Hospitals in Hurricane Katrina: Challenges Facing Custodial Institutions in a Disaster

Hospitals were part of the problem and the solution during the Hurricane Katrina crisis. They cared for some of the city's most vulnerable people, but they also presented some of its most difficult challenges once flooding made evacuation necessary

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

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102653/1/ejhfhfq077.pd

End-Stage Renal Disease in African Americans With Lupus Nephritis Is Associated With APOL1

Lupus nephritis (LN) is a severe manifestation of systemic lupus erythematosus (SLE) that exhibits familial aggregation and may progress to end-stage renal disease (ESRD). LN is more prevalent among African Americans than among European Americans. This study was undertaken to investigate the hypothesis that the apolipoprotein L1 gene (APOL1) nephropathy risk alleles G1/G2, common in African Americans and rare in European Americans, contribute to the ethnic disparity in risk

SUCCESS OF A MULTIDISCIPLINARY DISEASE MANAGEMENT PROGRAM IN LONG TERM SYSTOLIC HEART FAILURE CARE

Objective. The aim of this study was to evaluate the use of a standardized protocol in a heart failure disease management program (HFDMP) to improve medical adherence, blood pressure control and vaccination rates among patients with systolic heart failure. Background. Heart failure (HF) is becoming a major public health problem with a 1-year mortality rate that ranges from 28% in the youngest patients with minimal co morbidities to 61% in the oldest population with high risk factors. In spite of new diagnostic and therapeutic tools, the prognosis for a new diagnosis of heart failure is still poor. In an effort to reduce the morbidity, mortality, and economic cost of HF, several organizations, including the American College of Cardiology and the European Society of Cardiology have developed evidence-based HF management guidelines. Methods. We conducted a cross sectional study that included 561 patients, (56% Hispanic, 4.5% non-Hispanic Caucasian and 39% non-Hispanic African American), who were enrolled from September 2007 to January 2009 into a HFDM at the Jackson Memorial Hospital (JMH), an urban 1600 bed safety-net hospital, in Miami, Florida. The inclusion criteria were age e 18 years with systolic heart failure defined as ejection fraction d 40% by echocardiography. Medical adherence, blood pressure control and immunization state were assessed at baseline and follow up visits. Results. At baseline 82% of Hispanics, 75% of White and 79% of Black patients were taking ACEI/ARB. The percentage of White and Black patients taking ACEI/ARB increased over the four visits. There was also a significant difference in comparing baseline to fourth visit in Hispanic patients for the total dose (p=0.002) and target dose (p \u3c 0.001) for beta blocker therapy. Patients enrolled in the HFDMPs with untrolled BP experienced a significant decrease in their BP levels and those whose BP was under control at baseline remained within JNC VII recommendations throughout the study. The baseline prevalence of vaccination against influenza and pneumococcal disease was 28.3% and 30.7% respectively. Within the mean follow up period of 2- 4.6 months between the first and second visit to the HFDMP, vaccination prevalence improved for both influenza (50.4%) and pneumococcal disease (65.5%) with the combined prevalence improving to 60.5%. Conclusion. Enrollment into the HFDMP was effective in improving medical adherence, in achieving better blood pressure control and in increasing immunization prevalence without creating disparities. Grants. N/

The meaningful use of the review of symptoms in heart failure patients

Review of symptoms (ROS) is a time-honored tradition in medicine and has proved to be a case-finding maneuver in general medicine patients. The authors sought to investigate the prevalence of noncardiovascular symptoms in heart failure clinics by assessment of the ROS. Of the collected ROS, shortness of breath (SOB) represented the most frequent recalled symptom (8.6%), whereas fatigue (5.3%) was the most common noncardiac symptom. Multivariate regression analysis revealed that New York Heart Association class could, at least in part, explain the occurrence of SOB (R(2) =.4; P<.05). Importantly, alarm symptoms such as hemoptysis and bloody stools were present in <1% of the cohort. ROS evaluation remains a valuable tool for diagnostics; however, symptom-focused questionnaires should be routinely considered as a time-efficient strategy in the ambulatory specialty clinic

Racial and sex differences in prevalence of hypothyroidism in patients with cardiomyopathies enrolled into a heart failure disease management program

The authors evaluated the prevalence of hypothyroidism in patients with heart failure (HF) to determine whether there are racial and sex differences and to determine the number of new cases of hypothyroidism. The study included 194 patients in an HF disease management program (HFDMP) in South Florida. Patients were interviewed for a history of hypothyroidism and referred for measurement of thyrotropin. The prevalence of hypothyroidism was calculated by race and sex. The prevalence of hypothyroidism was 18% for all patients with HF and 23% among Hispanics; however, this trend was not statistically significant (P = .06). More men than women had hypothyroidism (P = .04). Patients with hypothyroidism had higher mean lipid profiles (P < .01) and lower mean heart rates (P = .03) than healthy patients. Hypothyroidism is prevalent among HF patients, especially men. Hispanics with HF may have a higher prevalence of hypothyroidism. The standardized protocol of the HFDMP helped identify new cases of hypothyroidism

Diagnosis and treatment of depression in patients with congestive heart failure: a review of the literature

Major depressive disorder (MDD) can be challenging to diagnose in patients with congestive heart failure, who often suffer from fatigue, insomnia, weight changes, and other neurovegetative symptoms that overlap with those of depression. Pathophysiologic mechanisms (eg, inflammation, autonomic nervous system dysfunction, cardiac arrhythmias, and altered platelet function) connect depression and congestive heart failure. We sought to review the prevalence, diagnosis, neurobiology, and treatment of depression associated with congestive heart failure. A search of all English-language articles between January 2003 and January 2013 was conducted using the search terms congestive heart failure and depression. We found 1,498 article abstracts and 19 articles (meta-analyses, systematic reviews, and original research articles) that were selected for inclusion, as they contained information about our focus on diagnosis, treatment, and pathophysiology of depression associated with congestive heart failure. The search was augmented with manual review of reference lists of articles from the initial search. Articles selected for review were determined by author consensus. The prevalence, diagnosis, neurobiology, and treatment of depression associated with congestive heart failure were reviewed. Particular attention was paid to the safety, efficacy, and tolerability of antidepressant medications commonly used to treat depression and how their side-effect profiles impact the pathophysiology of congestive heart failure. Drug-drug interactions between antidepressant medications and medications used to treat congestive heart failure were examined. MDD is highly prevalent in patients with congestive heart failure. Moreover, the prevalence and severity of depression correlate with the degree of cardiac dysfunction and development of congestive heart failure. Depression increases the risk of congestive heart failure, particularly in those patients with coronary artery disease , and is associated with a poorer quality of life, increased use of health care resources, more frequent adverse clinical events and hospitalizations, and twice the risk of mortality. At present, limited empirical data exist with regard to treatment of depression in the increasingly large population of patients with congestive heart failure. Evidence reveals that both psychotherapeutic treatment (eg, cognitive-behavioral therapy) and pharmacologic treatment (eg, use of the selective serotonin reuptake inhibitor sertraline) are safe and effective in reducing depression severity in patients with cardiovascular disease. Collaborative care programs featuring interventions that work to improve adherence to medical and psychiatric treatments improve both cardiovascular disease and depression outcomes. Depression rating scales such as the 9-item Patient Health Questionnaire should be used to monitor therapeutic efficacy