1
|
Amin S, Baron SJ, Galper BZ. Aortic valve replacement today: Outcomes, costs, and opportunities for improvement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 64:78-86. [PMID: 38388246 DOI: 10.1016/j.carrev.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/19/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
The introduction of transcatheter aortic valve replacement (TAVR) just two decades ago has transformed the treatment of severe symptomatic aortic stenosis. TAVR has not only extended the option of aortic valve replacement to patients deemed ineligible for surgery, it has also demonstrated similar or better short- and intermediate-term clinical outcomes compared with surgical aortic valve replacement (SAVR) in patients at all levels of surgical risk. These benefits have been achieved with similar or lower costs compared with SAVR, at least in the first 1-2 years for intermediate- and low-risk patients. Longer-term data will further inform clinical and shared decision-making. SUMMARY FOR ANNOTATED TABLE OF CONTENTS: In just over two decades, transcatheter aortic valve replacement has emerged as a frontline approach for appropriately selected patients with severe aortic stenosis. A growing body of evidence documents similar or better clinical outcomes and cost-effectiveness for transcatheter compared with surgical aortic valve replacement. Whether the mode is transcatheter or surgical, aortic valve replacement remains underutilized in patients with clear indications for intervention.
Collapse
Affiliation(s)
- Sameer Amin
- L.A. Care Health Plan, 1055 W. 7th St, 10th Floor, Los Angeles, CA 90017, United States
| | - Suzanne J Baron
- Interventional Cardiovascular Research, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States; Outcomes Research, Baim Institute for Clinical Research, 930 W. Commonwealth Ave., Boston, MA 02215, United States
| | - Benjamin Z Galper
- Structural Heart Disease Program, Mid-Atlantic Permanente Medical Group, 8008 Westpark Dr., McLean, VA 22102, United States; Cardiac Catheterization Laboratory, Virginia Hospital Center, 1701 N. George Mason Dr., Arlington, VA 22205, United States.
| |
Collapse
|
2
|
Moreines LT, David D, Murali KP, Dickson VV, Brody A. The perspectives of older adults related to transcatheter aortic valve replacement: An integrative review. Heart Lung 2024; 68:23-36. [PMID: 38901178 DOI: 10.1016/j.hrtlng.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/10/2024] [Accepted: 05/31/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Aortic Stenosis (AS) is a common syndrome in older adults wherein the narrowing of the aortic valve impedes blood flow, resulting in advanced heart failure.1 AS is associated with a high mortality rate (50 % at 6 months if left untreated), substantial symptom burden, and reduced quality of life.1-3 Transcatheter aortic valve replacement (TAVR) was approved in 2012 as a less invasive alternative to surgical valve repair, offering a treatment for older frail patients. Although objective outcomes have been widely reported,4 the perspectives of older adults undergoing the TAVR process have never been synthesized. OBJECTIVES To contextualize the perspectives and experiences of older adults undergoing TAVR. METHODS An integrative review was conducted using Whittemore and Knafl's five-stage methodology.5 Four electronic databases were searched in April 2023. Articles were included if a qualitative methodology was used to assess the perceptions of older adults (>65 years old) undergoing or recovering from TAVR. RESULTS Out of 4619 articles screened, 12 articles met the criteria, representing 353 individuals from 10 countries. Relevant themes included the need for an individualized care plan, caregiver and family support, communication and education, persistent psychosocial and physical symptoms, and the unique recovery journey. CONCLUSION Older adults with AS undergoing TAVR generally perceive their procedure positively. Improved interdisciplinary and holistic management, open communication, symptom assessment, support, and education is needed.
Collapse
Affiliation(s)
| | - Daniel David
- New York University Rory Meyers College of Nursing
| | | | | | - Abraham Brody
- New York University Rory Meyers College of Nursing; New York University Grossman School of Medicine
| |
Collapse
|
3
|
Cantey C. Treatment disparities in severe aortic stenosis with TAVR. Nurse Pract 2024; 49:13-15. [PMID: 38662489 DOI: 10.1097/01.npr.0000000000000167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
|
4
|
Antia A, Pius R, Ndukauba C, Zarauz VR, Olafiranye O. Temporal trends in the utilization and outcome of transcatheter aortic valve replacement across racial and ethnic groups. A nationwide analysis. Int J Cardiol 2024; 399:131669. [PMID: 38141727 DOI: 10.1016/j.ijcard.2023.131669] [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: 10/29/2023] [Revised: 12/09/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Transcatheter aortic valvular replacement (TAVR) improves outcomes in patients with aortic stenosis (AS). However, data describing racial disparities in the utilization and outcomes of TAVR are limited. We aimed to evaluate the utilization trends and outcomes of TAVR across racial and ethnic groups. METHODS All patients who underwent TAVR in the United States from 2016 through 2020 were identified from the National Inpatient Sample database. Patients were classified according to their racial and ethnic groups as Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Hispanic, and Asian. We assessed racial and ethnic differences in the outcomes of TAVR using multivariate logistic regression analysis adjusting for age, sex, insurance, income, hospital location and teaching status, bed size, region, and the Charlson Comorbidity Index. RESULTS Of the 280,290 patients who underwent TAVR, 89.5% were NHW, 4.24% were NHB, 4.9% were Hispanic, and 1.39% were Asian people. In 2016, the rates of all-TAVR procedures were 1.48 per 1000 patients among NHW group but 0.39 in NHB, 0.4 in Hispanic, and 0.47 in the Asian group. A steep rise was noted in the rate of TAVR among NHW but not in the NHB, Hispanic, and Asian groups. NHB patients had lower mortality rates (adjusted Odds Ratio [aOR]: 0.56; CI 0.35-0.88 p = 0.014) compared to their NHW counterparts. CONCLUSION The racial and ethnic gap in the utilization of TAVR widened during the study period with minority groups being disproportionately less likely to receive TAVR. NHB patients who received TAVR had lower mortality rates than NHW.
Collapse
Affiliation(s)
- Akanimo Antia
- Department of Medicine, Lincoln Medical Center, Bronx, NY, USA.
| | - Ruth Pius
- Department of Medicine, Lincoln Medical Center, Bronx, NY, USA
| | | | | | - Oladipupo Olafiranye
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center and Veterans Affairs North Texas Healthcare System, Dallas, TX, USA
| |
Collapse
|
5
|
Kulkarni A, Arafat M, Hou L, Liang S, Kassotis J. Racial Disparity Among Patients Undergoing Surgical Aortic Valve Replacement and Transcatheter Aortic Valve Replacement in the United States. Angiology 2023; 74:812-821. [PMID: 36426842 DOI: 10.1177/00033197221137025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive alternative to surgical aortic valve replacement (SAVR). However, racial disparities in the utilization of TAVR persist. This meta-analysis attempts to determine whether the prevalence of adverse outcomes (procedure-related complications) represent barriers to the use of TAVR among African Americans (AA). The TAVR cohort consisted of 89.6% Caucasian (C) and 4.7% AA, while the SAVR cohort included 86.9% C and 6.4% AA. The utilization rate (UR) of TAVR was 1.48 and .35 among C and AA, respectively, while the UR of SAVR was 1.44 and .48 among C and AA, respectively. Following TAVR, for AA the odds ratio (OR) was greater for stroke (OR = 1.22, P = .02) and transient ischemic attack (TIA) (OR = 1.57, P < .001) and lower for undergoing the insertion of a permanent pacemaker (OR = .81, P < .001). While there was a significant difference between C and AA in TAVR and SAVR utilization, outcomes between groups following TAVR are comparable; therefore, adverse outcomes do not appear to be a barrier to the use of TAVR among eligible AA.
Collapse
Affiliation(s)
- Abha Kulkarni
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Mohammod Arafat
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Linle Hou
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Shiochee Liang
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - John Kassotis
- Department of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| |
Collapse
|
6
|
Rice CT, Barnett S, O'Connell SP, Akowuah E, Appleby CE, Chambers JB, Shah BN, Blackman DJ. Impact of gender, ethnicity and social deprivation on access to surgical or transcatheter aortic valve replacement in aortic stenosis: a retrospective database study in England. Open Heart 2023; 10:e002373. [PMID: 37788920 PMCID: PMC10565153 DOI: 10.1136/openhrt-2023-002373] [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: 05/30/2023] [Accepted: 08/07/2023] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVE To assess gender, ethnicity, and deprivation-based differences in provision of aortic valve replacement (AVR) in England for adults with aortic stenosis (AS). METHODS We retrospectively identified adults with AS from the English Hospital Episode Statistics (HES) between April 2016 and March 2019 and those who subsequently had an AVR. We separately used HES-linked Clinical Practice Research Datalink (CPRD) to identify people with AVR and evaluate the timeliness of their procedure (CPRD-AVR cohort). ORs for AVR in people with an AS diagnosis were estimated using multivariable logistic regression adjusted for age, region and comorbidity. AVR was considered timely if performed electively and without evidence of cardiac decompensation before AVR. RESULTS 183 591 adults with AS were identified in HES; of these, 31 436 underwent AVR. The CPRD-AVR cohort comprised 10 069 adults. Women had lower odds of receiving AVR compared with men (OR 0.65; 95% CI 0.63 to 0.66); as did people of black (OR 0.70; 95% CI 0.60 to 0.82) or South Asian (OR 0.75; 95% CI 0.69 to 0.82) compared with people of white ethnicities. People in the most deprived areas were less likely to receive AVR than the least deprived areas (OR 0.8; 95% CI 0.75 to 0.86). Timely AVR occurred in 65% of those of white ethnicities compared with 55% of both those of black and South Asian ethnicities. 77% of the least deprived had a timely procedure compared with 58% of the most deprived; there was no gender difference. CONCLUSIONS In this large, national dataset, female gender, black or South Asian ethnicities and high deprivation were associated with significantly reduced odds of receiving AVR in England. A lower proportion of people of minority ethnicities or high deprivation had a timely procedure. Public health initiatives may be required to increase clinician and public awareness of unconscious biases towards minority and vulnerable populations to ensure timely AVR for everyone.
Collapse
Affiliation(s)
| | - Sophie Barnett
- Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | | | - Enoch Akowuah
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Clare E Appleby
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | | | - Benoy N Shah
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Daniel J Blackman
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
7
|
Hassan SMA, Ghunaim A, Verma R, Sicilia A, Yanagawa B. Racial and ethnic differences in aortic stenosis: the tip of the iceberg. Curr Opin Cardiol 2023; 38:103-107. [PMID: 36718619 DOI: 10.1097/hco.0000000000001019] [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: 02/01/2023]
Abstract
PURPOSE OF REVIEW There is a lack of data on the epidemiology and management of severe aortic stenosis (AS) in diverse populations. We summarize the contemporary literature on the racial and ethnic differences in AS prevalence, treatment and outcomes and discuss possible explanations for these disparities to inform future research and improve the delivery of care to under-represented patient groups. RECENT FINDINGS African American (AA) patients have significantly less prevalence of severe AS than White patients whereas paradoxically having higher traditional risk factors for severe AS. Non-White patients have less referral for aortic valve replacement (AVR) after adjusting for clinical and echocardiographic parameters. Surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) are both underutilized in non-White patients. Differences in race and ethnicity have not shown to result in worse in-hospital and long-term survival outcomes after either SAVR or TAVR. SUMMARY Much research is warranted to explore the epidemiology, true prevalence and treatment outcomes of severe AS in diverse populations. Greater inclusion of non-White ethnic groups in the primary analysis of prospective trials is needed. Lastly, further research is warranted to explore the complex causes of racial and ethnic disparities in utilization of surgical and transcatheter interventions.
Collapse
Affiliation(s)
- Syed M Ali Hassan
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | | | | | | | | |
Collapse
|
8
|
Jaiswal V, Peng Ang S, Hanif M, Savaliya M, Vadhera A, Raj N, Gera A, Aujla S, Daneshvar F, Ishak A, Subhan Waleed M, Hugo Aguilera-Alvarez V, Naz S, Hameed M, Wajid Z. The racial disparity among post transcatheter aortic valve replacement outcomes: A meta-analysis. IJC HEART & VASCULATURE 2023; 44:101170. [PMID: 36660201 PMCID: PMC9843207 DOI: 10.1016/j.ijcha.2023.101170] [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: 10/26/2022] [Revised: 12/17/2022] [Accepted: 01/01/2023] [Indexed: 01/13/2023]
Abstract
Background Racial disparities have been well described in cardiovascular disease. However, the impact of race on the outcomes post - Transcatheter aortic valve replacement (TAVR) remains unknown. Objective We aim to evaluate the disparity among the race (black and white) post - TAVR. Methods We systematically searched all electronic databases from inception until September 26, 2022. The primary outcome was in-hospital all-cause mortality, and secondary outcomes was myocardial infarction (MI), acute kidney injury (AKI), permanent pacemaker implantation (PPI) or ICD, stroke, vascular complications, and major bleeding. Results A total of three studies with 1,02,009 patients were included in the final analysis. The mean age of patients with white and black patients was 82.65 and 80.45 years, respectively. The likelihood of in-hospital all-cause mortality (OR, 1.01(95 %CI: 0.86-1.19), P = 0.93), stroke (OR, 0.83(95 %CI:0.61-1.13), P = 0.23, I2 = 46.57 %], major bleeding [OR, 1.05(95 %CI:0.92-1.20), P = 0.46), and vascular complications [OR, 0.92(95 %CI:0.81-1.06), P = 0.26), was comparable between white and black patients. However, patients with white race have lower odds of MI (OR, 0.65(95 %CI:0.50-0.84), P < 0.001), and AKI (OR, 0.84(95 %CI:0.74-0.95), P = 0.01) and higher odds of PPI or ICD (OR, 1.16(95 %CI: 1.06-1.27), P < 0.001, I2 = 0 %) compared with black race patients. Conclusion Our findings suggest disparity post - TAVR outcomes existed, and black patients are at higher risk of MI and AKI than white patients.Key Clinical Message:•What is already known on this topic: Disparity has been witnessed among patients with cardiovascular disease. However, no studies have drawn a significant association among post-TAVR patients' outcomes•What this study adds: Among patients who underwent TAVR, there is a difference in the adverse outcomes between black and white race patients. White patients have a lower risk of post-procedure MI and AKI compared with Black patients.•How this study might affect research, practice, or policy: These disparities need to be addressed, and proper guidelines need to be made along with engaging patients with better medical infrastructure and treatment options..
Collapse
Affiliation(s)
- Vikash Jaiswal
- JCCR Cardiology, Varanasi, India
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
- Corresponding author at: JCCR Cardiology, Varanasi, India.
| | - Song Peng Ang
- Division of Internal Medicine, Rutgers Health/Community Medical Center, NJ, USA
| | - Muhammad Hanif
- Department of Internal Medicine, SUNY Upstate Medical University, USA
| | - Mittal Savaliya
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
| | - Ananya Vadhera
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Nishchita Raj
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
| | - Asmita Gera
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
| | - Savvy Aujla
- Department of Medicine, Government Medical College Amritsar, Punjab, India
| | | | - Angela Ishak
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
| | - Madeeha Subhan Waleed
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
| | | | - Sidra Naz
- The University of Texas, MD Anderson Cancer Center, Texas, USA
| | - Maha Hameed
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
| | - Zarghoona Wajid
- Department of Internal Medicine, Wayne State University School of Medicine, USA
| |
Collapse
|
9
|
Burgess S, Cader FA, Shaw E, Banerjee S, Stehli J, Krishnamorthy R, Khor L, Forotan H, Bastiany A, Rao S, Chandrasekhar J, Zaman S, Alasnag M, Chieffo A, Coylewright M. Under-representation of Women as Proceduralists and Patients in TAVR and TMVr Procedures: Data, Implications and Proposed Solutions. Eur Cardiol 2022; 17:e27. [PMID: 36845217 PMCID: PMC9947929 DOI: 10.15420/ecr.2022.33] [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: 07/21/2022] [Accepted: 08/16/2022] [Indexed: 12/23/2022] Open
Abstract
Women are under-represented among transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair (TMVr) operators. This review assesses the representation of women as patients and as proceduralists and trial authors in major structural interventions. Women are under-represented as proceduralists in structural interventions: only 2% of TAVR operators and 1% of TMVr operators are women. Only 1.5% of authors in landmark clinical TAVR and TMVr trials are interventional cardiologists who are women (4/260). Significant under-representation and under-enrolment of women in landmark TAVR trials is evident: the calculated participation-to-prevalence ratio (PPR) is 0.73, and in TMVr trials, the PPR is 0.69. Under-representation of women is also evident in registry data (PPR = 0.84 for TAVR registries and for TMVr registries). In structural interventional cardiology, women are under-represented as proceduralists, trial participants and patients. This under-representation has the potential to affect the recruitment of women to randomised trials, subsequent guideline recommendations, selection for treatment, patient outcomes and sex-specific data analysis.
Collapse
Affiliation(s)
- Sonya Burgess
- Department of Medicine, University of SydneySydney, New South Wales, Australia,Department of Cardiology, Nepean HospitalSydney, New South Wales, Australia
| | - F. Aaysha Cader
- Department of Cardiology, Ibrahim Cardiac Hospital & Research InstituteDhaka, Bangladesh,Department of Population Health, University of OxfordOxford, UK
| | - Elizabeth Shaw
- Department of Medicine, University of SydneySydney, New South Wales, Australia,Department of Cardiology, Hornsby Ku-ring-gai Hospital,Sydney, New South Wales, Australia,Department of Cardiology, Sydney Adventist Hospital, WahroongaSydney, New South Wales, Australia
| | - Shrilla Banerjee
- Department of Cardiology, Surrey and Sussex Healthcare NHS TrustRedhill, UK
| | - Julia Stehli
- Department of Cardiology, University Hospital ZurichZurich, Switzerland
| | | | - Lynn Khor
- Department of Cardiology, Nepean HospitalSydney, New South Wales, Australia
| | - Homa Forotan
- Department of Cardiology, Princess Alexandra HospitalBrisbane, Queensland, Australia
| | - Alexandra Bastiany
- Thunder Bay Regional Health Sciences Centre and Northern Ontario School of MedicineThunder Bay, Ontario, Canada
| | - Sarita Rao
- Department of Cardiology, Apollo HospitalIndore, India
| | - Jaya Chandrasekhar
- Department of Cardiology, Eastern HealthMelbourne, Victoria, Australia,Eastern Health Clinical School, Monash UniversityMelbourne, Victoria, Australia
| | - Sarah Zaman
- Westmead Applied Research Centre, University of SydneySydney, New South Wales, Australia,Department of Cardiology, Westmead HospitalSydney, New South Wales, Australia
| | - Mirvat Alasnag
- Department of Cardiology, King Fahd Armed Forces HospitalJeddah, Saudi Arabia
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific InstituteMilan, Italy
| | - Megan Coylewright
- Section of Cardiovascular Medicine, Erlanger Heart and Lung InstituteChattanooga, Tennessee, US
| |
Collapse
|
10
|
Burgess SN, Mamas MA. Narrowing disparities in PCI outcomes in women; From risk assessment, to referral pathways and outcomes. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 24:100225. [PMID: 38560635 PMCID: PMC10978432 DOI: 10.1016/j.ahjo.2022.100225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 04/04/2024]
Abstract
This review evaluates published data regarding outcomes for women with ACS undergoing PCI. Data is discussed from a patient centred perspective and timeline, beginning with sex-based differences in perception of risk, time to presentation, time to treatment, access to angiography, access to angioplasty, the impact of incomplete revascularization, prescribing practices, under-representation of women in randomized controlled trials and in cardiology physician workforces. The objective of the review is to identify factors contributing to outcome disparities for women with ACS, and to discuss potential solutions to close this outcome gap.
Collapse
Affiliation(s)
- Sonya N. Burgess
- Department of Cardiology, Nepean Hospital, Sydney, Australia
- University of Sydney, NSW, Australia
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK
| |
Collapse
|
11
|
Steitieh D, Zaidi A, Xu S, Cheung JW, Feldman DN, Reisman M, Mallya S, Paul TK, Singh HS, Bergman G, Vadaketh K, Naguib M, Minutello RM, Wong SC, Amin NP, Kim LK. Racial Disparities in Access to High-Volume Mitral Valve Transcatheter Edge-to-Edge Repair Centers. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100398. [PMID: 39131452 PMCID: PMC11308692 DOI: 10.1016/j.jscai.2022.100398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 08/13/2024]
Abstract
Background Severe mitral regurgitation is a progressive disease associated with high morbidity and mortality, and frequent readmissions for heart failure. Surgical mitral valve repair or replacement has been the gold-standard treatment; however, advances in transcatheter edge-to-edge repair (TEER) have provided alternatives for high-risk surgical patients. There are no data on racial disparities in access to high-volume TEER centers. Methods Data on TEER hospitalizations from New York, New Jersey, Maryland, North Carolina, Washington, Colorado, Arizona, and Florida were analyzed using the State Inpatient Databases for 2016. The baseline characteristics of patients who underwent TEER at high- (≥25 procedures per year) and low-volume centers were identified. The association between race and the likelihood of undergoing TEER at high-volume centers was assessed. The secondary outcomes were mortality and the frequency of home discharges. Results Of 1567 patients included in the analysis, 1129 underwent TEER at high-volume centers. Patients treated at high-volume centers had a higher prevalence of chronic kidney disease and congestive heart failure. Black and Hispanic patients were 59% (adjusted odds ratio [OR], 0.41; P < .001) and 51% (adjusted OR, 0.49; P < .001) less likely to undergo TEER at high-volume centers, respectively, compared with White patients. Hispanic patients were 3 times more likely to die during index admission than White patients (adjusted OR, 3.32; P = .027). There was geographic clustering of TEER centers, and a higher ratio of White patients to minority patients in zip codes with high-volume TEER centers. Conclusions Racial minorities patients, particularly Black and Hispanic patients, are less likely to undergo TEER at high-volume centers. Hispanic patients experience higher rates of in-hospital mortality after TEER than White patients.
Collapse
Affiliation(s)
- Diala Steitieh
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Alyssa Zaidi
- Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | | | - Jim W. Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Dmitriy N. Feldman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Mark Reisman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Sonal Mallya
- Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Tracy K. Paul
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Harsimran S. Singh
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Geoffrey Bergman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Krista Vadaketh
- Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Mostafa Naguib
- Department of Medicine, Morristown Medical Center, Morristown, New Jersey
| | - Robert M. Minutello
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital Queens, New York, New York
| | - Shing Chiu Wong
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Nivee P. Amin
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Luke K. Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| |
Collapse
|
12
|
Ingle MP, Carroll AM, Matlock DD, Gama KD, Valle JA, Allen LA, Knoepke CE. Decision Support Needs for Patients with Severe Symptomatic Aortic Stenosis. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2022; 65:589-603. [PMID: 34809525 DOI: 10.1080/01634372.2021.1995095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/11/2021] [Accepted: 10/14/2021] [Indexed: 06/13/2023]
Abstract
Social workers in healthcare settings often support patient decision-making processes for complex medical decisions. The objective of this study was to examine decision support needs for patients considering aortic valve replacement (AVR) for aortic stenosis. Seventeen qualitative interviews were conducted to explore treatment decision experiences of patients who accepted AVR. Analysis was conducted using a mixed inductive-deductive approach. Fear was a prevalent response for most participants in the face of AVR. Two general paths of decision making emerged: an "active" information seeking approach, or a "passive" simplicity seeking approach. Patients with unique clinical presentations felt alienated by the decision-making process. Acknowledging fear while understanding different decision-making styles provide opportunities for social workers and other members of multidisciplinary teams to support complex patient decisions.
Collapse
Affiliation(s)
- M Pilar Ingle
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Adam M Carroll
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Daniel D Matlock
- Adult & Child Consortium for Outcomes Research & Delivery Science (Accords), University of Colorado School of Medicine, Aurora, Colorado, USA
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Geriatric Research Education and Clinical Center, Veterans Affairs Eastern Colorado, Denver, Colorado, USA
| | - Kristy D Gama
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Javier A Valle
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Interventional Cardiology, Veterans Affairs Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Larry A Allen
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christopher E Knoepke
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
13
|
Abstract
Racism and racial bias influence the lives and cardiovascular health of minority individuals. The fact that minority groups tend to have a higher burden of cardiovascular disease risk factors is often a result of racist policies that restrict opportunities to live in healthy neighbourhoods and have access to high-quality education and healthcare. The fact that minorities tend to have the worst outcomes when cardiovascular disease develops is often a result of institutional or individual racial bias encountered when they interact with the healthcare system. In this review, we discuss bias, discrimination, and structural racism from the viewpoints of cardiologists in Canada, the United Kingdom, and the US, and how racial bias impacts cardiovascular care. Finally, we discuss proposals to mitigate the impact of racism in our specialty.
Collapse
|
14
|
Ali A, Mather JF, McMahon S, Curtis LE, Hoover N, Ayer C, Amer MR, Dibble T, Roper L, Orlando R, McKay RG. Racial and ethnic disparities in the use of transcatheter aortic valve replacement in the State of Connecticut. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:7-12. [PMID: 34246611 DOI: 10.1016/j.carrev.2021.06.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Although prior national reports have identified trends in the underutilization of transcatheter aortic valve replacement (TAVR) in Afro-American and Latino populations, racial and ethnic healthcare disparities in TAVR use in the State of Connecticut have not been previously reported. METHODS We conducted a retrospective analysis of 1461 patients undergoing TAVR at our institute between from 2012 to 2020. Baseline demographics, procedural characteristics, clinical outcomes, median incomes and insurance coverage were compared between 1417 Caucasian and 44 minority patients, including 23 patients designated as Afro-American and 10 designated as Latino. Demographics of TAVR utilization at our institution were further compared to 6 additional Connecticut TAVR centers using Connecticut Hospital Association (CHA) ChimeData detailing hospital discharges for DRG 266 and 267. RESULTS In comparison to Caucasian patients, minority cohorts were younger (75.7 ± 9.0 vs 81.5 ± 5.1 years, p < 0.001) and had more co-morbidities including diabetes (64% vs 34%, p < 001), coronary artery disease (95% vs 78%, p = 0.039), end stage renal disease requiring dialysis (9% vs 3%, p = 0.009) and atrial fibrillation (77% vs 62%, p = 0.041). The two groups did not differ with respect to other risk factors or co-morbidities, baseline echocardiographic or CTA findings, STS risk score, or procedural technique. Minority patients had a longer length of hospital stay (9.5 ± 9.0 vs 6.4 ± 6.9 days, p = 0.003), but did not differ with respect to procedural complications. Socioeconomic differences between the two groups included lower median incomes and higher rates of Medicaid or no insurance coverage for minority versus Caucasian patients. CHA ChimeData revealed a similar underutilization of TAVR in minority subgroups in the remaining 6 Connecticut TAVR centers. CONCLUSIONS Despite statewide demographics describing 10.7% and 15.7% of the total population as Afro-American and Latino, respectively, only 3.0% of the total TAVR procedures performed at a large Connecticut health care facility were performed in minority subgroups. Despite having a higher burden of co-morbidities, minority patients had similar outcomes compared to Caucasian patients. Similar racial and ethnic disparities in TAVR utilization were confirmed statewide using CHA ChimeData.
Collapse
Affiliation(s)
- Abdelrahman Ali
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America.
| | - Jeffrey F Mather
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Sean McMahon
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Lauren E Curtis
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Nicole Hoover
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Courtney Ayer
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Mostafa R Amer
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Tina Dibble
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Lizabeth Roper
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Rocco Orlando
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Raymond G McKay
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| |
Collapse
|
15
|
Sparrow R, Sanjoy S, Choi YH, Elgendy IY, Jneid H, Villablanca PA, Holmes DR, Pershad A, Alraies C, Sposato LA, Mamas MA, Bagur R. Racial, ethnic and socioeconomic disparities in patients undergoing left atrial appendage closure. Heart 2021; 107:1946-1955. [PMID: 33795381 DOI: 10.1136/heartjnl-2020-318650] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This manuscript aims to explore the impact of race/ethnicity and socioeconomic status on in-hospital complication rates after left atrial appendage closure (LAAC). METHODS The US National Inpatient Sample was used to identify hospitalisations for LAAC between 1 October 2015 to 31 December 2018. These patients were stratified by race/ethnicity and quartiles of median neighbourhood income. The primary outcome was the occurrence of in-hospital major adverse events, defined as a composite of postprocedural bleeding, cardiac and vascular complications, acute kidney injury and ischaemic stroke. RESULTS Of 6478 unweighted hospitalisations for LAAC, 58% were male and patients of black, Hispanic and 'other' race/ethnicity each comprised approximately 5% of the cohort. Adjusted by the older Americans population, the estimated number of LAAC procedures was 69.2/100 000 for white individuals, as compared with 29.5/100 000 for blacks, 47.2/100 000 for Hispanics and 40.7/100 000 for individuals of 'other' race/ethnicity. Black patients were ~5 years younger but had a higher comorbidity burden. The primary outcome occurred in 5% of patients and differed significantly between racial/ethnic groups (p<0.001) but not across neighbourhood income quartiles (p=0.88). After multilevel modelling, the overall rate of in-hospital major adverse events was higher in black patients as compared with whites (OR: 1.60, 95% CI 1.22 to 2.10, p<0.001); however, the incidence of acute kidney injury was higher in Hispanics (OR: 2.19, 95% CI 1.52 to 3.17, p<0.001). No significant differences were found in adjusted overall in-hospital complication rates between income quartiles. CONCLUSION In this study assessing racial/ethnic disparities in patients undergoing LAAC, minorities are under-represented, specifically patients of black race/ethnicity. Compared with whites, black patients had higher comorbidity burden and higher rates of in-hospital complications. Lower socioeconomic status was not associated with complication rates.
Collapse
Affiliation(s)
- Robbie Sparrow
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Shubrandu Sanjoy
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Yun-Hee Choi
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Islam Y Elgendy
- Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Hani Jneid
- Division of Cardiology, Baylor College of Medicine and Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Pedro A Villablanca
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Ashish Pershad
- The University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA
| | - Chadi Alraies
- Department of Interventional Cardiology, Wayne State University, Detroit, Michigan, USA
| | - Luciano A Sposato
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, London, Ontario, Canada.,London Health Sciences Centre, London, Ontario, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, Stoke, UK
| | - Rodrigo Bagur
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada .,London Health Sciences Centre, London, Ontario, Canada.,Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, Stoke, UK
| |
Collapse
|
16
|
Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3101] [Impact Index Per Article: 1033.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
17
|
Wong B, Armstrong G, El-Jack S, To A. A Decade of Transcatheter Aortic Valve Implantation in New Zealand: Growth and Inequalities. Heart Lung Circ 2020; 30:540-546. [PMID: 33032895 DOI: 10.1016/j.hlc.2020.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/19/2020] [Accepted: 08/30/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is an effective treatment increasingly performed for severe aortic stenosis. Developing nationwide accessibility to TAVI can be met with barriers that result in treatment disparities. OBJECTIVES This nationwide retrospective study aimed to review the first decade of TAVI in New Zealand and identify potential inequalities. METHODS All patients undergoing TAVI in a New Zealand public hospital between 2008 and 2018 were included. Demographic and geographic details were analysed and TAVI rates were age standardised using census data. One-year survival was compared between groups. RESULTS A total of 952 patients were included in our study. The mean age was 80.0±7.5 years and women accounted for nearly half of all patients (42.5%). The age-standardised TAVI rate in New Zealand increased from 15 per million in 2013 to 49 per million in 2018. Since 2013, there has been a disproportionate growth in TAVI rates between different ethnicities. TAVI rates for Europeans grew from 16 to 66 per million compared to 7 to 8 per million for Pacific people and 3 to 5 per million for Maori. Despite nationwide access to TAVI in 2018, significant geographic heterogeneity remains, ranging from 2.0 to 12.8 procedures per 100,000 people between regions. One-year (1-yr) survival for Maori were significantly worse than Europeans (80.1% vs 93.9%, HR 4.2, 95%CI: 1.6-11.5, p=0.004) despite being younger (67.9 vs 80.6 years, p<0.05). CONCLUSION There are significant geographical and ethnic variations in TAVI rates in New Zealand. Maori had worse one-year survival than European patients following TAVI.
Collapse
Affiliation(s)
- Bernard Wong
- Department of Cardiology, Waitemata District Health Board, Auckland, New Zealand.
| | - Guy Armstrong
- Department of Cardiology, Waitemata District Health Board, Auckland, New Zealand
| | - Seif El-Jack
- Department of Cardiology, Waitemata District Health Board, Auckland, New Zealand
| | - Andrew To
- Department of Cardiology, Waitemata District Health Board, Auckland, New Zealand
| |
Collapse
|
18
|
Desale SE, Chinnathambi S. Role of dietary fatty acids in microglial polarization in Alzheimer's disease. J Neuroinflammation 2020; 17:93. [PMID: 32209097 PMCID: PMC7093977 DOI: 10.1186/s12974-020-01742-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/10/2020] [Indexed: 12/12/2022] Open
Abstract
Microglial polarization is an utmost important phenomenon in Alzheimer’s disease that influences the brain environment. Polarization depends upon the types of responses that cells undergo, and it is characterized by receptors present on the cell surface and the secreted cytokines to the most. The expression of receptors on the surface is majorly influenced by internal and external factors such as dietary lipids. Types of fatty acids consumed through diet influence the brain environment and glial cell phenotype and types of receptors on microglia. Reports suggest that dietary habits influence microglial polarization and the switching of microglial phenotype is very important in neurodegenerative diseases. Omega-3 fatty acids have more influence on the brain, and they are found to regulate the inflammatory stage of microglia by fine-tuning the number of receptors expressed on microglia cells. In Alzheimer’s disease, one of the pathological proteins involved is Tau protein, and microtubule-associated protein upon abnormal phosphorylation detaches from the microtubule and forms insoluble aggregates. Aggregated proteins have a tendency to propagate within the neurons and also become one of the causes of neuroinflammation. We hypothesize that tuning microglia towards anti-inflammatory phenotype would reduce the propagation of Tau in Alzheimer’s disease.
Collapse
Affiliation(s)
- Smita Eknath Desale
- Neurobiology Group, Division of Biochemical Sciences, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pune, 411008, India.,Academy of Scientific and Innovative Research (AcSIR), Pune, 411008, India
| | - Subashchandrabose Chinnathambi
- Neurobiology Group, Division of Biochemical Sciences, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pune, 411008, India. .,Academy of Scientific and Innovative Research (AcSIR), Pune, 411008, India.
| |
Collapse
|
19
|
Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4861] [Impact Index Per Article: 1215.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
20
|
Functional Status of Patients After Transcatheter Aortic Valve Replacement Surgery in the Acute Care Setting. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
21
|
Wilson JB, Jackson LR, Ugowe FE, Jones T, Yankey GS, Marts C, Thomas KL. Racial and Ethnic Differences in Treatment and Outcomes of Severe Aortic Stenosis. JACC Cardiovasc Interv 2020; 13:149-156. [DOI: 10.1016/j.jcin.2019.08.056] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/19/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022]
|
22
|
Rong LQ, Mao J, Sedrakyan AR, Wijeysundera HC, Naik A, Salemi A, Girardi LN, Fremes S, Gaudino M. Changes in the socioeconomic status of patients receiving TAVR in New York State. J Card Surg 2019; 35:54-57. [PMID: 31705817 DOI: 10.1111/jocs.14326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND When transcatheter aortic valve replacement (TAVR) was first approved by the Food and Drug Administration in October 2011, it was an innovative treatment with limited accessibility. However, over the past few years, TAVR has become standard of care in patients with aortic stenosis. The effect of socioeconomic status (SES) on this transition of use of TAVR is unknown. METHOD Using the New York state department Statewide Planning and Research Cooperative System database, we compared baseline patient characteristics and facilities in low-income areas and high-income areas. Trends in residential SES of patients undergoing TAVR were examined over time and assessed with a Poisson regression and Cochran Armitage trend tests. RESULT From October 2011 and 2012 to December 2016, we found that the numbers of TAVR procedures performed among patients from both low (187-1150 in 2016, P < .001) and high (227-1160, P < .001) income areas increased over time. The proportion of TAVR procedures performed in patients from low-income areas increased over time, while those in high-income areas decreased (from 45.2% in 2011 and 2012 to 49.8% in 2016 for low-income and from 54.8%-50.2% for high-income, P = .009). CONCLUSION In the case of TAVR in New York State, when the innovative treatment was introduced in the clinical practice, there were initial SES-based disparities in access to the procedure. However, these disparities resolved over time, probably due to the broader diffusion of the technique.
Collapse
Affiliation(s)
- Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Jialin Mao
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - Art R Sedrakyan
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | | | - Ajita Naik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Arash Salemi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Stephen Fremes
- Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto, Canada
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| |
Collapse
|
23
|
Khalil C, Megaly M, Ekladios C, Ibrahim A, Mosleh W, Tawadros M, Yatsynovich Y, Ramanan T, Youssef M, Hanna N, Khalil M, Al-Azizi KM, Shamoun F, Page B, Corbelli J. Evaluation of YouTube as a reliable source for patient education on aortic valve stenosis. Cardiovasc Diagn Ther 2019; 9:371-378. [PMID: 31555542 DOI: 10.21037/cdt.2019.08.05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Aortic stenosis (AS) is a prevalent disease in the elderly population and has been a public health concern for decades. YouTube is currently being used for obtaining healthcare related information. We evaluated the quality of information about AS on YouTube for patient education. Methods YouTube was queried for the search phrases "aortic valve stenosis", "aortic valve replacement", "transcatheter aortic valve replacement" and "TAVR". Videos were assessed for their reliability and content with two five-point scales. They were categorized into groups according to usefulness and uploader source. All videos were assessed for audience interaction. Videos were viewed and analyzed by 2 independent investigators. Conflicts were resolved by a third investigator. Results Search phrases yielded 69,300 videos, among which, 120 videos were evaluated and 85 videos were included in the final analysis. Of the 85 videos, only 45 videos (53%) were found to be useful while 40 videos (47%) were found to be non-useful. The majority (98%) of the useful videos were uploaded by professional sources. Overall, videos uploaded by non-professional sources had higher number of views (23,553 vs. 11,110, P≤0.001) despite of being less useful (14% vs. 67%, P<0.001) when compared to videos uploaded by professional sources. Conclusions There is a potential to increase public awareness about aortic valve stenosis and the available treatment options by utilizing YouTube. Professional societies are encouraged to provide more useful material that can deliver comprehensive and reliable information in an entertaining and intuitive manner to the public.
Collapse
Affiliation(s)
- Charl Khalil
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Michael Megaly
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA.,Division of Cardiology, Hennepin Healthcare, Minneapolis, MN, USA
| | - Catherine Ekladios
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Amira Ibrahim
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Wassim Mosleh
- Division of Cardiology, University of Connecticut, Farmington, CT, USA
| | - Mariam Tawadros
- Faculty of Medicine, Ain Shams University Hospitals, Cairo, Egypt
| | - Yan Yatsynovich
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Tharmathai Ramanan
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Mina Youssef
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Nader Hanna
- Division of Cardiology, Cleveland Clinic, Weston, FL, USA
| | - Mofid Khalil
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Karim M Al-Azizi
- Division of Interventional Cardiology and Structural Heart Disease, The Heart Hospital Plano, Baylor Scott & White, Plano, TX, USA
| | - Fadi Shamoun
- Division of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA
| | - Brian Page
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - John Corbelli
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| |
Collapse
|
24
|
Voeltz MD, O’Neill W. Racial Disparities in TAVR. JACC Cardiovasc Interv 2019; 12:949-950. [DOI: 10.1016/j.jcin.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 10/26/2022]
|
25
|
Hernandez-Suarez DF, Ranka S, Villablanca P, Yordan-Lopez N, González-Sepúlveda L, Wiley J, Sanina C, Roche-Lima A, Nieves-Rodriguez BG, Thomas S, Cox-Alomar P, Lopez-Candales A, Ramakrishna H. Racial/Ethnic Disparities in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights from the Healthcare Cost and Utilization Project's National Inpatient Sample. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:546-552. [PMID: 30987828 DOI: 10.1016/j.carrev.2019.04.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify racial/ethnic disparities in utilization rates, in-hospital outcomes and health care resource use among Non-Hispanic Whites (NHW), African Americans (AA) and Hispanics undergoing transcatheter aortic valve replacement (TAVR) in the United States (US). METHODS AND RESULTS The National Inpatient Sample database was queried for patients ≥18 years of age who underwent TAVR from 2012 to 2014. The primary outcome was all-cause in hospital mortality. A total of 36,270 individuals were included in the study. The number of TAVR performed per million population increased in all study groups over the three years [38.8 to 103.8 (NHW); 9.1 to 26.4 (AA) and 9.4 to 18.2 (Hispanics)]. The overall in-hospital mortality was 4.2% for the entire cohort. Race/ethnicity showed no association with in-hospital mortality (P > .05). Though no significant difference were found between AA and NHW in any secondary outcome, being Hispanic was associated with higher incidence of acute myocardial infarction (aOR = 2.02; 95% CI, 1.06-3.85; P = .03), stroke/transient ischemic attack (aOR = 1.81; 95% CI, 1.04-3.14; P = .04), acute kidney injury (aOR = 1.65; 95% CI, 1.23-2.21; P < .01), prolonged length of stay (aOR = 1.18; 95% CI, 1.08-1.29; P < .01) and higher hospital costs (aOR = 1.27; 95% CI, 1.18-1.36; P < .01). CONCLUSION There are significant racial disparities in patients undergoing TAVR in the US. Though in-hospital mortality was not associated with race/ethnicity, Hispanic patients had less TAVR utilization, higher in-hospital complications, prolonged length of stay and increased hospital costs.
Collapse
Affiliation(s)
- Dagmar F Hernandez-Suarez
- Division of Cardiovascular Medicine, Department of Medicine, University of Puerto Rico School of Medicine, San Juan, PR, USA.
| | - Sagar Ranka
- Department of Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Pedro Villablanca
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | | | - Lorena González-Sepúlveda
- Puerto Rico Clinical and Translational Research Consortium (PRCTRC), University of Puerto Rico, San Juan, PR, USA
| | - Jose Wiley
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Cristina Sanina
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Abiel Roche-Lima
- Center for Collaborative Research in Health Disparities, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Brenda G Nieves-Rodriguez
- Center for Collaborative Research in Health Disparities, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Stacey Thomas
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Phoenix, AZ, USA
| | - Pedro Cox-Alomar
- Division of Cardiology, Department of Medicine, Louisiana State University, New Orleans, LA, USA
| | - Angel Lopez-Candales
- Division of Cardiovascular Medicine, Department of Medicine, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Phoenix, AZ, USA
| |
Collapse
|
26
|
Al‐Ogaili A, Fugar S, Okoh A, Kolkailah AA, Al Hashemi N, Ayoub A, Russo MJ, Kavinsky CJ. Trends in complete heart block after transcatheter aortic valve replacement: A population based analysis. Catheter Cardiovasc Interv 2019; 94:773-780. [DOI: 10.1002/ccd.28156] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 01/03/2019] [Accepted: 02/06/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Ahmed Al‐Ogaili
- Department of MedicineJohn H Stroger Hospital of Cook County Chicago Illinois
| | - Setri Fugar
- Division of CardiologyRush University Medical Center Chicago Illinois
| | - Alexis Okoh
- Department of Cardiothoracic SurgeryRWJ Barnabas Health, Newark Beth Israel Medical Center Newark New Jersey
| | - Ahmed A. Kolkailah
- Department of MedicineJohn H Stroger Hospital of Cook County Chicago Illinois
| | - Nawaf Al Hashemi
- Department of MedicineJohn H Stroger Hospital of Cook County Chicago Illinois
| | - Ali Ayoub
- Department of MedicineJohn H Stroger Hospital of Cook County Chicago Illinois
| | - Mark J. Russo
- Department of Cardiothoracic SurgeryRWJ Barnabas Health, Newark Beth Israel Medical Center Newark New Jersey
| | | |
Collapse
|
27
|
Aortic Stenosis in African Americans: Focus On Disparities in Treatment and Outcomes. J Natl Med Assoc 2018; 111:328-333. [PMID: 30591233 DOI: 10.1016/j.jnma.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/30/2018] [Accepted: 11/15/2018] [Indexed: 11/21/2022]
Abstract
Aortic stenosis (AS) is the third most common type of cardiovascular disease after hypertension and coronary artery disease, and it carries a high mortality rate when left untreated. Risk factors include male sex, hypertension, tobacco use, advanced age, elevated LDL cholesterol, and coronary atherosclerosis. Definitive treatment for AS includes valve repair, either percutaneously or surgically; however, in aging populations corrective surgery carries increased risk. While research suggests that patients of some non-White ethnic groups, including African-Americans, are less likely than their Caucasian counterparts to have AS, these minority patients may experience may experience differences in the way they receive and accept care. This paper seeks to explicate the mechanisms of racial disparities among the African-Americans affected by aortic stenosis as they pertain to healthcare utilization, referral for valve replacement, acceptance of therapy, and overall treatment outcomes.
Collapse
|