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8. Poor Medication Access as a Driver of Excess Heart-Failure Readmissions Among Patients Living in Economically Deprived Neighborhoods.

Author

GANGAVELLI, APOORVA, LIU, ZIHAO, WANG, JEFFREY, OKOH, ALEXIS, STEINBERG, REBECCA S., PATEL, KRISHAN, PATEL, SHIVANI A., DICKERT, NEAL W., and MORRIS, ALANNA A.

Abstract

Patients residing in socioeconomically deprived neighborhoods experience higher hospital readmission rates after hospitalization for heart failure (HF). The role of medication access in the excessive readmissions in this group is poorly understood. This study explored patients' perspectives on medication access by individuals living in socioeconomically deprived neighborhoods who had experienced HF readmission. We conducted semistructured in-depth interviews with 25 patients (mean age 61 ± 9 years, 96% Black, 40% women) who were readmitted with acute HF at Emory Healthcare hospitals and were living in highly deprived neighborhoods (top decile of the Social Deprivation Index). Qualitative descriptive analyses of the interviews were performed by using a multilevel coding strategy. Most patients (84%) highlighted medications as a driver of HF readmission. Patients' reported reasons for lack of medication access included medication costs (60%), having access to refills only through an emergency department or hospitalization (36%), limited access to transportation (12%), and limited understanding of medications' role in disease management (12%). Lack of access to medications for patients with HF who live in socioeconomically distressed neighborhoods exacerbate excess hospitalizations in this vulnerable population. This study focuses on patients' perspectives and experiences and identifies some potentially high-value areas to focus on in trying to enhance access and adherence to evidence-based therapies. [ABSTRACT FROM AUTHOR]

Published
2024
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16. PROTEOMIC CORRELATES OF PLASMA POTASSIUM (K+) IN HEART FAILURE WITH PRESERVED EJECTION FRACTION (HFPEF)

Author

Steinberg, Rebecca S., primary, Salman, Oday, additional, Zhao, Lei, additional, Qian, Chenao, additional, Cohen, Jordana, additional, Zamani, Payman, additional, Ebert, Christina, additional, Sharma, Ankur, additional, Wang, Zhaoqing, additional, Greenawalt, Danielle, additional, Van Empel, Vanessa, additional, Richards, Mark, additional, Doughty, Rob N., additional, Rietzschel, Ernst R., additional, Javaheri, Ali, additional, Schafer, Peter, additional, Borentain, Maria, additional, Seiffert, Dietmar, additional, Chang, Ching-Pin, additional, Gordon, David, additional, Ramirez-Valle, Francisco, additional, Mann, Douglas L., additional, Morris, Alanna A., additional, Cappola, Thomas P., additional, and Chirinos, Julio A., additional

Published
2023
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26. Association of race and gender with primary caregiver relationships and eligibility for advanced heart failure therapies

Author

Steinberg, Rebecca S., primary, Nayak, Aditi, additional, Burke, Michael A., additional, Aldridge, Morgan, additional, Raja Laskar, S., additional, Bhatt, Kunal, additional, Sridharan, Lakshmi, additional, Abdou, Mahmoud, additional, Attia, Tamer, additional, Smith, Andrew, additional, Daneshmand, Mani, additional, David Vega, J., additional, Gupta, Divya, additional, and Morris, Alanna A., additional

Published
2021
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32. Association of race and gender with primary caregiver relationships and eligibility for advanced heart failure therapies.

Author

Steinberg, Rebecca S., Nayak, Aditi, Burke, Michael A., Aldridge, Morgan, Raja Laskar, S., Bhatt, Kunal, Sridharan, Lakshmi, Abdou, Mahmoud, Attia, Tamer, Smith, Andrew, Daneshmand, Mani, David Vega, J., Gupta, Divya, and Morris, Alanna A.

Subjects
*HEART failure, *HEART assist devices, *HEART transplantation, *BLACK people, *HEART failure patients
Abstract

Background: Caregiver support is considered necessary after heart transplant (HT) and left ventricular assist device (LVAD) for patients with end‐stage heart failure (HF). Few studies have demonstrated how caregivers differ by gender and race, and whether that impacts therapy eligibility. Methods: We examined caregiver relationships among 674 patients (32% women, 55% Black) evaluated at Emory University from 2011 to 2017. Therapy readiness was assessed using the Stanford Integrated Assessment for Transplant (SIPAT). Evaluation outcome according to caregiver relationship was compared using χ2 analysis. Multivariable logistic regression determined the association between caregiver and eligibility according to gender and race. Results: Women and Black patients were less likely to have spouses as their support person (P <.001). Women were less likely to be considered eligible for advanced therapies (adjusted odds ratio [aOR].64, 95% confidence interval [CI].46–.89; P =.008), with Black women having lower eligibility than White women (aOR.28, 95% CI.11–.72; P =.008). Social support and SIPAT scores did not significantly influence eligibility by gender or race. Conclusion: Lack of caregiver support is considered a relative contraindication to advanced therapies. Type of caregiver in our cohort varied according to race and gender but did not explain differences in eligibility for advanced therapies. [ABSTRACT FROM AUTHOR]

Published
2022
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33. Sex differences in eligibility for advanced heart failure therapies

Author

Steinberg, Rebecca S., primary, Nayak, Aditi, additional, O'Connell, Celena, additional, Burford, Sharon, additional, Pekarek, Ann, additional, Chesnut, Neile, additional, Cole, Robert T., additional, Gupta, Divya, additional, Laskar, S. Raja, additional, Bhatt, Kunal, additional, Burke, Michael, additional, Attia, Tamer, additional, Smith, Andrew, additional, Vega, J. David, additional, and Morris, Alanna A., additional

Published
2020
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