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National Trends in Pedal Bypass Surgery: Are We Offering Every Chance to Patients with Critical Limb Ischemia? (CR_118)
No full textSession 1: Juried Abstracts for Oral Presentations; Moderated by Mariela Mendez and Moses Kamit
Lunch and Poster Viewing - Poster Session 1
No full textPoster Session 1: Cell and Molecular Biology & Signaling; Immunology; Experimental Models of Disease; and Experimental Therapeutic
Henry Ford Medical Group Outstanding Publication of the Year – Basic Research: Tumor Sequencing of African Ancestry Reveals Differences in Clinically Relevant Alterations Across Common Cancers
No full textSession 2: Juried Abstracts for Oral Presentations; Moderated by Jessica Bensenhaver and Sushmitha Sriramulu; Henry Ford Medical Group Outstanding Publication of the Year - Basic Researc
From Insight to Impact: CNS Consults in the CVICU
Get PDFhttps://scholarlycommons.henryford.com/nursresconf2024/1002/thumbnail.jp
Chronic Total Occlusion Percutaneous Coronary Intervention of Anomalous Coronary Arteries: Insights from the PROGRESS CTO Registry
No full textBACKGROUND: There is limited information about the frequency and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in anomalous coronary arteries (ACA).
METHODS: We examined the clinical and angiographic characteristics and procedural outcomes of CTO PCI in ACA among 14,173 patients who underwent 14,470 CTO PCIs at 46 US and non-US centers between 2012 and 2023.
RESULTS: Of 14,470 CTO PCIs, 36 (0.24%) were CTO PCIs in an ACA. ACA patients had similar baseline characteristics as those without an ACA. The type of ACA in which the CTO lesion was found were as follows: anomalous origin of the right coronary artery (ARCA) (17, 48.5%), anomalous origin of left circumflex coronary artery (9, 25.7%), left anterior descending artery and left circumflex artery with separate origins (4, 11.4%), anomalous origin of the left anterior descending artery (2, 5.7%), dual left anterior descending artery (2, 5.7%) and woven coronary artery 1 (2.8%). The Japan CTO score was similar between both groups (2.17 ± 1.32 vs 2.38 ± 1.26, p = 0.30). The target CTO in ACA patients was more likely to have moderate/severe tortuosity (44% vs 28%, p = 0.035), required more often use of retrograde approach (27% vs 12%, p = 0.028), and was associated with longer procedure (142.5 min vs 112.00 min [74.0, 164.0], p = 0.028) and fluoroscopy (56 min [40, 79 ml] vs 42 min [25, 67], p = 0.014) time and higher contrast volume (260 ml [190, 450] vs 200 ml [150, 300], p = 0.004) but had similar procedural (91.4% vs 85.6%, p = 0.46) and technical (91.4% vs 87.0%, p = 0.59) success. No major adverse cardiac events (MACE) were seen in ACA patients (0% [0] vs 1.9% [281] in non-ACA patients, p = 1.00). Two coronary perforations were reported in ACA CTO PCI (p = 0.7 vs. non-ACA CTO PCI).
CONCLUSIONS: CTO PCI of ACA comprise 0.24% of all CTO PCIs performed in the PROGRESS CTO registry and was associated with higher procedural complexity but similar technical and procedural success rates and similar MACE compared with non-ACA CTO PCI
Utilizing Primary Care to Engage Underserved Patients in a Psychological Intervention for Chronic Pain
No full textBACKGROUND: Although psychological interventions can be used to improve chronic pain management, underserved individuals (i.e., racially minoritized and socioeconomically disadvantaged) may be less likely to engage in such services. The purpose of this study was to examine whether offering a psychological intervention for chronic pain in a primary care clinic could be a method in which to successfully engage underserved patients.
METHODS: There were 220 patients with chronic pain in a primary care clinic located in a socioeconomically and racially diverse city who were approached to discuss enrolment in a pilot randomized controlled trial of a five-session psychological intervention for chronic pain. Patients were introduced to the study by their primary care provider using the warm handoff model. We compared whether there were sociodemographic differences between those who enrolled in the study and those who declined to enrol.
RESULTS: There were no differences between those who enrolled and those who declined enrolment with regard to race, age, insurance type, and household income. However, females were more likely to enrol in the study compared to males.
CONCLUSIONS: Recruiting patients to participate in a trial of a psychological intervention for chronic pain in a primary care clinic appeared to be effective for engaging Black patients, patients with lower income, and those with government insurance. Thus, offering a psychological intervention for chronic pain in a primary care clinic may encourage engagement among racially minoritized individuals and those with lower socioeconomic status
Equal Treatment, Unequal Outcomes? Debunking the Racial Disparity in Renin Angiotensin Aldosterone System Inhibitor Associated Reduction in Heart Failure Hospitalizations
No full textBACKGROUND: Renin angiotensin aldosterone system inhibitors (RAASi) are a mainstay treatment in patients with heart failure with reduced ejection fraction (HFrEF) in part to prevent hospitalizations. However, whether RAAS inhibitors reduce the risk of hospitalization in Black patients is not entirely clear because enrollment of Black patients in previous clinical trials was low, and a previous meta-analysis showed a significant racial disparity: reduction in hospitalizations with an RAAS inhibitor in White patients but not Black patients. Previous studies relied on the use of self-identified race instead of genomic ancestry. Therefore, this study aimed to investigate the role of self-identified race and genomic ancestry in the racial disparity in RAAS inhibitor associated reductions in HFrEF hospitalizations.
METHODS: The primary outcome was time to first heart failure hospitalization. A (de-identified) heart failure patient registry and data from the GUIDE-IT multi-center randomized control trial were analyzed with Cox proportional hazards models un/adjusted for clinical risk factors, death as a competing risk, and time-varying RAAS inhibitor exposure. The proportion of Yoruba African ancestry was quantified.. Analysis of self - identified race were performed in both the registry and GUIDE-IT. Analysis of genomic ancestry was only performed in the registry since this information was not available in GUIDE-IT. A fixed effect meta-analysis combined results of both the registry and GUIDE-IT for race.
RESULTS: The registry had 1010 total HFrEF patients (Black = 509 and White = 501) with 852 having ancestry quantification (\u3e80% Yoruba African Ancestry = 381 and \u3c5% Yoruba African Ancestry = 471). GUIDE-IT had 810 HFrEF patients (Black = 322 and White = 488). There was no significant difference in the association of RAAS inhibitor exposure with heart failure hospitalization by race (meta-analysis p-value for race*RAAS inhibitor exposure interaction = 0.49; Black patients HR [95% CI] for RAAS inhibitor exposure = 0.89 [0.64-1.23)] P = 0.47; White patients = 1.20 (0.83-1.75) P = 0.34). Results were similar when analyzed by ancestry (p-value for ancestry*RAAS inhibitor exposure interaction = 0.57; \u3e80% Yoruba African Ancestry = 0.93 [0.51-1.69] P = 0.80; \u3c5% Yoruba African Ancestry = 1.29 [0.57-2.92] P = 0.54).
CONCLUSIONS: In contrast to a previous meta-analysis, this more contemporary analysis of 2 HFrEF patient datasets demonstrates the absence of a racial disparity in RAAS inhibitor associated reductions in heart failure hospitalizations. The difference in this racial disparity over time may be due to improvements in background heart failure therapies, racial differences in healthcare usage, and the use of more advanced statistical approaches
Rethinking Shared Decision-Making: Delivery of Care Options in a Telehealth World
No full textTelehealth modalities have given patients options for delivery of care, and in some cases increased access to care. However, great effort needs to be made by providers and clinic staff to ensure patients are given choice in their delivery of care methods and technological support to work toward equity in care. We propose applying the BEACH model for shared decision-making to help providers support patients in choosing the best care delivery method, while also encouraging providers to seek further education on telehealth competencies. Lastly, we stress the importance of the clinical staff in ensuring patient autonomy, education, and support when choosing telehealth modalities of care
Benign Metastasizing Leiomyoma in a Patient With No Known History of Uterine Leiomyomas
No full textBenign metastasizing leiomyoma (BML) is a rare medical condition characterized by metastasis of fibroid tissue from uterine leiomyomas to other areas of the body, most commonly the lungs. While BML is mostly prevalent in women with a prior history of uterine leiomyomas who underwent surgical intervention, this case report explores the case of a 50-year-old female who was diagnosed with pulmonary benign metastasizing leiomyoma (PBML) with no prior history of confirmed leiomyomas. After initially presenting with worsening cough and congestion, chest radiograph and computed tomography revealed multiple bilateral pulmonary nodules, initially raising concerns for malignancy. Further, a workup with bronchoscopy with fine needle aspiration and pulmonary lesion biopsy revealed the presence of smooth muscle tissue suggestive of PBML. Subsequent uterine ultrasonography revealed a 3-cm intramural uterine fibroid, supporting the diagnosis. This case highlights the diagnostic challenge posed by PBML due to its asymptomatic manifestation and radiological similarity with other serious conditions such as malignancy and sarcoidosis. The case further highlights the importance of recognizing typical radiological features of PBML and the necessity of histological examination for accurate diagnosis. Finally, the critical role of a multidisciplinary approach in managing such rare conditions and the need for individualized treatment are also explored