Using The Guide-It Randomized Control Trial For Post-Hoc Analysis Of Predictors Of Adverse Outcomes In Patients With Hfref

Abstract BackgroundWith the recent data sharing of the Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure (GUIDE-IT) randomized control trial (RCT) through the Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC), the opportunity has risen to investigate various risk factors for adverse events in patients with heart failure (HF), specifically heart failure with reduced ejection fraction (HFrEF). In this thesis we investigate the following: (1) the impact of depression on GDMT and outcomes in patients with HFrEF, (2) the impact of atrial fibrillation on patients with HFrEF, (3) and the effect of different BMI categories on patients with HFrEF. The purpose of this thesis was to investigate these risk factors and prove the value of post-hoc analysis of RCTs. MethodsThe following methodology was used. (1) Patients were split into cohorts based on the presence of clinical depression and their outcomes, biomarkers, and quality of life outcomes were compared. (2) Patients were split into cohorts based on the presence of atrial fibrillation (AF) and their outcomes, GDMT, biomarkers, and quality of life outcomes were compared. (3) Patients were split into cohorts based on BMI categories and the clinical outcomes of patients were explored. ResultsResults were as follows: (1) Patients with depression were found to have significantly higher rates of hospitalization despite similar GDMT. (2) Patients with atrial fibrillation were more likely to have hospitalizations specifically for heart failure and had worsening NT-proBNP over the course of the trial. (3) Patients with a BMI \u3e35 had significantly higher rates of hospitalizations than other BMI categories after adjustment for confounding variables. ConclusionsConclusions are as follows: (1) Patients with depression have worse outcomes and thereby there needs to be a concomitant focus on mental health in parallel to achievement of HF GDMT. (2) There is a pathological relationship between HFrEF and AF despite optimal HF medical treatment. (3) There is no evidence of the “obesity paradox” in HFrEF patients within the GUIDE IT trial in contrast to other studies

Analysis of Reported Voting Behaviors of US Physicians, 2000-2020

Physicians' engagement with the political process, particularly through voting, plays an important role in shaping public policy, affecting patient health and clinical practice. Historically, physicians in the US voted at lower rates than the general population in elections. However, physician voter engagement may have evolved, particularly given the changing political landscape and importance of US health care reform, as highlighted by the COVID-19 pandemic and differing policy proposals between the 2 major political parties. We assessed the trends in physician-voter turnout and reported reasons for not voting from 2000 through 2020

Atherosclerotic cardiovascular disease, cancer, and financial toxicity among adults in the United States

Background: Financial toxicity (FT) is a well-established side-effect of the high costs associated with cancer care. In recent years, studies have suggested that a significant proportion of those with atherosclerotic cardiovascular disease (ASCVD) experience FT and its consequences.Objectives: This study aimed to compare FT for individuals with neither ASCVD nor cancer, ASCVD only, cancer only, and both ASCVD and cancer.Methods: From the National Health Interview Survey, we identified adults with self-reported ASCVD and/or cancer between 2013 and 2018, stratifying results by nonelderly (age \u3c65 years) and elderly (age ≥65 years). We defined FT if any of the following were present: any difficulty paying medical bills, high financial distress, cost-related medication nonadherence, food insecurity, and/or foregone/delayed care due to cost.Results: The prevalence of FT was higher among those with ASCVD when compared with cancer (54% vs. 41%; p \u3c 0.001). When studying the individual components of FT, in adjusted analyses, those with ASCVD had higher odds of any difficulty paying medical bills (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.09 to 1.36), inability to pay bills (OR: 1.25; 95% CI: 1.04 to 1.50), cost-related medication nonadherence (OR: 1.28; 95% CI: 1.08 to 1.51), food insecurity (OR: 1.39; 95% CI: 1.17 to 1.64), and foregone/delayed care due to cost (OR: 1.17; 95% CI: 1.01 to 1.36). The presence of ≥3 of these factors was significantly higher among those with ASCVD and those with both ASCVD and cancer when compared with those with cancer (23% vs. 30% vs. 13%, respectively; p \u3c 0.001). These results remained similar in the elderly population.Conclusions: Our study highlights that FT is greater among patients with ASCVD compared with those with cancer, with the highest burden among those with both conditions

Clinical implications of Type 2 diabetes on outcomes after cardiac transplantation.

BackgroundT2D is an increasingly common disease that is associated with worse outcomes in patients with heart failure. Despite this, no contemporary study has assessed its impact on heart transplantation outcomes. This paper examines the demographics and outcomes of patients with type 2 diabetes (T2D) undergoing heart transplantation.MethodsUsing the United Network for Organ Sharing (UNOS) database, patients listed for transplant were separated into cohorts based on history of T2D. Demographics and comorbidities were compared, and cox regressions were used to examine outcomes.ResultsBetween January 1st, 2011 and June 12th, 2020, we identified 9,086 patients with T2D and 23,676 without T2D listed for transplant. The proportion of patients with T2D increased from 25.2% to 27.9% between 2011 and 2020. Patients with T2D were older, more likely to be male, less likely to be White, and more likely to pay with public insurance (pConclusionsOver the last ten years, the proportion of heart transplant recipients with T2D has increased. These patients are more likely to be from traditionally underserved populations. Patients with T2D have a lower likelihood of transplantation and a higher likelihood of post-transplant mortality. After the allocation system change, likelihood of transplantation has improved for patients with T2D