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Movahedi Nia Z, Prescod C, Westin M, Perkins P, Goitom M, Fevrier K, Bawa S, Kong J. Cross-sectional study to assess the impact of the COVID-19 pandemic on healthcare services and clinical admissions using statistical analysis and discovering hotspots in three regions of the Greater Toronto Area. BMJ Open 2024; 14:e082114. [PMID: 38485179 PMCID: PMC10941105 DOI: 10.1136/bmjopen-2023-082114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES The COVID-19 pandemic disrupted healthcare services, leading to the cancellation of non-urgent tests, screenings and procedures, a shift towards remote consultations, stalled childhood immunisations and clinic closures which had detrimental effects across the healthcare system. This study investigates the impact of the COVID-19 pandemic on clinical admissions and healthcare quality in the Peel, York and Toronto regions within the Greater Toronto Area (GTA). DESIGN In a cross-sectional study, the negative impact of the pandemic on various healthcare sectors, including preventive and primary care (PPC), the emergency department (ED), alternative level of care (ALC) and imaging, procedures and surgeries is investigated. Study questions include assessing impairments caused by the COVID-19 pandemic and discovering hotspots and critical subregions that require special attention to recover. The measuring technique involves comparing the number of cases during the COVID-19 pandemic with before that, and determining the difference in percentage. Statistical analyses (Mann-Whitney U test, analysis of variance, Dunn's test) is used to evaluate sector-specific changes and inter-relationships. SETTING This work uses primary data which were collected by the Black Creek Community Health Centre. The study population was from three regions of GTA, namely, the city of Toronto, York and Peel. For all health sectors, the sample size was large enough to have a statistical power of 0.95 to capture 1% variation in the number of cases during the COVID-19 pandemic compared with before that. RESULTS All sectors experienced a significant decline in patient volume during the pandemic. ALC admissions surged in some areas, while IPS patients faced delays. Surgery waitlists increased by an average of 9.75%, and completed IPS procedures decreased in several subregions. CONCLUSIONS The COVID-19 pandemic had a universally negative impact on healthcare sectors across various subregions. Identification of the hardest-hit subregions in each sector can assist health officials in crafting recovery policies.
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Affiliation(s)
- Zahra Movahedi Nia
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
- Resilience Research Atlantic Alliance on Sustainability, Supporting Recovery and Renewal (REASURE2) Network, Toronto, Ontario, Canada
| | - Cheryl Prescod
- Black Creek Community Health Centre, Toronto, Ontario, Canada
| | - Michelle Westin
- Black Creek Community Health Centre, Toronto, Ontario, Canada
| | - Patricia Perkins
- Resilience Research Atlantic Alliance on Sustainability, Supporting Recovery and Renewal (REASURE2) Network, Toronto, Ontario, Canada
- Faculty of Environment and Urban Change, York University, Toronto, Ontario, Canada
| | - Mary Goitom
- Resilience Research Atlantic Alliance on Sustainability, Supporting Recovery and Renewal (REASURE2) Network, Toronto, Ontario, Canada
- School of Social Work, York University, Toronto, Ontario, Canada
| | - Kesha Fevrier
- Resilience Research Atlantic Alliance on Sustainability, Supporting Recovery and Renewal (REASURE2) Network, Toronto, Ontario, Canada
- Department of Geography and Planning, Queen's University, Kingston, New York, Canada
| | - Sylvia Bawa
- Resilience Research Atlantic Alliance on Sustainability, Supporting Recovery and Renewal (REASURE2) Network, Toronto, Ontario, Canada
- Department of Sociology, York University, Toronto, Ontario, Canada
| | - Jude Kong
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
- Resilience Research Atlantic Alliance on Sustainability, Supporting Recovery and Renewal (REASURE2) Network, Toronto, Ontario, Canada
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Hughes Z, Simkowski J, Mendapara P, Fink N, Gupta S, Youmans Q, Khan S, Wilcox J, Mutharasan RK. Racial and Socioeconomic Differences in Heart Failure Hospitalizations and Telemedicine Follow-up During the COVID-19 Pandemic: A Retrospective Cohort Study (Preprint). JMIR Cardio 2022; 6:e39566. [DOI: 10.2196/39566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/13/2022] [Accepted: 11/13/2022] [Indexed: 11/15/2022] Open
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Morabito C, De Fazio MG, Parisi F, Demurtas E, Orlando L, Scarano M. Chronic heart failure and hypotensive effects of sacubitril/valsartan. A clinical case. Cor Vasa 2021; 63:715-8. [DOI: 10.33678/cor.2021.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Corrado E, Dattilo G, Coppola G, Morabito C, Bonni E, Zappia L, Novo G, de Gregorio C. Low- vs high-dose ARNI effects on clinical status, exercise performance and cardiac function in real-life HFrEF patients. Eur J Clin Pharmacol 2021; 78:19-25. [PMID: 34554274 PMCID: PMC8458558 DOI: 10.1007/s00228-021-03210-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/27/2021] [Indexed: 12/03/2022]
Abstract
Purpose Only a few studies are available on dose-related effects of sacubitril/valsartan (angiotensin receptor neprilysin inhibition (ARNI)) in real-life patients with heart failure and reduced ejection fraction (HFrEF). We sought to investigate clinical and functional effects in real-life HFrEF patients receiving ARNI at a different cumulative dose. Methods This was an observational study in consecutive outpatients admitted for HFrEF from October 2017 to June 2019. The PARADIGM criteria were needed for enrolment. ARNI was uptitrated according to blood pressure, drug tolerability, renal function and kaliemia. At least 10-month follow-up was required in each patient. Clinical assessment, Kansas City Cardiomyopathy Questionnaire (KCCQ) score, 6-min walk test and strain echocardiography were performed in each patient on a regular basis during the observational period. At the end of the study, patients were divided into two groups based on the median yearly dose of the ARNI medication. Results A total of 90 patients, 64 ± 11 years, 82% males, were enrolled. The cut-off dose was established in 75 mg BID, and the study population was divided into group A (≤ 75 mg), 52 patients (58%), and group B (> 75 mg), 38 patients (42%). The follow-up duration was 12 months (range 11–13). NYHA class, KCCQ score and 6MWT performance ameliorated in both groups, with a quicker time to benefit in group B. The proportion of patients walking > 350 m increased from 21 to 58% in group A (p < 0.001), and from 29 to 82% in group B (p < 0.001). A positive effect was also disclosed in the left ventricular remodelling, strain deformation and diastolic function. Conclusion One-year ARNI treatment was effective in our real-life HFrEF patient population, leading to clinical and functional improvement in both study groups, slightly greater and with a shorter time to benefit in group B. Supplementary information The online version contains supplementary material available at 10.1007/s00228-021-03210-0.
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Affiliation(s)
- Egle Corrado
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Division of Cardiology, University of Palermo, University Hospital of Palermo, Palermo, Italy
| | - Giuseppe Dattilo
- Department of Clinical and Experimental Medicine, Division of Cardiology, Heart Failure Outpatient Unit, University of Messina, Messina, Italy
| | - Giuseppe Coppola
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Division of Cardiology, University of Palermo, University Hospital of Palermo, Palermo, Italy
| | - Claudia Morabito
- Department of Clinical and Experimental Medicine, Division of Cardiology, Heart Failure Outpatient Unit, University of Messina, Messina, Italy
| | - Enrico Bonni
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Division of Cardiology, University of Palermo, University Hospital of Palermo, Palermo, Italy
| | - Luca Zappia
- Department of Clinical and Experimental Medicine, Division of Cardiology, Heart Failure Outpatient Unit, University of Messina, Messina, Italy
| | - Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Division of Cardiology, University of Palermo, University Hospital of Palermo, Palermo, Italy
| | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, Division of Cardiology, Heart Failure Outpatient Unit, University of Messina, Messina, Italy.
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Cordero A, Rodríguez-Mañero M, Bertomeu-González V, García-Acuña JM, Baluja A, Agra-Bermejo R, Álvarez-Álvarez B, Cid B, Zuazola P, González-Juanatey JR. Insuficiencia cardiaca de novo tras un síndrome coronario agudo en pacientes sin insuficiencia cardiaca ni disfunción ventricular izquierda. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.03.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Chan DZL, Kerr AJ, Doughty RN. Temporal trends in the burden of heart failure. Intern Med J 2021; 51:1212-1218. [PMID: 33650267 DOI: 10.1111/imj.15253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/13/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
Heart failure is a common healthcare problem associated with high morbidity and mortality. The burden of heart failure is changing; increases secondary to an ageing population may be offset by improved primary cardiovascular prevention and advances in heart failure therapies. In this review, we evaluate recent international trends in heart failure incidence, morbidity and mortality. Although the age-standardised incidence of heart failure has been decreasing since 2000, the incidence in those age groups <55 years is increasing with patients being diagnosed at younger ages. Despite improvements in therapies for heart failure, prognosis still remains poor with up to one-third of patients not surviving beyond 1 year following diagnosis and no improvements in mortality over the past 10 years. The case-mix of heart failure patients is changing with a greater proportion having non-ischaemic aetiology and preserved ejection fraction, and a higher prevalence of non-cardiovascular comorbidity and mortality.
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Affiliation(s)
- Daniel Z L Chan
- Department of Cardiology, Counties Manukau District Health Board, Auckland, New Zealand
| | - Andrew J Kerr
- Department of Cardiology, Counties Manukau District Health Board, Auckland, New Zealand.,School of Population Health, University of Auckland, Auckland, New Zealand
| | - Rob N Doughty
- Department of Medicine, University of Auckland, Auckland, New Zealand.,Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
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Casale M, Correale M, Laterra G, Vaccaro V, Morabito C, Crea P, Signorelli SS, Katsiki N, Luzza F, de Gregorio C, Dattilo G. Effects of Sacubitril/Valsartan in Patients with High Arrhythmic Risk and an ICD: A Longitudinal Study. Clin Drug Investig 2021; 41:169-176. [PMID: 33484468 DOI: 10.1007/s40261-020-00995-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Patients affected by heart failure with reduced ejection fraction (HFrEF) receive clinical and functional beneficial effects from treatment with sacubitril/valsartan. However previous studies have shown that patients with an implantable cardioverter defibrillator (ICD) could obtain even greater benefit, but only make up a only a small proportion of patients. In the current study we evaluated the effect of sacubitril/valsartan in patients with an ICD. METHODS Thirty-five outpatients with HFrEF (aged 60 ± 11 years, 28 were males), on optimal medical therapy were studied. All patients received an ICD at least 6 months before enrollment or were non-responders to ICD plus resynchronization (CRT-D). An open-label sacubitril/valsartan treatment was established at the maximum tolerated dose. Clinical assessment, 6-min walk test (6MWT) and echocardiography, were performed during follow-up at 90, 180, and 360 days. Quality of life score and perceived fatigue on exercise were assessed. RESULTS Clinical conditions dramatically improved in most patients, especially within the first 6 months of therapy (76 % were in NYHA-I and 24 % in NYHA-II at the end of study vs 71 % NYHA-II and 29 % NYHA III at enrollment, p < 0.001). Quality of life and exercise performance significantly improved according to N-terminal pro-brain natriuretic peptide (NT-proBNP) serum levels lowering. Walking distance at 6MWT increased from 274 ± 97 to 389 ± 53 m and walking speed from 0.74 ± 0.27 to 1.07 ± 0.15 m/s (p < 0.001), while oxygen saturation did not differ significantly (from 90 ± 1 % to 91 ± 2 %). More gradual was left ventricular reverse remodeling. Ejection fraction improved mildly (+ 5 points %, p < 0.001). Global longitudinal strain and diastolic function were also assessed over time. CONCLUSION Sacubitril/valsartan therapy for HFrEF may lead to significant clinical and functional improvements even in patients with ICD at greater arrhythmic risk. Clinical improvement is obtained within the first 6 months of treatment while reverse remodeling needs more time.
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Affiliation(s)
- Matteo Casale
- Operative Unit of ICCU and Cardiology, Hospital "S. Maria della Misericordia", ASUR Marche-Area Vasta 1, Urbino, Italy
| | - Michele Correale
- Operative Unit of Cardiology, University Hospital "Policlinico Riuniti", Foggia, Italy.
| | - Giulia Laterra
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vittoria Vaccaro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Claudia Morabito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Pasquale Crea
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Niki Katsiki
- Second Department of Propaedeutic Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Francesco Luzza
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Dattilo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Köse A, Çelik A, Altınsoy E, Bozkurt Babus S, Erdoğan S. The Effect of Emergency Department Visits and Inflammatory Markers on One-Year Mortality in Patients with Heart Failure. Cardiovasc Toxicol 2020; 21:49-58. [PMID: 32895868 DOI: 10.1007/s12012-020-09594-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
The neurohumoral and inflammatory pathways proposed for the development and progression of heart failure (HF) remain up-to-date. We aimed to investigate the effect of emergency department (ED) visits and inflammatory markers on mortality in HF patients. Two-hundred patients with stable chronic HF followed by the cardiology clinic were included in this study. The patients were divided into two groups as patients who had visited the ED due to worsening HF symptoms within the last 6 months (ED visit Group) and who had not (No ED visit Group). The demographical properties, clinical characteristics, and laboratory values including inflammatory markers of the patients were recorded. During the follow-up period, 38 patients (19%) died. In HF patients with previous ED visits, the mortality risk was 2.091 times higher (relative risk, RR). It was identified that the HF patients who died during the follow-up had higher initial NLR (p = 0.004), IG% (p = 0.029), hs-CRP (p = 0.001), and NT-proBNP (p = 0.004) values. It was observed that the area under the curve (AUC) values, NLR (AUC: 0.705, p < 0.001), IG% (AUC: 0.652, p = 0.003), and hs-CRP (AUC: 0.732, p < 0.001) were very strong predictors of the 1-year mortality. According to the cut-off points, the mortality risk (RR) was 3.39 times higher in patients with NLR > 3.7 (95% CI 1.783-6.444), 2.39 times higher when IG% > 0.4 (95% CI 1.16-4.957), and 4,2 times higher when hs-CRP > 9.9 mg/dl (95% CI 2.16-8.16) (p < 0.05). The patients with chronic stable HF who visited the ED within the last six months and having increased NLR, IG%, and CRP levels among inflammatory markers were associated with a higher mortality risk at 1 year.
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Affiliation(s)
- Ataman Köse
- Faculty of Medicine, Department of Emergency Medicine, Mersin University, Mersin, Turkey.
| | - Ahmet Çelik
- Faculty of Medicine, Department of Cardiology, Mersin University, Mersin, Turkey
| | - Ersin Altınsoy
- Faculty of Medicine, Department of Emergency Medicine, Mersin University, Mersin, Turkey
| | - Seyran Bozkurt Babus
- Faculty of Medicine, Department of Emergency Medicine, Mersin University, Mersin, Turkey
| | - Semra Erdoğan
- Faculty of Medicine, Department of Biostatistics and Medical Informatics, Mersin University, Mersin, Turkey
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de Gregorio C, Laterra G, Vaccaro V, Bitto R, Dattilo G. Time-based clinical and functional achievements in real-life HF patients on ARNI treatment. Eur J Intern Med 2020; 76:115-117. [PMID: 32089420 DOI: 10.1016/j.ejim.2020.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/04/2020] [Accepted: 02/11/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Cesare de Gregorio
- Cardiology HF Outpatient Unit, Department of Clinical and Experimental Medicine, Postgraduate Residency School in Cardiovascular Diseases, G. Martino University Hospital, Messina, Italy; Cardiology Unit at Department of Emergency, G. Martino University Hospital, Messina, Italy.
| | - Giulia Laterra
- Cardiology HF Outpatient Unit, Department of Clinical and Experimental Medicine, Postgraduate Residency School in Cardiovascular Diseases, G. Martino University Hospital, Messina, Italy
| | - Vittoria Vaccaro
- Cardiology HF Outpatient Unit, Department of Clinical and Experimental Medicine, Postgraduate Residency School in Cardiovascular Diseases, G. Martino University Hospital, Messina, Italy
| | - Roberto Bitto
- Cardiology Unit at Department of Emergency, G. Martino University Hospital, Messina, Italy
| | - Giuseppe Dattilo
- Cardiology HF Outpatient Unit, Department of Clinical and Experimental Medicine, Postgraduate Residency School in Cardiovascular Diseases, G. Martino University Hospital, Messina, Italy; Cardiology Unit at Department of Emergency, G. Martino University Hospital, Messina, Italy
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Cordero A, Rodríguez-Mañero M, Bertomeu-González V, García-Acuña JM, Baluja A, Agra-Bermejo R, Álvarez-Álvarez B, Cid B, Zuazola P, González-Juanatey JR. New-onset heart failure after acute coronary syndrome in patients without heart failure or left ventricular dysfunction. ACTA ACUST UNITED AC 2020; 74:494-501. [PMID: 32448726 DOI: 10.1016/j.rec.2020.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Coronary heart disease is the leading cause of heart failure (HF). The aim of this study was to assess the risk of readmission for HF in patients with acute coronary syndrome without previous HF or left ventricular dysfunction. METHODS Prospective study of consecutive patients admitted for acute coronary syndrome in 2 institutions. Risk factors for HF were analyzed by competing risk regression, taking all-cause mortality as a competing event. RESULTS We included 5962 patients and 567 (9.5%) experienced at least 1 hospital readmission for acute HF. Median follow-up was 63 months and median time to HF readmission was 27.1 months. The cumulative incidence of HF was higher than mortality in the first 7 years after hospital discharge. A higher risk of HF readmission was associated with age, diabetes, previous coronary heart disease, GRACE score> 140, peripheral arterial disease, renal dysfunction, hypertension and atrial fibrillation; a lower risk was associated with optimal medical treatment. The incidence of HF in the first year of follow-up was 2.73% and no protective variables were found. A simple HF risk score predicted HF readmissions risk. CONCLUSIONS One out of 10 patients discharged after an acute coronary syndrome without previous HF or left ventricular dysfunction had new-onset HF and the risk was higher than the risk of mortality. A simple clinical score can estimate individual risk of HF readmission even in patients without previous HF or left ventricular dysfunction.
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Affiliation(s)
- Alberto Cordero
- Departamento de Cardiología, Hospital Universitario de San Juan, Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Moisés Rodríguez-Mañero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Vicente Bertomeu-González
- Departamento de Cardiología, Hospital Universitario de San Juan, Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - José M García-Acuña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Aurora Baluja
- Departamento de Anestesiología, Cuidados Intensivos y Tratamiento del Dolor, Complejo Hospitalario de la Universidad de Santiago, Santiago de Compostela, A Coruña, Spain; Grupo de Investigación del Paciente Crítico, Fundación Instituto de Investigación Sanitaria de Santiago de Compostela, Universidad de Santiago de Compostela, A Coruña, Spain
| | - Rosa Agra-Bermejo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Belén Álvarez-Álvarez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Belén Cid
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Pilar Zuazola
- Departamento de Cardiología, Hospital Universitario de San Juan, Alicante, Spain
| | - José R González-Juanatey
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
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Sterling MR, Jannat-Khah D, Bryan J, Banerjee S, McClure LA, Wadley VG, Unverzagt FW, Levitan EB, Goyal P, Peterson JC, Manly JJ, Levine DA, Safford MM. The Prevalence of Cognitive Impairment Among Adults With Incident Heart Failure: The "Reasons for Geographic and Racial Differences in Stroke" (REGARDS) Study. J Card Fail 2018; 25:130-136. [PMID: 30582968 PMCID: PMC6377841 DOI: 10.1016/j.cardfail.2018.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cognitive impairment (CI) is estimated to be present in 25%-80% of heart failure (HF) patients, but its prevalence at diagnosis is unclear. To improve our understanding of cognition in HF, we determined the prevalence of CI among adults with incident HF in the REGARDS study. METHODS AND RESULTS REGARDS is a longitudinal cohort study of adults ≥45 years of age recruited in the years 2003-2007. Incident HF was expert adjudicated. Cognitive function was assessed with the Six-Item Screener. The prevalence of CI among those with incident HF was compared with the prevalence of CI among an age-, sex-, and race-matched cohort without HF. The 436 participants with incident HF had a mean age of 70.3 years (SD 8.9), 47% were female, and 39% were black. Old age, black race, female sex, less education, and anticoagulation use were associated with CI. The prevalence of CI among participants with incident HF (14.9% [95% CI 11.7%-18.6%]) was similar to the non-HF matched cohort (13.4% [11.6%-15.4%]; P < .43). CONCLUSIONS A total of 14.9% of the adults with incident HF had CI, suggesting that the majority of cognitive decline occurs after HF diagnosis. Increased awareness of CI among newly diagnosed patients and ways to mitigate it in the context of HF management are warranted.
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Affiliation(s)
- Madeline R Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York.
| | - Deanna Jannat-Khah
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Joanna Bryan
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Samprit Banerjee
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - Leslie A McClure
- Dornsife School of Public Health at Drexel University, Philadelphia, Pennsylvania
| | - Virginia G Wadley
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Frederick W Unverzagt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Parag Goyal
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Janey C Peterson
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Jennifer J Manly
- Department of Neurology, Columbia University Medical Center, New York, New York
| | - Deborah A Levine
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 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.
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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
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