Publications by authors named "Shannon Knapp"
Article Synopsis
- There is no uniform guideline for listing heart transplant patients who use cannabis, leading to differing opinions among clinicians.
- A survey of 140 healthcare providers showed that those in states where cannabis is legal are more lenient regarding its use prior to listing for transplant, emphasizing the need for standardized screening tools.
- The majority of clinicians from illegal cannabis states are less supportive of cannabis use in transplant candidates compared to those from legal states, highlighting significant disparities in practice and policies.
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.
Aims: Racial disparities exist in clinical outcomes for valvular heart disease (VHD). It is unknown whether clinician segregation contributes to these disparities. Among an adequately insured population, we evaluated the relationship between clinician segregation in a hospital and receipt of care by a cardiologist according to patient race.
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- The study investigates the impact of race and gender on heart transplant acceptance rates among candidates, focusing on disparities between Black and White individuals.
- It analyzed data from the United Network for Organ Sharing from 2018 to 2023, noting that Black candidates were significantly less likely to accept heart offers than White candidates.
- Results indicated that acceptance odds for Black candidates were consistently lower across multiple offers, while women overall had higher acceptance rates than men, highlighting notable inequities in heart transplant opportunities.
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.
View Article and Find Full Text PDFBackground & Aims: The hospital frailty risk score (HFRS) identifies older patients at risk of poor outcomes and may have value in cirrhosis. We compared the Charlson (CCI), Elixhauser (ECI), and cirrhosis (CirCom) comorbidity indices with the HFRS in predicting outcomes for cirrhosis hospitalisations.
Methods: Using the National Inpatient Sample (quarter 4 of 2015-2019), we analysed cirrhosis hospitalisations.
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.
Article Synopsis
- This study investigates the relationship between race and ethnicity and the receipt of lifesaving procedures for patients with decompensated cirrhosis in the US over a decade, from 2009 to 2018.
- The research utilized data from the National Inpatient Sample, focusing on hospitalized patients with complications related to portal hypertension and analyzed the trends in treatment accessibility and mortality rates among different racial and ethnic groups.
- Findings show that among a significant number of hospital admissions, there are noteworthy disparities in the procedure rates for Black and Hispanic patients, suggesting ongoing racial inequities in medical interventions for cirrhosis.
Background: Durable left ventricular assist devices (VADs) improve survival in eligible patients, but allocation has been associated with patient race in addition to presumed heart failure (HF) severity.
Objectives: This study sought to determine racial and ethnic differences in VAD implantation rates and post-VAD survival among patients with ambulatory HF.
Methods: Using the INTERMACS (Interagency Registry of Mechanically Assisted Circulatory Support) database (2012-2017), this study examined census-adjusted VAD implantation rates by race, ethnicity, and sex in patients with ambulatory HF (INTERMACS profile 4-7) using negative binomial models with quadratic effect of time.
The objective of this study was to assess the overall differences in the standard of preventive foot care for patients at risk of diabetic foot ulceration and to identify specific demographic factors affecting these health care practices, including race and ethnicity. The National Health and Nutrition Examination Survey data for 2011 to 2018 were analyzed. Participants (20 years and older) with diabetes were categorized as White, Black, Hispanic, Asian, and others (including multiracial participants) based on self-reported race and ethnicity.
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- Advanced heart failure (AHF) therapy often faces biases that impact how resources are allocated, so a study tested a targeted training strategy to improve equity in this process.
- The 8-week program included training on bias reduction, standardized assessments, and enhanced teamwork, with evaluations conducted through surveys and meeting transcripts to measure outcomes.
- Results indicated positive changes in group dynamics and equity promotion, with conclusions supporting the strategy's feasibility for organizational change and potential application beyond AHF.
Article Synopsis
- The study examines how group dynamics in advanced heart failure therapy (AHFT) decision-making can lead to potential biases against women and minorities.
- Researchers analyzed audio recordings from meetings at four AHFT centers to evaluate the quality of decision-making processes using specific metrics.
- Findings indicate that improved group function correlates with higher allocation rates for women in AHFT, suggesting a need for better decision-making practices to reduce disparities in treatment allocation.
Race and Gender-Based Perceptions of Older Septuagenarian Adults.
Womens Health Rep (New Rochelle)
November 2022
Objectives: Older adults face racism, sexism, and ageism. As the U.S.
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- Black and Hispanic patients are less likely to receive cardiac resynchronization therapy (CRT) compared to White patients, despite Medicaid expansion improving access to cardiovascular care for underinsured racial and ethnic groups.
- A study analyzed data from 19 states to see how Medicaid expansion affected CRT rates, finding no significant change for Black or Hispanic patients, but a notable 34% increase in CRT rates among White individuals in states that adopted Medicaid expansion.
- The findings suggest that Medicaid expansion successfully improved CRT access for White patients but did not alleviate disparities faced by Black and Hispanic patients, indicating a need for further research to tackle these inequities.
Article Synopsis
- In 2018, UNOS expanded the matching radius for heart transplant candidates, leading to a study evaluating its impact on waitlist times and post-transplant outcomes across different population settings (rural, micropolitan, and metropolitan).
- The study analyzed data from 8,747 adult patients listed for heart transplants, revealing that metropolitan and micropolitan patients received transplants earlier after the policy change, while rural patients did not see significant changes.
- There was no significant difference in the risk of death after transplantation across different population densities following the policy change.
Importance: It is not known whether implementation of Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) was associated with improvements in the outcomes among racial and ethnic minority adults at risk of diabetes-related major amputations.
Objective: To explore the association of early Medicaid expansion with outcomes of diabetic foot ulcerations (DFUs).
Design, Setting, And Participants: This cohort study included hospitalizations for DFUs among African American, Asian and Pacific Islander, American Indian or Alaska Native, and Hispanic adults as well as adults with another minority racial or ethnic identification aged 20 to 64 years.
Background: The U.S. National Library of Medicine and Department of Homeland Security assembled subject matter experts (SMEs) for the Toxic Chemical Syndrome Definitions and Nomenclature Workshop.
View Article and Find Full Text PDFThe jury is still out on whether a low-carbohydrate, ketosis-inducing diet is an effective and safe adjunctive therapy to insulin in type 1 diabetes. The limited published literature reports an association with weight loss and improved glycemic control and may, over the long-term, lead to reduced macrovascular and microvascular harm. However, the attendant increased risk of dyslipidemia, diabetic ketoacidosis, and hypoglycemia warrant caution, close monitoring of patients who embark on the diet, and further research.
View Article and Find Full Text PDFBackground The majority of living organ donors are women, but few are deceased organ donors, which increases risks associated with sex mismatched organs. We sought to identify reasons for sex disparities in organ donation and strategies for equity. Methods and Results Using Amazon's Mechanical Turk, we examined US adults' perceptions regarding donation in a mixed-methods survey study.
View Article and Find Full Text PDFIntroduction: With increasing burden of obesity and liver disease in the United States, a better understanding of bariatric surgery in context of cirrhosis is needed. We described trends of hospital-based outcomes of bariatric surgery among cirrhotics and determined effect of volume status and type of surgery on these outcomes.
Methods: In this population-based study, admissions for bariatric surgery were extracted from the National Inpatient Sample using International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes from 2004 to 2016 and grouped by cirrhosis status, type of bariatric surgery, and center volume.
Objectives: To examine health outcomes associated with adherence to Healthcare Effectiveness Data and Information Set (HEDIS) antidepressant medication management (AMM) during acute and continuation phases of depression treatment among older adults with dementia and major depressive disorder (MDD).
Design: Retrospective cohort study.
Setting: Medicare 5% sample data (2011-2013).
Importance: Racial bias is associated with the allocation of advanced heart failure therapies, heart transplants, and ventricular assist devices. It is unknown whether gender and racial biases are associated with the allocation of advanced therapies among women.
Objective: To determine whether the intersection of patient gender and race is associated with the decision-making of clinicians during the allocation of advanced heart failure therapies.