American journal of preventive cardiology最新文献

{"title":"IMPROVING COMMUNICATION OF 30-YEAR CARDIOVASCULAR DISEASE RISK ESTIMATES: AGE- AND SEX-STANDARDIZED PERCENTILES","authors":"Vaishnavi Krishnan BS","doi":"10.1016/j.ajpc.2024.100818","DOIUrl":"10.1016/j.ajpc.2024.100818","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Background</h3><div>American Heart Association/American College of Cardiology primary prevention guidelines recommend estimation of 30-year cardiovascular disease (CVD) risk to guide clinician-patient discussions in younger adults. While the novel AHA PREVENT equations included 30-year risk models, interpretation of these risk estimates is challenging for both clinicians and patients. Standardized risk percentiles based on the U.S. population may provide a useful and accessible tool to optimize risk communication.</div></div><div><h3>Methods</h3><div>Using data from the 2011 to 2018 National Health and Nutrition Examination Surveys (NHANES) in U.S. adults aged 30-59 years, we estimated the population-level distribution of 30-year risk for CVD (which includes atherosclerotic CVD [ASCVD] and heart failure [HF]) using the AHA PREVENT equations. We calculated the 30-year risk corresponding to percentile ranks and generated age- and sex-specific standardized risk percentiles for CVD, ASCVD, and HF.</div></div><div><h3>Results</h3><div>Among 9,204 participants, representing approximately 109 million US adults, 34% were 30-39 years old, 31% were 40-49 years old, and 35% were 50-59 years old. The population-level distribution of 30-year risk for CVD, ASCVD, and HF was significantly higher in older age strata and in males compared with females (Figure). Among females, the 30-year absolute risk for CVD that represented the 75^th percentile (i.e., only 25% of age- and sex-matched peers would have higher risk) was 6% for 30 to 39- year-olds, 16% for 40 to 49-year-olds, and 29% for 50 to 59-year-olds. Among males, the 30-year absolute risk for CVD that represented the 75th percentile was 11% for 30 to 39-year-olds, 23% for 40 to 49-year-olds, and 33% for 50 to 59-year-olds. Similar patterns were observed for percentile distributions in 30-year risk estimates for ASCVD and HF.</div></div><div><h3>Conclusions</h3><div>Translation of PREVENT-based 30-year CVD, ASCVD, and HF risk estimates into age- and sex-standardized percentiles may offer a useful tool for clinicians and patients to interpret risk.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100818"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PLANT-FORWARD CULINARY MEDICINE FOR THE PREVENTION OF CARDIOVASCULAR DISEASE FOR PRIMARY CARE RESIDENTS: A RANDOMIZED CONTROLLED TRIAL","authors":"Nathan Wood MD","doi":"10.1016/j.ajpc.2024.100809","DOIUrl":"10.1016/j.ajpc.2024.100809","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Nutrition/Exercise</div></div><div><h3>Background</h3><div>In the United States, cardiovascular disease (CVD) is the leading cause of death, and nutrition is the leading risk factor. However, fewer than a third of internal medicine residents feel confident discussing nutrition with patients. “Culinary medicine,” by combining didactics with hands-on cooking instruction, empowers medical trainees to prevent and treat diet-related disease with their patients.</div></div><div><h3>Methods</h3><div>All 51 primary care residents at an academic medical center in New England participated in this randomized controlled study. Twenty-five residents were randomized to the intervention group and 26 to the control group. Both groups participated in 3 hours of cased-based learning, group discussion, lecture, and dietitian Q&amp;A sessions. The intervention group also received 1 hour of culinary medicine instruction in a “virtual teaching kitchen,” cooking together on Zoom and learning strategies for modifying recipes for heart-healthiness. The control group watched 1 hour of videos from the Nutrition Made Clear curriculum. Nutrition knowledge was assessed via multiple-choice questions. Confidence was measured on 6-point Likert scales. Attitudes were measured via a subscale of the Nutrition in Patient Care Survey (NIPS).</div></div><div><h3>Results</h3><div>NIPS subscale scores did not differ from baseline to immediate post in the control group (mean score 33.1 to 34.3, p=0.08) but did in the intervention group (34.7 to 36.1, p=0.04). Nutrition knowledge scores increased significantly from baseline to immediate post in both groups (mean % correct 53.6% to 93.7%, p=0.001 for control vs. 60.0% to 92.2%, p=0.001 for intervention). Percent of residents who felt confident providing patient-accessible dietary counseling for CVD increased significantly in the intervention group (8.3% to 52.2%, p=0.002) but did not in the control group (36.4% to 63.2%, p=0.453). At 8 weeks post, 96% of all residents reported implementing something they had learned from the curriculum into caring for patients, and their nutrition knowledge scores remained high. All residents said they would recommend the curriculum to colleagues and wanted additional nutrition education.</div></div><div><h3>Conclusions</h3><div>Both culinary medicine and didactics-only nutrition education can be feasible, well-received, and effective in improving nutrition knowledge. Culinary medicine may be superior in improving learners’ attitudes about nutrition and confidence in providing dietary counseling.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100809"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"STRESS CARDIOMYOPATHY AFTER DOWNHILL SKIING: A CASE REPORT","authors":"Anne Marie Arcidiacono DO","doi":"10.1016/j.ajpc.2024.100798","DOIUrl":"10.1016/j.ajpc.2024.100798","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Heart Failure</div></div><div><h3>Case Presentation</h3><div>A 61-year-old female presented after a day of anxiety-filled downhill skiing, with 2 syncopal episodes in the ski lodge. The patient had an electrocardiogram (ECG) showing deep T-wave inversions in anterior leads, QTc 600 msec, troponin of 0.299 ng/mL (normal &lt;0.034 ng/mL), and BNP of 4,530 pg/mL (normal &lt;221 pg/mL). The patient was given intravenous magnesium, furosemide, and an infusion of lidocaine for polymorphic ventricular tachycardia seen on telemetry. A transthoracic echocardiogram (TTE) revealed reduced ejection fraction (LVEF) of 30-35% with akinesis of the apex, hypokinesis of all mid-apical myocardial segments, suspicious for takotsubo cardiomyopathy (TTC). The patient underwent a diagnostic coronary angiography revealing no signs of ischemic disease. On day 3 of hospitalization, the patient's ECG normalized with resolution of prolonged QTc, repeat TTE showed recovered LVEF of 50-55%, and was discharged home with complete cardiovascular recovery.</div></div><div><h3>Background</h3><div>TTC, also called stress cardiomyopathy or broken heart syndrome, is characterized by chest pain, ECG changes, transient apical “ballooning” of the left ventricle with mid-ventricular akinesis seen on TTE, and absence of obstructive coronary artery disease or plaque rupture. TTC is typically preceded by intense psychological or physical stress, diagnosed in 2% of patients presenting with acute myocardial infarction and has a 6% incidence for female patients, ages 50 and older. TTC has an in-hospital mortality from 0–8% and is thought to occur due to the negative inotropy effect of high levels of epinephrine on the largest density of β-adrenoceptors in the apical ventricular myocardium. As epinephrine levels return to normal, left ventricular function and apical wall motion return to baseline within days to weeks. At 6-month follow-up, women with TTC showed a better survival rate (97% vs 86%) and less major events such as death, reinfarction, or rehospitalization than women with CAD (8% vs 31%).</div></div><div><h3>Conclusions</h3><div>Our case highlights an inciting event of TTC with combined physical and emotional stress. Stress management, emotional regulation, and treatment of mood disorders, represent a crucial point to prevent TTC, reduce medical costs, and improve the long-term quality of life of patients.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100798"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"STATIN RATES ONE YEAR AFTER OPPORTUNISTIC SCREENING FOR CORONARY ARTERY CALCIUM ON NON-GATED CHEST CT SCANS (NOTIFY-EXTEND PROJECT)","authors":"Sarkis G. Bouladian BS","doi":"10.1016/j.ajpc.2024.100804","DOIUrl":"10.1016/j.ajpc.2024.100804","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD /CVD Risk Reduction</div></div><div><h3>Background</h3><div>Cardiovascular disease prevention is suboptimal, especially among high-risk individuals who would benefit from lipid-lowering therapy. The NOTIFY-1 project demonstrated that screening for incidental coronary artery calcium (CAC) on non-gated chest computed tomography (CT) scans with a deep-learning algorithm, followed by patient and clinician notification, significantly increased statin prescriptions at 6 months. NOTIFY-EXTEND assessed statin initiation and persistence in a larger sample at 12 months post-notification.</div></div><div><h3>Methods</h3><div>The NOTIFY-1 project identified Stanford Healthcare patients without prior diagnosis of atherosclerotic cardiovascular disease (ASCVD) or statin therapy who underwent non-gated, non-contrast chest CT. Patients with CAC were identified via a deep-learning algorithm and initially randomized to notification (“early notification,” including their primary care clinicians) or usual care. Following completion of the project, patients in usual care who had not started statin therapy received a similar notification (“delayed notification”). The primary outcome of this follow-up study was statin prescription rates at 12 months. Secondary outcomes included discontinuation rates, cholesterol levels, cardiovascular testing, and outpatient encounters.</div></div><div><h3>Results</h3><div>There were 163 patients that received CAC notification, including 86 with early notification and 77 with delayed notification. Following notification, 75 participants (46%) were prescribed a statin within 6 months and 86 participants (53%) within 12 months. There were 117 participants (72%) that were either prescribed a statin or had a documented discussion regarding statin therapy within 12 months post-notification. Of participants prescribed a statin, 5% discontinued statin therapy within the 12-month follow-up period.</div><div>There was a significant decrease in low-density lipoprotein cholesterol (115.6 mg/dL to 90.6 mg/dL; p&lt;0.001) and triglyceride (106.2 mg/dL to 91.3 mg/dL; p=0.003) levels from baseline to 12 months post-notification. Additionally, we observed increased healthcare utilization in the post-notification period (Table 1).</div></div><div><h3>Conclusions</h3><div>Opportunistic screening and notification of CAC from non-gated chest CTs was associated with an increase in statin prescription rates that persisted at 12 months post-notification. Opportunistic screening for incidental CAC may be a powerful approach to motivating statin initiation and persistence.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100804"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remembering Dr. George L. Bakris: A pillar of cardiorenal medicine and mentorship","authors":"Yuichiro Yano ,&nbsp;Donald M. Lloyd-Jones ,&nbsp;Martha Gulati","doi":"10.1016/j.ajpc.2024.100728","DOIUrl":"10.1016/j.ajpc.2024.100728","url":null,"abstract":"","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100728"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666667724000965/pdfft?md5=b6ff057968abcc37597f0ebb5c8b56c9&pid=1-s2.0-S2666667724000965-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASSOCIATION BETWEEN PEAK METABOLIC WORKLOAD (METS) AND CARDIOVASCULAR MORBIDITY IN A LOW SOCIOECONOMIC POPULATION: A RETROSPECTIVE STUDY","authors":"Moiud Mohyeldin MD","doi":"10.1016/j.ajpc.2024.100731","DOIUrl":"10.1016/j.ajpc.2024.100731","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>CVD Prevention – Primary and Secondary</div></div><div><h3>Background</h3><div>The non-linear correlation between peak metabolic workload and cardiovascular disease incidence is under scrutiny in this study, particularly within the low socioeconomic residents of South Bronx.</div></div><div><h3>Methods</h3><div>A retrospective examination of 190 patients subjected to cardiac graded treadmill stress testing and MET level evaluation between January 2007 and July 2023 was performed. Patients with incomplete testing, known heart disease, prior strokes, peripheral artery disease, severe systemic conditions, and pregnancy were excluded. Participants were segregated into low (&lt;5), moderate (5-8), and high (&gt;8) MET groups. The primary outcome was cardiovascular morbidity incidence. Data analysis was controlled for age, sex, cardiac disease family history, BMI, smoking, and DM, HTN, and HLD histories.</div></div><div><h3>Results</h3><div>Of the 190 participants, (47.9% females, 52.1% males, mean age 53 ± 14) 20 (11%) had at least one CV morbidity during the study period. Adjusted models demonstrated that patients with MET &gt;5 had 0.14 lower odds of a cardiovascular event than MET 5-8 patients (OR 0.86; 95% CI 0.20-3.82), whereas METS &gt;8 patients had 1.8 times higher odds (OR 1.8, CI 95% 0.51-6.46).</div></div><div><h3>Conclusions</h3><div>Among the low-income population, our findings challenge previous studies, suggesting a linear relationship between higher METs and increased cardiovascular events. This warrants further investigation to validate our findings.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100731"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"INCIDENTAL CORONARY ARTERY CALCIUM REPORTING ON CHEST CT SCANS USING NATURAL LANGUAGE PROCESSING: INSIGHTS FROM VETERANS HEALTH ADMINISTRATION","authors":"Natasha Din MD, MAS","doi":"10.1016/j.ajpc.2024.100763","DOIUrl":"10.1016/j.ajpc.2024.100763","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Background</h3><div>Coronary artery calcium (CAC) is the strongest predictor of cardiovascular events. CAC can be identified on non-cardiac chest CTs, but reporting is inconsistent. We developed a natural language processing (NLP) algorithm to identify incidental CAC reporting on non-gated chest CT reports and described patterns in CAC reporting across the Veterans Health Administration (VHA).</div></div><div><h3>Methods</h3><div>We identified non-cardiac CT scan reports across the VHA between 2006-2024. We developed an NLP algorithm by creating Regex rules to detect mentions of CAC (none, mild, moderate, severe, or unclassified). We manually annotated 1,060 reports as the gold standard for algorithm development. We iteratively refined an NLP algorithm based on accuracy with the development scans. We validated the algorithm's performance on an independent sample of 1,000 scans and applied the algorithm to all non-cardiac chest CTs in the VHA over the study period. We described the frequency of CAC reporting over time in addition to facility-level variation.</div></div><div><h3>Results</h3><div>Across 1,000 validation reports, the algorithm had a sensitivity of 99% and a positive predictive value (PPV) of 94% for CAC being mentioned in the CT report. Among reports in which CAC was mentioned, the algorithm had a 99% sensitivity and 97% PPV for correctly noting the presence of CAC. The algorithm had a 96% accuracy for correctly detecting the reported CAC severity.</div><div>There were 6,825,889 non-cardiac chest CTs between January 2006 and March 2024 in the VHA. The presence or absence of CAC was described in 2,519,296 reports (37%). CAC reporting was highest among lung cancer screening CTs (49%). CAC reporting increased over time (Table). In 2023, reporting ranged from 0% to 63% across 128 VA facilities.</div><div>Among CTs that reported CAC presence or absence, CAC was described as present on 2,425,416 reports (96%). Among CTs that reported CAC presence, CAC severity was unclassified in 56%, mild in 16%, moderate in 13%, and severe in 15% of scans.</div></div><div><h3>Conclusions</h3><div>CAC is not reported on a majority of non-cardiac chest CTs in a large national cohort, but reporting is increasing over time. Strategies to improve CAC reporting or leverage emerging automated CAC detection algorithms are needed.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100763"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COMORBIDITIES AND PROCEDURAL OUTCOMES IN STEMI PATIENTS WITH AND WITHOUT A HISTORY OF DRUG ABUSE","authors":"Sai Allu MD","doi":"10.1016/j.ajpc.2024.100794","DOIUrl":"10.1016/j.ajpc.2024.100794","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Factors</div></div><div><h3>Background</h3><div>Patients with a history of drug abuse are at increased risk for cardiovascular events, including ST-segment elevation myocardial infarction (STEMI). However, the prevalence of comorbidities and procedural outcomes in this population remain understudied. This study aimed to compare the prevalence of comorbidities and procedural outcomes in STEMI patients with and without a history of drug abuse.</div></div><div><h3>Methods</h3><div>A total of 180,265 patients diagnosed with STEMI in 2020 with NIS data using SPSS were included in this registry study. Patients were categorized into two groups: those with a history of drug abuse (n=8,843; 4.9%) and those without (n=171,422; 95.1%). The prevalence of comorbidities, including congestive heart failure, diabetes, and renal failure, was compared between the two groups using odds ratios (OR) and 95% confidence intervals (CI). Procedural outcomes, such as percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG), were also analyzed.</div></div><div><h3>Results</h3><div>Drug users had a higher prevalence of congestive heart failure (69% vs. 62%) and renal failure (31% vs. 39%) compared to non-drug users. However, diabetes was less prevalent among drug users (14% vs. 43%). Non-drug users with congestive heart failure had higher odds of mortality (OR 1.353, 95% CI: 1.301-1.408) compared to those without, while drug users had lower odds (OR 0.724, 95% CI: 0.581-0.902). No significant differences in mortality odds were observed for diabetes in either group. Non-drug users with renal failure had higher odds of mortality (OR 1.266, 95% CI: 1.218-1.314), while drug users exhibited no significant change. Among patients undergoing procedures, non-drug users had higher rates of single-vessel PCI (0.436% vs. 0.339%), double-vessel PCI (0.080% vs. 0.034%), and single-vessel CABG (0.046% vs. 0.034%) compared to drug users.</div></div><div><h3>Conclusions</h3><div>This study highlights the differences in comorbidities and procedural outcomes between STEMI patients with and without a history of drug abuse. Drug users had a higher prevalence of congestive heart failure and renal failure but a lower prevalence of diabetes compared to non-drug users. Non-drug users with congestive heart failure and renal failure had higher odds of mortality, while drug users had lower or no significant change in mortality odds. Non-drug users also had higher rates of PCI and CABG procedures compared to drug users. These findings emphasize the need for tailored management strategies considering the unique comorbidity profiles and procedural outcomes in STEMI patients with a history of drug abuse.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100794"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CARDIAC INPATIENTS ARE HIGHLY INTERESTED IN VIRTUAL CARDIAC REHABILITATION","authors":"Vennela Avula BSPH","doi":"10.1016/j.ajpc.2024.100797","DOIUrl":"10.1016/j.ajpc.2024.100797","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Rehabilitation</div></div><div><h3>Background</h3><div>Cardiac rehabilitation (CR) improves cardiovascular health and decreases hospital readmissions; unfortunately, it is widely underused by patients. Digital health interventions offer a potential solution to increase participation in CR. However, patients’ interest and concerns regarding virtual CR have not been fully explored.</div></div><div><h3>Methods</h3><div>A Qualtrics survey was administered to cardiac inpatients in the progressive cardiac care unit at Johns Hopkins Hospital from 2020-2024. This study included English-speaking patients, &gt;18 years of age who met medical eligibility for CR. One-way ANOVA, Chi-square, and Fisher's Exact test were used to assess differences in interest in engaging in virtual CR by age, sex, and race, respectively.</div></div><div><h3>Results</h3><div>A total of 150 cardiac inpatients were included: age 64 ± 13 years, 62% (93/150) male, 57% (85/150) White, and 41% (61/150) completing a 4-year degree or higher. 93% (139/150) of patients reported owning a smartphone. The patients reported that their primary barriers to CR participation were traveling to the CR center (49%, 73/150), costs/insurance coverage (29%, 44/150), and a tight schedule (28%, 42/150). Notably, the majority of patients (71%, 107/150) expressed interest in engaging in virtual CR. Interest in virtual CR did not differ by age (p=0.35) or sex (p=0.49); however, Black (90%, 46/51) and Asian (83%, 5/6) adults reported being more interested in virtual CR than White (61%, 52/85) adults (p&lt;0.001). While 39% of patients (58/150) felt less safe exercising at home compared to a supervised center, 83% (48/58) of these patients reported they would feel more confident exercising at home if able to communicate by phone with specialized staff during training sessions. Additionally, 39% (58/150) of patients expressed concerns about decreased motivation training alone at home; however, 52% (30/58) of these patients felt group calls with other patients could enhance engagement.</div></div><div><h3>Conclusions</h3><div>Virtual CR may advance health equity by overcoming traditional barriers to participation, with the majority of patients, especially Black and Asian adults, expressing interest. High prevalence of smartphone ownership suggests this may be feasible. Virtual CR efforts should focus on addressing safety concerns and enhancing motivation via direct communication with staff and other patients.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100797"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PROVIDER-LEVEL VARIATION IN NOVEL CARDIOVASCULAR MEDICATION PRESCRIPTION AMONG PATIENTS HOSPITALIZED FOR HEART FAILURE AND CORONARY ARTERY DISEASE IN THE VETERANS AFFAIRS SYSTEM","authors":"Taufiq Salahuddin MD","doi":"10.1016/j.ajpc.2024.100828","DOIUrl":"10.1016/j.ajpc.2024.100828","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Preventive Cardiology Best Practices – clinic operations, team approaches, outcomes research</div></div><div><h3>Background</h3><div>Novel therapies such as angiotensin receptor-neprilysin inhibitors (ARNI), sodium-glucose cotransporter-2 inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP-1 RA) have well-established benefit for patients with heart failure (HF) and coronary artery disease (CAD), but use remains low. We aimed to characterize provider-level variation in the use of these medications in the Veterans Health Administration (VA).</div></div><div><h3>Methods</h3><div>Using VA health record and administrative data, two patient cohorts were retrospectively identified with hospitalization from 2017-2023 for either HF or CAD with concurrent Type 2 diabetes (T2D). Provider-level data for use of ARNI and SGLT2i for HF and SGTL2i or GLP-1 RA for CAD+T2D were assessed, including at hospital admission, discharge, or within 6 months of discharge. Providers were considered users if they had an outpatient visit with a patient who had a filled prescription for a given medication within 6 months of discharge, regardless of when or by whom the prescription was written. Providers with above-median utilization for all 3 classes were considered high utilizers. Histograms and adjusted median odds ratios were used to characterize provider-level variability in prevalent use of novel medications by medical subspecialty.</div></div><div><h3>Results</h3><div>The HF and CAD+T2D cohorts included 83,849 and 71,678 unique patients, respectively, with 14,645 providers. Distributions of providers by prevalent use of each respective medication class are shown by medical subspecialty in the Figure. Mean prevalent use over the study period ranged from 17-44% for a given specialty and medication class. Most providers had &lt;50% use of each medication class, though there were smaller numbers of providers with near-100% prevalent use of novel medications. Endocrinology and cardiology had the highest proportions of high utilizers (44% and 39%, respectively, compared with 24% and 15% for primary care and nephrology). Adjusted median odds ratios across all providers over the full study period were 1.7 and 1.8 for ARNI and SGLT2i in the HF cohort and 1.8 in the CAD+T2D cohort.</div></div><div><h3>Conclusions</h3><div>Cardiologists and endocrinologists were mostly likely to use novel cardiovascular medications, but there was substantial provider-level variation across all prescribing subspecialities. Further research is needed to identify implementation strategies to improve uptake among all providers.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100828"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}