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  • 1
    Online Resource
    Online Resource
    Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Circulation: Heart Failure Vol. 12, No. 11 ( 2019-11)
    Details
    In: Circulation: Heart Failure, Ovid Technologies (Wolters Kluwer Health), Vol. 12, No. 11 ( 2019-11)
    Abstract: Racial inequities for patients with heart failure (HF) have been widely documented. HF patients who receive cardiology care during a hospital admission have better outcomes. It is unknown whether there are differences in admission to a cardiology or general medicine service by race. This study examined the relationship between race and admission service, and its effect on 30-day readmission and mortality Methods: We performed a retrospective cohort study from September 2008 to November 2017 at a single large urban academic referral center of all patients self-referred to the emergency department and admitted to either the cardiology or general medicine service with a principal diagnosis of HF, who self-identified as white, black, or Latinx. We used multivariable generalized estimating equation models to assess the relationship between race and admission to the cardiology service. We used Cox regression to assess the association between race, admission service, and 30-day readmission and mortality. Results: Among 1967 unique patients (66.7% white, 23.6% black, and 9.7% Latinx), black and Latinx patients had lower rates of admission to the cardiology service than white patients (adjusted rate ratio, 0.91; 95% CI, 0.84–0.98, for black; adjusted rate ratio, 0.83; 95% CI, 0.72–0.97 for Latinx). Female sex and age 〉 75 years were also independently associated with lower rates of admission to the cardiology service. Admission to the cardiology service was independently associated with decreased readmission within 30 days, independent of race. Conclusions: Black and Latinx patients were less likely to be admitted to cardiology for HF care. This inequity may, in part, drive racial inequities in HF outcomes.
    Type of Medium: Online Resource
    ISSN: 1941-3289 , 1941-3297
    URL: Article
    DOI: 10.1161/CIRCHEARTFAILURE.119.006214
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2428100-1
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  • 2
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    Abstract 13360: The Association Between Food Insecurity and Cardiovascular Mortality in the United States From 2011 to 2017 - A Longitudinal Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_3 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_3 ( 2020-11-17)
    Abstract: Introduction: Prior analyses suggest a link between food insecurity and cardiovascular (CV) health but are limited by cross-sectional designs. We investigated whether longitudinal changes in food insecurity are independently associated with CV mortality. Methods: Using National Center for Health Statistics data, we determined annual U.S. county-level age-adjusted CV mortality rates for non-elderly (20-64 years old) and elderly (65 years and older) adults. County-level food insecurity rates were obtained from the Map the Meal Gap project. We examined CV mortality trends by quartiles of average annual percent change (APC) in food insecurity. Using a Poisson fixed effects estimator, we assessed the association between longitudinal changes in food insecurity and CV mortality rates after accounting for time-varying demographic (proportion of residents who were male, black, Hispanic), economic (median household income, unemployment, poverty, education attainment, and housing vacancy rates), and healthcare access (insurance coverage, density of healthcare providers and hospital beds) variables. Results: Between 2011 and 2017, mean food insecurity rates decreased from 14.7% to 13.3%. In counties in the highest quartile of APC for absolute value change in food insecurity, non-elderly CV mortality increased from 82.2(SD=33.9) to 87.4(SD=37.3) per 100,000 individuals (p 〈 0.001), while in counties in the lowest quartile of APC, mortality was stable [60.8(SD=22.2) to 60.0(SD=23.0) per 100,000 individuals, p=0.64]. Elderly CV mortality signifi cantly declined in all quartiles [1643.3(SD=315.7) to 1542.7(SD=299.4) per 100,000 (p 〈 0.001) in the highest quartile and 1408.3(SD=225.9) to 1338.6(SD=213.8) per 100,000 (p 〈 0.001) in the lowest quartile). A 1 percentage point increase in food insecurity was independently associated with a 0.83% (95% CI 0.42 - 1.25, P 〈 0.001) increase in CV mortality for non-elderly adults. This was not significant for elderly adults (-0.06%, 95% CI -0.39 - 0.28, P=0.74). Conclusion: From 2011 to 2017, an increase in food insecurity was independently associated with an increase in CV mortality rates for non-elderly adults in the U.S. Interventions targeting food insecurity may play a role in improving community CV health.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_3.13360
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1466401-X
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  • 3
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    Online Resource
    Patient Characteristics Associated With Telemedicine Access for Primary and Specialty Ambulatory Care During the COVID-19 Pandemic
    American Medical Association (AMA) ; 2020
    In:  JAMA Network Open Vol. 3, No. 12 ( 2020-12-29), p. e2031640-
    Details
    In: JAMA Network Open, American Medical Association (AMA), Vol. 3, No. 12 ( 2020-12-29), p. e2031640-
    Type of Medium: Online Resource
    ISSN: 2574-3805
    URL: Article
    DOI: 10.1001/jamanetworkopen.2020.31640
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2020
    detail.hit.zdb_id: 2931249-8
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  • 4
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    Cardiovascular Disease Burden and Outcomes Among American Indian and Alaska Native Medicare Beneficiaries
    American Medical Association (AMA) ; 2023
    In:  JAMA Network Open Vol. 6, No. 9 ( 2023-09-22), p. e2334923-
    Details
    In: JAMA Network Open, American Medical Association (AMA), Vol. 6, No. 9 ( 2023-09-22), p. e2334923-
    Abstract: American Indian and Alaska Native persons face significant health disparities; however, data regarding the burden of cardiovascular disease in the current era is limited. Objective To determine the incidence and prevalence of cardiovascular disease, the burden of comorbid conditions, including cardiovascular disease risk factors, and associated mortality among American Indian and Alaska Native patients with Medicare insurance. Design, Setting, and Participants This was a population-based cohort study conducted from January 2015 to December 2019 using Medicare administrative data. Participants included American Indian and Alaska Native Medicare beneficiaries 65 years and older enrolled in both Medicare part A and B fee-for-service Medicare. Statistical analyses were performed from November 2022 to April 2023. Main Outcomes and Measures The annual incidence, prevalence, and mortality associated with coronary artery disease (CAD), heart failure (HF), atrial fibrillation/flutter (AF), and cerebrovascular disease (stroke or transient ischemic attack [TIA]). Results Among 220 598 American Indian and Alaska Native Medicare beneficiaries, the median (IQR) age was 72.5 (68.5-79.0) years, 127 402 were female (57.8%), 78 438 (38.8%) came from communities in the most economically distressed quintile in the Distressed Communities Index. In the cohort, 44.8% of patients (98 833) were diagnosed with diabetes, 61.3% (135 124) were diagnosed with hyperlipidemia, and 72.2% (159 365) were diagnosed with hypertension during the study period. The prevalence of CAD was 38.6% (61 125 patients) in 2015 and 36.7% (68 130 patients) in 2019 ( P   & amp;lt; .001). The incidence of acute myocardial infarction increased from 6.9 per 1000 person-years in 2015 to 7.7 per 1000 patient-years in 2019 (percentage change, 4.79%; P   & amp;lt; .001). The prevalence of HF was 22.9% (36 288 patients) in 2015 and 21.4% (39 857 patients) in 2019 ( P   & amp;lt; .001). The incidence of HF increased from 26.1 per 1000 person-years in 2015 to 27.0 per 1000 person-years in 2019 (percentage change, 4.08%; P   & amp;lt; .001). AF had a stable prevalence of 9% during the study period (2015: 9.4% [14 899 patients] vs 2019: 9.3% [25 175 patients] ). The incidence of stroke or TIA decreased slightly throughout the study period (12.7 per 1000 person-years in 2015 and 12.1 per 1000 person-years in 2019; percentage change, 5.08; P = .004). Fifty percent of patients (110 244) had at least 1 severe cardiovascular condition (CAD, HF, AF, or cerebrovascular disease), and the overall mortality rate for the cohort was 19.8% (43 589 patients). Conclusions and Relevance In this large cohort study of American Indian and Alaska Native patients with Medicare insurance in the US, results suggest a significant burden of cardiovascular disease and cardiometabolic risk factors. These results highlight the critical need for future efforts to prioritize the cardiovascular health of this population.
    Type of Medium: Online Resource
    ISSN: 2574-3805
    URL: Article
    DOI: 10.1001/jamanetworkopen.2023.34923
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2023
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  • 5
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    Abstract 11417: Association Between Community-Level Violent Crime and Cardiovascular Mortality in Chicago - A Longitudinal Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_1 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
    Abstract: Introduction: Prior studies suggest an association between neighborhood crime levels and cardiovascular (CV) risk factors and disease but have been limited by cross-sectional designs. We investigated whether longitudinal changes in violent crime are associated with CV mortality at the community level in a large US city - Chicago. Methods: Chicago is divided into 77 community areas. Using the Illinois Department of Public Health Division of Vital Records, we obtained age-adjusted mortality rates by community area for heart disease, stroke, and coronary artery disease deaths from 2000-2014 aggregated at 5-year intervals. Annual violent crime data were obtained from the City of Chicago Police Data Portal and were geocoded to the community area level. Violent crime was defined as assault, battery, criminal sexual assault, robbery, and homicide. Using a two-way fixed effects estimator, a robust longitudinal estimation method that accounts for measured or unmeasured time-invariant confounders, we assessed the association between longitudinal changes in violent crime and CV mortality after accounting for changes in demographic (proportion of racial/ethnic minorities) and economic (household income, unemployment, housing vacancy, education attainment) variables for each community area. Results: Between 2000 and 2014, the median violent crime rate in Chicago decreased from 3620 per 100,000 [IQR 2256, 7777] in the 2000-2004 period to 2390 [IQR 1507, 5745] in the 2010-2014 period (p=0.005 for trend). In the fixed effects model, after accounting for changes in demographic and economic variables, a 1% increase in community-area violent crime was independently associated with a 0.21% (95% CI 0.09, 0.33) increase in heart disease deaths (p=0.0006) and a 0.19% (95% CI 0.04, 0.33) increase in deaths from coronary artery disease (p=0.01). There was no significant association between change in violent crime and stroke deaths [0.17% (95% CI -0.08, 0.42; p=0.017)]. Conclusions: From 2000 to 2014, an increase in violent crime at the community level was associated with an increase in heart disease and coronary artery disease deaths in Chicago. Detecting rises in community-level violent crime may identify areas with worsening CV health independent of other factors.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_1.11417
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1466401-X
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  • 6
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    Association of Race With Disease Expression and Clinical Outcomes Among Patients With Hypertrophic Cardiomyopathy
    American Medical Association (AMA) ; 2020
    In:  JAMA Cardiology Vol. 5, No. 1 ( 2020-01-01), p. 83-
    Details
    In: JAMA Cardiology, American Medical Association (AMA), Vol. 5, No. 1 ( 2020-01-01), p. 83-
    Type of Medium: Online Resource
    ISSN: 2380-6583
    URL: Article
    DOI: 10.1001/jamacardio.2019.4638
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2020
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  • 7
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    Characteristics of Clinical Trial Sites for Novel Transcatheter Mitral and Tricuspid Valvular Therapies
    American Medical Association (AMA) ; 2023
    In:  JAMA Cardiology Vol. 8, No. 2 ( 2023-02-01), p. 120-
    Details
    In: JAMA Cardiology, American Medical Association (AMA), Vol. 8, No. 2 ( 2023-02-01), p. 120-
    Abstract: Racial and ethnic minority and socioeconomically disadvantaged patients have been underrepresented in randomized clinical trials. Efforts have focused on enhancing inclusion of minority groups at sites participating at clinical trials; however, there may be differences in the patient populations of the sites that participate in clinical trials. Objective To identify any differences in the racial, ethnic, and socioeconomic composition of patient populations among candidate sites in the US that did vs did not participate in trials for novel transcatheter therapies. Design, Setting, and Participants This cross-sectional analysis used Medicare Provider Claims from 2019 for patients admitted to hospitals in the US. All clinical trials for transcatheter mitral and tricuspid valve therapies and the hospitals participating in each of the trials were identified using ClinicalTrials.gov. Hospitals with active cardiac surgical programs that did not participate in the trials were also identified. Data analysis was performed between July 2021 and July 2022. Exposures Multivariable linear regression models were used to identify differences in racial, ethnic, and socioeconomic characteristics among patients undergoing cardiac surgery or transcatheter aortic valve replacement at trial vs nontrial hospitals. Main Outcome and Measures The main outcome of the study was participation in a clinical trial for novel transcatheter mitral or tricuspid valve therapies. Results A total of 1050 hospitals with cardiac surgery programs were identified, of which 121 (11.5%) participated in trials for transcatheter mitral or tricuspid therapies. Patients treated in trial hospitals had a higher median zip code–based household income (difference of $5261; 95% CI, $2986-$7537), a lower Distressed Communities Index score (difference of 5.37; 95% CI, 2.59-8.15), and no significant difference in the proportion of patients dual eligible for Medicaid (difference of 0.86; 95% CI, −2.38 to 0.66). After adjusting for each of the socioeconomic indicators separately, there was less than 1% difference in the proportion of Black and Hispanic patients cared for at hospitals participating vs not participating in clinical trials. Conclusions and Relevance In this cohort study among candidate hospitals for clinical trials for transcatheter mitral or tricuspid valve therapies, trial hospitals took care of a more socioeconomically advantaged population than nontrial hospitals, with a similar proportion of Black and Hispanic patients. These data suggest that site selection efforts may improve enrollment of socioeconomically disadvantaged patients but may not improve the enrollment of Black and Hispanic patients.
    Type of Medium: Online Resource
    ISSN: 2380-6583
    URL: Article
    DOI: 10.1001/jamacardio.2022.4457
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2023
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  • 8
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    Racial Differences in Presentation and Outcomes After Peripheral Arterial Interventions: Insights From the NCDR-PVI Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Circulation: Cardiovascular Interventions Vol. 16, No. 6 ( 2023-06)
    Details
    In: Circulation: Cardiovascular Interventions, Ovid Technologies (Wolters Kluwer Health), Vol. 16, No. 6 ( 2023-06)
    Abstract: We assess the rates of device use and outcomes by race among patients undergoing lower extremity peripheral arterial intervention using the American College of Cardiology National Cardiovascular Data Registry-Peripheral Vascular Intervention (PVI) registry. Methods: Patients who underwent PVI between April 2014 and March 2019 were included. Socioeconomic status was evaluated using the Distressed Community Index score for patients’ zip codes. Multivariable logistic regression was used to assess factors associated with utilization of drug-eluting technologies, intravascular imaging, and atherectomy. Among patients with Centers for Medicare and Medicaid Services data, we compared 1-year mortality, rates of amputation, and repeat revascularizations. Results: Of 63 150 study cases, 55 719 (88.2%) were performed in White patients and 7431 (11.8%) in Black patients. Black patients were younger (67.9 versus 70.0 years), had higher rates of hypertension (94.4% versus 89.5%), diabetes (63.0% versus 46.2%), less likely to be able to walk 200 m (29.1% versus 24.8%), and higher Distressed Community Index scores (65.1 versus 50.6). Black patients were provided drug-eluting technologies at a higher rate (adjusted odds ratio, 1.14 [95% CI, 1.06–1.23]) with no difference in atherectomy (adjusted odds ratio, 0.98 [95% CI, 0.91–1.05] ) or intravascular imaging (adjusted odds ratio, 1.03 [95% CI, 0.88–1.22]) use. Black patients experienced a lower rate of acute kidney injury (adjusted odds ratio, 0.79 [95% CI, 0.72–0.88] ). In Centers for Medicare and Medicaid Services-linked analyses of 7429 cases (11.8%), Black patients were significantly less likely to have surgical (adjusted hazard ratio, 0.40 [95% CI, 0.17–0.96]) or repeat PVI revascularization (adjusted hazard ratio, 0.42 [95% CI, 0.30–0.59] ) at 1 year compared with White patients. There was no difference in mortality (adjusted hazard ratio [0.8–1.4]) or major amputation (adjusted hazard ratio, 2.5 [95% CI, 0.8–7.6] ) between Black and White patients. Conclusions: Black patients presenting for PVI were younger, had higher prevalence of comorbidities and lower socioeconomic status. After adjustment, Black patients were less likely to have surgical or repeat PVI revascularization after the index PVI procedure.
    Type of Medium: Online Resource
    ISSN: 1941-7640 , 1941-7632
    URL: Article
    DOI: 10.1161/CIRCINTERVENTIONS.121.011485
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2450801-9
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  • 9
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    Predictors of telemedicine use during the COVID-19 pandemic in the United States–an analysis of a national electronic medical record database
    Public Library of Science (PLoS) ; 2022
    In:  PLOS ONE Vol. 17, No. 6 ( 2022-6-29), p. e0269535-
    Details
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 17, No. 6 ( 2022-6-29), p. e0269535-
    Abstract: Telemedicine utilization increased significantly in the United States during the COVID-19 pandemic. However, there is concern that disadvantaged groups face barriers to access based on single-center studies. Whether there has been equitable access to telemedicine services across the US and during later parts of the pandemic is unclear. This study retrospectively analyzes outpatient medical encounters for patients 18 years of age and older using Healthjump–a national electronic medical record database–from March 1 to December 31, 2020. A mixed effects multivariable logistic regression model was used to assess the association between telemedicine utilization and patient and area-level factors and the odds of having at least one telemedicine encounter during the study period. Among 1,999,534 unique patients 21.6% had a telemedicine encounter during the study period. In the multivariable model, age [OR = 0.995 (95% CI 0.993, 0.997); p 〈 0.001], non-Hispanic Black race [OR = 0.88 (95% CI 0.84, 0.93); p 〈 0.001], and English as primary language [OR = 0.78 (95% CI 0.74, 0.83); p 〈 0.001] were associated with a lower odds of telemedicine utilization. Female gender [OR = 1.24 (95% CI 1.22, 1.27); p 〈 0.001], Hispanic ethnicity or non-Hispanic other race [OR = 1.40 (95% CI 1.33, 1.46);p 〈 0.001 and 1.29 (95% CI 1.20, 1.38); p 〈 0.001, respectively] were associated with a higher odds of telemedicine utilization. During the COVID-19 pandemic, therefore, utilization of telemedicine differed significantly among patient groups, with older and non-Hispanic Black patients less likely to have telemedicine encounters. These findings are relevant for ongoing efforts regarding the nature of telemedicine as the COVID-19 pandemic ends.
    Type of Medium: Online Resource
    ISSN: 1932-6203
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.1371/journal.pone.0269535
    DOI: 10.1371/journal.pone.0269535.g001
    DOI: 10.1371/journal.pone.0269535.g002
    DOI: 10.1371/journal.pone.0269535.t001
    DOI: 10.1371/journal.pone.0269535.t002
    DOI: 10.1371/journal.pone.0269535.s001
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2022
    detail.hit.zdb_id: 2267670-3
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  • 10
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    Food Insecurity and Cardiovascular Mortality for Nonelderly Adults in the United States From 2011 to 2017 : A County-Level Longitudinal Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 14, No. 1 ( 2021-01)
    Details
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 14, No. 1 ( 2021-01)
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    URL: Article
    DOI: 10.1161/CIRCOUTCOMES.120.007473
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2453882-6
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