Browsing by Author "Essien, Utibe R."

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    Creation of the American Heart Association Journals Equity, Diversity, and Inclusion Editorial Board: Next Step to Achieving 2024 Impact Goal
    (American Heart Association, 2022) Lewis, Eldrin F.; Beatty, Christine; Boltze, Johannes; Breathett, Khadijah; Clair, Walter K.; de las Fuentes, Lisa; Essien, Utibe R.; Goodell, Heather; Hinson, H. E.; Kershaw, Kiarri N.; Knowles, Joshua W.; Mazimba, Sula; Mujahid, Mahasin; Okafor, Henry E.; Park, Kyung Woo; Schultz, Jonathan; Medicine, School of Medicine
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    Relation of household income to access and adherence to combination sacubitril/valsartan in heart failure: a retrospective analysis of commercially insured patients
    (American Heart Association, 2022) Johnson, Amber E.; Swabe, Gretchen M.; Addison, Daniel; Essien, Utibe R.; Breathett, Khadijah; Brewer, LaPrincess C.; Mazimba, Sula; Mohammed, Selma F.; Magnani, Jared W.; Medicine, School of Medicine
    Background: Outcomes in heart failure with reduced ejection fraction (HFrEF) are influenced by access and adherence to guideline-directed medical therapy. Our objective was to study the association between annual household income and: (1) the odds of having a claim for sacubitril/valsartan among insured patients with HFrEF and (2) medication adherence (measured as the proportion of days covered). We hypothesized that lower annual household income is associated with decreased odds of having a claim for and adhering to sacubitril/valsartan. Methods: Using the Optum de-identified Clinformatics Data Mart, patients with HFrEF and ≥6 months of enrollment for follow-up (2016-2020) were included. Covariates included age, sex, race, ethnicity, educational attainment, US region, number of prescribed medications, and Elixhauser Comorbidity Index. Prescription for sacubitril/valsartan was defined by the presence of a claim within 6 months of HFrEF diagnosis. Adherence was defined as proportion of days covered ≥80%. We fit multivariable-adjusted logistic regression models and hierarchical logistic regression accounting for covariates. Results: Among 322 007 individuals with incident HFrEF, 135 282 had complete data for analysis. Of the patients eligible for sacubitril/valsartan, 4.7% (6372) had a claim within 6 months of HFrEF diagnosis. Following multivariable adjustment, individuals in the lowest annual income category (<$40 000) were significantly less likely (odds ratio, 0.83 [95% CI, 0.76-0.90]) to have a sacubitril/valsartan claim within 6 months of HFrEF diagnosis than those in the highest annual income category (≥$100 000). Annual income <$40 000 was associated with lower odds of proportion of days covered ≥80% compared with income ≥$100 000 (odds ratio, 0.70 [95% CI, 0.59-0.83]). Conclusions: Lower household income is associated with decreased likelihood of a sacubitril/valsartan claim and medication adherence within 6 months of HFrEF diagnosis, even after adjusting for sociodemographic and clinical factors. Future analyses are needed to identify additional social factors associated with delays in sacubitril/valsartan initiation and long-term adherence.
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    The Groundwater of Racial and Ethnic Disparities Research. A Statement from Circulation: Cardiovascular Quality & Outcomes
    (American Heart Association, 2021) Breathett, Khadijah; Spatz, Erica S.; Kramer, Daniel B.; Essien, Utibe R.; Wadhera, Rishi K.; Peterson, Pamela N.; Ho, P. Michael; Nallamothu, Brahmajee K.; Medicine, School of Medicine
    The Fish. The Pond. The Groundwater. Imagine that you have a personal pond filled with fish. When viewing your pond, you notice that one fish has died, floating belly-up. You decide that the fish must have been ill and think nothing more of it. The next day, you notice that half of the fish in your pond are now dead. You are alarmed and decide to contact the neighborhood management services to investigate your pond. Something must be wrong with the local system. The following day, however, you discover that all of your neighbors with ponds have noticed the same thing. In fact, half of the fish are dead throughout all waterways in the entire state. At this point, it is clear something deeper must be wrong. This is when you need to analyze the groundwater feeding these ponds. The fish are not at fault, and not even the local systems. Rather the underlying structures through which the fish seek life has failed. Imagine that instead of fish, we are discussing patients. —Paraphrase of Groundwater Approach Metaphor by Love and Hayes-Greene of The Racial Equity Institute.