1
|
Abe T, Olanipekun T, Effoe V, Yan F, Yimer W, Oshunbade A, Udongwo N, Egbuche O, Ghali JK, Correa A, Onwuanyi A, Echols MR. CAROTID INTIMA MEDIA THICKNESS AND INCIDENT STROKE IN AFRICAN AMERICANS WITH HYPERTENSION: THE JACKSON HEART STUDY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02327-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
2
|
Edwards P, Anyaogu C, Mezue K, Baugh D, Goha A, Egbuche O, Nunura F, Madu E. Focused cardiac ultrasound in pregnancy. J Investig Med 2023; 71:81-91. [PMID: 36691704 DOI: 10.1177/10815589221142195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cardiac disease in pregnancy is an important cause of maternal morbidity and mortality. In many high-income countries, acquired cardiac disease is now the largest cause of maternal mortality. Given its prevalence in low- and middle-income countries (LMICs), rheumatic heart disease is the most common cause of cardiac disease in pregnancy worldwide and is associated with poor maternal outcome. The diagnosis of cardiac disease in pregnancy is often delayed resulting in excess maternal morbidity and mortality. Maternal mortality review committees have suggested that prompt recognition and treatment of heart disease in pregnancy may improve maternal outcome. Given the similarities between symptoms of normal pregnancy and those of cardiac disease, the clinical diagnosis of heart disease in pregnancy is challenging with echocardiography being the primary diagnostic modality. Focused cardiac ultrasound (FOCUS) at the point of care provides supplemental data to the history and physical examination and has been demonstrated to permit early diagnosis and improvement in the management of cardiac disease in emergency medicine, intensive care, and anesthesia. It has also been demonstrated to be useful in surveillance for rheumatic heart disease in LMICs. The use of FOCUS may allow earlier and more accurate diagnosis of cardiac disease in pregnancy with the potential to decrease morbidity and mortality in both developed and developing countries.
Collapse
Affiliation(s)
- Paul Edwards
- Heart Institute of the Caribbean, Kingston, Jamaica
| | | | - Kenechukwu Mezue
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Dainia Baugh
- Heart Institute of the Caribbean, Kingston, Jamaica
| | - Ahmed Goha
- Cardiology department, Cardiac Center Hail, Hail, Saudi Arabia
| | - Obiora Egbuche
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Felix Nunura
- Heart Institute of the Caribbean, Kingston, Jamaica
| | - Ernest Madu
- Heart Institute of the Caribbean, Kingston, Jamaica
| |
Collapse
|
3
|
Olanipekun T, Abe T, Effoe V, Egbuche O, Mather P, Echols M, Adedinsewo D. Racial and Ethnic Disparities in the Trends and Outcomes of Cardiogenic Shock Complicating Peripartum Cardiomyopathy. JAMA Netw Open 2022; 5:e2220937. [PMID: 35788668 PMCID: PMC9257562 DOI: 10.1001/jamanetworkopen.2022.20937] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Cardiogenic shock (CS) is a recognized complication of peripartum cardiomyopathy (PPCM) associated with poor prognosis. Although racial and ethnic disparities have been described in the occurrence and outcomes of PPCM, it is unclear if these disparities persist among patients with PPCM and CS. OBJECTIVES To evaluate the temporal trends in CS incidence among hospitalized patients with PPCM stratified by race and ethnicity and to investigate the racial and ethnic differences in hospital mortality, mechanical circulatory support (MCS) use, and heart transplantation (HT). DESIGN, SETTING, AND PARTICIPANTS This multicenter retrospective cohort study included hospitalized patients with PPCM complicated by CS in the US from 2005 to 2019 identified from the National Inpatient Sample (NIS). Data analysis was conducted in November 2021. EXPOSURE PPCM complicated by CS. MAIN OUTCOMES AND MEASURES The main outcome was incidence of CS in PPCM stratified by race and ethnicity. The secondary outcome was racial and ethnic differences in hospital mortality, MCS use, and HT. RESULTS Of 55 804 hospitalized patients with PPCM, 1945 patients had CS, including 947 Black patients, 236 Hispanic patients, and 702 White patients, translating to an incidence rate of 35 CS events per 1000 patients with PPCM. The mean (SD) age was 31 (9) years. Black and Hispanic patients had higher CS incidence rates (39 events per 1000 patients with PPCM) compared with White patients (33 events per 1000 patients with PPCM). CS incidence rates significantly increased across all races and ethnicities over the study period. Overall, the odds of developing CS were higher in Black patients (aOR, 1.17 [95% CI, 1.15-1.57]; P < .001) and Hispanic patients (aOR, 1.37 [95% CI, 1.17-1.59]; P < 001) compared with White patients during the study period. Compared with White patients, the odds of in-hospital mortality were higher in Black (adjusted odds ratio [aOR], 1.67 [95% CI, 1.21-2.32]; P = .002) and Hispanic (aOR, 2.20 [95% CI, 1.45-3.33]; P < .001) patients. Hispanic patients were more likely to receive any type of MCS device (aOR, 2.23 [95% CI, 1.60-3.09]; P < .001), intraaortic balloon pump (aOR, 1.65 [95% CI, 1.11-2.44]; P < .001), and ventricular assisted device (aOR, 4.45 [95% CI, 2.45-8.08]; P < .001), compared with White patients. Black patients were more likely to receive VAD (aOR, 2.69 [95% CI, 1.63-4.42]; P < .001) compared with White patients. Black and Hispanic patients were significantly less likely to receive HT compared with White patients (Black patients: aOR, 0.51 [95% CI, 0.33-0.78]; P = .02; Hispanic patients: aOR, 0.15 [95% CI, 0.06-0.42]; P < .001). CONCLUSIONS AND RELEVANCE These findings highlight significant racial disparities in mortality and HT among hospitalized patients with PPCM complicated by CS in the US. More research to identify factors of racial and ethnic disparities is needed to guide interventions to improve outcomes of patients with PPCM.
Collapse
Affiliation(s)
- Titilope Olanipekun
- Department of Hospital Medicine, Covenant Health System, Knoxville, Tennessee
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Temidayo Abe
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Valery Effoe
- Department of Cardiovascular Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Obiora Egbuche
- Department of Interventional Cardiology, Ohio School of Medicine, Columbus
| | - Paul Mather
- Department of Cardiovascular Disease, Perelman School of Medicine, East Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - Melvin Echols
- Department of Cardiovascular Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | | |
Collapse
|
4
|
Biersmith M, Alston M, Makki N, Hatoum H, Yeats B, Egbuche O, Biswas M, Orsinelli D, Boudoulas KD, Dasi L, Lilly S. Comparison of Catheterization Versus Echocardiographic-Based Gradients in Balloon-Expandable Versus Self-Expanding Transcatheter Aortic Valve Implantation. J Invasive Cardiol 2022; 34:E442-E447. [PMID: 35652707] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES In patients with transcatheter aortic valve implantation (TAVI), accurate assessment of gradients is important to assess valve function and durability, which drives clinical decision-making. We sought to evaluate discrepancies in aortic valve mean gradients with balloon-expandable and self-expanding TAVI. METHODS We retrospectively reviewed 507 patients that underwent TAVI and compared mean gradients by catheterization to transthoracic Doppler echocardiography. RESULTS Mean gradients by Doppler in balloon-expandable (11.0 ± 5.8 mm Hg) and self-expanding devices (8.7 ± 4.5 mm Hg) were significantly higher than catheterization (3.2 ± 4.0 mm Hg vs 3.5 ± 4.1 mm Hg, respectively; P<.001). In a subgroup analysis of skirted valves, Doppler gradients in balloon-expandable (9.8 ± 4.4 mm Hg) and self-expanding devices (8.6 ± 5.1 mm Hg) were significantly higher than catheterization (3.5 ± 4.1 mm Hg vs 4.2 ± 4.8 mm Hg, respectively; P<.001). When the effect of valve size on gradients was analyzed, Doppler gradients were significantly higher than catheterization for all comparisons. When indexed for valve size, patients with large aortas who received a balloon-expandable TAVI had greater pressure differential than those who received a self-expanding TAVI (8.24 ± 0.46 mm Hg vs 5.16 ± 0.66 mm Hg; P<.001). This trend was not seen in patients with a small aorta-to-valve index. CONCLUSION Following TAVI, aortic valve mean gradients acquired by Doppler were higher than catheterization and the discrepancy was more pronounced in balloon-expandable than self-expanding prostheses. These differences persist in skirted valves and across valve sizes. These observations may reflect periprocedural hemodynamic changes, differences between prosthetic flow acceleration, and/or pressure recovery.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Scott Lilly
- The Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, 473 West 12th Avenue, Suite 200, Columbus, OH 43210 USA.
| |
Collapse
|
5
|
Abe T, Olanipekun T, Igwe J, Ndausung U, Amah C, Chang A, Effoe V, Egbuche O, Ogunbayo G, Onwuanyi A. Incidence and predictors of sudden cardiac arrest in the immediate post-percutaneous coronary intervention period for ST-elevation myocardial infarction: a single-center study. Coron Artery Dis 2022; 33:261-268. [PMID: 35102067 DOI: 10.1097/mca.0000000000001119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data on the incidence, predictors, and outcomes of sudden cardiac arrest (SCA) in the immediate post-percutaneous coronary intervention (PCI) period for ST-elevation myocardial infarction (STEMI) are limited. OBJECTIVES The study aimed to investigate the trends and predictors of SCA occurring within 48 h post PCI for STEMI. METHODS We systematically reviewed data from the electronic medical records of 403 patients who underwent PCI for STEMI between January 2014 and December 2019. Trends in the incidence of SCA 48 h post PCI for STEMI were assessed using the Cochrane-Armitage test. Multivariable logistic regression was used to determine the predictors of SCA within 48 h post PCI for STEMI. RESULTS Of the 403 patients who underwent PCI for STEMI, 44 (11%) had SCA within 48 h post PCI. The incidence of SCA within 48 h post PCI decreased from 22% in 2014 to 8% in 2019; P = 0.03. After adjusting for underlying confounding variables in the multivariable logistic regression models, out of hospital cardiac arrest [adjusted odds ratio (aOR), 23.9; confidence interval (CI), 10.2-56.1], left main coronary artery disease (aOR, 3.1; CI, 1.1-9.4), left main PCI (aOR, 6.6; CI: 1.4-31.7), new-onset heart failure (aOR, 2.0; CI, 4.3-9.4), and cardiogenic shock (aOR, 5.8; CI, 1.7-20.2) were statistically significant predictors of SCA within 48 h post PCI for STEMI. CONCLUSION We identified essential factors associated with SCA within 48 h post PCI for STEMI. Future studies are needed to devise effective strategies to decrease the risk of SCA in the early post-PCI period.
Collapse
Affiliation(s)
- Temidayo Abe
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | | | - Joseph Igwe
- Department of Medicine, Internal Medicine Residency Program, Morehouse School of Medicine, Atlanta, Georgia
| | - Udongwo Ndausung
- Department of Medicine, Internal Medicine Residency Program, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Chidi Amah
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Albert Chang
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Valery Effoe
- Department of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, Georgia
| | - Obiora Egbuche
- Department of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, Georgia
| | - Gbolahan Ogunbayo
- Department of Internal Medicine, Division of Cardiology, University of Kentucky, Lexington, Kentucky, USA
| | - Anekwe Onwuanyi
- Department of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, Georgia
| |
Collapse
|
6
|
Obi CA, Egbuche O, Nwokike SI, Mezue K, Abe T, Bulsara K, Olanipekun T, Onuorah I. Implantable Cardiac Defibrillator Lead Infective Endocarditis Due to Rothia Specie: A Rare Case in An Immunocompetent Man. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2305149] [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: 11/06/2022] Open
|
7
|
Egbuche O, Abe T, Nwokike SI, Jegede O, Mezue K, Olanipekun T, Onuorah I, Echols MR. Racial differences in cardiopulmonary outcomes of hospitalized COVID-19 patients with acute kidney injury. Rev Cardiovasc Med 2021; 22:1667-1675. [PMID: 34957809 PMCID: PMC9054458 DOI: 10.31083/j.rcm2204174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/12/2021] [Accepted: 11/01/2021] [Indexed: 01/08/2023] Open
Abstract
In-hospital acute kidney injury (IH-AKI) has been reported in a significant proportion of patients with COVID-19 and is associated with increased disease burden and poor outcomes. However, the mechanisms of injury are not fully understood. We sought to determine the significance of race on cardiopulmonary outcomes and in-hospital mortality of hospitalized COVID-19 patients with AKI. We conducted a retrospective cohort study of consecutive patients hospitalized in Grady Health System in Atlanta, Georgia between February and July 2020, who tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) on qualitative polymerase-chain-reaction assay. We evaluated the primary composite outcome of in-hospital cardiac events, and mortality in blacks with AKI versus non-blacks with AKI. In a subgroup analysis, we evaluated the impact of AKI in all blacks and in all non-blacks. Of 293 patients, effective sample size was 267 after all exclusion criteria were applied. The mean age was 61.4 ± 16.7, 39% were female, and 75 (28.1%) had IH-AKI. In multivariable analyses, blacks with IH-AKI were not more likely to have in-hospital cardiac events (aOR 0.3, 95% Confidence interval (CI) 0.04-1.86, p = 0.18), require ICU stay (aOR 0.80, 95% CI 0.20-3.25, p = 0.75), acute respiratory distress syndrome (aOR 0.77, 95% CI 0.16-3.65, p = 0.74), require mechanical ventilation (aOR 0.51, 95% CI 0.12-2.10, p = 0.35), and in-hospital mortality (aOR 1.40, 95% CI 0.26-7.50, p = 0.70) when compared to non-blacks with IH-AKI. Regardless of race, the presence of AKI was associated with worse outcomes. Black race is not associated with higher risk of in-hospital cardiac events and mortality in hospitalized COVID-19 patients who develop AKI. However, blacks with IH-AKI are more likely to have ARDS or die from any cause when compared to blacks without IH-AKI.
Collapse
Affiliation(s)
- Obiora Egbuche
- Division of Cardiovascular Medicine, Ohio State University, Columbus, OH 43210, USA,Correspondence: (Obiora Egbuche)
| | - Temidayo Abe
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Shirley I. Nwokike
- Department of Internal Medicine, Medical College of Georgia, Augusta, GA 30912, USA
| | - Opeyemi Jegede
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort-Worth, TX 76107, USA
| | - Kenechukwu Mezue
- Division of Nuclear Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Titilope Olanipekun
- Department of Hospital Medicine, Covenant Health System, Knoxville, TN 37902, USA
| | - Ifeoma Onuorah
- Division of Cardiovascular Disease, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Melvin R. Echols
- Division of Cardiovascular Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA
| |
Collapse
|
8
|
Abe T, Olanipekun T, Khoury M, Egbuche O, Effoe V, Ghali J. Trends, Associations, and Impact of Atrial Fibrillation in Patients With Light-chain Cardiac Amyloidosis. Crit Pathw Cardiol 2021; 20:168-172. [PMID: 33606412 DOI: 10.1097/hpc.0000000000000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In this study, we investigated the temporal trends in the prevalence and prognostic implication of atrial fibrillation (AF) in patient with light-chain cardiac amyloidosis (AL-CA). METHODS We identified 3030 patients with AL-CA from the 2015 to 2017 National Inpatient Sample, of which 1577 (52%) had AF. We used trend analysis to assess the temporal trends in the prevalence of AF by subtype from 2015 to 2017. We compared inhospital mortality, acute on chronic heart failure, stroke, length of stay (LOS), and total cost in patients with to those without AF, stratified by subtype of AF. RESULTS The prevalence of AF among patients with AL-CA was unchanged from 2015 to 2017 (50%-53%; adjusted odds ratio, 1.1 [0.9-1.5]; P = 0.3). The trend was unchanged in the stratified analysis by subtype of AF. Patients with AF were older and had more comorbidities. After propensity matching, acute on chronic heart failure was significantly higher in patients with AL-CA and AF, compared with those with AL-CA alone (55.6% vs. 48.3%; P < 0.0001). There was no difference in inhospital mortality (7.5% vs. 7.5%; P = 0.9), stroke (2.0% vs. 2.5%; P = 0.5), median LOS (5 [3-9] vs. 5 [3-8]; P = 0.3), and median total hospital cost $42,469 ([$21,309-$92,855] vs. $44,008 [$22,889-$94,200]; P = 0.6). In the stratified analysis, acute on chronic heart failure remained significant higher in patients with paroxysmal and nonparoxysmal AF, while LOS became significantly longer in patients with paroxysmal AF. CONCLUSIONS Among patients with AL-CA, AF is associated with a higher risk of acute on chronic heart failure.
Collapse
Affiliation(s)
- Temidayo Abe
- From the Internal Medicine Residency Program, Morehouse School of Medicine, Atlanta, GA
| | | | - Mtanis Khoury
- Department of Medicine, Mount Sinai Hospital, Chicago, IL
| | - Obiora Egbuche
- Department of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, GA
| | - Valery Effoe
- Department of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, GA
| | - Jalal Ghali
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA
| |
Collapse
|
9
|
Abe T, Olanipekun T, Igwe J, Khoury M, Busari O, Musonge-Effoe J, Valery E, Egbuche O, Mather P, Ghali J. Trends, Predictors and Outcomes of Ischemic Stroke Among Patients Hospitalized with Takotsubo Cardiomyopathy. J Stroke Cerebrovasc Dis 2021; 30:106005. [PMID: 34332228 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106005] [Citation(s) in RCA: 3] [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] [Received: 05/27/2021] [Revised: 07/04/2021] [Accepted: 07/09/2021] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES This study assessed the temporal trends in the incidence of ischemic stroke among patients hospitalized with takotsubo cardiomyopathy (TCM) stratified by the subtypes of ischemic stroke (cardioembolic versus thrombotic). Predictors of each stroke subtype, the association with atrial fibrillation (AF), the occurrence of ventricular fibrillation/ventricular tachycardia (VF/VT), cardiogenic shock (CS), in-hospital mortality, length of stay (LOS), and total healthcare cost were also assessed. BACKGROUND Ischemic stroke in TCM is thought to be primarily cardioembolic from left ventricular mural thromboembolism. Limited data are available on the incidence of thrombotic ischemic stroke in TCM. MATERIALS AND METHODS We identified 27,970 patients hospitalized with the primary diagnosis of TCM from the 2008 to 2017 National Inpatient Sample, of which 751 (3%) developed ischemic stroke. Of those with ischemic stroke, 571 (76%) had thrombotic stroke while 180 (24%) had cardioembolic stroke. Cochrane armitage test was used to assess the incidence of thrombotic and cardioembolic strokes and multivariate regression was used to identify risk factors associated with each stroke subtype. We compared the incidence of AF, VF/VT, CS, LOS, in-hospital mortality and total cost between hospitalized patients with TCM alone to those with cardioembolic and thrombotic strokes. RESULTS From 2008 - 2017, the incidence of thrombotic stroke (4.7%-9.5% (p< 0.0001) increased while it was unchanged for cardioembolic stroke (0.5%-0.7% P=0.5). In the multivariate regression, peripheral artery disease, prior history of stroke, and hyperlipidemia were significantly associated with thrombotic stroke, while CS, AF, and Asian race (compared to White race) were associated with cardioembolic stroke. Both cardioembolic and thrombotic strokes were associated with higher odds of IHM, AF, CS, longer LOS and increased cost. Trends in in-hospital mortality and the utilization of thrombolysis, cerebral angiography, and mechanical thrombectomy among patients with TCM and ischemic stroke were unchanged from 2008 to 2017. CONCLUSION Among patients with TCM and ischemic stroke, thrombotic stroke was more common compared to cardioembolic stroke. Ischemic stroke was associated with poorer outcomes, including higher in-hospital mortality and increased healthcare resource utilization in TCM.
Collapse
Affiliation(s)
- Temidayo Abe
- Department of Medicine, Morehouse School of Medicine, 720 Westview Drive S.W., Atlanta, GA 30310, United States.
| | - Titilope Olanipekun
- Department of Medicine, Morehouse School of Medicine, 720 Westview Drive S.W., Atlanta, GA 30310, United States.
| | - Joseph Igwe
- Department of Medicine, Morehouse School of Medicine, 720 Westview Drive S.W., Atlanta, GA 30310, United States.
| | - Mtanis Khoury
- Department of Medicine, Mount Sinai Hospital, 1500 S California Ave, Chicago, IL 60608, United States.
| | - Olukayode Busari
- Department of Medicine, Coney Island Hospital, 2601 Ocean Pkway, Brooklyn, NY 11235, United States.
| | - Joffi Musonge-Effoe
- Department of Community and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive S.W., Atlanta, GA 30310, United States.
| | - Effoe Valery
- Department of Cardiovascular Disease, Morehouse School of Medicine, 720 Westview Drive S.W., Atlanta, GA 30310, United States.
| | - Obiora Egbuche
- Department of Cardiovascular Disease, Morehouse School of Medicine, 720 Westview Drive S.W., Atlanta, GA 30310, United States.
| | - Paul Mather
- Department of Cardiovascular Disease, Perelman School of Medicine, 2 East Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States.
| | - Jalal Ghali
- Department of Medicine, Morehouse School of Medicine, 720 Westview Drive S.W., Atlanta, GA 30310, United States.
| |
Collapse
|
10
|
Ivy K, Egbuche O, Gill S, Mezue K, Nwokike SI, Ram P, Abe T, Onuorah I, Echols M. Acute on chronic severe aortic insufficiency due to rheumatoid arthritis-associated valvulitis. Am J Cardiovasc Dis 2021; 11:404-409. [PMID: 34322311 PMCID: PMC8303038] [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] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/10/2021] [Indexed: 06/13/2023]
Abstract
Rheumatoid Arthritis associated valvular heart disease (RA-VHD) may occur in patients in varying degrees of severity. Aortic valve involvement leading to severe symptomatic aortic insufficiency is a rare complication of rheumatoid arthritis. This entity has not been well characterized and its clinical predictors are undefined. The pathology of RA-VHD can extend from benign nodular development to acute valvulitis with late-stage leaflet fibrosis and severe valvular regurgitation. In this report, we describe a rare case of acute heart failure (AHF) resulting from severe aortic valve destruction and insufficiency due to persistent chronic inflammation in a patient with long-standing RA. Persistent systemic inflammation of RA involved the aortic valve causing nodular thickening and leaflet destruction. Our patient had compensated chronic heart failure due to progressive aortic insufficiency resulting from gradual leaflet destruction. However, she suddenly developed AHF requiring valve replacement. Her clinical presentation, gross and histological images suggest an acute/subacute disruption of the friable aortic leaflets that resulted in AHF.
Collapse
Affiliation(s)
- Kendra Ivy
- Division of Cardiovascular Disease, Morehouse School of MedicineAtlanta, GA, USA
| | - Obiora Egbuche
- Division of Cardiovascular Disease, Morehouse School of MedicineAtlanta, GA, USA
| | - Sartaj Gill
- Division of Cardiovascular Disease, Morehouse School of MedicineAtlanta, GA, USA
| | - Kenechukwu Mezue
- Division of Nuclear Cardiology, Massachesetts General HospitalBoston, MA, USA
| | - Shirley I Nwokike
- Department of Internal Medicine, Medical College of GeorgiaAugusta, GA, USA
| | - Pradhum Ram
- Division of Cardiovascular Disease, Emory University School of MedicineAtlanta, GA, USA
| | - Temidayo Abe
- Division of Cardiovascular Disease, Morehouse School of MedicineAtlanta, GA, USA
| | - Ifeoma Onuorah
- Division of Cardiovascular Disease, Emory University School of MedicineAtlanta, GA, USA
| | - Melvin Echols
- Division of Cardiovascular Disease, Morehouse School of MedicineAtlanta, GA, USA
| |
Collapse
|
11
|
Egbuche O, Mezue KN, Nwokike SI, Abe T, Olanipekun T, Onuorah I, Tharpe C. Left main stenting with stent dislodgement and entrapment in the common femoral artery: a successful transcatheter stent retrieval. Am J Cardiovasc Dis 2021; 11:421-428. [PMID: 34322313 PMCID: PMC8303031] [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] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/12/2021] [Indexed: 06/13/2023]
Abstract
Proximal left main stenting in symptomatic patients with flow-limiting stenosis is an alternative revascularization strategy in individuals with low syntax score and high operative risk. Stent dislodgement is associated with adverse cardiovascular events and retrieval of fully deployed stents is generally prohibited as it increases the risk of severe complications. Stent dislodgement and entrapment in the femoral vascular system occur infrequently during percutaneous coronary interventions. In this report, we illustrate a prompt and safe transcatheter technique to successfully retrieve an expanded and dislodged coronary stent entrapped in the common femoral artery without need for a more invasive surgical approach.
Collapse
Affiliation(s)
- Obiora Egbuche
- Division of Cardiovascualr Medicine, Ohio State UniversityColumbus, OH, USA
| | - Kenechukwu N Mezue
- Division of Nuclear Cardiology, Massachusetts General HospitalBoston, MA, USA
| | - Shirley I Nwokike
- Division of Internal Medicine, Medical College of GeorgiaAugusta, GA, USA
| | - Temidayo Abe
- Division of Internal Medicine, Morehouse School of MedicineAtlanta, GA, USA
| | | | - Ifeoma Onuorah
- Division of Cardiovascular Disease, Emory University School of MedicineAtlanta, GA, USA
| | - Carter Tharpe
- Division of Cardiovascular Disease, Navicent Health Medical CenterMacon, GA, USA
| |
Collapse
|
12
|
Egbuche O, Jegede O, Abe T, Wagle B, Huynh K, Hayes D, Campbell ML, Mezue K, Ram P, Desai R, Kpodonu J, Morgan J, Ofili E, Onwuanyi A, Echols M. PRE-EXISTING CARDIOVASCULAR DISEASE, ACUTE KIDNEY INJURY, AND CARDIOVASCULAR OUTCOMES IN HOSPITALIZED BLACKS WITH COVID-19 INFECTION. J Am Coll Cardiol 2021. [PMCID: PMC8091265 DOI: 10.1016/s0735-1097(21)04436-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
13
|
Igwe J, Egbuche O, Ezeagwu D, Abe T, Ghali J. HEART RHYTHM ABNORMALITY DUE TO AUTONOMIC DYSFUNCTION FOLLOWING CERVICAL SPINAL CORD INJURY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)04358-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
14
|
Abe T, Olanipekun T, Effoe VS, Igwe J, Egbuche O, Ogunbayo G, Amah C, Chang A, Morkeh P, Huynh K, Echols M, Onwuanyi A. TRENDS, PREDICTORS, AND OUTCOMES OF PERCUTANEOUS CORONARY INTERVENTION COMPLICATED BY IN-HOSPITAL CARDIAC ARREST. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01562-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
15
|
Egbuche O, Jegede O, Abe T, Wagle B, Huynh K, Hayes D, Campbell ML, Mezue K, Ram P, Nwokike SI, Desai R, Effoe V, Kpodonu J, Morgan J, Ofili E, Onwuanyi A, Echols MR. Pre-existing cardiovascular disease, acute kidney injury, and cardiovascular outcomes in hospitalized blacks with COVID-19 infection. Am J Cardiovasc Dis 2021; 11:212-221. [PMID: 34084656 PMCID: PMC8166582] [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] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The Corona Virus 19 (COVID-19) infection is associated with worse outcomes in blacks, although the mechanisms are unclear. We sought to determine the significance of black race, pre-existing cardiovascular disease (pCVD), and acute kidney injury (AKI) on cardiopulmonary outcomes and in-hospital mortality of COVID-19 patients. METHODS We conducted a retrospective cohort study of blacks with/without pCVD and with/without in-hospital AKI, hospitalized within Grady Memorial Hospital in Georgia between February and July 2020, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on qualitative polymerase-chain-reaction assay. The primary outcome was a composite of in-hospital cardiac events. RESULTS Of the 293 patients hospitalized with COVID-19 in this study, 71 were excluded from the primary analysis (for race/ethnicity other than black non-Hispanic). Of the 222 hospitalized COVID-19 patients included in our analyses, 41.4% were female, 78.8% had pCVD, and 30.6% developed AKI during the admission. In multivariable analyses, pCVD (OR 4.7, 95% CI 1.5-14.8, P=0.008) and AKI (OR 2.7, 95% CI 1.3-5.5, P=0.006) were associated with increased odds of in-hospital cardiac events. AKI was associated with increased odds of in-hospital mortality (OR 8.9, 95% CI 3.3-23.9, P<0.0001). The presence of AKI was associated with increased odds of ICU stay, mechanical ventilation, and acute respiratory distress syndrome (ARDS). CONCLUSION pCVD and AKI were associated with higher risk of in-hospital cardiac events, and AKI was associated with a higher risk of in-hospital mortality in blacks.
Collapse
Affiliation(s)
- Obiora Egbuche
- Division of Cardiovascular Disease, Morehouse School of MedicineAtlanta, GA 30310, USA
| | - Opeyemi Jegede
- Department of Biostatistics and Epidemiology, University of North Texas Health Science CenterFort-Worth, TX 76107, USA
| | - Temidayo Abe
- Department of Internal Medicine, Morehouse School of MedicineAtlanta, GA 30310, USA
| | - Bivek Wagle
- Department of Internal Medicine, Morehouse School of MedicineAtlanta, GA 30310, USA
| | - Ky Huynh
- Department of Internal Medicine, Morehouse School of MedicineAtlanta, GA 30310, USA
| | - Dolphurs Hayes
- Department of Internal Medicine, Morehouse School of MedicineAtlanta, GA 30310, USA
| | | | - Kenechukwu Mezue
- Division of Nuclear Cardiology, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA 02114, USA
| | - Pradhum Ram
- Division of Cardiovascular Disease, Emory University School of MedicineAtlanta, GA 30322, USA
| | - Shirley I Nwokike
- Department of Internal Medicine, Medical College of GeorgiaAugusta, GA 30912, USA
| | - Rupak Desai
- Division of Cardiovascular Disease, Atlanta VA Medical CenterDecatur, GA 30033, USA
| | - Valery Effoe
- Division of Cardiovascular Disease, Morehouse School of MedicineAtlanta, GA 30310, USA
| | - Jacques Kpodonu
- Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical SchoolBoston, MA 02215, USA
| | - Jayne Morgan
- Division of Quality and Safety, Piedmont Healthcare, Inc.Atlanta, GA 30309, USA
| | - Elizabeth Ofili
- Division of Cardiovascular Disease, Morehouse School of MedicineAtlanta, GA 30310, USA
| | - Anekwe Onwuanyi
- Division of Cardiovascular Disease, Morehouse School of MedicineAtlanta, GA 30310, USA
| | - Melvin R Echols
- Division of Cardiovascular Disease, Morehouse School of MedicineAtlanta, GA 30310, USA
| |
Collapse
|
16
|
Eze P, Mezue KN, Nduka CU, Obianyo I, Egbuche O. Efficacy and safety of chloroquine and hydroxychloroquine for treatment of COVID-19 patients-a systematic review and meta-analysis of randomized controlled trials. Am J Cardiovasc Dis 2021; 11:93-107. [PMID: 33815925 PMCID: PMC8012280] [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] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Abstract
The coronavirus disease 19 (COVID-19) pandemic has caused significant morbidity and mortality worldwide and an effective treatment is needed. Chloroquine (CQ) and hydroxychloroquine (HCQ) have shown in vitro antiviral activity against SARS-CoV-2 which causes the disease, but the evidence from in vivo studies so far has been inconclusive. OBJECTIVE To evaluate the efficacy and safety of CQ and HCQ in the treatment of COVID-19. DATA SOURCES We systematically searched the PubMed, Embase, MEDLINE, Cochrane CENTRAL, CINAHL, Scopus, Joanna Briggs Institute Database, ClinicalTrials.gov, and Chinese Clinical Trial Registry (ChiCTR) for all articles published between 01 January 2020 to 15 September 2020 on CQ/HCQ and COVID-19 using a predefined search protocol; without any language restrictions. A search of grey literature repositories (New York Academy of Medicine Grey Literature and Open Grey), and pre-publication server deposits (medRxIV and bioRxIV) was also performed. STUDY SELECTION Randomized clinical trials (RCT) which compared CQ/HCQ to standard supportive therapy in treating COVID-19 were included. DATA EXTRACTION AND SYNTHESIS Data were extracted from original publications by four independent reviewers. Risk of bias was assessed using the Cochrane Collaboration's assessment tool. Data were meta-analyzed using a random-effect models. Results are reported according to PRISMA guidelines. Main Outcome(s) and Measure(s): The primary prespecified efficacy outcome was all-cause mortality. The primary safety outcome was any adverse effect attributed to use of CQ/HCQ. RESULTS Eight RCTs were included and pooled in the mortality meta-analysis (6,592 unique participants; mean age = 59.4 years; 42% women). CQ/HCQ did not show any mortality benefit when compared to standard supportive therapy (Pooled Relative Risk [RR] 1.07; 95% CI = 0.97-1.18; I2 statistic = 0.00%). Sensitivity and sub-group analyses showed similar findings. Any adverse event was significantly higher in patients randomized to CQ/HCQ (RR = 2.51; 95% CI = 1.53-4.12; n = 1,818 patients), but the risk of developing severe adverse event was not statistically significant (RR = 0.99, 95% CI = 0.53-1.86; n = 6,456 patients). CONCLUSIONS AND RELEVANCE Evidence from currently published RCTs do not demonstrate any added benefit for the use of CQ or HCQ in the treatment of COVID-19 patients.
Collapse
Affiliation(s)
- Paul Eze
- Department of Health Policy and Administration, Pennsylvania State UniversityUniversity Park, PA 16802, USA
| | - Kenechukwu N Mezue
- Division of Nuclear Cardiology, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA 02114, USA
| | - Chidozie U Nduka
- Population Evidence and Technologies, Warwick Medical School, University of WarwickCoventry, CV4 7AL, UK
| | - Ijeoma Obianyo
- Department of Surgery, University of Nigeria Teaching HospitalItuku-Ozalla, Enugu, Nigeria
| | - Obiora Egbuche
- Division of Cardiovascular Disease, Morehouse School of MedicineAtlanta, GA 30310, USA
| |
Collapse
|
17
|
Abe T, Egbuche O, Igwe J, Jegede O, Wagle B, Olanipekun T, Onwuanyi A. Cardiovascular complications in COVID-19 patients with or without diabetes mellitus. Endocrinol Diabetes Metab 2020; 4:e00218. [PMID: 33614986 PMCID: PMC7883043 DOI: 10.1002/edm2.218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/18/2020] [Revised: 10/26/2020] [Accepted: 11/23/2020] [Indexed: 12/17/2022]
Abstract
Introduction Coronavirus disease 2019 (COVID‐19) has become a major global crisis. Preliminary reports have, in general, indicated worse outcomes in diabetes mellitus (DM) patients, but the magnitude of cardiovascular (CV) complications in this subgroup has not been elucidated. Methods We included 142 patients admitted with laboratory‐confirmed COVID‐19 from April 1st to May 30th 2020; 71 (50%) had DM. We compared baseline demographics and study outcomes between those with or without DM using descriptive statistics. Multivariate logistic regression was used to estimate the adjusted odds ratio for the study outcomes in DM patients, compared to those without DM, stratified by age, sex and glycaemic control. CV outcomes of interest include acute myocarditis, acute heart failure, acute myocardial infarction, new‐onset atrial fibrillation and composite cardiovascular end‐point consisting of all individual outcomes above. Result Mean age was 58 years. The unadjusted rates were higher in DM patients compared to non‐diabetics for the composite cardiovascular end‐point (73.2% vs. 40.6% p < .0001), acute myocarditis (36.6% vs. 15.5% p = .004), acute heart failure (25.3% vs. 5.6% p = .001), acute myocardial infarction (9.9% vs. 1.4% p = .03) and new‐onset atrial fibrillation (12.7% vs. 1.4% p = .009). After controlling for relevant confounding variables, diabetic patients had higher odds of composite cardiovascular end‐point, acute heart failure and new‐onset atrial fibrillation.
Collapse
Affiliation(s)
- Temidayo Abe
- Internal Medicine Residency Program Morehouse School of Medicine Atlanta GA USA
| | - Obiora Egbuche
- Department of Cardiovascular Disease Morehouse School of Medicine Atlanta GA USA
| | - Joseph Igwe
- Internal Medicine Residency Program Morehouse School of Medicine Atlanta GA USA
| | - Opeyemi Jegede
- Department of Epidemiology and Biostatistics University of North Texas Health Science Center Fort Worth TX USA
| | - Bivek Wagle
- Department of Medicine Morehouse School of Medicine Atlanta GA USA
| | | | - Anekwe Onwuanyi
- Department of Cardiovascular Disease Morehouse School of Medicine Atlanta GA USA
| |
Collapse
|
18
|
Egbuche O, Nwagbara K, Mezue KN, Abe T, Nwokike S. Transvenous Retrieval of a Pulmonary Artery Catheter Knot Around Pacing Leads: A Case Report. Cardiovasc Revasc Med 2020; 28S:144-146. [PMID: 33077395 DOI: 10.1016/j.carrev.2020.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/08/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pulmonary Artery Catheter (PAC) knotting is a rare complication of PAC insertion. In patients with dilated right heart chambers, blind insertion of PAC significantly increases the risk of catheter knotting. We demonstrate a safe and successful approach to resolving a PAC knot around pacing leads of a cardiac resynchronization device. CASE PRESENTATION A 63-year-old African American male with dilated cardiomyopathy and a cardiac resynchronization therapy (CRT) device for severe left ventricular systolic dysfunction required PAC insertion for hemodynamic management of acute heart failure. PAC insertion was complicated by catheter knotting around the pacing leads. The PAC was successfully retrieved using a transvenous technique. CONCLUSION Fluoroscopy-guided insertion of PAC is advisable and preferred over blind insertion in patients with high risk of PAC entanglement. LEARNING OBJECTIVE To highlight a potential complication of blind pulmonary artery catheter insertion and provide a safe technique to resolve catheter knots.
Collapse
Affiliation(s)
- Obiora Egbuche
- Division of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, GA, United States of America.
| | - Kenechukwu Nwagbara
- Division of Hospital Medicine, Mercy Hospital, Joplin, MO, United States of America
| | - Kenechukwu N Mezue
- Division of Nuclear Cardiology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Temidayo Abe
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States of America
| | - Shirley Nwokike
- Department of Medicine, Medical College of Georgia, Augusta, GA, United States of America
| |
Collapse
|
19
|
Mezue K, Ram P, Egbuche O, Menezes RG, Lerma E, Rangaswami J. Anticoagulation-related nephropathy for the internist: a concise review. Am J Cardiovasc Dis 2020; 10:301-305. [PMID: 33224577 PMCID: PMC7675155] [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] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
Anticoagulation-related nephropathy (ARN) is a clinical entity that has significant morbidity and mortality consequences/burden but has not been well described. Consequently, ARN has been underdiagnosed and sub-optimally managed. ARN has been reported with warfarin use especially in the setting of supratherapeutic international normalized ratio (INR) but the association is far less established with the use of direct-acting oral anticoagulants (DOAC). Accelerated progression to CKD and ultimately ESRD has been reported in patients with ARN. With the expanding indications for DOAC use, there is growing concern about ARN in the setting of DOAC use and its attendant clinical and socioeconomic burden. In this review, we highlight precautionary measures to aid prompt diagnosis of ARN and suggest possible therapeutic strategies.
Collapse
Affiliation(s)
- Kenechukwu Mezue
- Division of Hospital Medicine, Altru Health SystemGrand Forks, ND, USA
| | - Pradhum Ram
- Department of Cardiovascular Disease, Emory University HospitalAtlanta, GA, USA
| | - Obiora Egbuche
- Department of Cardiovascular Disease, Morehouse School of MedicineAtlanta, GA, USA
| | - Ritesh G Menezes
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal UniversityDammam, Saudi Arabia
| | - Edgar Lerma
- University of Illinois at Chicago College of Medicine/Advocate Christ Medical CenterOak Lawn, IL, USA
| | - Janani Rangaswami
- Sidney Kimmel College of Thomas Jefferson UniversityPhiladelphia, PA, USA
| |
Collapse
|
20
|
Abe T, Effoe V, Hayes D, Egbuche O, Ky H, Ajose T, Olowu A. Alcohol Use Disorder is Associated with an Increased Risk for Respiratory Failure among Patients with Takotsubo Cardiomyopathy. Open Access Maced J Med Sci 2020. [DOI: 10.3889/oamjms.2020.4166] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: While takotsubo cardiomyopathy (TCM) was initially considered a benign disease, recent studies have demonstrated poor cardiovascular outcomes. It is important to determine the predictors of these outcomes for appropriate risk stratification and to decrease the overall disease burden. Physical stressors (e.g., acute neurologic disorder and lung disorder) and pre-existing heart failure have been associated with worse outcomes. Alcohol abuse has been associated with cardiomyopathy and may also exacerbate pre-existing heart conditions.
AIM: We aimed to determine the impact of alcohol abuse on patients with TCM.
METHODS: We identified 11,221 patients from the 2009 to 2012 National Inpatient Sample, of which 10,622 had TCM alone and 599 had TCM and alcohol use disorder (AUD). Our outcomes of interest were overall mortality, need for mechanical hemodynamic support (MHS), acute respiratory failure, sudden cardiac arrest, cardiogenic shock, stroke, and atrial fibrillation. All clinical characteristics were defined per the International Classification of Diseases 9th revision codes. Logistic regression was used to estimate the odds ratios of the outcomes in patients with concomitant TCM and AUD, compared to those with TCM without AUD while adjusting for confounders.
RESULTS: The mean age of the sample was 60.5 ± 11 for TCM with AUD and 56.0 ± 11 for TCM alone. There was no significant difference between the two groups in the rates of atrial fibrillation (10.4% vs. 8,5%; p = 0.134), cardiogenic shock (5.9% vs. 4.8%; p = 0.3), use of MHS (2.6% vs. 1.7%; p = 0.165), overall in-hospital mortality (4.0% vs. 3.7%; p = 0.691), stroke (1.6% vs. 1.3%; p = 0.593), and sudden cardiac arrest (2.7% vs. 3.5%; p = 0.24). Rates of acute respiratory failure (17.7% vs. 25.2%; p < 0.0001) were significantly higher in patients with TCM with AUD compared to those with TCM alone. After adjusting for significant cofounders, the odds ratio for respiratory failure among patients with concomitant TCM and AUD was 1.36 (95% CI: 1.11–1.66) compared to those with TCM without AUD.
CONCLUSION: Pre-existing AUD is associated with an increased risk for respiratory failure in a patient with TCM.
Collapse
|
21
|
Egbuche O, Hanna B, Onuorah I, Uko E, Taha Y, Ghali JK, Onwuanyi A. Contemporary Pharmacologic Management of Heart Failure with Reduced Ejection Fraction: A Review. Curr Cardiol Rev 2020; 16:55-64. [PMID: 31288726 PMCID: PMC7393599 DOI: 10.2174/1573403x15666190709185011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Received: 05/02/2019] [Revised: 06/11/2019] [Accepted: 06/21/2019] [Indexed: 12/11/2022] Open
Abstract
Heart failure with reduced ejection fraction (HFrEF) is defined as the presence of typical symptoms of heart failure (HF) and a left ventricular ejection fraction ≤ 40%. HFrEF patients constitute approximately 50% of all patients with clinical HF. Despite breakthrough discoveries and advances in the pharmacologic management of HF, HFrEF patients continue to pose a significant economic burden due to a progressive disease characterized by recurrent hospitalizations and need for advanced therapy. Although there are effective, guideline-directed medical therapies for patients with HFrEF, a significant proportion of these patients are either not on appropriate medications’ combination or on optimal tolerable medications’ doses. Since the morbidity and mortality benefits of some of the pharmacologic therapies are dose-dependent, optimal medical therapy is required to impact the burden of disease, quality of life, prognosis, and to curb health care expenditure. In this review, we summarize landmark trials that have impacted the management of HF and we review contemporary pharmacologic management of patients with HFrEF. We also provide insight on general considerations in the management of HFrEF in specific populations. We searched PubMed, Scopus, Medline and Cochrane library for relevant articles published until April 2019 using the following key words “heart failure”, “management”, “treatment”, “device therapy”, “reduced ejection fraction”, “guidelines”, “guideline directed medical therapy”, “trials” either by itself or in combination. We also utilized the cardiology trials portal to identify trials related to heart failure. We reviewed guidelines, full articles, review articles and clinical trials and focused on the pharmacologic management of HFrEF.
Collapse
Affiliation(s)
- Obiora Egbuche
- Division of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, GA 30303, United States
| | - Bishoy Hanna
- Division of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, GA 30303, United States
| | - Ifeoma Onuorah
- Division of Cardiovascular Disease, Emory University Hospital, Atlanta, GA 30322, United States
| | - Emmanuela Uko
- Division of Peadiatric Medicine, Icahn School of Medicine at Mount Sinai, NYC, New York, United States
| | - Yasir Taha
- Division of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, GA 30303, United States
| | - Jalal K Ghali
- Division of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, GA 30303, United States
| | - Anekwe Onwuanyi
- Division of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, GA 30303, United States
| |
Collapse
|
22
|
Egbuche O, Biggs ML, Ix JH, Kizer JR, Lyles MF, Siscovick DS, Djoussé L, Mukamal KJ. Fatty Acid Binding Protein-4 and Risk of Cardiovascular Disease: The Cardiovascular Health Study. J Am Heart Assoc 2020; 9:e014070. [PMID: 32248728 PMCID: PMC7428637 DOI: 10.1161/jaha.119.014070] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background FABP‐4 (fatty acid binding protein‐4) is a lipid chaperone in adipocytes and has been associated with prognosis in selected clinical populations. We investigated the associations between circulating FABP‐4, risk of incident cardiovascular disease (CVD), and risk of CVD mortality among older adults with and without established CVD. Methods and Results In the Cardiovascular Health Study, we measured FABP4 levels in stored specimens from the 1992–993 visit and followed participants for incident CVD if they were free of prevalent CVD at baseline and for CVD mortality through June 2015. We used Cox regression to estimate hazard ratios for incident CVD and CVD mortality per doubling in serum FABP‐4 adjusted for age, sex, race, field center, waist circumference, blood pressure, lipids, fasting glucose, and C‐reactive protein. Among 4026 participants free of CVD and 681 with prevalent CVD, we documented 1878 cases of incident CVD and 331 CVD deaths, respectively. In adjusted analyses, FABP‐4 was modestly associated with risk of incident CVD (mean, 34.24; SD, 18.90; HR, 1.10 per doubling in FABP‐4, 95% CI, 1.00–1.21). In contrast, FABP‐4 was more clearly associated with risk of CVD mortality among participants without (HR hazard ratio 1.24, 95% CI, 1.10–1.40) or with prevalent CVD (HR hazard ratio 1.57, 95% CI, 1.24–1.98). These associations were not significantly modified by sex, age, and waist circumference. Conclusions Serum FABP‐4 is modestly associated with risk of incident CVD even after adjustment for standard risk factors, but more strongly associated with CVD mortality among older adults with and without established CVD.
Collapse
Affiliation(s)
- Obiora Egbuche
- Division of Cardiovascular Disease Morehouse School of Medicine Atlanta GA
| | - Mary L Biggs
- Cardiovascular Health Research Unit University of Washington Seattle WA
| | - Joachim H Ix
- Division of Nephrology Department of Medicine University of California San Diego CA
| | - Jorge R Kizer
- Division of Cardiology Veterans Affairs Medical Center University of California San Francisco CA
| | - Mary F Lyles
- Department of Gerontology School of Medicine Wake Forest University Winston-Salem NC
| | | | - Luc Djoussé
- Division of Aging Department of Medicine Brigham and Women's Hospital Boston MA
| | - Kenneth J Mukamal
- Division of General Medicine Beth Israel Deaconess Medical Center Boston MA
| |
Collapse
|
23
|
Egbuche O. Contemporary Pharmacologic Management of Heart Failure with Reduced Ejection Fraction: A Review. Curr Cardiol Rev 2020. [DOI: 10.2174/18756557otk1omdmrtcvy] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
24
|
Egbuche O, Biggs ML, Ix J, Kizer J, Lyles M, Siscovick D, Djousse L, Mukamal K. FATTY ACID BINDING PROTEIN-4 AND RISK OF CARDIOVASCULAR DISEASE: THE CARDIOVASCULAR HEALTH STUDY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32439-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
25
|
Egbuche O, Hanna B, Onyiagu A, Onwuanyi A. LIFE-THREATENING METHEMOGLOBINEMIA CAUSED BY TOPICAL ANESTHETIC GIVEN PRIOR TO TRANSESOPHAGEAL ECHOCARDIOGRAPHY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)33025-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
26
|
Agasthi P, Kanmanthareddy A, Khalil C, Egbuche O, Yarlagadda V, Sachdeva R, Arsanjani R. Comparison of Computed Tomography derived Fractional Flow Reserve to invasive Fractional Flow Reserve in Diagnosis of Functional Coronary Stenosis: A Meta-Analysis. Sci Rep 2018; 8:11535. [PMID: 30069020 PMCID: PMC6070545 DOI: 10.1038/s41598-018-29910-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/19/2018] [Indexed: 12/14/2022] Open
Abstract
Computed Tomography derived Fractional Flow Reserve (CTFFR) is an emerging non-invasive imaging modality to assess functional significance of coronary stenosis. We performed a meta-analysis to compare the diagnostic performance of CTFFR to invasive Fractional Flow reserve (FFR). Electronic search was performed to identify relevant articles. Pooled Estimates of sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-) and diagnostic odds ratio (DOR) with corresponding 95% confidence intervals (CI) were calculated at the patient level as well as the individual vessel level using hierarchical logistic regression, summary receiver operating characteristic (SROC) curve and area under the curve were estimated. Our search yielded 559 articles and of these 17 studies was included in the analysis. A total of 2,191 vessels in 1294 patients were analyzed. Pooled estimates of sensitivity, specificity, LR+, LR- and DOR with corresponding 95% CI at per-patient level were 83% (79-87), 72% (68-76), 3.0 (2.6-3.5), 0.23 (0.18-0.29) and 13 (9-18) respectively. Pooled estimates of sensitivity, specificity, LR+, LR- and DOR with corresponding 95% CI at per-vessel level were 85% (83-88), 76% (74-79), 3.6 (3.3-4.0), 0.19 (0.16-0.22) and 19 (15-24). The area under the SROC curve was 0.89 for both per patient level and at the per vessel level. In our meta-analysis, CTFFR demonstrated good diagnostic performance in identifying functionally significant coronary artery stenosis compared to the FFR.
Collapse
Affiliation(s)
- Pradyumna Agasthi
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA.
| | - Arun Kanmanthareddy
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Charl Khalil
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Obiora Egbuche
- Division of Cardiology, Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Vivek Yarlagadda
- Department of Internal Medicine, Atlanticare Regional Medical Center, Atlantic City, New Jersey, USA
| | - Rajesh Sachdeva
- Division of Cardiology, Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Reza Arsanjani
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA
| |
Collapse
|
27
|
Egbuche O, Ekechukwu I, Effoe V, Maduabum N, Millard HR, Maihemuti A, Cross JA, Adedinsewo D, Onwuanyi AE. Effect of β-blocker Therapy on Hospital Readmission and Mortality in Heart Failure Patients With Concurrent Cocaine Use. J Cardiovasc Pharmacol Ther 2018; 23:518-523. [PMID: 29793347 DOI: 10.1177/1074248418778550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND β-Blockers are first-line agents for reduction in symptoms, hospitalization, and mortality in patients with heart failure having reduced ejection fraction (HFrEF). However, the safety and efficacy of continuous β-blocker therapy (BBT) in patients who actively use cocaine remain controversial, and available literature is limited. We aimed to evaluate the effect of BBT on hospital readmission and mortality in patients having HFrEF with concurrent cocaine use. METHODS We conducted a retrospective study of patients with a diagnosis of HFrEF between 2011 and 2014 based on International Classification of Diseases 9-Clinical Modification codes. We included patients aged 18 and older who tested positive for cocaine on a urine toxicology test obtained at the time of index admission. Patients were followed for 1 year. Multivariate logistic regression was used to assess the effect of BBT on the 30-day, all-cause and heart failure-related readmissions. RESULTS The 30-day readmission rates for BBT versus no BBT groups were 20% versus 41% (odds ratio [OR]: 0.17, 95% confidence interval [CI] = 0.05-0.56, P = .004) for heart failure-related readmissions and 25% versus 46% (OR: 0.19, 95% CI = 0.06-0.64, P = .007) for all-cause readmissions. CONCLUSION The BBT reduced 30-day, all-cause and heart failure-related readmission rate but not 1-year mortality in patients having HFrEF with concurrent cocaine use.
Collapse
Affiliation(s)
- Obiora Egbuche
- 1 Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Ifunanya Ekechukwu
- 3 Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Valery Effoe
- 1 Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Nnamdi Maduabum
- 4 Department of Environmental Sciences, University of North Texas Health Science Center, Fort-Worth, TX, USA
| | - Heather R Millard
- 5 Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Axiyan Maihemuti
- 6 Department of Cardiology, Bridgeport Hospital-Yale New Haven Health, Bridgeport, CT, USA
| | - Jo Ann Cross
- 1 Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA.,2 Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Demilade Adedinsewo
- 1 Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Anekwe E Onwuanyi
- 2 Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, USA.,7 Department of Cardiology, Grady Memorial Hospital, Atlanta, GA, USA
| |
Collapse
|
28
|
Abstract
Background:
Wooden chest syndrome (WCS) is a known manifestation of fentanyl toxicity, especially with high doses used for anesthetic induction in rapid sequence intubation (RSI). We present a rare case of WCS leading to cardiopulmonary arrest (CPA) following administration of low dose fentanyl.
Case Report:
A 37-year-old woman with no past medical history was admitted for management of septic abortion complicated by respiratory failure requiring mechanical ventilation. With clinical improvement, a spontaneous breathing trial (SBT) was attempted. Given respiratory acidosis during SBT, mechanical ventilation was continued. 25 micrograms (mcg) IV fentanyl bolus was given for analgesia. A few minutes later, she developed abdominal and chest wall rigidity with agonal breathing, culminating in CPA. Telemetry rhythm strip revealed asystole. Cardiopulmonary resuscitation (CPR) was initiated. She had absent breath sounds and high airway resistance causing difficulty with bag-mask ventilation. Arterial blood gas revealed hypoxia and hypercapnia. She achieved return of spontaneous circulation within a few minutes of CPR. CXR ruled out pneumothorax. She received 25mcg IV fentanyl bolus for sedation while undergoing CT chest and had another episode of chest wall rigidity. Cisatracurium was started. Her chest wall rigidity resolved and she was extubated the next day.
Discussion:
Our patient likely had WCS from fentanyl toxicity demonstrated by recurrence of chest wall rigidity with fentanyl doses. WCS should be suspected in patients who develop chest wall rigidity following fentanyl administration. It should be managed with ventilator support and reversal with naloxone or a short acting neuromuscular blocker.
Conclusion:
CPA is a rare but fatal complication of WCS. WCS can occur with low doses of fentanyl even in patients who have previously tolerated higher doses.
Collapse
|
29
|
Adedinsewo D, Xu J, Omole O, Akinjero A, Egbuche O, Bakinde N, Oderinde A, Onwuanyi A, Taylor H, Yamani M. EFFECT OF COMBINED BETA-BLOCKER AND BETA-AGONIST USE ON CLINICAL OUTCOMES AMONG MEDICAID BENEFICIARIES WITH COEXISTING HEART FAILURE AND ASTHMA. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31409-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
30
|
Effoe V, Bertoni A, Yan F, Taka N, Egbuche O, Olanipekun T, Adedinsewo D, Fox E, Taylor H. CAROTID INTIMA-MEDIA THICKNESS VERSUS CORONARY ARTERY CALCIUM SCORE IN PREDICTING INCIDENT CORONARY HEART DISEASE AND STROKE AMONG AFRICAN AMERICANS: THE JACKSON HEART STUDY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32413-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
31
|
Chang E, Egbuche O, Wirth D, Quinn B, Balan S, Fatima S, Onwuanyi A. IMPACT OF AN ENHANCED COMPREHENSIVE HEART FAILURE PROGRAM ON EMERGENCY DEPARTMENT VISITS IN HEART FAILURE PATIENTS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31261-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
32
|
Egbuche O, Millard HR, Renelus B, Maihemuti A, Musani SK, Fox ER, Liu J, Taylor HA, Bidulescu A. Serum Ferritin Levels in Blacks Without Known Cardiovascular Disease (from the Jackson Heart Study). Am J Cardiol 2017; 120:1533-1540. [PMID: 28865891 DOI: 10.1016/j.amjcard.2017.07.045] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/07/2017] [Accepted: 07/24/2017] [Indexed: 11/18/2022]
Abstract
There has been conflicting results regarding the role of ferritin, a nonspecific marker of systemic inflammation, in the development of coronary heart disease (CHD). We aimed to evaluate the association of serum ferritin with incident CHD, incident stroke, and subclinical measurements of atherosclerosis among blacks. For our prospective study, we utilized data from the Jackson Heart Study. Eligible participants (n = 4,659) who were free from CHD were enrolled in 2000 to 2004. The participants' baseline serum ferritin levels were obtained, and they were followed up for an average of 8 years to identify incident CHD events and incident stroke. We used multivariate linear regression and Cox proportional hazard models to evaluate the association of serum ferritin with incident CHD events and incident stroke. The age-adjusted correlations between ferritin and specific study covariates, including carotid intima-media thickness, coronary artery calcium, and abdominal aortic calcium, were obtained. During an average of 8 years of follow-up, 161 incident CHD events and 117 incident stroke events were documented. There was no significant association between ferritin levels and incident CHD events (p = 0.54 in men and p = 0.31 in women) and incident stroke (p = 0.17 in men and p = 0.56 in women), or both considered together (p = 0.70 in men and p = 0.69 in women). Ferritin was significantly correlated with abdominal aortic calcium (r = 0.09, p <0.01) in women but not in men. In conclusion, a higher serum ferritin level was not associated with an increased risk of incident CHD events or incident stroke, and may not be an independent predictor of incident CHD or stroke in blacks.
Collapse
Affiliation(s)
- Obiora Egbuche
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia.
| | - Heather R Millard
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health Bloomington, Bloomington, Indiana; Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Benjamin Renelus
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Axiyan Maihemuti
- Department of Cardiology, Bridgeport Hospital, Yale New Haven Health, Bridgeport, Connecticut
| | - Solomon K Musani
- Department of Medicine, University of Mississippi Medical Ctr, Jackson, Mississippi
| | - Ervin R Fox
- Department of Medicine, University of Mississippi Medical Ctr, Jackson, Mississippi
| | - Jiankang Liu
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Herman A Taylor
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Aurelian Bidulescu
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health Bloomington, Bloomington, Indiana
| |
Collapse
|
33
|
Chang E, Adedinsewo D, Calcano C, Egbuche O, Chaudhry A, Bakinde N, King M, Onwuanyi A. Abstract 112: Statin Utilization in the Outpatient Clinic of a University Based Residency Training Program. Circ Cardiovasc Qual Outcomes 2017. [DOI: 10.1161/circoutcomes.10.suppl_3.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Current guidelines released in 2013 recommend statins for five specific patient groups including persons with clinical atherosclerotic cardiovascular disease (ASCVD) and diabetes. National estimates of statin utilization in 2012 report statin use in persons with ASCVD at 58.8% and 63.5% among persons with diabetes. A recent review also showed suboptimal statin prescription rates prior to 2013, with only 23% being prescribed a statin at goal dose. Our goal was to assess statin prescriptions in a large resident run outpatient clinic and identify factors affecting statin prescriptions as potential targets for intervention to improve compliance with the guidelines.
Methods:
We obtained data from the medical record data warehouse of a primary care outpatient clinic within a large safety-net hospital from Jan–Dec 2015. The clinic is predominantly run by internal medicine residents and supervised by general internal medicine attending physicians. Patients with a diagnosis of ASCVD and diabetes were identified and electronic medical records abstraction was done to identify persons who were prescribed a statin (regardless of dose). Bivariate analyses were conducted to identify potential factors affecting statin prescriptions.
Results:
Our patient population was predominantly African American, representing more than 70% of our clinic patients. We found 87% of persons with ASCVD and 70% of persons with diabetes were on statin. We found no differences in statin prescriptions by demographic characteristics among persons with ASCVD. Among patients with diabetes, younger age (p<0.01), female sex (p<0.05), non-black race (p<0.05) and private insurance/lack of insurance (p<0.01) were associated with a lower likelihood of being prescribed a statin.
Conclusion:
Statin prescriptions among patients with ASCVD and diabetes appear to be higher in our patient population compared to prior national estimates, however statin prevalence remains suboptimal. Our next steps are to begin a targeted educational intervention for residents in the continuity clinic and ultimately demonstrate that resident driven intervention is an effective way to increase compliance with the guidelines.
Collapse
|
34
|
Agasthi P, Kanmanthareddy A, Egbuche O, Yarlagadda V, Wilansky S, Fortuin FD, Sachdeva R. TCT-504 Comparison of Computed Tomography derived Fractional Flow Reserve to invasive Fractional Flow Reserve in Diagnosis of Functional Coronary Stenosis: A Meta-Analysis. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|