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Purpose: To determine whether high-sensitivity C-reactive protein (hsCRP) is associated with incident Metabolic Syndrome (MetS) among U.S. Hispanic/Latino adults. Patients and Methods: The Hispanic Community Health Study/Study of Latinos is a longitudinal observational cohort assessing cardiovascular health among diverse U.S. Hispanic/Latino adults. hsCRP was measured at visit 1 (2008–2011) and classified as low, moderate, or high, based on the Centers for Disease Control and Prevention and American Heart Association (CDC/AHA) guidelines. All MetS components [abdominal obesity, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, and fasting glucose] were measured at visit 1 and visit 2 (2014–2017). MetS was defined as the presence of three or more components based on the 2005 definition from the modified Third Report of the National Cholesterol Education Program Adult Treatment Panel (modified NCEP ATP III). Participants free of MetS at visit 1 and with complete data on hsCRP and all MetS components were included (n = 6121 participants). We used Poisson regression analysis to determine whether hsCRP was associated with incident MetS after adjusting for demographic, behavioral, and clinical factors. All analyses accounted for the complex survey design of the study. Results: In fully adjusted models, moderate versus low hsCRP was associated with a 33% increased risk of MetS [incidence rate ratio (IRR): 1.33, 95% confidence interval (CI): 1.10–1.61], while high versus low hsCRP was associated with a 89% increased risk of MetS (IRR: 1.89, 95% CI: 1.58–2.25). Conclusions: Greater levels of hsCRP were associated with new onset of MetS in a diverse sample of U.S. Hispanic/Latino adults. Results suggest that hsCRP may be an independent risk factor for MetS. [ABSTRACT FROM AUTHOR]

The prevalence of prediabetes continues to grow in the United States. Our study aimed to determine the accuracy of a population health approach that applies an algorithm to electronic health data at identifying patients with undiagnosed prediabetes. We conducted a cross-sectional study among patients receiving care at the Miami VA Healthcare System. The algorithm classified subjects into three groups using HbA1c level. We then used ICD-9-CM or ICD-10 codes for diabetes and prediabetes and medication use data to classify subjects into one of five groups: known diabetic patients with HbA1c level greater than 6.5 percent in the past; new diabetic patients without evidence of abnormal Hba1c in the past or diabetic medication use; patients with known prediabetes with HbA1c of 5.7 to 6.4 percent in the past or on metformin therapy; new prediabetes patients; and normal patients. We identified 1,190 subjects and then selected 25 percent of each group to have an overall validation sample of 300 patients. Of the sample of 68 patients with prediabetes, 60 percent had a prior HbA1c value in the prediabetic range but no diagnosis or recommended treatment. The positive predictive values of the algorithm were 80 percent for new prediabetes, 100 percent for known prediabetes, 75 percent for new diabetes, and 100 percent for known diabetes. We concluded that this electronic medical record--based automatic algorithm is accurate and effective at identifying diabetes and prediabetes status in large at-risk populations receiving care in health systems such as the VA. Future studies should evaluate strategies that health systems can use to deploy sustainable evidence-based interventions known to delay the progression to diabetes. [ABSTRACT FROM AUTHOR]

Social determinants of health (SDH) influence clinical outcomes. Our study explores barriers and facilitators for the integration of SDH into the electronic health record (EHR) system of a large diverse healthcare system in South Florida. We conducted key informant interviews of stakeholders at our institution. We evaluated the strengths, weaknesses, opportunities, and threats of the transformation and used the Consolidated Framework for Implementation Research to analyze the process. We interviewed 37 stakeholders, including seven in key leadership positions, four information technology personnel, five physicians, two researchers, four staff, three management/administrators, 10 patients, one in a regulatory role, and one in a privacy role. All agreed that the process of collecting and including data on SDH in the EHR should not affect healthcare delivery and highlighted the importance of linking the SDH survey with clinical outcomes and of having resources and processes in place to address social risks. Collection of social risk factors and integration with the EHR within a large health systems are feasible if there is buy-in from the health system leadership. [ABSTRACT FROM AUTHOR]

Background: New oral anticoagulants have similar efficacy and lower bleeding rates compared with warfarin. However, in case of bleeding there is no specific antidote to reverse their effects. We evaluated the preferences and values of anticoagulants of patients at risk of atrial fibrillation and those who have already made a decision regarding anticoagulation. Methods: We conducted a cross-sectional study of Veterans in the primary care clinics and the international normalized ratio (INR) laboratory. We developed an instrument with patient and physician input to measure patient values and preferences. The survey contained a hypothetical scenario of the risk of atrial fibrillation and the attributes of each anticoagulant. After the scenario, we asked participants to choose the option that best fits their preferences. The options were: 1) has better efficacy at reducing risk of stroke; 2) has been in the market for a long period of time; 3) has an antidote to reverse the rare case of bleeding; 4) has better quality of life profile with no required frequent laboratory tests; or 5) I want to follow physician recommendations. We stratified our results by those patients who are currently exposed to anticoagulants and those who are not exposed but are at risk of atrial fibrillation. Results: We approached 173 Veterans and completed 137 surveys (79% response rate). Ninety subjects were not exposed to anticoagulants, 46 reported being on warfarin, and one reported being on dabigatran at the time of the survey. Ninety-eight percent of subjects stated they would like to participate in the decision-making process of selecting an anticoagulant. Thirty-six percent of those exposed and 37% of those unexposed to anticoagulants reported that they would select a medication that has an antidote even if the risk of bleeding was very small. Twenty-three percent of the unexposed and 22% of the exposed groups reported that they would prefer the medication that gives the best quality of life. Conclusion: Our study found that patients who may be exposed to an anticoagulation decision prefer to actively participate in the decision-making process, and have individual values for making a decision that cannot be predicted or assumed by anyone in the health care system. [ABSTRACT FROM AUTHOR]

Objectives: To study rates and predictors of hepatitis C virus (HCV) cure among human immunodeficiency virus (HIV)/HCV-coinfected patients, and then to evaluate the effect of attendance at clinic visits on HCV cure., Methods: Retrospective cohort study of adult HIV/HCV-coinfected patients who initiated and completed treatment for HCV with direct-acting antivirals (DAAs) between January 1, 2014, and June 30, 2015., Results: Eighty-four participants reported completing treatment. The median age was 58 years (interquartile ratio, 50-66); 88% were male and 50% were black. One-third were cirrhotic and half were HCV-treatment-experienced. The most commonly used regimen was sofosbuvir/ledipasvir (40%) followed by simeprevir/sofosbuvir (30%). Cure was achieved in 83.3%, 11.9% relapsed, and 2.3% experienced virological breakthrough. Two patients (2.3%) did not complete treatment based on pill counts and follow-up visit documentation. In multivariable analysis, cure was associated with attendance at follow-up clinic visits (odds ratio [OR], 9.0; 95% CI, 2.91-163) and with use of an integrase-based HIV regimen versus other non-integrase regimens, such as non-nucleoside analogues or protease inhibitors (OR, 6.22; 95% CI 1.81-141). Age, race, genotype, presence of cirrhosis, prior HCV treatment, HCV regimen, and pre-treatment CD4 counts were not associated with cure., Conclusions: Real-world HCV cure rates with DAAs in HCV/HIV coinfection are lower than those seen in clinical trials. Cure is associated with attendance at follow-up clinic visits and with use of an integrase-based HIV regimen. Future studies should evaluate best antiretroviral regimens, predictors of attendance at follow-up visits, impact of different monitoring protocols on medication adherence, and interventions to ensure adequate models of HIV/HCV care.