Integrating a diet quality screener into a cardiology practice: assessment of nutrition counseling, cardiometabolic risk factors and patient/provider satisfaction
Objective/UNASSIGNED:We assessed factors related to the integration of an office-based diet quality screener: nutrition counselling, cardiometabolic risk factors and patient/physician satisfaction. Methods/UNASSIGNED:We evaluated the impact of a 10-item diet quality measure (self-rated diet quality question and a 9-item Mediterranean Diet Score (MDS)) prior to the cardiology visit on assessment of nutrition counselling, cardiometabolic risk factors and patient/provider satisfaction. Study staff trained the nine participating physicians on the purpose and use of the screener. To assess physician uptake of the diet quality screener, we reviewed all charts having a documented dietitian referral or visit and a 20% random sample of remaining participants that completed the screener at least once to determine the proportion of notes that referenced the diet quality screener and documented specific counselling based on the screener. Results/UNASSIGNED:. Almost one-fifth (18.5%) of participants rated their diet as fair or poor, and mean MDS (range 0-9) was moderate (mean 5.6Â±1.8â€‰SD). Physicians referred 22 patients (2.5%) to a dietitian. Conclusion/UNASSIGNED:Integrating the screener into the electronic health record did not increase dietitian referrals, and improvements in screener scores were modest among the subset of patients completing multiple screeners. Future work could develop best practices for physicians in using diet quality screeners to allow for some degree of standardisation of nutrition referral and counselling received by the patients.
Evaluating the Utility of a Diet Quality Screener in Clinical Practice to Improve Quality of Preventive Care (P07-002-19)
Objectives/UNASSIGNED:To assess the impact of an office based dietary screener aimed to improve dietary counseling for the cost effective improvement of patient health. Methods/UNASSIGNED:Ã‚ =Ã‚ 190) to determine the proportion of notes that referenced the dietary screener and documented specific counseling based on the screener. Results/UNASSIGNED:. 18.5% of participants rated their diet as fair or poor, and mean score on the screener (range 0-9) was 5.6 (SD 1.8). Overall, the diet screener appeared in the chart in 87%, the physician gave specific counseling based on the screener in 11% of the visits. Conclusions/UNASSIGNED:Findings from this work demonstrate a dietary screener can facilitate identification of patients who might benefit from specific interventions such as the Diabetes Prevention Program. Since cardiovascular disease is just one diet-influenced disease state, this screener could be implemented in other aspects of the health system to guide referrals to RDs for patients with other diet-related disease states. Funding Sources/UNASSIGNED:This work was funded by the Center for Healthcare Innovation and Delivery Sciences at NYU Langone Health. Supporting Tables Images and/or Graphs/UNASSIGNED/:
Enhanced external counterpulsation (EECP) improves biomarkers of glycemic control in patients with non-insulin-dependent type II diabetes mellitus for up to 3Â months following treatment
AIMS/OBJECTIVE:The purpose of the present study was to evaluate the potential clinical benefits of EECP on glycemic parameters [fasting plasma glucose (FPG), postprandial glucose (PPG120), glycosylated hemoglobin (HbA1c)] in patients with a clinical diagnosis of type II diabetes mellitus (T2DM). METHODS:Thirty subjects (60.7Â Â±Â 1.9Â years) with T2DM were randomly assigned (2:1 ratio) to receive either 35 1-h sessions of EECP (nÂ =Â 20) or time-matched control of standard care (nÂ =Â 10). FPG, PPG120, and HbA1c were evaluated before and at 48Â h, 2Â weeks, 3 and 6Â months following EECP treatment or time-matched control. RESULTS:EECP significantly decreased FPG (-14.6 and -12.0Â %), PPG120 (-14.6 and -13.5Â %), and HbA1c (-11.5 and -19.6Â %) 48Â h following EECP and 2Â weeks following EECP, respectively. HbA1c remained significantly reduced at 3Â months following EECP (-14.3Â %). The homeostasis model assessment of insulin resistance (-31.1Â %) and whole-body composite insulin sensitivity index (+54.2Â %) were significantly improved 48Â h following EECP. Nitrite/nitrate (NO x ) was significantly increased 48Â h following EECP (+48.4Â %) and 2Â weeks (+51.9Â %) following EECP treatment. CONCLUSIONS:Our findings provide novel evidence that EECP improves glycemic control in patients with T2DM that persist for up to 3Â months following treatment.
Enhanced external counterpulsation (EECP) decreases advanced glycation end products and proinflammatory cytokines in patients with non-insulin-dependent type II diabetes mellitus for up to 6Â months following treatment
AIMS/OBJECTIVE:Enhanced external counterpulsation (EECP) is a noninvasive, non-pharmacologic intervention proven to increase nitric oxide bioavailability in patients with coronary artery disease. The purpose of the present study was to evaluate the potential clinical benefits of EECP on advanced glycation end products (AGEs) and proinflammatory cytokine concentrations in patients with a clinical diagnosis of type II diabetes mellitus (T2DM). METHODS:Thirty subjects (60.7Â Â±Â 1.9Â years) with T2DM were randomly assigned (2:1 ratio) to receive either 35 1-h sessions of EECP (nÂ =Â 20) or time-matched standard care (nÂ =Â 10). AGEs, receptors for AGEs (RAGEs), soluble vascular cell adhesion molecules-1 (sVCAM-1), and 8-iso-prostaglandin 2Î± (8-iso-PGF2Î±) were evaluated before and at 48Â h, 2Â weeks, 3, and 6Â months following EECP treatment or time-matched control. RESULTS:EECP significantly decreased AGEs and RAGEs at all follow-up measurement time points. AGEs and RAGEs were decreased at 48Â h (-75 and -16Â %), 2Â weeks (-87 and -28Â %), 3Â months (-89 and -29Â %), and 6Â months (-92 and -20Â %) following EECP treatment, respectively. sVCAM-1 and 8-iso-PGF2Î± were significantly decreased at 48Â h (-30 and -49Â %) and 2Â weeks (-22 and -27Â %) following EECP, respectively. sVCAM-1 (-27Â %) remained significantly reduced at 3Â months following EECP. Nitrite/nitrate (NOx) was significantly increased at 48Â h (+48.4Â %) and 2Â weeks (+51.9Â %) following EECP treatment. CONCLUSIONS:Our findings provide novel evidence that EECP decreases AGE/RAGE concentrations, inflammation, and oxidative stress in patients with T2DM that persist for up to 6Â months following treatment.
Enhanced external counterpulsation reduces indices of central blood pressure and myocardial oxygen demand in patients with left ventricular dysfunction
Enhanced external counterpulsation (EECP) therapy decreases angina episodes and improves quality of life in patients with left ventricular (LV) dysfunction. However, the underlying mechanisms relative to the benefits of EECP therapy in patients with LV dysfunction have not been fully elucidated. The purpose of this study was to investigate the effects of EECP on indices of central haemodynamics, aortic pressure wave reflection characteristics, and estimates of LV load and myocardial oxygen demand in patients with LV dysfunction. Patients with chronic stable angina and LV ejection fraction < 40% but > 30%, were randomized to either an EECP group (LV ejection fraction = 35.1 Â± 4.6%; n = 10) or sham-EECP group (LV ejection fraction = 34.3 Â± 4.2%; n = 7). Pulse wave analysis of the central aortic pressure waveform and LV function were evaluated by applanation tonometry before and after 35 1-h sessions of EECP or sham-EECP. Enhanced external counterpulsation therapy was effective in reducing indices of LV wasted energy and myocardial oxygen demand by 25% and 19%, respectively. In addition, indices of coronary perfusion pressure and subendocardial perfusion were increased by 9% and 30%, respectively, after EECP. Our data indicate that EECP may be useful as adjuvant therapy for improving functional classification in heart failure patients through reductions in central blood pressure, aortic pulse pressure, wasted LV energy, and myocardial oxygen demand, which also suggests improvements in ventricular-vascular interactions.
Enhanced external counterpulsation improves endothelial function and exercise capacity in patients with ischaemic left ventricular dysfunction
Enhanced external counterpulsation (EECP) therapy decreases angina episodes and improves quality of life in patients with left ventricular (LV) dysfunction (LVD). However, studies have not elucidated the mechanisms of action and overall effects of EECP in patients with LVD. The purpose of the present study was to investigate the effects of EECP on endothelial function in peripheral conduit arteries and exercise capacity (peak Vo2 ) in patients with LVD. Patients with ischaemic LVD (ejection fraction (EF) 34.5Â Â±Â 4.2%; nÂ =Â 9) and patients with symptomatic coronary artery disease (CAD) and preserved LV function (EF 53.5Â Â±Â 6.6%; nÂ =Â 15) were studied before and after 35 sessions (1Â h) of EECP. Brachial and femoral artery flow-mediated dilation (bFMD and fFMD, respectively) were evaluated using high-resolution ultrasound. Enhanced external counterpulsation elicited similar significant improvements in the following FMD parameters in the CAD and LVD groups (PÂ â‰¥Â 0.05 between groups for all): absolute bFMD (+53% and +70%, respectively), relative bFMD (+50% and +74%, respectively), bFMD normalized for shear rate (+70% and +61%, respectively), absolute fFMD (+33% and +21%, respectively) and relative fFMD (+32% and +17%, respectively). In addition, EECP significantly improved plasma levels of nitrate/nitrite (+55% and +28%) and prostacyclin (+50% and +70%), as well as peak Vo2 (+36% and +21%), similarly in both the CAD and LVD groups (PÂ â‰¥Â 0.05 between groups for all). Despite reduced LV function, EECP therapy significantly improves peripheral vascular function and functional capacity in CAD patients with ischaemic LVD to a similar degree to that seen in CAD patients with preserved LV function.
Enhanced external counterpulsation improves peripheral resistance artery blood flow in patients with coronary artery disease
Enhanced external counterpulsation (EECP) increases coronary artery perfusion and improves endothelium-dependent vasodilation in peripheral muscular conduit arteries. It is unknown whether vasodilatory capacity is improved in the peripheral resistance vasculature. Here we provide novel evidence from the first randomized, sham-controlled study that EECP increases peak limb blood flow and improves endothelium-dependent vasodilation in both calf and forearm resistance arteries in patients with coronary artery disease.
Enhanced External Counterpulsation Improves Limb Blood Flow in Patients with Coronary Artery Disease [Meeting Abstract]