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Ali HJ, Sahay S. End-of-Life and Palliative Care Issues for Patients Living with Pulmonary Arterial Hypertension: Barriers and Opportunities. Semin Respir Crit Care Med 2023; 44:866-876. [PMID: 37459883 DOI: 10.1055/s-0043-1770124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a progressive, incurable disease that results in significant symptom burden, health care utilization, and eventually premature death. Despite the advancements made in treatment and management strategies, survival has remained poor. End-of-life care is a challenging issue in management of PAH, especially when patients are in younger age group. End-of-life care revolves around symptom palliation and reducing psychosocial disease burden for a dying patient and entails advanced care planning that are often challenging. Thus, support from palliative care specialist becomes extremely important in these patients. Early introduction to palliative care in patients with high symptom burden and psychosocial suffering is suggested. Despite of the benefits of an early intervention, palliative care remains underutilized in patients with PAH, and this significantly raises issues around end-of-life care in PAH. In this review, we will discuss the opportunities offered and the existing barriers in addressing high symptom burden and end-of-life care issues. We will focus on the current evidence, identify areas for future research, and provide a call-to-action for better guidance to PAH specialists in making timely, appropriate interventions that can help mitigate end-of-life care issues.
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Affiliation(s)
- Hyeon-Ju Ali
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Sandeep Sahay
- Division of Pulmonary, Critical Care and Sleep Medicine, Houston Methodist Lung Center, Houston Methodist Hospital, Houston, Texas
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Ali HJ, Deswal A. In patients with HFpEF and obesity, semaglutide increased weight loss and reduced symptoms and physical limitations at 52 wk. Ann Intern Med 2023; 176:JC136. [PMID: 38048584 DOI: 10.7326/j23-0101] [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] [Indexed: 12/06/2023] Open
Abstract
SOURCE CITATION Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al; STEP-HFpEF Trial Committees and Investigators. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389:1069-1084. 37622681.
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Affiliation(s)
- Hyeon-Ju Ali
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA (H.A., A.D.)
| | - Anita Deswal
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA (H.A., A.D.)
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Abstract
Restrictive cardiomyopathy (RCM) includes a heterogeneous group of diseases that cause increased myocardial stiffness, leading to impaired ventricular relaxation and severe diastolic dysfunction. Given that it is the least common type of cardiomyopathy, it can be a diagnostic challenge due to its varied pathogenesis, clinical presentation, and diagnostic evaluation. In this review, we provide an overview of different etiologies of RCM and examine the diagnostic and treatment approaches for various types.
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Affiliation(s)
- Smitha Narayana Gowda
- Department of Cardiovascular Medicine, Houston Methodist Hospital, Houston, Texas, US
| | - Hyeon-Ju Ali
- Department of Cardiovascular Medicine, Houston Methodist Hospital, Houston, Texas, US
| | - Imad Hussain
- Department of Cardiovascular Medicine, Houston Methodist Hospital, Houston, Texas, US
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Chang R, Javed Z, Taha M, Yahya T, Valero-Elizondo J, Brandt EJ, Cainzos-Achirica M, Mahajan S, Ali HJ, Nasir K. Food insecurity and cardiovascular disease: Current trends and future directions. Am J Prev Cardiol 2022; 9:100303. [PMID: 34988538 PMCID: PMC8702994 DOI: 10.1016/j.ajpc.2021.100303] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/20/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022] Open
Abstract
Food insecurity (FI) - a state of limited access to nutritionally adequate food - is notably more prominent among patients with cardiovascular disease (CVD) than the general population. Current research suggests that FI increases the risk of cardiovascular morbidity and mortality through various behavioral and biological pathways. Importantly, FI is more prevalent among low-income households and disproportionately affects households with children, particularly those led by single mothers. These disparities necessitate solutions specifically geared towards helping these high-risk subgroups, who also experience increased risk of CVD associated with FI. Further, individuals with CVD may experience increased risk of FI due to the financial burden imposed by CVD care. While participation in federal aid programs like the Supplemental Nutrition Assistance Program and the Special Supplemental Nutrition Program for Women, Infants, and Children has been associated with cardiovascular health benefits, residual FI and lower dietary quality among many families suggest a need for better outreach and expanded public assistance programs. Healthcare systems and community organizations can play a vital role in screening individuals for FI and connecting them with food and educational resources. While further research is needed to evaluate sociodemographic differences in the FI-CVD relationship, interventions at the policy, health system, and community levels can help address both the burden of FI and its impacts on cardiovascular health.
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Affiliation(s)
- Ryan Chang
- Washington University in St. Louis, St. Louis, MO, USA
- Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Zulqarnain Javed
- Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Mohamad Taha
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Tamer Yahya
- Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Javier Valero-Elizondo
- Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), USA
| | - Eric J. Brandt
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Miguel Cainzos-Achirica
- Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Shiwani Mahajan
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Hyeon-Ju Ali
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Khurram Nasir
- Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins Medicine, Baltimore, MD, USA
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Wang SY, Valero-Elizondo J, Ali HJ, Pandey A, Cainzos-Achirica M, Krumholz HM, Nasir K, Khera R. Out-of-Pocket Annual Health Expenditures and Financial Toxicity From Healthcare Costs in Patients With Heart Failure in the United States. J Am Heart Assoc 2021; 10:e022164. [PMID: 33998273 PMCID: PMC8483501 DOI: 10.1161/jaha.121.022164] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 01/01/2023]
Abstract
Background Heart failure (HF) poses a major public health burden in the United States. We examined the burden of out‐of‐pocket healthcare costs on patients with HF and their families. Methods and Results In the Medical Expenditure Panel Survey, we identified all families with ≥1 adult member with HF during 2014 to 2018. Total out‐of‐pocket healthcare expenditures included yearly care‐specific costs and insurance premiums. We evaluated 2 outcomes of financial toxicity: (1) high financial burden—total out‐of‐pocket healthcare expense to postsubsistence income ratio of >20%, and (2) catastrophic financial burden with the ratio of >40%—a bankrupting expense defined by the World Health Organization. There were 788 families in the Medical Expenditure Panel Survey with a member with HF representing 0.54% (95% CI, 0.48%–0.60%) of all families nationally. The overall mean annual out‐of‐pocket healthcare expenses were $4423 (95% CI, $3908–$4939), with medications and health insurance premiums representing the largest categories of cost. Overall, 14% (95% CI, 11%–18%) of families experienced a high burden and 5% (95% CI, 3%–6%) experienced a catastrophic burden. Among the two‐fifths of families considered low income, 24% (95% CI, 18%–30%) experienced a high financial burden, whereas 10% (95% CI, 6%–14%) experienced a catastrophic burden. Low‐income families had 4‐fold greater risk‐adjusted odds of high financial burden (odds ratio [OR] , 3.9; 95% CI, 2.3–6.6), and 14‐fold greater risk‐adjusted odds of catastrophic financial burden (OR, 14.2; 95% CI, 5.1–39.5) compared with middle/high‐income families. Conclusions Patients with HF and their families experience large out‐of‐pocket healthcare expenses. A large proportion encounter financial toxicity, with a disproportionate effect on low‐income families.
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Affiliation(s)
- Stephen Y Wang
- Department of Internal Medicine Yale-New Haven Hospital New Haven CT
| | | | - Hyeon-Ju Ali
- Department of Cardiology Houston Methodist Houston TX
| | - Ambarish Pandey
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | | | - Harlan M Krumholz
- Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Khurram Nasir
- Department of Cardiology Houston Methodist Houston TX
| | - Rohan Khera
- Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
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Corbet PS, Ali HJ. Diel patterns of pupation and emergence, and protogyny, in Toxorhynchites brevipalpis brevipalpis (Theobald) (Diptera: Culicidae): a laboratory study. Ann Trop Med Parasitol 1987; 81:437-43. [PMID: 3446030 DOI: 10.1080/00034983.1987.11812141] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A batch of Toxorhynchites brevipalpis brevipalpis (Theobald) of uniform age was reared from egg to adult under controlled conditions in the laboratory. Diel patterns of pupation and emergence, and duration of larval and pupal stages, were recorded for males and females separately. Pupation showed no detectable diel periodicity, but emergence was almost exclusively diurnal and occurred most frequently during the middle six hours of the 12-hour photophase. T. b. brevipalpis is exceptional among mosquitoes in being protogynous at emergence, although it is not protogynous at pupation: the earlier emergence of females reflects the shorter duration of their pupal stage.
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Affiliation(s)
- P S Corbet
- Department of Biological Sciences, The University, Dundee, U.K
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