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Huffman MD, Baldridge AS, Lazar D, Abbas H, Mejia J, Flowers FM, Quintana A, Jackson A, Kandula NR, Lloyd-Jones DM, Persell SD, Khan SS, Paparello JJ, Chopra A, Tripathi P, Vu MH, Chow CK, Ciolino JD. Efficacy and safety of a four-drug, quarter-dose treatment for hypertension: the QUARTET USA randomized trial. Hypertens Res 2024:10.1038/s41440-024-01658-y. [PMID: 38584159 DOI: 10.1038/s41440-024-01658-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 04/09/2024]
Abstract
New approaches are needed to lower blood pressure (BP) given persistently low control rates. QUARTET USA sought to evaluate the effect of four-drug, quarter-dose BP lowering combination in patients with hypertension. QUARTET USA was a randomized (1:1), double-blinded trial conducted in federally qualified health centers among adults with hypertension. Participants received either a quadpill of candesartan 2 mg, amlodipine 1.25 mg, indapamide 0.625 mg, and bisoprolol 2.5 mg or candesartan 8 mg for 12 weeks. If BP was >130/>80 mm Hg at 6 weeks in either arm, then participants received open label add-on amlodipine 5 mg. The primary outcome was mean change in systolic blood pressure (SBP) at 12 weeks, controlling for baseline BP. Secondary outcomes included mean change in diastolic blood pressure (DBP), and safety included serious adverse events, relevant adverse drug effects, and electrolyte abnormalities. Among 62 participants randomized between August 2019-May 2022 (n = 32 intervention, n = 30 control), mean (SD) age was 52 (11.5) years, 45% were female, 73% identified as Hispanic, and 18% identified as Black. Baseline mean (SD) SBP was 138.1 (11.2) mmHg, and baseline mean (SD) DBP was 84.3 (10.5) mmHg. In a modified intention-to-treat analysis, there was no significant difference in SBP (-4.8 mm Hg [95% CI: -10.8, 1.3, p = 0.123] and a -4.9 mmHg (95% CI: -8.6, -1.3, p = 0.009) greater mean DBP change in the intervention arm compared with the control arm at 12 weeks. Adverse events did not differ significantly between arms. The quadpill had a similar SBP and greater DBP lowering effect compared with candesartan 8 mg. Trial registration number: NCT03640312.
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Affiliation(s)
- Mark D Huffman
- Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, MO, USA.
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Abigail S Baldridge
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, USA
| | | | - Hiba Abbas
- Access Community Health Network, Chicago, IL, USA
| | - Jairo Mejia
- Access Community Health Network, Chicago, IL, USA
| | | | | | | | - Namratha R Kandula
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Stephen D Persell
- Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sadiya S Khan
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - James J Paparello
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Nephrology and Hypertension, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Aashima Chopra
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Priya Tripathi
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - My H Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Clara K Chow
- Westmead Applied Research Centre, University of Sydney, Westmead, NSW, Australia
| | - Jody D Ciolino
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Northwestern University Data Analysis and Coordinating Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Appadurai V, Ayuba G, Flaherty JD, Malaisrie SC, Meng Z, Baldridge AS, Chen C, Slostad B, McCarthy P, Puthumana J, Davidson CJ, Narang A. Temporal Trends in Right Ventricular to Pulmonary Artery Coupling in Patients Undergoing Transcatheter Mitral Valve-in-Valve Replacement for Degenerated Mitral Bioprostheses. J Am Soc Echocardiogr 2024; 37:471-473. [PMID: 38237692 DOI: 10.1016/j.echo.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 12/27/2023] [Accepted: 12/30/2023] [Indexed: 02/23/2024]
Affiliation(s)
- Vinesh Appadurai
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Gloria Ayuba
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - James D Flaherty
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - S Christopher Malaisrie
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Zhiying Meng
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Abigail S Baldridge
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Chen Chen
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Brody Slostad
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Patrick McCarthy
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Jyothy Puthumana
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Charles J Davidson
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Akhil Narang
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611.
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Orji IA, Baldridge AS, Ikechukwu-Orji MU, Banigbe B, Eze NC, Chopra A, Omitiran K, Iyer G, Odoh D, Alex-Okoh M, Reng R, Hirschhorn LR, Huffman MD, Ojji DB. Evaluation of Primary Healthcare Centers' Service Availability and Readiness for Implementing Diabetes Care in Abuja, Nigeria: A Cross-Sectional, Formative Assessment. Res Sq 2024:rs.3.rs-3959541. [PMID: 38585872 PMCID: PMC10996784 DOI: 10.21203/rs.3.rs-3959541/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Introduction Noncommunicable diseases (NCDs) are associated with a high and rising burden of morbidity and mortality in sub-Saharan Africa, including Nigeria. Diabetes mellitus (DM) is among the leading causes of NCD-related deaths worldwide and is a foremost public health problem in Nigeria. As part of the National Multi-Sectoral Action Plan for the Prevention and Control of NCDs, Nigeria has committed to implementing the World Health Organization (WHO) Package of Essential NCD control interventions. Implementing the intervention requires the availability of essential elements, including guidelines, trained staff, health management information systems, equipment, and medications, in primary healthcare centers (PHCs). This study assessed the availability of the WHO package components and the readiness of PHCs to implement a DM screening, evaluation, and management program. Methods This cross-sectional formative assessment adapted the WHO Service Availability and Readiness Assessment (SARA) tool to survey 30 PHCs selected by multistage sampling for readiness to deliver DM diagnosis and care in Abuja, Nigeria, between August 2021 and October 2021. The service availability and readiness indicator scores were calculated based on the proportion of PHCs with available DM care services, minimum staff requirement, diagnostic tests, equipment, medications, and national guidelines/protocols for DM care within the defined SARA domain. Results All 30 PHCs reported the availability of at least two full-time staff (median [interquartile range] staff = 5 [4-9]), which were mostly community health extension workers (median [interquartile range]) = 3 [1-4]. At least one staff member was recently trained in DM care in only 11 (36%) of the PHCs. The study also reported high availability (100%) of paper-based health management information systems (HMIS) and DM screening services using a glucometer (87%), but low availability of DM treatment (23%), printed job aids (27%), and national guidelines/protocols (0%). Conclusion This systematic assessment of PHCs' readiness to implement a DM screening, evaluation, and management program in Abuja demonstrated readiness to integrate DM care into PHCs in terms of equipment, paper-based HMIS, and nonphysician health workers' availability. However, strategies are needed to promote DM health workforce training, provide DM management guidelines, and ensure a reliable supply of essential DM medications.
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Affiliation(s)
- Ikechukwu A Orji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja
| | - Abigail S Baldridge
- Department of Medical Social Science, Northwestern University Feinberg School of Medicine and Robert J Havey Institute for Global Health, Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Nelson C Eze
- Department of Public Health, Federal Ministry of Health, Abuja
| | - Aashima Chopra
- Department of Medical Social Science, Northwestern University Feinberg School of Medicine and Robert J Havey Institute for Global Health, Feinberg School of Medicine, Chicago, Illinois
| | - Kasarachi Omitiran
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja
| | - Guhan Iyer
- Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, Missouri
| | - Deborah Odoh
- Department of Public Health, Federal Ministry of Health, Abuja
| | | | - Rifkatu Reng
- Prof. F. Anuma Diabetes & Endocrine Center, University of Abuja Teaching Hospital, Gwagwalada, Abuja
| | - Lisa R Hirschhorn
- Department of Medical Social Science, Northwestern University Feinberg School of Medicine and Robert J Havey Institute for Global Health, Feinberg School of Medicine, Chicago, Illinois
| | - Mark D Huffman
- Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, Missouri
| | - Dike B Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja
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Ye J, Sanuade OA, Hirschhorn LR, Walunas TL, Smith JD, Birkett MA, Baldridge AS, Ojji DB, Huffman MD. Interventions and contextual factors to improve retention in care for patients with hypertension in primary care: Hermeneutic systematic review. Prev Med 2024; 180:107880. [PMID: 38301908 PMCID: PMC10919242 DOI: 10.1016/j.ypmed.2024.107880] [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: 04/07/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Regular engagement over time in hypertension care, or retention, is a crucial but understudied step in optimizing patient outcomes. This systematic review leverages a hermeneutic methodology to identify, evaluate, and quantify the effects of interventions and contextual factors for improving retention for patients with hypertension. METHODS We searched for articles that were published between 2000 and 2022 from multiple electronic databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, and WHO International Trials Registry. We followed the latest version of the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline to report the findings for this review. We also synthesized the findings using a hermeneutic methodology for systematic reviews, which used an iterative process to review, integrate, analyze, and interpret evidence. RESULTS From 4686 screened titles and abstracts, 18 unique studies from 9 countries were identified, including 10 (56%) randomized controlled trials (RCTs), 3 (17%) cluster RCTs, and 5 (28%) non-RCT studies. The number of participants ranged from 76 to 1562. The overall mean age range was 41-67 years, and the proportion of female participants ranged from 0% to 100%. Most (n = 17, 94%) studies used non-physician personnel to implement the proposed interventions. Fourteen studies (78%) implemented multilevel combinations of interventions. Education and training, team-based care, consultation, and Short Message Service reminders were the most common interventions tested. CONCLUSIONS This review presents the most comprehensive findings on retention in hypertension care to date and fills the gaps in the literature, including the effectiveness of interventions, their components, and contextual factors. Adaptation of and implementing HIV care models, such differentiated service delivery, may be more effective and merit further study. REGISTRATION CRD42021291368. PROTOCOL REGISTRATION PROSPERO 2021 CRD42021291368. Available at: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=291368.
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Affiliation(s)
- Jiancheng Ye
- Weill Cornell Medicine, NY, New York, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Olutobi A Sanuade
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern University Robert J Havey Institute for Global Health, Chicago, IL, USA
| | - Theresa L Walunas
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | | | - Abigail S Baldridge
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern University Robert J Havey Institute for Global Health, Chicago, IL, USA
| | - Dike B Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria; University of Abuja, Abuja, Nigeria
| | - Mark D Huffman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Washington University in St. Louis, St. Louis, MO, USA; The George Institute for Global Health, Sydney, Australia
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5
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Patel R, Singh A, Meng Z, Baldridge AS, Addison D, Akhter N. The risk vs. benefit calculus of anticoagulation in patients with ibrutinib-related atrial fibrillation. Leuk Lymphoma 2024; 65:168-174. [PMID: 37953609 PMCID: PMC10952122 DOI: 10.1080/10428194.2023.2278433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/29/2023] [Indexed: 11/14/2023]
Abstract
For ibrutinib-related atrial fibrillation (IRAF), guidelines for anticoagulation do not exist. We sought to describe stroke, bleeding, and anticoagulation rates among patients with IRAF. We performed a single-center retrospective review of 168 patients treated with ibrutinib followed from 2013 to 2022. Over a median follow-up of 6.4 years, 44 (26.0%) patients developed IRAF of which 38 (86.4%) had a CHA2DS2-VASc ≥2 and 7 (15.9%) had a HAS-BLED ≥3. Anticoagulation was initiated in 20 (45.5%) without a clear pattern in scores, risk factors, or cumulative dose, besides having another reason for anticoagulation. Few patients with IRAF developed non-hemorrhagic CVA (n = 3, 6.8%) or significant bleeding (n = 3, 6.8%). Among those with each adverse outcome, 2 in each group were anticoagulated and all were older than 65 years old. In conclusion, decisions for anticoagulation vary widely and patients who are elderly or with HTN may be most at risk for CVA or significant bleed.
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Affiliation(s)
- Ruchi Patel
- Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Arushi Singh
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Zhiying Meng
- Department of Medicine, Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Abigail S. Baldridge
- Department of Medicine, Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel Addison
- Division of Cardiology, CardioOncology Program, The Ohio State University Medical Center, Columbus, OH
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH
| | - Nausheen Akhter
- Department of Medicine, Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Yaranov DM, Baldridge AS, Gonzalez M, Biglane JB, Tanaka D, Fischer W, Larkin C, Ullah R, Chaudhry SP, Pham DT. Anticoagulation Bridging in Patients With Left Ventricular Assist Device: A Regional Analysis of HeartMate 3 Recipients. ASAIO J 2024; 70:93-98. [PMID: 37862687 DOI: 10.1097/mat.0000000000002067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
Advances in left ventricular assist device technologies have led to an improvement in pump hemocompatibility and outcomes. Because of concerns of thromboembolic complications in prior generations of left ventricular assist devices, bridging with parenteral anticoagulants was routinely. Management strategies of subtherapeutic INRs and their effects on the current generation of devices deserve review. We performed analysis of the MOMENTUM 3 trial including 6 centers in the mid-America region. Patients with subtherapeutic INRs (INR < 2) occurring after the index admission underwent chart review to determine the management strategies taken by clinicians. Strategies were divided into two groups, bridging or nonbridging. Of the 225 patients included in the analysis, 130 (58%) patients had a total of 235 subtherapeutic international normalized ratio (INR) events. Most (n = 179, 76.2%) of these INRs were not bridged (n = 100 warfarin dose adjustment, n = 79 no change in warfarin dose). Among those INRs (n = 56, 23.8%) treated with bridging, approximately half (n = 30, 53.6%) were treated with subcutaneous agents and other half (n = 26, 46.4%) were treated with intravenous agents. There was no difference in individual outcomes or composite endpoints of death, rehospitalization, CVA, or bleeding events between the groups.
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Affiliation(s)
| | | | | | | | | | | | - Chris Larkin
- Ascension Saint Thomas West, Nashville, Tennessee
| | - Rafath Ullah
- Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | | | - Duc Thinh Pham
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Sanuade OA, Jacobson TA, Quintana A, Flowers FM, Abbasi H, Vu MH, Baldridge AS, Mejia J, Lazar D, Ciolino JD, Huffman MD, Kandula NR. Process Evaluation of a Double-Blind Randomized Controlled Trial to Assess the Efficacy and Safety of a Quadruple Ultra-Low-Dose Treatment for Hypertension Within a Federally Qualified Health Center Network (QUARTET USA). J Am Heart Assoc 2024; 13:e032236. [PMID: 38156601 PMCID: PMC10863813 DOI: 10.1161/jaha.123.032236] [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: 08/17/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND This convergent parallel-design mixed-methods process evaluation of the QUARTET USA (Quadruple Ultra-Low-Dose Treatment for Hypertension USA) clinical trial (NCT03640312) explores patient and health care professional perceptions about the use of low-dose quadruple therapy (LDQT) as a novel strategy for hypertension management. METHODS AND RESULTS A survey of all 62 patients enrolled in the QUARTET USA trial was conducted. A subsample of 13 patients and 11 health care professionals, recruited via purposive sampling, took part in semistructured interviews. At enrollment, 68% of participants (mean [SD] age, 51.7 [11.5] years; 56% self-identified as Hispanic: Mexican ethnicity, 16% as Hispanic: other ethnicity, 16% as Black race, 8% as White race, and 1.6% as South Asian race) reported that their current health depended on blood pressure medications, and 48% were concerned about blood pressure medications. At trial completion, 80% were satisfied with LDQT, 96% were certain the benefits of taking LDQT outweighed the disadvantages, and 96% reported that LDQT was convenient to take. Both patients and health care professionals found LDQT acceptable because it reduced patients' perceived pill burden and facilitated medication adherence. Health care professionals stated that a perceived limitation of LDQT was the inability to titrate doses. Steps to facilitate LDQT implementation include introducing stepped-care combinations and treatment protocols, inclusion in clinical practice guidelines, and eliminating patient cost barriers. CONCLUSIONS LDQT was an acceptable strategy for hypertension treatment among patients and health care professionals involved in the QUARTET USA clinical trial. Although LDQT was generally perceived as beneficial for maintaining patients' blood pressure control and facilitating adherence, some clinicians perceived limitations in titration inflexibility, adverse effects, and costs. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03640312.
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Affiliation(s)
- Olutobi A. Sanuade
- Division of Health System Innovation and Research, Department of Population Health SciencesSpencer Fox Eccles School of Medicine at the University of UtahSalt Lake CityUT
| | | | | | | | | | - My H. Vu
- Feinberg School of MedicineNorthwestern UniversityChicagoIL
| | | | | | | | | | - Mark D. Huffman
- Feinberg School of MedicineNorthwestern UniversityChicagoIL
- Cardiovascular Division and Global Health CenterWashington University in St. LouisSt. LouisMO
- The George Institute for Global Health, University of New South WalesSydneyAustralia
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Patel NP, Dalal PJ, Meng Z, Baldridge AS, Cascino GJ, Sunderraj A, Sinha A, Karmali R, Feinstein MJ, Akhter N. Myocardial strain is associated with adverse cardiac events in patients treated with chimeric antigen receptor (CAR) T-cell therapy. Eur J Haematol 2024; 112:102-110. [PMID: 37649240 DOI: 10.1111/ejh.14088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Cardiovascular events, including heart failure and arrhythmias, following chimeric antigen receptor (CAR) T-cell therapy are increasingly recognized. Although global longitudinal strain (GLS) has demonstrated prognostic utility for other cancer therapy-related cardiac dysfunction, less is known regarding the association of GLS with adverse cardiac events following CAR T-cell therapy. OBJECTIVES To determine the association of baseline GLS with adverse cardiovascular events in adults receiving CAR-T cell therapy. METHODS Patients who had an echocardiogram within 6 months prior to receiving CAR T-cell therapy were retrospectively identified. Clinical data and cardiac events were collected via chart review. Echocardiograms were analyzed offline for GLS, left ventricular ejection fraction, and Doppler parameters. Multivariable logistic regression was used to determine the association between adverse cardiovascular events and echocardiographic parameters. RESULTS Among 75 CAR T-cell therapy patients (mean age 63.9, 34.7% female), nine patients (12%) experienced cardiac events (CEs) including cardiovascular death, new/worsening heart failure, and new/worsening arrhythmia within 1 year of treatment. In univariable models, higher baseline GLS (OR 0.78 [0.63, 0.96], p = .021) was associated with a lower risk of CE and higher baseline mitral E/e' (OR 1.40 [1.08, 1.81], p = .012) was associated with a higher risk of CE. After adjusting for age and LDH, higher baseline GLS (OR 0.65 [0.48-0.88], p = <.01) was associated with a lower risk of CE and higher baseline mitral E/e' (OR 1.56 [1.06, 2.29], p = .024) was associated with a higher risk of CE. CONCLUSION Lower GLS and higher mitral E/e' on a baseline echocardiogram were associated with higher risk for CEs in patients receiving CAR T-cell therapy.
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Affiliation(s)
- Nikita P Patel
- Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA
| | - Prarthana J Dalal
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Zhiying Meng
- Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Illinois, USA
| | - Abigail S Baldridge
- Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Illinois, USA
| | - Gregory J Cascino
- Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Illinois, USA
| | - Ashwin Sunderraj
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Arjun Sinha
- Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Illinois, USA
| | - Reem Karmali
- Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA
| | - Matthew J Feinstein
- Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Illinois, USA
| | - Nausheen Akhter
- Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Illinois, USA
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Baldridge AS, Goldstar N, Bellinger GC, DeNoma AT, Orji IA, Shedul GL, Okoli RCB, Ripiye NR, Odukwe A, Dabiri O, Mobisson LN, Ojji DB, Huffman MD, Kandula NR, Hirschhorn LR. Formative Evaluation and Adaptation of a Hypertension Extension for Community Health Outcomes Program for Healthcare Workers within the Federal Capital Territory, Nigeria. Glob Heart 2023; 18:64. [PMID: 38045112 PMCID: PMC10691284 DOI: 10.5334/gh.1277] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023] Open
Abstract
Background The Extension for Community Health Outcomes (ECHO) model has been used extensively to link care providers in rural communities with experts with the aim of improving local patient care. Objective The aim of this qualitative research study was to assess the feasibility, acceptability, perceived needs, and contextual factors to guide implementation of a hypertension focused ECHO program for Community Health Extension Workers (CHEWs) in the Federal Capital Territory, Nigeria. Methods From September 2020 to December 2020, key informant interviews were performed with seven global organizations (hubs) providing ECHO training focused on cardiovascular disease or nephrology to identify contextual factors and implementation strategies used by each hub. In February 2022, seven focus group discussions were performed with 42 frontline healthcare workers in the Federal Capital Territory to inform local adaptation of a hypertension ECHO program. Directed content analysis identified major themes which were mapped to the Consolidated Framework for Implementation Research. Qualitative analyses were performed using Dedoose, and results were synthesized using the Implementation Research Logic Model. Results We found both barriers and facilitators across the Consolidated Framework for Implementation Research domains that mapped to a number of constructs in each one. The results of these analyses confirmed that the core components of the ECHO model are a feasible and appropriate intervention for hypertension education of healthcare workers. However, implementing the ECHO program within the Federal Capital Territory may require strategies such as utilizing communications resources effectively, developing incentives to motivate initial participation, and providing rewards or recognition for ongoing engagement. Conclusions These results provide valuable formative insights to guide implementation of our proposed hypertension ECHO program for CHEWs in the Federal Capital Territory, Nigeria. This information was used for key decisions around: 1) scope and content of training, 2) format and frequency, 3) selection of implementation strategies, and 4) building a community of practice.
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Affiliation(s)
- Abigail S. Baldridge
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- Havey Institute for Global Health, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nadia Goldstar
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Grace C. Bellinger
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Abigail T. DeNoma
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Gabriel L. Shedul
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- University of Abuja Teaching Hospital, Abuja, Nigeria
| | | | | | | | | | | | - Dike B. Ojji
- University of Abuja Teaching Hospital, Abuja, Nigeria
- University of Abuja, Abuja, Nigeria
| | - Mark D. Huffman
- Havey Institute for Global Health, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- The George Institute for Global Health, Sydney, Australia
- Washington University St. Louis, St. Louis, Missouri, USA
| | - Namratha R. Kandula
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- The George Institute for Global Health, Sydney, Australia
| | - Lisa R. Hirschhorn
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- The George Institute for Global Health, Sydney, Australia
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10
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Shah KP, Khan SS, Baldridge AS, Grady KL, Cella D, Goyal P, Allen LA, Smith JD, Lagu TC, Ahmad FS. Health Status in Heart Failure and Cancer: Analysis of the Medicare Health Outcomes Survey 2016-2020. JACC Heart Fail 2023:S2213-1779(23)00678-9. [PMID: 37930290 DOI: 10.1016/j.jchf.2023.10.003] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/19/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND People with heart failure (HF) and cancer experience impaired physical and mental health status. However, health-related quality of life (HRQOL) has not been directly compared between these conditions in a contemporary population of older people. OBJECTIVES The authors sought to compare HRQOL in people with HF vs those with lung, colorectal, breast, and prostate cancers. METHODS The authors performed a pooled analysis of Medicare Health Outcomes Survey data from 2016 to 2020 in participants ≥65 years of age with a self-reported history of HF or active treatment for lung, colon, breast, or prostate cancer. They used the Veterans RAND-12 physical component score (PCS) and mental component score (MCS), which range from 0-100 with a mean score of 50 (based on the U.S. general population) and an SD of 10. The authors used pairwise Student's t-tests to evaluate for differences in PCS and MCS between groups. RESULTS Among participants with HF (n = 71,025; 54% female, 16% Black), mean PCS was 29.5 and mean MCS 47.9. Mean PCS was lower in people with HF compared with lung (31.2; n = 4,165), colorectal (35.6; n = 4,270), breast (37.7; n = 14,542), and prostate (39.6; n = 17,670) cancer (all P < 0.001). Participants with HF had a significantly lower mean MCS than those with lung (31.2), colon (50.0), breast (52.0), and prostate (53.0) cancer (all P < 0.001). CONCLUSIONS People with HF experience worse HRQOL than those with cancer actively receiving treatment. The pervasiveness of low HRQOL in HF underscores the need to implement evidence-based interventions that target physical and mental health status and scale multidisciplinary clinics.
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Affiliation(s)
- Kriti P Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Abigail S Baldridge
- Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois, USA
| | - Kathleen L Grady
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Center for Patient-Centered Outcomes, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Parag Goyal
- Program for the Care and the Study of the Aging Heart, Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Justin D Smith
- Division of Health System Innovation and Research, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Tara C Lagu
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Center for Health Services and Outcomes Research, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Faraz S Ahmad
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Center for Health Information Partnerships, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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11
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Romano M, McCarthy PM, Baldridge AS, Kruse J, Huskin A, Green C, Woodford J, Byrd H, Bolling SF. Should mitral valve replacement age guidelines be lowered due to better bioprosthetic mitral valve durability? J Thorac Cardiovasc Surg 2023:S0022-5223(23)00968-6. [PMID: 37839657 DOI: 10.1016/j.jtcvs.2023.10.012] [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: 05/26/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE Guideline recommendations for mechanical or bioprosthetic valve for mitral valve replacement by age remains controversial. We sought to determine bovine pericardial valve durability by age and risk of reintervention. METHODS This retrospective study between 2 large university-based cardiac surgery programs examined patients who underwent bioprosthetic mitral valve replacement from 2004 to 2020. Follow-up was obtained through June 2022. Durability outcomes involving structural valve deterioration were compared by age decile. RESULTS Of 1544 available patients, mean age was 66 ± 13 years and 652 (42%) were aged less than 65 years. Indications for mitral valve replacement were as follows: mitral regurgitation greater than 2+ in 53% (n = 813), mitral stenosis in 44% (n = 650), endocarditis in 18% (n = 277), and reoperation in 39% (n = 602). Concomitant procedures were aortic valve replacement in 28% (n = 426), tricuspid valve in 36% (n = 550), and coronary artery bypass in 19% (n = 290). Thirty-day mortality was 5.4%. In follow-up (clinical: median [interquartile range] 75 [25-129] months), reoperation for endocarditis and new stroke were low (0.30 and 1.06 per 100 patient/years, respectively). The cumulative incidence of mitral valve reintervention for structural valve deterioration among all patients was 6.2% at 10 years and 9.0% at 12 years with no statistical difference in structural valve deterioration in patients aged 40 to 70 years (P = .1). In 90 patients with mitral valve reintervention, 30-day mortality after reintervention was 4.7% (n = 2) for 43 with mitral valve-in-valve and 6.4% (n = 3) for 47 with reoperation. CONCLUSIONS Bovine pericardial mitral valve replacement is a durable option for younger patients. The opportunity to avoid anticoagulation and the associated risks with mechanical mitral valve replacement may be of benefit to patients. These insights may provide data needed to revise the current guidelines.
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Affiliation(s)
- Matthew Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Patrick M McCarthy
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine and Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Abigail S Baldridge
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine and Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Jane Kruse
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine and Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Anna Huskin
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine and Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - China Green
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Jessica Woodford
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Heather Byrd
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine and Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
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12
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Ughreja AB, Chow KY, Gong FF, Patel N, Marion M, Baldridge AS, Akhter N. The Association Between Blood Pressure Control and Global Longitudinal Strain in Patients With HER2-Positive Breast Cancer on Trastuzumab-Based Regimens. J Am Soc Echocardiogr 2023; 36:1118-1119. [PMID: 37343894 DOI: 10.1016/j.echo.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Avni Bavishi Ughreja
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kimberly Y Chow
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Fei Fei Gong
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nikita Patel
- Division of Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Milica Marion
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Abigail S Baldridge
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nausheen Akhter
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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13
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Garg G, Appadurai V, Cheema B, Gruca M, Kinno M, Ryan J, Bavishi A, Baldridge AS, Rigolin VH, Thomas JD, Zielinski A, Puthumana JJ. Right Ventricular Remodeling in Elite Basketball Athletes. J Am Soc Echocardiogr 2023; 36:1120-1125. [PMID: 37364756 DOI: 10.1016/j.echo.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023]
Affiliation(s)
- Gaurang Garg
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Vinesh Appadurai
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Baljash Cheema
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Martin Gruca
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois
| | - Menhel Kinno
- Division of Cardiology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Juliet Ryan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Aakash Bavishi
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Abigail S Baldridge
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Vera H Rigolin
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James D Thomas
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Allison Zielinski
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jyothy J Puthumana
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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14
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Bavishi A, Witting C, Guo J, Wu E, John J, Jankowski M, Baldridge AS, Meng D, Maganti K. Predictive Value of Relative Apical Sparing of Longitudinal Strain on Echocardiography for Cardiac Amyloidosis. Am J Cardiol 2023; 200:66-71. [PMID: 37302282 DOI: 10.1016/j.amjcard.2023.04.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/13/2023] [Accepted: 04/30/2023] [Indexed: 06/13/2023]
Abstract
Relative apical longitudinal sparing (RALS) on echocardiography has become an increasingly used tool to evaluate for cardiac amyloidosis (CA), but the predictive value of this finding remains unclear. This is a retrospective analysis at a single tertiary care center across 3 years. Patients were included if they had RALS, defined by strain ratio ≥2.0 on echocardiography, and sufficient laboratory, imaging, or histopathologic workup to indicate their likelihood of CA. Patients were stratified by their likelihood of CA, and contributions of other co-morbidities previously shown to be associated with RALS. Of the 220 patients who had adequate workup to determine their likelihood of having CA, 50 (22.7%) had confirmed CA, 35 (15.9%) had suspicious CA, 83 (37.7%) had unlikely CA, and 52 (23.7%) had ruled-out CA. The positive predictive value of RALS for CA was 38.6% for confirmed or suspicious CA. The remaining 61.4% of patients who were unlikely or ruled out for CA had other co-morbidities such as hypertension, chronic kidney disease, malignancy, or aortic stenosis, 17.0% of this group had none of these co-morbidities. In our tertiary care cohort of patients with RALS pattern on echocardiography, we found that fewer than half of patients with RALS were likely to have CA. Given the increasing use of strain technology, further studies are warranted to determine the optimal strategy for assessing CA in a patient with RALS.
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Affiliation(s)
- Aakash Bavishi
- Division of Cardiology, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Celeste Witting
- Department of Medicine, Stanford Health Care, Stanford, California
| | - James Guo
- Division of Cardiology, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Erik Wu
- Division of Cardiology, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jordan John
- Division of Cardiology, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Madeline Jankowski
- Division of Cardiology, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Abigail S Baldridge
- Division of Cardiology, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Daisy Meng
- Division of Cardiology, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Kameswari Maganti
- Division of Cardiology, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois.
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15
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Gerçek M, Goncharov A, Narang A, Körber ML, Friedrichs KP, Baldridge AS, Meng Z, Puthumana JJ, Davidson LJ, Malaisrie SC, Thomas JD, Rudolph TK, Pfister R, Rudolph V, Davidson CJ. Characterization of Screen Failures Among Patients Evaluated for Transcatheter Tricuspid Valve Repair (TriSelect-Study). JACC Cardiovasc Interv 2023; 16:1579-1589. [PMID: 37438025 DOI: 10.1016/j.jcin.2023.03.036] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/09/2023] [Accepted: 03/21/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Transcatheter tricuspid valve repair (TTVr) has significantly expanded treatment options for tricuspid regurgitation (TR). However, a sizeable proportion of patients are still declined for TTVr and little is known about their clinical characteristics and cardiac morphology. OBJECTIVES This study sought to characterize patients who screen fail for TTVr with respect to their clinical characteristics and cardiac morphology. METHODS A total of 547 patients were evaluated for TTVr between January 2016 to December 2021 from 3 centers in the United States and Germany. Clinical records and echocardiographic studies were used to assess medical history and right ventricular (RV) and tricuspid valve (TV) characteristics. RESULTS Median age was 80 (IQR: 74-83) years and 60.0% were female. Over half (58.1%) were accepted for TTVr. Of those who were deemed unsuitable for TTVr (41.9%), the most common exclusion reasons were anatomical criteria (56.8%). In the regression analysis, RV and right atrial size, TV coaptation gap, and tethering area were identified as independent screen failure predictors. Other rejection reasons included clinical futility (17.9%), low symptom burden (12.7%), and technical limitations (12.7%). Most of the excluded patients (71.6%) were managed conservatively with medical therapy, while a small number either proceeded to TV surgery (22.3%) or subsequently became eligible for transcatheter tricuspid valve replacement in later available clinical trials in the United States (6.1%). CONCLUSIONS The majority of TTVr screen failure patients are excluded due to TV, right atrial, and RV enlargement. However, a significant proportion is excluded due to clinical futility. These identifiable anatomical and clinical characteristics emphasize the importance of earlier referral and intervention of TR and the need for continued innovation of Transcatheter tricuspid valve interventions.
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Affiliation(s)
- Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Arseniy Goncharov
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Akhil Narang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maria L Körber
- Department for Internal Medicine III, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Kai P Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | | | - Zhiying Meng
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jyothy J Puthumana
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - James D Thomas
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tanja K Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Roman Pfister
- Department for Internal Medicine III, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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16
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Mahmoud Z, Orji IA, Shedul GL, Aluka-Omitiran K, Ripiye N, Akor B, Eze H, Ojo T, Iyer G, Baldridge AS, Hirschhorn LR, Huffman MD, Ojji DB. Clinical characteristics and treatment patterns of pregnant women with hypertension in primary care in the Federal Capital Territory of Nigeria: cross-sectional results from the hypertension treatment in Nigeria Program. BMC Pregnancy Childbirth 2023; 23:416. [PMID: 37270521 DOI: 10.1186/s12884-023-05723-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy, including hypertension, are a leading cause of maternal mortality in Nigeria. However, there is a paucity of data on pregnant women with hypertension who receive care in primary health care facilities. This study presents the results from a cross-sectional analysis of pregnant women enrolled in the Hypertension Treatment in Nigeria Program which is aimed at integrating and strengthening hypertension care in primary health care centres. METHODS A descriptive analysis of the baseline results from the Hypertension Treatment in Nigeria Program was performed. Baseline blood pressures, treatment and control rates of pregnant women were analysed and compared to other adult women of reproductive age. A complete case analysis was performed, and a two-sided p value < 0.05 was considered statistically significant. RESULTS Between January 2020 to October 2022, 5972 women of reproductive age were enrolled in the 60 primary healthcare centres participating in the Hypertension Treatment in Nigeria Program and 112 (2%) were pregnant. Overall mean age (SD) was 39.6 years (6.3). Co-morbidities were rare in both groups, and blood pressures were similar amongst pregnant and non-pregnant women (overall mean (SD) first systolic and diastolic blood pressures were 157.4 (20.6)/100.7 (13.6) mm Hg and overall mean (SD) second systolic and diastolic blood pressures were 151.7 (20.1)/98.4 (13.5) mm Hg). However, compared to non-pregnant women, pregnant women had a higher rate of newly diagnosed hypertension (65.2% versus 54.4% p = 0.02) and lower baseline walk-in treatment (32.1% versus 42.1%, p = 0.03). The control rate was numerically lower among pregnant patients (6.3% versus 10.2%, p = 0.17), but was not statistically significant. Some pregnant patients (8.3%) were on medications contraindicated in pregnancy, and none of the pregnant women were on aspirin for primary prevention of preeclampsia. CONCLUSIONS These findings indicate significant gaps in care and important areas for future studies to improve the quality of care and outcomes for pregnant women with hypertension in Nigeria, a country with the highest burden of maternal mortality globally.
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Affiliation(s)
- Zainab Mahmoud
- Washington University, 660 S Euclid Ave, Campus Box 6068, St Louis, MO, 63110, USA.
| | - Ikechukwu A Orji
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Gabriel L Shedul
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Kasarachi Aluka-Omitiran
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Nanna Ripiye
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Blessing Akor
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Helen Eze
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Tunde Ojo
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Guhan Iyer
- Washington University, 660 S Euclid Ave, Campus Box 6068, St Louis, MO, 63110, USA
| | | | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert J Havey Institute for Global Health, Chicago, IL, USA
| | - Mark D Huffman
- Washington University, 660 S Euclid Ave, Campus Box 6068, St Louis, MO, 63110, USA.
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- The George Institute for Global Health, Sydney, Australia.
| | - Dike B Ojji
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.
- Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria.
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17
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Guo MT, Baldridge AS, Kershaw KN, Van Horn LV, Rumalla K, Bright B, Xavier D, Huffman MD. Eligibility and Prevalence of the American Heart Association Heart Check Certification Program in the US Packaged Food and Beverage Supply: A Cross-Sectional Study. Nutr Health 2023; 29:309-317. [PMID: 35130084 DOI: 10.1177/02601060221075536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Objective: Consumers in the US make choices within a food supply dominated by processed packaged foods and beverage products. Front-of-package nutrition labels (FOPL) equip consumers to make healthier choices, but further evaluation and regulation regarding FOPL format, scope, and display have been recommended by the World Health Organization. As a leader in consumer FOPL guidance, the American Heart Association's (AHA) Heart Check programme certifies food companies seeking to add an AHA Heart Check logo as a FOPL for qualifying heart healthy products. A cross-sectional assessment of the AHA Heart Check Standard Certification was conducted within the US packaged food and beverage supply to assess the eligibility and prevalence of the programme as a FOPL. Methods: Data were derived from Label Insight's Open Data initiative, which is the largest publicly-available US branded food composition database. The proportions of products that were certified and eligible to be certified for the Standard Certification were reported by nutrient attributes, grocery aisles and food brands. Results: Among 153,453 products examined, fewer than 1% exhibited the Heart Check certification on their label. Among products that were not Heart Check certified,13.8% were eligible for Standard Certification. The most common reason for ineligibility was the saturated fat content (52%), followed by total fat content (47%) and sodium content (47%). Heart Check certification and eligibility differed substantially across grocery aisle categories. Conclusions: The abundance of unhealthy products in the US packaged food and beverage supply and absence of harmonized FOPL policies suggest the need for FOPL like the Heart Check label to promote adherence to healthy diets. There are opportunities for food manufacturers and the AHA to certify more heart healthy foods and beverages. However, more consistent criteria and transparent labelling could enhance Heart Check certification to facilitate consumers' ability to make more informed and healthful purchases.
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Affiliation(s)
- Mianzhao Tracy Guo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Abigail S Baldridge
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Linda V Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Kranti Rumalla
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | | | | | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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18
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Westerman KE, Walker ME, Gaynor SM, Wessel J, DiCorpo D, Ma J, Alonso A, Aslibekyan S, Baldridge AS, Bertoni AG, Biggs ML, Brody JA, Chen YDI, Dupuis J, Goodarzi MO, Guo X, Hasbani NR, Heath A, Hidalgo B, Irvin MR, Johnson WC, Kalyani RR, Lange L, Lemaitre RN, Liu CT, Liu S, Moon JY, Nassir R, Pankow JS, Pettinger M, Raffield LM, Rasmussen-Torvik LJ, Selvin E, Senn MK, Shadyab AH, Smith AV, Smith NL, Steffen L, Talegakwar S, Taylor KD, de Vries PS, Wilson JG, Wood AC, Yanek LR, Yao J, Zheng Y, Boerwinkle E, Morrison AC, Fornage M, Russell TP, Psaty BM, Levy D, Heard-Costa NL, Ramachandran VS, Mathias RA, Arnett DK, Kaplan R, North KE, Correa A, Carson A, Rotter JI, Rich SS, Manson JE, Reiner AP, Kooperberg C, Florez JC, Meigs JB, Merino J, Tobias DK, Chen H, Manning AK. Investigating Gene-Diet Interactions Impacting the Association Between Macronutrient Intake and Glycemic Traits. Diabetes 2023; 72:653-665. [PMID: 36791419 PMCID: PMC10130485 DOI: 10.2337/db22-0851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023]
Abstract
Few studies have demonstrated reproducible gene-diet interactions (GDIs) impacting metabolic disease risk factors, likely due in part to measurement error in dietary intake estimation and insufficient capture of rare genetic variation. We aimed to identify GDIs across the genetic frequency spectrum impacting the macronutrient-glycemia relationship in genetically and culturally diverse cohorts. We analyzed 33,187 participants free of diabetes from 10 National Heart, Lung, and Blood Institute Trans-Omics for Precision Medicine program cohorts with whole-genome sequencing, self-reported diet, and glycemic trait data. We fit cohort-specific, multivariable-adjusted linear mixed models for the effect of diet, modeled as an isocaloric substitution of carbohydrate for fat, and its interactions with common and rare variants genome-wide. In main effect meta-analyses, participants consuming more carbohydrate had modestly lower glycemic trait values (e.g., for glycated hemoglobin [HbA1c], -0.013% HbA1c/250 kcal substitution). In GDI meta-analyses, a common African ancestry-enriched variant (rs79762542) reached study-wide significance and replicated in the UK Biobank cohort, indicating a negative carbohydrate-HbA1c association among major allele homozygotes only. Simulations revealed that >150,000 samples may be necessary to identify similar macronutrient GDIs under realistic assumptions about effect size and measurement error. These results generate hypotheses for further exploration of modifiable metabolic disease risk in additional cohorts with African ancestry. ARTICLE HIGHLIGHTS We aimed to identify genetic modifiers of the dietary macronutrient-glycemia relationship using whole-genome sequence data from 10 Trans-Omics for Precision Medicine program cohorts. Substitution models indicated a modest reduction in glycemia associated with an increase in dietary carbohydrate at the expense of fat. Genome-wide interaction analysis identified one African ancestry-enriched variant near the FRAS1 gene that may interact with macronutrient intake to influence hemoglobin A1c. Simulation-based power calculations accounting for measurement error suggested that substantially larger sample sizes may be necessary to discover further gene-macronutrient interactions.
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Affiliation(s)
- Kenneth E. Westerman
- Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Boston, MA
| | - Maura E. Walker
- Department of Medicine, Section of Preventive Medicine, Boston University School of Medicine, Boston, MA
- Department of Health Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA
| | - Sheila M. Gaynor
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jennifer Wessel
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indianapolis, IN
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
- Diabetes Translational Research Center, Indiana University, Indianapolis, IN
| | - Daniel DiCorpo
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Jiantao Ma
- Nutrition Epidemiology and Data Science, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Abigail S. Baldridge
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alain G. Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Mary L. Biggs
- Department of Biostatistics, University of Washington, Seattle, WA
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA
| | - Jennifer A. Brody
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Yii-Der Ida Chen
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Joseé Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Mark O. Goodarzi
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Natalie R. Hasbani
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Adam Heath
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Bertha Hidalgo
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Marguerite R. Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - W. Craig Johnson
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Rita R. Kalyani
- GeneSTAR Research Program, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Leslie Lange
- Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO
| | - Rozenn N. Lemaitre
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA
- Department of Internal Medicine, University of Washington, Seattle, WA
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
- National Heart, Lung, and Blood Institute and Boston University’s Framingham Heart Study, Framingham, MA
- Evans Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA
- Evans Department of Medicine, Whitaker Cardiovascular Institute and Cardiology Section, Boston University School of Medicine, Boston, MA
| | - Simin Liu
- Center for Global Cardiometabolic Health, Boston, MA
| | - Jee-Young Moon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Rami Nassir
- Department of Pathology, School of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - James S. Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Mary Pettinger
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Laura M. Raffield
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mackenzie K. Senn
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | - Albert V. Smith
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Nicholas L. Smith
- Department of Epidemiology, University of Washington, Seattle, WA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
- Department of Veterans Affairs Office of Research and Development, Seattle Epidemiologic Research and Information Center, Seattle, WA
| | - Lyn Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Sameera Talegakwar
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Kent D. Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Paul S. de Vries
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - James G. Wilson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Alexis C. Wood
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Lisa R. Yanek
- GeneSTAR Research Program, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jie Yao
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Yinan Zheng
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX
| | - Alanna C. Morrison
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Miriam Fornage
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Tracy P. Russell
- Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, VT
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | - Daniel Levy
- National Heart, Lung, and Blood Institute and Boston University’s Framingham Heart Study, Framingham, MA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Nancy L. Heard-Costa
- National Heart, Lung, and Blood Institute and Boston University’s Framingham Heart Study, Framingham, MA
- Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Vasan S. Ramachandran
- National Heart, Lung, and Blood Institute and Boston University’s Framingham Heart Study, Framingham, MA
- Evans Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA
- Evans Department of Medicine, Whitaker Cardiovascular Institute and Cardiology Section, Boston University School of Medicine, Boston, MA
| | - Rasika A. Mathias
- GeneSTAR Research Program, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Donna K. Arnett
- College of Public Health, University of Kentucky, Lexington, KY
| | - Robert Kaplan
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, CA
| | - Kari E. North
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Adolfo Correa
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS
| | - April Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Stephen S. Rich
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA
| | | | | | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jose C. Florez
- Department of Medicine, Harvard Medical School, Boston, MA
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Boston, MA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - James B. Meigs
- Department of Medicine, Harvard Medical School, Boston, MA
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Boston, MA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Jordi Merino
- Department of Medicine, Harvard Medical School, Boston, MA
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Boston, MA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - Deirdre K. Tobias
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Han Chen
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
- Center for Precision Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Alisa K. Manning
- Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Boston, MA
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19
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Doukas PG, Cascino GJ, Meng Z, Baldridge AS, Kang Y, Scherrer-Crosbie M, Akhter N. External validation of a heart failure risk score in patients with acute myeloid leukemia. Leuk Lymphoma 2023; 64:445-453. [PMID: 36331544 DOI: 10.1080/10428194.2022.2140289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 21-point risk score for heart failure (HF) has been developed for patients with acute myeloid leukemia (AML), stratifying patients into three groups: low, moderate, and high-risk. In this study, 193 patients with AML treated with anthracycline-based therapy were stratified using the risk score, and its prognostic utility for HF events and all-cause mortality at one year of follow-up were evaluated. HF occurred in 18% (34/193) of anthracycline-treated patients. Global longitudinal strain (GLS) was more negative among patients without HF events (-19 ± 3 vs. -17 ± 4%). One year incidence of HF was increased in the higher risk groups: 12% of low-risk, 24% of moderate-risk, and 50% of high-risk (p < 0.001). However, a higher risk score was not associated with an increased risk of all-cause mortality. This study provides external validation of a 21-point risk score for HF events but not all-cause mortality at one year in patients with AML.
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Affiliation(s)
- Peter G Doukas
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Gregory J Cascino
- Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Zhiying Meng
- Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Abigail S Baldridge
- Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Yu Kang
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marielle Scherrer-Crosbie
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nausheen Akhter
- Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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20
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Farina LA, Tibrewala A, Meng Z, Baldridge AS, Voit JM, Raissi SR, Lu M, Khan SS, Freed BH, Akhter N. Echocardiographic correlates of major adverse cardiac events at 1 year in patients with apical ballooning takotsubo syndrome. Echocardiography 2023; 40:86-95. [PMID: 36632682 DOI: 10.1111/echo.15524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/15/2022] [Accepted: 12/03/2022] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Takotsubo syndrome (TTS) is characterized by transient left ventricular dysfunction and associated with considerable morbidity and mortality. We sought to evaluate the association between change in cardiac mechanics after diagnosis of TTS with 1-year incidence of major adverse cardiovascular events (MACE). METHODS We retrospectively identified 85 patients with apical TTS based on ICD 9/10 codes and chart adjudication, who had a follow-up echocardiogram within 6 months of diagnosis. Echocardiograms were analyzed for left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), GLS ratio, global circumferential strain (GCS), and global radial strain (GRS). Multivariable logistic regression was performed to identify parameters associated with MACE (all-cause mortality, heart failure, stroke, and coronary artery disease [CAD] requiring percutaneous coronary intervention [PCI]) at 1 year. Event-free survival was assessed in patients with GLS (≤-18% vs. >18%) and LVEF (≥53% vs. <53%). RESULTS Within 1 year of diagnosis, MACE occurred in 15 (18%) patients. Between baseline and follow-up echocardiogram (median 15 [range 1-151] days), there were significant differences in change in LVEF and GLS in patients with versus without incident MACE. In multivariate analysis, change in LVEF (odds ratio [OR] = .93 [.87, .98], p = .013) and change in GLS (OR = 1.32 [1.04, 1.67], p = .022) were independently associated with MACE; however, the association with change in GLS was attenuated (odds ratio [OR] = 1.13 [.94, 1.36], p = .21) after adjustment for baseline and change in LVEF. Among patients with normalized LVEF at follow-up, there were five (14.7%) MACE; whereas, there were no events among patients with normalized GLS. CONCLUSIONS In patients with apical TTS, recovery in GLS and LVEF at follow-up was associated with significantly lower MACE at 1 year. Normalization of GLS at follow-up was better able to discriminate event-free survival than normalization of LVEF.
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Affiliation(s)
- Lauren A Farina
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anjan Tibrewala
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Zhiying Meng
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Abigail S Baldridge
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jay M Voit
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sasan R Raissi
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michelle Lu
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sadiya S Khan
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Benjamin H Freed
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nausheen Akhter
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
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21
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Sanuade OA, Ale BM, Baldridge AS, Orji IA, Shedul GL, Ojo TM, Shedul G, Ugwuneji EN, Egenti N, Omitiran K, Okoli R, Eze H, Nwankwo A, Hirschhorn LR, Chopra A, Ye J, Tripathi P, Banigbe B, Kandula NR, Huffman MD, Ojji DB. Fixed-dose combination therapy-based protocol compared with free pill combination protocol: Results of a cluster randomized trial. J Clin Hypertens (Greenwich) 2023; 25:127-136. [PMID: 36660886 PMCID: PMC9903187 DOI: 10.1111/jch.14632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/21/2023]
Abstract
Fixed-dose combination (FDC) therapy is recommended for hypertension management in Nigeria based on randomized trials at the individual level. This cluster-randomized trial evaluates effectiveness and safety of a treatment protocol that used two-drug FDC therapy as the second and third steps for hypertension control compared with a protocol that used free pill combinations. From January 2021 to June 2021, 60 primary healthcare centers in the Federal Capital Territory of Nigeria were randomized to a protocol using FDC therapy as second and third steps compared with a protocol that used the same medications in free pill combination therapy for these steps. Eligible patients were adults (≥18 years) with hypertension. The primary outcome was the odds of a patient being controlled at their last visit between baseline to 6-month follow-up in the FDC group compared to the free pill group. 4427 patients (mean [SD] age: 49.0 [12.4] years, 70.5% female) were registered with mean (SD) baseline systolic/diastolic blood pressure 155 (20.6)/96 (13.1) mm Hg. Baseline characteristics of groups were similar. After 6-months, hypertension control rate improved in the two treatment protocols, but there were no differences between the groups after adjustment (FDC = 53.9% versus free pill combination = 47.9%, cluster-adjusted p = .29). Adverse events were similarly low (<1%) in both groups. Both protocols improved hypertension control rates at 6-months in comparison to baseline, though no differences were observed between groups. Further work is needed to determine if upfront FDC therapy is more effective and efficient to improve hypertension control rates.
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Affiliation(s)
- Olutobi A. Sanuade
- Department of Population Health SciencesSpencer Fox EcclesSchool of Medicine at the University of UtahSalt Lake CityUtahUSA,Department of Medical Social Sciences and Robert J Havey Institute for Global HealthNorthwestern University Feinberg School of medicineChicagoIllinoisUSA
| | - Boni M. Ale
- Cardiovascular Research UnitUniversity of Abuja and University of Abuja Teaching HospitalGwagwaladaAbujaNigeria,Holo HealthcareNairobiKenya
| | - Abigail S. Baldridge
- Department of Medical Social Sciences and Robert J Havey Institute for Global HealthNorthwestern University Feinberg School of medicineChicagoIllinoisUSA,Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Ikechukwu A. Orji
- Cardiovascular Research UnitUniversity of Abuja and University of Abuja Teaching HospitalGwagwaladaAbujaNigeria
| | - Gabriel L. Shedul
- Cardiovascular Research UnitUniversity of Abuja and University of Abuja Teaching HospitalGwagwaladaAbujaNigeria
| | - Tunde M. Ojo
- Cardiovascular Research UnitUniversity of Abuja and University of Abuja Teaching HospitalGwagwaladaAbujaNigeria,Department of Public HealthFederal Ministry of HealthAbujaNigeria
| | - Grace Shedul
- Cardiovascular Research UnitUniversity of Abuja and University of Abuja Teaching HospitalGwagwaladaAbujaNigeria
| | - Eugenia N. Ugwuneji
- Cardiovascular Research UnitUniversity of Abuja and University of Abuja Teaching HospitalGwagwaladaAbujaNigeria
| | - Nonye Egenti
- College of Health SciencesUniversity of AbujaAbujaNigeria
| | - Kasarachi Omitiran
- Cardiovascular Research UnitUniversity of Abuja and University of Abuja Teaching HospitalGwagwaladaAbujaNigeria
| | | | - Helen Eze
- Cardiovascular Research UnitUniversity of Abuja and University of Abuja Teaching HospitalGwagwaladaAbujaNigeria
| | - Ada Nwankwo
- Cardiovascular Research UnitUniversity of Abuja and University of Abuja Teaching HospitalGwagwaladaAbujaNigeria
| | - Lisa R. Hirschhorn
- Department of Medical Social Sciences and Robert J Havey Institute for Global HealthNorthwestern University Feinberg School of medicineChicagoIllinoisUSA,Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Aashima Chopra
- Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Jiancheng Ye
- Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Priya Tripathi
- Stanley Manne Children's Research InstituteAnn and Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Bolanle Banigbe
- Boston University School of Public HealthBostonMassachusettsUSA
| | | | - Mark D. Huffman
- Northwestern University Feinberg School of MedicineChicagoIllinoisUSA,Cardiovascular Division and Global Health CenterWashington University in St. LouisSt. LouisMissouriUSA,The George Institute for Global HealthUniversity of New South WalesSydneyAustralia
| | - Dike B. Ojji
- Cardiovascular Research UnitUniversity of Abuja and University of Abuja Teaching HospitalGwagwaladaAbujaNigeria,Department of Internal MedicineFaculty of Clinical SciencesUniversity of AbujaAbujaNigeria
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22
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Ojji DB, Sancilio A, Shedul GL, Orji IA, Chopra A, Abu J, Akor B, Ripiye N, Akinlade F, Okoye D, Okpetu E, Eze H, Odoh E, Baldridge AS, Tripathi P, Abubakar H, Jamda AM, Hirschhorn LR, McDade T, Huffman MD. Nigeria healthcare worker SARS-CoV-2 serology study: Results from a prospective, longitudinal cohort. PLOS Glob Public Health 2023; 3:e0000549. [PMID: 36962953 PMCID: PMC10022168 DOI: 10.1371/journal.pgph.0000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/09/2022] [Indexed: 01/19/2023]
Abstract
Healthcare workers, both globally and in Nigeria, have an increased risk for SARS-CoV-2 infection compared with the general population due to higher risk contacts, including occupational exposures. In addition, primary healthcare workers represent an important group for estimating prior infection to SARS-CoV-2 because they work at the first point-of-contact for most patients yet have not been included in prior COVID-19 seroepidemiology research in Nigeria. We sought to evaluate baseline seroprevalence, rates of seroconversion (IgG- to IgG+) and seroreversion (IgG+ to IgG-), change in IgG concentration at 3- and 6-month follow-up, and factors associated with seropositivity. From June 2020 to December 2020, we conducted a longitudinal seroepidemiology study among frontline health care workers in Nigeria using a validated dried blood spot assay. Among 525 participants, mean (SD) age was 39.1 (9.7) years, 61.0% were female, and 45.1% were community health workers. The six-month follow-up rate was 93.5%. Seropositivity rates increased from 31% (95% CI: 27%, 35%) at baseline to 45% (95% CI: 40%, 49%) at 3-month follow-up, and 70% (95% CI: 66%, 74%) at 6-month follow-up. There was a corresponding increase in IgG levels from baseline (median = 0.18 ug/mL) to 3-month (median = 0.35 ug/mL) and 6-month follow-up (median = 0.59 ug/mL, Ptrend < .0001). A minority of participants reported symptoms from February 2020 until baseline (12.2%) or during 3-month (6.6%) or 6-month (7.5%) follow-up. only 1 participant was hospitalized. This study demonstrated high baseline, 3-month and 6-month follow-up prevalence of IgG antibodies to SARS-CoV-2 during the first two waves of the COVID-19 pandemic in Nigeria among a cohort of unvaccinated frontline healthcare workers, including primary healthcare workers despite low symptomatology. These results may have implications in state- and national-level disease pandemic modeling. Trial registration: NCT04158154.
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Affiliation(s)
- Dike B Ojji
- Department of Internal Medicine, Faculty of Clinical Sciences, Federal Capital Territory, University of Abuja, Abuja, Nigeria
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Federal Capital Territory, Abuja, Nigeria
| | - Amelia Sancilio
- Northwestern University Department of Anthropology and Institute for Policy Research, Evanston, Illinois, United States of America
| | - Gabriel L Shedul
- Department of Internal Medicine, Faculty of Clinical Sciences, Federal Capital Territory, University of Abuja, Abuja, Nigeria
| | - Ikechukwu A Orji
- Department of Internal Medicine, Faculty of Clinical Sciences, Federal Capital Territory, University of Abuja, Abuja, Nigeria
| | - Aashima Chopra
- Northwestern University Department of Preventive Medicine, Chicago, Illinois, United States of America
| | - Joel Abu
- Department of Internal Medicine, Faculty of Clinical Sciences, Federal Capital Territory, University of Abuja, Abuja, Nigeria
| | - Blessing Akor
- Department of Internal Medicine, Faculty of Clinical Sciences, Federal Capital Territory, University of Abuja, Abuja, Nigeria
| | - Nana Ripiye
- Department of Internal Medicine, Faculty of Clinical Sciences, Federal Capital Territory, University of Abuja, Abuja, Nigeria
| | - Funmi Akinlade
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Douglas Okoye
- Department of Internal Medicine, Faculty of Clinical Sciences, Federal Capital Territory, University of Abuja, Abuja, Nigeria
| | - Emmanuel Okpetu
- Department of Internal Medicine, Faculty of Clinical Sciences, Federal Capital Territory, University of Abuja, Abuja, Nigeria
| | - Helen Eze
- Department of Internal Medicine, Faculty of Clinical Sciences, Federal Capital Territory, University of Abuja, Abuja, Nigeria
| | - Emmanuel Odoh
- Abaji Department of Primary Care, Abaji, Federal Capital Territory, Abuja, Nigeria
| | - Abigail S Baldridge
- Northwestern University Department of Preventive Medicine, Chicago, Illinois, United States of America
- Bluhm Cardiovascular Institute Clinical Trials Unit, Northwestern Medicine, Chicago, Illinois, United States of America
| | - Priya Tripathi
- Northwestern University Department of Preventive Medicine, Chicago, Illinois, United States of America
| | - Haruna Abubakar
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Federal Capital Territory, Abuja, Nigeria
| | - Abubakar M Jamda
- Department of Community Medicine, Faculty of Clinical Sciences, Federal Capital Territory, University of Abuja, Abuja, Nigeria
| | - Lisa R Hirschhorn
- Northwestern University Department of Medical Social Sciences, Chicago, Illinois, United States of America
| | - Thomas McDade
- Northwestern University Department of Anthropology and Institute for Policy Research, Evanston, Illinois, United States of America
| | - Mark D Huffman
- Northwestern University Department of Preventive Medicine, Chicago, Illinois, United States of America
- Northwestern University Department of Medicine, Chicago, Illinois, United States of America
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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23
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Baldridge AS, Huffman MD, Lazar D, Abbas H, Flowers FM, Quintana A, Jackson A, Khan SS, Chopra A, Vu M, Tripathi P, Jacobson T, Sanuade OA, Kandula NR, Persell SD, Paparello JJ, Rosul LL, Mejia J, Lloyd-Jones DM, Chow CK, Ciolino JD. Efficacy and safety of a quadruple ultra-low-dose treatment for hypertension (QUARTET USA): Rationale and design for a randomized controlled trial. Am Heart J 2022; 254:183-193. [PMID: 36116516 PMCID: PMC10236716 DOI: 10.1016/j.ahj.2022.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 06/04/2023]
Abstract
BACKGROUND Over half of patients with elevated blood pressure require multi-drug treatment to achieve blood pressure control. However, multi-drug treatment may lead to lower adherence and more adverse drug effects compared with monotherapy. OBJECTIVE The Quadruple Ultra-low-dose Treatment for Hypertension (QUARTET) USA trial was designed to evaluate whether initiating treatment with ultra-low-dose quadruple-combination therapy will lower office blood pressure more effectively, and with fewer side effects, compared with initiating standard dose monotherapy in treatment naive patients with SBP < 180 and DBP < 110 mm Hg and patients on monotherapy with SBP < 160 and DBP < 100 mm Hg. METHODS/DESIGN QUARTET USA was a prospective, randomized, double-blind trial (ClinicalTrials.gov NCT03640312) conducted in federally qualified health centers in a large city in the US. Patients were randomly assigned (1:1) to either ultra-low-dose quadruple combination therapy or standard dose monotherapy. The primary outcome was mean change from baseline in office systolic blood pressure at 12-weeks, adjusted for baseline values. Secondary outcomes included measures of blood pressure change and variability, medication adherence, and health related quality of life. Safety outcomes included occurrence of serious adverse events, relevant adverse drug effects, and electrolyte abnormalities. A process evaluation aimed to understand provider experiences of implementation and participant experiences around side effects, adherence, and trust with clinical care. DISCUSSION QUARTET USA was designed to evaluate whether a novel approach to blood pressure control would lower office blood pressure more effectively, and with fewer side effects, compared with standard dose monotherapy. QUARTET USA was conducted within a network of federally qualified healthcare centers with the aim of generating information on the safety and efficacy of ultra-low-dose quadruple-combination therapy in diverse groups that experience a high burden of hypertension.
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Affiliation(s)
| | - Mark D Huffman
- Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, MO; The George Institute for Global Health, Sydney, Australia
| | | | - Hiba Abbas
- Access Community Health Network, Chicago, IL
| | | | | | - Alema Jackson
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sadiya S Khan
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Aashima Chopra
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - My Vu
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Priya Tripathi
- Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Tyler Jacobson
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Olutobi A Sanuade
- Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT
| | | | | | | | | | - Jairo Mejia
- Access Community Health Network, Chicago, IL
| | | | - Clara K Chow
- The George Institute for Global Health, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia; Westmead Hospital, Sydney, Australia
| | - Jody D Ciolino
- Northwestern University Feinberg School of Medicine, Chicago, IL
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24
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Ye J, Orji IA, Baldridge AS, Ojo TM, Shedul G, Ugwuneji EN, Egenti NB, Aluka-Omitiran K, Okoli RCB, Eze H, Nwankwo A, Hirschhorn LR, Chopra A, Ale BM, Shedul GL, Tripathi P, Kandula NR, Huffman MD, Ojji DB. Characteristics and Patterns of Retention in Hypertension Care in Primary Care Settings From the Hypertension Treatment in Nigeria Program. JAMA Netw Open 2022; 5:e2230025. [PMID: 36066896 PMCID: PMC9449788 DOI: 10.1001/jamanetworkopen.2022.30025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND More than 1.2 billion adults worldwide have hypertension. High retention in clinical care is essential for long-term management of hypertension, but 1-year retention rates are less than 50% in many resource-limited settings. OBJECTIVE To evaluate short-term retention rates and associated factors among patients with hypertension in primary health care centers in the Federal Capital Territory of Nigeria. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, data were collected by trained study staff from adults aged 18 years or older at 60 public, primary health care centers in Nigeria between January 2020 and July 2021 as part of the Hypertension Treatment in Nigeria (HTN) Program. Patients with hypertension were registered. EXPOSURES Follow-up visit for hypertension care within 37 days of the registration visit. MAIN OUTCOMES AND MEASURES The main outcome was the 3-month rolling average 37-day retention rate in hypertension care, calculated by dividing the number of patients who had a follow-up visit within 37 days of their first (ie, registration) visit in the program by the total number of registered patients with hypertension during multiple consecutive 3-month periods. Interrupted time series analyses evaluated trends in retention rates before and after the intervention phase of the HTN Program. Mixed-effects, multivariable regression models evaluated associations between patient-, site-, and area council-level factors, hypertension treatment and control status, and 37-day retention rate. RESULTS In total, 10 686 patients (68.3% female; mean [SD] age, 48.8 [12.7] years) were included in the analysis. During the study period, the 3-month rolling average 37-day retention rate was 41% (95% CI, 37%-46%), with wide variability among sites. The retention rate was higher among patients who were older (adjusted odds ratio [aOR], 1.01 per year; 95% CI, 1.01-1.02 per year), were female (aOR, 1.11; 95% CI, 1.01-1.23), had a higher body mass index (aOR, 1.01; 95% CI, 1.00-1.02), were in the Kuje vs the Abaji area council (aOR, 2.25; 95% CI, 1.25-4.04), received hypertension treatment at the registration visit (aOR, 1.27; 95% CI, 1.07-1.50), and were registered during the postintervention period (aOR, 1.16; 95% CI, 1.06-1.26). CONCLUSIONS AND RELEVANCE The findings suggest that retention in hypertension care is suboptimal in primary health care centers in Nigeria, although large variability among sites was found. Potentially modifiable and nonmodifiable factors associated with retention were identified and may inform multilevel, contextualized implementation strategies to improve retention.
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Affiliation(s)
- Jiancheng Ye
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ikechukwu A. Orji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | - Tunde M. Ojo
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Grace Shedul
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Eugenia N. Ugwuneji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Nonye B. Egenti
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | | | - Helen Eze
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Ada Nwankwo
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | - Aashima Chopra
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Boni M. Ale
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Holo Healthcare, Nairobi, Kenya
| | - Gabriel L. Shedul
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Priya Tripathi
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Mark D. Huffman
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Washington University in St Louis, St Louis, Missouri
| | - Dike B. Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- University of Abuja, Abuja, Nigeria
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25
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Beussink-Nelson L, Baldridge AS, Hibler E, Bello NA, Epps K, Cameron KA, Lloyd-Jones DM, Gooding HC, Catov JM, Rich-Edwards JW, Yee LM, Toledo P, Banayan JM, Khan SS. Knowledge and perception of cardiovascular disease risk in women of reproductive age. Am J Prev Cardiol 2022; 11:100364. [PMID: 35866048 PMCID: PMC9294042 DOI: 10.1016/j.ajpc.2022.100364] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/19/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in American women, but general knowledge and perception of risk in this population remains poor. In this cross-sectional study of young women, significant gaps in knowledge and perception of CVD risk in individuals who have experienced an APO were identified along with general knowledge deficits related to pregnancy-related risk factors and CVD risk in young women. These findings provide primary data to support the need for development and delivery of educational content on CVD risk to young women, particularly during the peripartum period.
Objective Women who experience adverse pregnancy outcomes (APO) are at increased risk for cardiovascular disease (CVD); however, their knowledge of CVD risk is not well characterized. We aimed to evaluate knowledge and perception of CVD risk in young women and to determine whether these factors differ based on experience of an APO. Methods We conducted a cross-sectional study among women with a recent live birth at an urban medical center. Knowledge and perception of CVD risk were assessed through a self-administered online survey adapted from the American Heart Association Survey of Women's CVD Awareness. Results Of 5612 individuals contacted between 3/1/21 and 4/18/21, 714 completed the survey; the mean (SD) age was 34 (4) years and 25% reported an APO. While 62% of respondents identified CVD as the leading cause of death in women, there was no significant difference in CVD knowledge scores between participants who reported experiencing an APO and those who did not (6.9 vs 6.8 out of 10; p = 0.51). Participants who reported experiencing an APO had higher perception of personal risk for CVD (adjusted odds ratio, 2.64 [95% CI 1.83-3.80]) compared with participants who did not. Half of participants who experienced an APO reported perceiving average, or below average, risk for CVD and only 41 (22.5%) reported speaking with a healthcare professional about CVD within the past year. Conclusions Gaps remain in knowledge of CVD risk among young women, particularly after an APO. The peripartum period may represent a unique opportunity for targeted education when healthcare engagement is high.
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26
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Baldridge AS, Aluka-Omitiran K, Orji IA, Shedul GL, Ojo TM, Eze H, Shedul G, Ugwuneji EN, Egenti NB, Okoli RCB, Ale BM, Nwankwo A, Osagie S, Ye J, Chopra A, Sanuade OA, Tripathi P, Kandula NR, Hirschhorn LR, Huffman MD, Ojji DB. Hypertension Treatment in Nigeria (HTN) Program: rationale and design for a type 2 hybrid, effectiveness, and implementation interrupted time series trial. Implement Sci Commun 2022; 3:84. [PMID: 35918703 PMCID: PMC9344662 DOI: 10.1186/s43058-022-00328-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 05/27/2022] [Accepted: 07/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Hypertension is the most common cardiovascular disease in Nigeria and contributes to a large non-communicable disease burden. Our aim was to implement and evaluate a large-scale hypertension treatment and control program, adapted from the Kaiser Permanent Northern California and World Health Organization HEARTS models, within public primary healthcare centers in the Federal Capital Territory, Nigeria. Methods A type 2 hybrid, interrupted time series design was used to generate novel information on large-scale implementation and effectiveness of a multi-level hypertension control program within 60 primary healthcare centers in the Federal Capital Territory, Nigeria. During the formative phase, baseline qualitative assessments were held with patients, health workers, and administrators to inform implementation package adaptation. The package includes a hypertension patient registry with empanelment, performance and quality reporting, simplified treatment guideline emphasizing fixed-dose combination therapy, reliable access to quality essential medicines and technology, team-based care, and health coaching and home blood pressure monitoring. Strategies to implement and adapt the package were identified based on barriers and facilitators mapped in the formative phase, previous implementation experience, mid-term qualitative evaluation, and ongoing stakeholder and site feedback. The control phase included 11 months of sequential registration of hypertensive patients at participating primary healthcare centers, followed by implementation of the remainder of the package components and evaluation over 37 subsequent, consecutive months of the intervention phase. The formative phase was completed between April 2019 and August 2019, followed by initiation of the control phase in January 2020. The control phase included 11 months (January 2020 to November 2020) of sequential registration and empanelment of hypertensive patients at participating primary healthcare centers. After completion of the control phase in November 2020, the intervention phase commenced in December 2020 and will be completed in December 2023. Discussion This trial will provide robust evidence for implementation and effectiveness of a multi-level implementation package more broadly throughout the Federal Capital Territory, which may inform hypertension systems of care throughout Nigeria and in other low- and middle-income countries. Implementation outcome results will be important to understand what system-, site-, personnel-, and patient-level factors are necessary for successful implementation of this intervention. Trial registration ClinicalTrials.gov NCT04158154. The trial was prospectively registered on November 8, 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00328-9.
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Affiliation(s)
| | | | - Ikechukwu A Orji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Gabriel L Shedul
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Tunde M Ojo
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria.,Federal Ministry of Health, Abuja, Nigeria.,University of Abuja, Abuja, Nigeria
| | - Helen Eze
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Grace Shedul
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Eugenia N Ugwuneji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Nonye B Egenti
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria.,University of Abuja, Abuja, Nigeria
| | | | - Boni M Ale
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria.,Holo Healthcare, Nairobi, Kenya
| | - Ada Nwankwo
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria
| | | | - Jiancheng Ye
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Aashima Chopra
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Olutobi A Sanuade
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Spencer Fox Eccles School of Medicine, University of Utah, UT, Salt Lake City, USA
| | - Priya Tripathi
- Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mark D Huffman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, MO, USA.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Dike B Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria.,University of Abuja, Abuja, Nigeria
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27
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DiCorpo D, Gaynor SM, Russell EM, Westerman KE, Raffield LM, Majarian TD, Wu P, Sarnowski C, Highland HM, Jackson A, Hasbani NR, de Vries PS, Brody JA, Hidalgo B, Guo X, Perry JA, O'Connell JR, Lent S, Montasser ME, Cade BE, Jain D, Wang H, D'Oliveira Albanus R, Varshney A, Yanek LR, Lange L, Palmer ND, Almeida M, Peralta JM, Aslibekyan S, Baldridge AS, Bertoni AG, Bielak LF, Chen CS, Chen YDI, Choi WJ, Goodarzi MO, Floyd JS, Irvin MR, Kalyani RR, Kelly TN, Lee S, Liu CT, Loesch D, Manson JE, Minster RL, Naseri T, Pankow JS, Rasmussen-Torvik LJ, Reiner AP, Reupena MS, Selvin E, Smith JA, Weeks DE, Xu H, Yao J, Zhao W, Parker S, Alonso A, Arnett DK, Blangero J, Boerwinkle E, Correa A, Cupples LA, Curran JE, Duggirala R, He J, Heckbert SR, Kardia SLR, Kim RW, Kooperberg C, Liu S, Mathias RA, McGarvey ST, Mitchell BD, Morrison AC, Peyser PA, Psaty BM, Redline S, Shuldiner AR, Taylor KD, Vasan RS, Viaud-Martinez KA, Florez JC, Wilson JG, Sladek R, Rich SS, Rotter JI, Lin X, Dupuis J, Meigs JB, Wessel J, Manning AK. Whole genome sequence association analysis of fasting glucose and fasting insulin levels in diverse cohorts from the NHLBI TOPMed program. Commun Biol 2022; 5:756. [PMID: 35902682 PMCID: PMC9334637 DOI: 10.1038/s42003-022-03702-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 07/12/2022] [Indexed: 01/04/2023] Open
Abstract
The genetic determinants of fasting glucose (FG) and fasting insulin (FI) have been studied mostly through genome arrays, resulting in over 100 associated variants. We extended this work with high-coverage whole genome sequencing analyses from fifteen cohorts in NHLBI's Trans-Omics for Precision Medicine (TOPMed) program. Over 23,000 non-diabetic individuals from five race-ethnicities/populations (African, Asian, European, Hispanic and Samoan) were included. Eight variants were significantly associated with FG or FI across previously identified regions MTNR1B, G6PC2, GCK, GCKR and FOXA2. We additionally characterize suggestive associations with FG or FI near previously identified SLC30A8, TCF7L2, and ADCY5 regions as well as APOB, PTPRT, and ROBO1. Functional annotation resources including the Diabetes Epigenome Atlas were compiled for each signal (chromatin states, annotation principal components, and others) to elucidate variant-to-function hypotheses. We provide a catalog of nucleotide-resolution genomic variation spanning intergenic and intronic regions creating a foundation for future sequencing-based investigations of glycemic traits.
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Affiliation(s)
- Daniel DiCorpo
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Sheila M Gaynor
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Emily M Russell
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Kenneth E Westerman
- Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital, Boston, MA, 02114, USA
- Metabolism Program, The Broad Institute of MIT and Harvard, Cambridge, MA, 02124, USA
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Laura M Raffield
- Department of Genetics, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Timothy D Majarian
- Metabolism Program, The Broad Institute of MIT and Harvard, Cambridge, MA, 02124, USA
| | - Peitao Wu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Chloé Sarnowski
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Heather M Highland
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27514, USA
| | - Anne Jackson
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Natalie R Hasbani
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Paul S de Vries
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Jennifer A Brody
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, 98101, USA
- Department of Medicine, University of Washington, Seattle, WA, 98101, USA
| | - Bertha Hidalgo
- Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - James A Perry
- Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Jeffrey R O'Connell
- Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Samantha Lent
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| | - May E Montasser
- Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Brian E Cade
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, 02115, USA
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, 02124, USA
| | - Deepti Jain
- Department of Biostatistics, University of Washington, Seattle, WA, 98195, USA
| | - Heming Wang
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, 02115, USA
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, 02124, USA
| | - Ricardo D'Oliveira Albanus
- Department of Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Arushi Varshney
- Department of Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Lisa R Yanek
- GeneSTAR Research Program, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Leslie Lange
- Department of Medicine, Anschutz Medical Campus, University of Colorado Denver, Aurora, CO, 80045, USA
| | - Nicholette D Palmer
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Marcio Almeida
- Department of Human Genetics and South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley School of Medicine, Brownsville and Edinburg, TX, 78539, USA
| | - Juan M Peralta
- Department of Human Genetics and South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley School of Medicine, Brownsville and Edinburg, TX, 78539, USA
| | | | - Abigail S Baldridge
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Alain G Bertoni
- Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-, Salem, NC, 27157, USA
| | - Lawrence F Bielak
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Chung-Shiuan Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | - Yii-Der Ida Chen
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | | | - Mark O Goodarzi
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - James S Floyd
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, 98195, USA
- Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Marguerite R Irvin
- Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Rita R Kalyani
- GeneSTAR Research Program, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Tanika N Kelly
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | | | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Douglas Loesch
- Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - JoAnn E Manson
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Ryan L Minster
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Take Naseri
- Ministry of Health, Government of Samoa, Apia, Samoa
| | - James S Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55454, USA
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Alexander P Reiner
- Department of Epidemiology, University of Washington, Seattle, WA, 98195, USA
| | | | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21287, USA
| | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Daniel E Weeks
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Huichun Xu
- Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Jie Yao
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Wei Zhao
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Stephen Parker
- Department of Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor, MI, 48109, USA
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Donna K Arnett
- College of Public Health, University of Kentucky, Lexington, KY, 40506, USA
| | - John Blangero
- Department of Human Genetics and South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley School of Medicine, Brownsville and Edinburg, TX, 78539, USA
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39211, USA
| | - L Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
- National Heart Lung and Blood Institute and Boston University's Framingham Heart Study, Framingham, MA, 01702, USA
| | - Joanne E Curran
- Department of Human Genetics and South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley School of Medicine, Brownsville and Edinburg, TX, 78539, USA
| | - Ravindranath Duggirala
- Department of Human Genetics and South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley School of Medicine, Brownsville and Edinburg, TX, 78539, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | - Susan R Heckbert
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, 98195, USA
- Department of Epidemiology, University of Washington, Seattle, WA, 98195, USA
| | - Sharon L R Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Ryan W Kim
- Psomagen, Inc, Rockville, MD, 20850, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Simin Liu
- Center for Global Cardiometabolic Health (CGCH), Boston, MA, 02215, USA
| | - Rasika A Mathias
- GeneSTAR Research Program, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Stephen T McGarvey
- International Health Institute and Department of Epidemiology, Brown University School of Public Health, Providence, RI, 02912, USA
| | - Braxton D Mitchell
- Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Geriatrics Research and Education Clinical Center, Baltimore VA Medical Center, Baltimore, MD, 21201, USA
| | - Alanna C Morrison
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Patricia A Peyser
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, 98101, USA
- Department of Medicine, University of Washington, Seattle, WA, 98101, USA
- Department of Epidemiology, University of Washington, Seattle, WA, 98195, USA
- Department of Health Services, University of Washington, Seattle, WA, 98101, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, 02115, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02115, USA
| | - Alan R Shuldiner
- Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD, 21231, USA
| | - Kent D Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Ramachandran S Vasan
- National Heart Lung and Blood Institute and Boston University's Framingham Heart Study, Framingham, MA, 01702, USA
- Evans Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA, 02118, USA
- Evans Department of Medicine, Whitaker Cardiovascular Institute and Cardiology Section, Boston University School of Medicine, Boston, MA, 02118, USA
| | | | - Jose C Florez
- Metabolism Program, The Broad Institute of MIT and Harvard, Cambridge, MA, 02124, USA
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, 02124, USA
- Center for Genomic Medicine and Diabetes Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - James G Wilson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02115, USA
| | - Robert Sladek
- Department of Human Genetics, McGill University, Montreal, Montreal, Quebec, H3A 0G1, Canada
- Department of Medicine, McGill University, Montreal, Montreal, Quebec, H3A 0G1, Canada
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, 22908, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Xihong Lin
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| | - James B Meigs
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, 02124, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Jennifer Wessel
- Department of Epidemiology, Fairbanks School of Public Health, Indiana University, IN, 46202, USA.
- Department of Medicine, School of Medicine, Indiana University, IN, 46202, USA.
- Diabetes Translational Research Center, Indiana University, IN, 46202, USA.
| | - Alisa K Manning
- Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital, Boston, MA, 02114, USA.
- Metabolism Program, The Broad Institute of MIT and Harvard, Cambridge, MA, 02124, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA.
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Ojji DB, Baldridge AS, Orji IA, Shedul GL, Ojo TM, Ye J, Chopra A, Ale BM, Shedul G, Ugwuneji EN, Egenti NB, Omitiran K, Okoli RC, Eze H, Nwankwo A, Banigbe B, Tripathi P, Kandula NR, Hirschhorn LR, Huffman MD. Characteristics, treatment, and control of hypertension in public primary healthcare centers in Nigeria: baseline results from the Hypertension Treatment in Nigeria Program. J Hypertens 2022; 40:888-896. [PMID: 35034080 PMCID: PMC9081131 DOI: 10.1097/hjh.0000000000003089] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are limited data on large-scale, multilevel implementation research studies to improve hypertension diagnosis, treatment, and control rates at the primary healthcare (PHC) level in Africa. We describe the characteristics, treatment, and control rates of patients with hypertension in public PHC centers in the Hypertension Treatment in Nigeria Program. METHODS Data were collected from adults at least 18 years at 60 public PHC centers between January 2020 and November 2020. Hypertension treatment rates were calculated at registration and upon completion of the initial visit. Hypertension control rates were calculated based on SBP and DBPs less than 140/90 mmHg. Regression models were created to evaluate factors associated with hypertension treatment and control status. RESULTS Four thousand, nine hundred and twenty-seven individuals [66.7% women, mean (SD) age = 48.2 (12.9) years] were included. Mean (SD) SBP was higher in men compared with women [152.9 (20.0) mmHg versus 150.8 (21) mmHg, P = 0.001]. Most (58.3%) patients were on treatment at the time of registration, and by the end of the baseline visit, 89.2% of patients were on treatment. The baseline hypertension control rate was 13.1%, and control was more common among patients who were older [adjusted OR (95% CI) 1.01 [1.01 -1.02)], women [adjusted OR (95% CI) 1.30 (1.05- 1.62)], who used fixed dose combination therapy [adjusted OR (95% CI) 1.83 (1.49 -2.26)], and had higher education levels. CONCLUSION This baseline report of the largest facility-based hypertension study in Africa demonstrates high hypertension treatment rates but low control rates.
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Affiliation(s)
- Dike B. Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- University of Abuja, Abuja, Nigeria
| | | | - Ikechukwu A. Orji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Gabriel L. Shedul
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Tunde M. Ojo
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Jiancheng Ye
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Aashima Chopra
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Boni M. Ale
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Grace Shedul
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Eugenia N. Ugwuneji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Nonye B. Egenti
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Kasarachi Omitiran
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | - Helen Eze
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Ada Nwankwo
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Bolanle Banigbe
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Priya Tripathi
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Lisa R. Hirschhorn
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mark D. Huffman
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- The George Institute for Global Health, Sydney, Australia
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29
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Agarwal A, Mohanan PP, Kondal D, Chopra A, Baldridge AS, Davies D, Devarajan R, Unni G, Abdullakutty J, Natesan S, Joseph J, Jayagopal PB, Joseph S, Gopinath R, Prabhakaran D, Huffman MD. Presentation, Management, and In-Hospital Outcomes of Patients with Acute Heart Failure in South India by Sex: A Secondary Analysis of a Prospective, Interrupted Time Series Study. Glob Heart 2021; 16:63. [PMID: 34692388 PMCID: PMC8485866 DOI: 10.5334/gh.1043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/25/2021] [Indexed: 11/20/2022] Open
Abstract
Background Sex differences in presentation, management, and outcomes of heart failure (HF) have been observed, but it is uncertain whether these differences exist in South India. Objective We describe sex differences in presentation, management, and in-hospital outcomes in patients hospitalized with HF in South India and explore sex-based differences in the effect of the quality improvement intervention in a secondary analysis of a prospective, interrupted time series study. Methods The Heart Failure Quality Improvement in Kerala (HF QUIK) study evaluated the effect of a quality improvement toolkit on process of care measures and clinical outcomes in patients hospitalized with HF in eight hospitals in Kerala using an interrupted time series design from February 2018 to August 2018. The primary outcome was guideline-directed medical therapy (GDMT) at hospital discharge for patients with HF with reduced ejection fraction (HFrEF). We performed sex-stratified analyses using mixed effect logistic regression models. Results Among 1,400 patients, 536 (38.3%) were female. Female patients were older (69.6 vs. 65 years, p < 0.001), were less likely to have an ischemic etiology of HF (control period: 78.2% vs. 87.5%; intervention period: 83.6% vs. 91.5%; p < 0.05 for both) and were less likely to undergo coronary angiography or percutaneous coronary intervention. The quality improvement intervention had similar effects on the odds of GDMT at discharge in females with HFrEF (adjusted OR 1.79, 95% CI 0.92, 3.47) and males with HFrEF (adjusted OR 1.68, 95% CI 1.07, 2.64, pinteraction = 0.69). Conclusions We observed sex-specific differences in presentation and procedural management of patients with HF but no differences in the effect of the quality improvement intervention on discharge GDMT rates. Both male and female patients with HFrEF remained undertreated in the study intervention period, demonstrating the need for implementation strategies to close the HFrEF treatment gap in South India.
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Affiliation(s)
- Anubha Agarwal
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | | | - Dimple Kondal
- Centre for Chronic Disease Control, New Delhi, Delhi, IN
| | - Aashima Chopra
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | - Abigail S. Baldridge
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | | | - Raji Devarajan
- Centre for Chronic Disease Control, New Delhi, Delhi, IN
| | - Govindan Unni
- Jubilee Mission Medical College and Hospital, Thrissur, Kerala, IN
| | | | | | | | | | - Stigi Joseph
- Little Flower Hospital and Research Centre, Angamaly, Kerala, IN
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, Delhi, IN
- The Public Health Foundation of India, Gurugram, Haryana, IN
| | - Mark D. Huffman
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, AU
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30
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Okoli RCB, Shedul G, Hirschhorn LR, Orji IA, Ojo TM, Egenti N, Omitiran K, Akor B, Baldridge AS, Huffman MD, Ojji D, Kandula NR. Stakeholder perspectives to inform adaptation of a hypertension treatment program in primary healthcare centers in the Federal Capital Territory, Nigeria: a qualitative study. Implement Sci Commun 2021; 2:97. [PMID: 34462016 PMCID: PMC8404273 DOI: 10.1186/s43058-021-00197-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 08/05/2021] [Indexed: 12/01/2022] Open
Abstract
Background Implementing an evidence-based hypertension program in primary healthcare centers (PHCs) in the Federal Capital Territory, Nigeria is an opportunity to improve hypertension diagnosis, treatment, and control and reduce deaths from cardiovascular diseases. This qualitative research study was conducted in Nigerian PHCs with patients, non-physician health workers, administrators and primary care physicians to inform contextual adaptations of Kaiser Permanente Northern California's hypertension model and the World Health Organization’s HEARTS technical package for the system-level, Hypertension Treatment in Nigeria (HTN) Program. Methods Purposive sampling in 8 PHCs identified patients (n = 8), non-physician health workers (n = 12), administrators (n = 3), and primary care physicians (n = 6) for focus group discussions and interviews. The Primary Health Care Performance Initiative (PHCPI) conceptual framework and Consolidated Framework for Implementation Research (CFIR) domains were used to develop semi-structured interviews (Appendix 1, Supplemental Materials) and coding guides. Content analysis identified multilevel factors that would influence program implementation. Results Participants perceived the need to strengthen four major health system inputs across CFIR domains for successful adaptation of the HTN Program components: (1) reliable drug supply and blood pressure measurement equipment, (2) enable and empower community healthcare workers to participate in team-based care through training and education, (3) information systems to track patients and medication supply chain, and (4) a primary healthcare system that could offer a broader package of health services to meet patient needs. Specific features of the PHCPI framework considered important included: accessible and person-centered care, provider availability and competence, coordination of care, and proactive community outreach. Participants also identified patient-level factors, such as knowledge and beliefs about hypertension, and financial and transportation barriers that could be addressed with better communication, home visits, and drug financing. Participants recommended using existing community structures, such as village health committees and popular opinion leaders, to improve knowledge and demand for the HTN Program. Conclusions These results provide information on specific primary care and community contextual factors that can support or hinder implementation and sustainability of an evidence-based, system-level hypertension program in the Federal Capital Territory, Nigeria, with the ultimate aim of scaling it to other parts of the country. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00197-8.
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Affiliation(s)
| | - Gabriel Shedul
- University of Abuja Teaching Hospital Gwagwalada, Abuja, Nigeria
| | - Lisa R Hirschhorn
- Feinberg School of Medicine, Northwestern University, 420 E Superior, 6th Floor, Chicago, IL, 60611, USA
| | - Ikechukwu A Orji
- University of Abuja Teaching Hospital Gwagwalada, Abuja, Nigeria
| | - Tunde M Ojo
- University of Abuja Teaching Hospital Gwagwalada, Abuja, Nigeria
| | - Nonye Egenti
- University of Abuja Teaching Hospital Gwagwalada, Abuja, Nigeria
| | | | - Blessing Akor
- University of Abuja Teaching Hospital Gwagwalada, Abuja, Nigeria
| | - Abigail S Baldridge
- Feinberg School of Medicine, Northwestern University, 420 E Superior, 6th Floor, Chicago, IL, 60611, USA
| | - Mark D Huffman
- Feinberg School of Medicine, Northwestern University, 420 E Superior, 6th Floor, Chicago, IL, 60611, USA
| | - Dike Ojji
- University of Abuja Teaching Hospital Gwagwalada, Abuja, Nigeria
| | - Namratha R Kandula
- Feinberg School of Medicine, Northwestern University, 420 E Superior, 6th Floor, Chicago, IL, 60611, USA.
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31
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Khan SS, Shah SJ, Strande JL, Baldridge AS, Flevaris P, Puckelwartz MJ, McNally EM, Rasmussen-Torvik LJ, Lee DC, Carr JC, Benefield BC, Afzal MZ, Heiman M, Gupta S, Shapiro AD, Vaughan DE. Identification of Cardiac Fibrosis in Young Adults With a Homozygous Frameshift Variant in SERPINE1. JAMA Cardiol 2021; 6:841-846. [PMID: 33439236 DOI: 10.1001/jamacardio.2020.6909] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Importance Cardiac fibrosis is exceedingly rare in young adults. Identification of genetic variants that cause early-onset cardiomyopathy may inform novel biological pathways. Experimental models and a single case report have linked genetic deficiency of plasminogen activator inhibitor-1 (PAI-1), a downstream target of cardiac transforming growth factor β, with cardiac fibrosis. Objective To perform detailed cardiovascular phenotyping and genotyping in young adults from an Amish family with a frameshift variant (c.699_700dupTA) in SERPINE1, the gene that codes for PAI-1. Design, Setting, and Participants This observational study included participants from 3 related nuclear families from an Amish community in the primary analysis and participants from the extended family in the secondary analysis. Participants were recruited from May 2015 to December 2016, and analysis took place from June 2015 to June 2020. Main Outcomes and Measures (1) Multimodality cardiovascular imaging (transthoracic echocardiography and cardiac magnetic resonance imaging), (2) whole-exome sequencing, and (3) induced pluripotent stem cell-derived cardiomyocytes. Results Among 17 participants included in the primary analysis, the mean (interquartile range) age was 23.7 (20.9-29.9) years and 9 individuals (52.9%) were confirmed to be homozygous for the SERPINE1 c.699_700dupTA variant. Late gadolinium enhancement was present in 6 of 9 homozygous participants (67%) with absolute PAI-1 deficiency vs 0 of 8 in the control group (P = .001). Late gadolinium enhancement patterns tended to be dense and linear, usually subepicardial but also midmyocardial and transmural with noncoronary distributions. Targeted whole-exome sequencing analysis identified that homozygosity for c.699_700dupTA SERPINE1 was the only shared pathogenic variant or variant of uncertain significance after examination of cardiomyopathy genes among those with late gadolinium enhancement. Induced pluripotent stem cell-derived cardiomyocytes from participants homozygous for the SERPINE1 c.699_700dupTA variant exhibited susceptibility to cardiomyocyte injury in response to angiotensin II (increased transforming growth factor β1 secretion and release of lactate dehydrogenase) compared with control induced pluripotent stem cell-derived cardiomyocytes. In a secondary analysis based on echocardiography in 155 individuals across 3 generations in the extended family, no difference in global longitudinal strain was observed in carriers for the SERPINE1 c.699_700dupTA variant compared with wild-type participants, supporting an autosomal recessive inheritance pattern. Conclusions and Relevance In this study, a highly penetrant, autosomal recessive, cardiac fibrosis phenotype among young adults with homozygous frameshift variant for SERPINE1 was identified, suggesting an optimal range of PAI-1 levels are needed for cardiac homeostasis.
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Affiliation(s)
- Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Associate Editor, JAMA Cardiology
| | - Jennifer L Strande
- Department of Medicine and Cardiovascular Center, Medical College of Wisconsin, Milwaukee
| | - Abigail S Baldridge
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Panagiotis Flevaris
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Megan J Puckelwartz
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth M McNally
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel C Lee
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James C Carr
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Brandon C Benefield
- Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Muhammad Zeeshan Afzal
- Department of Medicine and Cardiovascular Center, Medical College of Wisconsin, Milwaukee
| | - Meadow Heiman
- Indiana Hemophilia and Thrombosis Center, Indianapolis
| | - Sweta Gupta
- Indiana Hemophilia and Thrombosis Center, Indianapolis
| | - Amy D Shapiro
- Indiana Hemophilia and Thrombosis Center, Indianapolis
| | - Douglas E Vaughan
- Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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32
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Orji IA, Baldridge AS, Omitiran K, Guo M, Ajisegiri WS, Ojo TM, Shedul G, Kandula NR, Hirschhorn LR, Huffman MD, Ojji DB. Capacity and site readiness for hypertension control program implementation in the Federal Capital Territory of Nigeria: a cross-sectional study. BMC Health Serv Res 2021; 21:322. [PMID: 33836719 PMCID: PMC8034094 DOI: 10.1186/s12913-021-06320-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nigeria faces an increase in the burden of non-communicable diseases (NCDs), including cardiovascular diseases (CVDs), leading to an estimated 29% of all deaths in the country. Nigeria has an estimated hypertension prevalence ranging from 25 to 40% of her adult population. Despite this high burden, awareness (14-30%), treatment (< 20%), and control (9%) rates of hypertension are low in Nigeria. Against this backdrop, we sought to perform capacity and readiness assessments of public Primary Healthcare Centers (PHCs) to inform Nigeria's system-level hypertension control program's implementation and adaptation strategies. METHODS The study employed a multi-stage sampling to select 60 from the 243 PHCs in the Federal Capital Territory (FCT) of Nigeria. The World Health Organization (WHO) Service Availability and Readiness Assessment was adapted to focus on hypertension diagnosis and treatment and was administered to PHC staff from May 2019 - October 2019. Indicator scores for general and cardiovascular service readiness were calculated based on the proportion of sites with available amenities, equipment, diagnostic tests, and medications. RESULTS Median (interquartile range [IQR]) number of full-time staff was 5 (3-8), and were predominantly community health extension workers (median = 3 [IQR 2-5]). Few sites (n = 8; 15%) received cardiovascular disease diagnosis and management training within the previous 2 years, though most had sufficient capacity for screening (n = 58; 97%), diagnosis (n = 56; 93%), and confirmation (n = 50; 83%) of hypertension. Few PHCs had guidelines (n = 7; 13%), treatment algorithms (n = 3; 5%), or information materials (n = 1; 2%) for hypertension. Most sites (n = 55; 92%) had one or more functional blood pressure apparatus. All sites relied on paper records, and few had a functional computer (n = 10; 17%) or access to internet (n = 5; 8%). Despite inclusion on Nigeria's essential medicines list, 35 (59%) PHCs had zero 30-day treatment regimens of any blood pressure-lowering medications in stock. CONCLUSIONS This first systematic assessment of capacity and readiness for a system-level hypertension control program within the FCT of Nigeria demonstrated implementation feasibility based on the workforce, equipment, and paper-based information systems, but a critical need for essential medicine supply strengthening, health-worker training, and protocols for hypertension treatment and control in Nigeria.
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Affiliation(s)
- Ikechukwu A Orji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.
| | | | - Kasarachi Omitiran
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Mainzhao Guo
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Tunde M Ojo
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Gabriel Shedul
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mark D Huffman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Dike B Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.,University of Abuja, Abuja, Nigeria
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33
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Khan SS, Huffman MD, Harrington K, Baldridge AS, Yu J, Neal B, Arnott C, Shah SJ. Association of Baseline Diuretic Use With Cardiovascular Outcomes in Patients With Heart Failure With Preserved Ejection Fraction: A Secondary Analysis From TOPCAT. J Card Fail 2021; 27:816-818. [PMID: 33636330 DOI: 10.1016/j.cardfail.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katherine Harrington
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Abigail S Baldridge
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jie Yu
- The George Institute for Global Health, Sydney, Australia
| | - Bruce Neal
- The George Institute for Global Health, Sydney, Australia
| | - Clare Arnott
- The George Institute for Global Health, Sydney, Australia
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Yu J, Arnott C, Neuen BL, Heersprink HL, Mahaffey KW, Cannon CP, Khan SS, Baldridge AS, Shah SJ, Huang Y, Li C, Figtree GA, Perkovic V, Jardine MJ, Neal B, Huffman MD. Cardiovascular and renal outcomes with canagliflozin according to baseline diuretic use: a post hoc analysis from the CANVAS Program. ESC Heart Fail 2021; 8:1482-1493. [PMID: 33595905 PMCID: PMC8006652 DOI: 10.1002/ehf2.13236] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/09/2020] [Accepted: 01/19/2021] [Indexed: 01/10/2023] Open
Abstract
Aims The CANVAS Program identified the effect of canagliflozin on major adverse cardiovascular events (MACE) differed according to whether participants were using diuretics at study commencement. We sought to further evaluate this finding related to baseline differences, treatment effects, safety, and risk factor changes. Methods and results The CANVAS Program enrolled 10 142 participants with type 2 diabetes mellitus and high cardiovascular risk. Participants were randomized to canagliflozin or placebo and followed for a mean of 188 weeks. The primary outcome was major cardiovascular events, a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Secondary outcomes included multiple cardiovascular, renal, and safety events. In this post hoc subgroup analysis, participants were categorized according to baseline use of any diuretic. The effect on outcomes was compared using Cox proportional hazards models, while risk factor changes were compared using mixed‐effect models. At baseline, 4490 (44.3%) participants were using a diuretic. Compared with those not using a diuretic, participants using a diuretic were more likely to be older (mean age ± standard deviation, 64.3 ± 8.0 vs. 62.5 ± 8.3), be female (38.9% vs. 33.4%), and have heart failure (19.6% vs. 10.3%) (all Pdifference < 0.0001). The effect of canagliflozin on major cardiovascular events was greater for those using diuretic at baseline than for those who were not [adjusted hazard ratio 0.65 (95% confidence interval 0.54–0.78) vs. adjusted hazard ratio 1.13 (95% confidence interval 0.93–1.36), Pheterogeneity < 0.0001]. Changes in most risk factors, including blood pressure, body weight, and urine albumin‐to‐creatinine ratio, were similar between groups (all Pdifference > 0.11), although the effect of canagliflozin on haemoglobin A1c reduction was slightly weaker in participants using compared with not using diuretics at baseline (−0.52% vs. −0.64%, Pheterogeneity = 0.0007). Overall serious adverse events and key safety outcomes, including adverse renal events, were also similar (all Pheterogeneity > 0.07). Conclusions Participants on baseline diuretics derived a greater benefit for major cardiovascular events from canagliflozin, which was not fully explained by differences in participant characteristics nor risk factor changes.
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Affiliation(s)
- Jie Yu
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia.,Department of Cardiology, Peking University Third Hospital, Beijing, China.,Faculty of Medicine, University of New South Wales, Sydney, Sydney, Australia
| | - Clare Arnott
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Sydney, Australia
| | - Brendon L Neuen
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Sydney, Australia
| | - Hiddo L Heersprink
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia.,Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Sadiya S Khan
- Center for Global Cardiovascular Health, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Suite 800, Chicago, IL, 60611, USA
| | - Abigail S Baldridge
- Center for Global Cardiovascular Health, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Suite 800, Chicago, IL, 60611, USA
| | - Sanjiv J Shah
- Center for Global Cardiovascular Health, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Suite 800, Chicago, IL, 60611, USA
| | - Yuli Huang
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Chao Li
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Gemma A Figtree
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Kolling Institute, Royal North Shore Hospital and University of Sydney, Sydney, Australia
| | - Vlado Perkovic
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Sydney, Australia
| | - Meg J Jardine
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Sydney, Australia
| | - Bruce Neal
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia.,The Charles Perkins Centre, University of Sydney, Sydney, Australia.,Faculty of Clinical Epidemiology, Imperial College London, London, UK
| | - Mark D Huffman
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia.,Center for Global Cardiovascular Health, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Suite 800, Chicago, IL, 60611, USA
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Murthy VL, Xia R, Baldridge AS, Carnethon MR, Sidney S, Bouchard C, Sarzynski MA, Lima JAC, Lewis GD, Shah SJ, Fornage M, Shah RV. Polygenic Risk, Fitness, and Obesity in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. JAMA Cardiol 2021; 5:40-48. [PMID: 31913407 DOI: 10.1001/jamacardio.2019.5220] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Obesity is a major determinant of disease burden worldwide. Polygenic risk scores (PRSs) have been posited as key predictors of obesity. How a PRS can be translated to the clinical encounter (especially in the context of fitness, activity, and parental history of overweight) remains unclear. Objective To quantify the relative importance of a PRS, fitness, activity, parental history of overweight, and body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) in young adulthood on BMI trends over 25 years. Design, Setting, and Participants This population-based prospective cohort study at 4 US centers included white individuals and black individuals with assessments of polygenic risk of obesity, fitness, activity, and BMI in young adulthood (in their 20s) and up to 25 years of follow-up. Data collected between March 1985 and August 2011 were analyzed from April 25, 2019, to September 29, 2019. Main Outcomes and Measures Body mass index at the initial visit and 25 years later. Results This study evaluated an obesity PRS from a recently reported study of 1608 white individuals (848 women [52.7%]) and 909 black individuals (548 women [60.3%]) across the United States. At baseline (year 0), mean (SD) overall BMI was 24.2 (4.5), which increased to 29.6 (6.9) at year 25. Among white individuals, the PRS (combined with age, sex, self-reported parental history of overweight, and principal components of ancestry) explained 11.9% (at year 0) and 13.6% (at year 25) of variation in BMI. Although the addition of fitness increased the explanatory capability of the model (24.0% variance at baseline and up to 18.1% variance in BMI at year 25), baseline BMI in young adulthood was the strongest factor, explaining 52.3% of BMI in midlife in combination with age, sex, and self-reported parental history of overweight. Accordingly, models that included baseline BMI (especially BMI surveillance over time) were better in predicting BMI at year 25 compared with the PRS. In fully adjusted models, the effect sizes for fitness and the PRS on BMI were comparable in opposing directions. The added explanatory capacity of the PRS among black individuals was lower than among white individuals. Among white individuals, addition of baseline BMI and surveillance of BMI over time was associated with improved precision of predicted BMI at year 25 (mean error in predicted BMI 0 kg/m2 [95% CI, -11.4 to 11.4] to 0 kg/m2 [95% CI, -8.5 to 8.5] for baseline BMI and mean error 0 kg/m2 [95% CI, -5.3 to 5.3] for BMI surveillance). Conclusions and Relevance Cardiorespiratory fitness in young adulthood and a PRS are modestly associated with midlife BMI, although future BMI is associated with BMI in young adulthood. Fitness has a comparable association with future BMI as does the PRS. Caution should be exercised in the widespread use of polygenic risk for obesity prevention in adults, and close clinical surveillance and fitness may have prime roles in limiting the adverse consequences of elevated BMI on health.
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Affiliation(s)
- Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor.,Frankel Cardiovascular Center, University of Michigan, Ann Arbor
| | - Rui Xia
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Abigail S Baldridge
- Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Stephen Sidney
- Kaiser Permanente Northern California Division of Research, Oakland
| | - Claude Bouchard
- Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Mark A Sarzynski
- Department of Exercise Science, University of South Carolina, Columbia
| | - João A C Lima
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Gregory D Lewis
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston
| | - Sanjiv J Shah
- Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois.,Associate Editor
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Ravi V Shah
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston
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36
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Gottdiener JS, Seliger S, deFilippi C, Christenson R, Baldridge AS, Kizer JR, Psaty BM, Shah SJ. Relation of Biomarkers of Cardiac Injury, Stress, and Fibrosis With Cardiac Mechanics in Patients ≥ 65 Years of Age. Am J Cardiol 2020; 136:156-163. [PMID: 32946864 DOI: 10.1016/j.amjcard.2020.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 01/16/2023]
Abstract
High sensitivity cardiac troponin T (hscTnT), soluble ST2 (sST2), N-terminal B-type natriuretic peptide (NT-proBNP), and galectin-3 are biomarkers of cardiac injury, stress, myocardial stretch, and fibrosis. Elevated levels are associated with poor outcomes. However, their association with cardiac mechanics in older persons is unknown. Associations between these biomarkers and cardiac mechanics derived from speckle tracking echocardiography, including left ventricular longitudinal strain (LVLS), early diastolic strain, and left atrial reservoir strain (LARS) were evaluated using standardized beta coefficients () in a cross sectional analysis with cardiac biomarkers in older patients without cardiovascular disease, low ejection fraction, or wall motion abnormalities. Biomarker associations with strain were attenuated by demographics and risk factors. In adjusted models, LVLS was associated with continuous measures of hscTnT (β∧-0.06, p = 0.020), sST2 (β∧ -0.05, p = 0.024) and NT-proBNP (β∧ -0.06, p = 0.007). "High" levels (i.e., greater than prognostic cutpoint) of hscTnT (>13 ng/ml), sST2 (>35 ng/ml), and NT-proBNP (>190 pg/ml) were also associated with worse LVLS. In risk factor adjusted models, LARS was associated with hscTnT (β∧ -0.08, p = 0.003) and NT-proBNP (β∧-0.18, p <0.0001). High hscTnT (>13 ng/ml) and high NT-proBNP (>190 pg/ml) were also both associated with worse LARS. Gal-3 was not associated with any strain measure. In conclusion, in persons ≥ 65 years of age, without cardiovascular disease, low ejection fraction, or wall motion abnormalities, hscTnT, sST2, and NT-proBNP are associated with worse LVLS. HscTnT and NT-proBNP are associated with worse LARS. In conclusion, these subclinical increases in blood biomarkers, and their associations with subtle diastolic and systolic dysfunction, may represent pre-clinical heart failure.
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Affiliation(s)
- John S Gottdiener
- Divisions of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Stephen Seliger
- Divisions of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Robert Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Abigail S Baldridge
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jorge R Kizer
- Division of Cardiology, Department of Medicine, UCSF School of Medicine, San Francisco, California; San Francisco VA Medical Center, San Francisco, California
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington and Kaiser Permanente Washington Health Research Institute, Seattle Washington
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Welty LJ, Rasmussen LV, Baldridge AS, Whitley EW. Facilitating reproducible research through direct connection of data analysis with manuscript preparation: StatTag for connecting statistical software to Microsoft Word. JAMIA Open 2020; 3:342-358. [PMID: 33215069 PMCID: PMC7660954 DOI: 10.1093/jamiaopen/ooaa043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/06/2020] [Accepted: 09/09/2020] [Indexed: 12/14/2022] Open
Abstract
Objectives To enhance reproducible research by creating a broadly accessible, free, open-source software tool for connecting Microsoft Word to statistical programs (R/R Markdown, Python, SAS, Stata) so that results may be automatically updated in a manuscript. Materials and Methods We developed StatTag for Windows as a Microsoft Word plug-in using C# and for macOS as a native application using Objective-C. Source code is available under the MIT license at https://github.com/stattag. Results StatTag links analysis file(s) (R/R Markdown, SAS, Stata, or Python) and a Word document, invokes the statistical program(s) to obtain results, and embeds selected output in the document. StatTag can accommodate multiple statistical programs with a single document and features an interface to view, edit, and rerun statistical code directly from Word. Discussion and Conclusion StatTag may facilitate reproducibility within increasingly multidisciplinary research teams, improve research transparency through review and publication, and complement data-sharing initiatives.
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Affiliation(s)
- Leah J Welty
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Luke V Rasmussen
- Division of Health and Biomedical Informatics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Abigail S Baldridge
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Eric W Whitley
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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38
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Ojji DB, Baldridge AS, Orji AI, Shedul LG, Ojji OI, Egenti NB, Nwankwo AM, Huffman MD. Feasibility and effect of community health worker support and home monitoring for blood pressure control in Nigeria: a randomised pilot trial. Cardiovasc J Afr 2020; 31:213-215. [PMID: 32627803 DOI: 10.5830/cvja-2019-066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 10/23/2019] [Indexed: 11/06/2022] Open
Abstract
In a three-arm, randomised, controlled trial among 60 Nigerian adults with hypertension, community health worker support and home blood pressure monitoring led to greater reductions in systolic blood pressure at four weeks compared to the usual care.
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Affiliation(s)
- Dike B Ojji
- Cardiology Unit, Department of Medicine, College of Health Sciences, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria. dike.ojji@uniabuja,edu,ng
| | - Abigail S Baldridge
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anthony I Orji
- Disease Control Unit, Department of Health, Abuja Municipal Area Council, Federal Capital Territory, Nigeria
| | - Lamkur G Shedul
- Department of Family Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Olubunmi I Ojji
- Department of Community Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Nonye B Egenti
- Department of Community Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Ada M Nwankwo
- Department of Community Medicine, College of Health Sciences University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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39
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Yoo SGK, Davies D, Mohanan PP, Baldridge AS, Charles PM, Schumacher M, Bhalla S, Devarajan R, Hirschhorn LR, Prabhakaran D, Huffman MD. Hospital-Level Cardiovascular Management Practices in Kerala, India. Circ Cardiovasc Qual Outcomes 2020; 12:e005251. [PMID: 31092020 DOI: 10.1161/circoutcomes.118.005251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Hospital management practices are associated with cardiovascular process of care measures and patient outcomes. However, management practices related to acute cardiac care in India has not been studied. Methods and Results We measured management practices through semistructured, in-person interviews with hospital administrators, physician managers, and nurse managers in Kerala, India between October and November 2017 using the adapted World Management Survey. Trained interviewers independently scored management interview responses (range: 1-5) to capture management practices ranging from performance data tracking to setting targets. We performed univariate regression analyses to assess the relationship between hospital-level factors and management practices. Using Pearson correlation coefficients and mixed-effect logistic regression models, we explored the relationship between management practices and 30-day major adverse cardiovascular events defined as all-cause mortality, reinfarction, stroke, or major bleeding. Ninety managers from 37 hospitals participated. We found suboptimal management practices across 3 management levels (mean [SD]: 2.1 [0.5], 2.0 [0.3], and 1.9 [0.3] for hospital administrators, physician managers, and nurse managers, respectively [ P=0.08]) with lowest scores related to setting organizational targets. Hospitals with existing healthcare quality accreditation, more cardiologists, and private ownership were associated with higher management scores. In our exploratory analysis, higher physician management practice scores related to operation, performance, and target management were correlated with lower 30-day major adverse cardiovascular event. Conclusions Management practices related to acute cardiac care in participating Kerala hospitals were suboptimal but were correlated with clinical outcomes. We identified opportunities to strengthen nonclinical practices to improve patient care.
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Affiliation(s)
- Sang Gune K Yoo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.G.K.Y., A.S.B., M.D.H.)
| | - Divin Davies
- WestFort Hi-Tech Hospital Ltd, Thrissur, India (D.D., P.P.M.)
| | | | - Abigail S Baldridge
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.G.K.Y., A.S.B., M.D.H.)
| | | | - Mark Schumacher
- Northwestern Memorial Healthcare, Chicago, IL (P.M.C., M.S.)
| | - Sandeep Bhalla
- Public Health Foundation of India, Gurgaon, India (S.B., D.P.)
| | - Raji Devarajan
- Centre for Chronic Disease Control, New Delhi, India (R.D., D.P.)
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL (L.R.H.)
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Gurgaon, India (S.B., D.P.).,Centre for Chronic Disease Control, New Delhi, India (R.D., D.P.).,London School of Hygiene and Tropical Medicine, London, United Kingdom (D.P.)
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.G.K.Y., A.S.B., M.D.H.)
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40
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Swat SA, Cohen D, Shah SJ, Lloyd-Jones DM, Baldridge AS, Freed BH, Vorovich EE, Yancy CW, Jonnalagadda SR, Prenner S, Kim D, Wilcox JE. Baseline Longitudinal Strain Predicts Recovery of Left Ventricular Ejection Fraction in Hospitalized Patients With Nonischemic Cardiomyopathy. J Am Heart Assoc 2019; 7:e09841. [PMID: 30371257 PMCID: PMC6474980 DOI: 10.1161/jaha.118.009841] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Heart failure (HF) with “recovered” ejection fraction (HFrecEF) is an emerging phenotype, but no tools exist to predict ejection fraction (EF) recovery in acute HF. We hypothesized that indices of baseline cardiac structure and function predict HFrecEF in nonischemic cardiomyopathy and reduced EF. Methods and Results We identified a nonischemic cardiomyopathy cohort with EF<40% during the first HF hospitalization (n=166). We performed speckle‐tracking echocardiography to measure longitudinal, circumferential, and radial strain, and the average of these measures (myocardial systolic performance). HFrecEF was defined as follow‐up EF ≥40% and ≥10% improvement from baseline EF. Fifty‐nine patients (36%) achieved HFrecEF (baseline EF 26±7%; follow‐up EF 51±7%) within a median of 135 (interquartile range 58‐239) days after the first HF hospitalization. Baseline demographics, biomarker profiles, and comorbid conditions (except lower chronic kidney disease in HFrecEF) were similar between HFrecEF and persistent reduced‐EF groups. HFrecEF patients had smaller baseline left ventricular end‐systolic dimension (3.6 versus 4.8 cm; P<0.01), higher baseline myocardial systolic performance (9.2% versus 8.1%; P=0.02), and improved survival (adjusted hazard ratio 0.27, 95% confidence interval 0.11, 0.62). We found a significant interaction between baseline left ventricular end‐systolic dimension and absolute longitudinal strain. Among patients with left ventricular end‐systolic dimension >4.35 cm, higher absolute longitudinal strain (≥8%) was associated with HFrecEF (unadjusted odds ratio=3.9, 95% CI)confidence interval 1.2, 12.8). Incorporation of baseline indices of cardiac mechanics with clinical variables resulted in a predictive model for HFrecEF with c‐statistic=0.85. Conclusions Factors associated with achieving HFrecEF were specific to cardiac structure and indices of cardiac mechanics. Higher baseline absolute longitudinal strain is associated with HFrecEF among nonischemic cardiomyopathy patients with reduced EF and larger left ventricular dimensions.
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Affiliation(s)
- Stanley A Swat
- 1 Department of Medicine Northwestern University Chicago IL
| | - David Cohen
- 5 Division of Cardiology University of Michigan Ann Arbor MI
| | - Sanjiv J Shah
- 4 Division of Cardiology Feinberg School of Medicine Northwestern University Chicago IL
| | - Donald M Lloyd-Jones
- 2 Department of Preventative Medicine Northwestern University Chicago IL.,4 Division of Cardiology Feinberg School of Medicine Northwestern University Chicago IL
| | | | - Benjamin H Freed
- 4 Division of Cardiology Feinberg School of Medicine Northwestern University Chicago IL
| | - Esther E Vorovich
- 4 Division of Cardiology Feinberg School of Medicine Northwestern University Chicago IL
| | - Clyde W Yancy
- 4 Division of Cardiology Feinberg School of Medicine Northwestern University Chicago IL
| | | | - Stuart Prenner
- 6 Division of Cardiology University of Pennsylvania Philadelphia PA
| | - Daniel Kim
- 3 Department of Radiology Northwestern University Chicago IL
| | - Jane E Wilcox
- 2 Department of Preventative Medicine Northwestern University Chicago IL.,4 Division of Cardiology Feinberg School of Medicine Northwestern University Chicago IL
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41
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Do AN, Zhao W, Baldridge AS, Raffield LM, Wiggins KL, Shah SJ, Aslibekyan S, Tiwari HK, Limdi N, Zhi D, Sitlani CM, Taylor KD, Psaty BM, Sotoodehnia N, Brody JA, Rasmussen‐Torvik LJ, Lloyd‐Jones D, Lange LA, Wilson JG, Smith JA, Kardia SLR, Mosley TH, Vasan RS, Arnett DK, Irvin MR. Genome-wide meta-analysis of SNP and antihypertensive medication interactions on left ventricular traits in African Americans. Mol Genet Genomic Med 2019; 7:e00788. [PMID: 31407531 PMCID: PMC6785453 DOI: 10.1002/mgg3.788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/14/2019] [Accepted: 04/22/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Left ventricular (LV) hypertrophy affects up to 43% of African Americans (AAs). Antihypertensive treatment reduces LV mass (LVM). However, interindividual variation in LV traits in response to antihypertensive treatments exists. We hypothesized that genetic variants may modify the association of antihypertensive treatment class with LV traits measured by echocardiography. METHODS We evaluated the main effects of the three most common antihypertensive treatments for AAs as well as the single nucleotide polymorphism (SNP)-by-drug interaction on LVM and relative wall thickness (RWT) in 2,068 participants across five community-based cohorts. Treatments included thiazide diuretics (TDs), angiotensin converting enzyme inhibitors (ACE-Is), and dihydropyridine calcium channel blockers (dCCBs) and were compared in a pairwise manner. We performed fixed effects inverse variance weighted meta-analyses of main effects of drugs and 2.5 million SNP-by-drug interaction estimates. RESULTS We observed that dCCBs versus TDs were associated with higher LVM after adjusting for covariates (p = 0.001). We report three SNPs at a single locus on chromosome 20 that modified the association between RWT and treatment when comparing dCCBs to ACE-Is with consistent effects across cohorts (smallest p = 4.7 × 10-8 , minor allele frequency range 0.09-0.12). This locus has been linked to LV hypertrophy in a previous study. A marginally significant locus in BICD1 (rs326641) was validated in an external population. CONCLUSIONS Our study identified one locus having genome-wide significant SNP-by-drug interaction effect on RWT among dCCB users in comparison to ACE-I users. Upon additional validation in future studies, our findings can enhance the precision of medical approaches in hypertension treatment.
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Affiliation(s)
- Anh N. Do
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Wei Zhao
- Department of EpidemiologyUniversity of MichiganAnn ArborMichiganUSA
| | | | - Laura M. Raffield
- Department of GeneticsUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Kerri L. Wiggins
- Cardiovascular Health Research Unit, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Sanjiv J. Shah
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Stella Aslibekyan
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Hemant K. Tiwari
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Nita Limdi
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Degui Zhi
- School of Biomedical InformaticsUniversity of Texas Health Sciences Center at HoustonHoustonTexasUSA
| | - Colleen M. Sitlani
- Cardiovascular Health Research Unit, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Kent D. Taylor
- Department of Pediatrics, The Institute for Translational Genomics and Population SciencesLABioMed at Harbor‐UCLA Medical CenterSeattleWashingtonUSA
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health ServicesUniversity of WashingtonSeattleWashingtonUSA
- Kaiser Permanente Washington Health Research InstituteSeattleWashingtonUSA
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Division of Cardiology, Departments of Medicine and EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Jennifer A. Brody
- Cardiovascular Health Research Unit, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Laura J. Rasmussen‐Torvik
- Department of Preventive Medicine Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | | | - Leslie A. Lange
- Department of MedicineUniversity of Colorado DenverAuroraColoradoUSA
| | - James G. Wilson
- Department of Physiology and BiophysicsUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - Jennifer A. Smith
- Department of EpidemiologyUniversity of MichiganAnn ArborMichiganUSA
| | | | - Thomas H. Mosley
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - Ramachandran S. Vasan
- Departments of Medicine and Preventive MedicineBoston University School of MedicineBostonMassachusettsUSA
| | - Donna K. Arnett
- College of Public HealthUniversity of KentuckyLexingtonKentuckyUSA
| | - Marguerite R. Irvin
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Bahiru E, Agarwal A, Berendsen MA, Baldridge AS, Temu T, Rogers A, Farquhar C, Bukachi F, Huffman MD. Hospital-Based Quality Improvement Interventions for Patients With Acute Coronary Syndrome: A Systematic Review. Circ Cardiovasc Qual Outcomes 2019; 12:e005513. [PMID: 31525081 DOI: 10.1161/circoutcomes.118.005513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Quality improvement initiatives have been developed to improve acute coronary syndrome care largely in high-income country settings. We sought to synthesize the effect size and quality of evidence from randomized controlled trials (RCTs) and nonrandomized studies for hospital-based acute coronary syndrome quality improvement interventions on clinical outcomes and process of care measures for their potential implementation in low- and middle-income country settings. METHODS AND RESULTS We conducted a bibliometric search of databases and trial registers and a hand search in 2016 and performed an updated search in May 2018 and May 2019. We performed data extraction, risk of bias assessment, and quality of evidence assessments in duplicate. We assessed differences in outcomes by study design comparing RCTs to nonrandomized quasi-experimental studies and by country income status. A meta-analysis was not feasible due to substantial, unexplained heterogeneity among the included studies, and thus, we present a qualitative synthesis. We screened 5858 records and included 32 studies (14 RCTs [n=109 763] and 18 nonrandomized quasi-experimental studies [n=54-423]). In-hospital mortality ranged from 2.1% to 4.8% in the intervention groups versus 3.3% to 5.1% in the control groups in 5 RCTs (n=55 942). Five RCTs (n=64 313) reported 3.0% to 31.0% higher rates of reperfusion for patients with ST-segment-elevation myocardial infarction in the intervention groups. The effect sizes for in-hospital and discharge medical therapies in a majority of RCTs were 3.0% to 10.0% higher in the intervention groups. There was no significant difference in 30-day mortality evaluated by 4 RCTs (n=42 384), which reported 2.5% to 15.0% versus 5.9% to 22% 30-day mortality rates in the intervention versus control groups. In contrast, nonrandomized quasi-experimental studies reported larger effect sizes compared to RCTs. There were no significant consistent differences in outcomes between high-income and middle-income countries. Low-income countries were not represented in any of the included studies. CONCLUSIONS Hospital-based acute coronary syndrome quality improvement interventions have a modest effect on process of care measures but not on clinical outcomes with expected differences by study design. Although quality improvement programs have an ongoing and important role for acute coronary syndrome quality of care in high-income country settings, further research will help to identify key components for contextualizing and implementing such interventions to new settings to achieve their desired effects. Systematic Review Registration: URL: https://www.crd.york.ac.uk/PROSPERO/. Unique identifier: CRD42016047604.
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Affiliation(s)
- Ehete Bahiru
- Department of Medicine, University of California Los Angeles, CA (E.B.)
| | - Anubha Agarwal
- Department of Medicine (A.A., M.D.H.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mark A Berendsen
- Galter Health Sciences Library (M.A.B.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Abigail S Baldridge
- Department of Preventive Medicine (A.S.B., M.D.H.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tecla Temu
- Departments of Global Health (T.T.), University of Washington, Seattle
| | - Amy Rogers
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (A.R.)
| | - Carey Farquhar
- Departments of Epidemiology and Medicine (C.F.), University of Washington, Seattle
| | | | - Mark D Huffman
- Department of Medicine (A.A., M.D.H.), Northwestern University Feinberg School of Medicine, Chicago, IL.,Department of Preventive Medicine (A.S.B., M.D.H.), Northwestern University Feinberg School of Medicine, Chicago, IL.,The George Institute for Global Health, Food Policy Division, Sydney, Australia (M.D.H.)
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43
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Barata L, Feitosa MF, Bielak LF, Halligan B, Baldridge AS, Guo X, Yerges‐Armstrong LM, Smith AV, Yao J, Palmer ND, VanWagner LB, Carr JJ, Chen YI, Allison M, Budoff MJ, Handelman SK, Kardia SL, Mosley TH, Ryan K, Harris TB, Launer LJ, Gudnason V, Rotter JI, Fornage M, Rasmussen‐Torvik LJ, Borecki IB, O’Connell JR, Peyser PA, Speliotes EK, Province MA. Insulin Resistance Exacerbates Genetic Predisposition to Nonalcoholic Fatty Liver Disease in Individuals Without Diabetes. Hepatol Commun 2019; 3:894-907. [PMID: 31334442 PMCID: PMC6601321 DOI: 10.1002/hep4.1353] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/27/2019] [Indexed: 12/17/2022] Open
Abstract
The accumulation of excess fat in the liver (hepatic steatosis) in the absence of heavy alcohol consumption causes nonalcoholic fatty liver disease (NAFLD), which has become a global epidemic. Identifying metabolic risk factors that interact with the genetic risk of NAFLD is important for reducing disease burden. We tested whether serum glucose, insulin, insulin resistance, triglyceride (TG), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, body mass index (BMI), and waist-to-hip ratio adjusted for BMI interact with genetic variants in or near the patatin-like phospholipase domain containing 3 (PNPLA3) gene, the glucokinase regulatory protein (GCKR) gene, the neurocan/transmembrane 6 superfamily member 2 (NCAN/TM6SF2) gene, and the lysophospholipase-like 1 (LYPLAL1) gene to exacerbate hepatic steatosis, estimated by liver attenuation. We performed association analyses in 10 population-based cohorts separately and then meta-analyzed results in up to 14,751 individuals (11,870 of European ancestry and 2,881 of African ancestry). We found that PNPLA3-rs738409 significantly interacted with insulin, insulin resistance, BMI, glucose, and TG to increase hepatic steatosis in nondiabetic individuals carrying the G allele. Additionally, GCKR-rs780094 significantly interacted with insulin, insulin resistance, and TG. Conditional analyses using the two largest European ancestry cohorts in the study showed that insulin levels accounted for most of the interaction of PNPLA3-rs738409 with BMI, glucose, and TG in nondiabetic individuals. Insulin, PNPLA3-rs738409, and their interaction accounted for at least 8% of the variance in hepatic steatosis in these two cohorts. Conclusion: Insulin resistance, either directly or through the resultant elevated insulin levels, more than other metabolic traits, appears to amplify the PNPLA3-rs738409-G genetic risk for hepatic steatosis. Improving insulin resistance in nondiabetic individuals carrying PNPLA3-rs738409-G may preferentially decrease hepatic steatosis.
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Affiliation(s)
- Llilda Barata
- Division of Statistical Genomics, Department of GeneticsWashington University School of MedicineSt. LouisMO
| | - Mary F. Feitosa
- Division of Statistical Genomics, Department of GeneticsWashington University School of MedicineSt. LouisMO
| | - Lawrence F. Bielak
- Department of Epidemiology, School of Public HealthUniversity of MichiganAnn ArborMI
| | - Brian Halligan
- Division of Gastroenterology, Department of Internal Medicine, Department of Computational Medicine and BioinformaticsUniversity of MichiganAnn ArborMI
| | - Abigail S. Baldridge
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Xiuqing Guo
- Institute for Translational Genomics and Population Sciences, LABioMed and the Department of PediatricsHarbor‐University of California Los Angeles Medical CenterTorranceCA
| | | | - Albert V. Smith
- Department of Biostatistics, School of Public HealthUniversity of MichiganAnn ArborMI
| | - Jie Yao
- Institute for Translational Genomics and Population Sciences, LABioMed and the Department of PediatricsHarbor‐University of California Los Angeles Medical CenterTorranceCA
| | | | - Lisa B. VanWagner
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIL
- Division of Gastroenterology and HepatologyNorthwestern University Feinberg School of MedicineChicagoIL
| | - J. Jeffrey Carr
- Department of RadiologyVanderbilt University School of MedicineNashvilleTN
| | - Yii‐Der I. Chen
- Institute for Translational Genomics and Population Sciences, LABioMed and the Department of PediatricsHarbor‐University of California Los Angeles Medical CenterTorranceCA
| | - Matthew Allison
- Department of Family Medicine and Public HealthUniversity of California San DiegoSan DiegoCA
| | - Matthew J. Budoff
- Division of CardiologyLos Angeles Biomedical Research InstituteTorranceCA
| | - Samuel K. Handelman
- Division of Gastroenterology, Department of Internal Medicine, Department of Computational Medicine and BioinformaticsUniversity of MichiganAnn ArborMI
| | - Sharon L.R. Kardia
- Department of Epidemiology, School of Public HealthUniversity of MichiganAnn ArborMI
| | - Thomas H. Mosley
- Department of Medicine, Division of GeriatricsUniversity of Mississippi Medical CenterJacksonMS
| | - Kathleen Ryan
- Department of MedicineUniversity of Maryland School of MedicineBaltimoreMD
| | - Tamara B. Harris
- Laboratory of Epidemiology and Population SciencesNational Institute of AgingBethesdaMD
| | - Lenore J. Launer
- Laboratory of Epidemiology and Population SciencesNational Institute of AgingBethesdaMD
| | - Vilmundur Gudnason
- Icelandic Heart AssociationKopavogurIceland
- Faculty of MedicineUniversity of IcelandReykjavikIceland
| | - Jerome I. Rotter
- Institute for Translational Genomics and Population Sciences, LABioMed and the Department of PediatricsHarbor‐University of California Los Angeles Medical CenterTorranceCA
| | | | | | - Ingrid B. Borecki
- Division of Statistical Genomics, Department of GeneticsWashington University School of MedicineSt. LouisMO
| | | | - Patricia A. Peyser
- Department of Epidemiology, School of Public HealthUniversity of MichiganAnn ArborMI
| | - Elizabeth K. Speliotes
- Division of Gastroenterology, Department of Internal Medicine, Department of Computational Medicine and BioinformaticsUniversity of MichiganAnn ArborMI
| | - Michael A. Province
- Division of Statistical Genomics, Department of GeneticsWashington University School of MedicineSt. LouisMO
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Gay HC, Baldridge AS, Huffman MD. Feasibility, Process, and Outcomes of Cardiovascular Clinical Trial Data Sharing: A Reproduction Analysis of the SMART-AF Trial. JAMA Cardiol 2019; 2:1375-1379. [PMID: 29049540 DOI: 10.1001/jamacardio.2017.3808] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Data sharing is as an expanding initiative for enhancing trust in the clinical research enterprise. Objective To evaluate the feasibility, process, and outcomes of a reproduction analysis of the THERMOCOOL SMARTTOUCH Catheter for the Treatment of Symptomatic Paroxysmal Atrial Fibrillation (SMART-AF) trial using shared clinical trial data. Design, Setting, and Participants A reproduction analysis of the SMART-AF trial was performed using the data sets, data dictionary, case report file, and statistical analysis plan from the original trial accessed through the Yale Open Data Access Project using the SAS Clinical Trials Data Transparency platform. SMART-AF was a multicenter, single-arm trial evaluating the effectiveness and safety of an irrigated, contact force-sensing catheter for ablation of drug refractory, symptomatic paroxysmal atrial fibrillation in 172 participants recruited from 21 sites between June 2011 and December 2011. Analysis of the data was conducted between December 2016 and April 2017. Main Outcomes and Measures Effectiveness outcomes included freedom from atrial arrhythmias after ablation and proportion of participants without any arrhythmia recurrence over the 12 months of follow-up after a 3-month blanking period. Safety outcomes included major adverse device- or procedure-related events. Results The SMART AF trial participants' mean age was 58.7 (10.8) years, and 72% were men. The time from initial proposal submission to final analysis was 11 months. Freedom from atrial arrhythmias at 12 months postprocedure was similar compared with the primary study report (74.0%; 95% CI, 66.0-82.0 vs 76.4%; 95% CI, 68.7-84.1). The reproduction analysis success rate was higher than the primary study report (65.8%; 95% CI 56.5-74.2 vs 75.6%; 95% CI, 67.2-82.5). Adverse events were minimal and similar between the 2 analyses, but contact force range or regression models could not be reproduced. Conclusions and Relevance The feasibility of a reproduction analysis of the SMART-AF trial was demonstrated through an academic data-sharing platform. Data sharing can be facilitated through incentivizing collaboration, sharing statistical code, and creating more decentralized data sharing platforms with fewer restrictions to data access.
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Affiliation(s)
- Hawkins C Gay
- Department of Medicine, Northwestern University, Chicago, Illinois
| | - Abigail S Baldridge
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Mark D Huffman
- Department of Medicine, Northwestern University, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University, Chicago, Illinois.,Associate Editor
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45
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Mohanan PP, Huffman MD, Baldridge AS, Devarajan R, Kondal D, Zhao L, Ali M, Joseph J, Eapen K, Krishnan MN, Menon J, Thomas M, Lloyd-Jones DM, Harikrishnan S, Prabhakaran D. Microeconomic Costs, Insurance, and Catastrophic Health Spending Among Patients With Acute Myocardial Infarction in India: Substudy of a Randomized Clinical Trial. JAMA Netw Open 2019; 2:e193831. [PMID: 31099866 PMCID: PMC6537817 DOI: 10.1001/jamanetworkopen.2019.3831] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Ischemic heart disease is the leading cause of death in India, and treatment can be costly. OBJECTIVE To evaluate individual- and household-level costs and impoverishing effects of acute myocardial infarction among patients in Kerala, India. DESIGN, SETTING, AND PARTICIPANTS This investigation was a prespecified substudy of the Acute Coronary Syndrome Quality Improvement in Kerala study, a stepped-wedge, cluster randomized clinical trial conducted between November 2014 and November 2016 across 63 hospitals in Kerala, India. In this cross-sectional substudy, individual- and household-level cost data were collected 30 days after hospital discharge from a sample of 2114 respondents from November 2014 to July 2016. Data were analyzed from July through October 2018 and in March 2019. EXPOSURES Health insurance status. MAIN OUTCOMES AND MEASURES The primary outcomes were detailed direct and indirect cost data associated with acute myocardial infarction and respondent ability to pay as well as catastrophic health spending and distress financing. Catastrophic health spending was defined as 40% or more of household expenditures minus food costs spent on health, and distress financing was defined as borrowing money or selling assets to cover health costs. Hierarchical regression models were used to evaluate the association between health insurance and measures of financial risk. Costs were converted from Indian rupees to international dollars (represented herein as "$"). RESULTS Among 2114 respondents, the mean (SD) age was 62.3 (12.7) years, 1521 (71.9%) were men, 1144 (54.1%) presented with an ST-segment elevation myocardial infarction, and 1600 (75.7%) had no health insurance. The median (interquartile range) expenditure among respondents was $480.4 ($112.5-$1733.0) per acute myocardial infarction encounter, largely driven by in-hospital expenditures. There was greater than 15-fold variability between the 25th and 75th percentiles. Individuals with or without health insurance had similar monthly incomes and annual household expenditures, yet individuals without health insurance had approximately $400 higher out-of-pocket cardiovascular health care costs (median [interquartile range] total cardiovascular expenditures among uninsured, $560.3 [$134.1-$1733.6] vs insured, $161.4 [$23.2-$1726.9]; P < .001). Individuals without health insurance also had a 24% higher risk of catastrophic health spending (adjusted risk ratio, 1.24; 95% CI, 1.07-1.43) and 3-fold higher risk of distress financing (adjusted risk ratio; 3.05; 95% CI, 1.45-6.44). CONCLUSIONS AND RELEVANCE The results of this study indicate that acute myocardial infarction carries substantial financial risk for patients in Kerala. Expansion of health insurance may be an important strategy for financial risk protection to disrupt the poverty cycle associated with cardiovascular diseases in India.
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Affiliation(s)
| | - Mark D. Huffman
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Raji Devarajan
- Centre for Chronic Disease Control, Gurgaon, India
- Public Health Foundation of India, Gurgaon, India
| | - Dimple Kondal
- Centre for Chronic Disease Control, Gurgaon, India
- Public Health Foundation of India, Gurgaon, India
| | - Lihui Zhao
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mumtaj Ali
- Centre for Chronic Disease Control, Gurgaon, India
- Public Health Foundation of India, Gurgaon, India
| | - Johny Joseph
- Department of Cardiology, Caritas Hospital, Kottyam, India
| | - Koshy Eapen
- Department of Cardiology, Samaritan Hospital, Pazhangad, India
| | | | - Jaideep Menon
- Department of Cardiology, Sree Narayana Institute of Medical Sciences, Ernakulam, India
| | - Manoj Thomas
- Department of Cardiology, St Joseph’s Hospital, Dharmagiri, India
| | | | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, Gurgaon, India
- Public Health Foundation of India, Gurgaon, India
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Huffman MD, Kandula NR, Baldridge AS, Tsai MY, Prabhakaran D, Kanaya AM. Evaluating the Potential Association Between Lipoprotein(a) and Atherosclerosis (from the Mediators of Atherosclerosis Among South Asians Living in America Cohort). Am J Cardiol 2019; 123:919-921. [PMID: 30626499 DOI: 10.1016/j.amjcard.2018.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/30/2018] [Accepted: 12/07/2018] [Indexed: 12/31/2022]
Abstract
We sought to report the distribution of Lp(a) levels in the Mediators of Atherosclerosis among South Asians Living in America cohort of participants who were free from clinical atherosclerotic cardiovascular disease (ASCVD) at baseline and to evaluate the cross-sectional association with atherosclerosis measured by coronary artery calcification (CAC) and carotid intima media thickness. Among 886 participants (mean [SD] age: 55.4 [9.4] years, 54% male), median lipoprotein (a) level was 17 (9, 33) mg/dl. Compared with the lowest quartile (9 mg/dl), subjects in the highest Lp(a) quartile (33 to 178 mg/dl) were more likely to be women (51% vs 37%, p <0.01) and had a higher mean (SD) total cholesterol (193 [37] mg/dl vs 181 [35] mg/dl, p <0.01). CAC was present in 42% and both the presence and degree of CAC was similar across Lp(a) quartiles (p = 0.58). Median Interquartile range (IQR) common and internal carotid intima-media thickness (IMT) thicknesses were 0.84 (0.73, 0.98) mm and 1.12 (0.95, 1.34) mm, respectively, and were also similar across Lp(a) quartiles. After adjustment for cardiovascular risk factors, Lp(a) quartile had no association with prevalent CAC (p = 0.98), internal carotid IMT (p = 0.46), or common carotid IMT (p = 0.97). Among South Asian Americans, mean Lp(a) levels were higher than previous reports among Whites, Hispanic/Latino, and Chinese-Americans but lower than in Blacks. Unlike findings from other race/ethnic groups, Lp(a) levels were not associated with atherosclerosis among South Asian Americans.
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47
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Huffman MD, Mohanan PP, Devarajan R, Baldridge AS, Kondal D, Zhao L, Ali M, Spertus JA, Chan PS, Natesan S, Abdullakutty J, Krishnan MN, Tp A, Renga S, Punnoose E, Unni G, Prabhakaran D, Lloyd-Jones DM. Health-Related Quality of Life at 30 Days Among Indian Patients With Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2019; 12:e004980. [PMID: 30755027 DOI: 10.1161/circoutcomes.118.004980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite a high cardiovascular disease burden, data on patient-reported health status outcomes among individuals with cardiovascular disease in India are limited. METHODS AND RESULTS Between November 2014 and November 2016, we collected health-related quality of life data among 1261 participants in the ACS QUIK trial (Acute Coronary Syndrome Quality Improvement in Kerala). We used a translated, validated version of the Seattle Angina Questionnaire administered 30 days after discharge for acute myocardial infarction, wherein higher scores represent better health status. We compared results across sex, myocardial infarction type, and randomization status using regression models that account for clustering and temporal trends. Mean (SD) age was 60.8 (13.7) years, 62% were men, and 63% presented with ST-segment-elevation myocardial infarction. More than 2 out of 5 respondents (44%) experienced angina 30 days after hospitalization, but most (68% of respondents with angina; 27% of the total sample) experienced it less than once per week (Seattle Angina Questionnaire angina frequency score 60). Respondents rated high median (interquartile range [IQR]) scores for angina frequency (100.0 [80.0-100.0]) overall with similar unadjusted scores by sex, but between-hospitality variability was high. Median (IQR) physical limitation scale response was 58.3 (41.7-77.8), which is consistent with limitations in moderate- and high-intensity activities at 30-day follow-up. Older respondents had more angina frequency and physical limitations and lower treatment satisfaction and quality of life. Women had greater physical limitations (median [IQR], 52.8 [38.9-72.2] for women versus median [IQR], 61.1 [44.4-80.6] for men; P<0.01). Overall treatment satisfaction was high with median (IQR) score, 81.3 (75.0-93.8), but overall quality of life was lower with median (IQR) score, 66.7 (50.0-83.3). Allocation to the quality improvement intervention group had the strongest direct association with higher quality of life (difference, 4.2; P=0.03), but overall effects were modest. CONCLUSIONS This study represents the largest report of quality of life among myocardial infarction survivors in India with variability across age, sex, and quality improvement intervention status. Wide variability demonstrated across hospitals warrants further study. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT02256657.
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Affiliation(s)
- Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.D.H., A.S.B., L.Z., D.M.L.-J.)
| | - Padinhare P Mohanan
- Department of Cardiology, WestFort Hi-Tech Hospital, Ltd, Thrissur, India (P.P.M.)
| | - Raji Devarajan
- Centre for Chronic Disease Control, New Delhi, India (R.D., D.K., M.A., D.P.).,Public Health Foundation of India, Gurgaon (R.D., D.K., M.A., D.P.)
| | - Abigail S Baldridge
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.D.H., A.S.B., L.Z., D.M.L.-J.)
| | - Dimple Kondal
- Centre for Chronic Disease Control, New Delhi, India (R.D., D.K., M.A., D.P.).,Public Health Foundation of India, Gurgaon (R.D., D.K., M.A., D.P.)
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.D.H., A.S.B., L.Z., D.M.L.-J.)
| | - Mumtaj Ali
- Centre for Chronic Disease Control, New Delhi, India (R.D., D.K., M.A., D.P.).,Public Health Foundation of India, Gurgaon (R.D., D.K., M.A., D.P.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S., P.S.C.).,University of Missouri-Kansas City (J.A.S., P.S.C.)
| | - Paul S Chan
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S., P.S.C.).,University of Missouri-Kansas City (J.A.S., P.S.C.)
| | | | | | | | - Abhilash Tp
- Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram, India (A.T.P.)
| | - Sujay Renga
- Bishop Benziger Hospital, Kollam, India (S.R.)
| | - Eapen Punnoose
- Malankara Orthodox Syrian Church Medical College, Ernakulam, India (E.P.)
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India (R.D., D.K., M.A., D.P.).,Public Health Foundation of India, Gurgaon (R.D., D.K., M.A., D.P.).,London School of Hygiene and Tropical Medicine, United Kingdom (D.P.)
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.D.H., A.S.B., L.Z., D.M.L.-J.)
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48
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Singh K, Devarajan R, Mohanan PP, Baldridge AS, Kondal D, Victorson DE, Karmali KN, Zhao L, Lloyd-Jones DM, Prabhakaran D, Goenka S, Huffman MD. Implementation and acceptability of a heart attack quality improvement intervention in India: a mixed methods analysis of the ACS QUIK trial. Implement Sci 2019; 14:12. [PMID: 30728053 PMCID: PMC6364470 DOI: 10.1186/s13012-019-0857-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 01/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ACS QUIK trial showed that a multicomponent quality improvement toolkit intervention resulted in improvements in processes of care for patients with acute myocardial infarction in Kerala but did not improve clinical outcomes in the context of background improvements in care. We describe the development of the ACS QUIK intervention and evaluate its implementation, acceptability, and sustainability. METHODS We performed a mixed methods process evaluation alongside a cluster randomized, stepped-wedge trial in Kerala, India. The ACS QUIK intervention aimed to reduce the rate of major adverse cardiovascular events at 30 days compared with usual care across 63 hospitals (n = 21,374 patients). The ACS QUIK toolkit intervention, consisting of audit and feedback report, admission and discharge checklists, patient education materials, and guidelines for the development of code and rapid response teams, was developed based on formative qualitative research in Kerala and from systematic reviews. After four or more months of the center's participation in the toolkit intervention phase of the trial, an online survey and physician interviews were administered. Physician interviews focused on evaluating the implementation and acceptability of the toolkit intervention. A framework analysis of transcripts incorporated context and intervening mechanisms. RESULTS Among 63 participating hospitals, 22 physicians (35%) completed online surveys. Of these, 17 (77%) respondents reported that their hospital had a cardiovascular quality improvement team, 18 (82%) respondents reported having read an audit report, admission checklist, or discharge checklist, and 19 (86%) respondents reported using patient education materials. Among the 28 interviewees (44%), facilitators of toolkit intervention implementation were physicians' support and leadership, hospital administrators' support, ease-of-use of checklists and patient education materials, and availability of training opportunities for staff. Barriers that influenced the implementation or acceptability of the toolkit intervention for physicians included time and staff constraints, Internet access, patient volume, and inadequate understanding of the quality improvement toolkit intervention. CONCLUSIONS Implementation and acceptability of the ACS QUIK toolkit intervention were enhanced by hospital-level management support, physician and team support, and usefulness of checklists and patient education materials. Wider and longer-term use of the toolkit intervention and its expansion to potentially other cardiovascular conditions or other locations where the quality of care is not as high as in the ACS QUIK trial may be useful for improving acute cardiovascular care in Kerala and beyond. TRIAL REGISTRATION NCT02256657.
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Affiliation(s)
- Kavita Singh
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, Gurgaon, India
| | - Raji Devarajan
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, Gurgaon, India
| | - Padinhare P Mohanan
- Westfort Hi-Tech Hospital, Ltd, Thrissur, India
- Cardiological Society of India - Kerala Chapter, Kerala, India
| | - Abigail S Baldridge
- Department of Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Dimple Kondal
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, Gurgaon, India
| | - David E Victorson
- Department of Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Kunal N Karmali
- Department of Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Lihui Zhao
- Department of Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Donald M Lloyd-Jones
- Department of Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, Gurgaon, India
- London School of Hygiene and Tropical Medicine, London, UK
| | - Shifalika Goenka
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, Gurgaon, India
- Indian Institute of Public Health-Delhi, New Delhi, India
| | - Mark D Huffman
- Department of Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
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49
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Affiliation(s)
- Hawkins C Gay
- Department of Medicine, Northwestern University, Chicago, Illinois
| | - Abigail S Baldridge
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mark D Huffman
- Department of Medicine, Northwestern University, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Associate Editor
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50
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Loomis SJ, Li M, Maruthur NM, Baldridge AS, North KE, Mei H, Morrison A, Carson AP, Pankow JS, Boerwinkle E, Scharpf R, Rasmussen-Torvik LJ, Coresh J, Duggal P, Köttgen A, Selvin E. Genome-Wide Association Study of Serum Fructosamine and Glycated Albumin in Adults Without Diagnosed Diabetes: Results From the Atherosclerosis Risk in Communities Study. Diabetes 2018; 67:1684-1696. [PMID: 29844224 PMCID: PMC6054442 DOI: 10.2337/db17-1362] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 05/17/2018] [Indexed: 12/16/2022]
Abstract
Fructosamine and glycated albumin are potentially useful alternatives to hemoglobin A1c (HbA1c) as diabetes biomarkers. The genetic determinants of fructosamine and glycated albumin, however, are unknown. We performed genome-wide association studies of fructosamine and glycated albumin among 2,104 black and 7,647 white participants without diabetes in the Atherosclerosis Risk in Communities (ARIC) Study and replicated findings in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Among whites, rs34459162, a novel missense single nucleotide polymorphism (SNP) in RCN3, was associated with fructosamine (P = 5.3 × 10-9) and rs1260236, a known diabetes-related missense mutation in GCKR, was associated with percent glycated albumin (P = 5.9 × 10-9) and replicated in CARDIA. We also found two novel associations among blacks: an intergenic SNP, rs2438321, associated with fructosamine (P = 6.2 × 10-9), and an intronic variant in PRKCA, rs59443763, associated with percent glycated albumin (P = 4.1 × 10-9), but these results did not replicate. Few established fasting glucose or HbA1c SNPs were also associated with fructosamine or glycated albumin. Overall, we found genetic variants associated with the glycemic information captured by fructosamine and glycated albumin as well as with their nonglycemic component. This highlights the importance of examining the genetics of hyperglycemia biomarkers to understand the information they capture, including potential glucose-independent factors.
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Affiliation(s)
- Stephanie J Loomis
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Man Li
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Division of Nephrology and Department of Human Genetics, University of Utah, Salt Lake City, UT
| | - Nisa M Maruthur
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Abigail S Baldridge
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL
| | - Kari E North
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Hao Mei
- Department of Data Science, School of Population Health, University of Mississippi Medical Center, Jackson, MS
| | - Alanna Morrison
- Department of Epidemiology, The University of Texas Health Science Center at Houston School of Public Health at Houston, Houston, TX
| | - April P Carson
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL
| | - James S Pankow
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Eric Boerwinkle
- Department of Epidemiology, The University of Texas Health Science Center at Houston School of Public Health at Houston, Houston, TX
| | - Robert Scharpf
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Josef Coresh
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD
| | - Priya Duggal
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Anna Köttgen
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Institute of Genetic Epidemiology, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elizabeth Selvin
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD
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