TEXT MY BP MEDS NOLA: A pilot study of text-messaging and social support to increase hypertension medication adherence.

Study objective: Non-Hispanic Black (NHB) adults have high hypertension (HTN) and cardiovascular disease (CVD) burden. Medication nonadherence limits control and self-measured blood pressure (SMBP) improves diagnosis and adherence. This predominantly NHB cohort pilot, via community-clinical linkages, with uncontrolled HTN and low adherence, utilized bidirectional electronic messaging (BEM) with team-care, to assess medication adherence, quality of life, and BP. Setting: Academic clinic and community sources. Design: Recruitment included: uncontrolled HTN (BP ≥130/80 mm Hg), low adherence (Krousel-Wood Medication Adherence Scale (K-Wood-MAS-4) ≥1 score), and smartphone access. Participants and interventions: Participants (N = 36) received validated Bluetooth-enabled BP devices, synced to smartphones, via a secured cloud-based application. Main outcome measures: Demographics, adherence scores, Centers for Disease Control and Prevention (CDC) health-related quality of life (HRQOL-14), BP, body mass index (BMI), 8 weeks daily BEM, SMBP and text responses were obtained. Results: Age was 58.7 ± 12.8 years; BMI 34.8 ± 7.9; 63.9 % female; 88.9 % self-identified NHB adults; 72.2 % with obesity; 74.3 % with diabetes. K-Wood-MAS-4 adherence composite score improved: 2.19 to 1.58 (median -0.5, p = 0.0001). Systolic BP decreased by 10.5 ± 20.0 mm Hg (median -11.0, p = 0.0027). QOL did not significantly change. Mean 7-day average SBP/DBP differences were -4.94 ± 16.82 (median -3.5, p = 0.0285) and -0.17 ± 7.42 (median 0, p = 0.7001), respectively. Social support with taking BP medication was: "yes" (n = 19); 143.8 mm Hg to 131.5 mm Hg (median -12.5, p = 0.0198) and "no" (n = 14); 142.32 mm Hg to 130.25 mm Hg (median -4.0, p = 0.0771). Conclusions: Community-clinical linkages and SMBP with BEM significantly improved medication adherence and SBP without modifying pharmacotherapy.

A cardiovascular clinic patients' survey to assess challenges and opportunities of digital health adoption during the COVID-19 pandemic.

BACKGROUND: COVID-19 boosted healthcare digitalization and personalization in cardiology. However, understanding patient attitudes and engagement behaviors is essential to achieve successful acceptance and implementation of digital health technologies in personalized care. OBJECTIVE: This study aims to understand current and future trends in wearable device and telemedicine use in the cardiology clinic patient population, recognize patients' attitude towards digital health before and after COVID-19, and identify potential socioeconomic and racial/ethnic differences in adoption of digital health tools in a New Orleans patient population. METHODS: A cross-sectional survey was distributed to Tulane Cardiology Clinic patients between September 2020 and January 2021. Basic demographic information, medical comorbidities, device usage, and opinions on digital health tools were collected. RESULTS: Survey responses from 299 participants (average age = 54 years, 50.8% female, 24.4% African American) showed that digital health use was more prevalent in younger, healthier, and more educated individuals. Wearable use was also higher among White patients compared to African American patients. Patients cited costs and technology knowledge as primary deterrents for using wearables, despite being more inclined to use wearables for disease monitoring (41%). While wearable use did not increase after COVID-19 (36.6% pre-COVID vs 35.4% post-COVID, P = .77), telemedicine use rose significantly (10.8% pre-COVID vs 24.3% during COVID, P < .0001). Patients mostly noted telemedicine's effectiveness in overcoming difficult healthcare access barriers. Additionally, most patients are in support of wearables and telemedicine either complementing or replacing routine tests and traditional clinical visits. CONCLUSION: Demographic and socioeconomic disparities negatively impact wearable health device and telemedicine adoption within cardiovascular clinic patients. Although telemedicine use increased after COVID-19, this effect was not observed for wearables, reflecting significant economic and digital literacy challenges underlying wearable acceptance.

A systematic review of racial/ethnic disparities in pharmacotherapy and surgical treatment outcomes in peripheral arterial disease among African American/non-Hispanic Black, non-Hispanic White and Hispanic patients.

Background: Lower extremity peripheral arterial disease (PAD) is associated with significant morbidity and mortality in racial/ethnic diverse populations. However, limited data exist on treatment outcome disparities in racial/ethnic diverse populations, particularly in AA/NHB populations. Objective: The aim of this systematic review is to analyze disparities in the outcomes of PAD treatments, particularly pharmacotherapy and surgery, among racial/ethnic groups in the US. Methods: A comprehensive search of original investigations pertaining to PAD treatments between 2015 and 2021 was performed. Quality assessment of the studies was also completed. Results: Fourteen studies were included. Thirteen studies reported differences in treatment outcomes for surgical intervention, and one study reported differences for concurrent surgical and pharmacotherapy. NHB and Hispanic/Latinx ethnicities were associated with decreased overall and perioperative mortality in four studies. Six studies noted increased amputation risk among racial/ethnic diverse populations. Only one study noted significant survival benefit by race/ethnicity. Three studies noted increased risk of major adverse limb events and post-operative complications. One study noted increased limb patency after intervention in racial/ethnic cohorts. Overall, all studies reported high methodological quality with adequate assessment of outcomes and follow-up of cohort. Conclusion: In this analysis, the predominant intervention reported is surgical. Overall, racial/ethnic populations are less likely to experience PAD-associated mortality but are more likely to experience adverse events. Further studies are necessary to include all racial/ethnic diverse populations in assessing PAD therapeutic intervention outcomes. Moreover, targeted public health efforts are necessary to increase PAD educational awareness, community-driven risk modification, and patient-centered care planning.

New-onset atrial arrhythmias associated with mortality in black and white patients hospitalized with COVID-19.

BACKGROUND: Specific details about cardiovascular complications, especially arrhythmias, related to the coronavirus disease of 2019 (COVID-19) are not well described. OBJECTIVE: We sought to evaluate the incidence and predictive factors of cardiovascular complications and new-onset arrhythmias in Black and White hospitalized COVID-19 patients and determine the impact of new-onset arrhythmia on outcomes. METHODS: We collected and analyzed baseline demographic and clinical data from COVID-19 patients hospitalized at the Tulane Medical Center in New Orleans, Louisiana, between March 1 and May 1, 2020. RESULTS: Among 310 hospitalized COVID-19 patients, the mean age was 61.4 ± 16.5 years, with 58,7% females, and 67% Black patients. Black patients were more likely to be younger, have diabetes and obesity. The incidence of cardiac complications was 20%, with 9% of patients having new-onset arrhythmia. There was no significant difference in cardiovascular outcomes between Black and White patients. A multivariate analysis determined age ≥60 years to be a predictor of new-onset arrhythmia (OR = 7.36, 95% CI [1.95;27.76], p = .003). D-dimer levels positively correlated with cardiac and new-onset arrhythmic event. New onset atrial arrhythmias predicted in-hospital mortality (OR = 2.99 95% CI [1.35;6.63], p = .007), a longer intensive care unit length of stay (mean of 6.14 days, 95% CI [2.51;9.77], p = .001) and mechanical ventilation duration(mean of 9.08 days, 95% CI [3.75;14.40], p = .001). CONCLUSION: Our results indicate that new onset atrial arrhythmias are commonly encountered in COVID-19 patients and can predict in-hospital mortality. Early elevation in D-dimer in COVID-19 patients is a significant predictor of new onset arrhythmias. Our finding suggest continuous rhythm monitoring should be adopted in this patient population during hospitalization to better risk stratify hospitalized patients and prompt earlier intervention.

Acute Lesion Imaging in Predicting Chronic Tissue Injury in the Ventricles.

BACKGROUND: Chronic lesion formation after cardiac tissue ablation is an important indicator for procedural outcome. Moreover, there is a lack of knowledge regarding the features that predict chronic lesion formation. OBJECTIVE: The aim of this study is to determine whether acute lesion visualization using late gadolinium enhanced magnetic resonance imaging (LGE-MRI) can reliably predict chronic lesion size. METHODS: Focal lesions were created in left and right ventricles of canine models using either radiofrequency (RF) ablation or cryofocal ablation. Multiple ablation parameters were used. The first LGE-MRI was acquired within 1-5 h post-ablation and the second LGE-MRI was obtained 47-82 days later. Corview software was used to perform lesion segmentations and size calculations. RESULTS: Fifty-Five lesions were created in different locations in the ventricles. Chronic volume size decreased by a mean of 62.5 % (95% CI 58.83-67.97, p < 0.0005). Similar regression of lesion volume was observed regardless of ablation location (p = 0.32), ablation technique (p = 0.94), duration (p = 0.37), power (p = 0.55) and whether lesions were connected or not (p = 0.35). There was no significant difference in lesion volume reduction assessed at 47-54 days and 72-82 days after ablation (p = 0.31). Chronic lesion volume was equal to 0.32 of the acute lesion volumes (R2 = 0.75). CONCLUSION: Chronic tissue injury related to catheter ablation can be reliably modeled as a linear function of the acute lesion volume as assessed by LGE-MRI, regardless of the ablation parameters.

The COVID-19 and Influenza "Twindemic": Barriers to Influenza Vaccination and Potential Acceptance of SARS-CoV2 Vaccination in African Americans.

Influenza is a contagious respiratory virus that causes a significant annual health burden in the United States (US). In spite of effective yearly vaccinations to protect individuals against influenza-related health complications, especially with certain chronic co-morbid illnesses, persistent racial/ethnic disparities exist in influenza immunization. African Americans continue to experience low vaccination uptake, stemming, at least in part, from years of bias in and mistrust of orthodox medicine, safety concerns, and environmental barriers to vaccine access. The novel respiratory coronavirus, SARS-CoV2, causes COVID-19, leading to a pandemic that in the U.S. has exerted severe physical, psychological, and economic tolls on the African Americans and other disadvantaged communities. These two respiratory-borne virus' cause disparate effects in the black community, unmasking persistent disparities in healthcare. Unfortunately, suboptimal influenza immunization acceptance exacerbates flu-related adverse health outcomes, similar to difficulties from the effects of the COVID-19 pandemic. In consideration of the impending influenza-COVID-19 "twindemic", robust educational campaigns, policy initiatives, and novel approaches to influenza immunization must be considered for the African American community to build trust in the health benefits of the influenza vaccination and, ultimately, to trust in the health benefits of potential SARS-CoV2 vaccines, when available for the general public.

Hypertension in African Americans: Advances in community outreach and public health approaches.

While there have been significant advances made towards controlling cardiovascular disease (CVD) morbidity and mortality in recent decades, African- Americans continue to experience a markedly elevated burden of CVD. Multiple factors have contributed to this major public health crisis, including medication adherence, racial inequities in diagnosis and treatment, lack of culturally competent care, and disparities in healthcare access. Historical approaches to reduce this burden are targeted towards community outreach by recruiting community partners and healthcare providers to disseminate health information on CVD awareness and prevention. Current community-based approaches, such as the barbershop and faith-based programs, have built upon previous approaches and incorporated novel ideas to increase community engagement in risk factor and disease reduction. Based on these models, future directions point to an increased usage of community partners, alongside health information technology and healthy behavior patient education, to reduce risk factors and prevalence of CVD in an ethnically vulnerable community.