11210 research outputs found
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Navigating the Aftermath: Evaluating the Impact of COVID-19 on Nurse Well-Being Resource Use
No full textLearning Curves in Pulsed Field Ablation: Implementation in Academic and Non-Academic Centers
No full textMedications for Gastroparesis and the Development of Tardive Dyskinesia: A Review of the FDA Adverse Event Reporting System (FAERS)
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Community intervention to reduce cardiovascular disease in Chicago (CIRCL-Chicago): protocol for a type 3 hybrid effectiveness-implementation study using a parallel cluster-randomized trial design
No full textBackground:Hypertension affects nearly half of adults in the U.S., with African American and Black (AA/B) adults experiencing some of the highest rates domestically and globally. Despite improvements in blood pressure control in the general population, rates of control among AA/B adults have stagnated, contributing to significant health disparities in the prevalence of hypertension and its long-term health impacts. Systemic barriers, including poverty and historically earned distrust in healthcare, hinder patient and clinician adherence to best practices for hypertension management. Community-based interventions, particularly those involving faith-based organizations, show promise in improving blood pressure control among AA/B adults.
Methods:The CIRCL-Chicago Implementation Research Center will test the effectiveness of a community-adapted hypertension control program, a bundled intervention developed by and tested in the Kaiser Permanente system, in South Side Chicago community health centers. A key partner for this trial, the Total Resource Community Development Organization, isa faith-based community outreach hub networked with faith-based organizations throughout Chicago\u27s South Side community. The study employs a type 3 hybrid effectiveness-implementation approach with a parallel cluster-randomized trial. Sixteen clinics will be randomized to implement a community-adapted Kaiser bundle with or without practice facilitation. We will recruit adults who live, work, or practice their faith in Chicago\u27s South Side community to populate a community-based hypertension registry (target n = 5,760 participants). The primary implementation outcome is the reach of the intervention, measured by the proportion of eligible patients in the registry who receive the adapted Kaiser bundle. Secondary outcomes include blood pressure control rates, assessed at 12 months post-enrollment. The study will use community-engaged adaptation, practice facilitation, and education and training strategies to support implementation.
Discussion:The CIRCL-Chicago study aims to address cardiovascular health disparities by integrating clinical and community-based approaches to hypertension management. By leveraging trusted community settings and engaging local partners, the study seeks to enhance the reach and effectiveness of evidence-based hypertension interventions. The findings could inform scalable models for hypertension control in diverse urban communities, potentially reducing health disparities for AA/B adults.
Trial registration:Clinicaltrials.gov NCT04755153 on 24 August 2023, https://www.centerwatch.com/clinical-trials/listings/NCT04755153/community-intervention-to-reduce-cardiovascular-disease-in-chicago
Impact of statin therapy on mortality and rehospitalization in acute heart failure patients stratified by ejection fraction: Insights from the Gulf CARE Registry
No full textBackground:The prevalence and clinical outcomes of statin therapy in patients with acute heart failure [AHF] stratified by left ventricular ejection fraction [EF] in the Middle East are unknown.
Methods:We analysed 5005 patients admitted to 47 hospitals in seven Middle Eastern countries [Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain] with AHF from February to November 2012 with AHF who were enrolled in Gulf CARE, a multinational registry of patients with heart failure [HF]. AHF patients were stratified into three groups: HF patients with reduced [EF] [HFrEF] [\u3c40%], HF with mildly reduced EF [HFmrEF] [40-49%], and HF patients with preserved EF [HFpEF] [≥50%].
Results:The mean age of the cohort was 59.3±14.9 years, 62.6% [n=3131.0] of the patients were males. A total of 2555 [51%] AHF patients had used statins prior to hospital admission. The mean EF was 36.9±14%. HFrEF was observed in 2683 patients [53%], whereas 961 patients [19.2%] had HFmrEF, and 932 patients [18.6%] had HFpEF. Multivariate logistic regression analysis revealed that prior statin use was significantly associated with reduced in-hospital mortality risk [OR=1.43, 95% CI: 1.10-1.86, p=0.007] and hospitalization rates for heart failure [OR=0.71, 95% CI: 0.60-0.83, p\u3c0.001]. However, when examining rates of survival, there were no significant disparities between the two groups; at 3 months follow-up: aOR, 1.22; 95% Cl: 0.95-1.57; P=0.111; and 12-months follow-up: aOR, 1.07; 95% Cl: 1.07 0.87-1.31; P=0.553. Regarding rehospitalization rates, no significant difference was observed at a 3- month follow-up: aOR, 1.22; 95% Cl: 1.03-1.42; P=0.015. Interestingly, patients admitted with statin therapy were significantly associated with higher odds of hospitalization during the 12-month follow-up period: aOR, 1.42; 95% Cl: 1.21-1.66; P\u3c0.001.
Conclusion:Prior statin use was associated with a lower risk of in-hospital mortality and rehospitalization. However, there were no significant differences in all-cause mortality between the two groups at both 3- and 12-month follow-ups. While rehospitalization rates at the 3-month follow-up showed higher odds of rehospitalization at the 12-month follow-up. Prior statin therapy appears to influence both in-hospital mortality and long-term rehospitalization outcomes in a Middle Eastern patient population
