1
|
Sarraju A, Yan X, Huang Q, Dudum R, Palaniappan L, Rodriguez F. Patterns and gaps in guideline-directed statin use for atherosclerotic cardiovascular disease by race and ethnicity. Am J Prev Cardiol 2024; 17:100647. [PMID: 38525197 PMCID: PMC10958062 DOI: 10.1016/j.ajpc.2024.100647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 02/27/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024] Open
Abstract
Objective There remain disparities by race and ethnicity in atherosclerotic cardiovascular disease (ASCVD). Statins reduce low-density lipoprotein cholesterol (LDL-c) and improve ASCVD outcomes. ASCVD treatment patterns across disaggregated race and ethnicity groups are incompletely understood. We aimed to evaluate statin use and LDL-c control for ASCVD by race and ethnicity. Methods From an electronic health record (EHR)-based cohort from a multisite Northern California health system, we included adults with an ASCVD diagnosis from 2010 to 2021 and at least 2 primary care visits, stratified by race and ethnicity (Non-Hispanic White [NHW], Non-Hispanic Black [Black], Hispanic, and Asian). Hispanic (Mexican, Puerto Rican, Other) and Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other) groups were disaggregated. Primary outcomes were 1-year post-ASCVD statin use (prescription) and LDL-c control (at least one value <70 mg/dL). Adjusted odds ratios (ORs) were estimated using logistic regression. Results Of 133,158 patients, there were 89,944 NHW, 6,294 Black, 12,478 (9.4 %) Hispanic and 13,179 (9.9 %) Asian patients. At 1 year after incident ASCVD, there was suboptimal statin use (any statins <60 %, high-intensity <25 %) and LDL-c control (<30 %) across groups, with lowest proportions in Black patients for statin use (46.7 %, any statin) and LDL-c control (10.7 %, OR 0.89 (0.81-0.97), referent NHW). Disaggregation of Asian and Hispanic groups unmasked within-group heterogeneity. Conclusions In patients with incident ASCVD, we describe suboptimal and heterogenous 1-year post-ASCVD guideline-directed statin use and 1-year post-ASCVD LDL-c control across disaggregated race and ethnicity groups. Findings may improve understanding of ASCVD treatment disparities and guide implementation.
Collapse
Affiliation(s)
- Ashish Sarraju
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Xiaowei Yan
- Center for Health Systems Research and Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA, USA
| | - Qiwen Huang
- Center for Health Systems Research and Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA, USA
| | - Ramzi Dudum
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Latha Palaniappan
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| |
Collapse
|
2
|
Sood N, Shukla D, Mishra P, Sharma S, Gandhi S, Linder DF, Shah P. Impact of in-hospital statin use on mortality in COVID-19 patients from a majority African American population. Heart Lung 2024; 64:137-141. [PMID: 38184934 PMCID: PMC10008792 DOI: 10.1016/j.hrtlng.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND The COVID-19 pandemic has claimed over 6.4 million lives globally. Finding effective medications to reduce mortality in hospitalized COVID-19 patients remains critical. No previous study has been published on the effects of statin use in a majority African American COVID-19 patient population. OBJECTIVE This study aims to assess the relationship between in-hospital statin use and mortality in this population. METHODS A retrospective chart review of patients diagnosed with COVID-19 from March 2020 to June 2020 admitted to the Phoebe Putney Health System in Albany, Georgia, an early epicenter of the COVID-19 pandemic, was conducted. The outcomes of 735 hospitalized COVID-19 positive patients from over 40 counties in Georgia were analyzed. The primary outcome of interest was all-cause mortality, with secondary outcomes of interest of ICU care, length of ICU stay, need for mechanical ventilator, duration of intubation, and need for dialysis. Multivariate logistic regression and Cox proportional hazards analysis were conducted to examine the effect of in-hospital statin use and mortality. RESULTS 186 of 735 total patients were prescribed statins in-hospital. 83.8% were African American. Multivariate logistic regression found in-hospital statin use was not significantly associated with the primary outcome - all-cause mortality (p=0.23). Similar findings were seen in need for ICU care, length of ICU stay, need for mechanical ventilator, duration of intubation, and need for dialysis (p>0.05). Additionally, results from a Cox proportional hazards model found in-hospital statin use was not associated with survival time. Sensitivity analysis conducted on only African American patients validated that in-hospital statin use was not associated with all-cause mortality in these patients. Of note, immunosuppression and severe disease presentation were associated with a six-fold increase in risk of mortality and the largest decreases in survival time. CONCLUSION It is possible statins have no mortality benefit for this patient population, but further research beyond this association study would need to be conducted to determine this conclusively. From this study, the best clinical recommendation would be to continue statins for COVID-19 patients with pre-hospital statin use and to launch a randomized clinical trial to definitively determine the efficacy of statins in the treatment of hospitalized COVID-19 patients.
Collapse
Affiliation(s)
- Nitish Sood
- Medical College of Georgia, 1120 15th St, Augusta, GA 30912, USA.
| | - Dhairya Shukla
- Medical College of Georgia, 1120 15th St, Augusta, GA 30912, USA
| | - Pranjal Mishra
- Medical College of Georgia, 1120 15th St, Augusta, GA 30912, USA
| | - Saloni Sharma
- Medical College of Georgia, 1120 15th St, Augusta, GA 30912, USA
| | - Sahil Gandhi
- Medical College of Georgia, 1120 15th St, Augusta, GA 30912, USA
| | - Daniel F Linder
- Medical College of Georgia, 1120 15th St, Augusta, GA 30912, USA
| | - Priyank Shah
- Department of Cardiology, Phoebe Putney Memorial Hospital, Albany, GA, USA
| |
Collapse
|
3
|
Amin K, Bethel G, Jackson LR, Essien UR, Sloan CE. Eliminating Health Disparities in Atrial Fibrillation, Heart Failure, and Dyslipidemia: A Path Toward Achieving Pharmacoequity. Curr Atheroscler Rep 2023; 25:1113-1127. [PMID: 38108997 PMCID: PMC11044811 DOI: 10.1007/s11883-023-01180-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE OF REVIEW Pharmacoequity refers to the goal of ensuring that all patients have access to high-quality medications, regardless of their race, ethnicity, gender, or other characteristics. The goal of this article is to review current evidence on disparities in access to cardiovascular drug therapies across sociodemographic subgroups, with a focus on heart failure, atrial fibrillation, and dyslipidemia. RECENT FINDINGS Considerable and consistent disparities to life-prolonging heart failure, atrial fibrillation, and dyslipidemia medications exist in clinical trial representation, access to specialist care, prescription of guideline-based therapy, drug affordability, and pharmacy accessibility across racial, ethnic, gender, and other sociodemographic subgroups. Researchers, health systems, and policy makers can take steps to improve pharmacoequity by diversifying clinical trial enrollment, increasing access to inpatient and outpatient cardiology care, nudging clinicians to increase prescription of guideline-directed medical therapy, and pursuing system-level reforms to improve drug access and affordability.
Collapse
Affiliation(s)
- Krunal Amin
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Garrett Bethel
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Larry R Jackson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Utibe R Essien
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Center for the Study of Healthcare Innovation, Implementation & Policy, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
| | - Caroline E Sloan
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.
| |
Collapse
|
4
|
Decicco E, Peterson ED, Gupta A, Khalaf Gillard K, Sarnes E, Navar AM. Lipid-lowering therapy and LDL-C control for primary prevention in persons with diabetes across 90 health systems in the United States. Am J Prev Cardiol 2023; 16:100604. [PMID: 38162437 PMCID: PMC10757181 DOI: 10.1016/j.ajpc.2023.100604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/08/2023] [Accepted: 09/21/2023] [Indexed: 01/03/2024] Open
Abstract
Objective National guidelines recommend statin therapy for patients with type 2 diabetes. We assessed the extent of moderate- to high-intensity statin therapy utilization in community practice. Methods We evaluated lipid-lowering therapy (LLT) and low-density lipoprotein cholesterol (LDL-C) levels at baseline and 1-year follow-up in patients aged 40-75 years with type 2 diabetes but without atherosclerotic cardiovascular disease (ASCVD), across 90 health systems in the United States participating in an electronic health record-derived dataset, Cerner Real-World Data. Multivariable logistic regression was used to evaluate factors associated with utilization of moderate- to high-intensity statin. Results We identified 241,232 patients with type 2 diabetes (58.1 % on moderate- to high-intensity statin, 7.0 % on low-intensity statin, and 34.9 % on no statin). Predictors of moderate- to high-intensity statin therapy included retinopathy (adjusted odds ratio [aOR], 1.26; 95 % confidence interval [CI], 1.15-1.38), hypertension (aOR, 1.52; 95 % CI, 1.43-1.61), and stage 3 chronic kidney disease (aOR, 1.14; 95 % CI, 1.07-1.21). Women (aOR, 0.85; 95 % CI, 0.82-0.87), and those with rheumatoid arthritis (aOR, 0.79; 95 % CI, 0.71-0.87), psoriasis (aOR, 0.85; 95 % CI, 0.75-0.96), and hepatitis C (aOR, 0.40; 95 % CI, 0.39-0.46), had reduced odds of moderate- to high-intensity statin treatment. Utilization of ezetimibe was rare (2.0 %). LDL-C control was suboptimal at baseline (37.0 % and 27.9 % had LDL-C ≥100 mg/dL and <70 mg/dL, respectively). At 1-year follow-up, the rate of moderate- to high-intensity statin therapy utilization was 65.3 %. Conclusion Increased efforts are needed to improve LDL-C control and LLT use for primary prevention of ASCVD in adults with type 2 diabetes, in particular among women and those with risk-enhancing inflammatory conditions.
Collapse
Affiliation(s)
- Emily Decicco
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Eric D. Peterson
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anand Gupta
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Ann Marie Navar
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
5
|
Carabot F, Donat-Vargas C, Santoma-Vilaclara J, Ortega MA, García-Montero C, Fraile-Martínez O, Zaragoza C, Monserrat J, Alvarez-Mon M, Alvarez-Mon MA. Exploring Perceptions About Paracetamol, Tramadol, and Codeine on Twitter Using Machine Learning: Quantitative and Qualitative Observational Study. J Med Internet Res 2023; 25:e45660. [PMID: 37962927 PMCID: PMC10685273 DOI: 10.2196/45660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Paracetamol, codeine, and tramadol are commonly used to manage mild pain, and their availability without prescription or medical consultation raises concerns about potential opioid addiction. OBJECTIVE This study aims to explore the perceptions and experiences of Twitter users concerning these drugs. METHODS We analyzed the tweets in English or Spanish mentioning paracetamol, tramadol, or codeine posted between January 2019 and December 2020. Out of 152,056 tweets collected, 49,462 were excluded. The content was categorized using a codebook, distinguishing user types (patients, health care professionals, and institutions), and classifying medical content based on efficacy and adverse effects. Scientific accuracy and nonmedical content themes (commercial, economic, solidarity, and trivialization) were also assessed. A total of 1000 tweets for each drug were manually classified to train, test, and validate machine learning classifiers. RESULTS Of classifiable tweets, 42,840 mentioned paracetamol and 42,131 mentioned weak opioids (tramadol or codeine). Patients accounted for 73.10% (60,771/83,129) of the tweets, while health care professionals and institutions received the highest like-tweet and tweet-retweet ratios. Medical content distribution significantly differed for each drug (P<.001). Nonmedical content dominated opioid tweets (23,871/32,307, 73.9%), while paracetamol tweets had a higher prevalence of medical content (33,943/50,822, 66.8%). Among medical content tweets, 80.8% (41,080/50,822) mentioned drug efficacy, with only 6.9% (3501/50,822) describing good or sufficient efficacy. Nonmedical content distribution also varied significantly among the different drugs (P<.001). CONCLUSIONS Patients seeking relief from pain are highly interested in the effectiveness of drugs rather than potential side effects. Alarming trends include a significant number of tweets trivializing drug use and recreational purposes, along with a lack of awareness regarding side effects. Monitoring conversations related to analgesics on social media is essential due to common illegal web-based sales and purchases without prescriptions.
Collapse
Affiliation(s)
- Federico Carabot
- Department of Medicine and Medical Specialities, University of Alcalá, Alcalá de Henares, Spain
- Ramon y Cajal Institute of Sanitary Research, Madrid, Spain
| | - Carolina Donat-Vargas
- Institute of Environmental Medicine, Karolinska Institutet, Unit of Cardiovascular and Nutritional Epidemiology, Stockholm, Sweden
- ISGlobal, Institut de Salut Global de Barcelona, Campus MAR, Barcelona, Spain
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid, Spain
| | - Javier Santoma-Vilaclara
- Department of Medicine and Medical Specialities, University of Alcalá, Alcalá de Henares, Spain
- Data & AI, Filament Consultancy Group., London, United Kingdom
| | - Miguel A Ortega
- Department of Medicine and Medical Specialities, University of Alcalá, Alcalá de Henares, Spain
- Ramon y Cajal Institute of Sanitary Research, Madrid, Spain
- Cancer Registry and Pathology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Cielo García-Montero
- Department of Medicine and Medical Specialities, University of Alcalá, Alcalá de Henares, Spain
- Ramon y Cajal Institute of Sanitary Research, Madrid, Spain
| | - Oscar Fraile-Martínez
- Department of Medicine and Medical Specialities, University of Alcalá, Alcalá de Henares, Spain
- Ramon y Cajal Institute of Sanitary Research, Madrid, Spain
| | - Cristina Zaragoza
- Biomedical Sciences Department, University of Alcalá, Pharmacology Unit, Alcala de Henares, Spain
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, University of Alcalá, Alcalá de Henares, Spain
- Ramon y Cajal Institute of Sanitary Research, Madrid, Spain
| | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcalá, Alcalá de Henares, Spain
- Ramon y Cajal Institute of Sanitary Research, Madrid, Spain
- Immune System Diseases-Rheumatology and Internal Medicine Service, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, University Hospital Príncipe de Asturias, Alcala de Henares, Spain
| | - Miguel Angel Alvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcalá, Alcalá de Henares, Spain
- Ramon y Cajal Institute of Sanitary Research, Madrid, Spain
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
| |
Collapse
|
6
|
Avenatti E, Carrasco-Avila JA, Heidari B, Hagan K, Taha M, Nasir K. The Role of Lipid-Lowering Therapy in Post-Stroke Patients: Update and Recommendations. Curr Atheroscler Rep 2023; 25:889-898. [PMID: 37882944 DOI: 10.1007/s11883-023-01159-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE OF REVIEW Stroke is the second leading cause of death and disability-adjusted life years worldwide, and the global lifetime risk of stroke is rising. Moreover, patients with a prior stroke are at high risk of recurrent events. We aimed at reviewing the evidence supporting aggressive secondary prevention strategies for lipid-lowering treatment in this population. RECENT FINDINGS Statins are the key players in such aggressive management; however, stroke survivors remain at significant residual risk suggesting the need for both better implementation of statin use as well as additional lipid lowering therapies. Newer drugs have become available and represent important tools in the management of patients with prior ischemic stroke. The role of lipid lowering treatment in hemorrhagic stroke is more controversial, given epidemiological data linking low lipid levels with increased risk of first and recurrent events. Aggressive secondary prevention strategies, including lipid lowering treatments, have proven to mitigate the risk of recurrent events in post-stroke patients. The tools available for treating such high-risk population have expanded beyond statins, and clinicians should familiarize themselves with them.
Collapse
Affiliation(s)
- E Avenatti
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX, 77030, USA
| | | | - B Heidari
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX, 77030, USA
| | - K Hagan
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX, 77030, USA
- Center for Outcome Research Houston Methodist Hospital, Houston, TX, USA
| | - M Taha
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX, 77030, USA
| | - K Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX, 77030, USA.
- Center for Outcome Research Houston Methodist Hospital, Houston, TX, USA.
| |
Collapse
|
7
|
Ganguli I, Mackwood MB, Yang CWW, Crawford M, Mulligan KL, O'Malley AJ, Fisher ES, Morden NE. Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study. BMJ 2023; 383:e074908. [PMID: 37879735 PMCID: PMC10599254 DOI: 10.1136/bmj-2023-074908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To characterize racial differences in receipt of low value care (services that provide little to no benefit yet have potential for harm) among older Medicare beneficiaries overall and within health systems in the United States. DESIGN Retrospective cohort study SETTING: 100% Medicare fee-for-service administrative data (2016-18). PARTICIPANTS Black and White Medicare patients aged 65 or older as of 2016 and attributed to 595 health systems in the United States. MAIN OUTCOME MEASURES Receipt of 40 low value services among Black and White patients, with and without adjustment for patient age, sex, and previous healthcare use. Additional models included health system fixed effects to assess racial differences within health systems and separately, racial composition of the health system's population to assess the relative contributions of individual patient race and health system racial composition to low value care receipt. RESULTS The cohort included 9 833 304 patients (6.8% Black; 57.9% female). Of 40 low value services examined, Black patients had higher adjusted receipt of nine services and lower receipt of 20 services than White patients. Specifically, Black patients were more likely to receive low value acute diagnostic tests, including imaging for uncomplicated headache (6.9% v 3.2%) and head computed tomography scans for dizziness (3.1% v 1.9%). White patients had higher rates of low value screening tests and treatments, including preoperative laboratory tests (10.3% v 6.5%), prostate specific antigen tests (31.0% v 25.7%), and antibiotics for upper respiratory infections (36.6% v 32.7%; all P<0.001). Secondary analyses showed that these differences persisted within given health systems and were not explained by Black and White patients receiving care from different systems. CONCLUSIONS Black patients were more likely to receive low value acute diagnostic tests and White patients were more likely to receive low value screening tests and treatments. Differences were generally small and were largely due to differential care within health systems. These patterns suggest potential individual, interpersonal, and structural factors that researchers, policy makers, and health system leaders might investigate and address to improve care quality and equity.
Collapse
Affiliation(s)
- Ishani Ganguli
- Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew B Mackwood
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Ching-Wen Wendy Yang
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Maia Crawford
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | - A James O'Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Elliott S Fisher
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Nancy E Morden
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- UnitedHealthcare, Minnetonka, MN, USA
| |
Collapse
|
8
|
Browder SE, Yohann A, Filipowicz TR, Freeman NLB, Marston WA, Heisler S, Farber MA, Patel SR, Wood JC, McGinigle KL. Differential impact of missed initial wound clinic visit on 6-month wound healing by race/ethnicity among patients with chronic limb-threatening ischemia. Wound Repair Regen 2023; 31:647-654. [PMID: 37534781 PMCID: PMC10878832 DOI: 10.1111/wrr.13116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/07/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023]
Abstract
Chronic limb-threatening ischemia (CLTI) is associated with significant morbidity, including major limb amputation, and mortality. Healing ischemic wounds is necessary to optimise vascular outcomes and can be facilitated by dedicated appointments at a wound clinic. This study aimed to estimate the association between successful wound care initiation and 6-month wound healing, with specific attention to differences by race/ethnicity. This retrospective study included 398 patients with CLTI and at least one ischaemic wound who scheduled an appointment at our wound clinic between January 2015 and July 2020. The exposure was the completion status of patients' first scheduled wound care appointment (complete/not complete) and the primary outcome was 6-month wound healing (healed/not healed). The analysis focused on how this association was modified by race/ethnicity. We used Aalen-Johansen estimators to produce cumulative incidence curves and calculated risk ratios within strata of race/ethnicity. The final adjustment set included age, revascularization, and initial wound size. Patients had a mean age of 67 ± 14 years, were 41% female, 46% non-White and had 517 total wounds. In the overall cohort, 70% of patients completed their first visit and 34% of wounds healed within 6-months. There was no significant difference in 6-month healing based on first visit completion status for White/non-Hispanic individuals (RR [95% CI] = 1.18 [0.91, 1.45]; p-value = 0.130), while non-White individuals were roughly 3 times more likely to heal their wounds if they completed their first appointment (RR [95% CI] = 2.89 [2.66, 3.11]; p-value < 0.001). In conclusion, non-White patients were approximately three times more likely to heal their wound in 6 months if they completed their first scheduled wound care appointment while White/non-Hispanic individuals' risk of healing was similar regardless of first visit completion status. Future efforts should focus on providing additional resources to ensure minority groups with wounds have the support they need to access and successfully initiate wound care.
Collapse
Affiliation(s)
- Sydney E. Browder
- Department of Surgery—Vascular, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Avital Yohann
- Department of Surgery—Vascular, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Teresa R. Filipowicz
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Nikki L. B. Freeman
- Department of Surgery—Vascular, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - William A. Marston
- Department of Surgery—Vascular, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephen Heisler
- Department of Surgery—Vascular, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mark A. Farber
- Department of Surgery—Vascular, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shrunjay R. Patel
- Department of Surgery—Vascular, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jacob C. Wood
- Department of Surgery—Vascular, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | | |
Collapse
|
9
|
Zheutlin AR, Jacobs JA, Derington CG, Chaitoff A, Navar AM, Bress AP. Age-based disparities in statin use for primary prevention in US adults: National Health and Nutrition Examination Surveys 2013-2020. J Clin Lipidol 2023; 17:688-693. [PMID: 37599197 DOI: 10.1016/j.jacl.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023]
Abstract
Statin use among younger adults at high atherosclerotic cardiovascular disease (ASCVD) risk compared with older adults at the same risk is unclear. We determined prevalent statin use by 10-year ASCVD risk and age among US participants aged 40-75 eligible for risk-indicated primary prevention statins from the 2013-2020 National Health and Nutrition Examination Survey cycles. Among 3,503 participants, statin use by ASCVD risk (5-<7.5%, 7.5-<20%, and ≥20%) was 9.4%, 9.0%, and 12.2% among those age 40-54 compared to 22.0%, 23.9%, and 14.3% among adults 55-64 years and 39.3%, 33.6%, and 38.1% age 65-75 years. After adjusting for sociodemographic and healthcare access, the prevalence ratio (vs. 65-75 years) for statin use among adults with an ASCVD risk of 7.5-<20% age 40-54 years was 0.40 (95% confidence interval [CI] 0.39,0.41) and 0.87 (95% CI 0.87,0.88) for adults 55-64 years. Among high ASCVD-risk adults aged 40-75 years, primary prevention statin use was lower among adults <65 years despite similar ASCVD risk as older adults.
Collapse
Affiliation(s)
- Alexander R Zheutlin
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Joshua A Jacobs
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Catherine G Derington
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Alexander Chaitoff
- Center for Healthcare Delivery Science, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Ann Marie Navar
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Adam P Bress
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
10
|
Bierowski M, Galanis T, Majeed A, Mofid A. Peripheral Artery Disease: Overview of Diagnosis and Medical Therapy. Med Clin North Am 2023; 107:807-822. [PMID: 37541709 DOI: 10.1016/j.mcna.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
Peripheral artery disease (PAD) affects approximately 230 million people worldwide and is associated with an increased risk of major adverse cardiovascular and limb events. Even though this condition is considered a cardiovascular equivalent, it remains an underrecognized and undertreated entity. Antiplatelet and statin therapy, along with smoking cessation, are the foundations of therapy to reduce adverse events but are challenging to fully implement in this patient population. Race and socioeconomic status also have profound impacts on PAD outcomes.
Collapse
Affiliation(s)
- Matthew Bierowski
- Internal Medicine, Thomas Jefferson University Hospital, 1025 Walnut Street, Philadelphia, PA 19107, USA
| | - Taki Galanis
- Division Vascular Medicine, Jefferson Vascular Center, Sidney Kimmel Medical College, Philadelphia, PA, USA.
| | - Amry Majeed
- Internal Medicine, Thomas Jefferson University Hospital, 1025 Walnut Street, Philadelphia, PA 19107, USA
| | - Alireza Mofid
- Vascular Surgery, Thomas Jefferson University Hospital, 111 South 11th Street, Suite 6210 Gibbon, Philadelphia, PA 19107, USA
| |
Collapse
|
11
|
Piazza G, Desai NR, Baber U, Exter J, Kalich B, Monteleone P. Practical solutions for implementation of blood cholesterol guidelines in clinical practice. Trends Cardiovasc Med 2023:S1050-1738(23)00074-9. [PMID: 37634754 DOI: 10.1016/j.tcm.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/29/2023]
Abstract
Underutilization of lipid-lowering therapy (LLT) and failure to attain guideline-recommended low-density lipoprotein cholesterol (LDL-C) goals are important quality gaps in cardiovascular risk optimization, especially among patients with atherosclerotic cardiovascular disease (ASCVD). Large database analyses demonstrate an unmet need for improved LDL-C measurement, and that nearly 75% of patients with ASCVD have an LDL-C level above guideline-recommended levels, and greater than 50% are not treated with statins or ezetimibe. Proposed solutions for overcoming these obstacles to optimal lipid management include provider- and patient-facing educational interventions, health information technology strategies, implementation of incentive-based care, advocacy efforts, and systems-based process innovations. While individual interventions may not be enough to overcome the totality of barriers to optimal LLT, comprehensive multifaceted approaches that address barriers at the provider, patient, and healthcare delivery level are likely to offer the greatest likelihood of success and improved patient outcomes.
Collapse
Affiliation(s)
- Gregory Piazza
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
| | - Nihar R Desai
- Section of Cardiology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Usman Baber
- Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Jason Exter
- Amgen Inc., Thousand Oaks, CA, United States
| | | | - Peter Monteleone
- The University of Texas at Austin Dell School of Medicine, Austin, TX, United States
| |
Collapse
|
12
|
Sawant S, Wang N. Under-representation of ethnic and regional minorities in lipid-lowering randomized clinical trials: a systematic review and meta-analysis. Eur J Prev Cardiol 2023; 30:1120-1131. [PMID: 36748994 DOI: 10.1093/eurjpc/zwad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/27/2022] [Accepted: 02/02/2023] [Indexed: 02/08/2023]
Abstract
AIMS The efficacy of lipid-lowering therapies (LLT) amongst different ethnicities and regions remains unclear. We aimed to assess cardiovascular event reductions associated with LLT according to ethnicity and region in previously published randomized clinical trials (RCTs). METHODS AND RESULTS Medline, EMBASE, and Cochrane CENTRAL were searched for RCTs of statins, ezetimibe, or proprotein convertase subtilisin/kexin type 9 inhibitors comparing intensive vs. less-intensive low-density lipoprotein cholesterol (LDL-C) lowering. The primary endpoint was major adverse cardiovascular events (MACE) defined as the composite of cardiovascular mortality, myocardial infarction, stroke, and revascularization. Random-effects meta-analysis was used to pool risk ratios (RRs) with 95% confidence intervals (CI) adjusted per mmol/L reduction in LDL-C. Fifty-three trials with 329 897 participants were included. Amongst participants, 39.5% were from Europe, 16.0% from North America, 9.0% from Japan, 2.8% from Australasia, 1.8% from South America, 1.1% from Asia, 0.6% from South Africa, and 29.2% were unspecified. Amongst trials reporting ethnicities, there were 60.3% White, 20.2% Japanese, 9.4% Asian, 5.5% Black, and 4.7% Latin American. There was reduction in MACE with LLT in regions including Australasia (RR 0.75, 95% CI 0.67-0.85), North America (RR 0.75, 95% CI 0.69-0.83), Europe (RR 0.78, 95% CI 0.71-0.86), and Japan (RR 0.73, 95% CI 0.63-0.85) and in Black ethnicity (RR 0.55, 95% CI 0.37-0.82). Head-to-head comparisons between regions and ethnicities revealed no significant differences in MACE reduction. CONCLUSION Despite under-representation in clinical trials, regional and ethnic minority groups such as Australasia and Blacks appear to derive at least as much cardiovascular benefit from LLT.
Collapse
Affiliation(s)
- Sonia Sawant
- Cardiology Department, Royal Prince Alfred Hospital, 50-60 Missenden Road, Australia
- School of Public Health, Imperial College London, Exhibition Road, South Kensington, London SW7 2BX, UK
- Sydney Medical School, The University of Sydney, Parramatta Road, Camperdown NSW 2050, Australia
| | - Nelson Wang
- Cardiology Department, Royal Prince Alfred Hospital, 50-60 Missenden Road, Australia
- Sydney Medical School, The University of Sydney, Parramatta Road, Camperdown NSW 2050, Australia
- The George Institute for Global Health, University of New South Wales, King Street, Newtown NSW 2042, Australia
| |
Collapse
|
13
|
Frank DA, Johnson AE, Hausmann LRM, Gellad WF, Roberts ET, Vajravelu RK. Disparities in Guideline-Recommended Statin Use for Prevention of Atherosclerotic Cardiovascular Disease by Race, Ethnicity, and Gender : A Nationally Representative Cross-Sectional Analysis of Adults in the United States. Ann Intern Med 2023; 176:1057-1066. [PMID: 37487210 PMCID: PMC10804313 DOI: 10.7326/m23-0720] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Although statins are a class I recommendation for prevention of atherosclerotic cardiovascular disease and its complications, their use is suboptimal. Differential underuse may mediate disparities in cardiovascular health for systematically marginalized persons. OBJECTIVE To estimate disparities in statin use by race-ethnicity-gender and to determine whether these potential disparities are explained by medical appropriateness of therapy and structural factors. DESIGN Cross-sectional analysis. SETTING National Health and Nutrition Examination Survey from 2015 to 2020. PARTICIPANTS Persons eligible for statin therapy based on 2013 and 2018 American College of Cardiology/American Heart Association blood cholesterol guidelines. MEASUREMENTS The independent variable was race-ethnicity-gender. The outcome of interest was use of a statin. Using the Institute of Medicine framework for examining unequal treatment, we calculated adjusted prevalence ratios (aPRs) to estimate disparities in statin use adjusted for age, disease severity, access to health care, and socioeconomic status relative to non-Hispanic White men. RESULTS For primary prevention, we identified a lower prevalence of statin use that was not explained by measurable differences in disease severity or structural factors among non-Hispanic Black men (aPR, 0.73 [95% CI, 0.59 to 0.88]) and non-Mexican Hispanic women (aPR, 0.74 [CI, 0.53 to 0.95]). For secondary prevention, we identified a lower prevalence of statin use that was not explained by measurable differences in disease severity or structural factors for non-Hispanic Black men (aPR, 0.81 [CI, 0.64 to 0.97]), other/multiracial men (aPR, 0.58 [CI, 0.20 to 0.97]), Mexican American women (aPR, 0.36 [CI, 0.10 to 0.61]), non-Mexican Hispanic women (aPR, 0.57 [CI, 0.33 to 0.82), non-Hispanic White women (aPR, 0.69 [CI, 0.56 to 0.83]), and non-Hispanic Black women (aPR, 0.75 [CI, 0.57 to 0.92]). LIMITATION Cross-sectional data; lack of geographic, language, or statin-dose data. CONCLUSION Statin use disparities for several race-ethnicity-gender groups are not explained by measurable differences in medical appropriateness of therapy, access to health care, and socioeconomic status. These residual disparities may be partially mediated by unobserved processes that contribute to health inequity, including bias, stereotyping, and mistrust. PRIMARY FUNDING SOURCE National Institutes of Health.
Collapse
Affiliation(s)
- David A. Frank
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
- Department of Epidemiology, University of Pittsburgh School of Public Health
| | - Amber E. Johnson
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine
| | - Leslie R. M. Hausmann
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine
| | - Walid F. Gellad
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine
| | - Eric T. Roberts
- Department of Health Policy and Management, University of Pittsburgh School of Public Health
| | - Ravy K. Vajravelu
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine
| |
Collapse
|
14
|
Navar AM, Kolkailah AA, Gupta A, Gillard KK, Israel MK, Wang Y, Peterson ED. Gaps in Guideline-Based Lipid-Lowering Therapy for Secondary Prevention in the United States: A Retrospective Cohort Study of 322 153 Patients. Circ Cardiovasc Qual Outcomes 2023; 16:533-543. [PMID: 37529931 PMCID: PMC10527346 DOI: 10.1161/circoutcomes.122.009787] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/26/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Many patients with atherosclerotic cardiovascular disease (ASCVD) are not on guideline-recommended statin therapy. We evaluated utilization of statins and other lipid-lowering therapy (LLT), and changes in low-density lipoprotein cholesterol (LDL-C), among patients with ASCVD over a 1-year period. METHODS LLT and LDL-C levels at the first outpatient visit (January 1, 2017-December 31, 2018) and 1-year follow-up were evaluated using data from Cerner Real-World Data, an electronic health record-derived data set from 92 US health systems. Logistic regression was used to evaluate factors associated with high-intensity statin use. RESULTS We identified 322 153 patients with ASCVD (median age 69 years, 58.8% men, 81.8% White). Overall, 76.1% of patients were on statins, with only 39.4% on high-intensity statins. Men were more likely to receive high-intensity statins than women (multivariable-adjusted odds ratio, 1.34 [95% CI, 1.30-1.38]). Increasing age was associated with lower odds of statin use (odds ratio, 0.79 per 5-year increase at 60 years [95% CI, 0.78-0.81]). Patients with peripheral artery disease (odds ratio, 0.40 [95% CI, 0.37-0.42]) and cerebrovascular disease (odds ratio, 0.75 [95% CI, 0.70-0.80]) had lower odds of using high-intensity statins than those with coronary artery disease. At baseline, most patients (61.3%) had elevated LDL-C (≥70 mg/dL), including 59.8% of those on low/moderate-intensity statins and 76.1% on no statin; only 45.3% achieved an LDL-C <70 mg/dL at 1 year. Nonstatin LLT use was low (ezetimibe, 4.4%; proprotein convertase subtilisin/kexin type 9 inhibitors, 0.7%). Among patients on no statin or low/moderate-intensity statin at baseline, 14.8% and 13.4%, respectively, were on high-intensity statins at 1 year. CONCLUSIONS Among patients with ASCVD in routine care, high-intensity statins are underutilized, and uptitration and use of nonstatin therapy are uncommon. Women, older adults, and individuals with noncardiac ASCVD are particularly undertreated. Concerted efforts are needed to address therapeutic inertia for lipid management in patients with ASCVD.
Collapse
Affiliation(s)
- Ann Marie Navar
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.M.N., A.A.K., E.D.P., A.G., Y.W.)
| | - Ahmed A Kolkailah
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.M.N., A.A.K., E.D.P., A.G., Y.W.)
| | - Anand Gupta
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.M.N., A.A.K., E.D.P., A.G., Y.W.)
| | | | - Marc K Israel
- Esperion Therapeutics, Inc, Ann Arbor, MI (K.K.G., M.K.I.)
| | - Yiqing Wang
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.M.N., A.A.K., E.D.P., A.G., Y.W.)
| | - Eric D Peterson
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.M.N., A.A.K., E.D.P., A.G., Y.W.)
| |
Collapse
|
15
|
Zhao Q, Sun S, Zhou F, Yue J, Luo X, Qu X. The Inhibition of Evolocumab on Non-Infarct-Related Artery Disease in Patients with ST-Elevation Myocardial Infarction. Int J Gen Med 2023; 16:2771-2781. [PMID: 37408846 PMCID: PMC10319277 DOI: 10.2147/ijgm.s417481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose The effects of combing evolocumab and statin on the clinical outcome and physiological function of coronary arteries in STEMI patients with non-infarct-related artery (NIRA) disease are still unclear. Methods A total of 355 STEMI patients with NIRA were enrolled in this study, who underwent combined quantitative flow ratio (QFR) at baseline and after 12 months of treatment with statin monotherapy or statin plus evolocumab. Results Diameter stenosis and lesion length were significantly lower in the group undergoing statin plus evolocumab. While the group exhibited significantly higher minimum lumen diameter (MLD), and QFR values. Statin plus evolocumab (OR = 0.350; 95% CI: 0.149-0.824; P = 0.016) and plaque lesion length (OR = 1.223; 95% CI: 1.102-1.457; P = 0.033) were independently associated with rehospitalization for unstable angina (UA) within 12 months. Conclusion Evolocumab combined with statin therapy can significantly improve the anatomical and physiological function of the coronary arteries and downregulate the re-hospitalization rate due to UA in STEMI patients with NIRA.
Collapse
Affiliation(s)
- Qi Zhao
- Department of Cardiology, 1st Affiliated Hospital of Harbin Medical University, Harbin, 150086, People’s Republic of China
| | - Siyuan Sun
- Department of Cardiology, People’s Hospital of Taihe County, Taihe, Anhui, 236600, People’s Republic of China
| | - Fanghui Zhou
- Department of Hematology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China
| | - Jingkun Yue
- Department of Cardiology, People’s Hospital of Taihe County, Taihe, Anhui, 236600, People’s Republic of China
| | - Xing Luo
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China
| | - Xiufen Qu
- Department of Cardiology, 1st Affiliated Hospital of Harbin Medical University, Harbin, 150086, People’s Republic of China
| |
Collapse
|
16
|
Witting C, Azizi Z, Gomez SE, Zammit A, Sarraju A, Ngo S, Hernandez-Boussard T, Rodriguez F. Natural language processing to identify reasons for sex disparity in statin prescriptions. Am J Prev Cardiol 2023; 14:100496. [PMID: 37128554 PMCID: PMC10147966 DOI: 10.1016/j.ajpc.2023.100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/27/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023] Open
Abstract
Background Statins are the cornerstone of treatment of patients with atherosclerotic cardiovascular disease (ASCVD). Despite this, multiple studies have shown that women with ASCVD are less likely to be prescribed statins than men. The objective of this study was to use Natural Language Processing (NLP) to elucidate factors contributing to this disparity. Methods Our cohort included adult patients with two or more encounters between 2014 and 2021 with an ASCVD diagnosis within a multisite electronic health record (EHR) in Northern California. After reviewing structured EHR prescription data, we used a benchmark deep learning NLP approach, Clinical Bidirectional Encoder Representations from Transformers (BERT), to identify and interpret discussions of statin prescriptions documented in clinical notes. Clinical BERT was evaluated against expert clinician review in 20% test sets. Results There were 88,913 patients with ASCVD (mean age 67.8±13.1 years) and 35,901 (40.4%) were women. Women with ASCVD were less likely to be prescribed statins compared with men (56.6% vs 67.6%, p <0.001), and, when prescribed, less likely to be prescribed guideline-directed high-intensity dosing (41.4% vs 49.8%, p <0.001). These disparities were more pronounced among younger patients, patients with private insurance, and those for whom English is their preferred language. Among those not prescribed statins, women were less likely than men to have statins mentioned in their clinical notes (16.9% vs 19.1%, p <0.001). Women were less likely than men to have statin use reported in clinical notes despite absence of recorded prescription (32.8% vs 42.6%, p <0.001). Women were slightly more likely than men to have statin intolerance documented in structured data or clinical notes (6.0% vs 5.3%, p=0.003). Conclusions Women with ASCVD were less likely to be prescribed guideline-directed statins compared with men. NLP identified additional sex-based statin disparities and reasons for statin non-prescription in clinical notes of patients with ASCVD.
Collapse
Affiliation(s)
- Celeste Witting
- Stanford University Division of Cardiovascular Medicine and Cardiovascular Institute, Department of Medicine, Stanford University, Center for Academic Medicine, Mail Code 5687, 453 Quarry Road, Palo Alto, Stanford, CA, USA
| | - Zahra Azizi
- Stanford University Division of Cardiovascular Medicine and Cardiovascular Institute, Department of Medicine, Stanford University, Center for Academic Medicine, Mail Code 5687, 453 Quarry Road, Palo Alto, Stanford, CA, USA
- Center for Digital Health, Stanford University, Stanford, CA, USA
| | - Sofia Elena Gomez
- Stanford University Division of Cardiovascular Medicine and Cardiovascular Institute, Department of Medicine, Stanford University, Center for Academic Medicine, Mail Code 5687, 453 Quarry Road, Palo Alto, Stanford, CA, USA
| | - Alban Zammit
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Ashish Sarraju
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Summer Ngo
- Stanford University Division of Cardiovascular Medicine and Cardiovascular Institute, Department of Medicine, Stanford University, Center for Academic Medicine, Mail Code 5687, 453 Quarry Road, Palo Alto, Stanford, CA, USA
| | - Tina Hernandez-Boussard
- Department of Medicine, Biomedical Informatics, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Fatima Rodriguez
- Stanford University Division of Cardiovascular Medicine and Cardiovascular Institute, Department of Medicine, Stanford University, Center for Academic Medicine, Mail Code 5687, 453 Quarry Road, Palo Alto, Stanford, CA, USA
- Corresponding author. @FaRodriguezMD
| |
Collapse
|
17
|
Jain V, Qamar A, Matsushita K, Vaduganathan M, Ashley KE, Khan MS, Bhatt DL, Arora S, Caughey MC. Impact of Diabetes on Outcomes in Patients Hospitalized With Acute Myocardial Infarction: Insights From the Atherosclerosis Risk in Communities Study Community Surveillance. J Am Heart Assoc 2023; 12:e028923. [PMID: 37183850 DOI: 10.1161/jaha.122.028923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Background Diabetes is associated with increased risk of acute myocardial infarction (AMI). The demographic trends, clinical presentation, management, and outcomes of patients with diabetes who are hospitalized with AMI have not been recently reported. Methods and Results The ARIC (Atherosclerosis Risk in Communities) study conducted hospital surveillance of AMI in 4 US communities. AMI was classified by physician review using a validated algorithm. Medications and procedures were abstracted from the medical record. From 2000 to 2014, 21 094 weighted hospitalizations for AMI were sampled. The prevalence of diabetes steadily increased, from 35% to 41% to 43% (P-trend<0.0001) across 2000 to 2004, 2005 to 2009, and 2010 to 2014, respectively. Patients with diabetes were older (61 versus 59 years of age), more often Black (44% versus 31%), and more commonly women (42% versus 34%). The burden of cardiovascular comorbidities was higher with diabetes and increased temporally. Patients with diabetes less often presented with ST-segment elevation (9% versus 17%) or acute chest pain (72% versus 80%), and had higher mean GRACE (Global Registry of Acute Coronary Syndrome) score (123 versus 109), Thrombolysis in Myocardial Ischemia (TIMI) score (4.3 versus 4.0), and Killip class (1.9 versus 1.5). Patients with diabetes had a lower adjusted probability of receiving aspirin (relative probability, 0.95 [95% CI, 0.91-0.99]), nonaspirin antiplatelets (0.93 [95% CI, 0.86-0.99]), coronary angiography (0.85 [95% CI, 0.78-0.92]), and coronary revascularization (0.85 [95% CI, 0.76-0.92]). Diabetes was associated with a 52% higher hazard of all-cause 1-year mortality (hazard ratio, 1.52 [95% CI, 1.23-1.89]). Conclusions Diabetes is associated with higher risk of death in patients hospitalized with AMI, highlighting the need for adherence to evidence-based therapies in this high-risk population.
Collapse
Affiliation(s)
- Vardhmaan Jain
- Department of Cardiovascular Medicine Emory University School of Medicine Atlanta GA USA
| | - Arman Qamar
- CardioDiabetes Program, Section of Interventional Cardiology & Vascular Medicine Department of Medicine, NorthShore University Health System IL Evanston USA
| | - Kunihiro Matsushita
- Division of Cardiovascular Medicine Johns Hopkins University Baltimore MD USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School Boston MA USA
| | - Kellan E Ashley
- Department of Cardiovascular Medicine University of Mississippi Medical Centre Jackson MS USA
| | - Muhammad Shahzeb Khan
- Division of Cardiovascular Medicine Duke University School of Medicine Durham NC USA
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System New York NY USA
| | - Sameer Arora
- Department of Biomedical Engineering, Department of Medicine University of North Carolina & North Carolina State University NC Chapel Hill USA
| | - Melissa C Caughey
- Department of Biomedical Engineering, Department of Medicine University of North Carolina & North Carolina State University NC Chapel Hill USA
| |
Collapse
|
18
|
Jacobs JA, Addo DK, Zheutlin AR, Derington CG, Essien UR, Navar AM, Hernandez I, Lloyd-Jones DM, King JB, Rao S, Herrick JS, Bress AP, Pandey A. Prevalence of Statin Use for Primary Prevention of Atherosclerotic Cardiovascular Disease by Race, Ethnicity, and 10-Year Disease Risk in the US: National Health and Nutrition Examination Surveys, 2013 to March 2020. JAMA Cardiol 2023; 8:443-452. [PMID: 36947031 PMCID: PMC10034667 DOI: 10.1001/jamacardio.2023.0228] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/25/2023] [Indexed: 03/23/2023]
Abstract
Importance The burden of atherosclerotic cardiovascular disease (ASCVD) in the US is higher among Black and Hispanic vs White adults. Inclusion of race in guidance for statin indication may lead to decreased disparities in statin use. Objective To evaluate prevalence of primary prevention statin use by race and ethnicity according to 10-year ASCVD risk. Design, Setting, and Participants This serial, cross-sectional analysis performed in May 2022 used data from the National Health and Nutrition Examination Survey, a nationally representative sample of health status in the US, from 2013 to March 2020 (limited cycle due to the COVID-19 pandemic), to evaluate statin use for primary prevention of ASCVD and to estimate 10-year ASCVD risk. Participants aged 40 to 75 years without ASCVD, diabetes, low-density lipoprotein cholesterol levels 190 mg/dL or greater, and with data on medication use were included. Exposures Self-identified race and ethnicity (Asian, Black, Hispanic, and White) and 10-year ASCVD risk category (5%-<7.5%, 7.5%-<20%, ≥20%). Main Outcomes and Measures Prevalence of statin use, defined as identification of statin use on pill bottle review. Results A total of 3417 participants representing 39.4 million US adults after applying sampling weights (mean [SD] age, 61.8 [8.0] years; 1289 women [weighted percentage, 37.8%] and 2128 men [weighted percentage, 62.2%]; 329 Asian [weighted percentage, 4.2%], 1032 Black [weighted percentage, 12.7%], 786 Hispanic [weighted percentage, 10.1%], and 1270 White [weighted percentage, 73.0%]) were included. Compared with White participants, statin use was lower in Black and Hispanic participants and comparable among Asian participants in the overall cohort (Asian, 25.5%; Black, 20.0%; Hispanic, 15.4%; White, 27.9%) and within ASCVD risk strata. Within each race and ethnicity group, a graded increase in statin use was observed across increasing ASCVD risk strata. Statin use was low in the highest risk stratum overall with significantly lower rates of use among Black (23.8%; prevalence ratio [PR], 0.90; 95% CI, 0.82-0.98 vs White) and Hispanic participants (23.9%; PR, 0.90; 95% CI, 0.81-0.99 vs White). Among other factors, routine health care access and health insurance were significantly associated with higher statin use in Black, Hispanic, and White adults. Prevalence of statin use did not meaningfully change over time by race and ethnicity or by ASCVD risk stratum. Conclusions and Relevance In this study, statin use for primary prevention of ASCVD was low among all race and ethnicity groups regardless of ASCVD risk, with the lowest use occurring among Black and Hispanic adults. Improvements in access to care may promote equitable use of primary prevention statins in Black and Hispanic adults.
Collapse
Affiliation(s)
- Joshua A. Jacobs
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City
| | - Daniel K. Addo
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City
| | - Alexander R. Zheutlin
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City
| | - Catherine G. Derington
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City
| | - Utibe R. Essien
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles
- Center for the Study of Healthcare Innovation, Implementation & Policy, Greater Los Angeles VA Healthcare System, Los Angeles, California
| | - Ann Marie Navar
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
- Deputy Editor, Diversity, Equity, and Inclusion, JAMA Cardiology
| | | | - Donald M. Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jordan B. King
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
| | - Shreya Rao
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Jennifer S. Herrick
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Adam P. Bress
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| |
Collapse
|
19
|
Somani S, van Buchem MM, Sarraju A, Hernandez-Boussard T, Rodriguez F. Artificial Intelligence-Enabled Analysis of Statin-Related Topics and Sentiments on Social Media. JAMA Netw Open 2023; 6:e239747. [PMID: 37093597 PMCID: PMC10126874 DOI: 10.1001/jamanetworkopen.2023.9747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Importance Despite compelling evidence that statins are safe, are generally well tolerated, and reduce cardiovascular events, statins are underused even in patients with the highest risk. Social media may provide contemporary insights into public perceptions about statins. Objective To characterize and classify public perceptions about statins that were gleaned from more than a decade of statin-related discussions on Reddit, a widely used social media platform. Design, Setting, and Participants This qualitative study analyzed all statin-related discussions on the social media platform that were dated between January 1, 2009, and July 12, 2022. Statin- and cholesterol-focused communities, were identified to create a list of statin-related discussions. An artificial intelligence (AI) pipeline was developed to cluster these discussions into specific topics and overarching thematic groups. The pipeline consisted of a semisupervised natural language processing model (BERT [Bidirectional Encoder Representations from Transformers]), a dimensionality reduction technique, and a clustering algorithm. The sentiment for each discussion was labeled as positive, neutral, or negative using a pretrained BERT model. Exposures Statin-related posts and comments containing the terms statin and cholesterol. Main Outcomes and Measures Statin-related topics and thematic groups. Results A total of 10 233 unique statin-related discussions (961 posts and 9272 comments) from 5188 unique authors were identified. The number of statin-related discussions increased by a mean (SD) of 32.9% (41.1%) per year. A total of 100 discussion topics were identified and were classified into 6 overarching thematic groups: (1) ketogenic diets, diabetes, supplements, and statins; (2) statin adverse effects; (3) statin hesitancy; (4) clinical trial appraisals; (5) pharmaceutical industry bias and statins; and (6) red yeast rice and statins. The sentiment analysis revealed that most discussions had a neutral (66.6%) or negative (30.8%) sentiment. Conclusions and Relevance Results of this study demonstrated the potential of an AI approach to analyze large, contemporary, publicly available social media data and generate insights into public perceptions about statins. This information may help guide strategies for addressing barriers to statin use and adherence.
Collapse
Affiliation(s)
- Sulaiman Somani
- Department of Medicine, Stanford University, Stanford, California
| | - Marieke Meija van Buchem
- Department of Information Technology & Digital Innovation, Leiden University Medical Center (LUMC), Leiden, the Netherlands
- CAIRELab, LUMC, Leiden, the Netherlands
- Department of Biomedical Data Science, Stanford University, Stanford, California
| | - Ashish Sarraju
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Tina Hernandez-Boussard
- Department of Medicine, Stanford University, Stanford, California
- Department of Biomedical Data Science, Stanford University, Stanford, California
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, California
| |
Collapse
|
20
|
Diao JA, Wu GJ, Wang JK, Kohane IS, Taylor HA, Tighiouart H, Levey AS, Inker LA, Powe NR, Manrai AK. National Projections for Clinical Implications of Race-Free Creatinine-Based GFR Estimating Equations. J Am Soc Nephrol 2023; 34:309-321. [PMID: 36368777 PMCID: PMC10103103 DOI: 10.1681/asn.2022070818] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The National Kidney Foundation and American Society of Nephrology Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease recently recommended a new race-free creatinine-based equation for eGFR. The effect on recommended clinical care across race and ethnicity groups is unknown. METHODS We analyzed nationally representative cross-sectional questionnaires and medical examinations from 44,360 participants collected between 2001 and 2018 by the National Health and Nutrition Examination Survey. We quantified the number and proportion of Black, White, Hispanic, and Asian/Other adults with guideline-recommended changes in care. RESULTS The new equation, if applied nationally, could assign new CKD diagnoses to 434,000 (95% confidence interval [CI], 350,000 to 517,000) Black adults, reclassify 584,000 (95% CI, 508,000 to 667,000) to more advanced stages of CKD, restrict kidney donation eligibility for 246,000 (95% CI, 189,000 to 303,000), expand nephrologist referrals for 41,800 (95% CI, 19,800 to 63,800), and reduce medication dosing for 222,000 (95% CI, 169,000 to 275,000). Among non-Black adults, these changes may undo CKD diagnoses for 5.51 million (95% CI, 4.86 million to 6.16 million), reclassify 4.59 million (95% CI, 4.28 million to 4.92 million) to less advanced stages of CKD, expand kidney donation eligibility for 3.96 million (95% CI, 3.46 million to 4.46 million), reverse nephrologist referral for 75,800 (95% CI, 35,400 to 116,000), and reverse medication dose reductions for 1.47 million (95% CI, 1.22 million to 1.73 million). The racial and ethnic mix of the populations used to develop eGFR equations has a substantial effect on potential care changes. CONCLUSION The newly recommended 2021 CKD-EPI creatinine-based eGFR equation may result in substantial changes to recommended care for US patients of all racial and ethnic groups.
Collapse
Affiliation(s)
- James A. Diao
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts
| | - Gloria J. Wu
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts
| | - Jason K. Wang
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts
| | - Isaac S. Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Herman A. Taylor
- Cardiovascular Research Institute, Morehouse Medical School, Atlanta, Georgia
| | - Hocine Tighiouart
- Biostatistics Research Center, Tufts Clinical and Translational Science Institute, Boston, Massachusetts
| | - Andrew S. Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Lesley A. Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Neil R. Powe
- Department of Medicine, University of California San Francisco and the Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Arjun K. Manrai
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts
| |
Collapse
|
21
|
Laffin LJ, Bruemmer D, Garcia M, Brennan DM, McErlean E, Jacoby DS, Michos ED, Ridker PM, Wang TY, Watson KE, Hutchinson HG, Nissen SE. Comparative Effects of Low-Dose Rosuvastatin, Placebo, and Dietary Supplements on Lipids and Inflammatory Biomarkers. J Am Coll Cardiol 2023; 81:1-12. [PMID: 36351465 DOI: 10.1016/j.jacc.2022.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Supplements are commonly used by individuals with indications for lipid-lowering therapy, but evidence of their effectiveness to lower low-density lipoprotein cholesterol (LDL-C) is lacking, particularly when compared with statins. OBJECTIVES The trial objective was to compare the efficacy of a low-dose statin with placebo and 6 common supplements in impacting lipid and inflammatory biomarkers. METHODS This was a single-center, prospective, randomized, single-blind clinical trial among adults with no history of atherosclerotic cardiovascular disease (ASCVD), an LDL-C of 70 to 189 mg/dL, and an increased 10-year risk of ASCVD. Participants were randomized to rosuvastatin 5 mg daily, placebo, fish oil, cinnamon, garlic, turmeric, plant sterols, or red yeast rice. The primary endpoint was the percent change in LDL-C from baseline for rosuvastatin 5 mg daily compared with placebo and each supplement after 28 days. The primary endpoint was evaluated in a hierarchical fashion with rosuvastatin first compared with placebo, then each supplement in a prespecified order using analysis of covariance. RESULTS A total of 190 participants completed the study. The percent LDL-C reduction with rosuvastatin was greater than all supplements and placebo (P < 0.001). The difference in LDL-C reduction with rosuvastatin compared with placebo was -35.2% (95% CI: -41.3% to -29.1%; P < 0.001). None of the dietary supplements demonstrated a significant decrease in LDL-C compared with placebo. Adverse event rates were similar across study groups. CONCLUSIONS Among individuals with increased 10-year risk for ASCVD, rosuvastatin 5 mg daily lowered LDL-C significantly more than placebo, fish oil, cinnamon, garlic, turmeric, plant sterols, and red yeast rice. (Supplements, Placebo, or Rosuvastatin Study [SPORT]; NCT04846231).
Collapse
Affiliation(s)
| | | | - Michelle Garcia
- C5 Research, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Ellen McErlean
- C5 Research, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | - Paul M Ridker
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Karol E Watson
- University of California-Los Angeles, Los Angeles, California, USA
| | | | - Steven E Nissen
- Cleveland Clinic Foundation, Cleveland, Ohio, USA; C5 Research, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| |
Collapse
|
22
|
Adusumalli S, Kanter GP, Small DS, Asch DA, Volpp KG, Park SH, Gitelman Y, Do D, Leri D, Rhodes C, VanZandbergen C, Howell JT, Epps M, Cavella AM, Wenger M, Harrington TO, Clark K, Westover JE, Snider CK, Patel MS. Effect of Nudges to Clinicians, Patients, or Both to Increase Statin Prescribing: A Cluster Randomized Clinical Trial. JAMA Cardiol 2023; 8:23-30. [PMID: 36449275 PMCID: PMC9713674 DOI: 10.1001/jamacardio.2022.4373] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/29/2022] [Indexed: 12/02/2022]
Abstract
Importance Statins reduce the risk of major adverse cardiovascular events, but less than one-half of individuals in America who meet guideline criteria for a statin are actively prescribed this medication. Objective To evaluate whether nudges to clinicians, patients, or both increase initiation of statin prescribing during primary care visits. Design, Setting, and Participants This cluster randomized clinical trial evaluated statin prescribing of 158 clinicians from 28 primary care practices including 4131 patients. The design included a 12-month preintervention period and a 6-month intervention period between October 19, 2019, and April 18, 2021. Interventions The usual care group received no interventions. The clinician nudge combined an active choice prompt in the electronic health record during the patient visit and monthly feedback on prescribing patterns compared with peers. The patient nudge was an interactive text message delivered 4 days before the visit. The combined nudge included the clinician and patient nudges. Main Outcomes and Measures The primary outcome was initiation of a statin prescription during the visit. Results The sample comprised 4131 patients with a mean (SD) age of 65.5 (10.5) years; 2120 (51.3%) were male; 1210 (29.3%) were Black, 106 (2.6%) were Hispanic, 2732 (66.1%) were White, and 83 (2.0%) were of other race or ethnicity, and 933 (22.6%) had atherosclerotic cardiovascular disease. In unadjusted analyses during the preintervention period, statins were prescribed to 5.6% of patients (105 of 1876) in the usual care group, 4.8% (97 of 2022) in the patient nudge group, 6.0% (104 of 1723) in the clinician nudge group, and 4.7% (82 of 1752) in the combined group. During the intervention, statins were prescribed to 7.3% of patients (75 of 1032) in the usual care group, 8.5% (100 of 1181) in the patient nudge group, 13.0% (128 of 981) in the clinician nudge arm, and 15.5% (145 of 937) in the combined group. In the main adjusted analyses relative to usual care, the clinician nudge significantly increased statin prescribing alone (5.5 percentage points; 95% CI, 3.4 to 7.8 percentage points; P = .01) and when combined with the patient nudge (7.2 percentage points; 95% CI, 5.1 to 9.1 percentage points; P = .001). The patient nudge alone did not change statin prescribing relative to usual care (0.9 percentage points; 95% CI, -0.8 to 2.5 percentage points; P = .32). Conclusions and Relevance Nudges to clinicians with and without a patient nudge significantly increased initiation of a statin prescription during primary care visits. The patient nudge alone was not effective. Trial Registration ClinicalTrials.gov Identifier: NCT04307472.
Collapse
Affiliation(s)
| | | | - Dylan S. Small
- Wharton School, University of Pennsylvania, Philadelphia
| | - David A. Asch
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Wharton School, University of Pennsylvania, Philadelphia
| | - Kevin G. Volpp
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Wharton School, University of Pennsylvania, Philadelphia
- Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Sae-Hwan Park
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Yevgeniy Gitelman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - David Do
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Damien Leri
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Corinne Rhodes
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - John T. Howell
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Mika Epps
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ann M. Cavella
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Michael Wenger
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Kayla Clark
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | | |
Collapse
|
23
|
Chirinos DA, Vargas E, Kamsickas L, Carnethon M. The role of behavioral science in addressing cardiovascular health disparities: A narrative review of efforts, challenges, and future directions. Health Psychol 2022; 41:740-754. [PMID: 35849358 PMCID: PMC9886136 DOI: 10.1037/hea0001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in the United States. Despite improvements in the prevention and treatment of CVD over the past 20 years, racial/ethnic minority groups including non-Hispanic Blacks, Hispanic/Latinos, and some Asian subgroups (e.g., Asian Indians, Filipinos) experience higher rates of CVD risk factors and morbidity and mortality from CVD than non-Hispanic Whites. Therefore, addressing cardiovascular health disparities is an immediate priority. Behavioral science can play an important role in reducing disparities by capitalizing on expertise in human behavior change, social determinants of health, and implementation science. In this narrative review, we describe the efforts made within behavioral science to address CVD health disparities. We review current interventions to reduce CVD health disparities and provide practical recommendations that can be used as the field moves forward. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
Affiliation(s)
- Diana A. Chirinos
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Emily Vargas
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Lisa Kamsickas
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Mercedes Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| |
Collapse
|
24
|
Minhas AMK, Ijaz SH, Javed N, Sheikh AB, Jain V, Michos ED, Greene SJ, Fudim M, Warraich HJ, Shapiro MD, Al-Kindi SG, Sperling L, Virani SS. National trends and disparities in statin use for ischemic heart disease from 2006 to 2018: Insights from National Ambulatory Medical Care Survey. Am Heart J 2022; 252:60-69. [PMID: 35644222 DOI: 10.1016/j.ahj.2022.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/15/2022] [Accepted: 05/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Statins are a cornerstone guideline-directed medical therapy for secondary prevention of ischemic heart disease (IHD). However, recent temporal trends and disparities in statin utilization for IHD have not been well characterized. METHODS This retrospective analysis included data from outpatient adult visits with IHD from the National Ambulatory Medical Care Survey (NAMCS) between January 2006 and December 2018. We examined the trends and predictors of statin utilization in outpatient adult visits with IHD. RESULTS Between 2006 and 2018, we identified a total of 542,704,112 weighted adult ambulatory visits with IHD and of those 46.6% were using or prescribed statin. Middle age (50-74 years) (adjusted odds ratio [aOR] 1.65, 95% confidence interval [CI] 1.28-2.13 P < .001) and old age (≥75 years) (aOR = 1.66, CI 1.26-2.19, P < .001) compared to young age (18-49 years), and male sex (aOR = 1.35, CI 1.23-1.48, P < .001) were associated with greater likelihood of statin utilization, whereas visits with non-Hispanic (NH) Black patients (aOR = 0.75, CI 0.61-0.91, P = .005) and Hispanic patients (aOR = 0.74, CI 0.60-0.92, P = .006) were associated with decreased likelihood of statin utilization compared to NH White patient visits. Compared with private insurance, statin utilization was nominally lower in Medicare (aOR = 0.91, CI 0.80-1.02, P = .112), Medicaid (aOR = 0.78, CI 0.59-1.02, P = .072) and self-pay/no charge (aOR = 0.72, CI 0.48-1.09, P = .122) visits, however did not reach statistical significance. There was no significant uptake in statin utilization from 2006 (44.1%) to 2018 (46.2%) (P = .549). CONCLUSIONS Substantial gaps remain in statin utilization for patients with IHD, with no significant improvement in use between 2006 and 2018. Persistent disparities in statin prescription remain, with the largest treatment gaps among younger patients, women, and racial/ethnic minorities (NH Blacks and Hispanics).
Collapse
Affiliation(s)
| | - Sardar Hassan Ijaz
- Division of Cardiology, Lahey Hospital, and Medical Center, Beth Israel Lahey Health, Burlington, MA
| | - Nismat Javed
- Department of Internal Medicine, Shifa College of Medicine, Islamabad, Pakistan
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Vardhmaan Jain
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stephen J Greene
- Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Haider J Warraich
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michael D Shapiro
- Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, OH
| | - Laurence Sperling
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| |
Collapse
|
25
|
Shen M, Aghajani Nargesi A, Nasir K, Bhatt DL, Khera R. Contemporary National Patterns of Eligibility and Use of Novel Lipid-Lowering Therapies in the United States. J Am Heart Assoc 2022; 11:e026075. [PMID: 36102276 PMCID: PMC9683659 DOI: 10.1161/jaha.122.026075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The emergence of PCSK9i (proprotein convertase subtilisin kexin type 9 inhibitor) and icosapent ethyl (IPE) has expanded the role of lipid-lowering therapies beyond statins. Despite recommendations by clinical practice guidelines, their national eligibility and use rates remain unclear. Methods and Results In the National Health and Nutrition Examination Survey data from 2017 to 2020, we assessed eligibility and the use of statins, PCSK9i, and IPE among US adults according to American College of Cardiology/American Heart Association guideline recommendations. Eligibility for PCSK9i and IPE were determined in the following 2 scenarios: (1) assuming existing lipid-lowering therapy as the maximum tolerated before assessing eligibility for novel therapies and (2) assessing eligibility after assuming initiation and maximal escalation of preexisting lipid-lowering therapies and accounting for expected lipid improvements. Of 2729 sampled individuals, representing 149.3 million adults, 1376 had indications for statins, representing 65.8 million or 44.0% (95% CI, 40.9%-47.2%) of adults. Current statin use was 45% of those eligible and was low across demographic groups. A total of 9.7 and 11.6 million adults would benefit from PCSK9i and IPE, respectively, based on lipid profiles and existing therapies. Assuming maximal escalation of statins and addition of ezetimibe, 4.1% (95% CI, 2.8%-5.4%) of adults or 6.1 million would benefit from PCSK9i and 6.8% (95% CI, 5.4%-8.3%) or 10.2 million from IPE. Conclusions Six and 10 million individuals have clinical profiles whereby PCSK9i and IPE, respectively, would be expected to improve cardiovascular outcomes even after maximum escalation of statins and ezetimibe use, but remain undertreated with lipid-lowering therapies. Optimal use of lipid-targeted agents that include these novel agents is needed to improve population health outcomes.
Collapse
Affiliation(s)
- Miles Shen
- Department of Internal MedicineYale School of MedicineNew HavenCT
| | - Arash Aghajani Nargesi
- Department of Internal MedicineYale School of MedicineNew HavenCT
- Heart and Vascular CenterBrigham and Women’s Hospital, Harvard Medical SchoolBostonMA
| | - Khurram Nasir
- Division for Cardiovascular Prevention and Wellness, Department of CardiologyHouston Methodist DeBakey Heart and Vascular CenterHoustonTX
- Center for Outcomes ResearchHouston MethodistHoustonTX
| | - Deepak L. Bhatt
- Heart and Vascular CenterBrigham and Women’s Hospital, Harvard Medical SchoolBostonMA
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal MedicineYale School of MedicineNew HavenCT
- Center for Outcomes Research and EvaluationYale‐New Haven HospitalNew HavenCT
| |
Collapse
|
26
|
Jackson SL, Nair PR, Chang A, Schieb L, Loustalot F, Wall HK, Sperling LS, Ritchey MD. Antihypertensive and Statin Medication Adherence Among Medicare Beneficiaries. Am J Prev Med 2022; 63:313-323. [PMID: 35987557 PMCID: PMC10851130 DOI: 10.1016/j.amepre.2022.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/04/2022] [Accepted: 02/28/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Medication adherence is important for optimal management of chronic conditions, including hypertension and hypercholesterolemia. This study describes adherence to antihypertensive and statin medications, individually and collectively, and examines variation in adherence by demographic and geographic characteristics. METHODS The 2017 prescription drug event data for beneficiaries with Medicare Part D coverage were assessed. Beneficiaries with a proportion of days covered ≥80% were considered adherent. Adjusted prevalence ratios were estimated to quantify the associations between demographic and geographic characteristics and adherence. Adherence estimates were mapped by county of residence using a spatial empirical Bayesian smoothing technique to enhance stability. Analyses were conducted in 2019‒2021. RESULTS Among the 22.5 million beneficiaries prescribed antihypertensive medications, 77.1% were adherent; among the 16.1 million prescribed statin medications, 81.9% were adherent; and among the 13.5 million prescribed antihypertensive and statin medications, 70.3% were adherent to both. Adherence varied by race/ethnicity: American Indian/Alaska Native (adjusted prevalence ratio=0.83, 95% confidence limit=0.82, 0.842), Hispanic (adjusted prevalence ratio=0.90, 95% confidence limit=0.90, 0.91), and non-Hispanic Black (adjusted prevalence ratio=0.87, 95% confidence limit=0.86, 0.87) beneficiaries were less likely to be adherent than non-Hispanic White beneficiaries. County-level adherence ranged across the U.S. from 25.7% to 88.5% for antihypertensive medications, from 36.0% to 93.8% for statin medications, and from 20.8% to 92.9% for both medications combined and tended to be the lowest in the southern U.S. CONCLUSIONS This study highlights opportunities for efforts to remove barriers and support medication adherence, especially among racial/ethnic minority groups and within the regions at greatest risk for adverse cardiovascular outcomes.
Collapse
Affiliation(s)
- Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Priya R Nair
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anping Chang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Linda Schieb
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hilary K Wall
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laurence S Sperling
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew D Ritchey
- Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
27
|
Underberg J, Toth PP, Rodriguez F. LDL-C target attainment in secondary prevention of ASCVD in the United States: barriers, consequences of nonachievement, and strategies to reach goals. Postgrad Med 2022; 134:752-762. [PMID: 36004573 DOI: 10.1080/00325481.2022.2117498] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in the United States. Elevated low-density lipoprotein cholesterol (LDL-C) is a major causal risk factor for ASCVD. Current evidence overwhelmingly demonstrates that lowering LDL-C reduces the risk of secondary cardiovascular events in patients with previous myocardial infarction or stroke. There is no lower limit for LDL-C: large, randomized studies and meta-analyses have found continuous benefit and no safety concerns in patients achieving LDL-C levels <25 mg/dL. As 'Time is plaque' in patients with ASCVD, early, sustained reductions in LDL-C are critical to slow or halt disease progression. However, despite use of lipid-lowering medications, <30% of patients with ASCVD achieve guideline-recommended reductions in LDL-C, resulting in a substantial societal burden of preventable cardiovascular events and early mortality. LDL-C goals are not met due to several factors: lipid-lowering therapy is not initiated and intensified as directed by clinical guidelines (clinical inertia); most patients do not adhere to prescribed medications; and high-risk patients are frequently denied access to add-on therapies by their insurance providers. Promoting patient and clinician education, multidisciplinary collaboration, and other interventions may help to overcome these barriers. Ultimately, achieving population-level guideline-recommended reductions in LDL-C will require a collaborative effort from patients, clinicians, relevant professional societies, drug manufacturers, and payers.
Collapse
Affiliation(s)
| | - Peter P Toth
- Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
28
|
Pohlman FW, Ford CB, Weissler EH, Smerek MM, Hardy NC, Narcisse DI, Lippmann SJ, Greiner MA, Long C, Rymer JA, Gutierez JA, Patel MR, Jones WS. Impact of risk factor control on peripheral artery disease outcomes and health disparities. Vasc Med 2022; 27:323-332. [PMID: 35387516 PMCID: PMC10908093 DOI: 10.1177/1358863x221084360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) is associated with modifiable atherosclerotic risk factors like hypertension, diabetes, hyperlipidemia, and smoking. However, the effect of risk factor control on outcomes and disparities in achieving control is less well understood. METHODS All patients in an integrated, regional health system with PAD-related encounters, fee-for-service Medicare, and clinical risk factor control data were identified. Component risk factors were dichotomized into controlled and uncontrolled categories (control defined as low-density lipoprotein < 100 mg/dL, hemoglobin A1c < 7.0%, SBP < 140 mmHg, and current nonsmoker) and composite categories (none, 1, ⩾ 2 uncontrolled RFs) created. The primary outcome was major adverse vascular events (MAVE, a composite of all-cause mortality, myocardial infarction, stroke, and lower-extremity revascularization and amputation). RESULTS The cohort included 781 patients with PAD, average age 72.5 ± 9.8 years, of whom 30.1% were Black, and 19.1% were Medicaid dual-enrolled. In this cohort, 260 (33.3%) had no uncontrolled risk factors and 200 (25.6%) had two or more uncontrolled risk factors. Patients with the poorest risk factor control were more likely to be Black (p < 0.001), Medicaid dual-enrolled (p < 0.001), and have chronic limb-threatening ischemia (p = 0.009). Significant differences in MAVE by degree of risk factor control were observed at 30 days (none uncontrolled: 5.8%, 1 uncontrolled: 11.5%, ⩾ 2 uncontrolled: 13.6%; p = 0.01) but not at 1 year (p = 0.08). risk factor control was not associated with outcomes at 1 year after adjustment for patient and PAD-specific characteristics. CONCLUSIONS risk factor control is poor among patients with PAD. Significant disparities in achieving optimal risk factor control represent a potential target for reducing inequities in outcomes.
Collapse
Affiliation(s)
| | - Cassie B. Ford
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - E. Hope Weissler
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC
| | - Michelle M. Smerek
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - N. Chantelle Hardy
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | | | - Steven J. Lippmann
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Melissa A. Greiner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Chandler Long
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC
| | - Jennifer A. Rymer
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | | | - Manesh R. Patel
- Division of Cardiology, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - W. Schuyler Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| |
Collapse
|
29
|
Grant JK, Dangl M, Koester M, Tegegn M, Knijiik L, Singh H, Orringer CE. Under-reporting and Under-representation of Non-Hispanic Black Subjects in Lipid-Lowering Atherosclerotic Cardiovascular Disease Outcomes Trials: A Systematic Review. J Clin Lipidol 2022; 16:608-616. [DOI: 10.1016/j.jacl.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/10/2022] [Accepted: 08/18/2022] [Indexed: 10/14/2022]
|
30
|
Kyalwazi AN, Loccoh EC, Brewer LC, Ofili EO, Xu J, Song Y, Joynt Maddox KE, Yeh RW, Wadhera RK. Disparities in Cardiovascular Mortality Between Black and White Adults in the United States, 1999 to 2019. Circulation 2022; 146:211-228. [PMID: 35861764 DOI: 10.1161/circulationaha.122.060199] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Black adults experience a disproportionately higher burden of cardiovascular risk factors and disease in comparison with White adults in the United States. Less is known about how sex-based disparities in cardiovascular mortality between these groups have changed on a national scale over the past 20 years, particularly across geographic determinants of health and residential racial segregation. METHODS We used CDC WONDER (Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research) to identify Black and White adults age ≥25 years in the United States from 1999 to 2019. We calculated annual age-adjusted cardiovascular mortality rates (per 100 000) for Black and White women and men, as well as absolute rate differences and rate ratios to compare the mortality gap between these groups. We also examined patterns by US census region, rural versus urban residence, and degree of neighborhood segregation. RESULTS From 1999 to 2019, age-adjusted mortality rates declined overall for both Black and White adults. There was a decline in age-adjusted cardiovascular mortality among Black (602.1 to 351.8 per 100 000 population) and White women (447.0 to 267.5), and the absolute rate difference (ARD) between these groups decreased over time (1999: ARD, 155.1 [95% CI, 149.9-160.3]; 2019: ARD, 84.3 [95% CI, 81.2-87.4]). These patterns were similar for Black (824.1 to 526.3 per 100 000) and White men (637.5 to 396.0; 1999: ARD, 186.6 [95% CI, 178.6-194.6]; 2019: ARD, 130.3 [95% CI, 125.6-135.0]). Despite this progress, cardiovascular mortality in 2019 was higher for Black women (rate ratio, 1.32 [95% CI, 1.30-1.33])- especially in the younger (age <65 years) subgroup (rate ratio, 2.28 [95% CI, 2.23-2.32])-as well as for Black men (rate ratio, 1.33 [95% CI, 1.32-1.34]), compared with their respective White counterparts. There was regional variation in cardiovascular mortality patterns, and the Black-White gap differed across rural and urban areas. Cardiovascular mortality rates among Black women and men were consistently higher in communities with high levels of racial segregation compared with those with low to moderate levels. CONCLUSIONS During the past 2 decades, age-adjusted cardiovascular mortality declined significantly for Black and White adults in the United States, as did the absolute difference in death rates between these groups. Despite this progress, Black women and men continue to experience higher cardiovascular mortality rates than their White counterparts.
Collapse
Affiliation(s)
- Ashley N Kyalwazi
- Richard A. and Susan F. Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (A.N.K., J.X., Y.S., R.W.Y., R.K.W.).,Harvard Medical School, Boston, MA (A.N.K.)
| | - Eméfah C Loccoh
- Department of Medicine, Brigham and Women's Hospital, Boston, MA (E.C.L.)
| | - LaPrincess C Brewer
- Department of Cardiovascular Medicine and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN (L.C.B.)
| | - Elizabeth O Ofili
- Division of Cardiology and the Clinical Research Center, Morehouse School of Medicine, Atlanta, GA (E.O.O.)
| | - Jiaman Xu
- Richard A. and Susan F. Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (A.N.K., J.X., Y.S., R.W.Y., R.K.W.)
| | - Yang Song
- Richard A. and Susan F. Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (A.N.K., J.X., Y.S., R.W.Y., R.K.W.)
| | - Karen E Joynt Maddox
- Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St Louis, MO (K.E.J.M.)
| | - Robert W Yeh
- Richard A. and Susan F. Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (A.N.K., J.X., Y.S., R.W.Y., R.K.W.)
| | - Rishi K Wadhera
- Richard A. and Susan F. Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (A.N.K., J.X., Y.S., R.W.Y., R.K.W.)
| |
Collapse
|
31
|
Jain V, Minhas AMK, Kleiman NS, Arshad HB, Saleh Y, Pandat SS, Dani SS, Goel SS, Faza N, Butt SA, Blankstein R, Cainzos-Achirica M, Nasir K, Khan SU. Cardiac Arrest in Young Adults with Ischemic Heart Disease in the United States, 2004-2018. Curr Probl Cardiol 2022; 47:101312. [PMID: 35839933 DOI: 10.1016/j.cpcardiol.2022.101312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cardiac arrest (CA) among young adults (<45 y) with ischemic heart disease (IHD) remained understudied. OBJECTIVE To evaluate the trends in clinical profile, in-hospital mortality, and health care resource utilization in CA-related hospitalizations among young adults with IHD. METHODS National Inpatient Sample (2004-2018) was used to identify adults aged 18- 45 years. RESULTS Of 77,359 weighted CA-related hospitalizations (mean age: 39 [0.05] y; 34.3% women), 65% had a myocardial infarction (MI), and 58% had a shockable rhythm. Between 2004 and 2018, CA-related hospitalizations among young adults with IHD increased from 1.8% to 2.4%. Overall, in-hospital mortality was 36.4%, which was higher for women vs. men (40.4% vs. 34.2%; p<0.001) and Black vs. White adults (43.9% vs. 33.3%; p<0.001). In-hospital mortality increased from 33.5% to 38.1%, with a consistent upward trend in men, White adults, and both MI and non-MI cases. However, in STEMI (40%), in-hospital mortality decreased from 34.6% to 20.2% (p-trend <0.001), while it increased in NSTEMI (14.8%) from 34.3% to 47.5% (p-trend <0.001). Overall mean length of stay (LOS) (7 to 9 days) and mean inflation-adjusted care cost ($34,431 to $44,646) increased over the study duration. CONCLUSION CA-related hospitalizations and associated LOS and inflation-adjusted care costs have increased in the last 15 years. In-hospital mortality increased by ∼5% during the study period with a higher mortality in women and among black adults. While increased CA-related hospitalizations may reflect improved pre-hospital care, greater efforts are needed to address improve in-hospital survival in CA among young adults with IHD.
Collapse
Affiliation(s)
| | | | - Neal S Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Hassaan B Arshad
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Yehia Saleh
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Summit S Pandat
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital, and Medical Center, Beth Israel Lahey Health, Burlington, MA
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Nadeen Faza
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Sara Ayaz Butt
- Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Ron Blankstein
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | - Miguel Cainzos-Achirica
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX; Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX; Center for Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, TX; Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Khurram Nasir
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX; Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX; Center for Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, TX; Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX.
| |
Collapse
|
32
|
Maitra NS, Mahtta D, Navaneethan S, Vaughan EM, Kochar A, Gulati M, Levine GN, Petersen LA, Virani SS. A Mistake Not to Be Repeated: What Can We Learn from the Underutilization of Statin Therapy for Efficient Dissemination of Cardioprotective Glucose Lowering Agents? Curr Cardiol Rep 2022; 24:689-698. [PMID: 35352278 DOI: 10.1007/s11886-022-01694-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To review the factors contributing to underutilization of guideline-directed therapies, identify strategies to alleviate these factors, and apply these strategies for effective and timely dissemination of novel cardioprotective glucose-lowering agents. RECENT FINDINGS Recent analyses demonstrate underutilization of cardioprotective glucose lowering agents despite guideline recommendations for their use. Major contributors to underutilization of guideline-directed therapies include therapeutic inertia, perceptions about side effects, and factors found at the level of the clinicians, patients, and the healthcare system. The recent emergence of several novel therapies, such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, for use in cardiovascular disease provides a unique avenue to improve patient outcomes. To effectively utilize novel cardioprotective glucose lowering agents to improve cardiovascular outcomes, clinicians must recognize and learn from prior barriers to application of guideline-directed therapies. Further endeavors are prudent to ensure uptake of novel agents.
Collapse
Affiliation(s)
- Neil S Maitra
- Division of General Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Dhruv Mahtta
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA
| | - Sankar Navaneethan
- Section of Nephrology and Institute of Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
- Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Elizabeth M Vaughan
- Division of General Internal Medicine, Baylor College of Medicine, Houston, TX, USA
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ajar Kochar
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Martha Gulati
- Section of Cardiology, University of Arizona College of Medicine - Phoenix, Phoenix, AR, USA
| | - Glenn N Levine
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Laura A Petersen
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA
- Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA.
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
- Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development, 2002 Holcombe Boulevard, Houston, TX, USA.
| |
Collapse
|
33
|
Ukoha EP, Snavely ME, Hahn MU, Steinauer JE, Bryant AS. Toward the elimination of race-based medicine: replace race with racism as preeclampsia risk factor. Am J Obstet Gynecol 2022; 227:593-596. [PMID: 35640703 DOI: 10.1016/j.ajog.2022.05.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/17/2022] [Accepted: 05/23/2022] [Indexed: 11/01/2022]
Abstract
Pregnancy-related morbidity and mortality continue to disproportionately affect birthing people who identify as Black. The use of race-based risk factors in medicine exacerbates racial health inequities by insinuating a false conflation that fails to consider the underlying impact of racism. As we work toward health equity, we must remove race as a risk factor in our guidelines to address disparities due to racism. This includes the most recent US Preventive Services Taskforce, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine guidelines for aspirin prophylaxis in preeclampsia, where the risk factor for "Black race" should be replaced with "anti-Black racism." In this commentary, we reviewed the evidence that supports race as a sociopolitical construct and the health impacts of racism. We presented a call to action to remove racial determination in the guidelines for aspirin prophylaxis in preeclampsia and more broadly in our practice of medicine.
Collapse
|
34
|
Association between Statin Use and Risk of Parkinson’s Disease: Evidence from 18 Observational Studies Comprising 3.7 Million Individuals. J Pers Med 2022; 12:jpm12050825. [PMID: 35629248 PMCID: PMC9145914 DOI: 10.3390/jpm12050825] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
The potential impact of statins on the risk of Parkinson’s disease (PD) is still controversial; therefore, we conducted a comprehensive meta-analysis of observational studies to examine the effect of statin use on the risk of PD. We searched electronic databases, such as PubMed, EMBASE, Scopus, and Web of Science, for articles published between 1 January 2000 and 15 March 2022. Cohort studies which examined the association between statins and PD risk in the general population were also included. Two authors assessed the data and extracted all potential information for analysis. Random effects meta-analyses were performed to measure the risk ratio (RR) and 95% confidence intervals (CIs). Eighteen cohort studies including 3.7 million individuals with 31,153 PD participants were identified. In statin users, compared with non-users, the RR for PD was 0.79 (95% CI: 0.68–0.91). In a subgroup analysis of PD, this association was observed with medium and high quality, and the studies were adjusted for age, gender, and smoking status. When the data were stratified according to the duration of exposure, long-duration statin use was associated with a decreased risk of PD (RR = 0.49; 95% CI: 0.26–0.92). There was no significant decrease in the risk of PD in short-term statin users (RR = 0.94; 95% CI: 0.67–1.31). Moreover, no significant difference in the reduction in the risk of PD was observed between men (RR = 0.80; 95% CI: 0.75–0.86) and women (RR = 0.80; 95% CI: 0.75–0.86). Although our findings confirm a reduction in the PD risk associated with statin treatment and suggest that statins play a clinically favorable role, these findings should be interpreted with caution. Future randomized control trials with an ad hoc design are needed to confirm the potential utility of statins in reducing the risk of PD.
Collapse
|
35
|
Nelson AJ, Haynes K, Shambhu S, Eapen Z, Cziraky MJ, Nanna MG, Calvert SB, Gallagher K, Pagidipati NJ, Granger CB. High-Intensity Statin Use Among Patients With Atherosclerosis in the U.S. J Am Coll Cardiol 2022; 79:1802-1813. [PMID: 35512860 PMCID: PMC9344279 DOI: 10.1016/j.jacc.2022.02.048] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 01/26/2022] [Accepted: 02/23/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Preventive therapy among patients with established atherosclerotic cardiovascular disease (ASCVD) is generally underused. Whether new guideline recommendations and a focus on implementation have improved the use of high-intensity statins is unknown. OBJECTIVES This study sought to evaluate the patterns and predictors of statin use among patients with ASCVD. METHODS In this retrospective cohort study, pharmacy and medical claims data from a commercial health plan were queried for patients with established ASCVD between January 31, 2018, and January 31, 2019. Statin use on an index date of January 31, 2019, was evaluated, as was 12-month adherence and discontinuation. Multivariable logistic regression was used to determine independent associations with statin use of varying intensities. RESULTS Of the 601,934 patients with established ASCVD, 41.7% were female, and the mean age was 67.5 ± 13.3 years. Overall, 22.5% of the cohort were on a high-intensity statin, 27.6% were on a low- or moderate-intensity statin, and 49.9% were not on any statin. In multivariable analysis, younger patients, female patients, and those with higher Charlson comorbidity score were less likely to be prescribed any statin. Among statin users, female patients, older patients, and those with peripheral artery disease were less likely to be on a high-intensity formulation, whereas a cardiology encounter in the prior year increased the odds. The majority of high-intensity stain users achieved high levels of adherence. CONCLUSIONS Substantial underuse of statins persists in a large, insured, and contemporary cohort of patients with ASCVD from the United States. In particular, concerning gaps in appropriate statin use remain among younger patients, women, and those with noncoronary ASCVD.
Collapse
Affiliation(s)
- Adam J Nelson
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | | | - Zubin Eapen
- Element Science, San Francisco, California, USA
| | | | - Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sara B Calvert
- Duke Clinical Research Institute, Durham, North Carolina, USA; Clinical Trials Transformation Initiative, Durham, North Carolina, USA
| | | | | | | |
Collapse
|
36
|
Vickers AJ, Elfiky A, Freeman VL, Roach M. Race, Biology, Disparities, and Prostate Cancer. Eur Urol 2022; 81:463-465. [PMID: 35216858 DOI: 10.1016/j.eururo.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | | | - Vincent L Freeman
- Division of Epidemiology and Biostatistics, University of Illinois Chicago School of Public Health, Chicago, IL, USA
| | - Mack Roach
- Department of Radiation Oncology and Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, CA, USA
| |
Collapse
|
37
|
Khan S, Chang SH, Hicks V, Wang M, Grubb RL, Drake BF. Improved survival with post-diagnostic metformin and statin use in a racially diverse cohort of US Veterans with advanced prostate cancer. Prostate Cancer Prostatic Dis 2022; 25:707-712. [PMID: 34811499 DOI: 10.1038/s41391-021-00475-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To examine the association between post-diagnostic metformin or statin use with all-cause and prostate cancer (PCa)-specific mortality in men with advanced prostate cancer. METHODS Our study consisted of 4572 men (Black = 1352, White = 3192, Other Race = 28) diagnosed with advanced cancer (T4/M1/N1) between 1999 and 2013 in the Veteran Health Administration. The association between post-diagnostic (1) metformin and (2) statin use with all-cause and PCa-specific mortality was examined using multivariable, time-varying Cox Proportional Hazard Models. In a secondary analysis, models were stratified by race. RESULTS Post-diagnostic metformin use was associated with a reduced risk of all-cause (Hazard Ratio (HR) 0.84, 95% Confidence Interval (CI): 0.73, 0.96) and PCa-specific death (HR: 0.76, 95% CI: 0.63, 0.91). In stratified analyses, the inverse association between post-diagnostic metformin use and both all-cause PCa-specific mortality was limited to White men. Post-diagnostic statin use was associated with a reduced risk of all-cause (HR: 0.75, 95% CI: 0.68, 0.83) and PCa-specific mortality (HR: 0.72; 95% CI: 0.64, 0.81). In stratified analyses, similar inverse associations were observed for post-diagnostic statin use and all-cause and PCa-specific mortality in both Black and White men. CONCLUSION Post diagnostic metformin and statin use may prevent progression to lethal prostate cancer in men with advanced prostate cancer.
Collapse
Affiliation(s)
- Saira Khan
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO, USA. .,Epidemiology Program, College of Heath Sciences, University of Delaware, Newark, DE, USA.
| | - Su-Hsin Chang
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO, USA.,Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Veronica Hicks
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO, USA.,Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Mei Wang
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO, USA.,Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Robert L Grubb
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA
| | - Bettina F Drake
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO, USA.,Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| |
Collapse
|
38
|
Headen AC, Siaw-Asamoah A, Julien HM. Race and Modifiable Factors Influencing Cardiovascular Disease. Med Clin North Am 2022; 106:401-409. [PMID: 35227439 DOI: 10.1016/j.mcna.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A modern approach to mitigating the impact of cardiovascular disease on Americans demands not only an understanding of modifiable conditions that contribute to its development but also a greater appreciation of the heterogeneous distribution of these conditions based on race. As race is not a biological construct, further research is needed to fully elucidate the mechanisms that contribute to these differences. The consequences of the differential impact of modifiable risk factors on cardiovascular disease outcomes among black Americans compared with white Americans cannot be understated.
Collapse
Affiliation(s)
| | - Andrew Siaw-Asamoah
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Howard M Julien
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center; Penn Cardiovascular Center for Health Equity and Social Justice.
| |
Collapse
|
39
|
Ding A, Dixon SW, Ferries EA, Shrank WH. The role of integrated medical and prescription drug plans in addressing racial and ethnic disparities in medication adherence. J Manag Care Spec Pharm 2022; 28:379-386. [PMID: 35199574 PMCID: PMC10372970 DOI: 10.18553/jmcp.2022.28.3.379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Medication nonadherence in the United States contributes to 125,000 deaths and 10% of hospitalizations annually. The pain of preventable deaths and the personal costs of nonadherence are borne disproportionately by Black, Latino, and other minority groups because nonadherence is higher in these groups due to a variety of factors. These factors include socioeconomic challenges, issues with prescription affordability and convenience of filling and refilling them, lack of access to pharmacies and primary care services, difficulty taking advantage of patient engagement opportunities, health literacy limitations, and lack of trust due to historical and structural discrimination outside of and within the medical system. Solutions to address the drivers of lower medication adherence, specifically in minority populations, are needed to improve population outcomes and reduce inequities. While various solutions have shown some traction, these solutions have tended to be challenging to scale for wider impact. We propose that integrated medical and pharmacy plans are well positioned to address racial and ethnic health disparities related to medication adherence. DISCLOSURES: This study was not supported by any funding sources other than employment of all authors by Humana Inc. Humana products and programs are referred to in this article.
Collapse
|
40
|
Browning JA, Tsang CCS, Dong X, Wan JY, Chisholm-Burns MA, Finch CK, Tsao JW, Liu C, Wang J. Effects of Medicare comprehensive medication review on racial/ethnic disparities in nonadherence to statin medications among patients with Alzheimer's Disease: an observational analysis. BMC Health Serv Res 2022; 22:159. [PMID: 35130899 PMCID: PMC8822650 DOI: 10.1186/s12913-022-07483-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Alzheimer’s Disease (AD) is the mostcommon cause of dementia, a neurological disorder characterized by memory loss and judgment impairment. Hyperlipidemia, a commonly co-occurring condition, should be treated to prevent associated complications. Medication adherence may be difficult for individuals with AD due to the complexity of AD management. Comprehensive Medication Reviews (CMRs), a required component of Medicare Part D Medication Therapy Management (MTM), have been shown to improve medication adherence. However, many MTM programs do not target AD. Additionally, racial/ethnic disparities in MTM eligibility have been revealed. Thus, this study examined the effects of CMR receipt on reducing racial/ethnic disparities in the likelihood of nonadherence to hyperlipidemia medications (statins) among the AD population. Methods This retrospective study used 2015-2017 Medicare data linked to the Area Health Resources Files. The likelihood of nonadherence to statin medications across racial/ethnic groups was compared between propensity-score-matched CMR recipients and non-recipients in a ratio of 1 to 3. A difference-in-differences method was utilized to determine racial/ethnic disparity patterns using a logistic regression by including interaction terms between dummy variables for CMR receipt and each racial/ethnic minority group (non-Hispanic Whites, or Whites, as reference). Results The study included 623,400 Medicare beneficiaries. Blacks and Hispanics had higher statin nonadherence than Whites: Compared to Whites, Blacks’ nonadherence rate was 4.53% higher among CMR recipients and 7.35% higher among non-recipients; Hispanics’ nonadherence rate was 2.69% higher among CMR recipients and 7.38% higher among non-recipients. Differences in racial/ethnic disparities between CMR recipients and non-recipients were significant for each minority group (p < 0.05) except Others. The difference between Whites and Hispanics in the odds of statin nonadherence was 11% lower among CMR recipients compared to non-recipients (OR = 0.89; 95% Confidence Interval = 0.85-0.94 for the interaction term between dummy variables for CMR and Hispanics). Interaction terms between dummy variables for CMR and other racial/ethnic minorities were not significant. Conclusions Receiving a CMR was associated with a disparity reduction in nonadherence to statin medications between Hispanics and Whites among patients with AD. Strategies need to be explored to increase the number of MTM programs that target AD and promote CMR completion.
Collapse
Affiliation(s)
- Jamie A Browning
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA.
| | - Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Xiaobei Dong
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Jim Y Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, 66 North Pauline St, Memphis, TN, 38163, USA
| | - Marie A Chisholm-Burns
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Christopher K Finch
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Jack W Tsao
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 North Dunlap St, Memphis, 38105, USA.,Department of Neurology, University of Tennessee Health Science Center College of Medicine, 855 Monroe Avenue, Memphis, TN, 38163, USA
| | - Colin Liu
- University of Pennsylvania College of Arts and Sciences, Philadelphia, PA, 19104, USA
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| |
Collapse
|
41
|
Vyas DA, James A, Kormos W, Essien UR. Revising the atherosclerotic cardiovascular disease calculator without race. Lancet Digit Health 2021; 4:e4-e5. [PMID: 34952675 DOI: 10.1016/s2589-7500(21)00258-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Darshali A Vyas
- Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
| | - Aisha James
- Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - William Kormos
- Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Utibe R Essien
- Department of Medicine, University of Pittsburgh Hospital, Pittsburgh, PA, USA
| |
Collapse
|
42
|
Henson JB, Patel YA, Muir AJ. Trends in statin utilisation in US adults with non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2021; 54:1481-1489. [PMID: 34653272 DOI: 10.1111/apt.16646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) has high morbidity and mortality related to cardiovascular disease (CVD), but statins have been historically underutilised in these patients due to concern for hepatotoxicity. AIMS To characterise trends in statin use among individuals with NAFLD and to determine predictors of statin utilisation in this population. METHODS Individuals with NAFLD were identified from 2005 to 2018 continuous National Health and Nutrition Examination Survey. Trends in statin use over time were assessed, and predictors of statin under-utilisation for primary prevention were identified. The roles of a known diagnosis of liver disease and disease severity were examined. RESULTS We included 14 113 individuals; 34.6% had NAFLD, of whom 5.4% reported a liver disease diagnosis. There was a significant increase in statin use for primary prevention between 2005 and 2018 (18.1%-25.0%; P = 0.03), but guideline-indicated use for this purpose was low (54.5% between 2005 and 2012; 48.6% between 2013 and 2018). A known NAFLD diagnosis was a negative predictor of statin use during the earlier time period but not more recently. Utilisation did not decrease with increasing liver disease severity. CONCLUSIONS In a nationally representative population with NAFLD, statin use for primary prevention has increased over time, but guideline-concordant use remains low. A known liver disease diagnosis was associated with lack of statin use in the earlier time period but not more recently, suggesting a changing perspective of underlying liver disease impacting statin utilisation. Further work to improve guideline-indicated statin use in this high-risk population is needed.
Collapse
Affiliation(s)
- Jacqueline B Henson
- Division of Gastroenterology, Department of Medicine, Duke University, Durham, NC, USA
| | - Yuval A Patel
- Division of Gastroenterology, Department of Medicine, Duke University, Durham, NC, USA
| | - Andrew J Muir
- Division of Gastroenterology, Department of Medicine, Duke University, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| |
Collapse
|
43
|
Alvarez-Mon MA, Llavero-Valero M, Asunsolo Del Barco A, Zaragozá C, Ortega MA, Lahera G, Quintero J, Alvarez-Mon M. Areas of Interest and Attitudes Toward Antiobesity Drugs: Thematic and Quantitative Analysis Using Twitter. J Med Internet Res 2021; 23:e24336. [PMID: 34698653 PMCID: PMC8579215 DOI: 10.2196/24336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/02/2020] [Accepted: 08/12/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Antiobesity drugs are prescribed for the treatment of obesity in conjunction with healthy eating, physical activity, and behavior modification. However, poor adherence rates have been reported. Attitudes or beliefs toward medications are important to ascertain because they may be associated with patient behavior. The analysis of tweets has become a tool for health research. OBJECTIVE The aim of this study is to investigate the content and key metrics of tweets referring to antiobesity drugs. METHODS In this observational quantitative and qualitative study, we focused on tweets containing hashtags related to antiobesity drugs between September 20, 2019, and October 31, 2019. Tweets were first classified according to whether they described medical issues or not. Tweets with medical content were classified according to the topic they referred to: side effects, efficacy, or adherence. We additionally rated it as positive or negative. Furthermore, we classified any links included within a tweet as either scientific or nonscientific. Finally, the number of retweets generated as well as the dissemination and sentiment score obtained by the antiobesity drugs analyzed were also measured. RESULTS We analyzed a total of 2045 tweets, 945 of which were excluded according to the criteria of the study. Finally, 320 out of the 1,100 remaining tweets were also excluded because their content, although related to drugs for obesity treatment, did not address the efficacy, side effects, or adherence to medication. Liraglutide and semaglutide accumulated the majority of tweets (682/780, 87.4%). Notably, the content that generated the highest frequency of tweets was related to treatment efficacy, with liraglutide-, semaglutide-, and lorcaserin-related tweets accumulating the highest proportion of positive consideration. We found the highest percentages of tweets with scientific links in those posts related to liraglutide and semaglutide. Semaglutide-related tweets obtained the highest probability of likes and were the most disseminated within the Twitter community. CONCLUSIONS This analysis of posted tweets related to antiobesity drugs shows that the interest, beliefs, and experiences regarding these pharmacological treatments are heterogeneous. The efficacy of the treatment accounts for the majority of interest among Twitter users.
Collapse
Affiliation(s)
- Miguel Angel Alvarez-Mon
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain.,Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, Alcalá de Henares, Spain
| | - Maria Llavero-Valero
- Department of Endocrinology and Clinical Nutrition, Hospital Universitario Infanta Leonor, Madrid, Spain.,Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
| | - Angel Asunsolo Del Barco
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcala, Madrid, Spain.,Ramón y Cajal Institute of Sanitary Research, Madrid, Spain
| | - Cristina Zaragozá
- Pharmacology Unit, Biomedical Sciences Department, University of Alcalá, Madrid, Spain
| | - Miguel A Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, Alcalá de Henares, Spain.,Ramón y Cajal Institute of Sanitary Research, Madrid, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, Alcalá de Henares, Spain.,Ramón y Cajal Institute of Sanitary Research, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.,Psychiatry Service, Hospital Universitario Principe de Asturias, Alcalá de Henares, Spain
| | - Javier Quintero
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain.,Department of Legal Medicine and Psychiatry, Complutense University, Madrid, Spain
| | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, Alcalá de Henares, Spain.,Ramón y Cajal Institute of Sanitary Research, Madrid, Spain.,Internal Medicine and Autoimmunity/Rheumatology Service, Hospital Universitario Principe de Asturias, Madrid, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, Spain
| |
Collapse
|
44
|
Jia X, Lee MT, Ramsey DJ, Mahtta D, Akeroyd JM, Turchin A, Navar AM, Matheny ME, Gobbel G, Stone NJ, Nambi V, Ballantyne CM, Petersen LA, Virani SS. Association of patient, provider and facility related characteristics with statin associated side effects and statin use: Insight from the veteran's affairs healthcare system. J Clin Lipidol 2021; 15:832-839. [PMID: 34666951 DOI: 10.1016/j.jacl.2021.09.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Statin associated side effects (SASE) are a leading cause of statin discontinuation. OBJECTIVE We evaluated patient, provider, and facility characteristics associated with SASEs and whether these characteristics impact statin utilization. METHODS Patients with atherosclerotic cardiovascular disease (ASCVD) receiving care across the Veterans Affairs healthcare system from October 1, 2014 to September 30, 2015 were included. Multivariable logistic regression analyses were performed to determine (a) factors associated with SASE and (b) factors associated with statin use in those with SASE. RESULTS Our cohort included 1,225,576 patients with ASCVD. Of these, 171,189 (13.7%) had at least 1 reported SASE since year 2000. The most significant odds for SASEs were observed with female sex (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.36, 1.45), White race (OR 1.43, 95% CI 1.41, 1.45), hypertension (OR 1.37, 95% CI 1.33, 1.41) and ischemic heart disease (IHD: OR 1.45, 95% CI 1.43, 1.47). Lower odds were noted with care at a teaching facility (OR 0.89, 95% CI 0.88, 0.90). Factors most associated with being on a statin among patients with SASE included having diabetes (OR 1.18, 95% CI 1.15, 1.20), IHD (OR 1.39, 95% CI 1.35, 1.43) and a higher number of cardiology visits (OR 1.08, 95% CI 1.07, 1.09), while female sex was associated with lower odds (OR 0.65, 95% CI 0.61, 0.69). CONCLUSION There are significant disparities in statin use by sex, ASCVD type, and comorbidities among secondary prevention patients with SASE, which represent areas for improvement in optimizing statin utilization.
Collapse
Affiliation(s)
- Xiaoming Jia
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Michelle T Lee
- Health Services Research and Development Center for Innovations in Quality Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - David J Ramsey
- Health Services Research and Development Center for Innovations in Quality Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Dhruv Mahtta
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Julia M Akeroyd
- Health Services Research and Development Center for Innovations in Quality Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Alexander Turchin
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, United States
| | - Ann Marie Navar
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Michael E Matheny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States; Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, TN, United States
| | - Glenn Gobbel
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States; Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, TN, United States
| | - Neil J Stone
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Vijay Nambi
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Christie M Ballantyne
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Laura A Petersen
- Health Services Research and Development Center for Innovations in Quality Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston TX, United States
| | - Salim S Virani
- Health Services Research and Development Center for Innovations in Quality Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston TX, United States; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States.
| |
Collapse
|
45
|
Public perceptions and knowledge of cholesterol management in a multi-ethnic Asian population: A population-based survey. PLoS One 2021; 16:e0256218. [PMID: 34388221 PMCID: PMC8362937 DOI: 10.1371/journal.pone.0256218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. Hyperlipidemia is one of the important modifiable risk factors for CVDs. Raising public awareness of CVD risks is an important step in reducing CVD burdens. In this study, we aimed to assess public awareness and knowledge of cholesterol and its management in a multiethnic Asian population. Methods We recruited 1000 participants from three major ethnic groups for this nationwide population-based survey. A structured questionnaire was used to collect socio-demographics, knowledge of cholesterol and cholesterol-lowering medications. Univariate and multivariate analyses were conducted to identify factors associated with good knowledge on cholesterol and its management. Results Of the participants, 65% thought that high cholesterol produces symptoms and that lifestyle modification would be as effective as medication at lowering cholesterol. Nearly 70% believed that long term statin could lead to kidney or liver damage, and 56% thought that statin was associated with higher risk of cancer. A third saw herbal medicine or supplements as healthier and safer. About 45% believed that statin therapy should not be taken long term and that one could stop taking cholesterol medication when cholesterol is under control. Malays were more likely to have poor knowledge (adjusted OR 0.68; 95% CI 0.47–0.98; P = 0.039) compared to Chinese. Participants with intermediate education were more likely to have good knowledge of cholesterol and its management (adjusted OR 1.67; 95% CI 1.11–2.51; P = 0.013) compared to those with primary education. Conclusion Public knowledge and awareness of high cholesterol and its management remains poor in Asian multi-ethnic population. Understanding gaps in public knowledge can inform the implementation of health promotion programs to effectively raise awareness of cholesterol and its management.
Collapse
|
46
|
Colvin CL, Poudel B, Bress AP, Derington CG, King JB, Wen Y, Chen L, Bittner V, Brown TM, Monda KL, Mues KE, Rosenson RS, Jackson EA, Muntner P, Colantonio LD. Race/ethnic and sex differences in the initiation of non-statin lipid-lowering medication following myocardial infarction. J Clin Lipidol 2021; 15:665-673. [PMID: 34452823 DOI: 10.1016/j.jacl.2021.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Adults with atherosclerotic cardiovascular disease (ASCVD) at very high-risk for recurrent events who have low-density lipoprotein cholesterol ≥ 70 mg/dL despite maximally-tolerated statin therapy are recommended to initiate ezetimibe or a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor. OBJECTIVE Compare the initiation of ezetimibe and a PCSK9 inhibitor after a myocardial infarction (MI) among very high-risk ASCVD patients by race/ethnicity and sex. METHODS We analyzed data from 374,786 adults ≥ 66 years of age with Medicare fee-for-service coverage who had an MI between July 1, 2015 and December 31, 2018, were not taking ezetimibe or a PCSK9 inhibitor, and had very high-risk ASCVD defined by the 2018 American Heart Association/American College of Cardiology multi-society cholesterol guideline. Pharmacy claims through December 31, 2018 were used to determine ezetimibe and PCSK9 inhibitor initiation. RESULTS Overall, 6980 (1.9%) beneficiaries initiated ezetimibe, and 1433 (0.4%) initiated a PCSK9 inhibitor. Adjusted hazard ratios (aHR) for ezetimibe initiation among non-Hispanic Black, Hispanic, and Asian versus non-Hispanic White beneficiaries were 0.77 (95% confidence interval [95%CI]: 0.70-0.86), 0.92 (95%CI: 0.76-1.11) and 0.73 (95%CI: 0.59-0.89), respectively. Compared to non-Hispanic White beneficiaries, the aHRs for PCSK9 inhibitor initiation were 0.63 (95%CI: 0.48-0.81) among non-Hispanic Black, 0.70 (95%CI: 0.43-1.13) among Hispanic, and 0.93 (95%CI: 0.62-1.39) among Asian beneficiaries. The aHRs for ezetimibe and PCSK9 inhibitor initiation comparing women to men were 1.11 (95%CI: 1.06-1.17) and 1.13 (95%CI: 1.01-1.25), respectively. CONCLUSION There are race/ethnic and sex disparities in the initiation of ezetimibe and a PCSK9 inhibitor following MI among very high-risk ASCVD patients.
Collapse
Affiliation(s)
- Calvin L Colvin
- Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave South, RPHB 527C, Birmingham, AL 35294-0013, USA
| | - Bharat Poudel
- Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave South, RPHB 527C, Birmingham, AL 35294-0013, USA
| | - Adam P Bress
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA; Informatics, Decision Enhancement, and Surveillance (IDEAS) 2.0 Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Catherine G Derington
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jordan B King
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA; Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Ying Wen
- Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave South, RPHB 527C, Birmingham, AL 35294-0013, USA
| | - Ligong Chen
- Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave South, RPHB 527C, Birmingham, AL 35294-0013, USA
| | - Vera Bittner
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Todd M Brown
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Robert S Rosenson
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth A Jackson
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave South, RPHB 527C, Birmingham, AL 35294-0013, USA
| | - Lisandro D Colantonio
- Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave South, RPHB 527C, Birmingham, AL 35294-0013, USA.
| |
Collapse
|
47
|
Saddler N, Adams S, Robinson LA, Okafor I. Taking Initiative in Addressing Diversity in Medicine. CANADIAN JOURNAL OF SCIENCE, MATHEMATICS AND TECHNOLOGY EDUCATION = REVUE CANADIENNE DE L'ENSEIGNEMENT DES SCIENCES, DES MATHEMATIQUES ET DE LA TECHNOLOGIE 2021; 21:309-320. [PMID: 38624742 PMCID: PMC8294300 DOI: 10.1007/s42330-021-00154-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 04/17/2024]
Abstract
The existence of systemic racism in Canadian healthcare, among other determinants including accessible education, available occupation, and affordable housing, contributes to the racial divide in treatment and poor health outcomes for Black communities. Recent promising work has demonstrated patient-physician racial concordance in populations of colour as a potential area of focus for addressing health inequities for diverse communities. The impact of shared cultural experiences and cultural competency leads to mutual respect, trust, and improved communication between patients and physicians guiding their care. This approach is dependent on the availability of physicians of colour and similarly other healthcare providers. The Temerty Faculty of Medicine at the University of Toronto has attempted to address the deficit in its own community through a two-pronged approach: mentorship through the Community of Support (COS) and the Summer Mentorship Program (SMP), and the implementation of the Black Student Application Program (BSAP). These initiatives have significantly increased Black medical student representation and continue to have considerable impact on Black communities in the surrounding area. Through partnerships with community organizations that support the ethos of these programs, the vision of a more culturally diverse physician workforce in Canada has been reinforced. The adoption of similar programs across Canadian medical schools can lead to better representation within medicine and help contribute to a necessary culture shift within the ranks of medical institutions. These are critical steps in laying the foundation for a medical education grounded in equity, excellence, and strength in diversity, and a healthcare system that truly provides patient-centred care.
Collapse
Affiliation(s)
- Nelson Saddler
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Cir, Toronto, ON M5S 1A8 Canada
| | - Seana Adams
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Cir, Toronto, ON M5S 1A8 Canada
| | - Lisa A. Robinson
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Cir, Toronto, ON M5S 1A8 Canada
- Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Ike Okafor
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Cir, Toronto, ON M5S 1A8 Canada
| |
Collapse
|
48
|
Bernstein E, Guo N, Goto T, Rothberg MB. Characterizing the Variation of Alcohol Cessation Pharmacotherapy in Primary Care. J Gen Intern Med 2021; 36:1989-1996. [PMID: 33515195 PMCID: PMC8298666 DOI: 10.1007/s11606-020-06454-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/13/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Alcohol use disorder (AUD) imposes a high mortality and economic burden. Effective treatment is available, though underutilized. OBJECTIVE Describe trends in AUD pharmacotherapy, variation in prescribing, and associated patient factors. DESIGN Retrospective cohort using electronic health records from 2010 to 2019. PARTICIPANTS Primary care patients from 39 clinics in Ohio and Florida with diagnostic codes for alcohol dependence or abuse plus social history indicating alcohol use. PCPs in family or internal medicine with at least 20 AUD patients. MAIN MEASURES Pharmacotherapy for AUD (naltrexone, acamprosate, and disulfiram), abstinence from alcohol, patient demographics, and comorbidities. Generalized linear mixed models were used to identify patient factors associated with prescriptions and the association of pharmacotherapy with abstinence. KEY RESULTS We identified 13,250 patients; average age was 54 years, 66.9% were male, 75.0% were White, and median household income was $51,776 per year. Over 10 years, the prescription rate rose from 4.4 to 5.6%. Patients who were Black (aOR 0.74; 95% CI 0.58, 0.94) and insured by Medicare versus commercial insurance (aOR 0.61; 95% CI 0.48, 0.78) were less likely to be treated. Higher median household income ($10,000 increment, aOR 1.06; 95% CI 1.03, 1.10) and Medicaid versus commercial insurance (aOR 1.52; 95% CI 1.24, 1.87) were associated with treatment. Receiving pharmacotherapy was associated with subsequent documented abstinence from alcohol (aOR 1.60; 95% CI 1.33, 1.92). We identified 236 PCPs. The average prescription rate was 3.6% (range 0 to 24%). The top decile prescribed to 14.6% of their patients. The bottom 4 deciles had no prescriptions. Family physicians had higher rates of pharmacotherapy than internists (OR 1.50; 95% CI 1.21, 1.85). CONCLUSIONS Medications for AUD are infrequently prescribed, but there is considerable variation among PCPs. Increasing the use of pharmacotherapy by non-prescribers may increase abstinence from alcohol.
Collapse
Affiliation(s)
- Eden Bernstein
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ning Guo
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Toyomi Goto
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA
| | - Michael B Rothberg
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
49
|
Areas of Interest and Attitudes towards the Pharmacological Treatment of Attention Deficit Hyperactivity Disorder: Thematic and Quantitative Analysis Using Twitter. J Clin Med 2021; 10:jcm10122668. [PMID: 34204353 PMCID: PMC8235344 DOI: 10.3390/jcm10122668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 01/23/2023] Open
Abstract
We focused on tweets containing hashtags related to ADHD pharmacotherapy between 20 September and 31 October 2019. Tweets were classified as to whether they described medical issues or not. Tweets with medical content were classified according to the topic they referred to: side effects, efficacy, or adherence. Furthermore, we classified any links included within a tweet as either scientific or non-scientific. We created a dataset of 6568 tweets: 4949 (75.4%) related to stimulants, 605 (9.2%) to non-stimulants and 1014 (15.4%) to alpha-2 agonists. Next, we manually analyzed 1810 tweets. In the end, 481 (48%) of the tweets in the stimulant group, 218 (71.9%) in the non-stimulant group and 162 (31.9%) in the alpha agonist group were considered classifiable. Stimulants accumulated the majority of tweets. Notably, the content that generated the highest frequency of tweets was that related to treatment efficacy, with alpha-2 agonist-related tweets accumulating the highest proportion of positive consideration. We found the highest percentages of tweets with scientific links in those posts related to alpha-2 agonists. Stimulant-related tweets obtained the highest proportion of likes and were the most disseminated within the Twitter community. Understanding the public view of these medications is necessary to design promotional strategies aimed at the appropriate population.
Collapse
|
50
|
Sarraju A, Valencia A, Knowles JW, Maron DJ, Rodriguez F. Diverse Racial/Ethnic Group Underreporting and Underrepresentation in High-Impact Cholesterol Treatment Trials. Circulation 2021; 143:2409-2411. [PMID: 34125567 DOI: 10.1161/circulationaha.120.050034] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ashish Sarraju
- Division of Cardiovascular Medicine and the Cardiovascular Institute (A.S., J.W.K., D.J.M., F.R.)
| | | | - Joshua W Knowles
- Division of Cardiovascular Medicine and the Cardiovascular Institute (A.S., J.W.K., D.J.M., F.R.).,Stanford Diabetes Research Center, CA (J.W.K.)
| | - David J Maron
- Division of Cardiovascular Medicine and the Cardiovascular Institute (A.S., J.W.K., D.J.M., F.R.).,Stanford Prevention Research Center, CA (D.J.M.)
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute (A.S., J.W.K., D.J.M., F.R.)
| |
Collapse
|