1
|
Athreya DS, Saczynski JS, Gurwitz JH, Monahan KM, Bamgbade BA, Paul TJ, Sogade F, Lessard DM, McManus DD, Helm RH. Cognitive impairment and treatment strategy for atrial fibrillation in older adults: The SAGE-AF study. J Am Geriatr Soc 2024. [PMID: 38742376 DOI: 10.1111/jgs.18949] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Cognitive impairment is strongly associated with atrial fibrillation (AF). Rate and rhythm control are the two treatment strategies for AF and the effect of treatment strategy on risk of cognitive decline and frailty is not well established. We sought to determine how treatment strategy affects geriatric-centered outcomes. METHODS The Systematic Assessment of Geriatric Elements-AF (SAGE-AF) was a prospective, observational, cohort study. Older adults with AF were prospectively enrolled between 2016 and 2018 and followed longitudinally for 2 years. In a non-randomized fashion, participants were grouped by rate or rhythm control treatment strategy based on clinical treatment at enrollment. Baseline characteristics were compared. Longitudinal binary mixed models were used to compare treatment strategy with respect to change in cognitive function and frailty status. Cognitive function and frailty status were assessed with the Montreal Cognitive Assessment Battery and Fried frailty phenotype tools. RESULTS 972 participants (mean age = 75, SD = 6.8; 49% female, 87% non-Hispanic white) completed baseline examination and 2-year follow-up. 408 (42%) were treated with rate control and 564 (58%) with rhythm control. The patient characteristics of the two groups were different at baseline. Participants in the rate control group were older, more likely to have persistent AF, prior stroke, be treated with warfarin and have baseline cognitive impairment. After adjusting for baseline differences, participants treated with rate control were 1.5 times more likely to be cognitively impaired over 2 years (adjusted OR: 1.47, 95% CI:1.12, 1.98) and had a greater decline in cognitive function (adjusted estimate: -0.59 (0.23), p < 0.01) in comparison to rhythm control. Frailty did not vary between the treatment strategies. CONCLUSIONS Among those who had 2-year follow-up in non-randomized observational cohort, the decision to rate control AF in older adults was associated with increased odds of decline in cognitive function but not frailty.
Collapse
Affiliation(s)
- Deepti S Athreya
- College of Science, Northeastern University, Boston, Massachusetts, USA
| | - Jane S Saczynski
- Department of Pharmacy and Health System Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Jerry H Gurwitz
- Meyers Primary Care Institute and Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kevin M Monahan
- Evans Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Benita A Bamgbade
- Department of Pharmacy and Health System Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Tenes J Paul
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Felix Sogade
- Department of Medicine, Mercer University School of Medicine, Mercer, Georgia, USA
| | - Darleen M Lessard
- Division of Epidemiology of Chronic Diseases, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - David D McManus
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Robert H Helm
- Evans Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Bamgbade BA, McManus DD, Briesacher BA, Lessard D, Mehawej J, Gurwitz JH, Tisminetzky M, Mujumdar S, Wang W, Malihot T, Abu HO, Waring M, Sogade F, Madden J, Pierre-Louis IC, Helm R, Goldberg R, Kramer AF, Saczynski JS. Medication cost-reducing behaviors in older adults with atrial fibrillation: The SAGE-AF study. J Am Pharm Assoc (2003) 2023; 63:125-134. [PMID: 36171156 PMCID: PMC10699884 DOI: 10.1016/j.japh.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND As patient prices for many medications have risen steeply in the United States, patients may engage in cost-reducing behaviors (CRBs) such as asking for generic medications or purchasing medication from the Internet. OBJECTIVE The objective of this study is to describe patterns of CRB, cost-related medication nonadherence, and spending less on basic needs to afford medications among older adults with atrial fibrillation (AF) and examine participant characteristics associated with CRB. METHODS Data were from a prospective cohort study of older adults at least 65 years with AF and a high stroke risk (CHA2DS2VASc ≥ 2). CRB, cost-related medication nonadherence, and spending less on basic needs to afford medications were evaluated using validated measures. Chi-square and t tests were used to evaluate differences in characteristics across CRB, and statistically significant characteristics (P < 0.05) were entered into a multivariable logistic regression to examine factors associated with CRB. RESULTS Among participants (N = 1224; mean age 76 years; 49% female), 69% reported engaging in CRB, 4% reported cost-related medication nonadherence, and 6% reported spending less on basic needs. Participants who were cognitively impaired (adjusted odds ratio 0.69 [95% CI 0.52-0.91]) and those who did not identify as non-Hispanic white (0.66 [0.46-0.95]) were less likely to engage in CRB. Participants who were married (1.88 [1.30-2.72]), had a household income of $20,000-$49,999 (1.52 [1.02-2.27]), had Medicare insurance (1.38 [1.04-1.83]), and had 4-6 comorbidities (1.43 [1.01-2.01]) had significantly higher odds of engaging in CRB. CONCLUSION Although CRBs were common among older adults with AF, few reported cost-related medication nonadherence and spending less on basic needs. Patients with cognitive impairment may benefit from pharmacist intervention to provide support in CRB and patient assistance programs.
Collapse
Affiliation(s)
- Benita A. Bamgbade
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA
| | - David D. McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA; and Professor, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Becky A. Briesacher
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA
| | - Darleen Lessard
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA; and Biostatistician, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Jerry H. Gurwitz
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA; Executive Director, Meyers Health Care Institute, Worcester, MA; and Professor, Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Mayra Tisminetzky
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA; and Associate Professor, Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA
| | | | - Weija Wang
- Department of Cardiology, Johns Hopkins Hospital, Baltimore, MD
| | - Tanya Malihot
- Faculty of Nursing, Universite de Montreal, Montreal, Quebec, Canada; and Member, Montreal Heart Institute Research Center, Montreal, Quebec, Canada
| | - Hawa O. Abu
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Molly Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT
| | - Felix Sogade
- Department of Medicine, Mercer University School of Medicine, Mercer, GA
| | - Jeanne Madden
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA
| | | | - Robert Helm
- Cardiovascular Medicine, Department of Medicine, School of Medicine, Boston University, Boston, MA
| | - Robert Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Arthur F. Kramer
- Department of Psychology, Northeastern University, Boston, MA; and Professor, Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Jane S. Saczynski
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA
| |
Collapse
|
3
|
Chrispin J, Frazier-Mills C, Sogade F, Wan EY, Clair WK. Pandemic Highlights Disparities in Health Care. Circ Arrhythm Electrophysiol 2021; 14:e009908. [PMID: 33993701 DOI: 10.1161/circep.121.009908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jonathan Chrispin
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (J.C.)
| | - Camille Frazier-Mills
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (C.F.-M.)
| | - Felix Sogade
- Georgia Arrhythmia Consultants and Research Institute, Macon, GA (F.S.)
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY (E.Y.W.)
| | - Walter K Clair
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (W.K.C.)
| |
Collapse
|
4
|
Eyituoyo HO, Arinze NC, Aben RN, Sogade F. Ischemic Stroke in a Patient With Atrial Tachycardia, Methylenetetrahydrofolate Reductase Mutation and New-Onset Atrial Fibrillation: Is Early Initiation of Anticoagulation Therapy Indicated? Cureus 2020; 12:e9420. [PMID: 32864247 PMCID: PMC7449620 DOI: 10.7759/cureus.9420] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Atrial fibrillation is the most common dysrhythmia, affecting about 6 million people in the United States. Atrial fibrillation has been shown to be an independent risk factor for stroke. Atrial tachycardia are common findings on Holter monitoring in the general population and may be associated with the development of atrial remodeling and atrial fibrillation inducibility. Studies have shown that atrial tachycardia is associated with the development of atrial fibrillation and subsequent stroke. The American Heart Association current guidelines recommend the use of oral anticoagulants in patients with atrial fibrillation and an elevated CHA2DS2-VASc ≥2 in men or ≥3 in women. However, anticoagulant therapy is not currently recommended in patients with atrial tachycardia despite increasing evidence of its association with the development of stroke. We report the case of a 68-year-old woman with a past medical history significant for repetitive atrial tachycardia and methylenetetrahydrofolate reductase mutation who presented to an outside emergency department following a fall, weakness and associated aphasia while in atrial fibrillation. Thrombolysis and control of the patient's rhythm resulted in an initial improvement in the patient symptoms and reversal to normal sinus rhythm. She was subsequently referred to a tertiary stroke center for further management.
Collapse
Affiliation(s)
- Harry O Eyituoyo
- Internal Medicine/Community Medicine, Mercer University School of Medicine, Macon, USA
| | - Nkechi C Arinze
- Internal Medicine/Community Medicine, Mercer University School of Medicine, Macon, USA
| | - Rieta N Aben
- Internal Medicine/Community Medicine, Mercer University School of Medicine, Macon, USA
| | - Felix Sogade
- Electrophysiology, Georgia Arrhythmia Consultants and Research Institute, Macon, USA
| |
Collapse
|
5
|
Rwebembera J, Jeilan M, Ajijola OA, Talle M, Sani MU, Karaye KM, Yuyun MF, Nel G, Akinyi L, Subahi S, Aboulmaaty M, Sogade F, Aoudia Y, Mbakwem A, Tantchou C, Salim M, Tayebjee MH, Poku JW, Vezi B, Kaviraj B, Ngantcha M, Chin A, Bonny A. Cardiac Pacing Training in Africa. J Am Coll Cardiol 2020; 76:465-472. [DOI: 10.1016/j.jacc.2020.04.079] [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: 03/03/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 10/23/2022]
|
6
|
Bonny A, Ajijola OA, Jeilan M, Sani M, Yousef Z, Yuyun MF, Karaye K, Nahib MA, Aoudia Y, Akinyi L, Ngantcha M, Subahi S, Sogade F, Chin A. Cardiac pacing in sub-Saharan Africa. Cardiovasc J Afr 2020; 31:3-4. [PMID: 31995114 DOI: 10.5830/cvja-2020-001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Aimé Bonny
- District Hospital Bonassama, University of Douala, Cameroon; Douala Cardiovascular Research Network 'homeland'.
| | - Olujimi A Ajijola
- Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, USA
| | | | - Mahmoud Sani
- Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Matthew F Yuyun
- VA Boston Healthcare System and Harvard Medical School, Boston, USA
| | - Kamilu Karaye
- Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | | | | | | | - Saad Subahi
- Department of Cardiology, Khartoum Teaching Hospital, Khartoum, Sudan
| | - Felix Sogade
- Georgia Arrhythmia Consultants & Research Institute, Macon, Georgia, USA
| | - Ashley Chin
- Groote Schuur Hospital/University of Cape Town, South Africa
| |
Collapse
|
7
|
McManus DD, Kiefe C, Lessard D, Waring ME, Parish D, Awad HH, Marino F, Helm R, Sogade F, Goldberg R, Hayward R, Gurwitz J, Wang W, Mailhot T, Barton B, Saczynski J. Geriatric Conditions and Prescription of Vitamin K Antagonists vs. Direct Oral Anticoagulants Among Older Patients With Atrial Fibrillation: SAGE-AF. Front Cardiovasc Med 2019; 6:155. [PMID: 31737647 PMCID: PMC6831524 DOI: 10.3389/fcvm.2019.00155] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Received: 06/17/2019] [Accepted: 10/11/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Geriatric conditions are common among patients with atrial fibrillation (AF) and relate to complications of oral anticoagulation (OAC). Objective: To examine the prevalence of geriatric conditions among older patients with AF on OAC and relate type of OAC to geriatric conditions. Methods: Participants had a diagnosis of AF, were aged ≥65 years, CHA2DS2VASC ≥ 2, and had no OAC contraindications. Participants completed a 6-component geriatric assessment that included validated measures of frailty (CHS Frailty Scale), cognitive function (MoCA), social support (MOS), depressive symptoms (PHQ9), vision, and hearing. Type of OAC prescribed was documented in medical records. Results: 86% of participants were prescribed an OAC. These participants were on average aged 75.7 (SD: 7.1) years, 49% were women, two thirds were frail or pre-frail, and 44% received a DOAC. DOAC users were younger, had lower CHA2DS2VASC and HAS-BLED scores, and were less likely to be frail. In Massachusetts, pre-frailty was associated with a significantly lower odds of DOAC vs. VKA use (OR = 0.64, 95%CI 0.45, 0.91). Pre-frailty (OR = 0.33, 95%CI 0.18–0.59) and social isolation (OR = 0.38, 95%CI 0.14–0.99) were associated with lower odds of DOAC receipt in patients aged 75 years or older. Social isolation was associated with higher odds of DOAC use (OR = 2.13, 95%CI 1.05–4.29) in patients aged 65–74 years. Conclusions: Geriatric conditions were common and related to type of OAC prescribed, differentially by age group. Research is needed to evaluate whether a geriatric examination can be used clinically to better inform OAC decision-making in older patients with AF.
Collapse
Affiliation(s)
- David D McManus
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.,Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Catarina Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.,Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Molly E Waring
- Department of Allied Health Sciences, University of Connecticut, Mansfield, MA, United States
| | - David Parish
- Department of Community Medicine/Internal Medicine, Mercer University School of Medicine, Macon, GA, United States
| | - Hamza H Awad
- Department of Community Medicine/Internal Medicine, Mercer University School of Medicine, Macon, GA, United States
| | - Francesca Marino
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Robert Helm
- Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Felix Sogade
- Department of Medicine, Mercer University School of Medicine, Macon, GA, United States
| | - Robert Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Robert Hayward
- Department of Electrophysiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, United States
| | - Jerry Gurwitz
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Weijia Wang
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Tanya Mailhot
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA, United States.,Montreal Heart Institute Research Center, Montreal, QC, Canada
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jane Saczynski
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA, United States
| |
Collapse
|
8
|
Saczynski JS, Sanghai SR, Kiefe CI, Lessard D, Marino F, Waring ME, Parish D, Helm R, Sogade F, Goldberg R, Gurwitz J, Wang W, Mailhot T, Bamgbade B, Barton B, McManus DD. Geriatric Elements and Oral Anticoagulant Prescribing in Older Atrial Fibrillation Patients: SAGE-AF. J Am Geriatr Soc 2019; 68:147-154. [PMID: 31574165 DOI: 10.1111/jgs.16178] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [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: 06/25/2019] [Revised: 08/23/2019] [Accepted: 08/23/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Oral anticoagulants are the cornerstone of stroke prevention in high-risk patients with atrial fibrillation (AF). Geriatric elements, such as cognitive impairment and frailty, commonly occur in these patients and are often cited as reasons for not prescribing oral anticoagulants. We sought to systematically assess geriatric impairments in patients with AF and determine whether they were associated with oral anticoagulant prescribing. DESIGN Cross-sectional analysis of baseline data from the ongoing Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) prospective cohort study. SETTING Multicenter study with site locations in Massachusetts and Georgia that recruited participants from cardiology, electrophysiology, and primary care clinics from 2016 to 2018. PARTICIPANTS Participants with AF age 65 years or older, CHA2 DS2 -VASc (congestive heart failure; hypertension; aged ≥75 y [doubled]; diabetes mellitus; prior stroke, transient ischemic attack, or thromboembolism [doubled]; vascular disease; age 65-74; female sex) score of 2 or higher, and no oral anticoagulant contraindications (n = 1244). MEASUREMENTS A six-component geriatric assessment included validated measures of frailty, cognitive function, social support, depressive symptoms, vision, and hearing. Oral anticoagulant use was abstracted from the medical record. RESULTS A total of 1244 participants (mean age = 76 y; 49% female; 85% white) were enrolled; 42% were cognitively impaired, 14% frail, 53% pre-frail, 12% socially isolated, and 29% had depressive symptoms. Oral anticoagulants were prescribed to 86% of the cohort. Oral anticoagulant prescribing did not vary according to any of the geriatric elements (adjusted odds ratios [ORs] for oral anticoagulant prescribing and cognitive impairment: OR = .75; 95% confidence interval [CI] = .51-1.09; frail OR = .69; 95% CI = .35-1.36; social isolation OR = .90; 95% CI = .52-1.54; depression OR = .79; 95% CI = .49-1.27; visual impairment OR = .98; 95% CI = .65-1.48; and hearing impairment OR = 1.05; 95% CI = .71-1.54). CONCLUSION Geriatric impairments, particularly cognitive impairment and frailty, were common in our cohort, but treatment with oral anticoagulants did not differ by impairment status. These geriatric impairments are commonly cited as reasons for not prescribing oral anticoagulants, suggesting that prescribers may either be unaware or deliberately ignoring the presence of these factors in clinical settings. J Am Geriatr Soc 68:147-154, 2019.
Collapse
Affiliation(s)
- Jane S Saczynski
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, Massachusetts
| | - Saket R Sanghai
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Darleen Lessard
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Francesca Marino
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Molly E Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut
| | - David Parish
- Department of Community Medicine/ Internal Medicine, Mercer University School of Medicine, Macon, Georgia
| | - Robert Helm
- Department of Medicine, Boston University Medical Center, Boston, Massachusetts
| | - Felix Sogade
- Department of Medicine, Mercer University School of Medicine, Mercer, Georgia
| | - Robert Goldberg
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jerry Gurwitz
- Geriatric Medicine Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Weijia Wang
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Tanya Mailhot
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, Massachusetts.,Montreal Heart Institute Research Center, Montreal, Quebec, Canada
| | - Benita Bamgbade
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, Massachusetts
| | - Bruce Barton
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - David D McManus
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| |
Collapse
|
9
|
Wang W, Saczynski J, Lessard D, Mailhot T, Barton B, Waring ME, Sogade F, Hayward R, Helm R, McManus DD. Physical, cognitive, and psychosocial conditions in relation to anticoagulation satisfaction among elderly adults with atrial fibrillation: The SAGE-AF study. J Cardiovasc Electrophysiol 2019; 30:2508-2515. [PMID: 31515920 DOI: 10.1111/jce.14176] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 05/24/2019] [Revised: 08/29/2019] [Accepted: 09/06/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Successful anticoagulation is critical for stroke prevention in adults with atrial fibrillation (AF). Anticoagulation satisfaction is a key indicator of treatment success. While physical, cognitive, and psychosocial limitations are common in elderly AF patients, their associations with anticoagulation satisfaction are unknown. OBJECTIVE Examine whether anticoagulation satisfaction differs among AF patients with and without physical, cognitive, and psychosocial conditions. METHODS The study comprised AF patients greater than or equal to 65 years old who were prescribed an oral anticoagulant (warfarin 57%; direct oral anticoagulant [DOAC] 43%). Frailty, cognitive function, social support, depressive symptoms, vision, hearing, and anxiety were assessed using validated measures. Anticoagulation satisfaction was measured using the anticlot treatment scale. RESULTS Participants (n = 1037, 50% female) were on average 76 years old. The following conditions were prevalent: frailty (14%), cognitive impairment (42%), social isolation (13%), vision impairment (35%), hearing impairment (36%), depression (29%), and anxiety (24%). Average anticlot treatment burden scale was 55 out of 60 (lower burden scales indicating higher perceived burden). Patients with high perceived burden were older, more likely to be female, and receive warfarin. After adjusting for confounders, visual impairment (adjusted odds ratio [95% confidence interval]: 1.7 [1.2-2.4]), depressive symptoms (2.4 [1.6-3.7]), and anxiety (1.8 [1.2-2.7]) were significantly associated with high perceived burden. Different conditions were associated with high perceived burden in warfarin vs DOAC users. CONCLUSION Physical, cognitive, and psychosocial limitations are prevalent and associated with high perceived anticoagulation burden among elderly AF adults. These conditions merit consideration in anticoagulation prescribing.
Collapse
Affiliation(s)
- Weijia Wang
- Department of Medicine, Cardiology Division, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jane Saczynski
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, Massachusetts
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Tanya Mailhot
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, Massachusetts
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Molly E Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut
| | - Felix Sogade
- Department of Medicine, School of Medicine, Mercer University, Macon, Georgia
| | - Robert Hayward
- Department of Medicine, Cardiology Division, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Robert Helm
- Department of Medicine, School of Medicine, Boston University, Boston, Massachusetts
| | - David D McManus
- Department of Medicine, Cardiology Division, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| |
Collapse
|
10
|
Ofili EO, Schanberg LE, Hutchinson B, Sogade F, Fergus I, Duncan P, Hargrove J, Artis A, Onyekwere O, Batchelor W, Williams M, Oduwole A, Onwuanyi A, Ojutalayo F, Cross JA, Seto TB, Okafor H, Pemu P, Immergluck L, Foreman M, Mensah EA, Quarshie A, Mubasher M, Baker A, Ngare A, Dent A, Malouhi M, Tchounwou P, Lee J, Hayes T, Abdelrahim M, Sarpong D, Fernandez-Repollet E, Sodeke SO, Hernandez A, Thomas K, Dennos A, Smith D, Gbadebo D, Ajuluchikwu J, Kong BW, McCollough C, Weiler SR, Natter MD, Mandl KD, Murphy S. The Association of Black Cardiologists (ABC) Cardiovascular Implementation Study (CVIS): A Research Registry Integrating Social Determinants to Support Care for Underserved Patients. Int J Environ Res Public Health 2019; 16:ijerph16091631. [PMID: 31083298 PMCID: PMC6539418 DOI: 10.3390/ijerph16091631] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/14/2019] [Accepted: 02/28/2019] [Indexed: 01/12/2023]
Abstract
African Americans, other minorities and underserved populations are consistently under- represented in clinical trials. Such underrepresentation results in a gap in the evidence base, and health disparities. The ABC Cardiovascular Implementation Study (CVIS) is a comprehensive prospective cohort registry that integrates social determinants of health. ABC CVIS uses real world clinical practice data to address critical gaps in care by facilitating robust participation of African Americans and other minorities in clinical trials. ABC CVIS will include diverse patients from collaborating ABC member private practices, as well as patients from academic health centers and Federally Qualified Health Centers (FQHCs). This paper describes the rationale and design of the ABC CVIS Registry. The registry will: (1) prospectively collect socio-demographic, clinical and biospecimen data from enrolled adults, adolescents and children with prioritized cardiovascular diseases; (2) Evaluate the safety and clinical outcomes of new therapeutic agents, including post marketing surveillance and pharmacovigilance; (3) Support National Institutes of Health (NIH) and industry sponsored research; (4) Support Quality Measures standards from the Center for Medicare and Medicaid Services (CMS) and Commercial Health Plans. The registry will utilize novel data and technology tools to facilitate mobile health technology application programming interface (API) to health system or practice electronic health records (EHR). Long term, CVIS will become the most comprehensive patient registry for underserved diverse patients with cardiovascular disease (CVD) and co morbid conditions, providing real world data to address health disparities. At least 10,000 patients will be enrolled from 50 sites across the United States.
Collapse
Affiliation(s)
- Elizabeth O Ofili
- Department of Clinical Research Center, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, USA.
| | - Laura E Schanberg
- Department of Pediatrics, Duke Clinical Research Institute, Duke University School of Medicine, 2400 Pratt St., Durham, NC 27705, USA.
| | - Barbara Hutchinson
- Association of Black Cardiologists,2400 N Street, Suite 200, Washington, DC 20037, USA.
| | - Felix Sogade
- Association of Black Cardiologists,2400 N Street, Suite 200, Washington, DC 20037, USA.
| | - Icilma Fergus
- Association of Black Cardiologists,2400 N Street, Suite 200, Washington, DC 20037, USA.
| | - Phillip Duncan
- Association of Black Cardiologists,2400 N Street, Suite 200, Washington, DC 20037, USA.
| | - Joe Hargrove
- Department of Pediatrics, Duke Clinical Research Institute, Duke University School of Medicine, 2400 Pratt St., Durham, NC 27705, USA.
| | - Andre Artis
- Association of Black Cardiologists,2400 N Street, Suite 200, Washington, DC 20037, USA.
| | - Osita Onyekwere
- Association of Black Cardiologists,2400 N Street, Suite 200, Washington, DC 20037, USA.
| | - Wayne Batchelor
- Association of Black Cardiologists,2400 N Street, Suite 200, Washington, DC 20037, USA.
| | - Marcus Williams
- Association of Black Cardiologists,2400 N Street, Suite 200, Washington, DC 20037, USA.
| | - Adefisayo Oduwole
- Department of Clinical Research Center, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, USA.
| | - Anekwe Onwuanyi
- Department of Clinical Research Center, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, USA.
| | - Folake Ojutalayo
- Department of Clinical Research Center, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, USA.
| | - Jo Ann Cross
- Department of Clinical Research Center, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, USA.
| | - Todd B Seto
- Department of Academic Affairs and Research, The Queen's Medical Center, 1301 Punchbowl Street, Honolulu, HI 96813, USA.
| | - Henry Okafor
- Department of Medicine, Meharry Medical College,1818 Albion St, Nashville, TN 37208, USA.
| | - Priscilla Pemu
- Department of Clinical Research Center, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, USA.
| | - Lilly Immergluck
- Department of Clinical Research Center, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, USA.
| | - Marilyn Foreman
- Department of Clinical Research Center, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, USA.
| | - Ernest Alema Mensah
- Department of Clinical Research Center, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, USA.
| | - Alexander Quarshie
- Department of Clinical Research Center, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, USA.
| | - Mohamed Mubasher
- Department of Clinical Research Center, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, USA.
| | - Almelida Baker
- Department of Clinical Research Center, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, USA.
| | - Alnida Ngare
- RCMI Data Coordinating Center, Jackson State University, 1400 John R. Lynch Street, Jackson, MS 39217, USA.
| | - Andrew Dent
- RCMI Data Coordinating Center, Jackson State University, 1400 John R. Lynch Street, Jackson, MS 39217, USA.
| | - Mohamad Malouhi
- RCMI Data Coordinating Center, Jackson State University, 1400 John R. Lynch Street, Jackson, MS 39217, USA.
| | - Paul Tchounwou
- RCMI Data Coordinating Center, Jackson State University, 1400 John R. Lynch Street, Jackson, MS 39217, USA.
| | - Jae Lee
- RCMI Data Coordinating Center, Jackson State University, 1400 John R. Lynch Street, Jackson, MS 39217, USA.
| | - Traci Hayes
- RCMI Data Coordinating Center, Jackson State University, 1400 John R. Lynch Street, Jackson, MS 39217, USA.
| | - Muna Abdelrahim
- RCMI Data Coordinating Center, Jackson State University, 1400 John R. Lynch Street, Jackson, MS 39217, USA.
| | - Daniel Sarpong
- Department of Biostatistics, College of Pharmacy, Xavier University of Louisiana, 1 Drexel Drive, New Orleans, LA 70125, USA.
| | - Emma Fernandez-Repollet
- Department of Pharmacology and Toxicology, University of Puerto Rico Medical Sciences Campus, P.O. Box 365067, San Juan, PR 00936, Puerto Rico.
| | - Stephen O Sodeke
- Department of Bioethics, Tuskegee University, 1200 W. Montgomery Rd., Tuskegee, AL 36088, USA.
| | - Adrian Hernandez
- Department of Pediatrics, Duke Clinical Research Institute, Duke University School of Medicine, 2400 Pratt St., Durham, NC 27705, USA.
| | - Kevin Thomas
- Department of Pediatrics, Duke Clinical Research Institute, Duke University School of Medicine, 2400 Pratt St., Durham, NC 27705, USA.
| | - Anne Dennos
- Department of Pediatrics, Duke Clinical Research Institute, Duke University School of Medicine, 2400 Pratt St., Durham, NC 27705, USA.
| | - David Smith
- Association of Black Cardiologists,2400 N Street, Suite 200, Washington, DC 20037, USA.
| | - David Gbadebo
- Association of Black Cardiologists,2400 N Street, Suite 200, Washington, DC 20037, USA.
| | - Janet Ajuluchikwu
- Association of Black Cardiologists,2400 N Street, Suite 200, Washington, DC 20037, USA.
- Department of Medicine, College of Medicine of the University of Lagos, Private Mail Bag 12003, Idi Araba, Lagos, Nigeria.
| | - B Waine Kong
- Association of Black Cardiologists,2400 N Street, Suite 200, Washington, DC 20037, USA.
| | - Cassandra McCollough
- Association of Black Cardiologists,2400 N Street, Suite 200, Washington, DC 20037, USA.
| | - Sarah R Weiler
- Department of Pediatrics and Computational Health Informatics, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Marc D Natter
- Department of Pediatrics and Computational Health Informatics, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Kenneth D Mandl
- Department of Pediatrics and Computational Health Informatics, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Shawn Murphy
- Department of Pediatrics and Computational Health Informatics, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| |
Collapse
|
11
|
Aldrugh S, Sanghai S, Waring M, Kiefe C, Goldberg R, Gurwitz J, Lessard D, Parish D, Helm R, Sogade F, Hayward R, Mailhot T, Barton B, Saczynski J, McManus D. GERIATRIC ELEMENTS AND PRESCRIPTION OF WARFARIN VERSUS DIRECT ORAL ANTICOAGULANTS AMONG OLDER PATIENTS WITH AF: THE SAGE-AF STUDY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31046-0] [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: 10/27/2022]
|
12
|
Sanghai S, Aldrugh S, Waring M, Kiefe C, Goldberg R, Gurwitz J, Lessard D, Parish DC, Awad HH, Sogade F, Helm R, Hayward R, McManus D, Saczynski J. ASSOCIATION BETWEEN GERIATRIC ELEMENTS AND ORAL ANTICOAGULANT PRESCRIBING AMONG OLDER ADULTS WITH ATRIAL FIBRILLATION: DATA FROM THE SAGE-AF STUDY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31013-7] [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: 10/27/2022]
|
13
|
Rogers AJ, Xia K, Soe K, Sexias A, Sogade F, Hutchinson B, Vieira D, McFarlane SI, Jean-Louis G. Obstructive Sleep Apnea among Players in the National Football League: A Scoping Review. ACTA ACUST UNITED AC 2017; 6. [PMID: 29984115 PMCID: PMC6035001 DOI: 10.4172/2167-0277.1000278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/09/2022]
Abstract
Objective Obstructive sleep apnea (OSA) is a common sleep-disordered breathing condition that has emerged as a significant public health problem given its increased prevalence over the past decade. The high prevalence of obesity and large waist circumference among NFL players are two risk factors that might contribute to the high susceptibility of football players to develop OSA. National Football League linemen might be particularly vulnerable since they tend to have a higher body mass index. In this scoping review, we aim to bring attention to the limited research regarding OSA among National Football League players and highlight the negative consequences of OSA in an attempt to increase awareness of the urgent need for further research in this area. Methods Search terms associated with obstructive sleep apnea and football were used to examine Google Scholar, EMBASE, CINAHL, PubMed, ProQuest, and Web of Science Plus for relevant studies. All relevant studies were included and documented. Results Findings included (n=4) studies of interest. All 4 studies revealed a near or slightly above 50% prevalence of OSA in the investigated cohorts (mostly retired NFL linemen). Most participants in the study (active NFL players) showed symptoms associated with a sleep-disorder breathing condition (snoring). Conclusion OSA requires more attention from the research and medical community. As suggested by results in the 4 studies included in this paper, OSA and associated symptoms are prevalent in the NFL population. Further research is required to investigate the extent of OSA and OSA risk in this population. There is an urgent need to conduct OSA risk surveillance in the athletic community.
Collapse
Affiliation(s)
- April J Rogers
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, NY 10016, USA.,Department of Health Service Administration, St. John's University, Queens, NY 11439, USA
| | - Kevin Xia
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Kyaw Soe
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Azizi Sexias
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, NY 10016, USA
| | - Felix Sogade
- Department of Cardiology, Health Service of Central Georgia, Macon, Georgia 31201, USA
| | | | - Dorice Vieira
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, NY 10016, USA
| | - Samy I McFarlane
- Department of Medicine, Division of Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, NY 10016, USA
| |
Collapse
|
14
|
Stambler BS, Ellenbogen K, Zhang X, Porter TR, Xie F, Malik R, Small R, Burke M, Kaplan A, Nair L, Belz M, Fuenzalida C, Gold M, Love C, Sharma A, Silverman R, Sogade F, Van Natta B, Wilkoff BL. Right Ventricular Outflow Versus Apical Pacing in Pacemaker Patients with Congestive Heart Failure and Atrial Fibrillation. J Cardiovasc Electrophysiol 2003; 14:1180-6. [PMID: 14678131 DOI: 10.1046/j.1540-8167.2003.03216.x] [Citation(s) in RCA: 164] [Impact Index Per Article: 7.8] [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] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Prior studies suggest that right ventricular apical (RVA) pacing has deleterious effects. Whether the right ventricular outflow tract (RVOT) is a more optimal site for permanent pacing in patients with congestive heart failure (CHF) has not been established. METHODS AND RESULTS We conducted a randomized, cross-over trial to determine whether quality of life (QOL) is better after 3 months of RVOT than RVA pacing in 103 pacemaker recipients with CHF, left ventricular (LV) systolic dysfunction (LV ejection fraction < or = 40%), and chronic atrial fibrillation (AF). An additional aim was to compare dual-site (RVOT + RVA, 31-ms delay) with single-site RVA and RVOT pacing. QRS duration was shorter during RVOT (167 +/- 45 ms) and dual-site (149 +/- 19 ms) than RVA pacing (180 +/- 58 ms, P < 0.0001). At 6 months, the RVOT group had higher (P = 0.01) role-emotional QOL subscale scores than the RVA group. At 9 months, there were no significant differences in QOL scores between RVOT and RVA groups. Comparing RVOT to RVA pacing within the same patient, mental health subscale scores were better (P = 0.03) during RVOT pacing. After 9 months of follow-up, LVEF was higher (P = 0.04) in those assigned to RVA rather than RVOT pacing between months 6 and 9. After 3 months of dual-site RV pacing, physical functioning was worse (P = 0.04) than during RVA pacing, mental health was worse (P = 0.02) than during RVOT pacing, and New York Heart Association (NYHA) functional class was slightly better (P = 0.03) than during RVOT pacing. There were no other significant differences between RVA, RVOT and dual-site RV pacing in QOL scores, NYHA class, distance walked in 6 minutes, LV ejection fraction, or mitral regurgitation. CONCLUSION In patients with CHF, LV dysfunction, and chronic AF, RVOT and dual-site RV pacing shorten QRS duration but after 3 months do not consistently improve QOL or other clinical outcomes compared with RVA pacing.
Collapse
Affiliation(s)
- Bruce S Stambler
- University Hospitals of Cleveland, Case Western Reserve University, 22200 Euclid Avenue, Cleveland, Ohio 44106, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|