ABSTRACT
Cardiorenal syndrome (CRS) is a condition characterized by the intricate two-way relationship between the heart and kidneys, which can lead to acute or chronic dysfunction in these organs. The interplay between cardiorenal connectors and both hemodynamic and non-hemodynamic factors is crucial to understanding this syndrome. The clinical importance of these interactions is evident in the changes observed in hemodynamic factors, neurohormonal markers, and inflammatory processes. Identifying and understanding biomarkers associated with CRS is valuable for early detection and enabling intervention before significant organ dysfunction occurs. This comprehensive review focuses on the clinical significance of biomarkers in the diagnosis, prognosis, and management of CRS. Finally, it highlights the necessity for further advancements in managing this condition.
ABSTRACT
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has disrupted medical care across diverse populations with varying outcomes. In this study, we evaluated the relationship between health rating and disruption in medical care due to COVID-19 among individuals with atherosclerotic cardiovascular disease (ASCVD). METHODS: Data from the 2020 National Health Interview Survey was used for this study. ASCVD sample included those with self-reported coronary heart disease, stroke, and heart attack. Health rating was represented as fair to poor, good, and very good to excellent. The outcome variable was a disruption of medical care due to COVID-19 (delay in medical care or did not get care). The chi-square test was used for the descriptive analysis and multiple logistic regression was used to evaluate the relationship between health rating and disruption in medical care with demographic factors, comorbidities, and cumulative social risk adjusted for. RESULTS: Among the 31,568 adults, 1,707/31,568 representing 9,385,855 adults 18 years and above with ASCVD reported experiencing or not experiencing a disruption in medical care. After adjusting for cumulative risk, the odds of not getting medical care due to COVID-19 were high for those who rated their health as fair/poor as compared to excellent (adjusted odds ratio (AOR) = 1.95, 95% CI = 1.24-3.08, p = 0.004). These odds remained about the same after adjusting for cumulative social risk, demographic factors, and comorbidities (AOR = 1.84, 95% CI = 1.11-3.06, p = 0.018). After adjusting for cumulative risk, medical care utilization (received, delayed, did not receive) was rated. Those who rated their health as fair to poor as compared to excellent were more likely to report a delay in health care due to COVID-19 (AOR = 1.85, 95% CI = 1.28-2.68, p = 0.001) and remained about the same after adjusting for cumulative social risk, demographic factors, and comorbidities (AOR = 1.86, 95% CI = 1.22-2.82, p = 0.004). Female respondents with ASCVD who rated their health as fair/poor were more likely to experience a delay in medical care due to COVID-19 (AOR = 2.06, 95% CI = 1.06-4.01, p = 0.033) or not get medical care due to COVID-19 (AOR = 2.86, 95% CI = 1.42-5.76, p = 0.003) as compared to those who rated their health as excellent. With regards to men with ASCVD, health rating was not related to their reported disruption of medical care due to COVID-19. CONCLUSIONS: A poor to fair health rating is associated with a delay in getting or not getting medical care among individuals with ASCVD. Further studies are needed to evaluate this relationship further.
ABSTRACT
Background and Objective In the United States, hypertension remains a significant cause of cardiovascular disease mortality and morbidity, affecting various racial and ethnic groups. High blood pressure is a common health concern, given its high frequency among all populations and racial groups in the United States; nevertheless, the condition remains untreated in most individuals. It affects a significant number of individuals in the African American community and contributes to a notable proportion of deaths. Arguably more prevalent, severe, and tends to occur earlier in African Americans compared to some other races. This lack of blood pressure control may contribute to the increasing mortality rates associated with hypertension-related cardiovascular diseases in the United States, while notable race and sex disparities persist. This study aims to compare the number of deaths caused by each cardiovascular disease (hypertension) in African Americans to those of people of other races. Methodology To understand the impact of hypertension on mortality rates among different racial groups, this study utilized the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) dataset, which includes death certificates filed in the United States. The research focused on individuals aged 25 years or older with a mention of hypertension and cardiovascular disease as the underlying cause of death between 1999 and 2019. The study analyzed hypertension-associated deaths by different cardiovascular disease subtypes, such as ischemic heart disease, heart failure (HF), and cerebrovascular diseases that include acute ischemic attacks, which are the most frequent in the United States, with specific assessments for African Americans, White, and other races' decedents. Results The study findings indicated that African American males had higher mortality rates from cardiovascular diseases compared to African American females. The prevalence of hypertension was also higher among African Americans (87.47%) compared to Whites (30.33%), Asian/Pacific Islanders (40.26%), and American Indians/Alaska Natives (61.18%). Additionally, the study identified regional variations in mortality rates, with states like Arizona, California, Texas, Florida, and Washington having higher rates, while Vermont, North Dakota, and Wyoming had lower rates. The northwest region had lower mortality compared to the western and southwestern regions. Conclusions Within the studied period, there was an increase in the prevalence of mortality due to hypertension amongst African Americans when compared to other races. These findings underscore the pressing need to address the increasing prevalence of hypertension and mortality rates among African American. More efforts should focus on prevention of CVD and hypertension and the associated risk factors based on the World Health Organization (WHO) recommendations, which include the promotion of healthy lifestyle behaviors, improvement of access to quality healthcare, and implementation of culturally sensitive interventions tailored for African American communities.
ABSTRACT
OBJECTIVE: To assess the use of health information technology (HIT) among adults with chronic low back pain (CLBP) in the United States and to evaluate the relationship between HIT use and self-rated health. METHODS: The independent variable was the use of the internet to (1) fill prescriptions, (2) communicate with a healthcare provider, (3) look up health information, and (4) schedule a medical appointment. Respondents rated their health in the last 12 months as worse, about the same, or better. A Chi-square analysis was used to assess the use of HIT among those with CLBP; a logistic regression was used to determine predictors of HIT use; and an ordinal logistic regression was used to assess the relationship between HIT and self-rated health. RESULTS: As compared to those without CLBP, those with CLBP are more likely to use the internet to look up health information (58.9 vs. 53.8%, p-value<.001), refill prescriptions (13.9% vs. 10.5%, p-value<.001), and communicate with a healthcare provider (19.8% vs.15.3%, p-value<.001). Being employed and having a higher level of education were positive predictors of HIT use. As compared to other uses of the internet, using the internet to communicate with a healthcare provider was associated with higher odds of rating health as better compared to worse or about the same within the last 12 months. CONCLUSION: Among adults with CLBP, a more affluent social status is associated with the use of HIT. Also, HIT is associated with a better health rating as compared to not using it at all. Further studies should assess the longitudinal relationship between HIT use and how adults with CLBP rate their health.
