Relation of Living in a "Food Desert" to Recurrent Hospitalizations in Patients With Heart Failure.

Food deserts (FD), low-income areas with low access to healthful foods, are associated with higher burden of cardiovascular risk factors. Few studies have examined the impact of FD on clinical outcomes in heart failure (HF). FD status was assessed in 457 HF patients (mean age 55.9 ± 12.5 years; 50.3% Black) using the Food Desert Research Atlas. The Andersen-Gill extension of Cox model was used to examine the association of living in a FD with risk of repeat hospitalization (all-cause and HF-specific). Patients living in a FD were younger (p = 0.01), more likely to be Black (p <0.0001), less educated (p = 0.003), and less likely to have commercial insurance (p = 0.003). During a median follow-up of 827 (506, 1,379) days, death occurred in 60 (13.1%) subjects, and hospitalizations occurred in 262 (57.3%) subjects. There was no difference in the risk of death based on FD status. The overall frequency of all-cause (94.1 vs 63.6 per 100 patient-years) and HF-specific (59.6 vs 30.5 per 100 patient-years) hospitalizations was higher in subjects who lived in a FD. After adjustment for covariates, living in a FD was associated with an increased risk of repeat all-cause (hazard ratio 1.39, 95% confidence interval 1.19 to 1.63; p = 0.03) and HF-specific (hazard ratio 1.30, 95% confidence interval 1.02 to 1.65; p = 0.03) hospitalizations. In conclusion, patients living in a FD have a higher risk of repeat all-cause and HF-specific hospitalization.

Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions.

Socioeconomic status (SES) has a measurable and significant effect on cardiovascular health. Biological, behavioral, and psychosocial risk factors prevalent in disadvantaged individuals accentuate the link between SES and cardiovascular disease (CVD). Four measures have been consistently associated with CVD in high-income countries: income level, educational attainment, employment status, and neighborhood socioeconomic factors. In addition, disparities based on sex have been shown in several studies. Interventions targeting patients with low SES have predominantly focused on modification of traditional CVD risk factors. Promising approaches are emerging that can be implemented on an individual, community, or population basis to reduce disparities in outcomes. Structured physical activity has demonstrated effectiveness in low-SES populations, and geomapping may be used to identify targets for large-scale programs. Task shifting, the redistribution of healthcare management from physician to nonphysician providers in an effort to improve access to health care, may have a role in select areas. Integration of SES into the traditional CVD risk prediction models may allow improved management of individuals with high risk, but cultural and regional differences in SES make generalized implementation challenging. Future research is required to better understand the underlying mechanisms of CVD risk that affect individuals of low SES and to determine effective interventions for patients with high risk. We review the current state of knowledge on the impact of SES on the incidence, treatment, and outcomes of CVD in high-income societies and suggest future research directions aimed at the elimination of these adverse factors, and the integration of measures of SES into the customization of cardiovascular treatment.

High neighborhood incarceration rate is associated with cardiometabolic disease in nonincarcerated black individuals.

PURPOSE: To examine the association between residence in neighborhoods with high rates of incarceration and cardiometabolic disease among nonincarcerated individuals. METHODS: We used data from two community cohort studies (n = 1368) in Atlanta, Georgia-META-Health and Predictive Health (2005-2012)-to assess the association between neighborhood incarceration rate and cardiometabolic disease, adjusting for individual-level and neighborhood-level factors. We also examined the interaction between race and neighborhood incarceration rate. RESULTS: Individuals living in neighborhoods with high incarceration rates were more likely to have dyslipidemia (odds ratio [OR] = 1.47; 95% confidence interval [CI] = 1.03-2.09) and metabolic syndrome (OR = 1.67; 95% CI = 1.07-2.59) in fully adjusted models. Interactions between race and neighborhood incarceration rate were significant; black individuals living in neighborhoods with high incarceration rates were more likely to have hypertension (OR = 1.59; 95% CI = 1.01-2.49), dyslipidemia (OR = 1.77; 95% CI = 1.12-2.80), and metabolic syndrome (OR = 1.80; 95% CI = 1.09-2.99). CONCLUSIONS: Black individuals living in neighborhoods with high rates of incarceration have worse cardiometabolic health profiles. Criminal justice reform may help reduce race-specific health disparities in the United States.

The Wild Wild West: A Framework to Integrate mHealth Software Applications and Wearables to Support Physical Activity Assessment, Counseling and Interventions for Cardiovascular Disease Risk Reduction.

Physical activity (PA) interventions constitute a critical component of cardiovascular disease (CVD) risk reduction programs. Objective mobile health (mHealth) software applications (apps) and wearable activity monitors (WAMs) can advance both assessment and integration of PA counseling in clinical settings and support community-based PA interventions. The use of mHealth technology for CVD risk reduction is promising, but integration into routine clinical care and population health management has proven challenging. The increasing diversity of available technologies and the lack of a comprehensive guiding framework are key barriers for standardizing data collection and integration. This paper reviews the validity, utility and feasibility of implementing mHealth technology in clinical settings and proposes an organizational framework to support PA assessment, counseling and referrals to community resources for CVD risk reduction interventions. This integration framework can be adapted to different clinical population needs. It should also be refined as technologies and regulations advance under an evolving health care system landscape in the United States and globally.