Browsing by Subject "Cardiac resynchronization therapy"
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Item Association Between the Affordable Care Act Medicaid Expansion and Receipt of Cardiac Resynchronization Therapy by Race and Ethnicity(American Heart Association, 2022) Mwansa, Hunter; Barry, Ibrahim; Knapp, Shannon M.; Mazimba, Sula; Calhoun, Elizabeth; Sweitzer, Nancy K.; Breathett, Khadijah; Medicine, School of MedicineBackground: Black and Hispanic patients are less likely to receive cardiac resynchronization therapy (CRT) than White patients. Medicaid expansion has been associated with increased access to cardiovascular care among racial and ethnic groups with higher prevalence of underinsurance. It is unknown whether the Medicaid expansion was associated with increased receipt of CRT by race and ethnicity. Methods and Results: Using Healthcare Cost and Utilization Project Data State Inpatient Databases from 19 states and Washington, DC, we analyzed 1061 patients from early‐adopter states (Medicaid expansion by January 2014) and 745 patients from nonadopter states (no implementation 2013–2014). Estimates of change in census‐adjusted rates of CRT with or without defibrillator by race and ethnicity and Medicaid adopter status 1 year before and after January 2014 were conducted using a quasi‐Poisson regression model. Following the Medicaid expansion, the rate of CRT did not significantly change among Black individuals from early‐adopter states (1.07 [95% CI, 0.78–1.48]) or nonadopter states (0.79 [95% CI, 0.57–1.09]). There were no significant changes in rates of CRT among Hispanic individuals from early‐adopter states (0.99 [95% CI, 0.70–1.38]) or nonadopter states (1.01 [95% CI, 0.65–1.57]). There was a 34% increase in CRT rates among White individuals from early‐adopter states (1.34 [95% CI, 1.05–1.70]), and no significant change among White individuals from nonadopter states (0.77 [95% CI, 0.59–1.02]). The change in CRT rates among White individuals was associated with the timing of the Medicaid implementation (P=0.003). Conclusions: Among states participating in Healthcare Cost and Utilization Project Data State Inpatient Databases, implementation of Medicaid expansion was associated with increase in CRT rates among White individuals residing in states that adopted the Medicaid expansion policy. Further work is needed to address disparities in CRT among Black and Hispanic patients.Item Identifying Metaphors Used by Clinicians That Help Patients Conceptualize Complex Cardiac Device Data for Managing Their Health(2021-12) Daley, Carly Noel; Holden, Richard; Jones, Josette; Bolchini, Davide; Bute, JenniferMetaphors are used to conceptualize one thing in terms of another that is more familiar or concrete. The use of metaphors in patient-provider communication has helped providers generate empathy and explain concepts effectively, improving patient satisfaction and understanding of health-related concepts. With advances in technology, concepts related to health monitoring have become increasingly complex, making the potential for using metaphors in health communication at its highest relevancy. With the increase in health data there is a need to improve tools to help people understand complex information. Ethical considerations, such as possible misinterpretation of health data, as well as the potential to widen disparities because of factors such as health literacy, must be addressed. Metaphors are powerful tools that can make explanation of information accessible, accurate, and effective for people who are monitoring their data. The current research aims to contribute design recommendations for using metaphors in communication between clinicians and patients for monitoring biventricular (BiV) pacing, a complex device data element used in the monitoring of patients with heart failure (HF) who have cardiac resynchronization therapy (CRT) devices. The overarching goal is to understand this process such that it can be applied to broader communication needs in health informatics. The study addresses the following aims: Aim 1: Identify metaphors clinicians use to conceptualize BiV pacing for CRT devices using semi-structured interviews with clinician experts. Aim 2: Identify metaphors that help patients conceptualize BiV pacing for CRT devices using semi-structured interviews with patients, and exploring the metaphors identified in Aim 1. Aim 3: Develop design recommendations for health informatics interventions using an understanding of metaphors that help patients understand BiV pacing for CRT devices. Themes from analysis of Aims 1 and 2 contribute to recommendations for the use of metaphors in health informatics interventions. The purpose of this work is to contribute to an in-depth understanding of metaphors in a specific health informatics context. Importantly, this research applies methods and principles from the field of health communication to address a communication-related issue in health informatics.Item Left Bundle Branch Block–Induced Cardiomyopathy in a Transplanted Heart Treated With His Bundle Pacing(Elsevier, 2020-08-12) Khaira, Kavita B.; Singh, Rajeev; Devabhaktuni, Subodh; Simon, Joel W.; Dandamudi, Gopi; Medicine, School of MedicineA 70-year-old male with prior orthotopic heart transplant developed left bundle branch block followed by new-onset left ventricular systolic dysfunction. He underwent His bundle pacing for cardiac resynchronization therapy with complete normalization of his ejection fraction. This is the first reported case of left bundle branch block–induced cardiomyopathy in a transplanted heart.Item The Vulnerable Phase of Heart Failure(Wolters Kluwer, 2018-07) Gracia, Ely; Singh, Prabhjot; Collins, Sean; Chioncel, Ovidiu; Pang, Peter; Butler, Javed; Emergency Medicine, IU School of Medicine