1
|
Saha A, Li S, de Lemos JA, Pandey A, Bhatt DL, Fonarow GC, Nallamothu BK, Wang TY, Navar AM, Peterson E, Matsouaka RA, Bavry AA, Das SR, Grodin JL, Khera R, Drazner MH, Kumbhani DJ. Characteristics of High-Performing Hospitals in Cardiogenic Shock Following Acute Myocardial Infarction. Am J Cardiol 2024:S0002-9149(24)00237-6. [PMID: 38583700 DOI: 10.1016/j.amjcard.2024.04.002] [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: 10/21/2023] [Revised: 03/06/2024] [Accepted: 04/01/2024] [Indexed: 04/09/2024]
Abstract
Cardiogenic shock after acute myocardial infarction (AMI-CS) carries significant mortality despite advances in revascularization and mechanical circulatory support. We sought to identify the process-based and structural characteristics of centers with lower mortality in AMI-CS. We analyzed 16,337 AMI-CS cases across 440 centers enrolled in the Chest Pain-MI Registry, a retrospective cohort database between January 1, 2015 and December 31, 2018. Centers were stratified across tertiles of risk-adjusted in-hospital mortality rate (RAMR) for comparison. Risk-adjusted multivariable logistic regression was also performed to identify hospital-level characteristics associated with decreased mortality. The median participant age was 66.0 (interquartile range 57.0 to 75.0) years, and 33.0% (n = 5,390) were women. The median RAMR was 33.4% (interquartile range 26.0% to 40.0%) and ranged from 26.9% to 50.2% across tertiles. Even after risk adjustment, lower-RAMR centers saw patients with fewer co-morbidities. Lower-RAMR centers performed more revascularization (92.8% vs 90.6% vs 85.9%, p <0.001) and demonstrated better adherence to associated process measures. Left ventricular assist device capability (odds ratio [OR] 0.78 [0.67 to 0.92], p = 0.002), more frequent revascularization (OR 0.93 [0.88 to 0.98], p = 0.006), and higher AMI-CS volume (OR 0.95 [0.91 to 0.99], p = 0.009) were associated with lower in-hospital mortality. However, several such characteristics were not more frequently observed at low-RAMR centers, despite potentially reflecting greater institutional experience or resources. This may reflect the heterogeneity of AMI-CS even after risk adjustment. In conclusion, low-RAMR centers do not necessarily exhibit factors associated with decreased mortality in AMI-CS, which may reflect the challenges in performing outcomes research in this complex population.
Collapse
Affiliation(s)
- Amit Saha
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Shuang Li
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - James A de Lemos
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ambarish Pandey
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Deepak L Bhatt
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gregg C Fonarow
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Brahmajee K Nallamothu
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Michigan, Ann Arbor, Michigan
| | - Tracy Y Wang
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Ann Marie Navar
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Eric Peterson
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Roland A Matsouaka
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Anthony A Bavry
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sandeep R Das
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Justin L Grodin
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rohan Khera
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Biostatistics, Section of Health Informatics, Yale School of Public Health, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Mark H Drazner
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Dharam J Kumbhani
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
| |
Collapse
|
2
|
James CA, Dorsch MP, Piette JD, Nallamothu BK. Prescribing Mobile Health Applications. Circ Cardiovasc Qual Outcomes 2024:e010654. [PMID: 38525595 DOI: 10.1161/circoutcomes.123.010654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Affiliation(s)
- Cornelius A James
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. (C.A.J., J.D.P., B.K.N.)
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor. (C.A.J.)
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor. (C.A.J.)
| | - Michael P Dorsch
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor. (M.P.D.)
| | - John D Piette
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. (C.A.J., J.D.P., B.K.N.)
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor. (J.D.P.)
| | - Brahmajee K Nallamothu
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. (C.A.J., J.D.P., B.K.N.)
| |
Collapse
|
3
|
Brandt EJ, Kirch M, Ayanian JZ, Chang T, Thompson MP, Nallamothu BK. Dietary Counseling Documentation Among Patients Recently Hospitalized for Cardiovascular Disease. J Acad Nutr Diet 2024:S2212-2672(24)00111-4. [PMID: 38462127 DOI: 10.1016/j.jand.2024.03.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/22/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Diet intervention forms the cornerstone for cardiovascular disease (CVD) management. OBJECTIVE The objective was to measure the frequency of dietary counseling documentation for patients recently hospitalized with CVD. DESIGN This was an observational study. PARTICIPANTS AND SETTING Patients were included from the Michigan Value Collaborative Multipayer Claims Registry from October 2015 to February 2020. MAIN OUTCOME MEASURE The study measured the frequency of medical claims that document dietary counseling ≤90 days after hospitalization (ie, an episode of care) for CVD events (coronary artery bypass grafting, acute myocardial infarction, congestive heart failure, and percutaneous coronary intervention). Dietary counseling documentation was defined as having an encounter-level International Classification of Diseases 10th Revision code for dietary counseling or current procedural terminology code for medical nutrition therapy or cardiac rehabilitation. STATISTICAL ANALYSES PERFORMED Multivariable logistic regression was used to measure variation in documentation across gender, age, comorbidities, hospital geography, CVD event, and insurer. RESULTS There were 175,631 episodes of care (congesitve heart failure 47.1%, acute myocardial infarction 28.7%, percutaneous coronary intervention 17.0%, and coronary artery bypass grafting 7.3%) among 146,185 individuals. Most episodes occurred among men (55.8%) and those older than age 65 years (71.9%). Dietary counseling was documented for 22.8% of episodes and was more common as cardiac rehabilitation (18.6%) than other encounter types (5.1%). In multivariable analysis, there was lower odds for dietary counseling documentation among those older than age 65 years (odds ratio [OR] 0.77; P < .001), women (OR 0.83; P < .001), with chronic kidney disease (OR 0.74; P < .001), or diabetes (OR 0.95; P < .001), but greater odds for those with obesity (OR 1.28; P < .001) and nonmetropolitan hospitals (OR 1.31; P < .001). Compared with coronary artery bypass grafting, acute myocardial infarction (OR 0.29; P < .001), confestive heart failure (OR 0.12; P < .001), and percutaneous coronary intervention (OR 0.36; P < .001) episodes had lower odds to have dietary counseling coded. Compared with Traditional Medicare, Medicaid and Medicare Advantage health maintenance organization plans had lower odds, whereas Commercial or Medicare Advantage preferred provider organization and Commercial health maintenance organization plans had higher odds to have dietary counseling documented. Results were mostly similar when evaluated by race. CONCLUSIONS Dietary counseling was infrequently documented after hospitalization for CVD episodes in medical claims in a Michigan-based multipayer claims database with large variation by reason for hospitalization and patient factors.
Collapse
Affiliation(s)
- Eric J Brandt
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - John Z Ayanian
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Tammy Chang
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael P Thompson
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Section of Health Services Research and Quality, Department of Cardiac Surgery, Unversity of Michigan, Ann Arbor, Michigan; Michigan Value Collaborative, Ann Arbor, Michigan
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
4
|
Shore S, Li H, Zhang M, Whitney R, Gross AL, Bhatt AS, Nallamothu BK, Giordani B, Briceño EM, Sussman JB, Gutierrez J, Yaffe K, Griswold M, Johansen MC, Lopez OL, Gottesman RF, Sidney S, Heckbert SR, Rundek T, Hughes TM, Longstreth WT, Levine DA. Trajectory of Cognitive Function After Incident Heart Failure. medRxiv 2024:2024.02.09.24302608. [PMID: 38370803 PMCID: PMC10871464 DOI: 10.1101/2024.02.09.24302608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background The size/magnitude of cognitive changes after incident heart failure (HF) are unclear. We assessed whether incident HF is associated with changes in cognitive function after accounting for pre-HF cognitive trajectories and known determinants of cognition. Methods This pooled cohort study included adults without HF, stroke, or dementia from six US population-based cohort studies from 1971-2019: Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and Northern Manhattan Study. Linear mixed-effects models estimated changes in cognition at the time of HF (change in the intercept) and the rate of cognitive change over the years after HF (change in the slope), controlling for pre-HF cognitive trajectories and participant factors. Change in global cognition was the primary outcome. Change in executive function and memory were secondary outcomes. Cognitive outcomes were standardized to a t-score metric (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition. Results The study included 29,614 adults (mean [SD] age was 61.1 [10.5] years, 55% female, 70.3% White, 22.2% Black 7.5% Hispanic). During a median follow-up of 6.6 (Q1-Q3: 5-19.8) years, 1,407 (4.7%) adults developed incident HF. Incident HF was associated with an acute decrease in global cognition (-1.08 points; 95% CI -1.36, -0.80) and executive function (-0.65 points; 95% CI -0.96, -0.34) but not memory (-0.51 points; 95% CI -1.37, 0.35) at the time of the event. Greater acute decreases in global cognition after HF were seen in those with older age, female sex and White race. Individuals with incident HF, compared to HF-free individuals, demonstrated faster declines in global cognition (-0.15 points per year; 95% CI, -0.21, -0.09) and executive function (-0.16 points per year; 95% CI -0.23, -0.09) but not memory ( -0.11 points per year; 95% CI -0.26, 0.04) compared with pre-HF slopes. Conclusions In this pooled cohort study, incident HF was associated with an acute decrease in global cognition and executive function at the time of the event and faster declines in global cognition and executive function over the following years.
Collapse
Affiliation(s)
| | - Hanyu Li
- University of Michigan, Ann Arbor, MI, USA
| | - Min Zhang
- University of Michigan, Ann Arbor, MI, USA
| | | | - Alden L. Gross
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ankeet S. Bhatt
- Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, CA, USA
| | | | | | | | | | | | | | - Michael Griswold
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, MD, USA
| | - Stephen Sidney
- Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, CA, USA
| | | | - Tatjana Rundek
- University of Miami – Miller School of Medicine, Evelyn F. McKnight Brain Institute, FL, USA
| | | | | | | |
Collapse
|
5
|
Golbus JR, Jeganathan VSE, Stevens R, Ekechukwu W, Farhan Z, Contreras R, Rao N, Trumpower B, Basu T, Luff E, Skolarus LE, Newman MW, Nallamothu BK, Dorsch MP. A Physical Activity and Diet Just-in-Time Adaptive Intervention to Reduce Blood Pressure: The myBPmyLife Study Rationale and Design. J Am Heart Assoc 2024; 13:e031234. [PMID: 38226507 PMCID: PMC10926831 DOI: 10.1161/jaha.123.031234] [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: 05/31/2023] [Accepted: 09/13/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Smartphone applications and wearable devices are promising mobile health interventions for hypertension self-management. However, most mobile health interventions fail to use contextual data, potentially diminishing their impact. The myBPmyLife Study is a just-in-time adaptive intervention designed to promote personalized self-management for patients with hypertension. METHODS AND RESULTS The study is a 6-month prospective, randomized-controlled, remotely administered trial. Participants were recruited from the University of Michigan Health in Ann Arbor, Michigan or the Hamilton Community Health Network, a federally qualified health center network in Flint, Michigan. Participants were randomized to a mobile application with a just-in-time adaptive intervention promoting physical activity and lower-sodium food choices as well as weekly goal setting or usual care. The mobile study application encourages goal attainment through a central visualization displaying participants' progress toward their goals for physical activity and lower-sodium food choices. Participants in both groups are followed for up for 6 months with a primary end point of change in systolic blood pressure. Exploratory analyses will examine the impact of notifications on step count and self-reported lower-sodium food choices. The study launched on December 9, 2021, with 484 participants enrolled as of March 31, 2023. Enrollment of participants was completed on July 3, 2023. After 6 months of follow-up, it is expected that results will be available in the spring of 2024. CONCLUSIONS The myBPmyLife study is an innovative mobile health trial designed to evaluate the effects of a just-in-time adaptive intervention focused on improving physical activity and dietary sodium intake on blood pressure in diverse patients with hypertension. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05154929.
Collapse
Affiliation(s)
- Jessica R. Golbus
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
- Michigan Integrated Center for Health Analytics and Medical PredictionUniversity of MichiganAnn ArborMIUSA
| | - V. Swetha E. Jeganathan
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Rachel Stevens
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Weena Ekechukwu
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Zahera Farhan
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Rocio Contreras
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Nikhila Rao
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Brad Trumpower
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Tanima Basu
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Evan Luff
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Lesli E. Skolarus
- Division of Vascular Neurology, Department of Neurology–Internal MedicineNorthwestern UniversityEvanstonILUSA
| | - Mark W. Newman
- School of Information and Computer Science, College of EngineeringUniversity of MichiganAnn ArborMIUSA
| | - Brahmajee K. Nallamothu
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
- Michigan Integrated Center for Health Analytics and Medical PredictionUniversity of MichiganAnn ArborMIUSA
- The Center for Clinical Management and ResearchAnn ArborMIUSA
| | - Michael P. Dorsch
- Department of Clinical Pharmacy, College of PharmacyUniversity of MichiganAnn ArborMIUSA
| |
Collapse
|
6
|
Azizi Z, Golbus JR, Spaulding EM, Hwang PH, Ciminelli ALA, Lacar K, Hernandez MF, Gilotra NA, Din N, Brant LCC, Au R, Beaton A, Nallamothu BK, Longenecker CT, Martin SS, Dorsch MP, Sandhu AT. Challenge of Optimizing Medical Therapy in Heart Failure: Unlocking the Potential of Digital Health and Patient Engagement. J Am Heart Assoc 2024; 13:e030952. [PMID: 38226520 PMCID: PMC10926816 DOI: 10.1161/jaha.123.030952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Affiliation(s)
- Zahra Azizi
- Center for Digital HealthStanford UniversityStanfordCA
- Stanford University Division of Cardiovascular Medicine and Cardiovascular Institute, Department of MedicineStanford UniversityStanfordCA
| | - Jessica R. Golbus
- Division of Cardiovascular Diseases, Department of Internal MedicineUniversity of MichiganAnn ArborMI
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP)University of MichiganAnn ArborMI
- The Center for Clinical Management and ResearchAnn Arbor VA Medical CenterAnn ArborMI
| | - Erin M. Spaulding
- Johns Hopkins University School of NursingBaltimoreMD
- mTECH Center, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Phillip H. Hwang
- Department of EpidemiologyBoston University School of Public HealthBostonMA
| | - Ana L. A. Ciminelli
- School of Medicine and Hospital das Clínicas Telehealth CenterUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | - Kathleen Lacar
- Center for Digital HealthStanford UniversityStanfordCA
- Stanford University Division of Cardiovascular Medicine and Cardiovascular Institute, Department of MedicineStanford UniversityStanfordCA
| | - Mario Funes Hernandez
- Center for Digital HealthStanford UniversityStanfordCA
- Stanford University Division of Cardiovascular Medicine and Cardiovascular Institute, Department of MedicineStanford UniversityStanfordCA
| | - Nisha A. Gilotra
- mTECH Center, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Natasha Din
- Center for Digital HealthStanford UniversityStanfordCA
- Veterans Affairs Palo Alto Healthcare SystemPalo AltoCA
| | - Luisa C. C. Brant
- School of Medicine and Hospital das Clínicas Telehealth CenterUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | - Rhoda Au
- Department of EpidemiologyBoston University School of Public HealthBostonMA
- Department of Anatomy and NeurobiologyBoston University School of MedicineBostonMA
| | - Andrea Beaton
- Department of PediatricsUniversity of Cincinnati School of MedicineCincinnatiOH
- Department of PediatricsThe Heart Institute at Cincinnati Children’s HospitalCincinnatiOH
| | - Brahmajee K. Nallamothu
- Division of Cardiovascular Diseases, Department of Internal MedicineUniversity of MichiganAnn ArborMI
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP)University of MichiganAnn ArborMI
- The Center for Clinical Management and ResearchAnn Arbor VA Medical CenterAnn ArborMI
| | - Chris T. Longenecker
- Division of Cardiology and Department of Global HealthUniversity of WashingtonSeattleWA
| | - Seth S. Martin
- mTECH Center, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | | | - Alexander T. Sandhu
- Center for Digital HealthStanford UniversityStanfordCA
- Stanford University Division of Cardiovascular Medicine and Cardiovascular Institute, Department of MedicineStanford UniversityStanfordCA
- Veterans Affairs Palo Alto Healthcare SystemPalo AltoCA
| |
Collapse
|
7
|
Skolarus LE, Farhan Z, Mishra SR, Rao N, Bowie K, Bailey S, Dorsch MP, Newman MW, Nallamothu BK, Golbus JR. Resource Requirements for Participant Enrollment From a University Health System and a Federally Qualified Health Center Network in a Mobile Health Study: The myBPmyLife Trial. J Am Heart Assoc 2024; 13:e030825. [PMID: 38226521 PMCID: PMC10926785 DOI: 10.1161/jaha.123.030825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/26/2023] [Indexed: 01/17/2024]
Affiliation(s)
| | - Zahera Farhan
- Department of Emergency MedicineUniversity of MichiganAnn ArborMI
| | | | - Nikhila Rao
- Department of CardiologyUniversity of MichiganAnn ArborMI
| | - Kaitlyn Bowie
- Department of Emergency MedicineUniversity of MichiganAnn ArborMI
| | | | | | | | | | | |
Collapse
|
8
|
Atluri N, Mishra SR, Anderson T, Stevens R, Edwards A, Luff E, Nallamothu BK, Golbus JR. Acceptability of a Text Message-Based Mobile Health Intervention to Promote Physical Activity in Cardiac Rehabilitation Enrollees: A Qualitative Substudy of Participant Perspectives. J Am Heart Assoc 2024; 13:e030807. [PMID: 38226512 PMCID: PMC10926792 DOI: 10.1161/jaha.123.030807] [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: 05/04/2023] [Accepted: 08/08/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Mobile health (mHealth) interventions have the potential to deliver longitudinal support to users outside of episodic clinical encounters. We performed a qualitative substudy to assess the acceptability of a text message-based mHealth intervention designed to increase and sustain physical activity in cardiac rehabilitation enrollees. METHODS AND RESULTS Semistructured interviews were conducted with intervention arm participants of a randomized controlled trial delivered to low- and moderate-risk cardiac rehabilitation enrollees. Interviews explored participants' interaction with the mobile application, reflections on tailored text messages, integration with cardiac rehabilitation, and opportunities for improvement. Transcripts were thematically analyzed using an iteratively developed codebook. Sample size consisted of 17 participants with mean age of 65.7 (SD 8.2) years; 29% were women, 29% had low functional capacity, and 12% were non-White. Four themes emerged from interviews: engagement, health impact, personalization, and future directions. Participants engaged meaningfully with the mHealth intervention, finding it beneficial in promoting increased physical activity. However, participants desired greater personalization to their individual health goals, fitness levels, and real-time environment. Generally, those with lower functional capacity and less experience with exercise were more likely to view the intervention positively. Finally, participants identified future directions for the intervention including better incorporation of exercise physiologists and social support systems. CONCLUSIONS Cardiac rehabilitation enrollees viewed a text message-based mHealth intervention favorably, suggesting the potentially high usefulness of mHealth technologies in this population. Addressing participant-identified needs on increased user customization and inclusion of clinical and social support is crucial to enhancing the effectiveness of future mHealth interventions. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04587882.
Collapse
Affiliation(s)
- Namratha Atluri
- Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Sonali R. Mishra
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Theresa Anderson
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Rachel Stevens
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Angel Edwards
- Department of PharmacyUniversity of MichiganAnn ArborMIUSA
| | - Evan Luff
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Brahmajee K. Nallamothu
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP)University of MichiganAnn ArborMIUSA
- The Center for Clinical Management and Research, Ann Arbor VA Medical CenterAnn ArborMIUSA
| | - Jessica R. Golbus
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
- The Center for Clinical Management and Research, Ann Arbor VA Medical CenterAnn ArborMIUSA
| |
Collapse
|
9
|
Pastapur A, Pescatore NA, Shah N, Kheterpal S, Nallamothu BK, Golbus JR. Evaluation of atrial fibrillation using wearable device signals and home blood pressure data in the Michigan Predictive Activity & Clinical Trajectories in Health (MIPACT) Study: A Subgroup Analysis (MIPACT-AFib). Front Cardiovasc Med 2023; 10:1243574. [PMID: 38188255 PMCID: PMC10769487 DOI: 10.3389/fcvm.2023.1243574] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/24/2023] [Indexed: 01/09/2024] Open
Abstract
Background The rising adoption of wearable technology increases the potential to identify arrhythmias. However, specificity of these notifications is poorly defined and may cause anxiety and unnecessary resource utilization. Herein, we report results of a follow-up screening protocol for incident atrial fibrillation/flutter (AF) within a large observational digital health study. Methods The MIPACT Study enrolled 6,765 adult patients who were provided an Apple Watch and blood pressure (BP) monitors. From March to July 2019, participants were asked to contact the study team for any irregular heart rate (HR) notification. They were assessed using structured questionnaires and asked to provide 6 Apple Watch EKGs. Those with arrhythmias or non-diagnostic EKGs were sent 7-day monitors. The EHR was reviewed after 3 years to determine if participants developed arrhythmias. Results 86 participants received notifications and met inclusion criteria. Mean age was 50.5 (SD 16.9) years, and 46 (53.3%) were female. Of 76 participants assessed by the study team, 32 (42.1%) reported anxiety surrounding notifications. Of 59 participants who sent at least 1 EKG, 52 (88.1%) were in sinus rhythm, 3 (5.1%) AF, 2 (3.4%) indeterminate, and 2 (3.4%) sinus bradycardia. Cardiac monitor demonstrated AF in 2 of 3 participants with AF on Apple Watch EKGs. 2 contacted their PCPs and were diagnosed with AF. In total, 5 cases of AF were diagnosed with 1 additional case identified during EHR review. Conclusion Wearable devices produce alarms that can frequently be anxiety provoking. Research is needed to determine the implications of these alarms and appropriate follow-up.
Collapse
Affiliation(s)
- Aishwarya Pastapur
- Division of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Nicole A. Pescatore
- Division of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Nirav Shah
- Division of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Sachin Kheterpal
- Division of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Brahmajee K. Nallamothu
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, MI, United States
- The Center for Clinical Management and Research, Ann Arbor VA Medical Center, Ann Arbor, MI, United States
| | - Jessica R. Golbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
10
|
Chan PS, Greif R, Anderson T, Atiq H, Bittencourt Couto T, Considine J, De Caen AR, Djärv T, Doll A, Douma MJ, Edelson DP, Xu F, Finn JC, Firestone G, Girotra S, Lauridsen KG, Kah-Lai Leong C, Lim SH, Morley PT, Morrison LJ, Moskowitz A, Mullasari Sankardas A, Mustafa Mohamed MT, Myburgh MC, Nadkarni VM, Neumar RW, Nolan JP, Odakha JA, Olasveengen TM, Orosz J, Perkins GD, Previdi JK, Vaillancourt C, Montgomery WH, Sasson C, Nallamothu BK. Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality of Care and Outcomes. Resuscitation 2023; 193:109996. [PMID: 37942937 PMCID: PMC10769812 DOI: 10.1016/j.resuscitation.2023.109996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Paul S Chan
- Mid-America Heart Institute, Kansas City, MO, United States.
| | - Robert Greif
- Department of Anesthesiology and Pain Medicine, University of Bern, Switzerland
| | - Theresa Anderson
- Department of Internal Medicine, University of Michigan Medical, Ann Arbor, United States
| | - Huba Atiq
- Centre of Excellence for Trauma and Emergencies, Aga Khan University Hospital, Pakistan
| | | | | | - Allan R De Caen
- Division of Pediatric Critical Care, Stollery Children's Hospital, Edmonton, Canada
| | - Therese Djärv
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Ann Doll
- Global Resuscitation Alliance, Seattle, WA, United States
| | - Matthew J Douma
- Department of Critical Care Medicine, University of Alberta, Canada
| | - Dana P Edelson
- Department of Medicine, University of Chicago Medicine, IL, United States
| | - Feng Xu
- Department of Emergency Medicine, Qilu Hospital of Shandong University, China
| | - Judith C Finn
- School of Nursing, Curtin University, Perth, Australia
| | - Grace Firestone
- Department of Family Medicine, University of California Los Angeles Health, Santa Monica, United States
| | - Saket Girotra
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, United States
| | | | | | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Peter T Morley
- Department of Intensive Care, The University of Melbourne, Australia
| | - Laurie J Morrison
- Division of Emergency Medicine, University of Toronto, Ontario, Canada
| | - Ari Moskowitz
- Department of Medicine, Montefiore Medical Center, The Bronx, NY, United States
| | | | | | | | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care, Childrens Hospital of Philadelphia, PA, United States
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor, United States
| | | | | | - Theresa M Olasveengen
- Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Judit Orosz
- Department of Medicine, The Alfred, Melbourne, Australia
| | | | | | | | | | | | - Brahmajee K Nallamothu
- Department of Internal Medicine, University of Michigan Medical, Ann Arbor, United States
| |
Collapse
|
11
|
Poitrasson-Rivière A, Moody JB, Renaud JM, Hagio T, Arida-Moody L, Buckley CJ, Al-Mallah MH, Nallamothu BK, Weinberg RL, Ficaro EP, Murthy VL. Integrated myocardial flow reserve (iMFR) assessment: optimized PET blood flow quantification for diagnosis of coronary artery disease. Eur J Nucl Med Mol Imaging 2023; 51:136-146. [PMID: 37807004 DOI: 10.1007/s00259-023-06455-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE Distinguishing obstructive epicardial coronary artery disease (CAD) from microvascular dysfunction and diffuse atherosclerosis would be of immense benefit clinically. However, quantitative measures of absolute myocardial blood flow (MBF) integrate the effects of focal epicardial stenosis, diffuse atherosclerosis, and microvascular dysfunction. In this study, MFR and relative perfusion quantification were combined to create integrated MFR (iMFR) which was evaluated using data from a large clinical registry and an international multi-center trial and validated against invasive coronary angiography (ICA). METHODS This study included 1,044 clinical patients referred for 82Rb rest/stress positron emission tomography myocardial perfusion imaging and ICA, along with 231 patients from the Flurpiridaz 301 trial (clinicaltrials.gov NCT01347710). MFR and relative perfusion quantification were combined to create an iMFR map. The incremental value of iMFR was evaluated for diagnosis of obstructive stenosis, adjusted for patient demographics and pre-test probability of CAD. Models for high-risk anatomy (left main or three-vessel disease) were also constructed. RESULTS iMFR parameters of focally impaired perfusion resulted in best fitting diagnostic models. Receiver-operating characteristic analysis showed a slight improvement compared to standard quantitative perfusion approaches (AUC 0.824 vs. 0.809). Focally impaired perfusion was also associated with high-risk CAD anatomy (OR 1.40 for extent, and OR 2.40 for decreasing mean MFR). Diffusely impaired perfusion was associated with lower likelihood of obstructive CAD, and, in the absence of transient ischemic dilation (TID), with lower likelihood of high-risk CAD anatomy. CONCLUSIONS Focally impaired perfusion extent derived from iMFR assessment is a powerful incremental predictor of obstructive CAD while diffusely impaired perfusion extent can help rule out obstructive and high-risk CAD in the absence of TID.
Collapse
Affiliation(s)
| | - Jonathan B Moody
- INVIA Medical Imaging Solutions, 3025 Boardwalk Dr., Suite 200, Ann Arbor, MI, 48108, USA
| | - Jennifer M Renaud
- INVIA Medical Imaging Solutions, 3025 Boardwalk Dr., Suite 200, Ann Arbor, MI, 48108, USA
| | - Tomoe Hagio
- INVIA Medical Imaging Solutions, 3025 Boardwalk Dr., Suite 200, Ann Arbor, MI, 48108, USA
| | - Liliana Arida-Moody
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Mouaz H Al-Mallah
- Houston Methodist Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Richard L Weinberg
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Edward P Ficaro
- INVIA Medical Imaging Solutions, 3025 Boardwalk Dr., Suite 200, Ann Arbor, MI, 48108, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
12
|
Guetterman TC, Forman J, Fouche S, Simpson K, Fetters MD, Nelson C, Mendel P, Hsu A, Flohr JA, Domeier R, Rahim R, Nallamothu BK, Abir M. A cross-stakeholder approach to improving out-of-hospital cardiac arrest survival. Am Heart J 2023; 266:106-119. [PMID: 37709108 DOI: 10.1016/j.ahj.2023.09.004] [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: 05/26/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) affects over 300,000 individuals per year in the United States with poor survival rates overall. A remarkable 5-fold difference in survival-to-hospital discharge rates exist across United States communities. METHODS We conducted a study using qualitative research methods comparing the system of care across sites in Michigan communities with varying OHCA survival outcomes, as measured by return to spontaneous circulation with pulse upon emergency department arrival. RESULTS Major themes distinguishing higher performing sites were (1) working as a team, (2) devoting resources to coordination across agencies, and (3) developing a continuous quality improvement culture. These themes spanned the chain of survival framework for OHCA. By examining the unique processes, procedures, and characteristics of higher- relative to lower-performing sites, we gleaned lessons learned that appear to distinguish higher performers. The higher performing sites reported being the most collaborative, due in part to facilitation of system integration by progressive leadership that is willing to build bridges among stakeholders. CONCLUSIONS Based on the distinguishing features of higher performing sites, we provide recommendations for toolkit development to improve survival in prehospital systems of care for OHCA.
Collapse
Affiliation(s)
- Timothy C Guetterman
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI; Mixed Methods Program and Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Jane Forman
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Qualitative and Mixed Methods Core, Center for Clinical Management Research, U.S. Department of Veterans Affairs, Ann Arbor, MI
| | - Sydney Fouche
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI
| | - Kaitlyn Simpson
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI; University of Michigan Medical School, Ann Arbor, MI
| | - Michael D Fetters
- Mixed Methods Program and Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI
| | | | | | - Antony Hsu
- Trinity Health Ann Arbor Hospital, Ann Arbor, MI
| | - Jessica A Flohr
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI
| | - Robert Domeier
- Trinity Health Ann Arbor Hospital, Ann Arbor, MI; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Rebal Rahim
- Department of Clinical Sciences, Anesthesia and Intensive Care, Lund University, Skane University Hospital, Malmo, Sweden
| | - Brahmajee K Nallamothu
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI
| | - Mahshid Abir
- Acute Care Research Unit, University of Michigan, Ann Arbor, MI; RAND Corporation, Santa Monica, CA; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI.
| |
Collapse
|
13
|
Nallamothu BK, Greif R, Anderson T, Atiq H, Couto TB, Considine J, De Caen AR, Djärv T, Doll A, Douma MJ, Edelson DP, Xu F, Finn JC, Firestone G, Girotra S, Lauridsen KG, Leong CKL, Lim SH, Morley PT, Morrison LJ, Moskowitz A, Mullasari Sankardas A, Mohamed MTM, Myburgh MC, Nadkarni VM, Neumar RW, Nolan JP, Athieno Odakha J, Olasveengen TM, Orosz J, Perkins GD, Previdi JK, Vaillancourt C, Montgomery WH, Sasson C, Chan PS. Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality of Care and Outcomes. Circ Cardiovasc Qual Outcomes 2023; 16:e010491. [PMID: 37947100 PMCID: PMC10659256 DOI: 10.1161/circoutcomes.123.010491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
| | - Robert Greif
- Department of Anesthesiology and Pain Medicine, University of Bern, Switzerland (R.G.)
| | - Theresa Anderson
- Department of Internal Medicine, University of Michigan Medical, Ann Arbor (B.K.N., T.A.)
| | - Huba Atiq
- Centre of Excellence for Trauma and Emergencies, Aga Khan University Hospital, Pakistan (H.A.)
| | | | | | - Allan R. De Caen
- Division of Pediatric Critical Care, Stollery Children’s Hospital, Edmonton, Canada (A.R.D.C.)
| | - Therese Djärv
- Department of Medicine, Karolinska Institute, Stockholm, Sweden (T.D.)
| | - Ann Doll
- Global Resuscitation Alliance, Seattle, WA (A.D.)
| | - Matthew J. Douma
- Department of Critical Care Medicine, University of Alberta, Canada (M.J.D.)
| | - Dana P. Edelson
- Department of Medicine, University of Chicago Medicine, IL (D.P.E.)
| | - Feng Xu
- Department of Emergency Medicine, Qilu Hospital of Shandong University, China (F.X.)
| | - Judith C. Finn
- School of Nursing, Curtin University, Perth, Australia (J.F.)
| | - Grace Firestone
- Department of Family Medicine, University of California Los Angeles Health, Santa Monica (G.F.)
| | - Saket Girotra
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas (S.G.)
| | | | - Carrie Kah-Lai Leong
- Department of Emergency Medicine, Singapore General Hospital (C.K.-L.L., S.H.L.)
| | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital (C.K.-L.L., S.H.L.)
| | - Peter T. Morley
- Department of Intensive Care, The University of Melbourne, Australia (P.T.M.)
| | - Laurie J. Morrison
- Division of Emergency Medicine, University of Toronto, Ontario, Canada (L.J.M.)
| | - Ari Moskowitz
- Department of Medicine, Montefiore Medical Center, The Bronx, NY (A.M.)
| | | | | | | | - Vinay M. Nadkarni
- Department of Anesthesiology and Critical Care, Childrens Hospital of Philadelphia, PA (V.N.)
| | - Robert W. Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor (R.W.N.)
| | - Jerry P. Nolan
- University of Warwick, Coventry, United Kingdom (J.P.N., G.D.P.)
| | | | - Theresa M. Olasveengen
- Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway (T.M.O.)
| | - Judit Orosz
- Department of Medicine, The Alfred, Melbourne, Australia (J.O.)
| | - Gavin D. Perkins
- University of Warwick, Coventry, United Kingdom (J.P.N., G.D.P.)
| | | | | | | | | | - Paul S. Chan
- Mid-America Heart Institute, Kansas City, MO (P.S.C.)
| |
Collapse
|
14
|
Nallamothu BK. Better: Reflections on Retraction and Republication in Science. Circ Cardiovasc Qual Outcomes 2023; 16:e010579. [PMID: 37988443 DOI: 10.1161/circoutcomes.123.010579] [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] [Indexed: 11/23/2023]
Affiliation(s)
- Brahmajee K Nallamothu
- Department of Internal Medicine, University of Michigan Medical School and Lieutenant Colonel Charles S. Kettles VA Medical Center, Ann Arbor, Michigan
| |
Collapse
|
15
|
Levine DA, Whitney RT, Galecki AT, Fagerlin A, Wallner LP, Shore S, Langa KM, Nallamothu BK, Morgenstern LB, Giordani B, Reale BK, Blair EM, Sharma A, Kabeto MU, Plassman BL, Zahuranec DB. Patient Cognitive Status and Physician Recommendations for Cardiovascular Disease Treatment: Results of Two Nationwide, Randomized Survey Studies. J Gen Intern Med 2023; 38:3134-3143. [PMID: 37620721 PMCID: PMC10651817 DOI: 10.1007/s11606-023-08295-0] [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: 12/05/2022] [Accepted: 06/16/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Clinical guidelines recommend that older patients (65+) with mild cognitive impairment (MCI) and early-stage dementia receive similar guideline-concordant care after cardiovascular disease (CVD) events as those with normal cognition (NC). However, older patients with MCI and dementia receive less care for CVD and other conditions than those with NC. Whether physician recommendations for guideline-concordant treatments after two common CVD events, acute myocardial infarction (AMI) and acute ischemic stroke (stroke), differ between older patients with NC, MCI, and early-stage dementia is unknown. OBJECTIVE To test the influence of patient cognitive status (NC, MCI, early-stage dementia) on physicians' recommendations for guideline-concordant treatments for AMI and stroke. DESIGN We conducted two parallel, randomized survey studies for AMI and stroke in the US using clinical vignettes where the hypothetical patient's cognitive status was randomized between physicians. PARTICIPANTS The study included cardiologists, neurologists, and generalists who care for most patients hospitalized for AMI and stroke. MAIN MEASURES The primary outcome was a composite quality score representing the number of five guideline-concordant treatments physicians recommended for a hypothetical patient after AMI or stroke. KEY RESULTS 1,031 physicians completed the study (58.5% response rate). Of 1,031 respondents, 980 physicians had complete information. After adjusting for physician factors, physicians recommended similar treatments after AMI and stroke in hypothetical patients with pre-existing MCI (adjusted ratio of expected composite quality score, 0.98 [95% CI, 0.94, 1.02]; P = 0.36) as hypothetical patients with NC. Physicians recommended fewer treatments to hypothetical patients with pre-existing early-stage dementia than to hypothetical patients with NC (adjusted ratio of expected composite quality score, 0.90 [0.86, 0.94]; P < 0.001). CONCLUSION In these randomized survey studies, physicians recommended fewer guideline-concordant AMI and stroke treatments to hypothetical patients with early-stage dementia than those with NC. We did not find evidence that physicians recommend fewer treatments to hypothetical patients with MCI than those with NC.
Collapse
Affiliation(s)
- Deborah A Levine
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA.
- Department of Neurology and Stroke Program, U-M, Ann Arbor, MI, USA.
- Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, USA.
- Division of General Medicine, U-M, Ann Arbor, MI, USA.
| | - Rachael T Whitney
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
| | - Andrzej T Galecki
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
- Department of Biostatistics, U-M, Ann Arbor, MI, USA
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, and Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center for Innovation, Salt Lake City, UT, USA
| | - Lauren P Wallner
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, USA
- Department of Epidemiology, U-M, Ann Arbor, MI, USA
| | - Supriya Shore
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
| | - Kenneth M Langa
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Institute for Social Research, U-M, Ann Arbor, MI, USA
| | - Brahmajee K Nallamothu
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Lewis B Morgenstern
- Department of Neurology and Stroke Program, U-M, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, USA
- Department of Epidemiology, U-M, Ann Arbor, MI, USA
| | - Bruno Giordani
- Department of Psychiatry, U-M, Ann Arbor, MI, USA
- Michigan Alzheimer's Disease Center, U-M, Ann Arbor, MI, USA
| | - Bailey K Reale
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Emilie M Blair
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
| | - Anupriya Sharma
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
| | - Mohammed U Kabeto
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA
| | - Brenda L Plassman
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | | |
Collapse
|
16
|
Golbus JR, Gosch K, Birmingham MC, Butler J, Lingvay I, Lanfear DE, Abbate A, Kosiborod ML, Damaraju CV, Januzzi JL, Spertus J, Nallamothu BK. Association Between Wearable Device Measured Activity and Patient-Reported Outcomes for Heart Failure. JACC Heart Fail 2023; 11:1521-1530. [PMID: 37498273 DOI: 10.1016/j.jchf.2023.05.033] [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] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/10/2023] [Accepted: 05/26/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Wearable devices are increasingly used in research and clinical care though the relevance of their data in the context of validated outcomes remains unknown. OBJECTIVES The purpose of this study was to characterize the relationship between smartwatch activity and patient-centered outcomes in patients with heart failure. METHODS CHIEF-HF (Canagliflozin: Impact on Health Status, Quality of Life and Functional Status in Heart Failure) was a randomized-controlled clinical trial that enrolled participants with heart failure and a compatible smartphone. Participants were provided a Fitbit Versa 2 and completed serial Kansas City Cardiomyopathy Questionnaires (KCCQs) through a smartphone application. We evaluated the relationship between daily step count and floors climbed and KCCQ total symptom (TS) and physical limitation (PL) scores at baseline and their respective changes between 2 and 12 weeks using linear regression models, with restricted cubic splines for nonlinear associations. RESULTS In total, 425 patients were included: 44.5% women, 40.9% with reduced ejection fraction. Baseline daily step count increased across categories of KCCQ-TS scores (2,437.6 ± 1,419.5 steps/d for scores 0 to 24 vs 4,870.9 ± 3,171.3 steps/d for scores 75 to 100; P < 0.001) with similar results for KCCQ-PL scores. This relationship remained significant for KCCQ-TS and KCCQ-PL scores after multivariable adjustment. Importantly, changes in daily step count were significantly associated with nonlinear changes in KCCQ-TS (P = 0.004) and KCCQ-PL (P = 0.003) scores. Floors climbed was associated with baseline KCCQ scores alone. CONCLUSIONS Daily step count was nonlinearly associated with health status at baseline and over time in patients with heart failure. These results may inform interpretation of wearable device data in clinical and research contexts. (A Study on Impact of Canagliflozin on Health Status, Quality of Life, and Functional Status in Heart Failure [CHIEF-HF]; NCT04252287).
Collapse
Affiliation(s)
- Jessica R Golbus
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA; Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, Michigan, USA. https://twitter.com/JRGolbus
| | - Kensey Gosch
- University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | | | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - Ildiko Lingvay
- Department of Internal Medicine, Division of Endocrinology and Peter O'Donnel Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David E Lanfear
- Division of Cardiovascular Medicine and Center for Individualized and Genomic Medicine Research, Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Antonio Abbate
- Berne Cardiovascular Research Center, Department of Internal Medicine, Division of Cardiology, University of Virginia Health, Charlottesville, Virginia, USA
| | - Mikhail L Kosiborod
- University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - C V Damaraju
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - James L Januzzi
- Massachusetts General Hospital, Harvard Medical School and Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - John Spertus
- University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA; Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, Michigan, USA; The Center for Clinical Management and Research, Ann Arbor VA Medical Center, Ann Arbor, Michigan, USA
| |
Collapse
|
17
|
Zghouzi M, Mwansa H, Shore S, Hyder SN, Kamdar N, Moles VM, Barnes GD, Froehlich J, Mclaughlin VV, Paul TK, Rosenfield K, Giri J, Nallamothu BK, Aggarwal V. Sex, Racial, and Geographic Disparities in Pulmonary Embolism-related Mortality Nationwide. Ann Am Thorac Soc 2023; 20:1571-1577. [PMID: 37555732 DOI: 10.1513/annalsats.202302-091oc] [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] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/08/2023] [Indexed: 08/10/2023] Open
Abstract
Rationale: Acute pulmonary embolism is a leading cause of cardiovascular death. There are limited data on the national mortality trends from pulmonary embolism. Understanding these trends is crucial for addressing the mortality and associated disparities associated with pulmonary embolism. Objectives: To analyze the national mortality trends related to acute pulmonary embolism and determine the overall age-adjusted mortality rate (AAMR) per 100,000 population for the study period and assess changes in AAMR among different sexes, races, and geographic locations. Methods: We conducted a retrospective cohort analysis using mortality data of individuals aged ⩾15 years with pulmonary embolism listed as the underlying cause of death in the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database from January 2006 to December 2019. These data are produced by the National Center for Health Statistics. Results: A total of 109,992 pulmonary embolism-related deaths were noted in this dataset nationwide between 2006 and 2019. Of these, women constituted 60,113 (54.7%). The AAMR per 100,000 was not significantly changed, from 2.84 in 2006 to 2.81 in 2019 (average annual percentage change [AAPC], 0.2; 95% confidence interval [CI], -0.1 to 0.5; P = 0.15). AAMR increased for men throughout the study period compared with women (AAPC, 0.7 for men; 95% CI, 0.3 to 1.2; P = 0.004 vs. AAPC, -0.4 for women; 95% CI, -1.1 to 0.3; P = 0.23, respectively). Similarly, AAMR for pulmonary embolism increased for Black compared with White individuals, from 5.18 to 5.26 (AAPC, 0.4; 95% CI, 0.0 to 0.7; P = 0.05) and 2.82 to 2.86 (AAPC, 0.0; 95% CI, -0.6 to 0.6; P = 0.99), respectively. Similarly, AAMR for pulmonary embolism was higher in rural areas than in micropolitan and large metropolitan areas during the study period (4.07 [95% CI, 4.02 to 4.12] vs. 3.24 [95% CI, 3.21 to 3.27] vs. 2.32 [95% CI, 2.30-2.34], respectively). Conclusions: Pulmonary embolism mortality remains high and unchanged over the past decade, and enduring sex, racial and socioeconomic disparities persist in pulmonary embolism. Targeted efforts to decrease pulmonary embolism mortality and address such disparities are needed.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Timir K Paul
- University of Tennessee at Nashville, Ascension St. Thomas Hospital, Nashville, Tennessee
| | | | - Jay Giri
- University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Brahmajee K Nallamothu
- University of Michigan, Ann Arbor, Michigan
- Veteran Affairs Ann Arbor Health System, Ann Arbor, Michigan
| | - Vikas Aggarwal
- University of Michigan, Ann Arbor, Michigan
- Veteran Affairs Ann Arbor Health System, Ann Arbor, Michigan
| |
Collapse
|
18
|
Iyer K, Nallamothu BK, Figueroa CA, Nadakuditi RR. A multi-stage neural network approach for coronary 3D reconstruction from uncalibrated X-ray angiography images. Sci Rep 2023; 13:17603. [PMID: 37845232 PMCID: PMC10579444 DOI: 10.1038/s41598-023-44633-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023] Open
Abstract
We present a multi-stage neural network approach for 3D reconstruction of coronary artery trees from uncalibrated 2D X-ray angiography images. This method uses several binarized images from different angles to reconstruct a 3D coronary tree without any knowledge of image acquisition parameters. The method consists of a single backbone network and separate stages for vessel centerline and radius reconstruction. The output is an analytical matrix representation of the coronary tree suitable for downstream applications such as hemodynamic modeling of local vessel narrowing (i.e., stenosis). The network was trained using a dataset of synthetic coronary trees from a vessel generator informed by both clinical image data and literature values on coronary anatomy. Our multi-stage network achieved sub-pixel accuracy in reconstructing vessel radius (RMSE = 0.16 ± 0.07 mm) and stenosis radius (MAE = 0.27 ± 0.18 mm), the most important feature used to inform diagnostic decisions. The network also led to 52% and 38% reduction in vessel centerline reconstruction errors compared to a single-stage network and projective geometry-based methods, respectively. Our method demonstrated robustness to overcome challenges such as vessel foreshortening or overlap in the input images. This work is an important step towards automated analysis of anatomic and functional disease severity in the coronary arteries.
Collapse
Affiliation(s)
- Kritika Iyer
- University of Michigan, 2800 Plymouth Road Building 20-210W, Ann Arbor, MI, 48109, USA.
| | | | - C Alberto Figueroa
- University of Michigan, 2800 Plymouth Road Building 20-210W, Ann Arbor, MI, 48109, USA
| | - Raj R Nadakuditi
- University of Michigan, 2800 Plymouth Road Building 20-210W, Ann Arbor, MI, 48109, USA
| |
Collapse
|
19
|
Ghanbari H, Whibley D, Lehmann HI, Li Z, Kratz A, Clauw DJ, Nallamothu BK. Episodes of Atrial Fibrillation and Symptoms: A Temporal Analysis. Cardiovasc Digit Health J 2023; 4:143-148. [PMID: 37850044 PMCID: PMC10577487 DOI: 10.1016/j.cvdhj.2023.06.004] [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] [Indexed: 10/19/2023] Open
Abstract
Background Data on the relationship between symptoms and atrial fibrillation (AF) episodes are limited. Objective The objective of this study was to determine the strength of temporal association between AF episodes and symptoms. Methods This cross-sectional ambulatory assessment study was performed in a tertiary care center between June 2018 and December 2021. Patients with paroxysmal AF (1 episode of AF, burden not exceeding 95%) who used a mobile application and continuous wearable electrocardiogram monitor for 21 days were enrolled. The primary outcome was worse symptoms (symptoms above the mean score) over the study period. The association between worse symptoms and the presence of AF was evaluated for different time epochs. Multilevel mixed-effects models were used to quantify associations after accounting for confounders. Results Worse symptoms were more likely to be associated with the presence of AF episodes 15 minutes prior to the reporting of palpitations (OR, 2.8 [95% CI, 1.6-5.0]; P < .001), shortness of breath (OR, 2.2 [95% CI, 1.3-3.7]; P = .003), dizziness/lightheadedness (OR, 2.0 [95% CI, 1.0-3.7]; P = .04), and fatigue (OR, 1.7 [95% CI, 1.0-2.9]; P = .03). The correlation between the severity of symptoms and AF lessened as the time interval from AF events to symptoms increased. Conclusion There is a significant relationship between onset of AF episodes and reporting of symptoms. This association diminishes over time and varies across different symptoms. If confirmed in larger studies, these findings may inform AF interventions that target symptoms just in time prior to a clinical visit.
Collapse
Affiliation(s)
- Hamid Ghanbari
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Daniel Whibley
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan
| | - H. Immo Lehmann
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Zhi Li
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Anna Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan
| | - Daniel J. Clauw
- Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Brahmajee K. Nallamothu
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| |
Collapse
|
20
|
Uzendu AI, Spertus JA, Nallamothu BK, Girotra S, Jones PG, McNally BF, Del Rios M, Sasson C, Breathett K, Sperling J, Dukes KC, Chan PS. Cardiac Arrest Survival at Emergency Medical Service Agencies in Catchment Areas With Primarily Black and Hispanic Populations. JAMA Intern Med 2023; 183:1136-1143. [PMID: 37669067 PMCID: PMC10481323 DOI: 10.1001/jamainternmed.2023.4303] [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: 02/08/2023] [Accepted: 07/12/2023] [Indexed: 09/06/2023]
Abstract
Importance Black and Hispanic patients are less likely to survive an out-of-hospital cardiac arrest (OHCA) than White patients. Given the central importance of emergency medical service (EMS) agencies in prehospital care, a better understanding of OHCA survival at EMS agencies that work in Black and Hispanic communities and White communities is needed to address OHCA disparities. Objective To examine whether EMS agencies serving catchment areas with primarily Black and Hispanic populations (Black and Hispanic catchment areas) have different rates of OHCA survival than agencies serving catchment areas with primarily White populations (White catchment areas). Design, Setting, and Participants A cohort study including adults with nontraumatic OHCA from January 1, 2015, to December 31, 2019, in the Cardiac Arrest Registry to Enhance Survival was conducted. Data analysis was conducted from August 17, 2022, to July 7, 2023. Exposure Emergency medical service agencies, categorized as working in catchment areas where the combination of Black and Hispanic residents made up more than 50% of the population or where White residents made up more than 50% of the population. Main Outcomes and Measures The unit of analysis was the EMS agency. The primary outcome was agency-level risk-standardized survival rates (RSSRs) to hospital admission for OHCA at each EMS agency, which were calculated using hierarchical logistic regression and compared between agencies serving Black and Hispanic and White catchment areas. Whether differences in OHCA survival were explained by EMS and first responder measures was evaluated with additional adjustment for these factors. Results Among 764 EMS agencies representing 258 342 OHCAs, 82 EMS agencies (10.7%) had a Black and Hispanic catchment area. Overall median age of the patients was 63.0 (IQR, 52.0-75.0) years, 36.1% were women, and 63.9% were men. Overall, the mean (SD) RSSR was 27.5% (3.6%), with lower survival at EMS agencies with Black and Hispanic catchment areas (25.8% [3.6%]) compared with agencies with White catchment areas (27.7% [3.5%]; P < .001). Among the 82 EMS agencies with Black and Hispanic catchment areas, a disproportionately higher number (32 [39.0%]) was in the lowest survival quartile, whereas a lower number (12 [14.6%]) was in the highest survival quartile. Additional adjustment for EMS response times, EMS termination of resuscitation rates, and first responder rates of initiating cardiopulmonary resuscitation or applying an automated external defibrillator before EMS arrival did not meaningfully attenuate differences in RSSRs between agencies with Black and Hispanic compared with White catchment areas (mean [SD] RSSRs after adjustment, 25.9% [3.3%] vs 27.7% [3.1%]; P < .001). Conclusions and Relevance Risk-standardized survival rates for OHCA were 1.9% lower at EMS agencies working in Black and Hispanic catchment areas than in White catchment areas. This difference was not explained by EMS response times, rates of EMS termination of resuscitation, or first responder rates of initiating cardiopulmonary resuscitation or applying an automated external defibrillator. These findings suggest there is a need for further assessment of these discrepancies.
Collapse
Affiliation(s)
- Anezi I. Uzendu
- Saint Luke’s Hospital Mid America Heart Institute, Kansas City, Missouri
- Department of Medicine, University of Missouri–Kansas City, Kansas City
| | - John A. Spertus
- Saint Luke’s Hospital Mid America Heart Institute, Kansas City, Missouri
- Department of Medicine, University of Missouri–Kansas City, Kansas City
| | - Brahmajee K. Nallamothu
- Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Saket Girotra
- University of Texas–Southwestern Medical Center, Dallas
| | - Philip G. Jones
- Saint Luke’s Hospital Mid America Heart Institute, Kansas City, Missouri
| | - Bryan F. McNally
- Emory University School of Medicine, Rollins School of Public Health, Atlanta, Georgia
| | - Marina Del Rios
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Comilla Sasson
- Department of Psychiatry, University of Colorado School of Medicine, Aurora
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora
- American Heart Association, Dallas, Texas
| | - Khadijah Breathett
- Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Indianapolis
| | - Jessica Sperling
- Social Science Research Institute, Duke University, Durham, North Carolina
- Clinical and Translational Science Institute, Durham, North Carolina
| | - Kimberly C. Dukes
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City
- University of Iowa College of Public Health, Iowa City
| | - Paul S. Chan
- Saint Luke’s Hospital Mid America Heart Institute, Kansas City, Missouri
- Department of Medicine, University of Missouri–Kansas City, Kansas City
| |
Collapse
|
21
|
Harrod M, Hauschildt K, Kamphuis LA, Korpela PR, Rouse M, Nallamothu BK, Iwashyna TJ. Disrupted Lives: Caregivers' Experiences of In-Hospital Cardiac Arrest Survivors' Recovery 5 Years Later. J Am Heart Assoc 2023; 12:e028746. [PMID: 37671627 PMCID: PMC10547269 DOI: 10.1161/jaha.122.028746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/25/2023] [Indexed: 09/06/2023]
Abstract
Background Survivors of in-hospital cardiac arrest (IHCA) experience ongoing physical and cognitive impairments, often requiring support from a caregiver at home afterwards. Caregivers are important in the survivor's recovery, yet there is little research specifically focused on their experiences once the survivor is discharged home. In this study, we highlight how caregivers for veteran IHCA survivors described and experienced their caregiver role, the strategies they used to fulfill their role, and the additional needs they still have years after the IHCA event. Methods and Results Between March and July 2019, semistructured telephone interviews were conducted with 12 caregivers for veteran IHCA survivors. Interviews were transcribed, and content analysis was performed. Patterns within the data were further analyzed and grouped into themes. A predominant theme of "disruption" was identified across 3 different domains including the following: (1) disruption in caregiver's life, (2) disruption in caregiver-patient relationship, and (3) disruption in caregiver's well-being. Disruption was associated with both positive and negative caregiver experiences. Strategies caregivers used and resources they felt would have helped them adjust to their caregiver role were also identified. Conclusions Caregivers for veteran IHCA survivors experienced a disruption in many facets of their lives. Caregivers felt the veterans' IHCA impacted various aspects of their lives, and they continued to need additional support in order to care for the IHCA survivor and themselves. Although some were able to procure coping strategies, such as counseling and engaging in stress-relieving activities, most indicated additional help and resources were still needed.
Collapse
Affiliation(s)
- Molly Harrod
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
| | - Katrina Hauschildt
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
- Department of SociologyPopulation Studies CenterUniversity of MichiganAnn ArborMIUSA
- Division of Pulmonary and Critical Care MedicineDepartment of Internal MedicineUniversity of MichiganAnn ArborMIUSA
- Division of Pulmonary and Critical Care MedicineThe Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Lee A. Kamphuis
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
| | - Peggy R. Korpela
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
| | - Marylena Rouse
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
| | - Brahmajee K. Nallamothu
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
- Center for Healthcare Outcomes and PolicyUniversity of MichiganAnn ArborMIUSA
- Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Theodore J. Iwashyna
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
- Division of Pulmonary and Critical Care MedicineDepartment of Internal MedicineUniversity of MichiganAnn ArborMIUSA
- Division of Pulmonary and Critical Care MedicineThe Johns Hopkins University School of MedicineBaltimoreMDUSA
- Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
- Health Policy and Management, School of Public HealthThe Johns Hopkins UniversityBaltimoreMDUSA
| |
Collapse
|
22
|
Golbus JR, Gupta K, Stevens R, Jeganathan VSE, Luff E, Shi J, Dempsey W, Boyden T, Mukherjee B, Kohnstamm S, Taralunga V, Kheterpal V, Murphy S, Klasnja P, Kheterpal S, Nallamothu BK. A randomized trial of a mobile health intervention to augment cardiac rehabilitation. NPJ Digit Med 2023; 6:173. [PMID: 37709933 PMCID: PMC10502072 DOI: 10.1038/s41746-023-00921-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/07/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023] Open
Abstract
Mobile health (mHealth) interventions may enhance positive health behaviors, but randomized trials evaluating their efficacy are uncommon. Our goal was to determine if a mHealth intervention augmented and extended benefits of center-based cardiac rehabilitation (CR) for physical activity levels at 6-months. We delivered a randomized clinical trial to low and moderate risk patients with a compatible smartphone enrolled in CR at two health systems. All participants received a compatible smartwatch and usual CR care. Intervention participants received a mHealth intervention that included a just-in-time-adaptive intervention (JITAI) as text messages. The primary outcome was change in remote 6-minute walk distance at 6-months stratified by device type. Here we report the results for 220 participants enrolled in the study (mean [SD]: age 59.6 [10.6] years; 67 [30.5%] women). For our primary outcome at 6 months, there is no significant difference in the change in 6 min walk distance across smartwatch types (Intervention versus control: +31.1 meters Apple Watch, -7.4 meters Fitbit; p = 0.28). Secondary outcomes show no difference in mean step counts between the first and final weeks of the study, but a change in 6 min walk distance at 3 months for Fitbit users. Amongst patients enrolled in center-based CR, a mHealth intervention did not improve 6-month outcomes but suggested differences at 3 months in some users.
Collapse
Affiliation(s)
- Jessica R Golbus
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, MI, USA.
| | - Kashvi Gupta
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO, USA
| | - Rachel Stevens
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - V Swetha E Jeganathan
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Evan Luff
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jieru Shi
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Walter Dempsey
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Thomas Boyden
- Division of Cardiovascular Diseases, Department of Internal Medicine, Spectrum Health, Grand Rapids, MI, USA
| | | | - Sarah Kohnstamm
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Susan Murphy
- Departments of Statistics & Computer Science, Harvard University, Boston, MA, USA
| | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, MI, USA
- The Center for Clinical Management and Research, Ann Arbor VA Medical Center, Ann Arbor, MI, USA
| |
Collapse
|
23
|
Golbus JR, Ahn YS, Lyden GR, Nallamothu BK, Zaun D, Israni AK, Walsh MN, Colvin M. Use of exception status listing and related outcomes during two heart allocation policy periods. J Heart Lung Transplant 2023; 42:1298-1306. [PMID: 37182819 DOI: 10.1016/j.healun.2023.05.004] [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] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/06/2023] [Accepted: 05/10/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND The October 2018 update to the heart allocation policy was intended to decrease exception status requests, whereby candidates are listed at a specific status due to perceived need despite not meeting prespecified criteria of illness severity. We assessed the use of exception status and waitlist outcomes before and after the 2018 policy. METHODS We used data from the Scientific Registry of Transplant Recipients on adult heart transplant candidates listed from 2015 to 2021. We assessed (1) the use of exception status across patient characteristics between the two periods and (2) transplant rate and waitlist mortality or delisting due to deterioration in each period. Patients listed by exception versus standard criteria were compared with multivariable logistic regression, and waitlist outcomes were assessed using Cox proportional hazard models with medical urgency and exception status as time-dependent covariates. RESULTS During the study period (n = 19,213), heart transplants under exception status increased postpolicy from 10.0% to 32.3%, with 20.6% of transplants performed for patients at status 2 exception. Exception status candidates postpolicy were more frequently Black or Hispanic/Latino and less likely to have hypertrophic or restrictive cardiomyopathy and had worse hemodynamics. Exception status listing was associated with higher transplant rates in both periods. Postpolicy, candidates listed status 1 exception had a lower likelihood for waitlist mortality or delisting (hazard ratio, 0.60; 95% CI, 0.37-0.99; and p = 0.05). CONCLUSIONS Under the 2018 policy, exception status listings dramatically increased. The policy change shifted the population of patients listed by exception status and affected waitlist mortality, which suggests a need to further evaluate the policy's impact.
Collapse
Affiliation(s)
- Jessica R Golbus
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, MI; Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP) and Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, MI.
| | - Yoon S Ahn
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis MN
| | - Grace R Lyden
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis MN
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, MI; Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP) and Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, MI; The Center for Clinical Management and Research, Ann Arbor VA Medical Center, MI
| | - David Zaun
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis MN
| | - Ajay K Israni
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis MN; Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN; Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN
| | - Mary N Walsh
- Ascension St Vincent Heart Center, Indianapolis, IN
| | - Monica Colvin
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, MI; Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis MN
| |
Collapse
|
24
|
Golbus JR, Li J, Cascino TM, Tang W, Zhu J, Colvin M, Walsh MN, Nallamothu BK. Greater geographic sharing and heart transplantation waitlist outcomes following the 2018 heart allocation policy. J Heart Lung Transplant 2023; 42:936-942. [PMID: 36931987 PMCID: PMC10551820 DOI: 10.1016/j.healun.2023.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 09/19/2022] [Revised: 01/12/2023] [Accepted: 02/10/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND In 2018, a new heart allocation policy was introduced to reduce variability in access to and outcomes after transplantation, in part, through attempts at broader geographic sharing of donor hearts. We evaluated how this policy affected geographic sharing and waitlist outcomes by donation service area (DSA). METHODS This retrospective study of the Scientific Registry of Transplant Recipients database included adult patients waitlisted between October 2016 and October 2020, stratified by policy period. Our primary outcomes were mean proportion of imported and exported hearts aggregated by DSA as well as time to transplant. RESULTS Following the policy change, there was substantial evidence of sharing across DSAs. The mean proportion of imported hearts transplanted by a DSA increased from 32% (95% CI: 27%-36%) to 74% (95% CI: 71%-78%; p < 0.001), and the mean proportion of exported hearts increased from 37% (95% CI: 33%-42%) to 75% (95% CI: 71%-79%; p < 0.001). The mean sharing ratio, defined as the log-transformed ratio of imported to exported hearts per DSA, shifted from 1.15 (95% CI: 0.88-1.42) to 1.02 (95% CI: 0.96-1.07), with a 76% decline in the variance across DSAs. As sharing increased, time to transplant per DSA declined from 153.9 days (95% CI, 143.4-164.4 days) pre-policy to 89.6 days (95% CI, 83.1-96.1 days) post-policy (p < 0.001). A larger decrease in waitlist time was associated with a higher proportion of exported hearts. CONCLUSIONS The 2018 heart allocation policy was associated with more uniform access to heart transplantation and improved waitlist outcomes.
Collapse
Affiliation(s)
- Jessica R Golbus
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP) and Division of Cardiovascular Diseases, University of Michigan, Ann Arbor, Michigan.
| | - Jinming Li
- Department of Statistics, University of Michigan, Ann Arbor, Michigan
| | - Thomas M Cascino
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Weijing Tang
- Department of Statistics, University of Michigan, Ann Arbor, Michigan
| | - Ji Zhu
- Department of Statistics, University of Michigan, Ann Arbor, Michigan
| | - Monica Colvin
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Mary Norine Walsh
- Department of Internal Medicine, Ascension St Vincent Heart Center, Indianapolis, Indiana
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP) and Division of Cardiovascular Diseases, University of Michigan, Ann Arbor, Michigan; The Center for Clinical Management and Research, Ann Arbor VA Medical Center, Ann Arbor, Michigan
| |
Collapse
|
25
|
Cagino LM, Moskowitz A, Nallamothu BK, McSparron J, Iwashyna TJ. Trends in Return of Spontaneous Circulation and Survival to Hospital Discharge for In-Intensive Care Unit Cardiac Arrests. Ann Am Thorac Soc 2023; 20:1012-1019. [PMID: 36939838 DOI: 10.1513/annalsats.202205-393oc] [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: 05/05/2022] [Accepted: 03/17/2023] [Indexed: 03/21/2023] Open
Abstract
Rationale: Nearly 3 in 5 in-hospital cardiac arrests (IHCAs) occur in the intensive care unit (ICU), yet large-scale data on the outcomes of in-ICU cardiac arrests have not been published for over a decade. Objectives: We sought to examine outcomes of in-ICU cardiac arrests, evaluating both achievement of return of spontaneous circulation (ROSC) and subsequent survival to hospital discharge and how these have changed over time and by type of cardiac arrest. Methods: This was an observational study using the Get With The Guidelines-Resuscitation registry, an American Heart Association-sponsored, prospective, multisite registry of IHCAs in the United States, including adults 18 years of age and older with a confirmed initial cardiac arrest occurring in the ICU who underwent resuscitation. Outcomes included achievement of ROSC and survival to hospital discharge. Multivariable hierarchical logistic regression adjusting for patient-level factors and hospitals as random effects was used to evaluate ROSC and survival. Results: A total of 114,371 adult, in-ICU IHCAs from January 2006 to December 2018 were studied. The mean age was 63.8 years, 41.3% were women, and 82.1% had a nonshockable initial rhythm. Of the 114,371 ICU cardiac arrests, 70,610 (61.7%) achieved ROSC, and 21,747 (19.0%) survived until hospital discharge. The rate of ROSC improved from 2006 to 2018 (unadjusted rate, 55.0-65.4%; adjusted odds ratio [OR] per year, 1.04; 95% confidence interval [CI], 1.03-1.05). There was an increase in overall survival to discharge during this time (unadjusted rate, 16.7-20.5%; adjusted OR per year, 1.03; 95% CI, 1.03-1.04). The survival to discharge rate of the 70,610 patients who achieved ROSC increased slightly (unadjusted rate, 30.3-31.4%; adjusted OR per year, 1.02; 95% CI, 1.01, 1.02). Conclusions: There is an increase in survival to discharge for patients who experienced a cardiac arrest in the ICU between 2006 and 2018. There is an increase in achievement of ROSC and post-ROSC survival to discharge, although the increase in achievement of ROSC was greater than the increase in post-ROSC survival.
Collapse
Affiliation(s)
- Leigh M Cagino
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ari Moskowitz
- Division of Critical Care Medicine, Montefiore Medical Center, Bronx, New York
| | - Brahmajee K Nallamothu
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- VA Center for Clinical Management Research, Ann Arbor, Michigan; and
| | - Jakob McSparron
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Theodore J Iwashyna
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- VA Center for Clinical Management Research, Ann Arbor, Michigan; and
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
26
|
Ward MJ, Nikpay S, Shermeyer A, Nallamothu BK, Rokos I, Self WH, Hsia RY. Interfacility Transfer of Uninsured vs Insured Patients With ST-Segment Elevation Myocardial Infarction in California. JAMA Netw Open 2023; 6:e2317831. [PMID: 37294567 PMCID: PMC10257096 DOI: 10.1001/jamanetworkopen.2023.17831] [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: 02/20/2023] [Accepted: 04/26/2023] [Indexed: 06/10/2023] Open
Abstract
Importance Insurance status has been associated with whether patients with ST-segment elevation myocardial infarction (STEMI) presenting to emergency departments are transferred to other facilities, but whether the facility's percutaneous coronary intervention capabilities mediate this association is unknown. Objective To examine whether uninsured patients with STEMI were more likely than patients with insurance to experience interfacility transfer. Design, Setting, and Participants This observational cohort study compared patients with STEMI with and without insurance who presented to California emergency departments between January 1, 2010, and December 31, 2019, using the Patient Discharge Database and Emergency Department Discharge Database from the California Department of Health Care Access and Information. Statistical analyses were completed in April 2023. Exposures Primary exposures were lack of insurance and facility percutaneous coronary intervention capabilities. Main Outcomes and Measures The primary outcome was transfer status from the presenting emergency department of a percutaneous coronary intervention-capable hospital, defined as a facility performing 36 percutaneous coronary interventions per year. Multivariable logistic regression models with multiple robustness checks were performed to determine the association of insurance status with the odds of transfer. Results This study included 135 358 patients with STEMI, of whom 32 841 patients (24.2%) were transferred (mean [SD] age, 64 [14] years; 10 100 women [30.8%]; 2542 Asian individuals [7.7%]; 2053 Black individuals [6.3%]; 8285 Hispanic individuals [25.2%]; 18 650 White individuals [56.8%]). After adjusting for time trends, patient factors, and transferring hospital characteristics (including percutaneous coronary intervention capabilities), patients who were uninsured had lower odds of experiencing interfacility transfer than those with insurance (adjusted odds ratio, 0.93; 95% CI, 0.88-0.98; P = .01). Conclusions and Relevance After accounting for a facility's percutaneous coronary intervention capabilities, lack of insurance was associated with lower odds of emergency department transfer for patients with STEMI. These findings warrant further investigation to understand the characteristics of facilities and outcomes for uninsured patients with STEMI.
Collapse
Affiliation(s)
- Michael J. Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research, Education, and Clinical Center, Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Sayeh Nikpay
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Andrew Shermeyer
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Brahmajee K. Nallamothu
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor
- Michigan Integrated Center for Health Analytics and Medical Prediction, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Ivan Rokos
- Department of Emergency Medicine, UCLA-Olive View, Los Angeles, California
| | - Wesley H. Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Renee Y. Hsia
- Department of Emergency Medicine, University of California at San Francisco, San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco
| |
Collapse
|
27
|
Bohnen MS, Nallamothu BK, Zilinyi R, Saint S, Slater ED. A Wrong Turn. N Engl J Med 2023; 388:2087-2093. [PMID: 37256979 DOI: 10.1056/nejmcps2215388] [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] [Indexed: 06/02/2023]
Affiliation(s)
- Michael S Bohnen
- From the Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York (M.S.B., R.Z., E.D.S.); and the Department of Internal Medicine, University of Michigan, and the Health Services Research and Development Center of Excellence, Veterans Affairs Ann Arbor Healthcare System - both in Ann Arbor (B.K.N., S.S.)
| | - Brahmajee K Nallamothu
- From the Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York (M.S.B., R.Z., E.D.S.); and the Department of Internal Medicine, University of Michigan, and the Health Services Research and Development Center of Excellence, Veterans Affairs Ann Arbor Healthcare System - both in Ann Arbor (B.K.N., S.S.)
| | - Robert Zilinyi
- From the Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York (M.S.B., R.Z., E.D.S.); and the Department of Internal Medicine, University of Michigan, and the Health Services Research and Development Center of Excellence, Veterans Affairs Ann Arbor Healthcare System - both in Ann Arbor (B.K.N., S.S.)
| | - Sanjay Saint
- From the Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York (M.S.B., R.Z., E.D.S.); and the Department of Internal Medicine, University of Michigan, and the Health Services Research and Development Center of Excellence, Veterans Affairs Ann Arbor Healthcare System - both in Ann Arbor (B.K.N., S.S.)
| | - Emily D Slater
- From the Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York (M.S.B., R.Z., E.D.S.); and the Department of Internal Medicine, University of Michigan, and the Health Services Research and Development Center of Excellence, Veterans Affairs Ann Arbor Healthcare System - both in Ann Arbor (B.K.N., S.S.)
| |
Collapse
|
28
|
Jain N, Sheikh MA, Bajaj D, Townsend W, Krasuski R, Secemsky E, Chatterjee S, Moles V, Agarwal PP, Haft J, Visovatti SH, Cascino TM, Rosenfield K, Nallamothu BK, Mclaughlin VV, Aggarwal V. Periprocedural Complications With Balloon Pulmonary Angioplasty: Analysis of Global Studies. JACC Cardiovasc Interv 2023; 16:976-983. [PMID: 37100561 DOI: 10.1016/j.jcin.2023.01.361] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/15/2022] [Accepted: 01/10/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Balloon pulmonary angioplasty (BPA) was introduced as a treatment modality for patients with inoperable, medically refractory chronic thromboembolic pulmonary hypertension decades ago; however, reports of high rates of pulmonary vascular injury have led to considerable refinement in procedural technique. OBJECTIVES The authors sought to better understand the evolution of BPA procedure-related complications over time. METHODS The authors conducted a systematic review of original articles published by pulmonary hypertension centers globally and performed a pooled cohort analysis of procedure-related outcomes with BPA. RESULTS This systematic review identified 26 published articles from 18 countries worldwide from 2013 to 2022. A total of 1,714 patients underwent 7,561 total BPA procedures with an average follow up of 7.3 months. From the first period (2013-2017) to the second period (2018-2022), the cumulative incidence of hemoptysis/vascular injury decreased from 14.1% (474/3,351) to 7.7% (233/3,029) (P < 0.01); lung injury/reperfusion edema decreased from 11.3% (377/3,351) to 1.4% (57/3,943) (P < 0.01); invasive mechanical ventilation decreased from 0.7% (23/3,195) to 0.1% (4/3,062) (P < 0.01); and mortality decreased from 2.0% (13/636) to 0.8% (8/1,071) (P < 0.01). CONCLUSIONS Procedure-related complications with BPA, including hemoptysis/vascular injury, lung injury/reperfusion edema, mechanical ventilation, and death, were less common in the second period (2018-2022), compared with first period (2013-2017), likely from refinement in patient and lesion selection and procedural technique over time.
Collapse
Affiliation(s)
- Nishant Jain
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Muhammad A Sheikh
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Divyansh Bajaj
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Whitney Townsend
- University of Michigan Taubman Health Sciences Library, Ann Arbor, Michigan, USA
| | - Richard Krasuski
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Eric Secemsky
- Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Department of Medicine (E.A.S.), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Saurav Chatterjee
- Division of Cardiovascular Medicine, North Shore-Long Island Jewish Medical Centers, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Victor Moles
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Prachi P Agarwal
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan Haft
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott H Visovatti
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Thomas M Cascino
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kenneth Rosenfield
- Division of Cardiology, Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brahmajee K Nallamothu
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA; Section of Cardiology, Department of Internal Medicine, Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
| | - Vallerie V Mclaughlin
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Vikas Aggarwal
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA; Section of Cardiology, Department of Internal Medicine, Veterans Affairs Medical Center, Ann Arbor, Michigan, USA.
| |
Collapse
|
29
|
Hawkins RB, Nallamothu BK. Surgeons and systems working together to drive safety and quality. BMJ Qual Saf 2023; 32:181-184. [PMID: 36323509 DOI: 10.1136/bmjqs-2022-015045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Robert B Hawkins
- Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | |
Collapse
|
30
|
Davenport MS, Perazella MA, Nallamothu BK. Contrast-Induced Acute Kidney Injury and Cardiovascular Imaging: Danger or Distraction? Circulation 2023; 147:847-849. [PMID: 36913495 DOI: 10.1161/circulationaha.122.062783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Affiliation(s)
| | - Mark A Perazella
- Division of Nephrology. Yale University School of Medicine, New Haven, CT (M.A.P.)
| | | |
Collapse
|
31
|
Missel AL, Dowker SR, Chiola M, Platt J, Tsutsui J, Kasten K, Swor R, Neumar RW, Hunt N, Herbert L, Sams W, Nallamothu BK, Shields T, Coulter-Thompson EI, Friedman CP. Barriers to the Initiation of Telecommunicator-CPR during 9-1-1 Out-of-Hospital Cardiac Arrest Calls: A Qualitative Study. PREHOSP EMERG CARE 2023; 28:118-125. [PMID: 36857489 DOI: 10.1080/10903127.2023.2183533] [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] [Received: 09/08/2022] [Accepted: 02/15/2023] [Indexed: 03/03/2023]
Abstract
INTRODUCTION Fewer than 10% of individuals who suffer out-of-hospital cardiac arrest (OHCA) survive with good neurologic function. Bystander CPR more than doubles the chance of survival, and telecommunicator-CPR (T-CPR) during a 9-1-1 call substantially improves the frequency of bystander CPR. OBJECTIVE We examined the barriers to initiation of T-CPR. METHODS We analyzed the 9-1-1 call audio from 65 EMS-treated OHCAs from a single US 9-1-1 dispatch center. We initially conducted a thematic analysis aimed at identifying barriers to the initiation of T-CPR. We then conducted a conversation analysis that examined the interactions between telecommunicators and bystanders during the recognition phase (i.e., consciousness and normal breathing). RESULTS We identified six process themes related to barriers, including incomplete or delayed recognition assessment, delayed repositioning, communication gaps, caller emotional distress, nonessential questions and assessments, and caller refusal, hesitation, or inability to act. We identified three suboptimal outcomes related to arrest recognition and delivery of chest compressions, which are missed OHCA identification, delayed OHCA identification and treatment, and compression instructions not provided following OHCA identification. A primary theme observed during missed OHCA calls was incomplete or delayed recognition assessment and included failure to recognize descriptors indicative of agonal breathing (e.g., "snoring", "slow") or to confirm that breathing was effective in an unconscious victim. CONCLUSIONS We observed that modifiable barriers identified during 9-1-1 calls where OHCA was missed, or treatment was delayed, were often related to incomplete or delayed recognition assessment. Repositioning delays were a common barrier to the initiation of chest compressions.
Collapse
Affiliation(s)
- Amanda L Missel
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Stephen R Dowker
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Jodyn Platt
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | | | | | - Robert Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Nathaniel Hunt
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Logan Herbert
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Woodrow Sams
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Brahmajee K Nallamothu
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Theresa Shields
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Emilee I Coulter-Thompson
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Charles P Friedman
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| |
Collapse
|
32
|
Zghouzi M, Shore S, Mwansa H, Hyder S, Kamdar N, Moles V, Barnes GD, Froehlich JB, McLaughlin VV, Nallamothu BK, Aggarwal V. RACIAL DISPARITIES IN PULMONARY EMBOLISM MORTALITY AMONGST US ADULTS BEFORE AND DURING COVID-19 PANDEMIC. J Am Coll Cardiol 2023. [PMCID: PMC9982987 DOI: 10.1016/s0735-1097(23)02475-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
33
|
Zghouzi M, Shore S, Mwansa H, Hyder S, Kamdar N, Moles V, Barnes GD, Froehlich JB, McLaughlin VV, Paul TK, Nallamothu BK, Aggarwal V. TEMPORAL MORTALITY TRENDS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION, STROKE, AND PULMONARY EMBOLISM IN THE UNITED STATES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02466-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
|
34
|
Spaulding, PhD, RN EM, Isakadze NI, Molello N, Khoury S, Gao Y, Young L, Zghyer F, Azizi Z, Dorsch MP, Golbus JR, Commodore-Mensah Y, Gilotra NA, Sandhu A, Nallamothu BK, Martin SS. Abstract P398: Using Human-Centered Design Methodology to Identify Challenges and Inform the Development of a Digital Toolkit to Optimize Heart Failure Guideline-Directed Medical Therapy From Diverse Clinician, Patient, and Patient Health Partner Perspectives. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Introduction:
Despite overwhelming evidence that guideline-directed medical therapies (GDMT) for heart failure (HF) can reduce mortality and improve quality of life, significant gaps in treatment optimization persist. GDMT initiation and up-titration are especially critical for improving patient outcomes post-hospitalization.
Objective:
Identify challenges encountered post-hospitalization in optimizing GDMT for HF management by engaging key stakeholders in human-centered design (HCD) to guide the development of a digital toolkit to increase HF GDMT optimization.
Methods:
HCD is used to solve complex problems by soliciting input from stakeholders. We recruited: a) clinicians (physicians and advanced practice providers) who provide care to patients with HF across three health systems, b) patients with HF with Reduced Ejection Fraction (HFrEF, EF < 40%) discharged from the hospital within 30 days of enrollment, and c) patient health partners when available. We conducted separate virtual sessions for clinicians and patients/health partners using semi-structured interview guides to identify challenges, motivators and themes.
Results:
We enrolled 10 clinicians, 10 patients, and 2 patient health partners. The clinicians had a median age of 37 years (IQR: 35-41) and 12 years (IQR: 14-9) experience caring for patients with HF; 80% (8/10) were women, and 50% (5/10) were physicians. Patients had a median age of 53 years (IQR: 48-64); 40% (4/10) were women, 60% (6/10) were a racial/ethnic minority, and 50% (5/10) were married. Top challenges to HF GDMT optimization (e.g. number of medications) and digital toolkit features identified during the clinician HCD sessions are reported in Figure 1.
Conclusions:
The clinician and patient/health partner HCD findings will inform the development of the digital toolkit, including a patient-facing smartphone application and clinician dashboard, for HF GDMT optimization. We will also conduct HCD sessions in Brazil to further co-design the digital toolkit for low resource settings.
Collapse
Affiliation(s)
| | | | - Nancy Molello
- Johns Hopkins Univ Cntr for Health Equity, Baltimore, MD
| | | | - Yumin Gao
- Johns Hopkins Univ Sch of Medicine, Baltimore, MD
| | - Lisa Young
- Johns Hopkins Univ Sch of Medicine, Baltimore, MD
| | - Fawzi Zghyer
- Johns Hopkins Univ Sch of Medicine, Baltimore, MD
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Del Rios M, Nallamothu BK, Chan PS. Data Equity: The Foundation of Out-of-Hospital Cardiac Arrest Quality Improvement. Circ Cardiovasc Qual Outcomes 2023; 16:e009603. [PMID: 36503277 DOI: 10.1161/circoutcomes.122.009603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | - Paul S Chan
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, MO (P.S.C.)
| |
Collapse
|
36
|
Hellem AK, Casetti A, Bowie K, Golbus JR, Merid B, Nallamothu BK, Dorsch MP, Newman MW, Skolarus L. A Community Participatory Approach to Creating Contextually Tailored mHealth Notifications: myBPmyLife Project. Health Promot Pract 2023:15248399221141687. [PMID: 36704967 DOI: 10.1177/15248399221141687] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Just-in-time adaptive interventions (JITAIs) are a novel approach to mobile health (mHealth) interventions, sending contextually tailored behavior change notifications to participants when they are more likely to engage, determined by data from wearable devices. We describe a community participatory approach to JITAI notification development for the myBPmyLife Project, a JITAI focused on decreasing sodium consumption and increasing physical activity to reduce blood pressure. Eighty-six participants were interviewed, 50 at a federally qualified health center (FQHC) and 36 at a university clinic. Participants were asked to provide encouraging physical activity and low-sodium diet notifications and provided feedback on researcher-generated notifications to inform revisions. Participant notifications were thematically analyzed using an inductive approach. Participants noted challenging vocabulary, phrasing, and culturally incongruent suggestions in some of the researcher-generated notifications. Community-generated notifications were more direct, used colloquial language, and contained themes of grace. The FQHC participants' notifications expressed more compassion, religiosity, and addressed health-related social needs. University clinic participants' notifications frequently focused on office environments. In summary, our participatory approach to notification development embedded a distinctive community voice within our notifications. Our approach may be generalizable to other communities and serve as a model to create tailored mHealth notifications to their focus population.
Collapse
Affiliation(s)
| | | | | | | | - Beza Merid
- Arizona State University, Tempe, AZ, USA
| | | | | | | | | |
Collapse
|
37
|
Wheelock KM, Chan PS, Chen L, de Lemos JA, Miller PE, Nallamothu BK, Girotra S, Khera R. Time in therapeutic range for targeted temperature management and outcomes following out-of-hospital cardiac arrest. Resuscitation 2023; 182:109650. [PMID: 36442596 PMCID: PMC9885789 DOI: 10.1016/j.resuscitation.2022.11.016] [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: 07/21/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE For comatose survivors of out-of-hospital cardiac arrest (OHCA), current guidelines recommend targeted temperature management (TTM) with a goal temperature of 32 °C-36 °C for at least 24 h. We examined adherence to temperature targets, quantified as time-in-therapeutic range (TTR), and association of TTR with survival and neurologic outcomes. METHODS We conducted a retrospective cohort study of the Resuscitation Outcomes Consortium-Continuous Chest Compressions trial, including adults with OHCA who underwent TTM for >12 h. We imputed continuous temperatures between consecutive temperature measurements using the linear interpolation method and calculated TTR for multiple target temperatures. The association of TTR with survival to hospital discharge and favorable neurological outcome was evaluated using hierarchical regression models. MAIN RESULTS Among 2,637 patients (mean age 62.3 years, 29.9 % female), the median duration of TTR for TTM between 32 °C-36 °C was 23 (IQR: 21-24) hours with a median time outside therapeutic range of 0.9 (IQR: 0.0-4.2) hours. In risk-adjusted analyses, there was no association of TTR of 32 °C-36 °C with overall survival (OR 1.00 [95 % CI, 0.90-1.10]) or favorable neurologic outcome (1.02 [95 % CI, 0.90-1.14]). However, in assessments of TTR 33 °C-36 °C, there was a significant association with favorable neurologic survival (OR 1.12 [1.01-1.25]) but not overall survival (OR 1.04 [0.94-1.15]). CONCLUSIONS Among patients with OHCA who underwent TTM, we found variability in adherence to guideline-recommended treatment targets. Higher TTR was not associated with overall survival, but for certain temperature thresholds, TTR was associated with favorable neurologic outcome.
Collapse
Affiliation(s)
- Kevin M Wheelock
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Paul S Chan
- Division of Cardiology, Department of Internal Medicine, University of Missouri-Kansas City, United States; Mid America Heart Institute, Kansas City, MO, United States
| | - Lian Chen
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States
| | - James A de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - P Elliott Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Brahmajee K Nallamothu
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Saket Girotra
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Rohan Khera
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States; Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States.
| |
Collapse
|
38
|
Shore S, O'Leary M, Kamdar N, Harrod M, Silveira MJ, Hummel SL, Nallamothu BK. Do Not Attempt Resuscitation Order Rates in Hospitalized Patients With Heart Failure, Acute Myocardial Infarction, Chronic Obstructive Pulmonary Disease, and Pneumonia. J Am Heart Assoc 2022; 11:e025730. [PMID: 36382963 PMCID: PMC9851455 DOI: 10.1161/jaha.122.025730] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Descriptions of do not attempt resuscitation (DNAR) orders in heart failure (HF) are limited. We describe use of DNAR orders in HF hospitalizations relative to other common conditions, focusing on race. Methods and Results This was a retrospective study of all adult hospitalizations for HF, acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), and pneumonia from 2010 to 2016 using the California State Inpatient Dataset. Using a hierarchical multivariable logistic regression model with random effects for the hospital, we identified factors associated with DNAR orders for each condition. For racial variation, hospitals were divided into quintiles based on proportion of Black patients cared for. Our cohort comprised 399 816 HF, 190 802 AMI, 192 640 COPD, and 269 262 pneumonia hospitalizations. DNAR orders were most prevalent in HF (11.9%), followed by pneumonia (11.1%), COPD (7.9%), and AMI (7.1%). Prevalence of DNAR orders did not change from 2010 to 2016 for each condition. For all conditions, DNAR orders were more common in elderly people, women, and White people with significant site-level variation across 472 hospitals. For HF and COPD, hospitalizations at sites that cared for a higher proportion of Black patients were less likely associated with DNAR orders. For AMI and pneumonia, conditions such as dementia and malignancy were strongly associated with DNAR orders. Conclusions DNAR orders were present in 12% of HF hospitalizations, similar to pneumonia but higher than AMI and COPD. For HF, we noted significant variability across sites when stratified by proportion of Black patients cared for, suggesting geographic and racial differences in end-of-life care.
Collapse
Affiliation(s)
- Supriya Shore
- Division of Internal MedicineUniversity of MichiganAnn ArborMI,Institute of Healthcare Policy and Innovation, University of MichiganAnn ArborMI
| | - Michael O'Leary
- Division of Internal MedicineUniversity of MichiganAnn ArborMI,Institute of Healthcare Policy and Innovation, University of MichiganAnn ArborMI
| | - Neil Kamdar
- Division of Internal MedicineUniversity of MichiganAnn ArborMI,Institute of Healthcare Policy and Innovation, University of MichiganAnn ArborMI
| | - Molly Harrod
- Veterans Affairs Ann Arbor Center for Clinical Management ResearchAnn ArborMI
| | - Maria J. Silveira
- Division of Internal MedicineUniversity of MichiganAnn ArborMI,Veterans Affairs Geriatric Research Education and Clinical CenterAnn ArborMI
| | - Scott L. Hummel
- Division of Internal MedicineUniversity of MichiganAnn ArborMI,Institute of Healthcare Policy and Innovation, University of MichiganAnn ArborMI,Veterans Affairs Ann Arbor Center for Clinical Management ResearchAnn ArborMI
| | - Brahmajee K. Nallamothu
- Division of Internal MedicineUniversity of MichiganAnn ArborMI,Institute of Healthcare Policy and Innovation, University of MichiganAnn ArborMI,Veterans Affairs Ann Arbor Center for Clinical Management ResearchAnn ArborMI
| |
Collapse
|
39
|
Hejjaji V, Chakrabarti AK, Nallamothu BK, Iwashyna TJ, Krein SL, Trumpower B, Kennedy M, Chinnakondepalli K, Malik AO, Chan PS. Corrigendum to ‘Association Between Hospital Resuscitation Team Leader Credentials and Survival Outcomes for In-Hospital Cardiac Arrest’ [Mayo Clinic Proceedings Innovation Quality Outcomes, 2021, Vol 5, Issue 6, Pages 1021-1028, Article Number: doi: 10.1016/j.mayocpiqo.2021.06.002]. Mayo Clinic Proceedings: Innovations, Quality & Outcomes 2022; 6:636. [DOI: 10.1016/j.mayocpiqo.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
40
|
Brandt EJ, Chang T, Leung C, Ayanian JZ, Nallamothu BK. Food Insecurity Among Individuals With Cardiovascular Disease and Cardiometabolic Risk Factors Across Race and Ethnicity in 1999-2018. JAMA Cardiol 2022; 7:1218-1226. [PMID: 36170056 PMCID: PMC9520443 DOI: 10.1001/jamacardio.2022.3729] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 06/21/2022] [Accepted: 09/06/2022] [Indexed: 01/25/2023]
Abstract
Importance Food insecurity is a risk factor for poor cardiovascular outcomes that occur disproportionately among individuals from racial and ethnic minority backgrounds who have cardiovascular disease (CVD) or cardiometabolic risk factors. Objective To assess long-term prevalence of food insecurity among those with CVD or cardiometabolic risk factors in the United States. Design, Setting, and Participants This serial cross-sectional study includes data for noninstitutionalized US adults from the National Health and Nutrition Examination Survey (1999-2018). Main Outcomes and Measures Food insecurity was assessed using the US Department of Agriculture Adult Food Security Survey Module. We estimated prevalence of food insecurity among adults with prior CVD (myocardial infarction, stroke, heart failure) and cardiometabolic risk factors (hypertension, diabetes, obesity, hyperlipidemia) across racial and ethnic groups and prevalence of Supplemental Nutrition Assistance Program (SNAP) participation among those reporting food insecurity. Results In the analytic sample of 57 517 adults, 6770 individuals (11.8%) reported food insecurity, which was more prevalent among Hispanic (1938 [24.0%]) and non-Hispanic Black (1202 [18.2%]) than non-Hispanic Asian (100 [8.0%]) and non-Hispanic White adults (3221 [8.5%]). Among 57 517 adults, 4527 (7.9%) had any CVD, 2933 (5.1%) coronary artery disease, 1536 (2.7%) stroke, 1363 (2.4%) heart failure, 28 528 (49.6%) hypertension, 17 979 (33.2%) obesity, 6418 (11.2%) diabetes, and 19 178 (30.8%) dyslipidemia. All CVD and cardiometabolic diseases except coronary artery disease were more prevalent among those with food insecurity. Food insecurity increased over time and was more frequent for patients with CVD but not for cardiometabolic risk factors. From 2011 to 2018, non-Hispanic Black adults with CVD had a decrease in food insecurity prevalence (36.6%; 95% CI, 23.9%-49.4%, to 25.4%; 95% CI, 21.4%-29.3%; P = .04 for trend), whereas adults of other races and ethnicities or data based on cardiometabolic risk factors had no significant change. For individuals who had food insecurity, SNAP participation was higher among those with CVD vs without CVD (54.2%; 95% CI, 46.6%-61.8%, vs 44.3%; 95% CI, 40.5%-48.1%; P = .01). Conclusions and Relevance The prevalence of food insecurity among patients with CVD increased over time. Although members of non-Hispanic Black and Hispanic groups had the highest food insecurity, non-Hispanic Black individuals with CVD were the only group to have a significant decrease in food insecurity since 2011. Increased recognition of food insecurity and resources for treating it are needed to address the negative consequences of food insecurity on CVD outcomes.
Collapse
Affiliation(s)
- Eric J. Brandt
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Tammy Chang
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Family Medicine, University of Michigan, Ann Arbor
| | - Cindy Leung
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor
| | - John Z. Ayanian
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Brahmajee K. Nallamothu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| |
Collapse
|
41
|
Garcia RA, Spertus JA, Girotra S, Nallamothu BK, Kennedy KF, McNally BF, Breathett K, Del Rios M, Sasson C, Chan PS. Racial and Ethnic Differences in Bystander CPR for Witnessed Cardiac Arrest. N Engl J Med 2022; 387:1569-1578. [PMID: 36300973 PMCID: PMC9760357 DOI: 10.1056/nejmoa2200798] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [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] [Indexed: 02/03/2023]
Abstract
BACKGROUND Differences in the incidence of cardiopulmonary resuscitation (CPR) provided by bystanders contribute to survival disparities among persons with out-of-hospital cardiac arrest. It is critical to understand whether the incidence of bystander CPR in witnessed out-of-hospital cardiac arrests at home and in public settings differs according to the race or ethnic group of the person with cardiac arrest in order to inform interventions. METHODS Within a large U.S. registry, we identified 110,054 witnessed out-of-hospital cardiac arrests during the period from 2013 through 2019. We used a hierarchical logistic regression model to analyze the incidence of bystander CPR in Black or Hispanic persons as compared with White persons with witnessed cardiac arrests at home and in public locations. We analyzed the overall incidence as well as the incidence according to neighborhood racial or ethnic makeup and income strata. Neighborhoods were classified as predominantly White (>80% of residents), majority Black or Hispanic (>50% of residents), or integrated, and as high income (an annual median household income of >$80,000), middle income ($40,000-$80,000), or low income (<$40,000). RESULTS Overall, 35,469 of the witnessed out-of-hospital cardiac arrests (32.2%) occurred in Black or Hispanic persons. Black and Hispanic persons were less likely to receive bystander CPR at home (38.5%) than White persons (47.4%) (adjusted odds ratio, 0.74; 95% confidence interval [CI], 0.72 to 0.76) and less likely to receive bystander CPR in public locations than White persons (45.6% vs. 60.0%) (adjusted odds ratio, 0.63; 95% CI, 0.60 to 0.66). The incidence of bystander CPR among Black and Hispanic persons was less than that among White persons not only in predominantly White neighborhoods at home (adjusted odds ratio, 0.82; 95% CI, 0.74 to 0.90) and in public locations (adjusted odds ratio, 0.68; 95% CI, 0.60 to 0.75) but also in majority Black or Hispanic neighborhoods at home (adjusted odds ratio, 0.79; 95% CI, 0.75 to 0.83) and in public locations (adjusted odds ratio, 0.63; 95% CI, 0.59 to 0.68) and in integrated neighborhoods at home (adjusted odds ratio, 0.78; 95% CI, 0.74 to 0.81) and in public locations (adjusted odds ratio, 0.73; 95% CI, 0.68 to 0.77). Similarly, across all neighborhood income strata, the frequency of bystander CPR at home and in public locations was lower among Black and Hispanic persons with out-of-hospital cardiac arrest than among White persons. CONCLUSIONS In witnessed out-of-hospital cardiac arrest, Black and Hispanic persons were less likely than White persons to receive potentially lifesaving bystander CPR at home and in public locations, regardless of the racial or ethnic makeup or income level of the neighborhood where the cardiac arrest occurred. (Funded by the National Heart, Lung, and Blood Institute.).
Collapse
Affiliation(s)
- R Angel Garcia
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - John A Spertus
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Saket Girotra
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Brahmajee K Nallamothu
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Kevin F Kennedy
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Bryan F McNally
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Khadijah Breathett
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Marina Del Rios
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Comilla Sasson
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| | - Paul S Chan
- From Saint Luke's Mid America Heart Institute (R.A.G., J.A.S., K.F.K., P.S.C.) and University of Missouri-Kansas City (R.A.G., J.A.S., P.S.C.) - both in Kansas City, MO; University of Iowa Carver College of Medicine (S.G., M.D.R.) and the Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (S.G.) - both in Iowa City; the Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (B.K.N.); Rollins School of Public Health, Emory University School of Medicine, Druid Hills, Georgia (B.F.M); the Division of Cardiology, Krannert Cardiovascular Research Center, Indiana University, Bloomington (K.B.); and the American Heart Association, Dallas (C.S.)
| |
Collapse
|
42
|
Secrest KM, Anderson TM, Trumpower B, Harrod M, Krein SL, Guetterman TC, Chan PS, Nallamothu BK. Early changes in hospital resuscitation practices during the COVID-19 pandemic. Resusc Plus 2022; 12:100317. [PMID: 36248629 PMCID: PMC9550662 DOI: 10.1016/j.resplu.2022.100317] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 11/15/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic resulted in many disruptions in care for patients experiencing in-hospital cardiac arrest (IHCA). We sought to identify changes made in hospital resuscitation practices during progression of the COVID-19 pandemic. Methods We conducted a descriptive qualitative study using in-depth interviews of clinical staff leadership involved with resuscitation care at a select group of U.S. acute care hospitals in the national American Heart Association Get With The Guidelines-Resuscitation registry for IHCA. We focused interviews on resuscitation practice changes for IHCA since the initiation of the COVID-19 pandemic. We used rapid analysis techniques for qualitative data summarization and analysis. Results A total of 6 hospitals were included with interviews conducted with both physicians and nurses between November 2020 and April 2021. Three topical themes related to shifts in resuscitation practice through the COVID-19 pandemic were identified: 1) ensuring patient and provider safety and wellness (e.g., use of personal protective equipment); 2) changing protocols and training for routine educational practices (e.g., alterations in mock codes and team member roles); and 3) goals of care and end of life discussions (e.g., challenges with visitor and family policies). We found advances in leveraging technology use as an important topic that helped institutions address challenges across all 3 themes. Conclusions Early on, the COVID-19 pandemic resulted in many changes to resuscitation practices at hospitals placing an emphasis on enhanced safety, training, and end of life planning. These lessons have implications for understanding how systems may be better designed for resuscitation efforts.
Collapse
Affiliation(s)
- Kayla M. Secrest
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Theresa M. Anderson
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Brad Trumpower
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Molly Harrod
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Sarah L. Krein
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA,Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Timothy C. Guetterman
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Paul S. Chan
- Department of Internal Medicine, Saint Luke’s Health System, Kansas City, MO, USA
| | - Brahmajee K. Nallamothu
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA,Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| |
Collapse
|
43
|
GUPTA KASHVI, Byrd JB, Brook RD, Rubenfire M, Dorsch MP, Nallamothu BK, Murthy VL. Abstract 040: Prevalence Of Dual Indications For Antihypertensive Medications And Statins In The National Health And Nutrition Survey. Hypertension 2022. [DOI: 10.1161/hyp.79.suppl_1.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Despite widespread indications for concomitant treatment of hypertension and hyperlipidemia, the proportion of the U. S population eligible for both remains unknown. Further, although fixed-dose combinations of these drugs are associated with better adherence, few are available.
Hypothesis:
We hypothesized a significant proportion of the population would be eligible for antihypertensive medication and a statin.
Methods:
Data from the National Health and Nutrition Examination Survey from 2011 to 2018 with survey weighting to represent the noninstitutionalized U.S. population ≥18 years were utilized. Prevalence of individuals with dual indications for antihypertensive and statin therapy was determined using the 2017 ACC/AHA guidelines for hypertension and the 2019 ACC/AHA guidelines for primary prevention of cardiovascular disease, respectively.
Results:
Sociodemographic characteristics are shown in Table 1. Among those ≥18 years, there were 88 million (33.4%) individuals with an indication for antihypertensive medication and 88.5 million (33.9%) with an indication for a statin. 64.6 million adults or 24.8% (95% CI: 23.5 to 26.2) of the population had dual indications for antihypertensive medication and a statin. Notably, 73.4% of those indicated for antihypertensive medication were also indicated a statin.
Conclusions:
Quarter of the U.S. adult population and nearly three-quarters of hypertensive patients are eligible for antihypertensive medication and a statin. Combining antihypertensive medications with a statin in fixed-dose combinations could reduce medication disutility and increase adherence to optimize lipid and blood pressure goals.
Collapse
Affiliation(s)
| | - J B Byrd
- UNIVERSITY OF MICHIGAN, Ann Arbor, MI
| | | | | | | | | | | |
Collapse
|
44
|
Abstract
Background Current guidelines recommend use of sacubitril‐valsartan in patients with heart failure with reduced ejection fraction (HFrEF). Early data suggested low uptake of sacubitril‐valsartan, but contemporary data on real‐world use and their associated cost are limited. Methods and Results This was a retrospective study of individuals enrolled in Optum Clinformatics, a national insurance claims data set from 2016 to 2018. We included all adult patients with HFrEF with 2 outpatient encounters or 1 inpatient encounter with an International Classification of Diseases, Tenth Revision (ICD‐10), diagnosis of HFrEF and 6 months of continuous enrollment, also receiving β‐blockers and angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers within 6 months of HFrEF diagnosis. We included 70 245 patients with HFrEF, and 5217 patients (7.4%) received sacubitril‐valsartan prescriptions. Patients receiving care through a cardiologist compared with a primary care physician alone were more likely to receive sacubitril‐valsartan (odds ratio, 1.61 [95% CI, 1.52–1.71]). Monthly out‐of‐pocket (OOP) cost for sacubitril‐valsartan, compared with angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, was higher for both commercially insured patients (mean, $69 versus $6.74) and Medicare Advantage (mean, $62 versus $2.52). For patients with commercial insurance, OOP cost was lower in 2016 than in 2018. For patients with Medicare Advantage, there was a significant geographic variation in the OOP costs across the country, ranging from $31 to $68 per month across different regions, holding all other patient‐related factors constant. Conclusions Sacubitril‐valsartan use was infrequent among patients with HFrEF. Patients receiving care with a cardiologist were more likely to receive sacubitril‐valsartan. OOP costs remain high, potentially limiting use. Significant geographic variation in OOP costs, unexplained by patient factors, was noted.
Collapse
Affiliation(s)
- Supriya Shore
- Division of Internal Medicine University of Michigan Ann Arbor MI.,Institute of Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| | - Tanima Basu
- Division of Internal Medicine University of Michigan Ann Arbor MI
| | - Neil Kamdar
- Institute of Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| | - Patrick Brady
- Institute of Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| | - Edo Birati
- Division of Internal Medicine University of Pennsylvania Philadelphia PA.,Division of Cardiology Poriya Medical Center, Bar Ilan University Tiberias Israel
| | - Scott L Hummel
- Division of Internal Medicine University of Michigan Ann Arbor MI.,Ann Arbor Veterans Affairs Health System Ann Arbor MI
| | | | - Brahmajee K Nallamothu
- Division of Internal Medicine University of Michigan Ann Arbor MI.,Institute of Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| |
Collapse
|
45
|
Affiliation(s)
- Brahmajee K Nallamothu
- Michigan Integrated Center for Health Analytics and Medical Prediction; Department of Internal Medicine, University of Michigan, Ann Arbor
| |
Collapse
|
46
|
Merid B, Robles MC, Nallamothu BK, Newman MW, Skolarus LE. Correction: “Viewing Mobile Health Technology Design Through the Lens of Amplification Theory”. JMIR Mhealth Uhealth 2022; 10:e40273. [PMID: 35763796 PMCID: PMC9277527 DOI: 10.2196/40273] [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: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Beza Merid
- School for the Future of Innovation in SocietyArizona State UniversityTempe, AZUnited States
| | - Maria Cielito Robles
- Department of NeurologyUniversity of Michigan Medical SchoolAnn Arbor, MIUnited States
| | - Brahmajee K Nallamothu
- Department of Internal MedicineUniversity of Michigan Medical SchoolAnn Arbor, MIUnited States
| | - Mark W Newman
- School of InformationUniversity of MichiganAnn Arbor, MIUnited States
| | - Lesli E Skolarus
- Department of NeurologyUniversity of Michigan Medical SchoolAnn Arbor, MIUnited States
| |
Collapse
|
47
|
Merid B, Cielito Robles M, Nallamothu BK, Newman MW, Skolarus LE. Viewing Mobile Health Technology Design Through the Lens of Amplification Theory. JMIR Mhealth Uhealth 2022; 10:e31069. [PMID: 35687411 PMCID: PMC9233258 DOI: 10.2196/31069] [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] [Received: 06/08/2021] [Revised: 03/31/2022] [Accepted: 04/29/2022] [Indexed: 12/03/2022] Open
Abstract
Digital health interventions designed to promote health equity can be valuable tools in the delivery of health care to hardly served patient populations. But if the design of these technologies and the interventions in which they are deployed do not address the myriad structural barriers to care that minoritized patients, patients in rural areas, and patients who have trouble paying for care often face, their impact may be limited. Drawing on our mobile health (mHealth) research in the arena of cardiovascular care and blood pressure management, this viewpoint argues that health care providers and researchers should tend to structural barriers to care as a part of their digital health intervention design. Our 3-step predesign framework, informed by the Amplification Theory of Technology, offers a model that interventionists can follow to address these concerns.
Collapse
Affiliation(s)
- Beza Merid
- School for the Future of Innovation in Society, Arizona State University, Tempe, AZ, United States
| | - Maria Cielito Robles
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Brahmajee K Nallamothu
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Mark W Newman
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Lesli E Skolarus
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
| |
Collapse
|
48
|
Jeganathan VS, Golbus JR, Gupta K, Luff E, Dempsey W, Boyden T, Rubenfire M, Mukherjee B, Klasnja P, Kheterpal S, Nallamothu BK. Virtual AppLication-supported Environment To INcrease Exercise (VALENTINE) during cardiac rehabilitation study: Rationale and design. Am Heart J 2022; 248:53-62. [PMID: 35235834 DOI: 10.1016/j.ahj.2022.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 01/03/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND In-person, exercise-based cardiac rehabilitation improves physical activity and reduces morbidity and mortality for patients with cardiovascular disease. However, activity levels may not be optimized and decline over time after patients graduate from cardiac rehabilitation. Scalable interventions through mobile health (mHealth) technologies have the potential to augment activity levels and extend the benefits of cardiac rehabilitation. METHODS The VALENTINE Study is a prospective, randomized-controlled, remotely-administered trial designed to evaluate an mHealth intervention to supplement cardiac rehabilitation for low- and moderate-risk patients (ClinicalTrials.gov NCT04587882). Participants are randomized to the control or intervention arms of the study. Both groups receive a compatible smartwatch (Fitbit Versa 2 or Apple Watch 4) and usual care. Participants in the intervention arm of the study additionally receive a just-in-time adaptive intervention (JITAI) delivered as contextually tailored notifications promoting low-level physical activity and exercise throughout the day. In addition, they have access to activity tracking and goal setting through the mobile study application and receive weekly activity summaries via email. The primary outcome is change in 6-minute walk distance at 6-months and, secondarily, change in average daily step count. Exploratory analyses will examine the impact of notifications on immediate short-term smartwatch-measured step counts and exercise minutes. CONCLUSIONS The VALENTINE study leverages innovative techniques in behavioral and cardiovascular disease research and will make a significant contribution to our understanding of how to support patients using mHealth technologies to promote and sustain physical activity.
Collapse
Affiliation(s)
- V Swetha Jeganathan
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Jessica R Golbus
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, MI.
| | - Kashvi Gupta
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, MI; Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO
| | - Evan Luff
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Walter Dempsey
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - Thomas Boyden
- Division of Cardiovascular Diseases, Department of Internal Medicine, Spectrum Health, Grand Rapids, MI
| | - Melvyn Rubenfire
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | | | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI
| | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, MI; The Center for Clinical Management and Research, Ann Arbor VA Medical Center, Ann Arbor, MI
| |
Collapse
|
49
|
Golbus JR, Gupta K, Stevens R, Jeganathan VS, Luff E, Boyden T, Mukherjee B, Klasnja P, Kheterpal S, Kohnstamm S, Nallamothu BK. Understanding Baseline Physical Activity in Cardiac Rehabilitation Enrollees Using Mobile Health Technologies. Circ Cardiovasc Qual Outcomes 2022; 15:e009182. [PMID: 35559648 DOI: 10.1161/circoutcomes.122.009182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Baseline physical activity in patients when they initiate cardiac rehabilitation is poorly understood. We used mobile health (mHealth) technology to understand baseline physical activity of patients initiating cardiac rehabilitation within a clinical trial to potentially inform personalized care. Methods: The Virtual AppLication-Supported ENvironment To INcrease Exercise During Cardiac Rehabilitation Study (VALENTINE) Study is a prospective, randomized-controlled, remotely administered trial designed to evaluate an mHealth intervention to supplement cardiac rehabilitation for low and moderate risk patients. All participants receive a smartwatch and usual care. Baseline physical activity was assessed remotely after enrollment and included 1) 6-minute walk distance, 2) daily step count, and 3) daily exercise minutes, both over 7 days and for compliant days, defined by ≥8 hours of watch wear time. Multivariable linear regression identified patient-level features associated with these 3 measures of baseline physical activity. Results: From October 2020 to March 2022, 220 participants enrolled in the study. Participants are mostly White [184 (83.6%)]; 67 (30.5%) are female and 84 (38.2%) are ≥ 65 years old. Most participants enrolled in cardiac rehabilitation after percutaneous coronary intervention [105 (47.7%)] or coronary artery bypass surgery [39 (17.7 %)]. Clinical diagnoses include coronary artery disease (78.6%), heart failure (17.3%), and valve repair or replacement (26.4%). Baseline mean 6-minute walk distance was 489.6 (standard deviation [SD], 143.4) meters, daily step count was 6845 (SD, 3353), and exercise minutes was 37.5 (SD, 33.5). In a multivariable model, 6-minute walk distance was significantly associated with age and sex, but not cardiac rehabilitation indication. Sex but not age or cardiac rehabilitation indication was significantly associated with daily step count and exercise minutes. Conclusions: Baseline physical activity varies substantially in low and moderate risk patients enrolled in cardiac rehabilitation. Future studies are warranted to explore whether personalizing cardiac rehabilitation programs using mHealth technologies could optimize recovery. Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT04587882.
Collapse
Affiliation(s)
- Jessica R Golbus
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, MI; Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, MI
| | - Kashvi Gupta
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO
| | - Rachel Stevens
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, MI
| | - V Swetha Jeganathan
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, MI
| | - Evan Luff
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, MI
| | - Thomas Boyden
- Division of Cardiovascular Diseases, Department of Internal Medicine, Spectrum Health, MI
| | | | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI
| | | | - Sarah Kohnstamm
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, MI
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, MI; Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, MI; The Center for Clinical Management and Research, Ann Arbor VA Medical Center, MI
| |
Collapse
|
50
|
Osman AF, Elshafie A, Murthy VL, Hummel SL, Nallamothu BK, Dwamena B. Abstract 233: A Network Meta-analysis Comparing The Performance Of Magnetic Resonance Imaging, Positron Emission Tomography And Bone Scintigraphy Techniques In Detecting Cardiac Amyloidosis. Circ Cardiovasc Qual Outcomes 2022. [DOI: 10.1161/circoutcomes.15.suppl_1.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims:
Diagnosing cardiac amyloidosis with non-invasive imaging studies can be challenging. We aims to systematically review the published literature and compare the performance of magnetic resonance (CMR), positron emission tomography (PET) and bone scintigraphy (BS) for diagnosis of cardiac amyloidosis.
Methods:
Medical electronic databases were searched for studies evaluating the diagnostic performance of CMR, PET or BS in diagnosing cardiac amyloidosis where histopathological examination of endomyocardial biopsy tissue or extra-cardiac organs were used as reference standards. We evaluated; CMR: extracellular volume (ECV), late gadolinium enhancement (LGE), T1 mapping; PET: F18-Amyloid, F18-Sodium Fluoride (NaF), and C11-PIB; BS: Technetium-99m (Tc) hydroxymethylene diphosphonate (Tc-HMDP), Tc-3,3-diphosphono-1,2-propanodicarboxylicacid (Tc-DPD), Tc- pyrophosphate (Tc-PYP). Methodological quality was assessed using a Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). To summarize sensitivity, specificity, and superiority, we used an arm-based hierarchical model which expresses the logit transformed sensitivity and specificity as the sum of fixed effects for test, correlated study-effects to model the inherent correlation between sensitivity and specificity and a random error associated with various tests evaluated in each study.
Results:
Of the 2871 studies identified, 39 studies met the inclusion criteria. Sensitivity and specificity and Superiority of the various imaging modalities in diagnosing cardiac amyloidosis were calculated (Figure).
Study quality assessed by QUADAS-2 was generally good with negligible evidence of bias.
Conclusion:
Various non-invasive imaging modalities have been studied for diagnosing cardiac amyloidosis with varying sensitivity and specificity. Comparative studies may be warranted to improve non-invasive diagnostic algorithms of suspected cardiac amyloidosis.
Collapse
|