Screening echocardiograms in a senior focused value based primary care improves systolic heart failure detection and clinical management

Ghany, Reyan; Tamariz, Leonardo; Chen, Gordon; Ghany, Alina; Forbes, Emancia; Tajiri, Thiago; Palacio, Ana

doi:10.21037/cdt.2017.03.09

Cited by 7 publications

(10 citation statements)

References 23 publications

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“…We have previously found that screening echocardiograms identify stage B heart failure and when this information was shared with the physician there were medication changes and improved outcomes and costs. 18 , 19 …”

Section: Discussionmentioning

confidence: 99%

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Prior cardiovascular risk and screening echocardiograms predict hospitalization and severity of coronavirus infection among elderly medicare patients

Ghany

Palacio

Chen

et al. 2020

American Journal of Preventive Cardiology

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Background The COVID-19 pandemic has disproportionally impacted the elderly. In the United States and Europe the mortality rate of elderly patients with COVID-19 is greater than 30%. Our aim is to determine predictors of COVID-19 related hospitalization and severity of disease among elderly Medicare patients in the United States. Methods We conducted a retrospective cohort study including elderly Medicare COVID-19 patients across eight states. We collected data from the inpatient and outpatient electronic health record, demographic, clinical and echocardiographic predictors. Our primary outcomes were hospitalization and adult respiratory distress syndrome (ARDS). Our secondary outcome was mortality. Results We identified 400 COVID-19 positive patients (incidence 5.2; (95% CI 4.7-5.7) per 1000 patients). The mean age of our patients was 72+/-8, 60% were female, 82% were minorities and had a mean Charlson score of 2.9+/-1.4. Two-hundred and forty-four patients were hospitalized due to COVID-19 (63%) and the mortality rate was 18%; 95% CI 14-22 with 1 patient still in the hospital. Age, socioeconomic status, Charlson score, systolic blood pressure, body mass index, grade 2 or 3 diastolic dysfunction, moderate or severe left ventricular hypertrophy were significant predictors of hospitalization and ARDS (p<0.05). Conclusions Our study reports a lower incidence on a COVID-19 cohort than previously reported. Predictors of poor outcomes included socio-economic, cardiovascular risk and echocardiographic measures. High touch care with early cardiovascular risk factor modification could explain the low risk of events in our population.

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Section: Discussionmentioning

confidence: 99%

“…High-touch care with frequent preventative visits with primary care provider and specialists has been shown to result in higher use of cardiovascular medications, fewer hospitalizations and lower healthcare costs. 8 , 18 , 19 …”

Section: Discussionmentioning

confidence: 99%

Prior cardiovascular risk and screening echocardiograms predict hospitalization and severity of coronavirus infection among elderly medicare patients

Ghany

Palacio

Chen

et al. 2020

American Journal of Preventive Cardiology

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“…However, neither the American College of Cardiology nor the American Heart Association recommend screening echocardiograms for asymptomatic at-risk patients. We have previously shown that screening echocardiograms identify patients with previously unknown asymptomatic heart failure 6 and patients with unknown diastolic heart failure. 5 We also showed that identifying patients at higher risk leads to better cardiovascular risk factor control and better outcomes.…”

Section: Sudden Death Risk Score Prediction and Addition Of Echocarmentioning

confidence: 99%

“…The American College of Cardiology and the American Heart Association do not recommend screening echocardiograms in patients without heart disease unless there is a genetic predisposition to cardiomyopathy . However, echocardiograms in asymptomatic consecutive primary care patients have been able to identify new cases of heart failure (HF) and grade 3 diastolic dysfunction leading to changes in management . Therefore, the aim of our study is to evaluate if echocardiographic parameters in primary care patients can improve the ability of the SCD risk score to identify patients at risk of death.…”

Section: Introductionmentioning

confidence: 99%

“…4 However, echocardiograms in asymptomatic consecutive primary care patients have been able to identify new cases of heart failure (HF) and grade 3 diastolic dysfunction leading to changes in management. 5,6 Therefore, the aim of our study is to evaluate if echocardiographic parameters in primary care patients can improve the ability of the SCD risk score to identify patients at risk of death.…”

Section: Introductionmentioning

confidence: 99%

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The additive role of echocardiography in the screening for sudden death

et al. 2019

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Background A clinically based sudden cardiac death (SCD) risk score has predictive value. Echocardiographic parameters predict SCD. Our aim was to evaluate the effect of adding echocardiographic parameters to the clinical SCD risk score for the prediction of all‐cause mortality. Methods We conducted a retrospective cohort of screening echocardiograms performed on primary care patients. We calculated the SCD risk score and added the left ventricular (LV) mass index, LV hypertrophy, diastolic dysfunction, and LV ejection fraction (EF). We calculated the c‐statistic, net reclassification index (NRI), and Hosmer‐Lemeshow chi‐square for the SCD score alone or combined with each echocardiographic parameter in predicting all‐cause mortality. Results We included 6447 primary care patients who underwent a screening echocardiogram and had a SCD score. The c‐statistic of the SCD score for mortality was 0.61; 95% CI 0.58–0.62 and the c‐statistic for the score combined with LV mass index increased to 0.64; 95% CI 0.63–0.65 and for the score combined with LVEF, the c‐statistic was 0.64;95% CI 0.63–0.67. When diastolic dysfunction and LV hypertrophy were added to the SCD score, the c‐statistic did not significantly change (P > 0.05). The NRI for the addition of LV mass index and LVEF was 0.52 ± 0.02, and the Hosmer‐Lemeshow statistic was nonsignificant (P > 0.05). Conclusions Adding LV mass index or LVEF to the SCD risk score improves the ability to predict mortality, but in the primary care setting, the improvement is small and underscores the challenge of SCD prediction and prevention in the community.

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Access to Health Care Improves COVID-19 Vaccination and Mitigates Health Disparities Among Medicare Beneficiaries

Lane

Palacio

Chen

et al. 2022

J. Racial and Ethnic Health Disparities

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Background COVID-19 disproportionately impacts the elderly, particularly racial/ethnic minorities and those with low socioeconomic status (SES). These latter groups may also have higher vaccine hesitancy. We aim to evaluate if access to care improves COVID-19 vaccination rates and improves health disparities. Methods We conducted a retrospective cohort study of Medicare patients receiving care in a high-touch capitated network across ten states. We collected type and date of COVID-19 vaccine and demographic and clinical data from the inpatient and outpatient electronic health records and socioeconomic status from the US census. Our primary outcome was completing vaccination using logistic regression. Results Our cohort included 93,224 patients enrolled in the network during the study period. Sixty nine percent of all enrolled patients completed full vaccination. Those who completed vaccination did it with Pfizer (46%), Moderna (49%), and Jannsen (4.6%) vaccines. In adjusted models, we found that the following characteristics increased the odds of being vaccinated: being male, increasing age, BMI, and comorbidities, being Black or Hispanic, having had the flu vaccine in 2020, and increasing number of office primary care visits. Living in a neighborhood with higher social deprivation and having dual Medicaid/Medicare enrollment decreased the odds of completing full vaccination. Conclusions Increasing office visit in a high-touch primary care model is associated with higher vaccination rates among elderly populations who belong to racial/ethnic minorities or have low socioeconomic status. However, lower SES and Medicaid populations continue to have difficulty in completing vaccination. Key points • High COVID-19 vaccination rates of minorities enrolled in Medicare can be achieved. • Lower socioeconomic status is associated with completing vaccination. • Increasing office visits can lead to higher vaccination rates. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-022-01343-1.

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Screening echocardiograms in a senior focused value based primary care improves systolic heart failure detection and clinical management

Cited by 7 publications

References 23 publications

Prior cardiovascular risk and screening echocardiograms predict hospitalization and severity of coronavirus infection among elderly medicare patients

Prior cardiovascular risk and screening echocardiograms predict hospitalization and severity of coronavirus infection among elderly medicare patients

The additive role of echocardiography in the screening for sudden death

Access to Health Care Improves COVID-19 Vaccination and Mitigates Health Disparities Among Medicare Beneficiaries

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