Identification of Heart Failure Events in Medicare Claims: The Atherosclerosis Risk in Communities (ARIC) Study

We examined the accuracy of CMS Medicare HF diagnostic codes in the identification of acute decompensated and chronic stable HF (ADHF and CSHF)

Iterative Outlier Removal: A Method for Identifying Outliers in Laboratory Recalibration Studies

Extreme values that arise for any reason, including through non-laboratory measurement procedure-related processes (inadequate mixing, evaporation, mislabeling), lead to outliers and inflate errors in recalibration studies. We present an approach termed iterative outlier removal (IOR) for identifying such outliers

Obstructive Sleep Apnea and 15-Year Cognitive Decline: The Atherosclerosis Risk in Communities (ARIC) Study

Prospective data evaluating abnormal sleep quality and quantity with cognitive decline are limited because most studies used subjective data and/or had short follow-up. We hypothesized that, over 15 y of follow-up, participants with objectively measured obstructive sleep apnea (OSA) and other indices of poor sleep quantity and quality would experience greater decline in cognitive functioning than participants with normal sleep patterns

Identification of Incident CKD Stage 3 in Research Studies

In epidemiologic research, incident chronic kidney disease (CKD) is commonly determined by laboratory tests performed at planned study visits. Given the morbidity and mortality associated with CKD, persons with incident disease may be less likely to attend scheduled visits, affecting observed associations. The objective of this study was to quantify loss-to-follow-up by CKD status, and to determine whether supplementation with diagnostic code data improves capture of incident CKD

Perceived discrimination and cancer screening behaviors in US Hispanics: the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study

Perceived discrimination has been associated with lower adherence to cancer screening guidelines. We examined whether perceived discrimination was associated with adherence to breast, cervical, colorectal, and prostate cancer screening guidelines in US Hispanic/Latino adults

Hearing Impairment and Cognitive Decline: A Pilot Study Conducted Within the Atherosclerosis Risk in Communities Neurocognitive Study

Hearing impairment (HI) is prevalent, is modifiable, and has been associated with cognitive decline. We tested the hypothesis that audiometric HI measured in 2013 is associated with poorer cognitive function in 253 men and women from Washington County, Maryland (mean age = 76.9 years) in a pilot study carried out within the Atherosclerosis Risk in Communities Neurocognitive Study. Three cognitive tests were administered in 1990–1992, 1996–1998, and 2013, and a full neuropsychological battery was administered in 2013. Multivariable-adjusted differences in standardized cognitive scores (cross-sectional analysis) and trajectories of 20-year change (longitudinal analysis) were modeled using linear regression and generalized estimating equations, respectively. Hearing thresholds for pure tone frequencies of 0.5–4 kHz were averaged to obtain a pure tone average in the better-hearing ear. Hearing was categorized as follows: ≤25 dB, no HI; 26–40 dB, mild HI; and >40 dB, moderate/severe HI. Comparing participants with moderate/severe HI to participants with no HI, 20-year rates of decline in memory and global function differed by −0.47 standard deviations (P = 0.02) and −0.29 standard deviations (P = 0.02), respectively. Estimated declines were greatest in participants who did not wear a hearing aid. These findings add to the limited literature on cognitive impairments associated with HI, and they support future research on whether HI treatment may reduce risk of cognitive decline

Outcomes of Patients With Anemia and Acute Decompensated Heart Failure With Preserved Versus Reduced Ejection Fraction (from the ARIC Study Community Surveillance)

Anemia is associated with poor prognosis in patients hospitalized with acute decompensated heart failure (ADHF). Whether the impact of anemia differs by heart failure with preserved (HFpEF) or reduced (HFrEF) ejection fraction is uncertain. We examined hospital surveillance data captured by the Atherosclerosis Risk in Communities Study from January 1, 2005 – December 31, 2010. Diagnoses of ADHF were validated by standardized physician review of the medical record. Anemia was classified using WHO criteria (<12 g/dL for women, < 13 g/dL for men), and heart failure type was determined by the ejection fraction (<40% for HFrEF, ≥ 40% for HFpEF). Hospital length of stay and 1-year mortality outcomes were analyzed by multivariable regression, weighted to account for the sampling design, and adjusted for demographics and clinical covariates. Over 6 years, 15,461 (weighted) hospitalized events for ADHF (59% HFrEF) occurred in the ARIC catchment, based on 3,309 sampled events. Anemia was associated with a mortality hazard ratio of 2.1 (95% CI: 1.6 – 2.7) in patients classified with HFpEF, and 1.4 (95% CI: 1.1 – 1.7) among those with HFrEF; p for interaction = 0.05. The mean increase in length of hospital stay associated with anemia was 3.5 days (95% CI: 3.4 – 3.6) for patients with HFpEF, compared with 1.8 days (95% CI: 1.7 – 1.9) for those with HFrEF; p for interaction <0.0001. In conclusion, the incremental risks of death and lengthened hospital stay associated with anemia are more pronounced in ADHF patients classified with HFpEF than HFrEF

Trends in Myocardial Infarction Rates and Case Fatality by Anatomical Location in Four United States Communities, 1987 to 2008 (from the Atherosclerosis Risk in Communities Study)

Although the incidence of and mortality following ST-segment elevation myocardial infarction (STEMI) is decreasing, time-trends in anatomical location of STEMI and associated short-term prognosis have not been examined in a population-based community study. We determined 22-year trends in age- and race-adjusted, gender-specific incidence rates and 28-day case fatality of hospitalized STEMI by anatomic infarct location among a stratified random sample of 35-74 year old residents of four communities in the Atherosclerosis Risk in Communities (ARIC) study. STEMI infarct location was assessed by 12-lead electrocardiograms (ECG) from the hospital record, and was coded as anterior, inferior, lateral and multi-location STEMI using the Minnesota Code. Between 1987 and 2008, a total of 4,845 patients had an incident STEMI; 37.2% were inferior STEMI; 32.8% were anterior; 16.8% occurred in multiple infarct locations and 13.2% were lateral STEMI. For inferior, anterior and lateral STEMI in both men and women, significant declines were observed in the age-adjusted annual incidence rate and the associated 28-day case fatality. In contrast, for STEMI in multiple infarct locations, neither the annual incidence rate nor the 28-day case fatality changed over time. The age- and race-adjusted annual incidence rate and associated 28-day case fatality of STEMI in anterior, inferior and lateral infarct locations declined over 22 years of surveillance; however, no decline was observed for STEMI in multiple infarct locations. In conclusion, our findings suggest there is room for improvement in the care of patients with multi-location STEMI

High Cholesterol Awareness, Treatment, and Control Among Hispanic/Latinos: Results From the Hispanic Community Health Study/Study of Latinos

BackgroundWe assessed high cholesterol (HC) awareness, treatment, and control rates among US Hispanic/Latino adults and describe factors associated with HC awareness and management.Methods and ResultsBaseline data (collected 2008–2011) from a multisite probability sample of Hispanic/Latino adults in the Hispanic Community Health Study/Study of Latinos (18 to 74years old; N=16207) were analyzed. HC was defined as low-density lipoprotein-cholesterol ≥130mg/dL and/or total cholesterol ≥240mg/dL or use of cholesterol-lowering medication. Among Hispanic/Latino adults with HC, almost half (49.3%) were not aware of their condition and only 29.5% were receiving treatment. Men had a higher HC prevalence than women (44.0% versus 40.5%) but a lower rate of treatment (28.1% versus 30.6%). Younger adults were significantly less likely to be HC aware compared to those who were older. Those with hypertension, diabetes, and high socioeconomic position were more likely to be HC aware. US-born Hispanic/Latino were more likely to be HC unaware than foreign-born Hispanics/Latinos, but longer US residency was significantly associated with being HC aware, treated, and controlled. Cholesterol control was achieved among 64.3% of those who were HC treated. However, younger adults, women, those with lower income, those uninsured, and more recent immigrants were less likely to be HC controlled. Individuals of Puerto Rican or Dominican background were most likely to be HC aware and treated, whereas those of Mexican or Central American background were least likely to be HC treated. Individuals of Cuban and South American background had the lowest rates of HC control, whereas Puerto Ricans had the highest.ConclusionsUnderstanding gaps in HC awareness, treatment, and control among US Hispanic/Latino adults can help inform physicians and policymakers to improve disease management and patient education programs

Classification of Acute Decompensated Heart Failure: An Automated Algorithm Compared With a Physician Reviewer Panel: The Atherosclerosis Risk in Communities Study

An algorithm to classify heart failure (HF) endpoints inclusive of contemporary measures of biomarkers and echocardiography was recently proposed by an international expert panel. Our objective was to assess agreement of HF classification by this contemporaneous algorithm with that by a standardized physician reviewer panel, when applied to data abstracted from community-based hospital records