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Van Arsdale S, Cooper V, Bernhardt JS, Barrientos S, Messina LA, Gandhi S, Ferry LH, Shell D, Deuster PA. Bridging Total Force Fitness and Whole Health in Cardiovascular Disease Prevention. Mil Med 2023; 188:38-42. [PMID: 37665591 DOI: 10.1093/milmed/usad166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/14/2023] [Accepted: 07/19/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION The Cardiovascular Disease (CVD) Prevention project is a VA-DoD initiative, supported by the Joint Incentive Fund. The goal of the project is to create an innovative, 3D virtual space within the VA-Virtual Medical Center (VA-VMC) platform that provides Veterans and Active Duty Service Members with educational resources on the prevention of CVD. MATERIALS AND METHODS The Performance Health and Wellness Center is a new center within the VA-VMC. The space enables users to explore information and actionable resources on various risk factors related to CVD through independent and provider-led instruction, using a personalized 3D avatar. RESULTS Partners of DoD and VA envision users engaging with the learning resources securely and with a sense of anonymity, which can foster self-directed learning and healthy behavior change. The DoD is particularly invested in promoting CVD prevention through the early adoption of positive health behaviors and the Total Force Fitness framework. The VA team is also committed to supporting users by providing professionally led classes and support groups on various CVD risk factors like tobacco, diabetes, nutrition, and exercise. CONCLUSIONS This project is a unique and important collaboration during a time when telehealth and telemedicine services are in greater demand. The VA-VMC advances accessible, relevant, and evidence-based educational services for DoD and VA populations, and the Performance Health and Wellness Center, itself, presents Total Force Fitness concepts and a whole-person care approach while encouraging users to be actively involved in shared decision-making with their health care providers.
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Affiliation(s)
- Stephanie Van Arsdale
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Vaughn Cooper
- Production & Delivery, Institute for Learning, Education and Development (ILEAD), Washington, DC 20420, USA
| | - Jaime S Bernhardt
- Client Relations, Institute for Learning, Education and Development (ILEAD), Washington, DC 20420, USA
| | - Stephanie Barrientos
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Lauren A Messina
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Sabina Gandhi
- Preventive Medicine Section, VA Loma Linda Healthcare System (605-111PM), Loma Linda, CA 92357, USA
| | - Linda Hyder Ferry
- Preventive Medicine Section, VA Loma Linda Healthcare System (605-111PM), Loma Linda, CA 92357, USA
- Preventive Medicine and Family Medicine Department, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA
| | - Donald Shell
- Health Services Policy and Oversight OASD(HA), Disease Prevention, Disease Management and Population Health Policy & Oversight, Defense Health Headquarters, Falls Church, VA 22042, USA
| | - Patricia A Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
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Nguyen H, Jeon-Slaughter H. Examination of Gender Difference in Heart Disease-Related Excess Deaths during COVID-19 Pandemic Era: Findings from the United States. Rev Cardiovasc Med 2022; 23:182. [PMID: 39077605 PMCID: PMC11273782 DOI: 10.31083/j.rcm2305182] [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] [Received: 02/26/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 07/31/2024] Open
Abstract
Background/Objective Heart disease is the leading cause of death among women in the United States, and women are experiencing more strokes at younger ages than men. Despite accumulating evidence of increased burden of heart disease among women, there is little data on gender difference in heart disease-related mortality during the COVID-19 pandemic. Method This study extracted the data of weekly number of deaths between January 2017 and December 2020 from the United States Center for Disease and Control and Prevention (CDC) mortality and morbidity data, modified to a monthly scale. Stratified by gender, the study applied the Farrington method on monthly data to calculate excess number of deaths. Excess heart disease-related deaths were observed in March and July 2020 for both males and females. Results While the overall number of heart disease-related deaths was higher in men than women among US population < 75 years old, a greater rate increase of heart disease-related deaths in 2020 from 2019 was observed among women than men. This increased burden was more pronounced among young women < 25 years old. A similar pattern of excess deaths caused by underlying heart disease condition was observed for both genders during COVID-19 pandemic. On the other hand, increase in heart disease-related death burden in 2020 from 2019 was greater amongst females than males. This may be partially accounted for by deferred cardiovascular care and prevention amongst women during the pandemic. Conclusions While no gender difference was observed in excess deaths caused by underlying heart disease condition, females faced a greater increase in heart disease-related death burden during the pandemic compared to pre-pandemic than males.
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Affiliation(s)
- Hang Nguyen
- Department of Statistical Science, Southern Methodist University, Dallas, TX 75205, USA
| | - Haekyung Jeon-Slaughter
- VA North Texas Health Care System and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Jeon-Slaughter H, Chen X, Ramanan B, Tsai S. Assessing Performance of the Veterans Affairs Women Cardiovascular Risk Model in Predicting a Short-Term Risk of Cardiovascular Disease Incidence Using United States Veterans Affairs COVID-19 Shared Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910005. [PMID: 34639306 PMCID: PMC8508488 DOI: 10.3390/ijerph181910005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022]
Abstract
The current study assessed performance of the new Veterans Affairs (VA) women cardiovascular disease (CVD) risk score in predicting women veterans’ 60-day CVD event risk using VA COVID-19 shared cohort data. The study data included 17,264 women veterans—9658 White, 6088 African American, and 1518 Hispanic women veterans—ever treated at US VA hospitals and clinics between 24 February and 25 November 2020. The VA women CVD risk score discriminated patients with CVD events at 60 days from those without CVD events with accuracy (area under the curve) of 78%, 50%, and 83% for White, African American, and Hispanic women veterans, respectively. The VA women CVD risk score itself showed good accuracy in predicting CVD events at 60 days for White and Hispanic women veterans, while it performed poorly for African American women veterans. The future studies are needed to identify non-traditional factors and biomarkers associated with increased CVD risk specific to African American women and incorporate them to the CVD risk assessment.
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Affiliation(s)
- Haekyung Jeon-Slaughter
- VA North Texas Health Care System, Dallas, TX 75216, USA; (B.R.); (S.T.)
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Correspondence:
| | | | - Bala Ramanan
- VA North Texas Health Care System, Dallas, TX 75216, USA; (B.R.); (S.T.)
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Shirling Tsai
- VA North Texas Health Care System, Dallas, TX 75216, USA; (B.R.); (S.T.)
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Tsai S, Nguyen H, Ebrahimi R, Barbosa MR, Ramanan B, Heitjan DF, Hastings JL, Modrall JG, Jeon-Slaughter H. COVID-19 associated mortality and cardiovascular disease outcomes among US women veterans. Sci Rep 2021; 11:8497. [PMID: 33875764 PMCID: PMC8055870 DOI: 10.1038/s41598-021-88111-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/01/2021] [Indexed: 12/13/2022] Open
Abstract
The burden of COVID-19 has been noted to be disproportionately greater in minority women, a population that is nevertheless still understudied in COVID-19 research. We conducted an observational study to examine COVID-19-associated mortality and cardiovascular disease outcomes after testing (henceforth index) among a racially diverse adult women veteran population. We assembled a retrospective cohort from a Veterans Affairs (VA) national COVID-19 shared data repository, collected between February and August 2020. A case was defined as a woman veteran who tested positive for SARS-COV-2, and a control as a woman veteran who tested negative. We used Kaplan-Meier curves and the Cox proportional hazards model to examine the distribution of time to death and the effects of baseline predictors on mortality risk. We used generalized linear models to examine 60-day cardiovascular disease outcomes. Covariates studied included age, body mass index (BMI), and active smoking status at index, and pre-existing conditions of diabetes, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and a history of treatment with antiplatelet or anti-thrombotic drug at any time in the 2 years prior to the index date. Women veterans who tested positive for SARS-CoV-2 had 4 times higher mortality risk than women veterans who tested negative (Hazard Ratio 3.8, 95% Confidence Interval CI 2.92 to 4.89) but had lower risk of cardiovascular events (Odds Ratio OR 0.78, 95% CI 0.66 to 0.92) and developing new heart disease conditions within 60 days (OR 0.67, 95% CI 0.58 to 0.77). Older age, obesity (BMI > 30), and prior CVD and COPD conditions were positively associated with increased mortality in 60 days. Despite a higher infection rate among minority women veterans, there was no significant race difference in mortality, cardiovascular events, or onset of heart disease. SARS-CoV-2 infection increased short-term mortality risk among women veterans similarly across race groups. However, there was no evidence of increased cardiovascular disease incidence in 60 days. A longer follow-up of women veterans who tested positive is warranted.
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Affiliation(s)
- Shirling Tsai
- Veterans Affairs North Texas Health Care System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hang Nguyen
- Veterans Affairs North Texas Health Care System, Dallas, TX, USA
- Southern Methodist University, Dallas, TX, USA
| | - Ramin Ebrahimi
- Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, CA, USA
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Monica R Barbosa
- Veterans Affairs North Texas Health Care System, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bala Ramanan
- Veterans Affairs North Texas Health Care System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Daniel F Heitjan
- Southern Methodist University, Dallas, TX, USA
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey L Hastings
- Veterans Affairs North Texas Health Care System, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - J Gregory Modrall
- Veterans Affairs North Texas Health Care System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Haekyung Jeon-Slaughter
- Veterans Affairs North Texas Health Care System, Dallas, TX, USA.
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Jeon-Slaughter H, Chen X, Tsai S, Ramanan B, Ebrahimi R. Developing an Internally Validated Veterans Affairs Women Cardiovascular Disease Risk Score Using Veterans Affairs National Electronic Health Records. J Am Heart Assoc 2021; 10:e019217. [PMID: 33619994 PMCID: PMC8174271 DOI: 10.1161/jaha.120.019217] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The current American College of Cardiology/American Heart Association women cardiovascular disease (CVD) risk score suboptimally estimates CVD risk for young and minority women in the military. The current study developed an internally validated CVD risk score for women military service members and veterans using the Veterans Affairs (VA) national electronic health records data. Methods and Results The study cohort included 69 574 White, Black, and Hispanic women service members and veterans aged 30 to 79 years in 2007 treated in the VA Health Care System between January 1, 2007 and December 31, 2017 (henceforth, VA women). Stratified by race and ethnicity, the new VA women CVD risk model estimated risk coefficients and 10‐year CVD risk using a time‐variant covariate Cox model. Harrell C‐statistics, calibration plots, and net classification index were used to assess accuracy and prognostic performance of the new VA women CVD risk model. The new internally validated VA women CVD risk score performed better in predicting VA women 10‐year atherosclerosis cardiovascular disease risk than the pooled cohort American College of Cardiology/American Heart Association risk score in both accuracy (White Harrell C‐statistics, 70% versus 61%; Black, 68% versus 63%) and prognostic performance (White net classification index, 0.31; 95% CI, 0.26–0.33; Black net classification index, 0.06; 95% CI, 0.03–0.09). Conclusions The proposed VA women CVD risk score improves accuracy of the existing American College of Cardiology/American Heart Association CVD risk assessment tool in predicting long‐term CVD risk for VA women, particularly in young and racial/ethnic minority women.
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Affiliation(s)
- Haekyung Jeon-Slaughter
- Veterans Affairs North Texas Health Care System Dallas TX.,Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Xiaofei Chen
- Veterans Affairs North Texas Health Care System Dallas TX.,Southern Methodist University Dallas TX
| | - Shirling Tsai
- Veterans Affairs North Texas Health Care System Dallas TX.,Department of Surgery University of Texas Southwestern Medical Center Dallas TX
| | - Bala Ramanan
- Veterans Affairs North Texas Health Care System Dallas TX.,Department of Surgery University of Texas Southwestern Medical Center Dallas TX
| | - Ramin Ebrahimi
- Veterans Affairs Greater Los Angeles Health Care System Los Angeles CA.,Department of Medicine University of California at Los Angeles CA
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Chen X, Ramanan B, Tsai S, Jeon‐Slaughter H. Differential Impact of Aging on Cardiovascular Risk in Women Military Service Members. J Am Heart Assoc 2020; 9:e015087. [PMID: 32515249 PMCID: PMC7429070 DOI: 10.1161/jaha.120.015087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/30/2020] [Indexed: 01/08/2023]
Abstract
Background Atherosclerotic cardiovascular disease (ASCVD) is the third leading cause of death in women service members and veterans. This study assessed 10-year ASCVD risk in women service members and veterans using their own electronic health record data extracted from Veterans Affairs (VA) national Corporate Data Warehouse database. Methods and Results We retrospectively followed 69 574 VA women, aged 30 to 79 years, from 2007 to 2017. Of these, 52% were whites (n=36 172), 42% were blacks (n=29 232), and 6% were Hispanics (n=4171). Risk factors and ASCVD events (nonfatal myocardial infarction, nonfatal stroke, and cardiac deaths) were identified using diagnostic and procedural codes from electronic health records. Then, within the same construct of the current American College of Cardiology/American Heart Association 10-year ASCVD risk assessment models for women, coefficients for risks factors were recalculated using the VA national electronic health record data, stratified by race (hereafter, VA women model). Our study found a curvilinear association of aging with increased risk of 10-year ASCVD event in VA women starting at ages as young as 30 years across all race groups. The VA women model performance in predicting ASCVD events at 10 years was mixed-moderate in discrimination (C statistics, 0.61-0.64) but good in accuracy, as demonstrated by calibration plots approximating a 45° line. Conclusions The study finding, a curvilinear association of aging with increased ASCVD risk in VA women across all races, demonstrates the need for cardiovascular risk screening of younger VA women, aged <45 years.
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Affiliation(s)
- Xiaofei Chen
- Veterans Affairs North Texas Health Care SystemDallasTX
- Southern Methodist UniversityDallasTX
| | - Bala Ramanan
- Veterans Affairs North Texas Health Care SystemDallasTX
- Department of SurgeryUniversity of Texas Southwestern Medical CenterDallasTX
| | - Shirling Tsai
- Veterans Affairs North Texas Health Care SystemDallasTX
- Department of SurgeryUniversity of Texas Southwestern Medical CenterDallasTX
| | - Haekyung Jeon‐Slaughter
- Veterans Affairs North Texas Health Care SystemDallasTX
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTX
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