Publications by authors named "Amber E Johnson"

Article Synopsis
  • The study investigated the link between predelivery cardiology care and major adverse cardiovascular events (MACE) in Black and White patients with Preeclampsia/Eclampsia (PrE/E), using data from 29,336 patients delivered between 2008 and 2019.
  • Findings revealed that Black patients experienced a higher cumulative incidence of MACE within a year post-delivery compared to White patients, particularly in the first 14 days.
  • Predelivery cardiology care reduced the risk of MACE for White patients shortly after delivery, but did not have a significant impact for Black patients during the same period.
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Background: Unmet social and caregiving needs can make caregiving for a person with dementia more difficult. Although national policy encourages adoption of systematic screening for health-related social risks (HRSRs) in clinical settings, the accuracy of these risk-based screening tools for detecting unmet social needs is unknown.

Methods: We used baseline data from dementia caregivers (N = 343) enrolled in a randomized controlled trial evaluating CommunityRx-Dementia, a social care intervention conducted on Chicago's South Side.

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Article Synopsis
  • The study examined statin prescription rates and their impact on outcomes for atherosclerotic cardiovascular disease (ASCVD) in a large health care system, focusing on differences between Black and White patients.
  • Results showed that significantly fewer Black patients were prescribed statins compared to White patients, which was linked to increased ASCVD risks for both groups, though the race interaction was not a significant factor for ASCVD events.
  • Overall, the findings highlight that statins are underprescribed, and while disparities exist in prescription rates, they did not correlate directly with higher mortality risk among the studied populations.
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Atrial fibrillation (AF) and heart failure (HF)-specifically, heart failure with reduced ejection fraction (HFrEF)-often coexist, and each contributes to the propagation of the other. This relationship extends from the mechanistic and physiological to clinical syndromes, quality of life, and long-term cardiovascular outcomes. The risk factors for AF and HF overlap and create a critical opportunity to prevent adverse outcomes among patients at greatest risk for either condition.

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Article Synopsis
  • The text highlights the existing racial disparities in cardiovascular health, particularly sudden cardiac death (SCD) among competitive athletes, emphasizing the need to understand the influence of social determinants of health and structural racism on these disparities.* -
  • It advocates for a paradigm shift in sports cardiology that focuses on three principles: race-conscious awareness, clinical inclusivity, and research-driven refinement, suggesting a move away from race-based assumptions towards personalized and equitable health care.* -
  • The conclusion stresses the importance of recognizing structural racism and social determinants of health in understanding and addressing health outcome disparities, proposing that a race-conscious framework could improve the quality of cardiovascular care for diverse athletes.*
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Background: Black women with peripartum cardiomyopathy (PPCM) have a higher prevalence of hypertensive disorders of pregnancy (HDP) and worse clinical outcomes compared with non-Black women. We examined the impact of HDP on myocardial recovery in Black women with PPCM.

Methods: A total of 100 women were enrolled into the Investigation in Pregnancy Associated Cardiomyopathy (IPAC) study.

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The objective of this study was to determine whether exposure to structural racism-related state laws is associated with cardiovascular health among a racially and ethnically diverse sample of US adults. Data were from the Database of Structural Racism-Related State Laws and the Behavioral Risk Factor Surveillance System (BRFSS). The sample included 958,019 BRFSS 2011 and 2013 respondents aged 18+ from all 50 US states.

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Background: Transcatheter aortic valve replacement (TAVR) are not offered equitably to vulnerable population groups. Adequate levels of insurance may narrow gaps among patients with higher social vulnerability index (SVI). Among a national population of individuals with commercial or Medicare insurance, we sought to determine whether SVI was associated with urgency of receipt of TAVR for aortic stenosis.

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The neighborhoods where individuals reside shape environmental exposures, access to resources, and opportunities. The inequitable distribution of resources and opportunities across neighborhoods perpetuates and exacerbates cardiovascular health inequities. Thus, interventions that address the neighborhood environment could reduce the inequitable burden of cardiovascular disease in disenfranchised populations.

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Background Patients experience atrial fibrillation (AF) as a complex disease given its adversity, chronicity, and necessity for long-term treatments. Few studies have examined the experience of rural individuals with AF. We conducted qualitative assessments of patients with AF residing in rural, western Pennsylvania to identify barriers and facilitators to care.

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Background: Black patients with peripartum cardiomyopathy (PPCM) have disproportionately worse outcomes than White patients, possibly related to variable involvement of cardiovascular specialists in their clinical care. We sought to determine whether race was associated with cardiology involvement in clinical care during inpatient admission and whether cardiology involvement in care was associated with higher claims of guideline-directed medical therapy (GDMT) a week after hospital discharge.

Methods: Using Optum's de-identified Clinformatics® Data Mart (CDM), we included Black and White patients' first hospital admission for PPCM from 2008 to 2021.

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Background: Although statins are a class I recommendation for prevention of atherosclerotic cardiovascular disease and its complications, their use is suboptimal. Differential underuse may mediate disparities in cardiovascular health for systematically marginalized persons.

Objective: To estimate disparities in statin use by race-ethnicity-gender and to determine whether these potential disparities are explained by medical appropriateness of therapy and structural factors.

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Article Synopsis
  • The prevalence of Type 2 diabetes and heart failure in the U.S. is increasing, and while GLP-1 receptor agonists and SGLT2 inhibitors help improve patient outcomes, high medication costs may lead to lower adherence to these treatments.
  • This study examined the impact of prescription co-payment levels on adherence to GLP-1 and SGLT2 therapies over one year, using data from individuals with T2D and/or heart failure who had prescription claims from early 2014 to late 2020.
  • Results showed that individuals facing medium or high co-pays were significantly less likely to adhere to their medication regimen, with only 65.3% of GLP-1 users and
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Article Synopsis
  • Race-based disparities in atrial fibrillation (AF) treatment outcomes are prevalent, but little research has focused on the experiences of Black individuals living with AF.
  • The study involved three virtual focus groups with 16 participants, primarily Black males, to explore their challenges and themes related to managing AF.
  • Key findings revealed that AF poses significant physical and mental burdens, is hard to manage, and highlights the importance of self-education, community support, and strong patient-provider relationships for effective self-management.
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As high-speed internet becomes increasingly important as a resource for cardiovascular disease (CVD) prevention and management services, gaps in digital infrastructure may have detrimental impact on health outcomes. Using national census and CDC data from 2018 we evaluated state-level rates of household internet access and age-adjusted cardiac mortality. After adjusting for state level demographic variables, and rates of education, income, and health insurance, internet access rates were inversely associated with age adjusted CVD mortality, showing that the potential for internet access to affect CVD management deserves further study.

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Purpose Of Review: Health literacy is fundamental to primary and primordial prevention of atherosclerotic vascular disease (ASCVD) in children and adolescents. Here we summarize essential components of interventions which address health literacy challenges to reduce ASCVD risk in youth.

Recent Findings: There is a global pandemic of suboptimal health behaviors among youth that may contribute to the increasing rates of ASCVD worldwide.

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Background: The implications of coronavirus disease 2019 (COVID-19) infection on outcomes after invasive therapeutic strategies among patients presenting with acute myocardial infarction (AMI) are not well studied.

Hypothesis: To assess the outcomes of COVID-19 patients presenting with AMI undergoing an early invasive treatment strategy.

Methods: This study was a cross-sectional, retrospective analysis of the National COVID Cohort Collaborative database including all patients presenting with a recorded diagnosis of AMI (ST-elevation myocardial infarction (MI) and non-ST elevation MI).

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Background: Myocardial perfusion is an important determinant of cardiac function. We hypothesized that low coronary perfusion pressure (CPP) would be associated with adverse outcomes in heart failure. Myocardial perfusion impacts the contractile efficiency thus a low CPP would signal low myocardial perfusion in the face of increased cardiac demand as a result of volume overload

Methods: We analyzed patients with complete hemodynamic data in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial using Cox Proportional Hazards regression for the primary outcome of the composite risk of death, heart transplantation, or left ventricular assist device [(LVAD).

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Article Synopsis
  • The study investigates how annual household income affects access to and adherence to sacubitril/valsartan medication among insured patients with heart failure with reduced ejection fraction (HFrEF).
  • Researchers found that patients with lower incomes (under $40,000) were significantly less likely to obtain this medication within six months of diagnosis compared to those with higher incomes (over $100,000).
  • Additionally, lower income levels were linked to poorer adherence to the medication, as measured by the proportion of days covered.
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Patients with heart failure (HF) are heterogeneous with various intrapersonal and interpersonal characteristics contributing to clinical outcomes. Bias, structural racism, and social determinants of health have been implicated in unequal treatment of patients with HF. Through several methodologies, artificial intelligence (AI) can provide models in HF prediction, prognostication, and provision of care, which may help prevent unequal outcomes.

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Objective: Recent data indicate social determinants of health (SDOH) have a great impact on prevention and treatment outcomes across a broad variety of disease states, especially cardiovascular diseases. The area deprivation index (ADI) is a validated measure of neighborhood level disadvantage capturing key social determinate factors. Abdominal aortic aneurysm rupture (rAAA) is highly morbid, but also preventable through evidence-based screening.

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Background: Patients admitted with decompensated heart failure (HF) are at risk for hospital readmission and poor quality of life during the discharge period. Lifestyle behavior modifications that promote the self-management of chronic cardiac diseases have been associated with an improved quality of life. However, whether a mobile health (mHealth) program can assist patients in the self-management of HF during the acute posthospital discharge period is unknown.

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