher daily step counts (p = 0.044), MVPA minutes (p = 0.001), and were more likely to meet PA guidelines. ACS patients who engaged in higher levels of MVPA were more likely to enrol in CR (odds ratio [OR] 1.46; 95 % confidence interval [CI] 1.08, 1.98). CR enrolment was also positively associated with being married or in an intimate partnership (OR 9.93; 95 % CI 1.83, 53.85) and absence of depressive symptoms (OR 11.86; 95 % CI 1.91, 73.74). CONCLUSION Lower CR enrolment rates were observed among less physically active patients at 4-weeks post-ACS. However, each 10 min increment in MVPA increased the odds of CR enrolment by 46 %. Future research should explore strategies to target this inactive and high-risk group, given the potential for a large prognostic gain with CR participation.
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Affiliation(s)
- Matthew Hollings
- Faculty of Medicine and Health, University of Sydney, Australia; Charles Perkins Centre, University of Sydney, Australia.
| | - Emma Zhao
- Faculty of Medicine and Health, University of Sydney, Australia; Charles Perkins Centre, University of Sydney, Australia
| | - Joseph Weddell
- Faculty of Medicine and Health, University of Sydney, Australia; Charles Perkins Centre, University of Sydney, Australia
| | - Sharon Naismith
- Charles Perkins Centre, University of Sydney, Australia; Faculty of Science, University of Sydney, Australia
| | - Geoffrey Tofler
- Faculty of Medicine and Health, University of Sydney, Australia; Royal North Shore Hospital, St Leonards, Australia
| | - Adrian Bauman
- Faculty of Medicine and Health, University of Sydney, Australia; Charles Perkins Centre, University of Sydney, Australia
| | - Robyn Gallagher
- Faculty of Medicine and Health, University of Sydney, Australia; Charles Perkins Centre, University of Sydney, Australia; Royal North Shore Hospital, St Leonards, Australia
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Vervoort D, Elfaki LA, Servito M, Herrera-Morales KY, Kanyepi K. Redefining global cardiac surgery through an intersectionality lens. MEDICAL HUMANITIES 2024; 50:109-115. [PMID: 38388185 DOI: 10.1136/medhum-2023-012801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/24/2024]
Abstract
Although cardiovascular diseases are the leading cause of morbidity and mortality worldwide, six billion people lack access to safe, timely and affordable cardiac surgical care when needed. The burden of cardiovascular disease and disparities in access to care vary widely based on sociodemographic characteristics, including but not limited to geography, sex, gender, race, ethnicity, indigeneity, socioeconomic status and age. To date, the majority of cardiovascular, global health and global surgical research has lacked intersectionality lenses and methodologies to better understand access to care at the intersection of multiple identities and traditions. As such, global (cardiac) surgical definitions and health system interventions have been rooted in reductionism, focusing, at most, on singular sociodemographic characteristics. In this article, we evaluate barriers in global access to cardiac surgery based on existing intersectionality themes and literature. We further examine intersectionality methodologies to study access to cardiovascular care and cardiac surgery and seek to redefine the definition of 'global cardiac surgery' through an intersectionality lens.
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Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lina A Elfaki
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
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Beckie TM, Sengupta A, Dey AK, Dutta K, Ji M, Chellappan S. A Mobile Health Behavior Change Intervention for Women With Coronary Heart Disease: A RANDOMIZED CONTROLLED PILOT STUDY. J Cardiopulm Rehabil Prev 2024; 44:40-48. [PMID: 37285601 DOI: 10.1097/hcr.0000000000000804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE The aim of this study was to evaluate the effects of a mobile health (mHealth) intervention, HerBeat, compared with educational usual care (E-UC) for improving exercise capacity (EC) and other patient-reported outcomes at 3 mo among women with coronary heart disease. METHODS Women were randomized to the HerBeat group (n = 23), a behavior change mHealth intervention with a smartphone, smartwatch, and health coach or to the E-UC group (n = 24) who received a standardized cardiac rehabilitation workbook. The primary endpoint was EC measured with the 6-min walk test (6MWT). Secondary outcomes included cardiovascular disease risk factors and psychosocial well-being. RESULTS A total of 47 women (age 61.2 ± 9.1 yr) underwent randomization. The HerBeat group significantly improved on the 6MWT from baseline to 3 mo ( P = .016, d = .558) while the E-UC group did not ( P = .894, d =-0.030). The between-group difference of 38 m at 3 mo was not statistically significant. From baseline to 3 mo, the HerBeat group improved in anxiety ( P = .021), eating habits confidence ( P = .028), self-efficacy for managing chronic disease ( P = .001), diastolic blood pressure ( P = .03), general health perceptions ( P = .047), perceived bodily pain ( P = .02), and waist circumference ( P = .008) while the E-UC group showed no improvement on any outcomes. CONCLUSIONS The mHealth intervention led to improvements in EC and several secondary outcomes from baseline to 3 mo while the E-UC intervention did not. A larger study is required to detect small differences between groups. The implementation and outcomes evaluation of the HerBeat intervention was feasible and acceptable with minimal attrition.
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Affiliation(s)
- Theresa M Beckie
- College of Nursing, University of South Florida, Tampa, the United States (Drs Beckie and Ji); Business School, University of Queensland, Brisbane, Australia (Dr Sengupta); College of Engineering, University of South Florida, Tampa, the United States (Drs Dey and Chellappan); and College of Business, University of South Florida, Tampa, the United States (Dr Dutta)
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Thakker R, Khan M, Al-Hemyari B. Cardiac Rehabilitation After Hospitalization for Acute Coronary Syndrome. Curr Cardiol Rep 2023; 25:1699-1703. [PMID: 38063996 DOI: 10.1007/s11886-023-02010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE OF REVIEW Acute coronary syndrome (ACS) carries a high burden of morbidity and mortality. Cardiac rehabilitation over the past century has developed as an important tool in treating and preventing future myocardial infarction events in this critical group. We summarize the rationale and literature evidence supporting the use of cardiac rehabilitation and its role in ACS patients, with an emphasis on its impact on outcomes following hospitalization. RECENT FINDINGS Current literature and large-scale reviews and registry analyses provide conflicting data on the benefits of cardiac rehabilitation after ACS, including its impact on mortality, readmission, and quality of life. Cardiac rehabilitation is an important tool in the management ACS patients. It encompasses not only a graduated exercise regimen but also a holistic approach and is therefore best implemented as a comprehensive cardiac rehabilitation strategy including, in addition to exercise regimen, psychosocial counseling, smoking cessation education, medication adherence, nutrition guidance, and other tools for risk modification. Further trials on the role of cardiac rehabilitation after ACS are needed, especially trials examining different cardiac rehabilitation protocols, time period for its implementation after ACS, and optimal program duration.
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Affiliation(s)
- Ravi Thakker
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, 77555, USA
| | - Mahin Khan
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, 77555, USA
| | - Bashar Al-Hemyari
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, 77555, USA.
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12
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Dassanayake MT, Norton EL, Ward AF, Wenger NK. Sex-specific disparities in patients undergoing isolated CABG. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 35:100334. [PMID: 38511179 PMCID: PMC10945894 DOI: 10.1016/j.ahjo.2023.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 03/22/2024]
Abstract
Study objective Examine sex-specific characteristics in patients undergoing coronary artery bypass grafting (CABG) at our institution. Design Retrospective chart review was performed utilizing our institutional Society of Thoracic Surgeons (STS) database. Setting An academic, quaternary care center from 2010 to 2021. Participants 3163 females and 9573 males underwent isolated CABG. Interventions The institutional STS database was queried for preoperative, intraoperative, and postoperative variables. Main outcome measures Univariate comparisons between female and male groups were performed using chi-squared tests or fisher exact tests. Multivariate logistic regression was used to assess risk factors for 30-day mortality. Results Females had more preoperative comorbidities than males, including hypertension, diabetes, peripheral arterial disease, cerebrovascular disease, renal failure, and prior myocardial infarction. Females more frequently underwent urgent (61 % vs. 58 %) or emergent CABG (5.8 % vs. 4.3 %) compared to males (p < 0.0001). Females experienced longer total intensive care unit (ICU) hours (48.3 h vs. 43.5 h) (p < 0.0001), were more frequently discharged to an extended care facility (13 % vs. 6.4 %) (p < 0.0001) and prescribed less aspirin and beta blocker therapy at discharge than males. In-hospital mortality was higher in females (1.9 % vs. 1.2 %, p = 0.002), as was 30-day mortality (2.7 % vs. 1.6 %, p = 0.0001). Female sex was an independent risk factor for 30-day mortality (odds ratio = 1.46, 95 % CI: 1.06, 2.03, p = 0.02). Conclusion Over the past decade, females undergoing CABG had more preoperative comorbidities, urgent and emergent operations, longer postoperative ICU stay and a higher risk of mortality than their male counterparts. Further studies must investigate these disparities to improve outcomes for females undergoing CABG.
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Affiliation(s)
- Maya T. Dassanayake
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Elizabeth L. Norton
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Alison F. Ward
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Nanette K. Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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13
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Wang L, Liu J, Fang H, Wang X. Factors associated with participation in cardiac rehabilitation in patients with acute myocardial infarction: A systematic review and meta-analysis. Clin Cardiol 2023; 46:1450-1457. [PMID: 37594292 PMCID: PMC10642335 DOI: 10.1002/clc.24130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is effective in reducing morbidity and mortality in patients with acute myocardial infarction (AMI), but the participation rate is low and its influencing factors vary. Our study aimed to systematically review the literature and investigate the participation rates and influencing factors of CR in patients with AMI. METHODS We searched 10 databases, including PubMed, Web of Science, Cochrane Library, and so forth. A systematic review and meta-analysis were conducted on the studies on the factors affecting CR participation in AMI. The Q tests and the I2 tests were used to assess heterogeneity between studies. The combined effect size and odds ratio (OR) and their respective 95% confidence interval (CI) for CR participation rate and its influences are expressed, respectively. Stata 17.0 software was used for statistical analysis. RESULTS We included 14 studies with 114 542 participants. Current evidence indicates a CR participation rate of 34% (95% CI: 21%-46%) in patients with AMI. The pooled OR values and CI of each influencing factor are as follows: over 60 years old (OR = 0.865; 95% CI: 0.772-0.969), male (OR = 1.690; 95% CI: 1.276-2.239), college education or above (OR = 2.526; 95% CI: 1.117-5.711), ST-segment elevation myocardial infarction (OR = 4.257; 95% CI: 2.004-9.045), decrease in left ventricular ejection fraction (OR = 0.918; 95% CI: 0.868-0.971), higher economic level (OR = 1.282; 95% CI: 1.108-1.483), history of coronary heart disease(OR = 0.667; 95% CI: 0.509-0.875), smoking (OR = 0.665; 95% CI: 0.550-0.805), combined hypertension (OR = 0.638; 95% CI: 0.562-0.723), and combined hyperlipidemia (OR = 0.577; 95% CI: 0.512-0.651). CONCLUSIONS The overall participation rate of CR in AMI patients is low, and various factors affect the participation rate. Specialist medical staff are needed to further promote CR rehabilitation concepts and scientific knowledge, and take appropriate measures to address the influencing factors to increase CR utilization and improve patient prognosis.
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Affiliation(s)
- Lingyu Wang
- Nursing SchoolAnhui University of Chinese MedicineHefeiAnhuiChina
| | - Jingyu Liu
- Nursing SchoolAnhui University of Chinese MedicineHefeiAnhuiChina
| | - Haiyan Fang
- Nursing SchoolAnhui University of Chinese MedicineHefeiAnhuiChina
| | - Xiang Wang
- Nursing SchoolAnhui University of Chinese MedicineHefeiAnhuiChina
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14
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Wang DR, Li J, Parikh RV, Ziaeian B, Aksoy O, Jackson NJ, Hsu JJ. Racial/Ethnic Disparities in Outcomes After Percutaneous Coronary Intervention. Am J Cardiol 2023; 205:120-125. [PMID: 37597486 DOI: 10.1016/j.amjcard.2023.07.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 08/21/2023]
Abstract
Asian American/Pacific Islanders (AAPIs) and Hispanics are growing minority United States populations, but are poorly represented in the cardiovascular literature. This study examines guideline adherence and outcomes in AAPIs and Hispanics compared with non-Hispanic Whites (NHWs) in a quaternary care center after inpatient percutaneous coronary intervention (PCI). The primary end points were inpatient post-PCI bleed, heart failure, cardiogenic shock, and all-cause mortality, whereas the secondary end point was the prescription rate of post-PCI guideline-directed medical therapy including aspirin, statins, P2Y12 receptor blockers, and cardiopulmonary rehabilitation. Intergroup differences were assessed through analysis of variance or two-way chi-square tests, and the association of race with binary outcomes was examined through logistic regression with NHW as the reference group. Compared with NHW, AAPIs, and Hispanics had higher odds of diabetes mellitus, and AAPIs had higher odds of hypertension and being on dialysis. Hispanics had higher odds of post-PCI mortality versus NHW, both in acute coronary syndrome (odds ratio [OR] 2.04, p = 0.03) and elective PCI (OR 2.51, p = 0.04). AAPI also trended toward higher mortality than NHW in both categories. AAPIs were found to have higher odds of statin prescription (OR 1.91, p = 0.04). Hispanics had lower odds of ticagrelor prescription versus NHW (OR 0.65, p = 0.04), and AAPIs trended toward such. No differences were found for cardiopulmonary rehabilitation prescriptions in groups. This study suggests that despite quality improvement efforts, disparities remain in postprocedural outcomes in minority groups in comparison with NHW.
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Affiliation(s)
- Daniel R Wang
- Divisions of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California.
| | - Joshua Li
- Divisions of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California
| | - Rushi V Parikh
- Divisions of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California
| | - Boback Ziaeian
- Divisions of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California
| | - Olcay Aksoy
- Divisions of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California
| | - Nicholas J Jackson
- Divisions of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California
| | - Jeffrey J Hsu
- Divisions of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California; Division of Cardiology, Veteran Affairs Greater Los Angeles Healthcare, Los Angeles, California
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15
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Braver J, Marwick TH, Oldenburg B, Issaka A, Carrington MJ. Digital Health Programs to Reduce Readmissions in Coronary Artery Disease: A Systematic Review and Meta-Analysis. JACC. ADVANCES 2023; 2:100591. [PMID: 38938339 PMCID: PMC11198697 DOI: 10.1016/j.jacadv.2023.100591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/25/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2024]
Abstract
Background The use of mobile health (mHealth, wireless communication devices, and/or software technologies) in health care delivery has increased rapidly in recent years. Their integration into disease management programs (DMPs) has tremendous potential to improve outcomes for patients with coronary artery disease (CAD), yet a more robust evaluation of the evidence is required. Objectives The purpose of this study was to undertake a systematic review and meta-analysis of mHealth-enabled DMPs to determine their effectiveness in reducing readmissions and mortality in patients with CAD. Methods We systematically searched English language studies from January 1, 2007, to August 3, 2021, in multiple databases. Studies comparing mHealth-enabled DMPs with standard DMPs without mHealth were included if they had a minimum 30-day follow-up for at least one of all-cause or cardiovascular-related mortality, readmissions, or major adverse cardiovascular events. Results Of the 3,411 references from our search, 155 full-text studies were assessed for eligibility, and data were extracted from 18 publications. Pooled findings for all-cause readmissions (10 studies, n = 1,514) and cardiac-related readmissions (9 studies, n = 1,009) indicated that mHealth-enabled DMPs reduced all-cause (RR: 0.68; 95% CI: 0.50-0.91) and cardiac-related hospitalizations (RR: 0.55; 95% CI: 0.44-0.68) and emergency department visits (RR: 0.37; 95% CI: 0.26-0.54) compared to DMPs without mHealth. There was no significant reduction for mortality outcomes (RR: 1.72; 95% CI: 0.64-4.64) or major adverse cardiovascular events (RR: 0.68; 95% CI: 0.40-1.15). Conclusions DMPs integrated with mHealth should be considered an effective intervention for better outcomes in patients with CAD.
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Affiliation(s)
- Justin Braver
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
- Pre-Clinical Disease and Prevention Unit, Baker Heart and Diabetes Institute, Victoria, Australia
| | - Thomas H. Marwick
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
- Pre-Clinical Disease and Prevention Unit, Baker Heart and Diabetes Institute, Victoria, Australia
| | - Brian Oldenburg
- Non-Communicable Diseases and Implementation Science Unit, Baker Heart and Diabetes Institute, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Ayuba Issaka
- Non-Communicable Diseases and Implementation Science Unit, Baker Heart and Diabetes Institute, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Melinda J. Carrington
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
- Pre-Clinical Disease and Prevention Unit, Baker Heart and Diabetes Institute, Victoria, Australia
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16
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Keshvani N, Subramanian V, Wrobel CA, Solomon N, Alhanti B, Greene SJ, DeVore A, Yancy C, Allen LA, Fonarow GC, Pandey A. Patterns of Referral and Postdischarge Utilization of Cardiac Rehabilitation Among Patients Hospitalized With Heart Failure: An Analysis From the GWTG-HF Registry. Circ Heart Fail 2023; 16:e010144. [PMID: 37431671 PMCID: PMC11092317 DOI: 10.1161/circheartfailure.122.010144] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 05/10/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Coverage for cardiac rehabilitation (CR) for patients with heart failure with reduced ejection fraction was expanded in 2014, but contemporary referral and participation rates remain unknown. METHODS Patients hospitalized for heart failure with reduced ejection fraction (≤35%) in the American Heart Association Get With The Guidelines-Heart Failure registry from 2010 to 2020 were included, and CR referral status was described as yes, no, or not captured. Temporal trends in CR referral were assessed in the overall cohort. Patient and hospital-level predictors of CR referral were assessed using multivariable-adjusted logistic regression models. Additionally, CR referral and proportional utilization of CR within 1-year of referral were evaluated among patients aged >65 years with available Medicare administrative claims data who were clinically stable for 6-weeks postdischarge. Finally, the association of CR referral with the risk of 1-year death and readmission was evaluated using multivariable-adjusted Cox models. RESULTS Of 69,441 patients with heart failure with reduced ejection fraction who were eligible for CR (median age 67 years; 33% women; 30% Black), 17,076 (24.6%) were referred to CR, and referral rates increased from 8.1% in 2010 to 24.1% in 2020 (Ptrend<0.001). Of 8310 patients with Medicare who remained clinically stable 6-weeks after discharge, the CR referral rate was 25.8%, and utilization of CR among referred patients was 4.1% (mean sessions attended: 6.7). Patients not referred were more likely to be older, of Black race, and with a higher burden of comorbidities. In adjusted analysis, eligible patients with heart failure with reduced ejection fraction who were referred to CR (versus not referred) had a lower risk of 1-year death (hazard ratio, 0.84 [95% CI, 0.70-1.00]; P=0.049) without significant differences in 1-year readmission. CONCLUSIONS CR referral rates have increased from 2010 to 2020. However, only 1 in 4 patients are referred to CR. Among eligible patients who received CR referral, participation was low, with <1 of 20 participating in CR.
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Affiliation(s)
- Neil Keshvani
- Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, TX
- Parkland Health and Hospital System, Dallas, TX
| | - Vinayak Subramanian
- Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, TX
- Parkland Health and Hospital System, Dallas, TX
| | | | | | | | - Stephen J. Greene
- Division of Cardiology, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Adam DeVore
- Division of Cardiology, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Clyde Yancy
- Northwestern University Medical School, Chicago, IL
| | | | | | - Ambarish Pandey
- Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, TX
- Parkland Health and Hospital System, Dallas, TX
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17
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Zhang S, Ding R, Chen S, Meng X, Jianchao L, Wang DW, Hu D. Availability and trend of dissemination of cardiac rehabilitation in China: report from the multicenter national registration platform between 2012 and 2021. Front Cardiovasc Med 2023; 10:1210068. [PMID: 37404729 PMCID: PMC10315840 DOI: 10.3389/fcvm.2023.1210068] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Abstract
The study aimed to evaluate the current status of cardiac rehabilitation programs in China by registering and tracking patients undergoing CR programs in the database. Data were extracted from the online registry platform of the China Society of Cardiopulmonary Prevention and Rehabilitation from February 2012 to December 2021. Overall, data on 19,896 patients with cardiovascular diseases (CVDs) from 159 hospitals in 34 provinces of China were extracted. From a time point of view, the number of patients who had undergone CR and institutions that perform CR showed the first decline in 2009 and then increased until 2021. From a geographic point of view, the degree of participation varied greatly among regions, most of which were concentrated in eastern parts of China. A higher population of patients who underwent CR were male, aged less than 60 years, with low-a risk for coronary heart disease (CHD), and tended to choose the hospital-based CR program among all cases registered in the database. The top three diseases in the patients who participated in CR were CHD, hypertension, and metabolic syndrome (MS). Centers with CR were more likely to be tertiary-level hospitals. After adjusting for baseline values, there were significant differences in post-CR exercise capacity among the three groups (home-based CR group, hospital-based CR group, and hybrid CR group), which were in favor of the hybrid CR group compared with other groups. The underutilization of CR is a global issue, not just in China. Despite the number of CR programs showing an increasing trend in the past years, CR in China is still in the preliminary stage of development. Furthermore, the participation of CR in China shows wide diversity across geography, disease, age, sex, risk stratification, and hospital-level factors. These findings reinforce the importance of the implementation of effective measures to improve the participation, enrollment in, and uptake of cardiac rehabilitation.
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Affiliation(s)
- Sisi Zhang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rongjing Ding
- Department of Rehabilitation, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Sikun Chen
- Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, China
| | - Xiaoping Meng
- Department of Cardiology and Cardiac Rehabilitation, The Affiliated Hospital of Traditional Chinese Medicine, Changchun, China
| | - Li Jianchao
- School of Engineering Medicine, Beijing Advanced Innovation for Biomedical Engineering, Beihang University, Beijing, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dayi Hu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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18
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Maruf FA, Mohammed J. Unmet Needs for Cardiac Rehabilitation in Africa: A Perennial Gap in the Management of Individuals with Cardiac Diseases. High Blood Press Cardiovasc Prev 2023; 30:199-206. [PMID: 37093446 DOI: 10.1007/s40292-023-00573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
Cardiac rehabilitation (CR) is a standard model of care, and an established component of comprehensive care that has been proven to reduce mortality and morbidity in patients with cardiac diseases. International clinical practice guidelines routinely recommend that cardiac patients participate in CR programs for comprehensive secondary prevention. However, there is scant guidance on how to deliver these programs in low-resourced settings. This dearth of clinical practice guidelines may be an indication of low emphasis placed on CR as a component of cardiac health services in low-income countries, especially in Africa. Indeed, CR programs are almost non-existent in Africa despite the unmet need for CR in patients with ischemic heart disease in Africa reported to be about one million. This figure represents the highest unmet need of any World Health Organization region, and is colossal given the projected accelerated increases in incidence of cardiovascular diseases (CVD) in the region. This narrative review explored the availability of CR programs, potential barriers to CR and strategies that can mitigate such barriers in Africa.
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Affiliation(s)
- Fatai Adesina Maruf
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Nigeria.
| | - Jibril Mohammed
- Department of Physiotherapy, Bayero University, Kano, Nigeria
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19
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Alamri HM, Alotaibi TO, Alghatani AA, Alharthy TF, Sufyani AM, Alharthi AM, Mahmoud AA, Almahdi MK, Alama N, Al-Ebrahim KE. Effect of Gender on Postoperative Outcome and Duration of Ventilation After Coronary Artery Bypass Grafting (CABG). Cureus 2023; 15:e37717. [PMID: 37206527 PMCID: PMC10191450 DOI: 10.7759/cureus.37717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION The study assessed coronary artery bypass grafting (CABG) postoperative outcomes and associated factors in Saudi male and female patients. This was a retrospective cohort of patients who underwent CABG at the King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, from January 2015 to December 2022. Results: We included 392 patients, of whom 63 (16.1%) were female. Female undergoing CABG were significantly older (p=0.0001), had a significantly higher incidence of diabetes (p=0.0001), obesity (p=0.001), hypertension (p=0.001), and congestive heart failure (p=0.005), with a smaller body surface area (BSA) (p=0.0001) than male. Though renal dysfunction, previous cerebrovascular accident/transient ischemic attack (CVA/TIA), and myocardial infarction (MI), incidences were similar in both genders. Females were at significantly higher risk of mortality (p=0.0001), longer hospital stay (p=0.0001), and prolonged ventilation (p=0.0001). Preoperative renal dysfunction was the only statistically significant predictor of postoperative complications (p=0.0001). Female gender and preoperative renal dysfunction, were significant independent predictors of postoperative mortality and prolonged ventilation (p=0.005). CONCLUSION This study's findings indicated that females have worse CABG outcomes and a higher risk of morbidities and complications. Uniquely our study showed a higher incidence of prolonged ventilation in females postoperatively.
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Affiliation(s)
- Hassan M Alamri
- Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Turki O Alotaibi
- Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | - Tariq F Alharthy
- Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Albaraa M Sufyani
- Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | | | | | - Nabil Alama
- Medicine, King Abdulaziz University Hospital, Jeddah, SAU
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20
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Krishnamurthi N, Schopfer DW, Shen H, Rohrbach G, Elnaggar A, Whooley MA. Association of Home-Based Cardiac Rehabilitation With Lower Mortality in Patients With Cardiovascular Disease: Results From the Veterans Health Administration Healthy Heart Program. J Am Heart Assoc 2023; 12:e025856. [PMID: 36856057 PMCID: PMC10111465 DOI: 10.1161/jaha.122.025856] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Background Home-based cardiac rehabilitation (HBCR) and traditional facility-based cardiac rehabilitation (CR) programs have similar effects on mortality in clinical trials and meta-analyses. However, the effect of HBCR on mortality in clinical practice settings is less clear. Therefore, we sought to compare mortality rates in HBCR participants versus nonparticipants. Methods and Results We evaluated all patients who were referred to and eligible for outpatient CR between 2013 and 2018 at the San Francisco Veterans Health Administration. Patients who chose to attend facility-based CR and those who died within 30 days of hospitalization were excluded. Patients who chose to participate in HBCR received up to 9 telephonic coaching and motivational interviewing sessions over 12 weeks. All patients were followed through June 30, 2021. We used Cox proportional hazards regression models with inverse probability treatment weighting to compare mortality in HBCR participants versus nonparticipants. Of the 1120 patients (mean age 68, 98% male, 76% White) who were referred and eligible, 490 (44%) participated in HBCR. During a median follow-up of 4.2 years, 185 patients (17%) died. Mortality was lower among the 490 HBCR participants versus the 630 nonparticipants (12% versus 20%; P<0.01). In an inverse probability weighted Cox regression analysis adjusted for patient demographics and comorbid conditions, the hazard of mortality remained 36% lower among HBCR participants versus nonparticipants (hazard ratio, 0.64 [95% CI, 0.45-0.90], P=0.01). Conclusions Among patients eligible for CR, participation in HBCR was associated with 36% lower hazard of mortality. Although unmeasured confounding can never be eliminated in an observational study, our findings suggest that HBCR may benefit patients who cannot attend traditional CR programs.
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Affiliation(s)
- Nirupama Krishnamurthi
- Icahn School of Medicine at Mount Sinai New York NY.,Department of Cardiology Mount Sinai Morningside New York NY.,San Francisco Veterans Affairs Medical Center San Francisco CA
| | | | - Hui Shen
- San Francisco Veterans Affairs Medical Center San Francisco CA.,Department of Medicine University of California San Francisco CA
| | | | - Abdelaziz Elnaggar
- San Francisco Veterans Affairs Medical Center San Francisco CA.,Department of Medicine University of California San Francisco CA
| | - Mary A Whooley
- San Francisco Veterans Affairs Medical Center San Francisco CA.,Department of Medicine University of California San Francisco CA.,Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA
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21
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Clausyl Plummer II, Mensah C, Kline-Quiroz C. Disparities of health impacting head and neck cancer and rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023. [DOI: 10.1007/s40141-023-00382-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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22
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Ethnic Minorities' Experiences of Cardiac Rehabilitation: A Scoping Review. Healthcare (Basel) 2023; 11:healthcare11050757. [PMID: 36900762 PMCID: PMC10000677 DOI: 10.3390/healthcare11050757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/11/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Cardiac rehabilitation (CR) can improve cardiovascular risk factors, decrease cardiac mortality, and promote healthy lifestyle behaviours. However, services remain underutilized by groups of ethnic minorities. The purpose of the study was to identify patients' personal CR experiences to identify the differences CR makes towards minorities' lifestyle. An initial electronic search was performed in 2021 for papers ranging from 2008-2020 across specific databases, including PubMed, EMBASE, APA PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Medline. Google Scholar was also used to supplement the search process and to identify studies performed within grey literature. A total of 1230 records were screened, of which 40 were assessed for eligibility. The final sample consisted of seven qualitative design studies that were identified for inclusion in this review. Based on patient personal experiences, this review identified that ethnic minorities continue to remain disadvantaged when accessing healthcare interventions, primarily as a result of cultural behaviours, linguistic barriers, socioeconomic status, religious and fatalistic beliefs, and low physician referral rates. More research is needed to elucidate this phenomenon and address these factors faced by ethnic minorities.
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23
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Beatty AL, Beckie TM, Dodson J, Goldstein CM, Hughes JW, Kraus WE, Martin SS, Olson TP, Pack QR, Stolp H, Thomas RJ, Wu WC, Franklin BA. A New Era in Cardiac Rehabilitation Delivery: Research Gaps, Questions, Strategies, and Priorities. Circulation 2023; 147:254-266. [PMID: 36649394 PMCID: PMC9988237 DOI: 10.1161/circulationaha.122.061046] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and participation. The emergence of new virtual and remote delivery models has the potential to improve access to and participation in CR and ultimately improve outcomes for people with CVD. Although data suggest that new delivery models for CR have safety and efficacy similar to traditional in-person CR, questions remain regarding which participants are most likely to benefit from these models, how and where such programs should be delivered, and their effect on outcomes in diverse populations. In this review, we describe important gaps in evidence, identify relevant research questions, and propose strategies for addressing them. We highlight 4 research priorities: (1) including diverse populations in all CR research; (2) leveraging implementation methodologies to enhance equitable delivery of CR; (3) clarifying which populations are most likely to benefit from virtual and remote CR; and (4) comparing traditional in-person CR with virtual and remote CR in diverse populations using multicenter studies of important clinical, psychosocial, and cost-effectiveness outcomes that are relevant to patients, caregivers, providers, health systems, and payors. By framing these important questions, we hope to advance toward a goal of delivering high-quality CR to as many people as possible to improve outcomes in those with CVD.
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Affiliation(s)
- Alexis L Beatty
- Department of Epidemiology and Biostatistics (A.L.B.), University of California, San Francisco.,Department of Medicine, Division of Cardiology (A.L.B.), University of California, San Francisco
| | - Theresa M Beckie
- College of Nursing (T.M.B.), University of South Florida, Tampa.,College of Medicine, Division of Cardiovascular Sciences (T.M.B.), University of South Florida, Tampa
| | - John Dodson
- Leon H. Charney Division of Cardiology, Department of Medicine (J.D.), New York University School of Medicine, New York.,Department of Population Health (J.D.), New York University School of Medicine, New York
| | - Carly M Goldstein
- The Weight Control and Diabetes Research Center, the Miriam Hospital, Providence, RI (C.M.G.).,Department of Psychiatry and Human Behavior, The Warren Alpert Medical School (C.M.G.), Brown University, Providence, RI
| | - Joel W Hughes
- Department of Psychological Sciences, Kent State University, OH (J.W.H.)
| | - William E Kraus
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC (W.E.K.)
| | - Seth S Martin
- Department of Medicine, Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M.)
| | - Thomas P Olson
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, MN (T.P.O., R.J.T.)
| | - Quinn R Pack
- Department of Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield (Q.R.P.)
| | - Haley Stolp
- ASRT, Inc, Atlanta, GA (H.S.).,Centers for Disease Control and Prevention, Atlanta, GA (H.S.)
| | - Randal J Thomas
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, MN (T.P.O., R.J.T.)
| | - Wen-Chih Wu
- Lifespan Cardiovascular Institute (W.-C.W.), Brown University, Providence, RI.,Division of Cardiology, Providence VA Medical Center, RI (W.-C.W.)
| | - Barry A Franklin
- William Beaumont Hospital, Royal Oak, MI (B.A.F.).,Oakland University William Beaumont School of Medicine, Rochester, MI (B.A.F.)
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Thygesen LC, Zinckernagel L, Dalal H, Egstrup K, Glümer C, Grønbæk M, Holmberg T, Køber L, la Cour K, Nakano A, Nielsen CV, Sibilitz KL, Tolstrup JS, Zwisler AD, Taylor RS. Cardiac rehabilitation for patients with heart failure: association with readmission and mortality risk. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:830-839. [PMID: 34850879 DOI: 10.1093/ehjqcco/qcab086] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 02/07/2023]
Abstract
AIMS To examine the temporal trends and factors associated with national cardiac rehabilitation (CR) referral and compare the risk of hospital readmission and mortality in those referred for CR versus no referral. METHODS AND RESULTS This cohort study includes all adult patients alive 120 days from incident heart failure (HF) identified by the Danish Heart Failure Registry (n = 33 257) between 2010 and 2018. Multivariable logistic regression models were used to assess the association between CR referral and patient factors and acute all-cause hospital readmission and mortality at 1 year following HF admission. Overall, 46.7% of HF patients were referred to CR, increasing from 31.7% in 2010 to 52.2% in 2018. Several factors were associated with lower odds of CR referral: male sex [odds ratio (OR): 0.85; 95% confidence interval: 0.80-0.89], older age, unemployment, retirement, living alone, non-Danish ethnic origin, low educational level, New York Heart Association (NYHA) class IV vs. I (OR: 0.75; 0.60-0.95), left ventricular ejection fraction >40%, and comorbidity (stroke, chronic kidney disease, atrial fibrillation/flutter, and diabetes). Myocardial infarction, arthritis, coronary artery bypass grafting, percutaneous coronary intervention, valvular surgery, NYHA class II, and use of angiotensin-converting enzyme inhibitors were associated with higher odds of CR referral. CR referral was associated with lower risk of acute all-cause readmission (OR: 0.92; 0.87-0.97) and all-cause mortality (OR: 0.65; 0.58-0.72). CONCLUSION Although increased over time, only one in two HF patients in Denmark were referred to CR in 2018. Strategies are needed to reduce referral disparities, focusing on subgroups of patients at highest risk of non-referral.
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Affiliation(s)
- Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Line Zinckernagel
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Hasnain Dalal
- University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK.,Primary Care Research Group, University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Kenneth Egstrup
- Department of Cardiovascular Research, Odense University Hospital, Svendborg, Denmark
| | - Charlotte Glümer
- Center for Diabetes in the City of Copenhagen, Copenhagen, Denmark
| | - Morten Grønbæk
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Teresa Holmberg
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Karen la Cour
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anne Nakano
- The Danish Clinical Registries (RKKP), Aarhus. Denmark
| | - Claus Vinther Nielsen
- Institute of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark.,Regional Hospital West Jutland, Herning, Denmark
| | - Kirstine Lærum Sibilitz
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Janne Schurmann Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Ann Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
| | - Rod S Taylor
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark.,Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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25
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Islek D, Alonso A, Rosamond W, Kucharska-Newton A, Mok Y, Matsushita K, Koton S, Blaha MJ, Ali MK, Manatunga A, Vaccarino V. Differences in incident and recurrent myocardial infarction among White and Black individuals aged 35 to 84: Findings from the ARIC community surveillance study. Am Heart J 2022; 253:67-75. [PMID: 35660476 PMCID: PMC10007857 DOI: 10.1016/j.ahj.2022.05.020] [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: 02/02/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND No previous study has examined racial differences in recurrent acute myocardial infarction (AMI) in a community population. We aimed to examine racial differences in recurrent AMI risk, along with first AMI risk in a community population. METHODS The community surveillance of the Atherosclerosis Risk in Communities Study (2005-2014) included 470,000 people 35 to 84 years old in 4 U.S. communities. Hospitalizations for recurrent and first AMI were identified from ICD-9-CM discharge codes. Poisson regression models were used to compare recurrent and first AMI risk ratios between Black and White residents. RESULTS Recurrent and first AMI risk per 1,000 persons were 8.8 (95% CI, 8.3-9.2) and 20.7 (95% CI, 20.0-21.4) in Black men, 6.8 (95% CI, 6.5-7.0) and 14.1 (95% CI, 13.8-14.5) in White men, 5.3 (95% CI, 5.0-5.7) and 16.2 (95% CI, 15.6-16.8) in Black women, and 3.1 (95% CI, 3.0-3.3) and 8.8 (95% CI, 8.6-9.0) in White women, respectively. The age-adjusted risk ratios (RR) of recurrent AMI were higher in Black men vs White men (RR, 1.58 95% CI, 1.30-1.92) and Black women vs White women (RR, 2.09 95% CI, 1.64-2.66). The corresponding RRs were slightly lower for first AMI: Black men vs White men, RR, 1.49 (95% CI, 1.30-1.71) and Black women vs White women, RR, 1.65 (95% CI, 1.42-1.92) CONCLUSIONS: Large disparities exist by race for recurrent AMI risk in the community. The magnitude of disparities is stronger for recurrent events than for first events, and particularly among women.
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Affiliation(s)
- Duygu Islek
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology, Laney Graduate School, Emory University, Atlanta, GA.
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Wayne Rosamond
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC
| | - Anna Kucharska-Newton
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC
| | - Yejin Mok
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Silvia Koton
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Nursing, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Joseph Blaha
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Mohammed K Ali
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, GA; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Amita Manatunga
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Division of Cardiology, School of Medicine, Emory University, Atlanta, GA
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26
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Ebinger JE, Lan R, Driver MP, Rushworth P, Luong E, Sun N, Nguyen T, Sternbach S, Hoang A, Diaz J, Heath M, Claggett BL, Bairey Merz CN, Cheng S. Disparities in Geographic Access to Cardiac Rehabilitation in Los Angeles County. J Am Heart Assoc 2022; 11:e026472. [PMID: 36073630 PMCID: PMC9683686 DOI: 10.1161/jaha.121.026472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022]
Abstract
Background Exercise-based cardiac rehabilitation (CR) is known to reduce morbidity and mortality for patients with cardiac conditions. Sociodemographic disparities in accessing CR persist and could be related to the distance between where patients live and where CR facilities are located. Our objective is to determine the association between sociodemographic characteristics and geographic proximity to CR facilities. Methods and Results We identified actively operating CR facilities across Los Angeles County and used multivariable Poisson regression to examine the association between sociodemographic characteristics of residential proximity to the nearest CR facility. We also calculated the proportion of residents per area lacking geographic proximity to CR facilities across sociodemographic characteristics, from which we calculated prevalence ratios. We found that racial and ethnic minorities, compared with non-Hispanic White individuals, more frequently live ≥5 miles from a CR facility. The greatest geographic disparity was seen for non-Hispanic Black individuals, with a 2.73 (95% CI, 2.66-2.79) prevalence ratio of living at least 5 miles from a CR facility. Notably, the municipal region with the largest proportion of census tracts comprising mostly non-White residents (those identifying as Hispanic or a race other than White), with median annual household income <$60 000, contained no CR facilities despite ranking among the county's highest in population density. Conclusions Racial, ethnic, and socioeconomic characteristics are significantly associated with lack of geographic proximity to a CR facility. Interventions targeting geographic as well as nongeographic factors may be needed to reduce disparities in access to exercise-based CR programs. Such interventions could increase the potential of CR to benefit patients at high risk for developing adverse cardiovascular outcomes.
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Affiliation(s)
- Joseph E. Ebinger
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | - Roy Lan
- College of MedicineUniversity of Tennessee Health Science CenterMemphisTN
| | - Matthew P. Driver
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | | | - Eric Luong
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | - Nancy Sun
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | - Trevor‐Trung Nguyen
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | - Sarah Sternbach
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | - Amy Hoang
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | - Jacqueline Diaz
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | - Mallory Heath
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | | | - C. Noel Bairey Merz
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | - Susan Cheng
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCA
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27
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Johnson R, Ding Y, Venkateswaran V, Bhattacharya A, Boulier K, Chiu A, Knyazev S, Schwarz T, Freund M, Zhan L, Burch KS, Caggiano C, Hill B, Rakocz N, Balliu B, Denny CT, Sul JH, Zaitlen N, Arboleda VA, Halperin E, Sankararaman S, Butte MJ, Lajonchere C, Geschwind DH, Pasaniuc B. Leveraging genomic diversity for discovery in an electronic health record linked biobank: the UCLA ATLAS Community Health Initiative. Genome Med 2022; 14:104. [PMID: 36085083 PMCID: PMC9461263 DOI: 10.1186/s13073-022-01106-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 08/03/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Large medical centers in urban areas, like Los Angeles, care for a diverse patient population and offer the potential to study the interplay between genetic ancestry and social determinants of health. Here, we explore the implications of genetic ancestry within the University of California, Los Angeles (UCLA) ATLAS Community Health Initiative-an ancestrally diverse biobank of genomic data linked with de-identified electronic health records (EHRs) of UCLA Health patients (N=36,736). METHODS We quantify the extensive continental and subcontinental genetic diversity within the ATLAS data through principal component analysis, identity-by-descent, and genetic admixture. We assess the relationship between genetically inferred ancestry (GIA) and >1500 EHR-derived phenotypes (phecodes). Finally, we demonstrate the utility of genetic data linked with EHR to perform ancestry-specific and multi-ancestry genome and phenome-wide scans across a broad set of disease phenotypes. RESULTS We identify 5 continental-scale GIA clusters including European American (EA), African American (AA), Hispanic Latino American (HL), South Asian American (SAA) and East Asian American (EAA) individuals and 7 subcontinental GIA clusters within the EAA GIA corresponding to Chinese American, Vietnamese American, and Japanese American individuals. Although we broadly find that self-identified race/ethnicity (SIRE) is highly correlated with GIA, we still observe marked differences between the two, emphasizing that the populations defined by these two criteria are not analogous. We find a total of 259 significant associations between continental GIA and phecodes even after accounting for individuals' SIRE, demonstrating that for some phenotypes, GIA provides information not already captured by SIRE. GWAS identifies significant associations for liver disease in the 22q13.31 locus across the HL and EAA GIA groups (HL p-value=2.32×10-16, EAA p-value=6.73×10-11). A subsequent PheWAS at the top SNP reveals significant associations with neurologic and neoplastic phenotypes specifically within the HL GIA group. CONCLUSIONS Overall, our results explore the interplay between SIRE and GIA within a disease context and underscore the utility of studying the genomes of diverse individuals through biobank-scale genotyping linked with EHR-based phenotyping.
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Affiliation(s)
- Ruth Johnson
- Department of Computer Science, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
| | - Yi Ding
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Vidhya Venkateswaran
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Oral Biology, School of Dentistry, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Arjun Bhattacharya
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Institute for Quantitative and Computational Biosciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Kristin Boulier
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Medicine, Division of Cardiology, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Alec Chiu
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Sergey Knyazev
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Institute for Quantitative and Computational Biosciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Tommer Schwarz
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Malika Freund
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Genetics, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Lingyu Zhan
- Molecular Biology Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Kathryn S Burch
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Christa Caggiano
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Brian Hill
- Department of Computer Science, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Nadav Rakocz
- Department of Computer Science, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Brunilda Balliu
- Department of Computational Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Christopher T Denny
- Division of Hematology/Oncology, Department of Pediatrics, Gwynne Hazen Cherry Memorial Laboratories, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Jae Hoon Sul
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Noah Zaitlen
- Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Computational Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Valerie A Arboleda
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Computational Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Eran Halperin
- Department of Computer Science, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Computational Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Sriram Sankararaman
- Department of Computer Science, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Computational Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Manish J Butte
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Clara Lajonchere
- Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Institute of Precision Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Daniel H Geschwind
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Institute of Precision Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Bogdan Pasaniuc
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
- Department of Computational Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
- Institute of Precision Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
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28
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Garfein J, Guhl EN, Swabe G, Sekikawa A, Barinas-Mitchell E, Forman DE, Magnani JW. Racial and Ethnic Differences in Cardiac Rehabilitation Participation: Effect Modification by Household Income. J Am Heart Assoc 2022; 11:e025591. [PMID: 35730601 PMCID: PMC9333381 DOI: 10.1161/jaha.122.025591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Cardiac rehabilitation (CR) is associated with improved cardiovascular outcomes. Racial and ethnic differences in CR have been identified, but whether income may attenuate these disparities remains unknown. We evaluated (1) racial/ethnic differences in CR participation in a contemporary sample of insured US adults, and (2) assessed how household income modifies associations between race or ethnicity and CR participation. Methods and Results We identified 107 199 individuals with a CR‐qualifying diagnosis between January 1, 2016 and December 31, 2018 in Optum’s de‐identified Clinformatics database. We evaluated associations between race or ethnicity and participation in CR, and assessed interaction between race or ethnicity and annual household income. The mean±SD age of all participants was 70.4±11.6 years; 37.4% were female and 76.0% were White race. Overall, 28 443 (26.5%) attended ≥1 CR sessions. After adjustment, compared with White individuals, the probability of attending CR was 31% lower for Asian individuals (95% CI, 27%–36%), 19% lower for Black individuals (95% CI, 16%–22%), and 43% lower for Hispanic individuals (95% CI, 40%–45%), all P<0.0001. The time to CR attendance was also significantly longer for Asian, Black, and Hispanic individuals. Associations between race or ethnicity and attendance at CR differed significantly across household income categories (P interaction=0.0005); however, Asian, Black, and Hispanic individuals were less likely to attend CR at all incomes. Conclusions In a geographically and racially diverse cohort, participation in CR was low overall, and was lowest among Asian, Black, and Hispanic candidates. Household income may impact the link between race or ethnicity and attendance at CR, but substantial racial and ethnic disparities exist across incomes.
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Affiliation(s)
- Joshua Garfein
- Department of Medicine University of Pittsburgh School of Medicine Pittsburgh PA
| | - Emily N Guhl
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA.,Department of Epidemiology, Graduate School of Public Health University of Pittsburgh PA
| | - Gretchen Swabe
- Department of Medicine University of Pittsburgh School of Medicine Pittsburgh PA
| | - Akira Sekikawa
- Department of Epidemiology, Graduate School of Public Health University of Pittsburgh PA
| | - Emma Barinas-Mitchell
- Department of Epidemiology, Graduate School of Public Health University of Pittsburgh PA
| | - Daniel E Forman
- Department of Medicine University of Pittsburgh School of Medicine Pittsburgh PA.,Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA
| | - Jared W Magnani
- Department of Medicine University of Pittsburgh School of Medicine Pittsburgh PA.,Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA.,Department of Epidemiology, Graduate School of Public Health University of Pittsburgh PA
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29
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Wang M, Torosyan N, Bairey-Merz CN, Wei J, Shufelt CL. Internal medicine resident education improves cardiac rehabilitation knowledge, attitudes, and referral rates: A pilot study. Am J Prev Cardiol 2022; 10:100349. [PMID: 35600264 PMCID: PMC9118349 DOI: 10.1016/j.ajpc.2022.100349] [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: 03/17/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background Referrals to cardiac rehabilitation (CR) remain low despite evidence showing reduction in cardiovascular mortality and hospital readmissions. Resident education and awareness may be an opportunity to address barriers to CR referrals. Methods This pilot study involves 20 internal medicine residents rotating at an ambulatory primary care clinic. Voluntary surveys were sent through an online-based survey platform. Following survey completion, residents received a 10-minute scripted lecture and an educational handout outlining CR components, availability, indications, insurance eligibility criteria, and referral process. Surveys were redistributed 2 months post-education to assess changes in mean aggregate knowledge scores and attitude ratings on a 5-point Likert scale. CR referral rates of eligible patients pre- and post-education were obtained through review of electronic medical records. Results Sixteen (80%) residents completed both pre and post surveys, and 13 (81%) reported no education on CR in the prior year. There was a significant increase in mean aggregate knowledge scores on CR components (5.1 versus 7.0, P = 0.001), insurance coverage (2.4 versus 5.6, P< 0.001), and eligible diagnoses (7.1 versus 9.9, P = 0.03) following education. Attitudes towards CR also improved following education, particularly in self-reported comfort level with explaining CR to patients (3.69 versus 2.06, P<0.001) and perceived familiarity with CR referral process (4.00 versus 2.18, P<0.001). CR referrals increased from 0% (0 out of 10 eligible patients) to 33% (3 out of 9 eligible patients) over a 2-month period before and after education, respectively (P = 0.09). Conclusions Internal medicine resident knowledge and attitudes towards CR significantly improved after formal education. Although there was a modest increase in the rates of CR referrals following resident education, this pilot study was not powered to detect statistical significance.
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Affiliation(s)
- Maggie Wang
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nare Torosyan
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - C. Noel Bairey-Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
- Preventive and Rehabilitative Cardiac Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
- Preventive and Rehabilitative Cardiac Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Chrisandra L. Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
- Preventive and Rehabilitative Cardiac Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
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30
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Disparities in the Use of Cardiac Rehabilitation in African Americans. CURRENT CARDIOVASCULAR RISK REPORTS 2022; 16:31-41. [PMID: 35573267 PMCID: PMC9077032 DOI: 10.1007/s12170-022-00690-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/03/2022]
Abstract
Purpose of review Recent findings Summary
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31
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Quindry JC, McNamara M, Oser C, Fogle C. Cardiac Rehabilitation and Resting Blood Pressure: MONTANA OUTCOMES PROJECT CARDIAC REHABILITATION REGISTRY FINDINGS. J Cardiopulm Rehabil Prev 2022; 42:E23-E31. [PMID: 34508034 DOI: 10.1097/hcr.0000000000000638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Exercise-based cardiac rehabilitation (CR) is essential for treating cardiovascular disease, and modifying risk factor modification, including hypertension. Because the causes of hypertension and benefits of CR are faceted, we examined the influence of phase II CR on resting blood pressure (BP). METHODS Outcomes straddle the release of the updated BP guidelines, and study emphases included CR session number, sex, race/ethnicity, insurance provider, and referring diagnosis. RESULTS Patient files of 31 885 individuals uploaded to the Montana Outcomes Project registry indicated that lowered systolic and diastolic BP were further improved after the release of the revised BP guidelines. The CR session number was proportional to improvements in diastolic BP. Blood pressure improved independent of sex, although female patients exhibited lower diastolic BP before and after CR. Race/ethnicity analyses indicated that Asian and White patients experienced drops in systolic and diastolic BP, while diastolic BP was improved in Hispanic patients. Neither American Indian nor Black patients exhibited statistically altered BP. Medicare, Veterans Administration, and privately insured patients had lowered systolic and diastolic BP, while Medicaid patients had lower diastolic BP, and the uninsured had lower systolic BP. Blood pressure outcomes were generally improved independent of the primary referring diagnosis, while those with peripheral artery disease showed no improvements. CONCLUSIONS Findings demonstrate that phase II CR is highly effective in the control of BP, although improvements are not equally distributed to all individuals according to differences in sex, race/ethnicity, and access to insurance-funded health care.
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Affiliation(s)
- John C Quindry
- School of Integrative Physiology and Athletic Training, College of Health, University of Montana, Missoula (Dr Quindry); International Heart Institute, St Patrick Hospital, Missoula, Montana (Dr Quindry); and Cardiovascular Health Program, Montana Department of Public Health and Human Services, Helena, Montana (Mr McNamara and Mss Oser and Fogle)
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Abstract
Cardiovascular disease is a leading cause of morbidity and mortality in males and females in the United States and globally. Cardiac rehabilitation (CR) is recommended by the American Heart Association/American College of Cardiology for secondary prevention for patients with cardiovascular disease. CR participation is associated with improved cardiovascular disease risk factor management, quality of life, and exercise capacity as well as reductions in hospital admissions and mortality. Despite these advantageous clinical outcomes, significant sex disparities exist in outpatient phase II CR programming. This article reviews sex differences that are present in the spectrum of care provided by outpatient phase II CR programming (ie, from referral to clinical management). We first review CR participation by detailing the sex disparities in the rates of CR referral, enrollment, and completion. In doing so, we discuss patient, health care provider, and social/environmental level barriers to CR participation with a particular emphasis on those barriers that majorly impact females. We also evaluate sex differences in the core components incorporated into CR programming (eg, patient assessment, exercise training, hypertension management). Next, we review strategies to mitigate these sex differences in CR participation with a focus on automatic CR referral, female-only CR programming, and hybrid CR. Finally, we outline knowledge gaps and areas of future research to minimize and prevent sex differences in CR programming.
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Affiliation(s)
- Joshua R. Smith
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Randal J. Thomas
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Shane M. Hammer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Thomas P. Olson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Adedinsewo DA, Pollak AW, Phillips SD, Smith TL, Svatikova A, Hayes SN, Mulvagh SL, Norris C, Roger VL, Noseworthy PA, Yao X, Carter RE. Cardiovascular Disease Screening in Women: Leveraging Artificial Intelligence and Digital Tools. Circ Res 2022; 130:673-690. [PMID: 35175849 PMCID: PMC8889564 DOI: 10.1161/circresaha.121.319876] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease remains the leading cause of death in women. Given accumulating evidence on sex- and gender-based differences in cardiovascular disease development and outcomes, the need for more effective approaches to screening for risk factors and phenotypes in women is ever urgent. Public health surveillance and health care delivery systems now continuously generate massive amounts of data that could be leveraged to enable both screening of cardiovascular risk and implementation of tailored preventive interventions across a woman's life span. However, health care providers, clinical guidelines committees, and health policy experts are not yet sufficiently equipped to optimize the collection of data on women, use or interpret these data, or develop approaches to targeting interventions. Therefore, we provide a broad overview of the key opportunities for cardiovascular screening in women while highlighting the potential applications of artificial intelligence along with digital technologies and tools.
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Affiliation(s)
- Demilade A. Adedinsewo
- Department of Cardiovascular Medicine (D.A.A., A.W.P., S.D.P.), Mayo Clinic, Jacksonville, FL
| | - Amy W. Pollak
- Department of Cardiovascular Medicine (D.A.A., A.W.P., S.D.P.), Mayo Clinic, Jacksonville, FL
| | - Sabrina D. Phillips
- Department of Cardiovascular Medicine (D.A.A., A.W.P., S.D.P.), Mayo Clinic, Jacksonville, FL
| | - Taryn L. Smith
- Division of General Internal Medicine (T.L.S.), Mayo Clinic, Jacksonville, FL
| | - Anna Svatikova
- Department of Cardiovascular Diseases (A.S.), Mayo Clinic, Phoenix, AZ
| | - Sharonne N. Hayes
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
| | - Sharon L. Mulvagh
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada (S.L.M.)
| | - Colleen Norris
- Cardiovascular Health and Stroke Strategic Clinical Network, Edmonton, Canada (C.N.)
| | - Veronique L. Roger
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
- Department of Quantitative Health Sciences (V.L.R.), Mayo Clinic, Rochester, MN
- Epidemiology and Community Health Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (V.L.R.)
| | - Peter A. Noseworthy
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
| | - Xiaoxi Yao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (X.Y.), Mayo Clinic, Rochester, MN
| | - Rickey E. Carter
- Department of Quantitative Health Sciences (R.E.C.), Mayo Clinic, Jacksonville, FL
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Sawan MA, Calhoun AE, Fatade YA, Wenger NK. Cardiac rehabilitation in women, challenges and opportunities. Prog Cardiovasc Dis 2022; 70:111-118. [PMID: 35150655 DOI: 10.1016/j.pcad.2022.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
Cardiac rehabilitation(CR) has known proven benefits in reducing mortality related to cardiovascular disease (CVD), improving quality of life (QoL), and preventing CVD-related readmissions. Despite these known benefits, CR remains underutilized among women relative to men. Disparities exist at the level of referral, enrollment, and program completion. Much is left to be understood regarding the utility of CR in female-predominant CVD such as postpartum cardiomyopathy and Spontaneous Coronary Artery Dissection. This review identifies the benefits of CR for specific populations of women and elucidates on the barriers to CR. We also describe current recommendations to overcome barriers to CR in women.
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Affiliation(s)
- Mariem A Sawan
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Avery E Calhoun
- Department of Internal Medicine, Emory University Atlanta, GA, USA
| | - Yetunde A Fatade
- Department of Internal Medicine, Emory University Atlanta, GA, USA
| | - Nanette K Wenger
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
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35
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Ades PA, Khadanga S, Savage PD, Gaalema DE. Enhancing participation in cardiac rehabilitation: Focus on underserved populations. Prog Cardiovasc Dis 2022; 70:102-110. [PMID: 35108567 PMCID: PMC9119375 DOI: 10.1016/j.pcad.2022.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 01/23/2022] [Indexed: 02/07/2023]
Abstract
Participation in cardiac rehabilitation (CR) significantly decreases morbidity and mortality and improves quality of life following a wide variety of cardiac diagnoses and interventions. However, participation rates and adherence with CR are still suboptimal and certain populations, such as women, minorities, and those of lower socio-economic status, are particularly unlikely to engage in and complete CR. In this paper we review the current status of CR participation rates and interventions that have been used successfully to improve CR participation. In addition, we review populations known to be less likely to engage in CR, and interventions that have been used to improve participation specifically in these underrepresented populations. Finally, we will explore how CR programs may need to expand or change to serve a greater proportion of CR-eligible populations. The best studied interventions that have successfully increased CR participation include automated referral to CR and utilization of a CR liaison person to coordinate the sometimes awkward transition from inpatient status to outpatient CR participation. Furthermore, it appears likely that maximizing secondary prevention in these at-risk populations will require a combination of increasing attendance at traditional center-based CR programs among underrepresented populations, improving and expanding upon tele- or community-based programs, and alternative strategies for improving secondary prevention in those who do not participate in CR.
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Affiliation(s)
- Philip A Ades
- Department of Medicine, Division of Cardiology, University of Vermont Larner College of Medicine, Cardiac Rehabilitation and Prevention, Burlington, VT, United States of America.
| | - Sherrie Khadanga
- Department of Medicine, Division of Cardiology, University of Vermont Larner College of Medicine, Cardiac Rehabilitation and Prevention, Burlington, VT, United States of America
| | - Patrick D Savage
- Department of Medicine, Division of Cardiology, University of Vermont Larner College of Medicine, Cardiac Rehabilitation and Prevention, Burlington, VT, United States of America
| | - Diann E Gaalema
- Department of Psychiatry, University of Vermont Larner College of Medicine, Cardiac Rehabilitation and Prevention, Burlington, VT, United States of America
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36
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Lutz AH, Forman DE. Cardiac rehabilitation in older adults: Apropos yet significantly underutilized. Prog Cardiovasc Dis 2022; 70:94-101. [PMID: 35016915 PMCID: PMC8930627 DOI: 10.1016/j.pcad.2022.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/03/2022] [Indexed: 01/12/2023]
Abstract
Cardiac Rehabilitation (CR) is a comprehensive disease management program that utilizes exercise training, behavioral modification, education, and psychosocial counseling to optimize outcomes and functionality in patients with cardiovascular disease (CVD)1). While CR was initially designed as an exercise training and fitness program for younger patients, usually men, after debilitating hospitalizations for myocardial infarction or cardiac surgery, evidence has expanded to also include other types of CVD in women as well as men, including heart failure, valvular disease, and peripheral arterial disease2-4). As the population of older adults continues to expand, age-related CVD is endemic and is commonly associated with exercise decline, diminished quality of life, and dependence. CR has the potential to counterbalance these patterns, and therefore stands out as a particularly important consideration for older adults with CVD. Nevertheless, CR remains highly underutilized5,6). Novel approaches to CR including home-based and hybrid CR programs show promise for enhanced outreach to patients who may not otherwise participate. This review summarizes the current data available regarding CR in older adults with CVD with a focus on geriatric-specific complexities, current barriers to utilization, and approaches to enhance participation and effectiveness.
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Affiliation(s)
| | - Daniel E. Forman
- University of Pittsburgh, Department of Medicine, Divisions of Geriatrics and Cardiology Pittsburgh Geriatrics Research, Education and Clinical Center, VA Pittsburgh Healthcare System
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Gonzalez-Jaramillo N, Marcin T, Matter S, Eser P, Berlin C, Bano A, Heg D, Franco OH, Windecker S, Räber L, Wilhelm M. Clinical outcomes and cardiac rehabilitation in underrepresented groups after percutaneous coronary intervention: an observational study. Eur J Prev Cardiol 2021; 29:1093-1103. [PMID: 34894217 DOI: 10.1093/eurjpc/zwab204] [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] [Received: 09/03/2021] [Revised: 11/07/2021] [Accepted: 11/18/2021] [Indexed: 12/28/2022]
Abstract
AIMS Underrepresentation of migrants, women, and older adults in cardiovascular disease (CVD) trials may contribute to disparate care and survival. Among patients who underwent percutaneous coronary intervention (PCI), we aimed to investigate the associations of (i) underrepresented groups with major adverse cardiac events (MACE), CVD mortality, and non-CVD mortality, (ii) underrepresented groups with cardiac rehabilitation (CR) uptake, and (iii) CR uptake with outcomes. METHODS AND RESULTS We included 15 211 consecutive patients from the CARDIOBASE Bern PCI registry (2009-18). In multi-state models comparing transition probabilities of events, sex was not associated with increased risk of any event. For each year increase in age, the increased risk of non-CVD and CVD mortality was 8% [95% confidence interval (CI) 6-9%]. Being migrant was associated with a lower risk of non-CVD mortality [hazard ratio (HR) (95% CI) 0.49 (0.27-0.90)] but not with CVD mortality. In logistic regression analysis, CR uptake was lower among women [odds ratio (95% CI) = 0.72 (0.57-0.86)] and older adults [0.32 (0.27-0.38)], but not among migrants. In cox regression, CR was independently associated with lower all-cause [HR (95% CI) = 0.12 (0.03-0.37)] and CVD mortality [0.1 (0.02-0.7)], but not with MACE [1.08 (0.8-1.4)]. CONCLUSION Among underrepresented groups undergoing PCI, age, but not migration status nor sex, contributed to disparities in mortality. Migrant status did not result in lower attendance of CR. Considering the protective associations of CR on CVD mortality independent of age, sex, and migration status, the lower uptake in women and older adults is noteworthy.
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Affiliation(s)
- Nathalia Gonzalez-Jaramillo
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Thimo Marcin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Sophia Matter
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Claudia Berlin
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Arjola Bano
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Dik Heg
- CTU Bern, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
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Levine CG, Casiano RR, Lee DJ, Mantero A, Liu XZ, Palacio AM. Chronic Rhinosinusitis Disease Disparity in the South Florida Hispanic Population. Laryngoscope 2021; 131:2659-2665. [PMID: 34254684 DOI: 10.1002/lary.29664] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/28/2021] [Accepted: 05/19/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS The role of social determinants of health in chronic rhinosinusitis (CRS) is poorly characterized. Limited research examining CRS health disparities indicates that minority status is associated with worse CRS. However, many of these studies are retrospective or performed in populations without substantial ethnic minorities. Rhinologists need to characterize existing CRS disease disparities to develop targeted strategies for improving care in these populations. This prospective study assesses preoperative CRS disease burden in South Florida (SFL) Hispanic and non-Hispanic patients and examines potential factors contributing CRS disease disparities. STUDY DESIGN Prospective cohort study. METHODS The prospective cohort study included consecutive patients having primary endoscopic sinus surgery (ESS) for CRS between September 2019 and February 2020 with complete preoperative data. Data were collected in clinic and surgery. Descriptive statistics compare Hispanic and non-Hispanic cohorts. Linear regression adjusts for confounders. Relative risk (RR) compared CRS severity markers. RESULTS Thirty-eight Hispanic and 56 non-Hispanic patients met inclusion criteria. Age, sex, CT scores, insurance payer, and comorbidities were similar between cohorts. Hispanics presented with worse 22-item Sinonasal Outcome Test (SNOT-22) (55; SD = 18) compared to non-Hispanics (37; SD = 22) (P < .001). Hispanics tended to have a higher risk of severe CRS markers, including nasal polyps RR = 2.5 (95% CI: 1.0-5.9), neo-osteogenesis RR = 1.6 (95% CI: 0.5-4.7), extended procedures (i.e., draft III) RR = 2.97 (95% CI: 1.0-9.1), and tissue eosinophilia RR = 1.46 (95% CI: 0.6-3.5). Hispanics reported longer sinonasal symptom duration. CONCLUSIONS SFL hispanic patients presenting for primary ESS have worse sinonasal disease burden. SFL Hispanics have markers of greater CRS severity and report longer delays before receiving CRS care. These factors may contribute to increased sinonasal disease burden in Hispanic patients. LEVEL OF EVIDENCE 3 Laryngoscope, 131:2659-2665, 2021.
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Affiliation(s)
- Corinna G Levine
- Department of Otolaryngology- Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Roy R Casiano
- Department of Otolaryngology- Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - David J Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Alejandro Mantero
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Xue Zhong Liu
- Department of Otolaryngology- Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Ana M Palacio
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
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Zwischenberger BA, Jawitz OK, Lawton JS. Coronary surgery in women: How can we improve outcomes. JTCVS Tech 2021; 10:122-128. [PMID: 34977714 PMCID: PMC8691860 DOI: 10.1016/j.xjtc.2021.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 10/27/2022] Open
Affiliation(s)
- Brittany A. Zwischenberger
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Baltimore, Md
| | - Oliver K. Jawitz
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Baltimore, Md
| | - Jennifer S. Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Md
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40
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Kemp KA, Norris CM, Steele B, Fairie P, Santana MJ. Sex Differences in the Care Experiences of Patients Hospitalized Due to Ischemic Heart Disease in Alberta, Canada. CJC Open 2021; 3:S36-S43. [PMID: 34993432 PMCID: PMC8712602 DOI: 10.1016/j.cjco.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/24/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Women with heart disease experience disparities in the diagnosis, treatment, and management of their condition. However, it is unknown whether these sex differences exist with respect to in-hospital patient experience. We examined the comprehensive experience of patients hospitalized due to ischemic heart disease (IHD) across Alberta, Canada, according to sex. METHODS Patients completed a modified version of the Canadian Patient Experiences Survey-Inpatient Care (CPES-IC) within 6 weeks of discharge. We examined 37 questions, including 33 regarding specific care processes and 4 global rating scales. Survey responses were reported as raw "top-box" percentages, that is, the most-positive answer choice to each question. Odds and corresponding 95% confidence intervals of women reporting a top-box response were then calculated for each question, while controlling for demographic and clinical factors. RESULTS From April 2014 to March 2020, a total of 5795 surveys (1612 women, 4183 men) were completed. Taking the survey margin of error into account, women had lower top-box percentages on 26 of 37 questions. Similar results were obtained for the adjusted odds of reporting a top-box response. Women did not have a higher percentage of top-box responses on any of the questions studied. CONCLUSIONS This study is a Canadian first, which stratified the experiences of hospitalized patients living with ischemic heart disease according to sex. Our results highlighted important sex differences. Future research to understand the mechanisms associated with these observed sex differences in patient-reported experiences is warranted.
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Affiliation(s)
- Kyle A. Kemp
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Patient Engagement Platform, Alberta Strategy for Patient-Oriented Research (SPOR), Calgary, Alberta, Canada
| | - Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Cardiovascular Health and Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Brian Steele
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Paul Fairie
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Patient Engagement Platform, Alberta Strategy for Patient-Oriented Research (SPOR), Calgary, Alberta, Canada
| | - Maria J. Santana
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Patient Engagement Platform, Alberta Strategy for Patient-Oriented Research (SPOR), Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Abstract
Purpose of Review Cardiac rehabilitation (CR) referral is a Class I post-myocardial infarction (MI) recommendation from the American Heart Association and the American College of Cardiology, yet referral rates remain strikingly low, with cardiologists some of the worst under-referring offenders. This paper seeks to review the evolution of CR and its well-established benefits, as well as reasons behind the poor referral and utilization. Recent Findings CR is a secondary prevention program for cardiovascular disease (CVD) that was first initiated in the 1970s as a hospital-based exercise program after an acute MI, but then evolved into a comprehensive multi-disciplinary program for patients with a wider range of cardiovascular diseases. CR mortality and morbidity benefits have endured over decades, even as interventional and pharmacological cardiovascular therapeutics have improved and as patients have become relatively more stable. Summary Despite being an evidence-based clinical standard, referral and participation in CR are disconcertingly low. In efforts to combat poor referral rates, and improve care in the contemporary care environment, the approach to CR is evolving. Innovations include broadening CR beyond the hospital setting into remote- and hybrid-based formats, while still incorporating exercise training, risk factor reduction, and education, as well as behavioral and psychosocial support. Nonetheless, there still remain many challenges to overcome in order to increase participation of all ages, financials, races, and sexes. With new performance measures as well as an increasing number of NIH-funded studies on the horizon, there is hope that CR will become a relatively more valued and utilized component of cardiovascular preventative care.
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Affiliation(s)
- Rebecca Lolley
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. .,Cardiovascular Institute of North Colorado, Banner Health, 1800 15th St Suite 310, Greeley, CO, 80631, USA.
| | - Daniel E Forman
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Medicine, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Section of Geriatric Cardiology, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 500, Pittsburgh, PA, 15213, USA
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Thomas RJ, Petersen CE, Olson TP, Beatty AL, Ding R, Supervia M. Asynchronous and Synchronous Delivery Models for Home-Based Cardiac Rehabilitation: A SCIENTIFIC REVIEW. J Cardiopulm Rehabil Prev 2021; 41:407-412. [PMID: 34727559 PMCID: PMC9355022 DOI: 10.1097/hcr.0000000000000656] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To review the principles, advantages, and disadvantages of asynchronous and synchronous delivery models of home-based cardiac rehabilitation (HBCR). METHODS We reviewed recently published systematic reviews and other publications of randomized studies of asynchronous and synchronous HBCR to assess principles, outcomes, and limitations of those delivery methods compared with center-based cardiac rehabilitation (CBCR). SUMMARY While most studies prior to 2016 involved asynchronous HBCR approaches to care, studies since 2016 have included asynchronous or synchronous delivery models. Both delivery models have been shown to help provide core components of cardiac rehabilitation (CR). Studies using either method have been shown to have similar short-term patient outcomes as CBCR, at least in low- to moderate-risk patients who have been studied. Asynchronous HBCR offers greater flexibility for patients and CR staff, while synchronous HBCR provides greater real-time oversight and feedback to patients.Asynchronous and synchronous HBCR is an option to consider for patients eligible for CR. Additional research is needed for both delivery models, applied separately or in combination, to compare their impact on shorter- and longer-term patient outcomes and to assess their impact in patient subgroups (referral diagnosis, women, elderly, underrepresented racial and ethnic minority groups, patients at a higher cardiovascular disease risk, patients with multiple comorbid conditions, etc).
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Affiliation(s)
- Randal J Thomas
- Cardiac Rehabilitation Program, Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Thomas and Olson and Ms Petersen); Brigham Young University, Provo, Utah (Ms Petersen); Department of Epidemiology and Biostatistics and Department of Medicine (Cardiology), University of California, San Francisco (Dr Beatty); Department of Cardiology, Peiking University People's Hospital, Beijing, China (Dr Ding); and Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain (Dr Supervia)
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Abstract
PURPOSE Cardiac rehabilitation (CR) has been shown to improve functional status, quality of life, and recurrent cardiovascular disease (CVD) events. Despite its demonstrated compelling benefits and guideline recommendation, CR is underutilized, and there are significant disparities in CR utilization particularly by race, ethnicity, sex, and socioeconomic status. The purpose of this review is to summarize the evidence and drivers of these disparities and recommend potential solutions. METHODS In this review, key studies documenting disparities in CR referrals, enrollment, and completion are discussed. Additionally, potential mechanisms for these disparities are summarized and strategies are reviewed for addressing them. SUMMARY There is a wealth of literature demonstrating disparities among racial and ethnic minorities, women, those with lower income and education attainment, and those living in rural and dense urban areas. However, there was minimal focus on how the social determinants of health contribute to the observed disparities in CR utilization in many of the studies reviewed. Interventions such as automatic referrals, inpatient liaisons, mitigation of economic barriers, novel delivery mechanisms, community partnerships, and health equity metrics to incentivize health care organizations to reduce care disparities are potential solutions.
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Affiliation(s)
- Lena Mathews
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine
- Welch Center for Prevention, Epidemiology and Clinical Research; Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
| | - LaPrincess C. Brewer
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic College of Medicine, Rochester, Minnesota
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota
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Graham H, Prue-Owens K, Kirby J, Ramesh M. Systematic Review of Interventions Designed to Maintain or Increase Physical Activity Post-Cardiac Rehabilitation Phase II. Rehabil Process Outcome 2021; 9:1179572720941833. [PMID: 34497468 PMCID: PMC8282140 DOI: 10.1177/1179572720941833] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Cardiovascular disease (CVD) continues to be the No. 1 cause of death in the United States and globally, and individuals with a history of a cardiac event are at increased risk for a repeat event. Physical inactivity creates health problems for individuals with chronic heart disease. Evidence shows that physical activity (PA), as a central component of cardiac rehabilitation phase II (CRII), decreases hospital readmission and mortality. Yet, individual adherence to PA tends to decline several months following CRII completion. Objective: The purpose of this review was to evaluate current literature for interventions designed to assist individuals diagnosed with myocardial infarction (MI), coronary artery bypass graft (CABG), coronary artery disease (CAD), and percutaneous coronary intervention (PCI) to maintain or increase PA post-CRII. Methods: A systematic search of 5 electronic databases including hand-searched articles between 2000 and 2019. Key Medical Subject Headings (MeSH) search terms included cardiac rehabilitation, intervention, exercise or PA, outcomes, compliance, adherence, or maintenance. Only interventions implemented following CRII program completion were included for review. Results: Based on the inclusion criteria, the search yielded 19 randomized control trials retained for descriptive analysis. Interventions were categorized into 3 domains. The intervention designs varied widely in terms of duration of the intervention and the length of time to outcome measurement. Most interventions were short-term with only 2 studies offering a long-term intervention of greater than 1 year. Interventions using a theoretical approach most often included a cognitive-behavioral model. Conclusions: Interventions offered shortly after completion of CRII may help cardiac patients maintain PA and reduce the risk of experiencing additional cardiac events; however, more quality research is needed. Additional research to examine PA maintenance in older adults (70 years and older) would be valuable based on the increase in average lifespan. Studies with larger and more diverse samples, and less variation in methods and outcomes would greatly increase the ability to conduct a high-quality meta-analysis.
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Affiliation(s)
- Helen Graham
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Kathy Prue-Owens
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Jess Kirby
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Mythreyi Ramesh
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
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Farrugia A, Attard JA, Hanmer S, Bullock S, McKay S, Al-Azzawi M, Ali R, Bond-Smith G, Colleypriest B, Dyer S, Masterman B, Okocha M, Osborne A, Patel R, Sallam M, Selveraj E, Shalaby S, Sun W, Todd F, Ward J, Windle R, Khan S, Williams N, Arasaradnam RP. Rates of Bile Acid Diarrhoea After Cholecystectomy: A Multicentre Audit. World J Surg 2021; 45:2447-2453. [PMID: 33982189 PMCID: PMC8236047 DOI: 10.1007/s00268-021-06147-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Bile acid diarrhoea (BAD) can occur due to disruption to the enterohepatic circulation, e.g. following cholecystectomy. Post-cholecystectomy diarrhoea has been reported in 2.1-57.2% of patients; however, this is not necessarily due to BAD. The aim of this study was to determine the rates of bile acid diarrhoea diagnosis after cholecystectomy and to consider investigation practices. METHODS A retrospective analysis of electronic databases from five large centres detailing patients who underwent laparoscopic cholecystectomy between 2013 and 2017 was cross-referenced with a list of patients who underwent 75SeHCAT testing. A 7-day retention time of <15% was deemed to be positive. Patient demographics and time from surgery to investigation were collected and compared for significance (p < 0.05). RESULTS A total of 9439 patients underwent a laparoscopic cholecystectomy between 1 January 2013 and 31 December 2017 in the five centres. In total, 202 patients (2.1%) underwent investigation for diarrhoea via 75SeHCAT, of which 64 patients (31.6%) had a 75SeHCAT test result of >15%, while 62.8% of those investigated were diagnosed with bile acid diarrhoea (BAD). In total, 133 (65.8%) patients also underwent endoscopy and 74 (36.6%) patients had a CT scan. Median time from surgery to 75SeHCAT test was 672 days (SD ± 482 days). DISCUSSION/CONCLUSION Only a small proportion of patients, post-cholecystectomy, were investigated for diarrhoea with significant time delay to diagnosis. The true prevalence of BAD after cholecystectomy may be much higher, and clinicians need to have an increased awareness of this condition due to its amenability to treatment. 75SeHCAT is a useful tool for diagnosis of bile acid diarrhoea.
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Affiliation(s)
- Alexia Farrugia
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Stuart Hanmer
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - Stuart Bullock
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Siobhan McKay
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | | | - Roshneen Ali
- Oxford University Hospitals NHS Trust, Oxford, UK
| | | | | | | | | | | | | | | | | | | | | | - Wenrui Sun
- Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Joel Ward
- Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Saboor Khan
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - Nigel Williams
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - Ramesh P Arasaradnam
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK.
- Warwick Medical School, University of Warwick, Coventry, UK.
- School of Health and Life Sciences, Coventry University, Coventry, UK.
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Atwater BD, Li Z, Pritchard J, Greiner MA, Nabutovsky Y, Hammill BG. Early Increased Physical Activity, Cardiac Rehabilitation, and Survival After Implantable Cardioverter-Defibrillator Implantation. Circ Cardiovasc Qual Outcomes 2021; 14:e007580. [PMID: 34284598 DOI: 10.1161/circoutcomes.120.007580] [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: 11/16/2022]
Abstract
BACKGROUND Increased physical activity (PA) through cardiac rehabilitation (CR) improves outcomes in patients with heart failure and coronary disease, but CR referral remains infrequent. Implantable cardioverter-defibrillators (ICDs) can provide daily PA measurements to patients that may motivate them to increase PA, but it remains unclear if increased ICD measured PA is associated with improved outcomes with and without CR. METHODS This is a retrospective observational study of 41 731 Medicare beneficiaries with ICD implantation between January 1, 2014 and December 31, 2016. We linked daily ICD PA measurements and Medicare claims data to determine if increased PA is associated with a reduction in the likelihood of death or heart failure hospitalization. To determine if CR participation altered the effect of PA on outcomes, we performed two additional analyses matching CR participants and nonparticipants using propensity scores. The first match included demographics, comorbidities, and baseline PA measurements. The second match also included the change in PA measured during CR or the same time frame after ICD implant among nonparticipants. RESULTS The mean age was 75 (SD, 10) years, 30 182 beneficiaries (72.3%) were male, and 1324 (3%) participated in CR. Increased ICD detected PA was associated with improved survival. CR participants had a mean PA change of +9.7 (SD, 57.8) min/d, whereas nonparticipants had a mean change of -1.0 (SD, 59.7) min/d (P<0.001). After matching for demographics, comorbidities and baseline PA, CR participants had significantly lower 1- to 3-year mortality (hazard ratio, 0.76 [95% CI, 0.69-0.85], P=0.03). After additionally matching for the ICD measured change in PA during CR there were no differences in mortality with and without CR (hazard ratio, 1.00 [95% CI, 0.82-1.21], P=0.87). Every 10 minutes of increased daily PA was associated with a 1.1% reduction in all-cause mortality in both groups. CONCLUSIONS Among Medicare beneficiaries with ICDs, small increases in PA were associated with significant reductions in all-cause mortality.
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Affiliation(s)
- Brett D Atwater
- Inova Heart and Vascular Institute, Fairfax, VA (B.D.A.).,Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC (B.D.A.)
| | - Zhen Li
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC (Z.L., J.P., M.A.G., B.G.H.)
| | - Jessica Pritchard
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC (Z.L., J.P., M.A.G., B.G.H.)
| | - Melissa A Greiner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC (Z.L., J.P., M.A.G., B.G.H.)
| | | | - Bradley G Hammill
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC (Z.L., J.P., M.A.G., B.G.H.)
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Uzendu AI, Boudoulas KD, Capers Q. Black lives matter … in the cath lab, too! A proposal for the interventional cardiology community to counteract bias and racism. Catheter Cardiovasc Interv 2021; 99:213-218. [PMID: 34037303 PMCID: PMC9545946 DOI: 10.1002/ccd.29751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/08/2022]
Abstract
Structural racism in the United States underlies racial disparities in the criminal justice system, in the healthcare system generally, and with regards to the COVID-19 pandemic. In the year 2020, these inequities combined and magnified to such a degree that it left Black Americans and physicians caring for them questioning how much Black lives matter. Academic medical centers and the major cardiology organizations responded to a global call to end racism with bold statements and initiatives. Interventional cardiologists utilize advanced equipment to mechanically treat a wide spectrum of heart problems, yet this technology has not been applied in an equitable manner. Interventional therapies are often underutilized in Blacks, exacerbating healthcare disparities and contributing to the excess cardiovascular morbidity and mortality in these communities. Racial bias, whether intentional, unconscious, systemic, or at the individual level, plays a role in these disparities. Many in the interventional cardiology community aspire to take intentional steps to reduce the impact of bias and racism in our specialty. We discuss several proposals here and provide a "report card" for interventional programs to perform a self-assessment.
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Affiliation(s)
- Anezi I Uzendu
- Section of Interventional Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Quinn Capers
- Division of Cardiology, University of Texas Southwestern, Dallas, Texas, USA
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48
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Abstract
PURPOSE OF REVIEW This review discusses the current state of racial and ethnic inequities in heart failure burden, outcomes, and management. This review also frames considerations for bridging disparities to optimize quality heart failure care across diverse communities. RECENT FINDINGS Treatment options for heart failure have diversified and overall heart failure survival has improved with the advent of effective pharmacologic and nonpharmacologic therapies. With increased recognition, some racial/ethnic disparity gaps have narrowed whereas others in heart failure outcomes, utilization of therapies, and advanced therapy access persist or worsen. SUMMARY Racial and ethnic minorities have the highest incidence, prevalence, and hospitalization rates from heart failure. In spite of improved therapies and overall survival, the mortality disparity gap in African American patients has widened over time. Racial/ethnic inequities in access to cardiovascular care, utilization of efficacious guideline-directed heart failure therapies, and allocation of advanced therapies may contribute to disparate outcomes. Strategic and earnest interventions considering social and structural determinants of health are critically needed to bridge racial/ethnic disparities, increase dissemination, and implementation of preventive and therapeutic measures, and collectively improve the health and longevity of patients with heart failure.
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Affiliation(s)
- Sabra C. Lewsey
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ
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Mwansa H, Lewsey S, Mazimba S, Breathett K. Racial/Ethnic and Gender Disparities in Heart Failure with Reduced Ejection Fraction. Curr Heart Fail Rep 2021; 18:41-51. [PMID: 33666856 PMCID: PMC7989038 DOI: 10.1007/s11897-021-00502-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW This review highlights variability in prescribing of nonpharmacologic heart failure with reduced ejection fraction (HFrEF) therapies by race, ethnicity, and gender. The review also explores the evidence underlying these inequalities as well as potential mitigation strategies. RECENT FINDINGS There have been major advances in HF therapies that have led to improved overall survival of HF patients. However, racial and ethnic groups of color and women have not received equitable access to these therapies. Patients of color and women are less likely to receive nonpharmacologic therapies for HFrEF than White patients and men. Therapies including exercise rehabilitation, percutaneous transcatheter mitral valve repair, cardiac resynchronization therapy, heart transplant, and ventricular assist devices all have proven efficacy in patients of color and women but remain underprescribed. Outcomes with most nonpharmacologic therapy are similar or better among patients of color and women than White patients and men. System-level changes are urgently needed to achieve equity in access to nonpharmacologic HFrEF therapies by race, ethnicity, and gender.
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Affiliation(s)
- Hunter Mwansa
- Saint Francis Medical Center/University of Illinois College of Medicine, Peoria, IL, USA
| | - Sabra Lewsey
- Division of Cardiovascular Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, 1501 North Campbell Avenue, PO Box 245046, Tucson, AZ, 85724, USA.
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50
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Murphy BM, Zaman S, Tucker K, Alvarenga M, Morrison-Jack J, Higgins R, Le Grande M, Nasis A, Jackson AC. Enhancing the appeal of cardiac rehabilitation for women: development and pilot testing of a women-only yoga cardiac rehabilitation programme. Eur J Cardiovasc Nurs 2021; 20:633-640. [PMID: 33748850 DOI: 10.1093/eurjcn/zvab008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/14/2020] [Accepted: 01/20/2021] [Indexed: 11/13/2022]
Abstract
AIMS Despite its demonstrated benefits, cardiac rehabilitation (CR) attendance, and completion is suboptimal, particularly in women. The aims of this study were (i) to develop and pilot test a women-only yoga-based CR programme (the Women's Yoga CR Programme; WYCRP); (ii) to investigate programme acceptability; and (iii) to investigate attendance and completion of the WYCRP and continuation to Phase III community-based CR. METHODS AND RESULTS Women eligible for CR at a tertiary hospital in Melbourne, Australia were recruited. Over a 6-month period in 2019, they were offered the WYCRP or usual CR. The WYCRP involved attendance at a 1-h yoga session following the usual 1-h mixed-sex education session, over a 7-week period. Participants completed pre- and post-programme questionnaires and attended focus groups to assess programme acceptability. Rates of attendance, completion, and continuation for the WYCRP were recorded and compared to those for the standard CR programme offered in 2018. In total, 27 women were eligible for the study and attended the initial CR assessment. Of those, 22 (81%) attended the WYCRP, 1 (4%) attended usual CR, and 4 (15%) did not attend CR. Ratings of programme acceptability were consistently positive; qualitative comments highlighted both physical and emotional benefits. While attendance at the WYCRP was not significantly higher than for usual CR the previous year (81% vs. 76%; P = 0.40), CR completion, and continuation were (95% vs. 56%; P = 0.02, and 72% vs. 12%; P < 0.001, respectively). CONCLUSION This pilot study has demonstrated that women-only yoga-based CR is appealing to women and can improve women's CR completion and continuation. These preliminary findings support further development of women-only and yoga-based CR options.
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Affiliation(s)
- Barbara M Murphy
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia.,Faculty of Health, Deakin University, Melbourne, VIC, Australia.,Department of Psychology, University of Melbourne, Parkville, VIC, Australia
| | - Sarah Zaman
- MonashHeart, Monash Health, Clayton, VIC, Australia.,Monash Cardiovascular Research Centre, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Kim Tucker
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia.,MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Marlies Alvarenga
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia.,MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Jenni Morrison-Jack
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia.,Ihana Yoga Centre, St Kilda, VIC, Australia
| | - Rosemary Higgins
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia
| | - Michael Le Grande
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia.,Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Arthur Nasis
- MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Alun C Jackson
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia.,Faculty of Health, Deakin University, Melbourne, VIC, Australia.,Centre on Behavioural Health, University of Hong Kong, Pok Fu Lam, Hong Kong
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