scholarly journals Real-World Prescribing Pattern of Asthma Management in China: A Retrospective, Descriptive Analysis

2022 ◽  
Author(s):  
Jian Sun ◽  
Xin Wang ◽  
Xiaobin Ma ◽  
Yuyu Feng ◽  
Yajun Wang ◽  
...  
Keyword(s):  
Real World ◽  
Statistical Significance ◽  
Asthma Management ◽  
Prescribing Patterns ◽  
P Value ◽  
Valuable Insight ◽  
Inflammatory Disorder ◽  
Clinical Practices ◽  
Beta Agonists ◽  
Asthma Exacerbations

Abstract Background Asthma is a chronic inflammatory disorder of the airway that requires long-term medication management. Objective To describe the real-world prescribing patterns for asthma management in the Chinese population. Methods A retrospective analysis of 8,732 patients from January 2011 to September 2019 in 10 hospitals was conducted. Prescribing patterns of short-acting beta-agonists (SABA), long-acting beta-agonists (LABA), inhaled corticosteroids (ICS), intravenous corticosteroids, antihistamines, leukotriene receptor antagonists (LTRA), theophylline, antibiotics, and Chinese patent medicines were included in the analysis. Chi-square and logistic regression were calculated. P value of <0.05 was considered as statistical significance. Results ICS/LABA were prescribed for 2,940 (33.67%) patients with stable asthma and 141 (31.4%) patients with asthma exacerbations. LTRA was prescribed in 2,006 (22.97%) patients with stable asthma, and 86 (19.15%) patients with asthma exacerbations. Systemic antibiotics (46.1Z%), systemic corticosteroids (57.91%), and theophylline (51.45%) were frequently prescribed during exacerbations. A total of 5,766 patients (64.95%) were managed with traditional Chinese medication (TCM); 3237 patients (36.47%) received western medicine. Patients using ICS/LABA (P=0.019) and SABA (P=0.008) had a significantly lower rate of asthma exacerbations. Conclusions This study provides valuable insight into clinical practices of asthma management in China. Poor adherence to clinical reports was identified. Efforts are required to improve the quality of asthma care.

scholarly journals Real-World Prescribing Pattern of Asthma Management in China: A Retrospective, Descriptive Analysis

2021 ◽  
Author(s):  
Jian Sun ◽  
Xin Wang ◽  
Xiaobin Ma ◽  
Yuyu Feng ◽  
Yajun Wang ◽  
...  
Keyword(s):  
Real World ◽  
Statistical Significance ◽  
Asthma Management ◽  
Prescribing Patterns ◽  
P Value ◽  
Valuable Insight ◽  
Inflammatory Disorder ◽  
Clinical Practices ◽  
Beta Agonists ◽  
Asthma Exacerbations

Abstract Background: Asthma is a chronic inflammatory disorder of the airway that requires long-term medication management. Objective: To describe the real-world prescribing patterns for asthma management in the Chinese population. Methods: A retrospective analysis of 8,732 patients from January 2011 to September 2019 in 10 hospitals was conducted. Prescribing patterns of short-acting beta-agonists (SABA), long-acting beta-agonists (LABA), inhaled corticosteroids (ICS), intravenous corticosteroids, antihistamines, leukotriene receptor antagonists (LTRA), theophylline, antibiotics, and Chinese patent medicines were included in the analysis. Chi-square and logistic regression were calculated. A P value of <0.05 was considered as statistical significance.Results: ICS/LABA were prescribed for 2,940 (33.67%) patients with stable asthma and 141 (31.4%) patients with asthma exacerbations. LTRA was prescribed in 2,006 (22.97%) patients with stable asthma, and 86 (19.15%) patients with asthma exacerbations. Systemic antibiotics (46.1Z%), systemic corticosteroids (57.91%), and theophylline (51.45%) were frequently prescribed during exacerbations. A total of 5,766 patients (64.95%) were managed with traditional Chinese medication (TCM); 3237 patients (36.47%) received western medicine. Patients using ICS/LABA (P=0.019) and SABA (P=0.008) had a significantly lower rate of asthma exacerbations.Conclusions: This study provides valuable insight into clinical practices of asthma management in China. Poor adherence to clinical reports was identified. Efforts are required to improve the quality of asthma care.

scholarly journals Pediatricians’ Compliance to the Clinical Management Guidelines for Community-Acquired Pneumonia in Infants and Young Children in Pakistan

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 701
Author(s):  
Sadia Shakeel ◽  
Wajiha Iffat ◽  
Ambreen Qamar ◽  
Faiza Ghuman ◽  
Rabia Yamin ◽  
...  
Keyword(s):  
Management Practices ◽  
Statistical Significance ◽  
Severe Pneumonia ◽  
Community Acquired Pneumonia ◽  
P Value ◽  
Antibiotic Prescribing ◽  
Clinical Practices ◽  
Duration Of Treatment ◽  
Cross Sectional ◽  
Standard Clinical Practice

Community-acquired pneumonia (CAP) is among the most commonly prevailing acute infections in children that may require hospitalization. Inconsistencies among suggested care and actual management practices are usually observed, which raises the need to assess local clinical practices. The current study was conducted to evaluate pediatricians’ compliance with the standard clinical practice guidelines and their antibiotic-prescribing behavior for the management of CAP in children. Methods: A descriptive cross-sectional study was conducted using a self-administered questionnaire; which was provided to pediatricians by the researchers. Statistical analysis was performed with SPSS 25 Statistics; χ2 tests (or Fisher-exact tests) with the p-value set at < 0.05 as the threshold for statistical significance. Results: The overall response rate was 59.2%. Male respondents were (n = 101; 42.6%), and the respondents (n = 163; 68.7%) were under 30 years of age. Amoxicillin (n = 122; 51.5%) was considered as the most commonly used first-line treatment for non-severe pneumonia, whereas a smaller proportion (n = 81; 34.2%) of respondents selected amoxicillin–clavulanate. Likewise, amoxicillin (n = 100; 42.2%) was the most popular choice for non-severe pneumonia in hospitalized children; however, if children had used antibiotics earlier to admission, respondents showed an inclination to prescribe a macrolide (n = 95; 40.0%) or second-generation cephalosporin (n = 90; 37.9%). More than 90% responded that children <6 months old with suspected bacterial CAP will probably receive better therapeutic care by hospitalization. Restricting exposure to the antibiotic as much as possible (n = 71; 29.9%), improving antibiotic prescribing (n = 59; 24.8%), and using the appropriate dose of antimicrobials (n = 29; 12.2%) were considered the major factors by the respondents to reduce antimicrobials resistance. Conclusions: The selection of antibiotics and diagnostic approach was as per the recommendations, but indication, duration of treatment, and hospitalization still can be further improved.

SERUM PROLACTINE LEVEL IN PATIENTS OF PSORIASIS VULGARIS AND ITS CORRELATION WITH DISEASE SEVERITY: A CASE-CONTROL STUDY

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Pawan Kumar Saini ◽  
Devendra Yadav ◽  
Rozy Badyal ◽  
Suresh Jain ◽  
Arti Singh ◽  
...  
Keyword(s):  
Disease Severity ◽  
Prolactin Level ◽  
Case Control Study ◽  
Statistical Significance ◽  
Case Control ◽  
Serum Prolactin ◽  
P Value ◽  
Serum Prolactin Level ◽  
R Value ◽  
Control Study

Background: Psoriasis is an autoimmune chronic inflammatory disorder affecting the skin mediated by T-lymphocytes resulting in production of cytokines which cause hyperproliferation of keratinocytes.  Several factors and hormones like Prolactin have an action similar to these cytokines in promoting the multiplication of keratinocytes and other cells like lymphocytes and epithelial cells may have a role on the etiopathogenesis of psoriasis. Aim:-The aim of study is to compare the serum Prolactin levels in patients of psoriasis with a control group. Setting and study design: This is a case-control study conducted in the department of Dermatology, Venereology and Leprosy GMC, Kota over a period of 1year from July 2017 to June 2018 Material and method: The study included 100 cases of psoriasis (60 males and 40 females) and 100 controls similar for age and sex. Serum Prolactin levels were measured by ECLIA and results were obtained. Statistical analysis: Mean and standard deviation were calculated for each variable. Statistical significance of the results was analyzed using correlation analysis (Pearson correlation coefficient) and independent samples t-test. Statistical significance was assumed at p value<0.05. Result: Serum Prolactin level was significantly higher in cases of psoriasis compared to controls (p-value <0.001). PASI score and serum Prolactin levels were found to have a positive correlation (r value = 0.337; p-value: 0.001). No significant  correlation was found between serum levels of Prolactin and duration of disease r value= -0.034, P value =0.733). Serum Prolactin level was higher in male patients compared to females patients. Conclusion:- High serum Prolactin may be a biological marker of disease severity in psoriasis and may have a role in the pathogenesis of psoriasis. Further studies with large sample size are required to confirm this hypothesis.

Association of Vitamin D Levels and Other Risk Factors with Asthma Exacerbations in Children

2020 ◽  
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Serum Vitamin ◽  
Persistent Asthma ◽  
Food Allergies ◽  
P Value ◽  
Serum Vitamin D ◽  
Asthma Exacerbations ◽  
Vitamin D Levels ◽  
Animal Dander

Background: The risk factors for asthma exacerbations are well understood. However, the effect of vitamin D levels on number of asthma exacerbations per year is not clearly studied. The objective of the study was to find out the association of serum vitamin D levels and asthma risk factors on asthma exacerbations. Methods: In this study, ninety-nine subjects from 5 to 15 years of age were recruited at an episode of acute exacerbation. It was a cross sectional study and carried out from 2012 to 2015. Pulmonary function test was done by spirometry. Asthma exacerbation was labeled when forced expiratory volume/ forced vital capacity (FEV1/FVC) ratio was less than 80% (American Thoracic Society). Global Initiative for Asthma (GINA) guidelines were used to classify asthma into mild, moderate and severe persistent asthma. Serum vitamin D levels were measured by chemiluminescence method. Pearson Chi-square test was applied and p value (p<0.05) was considered as statistically significant. Results: Children who had exposure to animal dander had significantly lower asthma exacerbations per year (p-value <0.046). There was no significant association between vitamin D levels and number of exacerbations per years (p-value <0.099). Asthma was prevalent in girls of low socioeconomic status (SES) compared to males. However, there was no significant association between smoke, exercise, home environment, food allergies, weather, pollen and dust with asthma exacerbations. Conclusion: Low levels of vitamin D were not associated with increased number of asthma exacerbations per year. However, children exposed to animal dander had lesser number of exacerbations per year (p-value <0.046). Keywords: Asthma; Vitamin D; Children; Exacerbations, Risk factors.

Awareness of radiation doses and risks among radiology residents, fellows, specialists, consultants and technologists in Jeddah, Saudi Arabia: Cross-Sectional Study. (Preprint)

2019 ◽  
Author(s):  
Bashayer Hassan Shuaib ◽  
Rahaf Hisham Niazi ◽  
Ahmed Haitham Abduljabbar ◽  
Mohammed Abdulraheem Wazzan
Keyword(s):  
Interventional Radiology ◽  
Ionizing Radiation ◽  
Statistical Significance ◽  
Knowledge Score ◽  
P Value ◽  
Radiation Doses ◽  
Cross Sectional ◽  
The Right ◽  
Interventional Radiology Procedures ◽  
Radiology Staff

BACKGROUND Radiology now plays a major role to diagnose, monitoring, and management of several diseases; numerous diagnostic and interventional radiology procedures involve exposure to ionizing radiation. Radiology now plays a major role to diagnose, monitoring, and management of several diseases; numerous diagnostic and interventional radiology procedures involve exposure to ionizing radiation. OBJECTIVE This study aimed to discover and compare the awareness level of radiation doses, protection issues, and risks among radiology staff in Jeddah hospitals. METHODS A cross-sectional survey containing 25 questions on personal information and various aspects of radiation exposure doses and risks was designed using an online survey tool and the link was emailed to all radiology staff in eight tertiary hospitals in Jeddah. The authors were excluded from the study. A P-value of < .05 was used to identify statistical significance. All analyses were performed using SPSS, version 21. RESULTS Out of 156 participants the majority 151 (96.8%) had poor knowledge score, where the mean scores were 2.4±1.3 for doses knowledge, 2.1±1.1for cancer risks knowledge, 2.3±0.6 for general information, and 6.7±1.9 for the total score. Only 34.6% of the participants were aware of the dosage of a single-view chest x-ray, and 9.0% chose the right answer for the approximate effective dose received by a patient in a two-view. 42.9% were able to know the correct dose of CT abdomen single phase. There is a significant underestimation of cancer risk of CT studies especially for CT abdomen where only 23.7% knew the right risk. A p-value of <0.05 was used to identify statistical significance. No significant difference of knowledge score was detected regarding gender (P =.2) or work position (P=.66). CONCLUSIONS Our survey results show considerable inadequate knowledge in all groups without exception. We recommended a conscientious effort to deliver more solid education and obtain more knowledge in these matters and providing periodic training courses to teach how to minimize the dose of radiation and to avoid risk related. CLINICALTRIAL not applicable

scholarly journals Can diffusion and T2 star-weighted magnetic resonance imaging aid in the diagnosis of ectopic endometrium?

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Mariam Raafat ◽  
Soha H. Talaat ◽  
Salma M. Abdelghaffar ◽  
Engy A. Ali
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Statistical Significance ◽  
P Value ◽  
Large Sample Size ◽  
Resonance Imaging ◽  
Conventional Mri ◽  
Patient Will ◽  
Magnetic Resonance Imaging Mri ◽  
Ectopic Endometrium

Abstract Background Endometriosis is a common gynecologic disorder characterized by the implantation of the endometrial tissue ectopically outside the endometrial cavity. It affects about 10% of females at the childbearing period and is estimated to be present up to 20–50% in women complaining of infertility. While laparoscopy is considered the mainstay for diagnosis, magnetic resonance imaging (MRI) is recognized as a useful tool for definitive diagnosis, pre-surgical planning, and determining whether the patient will require multi-specialty involvement. The aim of this study is to evaluate the performance of MRI with the addition of diffusion-weighted imaging (DWI) and T2 star (T2*) to conventional MRI, for the accurate assessment of ectopic endometrium. Results Endometriotic lesions that showed diffusion restriction on DWI were 80.7%, and 96.1% of the endometriotic lesions had signal voids on the T2*W sequence, whereas only 65.4% of the lesions had typical signal intensities on T1WI and T2WI. Diagnostic performance of the MRI examination was improved by the use of the diffusion sequence and better improved by the T2* sequence, compared to the conventional MR protocol sensitivity (SE) = 96.12% and specificity (SP) = 85.7% in T2*-weighted images, SE = 80.7% and SP = 71.4% in DWI, and SE = 65.4% and SP = 71.4% in conventional MRI. P value for conventional MRI was 0.1, which is of no statistical significance (p < 0.05). P value for DWI was 0.016, which is statistically significant (p < 0.05). P value for T2*WI was 0.001, which is more statistically significant (p < 0.05) and could be adequately correlated with laparoscopy. Conclusion DWI and T2* significantly increase MRI diagnostic accuracy by allowing the detection of the hemorrhagic character of the endometriotic lesions. Studies with a large sample size are needed to confirm that they can replace invasive laparoscopy for the diagnosis of endometriosis.

Thromboelastography (TEG) results are predictive of ischemic and hemorrhagic complications in patients with unruptured intracranial aneurysms treated with flow diversion

2021 ◽  
pp. 159101992110259
Author(s):  
Kainaat Javed ◽  
Santiago R Unda ◽  
Ryan Holland ◽  
Adisson Fortunel ◽  
Rose Fluss ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracranial Aneurysms ◽  
Statistical Significance ◽  
Alpha Angle ◽  
Flow Diversion ◽  
P Value ◽  
Hemorrhagic Complication ◽  
Unruptured Intracranial Aneurysms ◽  
Hemorrhagic Complications ◽  
Groin Hematoma

Introduction Flow diversion is an effective treatment modality for intracranial aneurysms but is associated with ischemic and hemorrhagic complications. Patients treated with flow diversion require dual antiplatelet therapy and subsequent platelet function tests. At our institution, Thromboelastography with Platelet Mapping (TEG-PM) is the test of choice. The primary objective of this study was to identify TEG parameters that are predictive of postoperative complications in patients treated with elective flow diversion. Methods This was a retrospective study of 118 patients with unruptured intracranial aneurysms treated with flow diversion. Data was collected via chart review. Bivariate analyses were performed to identify significant variables in patients who suffered an ischemic stroke or a groin hematoma. ROC curves were constructed for the TEG parameters with statistical significance. Bivariate analyses were repeated using dichotomized TEG results. Results Patients who experienced a symptomatic ischemic stroke had a history of stroke (p value = 0.007), larger aneurysm neck width (p value = 0.017), and a higher alpha angle (p value = 0.013). Cut off point for ischemic complication is 63° on ROC curve with a sensitivity of 100% and specificity of 65%. Patients who experienced a groin hematoma were no different from their healthy peers but had a lower alpha angle (p value = 0.033). Cut off point for hemorrhagic complication is 53.3° with a sensitivity of 82% and specificity of 67%. Conclusion The Alpha Angle parameter of TEG-PM has a sizeable predictive ability for both ischemic complications of the central nervous system and hemorrhagic complications of the access site after elective flow diversion.

scholarly journals AB0799 REAL-WORLD EXPERIENCE OF SECUKINUMAB FOR PSORIATIC ARTHRITIS WITH AXIAL INVOLVEMENT.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1699.3-1699
Author(s):  
M. Martin Lopez ◽  
B. Joven-Ibáñez ◽  
J. L. Pablos
Keyword(s):  
Psoriatic Arthritis ◽  
Adverse Events ◽  
Real World ◽  
Spinal Pain ◽  
Tender Joint Count ◽  
P Value ◽  
X Ray ◽  
Activity Assessment ◽  
Real World Setting ◽  
Axial Involvement

Background:Evidence on the efficacy of biologics in the treatment of psoriatic arthritis (PsA) patients with axial manifestations affecting 30-70% of PsA patients is limited. Secukinumab (SEC) has provided significant and sustained improvement in the signs and symptoms of active PsA and ankylosing spondylitis.Objectives:This study aims to analyze the experience of using SEC for PsA patients with axial involvement in real-world setting.Methods:Multicentric observational, longitudinal, retrospective study conducted in a tertiary hospital between January 2016 and December 2019. Patients with PsA (CASPAR criteria) and clinical and/or image diagnosis of axial involvement receiving at least one dose of SEC were included. Patients with non-pathological sacroiliacs x-ray and MRI had to have spinal pain VAS ≥4/10 after failure to NSAIDs, prior to the onset of SEC, to be included. Medical records were reviewed to collect demographic and clinical data, features of PsA (manifestations, treatments and activity assessment). Descriptive statistics and then a comparative analysis with the Studentt-test to analyze the effectiveness of SEC were performed.Results:Of 98 PsA patients treated with SEC, 58 (59.2%) had axial involvement, of which 41 (71%) female. Mean age was 54 y.o (SD 10) and average duration of the disease was 10 years (SD 8). All 58 patients had peripheral disease (33% joint erosions), 55 (95%) had psoriasis, 20 (34%) showed dactilitis and 39 (67%) had enthesitis. Sacroiliacs x-ray was damaged in 38 (66%) patients (grade I-IV) and 23 (40%) pathological MRI, with HLAB27+ at 8 (14%) patients. Average BMI was 29 (SD 8), with an obesity rate of 33% (19 pt). Observed comorbidities were hypertension (27 pt, 47%), diabetes mellitus (6 pt, 10%), dyslipidemia (23 pt, 40%), active smoking (18 pt, 31%) and malignancy (6 pt, 10%). Regarding previous treatments, 90% had received cDMARDs, particularly methotrexate (86%) and 40 (69%) had been exposed to at least one bDMARD (15 pt to one, 9 to two, 6 to three and 10 to four or more). 7 patients were on 300 mg dose and 51 patients on 150 mg dose (dose escalation to 300 mg was performed in 16 patients and 44% respond and maintain SEC). Average drug survival time was 1.4 (SD 1) years. At 6 months of SEC therapy, tender and swollen joint count, spinal pain VAS, CRP, ASDAS-CRP and DAPSA had significantly decreased (Table 1). 29 (50%) patients suspended SEC during follow-up due to primary ineffectiveness (8), secondary ineffectiveness (16), adverse events (3), latex allergy (1) and remission (1). Adverse events do not differ from those reported in clinical trials.Table 1.Disease activity assessment at 6 months of secukinumab therapy.Baseline6 months after SECMean differenceP valueSJC4,8±5,41,9±3,1-2,8 (IC95% -3,9 a -1,7)p<0,0001TJC7,7±5,83,9±4,1-3,8 (IC95% -5,1 a -2,4)p<0,0001Spinal pVAS6,1±3,24,2±2,9-1,9 (IC95% -2,4 a -1,4)p<0,0001CRP (mg/L)7,7±9,94,9±5,9-2,9 (IC95% -4,5 a -1,2)p=0,0009ASDAS-CRP2,5±1,91,8±1,3-0,7 (IC95% -0,9 a -0,4)p<0,0001DAPSA27,7±12,116,7±10,4-11 (IC95% -15,3 a -6,8)p<0,0001SJC: swollen joint count, TJC: tender joint count, Spinal pVAS: spinal pain visual analog scale, CRP: C-reactive protein, SEC: secukinumab.Conclusion:Secukinumab in real-world setting provided improvements in the axial and peripheral manifestations of PsA, using both the 150 mg and 300 mg doses.Disclosure of Interests:MARIA MARTIN LOPEZ: None declared, Beatriz Joven-Ibáñez Speakers bureau: Abbvie, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, José Luis Pablos: None declared

scholarly journals Utility of routinely collected electronic health records data to support effectiveness evaluations in inflammatory bowel disease: a pilot study of tofacitinib

2021 ◽  
Vol 28 (1) ◽  
pp. e100337
Author(s):  
Vivek Ashok Rudrapatna ◽  
Benjamin Scott Glicksberg ◽  
Atul Janardhan Butte
Keyword(s):  
Inflammatory Bowel Disease ◽  
Pilot Study ◽  
Disease Activity ◽  
Real World ◽  
Bowel Disease ◽  
P Value ◽  
Health Records ◽  
Real World Evidence ◽  
Inflammatory Bowel

ObjectivesElectronic health records (EHR) are receiving growing attention from regulators, biopharmaceuticals and payors as a potential source of real-world evidence. However, their suitability for the study of diseases with complex activity measures is unclear. We sought to evaluate the use of EHR data for estimating treatment effectiveness in inflammatory bowel disease (IBD), using tofacitinib as a use case.MethodsRecords from the University of California, San Francisco (6/2012 to 4/2019) were queried to identify tofacitinib-treated IBD patients. Disease activity variables at baseline and follow-up were manually abstracted according to a preregistered protocol. The proportion of patients meeting the endpoints of recent randomised trials in ulcerative colitis (UC) and Crohn’s disease (CD) was assessed.Results86 patients initiated tofacitinib. Baseline characteristics of the real-world and trial cohorts were similar, except for universal failure of tumour necrosis factor inhibitors in the former. 54% (UC) and 62% (CD) of patients had complete capture of disease activity at baseline (month −6 to 0), while only 32% (UC) and 69% (CD) of patients had complete follow-up data (month 2 to 8). Using data imputation, we estimated the proportion achieving the trial primary endpoints as being similar to the published estimates for both UC (16%, p value=0.5) and CD (38%, p-value=0.8).Discussion/ConclusionThis pilot study reproduced trial-based estimates of tofacitinib efficacy despite its use in a different cohort but revealed substantial missingness in routinely collected data. Future work is needed to strengthen EHR data and enable real-world evidence in complex diseases like IBD.

scholarly journals Social determinants of telemedicine utilization in ambulatory cardiovascular patients during the COVID-19 pandemic

2021 ◽  
Author(s):  
Kemar J Brown ◽  
Njambi Mathenge ◽  
Daniela Crousillat ◽  
Jaclyn Pagliaro ◽  
Connor Grady ◽  
...  
Keyword(s):  
Statistical Significance ◽  
The Elderly ◽  
P Value ◽  
Chi Square ◽  
Cardiovascular Patients ◽  
Baseline Characteristics ◽  
Racial Ethnic ◽  
Cardiovascular Care ◽  
Zip Code ◽  
Hispanic White

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in the rapid uptake of telemedicine (TM) for routine cardiovascular care. Objectives To examine the predictors of TM utilization among ambulatory cardiology patients during the COVID-19 pandemic. Methods In this single centre retrospective study, all ambulatory cardiovascular encounters occurring between March 16th - June 19th, 2020 were assessed. Baseline characteristics by visit type (in-person, TM-phone, TM-video) were compared using Chi-square and student t-tests, with statistical significance defined by p value &lt; 0.05. Multivariate logistic regression was used to explore the predictors of TM versus in-person care. Results 8446 patients (86% Non-Hispanic White, 42% female, median age 66.8 +/- 15.2 years) completed an ambulatory cardiovascular visit during the study period. TM-phone (n = 4,981, 61.5%) was the primary mode of ambulatory care followed by TM-video (n = 2693, 33.2%). Non-Hispanic Black race (OR 0.56; 95% CI: 0.35 - 0.94, p-value=0.02), Hispanic ethnicity (OR 0.53; 95% CI: 0.29 - 0.98, p = 0.04), public insurance (Medicaid OR 0.50; 95% CI:0.32 – 0.79, p = 0.003, Medicare OR 0.65; 95% CI: 0.47– 0.89, p = 0.009), zip-code linked median household income (MHI) of &lt;$75,000, age &gt;85 years, and patients with a diagnosis of heart failure were associated with reduced access to TM-video encounters and a higher likelihood of in-person care. Conclusions Significant disparities in TM-video access for ambulatory cardiovascular care exist among the elderly, lower income, as well as Black and Hispanic racial/ethnic groups.

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