Browsing by Author "Arling, Gregory"

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    Receipt of cardiac screening does not influence 1-year post-cerebrovascular event mortality
    (Wolters Kluwer, 2018-06) Sico, Jason J.; Baye, Fitsum; Myers, Laura J.; Concato, John; Ferguson, Jared; Cheng, Eric M.; Jadbabaie, Farid; Yu, Zhangsheng; Arling, Gregory; Zillich, Alan J.; Reeves, Matthew J.; Williams, Linda S.; Bravata, Dawn M.; Biostatistics, School of Public Health
    Background: American Heart Association/American Stroke Association expert consensus guidelines recommend consideration of cardiac stress testing to screen for occult coronary heart disease (CHD) among patients with ischemic stroke/TIA who have a high-risk Framingham Cardiac Risk Score (FCRS). Whether this guideline is being implemented in routine clinical practice, and the association of its implementation with mortality, is less clear. Methods: Study participants were Veterans with stroke/TIA (n = 11,306) during fiscal year 2011 who presented to a VA Emergency Department or who were admitted. Patients were excluded (n = 6,915) based on prior CHD/angina/chest pain history, receipt of cardiac stress testing within 18 months prior to cerebrovascular event, death within 90 days of discharge, discharge to hospice, transfer to a non-VA acute care facility, or missing/unknown race. FCRS ≥20% was classified as high risk for CHD. ICD-9 and Common Procedural Terminology codes were used to identify receipt of any cardiac stress testing. Results: Among 4,391 eligible patients, 62.8% (n = 2,759) had FCRS ≥20%. Cardiac stress testing was performed infrequently and in similar proportion among high-risk (4.5% [123/2,759]) vs low/intermediate-risk (4.4% [72/1,632]) patients (adjusted odds ratio [aOR] 0.77, 95% confidence interval [CI] 0.54-1.10). Receipt of stress testing was not associated with reduced 1-year mortality (aOR 0.59, CI 0.26-1.30). Conclusions: In this observational cohort study of patients with cerebrovascular disease, cardiac screening was relatively uncommon and was not associated with 1-year mortality. Additional work is needed to understand the utility of CHD screening among high-risk patients with cerebrovascular disease.
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    State Policy Responses to COVID-19 in Nursing Homes
    (LSE Press, 2021) Van Houtven, Courtney; Miller, Katherine; Gorges, Rebecca; Campbell, Hilary; Dawson, Walter; McHugh, John; McGarry, Brian; Gilmartin, Ryan; Boucher, Nathan; Kaufman, Brystana; Chisholm, Latarsha; Beltran, Susanny; Fashaw, Shekinah; Wang, Xiaochuan; Reneau, Olivia; Chun, Alice; Jacobs, Josephine; Abrahamson, Kathleen; Unroe, Kathleen; Bishop, Christine; Arling, Gregory; Kelly, Sheila; Werner, Rachel M.; Konetzka, R. Tamara; Norton, Edward C.; Medicine, School of Medicine
    Context: COVID-19 has a high case fatality rate in high-risk populations and can cause severe morbidity and high healthcare resource use. Nursing home residents are a high-risk population; they live in congregate settings, often with shared rooms, and require hands-on care. Objectives: To assess state responses to the coronavirus pandemic related to nursing homes in the first half of 2020. Methods: An in-depth examination of 12 states’ responses to the COVID-19 pandemic in nursing homes through June 2020, using publicly reported information such as government decrees, health department guidance, and news reports. Findings: No state emerged as a model of care. All states faced difficulty with limited availability of testing and Personal Protective Equipment (PPE). State-level efforts to increase pay and benefits as a strategy to enable infected staff to quickly physically separate from residents were minimal, and other separation strategies depended on the ability to obtain test results rapidly and on state rules regarding accepting discharged COVID-19 patients into nursing homes. Visitor restrictions to reduce risk were ubiquitous, though based on a slim evidence-base. Limitations: The information used was limited to that which was publicly available. Implications: Overall, the results suggest that the states that handle the ongoing pandemic in nursing homes best will be those that find ways to make sure nursing homes have the resources to follow best practices for testing, PPE, separation, and staffing. Evidence is needed on visitor restrictions and transmission, as states and their citizens would benefit from finding safe ways to relax visitor restrictions.