Establishment of a cardiac telehealth program to support cardiovascular diagnosis and care in a remote, resource-poor setting in Uganda

Introduction To address workforce shortages and expand access to care, we developed a telemedicine program incorporating existing infrastructure for delivery of cardiovascular care in Gulu, Northern Uganda. Our study had three objectives: 1) assess feasibility and clinical impact 2) evaluate patient/parent satisfaction and 3) estimate costs. Methods All cardiology clinic visits during a two-year study period were included. All patients received an electrocardiogram and echocardiogram performed by a local nurse in Gulu which were stored and transmitted to the Uganda Heart Institute in the capital of Kampala for remote consultation by a cardiologist. Results were relayed to patients/families following cardiologist interpretation. The following telemedicine process was utilized: 1) clinical intake by nurse in Gulu; 2) ECG and echocardiography acquisition in Gulu; 3) echocardiography transmission to the Uganda Heart Institute in Kampala, Uganda; 4) remote telemedicine consultation by cardiologists in Kampala; and 5) communication of results to patients/families in Gulu. Clinical care and technical aspects were tracked. Diagnoses and recommendations were analyzed by age groups (0–5 years, 6–21 years, 22–50 years and > 50 years). A mixed methods approach involving interviews and surveys was used to assess patient satisfaction. Healthcare sector costs of telemedicine-based cardiovascular care were estimated using time-driven activity-based costing. Results Normal studies made up 47%, 55%, 76% and 45% of 1,324 patients in the four age groups from youngest to oldest. Valvular heart disease (predominantly rheumatic heart disease) was the most common diagnosis in the older three age groups. Medications were prescribed to 31%, 31%, 24%, and 48% of patients in the four age groups. The median time for consultation was 7 days. A thematic analysis of focus group transcripts displayed an overall acceptance and appreciation for telemedicine, citing cost- and time-saving benefits. The cost of telemedicine was $29.48/visit. Conclusions Our data show that transmission and interpretation of echocardiograms from a remote clinic in northern Uganda is feasible, serves a population with a high burden of heart disease, has a significant impact on patient care, is favorably received by patients, and can be delivered at low cost. Further study is needed to better assess the impact relative to existing standards of care and cost effectiveness.

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Cyanotic congenital heart disease: Impact on growth and endocrine functions.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.10.5471 ◽

2021 ◽

Vol 28 (10) ◽

pp. 1477-1483

Author(s):

Muhammad Sohail Arshad ◽

Waqas Imran Khan ◽

Arif Zulqarnain ◽

Hafiz Muhammad Anwar-ul-Haq ◽

Mudasser Adnan

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Pulmonary Stenosis ◽

Tertiary Care ◽

Cyanotic Congenital Heart Disease ◽

P Value ◽

Common Diagnosis ◽

Significant Difference ◽

The Impact

Objective: To find out the impact of Cyanotic Congenital Heart Disease (CCHD) on growth and endocrine functions at a tertiary care child healthcare facility of South Punjab. Study Design: Case Control study. Setting: Department of Pediatric Cardiology and Department of Pediatric Endocrinology, Institute of Child’s Health (ICH), Multan, Pakistan. Period: December 2018 to March 2020. Material & Methods: During the study period, a total of 53 cases of Echocardiography confirmed CCHD were registered. Along with 53 cases, 50 controls during the study period were also enrolled. Height, weight, body mass index (BMI) along with hormonal and biochemical laboratory investigations were done. Results: There was no significant difference between gender and age among cases and controls (p value>0.05). Most common diagnosis of CCHD among cases, 24 (45.3%) were Tetralogy of Fallot (TOF) followed by 9 (17.0%) transposition of the great arteries (TGA) with Ventricular Septal Defect (VSD) with Pulmonary Stenosis (PS). Mean weight of CCHD cases was significantly lower in comparison to controls (21.19+6.24 kg vs. 26.48+8.1 kg, p value=0.0003). Blood glucose was significantly lower among cases in comparison to controls (77.58+14.58 mg/dl vs. 87.25+11.82 mg/dl, p value=0.0004). No significant difference was found in between cases and controls in terms of various hormone levels studied (p value>0.05) except Insulin-like Growth Factor-1 (IGF-1) levels (p value<0.0001). Conclusion: Children with cyanotic congenital heart disease seem to have negative effects on nutrition and growth. Change in pituitary-adrenal axis is suspected while pituitary-thyroid axis seemed to be working fine among CCHD cases. Serum glucose and IGF-1 levels were significantly decreased among CCHD cases.

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Abstract MP30: The Health and Economic Impact of a Sugar Sweetened Beverage Tax in New York City: A Modeling Study

Circulation ◽

10.1161/circ.141.suppl_1.mp30 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Daniel D Bu ◽

Stella S Yi ◽

Heesun Eom ◽

Rienna Russo ◽

Brandon Bellows ◽

...

Keyword(s):

New York ◽

Coronary Heart Disease ◽

New York City ◽

Heart Disease ◽

Economic Impact ◽

York City ◽

Cost Savings ◽

Healthcare Sector ◽

Health Improvement ◽

The Impact

Background: Sugar-sweetened beverages (SSB) are currently the single largest source of added sugar in the US diet, and consumption in New York City (NYC) remains high. Evidence suggests that a high sugar consumption increases the risk of coronary heart disease. To date, excise taxes on SSB have been implemented in several US jurisdictions. While reductions in SSB consumption have been reported in several places where the SSB tax was implemented, it is unclear what the long term health and economic impact an SSB tax could have within the demographically and socioeconomically diverse NYC. In addition, the impact of varying tax structures remains unknown. Objective: To project the cardiovascular health outcomes and cost-savings of variations on the penny-per-ounce SSB tax structure (simulating a half-penny to two-penny range) using a validated microsimulation model of cardiovascular disease. Methods: The Simulations for Health Improvement and Equity (SHINE) CVD Model was used to estimate the lifetime direct medical costs (2019 USD) and effectiveness of SSB tax from a healthcare sector perspective. Population demographics and health profiles were estimated using data from the 2013-2014 NYC Health and Nutrition Examination Survey. CVD risk factor trajectories and risk of incident CVD events were derived from six pooled prospective U.S. cohorts. Policy effects and price elasticity were derived from recent meta-analyses. SSB tax was modeled to directly affect incidence rates of CVD events and was derived from variations of the penny-per-ounce tax scheme. Costs were discounted at 3%. Results: Compared to the non-policy situation, the SHINE CVD model projected that an SSB tax would prevent 29,341 (95% CI: 11,747-46,935) coronary heart disease (CHD) events at a half penny-per-ounce rate, 37,034 (95% CI: 19,336-54,732), at one penny-per-ounce, and 68,846 CHD events (95% CI: 51,306- 86,386) at a two-pennies-per-ounce rate over the simulated lifetimes of the NYC population. Total cost savings over this time period ranged from $662 million (95% CI $584-$741 million), $714 million (95% CI: $620-$808 million), and $1.03 billion (95% CI $0.92 - $1.16 billion), or $13.5 million/year, $14.6 million/year, $21.0 million/year for half-penny, one-penny, and two-pennies-per-ounce taxes respectively. Conclusion: Using a computer simulation model, we showed how different increments of the penny-per-ounce SSB tax could result in substantial benefits within the NYC population in terms of CVD outcomes and overall health care cost savings. Results from the SHINE CVD model may inform the ongoing policymaking efforts.

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Expanding the impact of a longstanding Canadian cardiac registry through data linkage: challenges and opportunities

International Journal for Population Data Science ◽

10.23889/ijpds.v3i3.441 ◽

2018 ◽

Vol 3 (3) ◽

Cited By ~ 1

Author(s):

Danielle A Southern ◽

Matthew T James ◽

Stephen B Wilton ◽

Lawrence DeKoning ◽

Hude Quan ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Data Linkage ◽

Point Of Care ◽

Clinical Information ◽

Inception Cohort ◽

Treatment Information ◽

Challenges And Opportunities ◽

The Impact ◽

Cardiovascular Care

The Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) began as a province-wide inception cohort of all adult Alberta residents undergoing cardiac catheterization for ischemic heart disease. As of September 2017, clinical information has been collected by APPROACH on over 240,000 adult Alberta residents. Use of the APPROACH platform has also expanded across Canada and now facilitates the measurement and reporting of cardiovascular care across more than 18 major cardiovascular centres in 8 provinces. Strengths of the APPROACH initiative include the prospective collection of detailed clinical, procedural, and treatment information, measured at point-of-care. While this aspect of APPROACH provides data users with several advantages over of use of typical administrative data, the ability to link APPROACH with data from multiple other sources has provided several unique opportunities to measure cardiovascular care and outcomes. This paper describes applied examples of work that has leveraged the potential of linking several external datasets with the APPROACH registry.

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The impact of smoking in elderly people

Reviews in Clinical Gerontology ◽

10.1017/s0959259899009387 ◽

1999 ◽

Vol 9 (3) ◽

pp. 273-280 ◽

Cited By ~ 2

Author(s):

Norman J Vetter

Keyword(s):

Lung Cancer ◽

Coronary Heart Disease ◽

Heart Disease ◽

Causes Of Death ◽

Age Groups ◽

The Elderly ◽

Death Rates ◽

Younger Age ◽

Prevention Programmes ◽

The Impact

Smoking has been closely implicated in many cardiovascular, lung and other diseases which are prevalent in the elderly, but most prevention programmes tend to be aimed at younger age groups.The prevention of smoking in retired people is a subject which is not yet fully researched, but there is a little information which suggests that it may be a worthwhile pursuit. Certainly, work has shown that longevity can be improved even in older people by stopping smoking. Coronary heart disease death rates for 65-74 year olds who have recently given up are similar to non-smokers. For other causes of death, especially lung cancer and bronchitis, the benefits of stopping smoking take up to five years to appear. In terms of morbidity, there are suggestions that ex-smokers move reasonably quickly towards the state of non-smokers for bone density, pulmonary function and muscle strength.

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Abstract 057: Increased Incidence of Ischemic Stroke in HIV-Infected Women in a Clinical Care Cohort

Circulation ◽

10.1161/circ.125.suppl_10.a057 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Felicia C Chow ◽

Susan Regan ◽

Steven Feske ◽

James B Meigs ◽

Steven K Grinspoon ◽

...

Keyword(s):

Heart Disease ◽

Ischemic Stroke ◽

Hiv Infection ◽

Clinical Care ◽

Age Groups ◽

Incidence Rates ◽

Hazard Ratio ◽

Right Censoring ◽

Stroke Event ◽

Stroke Incidence

Introduction: Coronary heart disease rates are increased among HIV-infected patients compared to control groups, with a relatively greater increase in women compared to men. Whether a similar pattern with respect to gender is true for ischemic stroke is not known. We assessed the hypothesis that the adjusted hazard ratio for ischemic stroke given HIV infection is greater among women compared to men. Methods: The study was conducted using data from an HIV observational clinical care cohort at a large Boston-based health care system. A control cohort of non-HIV-infected patients was matched in a 10:1 ratio to the HIV cohort based on age, gender, and race. The observation period was between 1996 and 2009, with right censoring at the initial stroke event or last encounter if prior to 2009. Ischemic stroke events were identified by pre-specified and validated ICD-9-CM codes. Gender-specific stroke incidence rates were calculated. To assess the association of HIV and ischemic stroke within each gender, Cox proportional hazard modeling was employed. Results: The cohorts consisted of 4,308 HIV-infected patients (31% women) and 32,423 non-HIV-infected patients (35% women). Among women, ischemic stroke event rates were 5.02 per 1000 person years (PY) in HIV-infected versus 2.31 per 1000 PY in non-HIV-infected patients (40 events in HIV and 177 events in non-HIV) with an unadjusted hazard ratio (HR) of 2.16 (95% confidence interval [CI] 1.53–3.04, P <0.001). In contrast, among men ischemic stroke rates were 5.38 per 1000 PY in HIV-infected versus 4.59 per 1000 PY in non-HIV-infected patients (92 events in HIV and 605 events in non-HIV patients) with an unadjusted HR of 1.18 (95% CI 0.95–1.47, P =0.14). Comparing HIV-infected to non-HIV-infected patients, incidence rates were significantly increased among women in the 18–29, 30–39, and 40–49 age groups and among men in the 30–39 age group. In a gender-stratified, multivariate regression model adjusting for age, race, hypertension, diabetes, dyslipidemia, smoking, structural heart disease, atrial fibrillation, aspirin use, and warfarin use, the adjusted HR for stroke associated with HIV infection was 1.76 (95% CI 1.24–2.52, P =0.002) among women compared with 1.05 (95% CI 0.84–1.32, P =0.639) among men. Conclusions: Ischemic stroke incidence rates were significantly increased in HIV-infected patients compared to non-HIV-infected patients among young women (< 50) and a subset of young men. HIV infection remained independently associated with stroke among women after adjusting for demographic and traditional stroke risk factors. While further studies are merited investigating causality and potential mechanisms for stroke among HIV-infected women, this group may represent a uniquely at-risk population for accelerated cerebrovascular aging.

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Determinants of prehospital coronary heart disease death

Scientific Reports ◽

10.1038/s41598-021-96575-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ute Amann ◽

Margit Heier ◽

Christian Thilo ◽

Jakob Linseisen ◽

Christa Meisinger

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Angina Pectoris ◽

Age Groups ◽

Case Fatality ◽

Cardiac Risk ◽

Population Based ◽

Living Alone ◽

Chronic Obstructive ◽

The Impact

AbstractLimited data on prehospital and early in-hospital coronary heart disease (CHD) deaths is available. Aims of this study were to provide a comprehensive description on CHD cases and to analyse determinants of prehospital death. From a population-based myocardial infarction (MI) registry in Augsburg, Germany we included 12,572 CHD cases aged 25–74 years between 2003–2017 and 4754 CHD cases aged 75–84 years between 2009–2017. Multivariable logistic regression models were conducted to identify patient characteristics associated with prehospital death compared to 28-day survival. In patients aged 25–74 years, 1713 (13.6%) died prehospital, 941 (7.5%) died within the first 24 h in-hospital and 560 (4.5%) died within the 2nd and 28th day after the acute event; in patients aged 75–84 years the numbers were 1263 (26.6%), 749 (15.8%) and 329 (6.9%), respectively. In both age groups increasing age, actual smoking or nicotine abuse, previous MI, angina pectoris and previous stroke were more likely and hypertension was less likely in cases, who died prehospital compared to 28-day survivors. For example, in the 25–74 years old we revealed an adjusted odds ratio (OR) of 4.53 (95% CI 3.84–5.34) for angina pectoris and an OR of 0.69 (95% CI 0.57–0.85) for hypertension. In cases aged 25–74 years, an association of living alone (OR 1.26, 95% CI 1.06–1.49) and diabetes (OR 1.20, 95% CI 1.03–1.41) with prehospital death was found. Whereas in cases aged 75–84 years, chronic obstructive pulmonary disease (OR 2.20, 95%CI 1.69–0.2.85) was associated with prehospital death. In summary, we observed high prehospital and early in-hospital case fatality. Besides classical cardiac risk factors, the impact of living alone on prehospital death was more important in patients aged 25–74 years than in older patients.

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Evaluating the effect of COVID-19 on dispensing patterns: a national cohort analysis

10.21203/rs.3.rs-233848/v1 ◽

2021 ◽

Author(s):

Fatemeh Torabi ◽

Ashley Akbari ◽

Laura North ◽

Daniel Harris ◽

Gareth Davies ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Clinical Care ◽

Cohort Analysis ◽

Age Groups ◽

Relative Increase ◽

Drug Dispensing ◽

National Patient ◽

National Cohort ◽

The Impact

Abstract BackgroundMedication prescribing and dispensing often regarded as one of the most effective ways to manage and improve population health. Prescribed and dispensed medications can be monitored through data linkage for each patient. We hypothesised that changes in patient care resulting from COVID-19, changed the way patients access their prescribed medication.Objective To develop an efficient approach for evaluation of the impact of COVID-19 on drug dispensing patterns.MethodsRetrospective observational study using national patient-level dispensing records in Wales-UK. Total dispensed drug items between 01-Jan-2016 and 31-Dec-2019 (counterfactual pre-COVID-19) were compared to 2020 (COVID-19 year). We compared trends of dispensed items in three main British National Formulary (BNF) sections(Cardiovascular system, Central Nervous System, Immunological & Vaccine) using European Age-Standardized rates. We developed an online tool to enable monitoring of changes in dispensing as the pandemic evolves.ResultAmongst all BNF chapters, 52,357,639 items were dispensed in 2020 compared to 49,747,141 items in 2019 demonstrating a relative increase of 5.25% in 2020(95%CI[5.21,5.29]). Comparison of monthly patterns of 2020 and 2019 dispensed items showed a notable difference between the total number of dispensed drug items each month, with an average difference (D) of +290,055 and average Relative Change (RC) of +5.52%. The greatest RC was observed in a substantial March-2020 increase (D=+1,501,242 and RC=+28%), followed by second peak in June (D=+565,004, RC=+10.97%). May was characterised by lower dispensing (D=-399,244, RC=-5.9%). Cardiovascular categories were characterised, across all age groups, by dramatic March-2020 increases, at the epidemic peak, followed by months of lower than expected dispensing, and gradual recovery by September. The Central Nervous System category was similar, but with only a short decline in May, and quicker recovery. A stand-out grouping was Immunological and Vaccine, which dropped to very low levels across all age groups, and all months (including the March dispensing peak).ConclusionsAberration in clinical service delivery during COVID-19 led to substantial changes in community pharmacy drug dispensing. This change may contribute to a long-term burden of COVID-19, raising the importance of a comprehensive and timely monitoring of changes for evaluation of the potential impact on clinical care and outcomes

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From Diagnoses to Ongoing Journey: Parent Experiences Following Congenital Heart Disease Diagnoses

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsz055 ◽

2019 ◽

Vol 44 (8) ◽

pp. 924-936 ◽

Cited By ~ 4

Author(s):

Tricia S Williams ◽

Kyla P McDonald ◽

Samantha D Roberts ◽

Vann Chau ◽

Mike Seed ◽

...

Keyword(s):

Mental Health ◽

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Quantitative Methods ◽

Clinical Care ◽

Age Groups ◽

Models Of Care ◽

Cross Sectional ◽

Parents Experiences

AbstractDespite improved survival among children with congenital heart disease (CHD), the risk of psychosocial difficulties remains largely unchanged with an increased emphasis of improving support for parents as a mechanism to optimize outcomes.ObjectiveUsing qualitative and quantitative methods, the current cross-sectional study examined parents' experiences at the time of their child's diagnosis, what they thought helped their child recover, barriers to support, and identified needs for future models of care.MethodThe sample included 26 parents (22 mothers, 3 fathers, and 1 mother/father pair) of children with CHD, ranging in age between 6 months and 4 years with a mean age of 2 years.ResultsQualitative results were organized around five themes: (a) They (medical team) saved my child's life, (b) My child is going to be okay, (c) Not out of the woods, (d) Optimizing support for my child and myself, and (e) What still gets in the way. Parents uniformly expressed a need for greater mental health support for their children as well as programs to improve parents' skill and confidence, with no difference between age groups (< 2 years and > 2 years of age). Common barriers to service included distance and time off work.ConclusionParents' experiences informed both acute and long term implications following CHD diagnoses, and highlight current gaps in mental health care. Direction for clinical care and improved intervention opportunities are discussed.

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ANMCO POSITION PAPER: cardio-oncology in the COVID era (CO and CO)

European Heart Journal Supplements ◽

10.1093/eurheartj/suab067 ◽

2021 ◽

Vol 23 (Supplement_C) ◽

pp. C128-C153

Author(s):

Irma Bisceglia ◽

Domenico Gabrielli ◽

Maria Laura Canale ◽

Giuseppina Gallucci ◽

Iris Parrini ◽

...

Keyword(s):

Health Care Systems ◽

Clinical Care ◽

Rebound Effect ◽

Relative Increase ◽

Standards Of Care ◽

Care Pathways ◽

Complication Rates ◽

Oncologic Patients ◽

Monitoring Protocols ◽

The Impact

Abstract The COVID-19 pandemic and its impact on patients with cancer and cardiovascular disease have confirmed the particular vulnerability of these populations. Indeed, not only a higher risk of contracting the infection has been reported but also an increased occurrence of a more severe course and unfavourable outcome. Beyond the direct consequences of COVID-19 infection, the pandemic has an enormous impact on global health systems. Screening programmes and non-urgent tests have been postponed; clinical trials have suffered a setback. Similarly, in the area of cardiology care, a significant decline in STEMI accesses and an increase in cases of late presenting heart attacks with increased mortality and complication rates have been reported. Health care systems must therefore get ready to tackle the ‘rebound effect’ that will likely show a relative increase in the short- and medium-term incidence of diseases such as heart failure, myocardial infarction, arrhythmias, and cardio- and cerebrovascular complications. Scientific societies are taking action to provide general guidance and recommendations aimed at mitigating the unfavourable outcomes of this pandemic emergency. Cardio-oncology, as an emerging discipline, is more flexible in modulating care pathways and represents a beacon of innovation in the development of multi-specialty patient management. In the era of the COVID-19 pandemic, cardio-oncology has rapidly modified its clinical care pathways and implemented flexible monitoring protocols that include targeted use of cardiac imaging, increased use of biomarkers, and telemedicine systems. The goal of these strategic adjustments is to minimize the risk of infection for providers and patients while maintaining standards of care for the treatment of oncologic and cardiovascular diseases. The aim of this document is to evaluate the impact of the pandemic on the management of cardio-oncologic patients with the-state-of-the-art knowledge about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease (COVID-19) in order to optimize medical strategies during and after the pandemic.

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Conoscenza e consapevolezza del rischio cardiovascolare nella donna: a che punto siamo?

CARDIOLOGIA AMBULATORIALE ◽

10.17473/1971-6818-2021-1-2 ◽

2021 ◽

Vol 1 (1) ◽

pp. 14-15

Author(s):

Adele Lillo ◽

Giovanni Battista Zito

Keyword(s):

Gender Differences ◽

Heart Disease ◽

Age Groups ◽

Vascular Diseases ◽

The United States ◽

Cultural Behavior ◽

The Past ◽

Rischio Cardiovascolare ◽

Cardio Vascular ◽

The Impact

Over the past two decades, several studies have examined gender differences in the clinical manifes-tations and prognosis of cardiovascular disease. The results of these studies have shown some important gender-related differences. While the effects that gender, age and cultural behavior have on the health of men and women have been extensively studied, knowledge and awareness of the impact that gender differences have on the pathophysiolo-gy and treatment of diseases in general and cardio-vascular diseases in particular are still low. Heart disease is the leading cause of death and a major contributor to disability among women world-wide. Although often considered an advanced-aging disease, more than 15,000 deaths each year among women aged ≤ 55 years in the United States can be at-tributed to heart disease. The prevalence of cardiovas-cular disease (CVD) in postmenopausal women is the same as in men, however, in all age groups, women with CVD have relatively worse outcomes than men. Therefore, young women would be less likely to be affected by CVD, but, if affected, are exposed to a death rate and higher complications than men.

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