Reyan Ghany1, Ana Palacio2,3, Gordon Chen1, Elissa Dawkins1, Alina Ghany1, Emancia Forbes1, Thiago Tajiri1, Leonardo Tamariz2,3. 1. Chen Senior Medical Centers, Miami, FL, USA. 2. Division of Population Health and Computational Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA. 3. Geriatric Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, Miami, FL, USA.
Abstract
BACKGROUND: Diastolic dysfunction (DD) can lead to heart failure and higher mortality. Echocardiograms can detect DD but are not indicated for screening in older adults. Our aim was to evaluate the prevalence of DD and the impact of identifying it in seniors. METHODS: We performed screening echocardiograms in 5227 consecutive patients between January 2014 and March 2015 in 36 senior-focused value-based clinics across six states. We determined the presence of the grade of DD and defined stage B grade II/III (asymptomatic) and of stage C grade II/III (symptomatic) DD by the presence or absence of typical HF symptoms. We obtained prescribed medications from the electronic health record to determine absolute changes in HF therapy before and after the echocardiogram. RESULTS: We included a group with no DD (n=649), a group with grade 1 DD (n=2875), and those with grades 2 and 3 (n=1357) who had normal ejection fraction. The prevalence of grade 2 or 3 DD with preserved ejection fraction was 25%; 95% CI: 24-26. The absolute change of ace-inhibitor use before and after the echocardiogram increased by 14, 19, 23, 27 in patients without DD, those with grade 1, grade 2 or 3 asymptomatic and grade 2 or 3 symptomatic, respectively. The use of β-blocker, statin, and diuretic had similar trends. CONCLUSIONS: Seniors without previously known stage B or stage C heart failure have moderate-to-severe DD, 27% of whom were stage C. Identifying seniors with DD leads to improvement in care.
BACKGROUND:Diastolic dysfunction (DD) can lead to heart failure and higher mortality. Echocardiograms can detect DD but are not indicated for screening in older adults. Our aim was to evaluate the prevalence of DD and the impact of identifying it in seniors. METHODS: We performed screening echocardiograms in 5227 consecutive patients between January 2014 and March 2015 in 36 senior-focused value-based clinics across six states. We determined the presence of the grade of DD and defined stage B grade II/III (asymptomatic) and of stage C grade II/III (symptomatic) DD by the presence or absence of typical HF symptoms. We obtained prescribed medications from the electronic health record to determine absolute changes in HF therapy before and after the echocardiogram. RESULTS: We included a group with no DD (n=649), a group with grade 1 DD (n=2875), and those with grades 2 and 3 (n=1357) who had normal ejection fraction. The prevalence of grade 2 or 3 DD with preserved ejection fraction was 25%; 95% CI: 24-26. The absolute change of ace-inhibitor use before and after the echocardiogram increased by 14, 19, 23, 27 in patients without DD, those with grade 1, grade 2 or 3 asymptomatic and grade 2 or 3 symptomatic, respectively. The use of β-blocker, statin, and diuretic had similar trends. CONCLUSIONS: Seniors without previously known stage B or stage C heart failure have moderate-to-severe DD, 27% of whom were stage C. Identifying seniors with DD leads to improvement in care.
Authors: Jason Lane; Ana Palacio; Li Ern Chen; Daniel McCarter; Leonardo Tamariz; Christopher James Chen; Reyan Ghany Journal: J Racial Ethn Health Disparities Date: 2022-09-28
Authors: Fangyu Chen; Jordan M Komisarow; Brianna Mills; Monica Vavilala; Adrian Hernandez; Daniel T Laskowitz; Joseph P Mathew; Michael L James; Krista L Haines; Karthik Raghunathan; Matt Fuller; Raquel R Bartz; Vijay Krishnamoorthy Journal: Anesth Analg Date: 2021-04-01 Impact factor: 6.627
Authors: Reyan Ghany; Ana Palacio; Gordon Chen; Elissa Dawkins; Daniel McCarter; Emancia Forbes; Brian Chung; Leonardo Tamariz Journal: Am J Prev Cardiol Date: 2020-10-01