Browsing by Author "Huffman, MD"

Now showing 1 - 9 of 9
  • Item
    A cross sectional study of the microeconomic impact of cardiovascular disease hospitalization in four Low and Middle –Income Countrie
    (PLoS One, 2011) Huffman, MD; Rao, KD; Pichon-Riviere, A; Zhao, D; Harikrishnan, S; Ramaiya, K; Ajay, VS; Goenka, S; Calcagno, JI; Caporale, JE; Niu, S; Li Y; Liu, J; Thankappan, KR; Daivadanam, M; Esch, JV; Murphy, A; Moran, AE; Gaziano, TA; Suhrcke, M; Reddy, KS; Leeder, S; Prabhakaran, D
    OBJECTIVE: To estimate individual and household economic impact of cardiovascular disease (CVD) in selected low- and middle-income countries (LMIC). BACKGROUND: Empirical evidence on the microeconomic consequences of CVD in LMIC is scarce. METHODS AND FINDINGS: We surveyed 1,657 recently hospitalized CVD patients (66% male; mean age 55.8 years) from Argentina, China, India, and Tanzania to evaluate the microeconomic and functional/productivity impact of CVD hospitalization. Respondents were stratified into three income groups. Median out-of-pocket expenditures for CVD treatment over 15 month follow-up ranged from 354 international dollars (2007 INT$, Tanzania, low-income) to INT$2,917 (India, high-income). Catastrophic health spending (CHS) was present in >50% of respondents in China, India, and Tanzania. Distress financing (DF) and lost income were more common in low-income respondents. After adjustment, lack of health insurance was associated with CHS in Argentina (OR 4.73 [2.56, 8.76], India (OR 3.93 [2.23, 6.90], and Tanzania (OR 3.68 [1.86, 7.26] with a marginal association in China (OR 2.05 [0.82, 5.11]). These economic effects were accompanied by substantial decreases in individual functional health and productivity. CONCLUSIONS: Individuals in selected LMIC bear significant financial burdens following CVD hospitalization, yet with substantial variation across and within countries. Lack of insurance may drive much of the financial stress of CVD in LMIC patients and their families.
  • Item
    A Cross-Sectional Study of the Microeconomic Impact of Cardiovascular Disease Hospitalization in Four Low- and Middle-Income Countries
    (PLOS ONE, 2011) Huffman, MD; Rao, KD; Pichon-Riviere, A; Zhao, D; Harikrishnan, S; Ramaiya, K; Ajay, VS; Goenka, S; Calcagno, JI; Caporale, JE; Niu, SL; Li, Y; Liu, J; Thankappan, KR; Daivadanam, M; van Esch, J; Murphy, A; Moran, AE; Gaziano, TA; Suhrcke, M; Reddy, KS; Leeder, S; Prabhakaran, D
    Objective: To estimate individual and household economic impact of cardiovascular disease (CVD) in selected low-and middle-income countries (LMIC). Background: Empirical evidence on the microeconomic consequences of CVD in LMIC is scarce. Methods and Findings: We surveyed 1,657 recently hospitalized CVD patients (66% male; mean age 55.8 years) from Argentina, China, India, and Tanzania to evaluate the microeconomic and functional/productivity impact of CVD hospitalization. Respondents were stratified into three income groups. Median out-of-pocket expenditures for CVD treatment over 15 month follow-up ranged from 354 international dollars (2007 INT$, Tanzania, low-income) to INT$2,917 (India, high-income). Catastrophic health spending (CHS) was present in >50% of respondents in China, India, and Tanzania. Distress financing (DF) and lost income were more common in low-income respondents. After adjustment, lack of health insurance was associated with CHS in Argentina (OR 4.73 [2.56, 8.76], India (OR 3.93 [2.23, 6.90], and Tanzania (OR 3.68 [1.86, 7.26] with a marginal association in China (OR 2.05 [0.82, 5.11]). These economic effects were accompanied by substantial decreases in individual functional health and productivity. Conclusions: Individuals in selected LMIC bear significant financial burdens following CVD hospitalization, yet with substantial variation across and within countries. Lack of insurance may drive much of the financial stress of CVD in LMIC patients and their families.
  • Item
    Association between Gender, Process of Care Measures, and Outcomes in ACS in India: Results from the Detection and Management of Coronary Heart Disease (DEMAT) Registry
    (PLOS ONE, 2013) Pagidipati, NJ; Huffman, MD; Jeemon, P; Gupta, R; Negi, P; Jaison, TM; Sharma, S; Sinha, N; Mohanan, P; Muralidhara, BG; Bijulal, S; Sivasankaran, S; Puri, VK; Jose, J; Reddy, KS; Prabhakaran, D
    Background: Studies from high-income countries have shown that women receive less aggressive diagnostics and treatment than men in acute coronary syndromes (ACS), though their short-term mortality does not appear to differ from men. Data on gender differences in ACS presentation, management, and outcomes are sparse in India. Methods and Results: The Detection and Management of Coronary Heart Disease (DEMAT) Registry collected data from 1,565 suspected ACS patients (334 women; 1,231 men) from ten tertiary care centers throughout India between 2007-2008. We evaluated gender differences in presentation, in-hospital and discharge management, and 30-day death and major adverse cardiovascular event (MACE; death, re-hospitalization, and cardiac arrest) rates. Women were less likely to present with STEMI than men (38% vs. 55%, p<0.001). Overall inpatient diagnostics and treatment patterns were similar between men and women after adjustment for potential confounders. Optimal discharge management with aspirin, clopidogrel, beta-blockers, and statin therapy was lower for women than men, (58% vs. 65%, p = 0.03), but these differences were attenuated after adjustment (OR = 0.86 (0.62, 1.19)). Neither the outcome of 30-day mortality (OR = 1.40 (0.62, 3.16)) nor MACE (OR = 1.00 (0.67, 1.48)) differed significantly between men and women after adjustment. Conclusions: ACS in-hospital management, discharge management, and 30-day outcomes did not significantly differ between genders in the DEMAT registry, though consistently higher treatment rates and lower event rates in men compared to women were seen. These findings underscore the importance of further investigation of gender differences in cardiovascular care in India.
  • Item
    Clinical presentation, management, in-hospital and 90-day outcomes of heart failure patients in Trivandrum, Kerala, India: the Trivandrum Heart Failure Registry
    (Eur J Heart Fail., 2015-07) Harikrishnan, S; Sanjay, G; Anees, T; Viswanathan, S; Vijayaraghavan, G; Bahuleyan, CG; Sreedharan, M; Biju, R; Nair, T; Suresh, K; Rao, AC; Dalus, D; Huffman, MD; Jeemon, P
    Objective To evaluate the presentation, management, and outcomes of patients hospitalized for heart failure (HF) in Trivandrum, India. Methods The Trivandrum Heart Failure Registry (THFR) enrolled consecutive admissions from 13 urban and five rural hospitals in Trivandrum with a primary diagnosis of HF from January to December 2013. Clinical characteristics at presentation, treatment, in-hospital outcomes, and 90-day mortality data were collected. ‘Guideline-based’ medical treatment was defined as the combination of beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and aldosterone receptor blockers in patients with left ventricular systolic dysfunction (LVSD). Results We enrolled 1205 cases (834 men, 69%) into the registry. Mean (standard deviation) age was 61.2 (13.7) years. The most common HF aetiology was ischaemic heart disease (IHD) (72%). Heart failure with preserved ejection fraction (≥45%) constituted 26% of the population. The median hospital stay was 6 days (interquartile range = 4–9 days) with an in-hospital mortality rate of 8.5% (95% confidence interval 6.9–10.0). The 90-day all-cause mortality rate was 2.43 deaths per 1000 person-days (95% confidence interval 2.11–2.78). Guideline-based medical treatment was given to 19% and 25% of patients with LVSD during hospital admission and at discharge, respectively. Older age, lower education, poor ejection fraction, higher serum creatinine, New York Heart Association functional class IV, and suboptimal medical treatment were associated with higher risk of 90-day mortality. Conclusion Patients hospitalized with HF in the THFR were younger, more likely to be men, had a higher prevalence of IHD, reported longer length of hospital stay, and higher mortality compared with published data from other registries. We also identified key areas for improving hospital-based HF medical care in Trivandrum.
  • Item
    Comparison of Risk Models to Predict In-Hospital Mortality for Patients With Acute Coronary Syndrome in India: The CSI-Kerala Risk Score
    (CIRCULATION, 2011) Huffman, MD; Mathew, R; Harikrishnan, S; Krishan, MN; Zachriah, G; Joseph, J; Prabhakaran, D; Faizal, A; Jayagopal, PB; Varghese, PK; Nambiar, A; Mohanan, PP
  • Item
    Distribution of 10-year and lifetime predicted risk for cardiovascular disease in the Indian Sentinel Surveillance Study population (cross-sectional survey results)
    (BMJ OPEN, 2011) Jeemon, P; Prabhakaran, D; Huffman, MD; Ramakrishnan, L; Goenka, S; Thankappan, KR; Mohan, V; Joshi, PP; Mohan, BVM; Ahmed, F; Ramanathan, M; Ahuja, R; Chaturvedi, V; Lloyd-Jones, DM; Reddy, KS
    Introduction: Cardiovascular disease (CVD) prevention guidelines recommend lifetime risk stratification for primary prevention of CVD, but no such risk stratification has been performed in India to date. Methods: The authors estimated short-term and lifetime predicted CVD risk among 10 054 disease-free, adult Indians in the 20-69-year age group who participated in a nationwide risk factor surveillance study. The study population was then stratified into high short-term (>= 10% 10-year risk or diabetes), low short-term (<10%)/high lifetime and low short-term/low lifetime CVD risk groups. Results: The mean age (SD) of the study population (men=63%) was 40.8 +/- 10.9 years. High short-term risk for coronary heart disease was prevalent in more than one-fifth of the population (23.5%, 95% CI 22.7 to 24.4). Nearly half of individuals with low short-term predicted risk (48.2%, 95% CI 47.1 to 49.3) had a high predicted lifetime risk for CVD. While the proportion of individuals with all optimal risk factors was 15.3% (95% CI 14.6% to 16.0%), it was 20.6% (95% CI 18.7% to 22.6%) and 8.8% (95% CI 7.7% to 10.5%) in the highest and lowest educational groups, respectively. Conclusion: Approximately one in two men and three in four women in India had low short-term predicted risks for CVD in this national study, based on aggregate risk factor burden. However, two in three men and one in two women had high lifetime predicted risks for CVD, highlighting a key limitation of short-term risk stratification.
  • Item
    Distribution of 10-year lifetime predicted risk for cardiovascular disease in the Indian Sentinel Surveillance Study population (Cross –sectional survey results).
    (BMJ Open, 2011) Jeemon, P; Prabhakaran, D; Huffman, MD; Ramakrishnan, L; Goenka, S; Thankappan, KR; Mohan, V; Joshi, PP; Mohan, BVM; Ahmed, F; Ramanathan, M; Ajuja, R; Chaturvedi, V; Lloyd-Jones, D; Reddy, KS
    Introduction:Cardiovascular disease (CVD) prevention guidelines recommend lifetime risk stratification for primary prevention of CVD, but no such risk stratification has been performed in India to date.METHODS:The authors estimated short-term and lifetime predicted CVD risk among 10,054 disease-free, adult Indians in the 20-69-year age group who participated in a nationwide risk factor surveillance study. The study population was then stratified into high short-term (? 10% 10-year risk or diabetes), low short-term (<10%)/high lifetime and low short-term/low lifetime CVD risk groups.RESULTS: The mean age (SD) of the study population (men=63%) was 40.8 ± 10.9 years. High short-term risk for coronary heart disease was prevalent in more than one-fifth of the population (23.5%, 95% CI 22.7 to 24.4). Nearly half of individuals with low short-term predicted risk (48.2%, 95% CI 47.1 to 49.3) had a high predicted lifetime risk for CVD. While the proportion of individuals with all optimal risk factors was 15.3% (95% CI 14.6% to 16.0%), it was 20.6% (95% CI 18.7% to 22.6%) and 8.8% (95% CI 7.7% to 10.5%) in the highest and lowest educational groups, respectively.CONCLUSION: Approximately one in two men and three in four women in India had low short-term predicted risks for CVD in this national study, based on aggregate risk factor burden. However, two in three men and one in two women had high lifetime predicted risks for CVD, highlighting a key limitation of short-term risk stratification.
  • Item
    Presentation, Management, and Outcomes of 25,748 Acute Coronary Syndrome Admissions in Kerala, India: Results from the Kerala ACS Registry
    (CIRCULATION, 2011) Mohanan, PP; Mathew, R; Harikrishnan, S; Krishan, MN; Zachriah, G; Joseph, J; Huffman, MD; Eapen, K; Abraham, M; Menon, J; Manoj, P; Jacob, S; Prabhakaran, D
  • Item
    Rural/Urban Differences in Hospital Characteristics, Patient Presentation, Process-of-Care Measures, and Outcomes of 25,748 Acute Coronary Syndrome Admissions in Kerala, India: Results From the Kerala ACS Registry
    (CIRCULATION, 2011) Mathew, R; Harikrishnan, S; Krishan, MN; Zachriah, G; Joseph, J; Huffman, MD; Prabhakaran, D; Cholakkal, M; Ponnouse, E; Govindannunni, U; Abraham, AK; Mohanan, PP