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Pikula A, Gulati M, Bonnet JP, Ibrahim S, Chamoun S, Freeman AM, Reddy K. Promise of Lifestyle Medicine for Heart Disease, Diabetes Mellitus, and Cerebrovascular Diseases. Mayo Clin Proc Innov Qual Outcomes 2024; 8:151-165. [PMID: 38434935 PMCID: PMC10907160 DOI: 10.1016/j.mayocpiqo.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
The burden of noncommunicable chronic diseases has relevant and negative consequences to persons, health care systems, and economies worldwide. Chronic diseases are the leading cause of disability and mortality and are responsible for 90% of health care expenditure. The most common chronic diseases are diabetes mellitus (DM), cardiovascular disease, and cerebrovascular disease (stroke and vascular cognitive impairment). Modifiable risk factors (MRFs) for these conditions include hypertension, hyperlipidemia, smoking, poor diet, and low-physical activity; with hypertension being the most prevalent MRF. Most MRFs can be successfully targeted through lifestyle medicine (LSM), which is a medical specialty that addresses the root causes of chronic diseases through its primary, secondary, and tertiary preventative approaches. Lifestyle medicine comprises 6 pillars (nutrition, physical activity, sleep health, stress reduction, social connections, and substance use) which through various behavioral approaches, focus on regular physical activity, healthy eating, good quality and quantity sleep, and meaningful social connections coupled with the reduction of stress and substance use. This paper will briefly review the evidence and promise of individual LSM pillars in addressing the underlying MRFs of DM, cardiovascular and cerebrovascular disease (specifically stroke and vascular cognitive impairment). Lifestyle medicine holds a great promise for comprehensive and much improved population health. However, the adoption of LSM at the societal scale requires a multifaceted approach and widespread integration would galvanize a paradigm shift to prevent, treat or reverse chronic diseases from the root causes and achieve health equity.
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Affiliation(s)
- Aleksandra Pikula
- Department of Medicine, Division of Neurology, University of Toronto, Ontario, Canada
- Jay and Sari Sonshine Centre for Stroke Prevention and Cerebrovascular Brain Health, Univeristy Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | - Mahima Gulati
- Department of Medical Sciences, Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut
| | - Jonathan P. Bonnet
- Palo Alto Veteran’s Affairs, Palo Alto, California
- Stanford University School of Medicine, Palo Alto, California
| | - Sarah Ibrahim
- University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Ontario, Canada
- SickKids Research Institute, Toronto, Ontario, Canada
- Centre for Advancing Collaborative Healthcare & Education (CACHE), University of Toronto, Ontario, Canada
| | | | - Andrew M. Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colorado
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Reddy KR, Freeman AM. Lifestyle Medicine: An Antidote to Cardiovascular Diseases. Am J Lifestyle Med 2024; 18:216-232. [PMID: 38559785 PMCID: PMC10979734 DOI: 10.1177/15598276221130684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Despite numerous advances in basic understanding of cardiovascular disease pathophysiology, pharmacology, therapeutic procedures, and systems improvement, there hasn't been much decline in heart disease related mortality in the US since 2010. Hypertension and diet induced risk continue to be the leading causes of cardiovascular morbidity. Even with the excessive mortality associated with the COVID-19 pandemic, in 2020, heart disease remained the leading cause of death. Given the degree of disease burden, morbidity, and mortality, there is an urgent need to redirect medical professionals' focus towards prevention through simple and cost effective lifestyle strategies. However, current practice paradigm and financial compensation systems are mainly centered disease management and not health promotion. For example, the financial value placed on 3-10 min smoking cessation counseling (.24RVUs) is 47-fold lower than an elective PCI (11.21 RVUs). The medical community seems to be enamored with the latest and greatest technology, new devices, and surgical procedures. What if the greatest technology of all was simply the way we live every day? Perhaps when this notion is known by enough, we will switch to this lifestyle medicine technology to prevent disease in the first place.
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Affiliation(s)
- Koushik R. Reddy
- Division of Cardiology, Department of Medicine, James A. Haley VA Medical Center and University of South Florida, Tampa, FL, USA (KRR); and Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO, USA (AMF)
| | - Andrew M. Freeman
- Division of Cardiology, Department of Medicine, James A. Haley VA Medical Center and University of South Florida, Tampa, FL, USA (KRR); and Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO, USA (AMF)
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Jafri SH, Guglin M, Rao R, Ilonze O, Ballut K, Qutrio Baloch Z, Qintar M, Cohn J, Wilcox M, Freeman AM, Kalra DK, Wu WC. Intensive Cardiac Rehabilitation Outcomes in Patients with Heart Failure. J Clin Med 2023; 12:6886. [PMID: 37959351 PMCID: PMC10650190 DOI: 10.3390/jcm12216886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/21/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Cardiac rehabilitation (CR) has proven to be beneficial for patients with heart failure (HF), potentially reducing morbidity and mortality while improving fitness and psychological outcomes. Intensive cardiac rehabilitation (ICR) represents an emerging form of CR that has demonstrated advantages for patients with various cardiovascular diseases. Nevertheless, the specific outcomes of ICR in patients with HF remain unknown. OBJECTIVES The purpose of this study is to assess the effectiveness of ICR in patients with HF. METHODS This retrospective study involved 12,950 patients who participated in ICR at 46 centers from January 2016 to December 2020. Patients were categorized into two groups: the HF group, comprising 1400 patients (11%), and the non-HF group, consisting of 11,550 patients (89%). The primary endpoints included the ICR completion rate, changes in body mass index (BMI), exercise minutes per week (EMW), and depression scores (CESD). A t-test was employed to compare variables between the two groups. RESULTS The HF group comprises older patients, with 37% being females (compared to 44% in the non-HF group). The ICR completion rate was higher in the non-HF group. After ICR completion, adjusted analyses revealed that patients without HF demonstrated a greater improvement in BMI. There were no differences in fitness, as measured via EMW, or in depression scores, as measured via CESD, between the two groups. CONCLUSIONS Despite the lower baseline functional status and psychosocial scores of HF patients compared to non-HF patients, patients with HF were able to attain similar or even better functional and psychosocial outcomes after ICR.
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Affiliation(s)
- S. Hammad Jafri
- Division of Cardiology, University of Louisville, 201 Abraham Flexner Way, Louisville, KY 40202, USA
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN 46202, USA
- Department of Medicine Providence, Veterans Affairs Medical Center, Providence VAMC, 830 Chalkstone Ave, Providence, RI 02908, USA;
- Department of Medicine, Providence VAMC, Alpert Medical School, Brown University, Providence, RI 02908, USA
| | - Maya Guglin
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN 46202, USA
| | - Roopa Rao
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN 46202, USA
| | - Onyedika Ilonze
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN 46202, USA
| | - Kareem Ballut
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN 46202, USA
| | | | | | - Joel Cohn
- Sparrow Health System, Lansing, MI 48912, USA (M.W.)
| | | | - Andrew M. Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | - Dinesh K. Kalra
- Division of Cardiology, University of Louisville, 201 Abraham Flexner Way, Louisville, KY 40202, USA
| | - Wen-Chih Wu
- Department of Medicine Providence, Veterans Affairs Medical Center, Providence VAMC, 830 Chalkstone Ave, Providence, RI 02908, USA;
- Department of Medicine, Providence VAMC, Alpert Medical School, Brown University, Providence, RI 02908, USA
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Freeman AM, Raman SV, Aggarwal M, Maron DJ, Bhatt DL, Parwani P, Osborne J, Earls JP, Min JK, Bax JJ, Shapiro MD. Corrigendum to 'Integrating Coronary Atherosclerosis Burden and Progression with Coronary Artery Disease Risk Factors to Guide Therapeutic Decision Making' The American Journal of Medicine 136:03 (2023); 260-269.e7. Am J Med 2023:S0002-9343(23)00221-8. [PMID: 37068988 DOI: 10.1016/j.amjmed.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Affiliation(s)
- Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colo.
| | - Subha V Raman
- Division of Cardiology, Indiana University School of Medicine, Indianapolis
| | - Monica Aggarwal
- Division of Cardiovascular Medicine, University of Florida, Gainesville
| | - David J Maron
- Department of Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY
| | | | | | | | | | - Jeroen J Bax
- Leiden University Medical Center, Leiden, Netherlands
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
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Jafri SH, Ngamdu KS, Price D, Baloch ZQ, Cohn J, Wilcox M, Freeman AM, Ornish D, Wu WC. Intensive Cardiac Rehabilitation Attenuates the Gender Gap in Cardiac Rehabilitation Participation. Curr Probl Cardiol 2023; 48:101668. [PMID: 36828042 DOI: 10.1016/j.cpcardiol.2023.101668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Traditional cardiac rehabilitation programs historically have had considerable gender gaps in cardiac rehabilitation (CR) outcomes. Intensive-Cardiac-Rehabilitation (ICR) has non-exercise components such as stress management, peer support and diet modification, in addition to exercise, which may reduce barriers to CR completion. However, there is a paucity of data in ICR outcomes based on gender. METHODS We conducted a nationwide retrospective cohort study of 15,613 patients enrolled in 46 Ornish-ICR programs across the US from January 2016 - December 2020 and compared ICR physical and psychological outcomes in women versus men. Primary endpoints were depression scores (CESD), health status (SF-36 physical and mental composite-scores) and exercise minutes per week. RESULTS Of 15,613 ICR participants who participated in the program, 6788 (44%) were women. ICR completion rates were 64.7% overall and nearly equal between men and women (63.3% women vs 65.9% men). There were a few small differences in outcomes after ICR completion: women had slightly more improvement in depression scores (women: -6.10 ± 8.79, 49.6% reduction vs. men: -4.92 ± 7.80, 46.4% reduction; P<0.01) and SF-36 physical (women: 5.95±6.86 vs men: 5.28±6.71, P<0.01) and SF-36 mental (women: 5.76±8.11 vs men: 4.60±7.33, P<0.01) composite scores than men. There was no significant difference in exercise-minutes per week between the two groups. CONCLUSIONS ICR attenuates the gender gap in cardiac rehabilitation completion. Further, of the completers, women achieved slightly higher depression and quality-of-life improvements compared to men. As such, ICR can be a good option to reduce gender-based differences in CR participation.
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Affiliation(s)
- S Hammad Jafri
- Advanced Heart Failure and Transplant Cardiology, Indiana University, Indianapolis, IN; Providence Veterans Affairs Medical Center, Providence, RI; Alpert Medical School, Brown University, Providence, RI.
| | - Kyari Sumayin Ngamdu
- Providence Veterans Affairs Medical Center, Providence, RI; Alpert Medical School, Brown University, Providence, RI
| | - Dana Price
- Providence Veterans Affairs Medical Center, Providence, RI; Alpert Medical School, Brown University, Providence, RI
| | | | - Joel Cohn
- Michigan State University, Lansing, MI
| | | | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO
| | - Dean Ornish
- Preventive Medicine Research Institute and University of California, San Francisco, CA
| | - Wen-Chih Wu
- Providence Veterans Affairs Medical Center, Providence, RI; Alpert Medical School, Brown University, Providence, RI.
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Freeman AM, Freeman MB. RESPONSE: Parenting in Early Career: Refining the Balance While Focusing on Your Children. J Am Coll Cardiol 2022; 80:950. [PMID: 36007994 DOI: 10.1016/j.jacc.2022.02.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Andrew M Freeman
- Department of Cardiology, National Jewish Health, Denver, Colorado, USA.
| | - Marti B Freeman
- Department of Cardiology, National Jewish Health, Denver, Colorado, USA
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Waldman CE, Min JH, Wassif H, Freeman AM, Rzeszut AK, Reilly J, Theriot P, Soliman AM, Thamman R, Bhatt A, Bhavnani SP. COVID-19 telehealth preparedness: a cross-sectional assessment of cardiology practices in the USA. Per Med 2022; 19:411-422. [PMID: 35912812 DOI: 10.2217/pme-2021-0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: The COVID-19 pandemic forced medical practices to augment healthcare delivery to remote and virtual services. We describe the results of a nationwide survey of cardiovascular professionals regarding telehealth perspectives. Materials & methods: A 31-question survey was sent early in the pandemic to assess the impact of COVID-19 on telehealth adoption & reimbursement. Results: A total of 342 clinicians across 42 states participated. 77% were using telehealth, with the majority initiating usage 2 months after the COVID-19 shutdown. A variety of video-based systems were used. Telehealth integration requirements differed, with electronic medical record integration being mandated in more urban than rural practices (70 vs 59%; p < 0.005). Many implementation barriers surfaced, with over 75% of respondents emphasizing reimbursement uncertainty and concerns for telehealth generalizability given the complexity of cardiovascular diseases. Conclusion: Substantial variation exists in telehealth practices. Further studies and legislation are needed to improve access, reimbursement and the quality of telehealth-based cardiovascular care.
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Affiliation(s)
- Carly E Waldman
- Department of Internal Medicine, Scripps Clinic, San Diego, CA, USA.,Division of Cardiology, Healthcare Innovation Laboratory, Prebys Cardiovascular Institute, Scripps Clinic, San Diego, CA 92037,USA
| | - Jean H Min
- Department of Internal Medicine, Scripps Clinic, San Diego, CA, USA.,Division of Cardiology, Healthcare Innovation Laboratory, Prebys Cardiovascular Institute, Scripps Clinic, San Diego, CA 92037,USA
| | - Heba Wassif
- Department of Cardiovascular Medicine, Section of Clinical Cardiology, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44103, USA
| | - Andrew M Freeman
- Department of Medicine, Division of Cardiology, National Jewish Health, Denver, CO 80206, USA
| | - Anne K Rzeszut
- American College of Cardiology, Heart House, Washington, DC 20037, USA
| | - Jack Reilly
- American College of Cardiology, Heart House, Washington, DC 20037, USA
| | - Paul Theriot
- American College of Cardiology, Heart House, Washington, DC 20037, USA
| | - Ahmed M Soliman
- Division of Cardiology, Houston Methodist DeBakey Cardiology Associates, Houston, TX 77030, USA
| | - Ritu Thamman
- Division of Medicine, University of Pittsburg School of Medicine, Pittsburg, PA 15213, USA
| | - Ami Bhatt
- Division of Cardiology, Adult Congenital Heart Disease Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sanjeev P Bhavnani
- Division of Cardiology, Healthcare Innovation Laboratory, Prebys Cardiovascular Institute, Scripps Clinic, San Diego, CA 92037,USA
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Lima FV, Kadiyala V, Huang A, Agusala K, Cho D, Freeman AM, Druz R. At the Crossroads! Time to Start Taking Smartwatches Seriously. Am J Cardiol 2022; 179:96-101. [PMID: 35842279 DOI: 10.1016/j.amjcard.2022.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022]
Abstract
Patients have demonstrated a growing interest in using wearable devices, particularly smartwatches, to monitor and improve their cardiovascular wellness. Wearable devices are now one of the fastest growing sectors of the technology industry, and big technology companies, such as Apple (Apple Watch), Google (Fitbit), and Samsung (Galaxy), have engineered smartwatch features that are capable of monitoring biometrics, such as heart rhythm, heart rate, blood pressure, and sleep. These devices hold significant potential to impact the relation between cardiologists and their patients, but concerns exist about device trustworthiness to detect pertinent data points and deliver alerts with accuracy. How these devices' features will interplay with cardiologists' workflow has also yet to be defined and requires thoughtful implementation. Furthermore, the success of smartwatches as medical devices is dependent on patients' continuous use. Keeping patients engaged with their devices through leveraging behavioral factors may lead to achieving and optimizing healthcare goals. Socioeconomic disparities and privacy concerns are other barriers in the path forward. Cardiovascular professional societies are uniquely poised to help impact how these devices are eventually accepted and used in everyday practice. In conclusion, engagement and collaboration with big tech companies will help guide how this market grows.
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Affiliation(s)
- Fabio V Lima
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Vishnu Kadiyala
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Alice Huang
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kartik Agusala
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - David Cho
- Division of Cardiovascular Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Regina Druz
- Department of Cardiology, St. Francis Hospital, Roslyn, New York
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Aggarwal M, Ros E, Allen K, Sikand G, Agarwala A, Aspry K, Kris-Etherton P, Devries S, Reddy K, Singh T, Litwin SE, Keefe JO, Miller M, Andrus B, Blankstein R, Batiste C, Belardo D, Wenger C, Batts T, Barnard ND, White BA, Ornish D, Williams KA, Ostfeld RJ, Freeman AM. Controversial Dietary Patterns: A High Yield Primer for Clinicians. Am J Med 2022; 135:680-687. [PMID: 35134371 DOI: 10.1016/j.amjmed.2022.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 12/20/2022]
Abstract
In cardiology clinic visits, the discussion of optimal dietary patterns for prevention and management of cardiovascular disease is usually very limited. Herein, we explore the benefits and risks of various dietary patterns, including intermittent fasting, low carbohydrate, Paleolithic, whole food plant-based diet, and Mediterranean dietary patterns within the context of cardiovascular disease to empower clinicians with the evidence and information they need to maximally benefit their patients.
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Affiliation(s)
| | - Emilio Ros
- Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona and Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | | | - Geeta Sikand
- Heart Disease Prevention Program, University of California Irvine
| | - Anandita Agarwala
- Cardiovascular Division, Baylor Scott and White the Heart Hospital - Plano, Texas
| | - Karen Aspry
- Division of Cardiology, Lifespan Cardiovascular Institute, East Providence, RI; Brown University, Providence, RI
| | - Penny Kris-Etherton
- Department of Nutritional Sciences, Penn State University, University Park, Pa
| | - Stephen Devries
- Gaples Institute for Integrative Cardiology, Deerfield, Ill; Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Koushik Reddy
- Division of Cardiology, James A Haley VA Medical Center, University of South Florida, Tampa
| | - Tamanna Singh
- Division of Cardiovascular Medicine, Heart, Vascular, Thoracic Institute Cleveland Clinic, Ohio
| | - Sheldon E Litwin
- Division of Cardiology, Medical University of South Carolina, Charleston; Division of Cardiology, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - James O' Keefe
- Saint Luke's Mid America Heart Institute, Kansas City, Mo
| | - Michael Miller
- Division of Cardiology, University of Maryland School of Medicine, Baltimore
| | - Bruce Andrus
- Division of Cardiology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Ron Blankstein
- Division of Cardiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Columbus Batiste
- Division of Cardiology, Kaiser Permanente Riverside Medical Center, Charleston, SC
| | | | | | - Travis Batts
- Division of Cardiology, Department of Medicine, Wilford Hall Ambulatory Surgical Center, San Antonio, Texas
| | - Neal D Barnard
- George Washington University School of Medicine, Washington, DC; Physicians Committee for Responsible Medicine, Washington, DC
| | - Beth A White
- Division of Cardiology Marshall Health, Joan C. Edward School of Medicine, Huntington, WV
| | - Dean Ornish
- Preventive Medicine Research Institute, Sausalito, Calif; University of California, San Francisco
| | - Kim A Williams
- Division of Cardiology, Rush University Medical Center, Chicago, Ill
| | | | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colo
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Min JK, Chang HJ, Andreini D, Pontone G, Guglielmo M, Bax JJ, Knaapen P, Raman SV, Chazal RA, Freeman AM, Crabtree T, Earls JP. Coronary CTA Plaque Volume Severity Stages According to Invasive Coronary Angiography and FFR. J Cardiovasc Comput Tomogr 2022; 16:415-422. [DOI: 10.1016/j.jcct.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/12/2022] [Accepted: 03/04/2022] [Indexed: 11/25/2022]
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Jafri SH, Ngamdu KS, Muhammad B, Freeman AM, Ornish D, Wu WC. INTENSIVE CARDIAC REHABILITATION: OUTCOMES FOR PATIENTS WITH CORONARY ARTERY DISEASE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02586-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Aggarwal M, Freeman AM, Ros E, Allen K, Sikand G, Aspry K, Kris-Etherton P, Devries S, Reddy K, Singh T, Litwin SE, O'Keefe J, Miller M, Andrus B, Blankstein R, Batiste C, Belardo D, Wenger C, Batts T, Barnard ND, White BA, Ornish D, Williams KA, Ostfeld RJ. Trending Nutrition Controversies #3: Top Controversies in 2021. Am J Med 2022; 135:146-156. [PMID: 34509452 DOI: 10.1016/j.amjmed.2021.07.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 12/27/2022]
Abstract
Each year, patients are bombarded with diverging and even contradictory reports concerning the impact of certain additives, foods, and nutrients on cardiovascular health and its risk factors. Accordingly, this third review of nutrition controversies examines the impact of artificial sweeteners, cacao, soy, plant-based meats, nitrates, and meats from grass compared to grain-fed animals on cardiovascular and other health outcomes with the goal of optimizing clinician-led diet counseling.
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Affiliation(s)
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colo
| | - Emilio Ros
- Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic, Barcelona and Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | | | - Geeta Sikand
- Heart Disease Prevention Program, University of California Irvine, Irvine
| | - Karen Aspry
- Division of Cardiology, Lifespan Cardiovascular Institute, and Brown University, Providence, RI
| | | | - Stephen Devries
- Gaples Institute for Integrative Cardiology, Deerfield, Ill; Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Koushik Reddy
- Division of Cardiology, James A Haley VA Medical Center, University of South Florida, Tampa
| | - Tamanna Singh
- Division of Cardiovascular Medicine, Heart, Vascular, Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sheldon E Litwin
- Division of Cardiology, University of South Carolina, Charleston; Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC
| | - James O'Keefe
- Saint Luke's Mid America Heart Institute, Kansas City, Mo
| | - Michael Miller
- Division of Cardiology, University of Maryland School of Medicine, Baltimore
| | - Bruce Andrus
- Division of Cardiology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Ron Blankstein
- Division of Cardiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Columbus Batiste
- Division of Cardiology, Kaiser Permanente Riverside Medical Center, Riverside, Calif
| | | | | | - Travis Batts
- Division of Cardiology, Department of Medicine, Wilford Hall Ambulatory Surgical Center, San Antonio, Tex
| | - Neal D Barnard
- Adjunct Faculty, George Washington University School of Medicine, Washington, DC; Physici Committee for Responsible Medicine, Washington, DC
| | - Beth A White
- Division of Cardiology, Marshall Health/Joan C. Edward School of Medicine, Huntington, WV
| | - Dean Ornish
- Preventive Medicine Research Institute, Sausalito, Calif; Deparment of Medicine, University of California, San Francisco, San Francisco
| | - Kim A Williams
- Division of Cardiology, Rush University Medical Center, Chicago, Ill
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Gianos E, Jackson EA, Tejpal A, Aspry K, O'Keefe J, Aggarwal M, Jain A, Itchhaporia D, Williams K, Batts T, Allen KE, Yarber C, Ostfeld RJ, Miller M, Reddy K, Freeman AM, Fleisher KE. Oral health and atherosclerotic cardiovascular disease: A review. Am J Prev Cardiol 2021; 7:100179. [PMID: 34611631 PMCID: PMC8387275 DOI: 10.1016/j.ajpc.2021.100179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Periodontal disease (PD) is common in the US and globally. Evidence suggests that poor oral health is associated with atherosclerotic cardiovascular disease (ASCVD); however, this relationship has not been a major focus in clinical cardiology. This manuscript will review the growing evidence linking PD to ASCVD, including pathophysiologic mechanisms and coexistent risk factors. Public health considerations with a focus on disparities, social determinants, preventive strategies, and a call to action to reduce the burden of coincident ASCVD and PD are also reviewed.
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Affiliation(s)
- Eugenia Gianos
- Division of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY, United States
| | - Elizabeth A Jackson
- Division of Cardiovascular Disease, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Astha Tejpal
- Division of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY, United States
| | - Karen Aspry
- Lifespan Cardiovascular Institute, and Division of Cardiology, Brown University, Alpert Medical School, Providence, RI, United States
| | - James O'Keefe
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City School of Medicine, Kansas City, MI, United States
| | - Monica Aggarwal
- Division of Cardiology, University of Florida, Gainesville, FL, United States
| | - Ankur Jain
- Division of Cardiology, University of Florida, Gainesville, FL, United States
| | - Dipti Itchhaporia
- Jeffrey M. Carlton Heart & Vascular Institute, Hoag Memorial Hospital, Newport Beach, CA, United States
| | - Kim Williams
- Department of Medicine, Division of Cardiology, Rush University Medical Center, Chicago, IL, United States
| | - Travis Batts
- Division of Cardiology, Department of Medicine, Wilford Hall Ambulatory Surgical Center, San Antonio, TX, United States
| | - Kathleen E Allen
- Geisel School of Medicine at Dartmouth, Hanover, NY, United States
| | - Clark Yarber
- Department of Internal Medicine, Montefiore Health System, Bronx, NY, United States
| | - Robert J Ostfeld
- Division of Cardiology, Department of Medicine, Montefiore Health System, Bronx, NY, United States
| | - Michael Miller
- Department of Cardiovascular Medicine, Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Koushik Reddy
- Division of Cardiology, James A. Haley VA Medical Center, University of South Florida, Tampa, FL, United States
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO, United States
| | - Kenneth E Fleisher
- Department of Oral and Maxillofacial Surgery, NYU College of Dentistry, New York, NY, United States
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14
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Shah NR, Winchester DE, Freeman AM. Using a sledgehammer to crack a nut: The burdensome appropriate use criteria program. J Nucl Cardiol 2021; 28:1998-2000. [PMID: 31832884 DOI: 10.1007/s12350-019-01978-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Nishant R Shah
- Division of Cardiology, Department of Medicine, Brown University Alpert Medical School, Providence, RI, USA
| | - David E Winchester
- Cardiology Section, Malcom Randall VAMC, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, 1400 Jackson St. J317, Denver, CO, 80206, USA.
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15
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Abstract
Cardiovascular disease and its associated risk factors such as hypertension, obesity, and diabetes are contributing to a large portion of morbidity, mortality, and health care costs in the United States. Diet and lifestyle education have been shown to be beneficial in reducing cost, mortality, and morbidity associated with these diseases. However, the lack of implementation of diet and lifestyle tools into clinical practices and into hospital systems leaves much room for improvement. Obstacles such as poor physician education, financial concerns, patient preference, and social resistance to change have made it difficult to promote healthy lifestyle and nutrition practices throughout all aspects of health systems. Some hospital systems and hospital-based clinical practices have had important successes in creating prevention clinic models, implementing plant-based menus in their hospital systems, and incorporating intensive rehabilitation programs that will pave the way for more future change. This review describes the current deficits, obstacles, and innovative strategies for implementing lifestyle medicine into hospital systems.
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Affiliation(s)
- Matthew R. Petersen
- Department of Medicine, Shands Hospital at the University of Florida, Gainesville, Florida
| | - Andrew M. Freeman
- the Department of Medicine, Division of Cardiology, National Jewish Health, Denver, Colorado
| | - Marcy Madrid
- Community Health, Midland Health, Midland, Texas
| | - Monica Aggarwal
- the Division of Cardiology, University of Florida, Gainesville, Florida (MA)
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16
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Hanson B, Steele Cooper S, Tegarden T, Tipton L, Freeman AM, Davis KG, Gillespie GL, Huston T. The impact of emergency responder musculoskeletal injuries in the State of Ohio. Work 2021; 68:1001-1008. [PMID: 33843711 DOI: 10.3233/wor-205065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Emergency personnel operate in environments that put them at higher risk of injury to the musculoskeletal system. These injuries result in lost workdays, medical costs, and decreased productivity, all which impact emergency response systems. OBJECTIVE This study serves to assess the causes, costs, and disability of common work-related musculoskeletal injuries within the police, emergency medical service (EMS) workers, and firefighters of Ohio based on data from the OBWC (Ohio Bureau of Workers' Compensation). METHODS Our dataset included all OBWC injury claims involving a shoulder, low back, or knee from 2010 through 2014. Police and Firefighter leaders were analyzed separately from those not in a leadership role, and workers with combined Firefighter/EMS roles were analyzed separately from "pure" Firefighters and EMS personnel. Data were organized through univariate analysis of variance with post-hoc Tukey tests and analyzed based on the job of the individual and whether the individual was in a leadership role. RESULTS Police Officers had the highest number of total injuries in the dataset, followed by Firefighters and Firefighters/EMS workers. Police Officers and Firefighters injured their back and knees more often than their shoulders, while EMS workers injured their backs and shoulders more often than their knees. CONCLUSIONS The mechanisms through which injuries occur are also dependent on the job. Police officers experienced a higher percentage of motor vehicle related back problems, while firefighters had a higher percentage of injuries from overexertion. Musculoskeletal injury claims in these emergency personnel resulted in opioid prescriptions approximately 10%of the time.
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Affiliation(s)
- Brendan Hanson
- Department of Environmental and Public Health Sciences, College of Medicine University of Cincinnati, Cincinnati, OH, USA
| | | | - Taryn Tegarden
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Logan Tipton
- Department of Environmental and Public Health Sciences, College of Medicine University of Cincinnati, Cincinnati, OH, USA
| | - Andrew M Freeman
- Department of Environmental and Public Health Sciences, College of Medicine University of Cincinnati, Cincinnati, OH, USA
| | - Kermit G Davis
- Department of Environmental and Public Health Sciences, College of Medicine University of Cincinnati, Cincinnati, OH, USA
| | | | - Thomas Huston
- College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, OH, USA
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17
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Gerding T, Syck M, Daniel D, Naylor J, Kotowski SE, Gillespie GL, Freeman AM, Huston TR, Davis KG. An assessment of ergonomic issues in the home offices of university employees sent home due to the COVID-19 pandemic. Work 2021; 68:981-992. [PMID: 33867366 DOI: 10.3233/wor-205294] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND As millions of workers have shifted to telework, special accommodations for workers with respect to ergonomics may be required to ensure the workforce remains healthy. METHODS A survey about home office ergonomics and discomfort was sent to faculty, staff, and administrators by email and was completed by 843 individuals. RESULTS Over 40%of the participants reported moderate to severe discomfort (severe low/middle back pain, moderate discomfort in eyes/neck/head, and discomfort in the upper back/shoulders). Laptops (always and often) were widely used (85%) with most using the laptop monitor (55%) of all respondents. Further, less than 45%of the seating conditions were reported as having adjustable arm rests. CONCLUSION As teleworking in makeshift offices becomes more common, the risk of significant discomfort and potentially more serious musculoskeletal disorders may result from poor static postures. Companies may need to accommodate workers by allowing them to take home office chairs, external monitors, keyboards, and mice as laptops are insufficient, ergonomically.
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Affiliation(s)
- Thomas Gerding
- Department of Environmental and Public Health Science, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Megan Syck
- Department of Environmental and Public Health Science, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Denise Daniel
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Jennifer Naylor
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Susan E Kotowski
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | | | - Andrew M Freeman
- Department of Environmental and Public Health Science, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Thomas R Huston
- Department of Mechanical Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Kermit G Davis
- Department of Environmental and Public Health Science, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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18
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Davis KG, Freeman AM, Ying J, Huth JR. Workers' compensation costs for healthcare caregivers: Home healthcare, long-term care, and hospital nurses and nursing aides. Am J Ind Med 2021; 64:369-380. [PMID: 33616226 DOI: 10.1002/ajim.23237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Healthcare workers (nurses and nursing aides) often have different exposures and injury risk factors depending on their occupational subsector and location (hospital, long-term care, or home health care). METHODS A total of 5234 compensation claims for nurses and nursing aides who suffered injuries to their lower back, knee, and/or shoulder over a 5-year period were obtained from the Ohio Bureau of Workers' Compensation and analyzed. Injury causation data was also collected for each claim. The outcome variables included indemnity costs, medical costs, total costs, and the number of lost work days. The highest prescribed morphine equivalent dose for opioid medications was also calculated for each claim. RESULTS Home healthcare nurses and nursing aides had the highest average total costs per claim. Hospital nurses and nursing aides had the highest total claim costs, of $5 million/year. Shoulder injuries for home healthcare nursing aides (HHNAs) had the highest average total claim costs ($20,600/injury) for all occupation, setting, and body area combinations. Opioids were most frequently prescribed for home healthcare nurses (HHNs) and nursing aides (18.9% and 17.7% having been prescribed opioids, respectively). Overexertion was the most common cause for HHN and nursing aide claims. CONCLUSIONS With the rapidly expanding workforce in the home healthcare sector, there is a potential health crisis from the continued expansion of home healthcare worker injuries and their associated costs. In addition, the potential for opioid drug usage places these workers at risk for future dependence, overdose, and prolonged disability. Future research is needed to investigate the specific and ideally reversible causes of injury in claims categorized as caused by overexertion.
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Affiliation(s)
- Kermit G. Davis
- Department of Environmental and Public Health Sciences, College of Medicine University of Cincinnati Cincinnati Ohio USA
| | - Andrew M. Freeman
- Department of Environmental and Public Health Sciences, College of Medicine University of Cincinnati Cincinnati Ohio USA
| | - Jun Ying
- Department of Environmental and Public Health Sciences, College of Medicine University of Cincinnati Cincinnati Ohio USA
| | - Jeffrey R. Huth
- Department of Environmental and Public Health Sciences, College of Medicine University of Cincinnati Cincinnati Ohio USA
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19
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Aggarwal M, Ornish D, Josephson R, Brown TM, Ostfeld RJ, Gordon N, Madan S, Allen K, Khetan A, Mahmoud A, Freeman AM, Aspry K. Closing Gaps in Lifestyle Adherence for Secondary Prevention of Coronary Heart Disease. Am J Cardiol 2021; 145:1-11. [PMID: 33454343 DOI: 10.1016/j.amjcard.2021.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 01/02/2021] [Accepted: 01/05/2021] [Indexed: 12/14/2022]
Abstract
The secondary prevention (SP) of coronary heart disease (CHD) has become a major public health and economic burden worldwide. In the United States, the prevalence of CHD has risen to 18 million, the incidence of recurrent myocardial infarctions (MI) remains high, and related healthcare costs are projected to double by 2035. In the last decade, practice guidelines and performance measures for the SP of CHD have increasingly emphasized evidence-based lifestyle (LS) interventions, including healthy dietary patterns, regular exercise, smoking cessation, weight management, depression screening, and enrollment in cardiac rehabilitation. However, data show large gaps in adherence to healthy LS behaviors and low rates of enrollment in cardiac rehabilitation in patients with established CHD. These gaps may be related, since behavior change interventions have not been well integrated into traditional ambulatory care models in the United States. The chronic care model, an evidence-based practice framework that incorporates clinical decision support, self-management support, team-care delivery and other strategies for delivering chronic care is well suited for both chronic CHD management and prevention interventions, including those related to behavior change. This article reviews the evidence base for LS interventions for the SP of CHD, discusses current gaps in adherence, and presents strategies for closing these gaps via evidence-based and emerging interventions that are conceptually aligned with the elements of the chronic care model.
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Affiliation(s)
- Monica Aggarwal
- Division of Cardiology, University of Florida, Gainesville, Florida
| | - Dean Ornish
- Preventive Medicine Research Institute, Sausalito, California, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Richard Josephson
- Division of Cardiology, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Todd M Brown
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert J Ostfeld
- Division of Cardiology, Montefiore Health System, Bronx, New York
| | - Neil Gordon
- Medical and Science Office, INTERVENT International, Savannah, GA and Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shivank Madan
- Division of Cardiology, Montefiore Health System, Bronx, New York
| | - Kathleen Allen
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Aditya Khetan
- Division of Cardiology, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Ahmed Mahmoud
- Division of Cardiology, University of Florida, Gainesville, Florida
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Karen Aspry
- Lifespan Cardiovascular Institute, and Department of Medicine, Division of Cardiology, Brown University, Alpert Medical School, Providence, Rhode Island.
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20
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Ostfeld RJ, Allen KE, Aspry K, Brandt EJ, Spitz A, Liberman J, Belardo D, O'Keefe JH, Aggarwal M, Miller M, Batiste C, Kopecky S, White B, Shah N, Hawamdeh H, Batts T, Blankstein R, Reddy K, Ornish D, Freeman AM. Vasculogenic Erectile Dysfunction: The Impact of Diet and Lifestyle. Am J Med 2021; 134:310-316. [PMID: 33227246 DOI: 10.1016/j.amjmed.2020.09.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022]
Abstract
Vasculogenic erectile dysfunction has been aptly called the "canary in the coal mine" for cardiovascular disease because it almost always precedes other manifestations of atherosclerotic cardiovascular disease, including myocardial infarction and stroke. It is common, associated with the presence of modifiable cardiovascular risk factors, and impacted by diet and lifestyle choices. This concise review provides an update on the use of dietary and other lifestyle interventions to improve vasculogenic erectile dysfunction and atherosclerotic cardiovascular disease.
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Affiliation(s)
| | | | - Karen Aspry
- Lifespan Cardiovascular Institute, and Department of Medicine, Division of Cardiology, Brown University, Alpert Medical School, Providence, RI
| | - Eric J Brandt
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
| | - Aaron Spitz
- Partner, Orange County Urology Associates, Volunteer Clinical Assistant Professor, University of California, Irvine Department of Urology, Orange
| | - Joshua Liberman
- Ascension Wisconsin Cardiovascular Specialists, Milwaukee, Wis
| | - Danielle Belardo
- Division of Cardiology, Lankenau Medical Center, Wynnewood, Penn
| | - James H O'Keefe
- Medical Director of the Charles and Barbara Duboc Cardio Health & Wellness Center, Saint Luke's Mid America Heart Institute, Kansas City, Mo
| | | | - Michael Miller
- Professor of Cardiovascular Medicine, Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore
| | - Columbus Batiste
- Division of Cardiology, Kaiser Permanente Riverside and Moreno Valley, Riverside, Calif
| | - Stephen Kopecky
- Division of Cardiology, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minn
| | - Beth White
- Department of Cardiology and Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, WV
| | - Nikhil Shah
- Division of Cardiology, University of Florida, Gainesville
| | | | - Travis Batts
- Division of Cardiology, Department of Medicine, Wilford Hall Ambulatory Surgical Center, San Antonio, Tex
| | - Ron Blankstein
- Division of Cardiology, Brigham and Women's Hospital, Boston, Mass
| | - Koushik Reddy
- Division of Cardiology, James A. Haley VA Medical Center, Tampa, Fla
| | - Dean Ornish
- Clinical Professor of Medicine, University of California, San Francisco
| | - Andrew M Freeman
- Department of Medicine, Division of Cardiology, National Jewish Health, Denver, Colo
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21
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Veeranna V, Freeman AM. The magic of improved crystal technology coupled with better resolution: Novel imaging findings may promise improved disease detection. J Nucl Cardiol 2021; 28:328-330. [PMID: 33025471 DOI: 10.1007/s12350-020-02380-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Vikas Veeranna
- New England Heart and Vascular Institute, Manchester, USA
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, USA.
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22
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Abudayyeh I, Tandon A, Wittekind SG, Rzeszut AK, Sivaram CA, Freeman AM, Madhur MS. Landscape of Mentorship and its Effects on Success in Cardiology. JACC Basic Transl Sci 2020; 5:1181-1186. [PMID: 33426375 PMCID: PMC7775959 DOI: 10.1016/j.jacbts.2020.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 01/27/2023]
Abstract
Mentees are more satisfied with their mentorship experience when they have had more than 3 mentors or a mentor from outside of their practice/institution. Satisfaction with the mentoring relationship is significantly associated with perceived satisfaction in achieving professional goals. Sex and race/ethnicity concordance in mentoring relationships is associated with positive outcomes. Characteristics that mentees desire in a mentor tend to change with time/career stage.
The effects of mentorship on measurable outcomes of success and the aspects of mentorship that are most valuable in promoting the careers of cardiologists are unclear. To address this, we conducted a large-scale survey of cardiologists in a real-world setting. We identified factors that enhance the mentorship experience, and found that mentee needs change with career stage. Importantly, satisfaction with the mentoring relationship is significantly associated with perceived satisfaction in achieving professional goals. Furthermore, we found that gender and race concordance in mentoring relationships is an important variable with the potential to increase diversity in the field of cardiology.
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Affiliation(s)
- Islam Abudayyeh
- Division of Cardiology, Loma Linda University, Loma Linda, California, USA
| | - Animesh Tandon
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Division of Cardiology, Children's Medical Center, Dallas, Texas, USA
| | - Samuel G Wittekind
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,The Heart Institute, Cincinnati Children's, Cincinnati, Ohio, USA
| | | | - Chittur A Sivaram
- Cardiovascular Section, Department of Medicine, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Meena S Madhur
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee, USA.,Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Institute for Infection, Immunology, and Inflammation, Nashville, Tennessee, USA
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23
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Krishnaswami A, Beavers C, Dorsch MP, Dodson JA, Masterson Creber R, Kitsiou S, Goyal P, Maurer MS, Wenger NK, Croy DS, Alexander KP, Batsis JA, Turakhia MP, Forman DE, Bernacki GM, Kirkpatrick JN, Orr NM, Peterson ED, Rich MW, Freeman AM, Bhavnani SP. Gerotechnology for Older Adults With Cardiovascular Diseases: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 76:2650-2670. [PMID: 33243384 PMCID: PMC10436190 DOI: 10.1016/j.jacc.2020.09.606] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/18/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022]
Abstract
The growing population of older adults (age ≥65 years) is expected to lead to higher rates of cardiovascular disease. The expansion of digital health (encompassing telehealth, telemedicine, mobile health, and remote patient monitoring), Internet access, and cellular technologies provides an opportunity to enhance patient care and improve health outcomes-opportunities that are particularly relevant during the current coronavirus disease-2019 pandemic. Insufficient dexterity, visual impairment, and cognitive dysfunction, found commonly in older adults should be taken into consideration in the development and utilization of existing technologies. If not implemented strategically and appropriately, these can lead to inequities propagating digital divides among older adults, across disease severities and socioeconomic distributions. A systematic approach, therefore, is needed to study and implement digital health strategies in older adults. This review will focus on current knowledge of the benefits, barriers, and use of digital health in older adults for cardiovascular disease management.
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Affiliation(s)
- Ashok Krishnaswami
- Division of Cardiology, Kaiser Permanente Medical Center, San Jose, California.
| | - Craig Beavers
- Division of Pharmacy, University of Kentucky, Lexington, Kentucky
| | - Michael P Dorsch
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan
| | - John A Dodson
- NYU Langone Health, NYU Grossman School of Medicine, New York, New York
| | - Ruth Masterson Creber
- Weill Cornell Medicine, Department of Population Health Sciences, Division of Health Informatics, New York, New York
| | - Spyros Kitsiou
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | | | - Karen P Alexander
- Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - John A Batsis
- Department of Medicine, Geisel School of Medicine and The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College and Dartmouth-Hitchcock, Lebanon, New Hampshire; Division of Geriatric Medicine, School of Medicine, Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Chapel Hill, North Carolina
| | - Mintu P Turakhia
- Center for Digital Health, Stanford University, Stanford, California; Palo Alto Veterans Administration Health Care System, Palo Alto, California
| | - Daniel E Forman
- Division of Geriatric Cardiology, University of Pittsburgh, Geriatric Research, Education and Clinical Center; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Gwen M Bernacki
- Cardiovascular Division, Department of Medicine, Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington
| | - James N Kirkpatrick
- Cardiovascular Division, Department of Medicine, Department of Bioethics and Humanities, University of Washington, Seattle, Washington
| | - Nicole M Orr
- Post-Acute Cardiology Care, LCC, Darien, Connecticut; Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - Eric D Peterson
- Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Michael W Rich
- Cardiovascular Division, Washington University, St. Louis, Missouri
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Sanjeev P Bhavnani
- Prebys Cardiovascular Institute, Scripps Clinic & Research Foundation, San Diego, California
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24
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D'Souza MS, Dong TA, Ragazzo G, Dhindsa DS, Mehta A, Sandesara PB, Freeman AM, Taub P, Sperling LS. From Fad to Fact: Evaluating the Impact of Emerging Diets on the Prevention of Cardiovascular Disease. Am J Med 2020; 133:1126-1134. [PMID: 32569590 DOI: 10.1016/j.amjmed.2020.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023]
Abstract
Cardiovascular disease remains one of the most prevalent and preventable chronic conditions worldwide. Diet modification is the foundation of cardiovascular disease prevention. Several dietary approaches have emerged to promote better cardiovascular health. The rapid dissemination of anecdotal and observational data through the internet and social media has caused confusion amongst providers and patients. The aim of this comprehensive review is to present objective insights into 2 of today's most popular fad diets: ketogenic diet and intermittent fasting. We will evaluate the performance of these diets based on their impact on cardiovascular risk factors.
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Affiliation(s)
- Melroy S D'Souza
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Tiffany A Dong
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, Ga
| | | | - Devinder S Dhindsa
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Ga
| | - Anurag Mehta
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Ga
| | - Pratik B Sandesara
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Ga
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colo
| | - Pam Taub
- Stepfamily Foundation Cardiovascular Wellness and Rehabilitation Center, Division of Cardiovascular Medicine, University of California San Diego
| | - Laurence S Sperling
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Ga.
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Parwani P, Martin GP, Mohamed MO, Hajeer A, Nwaokoro M, Narang A, Choi AD, Lopez-Mattei J, Freeman AM, Mamas MA. Relationship of Altmetric Attention Score to Overall Citations and Downloads for Papers Published in JACC. J Am Coll Cardiol 2020; 76:757-759. [PMID: 32762911 DOI: 10.1016/j.jacc.2020.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 10/23/2022]
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Kris-Etherton PM, Petersen KS, Velarde G, Barnard ND, Miller M, Ros E, O'Keefe JH, Williams K, Horn LV, Na M, Shay C, Douglass P, Katz DL, Freeman AM. Barriers, Opportunities, and Challenges in Addressing Disparities in Diet-Related Cardiovascular Disease in the United States. J Am Heart Assoc 2020; 9:e014433. [PMID: 32200727 PMCID: PMC7428614 DOI: 10.1161/jaha.119.014433] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In the United States, cardiovascular disease (CVD) is the leading cause of death and disability. Suboptimal diet quality is responsible for a greater percentage of CVD-related morbidity and mortality than any other modifiable risk factor. Further troubling are the stark racial/ethnic and socioeconomic disparities in diet quality. This represents a major public health concern that urgently requires a coordinated effort to better characterize the barriers to healthy dietary practices in population groups disproportionally affected by CVD and poor diet quality to inform multifaceted approaches at the government (policy), community environment, sociocultural, and individual levels. This paper reviews the barriers, opportunities, and challenges involved in shifting population behaviors, especially in underserved populations, toward healthy dietary practices. It is imperative that public health policies address the social determinants of nutrition more intensively than previously in order to significantly decrease CVD on a population-wide basis.
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Affiliation(s)
- Penny M Kris-Etherton
- Department of Nutritional Sciences The Pennsylvania State University University Park PA
| | - Kristina S Petersen
- Department of Nutritional Sciences The Pennsylvania State University University Park PA
| | - Gladys Velarde
- Division of Cardiology Department of Medicine University of Florida Jacksonville FL
| | - Neal D Barnard
- Adjunct Faculty George Washington University School of Medicine Physicians Committee for Responsible Medicine Washington DC
| | - Michael Miller
- Department of Medicine University of Maryland School of Medicine Baltimore MD
| | - Emilio Ros
- Lipid Clinic Endocrinology and Nutrition Service Institut d'Investigacions Biomediques August Pi Sunyer Hospital Clinic University of Barcelona, and Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición Instituto de Salud Carlos III Madrid Spain
| | - James H O'Keefe
- Saint Luke's Mid America Heart Institute School of Medicine University of Missouri-Kansas City MO
| | | | - Linda Van Horn
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Muzi Na
- Department of Nutritional Sciences The Pennsylvania State University University Park PA
| | - Christina Shay
- Center for Health Metrics and Evaluation American Heart Association American Heart Association Dallas TX
| | - Paul Douglass
- Wellstar Medical Group, Metro Atlanta Cardiovascular Medicine Atlanta GA
| | - David L Katz
- Yale-Griffin Prevention Research Center Derby CT
| | - Andrew M Freeman
- Division of Cardiology Department of Medicine National Jewish Health Denver CO
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Aggarwal M, Grady A, Desai D, Hartog K, Correa L, Ostfeld RJ, Freeman AM, McMacken M, Gianos E, Reddy K, Batiste C, Wenger C, Blankstein R, Williams K, Allen K, Seifried RM, Aspry K, Barnard ND. Successful Implementation of Healthful Nutrition Initiatives into Hospitals. Am J Med 2020; 133:19-25. [PMID: 31494109 DOI: 10.1016/j.amjmed.2019.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/14/2019] [Accepted: 08/28/2019] [Indexed: 02/05/2023]
Abstract
Poor dietary quality is a leading contributor to mortality in the United States, and to most cardiovascular risk factors. By providing education on lifestyle changes and, specifically, dietary changes, hospitals have the opportunity to use the patient experience as a "teachable moment." The food options provided to inpatients and outpatients can be a paradigm for patients to follow upon discharge from the hospital. There are hospitals in the United States that are showcasing novel ways to increase awareness of optimal dietary patterns and can serve as a model for hospitals nationwide.
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Affiliation(s)
- Monica Aggarwal
- Division of Cardiology, University of Florida, Gainesville, Florida.
| | - Ariel Grady
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Daya Desai
- University of Florida, Gainesville, Florida
| | | | - Lilian Correa
- Department of Medicine, NYC Health + Hospitals/Bellevue, New York
| | | | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colo
| | | | - Eugenia Gianos
- Division of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Koushik Reddy
- Division of Cardiology, James A. Haley VA Medical Center, Tampa, Fla
| | - Columbus Batiste
- Division of Cardiology, Kaiser Permanente Riverside Medical Center, Riverside, Calif
| | - Christopher Wenger
- Division of Preventative Cardiology, Lancaster General Hospital/Penn Medicine, Lancaster, Pa
| | - Ron Blankstein
- Division of Cardiology, Brigham and Women's Hospital, Boston, Mass
| | - Kim Williams
- Division of Cardiology, Rush University Medical Center, Chicago, Ill
| | - Kathleen Allen
- Geisel School of Medicine, Dartmouth Medical School, Hanover, NH
| | - Rebecca M Seifried
- Division of Cardiology, Walter Reed National Military Medical Center, Bethesda, Md
| | - Karen Aspry
- Brown University, Warren Alperty Medical School, Providence, RI
| | - Neal D Barnard
- George Washington University School of Medicine, and Physicians Committee for Responsible Medicine, Washington, DC
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Zipse MM, Tzou WS, Schuller JL, Aleong RG, Varosy PD, Tompkins C, Borne RT, Tumolo AZ, Sandhu A, Kim D, Freeman AM, Weinberger HD, Maier LA, Sung RK, Nguyen DT, Sauer WH. Electrophysiologic testing for diagnostic evaluation and risk stratification in patients with suspected cardiac sarcoidosis with preserved left and right ventricular systolic function. J Cardiovasc Electrophysiol 2019; 30:1939-1948. [DOI: 10.1111/jce.14058] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Matthew M. Zipse
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
| | - Wendy S. Tzou
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
| | - Joseph L. Schuller
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
| | - Ryan G. Aleong
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
| | - Paul D. Varosy
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
- Division of Cardiology, Section of Cardiac ElectrophysiologyEastern Colorado VA Medical CenterAurora Colorado
| | - Christine Tompkins
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
| | - Ryan T. Borne
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
| | - Alexis Z. Tumolo
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
| | - Amneet Sandhu
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
- Division of Cardiology, Section of Cardiac ElectrophysiologyEastern Colorado VA Medical CenterAurora Colorado
| | - Darlene Kim
- The Divisions of Cardiology and Pulmonary MedicineNational Jewish HealthDenver Colorado
| | - Andrew M. Freeman
- The Divisions of Cardiology and Pulmonary MedicineNational Jewish HealthDenver Colorado
| | - Howard D. Weinberger
- The Divisions of Cardiology and Pulmonary MedicineNational Jewish HealthDenver Colorado
| | - Lisa A. Maier
- The Divisions of Cardiology and Pulmonary MedicineNational Jewish HealthDenver Colorado
| | - Raphael K. Sung
- The Divisions of Cardiology and Pulmonary MedicineNational Jewish HealthDenver Colorado
| | - Duy T. Nguyen
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
| | - William H. Sauer
- Division of Cardiology, Section of Cardiac ElectrophysiologyUniversity of ColoradoAurora Colorado
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30
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Aggarwal M, Bozkurt B, Panjrath G, Aggarwal B, Ostfeld RJ, Barnard ND, Gaggin H, Freeman AM, Allen K, Madan S, Massera D, Litwin SE. Lifestyle Modifications for Preventing and Treating Heart Failure. J Am Coll Cardiol 2018; 72:2391-2405. [DOI: 10.1016/j.jacc.2018.08.2160] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 08/07/2018] [Accepted: 08/12/2018] [Indexed: 12/11/2022]
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Affiliation(s)
- Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Rosanne Nelson
- American College of Cardiology, Organization and Leadership Development, Washington, DC. https://twitter.com/rosanne_nelson1
| | - Shashank S Sinha
- Division of Cardiovascular Medicine, Samuel and Jean Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
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32
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Reddy KR, Freeman AM, Esselstyn CB. An Urgent Need to Incorporate Evidence-Based Nutrition and Lifestyle Medicine Into Medical Training. Am J Lifestyle Med 2018; 13:40-41. [PMID: 30627076 DOI: 10.1177/1559827618781764] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
It is well established that evidence based clinical nutrition and lifestyle practices play a pivotal role in the prevention, treatment and potential reversal of various common chronic diseases. However, this area of science is under appreciated at all levels of medical education and training. Most medical schools and residency programs do not offer any organized training in nutrition and lifestyle medicine. Given recent data on the rising cost and loss of quality of life secondary to preventable causes, there is an absolute need for a drastic reform of the US medical education system.
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Affiliation(s)
- Koushik R Reddy
- James A. Haley Veterans Hospital, Trinity, Florida (KRR).,National Jewish Health, Denver, Colorado (AMF).,Cleveland Clinic, Cleveland, Ohio (CBE)
| | - Andrew M Freeman
- James A. Haley Veterans Hospital, Trinity, Florida (KRR).,National Jewish Health, Denver, Colorado (AMF).,Cleveland Clinic, Cleveland, Ohio (CBE)
| | - Caldwell B Esselstyn
- James A. Haley Veterans Hospital, Trinity, Florida (KRR).,National Jewish Health, Denver, Colorado (AMF).,Cleveland Clinic, Cleveland, Ohio (CBE)
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Aspry KE, Van Horn L, Carson JAS, Wylie-Rosett J, Kushner RF, Lichtenstein AH, Devries S, Freeman AM, Crawford A, Kris-Etherton P. Medical Nutrition Education, Training, and Competencies to Advance Guideline-Based Diet Counseling by Physicians: A Science Advisory From the American Heart Association. Circulation 2018; 137:e821-e841. [DOI: 10.1161/cir.0000000000000563] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Growing scientific evidence of the benefits of heart-healthy dietary patterns and of the massive public health and economic burdens attributed to obesity and poor diet quality have triggered national calls to increase diet counseling in outpatients with atherosclerotic cardiovascular disease or risk factors. However, despite evidence that physicians are willing to undertake this task and are viewed as credible sources of diet information, they engage patients in diet counseling at less than desirable rates and cite insufficient knowledge and training as barriers. These data align with evidence of large and persistent gaps in medical nutrition education and training in the United States. Now, major reforms in undergraduate and graduate medical education designed to incorporate advances in the science of learning and to better prepare physicians for 21st century healthcare delivery are providing a new impetus and novel ways to expand medical nutrition education and training. This science advisory reviews gaps in undergraduate and graduate medical education in nutrition in the United States, summarizes reforms that support and facilitate more robust nutrition education and training, and outlines new opportunities for accomplishing this goal via multidimensional curricula, pedagogies, technologies, and competency-based assessments. Real-world examples of efforts to improve undergraduate and graduate medical education in nutrition by integrating formal learning with practical, experiential, inquiry-driven, interprofessional, and population health management activities are provided. The authors conclude that enhancing physician education and training in nutrition, as well as increasing collaborative nutrition care delivery by 21st century health systems, will reduce the health and economic burdens from atherosclerotic cardiovascular disease to a degree not previously realized.
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Gianos E, Williams KA, Freeman AM, Kris-Etherton P, Aggarwal M. How Pure is PURE? Dietary Lessons Learned and Not Learned From the PURE Trials. Am J Med 2018; 131:457-458. [PMID: 29229470 DOI: 10.1016/j.amjmed.2017.11.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 11/11/2017] [Accepted: 11/13/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Eugenia Gianos
- Department of Medicine, Division of Cardiology, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York.
| | - Kim A Williams
- Department of Medicine, Division of Cardiology, Rush University Medical Center, Chicago, Ill
| | - Andrew M Freeman
- Department of Medicine, Division of Cardiology, National Jewish Health, Denver, Colo
| | | | - Monica Aggarwal
- Department of Medicine, Division of Cardiology, University of Florida Health, Gainesville
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Aggarwal M, Devries S, Freeman AM, Ostfeld R, Gaggin H, Taub P, Rzeszut AK, Allen K, Conti RC. The Deficit of Nutrition Education of Physicians. Am J Med 2018; 131:339-345. [PMID: 29269228 DOI: 10.1016/j.amjmed.2017.11.036] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 11/24/2017] [Accepted: 11/27/2017] [Indexed: 11/24/2022]
Abstract
Globally, death rates from cardiovascular disease are increasing, rising 41% between 1990 and 2013, and are often attributed, at least in part, to poor diet quality. With urbanization, economic development, and mass marketing, global dietary patterns have become more Westernized to include more sugar-sweetened beverages, highly processed foods, animal-based foods, and fewer fruits and vegetables, which has contributed to increasing cardiovascular disease globally. In this paper, we will examine the trends occurring globally in the realm of nutrition and cardiovascular disease prevention and also present new data that international nutrition knowledge amongst cardiovascular disease providers is limited. In turn, this lack of knowledge has resulted in less patient education and counseling, which is having profound effects on cardiovascular disease prevention efforts worldwide.
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Affiliation(s)
- Monica Aggarwal
- Division of Cardiology, University of Florida, Gainesville, FL.
| | - Stephen Devries
- Gaples Institute for Integrative Cardiology, Deerfield, Ill; Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colo
| | - Robert Ostfeld
- Division of Cardiology, Montefiore Medical Center, New York, NY
| | - Hanna Gaggin
- Division of Cardiology, Massachusetts General Hospital, Boston; Baim Institute for Clinical Research, Boston, Mass
| | - Pam Taub
- Cardiovascular Division, UC San Diego Health System, Calif
| | - Anne K Rzeszut
- Market Intelligence, American College of Cardiology, Washington, DC
| | - Kathleen Allen
- Department of Nutrition & Food Studies, New York University, New York, NY
| | - Richard C Conti
- Division of Cardiology, University of Florida, Gainesville, FL
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Tong CW, Madhur MS, Rzeszut AK, Abdalla M, Abudayyeh I, Alexanderson E, Buber J, Feldman DN, Gopinathannair R, Hira RS, Kates AM, Kessler T, Leung S, Raj SR, Spatz ES, Turner MB, Valente AM, West K, Sivaram CA, Hill JA, Mann DL, Freeman AM. Status of Early-Career Academic Cardiology: A Global Perspective. J Am Coll Cardiol 2017; 70:2290-2303. [PMID: 29073958 PMCID: PMC5665176 DOI: 10.1016/j.jacc.2017.09.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/28/2017] [Accepted: 09/14/2017] [Indexed: 01/09/2023]
Abstract
Early-career academic cardiologists, who many believe are an important component of the future of cardiovascular care, face myriad challenges. The Early Career Section Academic Working Group of the American College of Cardiology, with senior leadership support, assessed the progress of this cohort from 2013 to 2016 with a global perspective. Data consisted of accessing National Heart, Lung, and Blood Institute public information, data from the American Heart Association and international organizations, and a membership-wide survey. Although the National Heart, Lung, and Blood Institute increased funding of career development grants, only a small number of early-career American College of Cardiology members have benefited as funding of the entire cohort has decreased. Personal motivation, institutional support, and collaborators continued to be positive influential factors. Surprisingly, mentoring ceased to correlate positively with obtaining external grants. The totality of findings suggests that the status of early-career academic cardiologists remains challenging; therefore, the authors recommend a set of attainable solutions.
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Affiliation(s)
- Carl W Tong
- Department of Medical Physiology, Texas A&M University College of Medicine and Department of Medicine, Division of Cardiology-Temple Region, Baylor Scott & White Health, Temple, Texas.
| | - Meena S Madhur
- Department of Medicine, Division of Clinical Pharmacology and Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anne K Rzeszut
- Market Intelligence, American College of Cardiology, Washington, District of Columbia
| | - Marwah Abdalla
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Islam Abudayyeh
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California
| | - Erick Alexanderson
- National Institute of Cardiology and Medical Physiology, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Jonathan Buber
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Dmitriy N Feldman
- Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York
| | | | - Ravi S Hira
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Andrew M Kates
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - Thorsten Kessler
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Steve Leung
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Satish R Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, Department of Medicine, Division of Cardiovascular Disease, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kristin West
- Member Strategy, American College of Cardiology, Washington, District of Columbia
| | - Chittur A Sivaram
- Department of Medicine, Cardiovascular Section, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Joseph A Hill
- Department of Internal Medicine, Cardiology Division, and Harry S. Moss Heart Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Douglas L Mann
- Center for Cardiovascular Research, Department of Medicine and Washington University School of Medicine, St. Louis, Missouri
| | - Andrew M Freeman
- Department of Medicine, Division of Cardiology, National Jewish Health, Denver, Colorado
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Freeman AM, Morris PB, Barnard N, Esselstyn CB, Ros E, Agatston A, Devries S, O'Keefe J, Miller M, Ornish D, Williams K, Kris-Etherton P. Trending Cardiovascular Nutrition Controversies. J Am Coll Cardiol 2017; 69:1172-1187. [PMID: 28254181 DOI: 10.1016/j.jacc.2016.10.086] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 12/13/2022]
Abstract
The potential cardiovascular benefits of several trending foods and dietary patterns are still incompletely understood, and nutritional science continues to evolve. However, in the meantime, a number of controversial dietary patterns, foods, and nutrients have received significant media exposure and are mired by hype. This review addresses some of the more popular foods and dietary patterns that are promoted for cardiovascular health to provide clinicians with accurate information for patient discussions in the clinical setting.
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Affiliation(s)
- Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colorado.
| | - Pamela B Morris
- Medical University of South Carolina, Charleston, South Carolina
| | - Neal Barnard
- George Washington University School of Medicine; Physicians Committee for Responsible Medicine, Washington, DC
| | | | - Emilio Ros
- Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona and Ciber Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Arthur Agatston
- Herbert Wertheim College of Medicine, Florida International University and Baptist Health of South Florida, Miami, Florida
| | - Stephen Devries
- Gaples Institute for Integrative Cardiology, Deerfield, Illinois; Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James O'Keefe
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Michael Miller
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Dean Ornish
- Preventive Medicine Research Institute, Sausalito, California and University of California-San Francisco, San Francisco, California
| | - Kim Williams
- Rush University Medical Center, Chicago, Illinois
| | - Penny Kris-Etherton
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania
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Lindman BR, Tong CW, Carlson DE, Balke CW, Jackson EA, Madhur MS, Barac A, Abdalla M, Brittain EL, Desai N, Kates AM, Freeman AM, Mann DL. National Institutes of Health Career Development Awards for Cardiovascular Physician-Scientists: Recent Trends and Strategies for Success. J Am Coll Cardiol 2016; 66:1816-1827. [PMID: 26483107 DOI: 10.1016/j.jacc.2015.08.858] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 11/25/2022]
Abstract
Nurturing the development of cardiovascular physician-scientist investigators is critical for sustained progress in cardiovascular science and improving human health. The transition from an inexperienced trainee to an independent physician-scientist is a multifaceted process requiring a sustained commitment from the trainee, mentors, and institution. A cornerstone of this training process is a career development (K) award from the National Institutes of Health (NIH). These awards generally require 75% of the awardee's professional effort devoted to research aims and diverse career development activities carried out in a mentored environment over a 5-year period. We report on recent success rates for obtaining NIH K awards, provide strategies for preparing a successful application and navigating the early career period for aspiring cardiovascular investigators, and offer cardiovascular division leadership perspectives regarding K awards in the current era. Our objective is to offer practical advice that will equip trainees considering an investigator path for success.
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Affiliation(s)
- Brian R Lindman
- Washington University School of Medicine, St. Louis, Missouri
| | - Carl W Tong
- Texas A&M University Health Science Center College of Medicine-Baylor Scott & White Health, Temple, Texas
| | - Drew E Carlson
- Office of Research Training and Career Development, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - C William Balke
- Washington University School of Medicine, St. Louis, Missouri.,John Cochran VA Medical Center, St. Louis, Missouri
| | | | - Meena S Madhur
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ana Barac
- MedStar Heart and Vascular Institute, Washington DC
| | | | - Evan L Brittain
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Nihar Desai
- Yale University School of Medicine, New Haven, Connecticut
| | - Andrew M Kates
- Washington University School of Medicine, St. Louis, Missouri
| | | | - Douglas L Mann
- Washington University School of Medicine, St. Louis, Missouri
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40
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Abdalla M, Kovach N, Liu C, Damp JB, Jahangir E, Hilliard A, Gopinathannair R, Abu-Fadel MS, El Chami MF, Gafoor S, Vedanthan R, Sanchez-Shields M, George JC, Priester T, Alasnag M, Barker C, Freeman AM. The Importance of Global Health Experiences in the Development of New Cardiologists. J Am Coll Cardiol 2016; 67:2789-2797. [PMID: 26763797 DOI: 10.1016/j.jacc.2015.10.089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/21/2015] [Indexed: 11/28/2022]
Abstract
As the global burden of cardiovascular disease continues to increase worldwide, nurturing the development of early-career cardiologists interested in global health is essential to create a cadre of providers with the skill set to prevent and treat cardiovascular diseases in international settings. As such, interest in global health has increased among cardiology trainees and early-career cardiologists over the past decade. International clinical and research experiences abroad present an additional opportunity for growth and development beyond traditional cardiovascular training. We describe the American College of Cardiology International Cardiovascular Exchange Database, a new resource for cardiologists interested in pursuing short-term clinical exchange opportunities abroad, and report some of the benefits and challenges of global health cardiovascular training in both resource-limited and resource-abundant settings.
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Affiliation(s)
- Marwah Abdalla
- Department of Medicine/Division of Cardiology, Columbia University Medical Center, New York, New York.
| | - Neal Kovach
- International Affairs, American College of Cardiology, Washington, DC
| | - Connie Liu
- International Affairs, American College of Cardiology, Washington, DC
| | - Julie B Damp
- Department of Medicine/Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eiman Jahangir
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, Louisiana
| | - Anthony Hilliard
- Division of Cardiology, Loma Linda University, Loma Linda, California
| | | | - Mazen S Abu-Fadel
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Mikhael F El Chami
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Sameer Gafoor
- Cardiovascular Center Frankfurt, Frankfurt, Germany, and the Swedish Heart and Vascular Institute, Seattle, Washington
| | - Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Monica Sanchez-Shields
- Department of Medicine/Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Jon C George
- Deborah Heart and Lung Center, Browns Mills, New Jersey
| | - Tiffany Priester
- Division of Cardiology, Loma Linda University, Loma Linda, California; School of Medicine, Loma Linda University, Loma Linda, California, and Department of Cardiology, Blantyre Adventist Hospital, Blantyre, Malawi
| | - Mirvat Alasnag
- Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | | | - Andrew M Freeman
- Department of Medicine/Division of Cardiology, National Jewish Health, Denver, Colorado
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Bullock-Palmer RP, Freeman AM, Kontak A, Shaw LJ, Dickert NW, Henzlova M, Shirani J, Dorbala S, Dilsizian V, Einstein AJ. Collegial pressure and patient-centered shared-decision making: A case-based ethics discussion. J Nucl Cardiol 2015; 22:920-2. [PMID: 26271957 DOI: 10.1007/s12350-015-0230-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 06/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Andrew Kontak
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Leslee J Shaw
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Emory Clinical Cardiovascular Research Institute, Atlanta, GA, USA
| | - Neal W Dickert
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Emory Clinical Cardiovascular Research Institute, Atlanta, GA, USA
| | - Milena Henzlova
- Mount Sinai Heart, Mount Sinai Medical Center, New York, NY, USA
| | - Jamshid Shirani
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Sharmila Dorbala
- Noninvasive Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiology), Brigham and Women's Hospital, Boston, MA, USA
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD, USA
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
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42
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Barac A, Murtagh G, Carver JR, Chen MH, Freeman AM, Herrmann J, Iliescu C, Ky B, Mayer EL, Okwuosa TM, Plana JC, Ryan TD, Rzeszut AK, Douglas PS. Cardiovascular Health of Patients With Cancer and Cancer Survivors: A Roadmap to the Next Level. J Am Coll Cardiol 2015; 65:2739-46. [PMID: 26112199 DOI: 10.1016/j.jacc.2015.04.059] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 04/30/2015] [Indexed: 11/19/2022]
Abstract
Many existing and emerging cancer therapies have a significant effect on the cardiovascular health of patients with cancer and cancer survivors. This paper examines current aspects of interdisciplinary cardio-oncology clinical care delivery and education in the United States and outlines how these data provide a platform for future development of the field. We present the results of the nationwide survey on cardio-oncology services, practices, and opinions, conducted among chiefs of cardiology and program directors, which demonstrate ranges of clinical activities and identify significant interest for increased educational opportunities and expert training of cardiovascular physicians in this field. The survey respondents recognized clinical relevance but emphasized lack of national guidelines, lack of funds, and limited awareness and infrastructure as the main challenges for development and growth of cardio-oncology. We discuss potential solutions to unmet needs through interdisciplinary collaboration and the active roles of professional societies and other stakeholders.
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Affiliation(s)
- Ana Barac
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC.
| | | | - Joseph R Carver
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ming Hui Chen
- Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Joerg Herrmann
- Mayo Clinic and College of Medicine, Rochester, Minnesota
| | | | - Bonnie Ky
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erica L Mayer
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | | | - Thomas D Ryan
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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43
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Freeman AM. HOW YOUNG PHYSICIANS CAN MASTER LEADERSHIP ROLES. Med Econ 2015; 92:38-39. [PMID: 26299049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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45
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Tong CW, Ahmad T, Brittain EL, Bunch TJ, Damp JB, Dardas T, Hijar A, Hill JA, Hilliard AA, Houser SR, Jahangir E, Kates AM, Kim D, Lindman BR, Ryan JJ, Rzeszut AK, Sivaram CA, Valente AM, Freeman AM. Challenges facing early career academic cardiologists. J Am Coll Cardiol 2014; 63:2199-208. [PMID: 24703919 PMCID: PMC4306449 DOI: 10.1016/j.jacc.2014.03.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 03/01/2014] [Accepted: 03/04/2014] [Indexed: 11/26/2022]
Abstract
Early career academic cardiologists currently face unprecedented challenges that threaten a highly valued career path. A team consisting of early career professionals and senior leadership members of American College of Cardiology completed this white paper to inform the cardiovascular medicine profession regarding the plight of early career cardiologists and to suggest possible solutions. This paper includes: 1) definition of categories of early career academic cardiologists; 2) general challenges to all categories and specific challenges to each category; 3) obstacles as identified by a survey of current early career members of the American College of Cardiology; 4) major reasons for the failure of physician-scientists to receive funding from National Institute of Health/National Heart Lung and Blood Institute career development grants; 5) potential solutions; and 6) a call to action with specific recommendations.
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Affiliation(s)
- Carl W Tong
- Department of Medical Physiology and Department of Medicine/Cardiology Division, Texas A&M University Health Science Center-Baylor Scott & White Healthcare, Temple, Texas.
| | - Tariq Ahmad
- Duke University Medical Center, Durham, North Carolina
| | - Evan L Brittain
- Department of Medicine/Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - T Jared Bunch
- Heart Rhythm Program, Intermountain Medical Center, Murray, Utah
| | - Julie B Damp
- Department of Medicine/Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd Dardas
- Department of Internal Medicine, University of Washington Medical Center, Seattle, Washington
| | - Amalea Hijar
- Member Strategy and Career Development Department, American College of Cardiology, Washington, DC
| | - Joseph A Hill
- Department of Internal Medicine/Cardiology Division and Harry S. Moss Heart Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anthony A Hilliard
- Department of Medicine/Cardiology Division, Loma Linda University Medical Center, Loma Linda, California
| | - Steven R Houser
- Department of Physiology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Eiman Jahangir
- Department of Cardiology, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, Louisiana
| | - Andrew M Kates
- Department of Medicine/Cardiology Division, Washington University School of Medicine, St. Louis, Missouri
| | - Darlene Kim
- Department of Medicine/Division of Cardiology, National Jewish Health, Denver, Colorado
| | - Brian R Lindman
- Department of Medicine/Cardiology Division, Washington University School of Medicine, St. Louis, Missouri
| | - John J Ryan
- Department of Medicine/Division of Cardiology, University of Utah Health Care, Salt Lake City, Utah
| | - Anne K Rzeszut
- Member Strategy and Career Development Department, American College of Cardiology, Washington, DC
| | - Chittur A Sivaram
- Department of Medicine/Cardiovascular Section, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Anne Marie Valente
- Department of Cardiology, Harvard Medical School, Brigham and Women's Hospital, and Boston Children's Hospital, Boston, Massachusetts
| | - Andrew M Freeman
- Department of Medicine/Division of Cardiology, National Jewish Health, Denver, Colorado
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Freeman AM, Curran-Everett D, Sabgir D. How starting a patient education/fitness program can improve health. 'Walk with a Doc' program shows you how to model healthy behaviors and strengthen the patient-physician bond. Med Econ 2014; 91:42-48. [PMID: 25211845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Fenster BE, Curran-Everett D, Freeman AM, Weinberger HD, Kern Buckner J, Carroll JD. Saline Contrast Echocardiography for the Detection of Patent Foramen Ovale in Hypoxia: A Validation Study Using Intracardiac Echocardiography. Echocardiography 2013; 31:420-7. [DOI: 10.1111/echo.12403] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Douglas Curran-Everett
- Division of Biostatistics and Bioinformatics; National Jewish Health; Denver Colorado
- Division of Biostatistics and Informatics; Colorado School of Public Health; Aurora Colorado
| | | | | | - J. Kern Buckner
- Division of Cardiology; National Jewish Health; Denver Colorado
| | - John D. Carroll
- Division of Cardiology; University of Colorado; Aurora Colorado
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Fenster BE, Nguyen BH, Buckner JK, Freeman AM, Carroll JD. Effectiveness of percutaneous closure of patent foramen ovale for hypoxemia. Am J Cardiol 2013; 112:1258-62. [PMID: 23871675 DOI: 10.1016/j.amjcard.2013.06.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 06/11/2013] [Accepted: 06/11/2013] [Indexed: 11/16/2022]
Abstract
The aim of this study was to evaluate the ability of percutaneous patent foramen ovale (PFO) closure to improve systemic hypoxemia. Although PFO-mediated right-to-left shunt (RTLS) is associated with hypoxemia, the ability of percutaneous closure to ameliorate hypoxemia is unknown. Between 2004 and 2009, 97 patients who underwent PFO closure for systemic hypoxemia and dyspnea that was disproportionate to underlying lung disease were included for evaluation. All patients exhibited PFO-mediated RTLS as determined by agitated saline echocardiography. Procedural success was defined as implantation of a device without major complications and mild or no residual shunt at 6 months. Clinical success was defined as a composite of an improvement in New York Heart Association (NYHA) functional class, reduction of dyspnea symptoms, or decreased oxygen requirement. Procedural success was achieved in 96 of 97 (99%), and clinical success was achieved in 68 of 97 (70%). The presence of any moderate or severe interatrial shunt by agitated saline study (odds ratio [OR] = 4.7; p <0.024), NYHA class at referral (OR = 2.9; p <0.0087), and 10-year increase in age (OR = 1.8; p <0.0017) increased likelihood of clinical success. In contrast, a pulmonary comorbidity (OR = 0.18; p <0.005) and male gender (OR = 0.30; p <0.017) decreased the likelihood of success. In conclusion, based on the largest single-center experience of patients referred for PFO closure for systemic hypoxemia, PFO closure was a mechanically effective procedure with an associated improvement in echocardiographic evidence of RTLS, NYHA functional class, and oxygen requirement.
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Affiliation(s)
- Brett E Fenster
- Division of Cardiology, National Jewish Health, Denver, Colorado.
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Norine Walsh M, Bove AA, Cross RR, Ferdinand KC, Forman DE, Freeman AM, Hughes S, Klodas E, Koplan M, Lewis WR, MacDonnell B, May DC, Messer JV, Pressler SJ, Sanz ML, Spertus JA, Spinler SA, Evan Teichholz L, Wong JB, Doermann Byrd K. ACCF 2012 Health Policy Statement on Patient-Centered Care in Cardiovascular Medicine. J Am Coll Cardiol 2012; 59:2125-43. [DOI: 10.1016/j.jacc.2012.03.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Freeman AM, Fenster BE, Weinberger HD, Buckner JK, Lynch D. Hypoxia caused by persistent left superior vena cava connecting to the left atrium a rare clinical entity. Tex Heart Inst J 2012; 39:662-664. [PMID: 23109762 PMCID: PMC3461683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We relate the case of a 40-year-old man with a history of premature birth and dextroposition of the heart who presented for an evaluation of persistent hypoxia. An unrevealing pulmonary evaluation and agitated-saline echocardiogram led to cardiac magnetic resonance imaging. This revealed a very unusual finding: a persistent left superior vena cava with insertion into the left atrium and a small connecting vein between the right and left superior venae cavae. The implications, embryology, and pathogenesis of this rare condition are discussed.
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Affiliation(s)
- Andrew M Freeman
- Department of Medicine, Division of Cardiology, National Jewish Health, Denver, Colorado 80207, USA.
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