Examining the Drivers of Racial/Ethnic Disparities in Non-Adherence to Antihypertensive Medications and Mortality Due to Heart Disease and Stroke: A County-Level Analysis

Background: Prior research has identified disparities in anti-hypertensive medication (AHM) non-adherence between Black/African Americans (BAAs) and non-Hispanic Whites (nHWs) but the role of determinants of health in these gaps is unclear. Non-adherence to AHM may be associated with increased mortality (due to heart disease and stroke) and the extent to which such associations are modified by contextual determinants of health may inform future interventions. Methods: We linked the Centers for Disease Control and Prevention (CDC) Atlas of Heart Disease and Stroke (2014–2016) and the 2016 County Health Ranking (CHR) dataset to investigate the associations between AHM non-adherence, mortality, and determinants of health. A proportion of days covered (PDC) with AHM < 80%, was considered as non-adherence. We computed the prevalence rate ratio (PRR)—the ratio of the prevalence among BAAs to that among nHWs—as an index of BAA–nHW disparity. Hierarchical linear models (HLM) were used to assess the role of four pre-defined determinants of health domains—health behaviors, clinical care, social and economic and physical environment—as contributors to BAA–nHW disparities in AHM non-adherence. A Bayesian paradigm framework was used to quantify the associations between AHM non-adherence and mortality (heart disease and stroke) and to assess whether the determinants of health factors moderated these associations. Results: Overall, BAAs were significantly more likely to be non-adherent: PRR = 1.37, 95% Confidence Interval (CI):1.36, 1.37. The four county-level constructs of determinants of health accounted for 24% of the BAA-nHW variation in AHM non-adherence. The clinical care (β = −0.21, p < 0.001) and social and economic (β = −0.11, p < 0.01) domains were significantly inversely associated with the observed BAA–nHW disparity. AHM non-adherence was associated with both heart disease and stroke mortality among both BAAs and nHWs. We observed that the determinants of health, specifically clinical care and physical environment domains, moderated the effects of AHM non-adherence on heart disease mortality among BAAs but not among nHWs. For the AHM non-adherence-stroke mortality association, the determinants of health did not moderate this association among BAAs; the social and economic domain did moderate this association among nHWs. Conclusions: The socioeconomic, clinical care and physical environmental attributes of the places that patients live are significant contributors to BAA–nHW disparities in AHM non-adherence and mortality due to heart diseases and stroke.

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Role of TEE in Improving Diagnostic Accuracy of Congenital Heart Disease

Journal of Perioperative Echocardiography ◽

10.5005/jp-journals-10034-1025 ◽

2014 ◽

Vol 2 (2) ◽

pp. 68-70

Author(s):

Sandeep Singh Rana ◽

Balbir Kumar ◽

Sethu Madhavan J

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Diagnostic Accuracy ◽

Multimodal Imaging ◽

Congenital Heart ◽

Heart Diseases ◽

Associated Lesions ◽

Cardiac Lesions ◽

Intraoperative Period

ABSTRACT Complex congenital heart diseases (CHD) often present as multiple cardiac lesions. The presence of one anomaly should stimulate the physician to perform a comprehensive assessment and look for other associated anomalies.1 Multimodal imaging may be necessary to diagnose such associated lesions as single imaging may occasionally miss them. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) are complimentary to each other. Routine use of TEE during intraoperative period may help us to refine diagnosis, detect the missing components and guide effective surgical repair. We present one such case where diagnosis and management were optimized by multimodal imaging. How to cite this article Kumar B, Madhavan JS, Puri GD, Rana SS. Role of TEE in Improving Diagnostic Accuracy of Congenital Heart Disease. J Perioper Echocardiogr 2014;2(2):68-70.

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The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03189-z ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Sonia Voleti ◽

Emmy Okello ◽

Meghna Murali ◽

Rachel Sarnacki ◽

Albert Majwala ◽

...

Keyword(s):

Heart Disease ◽

Social Determinants Of Health ◽

Rheumatic Heart Disease ◽

Social Determinants ◽

Determinants Of Health ◽

World Health ◽

Medical Decision ◽

Rheumatic Heart

Abstract Background Pre-existing maternal cardiac disease is a significant contributor to adverse maternal, fetal, and neonatal outcomes. In 2015–2017, our team conducted the first community-based study of maternal rheumatic heart disease (RHD) in sub-Saharan Africa and identified RHD in 88% of those with pre-existing heart disease. Here we conducted a follow up investigation of women previously identified with RHD, describing clinical and echocardiographic outcomes, identifying barriers to medical adherence and evaluating the personal impact of RHD. Methods A 2 week prospective follow up was completed at sites in Central and Eastern Uganda. Participants underwent a three-step mixed methods study comprising of 1) direct structured interview targeting clinical history and medication adherence, 2) echocardiogram to evaluate left-sided heart valves, and 3) semi-structured guideline interview to elicit personal impacts of RHD. Results The team evaluated 40 (80%) of the original 51 mothers with RHD at a median post-partum time of 2.5 years after delivery (IQR 0.5). Echocardiographic data showed improvement in nine women with the remaining 31 women showing stable echocardiographic findings. Adherence to Benzathine penicillin G (BPG) prophylaxis was poor, with 70% of patients either poorly adherent or non-adherent. Three major themes emerged from interviews: 1) social determinants of health (World Health Organization, Social determinants of health, 2019) negatively affecting healthcare, 2) RHD diagnosis negatively affecting female societal wellbeing, 3) central role of spouse in medical decision making. Conclusions Screening echocardiography can identify women with pre-existing rheumatic heart disease during pregnancy, but long-term follow-up in Uganda reveals adherence to medical care following diagnosis, including BPG, is poor. Additionally, mothers diagnosed with RHD may experience unintended consequences such as social stigmatization. As identification of occult RHD is critical to prevent adverse pregnancy outcomes, further research is needed to determine how to best support women who face a new diagnosis of RHD, and to determine the role of screening echocardiography in high-risk settings.

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A LITERATURE REVIEW ON ANALYSIS OF PALM PATTERNS TO DETECT CONGENITAL HEART DISEASES

Biomedical Engineering Applications Basis and Communications ◽

10.4015/s101623722050012x ◽

2020 ◽

Vol 32 (02) ◽

pp. 2050012

Author(s):

Y. Mahesha ◽

C. Nagaraju

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Heart Diseases ◽

Congenital Heart Diseases ◽

Normal People ◽

Different Types ◽

Left And Right ◽

Paper Method

This paper presents the survey on different techniques which can be used to detect congenital heart disease using palm patterns. The congenital heart disease is one of the heart diseases which starts from birth. Research works are carried out towards detecting congenital heart disease before symptom appears using palm patterns so that it avoids critical health problems in future. Researchers have collected palm prints from normal people who are not suffering from any kind of heart disease and from patients who are suffering from different types of congenital heart diseases. These palm prints are collected from different hospitals. The palm prints are taken using ink and paper method. These palm patterns are analyzed to determine the role of palm pattern while detection of the disease. Few researchers have considered only triradius of palm and most of the researchers have considered palm patterns such as whorl, loop, arch and hypothenar pattern. In case of triradius, researchers have calculated position of axial triradius and it is categorized into three types. In case of whorl, loop and arch, they have considered how often they appear in palm of normal people and patients. Few researchers have analyzed both left and right hands of normal people and patients.

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394 Incidence and prevalence of acute myocarditis and pericarditis prior to and during COVID-19 pandemic

European Heart Journal Supplements ◽

10.1093/eurheartj/suab135.028 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Roberto Licordari ◽

Chrysanthos Grigoratos ◽

Giancarlo Todiere ◽

Andrea Barison ◽

Antonio Micari ◽

...

Keyword(s):

Heart Disease ◽

Heart Diseases ◽

Acute Myocarditis ◽

Cardiac Injury ◽

Annual Incidence ◽

Time Intervals ◽

Inflammatory Heart Disease ◽

Heart Disorders ◽

Areas Of Interest

Abstract Aims Myocarditis and pericarditis have been proposed to account for a proportion of cardiac injury during SARS-CoV-2 infection. During the COVID-19 pandemic, it is reasonable to expect an increasing trend in incidence of this acute inflammatory cardiac diseases. To examine the incidence and prevalence of inflammatory heart disorders prior to and during the COVID-19 pandemic. Methods and results This is a retrospective cohort study examining the incidence and prevalence of acute inflammatory heart diseases (myocarditis, pericarditis) in provinces of Pisa, Lucca and Livorno (total population of 11421285 inhabitants) in two time-intervals: (i) prior to (PRECOVID, from 1 June 2018 to 31 May 2019) and (ii) during the COVID-19 pandemic (COVID, from 1 June 2020 to May 2021). Overall 259 cases of inflammatory heart disease (myocarditis and/or pericarditis) occurred in the areas of interest. The annual incidence was of 11.3 cases per 100 000 inhabitants. Particularly, 138 cases occurred in the PRECOVID, and 121 in the COVID period. The annual incidence of inflammatory heart disease was not significantly different (12.1/100 000 in PRECOVID vs. 10.3/100 000 in COVID; P = 0.22). The annual incidence of acute myocarditis was significantly higher in PRECOVID than in the COVID: respectively, 8.1/100 000/year vs. 5.9/100 000 year (P = 0.047), consisting in a net reduction of 27% of cases. Particularly the incidence of myocarditis was significantly lower in COVID than in PRECOVID in the class of age 18–24 (P = 0.048) (Figure). The annual incidence of pericarditis was not significantly different (4.03/100 000 vs. 4.47/100 000; P = 0.61). Conclusions Despite a possible etiologic role of SARS-CoV-2 and an expectable increased incidence of myocarditis and pericarditis, data suggest a decrease of acute myocarditis and a stable incidence pericarditis and both diseases.

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The growing landscape of succinylation links metabolism and heart disease

Epigenomics ◽

10.2217/epi-2020-0273 ◽

2021 ◽

Cited By ~ 1

Author(s):

Lanting Yang ◽

Shuo Miao ◽

Jing Zhang ◽

Peiyan Wang ◽

Gaoli Liu ◽

...

Keyword(s):

Heart Disease ◽

Heart Diseases ◽

Biochemical Process ◽

Post Translational Modification ◽

Functional Changes ◽

Lysine Succinylation ◽

Great Progress ◽

Metabolic Reactions ◽

Significant Chemical

Post-translational modification of proteins is an important biochemical process that occurs at the protein level. Succinylation is a newly discovered post-translational modification with the hallmark of a significant chemical and structural change. Succinylation has many similarities with other modifications, but succinylation may lead to more functional changes. Although the physiological significance of succinylation has not been well characterized, the lysine succinylation modification shows great potentials during disease processes. The discovery of SIRT5 has made great progress in exploring the role of succinylation in energy metabolism, heart disease and tumorigenesis. In this review, we focus on the discovery of succinylation in organisms and mechanism of succinylation. We are also concerned with the metabolic reactions and heart diseases associated with succinylation.

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The Role of MicroRNA and LncRNA–MicroRNA Interactions in Regulating Ischemic Heart Disease

Journal of Cardiovascular Pharmacology and Therapeutics ◽

10.1177/1074248416667600 ◽

2016 ◽

Vol 22 (2) ◽

pp. 105-111 ◽

Cited By ~ 18

Author(s):

Na Li ◽

Murugavel Ponnusamy ◽

Meng-peng Li ◽

Kun Wang ◽

Pei-Feng Li

Keyword(s):

Heart Disease ◽

Ischemic Heart Disease ◽

Heart Diseases ◽

Noncoding Rnas ◽

Ischemic Heart ◽

Messenger Rnas ◽

Protein Coding ◽

Coding Regions ◽

Pathological Cardiac Hypertrophy

Approximately 2% of the human genome consists of protein-coding regions. Therefore, the majority of transcripts are noncoding RNAs, such as microRNA (miRNA) and long noncoding RNAs (lncRNAs). In ischemic heart disease, the majority of miRNAs are repressors or destabilizers of target messenger RNAs. The lncRNAs are a second class of noncoding RNAs that have recently gained attention for their roles in heart disease and in regulating the functions of miRNA. In this review, we summarize the role of miRNA in pathological cardiac hypertrophy and myocardial infarction. In addition, we discuss the functional interactions of miRNA and lncRNA and its impact on these ischemic heart diseases.

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The Role of Cardiokines in Heart Diseases: Beneficial or Detrimental?

BioMed Research International ◽

10.1155/2018/8207058 ◽

2018 ◽

Vol 2018 ◽

pp. 1-14 ◽

Cited By ~ 7

Author(s):

Ye-Shun Wu ◽

Bin Zhu ◽

Ai-Lin Luo ◽

Ling Yang ◽

Chun Yang

Keyword(s):

Cardiovascular Disease ◽

Heart Disease ◽

Disease Burden ◽

Heart Diseases ◽

Critical Role ◽

Physiological Role ◽

Myocardial Damage ◽

Promising Therapeutic Target ◽

Potential Therapeutics

Cardiovascular disease remains the leading cause of morbidity and mortality, imposing a major disease burden worldwide. Therefore, there is an urgent need to identify new therapeutic targets. Recently, the concept that the heart acts as a secretory organ has attracted increasing attention. Proteins secreted by the heart are called cardiokines, and they play a critical physiological role in maintaining heart homeostasis or responding to myocardial damage and thereby influence the development of heart diseases. Given the critical role of cardiokines in heart disease, they might represent a promising therapeutic target. This review will focus on several cardiokines and discuss their roles in the pathogenesis of heart diseases and as potential therapeutics.

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Number of Social Determinants of Health and Fatal and Nonfatal Incident Coronary Heart Disease in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circulationaha.120.048026 ◽

2020 ◽

Author(s):

Monika M. Safford ◽

Evgeniya Reshetnyak ◽

Madeline R. Sterling ◽

Joshua S. Richman ◽

Paul M. Muntner ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Social Determinants Of Health ◽

Racial Differences ◽

Social Determinants ◽

Clinical Care ◽

Community Dwelling ◽

Determinants Of Health ◽

Incident Coronary Heart Disease ◽

Prospective Longitudinal

Background: Social determinants of health (SDH) are individually associated with incident coronary heart disease (CHD) events. Indices reflecting social deprivation have been developed for population management, but are difficult to operationalize during clinical care. We examined whether a simple count of SDH is associated with fatal incident CHD and nonfatal myocardial infarction (MI). Methods: We used data from the prospective longitudinal REasons for Geographic And Racial Differences in Stroke cohort study, a national population-based sample of community-dwelling Black and white adults age ≥45 years recruited from 2003-7. Seven SDH from the five Healthy People 2020 domains included social context (Black race, social isolation); education (educational attainment); economic stability (annual household income); neighborhood (living in a zip code with high poverty); and healthcare (lacking health insurance, living in one of the 9 US states with the least public health infrastructure). Outcomes were expert adjudicated fatal incident CHD and nonfatal MI. Results: Of 22,152 participants free of CHD at baseline, 58.8% were women, 42.0% were Blacks, 20.6% had no SDH, 30.6% had 1, 23.0% had 2, and 25.8% had ≥3. There were 463 fatal incident CHD events and 932 nonfatal MIs over median 10.7 years [IQR 6.6-12.7]. Fewer SDH were associated with nonfatal MI than with fatal incident CHD. The age-adjusted incidence per 1000 person-years increased with the number of SDH for both fatal incident CHD (0 SDH 1.30, 1 SDH 1.44, 2 SDH 2.05, ≥3 SDH 2.86) and nonfatal MI (0 SDH 3.91, 1 SDH 4.33, ≥2 SDH 5.44). Compared to those without SDH, crude and fully adjusted hazard ratios (HR) for fatal incident CHD among those with ≥3 SDH were 3.00 (95% CI 2.17, 4.15) and 1.67 (95% CI 1.18, 2.37), respectively; and that for nonfatal MI among those with ≥2 SDH were 1.57 (95% CI 1.30, 1.90) and 1.14 (0.93, 1.41), respectively. Conclusions: A greater burden of SDH was associated with a graded increase in risk of incident CHD, with greater magnitude and independent associations for fatal incident CHD. Counting the number of SDH may be a promising approach that could be incorporated into clinical care to identify individuals at high risk of CHD.

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Role of obesity and hypertension in the incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes

Cardiovascular Diabetology ◽

10.1186/s12933-021-01331-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Lucia La Sala ◽

Antonio E. Pontiroli

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Primary Care ◽

Body Mass Index ◽

Heart Disease ◽

Ischaemic Heart Disease ◽

Heart Diseases ◽

Treatment Of Hypertension ◽

Patients With Diabetes

AbstractIn a cohort study performed using primary care databases in a General Practitioners Network, Groenewegen et al. report a clear association between diabetes and incidence of the major chronic progressive heart diseases, notably heart failure (Groenewegen et al. in Cardiovasc Diabetol 20:123, 2021). However, no mention is made of body mass index and hypertension in the methods or in the results. Obesity is linked to hypertension and hypertension is a major risk factor for all cardiovascular diseases, and prospective studies have shown that obesity and hypertension contribute significantly to atrial fibrillation in persons with diabetes. The data would be improved by assessing the role of obesity and of hypertension in the incidence of heart diseases in these patients. This would also lead to a better and personalized treatment of patients with diabetes, for instance through weight loss and intensification of treatment of hypertension, to modify the incidence of atrial fibrillation, ischaemic heart disease and heart failure.

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Seasonal Variations of Heart Failure and Acute Coronary Syndrome in a Referral Center of Heart Diseases in Ahvaz, Southwest of Iran

Jundishapur Journal of Chronic Disease Care ◽

10.5812/jjcdc.111160 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Farzaneh Ahmadi ◽

Parisa Pourkhosravi

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Coronary Syndrome ◽

Heart Disease ◽

Seasonal Variations ◽

Heart Diseases ◽

Cold Season ◽

Coronary Syndrome ◽

Number Of Patients

Background: Despite the role of hot weather and activity at high temperatures in physical and environmental stress influencing the occurrence or recurrence of heart disease, the role of seasonal variations in temperature in this disease has not been well studied. Objectives: This study aimed to investigate the relation of seasonal variations in temperature to the number of patients with ischemic heart disease and heart failure (HF). Methods: We extracted data, including file number, diagnosis, age, gender, hospitalization date, and discharge date, from the medical files of patients admitted to a referral center of heart diseases in a tropical region from 2013 to 2015. Results: Diagnosed and studied patients (n = 4,041) were as follows: 625 (patients with HF), 2410 (patients with unstable angina), and 1006 (patients with myocardial infarction). A total of 57% of patients were male, and 43% were female. The average number of patients per day (P/d) in the cold season was higher than in other seasons (5.89 versus 5.53 in the moderate season and 5.18 during the warm season). The mean length of hospitalization for patients with myocardial infarction (MI) and HF in the cold season was longer than in other seasons, and this difference was statistically significant (P = 0.035 and 0.021, respectively). Conclusions: All hospitalizations occurring with these diagnoses in cold seasons are longer, increasing the burden on the health care system. There are considerable seasonal variations in HF hospitalization and mortality. Immunization against pneumococcus and influenza and also more care are recommended in HF patients. There is a need for a season-based approach for better handling of acute coronary syndrome (ACS).

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