Use of Palliative Care Among Adults With Newly Diagnosed Heart Failure: Insights From a US National Insured Patient Sample.

BACKGROUND: Despite the known benefits for individuals with heart failure (HF), incomplete data suggest a low use of palliative care (PC) for HF in the United States. We aimed to investigate the national PC use for adults with HF by determining when they received their first PC consultation (PCC) and the associations with clinical factors following diagnosis of HF. METHODS AND RESULTS: We conducted a retrospective cohort study in a national all-payer electronic health record database to identify adults (aged ≥18 years) with newly diagnosed HF between 2011 and 2018. The proportion of those who received PCC within 5 years following a diagnosis of HF, and associations of time to first PCC with patient characteristics and HF-specific clinical markers were determined. We followed 127 712 patients for a median of 792 days, of whom 18.3% received PCC in 5 years. Shorter time to receive PCC was associated with diagnoses of HF in 2016 to 2018 (compared with 2010-2015: adjusted hazard ratio [aHR], 1.421 [95% CI, 1.370-1.475]), advanced HF (aHR, 2.065 [95% CI, 1.940-2.198]), cardiogenic shock (aHR, 2.587 [95% CI, 2.414-2.773]), implantable cardioverter-defibrillator (aHR, 5.718 [95% CI, 5.327-6.138]), and visits at academic medical centers (aHR, 1.439 [95% CI, 1.381-1.500]). CONCLUSIONS: Despite an expanded definition of PC and recommendations by professional societies, PC for HF remains low in the United States. Racial and geographic variations in access and use of PC exist for patients with HF. Future studies should interrogate the mechanisms of PC underusage, especially before advanced stages, and address barriers to PC services across the health care system.

Gender, racial and ethnic disparities in acute coronary syndromes with coronary in-stent restenosis.

Background: Coronary in-stent restenosis (ISR) is a major clinical challenge of contemporary percutaneous revascularization and portends adverse cardiovascular outcomes. Objectives: We aimed to evaluate gender, race, and ethnicity related outcomes in acute coronary syndromes (ACS) with ISR. Methods: Primary hospitalizations for ACS and ISR in the National Inpatient Sample database from 2016 to 2019 were included. Patients were stratified by gender, race, and ethnicity. The primary end points were all cause in-hospital mortality and coronary revascularization defined as composite of percutaneous coronary intervention (PCI), balloon angioplasty and/or coronary artery bypass grafting (CABG). Results: During the study period, a nationally weighted total of 97,680 patients with ACS and ISR were included. There was substantial variation in comorbidities, with greatest burden among Black and Hispanic women. All-cause in-hospital mortality was 2.4 % in the study cohort, but significantly higher in women (2.1 % vs. 2.1 %; aOR: 1.282, 95 % CI: 1.174-1.4; p < 0.001) and revascularization rates were significantly lower in women (77 % vs 80.2 %; aOR: 0.891, 95 % CI: 0.862-0.921; p < 0.001). Compared to White men, all women except Hispanic women, had significantly higher likelihood of in-hospital mortality, while White women, Black men and women, and Hispanic men had lower odds of revascularization. Conclusions: There are significant gender, racial, and ethnic related differences in revascularization practices and clinical outcomes in patients with ACS and ISR with an adverse impact on women, racial and ethnic minorities in the U.S.

Practice patterns of rate control in atrial fibrillation and clinical outcomes from a nationwide cohort.

Atrial fibrillation (AF) is common, but there are limited data to guide selection of rate control medications (RCM). Reasons for selection are multivariable, and the impact on outcomes is unknown. We investigated prescribing patterns of RCM among patients with AF. Using a nationwide database, we identified 135,927 patients with AF. We stratified by baseline presence of heart failure with reduced ejection fraction (HFrEF) and examined prescription rates of RCM as a function of clinical variables. We also evaluated associations with clinical outcomes. Beta blockers (BB) were most commonly prescribed (44.6%), then calcium channel blockers (CCB) (14.0%) and digoxin (8.6%). Patients prescribed BB were more likely male (45.6% vs 43.4%, p < 0.0001), patients prescribed CCB were less likely male (12.0% vs 16.3%, p < 0.0001). There were higher rates of HF hospitalization (HFH) among females and those with Medicaid. Randomized trials are needed to define optimal choice of RCM.

Leadless pacemaker implantation in elderly patients with abandoned transvenous pacemakers with depleted batteries.

This spotlight article gives two clinical case examples for the implementation of a suggested safe and feasible strategy to implant leadless pacemakers instead of changing the generators of transvenous pacemakers with depleted batteries in elderly patients.

Understanding student perceptions of social computing and online tools to enhance learning.

Social computing software and online tools are gaining credence in teaching and learning spaces, including higher education contexts. However, the adoption of social computing software does not automatically translate into effective teaching and learning if students' views and needs are not considered along with course learning outcomes. Thus, this study was conducted to explore students' perspectives and preferences for social computing software and online tools in a university elective course. We employed quantitative and qualitative approaches to understand students' shared and nuanced thoughts about social computing applications in the study. A questionnaire with quantitative and open-ended qualitative questions was used to collect data. Data were analyzed using descriptive statistics and an inductive thematic analysis approach. Our findings indicated mixed students' viewpoints, with some tools reported as highly beneficial while others were less beneficial. For instance, students valued asynchronous sessions, assignment feedback, online discussion, videos, and gamification but reported less interest in phones, journals, icons, and blogs. Students' specializations also appeared to influence their choice of tools. Those from Arts, Humanities, and Social Sciences expressed a slightly different preference than their comparts from Medicine and Health Sciences. Drawing on the findings, we discuss the implications for effective teaching and learning using social computing software, focusing on essential stakeholders. For instance, instructors must regularly conduct diagnostic feedback to determine appropriate tools that can effectively customize students' learning.