120 results on '"Spatz, Erica S"'
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2. Bundled Payments for Care Improvement and Quality of Care and Outcomes in Heart Failure
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Oddleifson, D. August, Holmes, DaJuanicia N., Alhanti, Brooke, Xu, Xiao, Heidenreich, Paul A., Wadhera, Rishi K., Allen, Larry A., Greene, Stephen J., Fonarow, Gregg C., Spatz, Erica S., and Desai, Nihar R.
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IMPORTANCE: The Centers for Medicare & Medicaid Services (CMS) Bundled Payments for Care Improvement (BPCI) program was launched in 2013 with a goal to improve care quality while lowering costs to Medicare. OBJECTIVE: To compare changes in the quality and outcomes of care for patients hospitalized with heart failure according to hospital participation in the BPCI program. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a difference-in-difference approach to evaluate the BPCI program in 18 BPCI hospitals vs 211 same-state non-BPCI hospitals for various process-of-care measures and outcomes using American Heart Association Get With The Guidelines–Heart Failure registry and CMS Medicare claims data from November 1, 2008, to August 31, 2018. Data were analyzed from May 2022 to May 2023. EXPOSURES: Hospital participation in CMS BPCI Model 2 Heart Failure, which paid hospitals in a fee-for-service process and then shared savings or required reimbursement depending on how the total cost of an episode of care compared with a target price. MAIN OUTCOMES AND MEASURES: Primary end points included 7 quality-of-care measures. Secondary end points included 9 outcome measures, including in-hospital mortality and hospital-level risk-adjusted 30-day and 90-day all-cause readmission rate and mortality rate. RESULTS: During the study period, 8721 patients were hospitalized in the 23 BPCI hospitals and 94 530 patients were hospitalized in the 224 same-state non-BPCI hospitals. Less than a third of patients (30 723 patients, 29.8%) were 75 years or younger; 54 629 (52.9%) were female, and 48 622 (47.1%) were male. Hospital participation in BPCI Model 2 was not associated with significant differential changes in the odds of various process-of-care measures, except for a decreased odds of evidence-based β-blocker at discharge (adjusted odds ratio [aOR], 0.63; 95% CI, 0.41-0.98; P = .04). Participation in the BPCI was not associated with a significant differential change in the odds of receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors at discharge, receiving an aldosterone antagonist at discharge, having a cardiac resynchronization therapy (CRT)–defibrillator or CRT pacemaker placed or prescribed at discharge, having implantable cardioverter-defibrillator (ICD) counseling or an ICD placed or prescribed at discharge, heart failure education being provided among eligible patients, or having a follow-up visit within 7 days or less. Participation in the BPCI was associated with a significant decrease in odds of in-hospital mortality (aOR, 0.67; 95% CI, 0.51-0.86; P = .002). Participation was not associated with a significant differential change in hospital-level risk-adjusted 30-day or 90-day all-cause readmission rate and 30-day or 90-day all-cause mortality rate. CONCLUSION AND RELEVANCE: In this study, hospital participation in the BPCI Model 2 Heart Failure program was not associated with improvement in process-of-care quality measures or 30-day or 90-day risk-adjusted all-cause mortality and readmission rates.
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- 2024
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3. Race, Ethnicity, and Gender Differences in Patient Reported Well-Being and Cognitive Functioning Within 3 Months of Symptomatic Illness During COVID-19 Pandemic
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Hill, Mandy J., Huebinger, Ryan M., Ebna Mannan, Imtiaz, Yu, Huihui, Wisk, Lauren E., O’Laughlin, Kelli N., Gentile, Nicole L., Stephens, Kari A., Gottlieb, Michael, Weinstein, Robert A., Koo, Katherine, Santangelo, Michelle, Saydah, Sharon, Spatz, Erica S., Lin, Zhenqiu, Schaeffer, Kevin, Kean, Efrat, Montoy, Juan Carlos C., Rodriguez, Robert M., Idris, Ahamed H., McDonald, Samuel, Elmore, Joann G., and Venkatesh, Arjun
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Background: Differences in acute COVID-19 associated morbidity based on race, ethnicity, and gender have been well described; however, less is known about differences in subsequent longer term health-related quality of life and well-being. Methods: This prospective cohort study included symptomatic adults tested for SARS-CoV-2 who completed baseline and 3-month follow-up surveys. Using the PROMIS-29 tool, a validated measure of health and well-being, we compared outcomes at 3 months and change in outcomes from baseline to 3 months among groups with different races, ethnicities, and/or sexes. Results: Among 6044 participants, 4113 (3202 COVID +) were included. Among COVID + participants, compared to non-Hispanic White participants, Black participants had better PROMIS T-scores for cognitive function (3.6 [1.1, 6.2]) and fatigue (− 4.3 [− 6.6, − 2.0]) at 3 months and experienced more improvement in fatigue over 3 months (− 2.7 [− 4.7, − 0.8]). At 3 months, compared with males, females had worse PROMIS T-scores for cognitive function (− 4.1 [− 5.6, − 2.6]), physical function (− 2.1 [− 3.1, − 1.0]), social participation (− 2.8 [− 4.2, − 1.5]), anxiety (2.8 [1.5, 4.1]), fatigue (5.1 [3.7, 6.4]), and pain interference (2.0 [0.9, 3.2]). Females experienced less improvement in fatigue over 3 months (3.1 [2.0, 4.3]). Transgender/non-binary/other gender participants had worse 3-month scores in all domains except for sleep disturbance and pain interference. Conclusions: Three months after the initial COVID-19 infection, Black participants reported better cognitive function and fatigue, while females and other gender minoritized groups experienced lower well-being. Future studies are necessary to better understand how and why social constructs, specifically race, ethnicity, and gender, influence differences in COVID-19-related health outcomes.
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- 2024
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4. Illness Perception and the Impact of a Definitive Diagnosis on Women With Ischemia and No Obstructive Coronary Artery Disease: A Qualitative Study.
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Tseng, Leslie Yingzhijie, Göç, Nükte, Schwann, Alexandra N., Cherlin, Emily J., Kunnirickal, Steffne J., Odanovic, Natalija, Curry, Leslie A., Shah, Samit M., and Spatz, Erica S.
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BACKGROUND: Ischemia and no obstructive coronary artery disease (INOCA) disproportionately impacts women, yet the underlying pathologies are often not distinguished, contributing to adverse health care experiences and poor quality of life. Coronary function testing at the time of invasive coronary angiography allows for improved diagnostic accuracy. Despite increased recognition of INOCA and expanding access to testing, data lack on first-person perspectives and the impact of receiving a diagnosis in women with INOCA. METHODS: From 2020 to 2021, we conducted structured telephone interviews with 2 groups of women with INOCA who underwent invasive coronary angiography (n=29) at Yale New Haven Hospital, New Haven, CT: 1 group underwent coronary function testing (n=20, of whom 18 received a mechanism-based diagnosis) and the other group who did not undergo coronary function testing (n=9). The interviews were analyzed using the constant comparison method by a multidisciplinary team. RESULTS: The mean age was 59.7 years, and 79% and 3% were non-Hispanic White and non-Hispanic Black, respectively. Through iterative coding, 4 themes emerged and were further separated into subthemes that highlight disease experience aspects to be addressed in patient care: (1) distress from symptoms of uncertain cause: symptom constellation, struggle for sensemaking, emotional toll, threat to personal and professional identity; (2) a long journey to reach a definitive diagnosis: selfadvocacy and fortitude, healthcare interactions brought about further uncertainty and trauma, therapeutic alliance, sources of information; (3) establishing a diagnosis enabled a path forward: relief and validation, empowerment; and (4) commitment to promoting awareness and supporting other women: recognition of sex and racial/ethnic disparities, support for other women. CONCLUSIONS: Insights about how women experience the symptoms of INOCA and their interactions with clinicians and the healthcare system hold powerful lessons for more patient-centered care. A coronary function testing-informed diagnosis greatly influences the healthcare experiences, quality of life, and emotional states of women with INOCA. [ABSTRACT FROM AUTHOR]
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- 2023
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5. Physician responses to apple watch-detected irregular rhythm alerts.
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Demkowicz, Patrick C., Dhruva, Sanket S., Spatz, Erica S., Beatty, Alexis L., Ross, Joseph S., and Khera, Rohan
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While the US Food and Drug Administration (FDA) has cleared smartwatch software for detecting atrial fibrillation (AF), there is lack of guidance on management by physicians. We sought to evaluate the approach to management of Apple Watch alerts for AF by physicians and assess whether respondent and case characteristics were associated with their approach. We conducted a case-based survey of physicians practicing primary care, emergency medicine, and cardiology at 2 large academic centers (Yale and University of California San Francisco) between September and December 2021. Cases described asymptomatic patients receiving Apple Watch AF alerts; cases varied in sex, race, medical history, and notification frequency. We evaluated physician responses among prespecified diagnostic testing, referral, and treatment options. We emailed 636 physicians, of whom 95 (14.9%) completed the survey, including 39 primary care, 25 emergency medicine, and 31 cardiology physicians. Among a total of 192 cases (16 unique scenarios), physicians selected at least one diagnostic test in 191 (99.5%) cases and medications in 48 (25.0%). Physicians in primary care, emergency medicine, and cardiology reported varying preference for patient referral (14%, 30%, and 16%, respectively; P =.048), rhythm monitoring (84%, 46%, and 94%, respectively; P <.001), measurement of BNP (8%, 20%, and 2%; P =.003), and use of antiarrhythmics (16%, 4%, and 23%; P =.023). There were few physician differences in reported practices across patient demographics (sex and race), clinical complexity, and alert frequency of the clinical case. In hypothetical cases of patients presenting without clinical symptoms, physicians opted for further diagnostic testing and often to medical intervention based on Apple Watch irregular rhythm notifications. There was also considerable variation across physician specialties, suggesting a need for uniform clinical practice guidelines. Additional study is required before irregular rhythm notifications should be used in clinical settings. [ABSTRACT FROM AUTHOR]
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- 2023
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6. Individualising intensive systolic blood pressure reduction in hypertension using computational trial phenomaps and machine learning: a post-hoc analysis of randomised clinical trials
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Oikonomou, Evangelos K, Spatz, Erica S, Suchard, Marc A, and Khera, Rohan
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The cardiovascular benefits of intensive systolic blood pressure control vary across clinical populations tested in large randomised clinical trials. We aimed to evaluate the application of machine learning to clinical trials of patients without and with type 2 diabetes to define the personalised cardiovascular benefit of intensive control of systolic blood pressure.
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- 2022
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7. Analysis of Patient-Focused Information About Left Atrial Appendage Occlusion on US Hospital Web Pages
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Dhruva, Sanket S., Ji, Robin Z., Ross, Joseph S., Spatz, Erica S., and Redberg, Rita F.
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- 2022
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8. Shared Decision-making in the U.S.: Evidence exists, but implementation science must now inform policy for real change to occur.
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Lu, Yuan, Elwyn, Glyn, Moulton, Benjamin W., Volk, Robert J., Frosch, Dominick L., and Spatz, Erica S.
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- 2022
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9. National Trends in Racial and Ethnic Disparities in Antihypertensive Medication Use and Blood Pressure Control Among Adults With Hypertension, 2011-2018.
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Lu, Yuan, Liu, Yuntian, Dhingra, Lovedeep Singh, Massey, Daisy, Caraballo, César, Mahajan, Shiwani, Spatz, Erica S., Onuma, Oyere, Herrin, Jeph, and Krumholz, Harlan M.
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Poor hypertension awareness and underuse of guideline-recommended medications are critical factors contributing to poor hypertension control. Using data from 8095 hypertensive people aged ≥18 years from the National Health and Nutrition Examination Survey (2011-2018), we examined recent trends in racial and ethnic differences in awareness and antihypertensive medication use, and their association with racial and ethnic differences in hypertension control. Between 2011 and 2018, age-adjusted hypertension awareness declined for Black, Hispanic, and White individuals, but the 3 outcomes increased or did not change for Asian individuals. Compared with White individuals, Black individuals had a similar awareness (odds ratio, 1.20 [0.96-1.45]) and overall treatment rates (1.04 [0.84-1.25]), and received more intensive antihypertensive medication if treated (1.41 [1.27-1.56]), but had a lower control rate (0.72 [0.61-0.83]). Asian and Hispanic individuals had significantly lower awareness rates (0.69 [0.52-0.85] and 0.74 [0.59-0.89]), overall treatment rates (0.72 [0.57-0.88] and 0.69 [0.55-0.82]), received less intensive medication if treated (0.60 [0.50-0.72] and 0.86 [0.75-0.96]), and had lower control rates (0.66 [0.54-0.79] and 0.69 [0.57-0.81]). The racial and ethnic differences in awareness, treatment, and control persisted over the study period and were consistent across age, sex, and income strata. Lower awareness and treatment were significantly associated with lower control in Asian and Hispanic individuals (P<0.01 for all) but not in Black individuals. These findings highlight the need for interventions to improve awareness and treatment among Asian and Hispanic individuals, and more investigation into the downstream factors that may contribute to the poor hypertension control among Black individuals. [ABSTRACT FROM AUTHOR]
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- 2022
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10. Prioritizing the Exposome to Reduce Cardiovascular Disease Burden
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Spatz, Erica S., Chen, Kai, and Krumholz, Harlan M.
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- 2024
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11. Shared Decision-making in the U.S.: Evidence exists, but implementation science must now inform policy for real change to occur
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Lu, Yuan, Elwyn, Glyn, Moulton, Benjamin W., Volk, Robert J., Frosch, Dominick L., and Spatz, Erica S.
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Shared decision making (SDM) is defined as an approach in which clinicians and patients share the best available evidence when faced with the task of making decisions, and in which patients are supported to consider options to achieve informed preferences [1]. Over the past decade, SDM has been increasingly recognized as a component of value-based care in the US. There is greater acceptance overall that SDM is a key strategy for achieving patient-centered care, enhancing patient safety, and achieving the triple aim of better health, better care, and lower costs [2]. Essential elements of SDM include recognizing and acknowledging that a decision is required; knowing and understanding the best available evidence on risks and benefits; and incorporating the patient's values and preferences into the decision [3]. This paper provides an update of our previous review of SDM in the US published in 2017. We describe changes in healthcare policies to support SDM at the federal and state levels, the integration of SDM into clinical practice, and the role of implementation science to advance SDM. Finally, we discuss potential next steps to inform policies for SDM and facilitate uptake of SDM in clinical practice.
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- 2022
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12. Psychometric Evaluation of the Kansas City Cardiomyopathy Questionnaire in Men and Women With Heart Failure.
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Hejjaji, Vittal, Yuanyuan Tang, Coles, Theresa, Jones, Philip G., Reeve, Bryce B., Mentz, Robert J., Spatz, Erica S., Dunlay, Shannon M., Caldwell, Brittany, Saha, Anindita, Tarver, Michelle E., Tran, Andy, Patel, Krishna K., Henke, Debra, Piña, Ileana L., and Spertus, John A.
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BACKGROUND: The Kansas City Cardiomyopathy Questionnaire (KCCQ) has been psychometrically evaluated in multiple heart failure (HF) populations, but the comparability of its psychometric properties between men and women is unknown. METHODS: Data from 3 clinical trials (1 in stable HF with preserved ejection fraction, 1 each in stable and acute HF with reduced ejection fraction) and 1 prospective cohort study (stable HF with reduced ejection fraction), incorporating 6773 men and 3612 women with HF, were used to compare the construct validity, internal and test-retest reliability, ability to detect change, predict mortality and hospitalizations and minimally important differences between the 2 sexes. Interactions of the KCCQ overall summary and subdomain scores by sex were independently examined. RESULTS: The KCCQ-Overall Summary score correlated well with New York Heart Association functional class in both sexes across patients with stable (correlation coefficient: -0.40 in men versus -0.49 in women) and acute (-0.37 in men versus -0.34 in women) HF. All KCCQ subdomains demonstrated concordant relationships with relevant comparison standards with no significant interactions by sex in 19 of 21 of these construct validity analyses. All KCCQ scores were equally predictive and other psychometric evaluations showed similar results by sex: test-retest reliability (intraclass correlation coefficient 0.94 in men versus 0.92 in women), responsive to change (standardized response mean 1.01 in both sexes), as were the minimally important differences and internal reliability. CONCLUSIONS: The psychometric properties of the KCCQ, in terms of validity, prognosis, reliability, and sensitivity to change, are comparable in men and women with HF with preserved ejection fraction and HF with reduced ejection fraction. [ABSTRACT FROM AUTHOR]
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- 2021
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13. Utilization of Fixed-Dose Combination Treatment for Hypertension in Medicare and Medicaid From 2016 to 2020
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Essa, Mohammed, Ross, Joseph S., Dhruva, Sanket S., Desai, Nihar R., Spatz, Erica S., and Faridi, Kamil F.
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- 2024
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14. Obesity Prevalence and Risks Among Chinese Adults: Findings From the China PEACE Million Persons Project, 2014-2018.
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Lin Mu, Jiamin Liu, Guohai Zhou, Chaoqun Wu, Bowang Chen, Yuan Lu, Jiapeng Lu, Xiaofang Yan, Zhihong Zhu, Nasir, Khurram, Spatz, Erica S., Krumholz, Harlan M., Xin Zheng, Mu, Lin, Liu, Jiamin, Zhou, Guohai, Wu, Chaoqun, Chen, Bowang, Lu, Yuan, and Lu, Jiapeng
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OBESITY ,RESEARCH ,CROSS-sectional method ,RESEARCH methodology ,MEDICAL cooperation ,EVALUATION research ,COMPARATIVE studies ,WAIST circumference ,DISEASE prevalence ,RESEARCH funding ,BODY mass index - Abstract
Background: China has seen a burgeoning epidemic of obesity in recent decades, but few studies reported nationally on obesity across socio-demographic subgroups. We sought to assess the prevalence and socio-demographic associations of obesity nationwide.Methods: We assessed the prevalence of overall obesity (body mass index ≥28 kg/m2) and abdominal obesity (waist circumference ≥85/90 cm for women/men) among 2.7 million community-dwelling adults aged 35 to 75 years in the China PEACE Million Persons Project from 2014 to 2018 and quantified the socio-demographic associations of obesity using multivariable mixed models.Results: Age-standardized rates of overall and abdominal obesity were 14.4% (95% CI, 14.3%-14.4%) and 32.7% (32.6%-32.8%) in women and 16.0% (15.9%-16.1%) and 36.6% (36.5%-36.8%) in men. Obesity varied considerably across socio-demographic subgroups. Older women were at higher risk for obesity (eg, adjusted relative risk [95% CI] of women aged 65-75 versus 35-44 years: 1.29 [1.27-1.31] for overall obesity, 1.76 [1.74-1.77] for abdominal obesity) while older men were not. Higher education was associated with lower risk in women (eg, adjusted relative risk [95% CI] of those with college or university education versus below primary school: 0.47 [0.46-0.48] for overall obesity, 0.61 [0.60-0.62] for abdominal obesity) but higher risk in men (1.07 [1.05-1.10], 1.17 [1.16-1.19]).Conclusions: In China, over 1 in 7 individuals meet criteria for overall obesity, and 1 in 3 for abdominal obesity. Wide variation exists across socio-demographic subgroups. The associations of age and education with obesity are significant and differ by sex. Understanding obesity in contemporary China has broad domestic policy implications and provides a valuable international reference. [ABSTRACT FROM AUTHOR]- Published
- 2021
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15. The Groundwater of Racial and Ethnic Disparities Research: A Statement From .
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Breathett, Khadijah, Spatz, Erica S., Kramer, Daniel B., Essien, Utibe R., Wadhera, Rishi K., Peterson, Pamela N., Ho, P. Michael, and Nallamothu, Brahmajee K.
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- 2021
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16. "When you're homeless, they look down on you": A qualitative, community-based study of homeless individuals with heart failure.
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Pendyal, Akshay, Rosenthal, Marjorie S., Spatz, Erica S., Cunningham, Alison, Bliesener, Dawn, and Keene, Danya E.
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• Heart failure (HF) involves intensive self-management. • Homelessness poses a barrier to self-management of HF. • Homeless persons with HF face instability, difficult tradeoffs, and stigma. • Multilevel solutions are needed to address HF in homeless populations. Outpatient heart failure (HF) care involves intensive self-management (SM). Effective HF SM is associated with improved outcomes. Homelessness poses challenges to successful SM. To identify the ways in which homelessness may impede successful SM of HF and engagement with the healthcare system. We conducted open-ended, semi-structured interviews with homeless adults with HF. Data were analyzed by a multidisciplinary team using a grounded theory approach. We interviewed 19 participants, 11 (58%) of whom were homeless at the time of interview. Interviews revealed a combination of influences on HF SM. Major themes included instability and lack of routine, tradeoffs between basic necessities and HF SM, and stigmatization by healthcare providers. Anticipatory guidance aimed at the unique challenges faced by homeless individuals with HF may aid successful SM. HF providers should simlpify medication regimes and engage in non-stigmatizing discourse. Larger-scale interventions include the creation of medical respite programs. [ABSTRACT FROM AUTHOR]
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- 2021
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17. Cardio-obstetrics: Recognizing and managing cardiovascular complications of pregnancy.
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Shapero, Kayle S., Desai, Nihar R., Elder, Robert W., Lipkind, Heather S., Chou, Josephine C., and Spatz, Erica S.
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- 2020
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18. Heterogeneity in Trajectories of Systolic Blood Pressure among Young Adults in Qingdao Port Cardiovascular Health Study.
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Haiqun Lin, Meiping Cui, Spatz, Erica S., Yongfei Wang, Jiapeng Lu, Jing Li, Shuxia Li, Chenxi Huang, Xiancheng Liu, Lixin Jiang, Krumholz, Harlan M., and Xiao Xu
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Background: Although increased age is associated with higher systolic blood pressure (SBP) in general, there may be variation across individuals in how SBP changes over time. The goal of this paper is to identify heterogeneity in SBP trajectories among young adults with similar initial values and identify personal characteristics associated with different trajectory patterns. This may have important implications for prevention and prognosis. Methods: A cohort of 12,468 individuals aged 18-35 years in the Qingdao Port Cardiovascular Health Study in China was followed yearly during 2000-2011. Individuals were categorized into three strata according to their baseline SBP: ≤110 mmHg, 111-130 mmHg, and >130 mmHg. Within each stratum, group-based trajectory analyses were conducted to identify distinct SBP trajectory patterns, and their association with sociodemographic and baseline health characteristics was assessed by ordinal logistic regression. Results: Five distinct groups of individuals exhibiting divergent patterns of increasing, stable or decreasing SBP trends were identified within each stratum. This is a first report to identify a subgroup with decreasing trend in SBP. Individuals with more advanced age, having less than high school education, family history of cardiovascular diseases, greater body mass index, greater waist circumference, and hyperlipidemia at baseline were more likely to experience trajectories of higher SBP within each stratum. Conclusions: The diverging trajectories among young adults with similar initial SBP highlight the need for prevention and feasibility of effective blood pressure control, while the identified risk factors may inform targeted interventions. [ABSTRACT FROM AUTHOR]
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- 2020
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19. Newly diagnosed diabetes and outcomes after acute myocardial infarction in young adults
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Ding, Qinglan, Spatz, Erica S, Lipska, Kasia J, Lin, Haiqun, Spertus, John A, Dreyer, Rachel P, Whittemore, Robin, Funk, Marjorie, Bueno, Hector, and Krumholz, Harlan M
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ObjectiveTo examine prevalence and characteristics of newly diagnosed diabetes (NDD) in younger adults hospitalised with acute myocardial infarction (AMI) and investigate whether NDD is associated with health status and clinical outcomes over 12-month post-AMI.MethodsIn individuals (18–55 years) admitted with AMI, without established diabetes, we defined NDD as (1) baseline or 1-month HbA1c≥6.5%; (2) discharge diabetes diagnosis or (3) diabetes medication initiation within 1 month. We compared baseline characteristics of NDD, established diabetes and no diabetes, and their associations with baseline, 1-month and 12-month health status (angina-specific and non-disease specific), mortality and in-hospital complications.ResultsAmong 3501 patients in Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients study, 14.5% met NDD criteria. Among 508 patients with NDD, 35 (6.9%) received discharge diagnosis, 91 (17.9%) received discharge diabetes education and 14 (2.8%) initiated pharmacological treatment within 1 month. NDD was more common in non-White (OR 1.58, 95% CI 1.23 to 2.03), obese (OR 1.72, 95% CI 1.39 to 2.12), financially stressed patients (OR 1.27, 95% CI 1.02 to 1.58). Compared with established diabetes, NDD was independently associated with better disease-specific health status and quality of life (p≤0.04). No significant differences were found in unadjusted in-hospital mortality and complications between NDD and established or no diabetes.ConclusionsNDD was common among adults≤55 years admitted with AMI and was more frequent in non-White, obese, financially stressed individuals. Under 20% of patients with NDD received discharge diagnosis or initiated discharge diabetes education or pharmacological treatment within 1 month post-AMI. NDD was not associated with increased risk of worse short-term health status compared with risk noted for established diabetes.Trial registration numberNCT00597922.
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- 2021
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20. Exertional Syncope in College Varsity Athletes
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Gier, Chad, Shapero, Kayle, Lynch, Mathew, Spatz, Erica S., Young, Lawrence, Arlis-Mayor, Stephanie, and Lampert, Rachel
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- 2023
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21. Admission diagnoses among patients with heart failure: Variation by ACO performance on a measure of risk-standardized acute admission rates.
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Benchetrit, Liliya, Zimmerman, Chloe, Bao, Haikun, Dharmarajan, Kumar, Altaf, Faseeha, Herrin, Jeph, Lin, Zhenqiu, Krumholz, Harlan M., Drye, Elizabeth E., Lipska, Kasia J., and Spatz, Erica S.
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Background: A key quality metric for Accountable Care Organizations (ACOs) is the rate of hospitalization among patients with heart failure (HF). Among this patient population, non-HF-related hospitalizations account for a substantial proportion of admissions. Understanding the types of admissions and the distribution of admission types across ACOs of varying performance may provide important insights for lowering admission rates.Methods: We examined admission diagnoses among 220 Medicare Shared Savings Program ACOs in 2013. ACOs were stratified into quartiles by their performance on a measure of unplanned risk-standardized acute admission rates (RSAARs) among patients with HF. Using a previously validated algorithm, we categorized admissions by principal discharge diagnosis into: HF, cardiovascular/non-HF, and noncardiovascular. We compared the mean admission rates by admission type as well as the proportion of admission types across RSAAR quartiles (Q1-Q4).Results: Among 220 ACOs caring for 227,356 patients with HF, the median (IQR) RSAARs per 100 person-years ranged from 64.5 (61.7-67.7) in Q1 (best performers) to 94.0 (90.1-99.9) in Q4 (worst performers). The mean admission rates by admission types for ACOs in Q1 compared with Q4 were as follows: HF admissions: 9.8 (2.2) vs 14.6 (2.8) per 100 person years (P < .0001); cardiovascular/non-HF admissions: 11.1 (1.6) vs 15.9 (2.6) per 100 person-years (P < .0001); and noncardiovascular admissions: 42.7 (5.4) vs 69.6 (11.3) per 100 person-years (P < .0001). The proportion of admission due to HF, cardiovascular/non-HF, and noncardiovascular conditions was 15.4%, 17.5%, and 67.1% in Q1 compared with 14.6%, 15.9%, and 69.4% in Q4 (P < .007).Conclusions: Although ACOs with the best performance on a measure of all-cause admission rates among people with HF tended to have fewer admissions for HF, cardiovascular/non-HF, and noncardiovascular conditions compared with ACOs with the worst performance (highest admission rates), the largest difference in admission rates were for noncardiovascular admission types. Across all ACOs, two-thirds of admissions of patients with HF were for noncardiovascular causes. These findings suggest that comprehensive approaches are needed to reduce the diverse admission types for which HF patients are at risk. [ABSTRACT FROM AUTHOR]- Published
- 2019
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22. Traditional Chinese Medicine for Acute Myocardial Infarction in Western Medicine Hospitals in China.
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Spatz, Erica S., Wang, Yongfei, Beckman, Adam L., Xuekun Wu, Yuan Lu, Xue Du, Jing Li, Xiao Xu, Davidson, Patricia M., Masoudi, Frederick A., Spertus, John A., Krumholz, Harlan M., Lixin Jiang, Wu, Xuekun, Lu, Yuan, Du, Xue, Li, Jing, Xu, Xiao, and Jiang, Lixin
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MYOCARDIAL infarction diagnosis ,MYOCARDIAL infarction-related mortality ,HOSPITALS ,HERBAL medicine ,INTRAVENOUS therapy ,TIME ,MYOCARDIAL infarction ,RETROSPECTIVE studies ,HEALTH status indicators ,HOSPITAL mortality ,RISK assessment ,TREATMENT effectiveness ,RESEARCH funding ,CHINESE medicine ,HEMORRHAGE ,PATIENT safety ,DRUG administration ,DRUG dosage - Abstract
Background: Amid national efforts to improve the quality of care for people with cardiovascular disease in China, the use of traditional Chinese medicine (TCM) is increasing, yet little is known about its use in the early management of acute myocardial infarction (AMI).Methods and Results: We aimed to examine intravenous use of TCM within the first 24 hours of hospitalization (early IV TCM) for AMI. Data come from the China Patient-centered Evaluative Assessment of Cardiac Events Retrospective Study of Acute Myocardial Infarction, restricted to a large, representative sample of Western medicine hospitals throughout China (n=162). We conducted a chart review of randomly sampled patients with AMI in 2001, 2006, and 2011, comparing early intravenous TCM use across years, predictors of any early intravenous TCM use, and association with in-hospital bleeding and mortality. From 2001 to 2011, early intravenous TCM use increased (2001: 38.2% versus 2006: 49.1% versus 2011: 56.1%; P<0.01). Nearly all (99%) hospitals used early intravenous TCM. Salvia miltiorrhiza was most commonly prescribed, used in one third (35.5%) of all patients admitted with AMI. Patients receiving any early intravenous TCM, compared with those who did not, were similar in age and sex and had fewer cardiovascular risk factors. In multivariable hierarchical models, admission to a secondary (versus tertiary) hospital was most strongly associated with early intravenous TCM use (odds ratio: 2.85; 95% confidence interval: 1.98-4.11). Hospital-level factors accounted for 55% of the variance (adjusted median odds ratio: 2.84). In exploratory analyses, there were no significant associations between early intravenous TCM and in-hospital bleeding or mortality.Conclusions: Early intravenous TCM use for AMI in China is increasing despite the lack of evidence of their benefit or harm. There is an urgent need to define the effects of these medications because they have become a staple of treatment in the world's most populous country.Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01624883. [ABSTRACT FROM AUTHOR]- Published
- 2018
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23. Quantifying Blood Pressure Visit-to-Visit Variability in the Real-World Setting: A Retrospective Cohort Study.
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Lu, Yuan, Linderman, George C., Mahajan, Shiwani, Liu, Yuntian, Huang, Chenxi, Khera, Rohan, Mortazavi, Bobak J., Spatz, Erica S., and Krumholz, Harlan M.
- Abstract
Background: Visit-to-visit variability (VVV) in blood pressure values has been reported in clinical studies. However, little is known about VVV in clinical practice and whether it is associated with patient characteristics in real-world setting. Methods: We conducted a retrospective cohort study to quantify VVV in systolic blood pressure (SBP) values in a real-world setting. We included adults (age ≥18 years) with at least 2 outpatient visits between January 1, 2014 and October 31, 2018 from Yale New Haven Health System. Patient-level measures of VVV included SD and coefficient of variation of a given patient's SBP across visits. We calculated patient-level VVV overall and by patient subgroups. We further developed a multilevel regression model to assess the extent to which VVV in SBP was explained by patient characteristics. Results: The study population included 537 218 adults, with a total of 7 721 864 SBP measurements. The mean age was 53.4 (SD 19.0) years, 60.4% were women, 69.4% were non-Hispanic White, and 18.1% were on antihypertensive medications. Patients had a mean body mass index of 28.4 (5.9) kg/m
2 and 22.6%, 8.0%, 9.7%, and 5.6% had a history of hypertension, diabetes, hyperlipidemia, and coronary artery disease, respectively. The mean number of visits per patient was 13.3, over an average period of 2.4 years. The mean (SD) intraindividual SD and coefficient of variation of SBP across visits were 10.6 (5.1) mm Hg and 0.08 (0.04). These measures of blood pressure variation were consistent across patient subgroups defined by demographic characteristics and medical history. In the multivariable linear regression model, only 4% of the variance in absolute standardized difference was attributable to patient characteristics. Conclusions: The VVV in real-world practice poses challenges for management of patients with hypertension based on blood pressure readings in outpatient settings and suggest the need to go beyond episodic clinic evaluation. [ABSTRACT FROM AUTHOR]- Published
- 2023
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24. Heterogeneity in Early Responses in ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial).
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Dhruva, Sanket S., Chenxi Huang, Spatz, Erica S., Coppi, Andreas C., Warner, Frederick, Shu-Xia Li, Haiqun Lin, Xiao Xu, Furberg, Curt D., Davis, Barry R., Pressel, Sara L., Coifman, Ronald R., Krumholz, Harlan M., Huang, Chenxi, Li, Shu-Xia, Lin, Haiqun, and Xu, Xiao
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Randomized trials of hypertension have seldom examined heterogeneity in response to treatments over time and the implications for cardiovascular outcomes. Understanding this heterogeneity, however, is a necessary step toward personalizing antihypertensive therapy. We applied trajectory-based modeling to data on 39 763 study participants of the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) to identify distinct patterns of systolic blood pressure (SBP) response to randomized medications during the first 6 months of the trial. Two trajectory patterns were identified: immediate responders (85.5%), on average, had a decreasing SBP, whereas nonimmediate responders (14.5%), on average, had an initially increasing SBP followed by a decrease. Compared with those randomized to chlorthalidone, participants randomized to amlodipine (odds ratio, 1.20; 95% confidence interval [CI], 1.10-1.31), lisinopril (odds ratio, 1.88; 95% CI, 1.73-2.03), and doxazosin (odds ratio, 1.65; 95% CI, 1.52-1.78) had higher adjusted odds ratios associated with being a nonimmediate responder (versus immediate responder). After multivariable adjustment, nonimmediate responders had a higher hazard ratio of stroke (hazard ratio, 1.49; 95% CI, 1.21-1.84), combined cardiovascular disease (hazard ratio, 1.21; 95% CI, 1.11-1.31), and heart failure (hazard ratio, 1.48; 95% CI, 1.24-1.78) during follow-up between 6 months and 2 years. The SBP response trajectories provided superior discrimination for predicting downstream adverse cardiovascular events than classification based on difference in SBP between the first 2 measurements, SBP at 6 months, and average SBP during the first 6 months. Our findings demonstrate heterogeneity in response to antihypertensive therapies and show that chlorthalidone is associated with more favorable initial response than the other medications. [ABSTRACT FROM AUTHOR]
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- 2017
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25. Shared decision making as part of value based care: New U.S. policies challenge our readiness.
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Spatz, Erica S., Elwyn, Glyn, Moulton, Benjamin W., Volk, Robert J., and Frosch, Dominick L.
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- 2017
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26. Patient-Provider Communication and Health Outcomes Among Individuals With Atherosclerotic Cardiovascular Disease in the United States: Medical Expenditure Panel Survey 2010 to 2013.
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Okunrintemi, Victor, Spatz, Erica S., Di Capua, Paul, Salami, Joseph A., Valero-Elizondo, Javier, Warraich, Haider, Virani, Salim S., Blaha, Michael J., Blankstein, Ron, Butt, Adeel A., Borden, William B., Dharmarajan, Kumar, Ting, Henry, Krumholz, Harlan M., and Nasir, Khurram
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ASPIRIN ,ATHEROSCLEROSIS treatment ,ANTILIPEMIC agents ,PLATELET aggregation inhibitors ,ATHEROSCLEROSIS ,CLINICAL medicine ,COMMUNICATION ,HEALTH status indicators ,LENGTH of stay in hospitals ,HOSPITAL emergency services ,MEDICAL care costs ,MENTAL health ,PHYSICIAN-patient relations ,SURVEYS ,KEY performance indicators (Management) ,PATIENT-centered care ,ODDS ratio ,DIAGNOSIS ,THERAPEUTICS - Abstract
Background: Consumer-reported patient-provider communication (PPC) assessed by Consumer Assessment of Health Plans Survey in ambulatory settings is incorporated as a complementary value metric for patient-centered care of chronic conditions in pay-for-performance programs. In this study, we examine the relationship of PPC with select indicators of patient-centered care in a nationally representative US adult population with established atherosclerotic cardiovascular disease.Methods and Results: The study population consisted of a nationally representative sample of 6810 individuals (aged ≥18 years), representing 18.3 million adults with established atherosclerotic cardiovascular disease (self-reported or International Classification of Diseases, Ninth Edition diagnosis) reporting a usual source of care in the 2010 to 2013 pooled Medical Expenditure Panel Survey cohort. Participants responded to questions from Consumer Assessment of Health Plans Survey that assessed PPC, and we developed a weighted PPC composite score using their responses, categorized as 1 (poor), 2 (average), and 3 (optimal). Outcomes of interest were (1) patient-reported outcomes: 12-item Short Form physical/mental health status, (2) quality of care measures: statin and ASA use, (3) healthcare resource utilization: emergency room visits and hospital stays, and (4) total annual and out-of-pocket healthcare expenditures. Atherosclerotic cardiovascular disease patients reporting poor versus optimal were over 2-fold more likely to report poor outcomes; 52% and 26% more likely to report that they are not on statin and aspirin, respectively, had a significantly greater utilization of health resources (odds ratio≥2 emergency room visit, 1.41 [95% confidence interval, 1.09-1.81]; odds ratio≥2 hospitalization, 1.36 [95% confidence interval, 1.04-1.79]), as well as an estimated $1243 ($127-$2359) higher annual healthcare expenditure.Conclusions: This study reveals a strong relationship between PPC and patient-reported outcomes, utilization of evidence-based therapies, healthcare resource utilization, and expenditures among those with established atherosclerotic cardiovascular disease. [ABSTRACT FROM AUTHOR]- Published
- 2017
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27. Young Women With Acute Myocardial Infarction: Current Perspectives.
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Dreyer, Rachel P., Sciria, Christopher, Spatz, Erica S., Safdar, Basmah, D'Onofrio, Gail, and Krumholz, Harlan M.
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MYOCARDIAL infarction diagnosis ,MYOCARDIAL infarction treatment ,AGE factors in disease ,DEMOGRAPHY ,HEALTH services accessibility ,HEALTH status indicators ,MYOCARDIAL infarction ,RESEARCH funding ,TIME ,HEALTH equity ,TREATMENT effectiveness ,DISEASE prevalence - Abstract
In recent years, there has been growing public awareness and increasing attention to young women with acute myocardial infarction (AMI), who represent an extreme phenotype. Young women presenting with AMI may develop coronary disease by different mechanisms and often have worse recoveries, with higher risk for morbidity and mortality compared with similarly aged men. The purpose of this cardiovascular perspective piece is to review recent studies of AMI in young women. More specifically, we emphasize differences in the epidemiology, diagnosis, and management of AMI in young women (when compared with men) across the continuum of care, including their pre-AMI, in-hospital, and post-AMI periods, and highlight gaps in knowledge and outcomes that can inform the next generation of research. [ABSTRACT FROM AUTHOR]
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- 2017
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28. Sex Differences in Inflammatory Markers and Health Status Among Young Adults With Acute Myocardial Infarction: Results From the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients) Study.
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Yuan Lu, Shengfan Zhou, Dreyer, Rachel P., Spatz, Erica S., Geda, Mary, Lorenze, Nancy P., D'Onofrio, Gail, Lichtman, Judith H., Spertus, John A., Ridker, Paul M., Krumholz, Harlan M., Lu, Yuan, and Zhou, Shengfan
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MYOCARDIAL infarction diagnosis ,MYOCARDIAL infarction-related mortality ,MYOCARDIAL infarction treatment ,AGE factors in disease ,BIOCHEMISTRY ,C-reactive protein ,CHI-squared test ,COMPARATIVE studies ,ESTERASES ,INFLAMMATORY mediators ,LONGITUDINAL method ,PHENOMENOLOGY ,RESEARCH methodology ,MEDICAL cooperation ,MULTIVARIATE analysis ,MYOCARDIAL infarction ,REGRESSION analysis ,RESEARCH ,RESEARCH funding ,RISK assessment ,SEX distribution ,COMORBIDITY ,SOCIOECONOMIC factors ,EVALUATION research ,HEALTH equity - Abstract
Background: Young women (≤55 years of age) with acute myocardial infarction (AMI) have higher mortality risk than similarly aged men. Elevated inflammatory markers are associated with an increased risk of cardiovascular outcomes after AMI, but little is known about whether young women have higher inflammatory levels after AMI compared with young men.Methods and Results: We assessed sex differences in post-AMI inflammatory markers and whether such differences account for sex differences in 12-month health status, using data from 2219 adults with AMI, 18 to 55 years of age, in the United States. Inflammatory markers including high-sensitivity C-reactive protein (hsCRP) and lipoprotein-associated phospholipase A2 were measured 1 month after AMI. Overall, women had higher levels of hsCRP and lipoprotein-associated phospholipase A2 after AMI compared with men, and this remained statistically significant after multivariable adjustment. Regression analyses showed that elevated 1-month hsCRP was associated with poor health status (symptom, function, and quality of life) at 12 months. However, the association between hsCRP and health status became nonsignificant after adjustment for sociodemographics, comorbidities, and treatment factors. Half of these patients had residual inflammatory risk (hsCRP >3 mg/L) compared with a third who had residual cholesterol risk (Low-density lipoprotein cholesterol >100 mg/dL).Conclusions: Young women with AMI had higher inflammatory levels compared with young men. Elevated 1-month hsCRP was associated with poor health status at 12 months after AMI, but this was attenuated after adjustment for patient characteristics. Targeted anti-inflammatory treatments are worthy of consideration for secondary prevention in these patients if ongoing trials of anti-inflammatory therapy prove effective. [ABSTRACT FROM AUTHOR]- Published
- 2017
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29. Sex differences in lipid profiles and treatment utilization among young adults with acute myocardial infarction: Results from the VIRGO study.
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Lu, Yuan, Zhou, Shengfan, Dreyer, Rachel P., Caulfield, Michael, Spatz, Erica S., Geda, Mary, Lorenze, Nancy P., Herbert, Peter, D'Onofrio, Gail, Jackson, Elizabeth A., Lichtman, Judith H., Bueno, Héctor, Spertus, John A., Krumholz, Harlan M., and D'Onofrio, Gail
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Background: Young women with acute myocardial infarction (AMI) have higher mortality risk than similarly aged men. An adverse lipid profile is an important risk factor for cardiovascular outcomes after AMI, but little is known about whether young women with AMI have a higher-risk lipid pattern than men. We characterized sex differences in lipid profiles and treatment utilization among young adults with AMI.Methods: A total of 2,219 adults with AMI (1,494 women) aged 18-55 years were enrolled from 103 hospitals in the United States (2008-2012). Serum lipids and lipoprotein subclasses were measured 1 month after discharge.Results: More than 90% of adults were discharged on a statin, but less than half received a high-intensity dose and 12% stopped taking treatments by 1 month. For both men and women, the median of low-density lipoprotein (LDL) cholesterol was reduced to <100 mg/dL 1 month after discharge for AMI, but high-density lipoprotein (HDL) cholesterol remained <40 mg/dL. Multivariate regression analyses showed that young women had favorable lipoprotein profiles compared with men: women had higher HDL cholesterol and HDL large particle, but lower total cholesterol-to-HDL cholesterol ratio and LDL small particle.Conclusions: Young women with AMI had slightly favorable lipid and lipoprotein profiles compared with men, suggesting that difference in lipid and lipoprotein may not be a major contributor to sex differences in outcomes after AMI. In both men and women, statin remained inadequately used, and low HDL cholesterol level was a major lipid abnormality. [ABSTRACT FROM AUTHOR]- Published
- 2017
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30. Developing an Actionable Taxonomy of Persistent Hypertension Using Electronic Health Records.
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Lu, Yuan, Xinxin Du, Cindy, Khidir, Hazar, Caraballo, César, Mahajan, Shiwani, Spatz, Erica S., Curry, Leslie A., and Krumholz, Harlan M.
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Background: The digital transformation of medical data presents opportunities for novel approaches to manage patients with persistent hypertension. We sought to develop an actionable taxonomy of patients with persistent hypertension (defined as 5 or more consecutive measurements of blood pressure ≥160/100 mmHg over time) based on data from the electronic health records. Methods: This qualitative study was a content analysis of clinician notes in the electronic health records of patients in the Yale New Haven Health System. Eligible patients were 18 to 85 years and had blood pressure ≥160/100 mmHg at 5 or more consecutive outpatient visits between January 1, 2013 and October 31, 2018. A total of 1664 patients met criteria, of which 200 records were randomly selected for chart review. Through a systematic, inductive approach, we developed a rubric to abstract data from the electronic health records and then analyzed the abstracted data qualitatively using conventional content analysis until saturation was reached. Results: We reached saturation with 115 patients, who had a mean age of 66.0 (SD, 11.6) years; 54.8% were female; 52.2%, 30.4%, and 13.9% were White, Black, and Hispanic patients. We identified 3 content domains related to persistence of hypertension: (1) non-intensification of pharmacological treatment, defined as absence of antihypertensive treatment intensification in response to persistent severely elevated blood pressure; (2) non-implementation of prescribed treatment, defined as a documentation of provider recommending a specified treatment plan to address hypertension but treatment plan not being implemented; and (3) non-response to prescribed treatment, defined as clinician-acknowledged persistent hypertension despite documented effort to escalate existing pharmacologic agents and addition of additional pharmacologic agents with presumption of adherence. Conclusions: This study presents a novel actionable taxonomy for classifying patients with persistent hypertension by their contributing causes based on electronic health record data. These categories can be automated and linked to specific types of actions to address them. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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31. American Heart Association Goals Through a 20/20 Lens
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Spatz, Erica S.
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- 2020
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32. Heart Failure After Ischemic Stroke or Transient Ischemic Attack in Insulin-Resistant Patients Without Diabetes Mellitus Treated With Pioglitazone
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Young, Lawrence H., Viscoli, Catherine M., Schwartz, Gregory G., Inzucchi, Silvio E., Curtis, Jeptha P., Gorman, Mark J., Furie, Karen L., Conwit, Robin, Spatz, Erica S., Lovejoy, Anne, Abbott, J. Dawn, Jacoby, Daniel L., Kolansky, Daniel M., Ling, Frederick S., Pfau, Steven E., and Kernan, Walter N.
- Abstract
Supplemental Digital Content is available in the text.
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- 2018
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33. Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project)
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Lu, Jiapeng, Lu, Yuan, Wang, Xiaochen, Li, Xinyue, Linderman, George C, Wu, Chaoqun, Cheng, Xiuyuan, Mu, Lin, Zhang, Haibo, Liu, Jiamin, Su, Meng, Zhao, Hongyu, Spatz, Erica S, Spertus, John A, Masoudi, Frederick A, Krumholz, Harlan M, and Jiang, Lixin
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Hypertension is common in China and its prevalence is rising, yet it remains inadequately controlled. Few studies have the capacity to characterise the epidemiology and management of hypertension across many heterogeneous subgroups. We did a study of the prevalence, awareness, treatment, and control of hypertension in China and assessed their variations across many subpopulations.
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- 2017
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34. Editor’s Choice-Sex differences in young patients with acute myocardial infarction: A VIRGO study analysis
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Bucholz, Emily M, Strait, Kelly M, Dreyer, Rachel P, Lindau, Stacy T, D’Onofrio, Gail, Geda, Mary, Spatz, Erica S, Beltrame, John F, Lichtman, Judith H, Lorenze, Nancy P, Bueno, Hector, and Krumholz, Harlan M
- Abstract
Aims: Young women with acute myocardial infarction (AMI) have a higher risk of adverse outcomes than men. However, it is unclear how young women with AMI are different from young men across a spectrum of characteristics. We sought to compare young women and men at the time of AMI on six domains of demographic and clinical factors in order to determine whether they have distinct profiles.Methods and results: Using data from Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO), a prospective cohort study of women and men aged ⩽55 years hospitalized for AMI (n= 3501) in the United States and Spain, we evaluated sex differences in demographics, healthcare access, cardiovascular risk and psychosocial factors, symptoms and pre-hospital delay, clinical presentation, and hospital management for AMI. The study sample included 2349 (67%) women and 1152 (33%) men with a mean age of 47 years. Young women with AMI had higher rates of cardiovascular risk factors and comorbidities than men, including diabetes, congestive heart failure, chronic obstructive pulmonary disease, renal failure, and morbid obesity. They also exhibited higher levels of depression and stress, poorer physical and mental health status, and lower quality of life at baseline. Women had more delays in presentation and presented with higher clinical risk scores on average than men; however, men presented with higher levels of cardiac biomarkers and more classic electrocardiogram findings. Women were less likely to undergo revascularization procedures during hospitalization, and women with ST segment elevation myocardial infarction were less likely to receive timely primary reperfusion.Conclusions: Young women with AMI represent a distinct, higher-risk population that is different from young men.
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- 2017
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35. Quantifying Blood Pressure Visit-to-Visit Variability in the Real-World Setting: A Retrospective Cohort Study
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Lu, Yuan, Linderman, George C., Mahajan, Shiwani, Liu, Yuntian, Huang, Chenxi, Khera, Rohan, Mortazavi, Bobak J., Spatz, Erica S., and Krumholz, Harlan M.
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- 2023
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36. Diabetes Mellitus and Outcomes of Cardiac Resynchronization With Implantable Cardioverter-Defibrillator Therapy in Older Patients With Heart Failure.
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Echouffo-Tcheugui, Justin B., Masoudi, Frederick A., Bao, Haikun, Spatz, Erica S., and Fonarow, Gregg C.
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Background: Large-scale data on outcomes with cardiac resynchronization therapy with defibrillator in patients with diabetes mellitus are limited. We compared outcomes after cardiac resynchronization therapy with defibrillator implantation among patients with heart failure who have diabetes mellitus versus those without diabetes mellitus.Methods and Results: Survival curves and covariate adjusted hazard ratio (HR) or odds ratio were used to assess the risks for death, readmission, and device-related complications by diabetes mellitus status among 18 428 patients at least 65 years old receiving cardiac resynchronization therapy with defibrillator from the National Cardiovascular Data Registry, implantable cardioverter-defibrillator registry between 2006 and 2009, with up to 3 years of follow-up. Accounting for differences between groups, compared with those without diabetes mellitus (n=11 345), patients with diabetes mellitus (n=7083) had a higher risk of death both at 1 year (HR, 1.16 [95% confidence interval (CI), 1.05-1.29]; P=0.0037) and 3 years (HR, 1.21 [1.14-1.29]; P<0.001) after device implantation and higher risks of all-cause readmission (sub-HR, 1.16 [1.11-1.21] at 1 year; P<0.0001; sub-HR, 1.15 [1.11-1.19] at 3 years; P<0.0001) and heart failure-related readmission (sub-HR, 1.18 [1.09-1.28] at 1 year; P<0.0001; and sub-HR, 1.22 [1.15-1.30] at 3 years; P<0.0001). Device-related complications within 90 days did not differ between those with and without diabetes mellitus (odds ratio: 0.90 [0.77-1.06]; P=0.37). Interactions of age, sex, ischemic cardiomyopathy, renal failure, or QRS duration were not significant.Conclusions: In older patients with heart failure receiving cardiac resynchronization therapy with defibrillator, diabetes mellitus was independently associated with greater risks of death and rehospitalization, but similar risks of procedural complications. [ABSTRACT FROM AUTHOR]- Published
- 2016
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37. Favorable Cardiovascular Risk Profile Is Associated With Lower Healthcare Costs and Resource Utilization: The 2012 Medical Expenditure Panel Survey.
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Valero-Elizondo, Javier, Salami, Joseph A., Ogunmoroti, Oluseye, Osondu, Chukwuemeka U., Aneni, Ehimen C., Malik, Rehan, Spatz, Erica S., Rana, Jamal S., Virani, Salim S., Blankstein, Ron, Blaha, Michael J., Veledar, Emir, and Nasir, Khurram
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CARDIOVASCULAR disease diagnosis ,CARDIOVASCULAR disease prevention ,CARDIOVASCULAR diseases ,COST control ,COST effectiveness ,MEDICAL care costs ,MEDICAL care use ,PREVENTIVE health services ,RISK assessment ,SURVEYS ,RETROSPECTIVE studies ,ECONOMICS - Abstract
Background: The American Heart Association's 2020 Strategic Goals emphasize the value of optimizing risk factor status to reduce the burden of morbidity and mortality. In this study, we aimed to quantify the overall and marginal impact of favorable cardiovascular risk factor (CRF) profile on healthcare expenditure and resource utilization in the United States among those with and without cardiovascular disease (CVD).Methods and Results: The study population was derived from the 2012 Medical Expenditure Panel Survey (MEPS). Direct and indirect costs were calculated for all-cause healthcare resource utilization. Variables of interest included CVD diagnoses (coronary artery disease, stroke, peripheral artery disease, dysrhythmias, or heart failure), ascertained by International Classification of Diseases, Ninth Edition, Clinical Modification codes, and CRF profile (hypertension, diabetes mellitus, hypercholesterolemia, smoking, physical activity, and obesity). Two-part econometric models were used to study expenditure data. The final study sample consisted of 15 651 MEPS participants (58.5±12 years, 54% female). Overall, 5921 (37.8%) had optimal, 7002 (44.7%) had average, and 2728 (17.4%) had poor CRF profile, translating to 54.2, 64.1, and 24.9 million adults in United States, respectively. Significantly lower health expenditures were noted with favorable CRF profile across CVD status. Among study participants with established CVD, overall healthcare expenditures with optimal and average CRF profile were $5946 and $3731 less compared with those with poor CRF profile. The respective differences were $4031 and $2560 in those without CVD.Conclusions: Favorable CRF profile is associated with significantly lower medical expenditure and healthcare utilization among individuals with and without established CVD. [ABSTRACT FROM AUTHOR]- Published
- 2016
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38. Geriatric Conditions in Patients Undergoing Defibrillator Implantation for Prevention of Sudden Cardiac Death: Prevalence and Impact on Mortality.
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Green, Ariel R., Leff, Bruce, Yongfei Wang, Spatz, Erica S., Masoudi, Frederick A., Peterson, Pamela N., Daugherty, Stacie L., Matlock, Daniel D., and Wang, Yongfei
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CARDIAC arrest prevention ,HEART failure treatment ,STROKE-related mortality ,CHRONIC kidney failure ,DEMENTIA ,DIABETES ,FRAIL elderly ,HEART failure ,IMPLANTABLE cardioverter-defibrillators ,CIRRHOSIS of the liver ,LONGITUDINAL method ,OBSTRUCTIVE lung diseases ,PREVENTIVE health services ,RESEARCH funding ,TUMORS ,ACQUISITION of data - Abstract
Background: Geriatric conditions may influence outcomes among patients receiving implantable cardioverter-defibrillators (ICDs). We sought to determine the prevalence of frailty and dementia among older adults receiving primary prevention ICDs and to determine the impact of multimorbidity on mortality within 1 year of ICD implantation.Methods and Results: The cohort included 83 792 Medicare patients from the National Cardiovascular Data Registry ICD Registry who underwent first primary prevention ICD implantation between 2006 and 2009. These data were merged with Medicare analytic files to determine the prevalence of frailty, dementia, and other conditions before ICD implantation, as well as 1-year mortality. A validated claim-based algorithm was used to identify frail patients. Mutually exclusive patterns of chronic conditions were examined. The association of each pattern with 1-year mortality was assessed using logistic regression models adjusted for selected patient characteristics. Approximately 1 in 10 Medicare patients with heart failure receiving a primary prevention ICD had frailty (10%) or dementia (1%). One-year mortality was 22% for patients with frailty, 27% for patients with dementia, and 12% in the overall cohort. Several multimorbidity patterns were associated with high 1-year mortality rates: dementia with frailty (29%), frailty with chronic obstructive pulmonary disease (25%), and frailty with diabetes mellitus (23%). These patterns were present in 8% of the cohort.Conclusions: More than 10% of Medicare beneficiaries with heart failure receiving primary prevention ICDs have frailty or dementia. These patients had significantly higher 1-year mortality than those with other common chronic conditions. Frailty and dementia should be considered in clinical decision-making and guideline development. [ABSTRACT FROM AUTHOR]- Published
- 2016
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39. Shared decision making as part of value based care: New U.S. policies challenge our readiness
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Spatz, Erica S., Elwyn, Glyn, Moulton, Benjamin W., Volk, Robert J., and Frosch, Dominick L.
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Shared decision making in the United States is increasingly being recognized as part of value-based care. During the last decade, several state and federal initiatives have linked shared decision making with reimbursement and increased protection from litigation. Additionally, private and public foundations are increasingly funding studies to identify best practices for moving shared decision making from the research world into clinical practice. These shifts offer opportunities and challenges for ensuring effective implementation.
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- 2017
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40. National Trends in Statin Use and Expenditures in the US Adult Population From 2002 to 2013: Insights From the Medical Expenditure Panel Survey
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Salami, Joseph A., Warraich, Haider, Valero-Elizondo, Javier, Spatz, Erica S., Desai, Nihar R., Rana, Jamal S., Virani, Salim S., Blankstein, Ron, Khera, Amit, Blaha, Michael J., Blumenthal, Roger S., Lloyd-Jones, Donald, and Nasir, Khurram
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IMPORTANCE: Statins remain a mainstay in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD). OBJECTIVE: To detail the trends in use and total and out-of-pocket (OOP) expenditures associated with statins in a representative US adult population from 2002 to 2013. DESIGN, SETTING, AND PARTICIPANTS: This retrospective longitudinal cohort study was conducted from January 2002 to December 2013. Demographic, medical condition, and prescribed medicine information of adults 40 years and older between 2002 and 2013 were obtained from the Medical Expenditure Panel Survey database. MAIN OUTCOMES AND MEASURES: Estimated trends in statin use, total expenditure, and OOP share among the general adult population, those with established ASCVD, and those at risk for ASCVD. Costs were adjusted to 2013 US dollars using the Gross Domestic Product Index. RESULTS: From 2002 to 2013, more than 157 000 Medical Expenditure Panel Survey participants were eligible for the study (mean [SD] age, 57.7 [39.9] years; 52.1% female). Overall, statin use among US adults 40 years of age and older in the general population increased 79.8% from 21.8 million individuals (17.9%) in 2002-2003 (134 million prescriptions) to 39.2 million individuals (27.8%) in 2012-2013 (221 million prescriptions). Among those with established ASCVD, statin use was 49.8% and 58.1% in 2002-2003 and 2012-2013, respectively, and less than one-third were prescribed as a high-intensity dose. Across all subgroups, statin use was significantly lower in women (odds ratio, 0.81; 95% CI, 0.79-0.85), racial/ethnic minorities (odds ratio, 0.65; 95% CI, 0.61-0.70), and the uninsured (odds ratio, 0.33; 95% CI, 0.30-0.37). The proportion of generic statin use increased substantially, from 8.4% in 2002-2003 to 81.8% in 2012-2013. Gross domestic product–adjusted total cost for statins decreased from $17.2 billion (OOP cost, $7.6 billion) in 2002-2003 to $16.9 billion (OOP cost, $3.9 billion) in 2012-2013, and the mean annual OOP costs for patients decreased from $348 to $94. Brand-name statins were used by 18.2% of statin users, accounting for 55% of total costs in 2012-2013. CONCLUSION AND RELEVANCE: Statin use increased substantially in the last decade among US adults, although the uptake was suboptimal in high-risk groups. While total and OOP expenditures associated with statins decreased, further substitution of brand-name to generic statins may yield more savings.
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- 2017
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41. Developing an Actionable Taxonomy of Persistent Hypertension Using Electronic Health Records
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Lu, Yuan, Xinxin Du, Cindy, Khidir, Hazar, Caraballo, César, Mahajan, Shiwani, Spatz, Erica S., Curry, Leslie A., and Krumholz, Harlan M.
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- 2023
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42. Abstract P405: Low Social Support Mediates the Effect of Marital Stress on 12-month Cardiac-Specific Quality of Life in Young Adults With Acute Myocardial Infarction
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Zhu, Cenjing, Dreyer, Rachel P, Li, Fan, Spatz, Erica S, Caraballo, Cesar, Mahajan, Shiwani, Raparelli, Valeria, Leifheit, Erica C, Lu, Yuan, Krumholz, Harlan M, Spertus, John, DONOFRIO, Gail, Pilote, Louise, and Lichtman, Judith H
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Background:Marital stress is associated with worse cardiac outcomes in young adults (≤55 years) with acute myocardial infarction (AMI), but whether psychosocial factors mediate this association remains largely unknown. We conducted a mediation analysis to investigate whether marital stress worsened quality of life (QoL) after AMI by increasing the likelihood of depression or low social support.Methods:There were 1,037 married/partnered AMI survivors aged 18-55 years enrolled in the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study (2008-2012) (67% women, mean age 47 years). Marital stress was measured by the Stockholm Marital Stress Scale at 1 month post-AMI; categorized as absent/moderate or severe. Depression (Patient Health Questionnaire-9 score ≥10), low social support (ENRICHD Social Support Instrument score ≤3 on ≥2 items and total score ≤18), and cardiac-specific QoL (Seattle Angina Questionnaire) were assessed at 1 year post-AMI. Natural direct and indirect effects of marital stress, depression, and low social support on QoL were estimated by causal mediation analysis with bias-corrected bootstrapped confidence intervals. Baseline QoL, sex, age, race, and socioeconomic factors (education, income, employment, and insurance status) were entered as covariates in all models.Results:There was a statistically significant direct effect from severe marital stress to lower 1-year cardiac-specific QoL after adjusting for covariates (Figure). Low social support and depression mediated 14.7% and 11.1% of the total relationship between marital stress and QoL, respectively; however, only the mediating effect through low social support was statistically significant.Conclusion:Marital stress was significantly associated with worse 1-year cardiac-specific QoL, and this effect was partially mediated by low social support. Interventions to decrease marital stress that also screen and provide resources for social support may help to improve AMI outcomes.
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- 2023
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43. Abstract TMP25: Major Adverse Brain Events: Incidence Rates Of A Novel Composite Vascular Neurologic Outcome
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de Havenon, Adam, Sharma, Richa, Sarpong, Daniel, Forman, Rachel, Prabhakaran, Shyam, Spatz, Erica S, Krumholz, Harlan M, Fernandes, Claudia, Roy, Brita, Sheth, Kevin N, and Kernan, Walter N
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Background:The classical 3-point composite outcome MACE (major adverse cardiovascular events) includes incident stroke, myocardial infarction, and cardiovascular death. Conventional use of MACE may fail to account for important neurological consequences of vascular risk factors. We sought to report incidence rates of a novel composite neurologic outcome called major adverse brain events (MABE), comprised of incident stroke, dementia, and impaired balance in individuals with the vascular risk factor of hypertension.Methods:We analyzed TriNetX, the Health and Retirement Study (HRS), and Atherosclerosis Risk in Communities (ARIC), three longitudinal, publicly available datasets. We ascertained MABE as well as MACE and MACABE (MABE & MACE) as comparators by applying distinct adjudication methodologies in each dataset. We also evaluated the effect of good vascular health (maintenance of systolic blood pressure <140mm Hg and moderate or high physical activity, GVH) on rates of MABE and MACE in HRS through odds ratios (OR) adjusted for age, sex, and race/ethnicity.Results:We included 10,496,366 hypertensive individuals aged ≥40 years in the TriNetX sample with up to 4 years of follow-up, 2,251 hypertensive individuals aged ≥60 years in HRS with 4 years of follow-up, and 1,409 hypertensive individuals in ARIC with a mean of 4.9 years of follow-up. The incidence of MABE was 10.5% in TriNetX (Figure 1), 35.9% in HRS, and 33.3% in ARIC, of MACE was 17.5%, 40.8% and 12.9%, and of MACABE was 21.2%, 56.3%, and 39.9%, respectively. MABE incidence was highest in older, female, and Black individuals. In HRS, the adjusted OR in those with GVH was 0.50 (95% CI 0.34-0.73) for MABE, 0.71 (95% CI 0.51-0.99) for MACE, and 0.59 (95% CI 0.43-0.82) for MACABE.Conclusions:These data suggest that MABE is common among patients with hypertension, even in administrative datasets which are expected to have lower event rates. MABE may be useful for interventions that target brain health.
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- 2023
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44. Atorvastatin versus Placebo in ICU Patients with COVID-19: Ninety-day Results of the INSPIRATION-S Trial
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Talasaz, Azita H., Sadeghipour, Parham, Bakhshandeh, Hooman, Sharif-Kashani, Babak, Rashidi, Farid, Beigmohammadi, Mohammad Taghi, Moghadam, Keivan Gohari, Rezaian, Somaye, Dabbagh, Ali, Sezavar, Seyed Hashem, Farrokhpour, Mohsen, Abedini, Atefeh, Aliannejad, Rasoul, Riahi, Taghi, Yadollahzadeh, Mahdi, Lookzadeh, Somayeh, Rezaeifar, Parisa, Matin, Samira, Tahamtan, Ouria, Mohammadi, Keyhan, Zoghi, Elnaz, Rahmani, Hamid, Hosseini, Seyed Hossein, Mousavian, Seyed Masoud, Abri, Homa, Sadeghipour, Pardis, Baghizadeh, Elahe, Rafiee, Farnaz, Jamalkhani, Sepehr, Amin, Ahmad, Mohebbi, Bahram, Parhizgar, Seyed Ehsan, Soleimanzadeh, Mahshid, Aghakouchakzadeh, Maryam, Eslami, Vahid, Payandemehr, Pooya, Khalili, Hossein, Talakoob, Hamed, Tojari, Taranom, Shafaghi, Shadi, Tabrizi, Sanaz, Kakavand, Hessam, Kashefizadeh, Alireza, Najafi, Atabak, Jimenez, David, Gupta, Aakriti, Madhavan, Mahesh V., Sethi, Sanjum S., Parikh, Sahil A., Monreal, Manuel, Hadavand, Naser, Hajighasemi, Alireza, Ansarin, Khalil, Maleki, Majid, Sadeghian, Saeed, Barco, Stefano, Siegerink, Bob, Spatz, Erica S., Piazza, Gregory, Kirtane, Ajay J., Tassell, Benjamin W. Van, Lip, Gregory Y. H., Klok, Frederikus A., Goldhaber, Samuel Z., Stone, Gregg W., Krumholz, Harlan M., and Bikdeli, Behnood
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- 2023
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45. Lifetime Healthcare Expenses Across Demographic and Cardiovascular Risk Groups: The Application of a Novel Modeling Strategy in a Large Multiethnic Cohort Study
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Khera, Rohan, Kondamudi, Nitin, Liu, Mengni, Ayers, Colby, Spatz, Erica S, Rao, Shreya, Essien, Utibe R, Powell-Wiley, Tiffany M, Nasir, Khurram, Das, Sandeep R, Capers, Quinn, and Pandey, Ambarish
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•We examine the burden of lifetime healthcare expenses among disadvantaged individuals•Black men have higher lifetime healthcare expenses compared to other demographic groups•Lifetime healthcare expenditure tends to increase with higher cardiovascular risk factor prevalence
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- 2023
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46. Association Between a Prolonged PR Interval and Outcomes of Cardiac Resynchronization Therapy
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Friedman, Daniel J., Bao, Haikun, Spatz, Erica S., Curtis, Jeptha P., Daubert, James P., and Al-Khatib, Sana M.
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Supplemental Digital Content is available in the text.
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- 2016
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47. Sexual Activity and Function in the Year After an Acute Myocardial Infarction Among Younger Women and Men in the United States and Spain
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Lindau, Stacy Tessler, Abramsohn, Emily, Bueno, Hector, D’Onofrio, Gail, Lichtman, Judith H., Lorenze, Nancy P., Sanghani, Rupa Mehta, Spatz, Erica S., Spertus, John A., Strait, Kelly M., Wroblewski, Kristen, Zhou, Shengfan, and Krumholz, Harlan M.
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IMPORTANCE: Most younger adults who experience an acute myocardial infarction (AMI) are sexually active before the AMI, but little is known about sexual activity or sexual function after the event. OBJECTIVE: To describe patterns of sexual activity and function and identify indicators of the probability of loss of sexual activity in the year after AMI. DESIGN, SETTING, AND PARTICIPANTS: Data from the prospective, multicenter, longitudinal Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients study (conducted from August 21, 2008, to January 5, 2012) were assessed at baseline, 1 month, and 1 year. Participants were from US (n = 103) and Spanish (n = 24) hospitals and completed baseline and all follow-up interviews. Data analysis for the present study was conducted from October 15, 2014, to June 6, 2016. Characteristics associated with loss of sexual activity were assessed using multinomial logistic regression analyses. MAIN OUTCOMES AND MEASURES: Loss of sexual activity after AMI. RESULTS: Of the 2802 patients included in the analysis, 1889 were women (67.4%); median (25th-75th percentile) age was 49 (44-52) years (range, 18-55 years). At all time points, 637 (40.4%) of women and 437 (54.9%) of men were sexually active. Among people who were active at baseline, men were more likely than women to have resumed sexual activity by 1 month (448 [63.9%] vs 661 [54.5%]; P < .001) and by 1 year (662 [94.4%] vs 1107 [91.3%]; P = .01) after AMI. Among people who were sexually active before and after AMI, women were less likely than men to report no sexual function problems in the year after the event (466 [40.3%] vs 382 [54.8%]; P < .01). In addition, more women than men (211 [41.9%] vs 107 [30.5%]; P < .01) with no baseline sexual problems developed 1 or more incident problems in the year after the AMI. At 1 year, the most prevalent sexual problems were lack of interest (487 [39.6%]) and trouble lubricating (273 [22.3%]) among women and erectile difficulties (156 [21.7%]) and lack of interest (137 [18.8%]) among men. Those who had not communicated with a physician about sex in the first month after AMI were more likely to delay resuming sex (adjusted odds ratio [AOR], 1.51; 95% CI, 1.11-2.05; P = .008). Higher stress levels (AOR, 1.36; 95% CI, 1.01-1.83) and having diabetes (AOR, 1.90; 95% CI, 1.15-3.13) were significant indicators of the probability of loss of sexual activity in the year after the AMI. CONCLUSIONS AND RELEVANCE: Impaired sexual activity and incident sexual function problems were prevalent and more common among young women than men in the year after AMI. Attention to modifiable risk factors and physician counseling may improve outcomes.
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- 2016
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48. Cardiovascular Outcomes in the Wake of Financial Uncertainty
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Spatz, Erica S. and Herrin, Jeph
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- 2019
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49. Cardiac Resynchronization Therapy in Women Versus Men.
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Zusterzeel, Robbert, Spatz, Erica S., Curtis, Jeptha P., Sanders, William E., Selzman, Kimberly A., Piña, Ileana L., Bao, Haikun, Ponirakis, Angelo, Varosy, Paul D., Masoudi, Frederick A., Caños, Daniel A., and Strauss, David G.
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- 2015
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50. Abstract 15197: Trends in Prevalence and Treatment of Metabolic Syndrome and Individual Components by Race/Ethnicity, 1999-2020
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Lu, Yuan, Li, Xumin, Liu, Yuntian, Caraballo, Cesar, Mahajan, Shiwani, Massey, Daisy, Spatz, Erica S, Herrin, Jeph, and Krumholz, Harlan M
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Introduction:Nationally representative data evaluating recent trends in racial and ethnic differences in prevalence and treatment of metabolic syndrome (MetS) are sparse.Methods:We evaluated 21-year trends in the prevalence and treatment of MetS and individual components in 21,602 adults, using data from the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2020. We used weighted linear regression to estimate time trends and compared these trends by race and ethnicity.Results:Among participants, the mean age was 47.7 (SD, 2.2) years; 51 % were female; 78 %, 12.7%, and 9.3% were White, Black, and Hispanic. From 1999 to 2020, the prevalence of MetS as well as the prevalences of elevated waist circumference and elevated fasting glucose increased significantly for Black, Hispanic, and White individuals (P<0.01 for all). The prevalences of elevated blood pressure and elevated triglyceride increased among Black individuals but did not change among Hispanic and White individuals. The use of antihypertensive, antihyperglycemic, and lipid-modifying medications also increased for all racial/ethnic subgroups. Racial/ethnic disparities in prevalence and treatment of MetS and individual components persisted throughout the study period. Compared with White individuals, Black individuals had higher use of antihypertensive medications but lower use of lipid-modifying medications (P<0.01 for all). Hispanic individuals had lower use of antihypertensive medications and lipid-modifying medications (P<0.01 for all). Across all racial/ethnic subgroups, less than 60% and 30% of people with medication indications received lipid-modifying and antihyperglycemic medications, respectively.Conclusions:Temporal trends suggest an increase in prevalence of MetS. There were persistent racial/ethnic disparities in use of antihypertensive, antihyperglycemic, and lipid-modifying medications among people with medication indications.
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- 2022
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