1
|
Inui G, Tomita K, Fukuki M, Touge H, Ikeuchi T, Hisatome I, Yamasaki A. Clinical characteristics for distinguishing between acute cardiogenic pulmonary edema and community-acquired pneumonia in elderly patients: a prospective observational study. Monaldi Arch Chest Dis 2023. [PMID: 37545323 DOI: 10.4081/monaldi.2023.2633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/08/2023] [Indexed: 08/08/2023] Open
Abstract
Heart failure and pneumonia are highly prevalent in elderly patients. We conducted a study to evaluate the differences in the patterns of symptoms, laboratory findings, and computed tomography (CT) results in elderly patients with acute cardiogenic pulmonary edema (ACPE) and community-acquired pneumonia (CAP). From January 1, 2015 to December 31, 2017, we studied 140 patients aged >75 years who were diagnosed with ACPE and CAP. Symptoms, laboratory findings, mean ostial pulmonary vein (PV) diameter and patterns on CT images were assessed. The primary measures of diagnostic accuracy were assessed using the positive likelihood ratio (LR+). The cutoff value of ostial PVs for differentiating patients with ACPE from CAP was evaluated using the receiver operating characteristic (ROC) analysis. Ninety-three patients with ACPE, 36 with CAP, and 11 with complicated ACPE/CAP were included. In patients with ACPE, edema (LR+ 5.4) was a moderate factor for rule-in, and a high brain natriuretic peptide level (LR+ 4.2) was weak. In patients with CAP, cough (LR+ 5.7) and leukocytosis (LR+ 5.2) were moderate factors for rule-in, while fever (LR+ 3.8) and a high C-reactive protein level (LR+ 4.8) were weak factors. The mean diameter of ostial PVs in patients with ACPE was significantly larger than that of patients with CAP (15.8± 1.8 mm vs 9.6±1.5 mm, p< 0.01). ROC analysis revealed that an ostial PV diameter cutoff of 12.5 mm was strong evidence for distinguishing ACPE from CAP with an area under the ROC curve of 0.99 and LR+ 36.0. In conclusion, as ACPE and CAP have similar symptoms and laboratory findings, dilated ostial PVs were useful in characterizing CT images to distinguish ACPE from CAP.
Collapse
Affiliation(s)
- Genki Inui
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori; Department of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Yonago, Tottori.
| | - Katsuyuki Tomita
- Department of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Yonago, Tottori.
| | - Masaharu Fukuki
- Department of Cardiologic Medicine, National Hospital Organization Yonago Medical Center, Yonago, Tottori.
| | - Hirokazu Touge
- Department of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Yonago, Tottori.
| | - Tomoyuki Ikeuchi
- Department of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Yonago, Tottori.
| | - Ichiro Hisatome
- Department of Cardiologic Medicine, National Hospital Organization Yonago Medical Center, Yonago, Tottori.
| | - Akira Yamasaki
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori.
| |
Collapse
|
2
|
Yu B, Akushevich I, Yashkin AP, Yashin AI, Lyerly HK, Kravchenko J. Epidemiology of geographic disparities in heart failure among US older adults: a Medicare-based analysis. BMC Public Health 2022; 22:1280. [PMID: 35778761 PMCID: PMC9248157 DOI: 10.1186/s12889-022-13639-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/08/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND There are prominent geographic disparities in the life expectancy (LE) of older US adults between the states with the highest (leading states) and lowest (lagging states) LE and their causes remain poorly understood. Heart failure (HF) has been proposed as a major contributor to these disparities. This study aims to investigate geographic disparities in HF outcomes between the leading and lagging states. METHODS The study was a secondary data analysis of HF outcomes in older US adults aged 65+, using Center for Disease Control and Prevention sponsored Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database and a nationally representative 5% sample of Medicare beneficiaries over 2000-2017. Empiric estimates of death certificate-based mortality from HF as underlying cause of death (CBM-UCD)/multiple cause of death (CBM-MCD); HF incidence-based mortality (IBM); HF incidence, prevalence, and survival were compared between the leading and lagging states. Cox regression was used to investigate the effect of residence in the lagging states on HF incidence and survival. RESULTS Between 2000 and 2017, HF mortality rates (per 100,000) were higher in the lagging states (CBM-UCD: 188.5-248.6; CBM-MCD: 749.4-965.9; IBM: 2656.0-2978.4) than that in the leading states (CBM-UCD: 79.4-95.6; CBM-MCD: 441.4-574.1; IBM: 1839.5-2138.1). Compared to their leading counterparts, lagging states had higher HF incidence (2.9-3.9% vs. 2.2-2.9%), prevalence (15.6-17.2% vs. 11.3-13.0%), and pre-existing prevalence at age 65 (5.3-7.3% vs. 2.8-4.1%). The most recent rates of one- (77.1% vs. 80.4%), three- (59.0% vs. 60.7%) and five-year (45.8% vs. 49.8%) survival were lower in the lagging states. A greater risk of HF incidence (Adjusted Hazards Ratio, AHR [95%CI]: 1.29 [1.29-1.30]) and death after HF diagnosis (AHR: 1.12 [1.11-1.13]) was observed for populations in the lagging states. The study also observed recent increases in CBMs and HF incidence, and declines in HF prevalence, prevalence at age 65 and survival with a decade-long plateau stage in IBM in both leading and lagging states. CONCLUSION There are substantial geographic disparities in HF mortality, incidence, prevalence, and survival across the U.S.: HF incidence, prevalence at age 65 (age of Medicare enrollment), and survival of patients with HF contributed most to these disparities. The geographic disparities and the recent increase in incidence and decline in survival underscore the importance of HF prevention strategies.
Collapse
Affiliation(s)
- Bin Yu
- Department of Surgery, Duke University School of Medicine, Durham, NC, 27710, USA.
- Social Science Research Institute, Duke University, Durham, NC, 27710, USA.
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, 430071, China.
| | - Igor Akushevich
- Social Science Research Institute, Duke University, Durham, NC, 27710, USA
| | - Arseniy P Yashkin
- Social Science Research Institute, Duke University, Durham, NC, 27710, USA
| | - Anatoliy I Yashin
- Social Science Research Institute, Duke University, Durham, NC, 27710, USA
| | - H Kim Lyerly
- Department of Surgery, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Julia Kravchenko
- Department of Surgery, Duke University School of Medicine, Durham, NC, 27710, USA
| |
Collapse
|
3
|
Chávez Sosa JV, Guerra Pariona HN, Huancahuire-Vega S. Association Between Perceived Access to Healthcare and the Perception of Illness Among Peruvian Adults with Chronic Diseases During COVID-19 Pandemic. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221112832. [PMID: 35866539 PMCID: PMC9310277 DOI: 10.1177/00469580221112832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic has greatly affected the provision of care for patients with chronic diseases. Due to social restrictions and reductions in contact with health services, the negative perception of chronic disease is expected to have increased. The aim of this study was to determine the association between perceived access to healthcare and the perception of illness among Peruvian population with chronic disease. It was a cross-sectional analytical study, with a sample of 987 inhabitants to whom the questionnaires “Coverage of health services” and “The Brief Illness Perception Questionnaire” (BIPQ) were applied. Having health insurance (PRa = 0.683; 95% CI = 0.613-0.761) acts as a protective factor for a positive illness perception of chronic disease, however, a waiting time greater than 3 months to obtain a medical appointment (PRa = 1.417; 95% CI = 1.319-1.522) and poor access to health services (PRa = 1.435; 95% CI = 1.226-1.681) resulted in the probability of a negative illness perception of chronic disease. Thus, there is an association between perceived poor access to healthcare and the negative illness perception of chronic disease in Peruvian population during pandemic COVID-19.
Collapse
|
4
|
Faridi KF, Bhalla N, Atreja N, Venditto J, Khan ND, Wilson T, Fonseca E, Shen C, Yeh RW, Secemsky EA. New Heart Failure After Myocardial Infarction (From the National Cardiovascular Data Registries [NCDR] Linked With All-Payer Claims). Am J Cardiol 2021; 151:70-77. [PMID: 34053629 DOI: 10.1016/j.amjcard.2021.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/29/2021] [Accepted: 04/13/2021] [Indexed: 12/19/2022]
Abstract
Heart failure (HF) is common in patients presenting with acute myocardial infarction (MI), but incidence and predictors of new onset HF after hospitalization for MI are less well characterized. We evaluated patients hospitalized for acute MI without preceding or concurrent HF in the National Cardiovascular Data Registry (NCDR) CathPCI and Chest Pain-MI registries linked with claims data between April 2010 and March 2017. Cumulative incidence and independent predictors of HF after discharge were determined, and a simplified risk score was developed to predict incident HF following MI. In 337,274 patients with acute MI and no history of HF, 8.0% developed incident HF within 1 year after discharge and 18.8% developed HF within 5 years. Significant predictors of HF after MI included advanced chronic kidney disease (CKD) (HR 2.34, 95% confidence interval [CI] 2.23-2.46 for Stage IV vs Stage I, and HR 2.18, 95% CI 2.07-2.29 for Stage V vs. Stage I), recurrent MI following index MI (HR 2.24, 95% CI 2.19-2.28), African-American race (HR 1.44, 95% CI 1.40-1.48), and diabetes (HR 1.39, 95% CI 1.37-1.42). A risk score of 8 variables predicted HF with modest discrimination (optimism-corrected c-statistic 0.64) and good calibration. In conclusion, nearly 1 in 5 patients in a large nationally representative cohort without preceding or concurrent heart failure at time of MI developed incident HF within 5 years after discharge. Advanced CKD and recurrent MI were the strongest predictors of future HF. Increased recognition of specific risk factors for HF may help inform care strategies following MI.
Collapse
|
5
|
Pierce JB, Shah NS, Petito LC, Pool L, Lloyd-Jones DM, Feinglass J, Khan SS. Trends in heart failure-related cardiovascular mortality in rural versus urban United States counties, 2011-2018: A cross-sectional study. PLoS One 2021; 16:e0246813. [PMID: 33657143 PMCID: PMC7928489 DOI: 10.1371/journal.pone.0246813] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Adults in rural counties in the United States (US) experience higher rates broadly of cardiovascular disease (CVD) compared with adults in urban counties. Mortality rates specifically due to heart failure (HF) have increased since 2011, but estimates of heterogeneity at the county-level in HF-related mortality have not been produced. The objectives of this study were 1) to quantify nationwide trends by rural-urban designation and 2) examine county-level factors associated with rural-urban differences in HF-related mortality rates. METHODS AND FINDINGS We queried CDC WONDER to identify HF deaths between 2011-2018 defined as CVD (I00-78) as the underlying cause of death and HF (I50) as a contributing cause of death. First, we calculated national age-adjusted mortality rates (AAMR) and examined trends stratified by rural-urban status (defined using 2013 NCHS Urban-Rural Classification Scheme), age (35-64 and 65-84 years), and race-sex subgroups per year. Second, we combined all deaths from 2011-2018 and estimated incidence rate ratios (IRR) in HF-related mortality for rural versus urban counties using multivariable negative binomial regression models with adjustment for demographic and socioeconomic characteristics, risk factor prevalence, and physician density. Between 2011-2018, 162,314 and 580,305 HF-related deaths occurred in rural and urban counties, respectively. AAMRs were consistently higher for residents in rural compared with urban counties (73.2 [95% CI: 72.2-74.2] vs. 57.2 [56.8-57.6] in 2018, respectively). The highest AAMR was observed in rural Black men (131.1 [123.3-138.9] in 2018) with greatest increases in HF-related mortality in those 35-64 years (+6.1%/year). The rural-urban IRR persisted among both younger (1.10 [1.04-1.16]) and older adults (1.04 [1.02-1.07]) after adjustment for county-level factors. Main limitations included lack of individual-level data and county dropout due to low event rates (<20). CONCLUSIONS Differences in county-level factors may account for a significant amount of the observed variation in HF-related mortality between rural and urban counties. Efforts to reduce the rural-urban disparity in HF-related mortality rates will likely require diverse public health and clinical interventions targeting the underlying causes of this disparity.
Collapse
Affiliation(s)
- Jacob B. Pierce
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Nilay S. Shah
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Lucia C. Petito
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Lindsay Pool
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Donald M. Lloyd-Jones
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Joe Feinglass
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Sadiya S. Khan
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| |
Collapse
|
6
|
Heiney SP, Donevant SB, Arp Adams S, Parker PD, Chen H, Levkoff S. A Smartphone App for Self-Management of Heart Failure in Older African Americans: Feasibility and Usability Study. JMIR Aging 2020; 3:e17142. [PMID: 32242822 PMCID: PMC7165307 DOI: 10.2196/17142] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/26/2020] [Accepted: 03/12/2020] [Indexed: 12/23/2022] Open
Abstract
Background Mobile health (mHealth) apps are dramatically changing how patients and providers manage and monitor chronic health conditions, especially in the area of self-monitoring. African Americans have higher mortality rates from heart failure than other racial groups in the United States. Therefore, self-management of heart failure may improve health outcomes for African American patients. Objective The aim of the present study was to determine the feasibility of using an mHealth app, and explore the outcomes of quality of life, including self-care maintenance, management, and confidence, among African American patients managing their condition after discharge with a diagnosis of heart failure. Methods Prior to development of the app, we conducted qualitative interviews with 7 African American patients diagnosed with heart failure, 3 African American patients diagnosed with cardiovascular disease, and 6 health care providers (cardiologists, nurse practitioners, and a geriatrician) who worked with heart failure patients. In addition, we asked 6 hospital chaplains to provide positive spiritual messages for the patients, since spirituality is an important coping method for many African Americans. These formative data were then used for creating a prototype of the app, named Healthy Heart. Specifically, the Healthy Heart app incorporated the following evidence-based features to promote self-management: one-way messages, journaling (ie, weight and symptoms), graphical display of data, and customized feedback (ie, clinical decision support) based on daily or weekly weight. The educational messages about heart failure self-management were derived from the teaching materials provided to the patients diagnosed with heart failure, and included information on diet, sleep, stress, and medication adherence. The information was condensed and simplified to be appropriate for text messages and to meet health literacy standards. Other messages were derived from interviews conducted during the formative stage of app development, including interviews with African American chaplains. Usability testing was conducted over a series of meetings between nurses, social workers, and computer engineers. A pilot one-group pretest-posttest design was employed with participants using the mHealth app for 4 weeks. Descriptive statistics were computed for each of the demographic variables, overall and subscales for Health Related Quality of Life Scale 14 (HQOL14) and subscales for the Self-Care of Heart Failure Index (SCHFI) Version 6 using frequencies for categorical measures and means with standard deviations for continuous measures. Baseline and postintervention comparisons were computed using the Fisher exact test for overall health and paired t tests for HQOL14 and SCHFI questionnaire subscales. Results A total of 12 African American participants (7 men, 5 women; aged 51-69 years) diagnosed with heart failure were recruited for the study. There was no significant increase in quality of life (P=.15), but clinically relevant changes in self-care maintenance, management, and confidence were observed. Conclusions An mHealth app to assist with the self-management of heart failure is feasible in patients with low literacy, low health literacy, and limited smartphone experience. Based on the clinically relevant changes observed in this feasibility study of the Healthy Heart app, further research should explore effectiveness in this vulnerable population.
Collapse
Affiliation(s)
- Sue P Heiney
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Sara B Donevant
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Swann Arp Adams
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Pearman D Parker
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Hongtu Chen
- Environment and Health Group, Boston, MA, United States
| | - Sue Levkoff
- College of Social Work, University of South Carolina, Columbia, SC, United States
| |
Collapse
|
7
|
Primm K, Ferdinand AO, Callaghan T, Akinlotan MA, Towne SD, Bolin J. Congestive heart failure-related hospital deaths across the urban-rural continuum in the United States. Prev Med Rep 2019; 16:101007. [PMID: 31799105 PMCID: PMC6883321 DOI: 10.1016/j.pmedr.2019.101007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/08/2019] [Accepted: 10/20/2019] [Indexed: 12/02/2022] Open
Abstract
Congestive heart failure (CHF) is a growing public health problem that affects nearly 6.5 million individuals nationwide. Access to quality outpatient care and disease management programs has been shown to improve disease treatment and prognosis. Rural populations face unique challenges in the availability and accessibility of quality cardiovascular care. In 2018, we conducted a pooled cross-sectional analysis of the Nationwide Inpatient Sample (NIS) for 2009–2014 to examine recent trends in CHF-related hospital deaths in the United States, highlighting urban-rural differences within each census region. We performed a multivariable logistic regression analysis to compare the odds of CHF-related hospital death, by levels of rurality and within each census region. Most CHF-related hospital deaths occurred in the South and Midwest census regions and in large central metropolitan areas. Findings from census region stratified models revealed that non-core residents living within the West (OR 1.47, CI 1.26, 1.71), Midwest (OR 1.30, CI 1.17, 1.44), and South (OR = 1.21, 95% C.I. = 1.12–1.32) had a higher relative risk (but not higher absolute numbers) of experiencing death during a CHF-related hospitalization, compared to patients in large central metropolitan areas. Within each census region, there were also differences in odds of a CHF-related hospital death depending on patient sex, comorbidities, insurance type, median annual income, and year. As efforts to reduce rural health disparities in CHF morbidity continue, more work is needed to understand and test interventions to reduce the risk of death from CHF in noncore areas of the West, Midwest, and South.
Collapse
Affiliation(s)
- Kristin Primm
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843-1266, USA.,Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX 77843-1266, USA
| | - Alva O Ferdinand
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX 77843-1266, USA
| | - Timothy Callaghan
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX 77843-1266, USA
| | - Marvellous A Akinlotan
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX 77843-1266, USA
| | - Samuel D Towne
- Department of Health Management and Informatics, University of Central Florida, Orlando, FL 32816, USA.,Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL 32816, USA.,Department of Environmental & Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843-1266, USA
| | - Jane Bolin
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX 77843-1266, USA.,College of Nursing, Texas A&M University, Bryan, TX 77804-1266, USA
| |
Collapse
|
8
|
Omersa D, Erzen I, Lainscak M, Farkas J. Regional differences in heart failure hospitalizations, mortality, and readmissions in Slovenia 2004-2012. ESC Heart Fail 2019; 6:965-974. [PMID: 31264804 PMCID: PMC6816070 DOI: 10.1002/ehf2.12488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/26/2019] [Accepted: 06/01/2019] [Indexed: 12/28/2022] Open
Abstract
Aims Heart failure (HF) burden is displaying significant inter‐regional differences within Europe and within countries. Due to limited data focusing on regional differences, our aim was to evaluate HF hospitalizations, readmissions, and mortality burden in Slovenian statistical regions. Methods and results The Slovenian National Hospitalization Discharge Registry was searched for HF hospitalizations in patients 20 years or over in the period 2004–12. Annual sex and age‐standardized HF hospitalizations, mortality, and HF readmissions rates were calculated for Slovenia and for each Slovenian statistical region. Trends were evaluated using ANOVA. Multiple mixed effect logistic regression models, which included statistical region, admission year, sex, age, intensive care unit treatment, and co‐morbidities as a fixed effect and hospital identifier as a random effect, were calculated for mortality and readmissions. Overall, 156 859 HF hospitalizations (55 522 where HF was coded as a main diagnosis and 43 606 as first HF hospitalizations) were recorded. Annual standardized rates varied considerably between statistical regions for main (220–511) and first HF hospitalization (392–721), 30 day (12.6–27.1) and 1 year mortality (66–117), and 30 day (31–80.8) and 1 year readmission (99–24) (per 100 000 patient years in 2012). Yearly decline in HF hospitalization rates was seen for national main (3.6; 0.001) and first (8.4; 0.083) HF hospitalizations, while individual regional main and first HF hospitalization trends mostly did not reach statistical significance. No relevant differences in mortality and readmission endpoints for statistical regions were seen when adjusted for patient demographics and specific co‐morbidities. Conclusions Significant regional differences in standardized HF hospitalization, mortality, and readmissions between the regions were seen. There were no differences in mortality and readmissions between statistical regions for individual similar patients.
Collapse
Affiliation(s)
- Daniel Omersa
- General Hospital Jesenice, Jesenice, Slovenia.,General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, Rakican, 9000, Murska Sobota, Slovenia
| | - Ivan Erzen
- National Institute of Public Health, Ljubljana, Slovenia
| | - Mitja Lainscak
- General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, Rakican, 9000, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jerneja Farkas
- National Institute of Public Health, Ljubljana, Slovenia.,General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, Rakican, 9000, Murska Sobota, Slovenia
| |
Collapse
|
9
|
Saito M, Yamaoka M, Ohzawa M, Tominaga E, Takahashi K, Morofuji T, Sumimoto T, Inaba S. Impact of residence altitude on readmission in patients with heart failure. Open Heart 2018; 5:e000865. [PMID: 30245838 PMCID: PMC6144892 DOI: 10.1136/openhrt-2018-000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/20/2018] [Accepted: 08/22/2018] [Indexed: 11/25/2022] Open
Abstract
Objective Mountain districts normally have tougher geographic conditions than plain districts, which might worsen heart failure (HF) conditions in patients. Also, those places frequently are associated with social problems of ageing, underpopulation and fewer medical services, which might cause delay in detection of disease progression and require more admissions. We investigated the association of residence altitude with readmission in patients with HF. Methods We followed 452 patients with HF to determine all-cause readmissions over a median of 1.1 years. The altitude of patient residences, population, proportion of the elderly and number of hospitals or clinics in a minor administrative district (Cho-Aza district) located at the residences were examined using data from the 2010 census and Google Maps. Results All-cause readmissions were observed in 269 (60%) patients. The altitude of ≥200 m was significantly associated with readmissions (HR, 1.49; 95 % CI 1.12 to 1.96; p=0.006) after adjustment for physical and haemodynamic parameters, left ventricular ejection fraction, brain natriuretic peptide and components of the established score for predicting readmission for HF. Altitude was significantly associated with ageing, underpopulation, fewer hospitals or clinics and lower temperature (all p<0.01), with an increased tendency for readmission during the winter season; however, it was not associated with patient clinical parameters. Conclusions High altitude residence may be an important predictor for readmission in patients with HF. This relationship may be confounded by unfavourable sociogeographic conditions at higher altitudes.
Collapse
|
10
|
Cuthbertson CC, Heiss G, Wright JD, Camplain R, Patel MD, Foraker RE, Matsushita K, Puccinelli-Ortega N, Shah AM, Kucharska-Newton AM. Socioeconomic status and access to care and the incidence of a heart failure diagnosis in the inpatient and outpatient settings. Ann Epidemiol 2018; 28:350-355. [PMID: 29709334 PMCID: PMC5971162 DOI: 10.1016/j.annepidem.2018.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE Despite well-documented associations of socioeconomic status with incident heart failure (HF) hospitalization, little information exists on the relationship of socioeconomic status with HF diagnosed in the outpatient (OP) setting. METHODS We used Poisson models to examine the association of area-level indicators of educational attainment, poverty, living situation, and density of primary care physicians with incident HF diagnosed in the inpatient (IP) and OP settings among a cohort of Medicare beneficiaries (n = 109,756; 2001-2013). RESULTS The age-standardized rate of HF incidence was 35.8 (95% confidence interval [CI], 35.1-36.5) and 13.9 (95% CI, 13.5-14.4) cases per 1000 person-years in IP and OP settings, respectively. The incidence rate differences (IRDs) per 1000 person-years in both settings suggested greater incidence of HF in high- compared to low-poverty areas (IP IRD = 4.47 [95% CI, 3.29-5.65], OP IRD = 1.41 [95% CI, 0.61-2.22]) and in low- compared to high-education areas (IP IRD = 3.73 [95% CI, 2.63-4.82], OP IRD = 1.72 [95% CI, 0.97-2.47]). CONCLUSIONS Our results highlight the role of area-level social determinants of health in the incidence of HF in both the IP and OP settings. These findings may have implications for HF prevention policies.
Collapse
Affiliation(s)
- Carmen C Cuthbertson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill.
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Jacqueline D Wright
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Ricky Camplain
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ
| | - Mehul D Patel
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Randi E Foraker
- School of Medicine, Washington University in St. Louis, St. Louis, MO
| | | | | | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | | |
Collapse
|
11
|
Leading causes of cardiovascular hospitalization in 8.45 million US veterans. PLoS One 2018; 13:e0193996. [PMID: 29566396 PMCID: PMC5864414 DOI: 10.1371/journal.pone.0193996] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/22/2018] [Indexed: 11/19/2022] Open
Abstract
Background We sought to determine the leading causes of cardiovascular (CV) hospitalization, and to describe and compare national rates of CV hospitalization by age, gender, race, ethnicity, region, and year, among U.S. veterans. Methods We evaluated the electronic health records of all veterans aged ≥18 years who had accessed any healthcare services at either a VA healthcare facility or a non-VA healthcare facility that was reimbursed by the VA, between January 1 2010 and December 31 2014. Among these 8,452,912 patients, we identified the 5 leading causes of CV hospitalization and compared rates of hospitalization by age, gender, race, ethnicity, region, year and type of VA healthcare user. Results The top 5 causes of CV hospitalization were: coronary atherosclerosis, heart failure, acute myocardial infarction, stroke and atrial fibrillation. Overall, 297,373 (3.5%) veterans were hospitalized for one or more of these cardiovascular conditions. The percentage of veterans hospitalized for one or more of these CV conditions decreased over time, from 1.23% in 2010 to 1.18% in 2013, followed by a slight increase to 1.20% in 2014. There was significant variation in rates of CV hospitalization by gender, race, ethnicity, geographic region, and urban vs. rural zip code. In particular, older, male, Black, non-Hispanic, urban and Continental region veterans experienced the highest rates of CV hospitalizations. Conclusions Among 8.5 million patients enrolled in the VA healthcare system from 2010 to 2014, there was substantial variation in rates of CV hospitalization by age, gender, race, geographical distribution, year, and use of non-VA (vs. VA only) healthcare care facilities.
Collapse
|
12
|
Carnethon MR, Pu J, Howard G, Albert MA, Anderson CAM, Bertoni AG, Mujahid MS, Palaniappan L, Taylor HA, Willis M, Yancy CW. Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e393-e423. [PMID: 29061565 DOI: 10.1161/cir.0000000000000534] [Citation(s) in RCA: 645] [Impact Index Per Article: 92.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Population-wide reductions in cardiovascular disease incidence and mortality have not been shared equally by African Americans. The burden of cardiovascular disease in the African American community remains high and is a primary cause of disparities in life expectancy between African Americans and whites. The objectives of the present scientific statement are to describe cardiovascular health in African Americans and to highlight unique considerations for disease prevention and management. METHOD The primary sources of information were identified with PubMed/Medline and online sources from the Centers for Disease Control and Prevention. RESULTS The higher prevalence of traditional cardiovascular risk factors (eg, hypertension, diabetes mellitus, obesity, and atherosclerotic cardiovascular risk) underlies the relatively earlier age of onset of cardiovascular diseases among African Americans. Hypertension in particular is highly prevalent among African Americans and contributes directly to the notable disparities in stroke, heart failure, and peripheral artery disease among African Americans. Despite the availability of effective pharmacotherapies and indications for some tailored pharmacotherapies for African Americans (eg, heart failure medications), disease management is less effective among African Americans, yielding higher mortality. Explanations for these persistent disparities in cardiovascular disease are multifactorial and span from the individual level to the social environment. CONCLUSIONS The strategies needed to promote equity in the cardiovascular health of African Americans require input from a broad set of stakeholders, including clinicians and researchers from across multiple disciplines.
Collapse
|
13
|
Galiatsatos P, Win TT, Monti J, Johnston PV, Herzog W, Trost JC, Hwang CW, Fridman GY, Wang NY, Silber HA. Usefulness of a Noninvasive Device to Identify Elevated Left Ventricular Filling Pressure Using Finger Photoplethysmography During a Valsalva Maneuver. Am J Cardiol 2017; 119:1053-1060. [PMID: 28185634 DOI: 10.1016/j.amjcard.2016.11.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/30/2016] [Accepted: 11/30/2016] [Indexed: 11/25/2022]
Abstract
The high rate of re-hospitalization for heart failure might be reduced by improving noninvasive techniques for identifying elevated left ventricular (LV) filling pressure. We previously showed that changes in a finger photoplethysmography (PPG) waveform during the Valsalva maneuver (VM) reflect invasively measured LV end-diastolic pressure (LVEDP). We have since developed a hand-held device that analyzes PPG while guiding the expiratory effort of a VM. Here we assessed the sensitivity and specificity of this device for identifying elevated LVEDP in patients. We tested 82 participants (28 women), aged 40 to 85 years, before a clinically indicated left heart catheterization. Each performed a VM between 18 and 25 mm Hg for 10 seconds into a pressure transducer. PPG was recorded continuously before and during the VM. LVEDP was measured during the catheterization. An equation for calculating LVEDP was derived using (1) ratio of signal amplitudes: minimum during VM to average at baseline, (2) ratio of peak-to-peak time intervals: minimum during VM to average at baseline, and (3) mean blood pressure. Calculated and measured LVEDP were compared. The range of measured LVEDP was 4 to 35 mm Hg. Calculated LVEDP correlated with measured LVEDP (p <0.0001, r = 0.56). A calculated LVEDP >20 mm Hg had a 70% sensitivity and 86% specificity for identifying measured LVEDP >20 mm Hg (area under receiver-operating characteristic curve 0.83). In conclusion, a hand-held device for assessing LV filling pressure had high specificity and good sensitivity for identifying LVEDP >20 mm Hg, a clinically meaningful threshold in heart failure.
Collapse
|
14
|
Liu Y, Croft JB, Wheaton AG, Kanny D, Cunningham TJ, Lu H, Onufrak S, Malarcher AM, Greenlund KJ, Giles WH. Clustering of Five Health-Related Behaviors for Chronic Disease Prevention Among Adults, United States, 2013. Prev Chronic Dis 2016; 13:E70. [PMID: 27236381 PMCID: PMC4885683 DOI: 10.5888/pcd13.160054] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Introduction Five key health-related behaviors for chronic disease prevention are never smoking, getting regular physical activity, consuming no alcohol or only moderate amounts, maintaining a normal body weight, and obtaining daily sufficient sleep. The objective of this study was to estimate the clustering of these 5 health-related behaviors among adults aged 21 years or older in each state and the District of Columbia and to assess geographic variation in clustering. Methods We used data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) to assess the clustering of the 5 behaviors among 395,343 BRFSS respondents aged 21 years or older. The 5 behaviors were defined as currently not smoking cigarettes, meeting the aerobic physical activity recommendation, consuming no alcohol or only moderate amounts, maintaining a normal body mass index (BMI), and sleeping at least 7 hours per 24-hour period. Prevalence of having 4 or 5 of these behaviors, by state, was also examined. Results Among US adults, 81.6% were current nonsmokers, 63.9% obtained 7 hours or more sleep per day, 63.1% reported moderate or no alcohol consumption, 50.4% met physical activity recommendations, and 32.5% had a normal BMI. Only 1.4% of respondents engaged in none of the 5 behaviors; 8.4%, 1 behavior; 24.3%, 2 behaviors; 35.4%, 3 behaviors; and 24.3%, 4 behaviors; only 6.3% reported engaging in all 5 behaviors. The highest prevalence of engaging in 4 or 5 behaviors was clustered in the Pacific and Rocky Mountain states. Lowest prevalence was in the southern states and along the Ohio River. Conclusion Additional efforts are needed to increase the proportion of the population that engages in all 5 health-related behaviors and to eliminate geographic variation. Collaborative efforts in health care systems, communities, work sites, and schools can promote all 5 behaviors and produce population-wide changes, especially among the socioeconomically disadvantaged.
Collapse
Affiliation(s)
- Yong Liu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Hwy, MS F-78, Atlanta, GA 30341
| | - Janet B Croft
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anne G Wheaton
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dafna Kanny
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Timothy J Cunningham
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hua Lu
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen Onufrak
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ann M Malarcher
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kurt J Greenlund
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wayne H Giles
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
15
|
Abstract
BACKGROUND Heart failure (HF) is a potentially disabling condition requiring significant patient knowledge to manage the requirements of self-care. The need for self-care is important for all patients but particularly for those living in rural areas that are geographically remote from healthcare services. OBJECTIVE The aim of this study was to identify the level of knowledge of rural patients with HF and the clinical and demographic characteristics associated with low levels of HF knowledge. METHODS Baseline data from 612 patients with HF enrolled in the Rural Education to Improve Outcomes in Heart Failure trial were analyzed using the Heart Failure Knowledge Scale, the Short Test of Functional Health Literacy in Adults, and the anxiety subscale of the Brief Symptom Inventory. Multiple linear regression was used to explore the contribution of sociodemographic and clinical variables to levels of HF knowledge. RESULTS The mean (SD) age was 66 (13) years; 59% were men, and 50.5% had an ejection fraction of less than 40%. The mean (SD) percent correct on the Heart Failure Knowledge Scale was 69.5% (13%; range, 25%-100%), with the most frequent incorrect items related to symptoms of HF and the need for daily weights. The men and the older patients scored significantly lower in HF knowledge than did the women and the younger patients (P = 0.002 and 0.011, respectively). The patients with preserved systolic function also scored significantly lower than those with systolic HF (P = 0.030). CONCLUSIONS Patients who are at risk for poor self-care because of low levels of HF knowledge can be identified. Older patients, men, and, patients with HF with preserved systolic function may require special educational strategies to gain the knowledge required for effective self-care.
Collapse
|
16
|
Busby J, Purdy S, Hollingworth W. A systematic review of the magnitude and cause of geographic variation in unplanned hospital admission rates and length of stay for ambulatory care sensitive conditions. BMC Health Serv Res 2015; 15:324. [PMID: 26268576 PMCID: PMC4535775 DOI: 10.1186/s12913-015-0964-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 07/16/2015] [Indexed: 12/03/2022] Open
Abstract
Background Unplanned hospital admissions place a large and increasing strain on healthcare budgets worldwide. Many admissions for ambulatory care sensitive conditions (ACSCs) are thought to be preventable, a belief supported by significant geographic variations in admission rates. We conducted a systematic review of the evidence on the magnitude and correlates of geographic variation in ACSC admission rates and length of stay (LOS). Methods We performed a search of Medline and Embase databases for English language cross-sectional and cohort studies on 28th March 2013 reporting geographic variation in admission rates or LOS for patients receiving unplanned care across at least 10 geographical units for one of 35 previously defined ACSCs. Forward and backward citation searches were undertaken on all included studies. We provide a narrative synthesis of study findings. Study quality was assessed using a modified Newcastle-Ottawa scale. Results We included 39 studies comprising 25 on admission rates and 14 on LOS. Studies generally compared admission rates between regions (e.g. states) and LOS between hospitals. Most of the published research was undertaken in the US, UK or Canada and often focussed on patients with pneumonia, COPD or heart failure. 35 (90 %) studies concluded that geographic variation was present. Primary care quality and secondary care access were frequently suggested as drivers of admission rate variation whilst secondary care quality and adherence to clinical guidelines were often listed as contributors to LOS variation. Several different methods were used to quantify variation, some studies listed raw data, failed to control for confounders and used naive statistical methods which limited their utility. Conclusions The substantial geographical variations in the admission rates and LOS of potentially avoidable conditions could be a symptom of variable quality of care and should be a concern for clinicians and policymakers. Policymakers targeting a reduction in unplanned admissions could introduce initiatives to improve primary care access and quality or develop alternatives to admission. Those attempting to curb unnecessarily long LOS could introduce care pathways or guidelines. Methodological work on the quantification and reporting of geographic variation is needed to aid inter-study comparisons. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0964-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- John Busby
- School of Social and Community Medicine, University of Bristol, Room 2.07, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Sarah Purdy
- Professor of Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - William Hollingworth
- Professor of Health Economics, School of Social and Community Medicine, University of Bristol, Bristol, UK
| |
Collapse
|
17
|
Gustat J, O'Malley K, Hu T, Tabak RG, Goins KV, Valko C, Litt J, Eyler A. Support for physical activity policies and perceptions of work and neighborhood environments: variance by BMI and activity status at the county and individual levels. Am J Health Promot 2015; 28:S33-43. [PMID: 24380463 DOI: 10.4278/ajhp.130430-quan-216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine support for local policies encouraging physical activity and perceived neighborhood environment characteristics by physical activity and weight status of respondents across U.S. counties. DESIGN We used a random-digit-dial, computer-assisted telephone interview (CATI) to conduct a cross-sectional telephone questionnaire in selected U.S. counties in 2011. SETTING Counties with high prevalences of obesity and sedentary behavior (HH; n = 884) and counties with low prevalences of obesity and sedentary behavior (LL; n = 171) were selected nationally. SUBJECTS Adult respondents from HH (n = 642) and LL (n = 566) counties. MEASURES Questions were asked of respondents, pertaining to support for physical activity policies in various settings, neighborhood features, time spent in physical activity and sedentary behaviors, self-reported weight and height, and personal demographic information. ANALYSIS Means and frequencies were calculated; bivariable and multivariable linear and logistic regression models, developed. Models were adjusted for individual characteristics and county HH/LL status. RESULTS Respondents in LL counties perceived their neighborhood and work environments to be more supportive of healthy behaviors and were more supportive of local physical activity policies than respondents in HH counties (p < .001 for all). Positive neighborhood environment perceptions were related to reduced body mass index, increased physical activity, and decreased sedentary behavior. CONCLUSION Policy support and neighborhood environments are associated with behaviors. Results can inform targeting policy agendas to facilitate the improvement of environments (community, work, and school) to be more supportive of physical activity.
Collapse
|
18
|
Cano Martín JA, Martínez-Pérez B, de la Torre-Díez I, López-Coronado M. Economic impact assessment from the use of a mobile app for the self-management of heart diseases by patients with heart failure in a Spanish region. J Med Syst 2014; 38:96. [PMID: 24994514 DOI: 10.1007/s10916-014-0096-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/18/2014] [Indexed: 10/25/2022]
Abstract
Currently, cardiovascular diseases are the deadliest diseases with a total of 17 million deaths worldwide. Hence, they are the focus of many mobile applications for smartphones and tablets. This paper will assess the ex-ante economic impact as well as will determine the cost-effectiveness analysis that the use of one of this app, CardioManager, by patients with heart failure will have in a Spanish community, Castile and Leon. For this, a cost-effectiveness analysis using the hidden Markov model were performed in a hypothetical cohort of patients diagnosed with heart failure, based on the information of epidemiological parameters and the costs derived from the management and care of heart failure patients by the Public Health Care System of Castile and Leon. The costs of patient care were estimated from the perspective of the Ministry of Health of Spain using a discount rate of 3 %. Finally, an estimation of the ex-ante impact that would suppose the introduction of CardioManager in the Health Care System is performed. It is concluded that the introduction of CardioManager may generate a 33 % reduction in the cost of management and treatment of the disease. This means that CardioManager may be able to save more than 9,000 € per patient to the local Health Care System of Castile and Leon, which can be translated in a saving of 0.31 % of the total health expenditure of the region.
Collapse
Affiliation(s)
- José Antonio Cano Martín
- Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid Paseo de Belén, 15. 47011, Valladolid, Spain,
| | | | | | | |
Collapse
|
19
|
Martínez-Pérez B, de la Torre-Díez I, López-Coronado M, Sainz-De-Abajo B. Comparison of mobile apps for the leading causes of death among different income zones: a review of the literature and app stores. JMIR Mhealth Uhealth 2014; 2:e1. [PMID: 25099695 PMCID: PMC4114467 DOI: 10.2196/mhealth.2779] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/07/2013] [Accepted: 12/03/2013] [Indexed: 12/11/2022] Open
Abstract
Background The advances achieved in technology, medicine, and communications in the past decades have created an excellent scenario for the improvement and expansion of eHeath and mHealth in particular. Mobile phones, smartphones, and tablets are exceptional means for the application of mobile health, especially for those diseases and health conditions that are the deadliest worldwide. Objective The main aim of this paper was to compare the amount of research and the number of mobile apps dedicated to the diseases and conditions that are the leading causes of death according to the World Health Organization grouped by different income regions. These diseases and conditions were ischemic heart disease; stroke and other cerebrovascular diseases; lower respiratory infections; chronic obstructive pulmonary disease; diarrheal diseases; HIV/AIDS; trachea, bronchus, and lung cancers; malaria; and Alzheimer disease and other dementias. Methods Two reviews were conducted. In the first, the systems IEEE Xplore, Scopus, Web of Knowledge, and PubMed were used to perform a literature review of applications related to the mentioned diseases. The second was developed in the currently most important mobile phone apps stores: Google play, iTunes, BlackBerry World, and Windows Phone Apps+Games. Results Search queries up to June 2013 located 371 papers and 557 apps related to the leading causes of death, and the following findings were obtained. Alzheimer disease and other dementias are included in the diseases with more apps, although it is not among the top 10 causes of death worldwide, whereas lower respiratory infections, the third leading cause of death, is one of the less researched and with fewer apps. Two diseases that are the first and second of low-income countries (lower respiratory infections and diarrheal diseases) have very little research and few commercial applications. HIV/AIDS, in the top 6 of low-income and middle-income zones, is one of the diseases with more research and applications, although it is not in the top 10 in high-income countries. Trachea, bronchus, and lung cancers are the third cause of death in high-income countries but are one of the least researched diseases with regard to apps. Conclusions Concerning mobile apps, there is more work done in the commercial field than in the research field, although the distribution among the diseases is similar in both fields. In general, apps for common diseases of low- and middle-income countries are not as abundant as those for typical diseases of developed countries. Nevertheless, there are some exceptions such as HIV/AIDS, due to its important social conscience; and trachea, bronchus and lung cancers, which was totally unexpected.
Collapse
Affiliation(s)
- Borja Martínez-Pérez
- University of Valladolid, Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid, Valladolid, Spain.
| | | | | | | |
Collapse
|
20
|
Seymour CW, Iwashyna TJ, Ehlenbach WJ, Wunsch H, Cooke CR. Hospital-level variation in the use of intensive care. Health Serv Res 2012; 47:2060-80. [PMID: 22985033 PMCID: PMC3513618 DOI: 10.1111/j.1475-6773.2012.01402.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine the extent to which hospitals vary in the use of intensive care, and the proportion of variation attributable to differences in hospital practice that is independent of known patient and hospital factors. DATA SOURCE Hospital discharge data in the State Inpatient Database for Maryland and Washington States in 2006. STUDY DESIGN Cross-sectional analysis of 90 short-term, acute care hospitals with critical care capabilities. DATA COLLECTION/METHODS: We quantified the proportion of variation in intensive care use attributable to hospitals using intraclass correlation coefficients derived from mixed-effects logistic regression models after successive adjustment for known patient and hospital factors. PRINCIPAL FINDINGS The proportion of hospitalized patients admitted to an intensive care unit (ICU) across hospitals ranged from 3 to 55 percent (median 12 percent; IQR: 9, 17 percent). After adjustment for patient factors, 19.7 percent (95 percent CI: 15.1, 24.4) of total variation in ICU use across hospitals was attributable to hospitals. When observed hospital characteristics were added, the proportion of total variation in intensive care use attributable to unmeasured hospital factors decreased by 26-14.6 percent (95 percent CI: 11, 18.3 percent). CONCLUSIONS Wide variability exists in the use of intensive care across hospitals, not attributable to known patient or hospital factors, and may be a target to improve efficiency and quality of critical care.
Collapse
Affiliation(s)
- Christopher W Seymour
- Departments of Critical Care and Emergency Medicine, University of Pittsburgh School of Medicine, Core Faculty, Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, 639 Scaife Hall 3550 Terrace Street, Pittsburgh, PA 15261, USA.
| | | | | | | | | |
Collapse
|
21
|
Rural–urban disparities in use of post-lumpectomy radiation. Med Oncol 2012; 29:3250-7. [DOI: 10.1007/s12032-012-0266-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 05/24/2012] [Indexed: 10/28/2022]
|
22
|
Geographic variations in heart failure hospitalizations among medicare beneficiaries in the Tennessee catchment area. Am J Med Sci 2012; 343:71-7. [PMID: 21804374 DOI: 10.1097/maj.0b013e318223bbd4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Although differences in heart failure (HF) hospitalization rates by race and sex are well documented, little is known about geographic variations in hospitalizations for HF, the most common discharge diagnosis for Medicare beneficiaries. METHODS Using exploratory spatial data analysis techniques, the authors examined hospitalization rates for HF as the first-listed discharge diagnosis among Medicare beneficiaries in a 10-state Tennessee catchment area, based on the resident states reported by Tennessee hospitals from 2000 to 2004. RESULTS The age-adjusted HF hospitalization rate (per 1000) among Medicare beneficiaries was 23.3 [95% confidence interval (CI), 23.3-23.4] for the Tennessee catchment area, 21.4 (95% CI, 21.4-21.5) outside the catchment area and 21.9 (95% CI, 21.9-22.0) for the overall United States. The age-adjusted HF hospitalization rates were also significantly higher in the catchment area than outside the catchment area and overall, among men, women and whites, whereas rates among the blacks were higher outside the catchment area. Beneficiaries in the catchment area also had higher age-specific HF hospitalization rates. Among states in the catchment area, the highest mean county-level rates were in Mississippi (30.6 ± 7.6) and Kentucky (29.2 ± 11.5), and the lowest were in North Carolina (21.7 ± 5.7) and Virginia (21.8 ± 6.6). CONCLUSIONS Knowledge of these geographic differences in HF hospitalization rates can be useful in identifying needs of healthcare providers, allocating resources, developing comprehensive HF outreach programs and formulating policies to reduce these differences.
Collapse
|
23
|
Hlatky MA, Heidenreich PA. The year in epidemiology, health services research, and outcomes research. J Am Coll Cardiol 2011; 57:1859-66. [PMID: 21545941 DOI: 10.1016/j.jacc.2011.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 01/11/2011] [Accepted: 01/17/2011] [Indexed: 01/08/2023]
Affiliation(s)
- Mark A Hlatky
- Stanford University School of Medicine, Stanford, CA 94305, USA.
| | | |
Collapse
|
24
|
|
25
|
Sacramento area breast cancer epidemiology study: use of postmastectomy breast reconstruction along the rural-to-urban continuum. Plast Reconstr Surg 2011; 126:1815-1824. [PMID: 21124121 DOI: 10.1097/prs.0b013e3181f444bc] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health care disparities have been documented in rural populations. The authors hypothesized that breast cancer patients in urban counties would have higher rates of postmastectomy breast reconstruction relative to patients in surrounding near-metro and rural counties. METHODS The authors used the Surveillance, Epidemiology, and End Results database to identify patients diagnosed with breast cancer and treated with mastectomy in the greater Sacramento area between 2000 and 2006. Counties were categorized as urban, near-metro, or rural. Univariate models evaluated the relationship of rural, near-metro, or urban location with use of breast reconstruction by means of the chi-square test. Multivariate logistic regression models controlling for patient, tumor, and treatment-related factors predicted use of breast reconstruction. The likelihood of undergoing breast reconstruction was reported as odds ratios with 95 percent confidence intervals; significance was set at p≤0.05. RESULTS Complete information was available for 3552 breast cancer patients treated with mastectomy. Of these, 718 (20.2 percent) underwent breast reconstruction. On univariate analysis, differences in the rates of breast reconstruction were noted among urban, near-metro, and rural areas (p<0.001). On multivariate analysis, patients from rural (odds ratio, 0.51; 95 percent confidence interval, 0.28 to 0.93; p<0.03) and near-metro (odds ratio, 0.73; 95 percent confidence interval, 0.59 to 0.89; p=0.002) areas had a decreased likelihood of undergoing breast reconstruction relative to patients from urban areas. CONCLUSIONS Patients from near-metro and rural areas are less likely to undergo breast reconstruction following mastectomy for breast cancer than their urban counterparts. Differences in use of breast reconstruction detected at a population level should guide future interventions to increase rates of breast reconstruction at the local level.
Collapse
|