Lee M. Arcement

Epidemiology and survival of the five stages of chronic kidney disease in a systolic heart failure population

The epidemiology of the five stages of chronic kidney disease (CKD) in systolic heart failure (HF) patients has predominantly been described in hospitalized White patients, with little known about the prevalence in outpatient Blacks and Hispanics. The purpose of this study was to compare the prevalence of the five stages of CKD by race, ethnicity (Whites, Blacks, and Hispanics), and gender in an outpatient systolic HF population and also to evaluate the impact of CKD on mortality.

The prevalence of erectile dysfunction in heart failure patients by race and ethnicity

Erectile dysfunction (ED) is a common problem in male patients with heart failure (HF). However, no study was found that estimates the prevalence of ED by US ethnic groups with HF. We conducted an observational, cross-sectional study of patients enrolled in a HF disease management program in two sites Louisiana (N=329; 178 white, 99 black) and Florida (N=52; Hispanic). All male patients with an ejection fraction ⩽40% were included. The Sexual Health Inventory for Men was used to estimate the prevalence of ED. Overall prevalence of ED was 89% and ED severity did not vary by race/ethnic group. Race/ethnic group differences were found for age, New York Heart Association functional classification, and blood pressure. Hispanic patients had the lowest unadjusted and adjusted prevalence rate of ED (81, 85%) compared to Black (90, 95%) and White (91, 92%) patients. There is a high prevalence of ED in Hispanic, Black and White ethnic groups with HF.

Open Access to an Outpatient Intravenous Diuresis Program in a Systolic Heart Failure Disease Management Program

In order to provide efficient utilization of resources in an outpatient setting for acute exacerbation of heart failure (HF), the authors piloted an open-access outpatient intravenous (IV) diuretic program (IVDP) to evaluate utilization in an HF disease management program (HFDMP), patient characteristics for users of the program, and safety. An outpatient HFDMP at Jackson Memorial Hospital in Miami, Florida, enrolling 577 patients 18 years and older with an ejection fraction ≤40% was implemented. For symptoms or weight gain ≥5 pounds, patients were eligible to use an open-access IVDP during clinic hours. A total of 130 HFDM patients (22.5%) used the IVDP. IVDP users were more likely to be diabetic, with lower body mass indices than non-IVDP users. New York Heart Association class IV patients and previously hospitalized patients were more likely to use the IVDP. There were no documented adverse reactions for patients receiving treatment and no difference in mortality between groups. This open-access outpatient IVDP model for patients with HF was readily utilized by the HFDMP participants and appears safe for use in this population. This unique model may provide alternative access for acute HF treatment. Congest Heart Fail.

The Prevalence of Peripheral Arterial Disease in Patients With Heart Failure by Race and Ethnicity

More than 5 million people live with heart failure (HF) in the United States, and this number is expected to rise due to several factors including increased life expectancy brought about by medical therapy and the aging of the population. HF and peripheral arterial disease (PAD) share many risk factors. A review of the literature reveals several studies supporting a higher prevalence of HF in patients with PAD than in those without PAD. However, no study was found that estimates the prevalence of PAD in patients with HF. Moreover, the prevalence of PAD by US race/ethnic groups with HF has not been studied. The authors conducted a cross-sectional multicenter study of patients enrolled in an HF disease management program in Louisiana (n=330) and Florida (n=464). All patients with an ejection fraction <or=40% and a measured ankle-brachial index (ABI) were included in the study. PAD was defined as an ABI <0.9. The overall prevalence of PAD was 17.1%. The prevalence of PAD was 25.9% for white, 13.4% for Hispanic, and 13.7% for black patients. White patients had a higher prevalence of PAD than black or Hispanic patients (P<.001). Routine ABI measurements in these groups would enhance efforts to detect subclinical PAD.

Metabolic Syndrome Increases Mortality in Heart Failure

Metabolic syndrome (MetS) is a risk factor for diabetes, cardiovascular disease, and heart failure, but little is known about the impact of MetS in patients who already have heart failure (HF).

Prevalence of conduction abnormalities in a systolic heart failure population by race, ethnicity, and gender.

Background: There is paucity of data regarding conduction abnormalities in the Hispanic population with systolic heart failure (HF). We aimed to evaluate the prevalence of electrocardiogram (ECG) abnormalities in a systolic HF population, with attention to the Hispanic population.

Evidence‐Based Medication Adherence in Hispanic Patients With Systolic Heart Failure in a Disease Management Program

The Hispanic population is the fastest growing minority in the United States, yet there is a paucity of data regarding patient follow-up in heart failure disease management programs (HFDMPs) and evidence-based medication adherence. The purpose of this study is to measure the compliance of evidence-based medication use, specifically measuring angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and beta-blockers (BBs) in the Hispanic population, and compare these data to the white and black population. The authors conducted a cross-sectional study of 561 patients enrolled in an HFDMP at Jackson Medical Hospital in Miami, Florida. At the first visit, 82% of Hispanic, 75% of white, and 79% of black patients were taking ACEIs/ARBs, but only 21% of Hispanic, 35% of white, and 32% of black patients were taking target doses. Hispanic patients are as compliant with ACEI/ARB and BB regimens as are the white and black populations in HFDMPs in a setting of similar socioeconomic features.

Peripheral Vascular Disease and Erectile Dysfunction as Predictors of Mortality in Heart Failure Patients

INTRODUCTION Seventy percent to 90% of patients with heart failure (HF) report erectile problems. There are no published data on whether erectile dysfunction (ED) and peripheral vascular disease (PVD) correlate with mortality in HF patients. Also, little is known regarding the impact of HF etiology on mortality in patients with ED. AIMS Our aim was to investigate the relationship between ED and mortality in HF patients, to evaluate whether the etiology of HF carries a prognostic measure in patients with ED, and to assess the impact of PVD on mortality in optimally treated HF patients with ED. MAIN OUTCOME MEASURES The measures are: (i) mortality by presence or absence of ED; (ii) mortality by HF etiology and presence or absence of ED; and (iii) PVD and mortality in HF patients on optimal medical therapy with ED. METHODS This is a single-center, prospective cohort study of 328 male HF patients (ejection fraction < or = 40%) followed while being treated with optimal doses of beta blockers and angiotensin-converting enzyme inhibitors. The Sexual Health Inventory for Men survey was used to assess ED (no ED > or = 22 and ED < or = 21). Ankle brachial index (ABI) was used to assess PVD (normal ABI > or = 0.9 and abnormal ABI < 0.9). RESULTS Kaplan-Meier curves were constructed to examine the relationship between the presence or absence of ED and PVD, and mortality in a HF population. Although not statistically significant, a trend for increased risk of death was demonstrated in the ischemic cardiomyopathy cohort with ED. CONCLUSIONS ED, highly prevalent in this cohort, did not identify HF patients on optimal medical therapy at increased risk for mortality. Among the HF patients with ED, HF type was not associated with increased risk for mortality whereas PVD was independently associated with a statistically significant increase in mortality.

Prevalence of Vaccination Rates in Systolic Heart Failure: A Prospective Study of 549 Patients by Age, Race, Ethnicity, and Sex in a Heart Failure Disease Management Program

Healthy People 2010 aims at immunizing 60% of high-risk adults annually against influenza and once against pneumococcal disease. The aim of this study was to evaluate the use of a standardized approach to improve vaccination rates in patients with heart failure (HF); to determine whether disparities exist based on age, race, ethnicity, or sex at baseline and follow-up; and to evaluate the impact of clinical variables on the odds of being vaccinated. A prospective study of 549 indigent patients enrolled in a systolic HF disease management program (HFDMP) began enrollment from August 2007 to January 2009 at Jackson Memorial Hospital. Patients were interviewed at their initial visit for immunization status; those without vaccinations were offered the vaccines. Prevalence of vaccination (POV) for influenza and pneumococcal disease was obtained at baseline and at follow-up. The odds ratio for being vaccinated was calculated using logistic regression. The study population comprised mostly Hispanic (56%), black (37%), and male (70%) patients, with a mean age of 56 ± 12 years and a mean ejection fraction of 25% ± 10%. The initial POV for both was 22% at baseline. At follow-up, POV improved to 60.5%. Of those not vaccinated at baseline, 17.5% refused vaccination. Odds ratios at baseline for age, race/ethnicity, and sex were 0.99 (P=.99), 0.63 (P=.08), and 0.62 (P=.14), respectively. These did not change significantly at follow-up. Prevalence of vaccination in our cohort was low. Enrollment into the HFDMP improved immunization prevalence without creating age, race, ethnicity, or sex disparities.

Feasibility of a Heart Failure Disease Management Program in Eastern Europe: Tbilisi, Georgia

Background— Little is known about the importation of a heart failure disease management program (HFDMP) into low- and middle-income countries. We examined the feasibility of importing a HFDMP into the country of Georgia, located in the Caucuses. Methods and Results— Patients with ejection fraction ⩽40% were enrolled into a prospective, observational study consisting of a new HFDMP staffed by local cardiologists. Medications, emergency department use, hospital admissions, and mortality were assessed by interviews with patients or their families. Screening resulted in 400 patients who were followed for 10.2±3.5 months. &bgr;-Blocker prescriptions increased from 7.4–80.7% (P<0.001), angiotensin-converting enzyme inhibitor prescriptions increased from 18.4–92.6% (P<0.001), and mean systolic blood pressure declined from 145 to 114 mm Hg (P<0.001). Patients visiting the emergency department and hospitalizations were lowered by 40.7% and 52.5%, respectively, but were also influenced by the outbreak of war, during which 17.5% (n=70) of patients received follow-up in refugee tents. All-cause mortality extended to 7% of patients, with 12 of 28 deaths caused by war-related events. Conclusions— Importation of a Western HFDMP was demonstrated to be feasible, with a 5-fold increase in the use of recommended therapies, reduction of blood pressure, decrease of emergency department visits, and hospitalizations for heart failure. These measures could result in substantial cost savings in resource-limited settings, but assessment is complicated in unstable areas. Translating effective interventions to low- and middle-income countries requires sensitivity to regional cultures and flexibility to adapt both clinical goals and strategies to unexpected conditions.