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Goyal P, Zhu A, Clarkson SA, Brown TM, Durant R, Kingery JR, Shen MJ, Khodneva Y, Jackson EA, Safford MM, Levitan EB. Patient Awareness of Their Heart Failure Diagnosis and Its Implications for Epidemiologic Studies and Clinical Care. Am J Cardiol 2023; 195:27-27.c3. [PMID: 37003081 DOI: 10.1016/j.amjcard.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York.
| | | | | | - Todd M Brown
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Raegan Durant
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Justin R Kingery
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Megan J Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Yulia Khodneva
- Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Monika M Safford
- Department of Medicine, Weill Cornell Medicine, New York, New York
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Stockdill ML, Dionne-Odom JN, Wells R, Ejem D, Azuero A, Keebler K, Sockwell E, Tims S, Burgio KL, Engler S, Durant R, Pamboukian SV, Tallaj J, Swetz KM, Kvale E, Tucker R, Bakitas M. African American Recruitment in Early Heart Failure Palliative Care Trials: Outcomes and Comparison With the ENABLE CHF-PC Randomized Trial. J Palliat Care 2023; 38:52-61. [PMID: 33258422 PMCID: PMC8314978 DOI: 10.1177/0825859720975978] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Palliative care trial recruitment of African Americans (AAs) is a formidable research challenge. OBJECTIVES Examine AA clinical trial recruitment and enrollment in a palliative care randomized controlled trial (RCT) for heart failure (HF) patients and compare patient baseline characteristics to other HF palliative care RCTs. METHODS This is a descriptive analysis the ENABLE CHF-PC (Educate, Nurture, Advise, Before Life Ends: Comprehensive Heartcare for Patients and Caregivers) RCT using bivariate statistics to compare racial and patient characteristics and differences through recruitment stages. We then compared the baseline sample characteristics among three palliative HF trials. RESULTS Of 785 patients screened, 566 eligible patients with NYHA classification III-IV were approached; 461 were enrolled and 415 randomized (AA = 226). African Americans were more likely to consent than Caucasians (55%; P FDR = .001), were younger (62.7 + 8; P FDR = .03), had a lower ejection fraction (39.1 + 15.4; PFDR = .03), were more likely to be single (P FDR = .001), and lack an advanced directive (16.4%; P FDR < .001). AAs reported higher goal setting (3.3 + 1.3; P FDR = .007), care coordination (2.8 + 1.3; P FDR = .001) and used more "denial" coping strategies (0.8 + 1; P FDR = .001). Compared to two recent HF RCTs, the ENABLE CHF-PC sample had a higher proportion of AAs and higher baseline KCCQ clinical summary scores. CONCLUSION ENABLE CHF-PC has the highest reported recruitment rate and proportion of AAs in a palliative clinical trial to date. Community-based recruitment partnerships, recruiter training, ongoing communication with recruiters and clinician co-investigators, and recruiter racial concordance likely contributed to successful recruitment of AAs. These important insights provide guidance for design of future HF palliative RCTs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02505425.
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Affiliation(s)
- Macy L. Stockdill
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Konda Keebler
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Sockwell
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sheri Tims
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathryn L. Burgio
- Division of Gerontology, Department of Medicine, Geriatrics, Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Raegan Durant
- Division of Preventative Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Salpy V. Pamboukian
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jose Tallaj
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Keith M. Swetz
- Division of Gerontology, Department of Medicine, Geriatrics, Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Kvale
- Department of Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Rodney Tucker
- Department of Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Marie Bakitas
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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Hernandez ND, Durant R, Lisovicz N, Nweke C, Belizaire C, Cooper D, Soiro F, Rivers D, Sodeke S, Rivers BM. African American Cancer Survivors' Perspectives on Cancer Clinical Trial Participation in a Safety-Net Hospital: Considering the Role of the Social Determinants of Health. J Cancer Educ 2022; 37:1589-1597. [PMID: 33728872 PMCID: PMC8443686 DOI: 10.1007/s13187-021-01994-4] [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] [Subscribe] [Scholar Register] [Accepted: 03/07/2021] [Indexed: 05/21/2023]
Abstract
Although there has been an increase focus on recruitment of minority populations at safety-net hospitals into cancer clinical trials, there is still a paucity of research exploring minority participation in cancer clinical trials at safety-net settings. The study utilized a multi-level, qualitative approach to assess the clinical and non-clinical facilitators and barriers to African American participation in cancer clinical trials at a safety-net hospital. From June 2018 to July 2019, cancer survivors (n = 25) were recruited from a cancer center at a safety-net hospital in the southeastern USA and participated in a 60-min focus group. Data was coded and analyzed to identify the most prominent themes. Most participants were female (78%), with a mean age of 56 years. The majority were diagnosed with breast cancer (68%) and disabled or unemployed (55%). Major themes identified were (1) lack of understanding of cancer clinical trials, (2) perceptions and fears of cancer clinical trials, and (3) preferred role and characteristics of patient navigator. The barriers and facilitators to enrollment in cancer clinical trials were more pronounced in the safety-net setting, given the overdue burden of social determinants of health. Study findings yield important insights and essential practices for recruiting and engaging underrepresented Black cancer patients into cancer clinical trials, specifically for safety-net settings. Including patient navigators may help traverse potential barriers to cancer clinical trial participation and will allow for the attention to social determinants of health, and ultimately increase the number of African Americans participating in cancer clinical trials.
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Affiliation(s)
- N D Hernandez
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA.
| | - R Durant
- Division of Preventive Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - N Lisovicz
- Division of Preventive Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - C Nweke
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA
| | | | - D Cooper
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA
| | - F Soiro
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA
| | - D Rivers
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA
| | - S Sodeke
- Tuskegee University, Tuskegee, AL, USA
| | - B M Rivers
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA
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Balkan L, Ringel JB, Levitan EB, Khodneva YA, Pinheiro LC, Sterling MR, Kim SM, Kronish IM, Jackson EA, Durant R, Safford M, Goyal P. Association of Perceived Stress With Incident Heart Failure. J Card Fail 2022; 28:1401-1410. [PMID: 35568129 PMCID: PMC9704753 DOI: 10.1016/j.cardfail.2022.04.013] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The relationship between psychological stress and heart failure (HF) has not been well studied. We sought to assess the relationship between perceived stress and incident HF. METHODS We used data from the national REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a large prospective biracial cohort study that enrolled community-dwellers aged 45 years and older between 2003 and 2007, with follow-up. We included participants free of suspected prevalent HF who completed the Cohen 4-item Perceived Stress Scale (PSS-4). Our outcome variables were incident HF event, HF with reduced ejection fraction events, and HF with preserved ejection fraction events. We estimated Cox proportional hazard models to determine if PSS-4 quartiles were independently associated with incident HF events, adjusting for sociodemographics, social support, unhealthy behaviors, comorbid conditions, and physiologic parameters. We also tested interactions by baseline statin use, given its anti-inflammatory properties. RESULTS Among 25,785 participants with a mean age of 64 ± 9.3 years, 55% were female and 40% were Black. Over a median follow-up of 10.1 years, 1109 ± 4.3% experienced an incident HF event. In fully adjusted models, the PSS-4 was not associated with HF or HF with reduced ejection fraction. However, PSS-4 quartiles 2-4 (compared with the lowest quartile) were associated with incident HF with preserved ejection fraction (Q2 hazard ratio 1.37, 95% confidence interval 1.00-1.88; Q3 hazard ratio 1.42, 95% confidence interval 1.03-1.95; Q4 hazard ratio 1.41, 95% confidence interval 1.04-1.92). Notably, this association was attenuated among participants who took a statin at baseline (P for interaction = .07). CONCLUSIONS Elevated perceived stress was associated with incident HF with preserved ejection fraction but not HF with reduced ejection fraction.
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Affiliation(s)
- Lauren Balkan
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Joanna B Ringel
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Yulia A Khodneva
- Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Laura C Pinheiro
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - Samuel M Kim
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
| | - Elizabeth A Jackson
- Division of Cardiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Raegan Durant
- Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Monika Safford
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York.
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Khodneva Y, Ringel JB, Rajan M, Goyal P, Jackson EA, Sterling MR, Cherrington A, Oparil S, Durant R, Safford MM, Levitan EB. Depressive symptoms, cognitive impairment, and all-cause mortality among REGARDS participants with heart failure. European Heart Journal Open 2022; 2:oeac064. [PMID: 36330357 PMCID: PMC9617474 DOI: 10.1093/ehjopen/oeac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/06/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022]
Abstract
Aims To ascertain whether depressive symptoms and cognitive impairment (CI) are associated with mortality among patients with heart failure (HF), adjusting for sociodemographic, comorbidities, and biomarkers. Methods and results We utilized Medicare-linked data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a biracial prospective ongoing cohort of 30 239 US community-dwelling adults, recruited in 2003-07. HF diagnosis was ascertained in claims analysis. Depressive symptoms were defined as a score ≥4 on the four-item Center for Epidemiological Studies-Depression scale. Cognitive impairment was defined as a score of ≤4 on the six-item screener that assessed three-item recall and orientation to year, month, and day of the week. Sequentially adjusted Cox proportional hazard models were used to estimate the risk of death. We analyzed 1059 REGARDS participants (mean age 73, 48%-African American) with HF; of those 146 (14%) reported depressive symptoms, 136 (13%) had CI and 31 (3%) had both. Over the median follow-up of 6.8 years (interquartile range, 3.4-10.3), 785 (74%) died. In the socio-demographics-adjusted model, CI was significantly associated with increased mortality, hazard ratio 1.24 (95% confidence interval 1.01-1.52), compared with persons with neither depressive symptoms nor CI, but this association was attenuated after further adjustment. Neither depressive symptoms alone nor their comorbidity with CI was associated with mortality. Risk factors of all-cause mortality included: low income, comorbidities, smoking, physical inactivity, and severity of HF. Conclusion Depressive symptoms, CI, or their comorbidity was not associated with mortality in HF in this study. Treatment of HF in elderly needs to be tailored to cognitive status and includes focus on medical comorbidities.
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Affiliation(s)
- Yulia Khodneva
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Joanna Bryan Ringel
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Mangala Rajan
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Parag Goyal
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
- Division of Cardiology, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Elizabeth A Jackson
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Madeline R Sterling
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Andrea Cherrington
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Suzanne Oparil
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Raegan Durant
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Monika M Safford
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Emily B Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, Al 35294, USA
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Khodneva Y, Goyal P, Levitan EB, Jackson EA, Oparil S, Sterling MR, Cherrington AL, Durant R, Safford MM. Depressive Symptoms and Incident Hospitalization for Heart Failure: Findings From the REGARDS Study. J Am Heart Assoc 2022; 11:e022818. [PMID: 35322678 PMCID: PMC9075424 DOI: 10.1161/jaha.121.022818] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/26/2022] [Indexed: 12/13/2022]
Abstract
Background Depressive symptoms are risk factors for several forms of cardiovascular disease including coronary heart disease (CHD). However, it is unclear whether depressive symptoms are associated with incident heart failure (HF), including hospitalization for HF overall or by subtype: HF with preserved (HFpEF) or reduced ejection fraction (HFrEF). Methods and Results Among 26 268 HF-free participants in the REGARDS (Reasons for Geographic And Racial Differences in Stroke) study, a prospective biracial cohort of US community-dwelling adults ≥45 years, baseline depressive symptoms were defined as a score ≥4 on the 4-item Center for Epidemiologic Studies Depression scale. Incident HF hospitalizations were expert-adjudicated and categorized as HFpEF (EF ≥50%) and HFrEF, including mid-range EF (EF<50%). Over a median of 9.2 [IQR 6.2-10.9] years of follow-up, there were 872 incident HF hospitalizations, 526 among those without CHD and 334 among those with CHD. The age-adjusted HF hospitalization incidence rates per 1000 person-years were 4.9 (95% CI 4.0-5.9) for participants with depressive symptoms versus 3.2 (95% CI 3.0-3.5) for those without depressive symptoms (P<0.001). For overall HF, the elevated risk became attenuated after controlling for covariates. When HFpEF was assessed separately, depressive symptoms were associated with incident hospitalization after controlling for all covariates (hazard ratio [HR] 1.48, 95% CI 1.00-2.18) among those without baseline CHD. In contrast, depressive symptoms were not associated with incident HFrEF hospitalizations. Conclusions Among individuals free of CHD at baseline, depressive symptoms were associated with incident hospitalization for HFpEF, but not for HFrEF, or among those with baseline CHD.
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Affiliation(s)
- Yulia Khodneva
- Department of Medicine School of Medicine University of Alabama at Birmingham AL
| | - Parag Goyal
- Division of Internal Medicine Weill Cornell University New York NY
- Division of Cardiology Weill Cornell University New York NY
| | - Emily B Levitan
- Department of Epidemiology School of Public Health University of Alabama at Birmingham AL
| | - Elizabeth A Jackson
- Department of Medicine School of Medicine University of Alabama at Birmingham AL
| | - Suzanne Oparil
- Department of Medicine School of Medicine University of Alabama at Birmingham AL
| | | | - Andrea L Cherrington
- Department of Medicine School of Medicine University of Alabama at Birmingham AL
| | - Raegan Durant
- Department of Medicine School of Medicine University of Alabama at Birmingham AL
| | - Monika M Safford
- Division of Internal Medicine Weill Cornell University New York NY
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Wells R, Dionne-Odom JN, Azuero A, Buck H, Ejem D, Burgio KL, Stockdill ML, Tucker R, Pamboukian SV, Tallaj J, Engler S, Keebler K, Tims S, Durant R, Swetz KM, Bakitas M. Examining Adherence and Dose Effect of an Early Palliative Care Intervention for Advanced Heart Failure Patients. J Pain Symptom Manage 2021; 62:471-481. [PMID: 33556493 PMCID: PMC8339177 DOI: 10.1016/j.jpainsymman.2021.01.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/01/2020] [Revised: 01/28/2021] [Accepted: 01/30/2021] [Indexed: 02/07/2023]
Abstract
CONTEXT Research priority guidelines highlight the need for examining the "dose" components of palliative care (PC) interventions, such as intervention adherence and completion rates, that contribute to optimal outcomes. OBJECTIVES Examine the "dose" effect of PC intervention completion vs. noncompletion on quality of life (QoL) and healthcare use in patients with advanced heart failure (HF) over 32 weeks. METHODS Secondary analysis of the ENABLE CHF-PC intervention trial for patients with New York Heart Association (NYHA) Class III/IV HF. "Completers" defined as completing a single, in-person outpatient palliative care consultation (OPCC) plus 6 weekly, PC nurse coach-led telehealth sessions. "Non-completers" were defined as either not attending the OPCC or completing <6 telehealth sessions. Outcome variables were QoL and healthcare resource use (hospital days; emergency department visits). Mixed models were used to model dose effects for "completers" vs "noncompleters" over 32 weeks. RESULTS Of 208 intervention group participants, 81 (38.9%) were classified as "completers" with a mean age of 64.6 years; 72.8% were urban-dwelling; 92.5% had NYHA Class III HF. 'Completers' vs. "non-completers"" groups were well-balanced at baseline; however "noncompleters" did report higher anxiety (6.0 vs 7.0, P < 0.05, d = 0.28). Moderate, clinically significant, improved QoL differences were found at 16 weeks in "completers" vs. "non-completers" (between-group difference: -9.71 (3.18), d = 0.47, P = 0.002) but not healthcare use. CONCLUSION Higher intervention completion rates of an early PC intervention was associated with QoL improvements in patients with advanced HF. Future work should focus on identifying the most efficacious "dose" of intervention components and increasing adherence to them. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02505425.
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Affiliation(s)
- Rachel Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - James Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Harleah Buck
- Csomay Center for Gerontological Excellence, College of Nursing, University of Iowa Iowa City, IA, USA
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathryn L Burgio
- Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA
| | - Macy L Stockdill
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rodney Tucker
- Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Salpy V Pamboukian
- Department of Medicine, Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jose Tallaj
- Department of Medicine, Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Konda Keebler
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sheri Tims
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Raegan Durant
- Department of Medicine, Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Keith M Swetz
- Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Medicine, Division of Gerontology, Geriatrics, Palliative Care, UAB Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL, USA
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Durant R, Levitan E, Muntner P, Brown T, Safford MM. Adding Heart Disease Outcomes to REGARDS: The REGARDS Myocardial Infarction Ancillary Study. Innov Aging 2020. [PMCID: PMC7742306 DOI: 10.1093/geroni/igaa057.3154] [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: 11/14/2022] Open
Abstract
The REGARDS-MI ancillary study provided new outcomes of heart disease events and adjudicated cause of death. A primary focus has been disparities in and risk factors for coronary artery disease. We demonstrated that compared to White men, Black men have a higher risk of fatal coronary heart disease (CHD) but a lower risk of non-fatal CHD. Ongoing work is investigating potential reasons for this. We have investigated the role of CHD in aging including the relationship between heart failure and cognitive function and the association of MI with functional status. The REGARDS-MI study has served as a platform for mentoring trainees and early stage investigators, many from underrepresented groups, and provided data to a large number of investigators to purse research in CHD. To date, REGARDS-MI has contributed to nearly 200 publications and spawned additional ancillary studies. This presentation will highlight some of these publications and other research in progress.
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Affiliation(s)
- Raegan Durant
- University of Alabama at Birmingham, BIRMINGHAM, Alabama, United States
| | - Emily Levitan
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Paul Muntner
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Todd Brown
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Monika M Safford
- Weill Cornell Medical College, New York, New York, United States
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Ejem DB, Barrett N, Rhodes RL, Olsen M, Bakitas M, Durant R, Elk R, Steinhauser K, Quest T, Dolor RJ, Johnson K. Reducing Disparities in the Quality of Palliative Care for Older African Americans through Improved Advance Care Planning: Study Design and Protocol. J Palliat Med 2020; 22:90-100. [PMID: 31486728 DOI: 10.1089/jpm.2019.0146] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Advance care planning (ACP) improves end-of-life care for patients and their caregivers. However, only one-third of adults have participated in ACP and rates are substantially lower among African Americans than among whites. Importantly, ACP improves many domains of care where there are racial disparities in outcomes, including receipt of goal-concordant care, hospice use, and provider communication. Yet, few studies have examined the effectiveness of ACP interventions among African Americans. The objectives of reducing disparities in the quality of palliative care for older African Americans through improved advance care planning (EQUAL ACP) are as follows: to compare the effectiveness of two interventions in (1) increasing ACP among African Americans and whites and (2) reducing racial disparities in both ACP and end-of-life care; and to examine whether racial concordance of the interventionist and patient is associated with ACP. EQUAL ACP is a longitudinal, multisite, cluster randomized trial and a qualitative study describing the ACP experience of participants. The study will include 800 adults ≥65 years of age (half African American and half white) from 10 primary care clinics in the South. Eligible patients have a serious illness (advanced cancer, heart failure, lung disease, etc.), disability in activities of daily living, or recent hospitalization. Patients are followed for one year and participate in either a patient-guided, self-management ACP approach, including a Five Wishes form or structured ACP with Respecting Choices First Steps. The primary outcome is formal or informal ACP-completion of advance directives, documented discussions with clinicians, and other written or verbal communication with surrogate decision makers about care preferences. Secondary outcomes assessed through after-death interviews with surrogates of patients who die during the study include receipt of goal-concordant care, health services use in the last year of life, and satisfaction with care. EQUAL ACP is the first large study to assess which strategies are most effective at both increasing rates of ACP and promoting equitable palliative care outcomes for seriously ill African Americans.
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Affiliation(s)
- Deborah B Ejem
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nadine Barrett
- Deparment of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Ramona L Rhodes
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Maren Olsen
- Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.,Center for Health Services Research, Durham VA Medical Center, Durham, North Carolina
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Geriatrics, Gerontology, and Palliative Care, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Raegan Durant
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ronit Elk
- Division of Geriatrics, Gerontology, and Palliative Care, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Karen Steinhauser
- Deparment of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Tammie Quest
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Rowena J Dolor
- Deparment of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Kimberly Johnson
- Division of Geriatrics, Department of Medicine, Center for the Study of Aging and Human Development, Center for Palliative Care Duke University School of Medicine and Geriatrics Research Education and Clinical Center, Durham VA Medical Center, Durham, North Carolina
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Rivers BM, Harris M, Cooper DL, Lisovicz N, Durant R, Hernandez ND, Rivers D, McKinney L, Carmichael B, Rutland SB, Shamim A. Abstract A008: Barriers and facilitator to minorities' participation in cancer clinical trials: Perspectives from a safety-net hospital. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-a008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Introduction: Cancer clinical trials (CCTs) are vital to clinical oncology research, in that they provide a foundation for the development and implementation of effective cancer therapies. However, there is a disparity in CCT participation given that only 2.7% of all CCT participants in the U.S. are African-American (AA). Grady Memorial Hospital in Atlanta, Georgia, the setting for this study, is a safety-net hospital with over 80% of its patients on Medicare, Medicaid, or uninsured. The objective of this two-phase pilot study is to utilize a multilevel, qualitative approach to assess the clinical and nonclinical facilitators and barriers to AA participation in CCTs (Phase I) and develop and pilot a multilevel intervention (Phase II).
Methods: Study participants were recruited from a cancer center at a safety-net hospital in Atlanta, GA. Twenty key informant interviews were conducted with key stakeholders at the safety-net hospital and 2 focus groups with AA cancer survivors. Interview guides were adapted from the NIH-funded EMPACT study. The interviews and focus groups were recorded on digital devices upon which the data was transcribed and subsequently analyzed using NVIVO 11 software.
Results: The interview transcripts were analyzed using a combination of hand coding and NVIVO 11 software. Content analysis was conducted using an immersion/crystallizing analysis plan. Common themes regarding Barriers and Facilitators within the context of Institution-level, Participant-level, System-level, and Trial-level will be presented.
Conclusion: These findings will assist in the development and testing of culturally appropriate resources and interventions to increase AA participation in CCTs.
Citation Format: Brian M. Rivers, Monica Harris, Dexter L. Cooper, Nedra Lisovicz, Raegan Durant, Natalie D. Hernandez, Desiree Rivers, Lawrence McKinney, Bria Carmichael, Sarah B. Rutland, Ainny Shamim. Barriers and facilitator to minorities' participation in cancer clinical trials: Perspectives from a safety-net hospital [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A008.
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Affiliation(s)
| | | | | | | | - Raegan Durant
- 2University of Alabama at Birmingham, Birmingham, AL
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Bakitas M, Dionne-Odom JN, Pamboukian SV, Tallaj J, Kvale E, Swetz KM, Frost J, Wells R, Azuero A, Keebler K, Akyar I, Ejem D, Steinhauser K, Smith T, Durant R, Kono AT. Engaging patients and families to create a feasible clinical trial integrating palliative and heart failure care: results of the ENABLE CHF-PC pilot clinical trial. BMC Palliat Care 2017; 16:45. [PMID: 28859648 PMCID: PMC5580310 DOI: 10.1186/s12904-017-0226-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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: 04/10/2017] [Accepted: 08/01/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Early palliative care (EPC) is recommended but rarely integrated with advanced heart failure (HF) care. We engaged patients and family caregivers to study the feasibility and site differences in a two-site EPC trial, ENABLE CHF-PC (Educate, Nurture, Advise, Before Life Ends Comprehensive Heartcare for Patients and Caregivers). METHODS We conducted an EPC feasibility study (4/1/14-8/31/15) for patients with NYHA Class III/IV HF and their caregivers in academic medical centers in the northeast and southeast U.S. The EPC intervention comprised: 1) an in-person outpatient palliative care consultation; and 2) telephonic nurse coach sessions and monthly calls. We collected patient- and caregiver-reported outcomes of quality of life (QOL), symptom, health, anxiety, and depression at baseline, 12- and 24-weeks. We used linear mixed-models to assess baseline to week 24 longitudinal changes. RESULTS We enrolled 61 patients and 48 caregivers; between-site demographic differences included age, race, religion, marital, and work status. Most patients (69%) and caregivers (79%) completed all intervention sessions; however, we noted large between-site differences in measurement completion (38% southeast vs. 72% northeast). Patients experienced moderate effect size improvements in QOL, symptoms, physical, and mental health; caregivers experienced moderate effect size improvements in QOL, depression, mental health, and burden. Small-to-moderate effect size improvements were noted in patients' hospital and ICU days and emergency visits. CONCLUSIONS Between-site demographic, attrition, and participant-reported outcomes highlight the importance of intervention pilot-testing in culturally diverse populations. Observations from this pilot feasibility trial allowed us to refine the methodology of an in-progress, full-scale randomized clinical efficacy trial. TRIAL REGISTRATION Clinicaltrials.gov NCT03177447 (retrospectively registered, June 2017).
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Affiliation(s)
- Marie Bakitas
- School of Nursing and Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA. .,School of Nursing, University of Alabama at Birmingham, 1720 2nd Ave South, MT 412C, Birmingham, AL, 35294, USA.
| | - J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Ave South, MT 412C, Birmingham, AL, 35294, USA
| | - Salpy V Pamboukian
- Department of Medicine, Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jose Tallaj
- Department of Medicine, Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Kvale
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Keith M Swetz
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer Frost
- Cardiology, Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Ave South, MT 412C, Birmingham, AL, 35294, USA
| | - Konda Keebler
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Ave South, MT 412C, Birmingham, AL, 35294, USA
| | - Imatullah Akyar
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Ave South, MT 412C, Birmingham, AL, 35294, USA.,Faculty of Health Sciences, Nursing Department, Hacettepe University, Ankara, Turkey
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Ave South, MT 412C, Birmingham, AL, 35294, USA
| | - Karen Steinhauser
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Tasha Smith
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Ave South, MT 412C, Birmingham, AL, 35294, USA
| | - Raegan Durant
- Department of Medicine, Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alan T Kono
- Cardiology, Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Ghebre RG, Jones LA, Wenzel J, Martin MY, Durant R, Ford JG. State-of-the-science of patient navigation as a strategy for enhancing minority clinical trial accrual. Cancer 2014; 120 Suppl 7:1122-30. [PMID: 24643650 PMCID: PMC4039342 DOI: 10.1002/cncr.28570] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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: 06/13/2013] [Revised: 08/09/2013] [Accepted: 08/12/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patient navigation programs are emerging that aim to address disparities in clinical trial participation among medically underserved populations, including racial/ethnic minorities. However, there is a lack of consensus on the role of patient navigators within the clinical trial process as well as outcome measures to evaluate program effectiveness. METHODS A review of the literature was conducted of PubMed, Medline, CINHAL, and other sources to identify qualitative and quantitative studies on patient navigation in clinical trials. The search yielded 212 studies, of which only 12 were eligible for this review. RESULTS The eligible studies reported on the development of programs for patient navigation in cancer clinical trials, including training and implementation among African Americans, American Indians, and Native Hawaiians. A low rate of clinical trial refusal (range, 4%-6%) was reported among patients enrolled in patient navigation programs. However, few studies reported on the efficacy of patient navigation in increasing clinical treatment trial enrollment. CONCLUSIONS Outcome measures are proposed to assist in developing and evaluating the efficacy and/or effectiveness of patient navigation programs that aim to increase participation in cancer clinical trials. Future research is needed to evaluate the efficacy of patient navigators in addressing barriers to clinical trial participation and increasing enrollment among medically underserved cancer patients.
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Affiliation(s)
- Rahel G. Ghebre
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, MN, USA
| | - Lovell A. Jones
- Dorothy I. Height Center for Health Equity and Evaluation Research, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer Wenzel
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Michelle Y. Martin
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Raegan Durant
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jean G. Ford
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
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Muntner P, Halanych JH, Reynolds K, Durant R, Vupputuri S, Sung VW, Meschia JF, Howard VJ, Safford MM, Krousel-Wood M. Low medication adherence and the incidence of stroke symptoms among individuals with hypertension: the REGARDS study. J Clin Hypertens (Greenwich) 2011; 13:479-86. [PMID: 21762360 DOI: 10.1111/j.1751-7176.2011.00464.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The authors analyzed data on 9950 participants taking antihypertensive medications in the nationwide Reasons for Geographic and Racial Differences in Stroke (REGARDS) study to determine the association between medication adherence and incident stroke symptoms. Medication adherence was assessed using a validated 4-item self-report scale and participants were categorized into 4 groups (scores of 0, 1, 2, and 3 or 4, with higher scores indicating worse adherence). The incidence of 6 stroke symptoms (sudden weakness on one side of the body, numbness, painless loss of vision in one or both eyes, loss of half vision, losing the ability to understand people, and losing the ability to express oneself verbally or in writing) was assessed via telephone interviews every 6 months. During a median of 4 years, the incidence of any stroke symptom was 14.6%, 17.9%, 20.2%, and 24.9% among participants with adherence scores of 0, 1, 2, and 3 or 4, respectively (P<.001). The multivariable adjusted hazard ratio (95% confidence interval) for any stroke symptom associated with adherence scores of 1, 2, and 3 or 4, vs 0, was 1.20 (1.04-1.39), 1.23 (0.94-1.60), and 1.59 (1.08-2.33), respectively (P<.001). Worse adherence was also associated with higher multivariable adjusted hazard ratios for each of the 6 stroke symptoms.
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Affiliation(s)
- Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294-0022, USA.
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Guillaumou G, Celton B, Ferreira E, Ventura E, Reygrobellet P, Durant R. Intérêt du peptide natriurétique B et du N-terminal–proBNP chez le sujet âgé. Rev Med Interne 2009; 30:678-85. [DOI: 10.1016/j.revmed.2008.11.003] [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] [Received: 03/27/2008] [Revised: 10/05/2008] [Accepted: 11/09/2008] [Indexed: 11/29/2022]
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Klouche K, Da Mota EF, Durant R, Amigues L, Corne P, Jonquet O, Beraud JJ. Hypothalamic-pituitary-adrenal axis reactivity and dehydroepiandrosterone sulfate plasma concentrations in the critically ill elderly. Age Ageing 2007; 36:686-9. [PMID: 17965042 DOI: 10.1093/ageing/afm113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Klouche
- Lapeyronie University Hospital, Intensive Care Unit, 371, Avenue du Doyen Gaston, Giraud, 34 95, Montpellier, France.
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Dupuy AM, Jaussent I, Lacroux A, Durant R, Cristol JP, Delcourt C. Waist Circumference Adds to the Variance in Plasma C-Reactive Protein Levels in Elderly Patients with Metabolic Syndrome. Gerontology 2007; 53:329-39. [PMID: 17551260 DOI: 10.1159/000103555] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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: 12/06/2005] [Accepted: 03/13/2007] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND C-reactive protein (CRP), a nonspecific marker of the inflammatory status, is associated with cardiovascular disease risk factors and may be an important feature of the metabolic syndrome (MSX) in middle-aged subjects. OBJECTIVES We assessed the relationship of CRP levels to specific components of MSX and other potential determinants in apparently healthy elderly subjects living in the South of France. METHODS In the framework of the population-based POLA (Pathologies Oculaires Liées à l'Age) Study, performed in 2,404 subjects aged 60 years or more, we measured the plasma CRP levels. All subjects with known systemic inflammatory diseases, such as chronic bronchitis, cardiovascular disease, and diabetes, and those who were on systemic steroid therapy as well as subjects with CRP levels >10 mg/l were excluded from the study, leaving 1,709 subjects for the statistical analyses. MSX was defined according to NCEP (National Cholesterol Education Program) criteria. Other potential determinants were assessed through interviewer-based questionnaire. RESULTS We grouped the subjects into three categories based on the 75th and 25th percentiles, corresponding to 3.05 and 0.82, respectively. We compared subjects in the highest quartile, i.e., with CRP >/=3.05 mg/l, with those in the two intermediate quartiles, i.e., with 0.82 < CRP < 3.05, and those in the lowest quartile, i.e., with CRP <0.82 mg/l according to gender. MSX, which had a prevalence of 31%, was significantly associated with elevated CRP levels. Among MSX components, the strongest positive association with the highest quartile of CRP was with waist circumference in males as well as in females (age-adjusted odds ratio OR 3.06 and 95% confidence interval CI 1.82-5.14; OR 7.04 and 95% CI 4.79-10.34, respectively). Each component of the MSX, such as abnormal fasting plasma glucose (OR 2.90, 95% CI 1.69-4.99), triglycerides (OR 1.96, 95% CI 1.30-2.96), high-density lipoprotein cholesterol (OR 2.31, 95% CI 1.61-3.30), and blood pressure (OR 1.66, 95% CI 1.12-2.45), was significantly associated with high CRP values in elderly women only. In men, only current smoking was significantly associated with high CRP levels (OR 1.52, 95% CI 1.04-2.2). In multivariate analysis, the waist circumference remained significantly associated with high CRP levels, with a graded effect of CRP quartile whatever the gender. In men, current and former smoking remained significantly associated with the CRP levels. In women, the association observed in univariate analysis with fasting glucose or hypertension did not reach statistical significance in the multivariate analysis, while only a weak association could be observed with lipid parameters such as triglycerides and high-density lipoprotein cholesterol. CONCLUSIONS Abdominal adiposity adds to the variance in plasma CRP levels in elderly patients with MSX. This suggests that weight loss or other interventions targeted at adipocyte-related inflammation may represent an important means to prevent subclinical inflammation in the elderly, bearing a high risk of cardiovascular disease.
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Affiliation(s)
- A M Dupuy
- Laboratoire de Biochimie, Hôpital Lapeyronie, CHU de Montpellier, Montpellier, France
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Boubakri C, Durant R, Simorre B, Mota DA, Jeandel C. Thrombose veineuse profonde asymptomatique en gériatrie: dépistage systématique par écho-doppler. Rev Med Interne 2007. [DOI: 10.1016/j.revmed.2007.03.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Guillaumou G, Durant R, Ventura E, Reygrobellet P, Ferreira Da Mota E, Cristol JP, Jeandel C. Intérêt des peptides natriurétiques dans le diagnostic et le pronostic de l'insuffisance cardiaque du sujet âgé dyspnéique hospitalisé. Rev Med Interne 2007. [DOI: 10.1016/j.revmed.2007.03.103] [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: 10/23/2022]
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Ferreira Da Mota E, Durant R, Klouche K, Corne P, Jeandel C. Relation entre l'activité de l'axe hypothalamohypophysosurrénalien (HHS) et l'âge chez les patients hospitalisés en réanimation. Rev Med Interne 2007. [DOI: 10.1016/j.revmed.2007.03.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tiganas D, Durant R, Raschilas F, Blain H, Tigoulet F, Mitermite N, Hemmi P, Jeandel C. [Diagnostic value of the clinical probability score of deep venous thrombosis in the elderly]. Rev Med Interne 2005; 26:931-7. [PMID: 16236396 DOI: 10.1016/j.revmed.2005.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 10/04/2004] [Accepted: 08/22/2005] [Indexed: 11/16/2022]
Abstract
SUBJECT There is a lack of scientific data concerning the incidence, clinical signs, risk factors and diagnostic management of deep vein thrombosis (DVT) in the elderly. METHODS We carried out a prospective case-control study in a geriatric setting. We included one in-patient without clinical signs of deep vein thrombosis for each hospitalised patient with clinically suspected DVT. Clinical signs, risk factors of DVT and a compression ultrasonography of the proximal and distal leg veins were performed in all patients at admission. Also, the clinical probability was assessed by means of the clinical score model described by Wells. RESULTS There were 102 patients aged over 85 included during the 5 months period of the study. Fifty-one patients have had a clinical suspicion of DVT and 51 patients were clinically asymptomatic. There were 43% symptomatic DVT and 12% asymptomatic DVT. Clinical signs and symptoms of DVT were neither sensitive nor specific. Risk factors associated most frequently with DVT were: immobilisation (prevalence 64%), paralysis of the legs (22%), varicose veins (25%), deshydratation (28,5%), infections (18%). A significant relationship between a risk factor and DVT was found only for immobilisation (P<0,05) and deshydratation (P<0,02). The prevalence of DVT increased with the clinical probability score: 11.4% for the low score, 27.6% for the moderate score and 55% for the high score. CONCLUSION Incidence of DVT is high among hospitalised elderly patients, especially for the asymptomatic ones. Clinical signs alone do not reliably predict DVT. Clinical probability score could be useful to improve diagnostic management of DVT in this population.
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Affiliation(s)
- D Tiganas
- Service de médecine interne gériatrique, centre de gérontologie clinique, A.-Balmes, CHU de Montpellier, 39, avenue Charles-Flahaut, 34295 Montpellier cedex 05, France
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Durant R, Konaté A, Blain H, Raschilas F, Brunel M, Jeandel C. Évaluation d'un nouvel outil pédagogique enmédecine : le système de vote informatisé (Périclès®). Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80353-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tiganas D, Durant R, Raschilas F, Blain H, Hemmi P, Jeandel C. Intérêt du score de probabilité clinique dans le diagnostic de thrombose veineuse profonde en gériatrie. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bonnaure H, Raschilas F, Durant R, Blain H, Jeandel C. Une maladie de Horton à rechutevingt ans après! Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80218-7] [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: 10/25/2022]
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Bonnaure H, Durant R, Raschilas F, Blain H, Jeandel C. Coma révélant une thyroïdite auto-immune. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80297-7] [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: 10/25/2022]
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Durant R, Jaussent I, Dupuy A, Cristol J, Blain H, Jeandel C, Delcourt C. La protéine C-réactive de haute sensibilitéest un marqueur du risque coronarien chez le sujet âgé. Résultats de l'étude POLA. Rev Med Interne 2002. [DOI: 10.1016/s0248-8663(02)80467-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Blain H, Durant R, Blain A, Co-Minh H, Barré A, Jeandel C. Expression clinique trompeuse d'une thrombophlébite cérébralecompliquant une poussée de rectocolite ulcéro-hémorragique. Rev Med Interne 2002. [DOI: 10.1016/s0248-8663(02)80281-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Durant R, Makinson A, Blain H, Jeandel C. Thromboses veineuses et inhibiteur sélectif des Cox-2. Rev Med Interne 2002. [DOI: 10.1016/s0248-8663(02)80270-3] [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: 10/25/2022]
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Durant R, Lukas C, Blain H, Carlander B, Jeandel C. Syndrome de Meige induit par les neuroleptiques : une cause exceptionnelle de dyspnée laryngée. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)80144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lukas C, Durant R, Blain H, Blain A, Jeandel C. Efficacité remarquable du vérapamil dans les colites microscopiques réfractaires a propos dun cas. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)80173-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Durant R, Boulenger-Morel M, Blain H, Blain A, Jeandel C. La prescription médicamenteuse chez la personne âgée.À propos d'une enquête sur 4 409 ordonnances. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)80048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Durant R, Klouche K, Morena M, Cristol J. Surproduction d'anion superoxyde dans le syndrome de réponse inflammatoire systémique. Modulation in vitro de la NADPH oxydase par la vitamine E et la simvastatine. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)80065-5] [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: 10/25/2022]
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Durant R, Yeche S, Reynaud D, Dubois A. Une ascite à éosinophiles. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)83553-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Durant R, Labauge P, Yeche S, Castelnovo G, Reynaud D, Dubois A. Un grêle fatigué. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)83518-9] [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: 10/27/2022]
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Durant R, Labauge P, Yeche S, Castelnovo G, Reynaud D, Figarella-Branger D, Dubois A. [An exhausted small intestine....Susac syndrome]. Rev Med Interne 2001; 22 Suppl 2:230s-231s. [PMID: 11433578 DOI: 10.1016/s0248-8663(01)83656-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R Durant
- Service de médecine interne, clinique Beau-Soleil, 34000 Montpellier, France
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Carti P, Durant R, Yao N, Alla P, Marlier S, Paris JF. Camptocormie révélatrice d'une sclérose latérale amyotrophique. Rev Med Interne 1998. [DOI: 10.1016/s0248-8663(98)80328-7] [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: 10/17/2022]
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Paris JF, Marlier S, Molinier S, Amah Y, Hercelin D, Durant R, Carli P. Association glomérulonéphrite extracapillaire pauci-immune et rectocolite hémorragique: rôle pathogénique des p-ANCA? Rev Med Interne 1997. [DOI: 10.1016/s0248-8663(97)80528-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Durant R. PACS: Model T = model for tomorrow. Adm Radiol J 1997; 16:38-9. [PMID: 10166835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Paris JF, Galzin M, Durant R, Amah Y, Carli P. Hémorragie surrénalienne unilatérale par syndrome des antiphospholipides au cours d’un cancer bronchique. Rev Med Interne 1997. [DOI: 10.1016/s0248-8663(97)80667-4] [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: 10/17/2022]
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Faucher J, Leclercq C, Durant R, Simorre B, Reynes J, Janbon F. Abcès sous-cutanés révélant une aspergillose au cours du sida. Rev Med Interne 1996. [DOI: 10.1016/s0248-8663(97)81040-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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