1
|
Zhang DT, Onyebeke C, Nahid M, Balkan L, Musse M, Pinheiro LC, Sterling MR, Durant RW, Brown TM, Levitan EB, Safford MM, Goyal P. Social Determinants of Health and Cardiologist Involvement in the Care of Adults Hospitalized for Heart Failure. JAMA Netw Open 2023; 6:e2344070. [PMID: 37983029 PMCID: PMC10660170 DOI: 10.1001/jamanetworkopen.2023.44070] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/10/2023] [Indexed: 11/21/2023] Open
Abstract
Importance Involvement of a cardiologist in the care of adults during a hospitalization for heart failure (HF) is associated with reduced rates of in-hospital mortality and hospital readmission. However, not all patients see a cardiologist when they are hospitalized for HF. Objective To determine whether social determinants of health (SDOH) are associated with cardiologist involvement in the management of adults hospitalized for HF. Design, Setting, and Participants This retrospective cohort study used data from the Reasons for Geographic and Racial Difference in Stroke (REGARDS) cohort. Participants included adults who experienced an adjudicated hospitalization for HF between 2009 and 2017 in all 48 contiguous states in the US. Data analysis was performed from November 2022 to January 2023. Exposures A total of 9 candidate SDOH, aligned with the Healthy People 2030 conceptual model, were examined: Black race, social isolation, social network and/or caregiver availability, educational attainment less than high school, annual household income less than $35 000, living in rural area, living in a zip code with high poverty, living in a Health Professional Shortage Area, and living in a state with poor public health infrastructure. Main Outcomes and Measures The primary outcome was cardiologist involvement, defined as involvement of a cardiologist as the primary responsible clinician or as a consultant. Bivariate associations between each SDOH and cardiologist involvement were examined using Poisson regression with robust SEs. Results The study included 1000 participants (median [IQR] age, 77.8 [71.5-84.0] years; 479 women [47.9%]; 414 Black individuals [41.4%]; and 492 of 876 with low income [56.2%]) hospitalized at 549 unique US hospitals. Low annual household income (<$35 000) was the only SDOH with a statistically significant association with cardiologist involvement (relative risk, 0.88; 95% CI, 0.82-0.95). In a multivariable analysis adjusting for age, race, sex, HF characteristics, comorbidities, and hospital characteristics, low income remained inversely associated with cardiologist involvement (relative risk, 0.89; 95% CI, 0.82-0.97). Conclusions and Relevance This cohort study found that adults with low household income were 11% less likely than adults with higher incomes to have a cardiologist involved in their care during a hospitalization for HF. These findings suggest that socioeconomic status may bias the care provided to patients hospitalized for HF.
Collapse
Affiliation(s)
- David T. Zhang
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - Musarrat Nahid
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Lauren Balkan
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Mahad Musse
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Laura C. Pinheiro
- Department of Health Policy and Management, Weill Cornell Medicine, New York, New York
| | | | - Raegan W. Durant
- Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Todd M. Brown
- Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Emily B. Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham
| | | | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York
- Program for the Care and Study of the Aging Heart, Weill Cornell Medicine, New York, New York
| |
Collapse
|
2
|
Park C, Ringel JB, Pinheiro LC, Morris AA, Sterling M, Balkan L, Banerjee S, Levitan EB, Safford MM, Goyal P. Allostatic load and incident heart failure in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. BMC Cardiovasc Disord 2023; 23:340. [PMID: 37403029 DOI: 10.1186/s12872-023-03371-z] [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: 02/14/2023] [Accepted: 06/28/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Allostatic load (AL) is the physiologic "wear and tear" on the body from stress. Yet, despite stress being implicated in the development heart failure (HF), it is unknown whether AL is associated with incident HF events. METHODS We examined 16,765 participants without HF at baseline from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. The main exposure was AL score quartile. AL was determined according to 11 physiologic parameters, whereby each parameter was assigned points (0-3) based on quartiles within the sample, and points were summed to create a total AL score ranging from 0-33. The outcome was incident HF event. We examined the association between AL quartile (Q1-Q4) and incident HF events using Cox proportional hazards models, adjusted for demographics, socioeconomic factors, and lifestyle. RESULTS The mean age was 64 ± 9.6 years, 61.5% were women, and 38.7% were Black participants. Over a median follow up of 11.4 years, we observed 750 incident HF events (635 HF hospitalizations and 115 HF deaths). Compared to the lowest AL quartile (Q1), the fully adjusted hazards of an incident HF event increased in a graded fashion: Q2 HR 1.49 95% CI 1.12-1.98; Q3 HR 2.47 95% CI 1.89-3.23; Q4 HR 4.28 95% CI 3.28-5.59. The HRs for incident HF event in the fully adjusted model that also adjusted for CAD were attenuated, but remained significant and increased in a similar, graded fashion by AL quartile. There was a significant age interaction (p-for-interaction < 0.001), whereby the associations were observed across each age stratum, but the HRs were highest among those aged < 65 years. CONCLUSION AL was associated with incident HF events, suggesting that AL could be an important risk factor and potential target for future interventions to prevent HF.
Collapse
Affiliation(s)
- Christine Park
- Department of Medicine, New York Presbyterian-Weill Cornell, New York, NY, USA
| | - Joanna B Ringel
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Laura C Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Alanna A Morris
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Madeline Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lauren Balkan
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Samprit Banerjee
- Division of Biostatistics and Epidemiology, Department of Public Health, Weill Medical College of Cornell University, New York, NY, USA
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Parag Goyal
- Department of Medicine, New York Presbyterian-Weill Cornell, New York, NY, USA.
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 420 E. 70Th St, LH-365, New York, NY, 10021, USA.
| |
Collapse
|
3
|
Mahmood SS, Riedell PA, Feldman S, George G, Sansoterra SA, Althaus T, Rehman M, Mead E, Liu JE, Devereux RB, Weinsaft JW, Kim J, Balkan L, Barbar T, Lee Chuy K, Harchandani B, Perales MA, Geyer MB, Park JH, Palomba ML, Shouval R, Tomas AA, Shah GL, Yang EH, Gaut DL, Rothberg MV, Horn EM, Leonard JP, Van Besien K, Frigault MJ, Chen Z, Mehrotra B, Neilan TG, Steingart RM. Biomarkers and cardiovascular outcomes in chimeric antigen receptor T-cell therapy recipients. Eur Heart J 2023; 44:2029-2042. [PMID: 36939851 PMCID: PMC10256191 DOI: 10.1093/eurheartj/ehad117] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 03/21/2023] Open
Abstract
AIMS Chimeric antigen receptor T-cell therapy (CAR-T) harnesses a patient's immune system to target cancer. There are sparse existing data characterizing death outcomes after CAR-T-related cardiotoxicity. This study examines the association between CAR-T-related severe cardiovascular events (SCE) and mortality. METHODS AND RESULTS From a multi-centre registry of 202 patients receiving anti-CD19 CAR-T, covariates including standard baseline cardiovascular and cancer parameters and biomarkers were collected. Severe cardiovascular events were defined as a composite of heart failure, cardiogenic shock, or myocardial infarction. Thirty-three patients experienced SCE, and 108 patients died during a median follow-up of 297 (interquartile range 104-647) days. Those that did and did not die after CAR-T were similar in age, sex, and prior anthracycline use. Those who died had higher peak interleukin (IL)-6 and ferritin levels after CAR-T infusion, and those who experienced SCE had higher peak IL-6, C-reactive protein (CRP), ferritin, and troponin levels. The day-100 and 1-year Kaplan-Meier overall mortality estimates were 18% and 43%, respectively, while the non-relapse mortality (NRM) cumulative incidence rates were 3.5% and 6.7%, respectively. In a Cox model, SCE occurrence following CAR-T was independently associated with increased overall mortality risk [hazard ratio (HR) 2.8, 95% confidence interval (CI) 1.6-4.7] after adjusting for age, cancer type and burden, anthracycline use, cytokine release syndrome grade ≥ 2, pre-existing heart failure, hypertension, and African American ancestry; SCEs were independently associated with increased NRM (HR 3.5, 95% CI 1.4-8.8) after adjusting for cancer burden. CONCLUSION Chimeric antigen receptor T-cell therapy recipients who experience SCE have higher overall mortality and NRM and higher peak levels of IL-6, CRP, ferritin, and troponin.
Collapse
Affiliation(s)
- Syed S Mahmood
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 520 East 70th Street. ST 443, New York, NY 10021, USA
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Peter A Riedell
- The David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL 60637, USA
| | - Stephanie Feldman
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Gina George
- Cornell MPH Program, Cornell University, Ithaca, NY 14853, USA
| | | | - Thomas Althaus
- The David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL 60637, USA
| | - Mahin Rehman
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Elena Mead
- Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jennifer E Liu
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Richard B Devereux
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 520 East 70th Street. ST 443, New York, NY 10021, USA
| | - Jonathan W Weinsaft
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 520 East 70th Street. ST 443, New York, NY 10021, USA
| | - Jiwon Kim
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 520 East 70th Street. ST 443, New York, NY 10021, USA
| | - Lauren Balkan
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Tarek Barbar
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Katherine Lee Chuy
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Bhisham Harchandani
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Miguel-Angel Perales
- Adult BMT Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Mark B Geyer
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Jae H Park
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - M Lia Palomba
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Roni Shouval
- Adult BMT Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Ana A Tomas
- Adult BMT Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Gunjan L Shah
- Adult BMT Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Daria L Gaut
- Division of Hematology/Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Michael V Rothberg
- David Geffen School of Medicine, University of California at Los Angeles, CA 90095, USA
| | - Evelyn M Horn
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 520 East 70th Street. ST 443, New York, NY 10021, USA
| | - John P Leonard
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Koen Van Besien
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Matthew J Frigault
- Cellular Immunotherapy Program, Division of Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Division of Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Zhengming Chen
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY 10021, USA
| | - Bhoomi Mehrotra
- The Cancer Center, St Francis Hospital, Roslyn, NY 11576, USA
| | - Tomas G Neilan
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Richard M Steingart
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| |
Collapse
|
4
|
Zhang DT, Onyebeke C, Nahid M, Balkan L, Musse M, Pinheiro LC, Sterling MR, Durant RW, Brown TM, Levitan EB, Safford MM, Goyal P. Social Determinants of Health and Cardiologist Involvement in the Care of Adults Hospitalized for Heart Failure. medRxiv 2023:2023.03.23.23287671. [PMID: 36993687 PMCID: PMC10055565 DOI: 10.1101/2023.03.23.23287671] [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] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Introduction The involvement of a cardiologist in the care of adults during a hospitalization for heart failure (HF) is associated with reduced rates of in-hospital mortality and hospital readmission. However, not all patients see a cardiologist when they are hospitalized for HF. Since reasons for this are not entirely clear, we sought to determine whether social determinants of health (SDOH) are associated with cardiologist involvement in the management of adults hospitalized for HF. We hypothesized that SDOH would be inversely associated with cardiologist involvement in the care of adults hospitalized for HF. Methods We included adult participants from the national REasons for Geographic And Racial Difference in Stroke (REGARDS) cohort, who experienced an adjudicated hospitalization for HF between 2009 and 2017. We excluded participants who were hospitalized at institutions that lacked cardiology services (n=246). We examined nine candidate SDOH, which align with the Healthy People 2030 conceptual model: Black race, social isolation (0-1 visits from a family or friend in the past month), social network/caregiver availability (having someone to care for them if ill), educational attainment < high school, annual household income < $35,000, living in rural areas, living in a zip code with high poverty, living in a Health Professional Shortage Area, and residing in a state with poor public health infrastructure. The primary outcome was cardiologist involvement, a binary variable which was defined as involvement of a cardiologist as the primary responsible clinician or as a consultant, collected via chart review. We examined associations between each SDOH and cardiologist involvement using Poisson regression with robust standard errors. Candidate SDOH with statistically significant associations (p<0.10) were retained for multivariable analysis. Potential confounders/covariates for the multivariable analysis included age, race, sex, HF characteristics, comorbidities, and hospital characteristics. Results We examined 876 participants hospitalized at 549 unique US hospitals. The median age was 77.5 years (IQR 71.0-83.7), 45.9% were female, 41.4% were Black, and 56.2% had low income. Low household income (<$35,000/year) was the only SDOH that had a statistically significant association with cardiologist involvement in a bivariate analysis (RR: 0.88 [95% CI: 0.82-0.95]). After adjusting for potential confounders, low income remained inversely associated (RR: 0.89 [95% CI: 0.82-0.97]). Conclusions Adults with low household income were 11% less likely to have a cardiologist involved in their care during a hospitalization for HF. This suggests that socioeconomic status may implicitly bias the care provided to patients hospitalized for HF.
Collapse
Affiliation(s)
- David T. Zhang
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Musarrat Nahid
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Lauren Balkan
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Mahad Musse
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Laura C. Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Madeline R. Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Raegan W. Durant
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Todd M. Brown
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Emily B. Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Parag Goyal
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY
| |
Collapse
|
5
|
Balkan L, Ringel JB, Levitan EB, Khodneva YA, Pinheiro LC, Sterling MR, Kim SM, Kronish IM, Jackson EA, Durant R, Safford M, Goyal P. Association of Perceived Stress With Incident Heart Failure. J Card Fail 2022; 28:1401-1410. [PMID: 35568129 PMCID: PMC9704753 DOI: 10.1016/j.cardfail.2022.04.013] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The relationship between psychological stress and heart failure (HF) has not been well studied. We sought to assess the relationship between perceived stress and incident HF. METHODS We used data from the national REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a large prospective biracial cohort study that enrolled community-dwellers aged 45 years and older between 2003 and 2007, with follow-up. We included participants free of suspected prevalent HF who completed the Cohen 4-item Perceived Stress Scale (PSS-4). Our outcome variables were incident HF event, HF with reduced ejection fraction events, and HF with preserved ejection fraction events. We estimated Cox proportional hazard models to determine if PSS-4 quartiles were independently associated with incident HF events, adjusting for sociodemographics, social support, unhealthy behaviors, comorbid conditions, and physiologic parameters. We also tested interactions by baseline statin use, given its anti-inflammatory properties. RESULTS Among 25,785 participants with a mean age of 64 ± 9.3 years, 55% were female and 40% were Black. Over a median follow-up of 10.1 years, 1109 ± 4.3% experienced an incident HF event. In fully adjusted models, the PSS-4 was not associated with HF or HF with reduced ejection fraction. However, PSS-4 quartiles 2-4 (compared with the lowest quartile) were associated with incident HF with preserved ejection fraction (Q2 hazard ratio 1.37, 95% confidence interval 1.00-1.88; Q3 hazard ratio 1.42, 95% confidence interval 1.03-1.95; Q4 hazard ratio 1.41, 95% confidence interval 1.04-1.92). Notably, this association was attenuated among participants who took a statin at baseline (P for interaction = .07). CONCLUSIONS Elevated perceived stress was associated with incident HF with preserved ejection fraction but not HF with reduced ejection fraction.
Collapse
Affiliation(s)
- Lauren Balkan
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Joanna B Ringel
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Yulia A Khodneva
- Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Laura C Pinheiro
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - Samuel M Kim
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
| | - Elizabeth A Jackson
- Division of Cardiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Raegan Durant
- Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Monika Safford
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York.
| |
Collapse
|
6
|
Goyal P, Balkan L, Ringel JB, Hummel SL, Sterling MR, Kim S, Arora P, Jackson EA, Brown TM, Shikany JM, Judd SE, Safford MM, Levitan EB. The Dietary Approaches to Stop Hypertension (DASH) Diet Pattern and Incident Heart Failure. J Card Fail 2021; 27:512-521. [PMID: 33962741 PMCID: PMC8396128 DOI: 10.1016/j.cardfail.2021.01.011] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The Dietary Approaches to Stop Hypertension (DASH) diet pattern has shown some promise for preventing heart failure (HF), but studies have been conflicting. OBJECTIVE To determine whether the DASH diet pattern was associated with incident HF in a large biracial and geographically diverse population. METHODS AND RESULTS Among participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study of adults aged ≥45 years who were free of suspected HF at baseline in 2003-2007, the DASH diet score was derived from the baseline food frequency questionnaire. The main outcome was incident HF defined as the first adjudicated HF hospitalization or HF death through December 31, 2016. We estimated hazard ratios for the associations of DASH diet score quartiles with incident HF, and incident HF with reduced ejection fraction and HF with preserved ejection fraction using the Lunn-McNeil extension to the Cox model. We tested for several prespecified interactions, including with age. Compared with the lowest quartile, individuals in the second to fourth DASH diet score quartiles had a lower risk for incident HF after adjustment for sociodemographic and health characteristics: quartile 2 hazard ratio, 0.69 (95% confidence interval [CI], 0.56-0.85); quartile 3 hazard ratio, 0.71 (95% CI, 0.58-0.87); and quartile 4 hazard ratio, 0.73 (95% CI, 0.58-0.92). When stratifying results by age, quartiles 2-4 had a lower hazard for incident HF among those age <65 years, quartiles 3-4 had a lower hazard among those age 65-74, and the quartiles had similar hazard among those age ≥75 years (Pinteraction = .003). We did not find a difference in the association of DASH diet with incident HF with reduced ejection fraction vs HF with preserved ejection fraction (P = .11). CONCLUSIONS DASH diet adherence was inversely associated with incident HF, specifically among individuals <75 years old.
Collapse
Affiliation(s)
- Parag Goyal
- Department of Medicine, Weill Cornell Medicine, Cornell, New York.
| | - Lauren Balkan
- Department of Medicine, Weill Cornell Medicine, Cornell, New York
| | - Joanna B Ringel
- Department of Medicine, Weill Cornell Medicine, Cornell, New York
| | - Scott L Hummel
- Department of Medicine, University of Michigan; Section of Cardiology, Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | | | - Samuel Kim
- Department of Medicine, Weill Cornell Medicine, Cornell, New York
| | - Pankaj Arora
- Division of Cardiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth A Jackson
- Division of Cardiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Todd M Brown
- Division of Cardiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - James M Shikany
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medicine, Cornell, New York
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
7
|
Toy D, Mahmood SS, Rotman J, Weisman SV, Escalon JG, Legasto AC, Cheng EP, McKenney AS, Barbar T, Balkan L, Chen Y, Razavi P, Zainul O, Abedian S, Gruden JF, Truong QA. Imaging Utilization and Outcomes in Vulnerable Populations during COVID-19 in New York City. Radiol Cardiothorac Imaging 2020; 2:e200464. [PMID: 33778647 PMCID: PMC7751279 DOI: 10.1148/ryct.2020200464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) affects vulnerable populations (VP) adversely. Purpose To evaluate overall imaging utilization in vulnerable subgroups (elderly, racial/ethnic minorities, socioeconomic status [SES] disadvantage) and determine if a particular subgroup has worse outcomes from COVID-19. Materials/Methods Of 4110 patients who underwent COVID-19 testing from March 3-April 4, 2020 at NewYork-Presbyterian Hospital (NYP) health system, we included 1121 COVID-19 positive adults (mean age 59±18 years, 59% male) from two academic hospitals and evaluated imaging utilization rates and outcomes, including mortality. Results Of 897 (80%) VP, there were 465 (41%) elderly, 380 (34%) racial/ethnic minorities, and 479 (43%) SES disadvantage patients. Imaging was performed in 88% of patients and mostly portable/bedside studies, with 87% of patients receiving chest radiographs. There were 83% hospital admissions, 25% ICU admissions, 23% intubations, and 13% deaths. Elderly patients had greater imaging utilization, hospitalizations, ICU/intubation requirement, longer hospital stays, and >4-fold increase in mortality compared to non-elderlies (adjusted hazard ratio[aHR] 4.79, p<0.001). Self-reported minorities had fewer ICU admissions (p=0.03) and reduced hazard for mortality (aHR 0.53, p=0.004; complete case analysis: aHR 0.39, p<0.001 excluding "not reported"; sensitivity analysis: aHR 0.61, p=0.005 "not reported" classified as minorities) with similar imaging utilization, compared to non-minorities. SES disadvantage patients had similar imaging utilization and outcomes as compared to their counterparts. Conclusions In a predominantly hospitalized New York City cohort, elderly patients are at highest mortality risk. Racial/ethnic minorities and SES disadvantage patients fare better or similarly to their counterparts, highlighting the critical role of access to inpatient medical care during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Dennis Toy
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Syed S Mahmood
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Jessica Rotman
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Stacey Verzosa Weisman
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Joanna G Escalon
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Alan C Legasto
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Edward P Cheng
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Anna Sophia McKenney
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Tarek Barbar
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Lauren Balkan
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Yunchan Chen
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Peyman Razavi
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Omar Zainul
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Sajjad Abedian
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - James F Gruden
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Quynh A Truong
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| |
Collapse
|
8
|
Balkan L, Bryan J, Kim S, Sterling M, Brown T, Judd S, Hummel S, Arora P, Jackson E, Safford M, Levitan E, Goyal P. THE DASH DIET PATTERN PROTECTS AGAINST INCIDENT HEART FAILURE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31348-6] [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: 11/25/2022]
|