Publications by authors named "Julien H"

Background: Black patients, those with low socioeconomic status (SES), and those living in rural areas have elevated rates of major lower extremity amputation, which may be related to a lack of subspecialty chronic limb-threatening ischemia care. We evaluated the association between race, rurality, SES, and preamputation vascular care.

Methods: Among patients aged 66 to 86 years with fee-for-service Medicare who underwent major lower extremity amputation for chronic limb-threatening ischemia from July 2010 to December 2019, we compared the proportion who received vascular care in the 12 months before amputation by race (Black versus White), rurality, and SES (dual eligibility for Medicaid versus no dual eligibility) using multivariable logistic regression adjusting for clinical and demographic covariates.

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Background: Veterans are disproportionately more likely to experience homelessness and unstable housing (HUH) compared with the general population. Cardiovascular disease is the leading cause of death among Veterans experiencing HUH. We aimed to understand whether HUH status among Veterans with preexisting cardiovascular disease was associated with disparities in cardiovascular care access and utilization.

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Background: Hospital admissions for cardiogenic shock have increased in the United States. Temporary mechanical circulatory support (tMCS) can be used to acutely stabilize patients. We sought to evaluate the presence of racial, ethnic, and socioeconomic inequities in access to MCS in the United States among patients with cardiogenic shock.

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Use of peripheral vascular intervention (PVI) for intermittent claudication (IC) continues to expand, but there is uncertainty whether baseline demographics, procedural techniques and outcomes differ by sex, race, and ethnicity. This study aimed to examine amputation and revascularization rates up to 4 years after femoropopliteal (FP) PVI for IC by sex, race, and ethnicity. Patients who underwent FP PVI for IC between 2016 and 2020 from the PINC AI Healthcare Database were analyzed.

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Background: Thirty-day mortality is higher after urgent major lower extremity amputations compared to elective lower extremity amputations. This study aims to identify factors associated with urgent amputations and to examine their impact on perioperative outcomes and long-term mortality.

Methods: Patients undergoing major lower limb amputation from 2013 to 2020 in the Vascular Quality Initiative were included.

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  • This study analyzed the rates of permanent pacemaker (PPM) implantation following transcatheter aortic valve replacement (TAVR) across various hospitals from 2016 to 2020, revealing significant variations in implantation rates.
  • Overall, the PPM implantation rate was 11.3%, with some hospitals showing rates as low as 0% and others as high as 36.4%, but these rates have trended downward over the years.
  • Even after adjusting for patient characteristics and hospital factors like volume and teaching status, notable differences in PPM rates among hospitals persisted, suggesting further research is needed to understand the causes of these variations.
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Background: Racial residential segregation is associated with racial health inequities, but it is unclear if segregation may exacerbate Black-White disparities in cardiovascular disease (CVD) mortality. This study aimed to assess associations between Black-White residential segregation, CVD mortality rates among non-Hispanic (NH) Black and NH White populations, and Black-White disparities in CVD mortality.

Methods: This cross-sectional study analyzed Black-White residential segregation, as measured by county-level interaction index, of US counties, county-level CVD mortality among NH White and NH black adults aged 25 years and older, and county-level Black-White disparities in CVD mortality in years 2014 to 2017.

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  • The study analyzed the use of medical devices and outcomes related to lower extremity peripheral arterial interventions for different racial groups using data from the American College of Cardiology National Cardiovascular Data Registry from 2014 to 2019.
  • It found that while Black patients had higher rates of specific health conditions and socio-economic challenges, they received drug-eluting technologies more often than White patients, but there were no significant differences in the use of atherectomy or intravascular imaging.
  • Interestingly, Black patients were less likely to undergo surgical or repeat procedures after 1 year, although there were no differences in mortality or major amputations between the groups.
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Background Inequitable access to high-technology therapeutics may perpetuate inequities in care. We examined the characteristics of US hospitals that did and did not establish left atrial appendage occlusion (LAAO) programs, the patient populations those hospitals served, and the associations between zip code-level racial, ethnic, and socioeconomic composition and rates of LAAO among Medicare beneficiaries living within large metropolitan areas with LAAO programs. Methods and Results We conducted cross-sectional analyses of Medicare fee-for-service claims for beneficiaries aged 66 years or older between 2016 and 2019.

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  • Catheter ablation of ventricular arrhythmias from left ventricular papillary muscles can impact mitral valve function, which prompted this study to investigate the effects of lesions on mitral valve performance.
  • The study analyzed 103 patients from 2015 to 2020, assessing mitral valve regurgitation before and after radiofrequency ablation using echocardiograms.
  • Results showed that 99% of patients experienced no significant changes in mitral valve function post-procedure, indicating that the ablation can be performed safely without negatively affecting the mitral valve.
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  • * A study analyzing 3,386 patients from a university hospital system showed that men received guideline-directed lipid therapy (GDLT) significantly more often than women and achieved better LDL-c levels, while Black and Hispanic patients had high prescription rates but lower success in reaching optimal LDL-c levels.
  • * Overall, patients who effectively reduced their LDL-c levels below 70 mg/100 ml had higher GDLT prescription rates, highlighting the importance of adherence to lipid-l
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  • Racial and ethnic minorities, along with socioeconomically disadvantaged patients, are often underrepresented in clinical trials, prompting a need for better inclusivity efforts.
  • The study aimed to examine differences in the racial, ethnic, and socioeconomic demographics of patients at US hospitals participating in clinical trials for new transcatheter therapies versus those that did not.
  • Findings revealed that hospitals involved in trials had patients with higher average household incomes and lower levels of community distress, indicating disparities in access to clinical trial participation.
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  • Postpartum cardiovascular evaluations for women with preeclampsia are crucial for managing risk factors that could lead to long-term heart issues, yet many patients miss in-person follow-up visits.
  • A study compared completion rates for postpartum hypertension management via telemedicine versus traditional in-person visits, finding a 32% completion rate for in-person visits compared to 70% for telemedicine.
  • The results showed that younger and Black women were less likely to attend in-person visits, suggesting telemedicine could be a more effective way to reach and manage care for these at-risk populations.
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Importance: Randomized clinical trials have shown that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) cause significant weight loss and reduce cardiovascular events in patients with type 2 diabetes (T2D). Black patients have a disproportionate burden of obesity and cardiovascular disease and have a higher rate of cardiovascular-related mortality. Racial and ethnic disparities in health outcomes are largely attributable to the pervasiveness of structural racism, and patients who are marginalized by racism have less access to novel therapeutics.

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Background Violent crime has recently increased in many major metropolitan cities in the United States. Prior studies suggest an association between neighborhood crime levels and cardiovascular disease, but many have been limited by cross-sectional designs. We investigated whether longitudinal changes in violent crime rates are associated with changes in cardiovascular mortality rates at the community level in one large US city-Chicago, IL.

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  • Telemedicine use surged in the U.S. during the COVID-19 pandemic, but access disparities among disadvantaged groups raised concerns due to limited studies.
  • A retrospective analysis of data from over 1.9 million patients revealed only 21.6% engaged in telemedicine from March to December 2020, indicating significant variability in access.
  • Factors influencing telemedicine utilization included lower odds for older patients and non-Hispanic Black individuals, while female gender and Hispanic ethnicity increased the odds, highlighting ongoing inequalities in access to telehealth services.
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Background: Black adults have a higher incidence of peripheral artery disease and limb amputations than White adults in the United States. Given that peripheral endovascular intervention (PVI) is now the primary revascularization strategy for peripheral artery disease, it is important to understand whether racial differences exist in PVI incidence and outcomes.

Methods: Data from fee-for-service Medicare beneficiaries ≥66 years of age from 2016 to 2018 were evaluated to determine age- and sex-standardized population-level incidences of femoropopliteal PVI among Black and White adults over the 3-year study period.

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Community colleges offer a unique context in higher education and yet specific guidance on implementing the ACRL in community colleges is lacking. Semi-structured interviews with 30 community college librarians who had instruction duties explored the state of the implementation of the in community colleges and the effect of the recent pandemic on information literacy instruction (ILI). The is most lauded for its effect on the design and delivery of instruction, but its components mainly underpin ILI rather than being explicitly taught.

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A modern approach to mitigating the impact of cardiovascular disease on Americans demands not only an understanding of modifiable conditions that contribute to its development but also a greater appreciation of the heterogeneous distribution of these conditions based on race. As race is not a biological construct, further research is needed to fully elucidate the mechanisms that contribute to these differences. The consequences of the differential impact of modifiable risk factors on cardiovascular disease outcomes among black Americans compared with white Americans cannot be understated.

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This pilot randomized clinical trial evaluates the increased uptake and acceptability of a text-based model for home blood pressure monitoring compared with online portal use among Black patients with Medicaid and Medicare insurance who have hypertension and cardiovascular disease.

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Clathrin mediated endocytosis is an essential and complex cellular process involving more than 60 proteins. In yeast, successful endocytosis requires counteracting a large turgor pressure. To this end, yeasts assemble actin patches, which accumulate elastic energy during their assembly.

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Article Synopsis
  • High-tech medical treatments like transcatheter aortic valve replacement (TAVR) may not be equally accessible, leading to healthcare disparities based on location and demographics.
  • This study analyzed Medicare data from 2012 to 2018 to determine how racial, ethnic, and socioeconomic factors at the zip code level influenced TAVR rates among patients in large U.S. metropolitan areas.
  • Findings revealed that lower median household incomes and higher rates of Medicaid dual eligibility were associated with fewer TAVR procedures performed per 100,000 Medicare beneficiaries, highlighting significant access issues for underserved communities.
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