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Witt LS, Howard-Anderson J, Prakash-Asrani R, Overton E, Jacob JT. The role of the hospital bed in hospital-onset Clostridioides difficile: A retrospective study with mediation analysis. Infect Control Hosp Epidemiol 2024; 45:599-603. [PMID: 38087652 PMCID: PMC11027076 DOI: 10.1017/ice.2023.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/29/2023] [Accepted: 10/14/2023] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To determine whether residing in a hospital bed that previously held an occupant with Clostridioides difficile increases the risk of hospital-onset C. difficile infection (HO-CDI). METHODS In this retrospective cohort study, we used a real-time location system to track the movement of hospital beds in 2 academic hospitals from April 2018 to August 2019. We abstracted patient demographics, clinical characteristics, and C. difficile polymerase chain reaction (PCR) results from the medical record. We defined patients as being exposed to a potentially "contaminated" bed or room if, within the preceding 7 days from their HO-CDI diagnosis, they resided in a bed or room respectively, that held an occupant with C. difficile in the previous 90 days. We used multivariable logistic regression to determine whether residing in a contaminated bed was associated with HO-CDI after controlling for time at risk and requiring intensive care. We assessed mediation and interaction from a contaminated hospital room. RESULTS Of 25,032 hospital encounters with 18,860 unique patients, we identified 237 cases of HO-CDI. Exposure to a contaminated bed was associated with HO-CDI in unadjusted analyses (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.4-2.31) and adjusted analyses (OR, 1.5; 95% CI, 1.2-2.0). Most of this effect was due to both mediation from and interaction with a contaminated hospital room. CONCLUSIONS Residing in a hospital bed or room that previously had a patient with C. difficile increases the risk of HO-CDI. Increased attention to cleaning and disinfecting the healthcare environment may reduce hospital transmission of C. difficile.
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Affiliation(s)
- Lucy S. Witt
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Emory Healthcare, Atlanta, Georgia
| | - Jessica Howard-Anderson
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Emory Healthcare, Atlanta, Georgia
- Emory Antibiotic Resistance Center, Atlanta, Georgia
| | - Radhika Prakash-Asrani
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | | | - Jesse T. Jacob
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Emory Healthcare, Atlanta, Georgia
- Emory Antibiotic Resistance Center, Atlanta, Georgia
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Witt LS, Sexton ME, Smith G, Farley M, Jacob JT. Evaluating indwelling devices and other risk factors for mortality in invasive Carbapenem-resistant Enterobacterales infections in Georgia, 2012-2019. Antimicrob Steward Healthc Epidemiol 2024; 3:e254. [PMID: 38178877 PMCID: PMC10762638 DOI: 10.1017/ash.2023.531] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024]
Abstract
Objective Carbapenem-resistant Enterobacterales (CRE) infections are a public health threat due to the risk of transmission between patients and high associated mortality. We sought to identify risk factors for mortality in patients with invasive CRE infections and to specifically evaluate whether there was an association between indwelling medical devices and 90-day mortality. Design Retrospective observational cohort study of patients infected with CRE in the eight-county metropolitan Atlanta area between 2012 and 2019. Methods Patients with invasive CRE infections were identified via the Georgia Emerging Infections Program's active, population- and laboratory-based surveillance system and linked with the Georgia Vital Statistics database. We used bivariate analysis to identify risk factors for mortality and completed log binomial multivariable regression to estimate risk ratios (RR) for the association between indwelling devices and mortality. Results In total, 154 invasive CRE infections were identified, with indwelling devices present in most patients (87.7%) around the time of infection. Admission to an intensive care unit was found to be associated with 90-day mortality (adjusted RR [aRR] 1.55, 95% CI 1.07, 2.24); however, the presence of any indwelling device was not associated with increased risk of 90-day mortality in multivariable analysis (aRR 1.22, 95% CI 0.55, 2.73). Having at least two indwelling devices was associated with increased mortality (aRR 1.79, 95% CI 1.05, 3.05). Conclusions Indwelling devices were prevalent in our cohort but were not consistently associated with an increased risk of mortality. Further studies are needed to examine this relationship and the role of device removal.
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Affiliation(s)
- Lucy S. Witt
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Atlanta, GA, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA
| | - Mary Elizabeth Sexton
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Gillian Smith
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Atlanta, GA, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA
| | - Monica Farley
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Atlanta, GA, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA
| | - Jesse T. Jacob
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Atlanta, GA, USA
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3
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Spicer JO, Ujunwa KC, Witt LS, Meka J, Gooding HC. Using instructor-developed study resources to increase evidence-based learning strategies among medical students: A mixed-methods study. Med Teach 2023; 45:1380-1386. [PMID: 37270765 PMCID: PMC11002966 DOI: 10.1080/0142159x.2023.2218537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Applying effective learning strategies to address knowledge gaps is a critical skill for lifelong learning, yet prior studies demonstrate that medical students use ineffective study habits. METHODS To address this issue, the authors created and integrated study resources aligned with evidence-based learning strategies into a medical school course. Pre-/post-course surveys measured changes in students' knowledge and use of evidence-based learning strategies. Eleven in-depth interviews subsequently explored the impact of the learning resources on students' study habits. RESULTS Of 139 students, 43 and 66 completed the pre- and post-course surveys, respectively. Students' knowledge of evidence-based learning strategies was unchanged; however, median time spent using flashcards (15% to 50%, p < .001) and questions (10% to 20%, p = .0067) increased while time spent creating lecture notes (20% to 0%, p = .003) and re-reading notes (10% to 0%, p = .009) decreased. In interviews, students described four ways their habits changed: increased use of active learning techniques, decreased time spent creating learning resources, reviewing content multiple times throughout the course, and increased use of study techniques synthesizing course content. CONCLUSION Incorporating evidence-based study resources into the course increased students' use of effective learning techniques, suggesting this may be more effective than simply teaching about evidence-based learning.
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Affiliation(s)
- Jennifer O. Spicer
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Katherine C. Ujunwa
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lucy S. Witt
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer Meka
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Holly C. Gooding
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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Witt LS, Page A, Burd EM, Ozturk T, Weiss DS, Ray SM, Satola S, Gottlieb LB. Discordant antimicrobial susceptibility and polymerase chain reaction (PCR) testing in a Klebsiella pneumoniae isolate with a carbapenemase gene. Infect Control Hosp Epidemiol 2023; 44:2100-2102. [PMID: 37652898 DOI: 10.1017/ice.2023.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Lucy S Witt
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta Veterans' Affairs Medical Center, Decatur, Georgia
| | - Alex Page
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta Veterans' Affairs Medical Center, Decatur, Georgia
| | - Eileen M Burd
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
- Emory Antibiotic Resistance Center, Atlanta, Georgia
| | - Tugba Ozturk
- Emory Antibiotic Resistance Center, Atlanta, Georgia
| | - David S Weiss
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Emory Antibiotic Resistance Center, Atlanta, Georgia
| | - Susan M Ray
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta Veterans' Affairs Medical Center, Decatur, Georgia
| | - Sarah Satola
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta Veterans' Affairs Medical Center, Decatur, Georgia
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
- Emory Antibiotic Resistance Center, Atlanta, Georgia
| | - Lindsey B Gottlieb
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
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Witt LS, Howard-Anderson JR, Jacob JT, Gottlieb LB. The impact of COVID-19 on multidrug-resistant organisms causing healthcare-associated infections: a narrative review. JAC Antimicrob Resist 2022; 5:dlac130. [PMID: 36601548 PMCID: PMC9798082 DOI: 10.1093/jacamr/dlac130] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) changed healthcare across the world. With this change came an increase in healthcare-associated infections (HAIs) and a concerning concurrent proliferation of MDR organisms (MDROs). In this narrative review, we describe the impact of COVID-19 on HAIs and MDROs, describe potential causes of these changes, and discuss future directions to combat the observed rise in rates of HAIs and MDRO infections.
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Affiliation(s)
- Lucy S Witt
- Corresponding author. E-mail: ; @drwittID, @JessH_A, @jestjac
| | - Jessica R Howard-Anderson
- Division of Infection Diseases, Emory University School of Medicine, Atlanta, GA, USA,Emory Antibiotic Resistance Group, Emory University, Atlanta, GA, USA
| | - Jesse T Jacob
- Division of Infection Diseases, Emory University School of Medicine, Atlanta, GA, USA,Emory Antibiotic Resistance Group, Emory University, Atlanta, GA, USA
| | - Lindsey B Gottlieb
- Division of Infection Diseases, Emory University School of Medicine, Atlanta, GA, USA,Emory Antibiotic Resistance Group, Emory University, Atlanta, GA, USA
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Witt LS, Wendy Fujita A, Ho J, Shin YM, Kobaidze K, Workowski K. Otosyphilis. Open Forum Infect Dis 2022; 10:ofac685. [PMID: 36776779 PMCID: PMC9907508 DOI: 10.1093/ofid/ofac685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Otosyphilis can be challenging to diagnose, but, if left unrecognized, it may cause irreversible damage. An immunologic interplay between syphilis and human immunodeficiency virus (HIV) makes coinfection likely and may predispose people with HIV to neurosyphilis. In this study, we present a case of a man in his 50s with hearing loss and vertigo diagnosed with otosyphilis as well as a new diagnosis of HIV. This case and corresponding discussion serve to inform the noninfectious disease-trained clinician of the symptoms, diagnostics, and treatment options for otosyphilis as well as to discuss the relationship between HIV and syphilis and demonstrate the importance of disease recognition.
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Affiliation(s)
- Lucy S Witt
- Correspondence: Lucy S. Witt, MD, MPH, 550 Peachtree St. NE, Medical Office Tower, FLR. 7, Atlanta, GA 30308. E-mail: . Wendy Fujita, MD, Department of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30308. E-mail:
| | - A Wendy Fujita
- Correspondence: Lucy S. Witt, MD, MPH, 550 Peachtree St. NE, Medical Office Tower, FLR. 7, Atlanta, GA 30308. E-mail: . Wendy Fujita, MD, Department of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30308. E-mail:
| | - Jeanne Ho
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yoo Mee Shin
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ketino Kobaidze
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Witt LS, Smith G, Sexton ME, Farley MM, Jacob JT. 416. Evaluating Indwelling Devices and Mortality in Invasive Carbapenem-Resistant Enterobacterales Infections, Atlanta, GA, 2012–2019. Open Forum Infect Dis 2022. [PMCID: PMC9752111 DOI: 10.1093/ofid/ofac492.493] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Carbapenem-resistant Enterobacterales (CRE) infections pose a grave public health threat due to the potentially silent transmission leading to outbreaks, limited therapeutic options and high mortality. We sought to identify risk factors for mortality in patients with invasive CRE infections and describe the association between indwelling medical devices and 90-day mortality. Methods The Georgia Emerging Infections Program performs active population and laboratory based surveillance for CRE in the Atlanta, Georgia metropolitan area. Using this data we created a retrospective observational cohort of patients with invasive CRE infections between 2012 and 2019. Invasive infections were defined as resistant isolates obtained from a normally sterile site (Table 1). Indwelling medical devices, including central venous catheters (CVCs), were present within two calendar days prior to infection. We completed bivariate analyses examining the relationship between covariates and mortality. Multivariable log binomial regression was used to estimate adjusted risk ratios (aRR) for the association of covariates and all-cause 90-day mortality. Sub-group analyses were completed evaluating only those patients with CVCs and those with at least two indwelling devices.
Definition of Carbapenem-resistant Enterobacterales ![]() Abbreviations: MIC – minimum inhibitory concentration Results There were 154 invasive CRE infections (Table 2) with 87.7% having at least one indwelling device and an overall mortality of 23.4%. Intensive care unit (ICU) admission, having at least two indwelling devices, and requiring chronic dialysis were associated with mortality on bivariate analysis. The presence of any indwelling device (aRR 1.02, 95% CI 0.36, 2.89) or specifically a CVC (aRR 1.13, 95% CI 0.54, 2.37) were not associated with increased risk of 90-day mortality in unadjusted or multivariable analysis (Table 3). Having at least two indwelling devices was associated with increased risk of mortality (aRR 2.48, 95% CI: 1.02, 5.99) (Table 3). Characteristics of Patients with Invasive CRE Infections in Atlanta, Georgia 2012-2019
![]() Race: 6 unknowns, Ethnicity: 28 unknowns Other race: American Indian or Alaska Native, Asian, Native Hawaiian or Pacific Islander Other sites of infection: deep tissue, sterile fluid, or other sterile site Other indwelling devices: endotracheal or nasotracheal tube, nephrostomy tube, nasogastric tube, other * 1 missing **16 patients never admitted to the hospital and 2 with missing data Risk Ratios for Invasive Devices and Mortality Including Subgroup Analyses
![]() 1 Adjusted for indwelling device, Charlson comorbidity score, intensive care admission, previous stay at LTACH 2 Adjusted for central venous catheter, Charlson comorbidity score, intensive care admission, previous stay at LTACH 3 Adjusted for at least two indwelling devices, Charlson comorbidity score, previous stay at LTACH Abbreviations: LTACH - Long Term Acute Care hospital Conclusion In patients with invasive CRE infections, indwelling medical device use was frequent but only associated with mortality in patients with multiple devices. Stewardship of medical devices may be an important target for intervention in this population. Disclosures All Authors: No reported disclosures.
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Affiliation(s)
| | - Gillian Smith
- Georgia Emerging Infections Program, Atlanta, GA; Foundation for Atlanta Veterans Education and Research, Decatur, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA, Atlanta, Georgia
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8
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Witt LS, Burd EM, Ozturk T, Satola SW, Weiss DS, Jacob JT. 'Bacteraemia with an MBL-producing Klebsiella pneumoniae: treatment and the potential role of cefiderocol heteroresistance'-authors' response. J Antimicrob Chemother 2022; 77:3212. [PMID: 36177772 DOI: 10.1093/jac/dkac330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lucy S Witt
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30322, USA.,Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, GA 30303, USA
| | - Eileen M Burd
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30322, USA.,Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.,Emory School of Medicine, Emory Antibiotic Resistance Center, Atlanta, GA 30322, USA
| | - Tugba Ozturk
- Emory School of Medicine, Emory Antibiotic Resistance Center, Atlanta, GA 30322, USA
| | - Sarah W Satola
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30322, USA.,Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, GA 30303, USA.,Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.,Emory School of Medicine, Emory Antibiotic Resistance Center, Atlanta, GA 30322, USA
| | - David S Weiss
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30322, USA.,Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, GA 30303, USA.,Emory School of Medicine, Emory Antibiotic Resistance Center, Atlanta, GA 30322, USA
| | - Jesse T Jacob
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30322, USA.,Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, GA 30303, USA.,Emory School of Medicine, Emory Antibiotic Resistance Center, Atlanta, GA 30322, USA
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9
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Witt LS, Steed DB, Burd EM, Ozturk T, Davis MH, Satola SW, Weiss DS, Jacob JT. Bacteraemia with an MBL-producing Klebsiella pneumoniae: treatment and the potential role of cefiderocol heteroresistance. J Antimicrob Chemother 2022; 77:2569-2571. [PMID: 35726616 PMCID: PMC9989728 DOI: 10.1093/jac/dkac197] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Lucy S Witt
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, GA, USA
| | - Danielle Barrios Steed
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Eileen M Burd
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Emory Antibiotic Resistance Center, Atlanta, GA, USA
| | - Tugba Ozturk
- Emory Antibiotic Resistance Center, Atlanta, GA, USA
| | | | - Sarah W Satola
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, GA, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Emory Antibiotic Resistance Center, Atlanta, GA, USA
| | - David S Weiss
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, GA, USA
- Emory Antibiotic Resistance Center, Atlanta, GA, USA
| | - Jesse T Jacob
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, GA, USA
- Emory Antibiotic Resistance Center, Atlanta, GA, USA
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10
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Faulkner KM, Dickson VV, Fletcher J, Katz SD, Chang PP, Gottesman RF, Witt LS, Shah AM, D'Eramo Melkus G. Factors Associated With Cognitive Impairment in Heart Failure With Preserved Ejection Fraction. J Cardiovasc Nurs 2022; 37:17-30. [PMID: 32649377 PMCID: PMC9069246 DOI: 10.1097/jcn.0000000000000711] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Cognitive impairment is prevalent in heart failure and is associated with higher mortality rates. The mechanism behind cognitive impairment in heart failure with preserved ejection fraction (HFpEF) has not been established. OBJECTIVE The aim of this study was to evaluate associations between abnormal cardiac hemodynamics and cognitive impairment in individuals with HFpEF. METHODS A secondary analysis of Atherosclerosis Risk in Communities (Atherosclerosis Risk in Communities) study data was performed. Participants free of stroke or dementia who completed in-person assessments at visit 5 were included. Neurocognitive test scores among participants with HFpEF, heart failure with reduced ejection fraction (HFrEF), and no heart failure were compared. Sociodemographics, comorbid illnesses, medications, and echocardiographic measures of cardiac function that demonstrated significant (P < .10) bivariate associations with neurocognitive test scores were included in multivariate models to identify predictors of neurocognitive test scores among those with HFpEF. Multiple imputation by chained equations was used to account for missing values. RESULTS Scores on tests of attention, language, executive function, and global cognitive function were worse among individuals with HFpEF than those with no heart failure. Neurocognitive test scores were not significantly different among participants with HFpEF and HFrEF. Worse diastolic function was weakly associated with worse performance in memory, attention, and language. Higher cardiac index was associated with worse performance on 1 test of attention. CONCLUSIONS Cognitive impairment is prevalent in HFpEF and affects several cognitive domains. The current study supports the importance of cognitive screening in patients with heart failure. An association between abnormal cardiac hemodynamics and cognitive impairment was observed, but other factors are likely involved.
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Witt LS, Rotter J, Stearns SC, Gottesman RF, Kucharska-Newton AM, Richey Sharrett A, Wruck LM, Bressler J, Sueta CA, Chang PP. Heart Failure and Cognitive Impairment in the Atherosclerosis Risk in Communities (ARIC) Study. J Gen Intern Med 2018; 33:1721-1728. [PMID: 30030736 PMCID: PMC6153245 DOI: 10.1007/s11606-018-4556-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/26/2018] [Accepted: 06/27/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Previous studies suggest that heart failure (HF) is an independent risk factor for cognitive decline. A better understanding of the relationship between HF, cognitive status, and cognitive decline in a community-based sample may help clinicians understand disease risk. OBJECTIVE To examine whether persons with HF have a higher prevalence of cognitive impairment and whether persons developing HF have more rapid cognitive decline. DESIGN This observational cohort study of American adults in the Atherosclerosis Risk in Communities (ARIC) study has two components: cross-sectional analysis examining the association between prevalent HF and cognition using multinomial logistic regression, and change over time analysis detailing the association between incident HF and change in cognition over 15 years. PARTICIPANTS Among visit 5 (2011-2013) participants (median age 75 years), 6495 had neurocognitive information available for cross-sectional analysis. Change over time analysis examined the 5414 participants who had cognitive scores and no prevalent HF at visit 4 (1996-1998). MEASUREMENTS The primary outcome was cognitive status, classified as normal, mild cognitive impairment [MCI], and dementia on the basis of standardized cognitive tests (delayed word recall, word fluency, and digit symbol substitution). Cognitive change was examined over a 15-year period. Control variables included socio-demographic, vascular, and smoking/drinking measures. RESULTS At visit 5, participants with HF had a higher prevalence of dementia (adjusted relative risk ratio [RRR] = 1.60 [95% CI 1.13, 2.25]) and MCI (RRR = 1.36 [1.12, 1.64]) than those without HF. A decline in cognition between visits 4 and 5 was - 0.07 standard deviation units [- 0.13, - 0.01] greater among persons who developed HF compared to those who did not. Results did not differ by ejection fraction. CONCLUSION HF is associated with neurocognitive dysfunction and decline independent of other co-morbid conditions. Further study is needed to determine the underlying pathophysiology.
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Affiliation(s)
- Lucy S Witt
- Department of Hospital Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA.
| | - Jason Rotter
- Department of Health Policy & Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sally C Stearns
- Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna M Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa M Wruck
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Jan Bressler
- Human Genetics, and Environmental Sciences, University of Texas Health School of Public Health Department of Epidemiology, Austin, TX, USA
| | - Carla A Sueta
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Patricia P Chang
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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