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Forrester SN, Baek J, Hou L, Roger V, Kiefe CI. A Comparison of 5 Measures of Accelerated Biological Aging and Their Association With Incident Cardiovascular Disease: The CARDIA Study. J Am Heart Assoc 2024; 13:e032847. [PMID: 38606769 DOI: 10.1161/jaha.123.032847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/04/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Accelerated biological aging is an increasingly popular way to track the acceleration of biology over time that may not be captured by calendar time. Biological aging has been linked to external and internal chronic stressors and has the potential to be used clinically to understand a person's personalized functioning and predict future disease. We compared the association of different measures of biological aging and incident cardiovascular disease (CVD) overall and by race. METHODS AND RESULTS We used multiple informants models to compare the strength of clinical marker-derived age acceleration, 5 measures of epigenetic age acceleration (intrinsic and extrinsic epigenetic age acceleration, GrimAge acceleration, and PhenoAge acceleration), and 1 established clinical predictor of future CVD, Framingham 10-year risk score, with incident CVD over an 11-year period (2007-2018). Participants were 913 self-identified Black or White (41% and 59%, respectively) female or male (51% and 49%, respectively) individuals enrolled in the US-based CARDIA (Coronary Artery Risk Development in Young Adults) cohort study. The analytic baseline for this study was the 20-year follow-up examination (2005-2006; median age 45 years). We also included race-specific analysis. We found that all measures were modestly correlated with one another. However, clinical marker-derived age acceleration and Framingham 10-year risk score were more strongly associated with incident CVD than all the epigenetic measures. Clinical marker-derived age acceleration and Framingham 10-year risk score were not significantly different than one another in their association with incident CVD. CONCLUSIONS The type of accelerated aging measure should be taken into consideration when comparing their association with clinical outcomes. A multisystem clinical composite shows associations with incident CVD equally to a well-known clinical predictor.
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Affiliation(s)
- Sarah N Forrester
- Division of Epidemiology, Department of Population and Quantitative Health Sciences University of Massachusetts Chan Medical School Worcester MA
| | - Jonggyu Baek
- Division of Biostatistics and Health Services, Department of Population and Quantitative Health Sciences University of Massachusetts Chan Medical School Worcester MA
| | - Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine Northwestern University Chicago IL
| | - Veronique Roger
- Laboratory of Heart Disease Phenomics National Heart, Lung, and Blood Institute Bethesda MD
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences University of Massachusetts Chan Medical School Worcester MA
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Stanhope KK, Gunderson EP, Suglia SF, Boulet SL, Jamieson DJ, Kiefe CI, Kershaw KN. Childhood maltreatment and trajectories of cardiometabolic health across the reproductive life span among individuals with a first birth during the Coronary Artery Risk Development in Young Adults Study. Prev Med 2024; 180:107894. [PMID: 38346564 PMCID: PMC10896584 DOI: 10.1016/j.ypmed.2024.107894] [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: 10/06/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Childhood adversity is associated with poor cardiometabolic health in adulthood; little is known about how this relationship evolves through childbearing years for parous individuals. The goal was to estimate differences in cardiometabolic health indicators before, during and after childbearing years by report of childhood maltreatment in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study. METHODS Including 743 individuals nulliparous at baseline (1985-1986) with one or more pregnancies >20 weeks during follow-up (1986-2022), we fit segmented linear regression models to estimate mean differences between individuals reporting or not reporting childhood maltreatment (physical or emotional) in waist circumference, triglycerides, high-density lipoprotein cholesterol, systolic and diastolic blood pressure, fasting glucose, and body mass index (BMI) prior to, during, and following childbearing years using generalized estimating equations, allowing for interaction between maltreatment and time within each segment, and adjusting for total parity, parental education, and race (Black or white, self-reported). RESULTS Individuals reporting maltreatment (19%; 141) had a greater waist circumference (post-childbearing: +2.9 cm, 95% CI (0.7, 5.0), higher triglycerides [post-childbearing: +8.1 mg/dL, 95% CI (0.7, 15.6)], and lower HDL cholesterol [post-childbearing: -2.1 mg/dL, 95% CI (-4.7, 0.5)] during all stages compared to those not reporting maltreatment. There were not meaningful differences in blood pressure, fasting glucose, or BMI. Individuals who reported maltreatment did not report faster changes over time. CONCLUSION Differences in some aspects of cardiometabolic health between individuals reporting versus not reporting childhood maltreatment were sustained across reproductive life stages, suggesting potentially persistent impacts of childhood adversity.
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Affiliation(s)
- Kaitlyn K Stanhope
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA 30307, United States; Department of Epidemiology, Emory Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States of America.
| | - Erica P Gunderson
- Division of Research, Kaiser Permanente Northern California, and Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S. Los Robles Ave., Pasadena, CA 91101, United States
| | - Shakira F Suglia
- Department of Epidemiology, Emory Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States of America
| | - Sheree L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA 30307, United States
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA 30307, United States
| | - Catarina I Kiefe
- Population and Quantitative Health Sciences, UMass Chan Medical School, 55 Lake Avenue North, The Albert Sherman Center, Worcester, MA 01655, United States
| | - Kiarri N Kershaw
- Preventive Medicine, Northwestern Feinberg School of Medicine, Suite 1400, 680 N. Lake Shore Drive, Chicago, IL 60611, United States
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Stanhope KK, Gunderson EP, Suglia SF, Boulet SL, Jamieson DJ, Kiefe CI, Kershaw KN. Understanding the role of childhood nurture, abuse, and stability on gestational diabetes in the Coronary Artery Risk Development in Young Adults study (CARDIA). Ann Epidemiol 2024; 91:30-36. [PMID: 38266664 PMCID: PMC10922764 DOI: 10.1016/j.annepidem.2024.01.007] [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: 10/06/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND To estimate associations between facets of the maternal childhood family environment with gestational diabetes (GDM) and to test mediation by pre-pregnancy waist circumference. METHODS We used data from CARDIA, a cohort of individuals aged 18-30 years at baseline (1985-86), followed over 30 years (2016). We included participants with one or more pregnancies ≥ 20 weeks after baseline, without pre-pregnancy diabetes. The primary exposure was the Childhood Family Environment Scale (assessed year 15), including the total score and abuse, nurture, and stability subscales as continuous, separate exposures. The outcome was GDM (self-reported at each visit for each pregnancy). We fit log binomial models with generalized estimating equations to calculate risk ratios (RR) and 95% confidence intervals (CI), adjusting for age at delivery, parity, race (Black or White), and parental education. We used regression models with bootstrapped CIs to test mediation and effect modification by excess abdominal adiposity at the last preconception CARDIA visit (waist circumference ≥ 88 cm). RESULTS We included 1033 individuals (46% Black) with 1836 pregnancies. 130 pregnancies (7.1%) were complicated by GDM. For each 1 point increase on the abuse subscale (e.g., from "rarely or never" to "some or little of the time") there was a 30% increased risk of GDM (RR: 1.3, 95% CI: 1.0, 1.7). There was evidence of effect modification but not mediation by preconception abdominal adiposity. CONCLUSIONS A more adverse childhood family environment was associated with increased risk of GDM, with a stronger association among individuals with preconception waist circumference ≥ 88 cm.
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Affiliation(s)
- Kaitlyn K Stanhope
- Department of Gynecology and Obstetrics, Emory University School of Medicine, USA.
| | - Erica P Gunderson
- Division of Research, Kaiser Permanente Northern California, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, USA
| | - Shakira F Suglia
- Department of Epidemiology, Emory Rolling School of Public Health, USA
| | - Sheree L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, USA
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, USA
| | - Catarina I Kiefe
- Population and Quantitative Health Sciences, UMass Chan Medical School, USA
| | - Kiarri N Kershaw
- Preventive Medicine, Northwestern Feinberg School of Medicine, USA
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Larkin C, Kiefe CI, Morena AL, Rahmoun MB, Lazar P, Sefair AV, Boudreaux ED. Clinician Attitudes Toward Suicide Prevention Practices and Their Implementation: Findings From the System of Safety Study. Psychiatr Serv 2023:appips20230082. [PMID: 38124552 DOI: 10.1176/appi.ps.20230082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The authors aimed to assess clinicians' attitudes toward suicide-related practices and their implementation, across roles and settings, before implementation of the Zero Suicide model in a health care system. METHODS Clinicians (N=5,559) were invited to complete a survey assessing demographic characteristics; confidence and self-reported suicide-related practice; leadership buy-in; and attitudes toward suicide prevention, safety planning, and continuous quality improvement (CQI). RESULTS Of 1,224 respondents, most felt confident conducting suicide screening but less confident performing other suicide-related care. Provider role and care setting were significantly associated with confidence (p<0.001, Kruskal-Wallis H test) and practice (p<0.001, Kruskal-Wallis H test) of providing suicide prevention care, with behavioral health providers and providers in the emergency department (ED) reporting the highest confidence. Attitudes toward safety planning were more positive among women (p<0.001, t test) and behavioral health providers (p<0.001, F test) than among their counterparts or peers. Positive attitudes toward CQI were significantly associated with male sex (p=0.01), non-White race (p=0.03), younger age (p=0.02), fewer years working in health care (p<0.001), administrative role (p<0.001), working in the ED (p<0.001), outpatient settings (p<0.02), and medical provider role (p<0.001). CONCLUSIONS Behavioral health providers and those in the ED reported feeling prepared to deliver suicide-related care, with nurses feeling less confident and less supported. Initiatives to improve suicide-related care should account for clinical role and care setting during planning. CQI could help engage a broader range of clinicians in suicide-related care improvements.
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Affiliation(s)
- Celine Larkin
- Departments of Emergency Medicine (Larkin, Rahmoun, Sefair, Boudreaux), Psychiatry (Larkin, Boudreaux), and Population and Quantitative Health Sciences (Kiefe, Lazar), University of Massachusetts Chan Medical School, Worcester; Department of Psychology, University of Massachusetts Lowell, Lowell (Morena)
| | - Catarina I Kiefe
- Departments of Emergency Medicine (Larkin, Rahmoun, Sefair, Boudreaux), Psychiatry (Larkin, Boudreaux), and Population and Quantitative Health Sciences (Kiefe, Lazar), University of Massachusetts Chan Medical School, Worcester; Department of Psychology, University of Massachusetts Lowell, Lowell (Morena)
| | - Alexandra L Morena
- Departments of Emergency Medicine (Larkin, Rahmoun, Sefair, Boudreaux), Psychiatry (Larkin, Boudreaux), and Population and Quantitative Health Sciences (Kiefe, Lazar), University of Massachusetts Chan Medical School, Worcester; Department of Psychology, University of Massachusetts Lowell, Lowell (Morena)
| | - Mhd B Rahmoun
- Departments of Emergency Medicine (Larkin, Rahmoun, Sefair, Boudreaux), Psychiatry (Larkin, Boudreaux), and Population and Quantitative Health Sciences (Kiefe, Lazar), University of Massachusetts Chan Medical School, Worcester; Department of Psychology, University of Massachusetts Lowell, Lowell (Morena)
| | - Peter Lazar
- Departments of Emergency Medicine (Larkin, Rahmoun, Sefair, Boudreaux), Psychiatry (Larkin, Boudreaux), and Population and Quantitative Health Sciences (Kiefe, Lazar), University of Massachusetts Chan Medical School, Worcester; Department of Psychology, University of Massachusetts Lowell, Lowell (Morena)
| | - Ana Vallejo Sefair
- Departments of Emergency Medicine (Larkin, Rahmoun, Sefair, Boudreaux), Psychiatry (Larkin, Boudreaux), and Population and Quantitative Health Sciences (Kiefe, Lazar), University of Massachusetts Chan Medical School, Worcester; Department of Psychology, University of Massachusetts Lowell, Lowell (Morena)
| | - Edwin D Boudreaux
- Departments of Emergency Medicine (Larkin, Rahmoun, Sefair, Boudreaux), Psychiatry (Larkin, Boudreaux), and Population and Quantitative Health Sciences (Kiefe, Lazar), University of Massachusetts Chan Medical School, Worcester; Department of Psychology, University of Massachusetts Lowell, Lowell (Morena)
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Chirinos DA, Kershaw KN, Allen NB, Carroll AJ, Lewis TT, Schreiner PJ, Lewis CE, Kiefe CI, Mezuk B, Carnethon MR. Depressive Symptom Subgroups and Their Association with Prevalent and Incident Cardiovascular Risk Factors in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Int J Behav Med 2023; 30:891-903. [PMID: 36670342 DOI: 10.1007/s12529-022-10144-z] [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] [Accepted: 12/06/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND We sought to identify depressive symptom subgroups in a community sample of young adults, investigate their stability over time, and determine their association with prevalent and incident cardiovascular disease (CVD) risk factors. METHOD Participants were 3377 adults from the Coronary Artery Risk Development in Young Adults study. Using latent class and latent transition analysis, we derived subgroups based on items of the 20-item version of the Center for Epidemiologic Studies Depression Scale in 1990, and examined patterns of change over a 10-year period (1990-2000). Cox regression models were used to examine associations between subgroup membership and prevalent (2000) and incident (2000 to 2016) obesity, hypertension, and diabetes. RESULTS Three baseline subgroups were identified and labeled: "No Symptoms" (63.5%), "Lack of Positive Affect" (PA, 25.6%), and "Depressed Mood" (10.9%). At 10-year follow-up, individuals in "No Symptoms" subgroup had the highest probability (0.84) of being classified within the same subgroup. Participants classified as "Lack of PA" were likely (0.46) to remain in the same subgroup or be classified as "No Symptoms." Participants in the "Depressed Mood" were most likely to transition to the "Lack of PA" subgroup (0.38). Overall, 30.5% of participants transitioned between subgroups, with 11.4% classified as "Worsening" and 19.1% as "Improving." Relative to the "No Symptoms Stable," other subgroups ("Depressed Stable," "Worsening," and "Improving") were associated with prevalent obesity and hypertension. CONCLUSION We identified distinct depressive symptom subgroups that are variably stable over time, and their change patterns were differentially associated with CVD risk factor prevalence.
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Affiliation(s)
- Diana A Chirinos
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Allison J Carroll
- Department of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Cora E Lewis
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Briana Mezuk
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA
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Alcusky MJ, Mick EO, Allison JJ, Kiefe CI, Sabatino MJ, Eanet FE, Ash AS. Paying for Medical and Social Complexity in Massachusetts Medicaid. JAMA Netw Open 2023; 6:e2332173. [PMID: 37669052 PMCID: PMC10481227 DOI: 10.1001/jamanetworkopen.2023.32173] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/28/2023] [Indexed: 09/06/2023] Open
Abstract
Importance The first MassHealth Social Determinants of Health payment model boosted payments for groups with unstable housing and those living in socioeconomically stressed neighborhoods. Improvements were designed to address previously mispriced subgroups and promote equitable payments to MassHealth accountable care organizations (ACOs). Objective To develop a model that ensures payments largely follow observed costs for members with complex health and/or social risks. Design, Setting, and Participants This cross sectional study used administrative data for members of the Massachusetts Medicaid program MassHealth in 2016 or 2017. Participants included members who were eligible for MassHealth's managed care, aged 0 to 64 years, and enrolled for at least 183 days in 2017. A new total cost of care model was developed and its performance compared with 2 earlier models. All models were fit to 2017 data (most recent available) and validated on 2016 data. Analyses were begun in February 2019 and completed in January 2023. Exposures Model 1 used age-sex categories, a diagnosis-based morbidity relative risk score (RRS), disability, serious mental illness, substance use disorder, housing problems, and neighborhood stress. Model 2 added an interaction for unstable housing with RRS. Model 3 added rurality and updated diagnosis-based RRS, medication-based RRS, and interactions between sociodemographic characteristics and morbidity. Main Outcome and Measures Total 2017 annual cost was modeled and overall model performance (R2) and fair pricing of subgroups evaluated using observed-to-expected (O:E) ratios. Results Among 1 323 424 members, mean (SD) age was 26.4 (17.9) years, 53.4% were female (46.6% male), and mean (SD) 2017 cost was $5862 ($15 417). The R2 for models 1, 2, and 3 was 52.1%, 51.5%, and 60.3%, respectively. Earlier models overestimated costs for members without behavioral health conditions (O:E ratios 0.94 and 0.93 for models 1 and 2, respectively) and underestimated costs for those with behavioral health conditions (O:E ratio >1.10); model 3 O:E ratios were near 1.00. Model 3 was better calibrated for members with housing problems, those with children, and those with high morbidity scores. It reduced underpayments to ACOs whose members had high medical and social complexity. Absolute and relative model performance were similar in 2016 data. Conclusions and Relevance In this cross-sectional study of data from Massachusetts Medicaid, careful modeling of social and medical risk improved model performance and mitigated underpayments to safety-net systems.
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Affiliation(s)
- Matthew J. Alcusky
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
| | - Eric O. Mick
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
| | - Jeroan J. Allison
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
| | - Catarina I. Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
| | - Meagan J. Sabatino
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
| | - Frances E. Eanet
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
| | - Arlene S. Ash
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
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Pierre-Louis IC, Saczynski JS, Lopez-Pintado S, Waring ME, Abu HO, Goldberg RJ, Kiefe CI, Helm R, McManus DD, Bamgbade BA. Characteristics associated with poor atrial fibrillation-related quality of life in adults with atrial fibrillation. J Cardiovasc Med (Hagerstown) 2023; 24:422-429. [PMID: 37129916 PMCID: PMC10699883 DOI: 10.2459/jcm.0000000000001479] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE Few studies have examined the relationship between poor atrial fibrillation-related quality of life (AFQoL) and a battery of geriatric factors. The objective of this study is to describe factors associated with poor AFQoL in older adults with atrial fibrillation (AF) with a focus on sociodemographic and clinical factors and a battery of geriatric factors. METHODS Cross-sectional analysis of a prospective cohort study of participants aged 65+ with high stroke risk and AF. AFQoL was measured using the validated Atrial Fibrillation Effect on Quality of Life (score 0-100) and categorized as poor (<80) or good (80-100). Chi-square and t -tests evaluated differences in factors across poor AFQoL and significant characteristics ( P < 0.05) were entered into a logistic regression model to identify variables related to poor AFQoL. RESULTS Of 1244 participants (mean age 75.5), 42% reported poor AFQoL. Falls in the past 6 months, pre/frail and frailty, depression, anxiety, social isolation, vision impairment, oral anticoagulant therapy, rhythm control, chronic obstructive pulmonary disease and polypharmacy were associated with higher odds of poor AFQoL. Marriage and college education were associated with a lower odds of poor AFQoL. CONCLUSIONS More than 4 out of 10 older adults with AF reported poor AFQoL. Geriatric factors associated with higher odds of reporting poor AFQoL include recent falls, frailty, depression, anxiety, social isolation and vision impairment. Findings from this study may help clinicians screen for patients with poor AFQoL who could benefit from tailored management to ensure the delivery of patient-centered care and improved well being among older adults with AF.
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Affiliation(s)
| | - Jane S. Saczynski
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy
| | | | - Molly E. Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT
| | - Hawa O. Abu
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School, Worcester
- Internal Medicine Department Saint Vincent Hospital, Worcester
| | - Robert J. Goldberg
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester
| | - Catarina I. Kiefe
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester
| | - Robert Helm
- Department of Radiology, Boston University, Boston, MA, USA
| | - David D. McManus
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School, Worcester
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Adamowicz JL, Vélez-Bermúdez ME, Thomas EBK, Kershaw KN, Kiefe CI, Allen NB, Whitaker KM. Psychological resources and incident hypertension in the coronary artery risk development in young adults (CARDIA) study. Health Psychol 2023; 42:368-377. [PMID: 37227879 PMCID: PMC10283072 DOI: 10.1037/hea0001291] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Examining factors that may protect against the development of hypertension is critical, as hypertension is a major public health concern. We examined the individual and combined associations of psychological resources (optimism and mastery) on incident hypertension over 15 years. METHOD We used data from four exams of the Coronary Artery Risk Development in Young Adults (CARDIA) study over 15 years (CARDIA exam years 15-30). Optimism and mastery were standardized to a z-score separately and summed to generate a psychological resources score. We examined the incidence of hypertension (stages 1 and 2; systolic blood pressure [SBP] ≥ 130 mmHg or diastolic blood pressure [DBP] ≥ 80 mmHg) and stage 2 hypertension (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg) among participants without hypertension at baseline. Multivariable logistic regressions adjusted for sociodemographic factors, behavioral factors, and depressive symptoms. RESULTS Of 2,927 participants, 58% were women, 42% were Black, and the average age at the study baseline was 40 years (3.63). A higher psychological resources score was associated with lower odds of developing hypertension (stages 1 and 2; odds ratio [OR]: 0.89, 95% CI [-0.21, -0.03], p < .01) and stage 2 hypertension (OR: 0.88, [-0.21, -0.04], p < .01), after adjustment for sociodemographic factors. However, following adjustment for behavioral factors and depressive symptoms, the associations for hypertension (stages 1 and 2) and stage 2 hypertension were no longer statistically significant. CONCLUSIONS Greater psychological resources are associated with lower odds of hypertension. Associations were attenuated after additional adjustment for behavioral factors, indicating these factors may be important confounders or mediators. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | - Emily B K Thomas
- Department of Psychological and Brain Sciences, University of Iowa
| | - Kiarri N Kershaw
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School
| | - Norinna B Allen
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine
| | - Kara M Whitaker
- Department of Health and Human Physiology, University of Iowa
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Song C, Bancks MP, Whitaker KM, Wong M, Carson AP, Dutton GR, Goff DC, Gordon-Larsen P, Gunderson EP, Jacobs DR, Kiefe CI, Lewis CE, Lloyd-Jones DM, Shikany JM, Kershaw KN. Contribution of social, behavioral, and contextual exposures to Black-White disparities in incident obesity: The CARDIA study. Obesity (Silver Spring) 2023; 31:1402-1414. [PMID: 37041722 PMCID: PMC10191978 DOI: 10.1002/oby.23698] [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: 06/09/2022] [Revised: 11/29/2022] [Accepted: 12/13/2022] [Indexed: 04/13/2023]
Abstract
OBJECTIVE The aim of this study was to quantify the contributions of socioeconomic, psychosocial, behavioral, reproductive, and neighborhood exposures in young adulthood to Black-White differences in incident obesity. METHODS In the Coronary Artery Risk Development in Young Adults (CARDIA) study, 4488 Black or White adults aged 18 to 30 years without obesity at baseline (1985-1986) were followed over 30 years. Sex-specific Cox proportional hazard models were used to estimate Black-White differences in incident obesity. Models were adjusted for baseline and time-updated indicators. RESULTS During follow-up, 1777 participants developed obesity. Black women were 1.87 (95% CI: 1.63-2.13) times more likely and Black men were 1.53 (95% CI: 1.32-1.77) times more likely to develop obesity than their White counterparts after adjusting for age, field center, and baseline BMI. Baseline exposures explained 43% of this difference in women and 52% in men. Time-updated exposures explained more of the racial difference in women but less for men, compared with baseline exposures. CONCLUSIONS Adjusting for these exposures accounted for a substantial but incomplete proportion of racial disparities in incident obesity. Remaining differences may be explained by incomplete capture of the most salient aspects of these exposures or potential variation in the impact of these exposures on obesity by race.
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Affiliation(s)
- Christopher Song
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Keck Medicine Family Residency Program, Los Angeles, California, USA
| | - Michael P. Bancks
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kara M. Whitaker
- Department of Health and Human Physiology, College of Liberal Arts & Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Mandy Wong
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - April P. Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Gareth R. Dutton
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David C. Goff
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Penny Gordon-Larsen
- Depatrment of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Erica P. Gunderson
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - David R. Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Catarina I. Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Cora E. Lewis
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Donald M. Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - James M. Shikany
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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10
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Lopez Cepero AA, Suglia SF, Spruill T, Lewis TT, Almodovar I, Kiefe CI, Tucker KL, Rodriguez-Orengo JF, Rosal MC, Perez CM. Abstract P118: Association Between Shift-and-Persist and Cardiovascular Health Among Young Adults in Puerto Rico. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p118] [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: 03/15/2023]
Abstract
Background:
Shift-and-persist (SP), defined as the ability to adapt the self to stressors while preserving focus in the future, is associated with favorable cardiometabolic outcomes. SP may be of great importance to individuals in Puerto Rico (PR) given their disproportionate exposure to social and environmental stressors. However, there is a scarcity of data on SP and cardiovascular health (CVH), and none in PR. This study examined the association between SP and CVH, as measured by the Life’s Essential 8 metric, among young adults in PR.
Hypothesis:
We hypothesize that greater SP will be associated with higher CVH scores.
Methods:
Baseline data from the PR-OUTLOOK study were used for this cross-sectional analysis. Young adults (18-29y, 64% women) completed baseline and clinic assessments between September 2020 and September 2022. Those with complete data on CVH were included (n=962). SP was measured with the Chen & Miller scale, with higher scores indicative of greater SP, and categorized in quartiles (SP Q1-Q4). Because dietary data are not yet available, we used questionnaires, anthropometric measurements, and fasting blood samples to calculate an adapted Life’s Essential 8 metric including physical activity, nicotine exposure, sleep health, BMI, blood lipids, blood glucose, and blood pressure; thus, actual CVH scores may be lower due to potentially low diet quality scores. Relationships between CVH and SP scores were assessed with multivariable linear regression models.
Results:
SP was significantly associated with CVH and its components. After adjustment for confounders, individuals in SP Q2-Q4, vs. Q1, had significantly higher total CVH (b=2.81, 95%CI=0.60, 5.03; b=4.68, 95%CI=2.54, 6.82; and b=7.34, 95%CI=4.85, 9.83, respectively) and physical activity CVH-score (b=-11.5, 95%CI=3.96, 19.1; b=11.6, 95%CI=4.27, 18.9; and b=18.6, 95%CI=10.1, 27.1, respectively). Individuals in SP Q3-Q4 also had higher BMI CVH-score (b=8.89, 95%CI=3.10, 14.7; and b=10.4, 95%CI=3.61, 17.1, respectively) than those in Q1. Additionally, those in the SP Q4, vs. Q1, had higher blood lipids (b=7.10, 95%CI=2.24, 12.0), blood glucose (B=3.91, 95%CI=0.41, 7.41), and blood pressure (b=6.23, 95%CI=1.93, 10.5) CVH-scores. Estimates were similar by sex and socioeconomic status.
Conclusion:
Higher SP scores were associated with higher CVH among young adults in PR. Longitudinal analyses are needed to confirm our results. We need to further understand the potential benefits of SP for CVH and identify strategies to improve SP and promote CVH in underserved populations.
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11
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Wang W, Lessard D, Kiefe CI, Goldberg RJ, Parish D, Helm R, Trymbulak K, Mehawej J, Abu H, Bamgbade BA, Hayward R, Gore J, Gurwitz JH, McManus DD, Saczynski JS. Cover. J Am Geriatr Soc 2023. [DOI: 10.1111/jgs.17236] [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: 02/18/2023]
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12
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Wang W, Lessard D, Kiefe CI, Goldberg RJ, Parish D, Helm R, Trymbulak K, Mehawej J, Abu H, Bamgbade BA, Hayward R, Gore J, Gurwitz JH, McManus DD, Saczynski JS. Differential effect of anticoagulation according to cognitive function and frailty in older patients with atrial fibrillation. J Am Geriatr Soc 2023; 71:394-403. [PMID: 36273408 PMCID: PMC10207283 DOI: 10.1111/jgs.18079] [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: 04/05/2022] [Revised: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND In older patients with atrial fibrillation (AF), cognitive impairment and frailty are prevalent. It is unknown whether the risk and benefit of anticoagulation differ by cognitive function and frailty. METHODS A total of 1244 individuals with AF with age ≥65 years and a CHADSVASC score ≥2 were recruited from clinics in Massachusetts and Georgia between 2016 and 18 and followed until 2020. At baseline, frailty status and cognitive function were assessed. Hazard ratios of anticoagulation on physician adjudicated outcomes were adjusted by the propensity for receiving anticoagulation and stratified by cognitive function and frailty status. RESULTS The average age was 75.5 (± 7.1) years, 49% were women, and 86% were prescribed oral anticoagulants. At baseline, 528 (42.4%) participants were cognitively impaired and 172 (13.8%) were frail. The adjusted hazard ratios of anticoagulation for the composite of major bleeding or death were 2.23 (95% confidence interval: 1.08-4.61) among cognitively impaired individuals and 0.94 (95% confidence interval: 0.49-1.79) among cognitively intact individuals (P for interaction = 0.08). Adjusted hazard ratios for anticoagulation were 1.84 (95% confidence interval: 0.66-5.13) among frail individuals and 1.39 (95% confidence interval: 0.84-2.40) among not frail individuals (P for interaction = 0.67). CONCLUSION Compared with no anticoagulation, anticoagulation is associated with more major bleeding episodes and death in older patients with AF who are cognitively impaired.
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Affiliation(s)
- Weijia Wang
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Catarina I. Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert J. Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - David Parish
- Department of Medicine, School of Medicine, Mercer University, Macon, GA
| | - Robert Helm
- Department of Medicine, School of Medicine, Boston University, Boston, MA
| | - Katherine Trymbulak
- Frank H. Netter M.D. School of Medicine at Quinnipiac University, North Haven, CT USA
| | - Jordy Mehawej
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Hawa Abu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Benita A. Bamgbade
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA
| | - Robert Hayward
- Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA
| | - Joel Gore
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jerry H. Gurwitz
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA
| | - David D. McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jane S. Saczynski
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA
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13
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Forrester SN, Whitfield KE, Kiefe CI, Thorpe RJ. Navigating Black Aging: The Biological Consequences of Stress and Depression. J Gerontol B Psychol Sci Soc Sci 2022; 77:2101-2112. [PMID: 34875069 PMCID: PMC9683493 DOI: 10.1093/geronb/gbab224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Black persons in the United States are more likely to suffer from social inequality. Chronic stress caused by social inequality and racial discrimination results in weathering of the body that causes physiological dysregulation and biological age being higher than chronological age (accelerated aging). Depression has been linked to both racial discrimination and accelerated aging and accelerated aging has been demonstrated to be higher in Black than White persons, on average. However, we know little about accelerated aging across the life course in Black Americans. METHODS We used mixed-effects growth models to measure biological age acceleration, measured with cardiometabolic markers, over a 20-year period in Black participants of the Coronary Artery Risk Development in Young Adults Study who were aged 27-42 years at analytic baseline. We included an interaction between depressive symptoms and time to determine whether risk of depression was associated with a faster rate of biological aging. RESULTS We found that the rate of biological aging increased over a 20-year span and that those at risk for depression had a faster rate of biological aging than those not at risk. We also found that various social factors were associated with biological age acceleration over time. DISCUSSION Given the known association between perceived racial discrimination and depressive symptoms, we provide a novel instance of the long-term effects of social inequality. Specifically, biological age acceleration, a marker of physiological dysregulation, is associated with time among Black persons and more strongly associated among those with depressive symptoms.
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Affiliation(s)
- Sarah N Forrester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Roland J Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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14
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Wang W, Saczynski JS, Lessard D, Goldberg RJ, Parish D, Helm R, Kiefe CI, Trymbulak K, Mehawej J, Abu H, Hayward R, Gore J, Gurwitz JH, McManus DD. Presence of Geriatric Conditions Is Prognostic of Major Bleeding in Older Patients with Atrial Fibrillation: a Cohort Study. J Gen Intern Med 2022; 37:3893-3899. [PMID: 35102482 PMCID: PMC9640487 DOI: 10.1007/s11606-022-07410-x] [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: 09/14/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In older patients with atrial fibrillation (AF), physical, cognitive, and psychosocial limitations are prevalent. The prognostic value of these conditions for major bleeding is unclear. OBJECTIVE To determine whether geriatric conditions are prospectively associated with major bleeding in older patients with AF on anticoagulation. DESIGN Multicenter cohort study with 2-year follow-up from 2016 to 2020 in Massachusetts and Georgia from cardiology, electrophysiology, and primary care clinics. PARTICIPANTS Diagnosed with AF, age 65 years or older, CHA2DS2-VASc score of 2 or higher, and taking oral anticoagulant (n=1,064). A total of 6507 individuals were screened. MAIN MEASURES A six-component geriatric assessment of frailty, cognitive function, social support, depressive symptoms, vision, and hearing. Main outcome was major bleeding adjudicated by a physician panel. KEY RESULTS At baseline, participants were, on average, 75.5 years old and 49% were women. Mean CHA2DS2-VASc score was 4.5 and the mean HAS-BLED score was 3.3. During 2.0 (± 0.4) years of follow-up, 95 (8.9%) participants developed an episode of major bleeding. After adjusting for key covariates and accounting for competing risk from death, cognitive impairment (hazard ratio [HR] 1.62, 95% confidence interval [CI]: 1.02-2.56) and frailty (HR 2.77, 95% CI 1.38-5.58) were significantly associated with the development of major bleeding. CONCLUSIONS In older patients with AF taking anticoagulants, cognitive impairment and frailty were independently associated with major bleeding.
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Affiliation(s)
- Weijia Wang
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Jane S Saczynski
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA, USA
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert J Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - David Parish
- Department of Medicine, School of Medicine, Mercer University, Macon, GA, USA
| | - Robert Helm
- Department of Medicine, School of Medicine, Boston University, Boston, MA, USA
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Katherine Trymbulak
- Frank H. Netter M.D. School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Jordy Mehawej
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Hawa Abu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert Hayward
- Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, USA
| | - Joel Gore
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jerry H Gurwitz
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Meyers Health Care Institute, University of Massachusetts Medical School, Worcester, MA, USA
| | - David D McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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15
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Phillips AZ, Kiefe CI, Lewis CE, Schreiner PJ, Tajeu GS, Carnethon MR. Alcohol Use and Blood Pressure Among Adults with Hypertension: the Mediating Roles of Health Behaviors. J Gen Intern Med 2022; 37:3388-3395. [PMID: 35212874 PMCID: PMC9551008 DOI: 10.1007/s11606-021-07375-3] [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: 07/05/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Alcohol use is associated with increased blood pressure among adults with hypertension, but it is unknown whether some of the observed relationship is explained by mediating behaviors related to alcohol use. OBJECTIVE We assess the potential indirect role of smoking, physical inactivity, unhealthy diet, and poor medication adherence on the association between alcohol use and blood pressure among Black and White men and women with hypertension. DESIGN Adjusted repeated-measures analyses using generalized estimating equations and mediation analyses using inverse odds ratio weighting. PARTICIPANTS 1835 participants with hypertension based on ACC/AHA 2017 guidelines in three most recent follow-up exams of the longitudinal Coronary Artery Risk Development in Young Adults cohort study (2005-2016). MAIN MEASURES Alcohol use was assessed using both self-reported average ethanol intake (drinks/day) and engagement in heavy episodic drinking (HED) in the past 30 days. Systolic and diastolic blood pressure (SBP, DBP) were measured by trained technicians (mmHg). Smoking, physical inactivity, and diet were self-reported and categorized according to American Heart Association criteria, and medication adherence was assessed using self-reported typical adherence to antihypertensive medications. KEY RESULTS At baseline (2005-2006), 57.9% of participants were Black and 51.4% were women. Mean age (standard deviation) was 45.5 (3.6) years, mean SBP was 128.7 (15.5) mmHg, and mean DBP was 83.2 (10.1) mmHg. Each additional drink per day was significantly associated with higher SBP (β = 0.713 mmHg, 95% confidence interval (CI): 0.398, 1.028) and DBP (β = 0.398 mmHg, 95% CI: 0.160, 0.555), but there was no evidence of mediation by any of the behaviors. HED was not associated with blood pressure independent of average consumption. CONCLUSIONS These findings support the direct nature of the association of alcohol use with blood pressure and the utility of advising patients with hypertension to limit consumption in addition to other behavioral and pharmacological interventions.
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Affiliation(s)
- Aryn Z Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, 1665 University Boulevard, Birmingham, AB, 35233, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Gabriel S Tajeu
- Department of Health Services Administration and Policy, Temple University College of Public Health, 1101 W. Montgomery Avenue, Philadelphia, PA, 19122, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
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16
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Shah NS, Ning H, Petito LC, Kershaw KN, Bancks MP, Reis JP, Rana JS, Sidney S, Jacobs DR, Kiefe CI, Carnethon MR, Lloyd-Jones DM, Allen NB, Khan SS. Associations of Clinical and Social Risk Factors With Racial Differences in Premature Cardiovascular Disease. Circulation 2022; 146:201-210. [PMID: 35607988 PMCID: PMC9308688 DOI: 10.1161/circulationaha.121.058311] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Racial differences in cardiovascular disease (CVD) are likely related to differences in clinical and social factors. The relative contributions of these factors to Black-White differences in premature CVD have not been investigated. METHODS In Black and White adults aged 18 to 30 years at baseline in the CARDIA study (Coronary Artery Risk Development in Young Adults), the associations of clinical, lifestyle, depression, socioeconomic, and neighborhood factors across young adulthood with racial differences in incident premature CVD were evaluated in sex-stratified, multivariable-adjusted Cox proportional hazards models using multiply imputed data assuming missing at random. Percent reduction in the β estimate (log-hazard ratio [HR]) for race quantified the contribution of each factor group to racial differences in incident CVD. RESULTS Among 2785 Black and 2327 White participants followed for a median 33.9 years (25th-75th percentile, 33.7-34.0), Black (versus White) adults had a higher risk of incident premature CVD (Black women: HR, 2.44 [95% CI, 1.71-3.49], Black men: HR, 1.59 [1.20-2.10] adjusted for age and center). Racial differences were not statistically significant after full adjustment (Black women: HR, 0.91 [0.55-1.52], Black men: HR 1.02 [0.70-1.49]). In women, the largest magnitude percent reduction in the β estimate for race occurred with adjustment for clinical (87%), neighborhood (32%), and socioeconomic (23%) factors. In men, the largest magnitude percent reduction in the β estimate for race occurred with an adjustment for clinical (64%), socioeconomic (50%), and lifestyle (34%) factors. CONCLUSIONS In CARDIA, the significantly higher risk for premature CVD in Black versus White adults was statistically explained by adjustment for antecedent multilevel factors. The largest contributions to racial differences were from clinical and neighborhood factors in women, and clinical and socioeconomic factors in men.
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Affiliation(s)
- Nilay S. Shah
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lucia C. Petito
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael P. Bancks
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jared P. Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Jamal S. Rana
- Kaiser Permanente Oakland Medical Center, Oakland, CA
| | | | - David R. Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | | | - Mercedes R. Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Donald M. Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Norrina B. Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sadiya S. Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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17
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Forrester SN, Zmora R, Schreiner PJ, Jacobs DR, Roger VL, Thorpe RJ, Kiefe CI. Racial differences in the association of accelerated aging with future cardiovascular events and all-cause mortality: the coronary artery risk development in young adults study, 2007-2018. Ethn Health 2022; 27:997-1009. [PMID: 33222499 PMCID: PMC8137718 DOI: 10.1080/13557858.2020.1839021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 02/07/2020] [Accepted: 10/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Variability of Cardiovascular disease (CVD) risk, including racial difference, is not fully accounted for by the variability of traditional CVD risk factors. We used a multiple biomarker model as a framework to explore known racial differences in CVD burden. DESIGN We measured associations between accelerated aging (AccA) measured by a combination of biomarkers, and cardiovascular morbidity and all-cause mortality using data from the Coronary Artery Risk Development in Young Adults study (CARDIA). AccA was defined as the difference between biological age, calculated using biomarkers with the Klemera and Doubal method, and chronological age. Using logistic regression, we assessed overall and race-specific associations between AccA, CVD, and all-cause mortality. RESULTS Among our cohort of 2959 Black or White middle-aged adults, after adjustment, a one-year increase in AccA was associated with increased odds of CVD (Odds Ratio (OR) = 1.04; 95% CI: 1.02, 1.06), stroke (OR = 1.12; 95% CI: 1.07, 1.17), and all-cause mortality (OR = 1.05; 95% CI: 1.02, 1.08). We did not find significant overall racial differences, but we did find race by sex differences where Black men differed markedly from White men in the strength of association with CVD (OR = 1.06, 95% CI: 1.01, 1.12). CONCLUSIONS We provide evidence that AccA is associated with future CVD.
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Affiliation(s)
- Sarah N Forrester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rachel Zmora
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
| | - Pamela J Schreiner
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
| | - David R Jacobs
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
| | - Veronique L Roger
- Department of Cardiovascular Medicine, Veronique L. Roger, Mayo Clinic, Division of Circulatory Failure, Rochester, MN, USA
| | - Roland J Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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18
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Vargas EA, Chirinos DA, Wong M, Carnethon MR, Carroll AJ, Kiefe CI, Carson AP, Kershaw KN. Psychosocial profiles and longitudinal achievement of optimal cardiovascular risk factor levels: the Coronary Artery Risk Development in Young Adults (CARDIA) study. J Behav Med 2022; 45:172-185. [PMID: 34671896 PMCID: PMC10083095 DOI: 10.1007/s10865-021-00259-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 09/22/2021] [Indexed: 11/24/2022]
Abstract
Psychosocial factors are associated with the achievement of optimal cardiovascular disease risk factor (CVDRF) levels. To date, little research has examined multiple psychosocial factors simultaneously to identify distinguishing psychosocial profiles among individuals with CVDRF. Further, it is unknown whether profiles are associated with achievement of CVDRF levels longitudinally. Therefore, we characterized psychosocial profiles of individuals with CVDRF and assessed whether they are associated with achievement of optimal CVDRF levels over 15 years. We included 1148 CARDIA participants with prevalent hypertension, hypercholesterolemia and/or diabetes mellitus in 2000-2001. Eleven psychosocial variables reflecting psychological health, personality traits, and social factors were included. Optimal levels were deemed achieved if: Hemoglobin A1c (HbA1c) < 7.0%, low-density lipoprotein (LDL) cholesterol < 100 mg/dl, and systolic blood pressure (SBP) < 140 mm Hg. Latent profile analysis revealed three psychosocial profile groups "Healthy", "Distressed and Disadvantaged" and "Discriminated Against". There were no significant differences in achievement of CVDRF levels of the 3 targets combined across profiles. Participants in the "Distressed and Disadvantaged" profile were less likely to meet optimal HbA1c levels compared to individuals in the "Healthy" profile after demographic adjustment. Associations were attenuated after full covariate adjustment. Distinct psychosocial profiles exist among individuals with CVDRF, representing meaningful differences. Implications for CVDRF management are discussed.
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Affiliation(s)
- Emily A Vargas
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Diana A Chirinos
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mandy Wong
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Allison J Carroll
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Services, University of Massachusetts Medical School, Worcester, MA, USA
| | - April P Carson
- Departments of Medicine and Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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19
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Mehawej J, Saczynski JS, Kiefe CI, Abu HO, Tisminetzky M, Wang W, Bamgbade BA, Ding E, Lessard D, Otabil EM, Saleeba C, Goldberg RJ, McManus DD. Association between risk of obstructive sleep apnea and cognitive performance, frailty, and quality of life among older adults with atrial fibrillation. J Clin Sleep Med 2022; 18:469-475. [PMID: 34432629 PMCID: PMC8805012 DOI: 10.5664/jcsm.9622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Geriatric impairments and obstructive sleep apnea (OSA) are prevalent among older patients with atrial fibrillation (AF). Little is known about the association between OSA and geriatric impairments, including frailty, cognitive performance, and AF-related quality of life. The objective of this study was to examine the associations of OSA with frailty, cognitive performance, and AF-related quality of life among older adults with AF. METHODS Data from the Systemic Assessment of Geriatrics Elements-AF study were used, which included AF participants 65 years and older and with a CHA2DS2-VASc ≥ 2. The STOP-BANG questionnaire was used to assess the risk of OSA. Multivariable logistic regression models were used to examine the association between risk of OSA and geriatric impairments, adjusting for sociodemographic, geriatric, and clinical characteristics. RESULTS A total of 970 participants (mean age 75 years; 51% male) were studied. Of the 680 participants without a medical history of OSA, 26% (n = 179) of participants had a low risk of OSA, 53% (n = 360) had an intermediate risk, and 21% (n = 141) had a high risk for OSA. Compared to those with low risk of OSA, participants with an intermediate or high risk of OSA were more likely to be frail (adjusted odds ratio = 1.67, 95% confidence interval: 1.08-2.56; adjusted odds ratio = 3.00, 95% confidence interval: 1.69-5.32, respectively) in the fully adjusted models. CONCLUSIONS Our findings identify a group of patients at high risk who would benefit from early screening for OSA. Future longitudinal studies are needed to assess the effect of OSA treatment on frailty, physical functioning, and quality of life among patients with AF. CITATION Mehawej J, Saczynski JS, Kiefe CI, et al. Association between risk of obstructive sleep apnea and cognitive performance, frailty, and quality of life among older adults with atrial fibrillation. J Clin Sleep Med. 2022;18(2):469-475.
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Affiliation(s)
- Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jane S. Saczynski
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, Massachusetts
| | - Catarina I. Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Hawa O. Abu
- Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Mayra Tisminetzky
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
- Division of Geriatrics, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Weijia Wang
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Benita A. Bamgbade
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, Massachusetts
| | - Eric Ding
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Edith Mensah Otabil
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Connor Saleeba
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Robert J. Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - David D. McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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Ding EY, Mehawej J, Abu H, Lessard D, Saczynski JS, McManus DD, Kiefe CI, Goldberg RJ. Cardiovascular Health Metrics in Patients Hospitalized with an Acute Coronary Syndrome. Am J Med 2021; 134:1396-1402.e1. [PMID: 34273284 PMCID: PMC8605989 DOI: 10.1016/j.amjmed.2021.06.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Life's Simple 7 (LS7) is a guiding metric for primordial/primary prevention of cardiovascular disease. However, little is known about the prevalence and distribution of LS7 metrics in patients with an acute coronary syndrome at the time of hospitalization. METHODS Data were obtained from patients hospitalized for an acute coronary syndrome at 6 hospitals in Central Massachusetts and Georgia (2011-2013). The LS7 assessed patient's smoking, diet, and physical activity based on self-reported measures, and patients' body mass index, blood pressure, and serum cholesterol and glucose levels were abstracted from medical records. All items were operationalized into 3 categories: poor (0), intermediate (1), or ideal (2). A total summary cardiovascular health score (0-14) was obtained and categorized into tertiles (0-5, 6-7, and 8-14). RESULTS The average age of study participants (n = 1110) was 59.6 years and 35% were women. Cardiovascular health scores ranged from 0-12 (mean = 6.2). Patients with higher scores were older, white, had lower burden of comorbidities, had fewer symptoms of anxiety, depression, and stress, better quality of life, more social support, and greater healthcare activation. One-third of patients had only 1 ideal cardiovascular health measure, less than 1% had 5, and no participant had more than 5 ideal factors. CONCLUSIONS Our results indicate that patients with acute coronary syndrome have poor cardiovascular health. Sociodemographic, clinical, and psychosocial characteristics differed across cardiovascular health groups. These findings highlight potential areas for educational and therapeutic interventions to reduce the risk of cardiovascular disease and promote cardiovascular health in adult men and women.
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Affiliation(s)
- Eric Y Ding
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester.
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Hawa Abu
- Department of Medicine, St. Vincent's Hospital, Worcester, Mass
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Jane S Saczynski
- Department of Pharmacy and Health Systems Sciences, Northeastern University, Boston, Mass
| | - David D McManus
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Robert J Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
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21
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Liu F, Zhou P, Baccei SJ, Masciocchi MJ, Amornsiripanitch N, Kiefe CI, Rosen MP. Qualifying Certainty in Radiology Reports through Deep Learning-Based Natural Language Processing. AJNR Am J Neuroradiol 2021; 42:1755-1761. [PMID: 34413062 DOI: 10.3174/ajnr.a7241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/19/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Communication gaps exist between radiologists and referring physicians in conveying diagnostic certainty. We aimed to explore deep learning-based bidirectional contextual language models for automatically assessing diagnostic certainty expressed in the radiology reports to facilitate the precision of communication. MATERIALS AND METHODS We randomly sampled 594 head MR imaging reports from an academic medical center. We asked 3 board-certified radiologists to read sentences from the Impression section and assign each sentence 1 of the 4 certainty categories: "Non-Definitive," "Definitive-Mild," "Definitive-Strong," "Other." Using the annotated 2352 sentences, we developed and validated a natural language-processing system based on the start-of-the-art bidirectional encoder representations from transformers (BERT), which can capture contextual uncertainty semantics beyond the lexicon level. Finally, we evaluated 3 BERT variant models and reported standard metrics including sensitivity, specificity, and area under the curve. RESULTS A κ score of 0.74 was achieved for interannotator agreement on uncertainty interpretations among 3 radiologists. For the 3 BERT variant models, the biomedical variant (BioBERT) achieved the best macro-average area under the curve of 0.931 (compared with 0.928 for the BERT-base and 0.925 for the clinical variant [ClinicalBERT]) on the validation data. All 3 models yielded high macro-average specificity (93.13%-93.65%), while the BERT-base obtained the highest macro-average sensitivity of 79.46% (compared with 79.08% for BioBERT and 78.52% for ClinicalBERT). The BioBERT model showed great generalizability on the heldout test data with a macro-average sensitivity of 77.29%, specificity of 92.89%, and area under the curve of 0.93. CONCLUSIONS A deep transfer learning model can be developed to reliably assess the level of uncertainty communicated in a radiology report.
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Affiliation(s)
- F Liu
- From the Department of Population and Quantitative Health Sciences (F.L., C.I.K.), University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Radiology (F.L., P.Z., S.J.B., M.J.M., N.A., M.P.R.), University of Massachusetts Medical School, Worcester, Massachusetts
| | - P Zhou
- Department of Radiology (F.L., P.Z., S.J.B., M.J.M., N.A., M.P.R.), University of Massachusetts Medical School, Worcester, Massachusetts
| | - S J Baccei
- Department of Radiology (F.L., P.Z., S.J.B., M.J.M., N.A., M.P.R.), University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Radiology (S.J.B., M.J.M., N.A., M.P.R.), UMass Memorial Medical Center, Worcester, Massachusetts
| | - M J Masciocchi
- Department of Radiology (F.L., P.Z., S.J.B., M.J.M., N.A., M.P.R.), University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Radiology (S.J.B., M.J.M., N.A., M.P.R.), UMass Memorial Medical Center, Worcester, Massachusetts
| | - N Amornsiripanitch
- Department of Radiology (F.L., P.Z., S.J.B., M.J.M., N.A., M.P.R.), University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Radiology (S.J.B., M.J.M., N.A., M.P.R.), UMass Memorial Medical Center, Worcester, Massachusetts
| | - C I Kiefe
- From the Department of Population and Quantitative Health Sciences (F.L., C.I.K.), University of Massachusetts Medical School, Worcester, Massachusetts
| | - M P Rosen
- Department of Radiology (F.L., P.Z., S.J.B., M.J.M., N.A., M.P.R.), University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Radiology (S.J.B., M.J.M., N.A., M.P.R.), UMass Memorial Medical Center, Worcester, Massachusetts
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Mehawej J, Saczynski J, Abu HO, Gagnier M, Bamgbade BA, Lessard D, Trymbulak K, Saleeba C, Kiefe CI, Goldberg RJ, McManus DD. Factors Associated With Patient Engagement in Shared Decision-Making for Stroke Prevention Among Older Adults with Atrial Fibrillation. Can Geriatr J 2021; 24:174-183. [PMID: 34484500 PMCID: PMC8390325 DOI: 10.5770/cgj.24.475] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine the extent of, and factors associated with, patient engagement in shared decision-making (SDM) for stroke prevention among patients with atrial fibrillation (AF). METHODS We used data from the Systematic Assessment of Geriatric Elements-Atrial Fibrillation study which includes older ( ≥65 years) patients with AF and a CHA2DS2-VASc≥2. Participants reported engagement in SDM by answering whether they actively participated in choosing to take an oral anticoagulant (OAC) for their condition. Multiple logistic regression was used to assess associations between sociodemographic, clinical, geriatric, and psychosocial factors and patient engagement in SDM. RESULTS A total of 807 participants (mean age 75 years; 48% female) on an OAC were studied. Of these, 61% engaged in SDM. Older participants (≥80 years) and those cognitively impaired were less likely to engage in SDM, while those very knowledgeable of their AF associated stroke risk were more likely to do so than respective comparison groups. CONCLUSIONS A considerable proportion of older adults with AF did not engage in SDM for stroke prevention with older patients and those cognitively impaired less likely to do so. Clinicians should identify patients who are less likely to engage in SDM, promote patient engagement, and foster better patient-provider communication which may enhance long-term patient outcomes.
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Affiliation(s)
- Jordy Mehawej
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jane Saczynski
- Department of Pharmacy and Health Systems Sciences, Northeastern University, Boston, MA, USA
| | - Hawa O. Abu
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Marc Gagnier
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Benita A. Bamgbade
- Department of Pharmacy and Health Systems Sciences, Northeastern University, Boston, MA, USA
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Katherine Trymbulak
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Connor Saleeba
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Catarina I. Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert J. Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - David D. McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Forrester SN, McManus DD, Saczynski JS, Pierre-Louis IC, Bamgbade BA, Kiefe CI. A cross-sectional analysis of racial differences in accelerated aging and cognitive function among patients with atrial fibrillation: The SAGE-AF study: Forrester, Accelerated aging and cognitive function. EClinicalMedicine 2021; 39:101060. [PMID: 34386761 PMCID: PMC8342899 DOI: 10.1016/j.eclinm.2021.101060] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/12/2021] [Accepted: 07/15/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Non-Whites are more likely to suffer from cognitive impairment and complications of atrial fibrillation (AF) than Whites, though Whites are more likely to be diagnosed with AF. We examined whether non-Whites with AF are biologically older than Whites with AF and whether accelerated biological aging is associated with cognitive functioning. METHODS We used baseline data from the ongoing Systematic Assessment of Geriatric Elements in Atrial Fibrillation prospective cohort study, collected 2016-2020 across ambulatory care practices in Massachusetts and Georgia. Of 1244 enrolled, 974 participants with full biological data were included in the present analysis. Accelerated aging (AccA) was calculated based on a combination of biomarkers associated with age and physiological "wear and tear." FINDINGS The main outcome was score on Montreal Cognitive Assessment (MoCA). Non-Whites had 2.9 years more AccA than Whites and higher AccA was associated with a lower MoCA score among both Whites (-0.06, 95% CI: -0.10, -0.03) and non-Whites (-0.14, 95% CI: -0.27, 0.02). This association was significantly greater among non-whites (-0.11, 95% CI: -0.20, -0.01). INTERPRETATION Non-White AF patients are functionally "older" than their White counterparts and experience a stronger deleterious association between AccA and cognition. These findings underscore the importance of taking functional age into account when treating patients with AF, particularly non-White patients, to enhance treatment and improve AF outcomes.
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Affiliation(s)
- Sarah N. Forrester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street AS6-1075, Worcester, MA 01605, United States
- Corresponding author.
| | - David D. McManus
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jane S. Saczynski
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston MA, United States
| | - Isabelle C. Pierre-Louis
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston MA, United States
| | - Benita A. Bamgbade
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston MA, United States
| | - Catarina I. Kiefe
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston MA, United States
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Chen J, Kiefe CI, Gagnier M, Lessard D, McManus D, Wang B, Houston TK. Non-specific pain and 30-day readmission in acute coronary syndromes: findings from the TRACE-CORE prospective cohort. BMC Cardiovasc Disord 2021; 21:383. [PMID: 34372783 PMCID: PMC8351351 DOI: 10.1186/s12872-021-02195-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/27/2021] [Indexed: 12/26/2022] Open
Abstract
Background Patients with acute coronary syndromes often experience non-specific (generic) pain after hospital discharge. However, evidence about the association between post-discharge non-specific pain and rehospitalization remains limited. Methods We analyzed data from the Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education (TRACE-CORE) prospective cohort. TRACE-CORE followed patients with acute coronary syndromes for 24 months post-discharge from the index hospitalization, collected patient-reported generic pain (using SF-36) and chest pain (using the Seattle Angina Questionnaire) and rehospitalization events. We assessed the association between generic pain and 30-day rehospitalization using multivariable logistic regression (N = 787). We also examined the associations among patient-reported pain, pain documentation identified by natural language processing (NLP) from electronic health record (EHR) notes, and the outcome. Results Patients were 62 years old (SD = 11.4), with 5.1% Black or Hispanic individuals and 29.9% women. Within 30 days post-discharge, 87 (11.1%) patients were re-hospitalized. Patient-reported mild-to-moderate pain, without EHR documentation, was associated with 30-day rehospitalization (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.14–3.62, reference: no pain) after adjusting for baseline characteristics; while patient-reported mild-to-moderate pain with EHR documentation (presumably addressed) was not (OR: 1.23, 95% CI: 0.52–2.90). Severe pain was also associated with 30-day rehospitalization (OR: 3.16, 95% CI: 1.32–7.54), even after further adjusting for chest pain (OR: 2.59, 95% CI: 1.06–6.35). Conclusions Patient-reported post-discharge generic pain was positively associated with 30-day rehospitalization. Future studies should further disentangle the impact of cardiac and non-cardiac pain on rehospitalization and develop strategies to support the timely management of post-discharge pain by healthcare providers. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02195-z.
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Affiliation(s)
- Jinying Chen
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | | | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - David McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
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Abstract
IMPORTANCE Better patient management can reduce emergency department (ED) use. Performance measures should reward plans for reducing utilization by predictably high-use patients, rather than rewarding plans that shun them. OBJECTIVE The objective of this study was to develop a quality measure for ED use for people diagnosed with serious mental illness or substance use disorder, accounting for both medical and social determinants of health (SDH) risks. DESIGN Regression modeling to predict ED use rates using diagnosis-based and SDH-augmented models, to compare accuracy overall and for vulnerable populations. SETTING MassHealth, Massachusetts' Medicaid and Children's Health Insurance Program. PARTICIPANTS MassHealth members ages 18-64, continuously enrolled for the calendar year 2016, with a diagnosis of serious mental illness or substance use disorder. EXPOSURES Diagnosis-based model predictors are diagnoses from medical encounters, age, and sex. Additional SDH predictors describe housing problems, behavioral health issues, disability, and neighborhood-level stress. MAIN OUTCOME AND MEASURES We predicted ED use rates: (1) using age/sex and distinguishing between single or dual diagnoses; (2) adding summarized medical risk (DxCG); and (3) further adding social risk (SDH). RESULTS Among 144,981 study subjects, 57% were women, 25% dually diagnosed, 67% White/non-Hispanic, 18% unstably housed, and 37% disabled. Utilization was higher by 77% for those dually diagnosed, 50% for members with housing problems, and 18% for members living in the highest-stress neighborhoods. SDH modeling predicted best for these high-use populations and was most accurate for plans with complex patients. CONCLUSION To set appropriate benchmarks for comparing health plans, quality measures for ED visits should be adjusted for both medical and social risks.
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Affiliation(s)
- Eric O Mick
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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Ingraham AM, Chaffee SM, Ayturk MD, Heh VK, Kiefe CI, Santry HP. Gaps in Emergency General Surgery Coverage in the United States. Ann Surg Open 2021; 2:e043. [PMID: 34485983 PMCID: PMC8409136 DOI: 10.1097/as9.0000000000000043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/21/2021] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Despite three million adults in the United States (US) being admitted annually for emergency general surgery (EGS) conditions, which disproportionately affect vulnerable populations, we lack an understanding of the barriers to round-the-clock EGS care. Our objective was to measure gaps in round-the-clock EGS care. METHODS From August 2015 to December 2015, we surveyed all US-based, adult acute care general hospitals that have an emergency room and ≥1 operating room and provide EGS care, utilizing paper and electronic methods. Surgeons or chief medical officers were queried regarding EGS practices. RESULTS Of 2,811 hospitals, 1,634 (58.1%) responded; 279 (17.1%) were unable to always provide round-the-clock EGS care. Rural location, smaller bed size, and non-teaching status were associated with lack of round-the-clock care. Inconsistent surgeon coverage was the primary reason for lacking round-the-clock EGS care (n=162; 58.1%). However, lack of a tiered system for booking emergency cases, no anesthesia availability overnight, and no stipend for EGS call were also associated with the inability to provide round-the-clock EGS care. DISCUSSION We found significant gaps in access to EGS care, often attributable to workforce deficiencies.
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Affiliation(s)
| | - Scott M. Chaffee
- Department of Surgery, The Ohio State University, Columbus, OH
- Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University, Columbus, OH
| | - M. Didem Ayturk
- §Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Victor K. Heh
- Department of Surgery, The Ohio State University, Columbus, OH
- Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University, Columbus, OH
| | - Catarina I. Kiefe
- §Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Heena P. Santry
- Department of Surgery, The Ohio State University, Columbus, OH
- Center for Surgical Health Assessment, Research, and Policy (SHARP), The Ohio State University, Columbus, OH
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Forrester SN, Zmora R, Schreiner PJ, Jacobs DR, Roger VL, Thorpe RJ, Kiefe CI. Accelerated aging: A marker for social factors resulting in cardiovascular events? SSM Popul Health 2021; 13:100733. [PMID: 33532540 PMCID: PMC7823205 DOI: 10.1016/j.ssmph.2021.100733] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/31/2020] [Accepted: 01/02/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Medicine and public health are shifting away from a purely "personal responsibility" model of cardiovascular disease (CVD) prevention towards a societal view targeting social and environmental conditions and how these result in disease. Given the strong association between social conditions and CVD outcomes, we hypothesize that accelerated aging, measuring earlier health decline associated with chronological aging through a combination of biomarkers, may be a marker for the association between social conditions and CVD. METHODS We used data from the Coronary Artery Risk Development in Young Adults study (CARDIA). Accelerated aging was defined as the difference between biological and chronological age. Biological age was derived as a combination of 7 biomarkers (total cholesterol, HDL, glucose, BMI, CRP, FEV1/h2, MAP), representing the physiological effect of "wear and tear" usually associated with chronological aging. We studied accelerated aging measured in 2005-06 as a mediator of the association between social factors measured in 2000-01 and 1) any incident CVD event; 2) stroke; and 3) all-cause mortality occurring from 2007 through 18. RESULTS Among 2978 middle-aged participants, mean (SD) accelerated aging was 3.6 (11.6) years, i.e., the CARDIA cohort appeared to be, on average, 3 years older than its chronological age. Accelerated aging partially mediated the association between social factors and CVD (N=219), stroke (N=36), and mortality (N=59). Accelerated aging mediated 41% of the total effects of racial discrimination on stroke after adjustment for covariates. Accelerated aging also mediated other relationships but to lesser degrees. CONCLUSION We provide new evidence that accelerated aging based on easily measurable biomarkers may be a viable marker to partially explain how social factors can lead to cardiovascular outcomes and death.
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Affiliation(s)
- Sarah N. Forrester
- University of Massachusetts Medical School, Department of Population and Quantitative Health Sciences, USA
| | - Rachel Zmora
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, USA
| | - Pamela J. Schreiner
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, USA
| | - David R. Jacobs
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, USA
| | - Veronique L. Roger
- Mayo Clinic, Division of Circulatory Failure, Department of Cardiovascular Medicine, USA
| | - Roland J. Thorpe
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, USA
| | - Catarina I. Kiefe
- University of Massachusetts Medical School, Department of Population and Quantitative Health Sciences, USA
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Mehawej J, S Saczysnki J, I Kiefe C, Ding E, O Abu H, Lessard D, H Helm R, A Bamgbade B, Saleeba C, Wang W, D McManus D, J Goldberg R. Factors Associated with Moderate Physical Activity Among Older Adults with Atrial Fibrillation. J Atr Fibrillation 2021; 13:2454. [PMID: 34950335 PMCID: PMC8691360 DOI: 10.4022/jafib.2454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/22/2020] [Accepted: 01/15/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Engaging patients with atrial fibrillation (AF) in moderate-intensity physical activity has been encouraged by published guidelines. We examined factors associated with engagement in moderate physical activity among older adults with AF. METHODS This was a retrospective study involving ninety patients with episodes of Afib with RVR duData are from the SAGE (Systematic Assessment of Geriatric Elements)-AF study. Older adults (≥ 65 years) with AF and a CHA2DS2-VASc ≥ 2 were recruited from several clinics in Massachusetts and Georgia between 2015 and 2018. The Minnesota Leisure Time Physical Activity questionnaire was used to assess whether participants engaged in moderate-intensity physical activity (i.e. at least 150 minutes of moderate exercise). Logistic regression was utilized to examine the sociodemographic and clinical characteristics and geriatric elements associated with engaging in moderate-intensity physical activity. RESULTS Participants were on average 76 years old and 48% were women. Approximately one-half (52%) of study participants engaged in moderate-intensity physical activity. Morbid obesity (adjusted OR [aOR]=0.41, 90%CI=0.23-0.73), medical history of renal disease (aOR= aOR=0.68,90%CI= 0.48-0.96), slow gait speed (aOR=0.44, 90%CI=0.32-0.60), cognitive impairment (aOR=0.74, 90%CI=0.56-0.97), and social isolation (aOR=0.58, 90%CI= 0.40-0.84) were independently associated with a lower likelihood, while higher AF related quality of life score (aOR=1.64, 90%CI=1.25-2.16) a greater likelihood, of meeting recommended levels of moderate physical activity. CONCLUSIONS Nearly one-half of older adults with NVAF did not engage in moderate-intensity exercise. Clinicians should identify older patients with NVAF who are less likely to engage in physical activity and develop tailored interventions to promote regular physical activity.
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Affiliation(s)
- Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester MA
| | - Jane S Saczysnki
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston MA
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Eric Ding
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Hawa O Abu
- Department of Medicine, Saint Vincent Hospital, Worcester, MA
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Robert H Helm
- Department of Cardiovascular Medicine, Boston University Medical, Boston, MA
| | - Benita A Bamgbade
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston MA
| | - Connor Saleeba
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester MA
| | - Weijia Wang
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester MA
| | - David D McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester MA
| | - Robert J Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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Coleman J, Lloyd-Jones DM, Ning H, Allen NB, Kiefe CI, Wang EA, Huffman MD. Association between incarceration and incident cardiovascular disease events: results from the CARDIA cohort study. BMC Public Health 2021; 21:214. [PMID: 33499836 PMCID: PMC7836455 DOI: 10.1186/s12889-021-10237-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background Incarceration has been associated with higher cardiovascular risk, yet data evaluating its association with cardiovascular disease events are limited. The study objective was to evaluate the association between incarceration and incident fatal and non-fatal cardiovascular disease (CVD) events. Methods Black and white adults from the community-based Coronary Artery Risk Development in Young Adult (CARDIA) study (baseline 1985–86, n = 5105) were followed through August 2017. Self-reported incarceration was measured at baseline (1985–1986) and Year 2 (1987–1988), and fatal and non-fatal cardiovascular disease events, including coronary heart disease, stroke, and heart failure, and all-cause mortality, were captured through 2017. Analyses were completed in September 2019. Cumulative CVD incidence rates and Cox proportional hazards were compared overall by incarceration status. An interaction between incarceration and race was identified, so results were also analyzed by sex-race groups. Results 351 (6.9%) CARDIA participants reported a history of incarceration. Over 29.0 years mean follow-up, CVD incidence rate was 3.52 per 1000 person-years in participants with a history of incarceration versus 2.12 per 1000 person-years in participants without a history of incarceration (adjusted HR = 1.33 [95% CI, 0.90–1.95]). Among white men, incarceration was associated with higher risk of incident cardiovascular disease (adjusted HR = 3.35 [95% CI, 1.54–7.29) and all-cause mortality (adjusted HR = 2.52 [95% CI, 1.32–4.83]), but these associations were not statistically significant among other sex-race groups after adjustment. Conclusions Incarceration was associated with incident cardiovascular disease rates, but associations were only significant in one sex-race group after multivariable adjustment. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10237-6.
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Affiliation(s)
- Jordan Coleman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N, 710 N Lake Shore Drive, Suite 800, Chicago, IL, 60611, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N, 710 N Lake Shore Drive, Suite 800, Chicago, IL, 60611, USA
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N, 710 N Lake Shore Drive, Suite 800, Chicago, IL, 60611, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N, 710 N Lake Shore Drive, Suite 800, Chicago, IL, 60611, USA
| | - Catarina I Kiefe
- University of Massachusetts Medical School, 368 Plantation Street, AS7-1077, Worcester, MA, 01605, USA
| | - Emily A Wang
- Department of Internal Medicine, Yale School of Medicine, PO Box 208056, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N, 710 N Lake Shore Drive, Suite 800, Chicago, IL, 60611, USA. .,The George Institute for Global Health, 1 King Street, 5th floor, Sydney, NSW, 2042, Australia.
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Daniel VT, Crawford A, Kiefe CI, Mahmoud BH. Recurrence and Mortality of Melanoma In Situ of the Trunk or Extremities: A Surveillance, Epidemiology, and End Results Analysis. Dermatol Surg 2021; 47:1-5. [PMID: 32271178 DOI: 10.1097/dss.0000000000002417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Recent studies demonstrate comparable outcomes of Mohs micrographic surgery (MMS) versus local excision (LE) for melanoma in situ. These studies are limited by their focus on the head and neck. OBJECTIVE The primary objective was to compare 5-year overall and melanoma-specific mortality among patients with melanoma in situ of the trunk or extremities who undergo MMS versus LE. The secondary objective was to compare 5-year local recurrence among the same cohort of patients who undergo MMS versus LE. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results (SEER) database (2000-2015) was queried to identify patients who underwent MMS versus LE for melanoma in situ of the trunk, upper extremities, or lower extremities. Outcomes were 5-year recurrence, melanoma-specific mortality, and overall mortality. Multivariable regression analyses were performed. RESULTS Thirty three thousand nine hundred eighty-three patients underwent surgical treatment (MMS 3%; LE 97%). In adjusted analyses, there was no difference in local recurrence (hazard ratio [HR] 1.00, 95% confidence interval [CI] 0.56-1.78), melanoma-specific mortality (HR 0.89, 95% CI 0.12-6.47), nor overall mortality (HR 1.10, 95% CI 0.82-1.48) between MMS versus LE. CONCLUSION There is no difference of 5-year local recurrence, melanoma-specific mortality, nor overall mortality associated with MMS versus LE for melanoma in situ of the trunk or extremities.
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Affiliation(s)
- Vijaya T Daniel
- Department of Dermatology, University of Massachusetts, Worcester, Massachusetts; and
| | | | - Catarina I Kiefe
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Bassel H Mahmoud
- Department of Dermatology, University of Massachusetts, Worcester, Massachusetts; and
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Santry HP, Strassels SA, Ingraham AM, Oslock WM, Ricci KB, Paredes AZ, Heh VK, Baselice HE, Rushing AP, Diaz A, Daniel VT, Ayturk MD, Kiefe CI. Identifying the fundamental structures and processes of care contributing to emergency general surgery quality using a mixed-methods Donabedian approach. BMC Med Res Methodol 2020; 20:247. [PMID: 33008294 PMCID: PMC7532630 DOI: 10.1186/s12874-020-01096-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Acute Care Surgery (ACS) was developed as a structured, team-based approach to providing round-the-clock emergency general surgery (EGS) care for adult patients needing treatment for diseases such as cholecystitis, gastrointestinal perforation, and necrotizing fasciitis. Lacking any prior evidence on optimizing outcomes for EGS patients, current implementation of ACS models has been idiosyncratic. We sought to use a Donabedian approach to elucidate potential EGS structures and processes that might be associated with improved outcomes as an initial step in designing the optimal model of ACS care for EGS patients. METHODS We developed and implemented a national survey of hospital-level EGS structures and processes by surveying surgeons or chief medical officers regarding hospital-level structures and processes that directly or indirectly impacted EGS care delivery in 2015. These responses were then anonymously linked to 2015 data from the American Hospital Association (AHA) annual survey, Medicare Provider Analysis and Review claims (MedPAR), 17 State Inpatient Databases (SIDs) using AHA unique identifiers (AHAID). This allowed us to combine hospital-level data, as reported in our survey or to the AHA, to patient-level data in an effort to further examine the role of EGS structures and processes on EGS outcomes. We describe the multi-step, iterative process utilizing the Donabedian framework for quality measurement that serves as a foundation for later work in this project. RESULTS Hospitals that responded to the survey were primarily non-governmental and located in urban settings. A plurality of respondent hospitals had fewer than 100 inpatient beds. A minority of the hospitals had medical school affiliations. DISCUSSION Our results will enable us to develop a measure of preparedness for delivering EGS care in the US, provide guidance for regionalized care models for EGS care, tiering of ACS programs based on the robustness of their EGS structures and processes and the quality of their outcomes, and formulate triage guidelines based on patient risk factors and severity of EGS disease. CONCLUSIONS Our work provides a template for team science applicable to research efforts combining primary data collection (i.e., that derived from our survey) with existing national data sources (i.e., SIDs and MedPAR).
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Affiliation(s)
- Heena P. Santry
- Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH USA
- Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH USA
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W 12th Ave, Suite 614, Columbus, OH 43210 USA
| | - Scott A. Strassels
- Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH USA
- Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH USA
| | - Angela M. Ingraham
- Department of Surgery, University of Wisconsin, 600 Highland Avenue, Madison, WI USA
| | - Wendelyn M. Oslock
- Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH USA
- Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH USA
| | - Kevin B. Ricci
- Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH USA
- Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH USA
| | - Anghela Z. Paredes
- Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH USA
- Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH USA
| | - Victor K. Heh
- Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH USA
- Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH USA
| | - Holly E. Baselice
- Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH USA
- Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH USA
| | - Amy P. Rushing
- Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH USA
- Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH USA
| | - Adrian Diaz
- Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH USA
- Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH USA
| | - Vijaya T. Daniel
- Department of Surgery, University of Massachusetts Medical School, 55 N Lake Avenue, Worcester, MA USA
| | - M. Didem Ayturk
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 N Lake Avenue, Worcester, MA USA
| | - Catarina I. Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 N Lake Avenue, Worcester, MA USA
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Abu HO, Saczynski JS, Mehawej J, Tisminetzky M, Kiefe CI, Goldberg RJ, McManus DD. Clinically Meaningful Change in Quality of Life and Associated Factors Among Older Patients With Atrial Fibrillation. J Am Heart Assoc 2020; 9:e016651. [PMID: 32875941 PMCID: PMC7726984 DOI: 10.1161/jaha.120.016651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Among older patients with atrial fibrillation, there are limited data examining clinically meaningful changes in quality of life (QoL). We examined the extent of, and factors associated with, clinically meaningful change in QoL over 1‐year among older adults with atrial fibrillation. Methods and Results Patients from cardiology, electrophysiology, and primary care clinics in Massachusetts and Georgia were enrolled in a cohort study (2015–2018). The Atrial Fibrillation Effect on Quality‐of‐Life questionnaire was used to assess overall QoL and across 3 subscales: symptoms, daily activities, and treatment concern. Clinically meaningful change in QoL (ie, difference between 1‐year and baseline QoL score) was categorized as either a decline (≤−5.0 points), no clinically meaningful change (−5.0 to +5.0 points), or an increase (≥+5.0 points). Ordinal logistic models were used to examine factors associated with QoL changes. Participants (n=1097) were on average 75 years old, 48% were women, and 87% White. Approximately 40% experienced a clinically meaningful increase in QoL and 1 in every 5 patients experienced a decline in QoL. After multivariable adjustment, women, non‐Whites, those who reported depressive and anxiety symptoms, fair/poor self‐rated health, low social support, heart failure, or diabetes mellitus experienced clinically meaningful declines in QoL. Conclusions These findings provide insights to the magnitude of, and factors associated with, clinically meaningful change in QoL among older patients with atrial fibrillation. Assessment of comorbidities and psychosocial factors may help identify patients at high risk for declining QoL and those who require additional surveillance to maximize important clinical and patient‐centered outcomes.
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Affiliation(s)
- Hawa O. Abu
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Jane S. Saczynski
- Department of Pharmacy and Health Systems SciencesSchool of PharmacyNorth Eastern UniversityBostonMA
| | - Jordy Mehawej
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Mayra Tisminetzky
- Division of Geriatrics and Meyers Primary Care InstituteDepartment of MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Catarina I. Kiefe
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Robert J. Goldberg
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMA
| | - David D. McManus
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
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Swift SL, Elfassy T, Bailey Z, Florez H, Feaster DJ, Calonico S, Sidney S, Kiefe CI, Zeki Al Hazzouri A. Association of negative financial shocks during the Great Recession with depressive symptoms and substance use in the USA: the CARDIA study. J Epidemiol Community Health 2020; 74:995-1001. [PMID: 32788306 DOI: 10.1136/jech-2020-213917] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 02/11/2020] [Revised: 06/03/2020] [Accepted: 07/10/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND The Great Recession of 2008 was marked by large increases in unemployment and decreases in the household wealth of many Americans. In the 21st century, there have also been increases in depressive symptoms, alcohol use and drug use among some groups in the USA. The objective of this analysis is to evaluate the influence of negative financial shocks incurred during the Great Recession on depressive symptoms, alcohol and drug use. METHODS We employed a quasi-experimental fixed-effects design, using data from adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Our financial shock predictors were within-person change in employment status, income and debt to asset ratio between 2005 and 2010. Our outcomes were within-person change in depressive symptoms score, alcohol use and past 30-day drug use. RESULTS In adjusted models, we found that becoming unemployed and experiencing a drop in income and were associated with an increase in depressive symptoms. Incurring more debts than assets was also associated with an increase in depressive symptoms and a slight decrease in daily alcohol consumption (mL). CONCLUSION Our findings suggest that multiple types of financial shocks incurred during an economic recession negatively influence depressive symptoms among black and white adults in the USA, and highlight the need for future research on how economic recessions are associated with health.
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Affiliation(s)
- Samuel Longworth Swift
- Center for Healthcare Equity in Kidney Disease, University of New Mexico, New Mexico, Albuquerque, USA
| | - Tali Elfassy
- Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Zinzi Bailey
- Sylvester Cancer Center, University of Miami, Miami, Florida, USA
| | - Hermes Florez
- Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Daniel J Feaster
- Public Health Sciences, University of Miami, Miami, Florida, USA
| | | | - Steve Sidney
- Kaiser Permanente Norther California Division of Research, Oakland, California, USA
| | - Catarina I Kiefe
- Quantitative Health Sciences, UMass Medical School, Worcester, Massachusetts, USA
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Peng C, He M, Cutrona SL, Kiefe CI, Liu F, Wang Z. Theme Trends and Knowledge Structure on Mobile Health Apps: Bibliometric Analysis. JMIR Mhealth Uhealth 2020; 8:e18212. [PMID: 32716312 PMCID: PMC7418015 DOI: 10.2196/18212] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/20/2020] [Accepted: 04/26/2020] [Indexed: 12/15/2022] Open
Abstract
Background Due to the widespread and unprecedented popularity of mobile phones, the use of digital medicine and mobile health apps has seen significant growth. Mobile health apps have tremendous potential for monitoring and treating diseases, improving patient care, and promoting health. Objective This paper aims to explore research trends, coauthorship networks, and the research hot spots of mobile health app research. Methods Publications related to mobile health apps were retrieved and extracted from the Web of Science database with no language restrictions. Bibliographic Item Co-Occurrence Matrix Builder was employed to extract bibliographic information (publication year and journal source) and perform a descriptive analysis. We then used the VOSviewer (Leiden University) tool to construct and visualize the co-occurrence networks of researchers, research institutions, countries/regions, citations, and keywords. Results We retrieved 2802 research papers on mobile health apps published from 2000 to 2019. The number of annual publications increased over the past 19 years. JMIR mHealth and uHealth (323/2802, 11.53%), Journal of Medical Internet Research (106/2802, 3.78%), and JMIR Research Protocols (82/2802, 2.93%) were the most common journals for these publications. The United States (1186/2802, 42.33%), England (235/2802, 8.39%), Australia (215/2802, 7.67%), and Canada (112/2802, 4.00%) were the most productive countries of origin. The University of California San Francisco, the University of Washington, and the University of Toronto were the most productive institutions. As for the authors’ contributions, Schnall R, Kuhn E, Lopez-Coronado M, and Kim J were the most active researchers. The co-occurrence cluster analysis of the top 100 keywords forms 5 clusters: (1) the technology and system development of mobile health apps; (2) mobile health apps for mental health; (3) mobile health apps in telemedicine, chronic disease, and medication adherence management; (4) mobile health apps in health behavior and health promotion; and (5) mobile health apps in disease prevention via the internet. Conclusions We summarize the recent advances in mobile health app research and shed light on their research frontier, trends, and hot topics through bibliometric analysis and network visualization. These findings may provide valuable guidance on future research directions and perspectives in this rapidly developing field.
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Affiliation(s)
- Cheng Peng
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Miao He
- Department of Information Center, The First Hospital of China Medical University, Shenyang, China
| | - Sarah L Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.,Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Feifan Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Zhongqing Wang
- Department of Information Center, The First Hospital of China Medical University, Shenyang, China.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
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Abu HO, Saczynski JS, Ware J, Mehawej J, Paul T, Awad H, Bamgbade BA, Pierre-Louis IC, Tisminetzky M, Kiefe CI, Goldberg RJ, McManus DD. Impact of comorbid conditions on disease-specific quality of life in older men and women with atrial fibrillation. Qual Life Res 2020; 29:3285-3296. [PMID: 32656722 DOI: 10.1007/s11136-020-02578-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Older persons with atrial fibrillation (AF) experience significant impairment in quality of life (QoL), which may be partly attributable to their comorbid diseases. A greater understanding of the impact of comorbidities on QoL could optimize patient-centered care among older persons with AF. OBJECTIVE To assess impairment in disease-specific QoL due to comorbid conditions in older adults with AF. METHODS Patients aged ≥ 65 years diagnosed with AF were recruited from five medical centers in Massachusetts and Georgia between 2015 and 2018. At 1 year of follow-up, the Quality of Life Disease Impact Scale-for Multiple Chronic Conditions was used to provide standardized assessment of patient self-reported impairment in QoL attributable to 34 comorbid conditions grouped in 10 clusters. RESULTS The mean age of study participants (n = 1097) was 75 years and 48% were women. Overall, cardiometabolic, musculoskeletal, and pulmonary conditions were the most prevalent comorbidity clusters. A high proportion of participants (82%) reported that musculoskeletal conditions exerted the greatest impact on their QoL. Men were more likely than women to report that osteoarthritis and stroke severely impacted their QoL. Patients aged < 75 years were more likely to report that obesity, hip/knee joint problems, and fibromyalgia extremely impacted their QoL than older participants. CONCLUSIONS Among older persons with AF, while cardiometabolic diseases were highly prevalent, musculoskeletal conditions exerted the greatest impact on patients' disease-specific QoL. Understanding the extent of impairment in QoL due to underlying comorbidities provides an opportunity to develop interventions targeted at diseases that may cause significant impairment in QoL.
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Affiliation(s)
- Hawa O Abu
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Jane S Saczynski
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - John Ware
- John Ware Research Group, Watertown, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Tenes Paul
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Hamza Awad
- Departments of Community Medicine and Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Benita A Bamgbade
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Isabelle C Pierre-Louis
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Mayra Tisminetzky
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Division of Geriatrics, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert J Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - David D McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
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Nwabuo CC, Betoko AS, Reis JP, Moreira HT, Vasconcellos HD, Guallar E, Cox C, Sidney S, Ambale-Venkatesh B, Lewis CE, Schreiner PJ, Lloyd-Jones D, Kiefe CI, Gidding SS, Lima JAC. Coffee and tea consumption in the early adult lifespan and left ventricular function in middle age: the CARDIA study. ESC Heart Fail 2020; 7:1510-1519. [PMID: 32449612 PMCID: PMC7373924 DOI: 10.1002/ehf2.12684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/01/2020] [Accepted: 03/08/2020] [Indexed: 01/12/2023] Open
Abstract
Aims The long‐term impact of coffee or tea consumption on subclinical left ventricular (LV) systolic or diastolic function has not been previously studied. We examined the association between coffee or tea consumption beginning in early adulthood and cardiac function in midlife. Methods and results We investigated 2735 Coronary Artery Risk Development in Young Adults (CARDIA) study participants with long‐term total caffeine intake, coffee, and tea consumption data from three visits over a 20 year interval and available echocardiography indices at the CARDIA Year‐25 exam (2010–2011). Linear regression models were used to assess the association between caffeine intake, tea, and coffee consumption (independent variables) and echocardiography outcomes [LV mass, left atrial volume, and global longitudinal strain (GLS), LV ejection fraction (LVEF), and transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/e´)]. Models were adjusted for standard cardiovascular risk factors, socioeconomic status, physical activity, alcohol use, and dietary factors (calorie intake, whole and refined grain intake, and fruit and vegetable consumption). Mean (standard deviation) age was 25.2 (3.5) years at the CARDIA Year‐0 exam (1985–1986), 57.4% were women, and 41.9% were African‐American. In adjusted multivariable linear regression models assessing the relationship between coffee consumption and GLS, beta coefficients when comparing coffee drinkers of <1, 1–2, 3–4, and >4 cups/day with non‐coffee drinkers were β = −0.30%, P < 0.05; β = −0.35%, P < 0.05; β = −0.32%, P < 0.05; β = −0.40%, P > 0.05; respectively (more negative values implies better systolic function). In adjusted multivariable linear regression models assessing the relationship between coffee consumption and E/e´, beta coefficients when comparing coffee drinkers of <1, 1–2, 3–4, and >4 cups/day with non‐coffee drinkers were β = −0.29, P < 0.05; β = −0.38, P < 0.01; β = −0.20, P > .05; and β = −0.37, P > 0.05, respectively (more negative values implies better diastolic function). High daily coffee consumption (>4 cups/day) was associated with worse LVEF (β = −1.69, P < 0.05). There were no associations between either tea drinking or total caffeine intake and cardiac function (P > 0.05 for all). Conclusions Low‐to‐moderate daily coffee consumption from early adulthood to middle age was associated with better LV systolic and diastolic function in midlife. High daily coffee consumption (>4cups/day) was associated with worse LV function. There was no association between caffeine or tea intake and cardiac function.
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Affiliation(s)
- Chike C Nwabuo
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Aisha S Betoko
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jared P Reis
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Henrique T Moreira
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.,Ribeirão Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Henrique D Vasconcellos
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Eliseo Guallar
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Christopher Cox
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen Sidney
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | | | - Cora E Lewis
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Catarina I Kiefe
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Samuel S Gidding
- Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - João A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Pierce JB, Kershaw KN, Kiefe CI, Jacobs DR, Sidney S, Merkin SS, Feinglass J. Association of Childhood Psychosocial Environment With 30-Year Cardiovascular Disease Incidence and Mortality in Middle Age. J Am Heart Assoc 2020; 9:e015326. [PMID: 32342717 PMCID: PMC7428574 DOI: 10.1161/jaha.119.015326] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Childhood adversity and trauma have been shown to be associated with poorer cardiovascular disease (CVD) outcomes in adulthood. However, longitudinal studies of this association are rare. Methods and Results Our study used the CARDIA (Coronary Artery Risk Development in Young Adults) Study, a longitudinal cohort that has followed participants from recruitment in 1985-1986 through 2018, to determine how childhood psychosocial environment relates to CVD incidence and all-cause mortality in middle age. Participants (n=3646) completed the Childhood Family Environment (CFE) questionnaire at the year 15 (2000-2001) CARDIA examination and were grouped by high, moderate, or low relative CFE adversity scores. We used sequential multivariable regression models to estimate hazard ratios of incident (CVD) and all-cause mortality. Participants were 25.1±3.6 years old, 47% black, and 56% female at baseline and 198 participants developed CVD (17.9 per 10 000 person-years) during follow-up. CVD incidence was >50% higher for those in the high CFE adversity group compared with those in the low CFE adversity group. In fully adjusted models, CVD hazard ratios (95% CI) for participants who reported high and moderate CFE adversity versus those reporting low CFE adversity were 1.40 (0.98-2.11) and 1.25 (0.89-1.75), respectively. The adjusted hazard ratios for all-cause mortality was 1.68 (1.17-2.41) for those with high CFE adversity scores and 1.55 (1.11-2.17) for those with moderate CFE adversity scores. Conclusions Adverse CFE was associated with CVD incidence and all-cause mortality later in life, even after controlling for CVD risk factors in young adulthood.
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Affiliation(s)
- Jacob B Pierce
- Northwestern University Feinberg School of Medicine Chicago IL
| | - Kiarri N Kershaw
- Division of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences University of Massachusetts Medical School Worcester MA
| | - David R Jacobs
- Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN
| | | | - Sharon Stein Merkin
- Division of Geriatrics Los Angeles Geffen School of Medicine University of California Los Angeles CA
| | - Joe Feinglass
- Division of General Internal Medicine and Geriatrics Northwestern University Feinberg School of Medicine Chicago IL
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Roy B, Kiefe CI, Jacobs DR, Goff DC, Lloyd-Jones D, Shikany JM, Reis JP, Gordon-Larsen P, Lewis CE. Education, Race/Ethnicity, and Causes of Premature Mortality Among Middle-Aged Adults in 4 US Urban Communities: Results From CARDIA, 1985-2017. Am J Public Health 2020; 110:530-536. [PMID: 32078342 PMCID: PMC7067110 DOI: 10.2105/ajph.2019.305506] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2019] [Indexed: 01/31/2023]
Abstract
Objectives. To assess causes of premature death and whether race/ethnicity or education is more strongly and independently associated with premature mortality in a diverse sample of middle-aged adults in the United States.Methods. The Coronary Artery Risk Development in Young Adults study (CARDIA) is a longitudinal cohort study of 5114 participants recruited in 1985 to 1986 and followed for up to 29 years, with rigorous ascertainment of all deaths; recruitment was balanced regarding sex, Black and White race/ethnicity, education level (high school or less vs. greater than high school), and age group (18-24 and 25-30 years). This analysis included all 349 deaths that had been fully reviewed through month 348. Our primary outcome was years of potential life lost (YPLL).Results. The age-adjusted mortality rate per 1000 persons was 45.17 among Black men, 25.20 among White men, 17.63 among Black women, and 10.10 among White women. Homicide and AIDS were associated with the most YPLL, but cancer and cardiovascular disease were the most common causes of death. In multivariable models, each level of education achieved was associated with 1.37 fewer YPLL (P = .007); race/ethnicity was not independently associated with YPLL.Conclusions. Lower education level was an independent predictor of greater YPLL.
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Affiliation(s)
- Brita Roy
- Brita Roy is with the Department of Internal Medicine, Yale School of Medicine, New Haven, CT. Catarina I. Kiefe is with the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. David R. Jacobs is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. During the time of the study, David C. Goff was with the Colorado School of Public Health, University of Colorado, Aurora, and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Donald Lloyd-Jones is with the Feinberg School of Medicine, Northwestern University, Evanston, IL. James M. Shikany is with the Division of Preventive Medicine, University of Alabama at Birmingham. Jared P. Reis is with the National Heart, Lung, and Blood Institute. Penny Gordon-Larsen is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill. Cora E. Lewis is with the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Catarina I Kiefe
- Brita Roy is with the Department of Internal Medicine, Yale School of Medicine, New Haven, CT. Catarina I. Kiefe is with the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. David R. Jacobs is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. During the time of the study, David C. Goff was with the Colorado School of Public Health, University of Colorado, Aurora, and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Donald Lloyd-Jones is with the Feinberg School of Medicine, Northwestern University, Evanston, IL. James M. Shikany is with the Division of Preventive Medicine, University of Alabama at Birmingham. Jared P. Reis is with the National Heart, Lung, and Blood Institute. Penny Gordon-Larsen is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill. Cora E. Lewis is with the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - David R Jacobs
- Brita Roy is with the Department of Internal Medicine, Yale School of Medicine, New Haven, CT. Catarina I. Kiefe is with the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. David R. Jacobs is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. During the time of the study, David C. Goff was with the Colorado School of Public Health, University of Colorado, Aurora, and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Donald Lloyd-Jones is with the Feinberg School of Medicine, Northwestern University, Evanston, IL. James M. Shikany is with the Division of Preventive Medicine, University of Alabama at Birmingham. Jared P. Reis is with the National Heart, Lung, and Blood Institute. Penny Gordon-Larsen is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill. Cora E. Lewis is with the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - David C Goff
- Brita Roy is with the Department of Internal Medicine, Yale School of Medicine, New Haven, CT. Catarina I. Kiefe is with the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. David R. Jacobs is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. During the time of the study, David C. Goff was with the Colorado School of Public Health, University of Colorado, Aurora, and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Donald Lloyd-Jones is with the Feinberg School of Medicine, Northwestern University, Evanston, IL. James M. Shikany is with the Division of Preventive Medicine, University of Alabama at Birmingham. Jared P. Reis is with the National Heart, Lung, and Blood Institute. Penny Gordon-Larsen is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill. Cora E. Lewis is with the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Donald Lloyd-Jones
- Brita Roy is with the Department of Internal Medicine, Yale School of Medicine, New Haven, CT. Catarina I. Kiefe is with the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. David R. Jacobs is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. During the time of the study, David C. Goff was with the Colorado School of Public Health, University of Colorado, Aurora, and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Donald Lloyd-Jones is with the Feinberg School of Medicine, Northwestern University, Evanston, IL. James M. Shikany is with the Division of Preventive Medicine, University of Alabama at Birmingham. Jared P. Reis is with the National Heart, Lung, and Blood Institute. Penny Gordon-Larsen is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill. Cora E. Lewis is with the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - James M Shikany
- Brita Roy is with the Department of Internal Medicine, Yale School of Medicine, New Haven, CT. Catarina I. Kiefe is with the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. David R. Jacobs is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. During the time of the study, David C. Goff was with the Colorado School of Public Health, University of Colorado, Aurora, and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Donald Lloyd-Jones is with the Feinberg School of Medicine, Northwestern University, Evanston, IL. James M. Shikany is with the Division of Preventive Medicine, University of Alabama at Birmingham. Jared P. Reis is with the National Heart, Lung, and Blood Institute. Penny Gordon-Larsen is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill. Cora E. Lewis is with the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Jared P Reis
- Brita Roy is with the Department of Internal Medicine, Yale School of Medicine, New Haven, CT. Catarina I. Kiefe is with the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. David R. Jacobs is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. During the time of the study, David C. Goff was with the Colorado School of Public Health, University of Colorado, Aurora, and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Donald Lloyd-Jones is with the Feinberg School of Medicine, Northwestern University, Evanston, IL. James M. Shikany is with the Division of Preventive Medicine, University of Alabama at Birmingham. Jared P. Reis is with the National Heart, Lung, and Blood Institute. Penny Gordon-Larsen is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill. Cora E. Lewis is with the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Penny Gordon-Larsen
- Brita Roy is with the Department of Internal Medicine, Yale School of Medicine, New Haven, CT. Catarina I. Kiefe is with the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. David R. Jacobs is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. During the time of the study, David C. Goff was with the Colorado School of Public Health, University of Colorado, Aurora, and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Donald Lloyd-Jones is with the Feinberg School of Medicine, Northwestern University, Evanston, IL. James M. Shikany is with the Division of Preventive Medicine, University of Alabama at Birmingham. Jared P. Reis is with the National Heart, Lung, and Blood Institute. Penny Gordon-Larsen is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill. Cora E. Lewis is with the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Cora E Lewis
- Brita Roy is with the Department of Internal Medicine, Yale School of Medicine, New Haven, CT. Catarina I. Kiefe is with the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. David R. Jacobs is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. During the time of the study, David C. Goff was with the Colorado School of Public Health, University of Colorado, Aurora, and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Donald Lloyd-Jones is with the Feinberg School of Medicine, Northwestern University, Evanston, IL. James M. Shikany is with the Division of Preventive Medicine, University of Alabama at Birmingham. Jared P. Reis is with the National Heart, Lung, and Blood Institute. Penny Gordon-Larsen is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill. Cora E. Lewis is with the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
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Moreira HT, Armstrong AC, Nwabuo CC, Vasconcellos HD, Schmidt A, Sharma RK, Ambale-Venkatesh B, Ostovaneh MR, Kiefe CI, Lewis CE, Schreiner PJ, Sidney S, Ogunyankin KO, Gidding SS, Lima JAC. Association of smoking and right ventricular function in middle age: CARDIA study. Open Heart 2020; 7:e001270. [PMID: 32201592 PMCID: PMC7061887 DOI: 10.1136/openhrt-2020-001270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 12/28/2022] Open
Abstract
Objective To evaluate the association of cigarette smoking and right ventricular (RV) systolic and diastolic functions in a population-based cohort of individuals at middle age. Methods This cross-sectional study included participants who answered the smoking questionnaire and underwent echocardiography at the Coronary Artery Risk Development in Young Adulthood year 25 examination. RV systolic function was assessed by echocardiographic-derived tricuspid annular plane systolic excursion (TAPSE) and by right ventricular peak systolic velocity (RVS'), while RV diastolic function was evaluated by early right ventricular tissue velocity (RVE'). Multivariable linear regression models assessed the relationship of smoking with RV function, adjusting for age, sex, race, body mass index, systolic blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, diabetes mellitus, alcohol consumption, pulmonary function, left ventricular systolic and diastolic function and coronary artery calcium score. Results A total of 3424 participants were included. The mean age was 50±4 years; 57% were female; and 53% were black. There were 2106 (61%) never smokers, 750 (22%) former smokers and 589 (17%) current smokers. In the multivariable analysis, current smokers had significantly lower TAPSE (β=-0.082, SE=0.031, p=0.008), RVS' (β=-0.343, SE=0.156, p=0.028) and RVE' (β=-0.715, SE=0.195, p<0.001) compared with never smokers. Former smokers had a significantly lower RVE' compared with never smokers (β=-0.414, SE=0.162, p=0.011), whereas no significant difference in RV systolic function was found between former smokers and never smokers. Conclusions In a large multicenter community-based biracial cohort of middle-aged individuals, smoking was independently related to both worse RV systolic and diastolic functions.
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Affiliation(s)
- Henrique T Moreira
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Cardiology, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | | | - Chike C Nwabuo
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Andre Schmidt
- Division of Cardiology, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Ravi K Sharma
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Catarina I Kiefe
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Cora E Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Division of Research, Oakland, California, USA
| | - Kofo O Ogunyankin
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Samuel S Gidding
- Chief Medical Officer, The FH Foundation, Passadena, California, USA
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
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Oates GR, Juarez LD, Hansen B, Kiefe CI, Shikany JM. Social Risk Factors for Medication Nonadherence: Findings from the CARDIA Study. Am J Health Behav 2020; 44:232-243. [PMID: 32019655 DOI: 10.5993/ajhb.44.2.10] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: Nonadherence to medications has been documented, but the combined effect of social risk factors on medication nonadherence has not been investigated. Methods: We conducted a cross-sectional analysis of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based prospective cohort. The sample (N = 1506) included subjects who at Year 20 (2005-06) were taking prescription medications and completed a 4-item Medication Adherence Scale. Social risk factors were education of high school or less, annual household income <$25,000, high financial strain, high chronic stress, low social support, and high social strain. Results: In a fully adjusted logistic regression model, income <$25,000 (OR = 2.37 [95% CI 1.12-4.98], p < .05) and high chronic stress (OR = 2.07 [95% CI 1.09-3.94], p < .05) were significantly associated with medication nonadherence. Individuals with ≥3 social risk factors had >3 times higher odds of nonadherence than counterparts with no social risk factors (OR = 3.26 [95% CI 1.72-6.19], p < .001). Conclusion: Low income and chronic stress are associated with medication nonadherence, and the odds of nonadherence increase with the accumulation of social risk factors. Findings may be used to develop risk prediction tools to identify individuals who can benefit from adherence-promoting interventions.
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Affiliation(s)
- Gabriela R. Oates
- Assistant Professor of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL.,
| | - Lucia D. Juarez
- Scientist III, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Barbara Hansen
- Scientist I, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Catarina I. Kiefe
- Professor and Chair, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - James M. Shikany
- Professor of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
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Abu HO, McManus DD, Kiefe CI, Goldberg RJ. Religiosity and Patient Activation Among Hospital Survivors of an Acute Coronary Syndrome. J Gen Intern Med 2020; 35:762-769. [PMID: 31677101 PMCID: PMC7080940 DOI: 10.1007/s11606-019-05345-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Optimum management after an acute coronary syndrome (ACS) requires considerable patient engagement/activation. Religious practices permeate people's lives and may influence engagement in their healthcare. Little is known about the relationship between religiosity and patient activation. OBJECTIVE To examine the association between religiosity and patient activation in hospital survivors of an ACS. DESIGN Secondary analysis using baseline data from Transitions, Risks, and Actions in Coronary Events: Center for Outcomes Research and Education (TRACE-CORE) Study. PARTICIPANTS A total of 2067 patients hospitalized for an ACS at six medical centers in Central Massachusetts and Georgia (2011-2013). MAIN MEASURES Study participants self-reported three items assessing religiosity-strength and comfort from religion, making petition prayers, and awareness of intercessory prayers for health. Patient activation was assessed using the 6-item Patient Activation Measure (PAM-6). Participants were categorized as either having low (levels 1 and 2) or high (levels 3 and 4) activation. RESULTS The mean age of study participants was 61 years, 33% were women, and 81% were non-Hispanic White. Approximately 85% derived strength and comfort from religion, 61% prayed for their health, and 89% received intercessory prayers for their health. Overall, 58% had low activation. Reports of a great deal (aOR, 2.02; 95% CI, 1.44-2.84), and little/some (aOR, 1.45; 95% CI, 1.07-1.98) strength and comfort from religion were associated with high activation, as were receipt of intercessions (aOR, 1.48; 95% CI, 1.07-2.05). Praying for one's health was associated with low activation (aOR, 0.78; 95% CI, 0.61-0.99). CONCLUSIONS Most ACS survivors acknowledge religious practices toward their recovery. Strength and comfort from religion and intercessory prayers for health were associated with high patient activation. Petition prayers for health were associated with low activation. Healthcare providers should use knowledge about patient's religiosity to enhance patient engagement in their care.
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Affiliation(s)
- Hawa O Abu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
| | - David D McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert J Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Carroll AJ, Huffman MD, Zhao L, Jacobs DR, Stewart JC, Kiefe CI, Brunner W, Liu K, Hitsman B. Associations between depressive symptoms, cigarette smoking, and cardiovascular health: Longitudinal results from CARDIA. J Affect Disord 2020; 260:583-591. [PMID: 31539696 PMCID: PMC6931258 DOI: 10.1016/j.jad.2019.09.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 11/07/2018] [Revised: 04/08/2019] [Accepted: 09/08/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Depression is associated with increased risk of incident and recurrent cardiovascular disease, while the association between depression and cardiovascular health (CVH) remains unknown. Because the natural course of depression varies widely, different patterns of depression, as well as co-occurring factors such as cigarette smoking, may influence this relationship. We examined potential interactions between longitudinal patterns of depression and smoking with CVH. METHODS Using data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, we modeled trajectories of depression (Center for Epidemiologic Studies Depression scale scores; Years 5, 10, 15, 20) and smoking (cigarettes/day; Years 0, 2, 5, 7, 10, 15, 20). We calculated a modified American Heart Association (AHA) CVH Score (weight, blood glucose, cholesterol, blood pressure, physical activity, and diet; Year 20); higher scores indicate better CVH. Generalized linear models evaluated associations between depression trajectories, smoking trajectories, and their interaction with CVH Score. RESULTS The depression trajectory x smoking trajectory interaction was not associated with CVH Score, but main effects of depression trajectory (p < .001) and smoking trajectory (p < .001) were observed. Participants with patterns of subthreshold depression (β = -0.26, SE=0.08), increasing depression (β = -0.51 SE = 0.14), and high depression (β = -0.65, SE = 0.32) had lower CVH Scores than those without depression. Compared to never smokers, participants who quit smoking had higher CVH Scores (β = 0.38, SE = 0.11), while participants with the greatest smoking exposure had lower CVH Scores (β = -0.49, SE = 0.22). LIMITATIONS CVH Scores were adapted from the AHA guidelines based on the available CARDIA data. CONCLUSIONS Deleterious depression and smoking trajectories are independently but not synergistically associated with worse CVH.
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Affiliation(s)
- Allison J Carroll
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Cardiac Surgery, Department of Surgery, Northwestern Medicine, Chicago, IL, USA.
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Food Policy, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David R Jacobs
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Wendy Brunner
- Center for Rural Community Health, Bassett Resarch Institute, Cooperstown, NY, USA
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Swift SL, Glymour MM, Elfassy T, Lewis C, Kiefe CI, Sidney S, Calonico S, Feaster D, Bailey Z, Zeki Al Hazzouri A. Racial discrimination in medical care settings and opioid pain reliever misuse in a U.S. cohort: 1992 to 2015. PLoS One 2019; 14:e0226490. [PMID: 31860661 PMCID: PMC6924655 DOI: 10.1371/journal.pone.0226490] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 11/26/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In the United States whites are more likely to misuse opioid pain relievers (OPRs) than blacks, and blacks are less likely to be prescribed OPRs than whites. Our objective is to determine whether racial discrimination in medical settings is protective for blacks against OPR misuse, thus mediating the black-white disparities in OPR misuse. METHODS We used data from 3528 black and white adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study, an ongoing multi-site cohort. We employ causal mediation methods, with race (black vs white) as the exposure, lifetime discrimination in medical settings prior to year 2000 as the mediator, and OPR misuse after 2000 as the outcome. RESULTS We found black participants were more likely to report discrimination in a medical setting (20.3% vs 0.9%) and less likely to report OPR misuse (5.8% vs 8.0%, OR = 0.71, 95% CI = 0.55, 0.93, adjusted for covariates). Our mediation models suggest that when everyone is not discriminated against, the disparity is wider with black persons having even lower odds of reporting OPR misuse (OR = 0.63, 95% CI = 0.45, 0.89) compared to their white counterparts, suggesting racial discrimination in medical settings is a risk factor for OPR misuse rather than protective. CONCLUSIONS These results suggest that racial discrimination in a medical setting is a risk factor for OPR misuse rather than being protective, and thus could not explain the seen black-white disparity in OPR misuse.
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Affiliation(s)
- Samuel L. Swift
- Center for Health Equity in Kidney Disease, University of New Mexico School of Medicine, Albuquerque, NM, United States of America
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States of America
| | - Tali Elfassy
- Division of Epidemiology, Department of Public Health Sciences, University of Miami, Miami, FL, United States of America
| | - Cora Lewis
- Division of Preventative Medicine, Department of Medicine, University of Alabama, Tuscaloosa, AL, United States of America
| | - Catarina I. Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Boston, MA, United States of America
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Sebastian Calonico
- Department of Health Policy and Management, Columbia University, New York, NY, United States of America
| | - Daniel Feaster
- Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami, FL, United States of America
| | - Zinzi Bailey
- Jay Weiss Institute for Health Equity, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States of America
| | - Adina Zeki Al Hazzouri
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Waring ME, Hills MT, Lessard DM, Saczynski JS, Libby BA, Holovatska MM, Kapoor A, Kiefe CI, McManus DD. Characteristics Associated With Facebook Use and Interest in Digital Disease Support Among Older Adults With Atrial Fibrillation: Cross-Sectional Analysis of Baseline Data From the Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) Cohort. JMIR Cardio 2019; 3:e15320. [PMID: 31758791 PMCID: PMC6883367 DOI: 10.2196/15320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/01/2019] [Revised: 08/28/2019] [Accepted: 08/31/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Online support groups for atrial fibrillation (AF) and apps to detect and manage AF exist, but the scientific literature does not describe which patients are interested in digital disease support. OBJECTIVE The objective of this study was to describe characteristics associated with Facebook use and interest in digital disease support among older patients with AF who used the internet. METHODS We used baseline data from the Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF), a prospective cohort of older adults (≥65 years) with AF at high stroke risk. Participants self-reported demographics, clinical characteristics, and Facebook and technology use. Online patients (internet use in the past 4 weeks) were asked whether they would be interested in participating in an online support AF community. Mobile users (owns smartphone and/or tablet) were asked about interest in communicating with their health care team about their AF-related health using a secure app. Logistic regression models identified crude and multivariable predictors of Facebook use and interest in digital disease support. RESULTS Online patients (N=816) were aged 74.2 (SD 6.6) years, 47.8% (390/816) were female, and 91.1% (743/816) were non-Hispanic white. Roughly half (52.5%; 428/816) used Facebook. Facebook use was more common among women (adjusted odds ratio [aOR] 2.21, 95% CI 1.66-2.95) and patients with mild to severe depressive symptoms (aOR 1.50, 95% CI 1.08-2.10) and less common among patients aged ≥85 years (aOR 0.27, 95% CI 0.15-0.48). Forty percent (40.4%; 330/816) reported interest in an online AF patient community. Interest in an online AF patient community was more common among online patients with some college/trade school or Bachelors/graduate school (aOR 1.70, 95% CI 1.10-2.61 and aOR 1.82, 95% CI 1.13-2.92, respectively), obesity (aOR 1.65, 95% CI 1.08-2.52), online health information seeking at most weekly or multiple times per week (aOR 1.84, 95% CI 1.32-2.56 and aOR 2.78, 95% CI 1.86-4.16, respectively), and daily Facebook use (aOR 1.76, 95% CI 1.26-2.46). Among mobile users, 51.8% (324/626) reported interest in communicating with their health care team via a mobile app. Interest in app-mediated communication was less likely among women (aOR 0.48, 95% CI 0.34-0.68) and more common among online patients who had completed trade school/some college versus high school/General Educational Development (aOR 1.95, 95% CI 1.17-3.22), sought online health information at most weekly or multiple times per week (aOR 1.86, 95% CI 1.27-2.74 and aOR 2.24, 95% CI 1.39-3.62, respectively), and had health-related apps (aOR 3.92, 95% CI 2.62-5.86). CONCLUSIONS Among older adults with AF who use the internet, technology use and demographics are associated with interest in digital disease support. Clinics and health care providers may wish to encourage patients to join an existing online support community for AF and explore opportunities for app-mediated patient-provider communication.
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Affiliation(s)
- Molly E Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Mellanie T Hills
- StopAfib.org, American Foundation for Women's Health, Decatur, TX, United States
| | - Darleen M Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jane S Saczynski
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA, United States
| | - Brooke A Libby
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Marta M Holovatska
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Alok Kapoor
- Division of Hospital Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - David D McManus
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.,Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
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Forrester SN, McManus DD, Saczynski JS, Kiefe CI. RACE, BIOLOGICAL AGE, AND COGNITION: THE SYSTEMATIC ASSESSMENT OF GERIATRIC ELEMENTS IN ATRIAL FIBRILLATION STUDY. Innov Aging 2019. [PMCID: PMC6840809 DOI: 10.1093/geroni/igz038.1175] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Atrial Fibrillation (AF) is associated with dementia and cognitive decline. AF is less prevalent among Blacks than Whites, although AF-related complications are more common in Blacks. In the general population, all-cause cognitive decline and dementia are more prevalent among Blacks than Whites. Thus, studying diverse populations with AF may advance our understanding of racial disparities in cognitive functioning. We created a measure of multisystem dysregulation (weathering), which includes but is more encompassing than aging, and examined its association with racial differences in cognition using data from the SAGE-AF study, a prospective cohort of >65-year olds with AF, at high stroke risk, and eligible for anticoagulation. Biological (as opposed to chronological) age among 974 participants was calculated using the Klemera and Doubal method using biomarkers representing physiological functioning, metabolism, and blood pressure. We defined weathering as the difference between biological and chronological age (weathering >0 indicates that biological age is higher than chronological age). We measured the association between weathering and the Montreal Cognitive Assessment (MoCA) score. Mean weathering (SD) was -0.7 (11.5) and 4.3 (12.6) for whites and non-whites, respectively. There was an interaction between race/ethnicity and weathering on cognition (P=0.004). In stratified analyses, higher weathering was associated with a lower MoCA score among both Whites and non-Whites but more so among non-whites (B = -0.09, 95% CI: -0.17, -0.02) for Whites (B = -0.03, 95% CI: -0.06, -0.01) for non-whites. Aging-related multisystem dysregulation is more strongly associated with worse cognition in non-whites than in whites.
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Affiliation(s)
- Sarah N Forrester
- University of Massachusetts Medical School, Worcester, Massachusetts, United States
| | - David D McManus
- University of Massachusetts Medical School, Worcester, Massachusetts, United States
| | | | - Catarina I Kiefe
- University of Massachusetts Medical School, Worcester, Massachusetts, United States
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46
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Saczynski JS, Sanghai SR, Kiefe CI, Lessard D, Marino F, Waring ME, Parish D, Helm R, Sogade F, Goldberg R, Gurwitz J, Wang W, Mailhot T, Bamgbade B, Barton B, McManus DD. Geriatric Elements and Oral Anticoagulant Prescribing in Older Atrial Fibrillation Patients: SAGE-AF. J Am Geriatr Soc 2019; 68:147-154. [PMID: 31574165 DOI: 10.1111/jgs.16178] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [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: 06/25/2019] [Revised: 08/23/2019] [Accepted: 08/23/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Oral anticoagulants are the cornerstone of stroke prevention in high-risk patients with atrial fibrillation (AF). Geriatric elements, such as cognitive impairment and frailty, commonly occur in these patients and are often cited as reasons for not prescribing oral anticoagulants. We sought to systematically assess geriatric impairments in patients with AF and determine whether they were associated with oral anticoagulant prescribing. DESIGN Cross-sectional analysis of baseline data from the ongoing Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) prospective cohort study. SETTING Multicenter study with site locations in Massachusetts and Georgia that recruited participants from cardiology, electrophysiology, and primary care clinics from 2016 to 2018. PARTICIPANTS Participants with AF age 65 years or older, CHA2 DS2 -VASc (congestive heart failure; hypertension; aged ≥75 y [doubled]; diabetes mellitus; prior stroke, transient ischemic attack, or thromboembolism [doubled]; vascular disease; age 65-74; female sex) score of 2 or higher, and no oral anticoagulant contraindications (n = 1244). MEASUREMENTS A six-component geriatric assessment included validated measures of frailty, cognitive function, social support, depressive symptoms, vision, and hearing. Oral anticoagulant use was abstracted from the medical record. RESULTS A total of 1244 participants (mean age = 76 y; 49% female; 85% white) were enrolled; 42% were cognitively impaired, 14% frail, 53% pre-frail, 12% socially isolated, and 29% had depressive symptoms. Oral anticoagulants were prescribed to 86% of the cohort. Oral anticoagulant prescribing did not vary according to any of the geriatric elements (adjusted odds ratios [ORs] for oral anticoagulant prescribing and cognitive impairment: OR = .75; 95% confidence interval [CI] = .51-1.09; frail OR = .69; 95% CI = .35-1.36; social isolation OR = .90; 95% CI = .52-1.54; depression OR = .79; 95% CI = .49-1.27; visual impairment OR = .98; 95% CI = .65-1.48; and hearing impairment OR = 1.05; 95% CI = .71-1.54). CONCLUSION Geriatric impairments, particularly cognitive impairment and frailty, were common in our cohort, but treatment with oral anticoagulants did not differ by impairment status. These geriatric impairments are commonly cited as reasons for not prescribing oral anticoagulants, suggesting that prescribers may either be unaware or deliberately ignoring the presence of these factors in clinical settings. J Am Geriatr Soc 68:147-154, 2019.
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Affiliation(s)
- Jane S Saczynski
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, Massachusetts
| | - Saket R Sanghai
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Darleen Lessard
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Francesca Marino
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Molly E Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut
| | - David Parish
- Department of Community Medicine/ Internal Medicine, Mercer University School of Medicine, Macon, Georgia
| | - Robert Helm
- Department of Medicine, Boston University Medical Center, Boston, Massachusetts
| | - Felix Sogade
- Department of Medicine, Mercer University School of Medicine, Mercer, Georgia
| | - Robert Goldberg
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jerry Gurwitz
- Geriatric Medicine Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Weijia Wang
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Tanya Mailhot
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, Massachusetts.,Montreal Heart Institute Research Center, Montreal, Quebec, Canada
| | - Benita Bamgbade
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, Massachusetts
| | - Bruce Barton
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - David D McManus
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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Abu HO, McManus DD, Lessard DM, Kiefe CI, Goldberg RJ. Religious practices and changes in health-related quality of life after hospital discharge for an acute coronary syndrome. Health Qual Life Outcomes 2019; 17:149. [PMID: 31481073 PMCID: PMC6724337 DOI: 10.1186/s12955-019-1218-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/27/2019] [Indexed: 01/17/2023] Open
Abstract
Background Religious beliefs and practices influence coping mechanisms and quality of life in patients with various chronic illnesses. However, little is known about the influence of religious practices on changes in health-related quality of life (HRQOL) among hospital survivors of an acute coronary syndrome (ACS). The present study examined the association between several items assessing religiosity and clinically meaningful changes in HRQOL between 1 and 6 months after hospital discharge for an ACS. Methods We recruited patients hospitalized for an ACS at six medical centers in Central Massachusetts and Georgia (2011–2013). Participants reported making petition prayers for their health, awareness of intercessory prayers by others, and deriving strength/comfort from religion. Generic HRQOL was assessed with the SF-36®v2 physical and mental component summary scores. Disease-specific HRQOL was evaluated using the Seattle Angina Questionnaire Quality of Life subscale (SAQ-QOL). We separately examined the association between each measure of religiosity and the likelihood of experiencing clinically meaningful increase in disease-specific HRQOL (defined as increases by ≥10.0 points) and Generic HRQOL (defined as increases by ≥3.0 points) between 1- and 6-months post-hospital discharge. Results Participants (n = 1039) were, on average, 62 years old, 33% were women, and 86% were non-Hispanic White. Two-thirds reported praying for their health, 88% were aware of intercessions by others, and 85% derived strength/comfort from religion. Approximately 42, 40, and 26% of participants experienced clinically meaningful increases in their mental, physical, and disease-specific HRQOL respectively. After adjustment for sociodemographic, psychosocial, and clinical characteristics, petition (aOR:1.49; 95% CI: 1.09–2.04) and intercessory (aOR:1.72; 95% CI: 1.12–2.63) prayers for health were associated with clinically meaningful increases in disease-specific and physical HRQOL respectively. Conclusions Most ACS survivors in a contemporary, multiracial cohort acknowledged praying for their health, were aware of intercessory prayers made for their health and derived strength and comfort from religion. Patients who prayed for their health and those aware of intercessions made for their health experienced improvement in their generic physical and disease-specific HRQOL over time. Healthcare providers should recognize that patients may use prayer as a coping strategy for improving their well-being and recovery after a life-threatening illness. Electronic supplementary material The online version of this article (10.1186/s12955-019-1218-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hawa O Abu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, 01605, USA.
| | - David D McManus
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, 01605, USA
| | - Darleen M Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, 01605, USA
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, 01605, USA
| | - Robert J Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, 01605, USA
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48
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Tran KV, Tanriverdi K, Aurigemma GP, Lessard D, Sardana M, Parker M, Shaikh A, Gottbrecht M, Milstone Z, Tanriverdi S, Vitseva O, Keaney JF, Kiefe CI, McManus DD, Freedman JE. Circulating extracellular RNAs, myocardial remodeling, and heart failure in patients with acute coronary syndrome. J Clin Transl Res 2019; 5:33-43. [PMID: 31579840 PMCID: PMC6765153] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/02/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Given high on-treatment mortality in heart failure (HF), identifying molecular pathways that underlie adverse cardiac remodeling may offer novel biomarkers and therapeutic avenues. Circulating extracellular RNAs (ex-RNAs) regulate important biological processes and are emerging as biomarkers of disease, but less is known about their role in the acute setting, particularly in the setting of HF. METHODS We examined the ex-RNA profiles of 296 acute coronary syndrome (ACS) survivors enrolled in the Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education Cohort. We measured 374 ex-RNAs selected a priori, based on previous findings from a large population study. We employed a two-step, mechanism-driven approach to identify ex-RNAs associated with echocardiographic phenotypes (left ventricular [LV] ejection fraction, LV mass, LV end-diastolic volume, left atrial [LA] dimension, and LA volume index) then tested relations of these ex-RNAs with prevalent HF (N=31, 10.5%). We performed further bioinformatics analysis of microRNA (miRNAs) predicted targets' genes ontology categories and molecular pathways. RESULTS We identified 44 ex-RNAs associated with at least one echocardiographic phenotype associated with HF. Of these 44 exRNAs, miR-29-3p, miR-584-5p, and miR-1247-5p were also associated with prevalent HF. The three microRNAs were implicated in the regulation p53 and transforming growth factor-β signaling pathways and predicted to be involved in cardiac fibrosis and cell death; miRNA predicted targets were enriched in gene ontology categories including several involving the extracellular matrix and cellular differentiation. CONCLUSIONS Among ACS survivors, we observed that miR-29-3p, miR-584-5p, and miR-1247-5p were associated with both echocardiographic markers of cardiac remodeling and prevalent HF. RELEVANCE FOR PATIENTS miR-29c-3p, miR-584-5p, and miR-1247-5p were associated with echocardiographic phenotypes and prevalent HF and are potential biomarkers for adverse cardiac remodeling in HF.
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Affiliation(s)
- Khanh-Van Tran
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA,Corresponding author: Khanh-Van Tran Cardiovascular Fellow, Department of Medicine, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01655, USA
| | - Kahraman Tanriverdi
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Gerard P. Aurigemma
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Darleen Lessard
- 2Population and Quantitative Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Mayank Sardana
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Matthew Parker
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Amir Shaikh
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Matthew Gottbrecht
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Selim Tanriverdi
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Olga Vitseva
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - John F. Keaney
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Catarina I. Kiefe
- 2Population and Quantitative Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - David D. McManus
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA,2Population and Quantitative Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Jane E. Freedman
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
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Carroll AJ, Huffman MD, Zhao L, Jacobs DR, Stewart JC, Kiefe CI, Liu K, Hitsman B. Evaluating Longitudinal Associations Between Depressive Symptoms, Smoking, and Biomarkers of Cardiovascular Disease in the CARDIA Study. Psychosom Med 2019; 81:372-379. [PMID: 30624288 PMCID: PMC6499647 DOI: 10.1097/psy.0000000000000667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate associations between 15-year trajectories of co-occurring depressive symptoms and smoking with biomarkers of cardiovascular disease at year 15. METHODS In the Coronary Artery Risk Development in Young Adults study, we modeled trajectories of depressive symptoms (Center for Epidemiologic Studies-Depression scale [CES-D]) and smoking (cigarettes per day [CPD]) among 3614 adults followed from year 0 (ages 18-30 years) through year 15 (ages 33-45 years). Biomarkers of inflammation (high-sensitivity C-reactive protein), oxidative stress (superoxide dismutase, F2-isoprostanes), and endothelial dysfunction (soluble intercellular adhesion molecule 1, soluble P-selectin) were assessed at year 15. We conducted separate linear regression analyses with CES-D trajectory, CPD trajectory, and their interaction with each of the five biomarkers. RESULTS The sample was 56% women, 47% black, and 40 years old on average at year 15. The CES-D trajectory by CPD trajectory interaction was not associated with any of the biomarkers (all p's > .01). Removing the interaction term, CES-D trajectory was associated with inflammation: higher levels of high-sensitivity C-reactive protein were observed in the subthreshold (β = 0.57, p = .004) and increasing depressive symptoms (β = 1.36, p < .001) trajectories compared with the no depression trajectory. CPD trajectory was associated with oxidative stress and endothelial dysfunction: compared with never smokers, heavy smokers had significantly higher levels of F2-isoprostanes (β = 6.20, p = .001), soluble intercellular adhesion molecule 1 (β = 24.98, p < .001), and soluble P-selectin (β = 2.91, p < .001). CONCLUSIONS Co-occurring depressive symptoms and smoking do not seem to synergistically convey risk for cardiovascular disease via processes of inflammation, oxidative stress, or endothelial dysfunction. Nonetheless, these results advance our understanding of the complex relationships between modifiable risk factors and chronic disease.
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Affiliation(s)
- Allison J. Carroll
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Mark D. Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - David R. Jacobs
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota
| | - Jesse C. Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis
| | - Catarina I. Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
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50
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Tran HV, Gore JM, Darling CE, Ash AS, Kiefe CI, Goldberg RJ. Clinically significant ventricular arrhythmias and progression of depression and anxiety following an acute coronary syndrome. J Psychosom Res 2019; 117:54-62. [PMID: 30482494 DOI: 10.1016/j.jpsychores.2018.10.008] [Citation(s) in RCA: 5] [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: 06/09/2018] [Revised: 10/12/2018] [Accepted: 10/18/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depression and anxiety are common and associated with worse clinical outcomes in patients who experience an acute coronary syndrome (ACS). We investigated the association between major ventricular arrhythmias (VAs) with the progression of depression and anxiety among hospital survivors of an ACS. METHODS Patients were interviewed in hospital and by telephone up to 12 months after hospital discharge. The primary outcome was the presence of moderate/severe symptoms of depression and anxiety defined as a Patient Health Questionnaire (PHQ)-9 score ≥ 10 and a Generalized Anxiety Disorder (GAD)-7 score ≥ 10 at baseline and 1 month and PHQ-2 ≥ 3 and GAD-2 ≥ 3 at 3, 6, and 12 months. We used marginal models to examine the association between major VAs and the symptoms of depression or anxiety over time. RESULTS The average age of the study population (n = 2074) was 61.1 years, 33.5% were women, and 78.3% were white. VAs developed in 105 patients (5.1%). Symptoms of depression and anxiety were present in 22.2% and 23.5% of patients at baseline, respectively, and declined to 14.1% and 12.6%, respectively, at 1-month post-discharge. VAs were not significantly associated with the progression of symptoms of depression (adjusted relative risk [aRR] = 1.29, 95% confidence interval [CI] = 0.94-1.77) and anxiety (aRR = 1.22, 95% CI = 0.86-1.72), or with change in average scores of PHQ-2 and GAD-2 over time, both before and after risk adjustment. CONCLUSION The prevalence of symptoms of depression and anxiety was high after an ACS but declined thereafter and may not be associated with the occurrence of major in-hospital VAs.
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Affiliation(s)
- Hoang V Tran
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, United States; Department of Medicine, Bridgeport Hospital, Yale New Haven Health, United States.
| | - Joel M Gore
- Department of Medicine, University of Massachusetts Medical School, United States
| | - Chad E Darling
- Department of Emergency Medicine, University of Massachusetts Medical School, United States
| | - Arlene S Ash
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, United States
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, United States
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, United States
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