Faculty Bibliography

BACKGROUND: Heart failure is among the most common reasons for hospitalizations in the United States. Recent data from Medicare suggest that the number of hospitalizations with a primary diagnosis of heart failure has declined over the past decade. However, heart failure may increase hospitalization rates for related comorbidities and individuals with heart failure are commonly admitted for other reasons. Using a nationally representative sample of hospital admissions, we studied trends in hospitalizations with both a primary and a secondary diagnosis of heart failure. METHODS: We evaluated trends in heart failure hospitalizations from 2001 to 2009 using the Nationwide Inpatient Sample (NIS), the largest all-payer inpatient database in the United States. We included hospitalizations with an International Classification of Diseases, Ninth Revision discharge diagnosis codes of 402.X1, 404.X1, 404.X3, 428.XX in any position; these codes in the primary position are used by The Centers for Medicare & Medicaid Services for reporting heart failure quality measures. Admissions were categorized as either primary heart failure hospitalization, if heart failure was the primary discharge code, or heart failure associated hospitalization, if heart failure was listed as a secondary diagnosis. National estimates of heart failure hospitalizations were calculated using the sampling weights and stratified sample design of the NIS. Yearly hospitalization rateswere determined by dividing the number of hospitalizations by the United States population in a given year. Population estimates were obtained from the United States Census Bureau. RESULTS: The total number of heart failure hospitalizations in the United States increased from 3,900,305 in 2001 to 4,398,376 in 2006 and then decreased to 4,253,937 in 2009. The number of primary heart failure admissions decreased from 1,139,607 in 2001 to 1,087,913 in 2009, while the number of heart failure associated hospitalizations increased from 2,760,698 to 3,166,024 over !

BACKGROUND: Despite evidence of a positive effect of collaborative patient-provider communication on patient outcomes, our understanding of this relationship is unclear. PURPOSE: The purpose of this paper is to determine whether racial composition of the relationship modified the association between ratings of provider communication and medication adherence. METHODS: Effect modification of the communication-adherence association, by racial composition of the relationship, was evaluated using general linear mixed models while adjusting for selected covariates. RESULTS: Three hundred ninety patients were in race-concordant (black patient, black provider) relationships, while 207 were in race-discordant (black patient, white provider) relationships. The communication-adherence association was significantly modified in race-discordant relationships (p = 0.04). Communication rated as more collaborative in race-discordant relationships was associated with better adherence, while communication rated as less collaborative was associated with poor adherence. There was no significant association between adherence and communication in race-concordant relationships (p = 0.24). CONCLUSIONS: Collaborative patient-provider communication may play an influential role in black patients' adherence behaviors when receiving care from white providers

OBJECTIVE: To assess whether functional capacity is a better predictor of coronary heart disease (CHD) than depression or abnormal sleep duration. METHODS: Adult civilians in the USA (n=29,818, mean age 48+/-18years, range 18-85years) were recruited by a cross-sectional household interview survey using multistage area probability sampling. Data on chronic conditions, estimated habitual sleep duration, functional capacity, depressed moods, and sociodemographic characteristics were obtained. RESULTS: Thirty-five percent of participants reported reduced functional capacity. The CHD rates among White and Black Americans were 5.2% and 4%, respectively. Individuals with CHD were more likely to report extreme sleep durations (short sleep [5h] or long sleep [9h]; odds ratio [OR] 1.65, 95% confidence interval [CI] 1.38-1.97; P<0.0001), less likely to be functionally active (anchored by the ability to walk one-quarter of a mile without assistance [OR 6.27, 95% CI 5.64-6.98; P<0.0001]) and more likely to be depressed (OR 1.78, 95% CI 1.60-1.99; P<0.0001) than their counterparts. On multivariate regression analysis adjusting for sociodemographic factors and health characteristics, only functional capacity remained an independent predictor of CHD (OR 1.81, 95% CI 1.42-2.31; P<0.0001). CONCLUSION: Functional capacity was an independent predictor of CHD in the study population, whereas depression and sleep duration were not independent predictors.

OBJECTIVE: To determine the morbidity and mortality in adult in-patients with stroke admitted to the Komfo Anokye Teaching Hospital (KATH). METHODS: A retrospective study of in-patients with stroke admitted to the KATH, from January 2006 to december 2007 was undertaken. Data from admission and discharge registers were analysed to determine stroke morbidity and mortality. RESULTS: Stroke constituted 9.1% of total medical adult admissions and 13.2% of all medical adult deaths within the period under review. The mean age of stroke patients was 63.7 (95% ci=62.8, 64.57) years. Males were younger than females. The overall male to female ratio was 1:0.96, and the age-adjusted risk of death from stroke was slightly lower for females than males (relative risk= 0.88; 95% ci=0.79, 1.02, p=0.08). The stroke case fatality rate was 5.7% at 24 hours, 32.7% at 7 days, and 43.2% at 28 days. CONCLUSION: Stroke constitutes a significant cause of morbidity and mortality in Ghana. Major efforts are needed in the prevention and treatment of stroke. Population-based health education programs and appropriate public health policy need to be developed. This will require a multidisciplinary approach of key players with a strong political commitment. There is also a clear need for further studies on this topic including, for example, an assessment of care and quality of life after discharge from hospital. The outcomes of these studies will provide important information for the prevention efforts.

BACKGROUND:Hypertension is becoming a common health problem worldwide with increasing life expectancy and increasing prevalence of risk factors. Epidemiological data on hypertension in Ghana is necessary to guide policy and develop effective interventions. METHODS:A review of population-based studies on hypertension in Ghana was conducted by a search of the PUBMED database, supplemented by a manual search of bibliographies of the identified articles and through the Ghana Medical Journal. A single reviewer extracted data using standard data collection forms. RESULTS:Eleven studies published on hypertension with surveys conducted between 1973 and 2009 were identified. The prevalence of hypertension was higher in urban than rural areas in studies that covered both types of area and increased with increasing age (prevalence ranging from 19.3% in rural to 54.6% in urban areas). Factors associated with high blood pressure included increasing body mass index, increased salt consumption, family history of hypertension and excessive alcohol intake. The levels of hypertension detection, treatment and control were generally low (control rates ranged from 1.7% to 12.7%). CONCLUSION/CONCLUSIONS:An increased burden of hypertension should be expected in Ghana as life expectancy increases and with rapid urbanisation. Without adequate detection and control, this will translate into a higher incidence of stroke and other adverse health outcomes for which hypertension is an established risk factor. Prevention and control of hypertension in Ghana is thus imperative and any delays in instituting preventive measures would most likely pose a greater challenge on the already overburdened health system.

BACKGROUND:Ghana's health system is ill-equipped to tackle the country's double burden of infectious and chronic diseases. The current focus is on empowering lay communities to adopt healthy practices to prevent chronic diseases. Understanding how individuals make sense of health, illness and chronic illnesses is an important first step to developing practical interventions. METHODS:Six focus group discussions with lay people (N= 51) in Accra, Nkoranza and Kintampo to explore: (1) knowledge of prevalent chronic diseases in Ghana; (2) chronic disease causal theories; and (3) chronic disease treatment. RESULTS:Nineteen conditions were listed cumulatively. Diabetes and hypertension were listed by all groups. Rural groups included HIV/AIDS on their list as well as diseases with alleged spiritual roots, in particular epilepsy and sickle cell disease. Multiple causal theories were presented for diabetes and hypertension; cancers were attributed to toxic foods; asthma attributed to environmental pollution. Biomedical care was preferred by the majority. Lay representations were drawn from multiple sources: medical professionals and chronically ill individuals were the most legitimate knowledge sources. CONCLUSION/CONCLUSIONS:This study provides insights on how lay representations of common chronic diseases and their major risk factors provide public health specialists with the conceptual tools to develop primary prevention strategies. The first challenge will be to train health experts to provide accurate information in practical language that lay people can understand and apply to their daily lives. A second challenge will be to develop sustainable behaviour-change interventions. Best practices from other African countries can inform interventions in Ghana.

BackgroundBlood pressure screening is an important component of cardiovascular disease prevention, but a hypertension diagnosis (i.e., label) can have unintended negative effects on patients' well-being. Despite persistent disparities in hypertension prevalence and outcomes, whether the impact of labeling differs by race is unknown. The purpose of this study was to evaluate possible race differences in the relationship between hypertension labeling and health-related quality of life and depression.MethodsThe sample included 308 normotensive and unmedicated hypertensive subjects from the Neighborhood Study of Blood Pressure and Sleep, a cross-sectional study conducted between 1999 and 2003. Labeled hypertension was defined (by self-report) as having been diagnosed with high blood pressure or prescribed antihypertensive medications. Effects of labeling and race on self-reported physical and mental health and depressive symptoms were tested using multivariate analysis of covariance, controlling for age, sex, body mass index (BMI), previous medication use, and "true" hypertension status, defined by average daytime ambulatory blood pressure (ABP).ResultsBoth black and white subjects who had been labeled as hypertensive reported similarly poorer physical health than unlabeled subjects (P = 0.001). However, labeling was associated with poorer mental health and greater depressive symptoms only among blacks (Ps < 0.05 for the interactions). These findings were not explained by differences in socioeconomic status.ConclusionsThese results are consistent with previous studies showing negative effects of hypertension labeling, and demonstrate important race differences in these effects. Clinical approaches to communicating diagnostic information that avoid negative effects on well-being are needed, and may require tailoring to patient characteristics such as race.American Journal of Hypertension 2012; doi:10.1038/ajh.2011.258.

J Clin Hypertens (Greenwich). 2012;14:250-255. (c)2012 Wiley Periodicals, Inc. The problem of medication adherence is pronounced in hypertensive black men. However, factors influencing their adherence are not well understood. This secondary analysis of the ongoing Counseling African Americans to Control Hypertension (CAATCH) randomized clinical trial investigated the patient, provider, and health care system factors associated with medication adherence among hypertensive black men. Participants (N=253) were aged 56.6+/-11.6 years, earned <$20,000 yearly (72.7%), and almost one half were on Medicaid (44%). Mean systolic blood pressure was 148.7+/-15.8 mm Hg and mean diastolic blood pressure was 92.7+/-9.8 mm Hg. Over one half of participants (54.9%) were nonadherent. In a hierarchical regression analysis, the patient factors that predicted medication adherence were age, self-efficacy, and depression. The final model accounted for 32.1% of the variance (F=7.80, df 10, 165, P<.001). In conclusion, age, self-efficacy, and depression were associated with antihypertensive medication adherence in black men followed in Community/Migrant Health Centers. Age is a characteristic that may allow clinicians to predict who may be at risk for poor medication adherence. Depression can be screened for and treated. Self-efficacy is modifiable and its implications for practice would be the development of interventions to increase self-efficacy in black men with hypertension.

Objectives: In spite of gains in hypertension awareness and treatment among African-Americans (AAs) over the past two decades, the proportion of AAs who achieve control still lags behind other groups. In 2004, NHLBI funded five projects to evaluate clinically feasible interventions in health care settings to increas the proportion of AA patients with controlled BP. Three of the groups collaborated to perform a pooled analysis of their trial results to: (1) determine whether small intervention effects seen in the individual trials were significant in the pooled sample; and (2) identify trends that could inform the design of future health-system level BP interventions. Methods: Each trial enrolled AAs with uncontrolled hypertension and targeted both patient and clinician behaviors to reduce BP. Randomization was by cluster. We used mixed effects longitudinal regression to assess the 12-month effect on SBP and

Introduction: Lifestyle changes of modernization, increased automation, dietary changes and related events have contributed to increased prevalence of heart disease worldwide. Rate of heart disease among