11 results on '"Sueta, Carla"'
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2. Analysis of the degree of undertreatment of hyperlipidemia and congestive heart failure secondary...
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Sueta, Carla A. and Chowdhury, Mridul
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HYPERLIPIDEMIA treatment , *CONGESTIVE heart failure treatment , *CORONARY heart disease treatment , *CARDIOVASCULAR diseases - Abstract
Analyzes the degree of undertreatment of hyperlipidemia and congestive heart failure secondary to coronary artery disease (CAD). Effects of cardiovascular disease and CAD; Analysis of data from the Quality Assurance Program; Predictors of medication prescription; Inadequacy of practice patterns in the management of the diseases in the United States.
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- 1999
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3. Performance assessment model for guideline-recommended pharmacotherapy in the secondary...
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Simpson Jr., Ross J. and Sueta, Carla A.
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CORONARY heart disease treatment - Abstract
Describes Merck and Co.-sponsored abstraction project for ambulatory practices to oversee the quality of care for patients suffering from coronary artery disease. Abstraction performed by healthcare organization to maintain patient confidentiality; Account of the abstraction process; Commitment to improve condition of coronary patients.
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- 1997
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4. Heart Failure and Cognitive Impairment in the Atherosclerosis Risk in Communities (ARIC) Study.
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Witt LS, Rotter J, Stearns SC, Gottesman RF, Kucharska-Newton AM, Richey Sharrett A, Wruck LM, Bressler J, Sueta CA, and Chang PP
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- Aged, Aged, 80 and over, Atherosclerosis epidemiology, Atherosclerosis psychology, Cognitive Dysfunction epidemiology, Cross-Sectional Studies, Dementia epidemiology, Dementia etiology, Female, Heart Failure epidemiology, Humans, Male, Middle Aged, Neuropsychological Tests, Prevalence, Risk Assessment methods, Risk Factors, United States epidemiology, Cognitive Dysfunction etiology, Heart Failure psychology
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Background: Previous studies suggest that heart failure (HF) is an independent risk factor for cognitive decline. A better understanding of the relationship between HF, cognitive status, and cognitive decline in a community-based sample may help clinicians understand disease risk., Objective: To examine whether persons with HF have a higher prevalence of cognitive impairment and whether persons developing HF have more rapid cognitive decline., Design: This observational cohort study of American adults in the Atherosclerosis Risk in Communities (ARIC) study has two components: cross-sectional analysis examining the association between prevalent HF and cognition using multinomial logistic regression, and change over time analysis detailing the association between incident HF and change in cognition over 15 years., Participants: Among visit 5 (2011-2013) participants (median age 75 years), 6495 had neurocognitive information available for cross-sectional analysis. Change over time analysis examined the 5414 participants who had cognitive scores and no prevalent HF at visit 4 (1996-1998)., Measurements: The primary outcome was cognitive status, classified as normal, mild cognitive impairment [MCI], and dementia on the basis of standardized cognitive tests (delayed word recall, word fluency, and digit symbol substitution). Cognitive change was examined over a 15-year period. Control variables included socio-demographic, vascular, and smoking/drinking measures., Results: At visit 5, participants with HF had a higher prevalence of dementia (adjusted relative risk ratio [RRR] = 1.60 [95% CI 1.13, 2.25]) and MCI (RRR = 1.36 [1.12, 1.64]) than those without HF. A decline in cognition between visits 4 and 5 was - 0.07 standard deviation units [- 0.13, - 0.01] greater among persons who developed HF compared to those who did not. Results did not differ by ejection fraction., Conclusion: HF is associated with neurocognitive dysfunction and decline independent of other co-morbid conditions. Further study is needed to determine the underlying pathophysiology.
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- 2018
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5. Recurrent Acute Decompensated Heart Failure Admissions for Patients With Reduced Versus Preserved Ejection Fraction (from the Atherosclerosis Risk in Communities Study).
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Caughey MC, Sueta CA, Stearns SC, Shah AM, Rosamond WD, and Chang PP
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- Acute Disease, Aged, Atherosclerosis therapy, Cause of Death trends, Comorbidity, Female, Follow-Up Studies, Heart Failure physiopathology, Heart Failure therapy, Hospitalization trends, Humans, Incidence, Male, Prognosis, Recurrence, Retrospective Studies, Risk Factors, Survival Rate trends, United States epidemiology, Atherosclerosis epidemiology, Heart Failure epidemiology, Risk Assessment, Stroke Volume physiology, Ventricular Function, Left physiology
- Abstract
Hospitals are required to report all-cause 30-day readmissions for patients discharged with heart failure. Same-cause readmissions have received less attention but may differ for heart failure with reduced ejection fraction (HFrEF) versus heart failure with preserved ejection fraction (HFpEF). The ARIC study began abstracting medical records for cohort members hospitalized with acute decompensated heart failure (ADHF) in 2005. ADHF was validated by physician review, with HFrEF defined by ejection fraction <50%. Recurrent admissions for ADHF were analyzed within 30 days, 90 days, 6 months, and 1 year of the index hospitalization using repeat-measures Cox regression models. All recurrent ADHF admissions per patient were counted rather than the more typical analysis of only the first occurring readmission. From 2005 to 2014, 1,133 cohort members survived at least 1 hospitalization for ADHF and had ejection fraction recorded. Half were classified as HFpEF. Patients with HFpEF were more often women and had more co-morbidities. The overall ADHF readmission rate was greatest within 30 days of discharge but was higher for patients with HFrEF (115 vs 88 readmissions per 100 person-years). After adjustments for demographics, year of admission, and co-morbidities, there was a trend for higher ADHF readmissions with HFrEF, relative to HFpEF, at 30 days (hazard ratio [HR] 1.41, 95% confidence interval [CI] 0.92 to 2.18), 90 days (HR 1.39, 95% CI 1.05 to 1.85), 6 months (HR 1.47, 95% CI, 1.18 to 1.84), and 1 year (HR 1.42, 95% CI 1.18 to 1.70) of follow-up. In conclusion, patients with HFrEF have a greater burden of short- and long-term readmissions for recurrent ADHF., (Copyright © 2018 Elsevier Inc. All rights reserved.)
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- 2018
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6. Guideline-Directed Medical Therapy and Survival Following Hospitalization in Patients with Heart Failure.
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Tran RH, Aldemerdash A, Chang P, Sueta CA, Kaufman B, Asafu-Adjei J, Vardeny O, Daubert E, Alburikan KA, Kucharska-Newton AM, Stearns SC, and Rodgers JE
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- Aged, Aged, 80 and over, Cardiovascular Agents administration & dosage, Comorbidity, Disease Progression, Female, Humans, Male, Middle Aged, Proportional Hazards Models, Retrospective Studies, Stroke Volume, United States, Cardiovascular Agents therapeutic use, Heart Failure drug therapy, Heart Failure mortality, Hospitalization statistics & numerical data, Practice Guidelines as Topic
- Abstract
Background: Modification of guideline-directed medical therapy (GDMT) in hospitalized patients with heart failure (HF) has not been extensively evaluated., Methods: The community surveillance arm of the Atherosclerosis Risk in Communities Study identified 6959 HF hospitalizations from 2005-2011. Predictors of GDMT modification and survival were assessed using multivariable logistic regression and Cox proportional hazards models., Results: For 5091 hospitalizations, patient mean age was 75 years, 53% were female, 69% were white, and 81% had acute decompensated heart failure (ADHF). Regarding ejection fraction (EF), 31% of patients had HF with reduced EF (HFrEF), 24% had HF with preserved EF (HFpEF), and 44% were missing EF values. At admission, 52% of patients received angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs), 66% β-blockers (BBs), 9% aldosterone-receptor antagonists, 16% digoxin, 10% hydralazine, and 29% nitrates. Modification of GDMT occurred in up to 23% of hospitalizations. Significant predictors of GDMT initiation included ADHF and HFrEF; discontinuation of medications was observed with select comorbidities. In HFrEF, initiation of any GDMT was associated with reduced 1-year all-cause mortality (adjusted hazard ratio [HR] 0.41, 95% confidence interval [CI] 0.23-0.71) as was initiation of ACEI/ARBs, BBs, and digoxin. Discontinuation of any therapy versus maintaining GDMT was associated with greater mortality (HR 1.30, 95% CI 1.02-1.66). Similar trends were observed in HFpEF., Conclusions: Our study suggests that GDMT initiation is associated with increased survival, and discontinuation of therapy is associated with reduced survival in hospitalized patients with HF. Future studies should be conducted to confirm the impact of GDMT therapy modification in this population., (© 2018 Pharmacotherapy Publications, Inc.)
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- 2018
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7. Antihypertensive adherence and outcomes among community-dwelling Medicare beneficiaries: the Atherosclerosis Risk in Communities Study.
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Federspiel JJ, Sueta CA, Kucharska-Newton AM, Beyhaghi H, Zhou L, Virani SS, Rodgers JE, Chang PP, and Stearns SC
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- Drug Utilization Review methods, Drug Utilization Review statistics & numerical data, Female, Health Services Research, Humans, Independent Living, Male, Medicare Part D statistics & numerical data, Middle Aged, Outcome Assessment, Health Care, Risk Assessment, Risk Factors, United States epidemiology, Antihypertensive Agents therapeutic use, Cardiovascular Diseases epidemiology, Hypertension drug therapy, Hypertension epidemiology, Medication Adherence statistics & numerical data
- Abstract
Rationale, Aims, and Objectives: Despite proven benefits for reducing incidence of major cardiac events, antihypertensive drug therapy remains underutilized in the United States. This analysis assesses antihypertensive drug adherence, utilization predictors, and associations between adherence and outcomes (a composite of cardiovascular events, Medicare inpatient payments, and inpatient days)., Methods: The sample consisted of Atherosclerosis Risk in Communities Study cohort participants reporting hypertension without prevalent cardiovascular disease during 2006 to 2007 annual follow-up calls. Atherosclerosis Risk in Communities records were linked to Medicare claims through 2012. Antihypertensive medication adherence was measured as more than 80% proportion days covered by using Medicare Part D claims. Standard and hierarchical regression models were used to evaluate adjusted associations between person characteristics and adherence and between adherence and outcomes., Results: Among 1826 hypertensive participants with Part D coverage, 31.5% had no antihypertensive class with more than 80% proportion days covered in the 3 months preceding the report of hypertension in 2006 to 2007. After adjustment for confounders, positive predictors of use included female gender and diabetes; negative predictors were African-American race and current smoking. Adjusted association between receiving no therapy and a composite endpoint of cardiovascular outcomes through 2012 was not statistically significant (hazard ratio: 0.93; 95% confidence interval: 0.72, 1.22) nor was the adjusted association with Medicare inpatient days or payments (incremental difference at 48 months in payments: $1217; 95% CI: -$2030, $4463)., Conclusions: Despite having medical and prescription coverage, nearly a third of hypertensive participants were not adherent to antihypertensive drug therapy. Differences in clinical outcomes associated with nonadherence, though not statistically significant, were consistent with results from randomized trials. The approach provides a model framework for rigorous assessment of detailed data that are increasingly available through emerging sources., (© 2016 John Wiley & Sons, Ltd.)
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- 2018
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8. Medication Adherence Based on Part D Claims for Patients With Heart Failure After Hospitalization (from the Atherosclerosis Risk in Communities Study).
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Sueta CA, Rodgers JE, Chang PP, Zhou L, Thudium EM, Kucharska-Newton AM, and Stearns SC
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- Aged, Atherosclerosis drug therapy, Atherosclerosis epidemiology, Female, Heart Failure epidemiology, Heart Failure etiology, Humans, Incidence, Male, Retrospective Studies, United States epidemiology, Atherosclerosis complications, Heart Failure drug therapy, Hospitalization statistics & numerical data, Insurance Claim Reporting statistics & numerical data, Medicare Part D statistics & numerical data, Medication Adherence statistics & numerical data
- Abstract
Medication nonadherence is a common precipitant of heart failure (HF) hospitalization and is associated with poor outcomes. Recent analyses of national data focus on long-term medication adherence. Little is known about adherence of patients with HF immediately after hospitalization. Hospitalized patients with HF were identified from the Atherosclerosis Risk in Communities study. Atherosclerosis Risk in Communities data were linked to Medicare inpatient and part D claims from 2006 to 2009. Inclusion criteria were a chart-adjudicated diagnosis of acute decompensated or chronic HF; documentation of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), β blocker (BB), or diuretic prescription at discharge; and Medicare part D coverage. Proportion of ambulatory days covered was calculated for up to twelve 30-day periods after discharge. Adherence was defined as ≥80% proportion of ambulatory days covered. We identified 402 participants with Medicare part D: mean age 75, 30% men, and 41% black. Adherence at 1, 3, and 12 months was 70%, 61%, and 53% for ACEI/ARB; 76%, 66%, and 62% for BB; and 75%, 68%, and 59% for diuretic. Adherence to any single drug class was positively correlated with being adherent to other classes. Adherence varied by geographic site/race for ACEI/ARB and BB but not diuretics. In conclusion, despite having part D coverage, medication adherence after discharge for all 3 medication classes decreases over 2 to 4 months after discharge, followed by a plateau over the subsequent year. Interventions should focus on early and sustained adherence., (Copyright © 2015 Elsevier Inc. All rights reserved.)
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- 2015
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9. Comparable ascertainment of newly-diagnosed atrial fibrillation using active cohort follow-up versus surveillance of centers for medicare and medicaid services in the atherosclerosis risk in communities study.
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Bengtson LG, Kucharska-Newton A, Wruck LM, Loehr LR, Folsom AR, Chen LY, Rosamond WD, Duval S, Lutsey PL, Stearns SC, Sueta C, Yeh HC, Fox E, and Alonso A
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- Aged, Atrial Fibrillation epidemiology, Cohort Studies, Female, Follow-Up Studies, Humans, Incidence, Male, Racial Groups, Risk Factors, United States epidemiology, Atherosclerosis complications, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Centers for Medicare and Medicaid Services, U.S., Population Surveillance, Residence Characteristics
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Objective: Increasingly, epidemiologic studies use administrative data to identify atrial fibrillation (AF). Capture of incident AF is not well documented. We examined incidence rates and concordance of AF diagnosis based on active cohort follow-up versus surveillance of Centers for Medicare and Medicaid Services data in the Atherosclerosis Risk in Communities study., Methods: Atherosclerosis Risk in Communities cohort participants without prevalent AF enrolled in fee-for-service Medicare, with inpatient and outpatient coverage, for at least 12 continuous months between 1991 and 2009 were included. In active Atherosclerosis Risk in Communities study follow-up, annual telephone calls captured hospitalizations and deaths with incident AF diagnosis codes. For Centers for Medicare and Medicaid Services data, incident AF was defined by billed inpatient and outpatient diagnoses., Results: Of 10,134 eligible cohort participants, 738 developed AF according to both Atherosclerosis Risk in Communities and Centers for Medicare and Medicaid Services data; an additional 93 and 288 incident cases were identified using only Atherosclerosis Risk in Communities and Centers for Medicare and Medicaid Services data, respectively. Incidence rates per 1,000 person-years were 10.8 (95% confidence interval: 10.1-11.6) and 13.6 (95% confidence interval: 12.8-14.4) in Atherosclerosis Risk in Communities and Centers for Medicare and Medicaid Services, respectively; agreement was 96%; kappa was 0.77 (95% confidence interval: 0.75-0.80). Earlier AF ascertainment by one system versus the other was not associated with any cardiovascular disease risk factors, after accounting for sociodemographic factors. Additional Centers for Medicare and Medicaid Services events did not alter observed associations between risk factors and AF., Conclusion: Among fee-for-service enrollees, AF incidence rates were slightly lower for active cohort follow-up than for Centers for Medicare and Medicaid Services surveillance, because the latter included outpatient atrial fibrillation. Concordance was high and combining the two approaches could provide a more complete picture of newly-diagnosed AF.
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- 2014
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10. Managed care patients with heart failure: spectrum of ventricular dysfunction and predictors of medication utilization.
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Sueta CA, Bertoni AG, Massing MW, McArdle J, Duren-Winfield V, Davis J, Croft JB, and Goff DC Jr
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- Adrenergic beta-Antagonists therapeutic use, Aged, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Comorbidity, Diuretics therapeutic use, Female, Humans, Logistic Models, Male, Medicaid statistics & numerical data, Medicare statistics & numerical data, Middle Aged, North Carolina epidemiology, Spironolactone therapeutic use, Systole physiology, United States, Heart Failure drug therapy, Heart Failure physiopathology, Managed Care Programs statistics & numerical data, Ventricular Dysfunction, Left epidemiology
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Background: Heart failure (HF) is a common clinical syndrome resulting in high morbidity and mortality. We examined the spectrum of ventricular dysfunction, and investigated the predictors of angiotensin-converting enzyme (ACE) inhibitor, beta-blocker, and spironolactone prescription in 1613 managed care patients with HF., Methods and Results: The diagnosis of HF was made by a HF discharge diagnosis or at least 3 physician encounters with a HF diagnosis during 2000. Logistic regression was used to identify predictors of medication prescription. Preserved systolic function was documented in 37%, moderate-severe systolic dysfunction in 31%, mild systolic in 14%, and 18% had inadequate documentation. The mean age was 69 years, 58% were women, 24% African American, and 60% were Medicare patients. Patients without HF type documented were the least aggressively treated. Coronary artery disease, hypertension, and diabetes predicted increased utilization of ACE inhibitor and beta-blocker therapies. History of nephropathy was associated with less ACE inhibitor prescription. Advancing age predicted less utilization of beta-blockers and spironolactone. Neither ethnicity nor gender influenced medication prescription., Conclusion: Preserved left ventricular function was common. Documentation of significant systolic dysfunction was associated with improved quality of care. Interventions to encourage documentation of HF type and further study of HF with preserved systolic function are warranted.
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- 2005
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11. Undertreatment of hyperlipidemia in patients with coronary artery disease and heart failure.
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Sueta CA, Massing MW, Chowdhury M, Biggs DP, and Simpson RJ Jr
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- Adult, Age Factors, Aged, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Cholesterol, LDL blood, Cholesterol, LDL drug effects, Coronary Artery Disease blood, Coronary Artery Disease complications, Drug Prescriptions, Evidence-Based Medicine, Female, Heart Failure blood, Heart Failure complications, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Hyperlipidemias blood, Hyperlipidemias complications, Hypolipidemic Agents therapeutic use, Male, Middle Aged, Predictive Value of Tests, Severity of Illness Index, Stroke Volume physiology, Systole physiology, Treatment Outcome, United States epidemiology, Ventricular Dysfunction, Left drug therapy, Ventricular Dysfunction, Left physiopathology, Coronary Artery Disease drug therapy, Heart Failure drug therapy, Hyperlipidemias drug therapy
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Background: Coronary artery disease patients with heart failure (CAD+HF) are at high risk for cardiovascular events. We examined the frequency of lipid assessment and prescription of lipid-lowering agents in outpatients with combined CAD+HF compared with patients with CAD alone., Methods: We analyzed an administrative data set from the Quality Assurance Program II, a Merck & Co., Inc., sponsored national retrospective chart audit of 41,487 CAD patients seen at 296 ambulatory medical practices. About 34% of these patients had CAD+HF., Results: Documentation of low-density lipoprotein (LDL) cholesterol was significantly lower in patients with CAD+HF (53%) compared with those with CAD alone (69%). Lipid-lowering drugs were prescribed in only 36% of patients with CAD+HF, compared with 52% of patients with CAD alone. Lipid levels alone did not justify this disparity. Patients with documented LDL cholesterol values were 4 times more likely to receive a prescription for a lipid-lowering medication than those without recorded values. Other predictors of lipid-lowering prescription included: younger age, history of myocardial infarction, revascularization, care by a cardiologist, and geographic region., Conclusions: Patients with CAD, HF, and advanced age simultaneously experience among the highest risk and the lowest lipid-lowering treatment rates. Strategies to increase LDL testing and aggressively treat patients with heart failure and CAD are warranted.
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- 2003
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