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Castañeda-Avila MA, Tisminetzky M, Oyinbo AG, Lapane K. Racial and Ethnic Disparities in Use of Colorectal Cancer Screening Among Adults With Chronic Medical Conditions: BRFSS 2012-2020. Prev Chronic Dis 2024; 21:E12. [PMID: 38386629 PMCID: PMC10890357 DOI: 10.5888/pcd21.230257] [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] [Indexed: 02/24/2024] Open
Abstract
Introduction People with chronic conditions and people with colorectal cancer (CRC) may share common risk factors; thus, CRC screening is important for people with chronic conditions. We examined racial and ethnic differences in the use of CRC screening among people with various numbers of chronic conditions. Methods We included data on adult respondents aged 50 to 75 years from the Behavioral Risk Factor Surveillance System in 2012 through 2020. We categorized counts of 9 conditions as 0, 1, 2, 3, and ≥4. We classified self-reported CRC screening status as up to date or not. We used Poisson models to estimate adjusted prevalence ratios (APRs) among the different counts of chronic conditions in 4 racial and ethnic groups: Hispanic adults with limited English proficiency (LEP), Hispanic adults without LEP, non-Hispanic Black adults, and non-Hispanic White adults. Results Overall, 66.5% of respondents were up to date with CRC screening. The prevalence of being up to date increased with the number of chronic conditions. We found disparities among racial and ethnic groups. Hispanic respondents with LEP had lower rates than non-Hispanic White adults of being up to date with CRC screening across all counts of chronic conditions (APR for 0 conditions = 0.67; 95% CI, 0.64-0.71; APR for ≥4 conditions = 0.85; 95% CI, 0.79-0.91). Hispanic respondents without LEP with 0, 1, or 2 conditions were less likely than non-Hispanic White respondents to be up to date with CRC screening. We found no significant differences between non-Hispanic Black and non-Hispanic White respondents. Conclusion We found disparities among Hispanic BRFSS respondents with LEP, who had lower rates than non-Hispanic White respondents of being up to date with CRC screening, regardless of the number of chronic conditions. Tailored interventions are needed to address these disparities and improve screening rates, particularly among Hispanic people.
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Affiliation(s)
- Maira A Castañeda-Avila
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA 01655
| | - Mayra Tisminetzky
- Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Atinuke G Oyinbo
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Kate Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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Tisminetzky M, Gurwitz JH, Tabada G, Reynolds K, Smith DH, Sung SH, Goldberg R, Go AS. Approach to Multimorbidity Burden Classification and Outcomes in Older Adults With Heart Failure. Med Care 2023; 61:268-278. [PMID: 36920167 PMCID: PMC10079617 DOI: 10.1097/mlr.0000000000001828] [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] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND The optimal approach to classifying multimorbidity burden in assessing treatment-associated outcomes using real-world data remains uncertain. We assessed whether 2 measurement approaches to characterize multimorbidity influenced observed associations of β-blocker use with outcomes in adults with heart failure (HF). METHODS We conducted a retrospective study on adults with HF from 4 integrated health care delivery systems. Multimorbidity burden was characterized by either (1) simple counts of chronic conditions or (2) a weighted multiple chronic conditions score using data from electronic health records. We assessed the impact of these 2 approaches to characterizing multimorbidity on associations between exposure to β-blockers and subsequent all-cause death, hospitalization for HF, and hospitalization for any cause. RESULTS The study population characterized by a count of chronic conditions included 9988 adults with HF who had a mean (SD) age of 76.4 (12.5) years, with 48.7% women and 24.7% racial/ethnic minorities. The cohort characterized by weighted multiple chronic conditions included 10,082 adults with HF who had a mean (SD) age of 76.4 (12.4) years, 48.9% women, and 25.5% racial/ethnic minorities. The multivariable associations of risks of death or hospitalizations for HF or for any cause associated with incident β-blocker use were similar regardless of how multimorbidity burden was characterized. CONCLUSIONS Simple counts of chronic conditions performed similarly to a weighted multimorbidity score in predicting outcomes using real-world data to examine clinical outcomes associated with β-blocker therapy in HF. Our findings challenge conventional wisdom that more complex measures of multimorbidity are always necessary to characterize patients in observational studies examining therapy-associated outcomes.
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Affiliation(s)
- Mayra Tisminetzky
- Meyers Health Care Institute, a joint endeavor of University of Massachusetts Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Chan Medical School
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Jerry H. Gurwitz
- Meyers Health Care Institute, a joint endeavor of University of Massachusetts Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Chan Medical School
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Grace Tabada
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - David H. Smith
- Center for Health Research, Kaiser Permanente Northwest, Portland Oregon
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Robert Goldberg
- Meyers Health Care Institute, a joint endeavor of University of Massachusetts Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Alan S. Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
- Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, CA
- Department of Medicine, Stanford University, Stanford, CA
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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.
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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
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Dai Q, Mehawej J, Saczynski JS, Tran KV, Abu HO, Lessard D, Fillippaios A, Paul T, Hariri E, Wang W, Tisminetzky M, Soni A, Howard-Wilson S, Waring ME, Goldberg RJ, McManus DD. Usefulness of Self-Reported Physical Activity and Clinical Outcomes in Older Patients With Atrial Fibrillation. Am J Cardiol 2022; 181:32-37. [PMID: 35985871 PMCID: PMC10427165 DOI: 10.1016/j.amjcard.2022.07.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022]
Abstract
Current guidelines encourage regular physical activity (PA) to gain cardiovascular health benefit. However, little is known about whether older adults with atrial fibrillation (AF) who engage in the guideline-recommended level of PA are less likely to experience clinically relevant outcomes. We did a retrospective study based on the data from Systemic Assessment of Geriatric Elements in AF (SAGE-AF) prospective cohort study. The study population consisted of older participants with AF (≥65 years) and a congestive heart failure, hypertension, age, diabetes, stroke vascular disease, age 65 to 75 and sex(CHA2DS2-VASc) score ≥2. PA was quantified by self-reported Minnesota Leisure Time PA questionnaire. Competing risk models were used to examine the association between PA level and clinical outcomes over 2 years while controlling for several potentially confounding variables. A total of 1,244 participants (average age 76 years; 51% men; 85% non-Hispanic White) were studied. A total of 50.5% of participants engaged in regular PA. Meeting the recommended level of PA was associated with lower mortality over 2 years (adjusted hazard ratio 0.60, 95% confidence interval 0.38 to 0.95) but was not associated with rates of stroke or major bleeding. In conclusion, older adults with AF who engaged in guideline-recommended PA are more likely to survive in the long term. Healthcare providers should promote and encourage engagement in PA and tailor interventions to address barriers of engagement.
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Affiliation(s)
- Qiying Dai
- Division of Cardiology, Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts.
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jane S Saczynski
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, Massachusetts
| | - Khanh-Van Tran
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Hawa O Abu
- Division of Cardiology, Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Andreas Fillippaios
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Tenes Paul
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Essa Hariri
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Weijia Wang
- Department of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Mayra Tisminetzky
- Division of Geriatrics, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Apurv Soni
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sakeina Howard-Wilson
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Molly E Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut
| | - Robert J Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - David D McManus
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
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Abu HO, Wang W, Otabil EM, Saczynski JS, Mehawej J, Mishra A, Tisminetzky M, Blanchard G, Gurwitz JH, Goldberg RJ, McManus DD. Perception of atrial fibrillation symptoms: Impact on quality of life and treatment in older adults. J Am Geriatr Soc 2022; 70:2805-2817. [PMID: 35791806 PMCID: PMC9588564 DOI: 10.1111/jgs.17954] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/09/2022] [Accepted: 06/08/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND In managing older adults with atrial fibrillation (AF), their symptomatology impacts their well-being and may inform treatment decision-making. We examined AF symptom perception, its impact on quality of life (QoL), and its relation to treatment strategies in older adults with AF. METHODS Data were obtained from older adults with AF enrolled in a multicenter study conducted at clinic sites in Massachusetts and Georgia between 2016 and 2018. Participants were stratified into three age groups: 65-74 (youngest-old), 75-84 (middle-old), and ≥85 (oldest). Perception of AF symptoms was assessed by participant self-report during their clinic visit and at study enrollment by the Atrial Fibrillation Effect on Quality-of-Life Questionnaire which assessed cardiac-specific and non-specific, non-cardiac AF symptoms and their impact on QoL. Treatment strategies (rate or rhythm control) utilized were ascertained from electronic medical records. RESULTS Among the 1184 participants (mean age 75 years, 48% women, 86% Non-Hispanic White), 51% were aged 65-74 years, 36% were 75-84 years, and 13% were ≥ 85 years. The most commonly reported AF symptoms were non-specific, non-cardiac symptoms (fatigue, dyspnea, lightheadedness) with similar prevalence and impact on QoL in all age groups. Cardiac-specific AF symptoms (palpitations, irregular heartbeat, pause in heart activity) were less prevalent, but most commonly reported by the youngest participants (65-74 years), who endorsed considerable impact of these symptoms on their QoL. Overall, those who reported experiencing any AF symptoms during their clinic visit were more likely to have received rhythm compared with rate control (OR: 1.56; 95% CI: 1.18-2.04) with similar findings for all age groups except those aged ≥85 years. CONCLUSIONS Our findings suggest a high prevalence of non-specific, non-cardiac symptoms among older adults with AF and that cardiac-specific AF symptoms may exert considerable impact on their QoL. The presence of any AF symptoms may drive more rhythm control in a majority of older adults.
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Affiliation(s)
- Hawa O. Abu
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester MA
- Department of Internal Medicine, Saint Vincent Hospital, Worcester MA
| | - Weijia Wang
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester MA
| | - Edith M. Otabil
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester MA
| | - Jane S. Saczynski
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston MA
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester MA
| | - Ajay Mishra
- Department of Internal Medicine, Saint Vincent Hospital, Worcester MA
| | - Mayra Tisminetzky
- Division of Geriatric Medicine and Meyers Health Care Institute. Department of Medicine, University of Massachusetts Medical School, Worcester MA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Gary Blanchard
- Division of Geriatrics, Department of Internal Medicine, Saint Vincent Hospital, Worcester MA
| | - Jerry H. Gurwitz
- Division of Geriatric Medicine and Meyers Health Care Institute. Department of Medicine, University of Massachusetts Medical School, Worcester MA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Robert J. Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - David D. McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester MA
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Tran VH, Mehawej J, Abboud DM, Tisminetzky M, Hariri E, Filippaios A, Gore JM, Yarzebski J, Goldberg JH, Lessard D, Goldberg R. Age and Sex Differences and Temporal Trends in the Use of Invasive and Noninvasive Procedures in Patients Hospitalized With Acute Myocardial Infarction. J Am Heart Assoc 2022; 11:e025605. [PMID: 36000439 PMCID: PMC9496437 DOI: 10.1161/jaha.122.025605] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Few studies have examined age and sex differences in the receipt of cardiac diagnostic and interventional procedures in patients hospitalized with acute myocardial infarction and trends in these possible differences during recent years. Methods and Results Data from patients hospitalized with a first acute myocardial infarction at the major medical centers in the Worcester, Massachusetts, metropolitan area were utilized for this study. Logistic regression analysis was used to examine age (<55, 55–64, 65–74, and ≥75 years) and sex differences in the receipt of echocardiography, exercise stress testing, coronary angiography, percutaneous coronary interventions, and coronary artery bypass graft surgery, and trends in the use of those procedures during patients' acute hospitalization, between 2005 and 2018, while adjusting for important confounding factors. The study population consisted of 1681 men and 1154 women with an initial acute myocardial infarction who were hospitalized on an approximate biennial basis between 2005 and 2018. A smaller proportion of women underwent cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft surgery, while there were no sex differences in the receipt of echocardiography and exercise stress testing. Patients aged ≥75 years were less likely to undergo cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft surgery, but were more likely to receive echocardiography compared with younger patients. Between 2005 and 2018, the use of echocardiography and coronary artery bypass graft surgery nonsignificantly increased among all age groups and both sexes, while the use of cardiac catheterization and percutaneous coronary intervention increased nonsignificantly faster in women and older patients. Conclusions We observed a continued lower receipt of invasive cardiac procedures in women and patients aged ≥75 years with acute myocardial infarction, but age and sex gaps associated with these procedures have narrowed during recent years.
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Affiliation(s)
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine University of Massachusetts Medical School Worcester MA
| | - Donna M Abboud
- Department of Medicine Lebanese American University Beirut Lebanon
| | - Mayra Tisminetzky
- Division of Geriatric Medicine, Department of Medicine University of Massachusetts Medical School Worcester MA.,Department of Population and Quantitative Health Sciences University of Massachusetts Medical School Worcester MA
| | - Essa Hariri
- Department of Medicine Cleveland Clinic Cleveland OH
| | - Andreas Filippaios
- UMass Memorial Medical Group Fitchburg MA.,Division of Cardiovascular Medicine, Department of Medicine University of Massachusetts Medical School Worcester MA
| | - Joel M Gore
- Division of Cardiovascular Medicine, Department of Medicine University of Massachusetts Medical School Worcester MA.,Department of Population and Quantitative Health Sciences University of Massachusetts Medical School Worcester MA
| | - Jorge Yarzebski
- Division of Geriatric Medicine, Department of Medicine University of Massachusetts Medical School Worcester MA
| | - Jordan H Goldberg
- Department of Population and Quantitative Health Sciences University of Massachusetts Medical School Worcester MA
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences University of Massachusetts Medical School Worcester MA
| | - Robert Goldberg
- Department of Population and Quantitative Health Sciences University of Massachusetts Medical School Worcester MA
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Tisminetzky M, Delude C, Hebert T, Carr C, Goldberg RJ, Gurwitz JH. Age, Multiple Chronic Conditions, and COVID-19: A Literature Review. J Gerontol A Biol Sci Med Sci 2022; 77:872-878. [PMID: 33367606 PMCID: PMC7799222 DOI: 10.1093/gerona/glaa320] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Various patient demographic and clinical characteristics have been associated with poor outcomes for individuals with coronavirus disease 2019 (COVID-19). To describe the importance of age and chronic conditions in predicting COVID-19-related outcomes. METHODS Search strategies were conducted in PubMed/MEDLINE. Daily alerts were created. RESULTS A total of 28 studies met our inclusion criteria. Studies varied broadly in sample size (n = 21 to more than 17,000,000). Participants' mean age ranged from 48 years to 80 years, and the proportion of male participants ranged from 44% to 82%. The most prevalent underlying conditions in patients with COVID-19 were hypertension (range: 15%-69%), diabetes (8%-40%), cardiovascular disease (CVD) (4%-61%), chronic pulmonary disease (1%-33%), and chronic kidney disease (range 1%-48%). These conditions were each associated with an increased in-hospital case fatality rate (CFR) ranging from 1% to 56%. Overall, older adults have a substantially higher case fatality rate (CFR) as compared to younger individuals affected by COVID-19 (42% for those <65 vs 65% > 65 years). Only one study examined the association of chronic conditions and the risk of dying across different age groups; their findings suggested similar trends of increased risk in those < 65 years and those > 65 years as compared to those without these conditions. CONCLUSIONS There has been a traditional, single-condition approach to consideration of how chronic conditions and advancing age relate to COVID-19 outcomes. A more complete picture of the impact of burden of multimorbidity and advancing patient age is needed.
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Affiliation(s)
- Mayra Tisminetzky
- Meyers Primary Care Institute, Worcester, Massachusetts, USA
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, USA
| | | | - Tara Hebert
- Meyers Primary Care Institute, Worcester, Massachusetts, USA
| | - Catherine Carr
- Lamar Soutter Library, University of Massachusetts Medical School, Worcester, USA
| | - Robert J Goldberg
- Meyers Primary Care Institute, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, USA
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, Worcester, Massachusetts, USA
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, USA
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Mehawej J, Mishra A, Saczynski JS, Waring ME, Lessard D, Abu HO, La V, Tisminetzky M, Tran KV, Hariri E, Filippaios A, Paul T, Soni A, Wang W, Ding EY, Bamgbade BA, Mathew J, Kiefe C, Goldberg RJ, McManus DD. Online Health Information Seeking, Low AF-Related Quality of Life, and High Perceived Efficacy in Patient-Physician Interactions in Older Adults with Atrial Fibrillation. Cardiovascular Digital Health Journal 2022; 3:118-125. [PMID: 35720678 PMCID: PMC9204795 DOI: 10.1016/j.cvdhj.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Little is known about online health information–seeking behavior among older adults with atrial fibrillation (AF) and its association with self-reported outcomes. Objective To examine patient characteristics associated with online health information seeking and the association between information seeking and low AF-related quality of life and high perceived efficacy in patient-physician interaction. Methods We used data from the SAGE-AF (Systematic Assessment of Geriatric Elements in AF) study, which includes older participants aged ≥65 years with AF and a CHA2DS2-VASc risk score ≥2. To assess online health information seeking, participants who reported using the Internet were asked at baseline if they used the Internet to search for advice or information about their health in the past 4 weeks (not at all vs at least once). Atrial Fibrillation Effect on Quality of Life and Perceived Efficacy in Patient-Physician Interactions questionnaires were used to examine AF-related quality of life (QOL) and patient-reported confidence in physicians. Logistic regression models were used to examine demographic and clinical factors associated with online health information seeking and associations between information seeking and low AF-related QOL (AFEQT <80) and high perceived efficacy for patient-physician interactions (PEPPI ≥45). Results A total of 874 online participants (mean age 74.5 years, 51% male, 91% non-Hispanic White) were studied. Approximately 60% of participants sought health information online. Participants aged 74 years or older and those on anticoagulation were less likely, while those with a college degree were more likely, to seek online health information after adjusting for potential confounders. Participants who sought health information online, compared to those who did not, were significantly more likely to have a low AF-related QOL, but less likely to self-report confidence in patient-physician interaction (aOR = 1.56, 95% CI: 1.15–2.13; aOR = 0.68, 95% CI: 0.49–0.93, respectively). Conclusion Clinicians should consider barriers to patient-physician interaction in older adults who seek health information online, encourage shared decision-making, and provide patients with a list of online resources for AF in addition to disease education plans to help patients manage their health.
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9
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Mehawej J, Saczynski JS, Kiefe CI, Abu HO, Tisminetzky M, Wang W, Bamgbade BA, Ding E, Lessard D, Otabil EM, Saleeba C, Goldberg RJ, McManus DD. Association between risk of obstructive sleep apnea and cognitive performance, frailty, and quality of life among older adults with atrial fibrillation. J Clin Sleep Med 2022; 18:469-475. [PMID: 34432629 PMCID: PMC8805012 DOI: 10.5664/jcsm.9622] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Geriatric impairments and obstructive sleep apnea (OSA) are prevalent among older patients with atrial fibrillation (AF). Little is known about the association between OSA and geriatric impairments, including frailty, cognitive performance, and AF-related quality of life. The objective of this study was to examine the associations of OSA with frailty, cognitive performance, and AF-related quality of life among older adults with AF. METHODS Data from the Systemic Assessment of Geriatrics Elements-AF study were used, which included AF participants 65 years and older and with a CHA2DS2-VASc ≥ 2. The STOP-BANG questionnaire was used to assess the risk of OSA. Multivariable logistic regression models were used to examine the association between risk of OSA and geriatric impairments, adjusting for sociodemographic, geriatric, and clinical characteristics. RESULTS A total of 970 participants (mean age 75 years; 51% male) were studied. Of the 680 participants without a medical history of OSA, 26% (n = 179) of participants had a low risk of OSA, 53% (n = 360) had an intermediate risk, and 21% (n = 141) had a high risk for OSA. Compared to those with low risk of OSA, participants with an intermediate or high risk of OSA were more likely to be frail (adjusted odds ratio = 1.67, 95% confidence interval: 1.08-2.56; adjusted odds ratio = 3.00, 95% confidence interval: 1.69-5.32, respectively) in the fully adjusted models. CONCLUSIONS Our findings identify a group of patients at high risk who would benefit from early screening for OSA. Future longitudinal studies are needed to assess the effect of OSA treatment on frailty, physical functioning, and quality of life among patients with AF. CITATION Mehawej J, Saczynski JS, Kiefe CI, et al. Association between risk of obstructive sleep apnea and cognitive performance, frailty, and quality of life among older adults with atrial fibrillation. J Clin Sleep Med. 2022;18(2):469-475.
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Affiliation(s)
- Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jane S. Saczynski
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, Massachusetts
| | - Catarina I. Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Hawa O. Abu
- Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Mayra Tisminetzky
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
- Division of Geriatrics, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Weijia Wang
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Benita A. Bamgbade
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, Massachusetts
| | - Eric Ding
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Edith Mensah Otabil
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Connor Saleeba
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Robert J. Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - David D. McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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10
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Tisminetzky M, Delude C, Allore HG, Anzuoni K, Bloomstone S, Charpentier P, Hepler JP, Kitzman DW, McAvay GJ, Miller M, Pajewski NM, Gurwitz J. The geriatrics research instrument library: A resource for guiding instrument selection for researchers studying older adults with multiple chronic conditions. Journal of Multimorbidity and Comorbidity 2022; 12:26335565221081200. [PMID: 35586036 PMCID: PMC9106318 DOI: 10.1177/26335565221081200] [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] [Received: 05/11/2021] [Accepted: 01/31/2021] [Indexed: 11/15/2022]
Abstract
Background After the passage of the 21st Century Cures Act in the U.S., the Inclusion Across the Lifespan policy eliminates upper-age limits for research participation unless risk justified. Broader inclusion will necessitate the use of reliable instruments in research that characterize the health status and function of older adults with multiple chronic conditions. As there is a plethora of such instruments, the Geriatrics Research Instrument Library (GRIL) was developed as freely available online resource of data collection instruments commonly used in gerontological research. GRIL has been revised and updated by the Advancing Geriatrics Infrastructure and Network Growth (AGING) Initiative, a joint endeavor of the Health Care Systems Research Network (HCSRN) and the Older Americans Independence Centers (OAICs). Methods Extensive PubMed literature searches and domain expert feedback were utilized to inventory and update GRIL through the addition of instruments and compiling of instrument metadata. GRIL is hosted on the National Institute on Aging OAIC Coordinating Center website with a platform utilizing Microsoft Structured Query Language (SQL) and an Adobe ColdFusion application server. Tracking statistics are collected using Google Analytics. Results Presently, GRIL includes 175 instruments across 18 domains, including instrument metadata such as instrument description, copyright information, completion time estimates, keywords, available translations, and a link and reference to the original manuscript describing the instrument. The GRIL website includes user-friendly features such as mobile platforming and resource links. Conclusions GRIL provides a user-friendly public resource that facilitates clinical researchers in efficiently selecting appropriate instruments to measure clinical outcomes relevant to older adults across a full range of domains.
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Affiliation(s)
- Mayra Tisminetzky
- University of Massachusetts Medical School and Meyers Health Care Institute, Worcester, MA, USA
| | | | - Heather G Allore
- Yale School of Medicine and Yale School of Public Health, New Haven, CT, USA
| | | | | | | | - John P Hepler
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Gail J McAvay
- Yale School of Medicine and Yale School of Public Health, New Haven, CT, USA
| | | | | | - Jerry Gurwitz
- University of Massachusetts Medical School and Meyers Health Care Institute, Worcester, MA, USA
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11
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Bamgbade BA, McManus DD, Helm R, Mehawej J, Gurwitz JH, Mailhot T, Abu HO, Goldberg R, Wang Z, Tisminetzky M, Pierre‐Louis IC, Saczynski JS. Differences in Perceived and Predicted Bleeding Risk in Older Adults With Atrial Fibrillation: The SAGE-AF Study. J Am Heart Assoc 2021; 10:e019979. [PMID: 34398677 PMCID: PMC8649256 DOI: 10.1161/jaha.120.019979] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/18/2021] [Indexed: 11/16/2022]
Abstract
Background Little research has evaluated patient bleeding risk perceptions in comparison with calculated bleeding risk among oral anticoagulant users with atrial fibrillation. Our objective was to investigate underestimation of bleeding risk and to describe the characteristics and patient-reported outcomes associated with underestimation of bleeding risk. Methods and Results In the SAGE-AF (Systematic Assessment of Geriatric Elements in Atrial Fibrillation) study, a prospective cohort study of patients ≥65 years with atrial fibrillation, a CHA2DS2-VASc risk score ≥2 and who were on oral anticoagulant therapy, we compared patients' self-reported bleeding risk with their predicted bleeding risk from their HAS-BLED score. Among the 754 participants (mean age 74.8 years, 48.3% women), 68.0% underestimated their bleeding risk. Participants who were Asian or Pacific Islander, Black, Native American or Alaskan Native, Mixed Race or Hispanic (non-White) (adjusted OR [AOR], 0.45; 95% CI, 0.24-0.82) and women (AOR, 0.62; 95% CI, 0.40-0.95) had significantly lower odds of underestimating their bleeding risk than respective comparison groups. Participants with a history of bleeding (AOR, 3.07; 95% CI, 1.73-5.44) and prior hypertension (AOR, 4.33; 95% CI, 2.43-7.72), stroke (AOR, 5.18; 95% CI, 1.87-14.40), or renal disease (AOR, 5.05; 95% CI, 2.98-8.57) had significantly higher odds of underestimating their bleeding risk. Conclusions We found that more than two-thirds of patients with atrial fibrillation on oral anticoagulant therapy underestimated their bleeding risk and that participants with a history of bleeding and several comorbid conditions were more likely to underestimate their bleeding risk whereas non-Whites and women were less likely to underestimate their bleeding risk. Clinicians should ensure that patients prescribed oral anticoagulant therapy have a thorough understanding of bleeding risk.
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Affiliation(s)
- Benita A. Bamgbade
- Department of Pharmacy and Health System SciencesNortheastern UniversityBostonMA
| | - David D. McManus
- Cardiology DivisionDepartment of MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Robert Helm
- Department of MedicineCardiovascular MedicineBoston University School of MedicineBostonMA
| | - Jordy Mehawej
- Cardiology DivisionDepartment of MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Jerry H. Gurwitz
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMA
- Meyers Primary Care InstituteWorcesterMA
- Division of Geriatric MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Tanya Mailhot
- Faculty of NursingUniversite de MontrealMontrealQuebecCanada
- Montreal Heart Institute Research CenterMontrealQuebecCanada
| | - Hawa O. Abu
- Cardiology DivisionDepartment of MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Robert Goldberg
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Ziyue Wang
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Mayra Tisminetzky
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMA
- Division of Geriatric MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
| | | | - Jane S. Saczynski
- Department of Pharmacy and Health System SciencesNortheastern UniversityBostonMA
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12
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Tisminetzky M, Mehawej J, Miozzo R, Gurwitz JH, Gore JM, Lessard D, Abu HO, Bamgbade BA, Yarzebski J, Granillo E, Goldberg RJ. Temporal Trends and Patient Characteristics Associated with 30-Day Hospital Readmission Rates after a First Acute Myocardial Infarction. Am J Med 2021; 134:1127-1134. [PMID: 33864760 PMCID: PMC8410623 DOI: 10.1016/j.amjmed.2021.03.024] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Limited data exist about relatively recent trends in the magnitude and characteristics of patients who are re-hospitalized after hospital admission for an acute myocardial infarction. This study examined trends in the frequency and sociodemographic and clinical characteristics of patients readmitted to the hospital within 30 days after an initial acute myocardial infarction. METHODS We reviewed the medical records of 3116 individuals who were hospitalized for a validated first acute myocardial infarction in 6 study periods between 2003 and 2015 at the 3 major medical centers in central Massachusetts. RESULTS The median age of our population was 67 years, and 42% were women. The risk of being readmitted to the hospital within 30 days after an initial acute myocardial infarction increased slightly during the most recent study years after controlling for potentially confounding factors. Overall, older adults and patients with previously diagnosed atrial fibrillation, heart failure, diabetes, chronic kidney disease, stroke, and peripheral vascular disease were at higher risk for being readmitted to the hospital than respective comparison groups. For those hospitalized in the most recent study years of 2011/2015, a higher risk of rehospitalization was associated with a previous diagnosis of chronic kidney disease, peripheral vascular disease, the presence of 3 or more chronic conditions, and having developed atrial fibrillation or heart failure during the patient's hospitalization for a first acute myocardial infarction. CONCLUSIONS We identified several groups at higher risk for hospital readmission in whom enhanced surveillance efforts as well as tailored educational and treatment approaches remain needed.
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Affiliation(s)
- Mayra Tisminetzky
- Meyers Primary Care Institute, Worcester, Mass; Division of Geriatric Medicine; Department of Population and Quantitative Health Sciences.
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Ruben Miozzo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, Worcester, Mass; Division of Geriatric Medicine; Department of Population and Quantitative Health Sciences
| | - Joel M Gore
- Department of Population and Quantitative Health Sciences; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | | | - Hawa O Abu
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester; Internal Medicine Department, Saint Vincent Hospital, Worcester, Mass
| | - Benita A Bamgbade
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, Mass
| | | | | | - Robert J Goldberg
- Meyers Primary Care Institute, Worcester, Mass; Department of Population and Quantitative Health Sciences
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13
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Tisminetzky M, Miozzo R, Gore JM, Gurwitz JH, Lessard D, Yarzebski J, Granillo E, Abu HO, Goldberg RJ. Trends in the magnitude of chronic conditions in patients hospitalized with a first acute myocardial infarction. J Comorb 2021; 11:2633556521999570. [PMID: 33738263 PMCID: PMC7934031 DOI: 10.1177/2633556521999570] [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] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/09/2020] [Accepted: 02/05/2021] [Indexed: 11/23/2022]
Abstract
Background: Among adults with heart disease, there is a high prevalence of concomitant chronic medical conditions. We studied patients with a first acute myocardial infarction to describe: sample population characteristics; trends of the most prevalent pairs of chronic conditions; and differences in hospital management according to burden of these morbidities. Methods and Results: Patients (n = 1,564) hospitalized with an incident AMI at the 3 major medical centers in central Massachusetts during 2005, 2011, and 2015 comprised the study population. Hospital medical records were reviewed to identify 11 more prevalent chronic conditions. The median age of this population was 68 years and 56% were men. The median number of previously diagnosed chronic conditions was 2. Patients hospitalized during 2015 were more likely to be younger than those hospitalized in the earliest study cohorts. The most common pairs of chronic conditions for those hospitalized in 2005 were: anemia-chronic kidney disease (31%), chronic kidney disease-heart failure (30%), and stroke-atrial fibrillation (27%). Among patients hospitalized during 2011, chronic kidney disease-heart failure (29%), hypertension-hyperlipidemia (27%), and hypertension-diabetes (27%) were the most common pairs whereas hypertension-hyperlipidemia (43%), diabetes-heart failure (30%), and chronic kidney disease-diabetes (23%) were the most frequent pairs recorded in 2015. There was a significant decrease in the odds of undergoing cardiac catheterization and a percutaneous coronary intervention in those with higher chronic disease burden in the most recent as compared to earliest study years. Conclusions: Our findings highlight the magnitude of chronic conditions in patients with AMI and the challenges of caring for this vulnerable population.
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Affiliation(s)
- Mayra Tisminetzky
- Meyers Primary Care Institute, Worcester, MA, USA.,Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Ruben Miozzo
- Johns Hopkins Bloomberg School of Public Health Baltimore, MD, USA
| | - Joel M Gore
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.,Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester MA, USA
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, Worcester, MA, USA.,Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jorge Yarzebski
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Edgard Granillo
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Hawa O Abu
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester MA, USA
| | - Robert J Goldberg
- Meyers Primary Care Institute, Worcester, MA, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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14
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Nicholson K, De Burghgraeve T, Fortin M, Griffith LE, Licher S, Lizotte D, Mair FS, Miozzo R, Nouri MS, Ryan BL, Lee ES, Smith S, Stewart M, Terry AL, Tisminetzky M, Ukhanova M, Wetmore S, Stranges S. Advancing cross-national planning and partnership: Proceedings from the International Multimorbidity Symposium 2019. J Comorb 2020; 10:2235042X20953313. [PMID: 33033706 PMCID: PMC7525218 DOI: 10.1177/2235042x20953313] [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] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 11/26/2022]
Abstract
The International Multimorbidity Symposium was held in November 2019 at
Western University to achieve three main objectives: to discuss
progress and findings from various jurisdictions; to facilitate
collaboration through group discussion to identify strategies to move
multimorbidity research forward; and to create concrete plans to
ensure advances in multimorbidity research and knowledge can be
achieved through cross-national partnership. This event included
keynote presentations, elevator pitch presentations and breakout
sessions and there was a total of 35 attendees from eight countries,
representing diverse disciplines and training levels. The overall
themes arising from the event were: the importance of integrating the
study and management of multimorbidity from both the primary care and
public health perspectives; meaningful engagement and collaboration
with patients and caregivers to understand key dimensions of
multimorbidity; the considerable benefit of collaborative
international partnerships; and the need to spread and scale
innovations for health care systems that can better respond to the
complex needs of patients and caregivers who are living with
multimorbidity. Finally, it was well-acknowledged among the attendees
that expanding the collaboration and discussion among international
colleagues via in-person and virtual events will be important to move
multimorbidity research forward.
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Affiliation(s)
- Kathryn Nicholson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Québec, Canada.,Centre intégré universitaire de santé et de services sociaux du Saguenay - Lac St-Jean, Québec, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Silvan Licher
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Daniel Lizotte
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada .,Department of Computer Science, Western University, London, Ontario, Canada
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Ruben Miozzo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maede Sadat Nouri
- Department of Computer Science, Western University, London, Ontario, Canada
| | - Bridget L Ryan
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada .,Department of Family Medicine, Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Eng Sing Lee
- National Healthcare Group Polyclinics, Singapore
| | - Susan Smith
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Moira Stewart
- Department of Family Medicine, Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Amanda L Terry
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada .,Department of Family Medicine, Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Mayra Tisminetzky
- Division of Geriatrics, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Stephen Wetmore
- Department of Family Medicine, Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Saverio Stranges
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada .,Department of Family Medicine, Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
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15
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Tisminetzky M, Gurwitz JH, Fan D, Reynolds K, Smith DH, Fouayzi H, Sung SH, Goldberg R, Go AS. Noncardiac-Related Morbidity, Mobility Limitation, and Outcomes in Older Adults With Heart Failure. J Gerontol A Biol Sci Med Sci 2020; 75:1981-1988. [PMID: 31813983 DOI: 10.1093/gerona/glz285] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To examine the individual and combined associations of noncardiac-related conditions and mobility limitation with morbidity and mortality in adults with heart failure (HF). METHODS We conducted a retrospective cohort study in a large, diverse group of adults with HF from five U.S. integrated healthcare delivery systems. We characterized patients with respect to the presence of noncardiac conditions (<3 vs ≥3) and/or mobility impairment (defined by the use/nonuse of a wheelchair, cane, or walker), categorizing them into four subgroups. Outcomes included all-cause death and hospitalizations for HF or any cause. RESULTS Among 114,553 adults diagnosed with HF (mean age: 73 years old, 46% women), compared with <3 noncardiac conditions/no mobility limitation, adjusted hazard ratios (HR) for all-cause death among those with <3 noncardiac conditions/mobility limitation, ≥3 noncardiac conditions/no mobility limitation, ≥3 noncardiac conditions/mobility limitation (vs) were 1.40 (95% CI, 1.31-1.51), 1.72 (95% CI, 1.69-1.75), and 1.93 (95% CI, 1.85-2.01), respectively. We did not observe an increased risk of any-cause or HF-related hospitalization related to the presence of mobility limitation among those with a greater burden of noncardiac multimorbidity. Consistent findings regarding mortality were observed within groups defined according to age, gender, and HF type (preserved, reduced, mid-range ejection fraction), with the most prominent impact of mobility limitation in those <65 years of age. CONCLUSIONS There is an additive association of mobility limitation, beyond the burden of noncardiac multimorbidity, on mortality for patients with HF, and especially prominent in younger patients.
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Affiliation(s)
- Mayra Tisminetzky
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.,Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.,Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Dongjie Fan
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - David H Smith
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Hassan Fouayzi
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Robert Goldberg
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland.,Department of Epidemiology and University of California, San Francisco.,Department of Biostatistics and University of California, San Francisco.,Department of Medicine, University of California, San Francisco.,Department of Medicine, Stanford University, California.,Department of Health Research and Policy, Stanford University, California
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16
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Abu HO, Saczynski JS, Mehawej J, Tisminetzky M, Kiefe CI, Goldberg RJ, McManus DD. Clinically Meaningful Change in Quality of Life and Associated Factors Among Older Patients With Atrial Fibrillation. J Am Heart Assoc 2020; 9:e016651. [PMID: 32875941 PMCID: PMC7726984 DOI: 10.1161/jaha.120.016651] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Among older patients with atrial fibrillation, there are limited data examining clinically meaningful changes in quality of life (QoL). We examined the extent of, and factors associated with, clinically meaningful change in QoL over 1‐year among older adults with atrial fibrillation. Methods and Results Patients from cardiology, electrophysiology, and primary care clinics in Massachusetts and Georgia were enrolled in a cohort study (2015–2018). The Atrial Fibrillation Effect on Quality‐of‐Life questionnaire was used to assess overall QoL and across 3 subscales: symptoms, daily activities, and treatment concern. Clinically meaningful change in QoL (ie, difference between 1‐year and baseline QoL score) was categorized as either a decline (≤−5.0 points), no clinically meaningful change (−5.0 to +5.0 points), or an increase (≥+5.0 points). Ordinal logistic models were used to examine factors associated with QoL changes. Participants (n=1097) were on average 75 years old, 48% were women, and 87% White. Approximately 40% experienced a clinically meaningful increase in QoL and 1 in every 5 patients experienced a decline in QoL. After multivariable adjustment, women, non‐Whites, those who reported depressive and anxiety symptoms, fair/poor self‐rated health, low social support, heart failure, or diabetes mellitus experienced clinically meaningful declines in QoL. Conclusions These findings provide insights to the magnitude of, and factors associated with, clinically meaningful change in QoL among older patients with atrial fibrillation. Assessment of comorbidities and psychosocial factors may help identify patients at high risk for declining QoL and those who require additional surveillance to maximize important clinical and patient‐centered outcomes.
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Affiliation(s)
- Hawa O. Abu
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Jane S. Saczynski
- Department of Pharmacy and Health Systems SciencesSchool of PharmacyNorth Eastern UniversityBostonMA
| | - Jordy Mehawej
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Mayra Tisminetzky
- Division of Geriatrics and Meyers Primary Care InstituteDepartment of MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Catarina I. Kiefe
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Robert J. Goldberg
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMA
| | - David D. McManus
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
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17
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Tisminetzky M, Gurwitz JH, Miozzo R, Nunes A, Gore JM, Lessard D, Yarzebski J, Granillo E, Goldberg RJ. Age Differences in the Chief Complaint Associated With a First Acute Myocardial Infarction and Patient's Care-Seeking Behavior. Am J Med 2020; 133:e501-e507. [PMID: 32199808 PMCID: PMC7483814 DOI: 10.1016/j.amjmed.2020.02.018] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study set out to describe age differences in patient's chief complaint related to a first myocardial infarction and how the "typicality" of patient's acute symptoms relates to extent of prehospital delay. METHODS The medical records of 2586 residents of central Massachusetts hospitalized at 11 greater Worcester medical centers with a first myocardial infarction on a biennial basis between 2001 and 2011 were reviewed. RESULTS The average age of the study population was 66.4 years, 39.6% were women, 40.2% were diagnosed with a ST-elevation myocardial infarction (STEMI), and 72.0 % presented with typical symptoms of myocardial infarction, namely acute chest pain or pressure. Patients were categorized into 5 age strata: >55 years (23%), 55-64 years (20%), 65-74 years (19%), 75-84 years (22%), and ≥85 years (16%). The lowest proportion (11%) of atypical symptoms of myocardial infarction was observed in patients <55 years, increasing to 17%, 28%, 40%, and 51% across the respective age groups. The most prevalent chief complaint reported at the time of hospitalization was chest pain, but the proportion of patients reporting this symptom decreased from the youngest (83%) to the oldest patient groups (45%). There was a slightly increased risk of prehospital delay across the different age groups (higher in the oldest old) in those who presented with atypical, rather than typical, symptoms of myocardial infarction. CONCLUSIONS The present results provide insights to the presenting chief complaint of patients hospitalized with a first myocardial infarction according to age and the relation of symptom presentation to patient's care-seeking behavior.
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Affiliation(s)
- Mayra Tisminetzky
- Meyers Primary Care Institute, Worcester, Mass; Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Mass; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass.
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, Worcester, Mass; Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Mass; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
| | - Ruben Miozzo
- Johns Hopkins Bloomberg School of Public Health Baltimore, Md
| | - Anthony Nunes
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
| | - Joel M Gore
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
| | - Jorge Yarzebski
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
| | - Edgard Granillo
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
| | - Robert J Goldberg
- Meyers Primary Care Institute, Worcester, Mass; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
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18
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Abu HO, Saczynski JS, Ware J, Mehawej J, Paul T, Awad H, Bamgbade BA, Pierre-Louis IC, Tisminetzky M, Kiefe CI, Goldberg RJ, McManus DD. Impact of comorbid conditions on disease-specific quality of life in older men and women with atrial fibrillation. Qual Life Res 2020; 29:3285-3296. [PMID: 32656722 DOI: 10.1007/s11136-020-02578-3] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Older persons with atrial fibrillation (AF) experience significant impairment in quality of life (QoL), which may be partly attributable to their comorbid diseases. A greater understanding of the impact of comorbidities on QoL could optimize patient-centered care among older persons with AF. OBJECTIVE To assess impairment in disease-specific QoL due to comorbid conditions in older adults with AF. METHODS Patients aged ≥ 65 years diagnosed with AF were recruited from five medical centers in Massachusetts and Georgia between 2015 and 2018. At 1 year of follow-up, the Quality of Life Disease Impact Scale-for Multiple Chronic Conditions was used to provide standardized assessment of patient self-reported impairment in QoL attributable to 34 comorbid conditions grouped in 10 clusters. RESULTS The mean age of study participants (n = 1097) was 75 years and 48% were women. Overall, cardiometabolic, musculoskeletal, and pulmonary conditions were the most prevalent comorbidity clusters. A high proportion of participants (82%) reported that musculoskeletal conditions exerted the greatest impact on their QoL. Men were more likely than women to report that osteoarthritis and stroke severely impacted their QoL. Patients aged < 75 years were more likely to report that obesity, hip/knee joint problems, and fibromyalgia extremely impacted their QoL than older participants. CONCLUSIONS Among older persons with AF, while cardiometabolic diseases were highly prevalent, musculoskeletal conditions exerted the greatest impact on patients' disease-specific QoL. Understanding the extent of impairment in QoL due to underlying comorbidities provides an opportunity to develop interventions targeted at diseases that may cause significant impairment in QoL.
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Affiliation(s)
- Hawa O Abu
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Jane S Saczynski
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - John Ware
- John Ware Research Group, Watertown, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Tenes Paul
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Hamza Awad
- Departments of Community Medicine and Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Benita A Bamgbade
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Isabelle C Pierre-Louis
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Mayra Tisminetzky
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Division of Geriatrics, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert J Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - David D McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
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19
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Tisminetzky M, Gurwitz JH, Miozzo R, Gore JM, Lessard D, Yarzebski J, Goldberg RJ. Impact of cardiac- and noncardiac-related conditions on adverse outcomes in patients hospitalized with acute myocardial infarction. J Comorb 2019; 9:2235042X19852499. [PMID: 31192141 PMCID: PMC6542121 DOI: 10.1177/2235042x19852499] [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] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/12/2019] [Indexed: 01/31/2023]
Abstract
Background To examine the impact of cardiac- and noncardiac-related conditions on the risk of hospital complications and 7- and 30-day rehospitalizations in older adult patients with an acute myocardial infarction (AMI). Methods and Results The study population consisted of 3863 adults aged 65 years and older hospitalized with AMI in Worcester, Massachusetts, during six annual periods between 2001 and 2011. Individuals were categorized into four groups based on the presence of 11 previously diagnosed cardiac and noncardiac conditions. The median age of the study population was 79 years and 49% were men. Twenty-eight percent of patients had two or less cardiac- and no noncardiac-related conditions, 21% had two or less cardiac and one or more noncardiac conditions, 20% had three or more cardiac and no noncardiac conditions, and 31% had three or more cardiac and one or more noncardiac conditions. Individuals who presented with one or more noncardiac-related conditions were less likely to have been prescribed evidence-based medications and/or to have undergone coronary revascularization procedures than patients without any noncardiac condition. After multivariable adjustment, individuals with three or more cardiac and one or more noncardiac conditions were at greatest risk for all adverse outcomes. Conclusions Older patients hospitalized with AMI carry a significant burden of cardiac- and noncardiac-related conditions. Older adults who presented with multiple cardiac and noncardiac conditions experienced the worse short-term outcomes and treatment strategies should be developed to improve their in-hospital and post-discharge care and outcomes.
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Affiliation(s)
- Mayra Tisminetzky
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA.,Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA.,Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Ruben Miozzo
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Joel M Gore
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert J Goldberg
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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20
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Goldberg RJ, Tisminetzky M, Tran HV, Yarzebski J, Lessard D, Gore JM. Decade Long Trends (2001-2011) in the Incidence Rates of Initial Acute Myocardial Infarction. Am J Cardiol 2019; 123:206-211. [PMID: 30409411 DOI: 10.1016/j.amjcard.2018.10.002] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/27/2018] [Accepted: 10/08/2018] [Indexed: 11/17/2022]
Abstract
Despite the magnitude and impact of acute coronary disease, there are limited population-based data in the United States describing relatively recent trends in the incidence rates of acute myocardial infarction (AMI). The objectives of this study were to describe decade long (2001-2011) trends in the incidence rates of initial hospitalized episodes of AMI, with further stratification of these rates by age, sex, and type of AMI, in residents of central Massachusetts hospitalized at 11 area medical centers. The study population consisted of 3,737 adults hospitalized with a first AMI at 11 medical centers in central Massachusetts on a biennial basis between 2001 and 2011. The median age of this study population was 70 years, 57% were men, and 90% were white. Patients hospitalized during the most recent study years (2009/11) were younger, more likely to be men, have more co-morbidities, and less in-hospital complications as compared with those in the earliest study years (2001/03). The overall age-adjusted hospital incidence rates (per 100,000 persons) of initial AMI declined (from 319 to 163), for men (from 422 to 219), women (from 232 to 120), for patients with a ST segment elevation (129 to 56), and for those with an non-ST segment elevation (190 to 107) between 2001 and 2011, respectively. In conclusion, the incidence rates of initial AMI declined appreciably in residents of central Massachusetts who were hospitalized with AMI during the years under study.
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Affiliation(s)
- Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Meyers Primary Care Institute and the Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Hoang V Tran
- Department of Medicine, Bridgeport Hospital, Yale New Haven Health, Bridgeport, Connecticut
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Joel M Gore
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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21
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Tisminetzky M, Gurwitz J, Fan D, Reynolds K, Smith D, Sung S, Murphy T, Go A. MULTIMORBIDITY BURDEN AND ADVERSE OUTCOMES IN OLDER ADULTS WITH HEART FAILURE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2611] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - J Gurwitz
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts
| | - D Fan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - K Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - D Smith
- Center for Health Research, Kaiser Permanente Northwest, Portland Oregon
| | - S Sung
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - T Murphy
- Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, CT, USA
| | - A Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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22
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Tisminetzky M, Gurwitz JH, Fan D, Reynolds K, Smith DH, Magid DJ, Sung SH, Murphy TE, Goldberg RJ, Go AS. Multimorbidity Burden and Adverse Outcomes in a Community-Based Cohort of Adults with Heart Failure. J Am Geriatr Soc 2018; 66:2305-2313. [PMID: 30246862 DOI: 10.1111/jgs.15590] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To assess multimorbidity burden and its association with clinical outcomes in adults with heart failure (HF) according to sex, age, and HF type. DESIGN Retrospective cohort study. SETTING Five healthcare delivery systems across the United States. PARTICIPANTS Adults with HF (N=114,553). MEASUREMENTS We characterized participants with respect to the presence of 26 chronic conditions categorized into quartiles based on overall burden of comorbidity (<5, 5-6, 7-8, ≥9). Outcomes included all-cause death and hospitalization for HF or any cause. Multivariable Cox regression was used to evaluate the adjusted association between categorized burden of multimorbidity burden and outcomes. RESULTS Individuals with more morbidities were more likely to die than those with fewer then 5 morbidities (5-6 morbidities: adjusted hazard ratio (aHR)=1.27 (95% confidence interval (CI)=1.24-1.31; 7-8 morbidities: aHR=1.52, 95% CI=1.48-1.57; ≥9 morbidities: aHR=1.92, 95% CI=1.86-1.99). There was a graded, higher adjusted rate of any-cause hospitalization associated with 5 or 6 (aHR=1.28, 95% CI=1.25-1.30), 7 or 8 (aHR=1.47, 95% CI=1.44-1.50), or 9 or more (aHR=1.77, 95% CI=1.73-1.82) morbidities (vs <5). Similar findings were observed for HF-specific hospitalization in those with 5 or 6 (aHR=1.22, 95% CI=1.19-1.26), 7 or 8 (aHR=1.39, 95% CI=1.34-1.44), or 9 or more (aHR 1.68, 95% CI=1.61-1.74) morbidities (vs <5). Consistent findings were seen according to sex, age group, and HF type (preserved, reduced, borderline HF), in the association between categorical burden of multimorbidity and outcomes especially prominent in individuals younger than 65. CONCLUSION After adjustment, higher levels of multimorbidity predicted worse HF outcomes and may be an important consideration in strategies to improve clinical and person-centered outcomes. J Am Geriatr Soc 66:2305-2313, 2018.
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Affiliation(s)
- Mayra Tisminetzky
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.,Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.,Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Dongjie Fan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - David H Smith
- Center for Health Research, Kaiser Permanente Northwest, Oregon, Portland
| | - David J Magid
- The Kaiser Institute for Health Research Denver, Denver, Colorado
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Terrence E Murphy
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Robert J Goldberg
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California.,Departments of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.,Departments of Medicine, University of California, San Francisco, San Francisco, California.,Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, California
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23
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Hariri E, Tisminetzky M, Lessard D, Yarzebski J, Gore J, Goldberg R. Twenty-Five-Year (1986-2011) Trends in the Incidence and Death Rates of Stroke Complicating Acute Myocardial Infarction. Am J Med 2018; 131:1086-1094. [PMID: 29730362 PMCID: PMC6163071 DOI: 10.1016/j.amjmed.2018.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 03/16/2018] [Revised: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The occurrence of a stroke after an acute myocardial infarction is associated with increased morbidity and mortality rates. However, limited data are available, particularly from a population-based perspective, about recent trends in the incidence and mortality rates associated with stroke complicating an acute myocardial infarction. The purpose of this study was to examine 25-year trends (1986-2011) in the incidence and in-hospital mortality rates of initial episodes of stroke complicating acute myocardial infarction. METHODS The study population consisted of 11,436 adults hospitalized with acute myocardial infarction at all 11 medical centers in central Massachusetts on a biennial basis between 1986 and 2011. RESULTS In this study cohort, 159 patients (1.4%) experienced an acute first-ever stroke during hospitalization for acute myocardial infarction. The proportion of patients with acute myocardial infarction who developed a stroke increased through the 1990s but decreased slightly thereafter. Compared with patients who did not experience a stroke, those who experienced a stroke were significantly older, were more likely to be female, had a previous acute myocardial infarction, had a significant burden of comorbidities, and were more likely to have died (32.1% vs 10.8%) during their index hospitalization. Patients who developed a first stroke in the most recent study years (2003-2011) were more likely to have died during hospitalization than those hospitalized during earlier study years. CONCLUSIONS Although the incidence rates of acute stroke complicating acute myocardial infarction remained relatively stable during the years under study, the in-hospital mortality rates of those experiencing a stroke have not decreased.
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Affiliation(s)
- Essa Hariri
- Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Joel Gore
- Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Robert Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
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24
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Tisminetzky M, Nguyen HL, Gurwitz JH, McManus D, Gore J, Singh S, Yarzebski J, Goldberg RJ. Magnitude and impact of multiple chronic conditions with advancing age in older adults hospitalized with acute myocardial infarction. Int J Cardiol 2018; 272:341-345. [PMID: 30172472 DOI: 10.1016/j.ijcard.2018.08.062] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/17/2018] [Accepted: 08/20/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND To examine age-specific differences in the frequency and impact of cardiac and non-cardiac conditions among patients aged 65 years and older hospitalized with acute myocardial infarction (AMI). METHODS Study population consisted of 3863 adults hospitalized with AMI at 11 medical centers in central Massachusetts on a biennial basis between 2001 and 2011. The presence of 11 chronic conditions (five cardiac and six non-cardiac) was based on the review of hospital medical records. RESULTS Participants' median age was 79 years, 49% were men, and had an average of three chronic conditions (average of cardiac conditions: 2.6 and average of non-cardiac conditions: 1.0). Approximately one in every two patients presented with two or more cardiac related conditions whereas one in every three patients presented with two or more non-cardiac related conditions. The most prevalent chronic conditions in our study population were hypertension, diabetes, heart failure, chronic kidney disease, and peripheral vascular disease. Patients across all age groups with a greater number of previously diagnosed cardiac or non-cardiac conditions were at higher risk for developing important clinical complications or dying during hospitalization as compared to those with 0-1 condition. CONCLUSIONS The prevalence of multimorbidity among older adults hospitalized with AMI is high and associated with worse outcomes that should be considered in the management of this vulnerable population.
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Affiliation(s)
- Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, United States of America; Division of Geriatrics, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Hoa L Nguyen
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America; Department of Quantitative Sciences, Baylor Scott and White Health, Dallas, TX, United States of America
| | - Jerry H Gurwitz
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, United States of America; Division of Geriatrics, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - David McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Joel Gore
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Sonal Singh
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, United States of America; Division of Geriatrics, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, United States of America; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America.
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25
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Tisminetzky M, Goldberg R, Gurwitz JH. Magnitude and Impact of Multimorbidity on Clinical Outcomes in Older Adults with Cardiovascular Disease: A Literature Review. Clin Geriatr Med 2017; 32:227-46. [PMID: 27113143 DOI: 10.1016/j.cger.2016.01.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 12/21/2022]
Abstract
The authors aim to synthesize the current literature on the magnitude and impact of multimorbidity on clinical outcomes in older adults with cardiovascular disease (CVD). Most studies reported a significant association between the number of morbidities and the risk of dying. Multimorbidity was assessed either by counting the number of conditions or by use of the Charlson or Elixhauser indices. There are limited data available on the magnitude and impact of multimorbidity on clinical outcomes in patients with CVD and essentially no data on universal health outcomes (eg, health-related quality of life, symptom burden, and function).
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Affiliation(s)
- Mayra Tisminetzky
- Division of Geriatric Medicine, Department of Medicine, Meyers Primary Care Institute, University of Massachusetts Medical School, 425 North Lake Avenue, Worcester, MA 01605, USA; Department of Quantitative Health Sciences, University of Massachusetts Medical School, 425 North Lake Avenue, Worcester, MA 01605, USA
| | - Robert Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 425 North Lake Avenue, Worcester, MA 01605, USA; Division of Cardiovascular Medicine, Department of Medicine, Meyers Primary Care Institute, University of Massachusetts Medical School, 425 North Lake Avenue, Worcester, MA 01605, USA
| | - Jerry H Gurwitz
- Division of Geriatric Medicine, Department of Medicine, Meyers Primary Care Institute, University of Massachusetts Medical School, 425 North Lake Avenue, Worcester, MA 01605, USA; Department of Quantitative Health Sciences, University of Massachusetts Medical School, 425 North Lake Avenue, Worcester, MA 01605, USA.
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26
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Tisminetzky M, Wang TY, Gurwitz J, Kaltenbach LA, McManus D, Gore J, Peterson E, Goldberg RJ. Magnitude and Characteristics of Patients Who Survived an Acute Myocardial Infarction. J Am Heart Assoc 2017; 6:JAHA.117.006373. [PMID: 28947562 PMCID: PMC5634289 DOI: 10.1161/jaha.117.006373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to describe the magnitude and characteristics of patients who did not experience any significant major adverse cardiovascular event early (within 6 weeks) and late (during the first year) after hospital discharge for an acute myocardial infarction (AMI). METHODS AND RESULTS Data from 12 243 patients discharged after an AMI from 233 sites across the United States in the TRANSLATE-ACS (Treatment With ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study were analyzed. Multivariable adjusted regression analyses modeled factors associated with 6-week and 1-year survivors who did not experience a recurrent AMI, stroke, unplanned coronary revascularization, or rehospitalization for unstable angina/chest pain during these time periods. The average age of this study population was 60.0 years, 72.0% were men, and 87.9% were white. In this population, 92.4% were classified as early low-risk survivors and 76.3% were classified as late low-risk survivors of an AMI. Factors associated with being an early and late postdischarge survivor included being male and having single-vessel coronary artery disease at the patient's index hospitalization. Patients who were not first seen with any chronic health condition, had an index hospital stay of ≤3 days, and had high baseline quality-of-life scores were more likely to be late low-risk survivors. CONCLUSIONS Identifying low-risk survivors of an AMI may permit healthcare providers to focus more intensive efforts and interventions on those at higher risk of experiencing adverse cardiovascular events during the postdischarge transition period. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01088503.
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Affiliation(s)
- Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA.,Division of Geriatrics, University of Massachusetts Medical School, Worcester, MA
| | | | - Jerry Gurwitz
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA.,Division of Geriatrics, University of Massachusetts Medical School, Worcester, MA
| | | | - David McManus
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA.,Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Joel Gore
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.,Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | | | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA .,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA
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Gurwitz JH, Magid DJ, Smith DH, Tabada GH, Sung SH, Allen LA, McManus DD, Goldberg RJ, Tisminetzky M, Go AS. Treatment Effectiveness in Heart Failure with Comorbidity: Lung Disease and Kidney Disease. J Am Geriatr Soc 2017; 65:2610-2618. [PMID: 28873219 DOI: 10.1111/jgs.15062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To assess the clinical effectiveness of beta-blocker therapy in individuals with heart failure (HF) and chronic lung disease and of angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin II receptor blockers (ARBs) in individuals with HF and chronic kidney disease. DESIGN Retrospective cohort study. SETTING Community. PARTICIPANTS Individuals with HF with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF). METHODS We undertook separate new-user cohort studies to assess the effectiveness of beta-blocker therapy in treating HF and chronic lung disease and ACE-Is and ARBs in treating HF and chronic kidney disease (CKD). Individuals with a chronic lung disease diagnosis were included in the group with HF and chronic lung disease (International Classification of Diseases, Ninth Revision, codes 490-496, 518). Individuals with an estimated glomerular filtration rate less than 60 mL/min per 1.73 m2 were included in the group with HF and CKD. The clinical outcomes of interest were death from any cause, hospitalization for HF, and hospitalization for any reason. We fitted pooled logistic marginal structural models using inverse probability weighting, stratified according to HF type. RESULTS For individuals with HFrEF with chronic lung disease, beta-blocker therapy was protective against death (relative risk (RR) = 0.58, 95% confidence interval (CI) = 0.44-0.77) and hospitalization for HF (RR = 0.78, 95% CI = 0.60-1.00). For those with HFpEF, no statistically significant associations between beta-blocker therapy use and any of the outcomes were observed. We found ACE-I and ARB use to be protective against all three outcomes of interest in individuals with HFrEF (death from any cause: RR = 0.60, 95% 0.40-0.91; hospitalization for HF: RR = 0.43, 95% CI = 0.28-0.67; hospitalization for any reason: RR = 0.63, 95% CI = 0.45-0.89, respectively) and those with HFpEF (death from any cause: RR = 0.52, 95% CI = 0.33-0.81; hospitalization for HF: RR = 0.35, 95% CI = 0.18-0.68; hospitalization for any reason: RR = 0.67, 95% CI = 0.47-0.95). CONCLUSION Large observational studies may allow for identification of important subgroups of individuals with HF that might benefit from existing treatment approaches. Our findings may also better inform the design of more-definitive future observational studies and randomized trials.
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Affiliation(s)
- Jerry H Gurwitz
- Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Community Health Plan and Reliant Medical Group, Worcester, Massachusetts.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - David J Magid
- Department of Emergency Medicine, Kaiser Permanente Colorado, Denver, Colorado
| | - David H Smith
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Grace H Tabada
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Larry A Allen
- Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado.,School of Medicine, University of Colorado, Aurora, Colorado
| | - David D McManus
- Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Community Health Plan and Reliant Medical Group, Worcester, Massachusetts.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Robert J Goldberg
- Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Community Health Plan and Reliant Medical Group, Worcester, Massachusetts.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Mayra Tisminetzky
- Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Community Health Plan and Reliant Medical Group, Worcester, Massachusetts.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California.,Department of Epidemiology, University of California San Francisco, San Francisco, California.,Department of Biostatistics, University of California San Francisco, San Francisco, California.,Department of Medicine, University of California San Francisco, San Francisco, California.,Department of Health Research and Policy, School of Medicine, Stanford University, Palo Alto, California
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Tisminetzky M, Anzuoni K, Shirley B, Magaziner J, Bayliss E, Gurwitz J. Research Priorities to Advance the Science of Multiple Chronic Conditions in Older Adults From the AGING Initiative Steering and Advisory Committees. J Patient Cent Res Rev 2017. [DOI: 10.17294/2330-0698.1465] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tisminetzky M, Gurwitz J, Nguyen H, Goldberg R. Age and Sex Differences in the Magnitude of, and Hospital Death Rates Associated With, Multiple Chronic Conditions in Older Adults Hospitalized With Acute Myocardial Infarction. J Patient Cent Res Rev 2017. [DOI: 10.17294/2330-0698.1464] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tisminetzky M, Bayliss EA, Magaziner JS, Allore HG, Anzuoni K, Boyd CM, Gill TM, Go AS, Greenspan SL, Hanson LR, Hornbrook MC, Kitzman DW, Larson EB, Naylor MD, Shirley BE, Tai-Seale M, Teri L, Tinetti ME, Whitson HE, Gurwitz JH. Research Priorities to Advance the Health and Health Care of Older Adults with Multiple Chronic Conditions. J Am Geriatr Soc 2017; 65:1549-1553. [PMID: 28555750 DOI: 10.1111/jgs.14943] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 01/10/2023]
Abstract
OBJECTIVES To prioritize research topics relevant to the care of the growing population of older adults with multiple chronic conditions (MCCs). DESIGN Survey of experts in MCC practice, research, and policy. Topics were derived from white papers, funding announcements, or funded research projects relating to older adults with MCCs. SETTING Survey conducted through the Health Care Systems Research Network (HCSRN) and Claude D. Pepper Older Americans Independence Centers (OAICs) Advancing Geriatrics Infrastructure and Network Growth Initiative, a joint endeavor of the HCSRN and OAICs. PARTICIPANTS Individuals affiliated with the HCSRN or OAICs and national MCC experts, including individuals affiliated with funding agencies having MCC-related grant portfolios. MEASUREMENTS A "top box" methodology was used, counting the number of respondents selecting the top response on a 5-point Likert scale and dividing by the total number of responses to calculate a top box percentage for each of 37 topics. RESULTS The highest-ranked research topics relevant to the health and healthcare of older adults with MCCs were health-related quality of life in older adults with MCCs; development of assessment tools (to assess, e.g., symptom burden, quality of life, function); interactions between medications, disease processes, and health outcomes; disability; implementation of novel (and scalable) models of care; association between clusters of chronic conditions and clinical, financial, and social outcomes; role of caregivers; symptom burden; shared decision-making to enhance care planning; and tools to improve clinical decision-making. CONCLUSION Study findings serve to inform the development of a comprehensive research agenda to address the challenges relating to the care of this "high-need, high-cost" population and the healthcare delivery systems responsible for serving it.
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Affiliation(s)
- Mayra Tisminetzky
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.,Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Elizabeth A Bayliss
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.,Department of Family Medicine, School of Medicine, University of Colorado, Aurora, Colorado
| | - Jay S Magaziner
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland
| | | | - Kathryn Anzuoni
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts
| | - Cynthia M Boyd
- Division of Geriatric Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Thomas M Gill
- School of Medicine, Yale University, New Haven, Connecticut
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Susan L Greenspan
- New Courtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Mark C Hornbrook
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Dalane W Kitzman
- Wake Forest Baptist Medical Center, Winston Salem, North Carolina
| | - Eric B Larson
- Kaiser Washington Health Research Institute, Seattle, Washington
| | - Mary D Naylor
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin E Shirley
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Ming Tai-Seale
- Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Linda Teri
- School of Nursing, University of Washington, Seattle, Washington
| | - Mary E Tinetti
- School of Medicine, Yale University, New Haven, Connecticut
| | - Heather E Whitson
- Duke University Aging Center, Duke University, Durham, North Carolina.,Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.,Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
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Goldberg RJ, Gore JM, McManus DD, McManus R, Tisminetzky M, Lessard D, Gurwitz JH, Parish DC, Allison J, Hess CN, Wang T, Kiefe C. Race and place differences in patients hospitalized with an acute coronary syndrome: Is there double jeopardy? Findings from TRACE-CORE. Prev Med Rep 2017; 6:1-8. [PMID: 28210536 PMCID: PMC5300696 DOI: 10.1016/j.pmedr.2017.01.010] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/18/2017] [Accepted: 01/22/2017] [Indexed: 11/10/2022] Open
Abstract
The objectives of this longitudinal study were to examine differences between whites and blacks, and across two geographical regions, in the socio-demographic, clinical, and psychosocial characteristics, hospital treatment practices, and post-discharge mortality for hospital survivors of an acute coronary syndrome (ACS). In this prospective cohort study, we performed in-person interviews and medical record abstractions for patients discharged from the hospital after an ACS at participating sites in Central Massachusetts and Central Georgia during 2011–2013. Among the 1143 whites in Central Massachusetts, 514 whites in Central Georgia, and 277 blacks in Central Georgia, we observed a gradient of socioeconomic position with whites in Central Massachusetts being the most privileged, followed by whites and then blacks from Central Georgia; similar gradients pertained to psychosocial vulnerability (e.g., 10.7%, 25.1%, and 49.1% had cognitive impairment, respectively) and to the hospital receipt of all 4 evidence-based cardiac medications (35.5%, 18.1%, and 14.4%, respectively) used in the acute management of patients hospitalized with an ACS. Multivariable adjusted odds ratios (95% confidence intervals) for the receipt of a percutaneous coronary intervention for whites and blacks in Georgia vs. whites in Massachusetts were 0.57 (0.46–0.71) and 0.40(0.30–0.52), respectively. Thirty-day and one-year mortality risks exhibited a similar gradient. The results of this contemporary clinical/epidemiologic study in a diverse patient cohort suggest that racial and geographic disparities continue to exist for patients hospitalized with an ACS. We observed a gradient of socio-economic position, treatment practices, and dying. Interplay of race and place with treatment practices and post discharge outcomes. Racial and geographic disparities continue to exist for patients after an ACS.
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Affiliation(s)
- Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Joel M Gore
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - David D McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Richard McManus
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Mayra Tisminetzky
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jerry H Gurwitz
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - David C Parish
- Department of Community Medicine, Mercer University School of Medicine, Macon, GA, United States
| | - Jeroan Allison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Connie Ng Hess
- University of Colorado Denver - Anschutz Medical Campus, Denver, CO, United States
| | - Tracy Wang
- Duke Clinical Research Institute, Durham, NC, United States
| | - Catarina Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
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Tisminetzky M, Gurwitz J, McManus DD, Saczynski JS, Waring ME, Erskine N, Anatchkova M, Parish DC, Lessard D, Kiefe C, Goldberg R. Multiple Chronic Conditions and Psychosocial Limitations in a Contemporary Cohort of Patients Hospitalized With an Acute Coronary Syndrome. J Patient Cent Res Rev 2016. [DOI: 10.17294/2330-0698.1279] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tisminetzky M, Goldberg R, Gurwitz JH. Impact of Multimorbidity on Clinical Outcomes in Older Adults With Cardiovascular Disease: A Literature Review. J Patient Cent Res Rev 2016. [DOI: 10.17294/2330-0698.1280] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tisminetzky M, Gurwitz J, McManus DD, Saczynski JS, Erskine N, Waring ME, Anatchkova M, Awad H, Parish DC, Lessard D, Kiefe C, Goldberg R. Multiple Chronic Conditions and Psychosocial Limitations in Patients Hospitalized with an Acute Coronary Syndrome. Am J Med 2016; 129:608-14. [PMID: 26714211 PMCID: PMC4879087 DOI: 10.1016/j.amjmed.2015.11.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 09/14/2015] [Revised: 11/19/2015] [Accepted: 11/19/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND As adults live longer, multiple chronic conditions have become more prevalent over the past several decades. We describe the prevalence of, and patient characteristics associated with, cardiac- and non-cardiac-related multimorbidities in patients discharged from the hospital after an acute coronary syndrome. METHODS We studied 2174 patients discharged from the hospital after an acute coronary syndrome at 6 medical centers in Massachusetts and Georgia between April 2011 and May 2013. Hospital medical records yielded clinical information including presence of eight cardiac-related and eight non-cardiac-related morbidities on admission. We assessed multiple psychosocial characteristics during the index hospitalization using standardized in-person instruments. RESULTS The mean age of the study sample was 61 years, 67% were men, and 81% were non-Hispanic whites. The most common cardiac-related morbidities were hypertension, hyperlipidemia, and diabetes (76%, 69%, and 31%, respectively). Arthritis, chronic pulmonary disease, and depression (20%, 18%, and 13%, respectively) were the most common noncardiac morbidities. Patients with ≥4 morbidities (37% of the population) were slightly older and more frequently female than those with 0-1 morbidity; they were also heavier and more likely to be cognitively impaired (26% vs 12%), have symptoms of moderate/severe depression (31% vs 15%), high perceived stress (48% vs 32%), a limited social network (22% vs 15%), low health literacy (42% vs 31%), and low health numeracy (54% vs 42%). CONCLUSION Multimorbidity, highly prevalent in patients hospitalized with an acute coronary syndrome, is strongly associated with indices of psychosocial deprivation. This emphasizes the challenge of caring for these patients, which extends well beyond acute coronary syndrome management.
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Affiliation(s)
- Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester; Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Jerry Gurwitz
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester; Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - David D McManus
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Jane S Saczynski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester; Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Nathaniel Erskine
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Molly E Waring
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Milena Anatchkova
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Hamza Awad
- Department of Community Medicine, Mercer University School of Medicine, Macon, Ga
| | - David C Parish
- Department of Community Medicine, Mercer University School of Medicine, Macon, Ga
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Catarina Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Robert Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester.
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Tisminetzky M, Gurwitz J, Chen HY, Erskine N, Yarzebski J, Gore J, Lessard D, Goldberg R. Identification and Characteristics of Low-Risk Survivors of an Acute Myocardial Infarction. Am J Cardiol 2016; 117:1552-1557. [PMID: 27013386 DOI: 10.1016/j.amjcard.2016.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 11/28/2022]
Abstract
There are limited contemporary data available describing the characteristics of patients who neither died nor were readmitted to the hospital during the first year after hospital discharge for an acute myocardial infarction (AMI) in comparison with those who died and/or were readmitted to the hospital during this high-risk period. Residents of the Worcester, Massachusetts, metropolitan area discharged after an AMI from 3 central Massachusetts hospitals on a biennial basis from 2001 to 2011 comprised the study population. The average age of this population (n = 4,268) was 69 years, 62% were men, and 92% were white. From 2001 to 2011, 43.5% of patients were classified as low-risk survivors of an AMI, 12.3% died, and 44.2% did not die but had at least 1 rehospitalization during the subsequent year. The proportion of low-risk survivors increased from 42.6% to 46.4%, whereas the proportion of those who died within a year after hospital discharge decreased from 14.3% to 10.5%, respectively, during the years under study. After adjusting for several patient characteristics, younger (≤65 years) persons, men, those who were married, those who did not present with multimorbidities, and patients who did not develop in-hospital clinical complications were more likely to be classified as a low-risk AMI survivor. Identifying low-risk survivors of an AMI may help health care providers to focus more intensive efforts and interventions on those at higher risk for dying and/or being readmitted to the hospital during the postdischarge transition period after an AMI.
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Chen HY, Tisminetzky M, Yarzebski J, Gore JM, Goldberg RJ. Decade-Long Trends in the Frequency of 90-Day Rehospitalizations After Hospital Discharge for Acute Myocardial Infarction. Am J Cardiol 2016; 117:743-8. [PMID: 26742475 DOI: 10.1016/j.amjcard.2015.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/03/2015] [Accepted: 12/03/2015] [Indexed: 11/26/2022]
Abstract
There are limited data available describing relatively contemporary trends in 90-day rehospitalizations in patients who survive hospitalization after an acute myocardial infarction (AMI) in a community setting. We examined decade-long (2001 to 2011) trends in, and factors associated with, 90-day rehospitalizations in patients discharged from 3 central Massachusetts (MA) hospitals after AMI. Residents of the Worcester, MA, metropolitan area discharged after AMI from 3 central MA hospitals on a biennial basis from 2001 to 2011 comprised the study population (n = 4,810). The average age of this population was 69 years, 42% were women, and 92% were white. From 2001 to 2011, 30.0% of patients were rehospitalized within 90 days after hospital discharge, and 38% of 90-day rehospitalizations occurred after the first month after hospital discharge. Crude 90-day rehospitalization rates decreased from 31.5% in 2001/2003 to 27.3% in 2009/2011. After adjusting for several sociodemographic characteristics, co-morbidities, and in-hospital factors, there was a reduced risk of being rehospitalized within 90 days after hospital discharge in 2009/2011 compared with 2001/2003 (risk ratio = 0.87, 95% CI = 0.77 to 0.98); this trend was slightly attenuated (risk ratio = 0.90, 95% CI = 0.79 to 1.02) after further adjustment for hospital treatment practices. Female sex, having several previously diagnosed co-morbidities, an increased hospital stay, and the in-hospital development of atrial fibrillation, cardiogenic shock, and heart failure were significantly associated with an increased risk of being rehospitalized. In conclusion, the likelihood of subsequent 90-day rehospitalizations remained frequent, and we did not observe a significant decrease in these rates during the years under study.
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Awad HH, Tisminetzky M, Metry D, McManus D, Yarzebski J, Gore JM, Goldberg RJ. Magnitude, treatment, and impact of diabetes mellitus in patients hospitalized with non-ST segment elevation myocardial infarction: A community-based study. Diab Vasc Dis Res 2016; 13:13-20. [PMID: 26499915 PMCID: PMC4816073 DOI: 10.1177/1479164115609027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE OF THE STUDY To examine differences in the characteristics, treatment practices and in-hospital outcomes of patients with and without previously diagnosed diabetes hospitalized for non-ST segment elevation myocardial infarction. KEY METHODS The study cohort consisted of 3916 patients diagnosed with non-ST segment elevation myocardial infarction at all 11 central MA medical centres between 1999 and 2009, of whom 1475 (38%) had been previously diagnosed with diabetes. MAIN RESULTS Diabetic patients were more likely to have received treatment with effective cardiac medications, and to have undergone coronary bypass surgery, but were less likely to have received a percutaneous coronary intervention, than non-diabetic patients. Patients with a history of diabetes were more likely to have developed cardiogenic shock, heart failure and died during their index hospitalization than non-diabetic patients. MAIN CONCLUSION Diabetic patients presenting with non-ST segment elevation myocardial infarction remain at high risk of developing significant clinical complications during hospitalization.
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Affiliation(s)
- Hamza H Awad
- Department of Community Medicine/Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Mayra Tisminetzky
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Diana Metry
- Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - David McManus
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jorge Yarzebski
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Joel M Gore
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert J Goldberg
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Coles AH, Tisminetzky M, Yarzebski J, Lessard D, Gore JM, Darling CE, Goldberg RJ. Magnitude of and Prognostic Factors Associated With 1-Year Mortality After Hospital Discharge for Acute Decompensated Heart Failure Based on Ejection Fraction Findings. J Am Heart Assoc 2015; 4:JAHA.115.002303. [PMID: 26702084 PMCID: PMC4845282 DOI: 10.1161/jaha.115.002303] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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] [Indexed: 12/03/2022]
Abstract
Background Limited data exist about the magnitude of and the factors associated with prognosis within 1 year for patients discharged from the hospital after acute decompensated heart failure. Data are particularly limited from the more generalizable perspective of a population‐based investigation and should be further stratified according to currently recommended ejection fraction (EF) findings. Methods and Results The hospital medical records of residents of the Worcester, Massachusetts, metropolitan area who were discharged after acute decompensated heart failure from all 11 medical centers in central Massachusetts during 1995, 2000, 2002, 2004, and 2006 were reviewed. The average age of the 4025 study patients was 75 years, 93% were white, and 44% were men. Of these, 35% (n=1414) had reduced EF (≤40%), 13% (n=521) had borderline preserved EF (41–49%), and 52% (n=2090) had preserved EF (≥50%); at 1 year after discharge, death rates were 34%, 30%, and 29%, respectively (P=0.03). Older age, a history of chronic obstructive pulmonary disease, systolic blood pressure findings <150 mm Hg on admission, and hyponatremia were important predictors of 1‐year mortality for all study patients, whereas several comorbidities and physiological factors were differentially associated with 1‐year death rates in patients with reduced, borderline preserved, and preserved EF. Conclusions This population‐based study highlights the need for further contemporary research into the characteristics, treatment practices, natural history, and long‐term outcomes of patients with acute decompensated heart failure and varying EF findings and reinforces ongoing discussions about whether different treatment guidelines may be needed for these patients to design more personalized treatment plans.
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Affiliation(s)
- Andrew H Coles
- Program in Gene Function and Expression, University of Massachusetts Medical School, Worcester, MA (A.H.C.)
| | - Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.T., J.Y., D.L., R.J.G.)
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.T., J.Y., D.L., R.J.G.)
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.T., J.Y., D.L., R.J.G.)
| | - Joel M Gore
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA (J.M.G.)
| | - Chad E Darling
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA (C.E.D.)
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.T., J.Y., D.L., R.J.G.)
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Chen HY, Tisminetzky M, Lapane KL, Yarzebski J, Person SD, Kiefe CI, Gore JM, Goldberg RJ. Decade-Long Trends in 30-Day Rehospitalization Rates After Acute Myocardial Infarction. J Am Heart Assoc 2015; 4:JAHA.115.002291. [PMID: 26534862 PMCID: PMC4845213 DOI: 10.1161/jaha.115.002291] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 11/16/2022]
Abstract
Background There are limited data available describing relatively contemporary trends in 30‐day rehospitalizations among patients who survive hospitalization after an acute myocardial infarction (AMI) in the community setting. We examined decade‐long (2001–2011) trends in, and factors associated with, 30‐day rehospitalizations in patients discharged from 3 central Massachusetts hospitals after AMI. Methods and Results Residents of the Worcester, MA, metropolitan area discharged after AMI from 3 central Massachusetts hospitals on a biennial basis between 2001 and 2011 comprised the study population (N=4810). Logistic regression analyses were used to examine the association between selected factors and 30‐day rehospitalizations. The average age of this population was 69 years, 42% were women, and 92% were white. During the years under study, 18.5% of patients were rehospitalized within 30 days after hospital discharge. Crude 30‐day rehospitalization rates decreased from 20.5% in 2001–2003 to 15.8% in 2009–2011. After adjusting for several patient characteristics, there was a reduced odds of being rehospitalized in 2009–2011 (odds ratio 0.74, 95% CI 0.61–0.91) compared with 2001–2003; this trend was slightly attenuated after further adjustment for hospital treatment practices. Female sex, having previously diagnosed heart failure and chronic kidney disease, and the development of in‐hospital cardiogenic shock and heart failure were associated with an increased odds of being rehospitalized. Conclusions While the likelihood of subsequent short‐term rehospitalizations remained frequent, we observed an encouraging decline during the most recent years under study. Several high‐risk groups were identified for purposes of heightened surveillance and intervention efforts to reduce the likelihood of being readmitted.
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Affiliation(s)
- Han-Yang Chen
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (H.Y.C., M.T., K.L.L., J.Y., S.D.P., C.I.K., J.M.G., R.J.G.)
| | - Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (H.Y.C., M.T., K.L.L., J.Y., S.D.P., C.I.K., J.M.G., R.J.G.)
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (H.Y.C., M.T., K.L.L., J.Y., S.D.P., C.I.K., J.M.G., R.J.G.)
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (H.Y.C., M.T., K.L.L., J.Y., S.D.P., C.I.K., J.M.G., R.J.G.)
| | - Sharina D Person
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (H.Y.C., M.T., K.L.L., J.Y., S.D.P., C.I.K., J.M.G., R.J.G.)
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (H.Y.C., M.T., K.L.L., J.Y., S.D.P., C.I.K., J.M.G., R.J.G.)
| | - Joel M Gore
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (H.Y.C., M.T., K.L.L., J.Y., S.D.P., C.I.K., J.M.G., R.J.G.) Department of Medicine, University of Massachusetts Medical School, Worcester, MA (J.M.G.)
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (H.Y.C., M.T., K.L.L., J.Y., S.D.P., C.I.K., J.M.G., R.J.G.) Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA (R.J.G.)
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Tisminetzky M, McManus DD, Erskine N, Saczynski JS, Yarzebski J, Granillo E, Gore J, Goldberg RJ. Thirty-day Hospital Readmissions in Patients with Non-ST-segment Elevation Acute Myocardial Infarction. Am J Med 2015; 128:760-5. [PMID: 25660250 PMCID: PMC4475427 DOI: 10.1016/j.amjmed.2015.01.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 12/19/2014] [Revised: 01/08/2015] [Accepted: 01/09/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Limited data exist about relatively recent trends in the magnitude and characteristics of patients who are rehospitalized shortly after admission for a non-ST-segment elevation acute myocardial infarction (NSTEMI). This observational study describes decade-long trends (1999-2009) in the magnitude and characteristics of patients readmitted to the hospital within 30 days of hospitalization for an incident (initial) episode of NSTEMI. METHODS We reviewed the medical records of 2249 residents of the Worcester (Mass) metropolitan area who were hospitalized for an initial NSTEMI in 6 biennial periods between 1999 and 2009 at 3 central Massachusetts medical centers. RESULTS The average age of our study population was 72 years, 90% were white, and 46% were women. The proportion of patients who were readmitted to the hospital for any cause within 30 days after discharge for an NSTEMI remained unchanged between 1999 and 2009 (approximately 15%) in both crude and multivariable adjusted analyses. Slight declines were observed for cardiovascular disease-related 30-day readmissions over the 10-year study period. Women, elderly patients, those with multiple chronic comorbidities or a prolonged index hospitalization, and patients who developed heart failure during their index hospitalization were at higher risk for being readmitted within 30 days than respective comparison groups. CONCLUSION Thirty-day hospital readmission rates after hospital discharge for a first NSTEMI remained stable between 1999 and 2009. We identified several groups at higher risk for hospital readmission; further surveillance efforts and/or tailored educational and treatment approaches remain needed for these groups.
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Affiliation(s)
- Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - David D McManus
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Nathaniel Erskine
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Jane S Saczynski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester; Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Edgard Granillo
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Joel Gore
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester.
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Tisminetzky M, McManus DD, Dor A, Miozzo R, Yarzebski J, Gore JM, Goldberg RJ. Decade-long trends (1999-2009) in the characteristics, management, and hospital outcomes of patients hospitalized with acute myocardial infarction with prior diabetes and chronic kidney disease. Int J Nephrol Renovasc Dis 2015; 8:41-51. [PMID: 25999755 PMCID: PMC4427079 DOI: 10.2147/ijnrd.s78749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/26/2022] Open
Abstract
Background Despite the increasing magnitude and impact, there are limited data available on the clinical management and in-hospital outcomes of patients who have diabetes mellitus (DM) and chronic kidney disease (CKD) at the time of hospitalization for acute myocardial infarction (AMI). The objectives of our population-based observational study in residents of central Massachusetts were to describe decade-long trends (1999–2009) in the characteristics, in-hospital management, and hospital outcomes of AMI patients with and without these comorbidities. Methods We reviewed the medical records of 6,018 persons who were hospitalized for AMI on a biennial basis between 1999 and 2009 at all eleven medical centers in central Massachusetts. Our sample consisted of the following four groups: DM with CKD (n=587), CKD without DM (n=524), DM without CKD (n=1,442), and non-DM/non-CKD (n=3,465). Results Diabetic patients with CKD were more likely to have a higher prevalence of previously diagnosed comorbidities, to have developed heart failure acutely, and to have a longer hospital stay compared with non-DM/non-CKD patients. Between 1999 and 2009, there were marked increases in the prescribing of beta-blockers, statins, and aspirin for patients with CKD and DM as compared to those without these comorbidities. In-hospital death rates remained unchanged in patients with DM and CKD, while they declined markedly in patients with CKD without DM (20.2% dying in 1999; 11.3% dying in 2009). Conclusion Despite increases in the prescribing of effective cardiac medications, AMI patients with DM and CKD continue to experience high in-hospital death rates.
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Affiliation(s)
- Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA
| | - David D McManus
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA ; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA
| | - Alon Dor
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA
| | - Ruben Miozzo
- Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA ; Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA
| | - Joel M Gore
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Ma, USA ; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Ma, USA
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Tisminetzky M, Erskine N, Chen HY, Gore J, Gurwitz J, Yarzebski J, Joffe S, Shaw P, Goldberg R. Changing Trends in, and Characteristics Associated with, Not Undergoing Cardiac Catheterization in Elderly Adults Hospitalized with ST-Segment Elevation Acute Myocardial Infarction. J Am Geriatr Soc 2015; 63:925-31. [PMID: 25940950 DOI: 10.1111/jgs.13399] [Citation(s) in RCA: 9] [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: 11/30/2022]
Abstract
OBJECTIVES To describe decade- long trends (1999-2009) in the rates of not undergoing cardiac catheterization and percutaneous coronary intervention (PCI) in individuals aged 65 and older presenting with an ST-segment elevation acute myocardial infarction (STEMI) and factors associated with not undergoing these procedures. DESIGN Observational population-based study. SETTING Worcester, Massachusetts, metropolitan area. PARTICIPANTS Individuals aged 65 and older hospitalized for an STEMI in six biennial periods between 1999 and 2009 at 11 central Massachusetts medical centers (N=960). MEASUREMENTS Analyses were conducted to examine the characteristics of people who did not undergo cardiac catheterization overall and stratified into two age strata (65-74, ≥75). RESULTS Between 1999 and 2009, dramatic declines (from 59.4% to 7.5%) were observed in the proportion of older adults who did not undergo cardiac catheterization at all greater Worcester hospitals. These declines were observed in individuals aged 65 to 74 (58.4-6.7%) and in those aged 75 and older (69.4-13.5%). The proportion of individuals not undergoing PCI after undergoing cardiac catheterization decreased from 36.6% in 1999 to 6.5% in 2009. Women, individuals with a prior MI, those with do-not-resuscitate orders, and those with various comorbidities were less likely to have undergone these procedures than comparison groups. CONCLUSION Older adults who develop an STEMI are increasingly likely to undergo cardiac catheterization and PCI, but several high-risk groups remain less likely to undergo these procedures.
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Affiliation(s)
- Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nathaniel Erskine
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Han-Yang Chen
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Joel Gore
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jerry Gurwitz
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts.,Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Samuel Joffe
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Peter Shaw
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Robert Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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Tisminetzky M, Coukos JA, McManus DD, Darling CE, Joffe S, Gore J, Lessard D, Goldberg RJ. Decade-long trends in the magnitude, treatment, and outcomes of patients aged 30 to 54 years hospitalized with ST-segment elevation and non-ST-segment elevation myocardial infarction. Am J Cardiol 2014; 113:1606-10. [PMID: 24666616 PMCID: PMC4030635 DOI: 10.1016/j.amjcard.2014.02.012] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/12/2014] [Accepted: 02/12/2014] [Indexed: 01/06/2023]
Abstract
Although acute myocardial infarction (AMI) occurs primarily in the elderly, this disease also affects young adults. Few studies have, however, presented data on relatively young patients hospitalized with AMI. The objectives of this population-based study were to examine recent trends in the magnitude, clinical characteristics, management, and in-hospital and long-term outcomes associated with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) in patients aged 30 to 54 years. We reviewed the medical records of 955 residents of the Worcester (Massachusetts) metropolitan area aged 30 to 54 years who were hospitalized for an initial STEMI or NSTEMI in 6 biennial periods from 1999 to 2009 at 11 greater Worcester medical centers. From 1999 to 2009, the proportion of young adults hospitalized with an STEMI decreased from approximately 2/3 to 2/5 of all patients with an initial AMI. Patients with STEMI were less likely to have a history of heart failure, hypertension, hyperlipidemia, and kidney disease than those with NSTEMI. Both groups received similar effective medical therapies during their acute hospitalization. In-hospital clinical complications and mortality were low and no significant differences in these end points were observed between patients with STEMI and NSTEMI or with regard to 1-year postdischarge death rates (1.9% vs 2.8%). The present results demonstrate recent decreases in the proportion of relatively young patients diagnosed with an initial STEMI. Patients with STEMI and NSTEMI had similar in-hospital outcomes and long-term survival. Trends in these and other important outcomes warrant continued monitoring.
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Affiliation(s)
- Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jennifer A Coukos
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - David D McManus
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Chad E Darling
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Samuel Joffe
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Joel Gore
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
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Tisminetzky M, Joffe S, McManus DD, Darling C, Gore JM, Yarzebski J, Lessard D, Goldberg RJ. Decade-long trends in the characteristics, management and hospital outcomes of diabetic patients with ST-segment elevation myocardial infarction. Diab Vasc Dis Res 2014; 11:182-9. [PMID: 24618530 PMCID: PMC4559847 DOI: 10.1177/1479164114524235] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Our objectives were to describe recent trends in the characteristics and in-hospital outcomes in diabetic as compared with non-diabetic patients hospitalized with ST-segment elevation myocardial infarction (STEMI). METHODS We reviewed the medical records of 2537 persons with (n = 684) and without (n = 1853) a history of diabetes who were hospitalized for STEMI between 1997 and 2009 at 11 medical centres in Central Massachusetts. RESULTS Diabetic patients were more likely to be older, female and to have a higher prevalence of previously diagnosed comorbidities. Diabetic patients were more likely to have developed important in-hospital complications and to have a longer hospital stay compared with non-diabetic patients. Between 1997 and 2009, there was a marked decline in hospital mortality in diabetic (20.0%-5.6%) and non-diabetic (18.6%-7.5%) patients. CONCLUSION Despite reduced hospital mortality in patients hospitalized with STEMI, diabetic patients continue to experience significantly more adverse outcomes than non-diabetics.
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Affiliation(s)
- Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Samuel Joffe
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA
| | - David D. McManus
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Chad Darling
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Joel M. Gore
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Robert J. Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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Tjia J, Allison J, Saczynski JS, Tisminetzky M, Givens JL, Lapane K, Lessard D, Goldberg RJ. Encouraging trends in acute myocardial infarction survival in the oldest old. Am J Med 2013; 126:798-804. [PMID: 23835196 PMCID: PMC3840395 DOI: 10.1016/j.amjmed.2013.02.026] [Citation(s) in RCA: 17] [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: 02/01/2013] [Accepted: 02/02/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND There are limited data informing the optimal treatment strategy for acute myocardial infarction in the oldest old (aged ≥85 years). The study aim was to examine whether decade-long increases in guideline-based cardiac medication use mediate declines in post-discharge mortality among oldest old patients hospitalized with acute myocardial infarction. METHODS The study sample included 1137 patients aged ≥85 years hospitalized in 6 biennial periods between 1997 and 2007 for acute myocardial infarction at all 11 greater Worcester, Massachusetts, medical centers. We examined trends in 90-day survival after hospital discharge and guideline-based medication use (aspirin, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, lipid-lowering agents) for acute myocardial infarction during hospitalization and at discharge. Sequential multivariable Cox regression models examined the relationship among guideline-based medication use, study year, and 90-day post-discharge survival rates. RESULTS Patients hospitalized between 2003 and 2007 experienced higher 90-day survival rates than those hospitalized between 1997 and 2001 (69.1% vs 59.8%, P < .05). Between 1997 and 2007, the average number of guideline-based medications prescribed at discharge increased significantly (1.8 to 2.9, P < .001). The unadjusted hazard ratio for 90-day post-discharge mortality in 2003-2007 compared with 1997-2001 was 0.73 (95% confidence interval, 0.60-0.89); after adjustment for patient characteristics and guideline-based cardiac medication use, this relationship was no longer significant (hazard ratio, 1.26; 95% confidence interval, 1.00-1.58). CONCLUSIONS Between 1997 and 2007, 90-day survival improved among a population-based sample of patients aged ≥85 years hospitalized for acute myocardial infarction. This encouraging trend was explained by increased use of guideline-based medications.
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Affiliation(s)
- Jennifer Tjia
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA.
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McManus DD, Nguyen HL, Saczynski JS, Tisminetzky M, Bourell P, Goldberg RJ. Multiple cardiovascular comorbidities and acute myocardial infarction: temporal trends (1990-2007) and impact on death rates at 30 days and 1 year. Clin Epidemiol 2012; 4:115-23. [PMID: 22701091 PMCID: PMC3372969 DOI: 10.2147/clep.s30883] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [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: 11/23/2022] Open
Abstract
Background The objectives of this community-based study were to examine the overall and changing (1990–2007) frequency and impact on 30-day and 1-year death rates from multiple cardiovascular comorbidities in adults from a large central New England metropolitan area hospitalized with acute myocardial infarction (AMI). Methods The study population consisted of 9581 patients hospitalized with AMI at all 11 medical centers in the metropolitan area of Worcester, MA, during 10 annual periods between 1990 and 2007. The comorbidities examined included atrial fibrillation, diabetes, heart failure, hypertension, and stroke. Results Thirty-five percent of participants had a single diagnosed cardiovascular comorbidity, 25% had two, 12% had three, and 5% had four or more comorbidities. Between 1990 and 2007, the proportion of patients without any of these comorbidities decreased significantly, while the proportion of patients with multiple comorbidities increased significantly during the years under study. An increasing number of comorbidities was associated with higher 30-day and 1-year postadmission death rates in patients hospitalized with AMI. Conclusion Patients hospitalized with AMI carry a significant burden of comorbid cardiovascular disease that adversely impacts their 30-day and longer-term survival. Increased attention to the management of AMI patients with multiple cardiovascular comorbidities is warranted.
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Affiliation(s)
- David D McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Tisminetzky M, Bray BC, Miozzo R, Aupont O, McLaughlin T. Classes of depression, anxiety, and functioning in acute coronary syndrome patients. Am J Health Behav 2012; 36:20-30. [PMID: 22251780 DOI: 10.5993/ajhb.36.1.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To describe change in subgroups characterized by patterns of depression, anxiety, and functional impairment; examine treatment effects on subgroup membership; examine effects of sex and age on subgroup membership. METHODS Latent class models were used to meet the first 2 objectives using 79 patients with depression/anxiety. Generalized estimating equations were used to meet the third objective. RESULTS Three subgroups characterized by different combinations of psychiatric disorders and functioning were identified. Patients who received treatment were more likely to transition to a less impaired subgroup. CONCLUSIONS Unique information about holistic treatment effects can be gained when multiple outcomes are considered simultaneously.
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Affiliation(s)
- Mayra Tisminetzky
- Dissemination and Implementation Unit, Center for Health Policy and Research, University of Massachusetts School ofMedicine, Worcester MA, USA.
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Tisminetzky M, Bray BC, Miozzo R, Aupont O, McLaughlin TJ. Identifying symptom profiles of depression and anxiety in patients with an acute coronary syndrome using latent class and latent transition analysis. Int J Psychiatry Med 2011; 42:195-210. [PMID: 22409097 PMCID: PMC3712857 DOI: 10.2190/pm.42.2.g] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify symptom profiles of depression and anxiety in patients with an acute coronary syndrome (ACS), to examine changes in symptom profiles over time, and finally, to examine the effects of age and sex on patients' symptom profiles. METHODS One hundred ACS patients with mild to severe symptoms of depression and/or anxiety at 1 month post-hospital discharge were enrolled in a randomized trial of cognitive behavioral therapy. Latent class and latent transition analyses were used to identify symptom profiles and describe change over the time in profile membership. RESULTS A two-class solution was selected to describe depression and anxiety symptom profiles. Class I (76% of patients at baseline) was labeled "depression and some anxiety symptoms." Class II (24% of patients at baseline) was labeled "anxiety and some depression symptoms." Approximately 25% of patients in the treatment condition transitioned from the depression and some anxiety symptoms class to the anxiety and some depression symptoms class at follow-up compared to 10% of patients in the control condition at follow-up; nearly 50% of patients in the control condition showed worsening of symptoms as compared to 28% in the treatment condition. Results suggested age differences in the probabilities of transitioning between the classes; older patients were more likely to continue having depression and some anxiety symptoms at the time of follow-up. CONCLUSIONS Identifying symptom profiles of depression and anxiety in patients with an ACS may improve diagnostic practices and help to design tailored interventions.
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Affiliation(s)
| | - Bethany C. Bray
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA
| | - Ruben Miozzo
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA
| | - Onesky Aupont
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA
| | - Thomas J. McLaughlin
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA,Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA,Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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Goldberg RJ, Spencer FA, Szklo-Coxe M, Tisminetzky M, Yarzebski J, Lessard D, Gore JM, Gaasch W. Symptom presentation in patients hospitalized with acute heart failure. Clin Cardiol 2010; 33:E73-80. [PMID: 20552612 DOI: 10.1002/clc.20627] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [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] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The objectives of this study were to examine the type and frequency of symptoms in patients hospitalized with acute heart failure (HF) as well as the relationship between symptom patterns and patient characteristics, treatment practices, and hospital outcomes in patients hospitalized with decompensated HF. METHODS The study sample consisted of 4537 residents of the Worcester, MA metropolitan area hospitalized for decompensated HF at 11 greater Worcester medical centers in 1995 and 2000. RESULTS The average age of the study sample was 76 years; the majority (57%) were women, and three-quarters of our patient population had been previously diagnosed with HF. Dyspnea (93%) was the most frequent complaint reported by patients followed by the presence of peripheral edema (70%), cough (51%), orthopnea (37%), and chest pain/discomfort (30%). Patients reporting few cardiac symptoms were less likely to be treated with effective cardiac therapies during hospitalization than patients with multiple cardiac signs and symptoms and experienced higher hospital (9.7% vs. 7.7%) as well as 30-day (17.1% vs. 10.2%) death rates (P < 0.05). CONCLUSIONS The results of this study in residents of a large New England community suggest that patients with fewer reported symptoms of decompensated HF were less likely to receive effective cardiac treatments and had worse short-term outcomes. Reasons for these differences in treatment practices and short-term outcomes need to be elucidated and attention directed to these high-risk patients.
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Affiliation(s)
- Robert J Goldberg
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
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Tisminetzky M, Aguirre P, Frankel D, García MG, Malamud M. [Alcoholism as an adaptation-disadaptation factor in the district of La Matanza]. Acta Psiquiatr Psicol Am Lat 1986; 32:223-31. [PMID: 3591398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This paper is concerned with the use of alcohol and folkloric medicine in migratory populations. Some field-research was undertaken as a systemic approach to reality in the district of La Matanza (Buenos Aires, Argentina). Considering a previous contribution presented by the author in reference to alcoholic families (Prize 1981, Journal of Family Therapy) findings highlight that alcoholism and folkloric medicine persist and increase insomuch as the possibilities for adjustment to a new culture decrease. Thus, social segregation of migratory populations increases. Finally, an interdisciplinary psychotherapeutic model is outlined.
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