scholarly journals Exercise capacity is associated with hospital readmission among patients with diabetes

2020 ◽  
Vol 8 (1) ◽  
pp. e001771
Author(s):  
Yaara Zisman-Ilani ◽  
Kevin Fasing ◽  
Mark Weiner ◽  
Daniel J Rubin
Keyword(s):  
Exercise Capacity ◽  
Hospital Readmission ◽  
Medical Center ◽  
Stress Test ◽  
Academic Medical Center ◽  
Univariate Analysis ◽  
Metabolic Equivalents ◽  
Patients With Diabetes ◽  
Incidence Of Hospitalization ◽  
Design And Methods

IntroductionPatients with diabetes are at greater risk of hospital readmission than patients without diabetes. There is a need to identify more modifiable risk factors for readmission as potential targets for intervention. Cardiorespiratory fitness is a predictor of morbidity and mortality. The purpose of this study was to examine whether there is an association between exercise capacity based on the maximal workload achieved during treadmill stress testing and readmission among patients with diabetes.Research design and methodsThis retrospective cohort study included adult patients with diabetes discharged from an academic medical center between July 1, 2012 and December 31, 2018 who had a stress test documented before the index discharge. Univariate analysis and multinomial multivariable logistic regressions were used to evaluate associations with readmission within 30 days, 6 months, and 1 year of discharge. Exercise capacity was measured as metabolic equivalents (METs).ResultsA total of 580 patients with 1598 hospitalizations were analyzed. Mean METs of readmitted patients were significantly lower than for non-readmitted patients (5.7 (2.6) vs 6.7 (2.6), p<0.001). After adjustment for confounders, a low METs level (<5) was associated with higher odds of readmission within 30 days (OR 5.46 (2.22–13.45), p<0.001), 6 months (OR 2.78 (1.36–5.65), p=0.005), and 1 year (OR 2.16 (1.12–4.16), p=0.022) compared with medium (5–7) and high (>7) METs level. During the 6.5-year study period, patients with low METs had a mean of 3.2±3.6 hospitalizations, while those with high METs had 2.5±2.4 hospitalizations (p=0.007).ConclusionsLower exercise capacity is associated with a higher risk of readmission within 30 days, 6 months, and 1 year, as well as a greater incidence of hospitalization, in patients with diabetes. Future studies are needed to explore whether exercise reduces readmission risk in this population.

Abstract NS5: Use of a Multidisciplinary Approach to Successfully Improve Inpatient Diabetes Self-Management Education and Diabetes Medication Reconciliation at Discharge for Persons With Diabetes and Stroke at a Major Academic Medical Center

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Suzanne Stone ◽  
Nancy Drobycki ◽  
Mark Johnson
Keyword(s):  
Medication Reconciliation ◽  
Medical Center ◽  
Diabetes Education ◽  
Academic Medical Center ◽  
Blood Pressure Reduction ◽  
Diabetes Medication ◽  
Effective Discharge ◽  
Inpatient Diabetes ◽  
Patients With Diabetes

Background: Persons with diabetes are 1.5 times more likely to have a stroke. Research shows that there is a correlation between increasing diabetes and stroke. Education for stroke patients, however, continues to focus on medication management and blood pressure reduction. American Diabetes Association indicates, “There should be a structured discharge plan tailored to the individual patient with diabetes.” Transitioning from the acute care is risky for diabetics, recommendations now include individualized education for diabetics with stroke. 40% of the stroke population at our institution showed risk factors for diabetes, yet 11% received diabetes education, and only 59% had diabetes medication pre-prescribed at discharge. The stroke team initiated an inpatient diabetes education to increase patient awareness and medication adherence. Purpose: The purpose of this project was to identify and address barriers related to the provision of individualized inpatient diabetes education and outpatient diabetes medication reconciliation for persons with diabetes and stroke. Method: The Endocrinology team was consulted for patients with diabetes and stroke with an A1c level of 7%. These team worked collaboratively to establish a consult process. Endocrinology APPs provided diabetic education and advised the Neurology team on the appropriate discharge medication regimen and follow-up. The stroke coordinator provided reminders during rounds to assure that consults were ordered for patients with diabetes having A1c 7% or greater. Results: Inpatient diabetes education improved from 11% in 2017 to 96% in 2019. Diabetes medication reconciliation, with listing of diabetes medications on the after visit summary at discharge increased from 59% in 2017 to 93% in 2019. Conclusions: Both metrics reflect improvement over a 2-year period, showing that collaboration between the Endocrinology and Neurology teams is key to effective discharge planning, diabetes medication reconciliation and outpatient follow-up.

scholarly journals Association Between Spirituality and Depression in Adults With Type 2 Diabetes

2012 ◽  
Vol 38 (3) ◽  
pp. 427-435 ◽  
Author(s):  
Cheryl P. Lynch ◽  
Melba A. Hernandez-Tejada ◽  
Joni L. Strom ◽  
Leonard E. Egede
Keyword(s):  
Type 2 Diabetes ◽  
Medical Center ◽  
Diabetes Education ◽  
Academic Medical Center ◽  
Depression Scale ◽  
Epidemiologic Studies ◽  
Depression Symptoms ◽  
Patients With Diabetes ◽  
Values And Beliefs

Purpose The purpose of the study was to examine the association between spirituality and depression among patients with type 2 diabetes. Methods This study included 201 adult participants with diabetes from an indigent clinic of an academic medical center. Participants completed validated surveys on spirituality and depression. The Daily Spiritual Experience (DSE) Scale measured a person’s perception of the transcendent (God, the divine) in daily life. The Center for Epidemiologic Studies–Depression scale assessed depression. Linear regression analyses examined the association of spirituality as the predictor with depression as the outcome, adjusted for confounding variables. Results Greater spirituality was reported among females, non-Hispanic blacks, those with lower educational levels, and those with lower income. The unadjusted regression model showed greater spirituality was associated with less depression. This association was mildly diminished but still significant in the final adjusted model. Depression scores also increased (greater depression risk) with females and those who were unemployed but decreased with older age and non-Hispanic black race/ethnicity. Conclusions Treatment of depression symptoms may be facilitated by incorporating the spiritual values and beliefs of patients with diabetes. Therefore, faith-based diabetes education is likely to improve self-care behaviors and glycemic control.

scholarly journals Exercise capacity benefit in relation to endogenous testosterone, coronary and central vascular physiology, and the Mediterranean regime in hypertensive males with erectile dysfunction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Angelis ◽  
K Aggeli ◽  
I Dimitroglou ◽  
N Ioakeimidis ◽  
C Georgakopoulos ◽  
...  
Keyword(s):  
Erectile Dysfunction ◽  
Exercise Capacity ◽  
Wave Reflection ◽  
Stress Test ◽  
Linear Regression Analysis ◽  
Well Being ◽  
Metabolic Equivalents ◽  
Flow Reserve ◽  
Vascular Physiology ◽  
The Mediterranean

Abstract Background The Mediterranean diet (Med-diet) benefits cardiovascular health, and erectile dysfunction (ED) often coexists in the hypertensive aging male population were endogenous testosterone (TT) typically declines. Coronary flow reserve (CFR) displays the ability of the coronary circulation to increase flow. Wave reflection amplification as expressed by augmentation index (AIx) exhibits a vital parameter of central vascular stiffness. Purpose To investigate the possible benefits of the Med-diet in exercise capacity, central physiology, CFR and erectile ability in relation to endogenous TT in the middle aged male hypertensive population with ED. Methods 250 hypertensive males (mean age 56 yo) with ED enrolled the study. All underwent a treadmill stress test (Bruce protocol). Exercise capacity was validated as metabolic equivalents (METs). We measured separately the CFR of the left anterior descending artery by an adenosine protocol (max dose 140μg/kg/min over 6 minutes). PW Doppler measurements were achieved at the middle/distal LAD segment under the guidance of color Doppler flow mapping. CFR was validated as ratio between peak diastolic flow velocity following drug infusion and rest. Ratios ≥2 are considered as non-ischemic response, higher values indicate microvascular coronary integrity. TT was measured on blood samples taken before 09:00 am. ED severity and adherence to the Med-diet were assessed by the SHIM-5 (range: 0–25) and the Med-diet (range: 0–55) scores. Higher values indicate a better erectile ability and Med-diet compliance respectively. Finally, central pulse pressure (cPP) and AIx were noninvasively estimated as parameters of central hemodynamic load and wave reflection amplification (Sphygmocor device). Results In bivariate analysis METs were positively associated to the Med-diet, CFR, TT and the SHIM-5 score (all p&lt;0,005) and negatively to the AIx and cPP (both p&lt;0,025). There was also positive association of the Med-diet to the CFR, TT and the SHIM-5 score (p&lt;0,02) and negative to the AIx and cPP (p&lt;0,025). By linear regression analysis association of METs to TT, CFR and Med-diet remained significant after adjustment for age, BMI, diabetes mellitus, use of statins and smoking status (p&lt;0,005). We further subdivide our population according to the TT threshold of hypogonadism (≤3 ng/ml). Hypogonadism patients exhibit a lower exercise capacity comparing to the normal TT group (picture). Conclusion The Med-diet regime benefits exercise tolerance and erectile performance in hypertensive males with ED by enhancing endogenous testosterone and so coronary and central vascular physiology. We strongly recommend this culinary preference promoting thus vascular health and the sense of well being. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Incremental value of diastolic stress test in identifying subclinical heart failure in patients with diabetes mellitus

2020 ◽  
Vol 21 (8) ◽  
pp. 876-884 ◽  
Author(s):  
Tomoko Nishi ◽  
Yukari Kobayashi ◽  
Jeffrey W Christle ◽  
Nicholas Cauwenberghs ◽  
Kalyani Boralkar ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Stress Test ◽  
Left Ventricular ◽  
Metabolic Equivalents ◽  
Incremental Value ◽  
Asymptomatic Patients ◽  
Patients With Diabetes ◽  
Male Sex

Abstract Aims Resting echocardiography is a valuable method for detecting subclinical heart failure (HF) in patients with diabetes mellitus (DM). However, few studies have assessed the incremental value of diastolic stress for detecting subclinical HF in this population. Methods and results Asymptomatic patients with Type 2 DM were prospectively enrolled. Subclinical HF was assessed using systolic dysfunction (left ventricular longitudinal strain &lt;16% at rest and &lt;19% after exercise in absolute value), abnormal cardiac morphology, or diastolic dysfunction (E/e′ &gt; 10). Metabolic equivalents (METs) were calculated using treadmill speed and grade, and functional capacity was assessed by percent-predicted METs (ppMETs). Among 161 patients studied (mean age of 59 ± 11 years and 57% male sex), subclinical HF was observed in 68% at rest and in 79% with exercise. Among characteristics, diastolic stress had the highest yield in improving detection of HF with 57% of abnormal cases after exercise and 45% at rest. Patients with revealed diastolic dysfunction during stress had significantly lower exercise capacity than patients with normal diastolic stress (7.3 ± 2.1 vs. 8.8 ± 2.5, P &lt; 0.001 for peak METs and 91 ± 30% vs. 105 ± 30%, P = 0.04 for ppMETs). On multivariable modelling found that age (beta = −0.33), male sex (beta = 0.21), body mass index (beta = −0.49), and exercise E/e′ &gt;10 (beta = −0.17) were independently associated with peak METs (combined R2 = 0.46). A network correlation map revealed the connectivity of peak METs and diastolic properties as central features in patients with DM. Conclusion Diastolic stress test improves the detection of subclinical HF in patients with diabetes mellitus.

Abstract 16451: The Temporal Trend in the Utilization of Noninvasive Cardiac Test for Chest Pain Evaluation and Its Impact on Cardiac Catheterization Trends

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Stephanie Hong ◽  
Getu Teressa
Keyword(s):  
Chest Pain ◽  
Cardiac Catheterization ◽  
Stress Testing ◽  
Temporal Trend ◽  
Medical Center ◽  
Stress Test ◽  
Academic Medical Center ◽  
Diagnostic Testing ◽  
High Sensitivity ◽  
Artery Disease

Introduction: Noninvasive diagnostic testing serves as gatekeepers to invasive cardiac catheterization. Computed tomography coronary angiogram (CTCA) has been shown to have high sensitivity and negative predictive value in the diagnosis of coronary artery disease (CAD). However, the temporal trend of CTCA compared to functional tests and the differential downstream impact on cardiac catheterization is unknown. Objective: This study aimed to investigate the temporal trend of the use in CTCA for the evaluation of patients with chest pain and how it compares to the temporal trend of stress testing. The secondary aim was to investigate the temporal pattern in the cardiac catheterization rate and how it varies between CTCA and stress testing. Methods: We performed a retrospective review of 65,686 patients who presented to a large academic medical center with chest pain between 2012 and 2019. We identified those who received CTCA testing or stress testing as the initial diagnostic testing for diagnosing suspected CAD and collected data on downstream cardiac catheterization. We calculated the testing rate per 1000 for each year. Results: Of the patient who received noninvasive imaging (n=18,843), more CTCA was performed (18.6%) compared to stress test (10.1%). After an initial upward trend in CCTA use and a downward trend in stress test use between 2012 and 2014, the trend reversed for both modalities after 2015. The rate of cardiac catheterization increased after 2014, mirroring an increase in stress test utilization. Patients who had stress test first have increased odds of undergoing catheterization compared to those who had CTCA first, even after adjusting for risk factors. However, compared to CTCA, stress test shows a relative decline in the odds of catheterization (Relative adjusted Odd Ratio: 5.6 in 2012 down to 2.8 in 2019) Conclusion: In this large single-center study of chest pain patients, stress-testing leads to increased odds of cardiac catheterization compared to CCTA. However, the relative odds of undergoing catheterization following stress testing show a declining trend.

Relationship between dental loss and health outcomes among hospitalized patients with and without diabetes

2018 ◽  
Vol 67 (3) ◽  
pp. 669-673
Author(s):  
Kenneth Izuora ◽  
Ammar Yousif ◽  
Gayle Allenback ◽  
Civon Gewelber ◽  
Michael Neubauer
Keyword(s):  
Diabetes Mellitus ◽  
Heart Disease ◽  
Health Outcomes ◽  
Medical Center ◽  
Dental Health ◽  
Academic Medical Center ◽  
Hospitalized Patients ◽  
Academic Medical ◽  
Patients With Diabetes ◽  
The Impact

There is mixed evidence regarding the impact of poor dental health on cardiovascular disease and other health outcomes. Our objective was to determine the outcomes associated with poor dental health among hospitalized patients with and without diabetes mellitus (DM) at our institution. We enrolled a consecutive sample of adult patients admitted to an academic medical center. We gathered demographic, health and dental information, reviewed their medical records and then examined their teeth. We analyzed data using SPSS V.24. There was a high prevalence of dental loss among all hospitalized patients. Older age (p<0.001), smoking (p=0.034), having DM (p=0.001) and lower frequency of teeth brushing (p<0.001) were predictors of having a lower number of healthy teeth. Among DM and non-DM patients, fewer remaining healthy teeth was associated with presence of heart disease (p=0.025 and 0.003, respectively). Patients with diabetes mellitus (DM) had a higher prevalence of stroke (p=0.006) while patients without DM had a higher number of discharge medications (p=0.001) associated with having fewer number of healthy teeth. There was no correlation between number of healthy teeth and the length or frequency of hospitalization. Patients with DM are more likely to have fewer number of healthy teeth compared with non-DM patients. Fewer number of healthy teeth was associated with higher prevalence of heart disease in both DM and non-DM patients and with more discharge medications in non-DM patients.

scholarly journals Readmission Rates and Medication Selection for Patients with Heart Failure Preserved Ejection Fraction

2020 ◽  
Author(s):  
Troy Kramer ◽  
Carrie Vogler ◽  
Robert Robinson ◽  
Mukul Bhattarai
Keyword(s):  
Heart Failure ◽  
Logistic Regression ◽  
Ejection Fraction ◽  
Medical Center ◽  
Academic Medical Center ◽  
Univariate Analysis ◽  
Prescribing Patterns ◽  
Preserved Ejection Fraction ◽  
Multivariate Logistic Regression ◽  
Readmission Rates

Purpose Heart failure with preserved ejection fraction (HFpEF) has less guideline driven treatment options due to a lack of trials demonstrating medications with improved clinical outcomes for this patient population. The primary objective of this study is to determine which medications and dosages are related to high readmission rates for HFpEF patients. Methods A retrospective, single center, chart review was performed on patients with HFpEF at an academic medical center. Heart failure patients ages between 18-89 with an ejection fraction ≥45% from a transthoracic echocardiogram (TTE) were included. Primary outcomes include 30-day all cause readmission rates, prescribing patterns, and avoidance of potentially harmful medications. Descriptive statistics and multivariate logistic regression were used to assess potential risk factors. Results This study analyzed 455 patient admissions. Univariate analysis shows patients who were not readmitted were more likely to be on furosemide (54% vs 42%; p = 0.019). Conversely, readmitted patients were more likely to be taking bumetanide (4% vs 1%; p = 0.039). Lisinopril was the only angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) associated with lower readmission rates (p = 0.036). Multivariate logistic regression showed bumetanide on admission (OR 14.6, p = 0.001), discharged on rosuvastatin (OR 6.29, p = 0.003) and meloxicam therapy (OR 6.33, p = 0.003) to be independent predictors of hospital readmission. Conclusion Three independent pharmacologic predictors for 30-day readmissions for patients with HFpEF were therapy with bumetanide, meloxicam, or rosuvastatin. Further research is needed to clarify the significance of these results.

scholarly journals Thirty-day medical and surgical readmission following prenatal versus postnatal myelomeningocele repair

2019 ◽  
Vol 47 (4) ◽  
pp. E14 ◽  
Author(s):  
Michael Cools ◽  
Weston Northam ◽  
William Goodnight ◽  
Graham Mulvaney ◽  
Scott Elton ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Neonatal Intensive Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Lengths Of Stay ◽  
Surgery Patient ◽  
Csf Diversion ◽  
Surgery Rates ◽  
Repair Group

OBJECTIVEHospital readmission is an important quality metric that has not been evaluated in prenatal versus postnatal myelomeningocele (MMC) repair. This study compares hospital readmission outcomes between these two groups as well as their etiologies.METHODSThe medical records of patients who had undergone MMC repair in the period from 2011 to 2017 at a single academic medical center were retrospectively reviewed. Collected clinical data included surgery and defect details, neonatal intensive care unit (NICU) stay, and any readmissions or surgical procedures up to 1 year after surgery. Patient and defect characteristics, readmission outcomes at 30 and 60 days and 1 year after discharge from the NICU, and cerebrospinal fluid (CSF) diversion surgery rates were analyzed with the two-tailed t-test and/or k-sample test on the equality of medians.RESULTSA total of 24 prenatal and 34 postnatal MMC repairs were completed during the study period. Prenatally repaired patients were born more prematurely (p < 0.001) and with lower birth weights (p < 0.001), although the NICU stay was similar between the two groups (p = 0.59). Fewer prenatally repaired patients were readmitted at 30 days (p = 0.005), 90 days (p = 0.004), and 1 year (p = 0.007) than the postnatal repair group. Hydrocephalus was the most common readmission etiology, and 29% of prenatal repair patients required CSF diversion at 1 year versus 81% of the postnatal repair group (p < 0.01). Prenatal patients who required CSF diversion had a higher body weight (p = 0.02) and an older age (p = 0.01) at the time of CSF diversion surgery than the postnatal group.CONCLUSIONSPatients with prenatal MMC repair had fewer hospital readmissions at 30 days, 60 days, and 1 year than the postnatal repair group, despite similar NICU lengths of stay. The prenatal repair group had lower requirements for CSF diversion at 1 year and was older with greater body weights at the time of CSF diversion surgery, compared to those of the postnatal repair group. Future study of hospital quality metrics such as readmissions should be performed to better understand outcomes of these two procedures.

scholarly journals Post-vaccination SARS-CoV-2 infections and incidence of the B.1.427/B.1.429 variant among healthcare personnel at a northern California academic medical center

2021 ◽  
Author(s):  
Karen Blake Jacobson ◽  
Benjamin Pinsky ◽  
Maria E. Montez Rath ◽  
Hannah Wang ◽  
Jacob A. Miller ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Univariate Analysis ◽  
Vaccine Dose ◽  
Great Majority ◽  
The United States ◽  
Control Measures ◽  
Healthcare Personnel ◽  
Improvement Project ◽  
Post Vaccination

Background: Distribution of mRNA-based SARS-CoV-2 vaccines to healthcare personnel (HCP) in the United States began in December 2020, with efficacy > 90%. However, breakthrough infections in fully vaccinated individuals have been reported. Meanwhile, multiple SARS-CoV-2 variants of concern have emerged worldwide, including the B.1.427/B.1.429 variant first described in California. Little is known about the real-world effectiveness of the mRNA-based SARS-CoV-2 vaccines against novel variants including B.1.427/B.1.429. Methods: In this quality improvement project, post-vaccine SARS-CoV-2 cases (PVSCs) were defined as individuals with positive SARS-CoV-2 PCR test after receiving at least one dose of a SARS-CoV-2 vaccine. Chart extraction of demographic and clinical information was performed, and available specimens meeting cycle threshold value criteria were tested for L452R, N501Y and E484K mutations by RT-PCR. Results: From December 2020 to March 2021, 184 PVSCs were identified out of 22,729 healthcare personnel who received at least one dose of an mRNA-based SARS-CoV-2 vaccine. Of these, 114 (62.0%) occurred within 14 days of first vaccine dose (early post-vaccination), 49 (26.6%) within 14 days of the second vaccine dose (partially vaccinated), and 21 (11.4%) >14 days after the second dose (fully vaccinated). Of 112 samples available for mutation testing, 40 were positive for L452R alone, presumptive of B.1.427/B.1.429; two had N501Y mutation alone and none were found with E484K mutation. Though on univariate analysis partially- and fully-vaccinated PVSCs were more likely than early post-vaccination PVSCs to be infected with presumptive B.1.427/B.1.429, when adjusted for community prevalence of B.1.427/B.1.429 at the time of infection, partially- and fully-vaccinated PVSC did not have statistically significantly elevated risk ratios for infection with this variant (RR 1.39, 95% CI 0.80-2.40 and RR 0.96, 95% CI 0.47-1.95, respectively). Conclusions: Of 184 PVSCs, as expected, the great majority occurred prior to the expected onset of full, vaccine-derived immunity. Although presumptive B.1.427/B.1.429 did not represent a significantly higher proportion of late PVSCs than would be expected based on rising community prevalence over the study period, numbers of PVSCs were small. Continued infection control measures in the workplace and in the community including social distancing and masking, particularly in the early days post-vaccination, as well as continued variant surveillance in PVSCs, is imperative in order to anticipate and control future surges of infection.

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