Related publications

Abstracts

Incidence Rates and Social Factors Associated with Heart Failure Related Encounters in Metropolitan Detroit, Michigan, Emergency Departments from 2018-2024.

Brian Haber, Robert Ehrman, Samantha Bauer, and Steven J. Korzeniewski

Objective: Population-level heart failure (HF) incidence and hospitalizations have increased in the past decade but there is sparse evidence on ED-related visits, particularly from densely populated urban areas in the post-pandemic era. Lack of epidemiologic data is detrimental as individuals in these areas often experience substantial social and economic stressors, which prior literature has suggested are associated with greater ED use and worse outcomes. The goal of this project was to estimate the prevalence and incidence density rates of HF-related ED visits in Metropolitan Detroit, MI, and characterize associations between measures of social stress, ED visits, and hospital admissions for HF.

Methods: Using an existing surveillance database from 5 EDs, we identified adults presenting between 12/2018-3/2024 and had home addresses that were geocoded in four catchment counties. HF was identified as the primary diagnosis by ICD-10 codes (I50.x). Prevalence and incidence density rates were calculated per 10,000 (10k) encounters, unique patients, and total population (separately) using county denominators from the 2020 U.S. Census. Trends were examined using locally weighted regression. A subset of patients had data available for repeat ED visits and ED disposition from 2023. We matched patients to zipcode-level Social Deprivation Index (SDI, range 0-100 with greater scores representing more deprivation), proportion of patients without health insurance (PWI), and mean systolic blood pressure (SBP) of patients visiting the ED, abstracted from the Wayne State Population Health Outcomes Information Exchange (PHOENIX). Social factors associated with repeat ED visits were modeled using negative binomial regression. For factors associated with admission vs. discharge, a mixed-effects logistic model with a random intercept for each patient was used. In both models, the primary predictor of interest was SDI, and an offset of ED visits per 100k patients from each zip code (also abstracted from PHOENIX) was used. Selection of final models was based on Bayesian Information Criteria.

Results: The 502,367 patients who presented during the study period accounted for 1,034,591 total encounters. There were 2,259 unique patients with EHR-documented HF resulting in estimated prevalence rates of 5.7 (95%CI 5.5-5.9) per 10K total population, 25.3 (95%CI 24.3-26.3) per 10K encounters, and 45 (95%CI 43.1-46.8) per 10k unique patients. Incidence density rates declined after 2020, but the pattern coincided with an overall reduction in ED utilization. In the 2023 cohort, complete data were available on 284 patients who accounted for 785 HF visits. Unadjusted SDI < median (95, IQR 6) was associated with increased relative risk (RR) of a repeat ED visit of 1.36 (p<0.0001). After adjusting for PWI, RR of a repeat visit for SDI was 1.12 (p=0.2) and for PWI 9.42 (p=0.0005). The same pattern was seen for odds ratio (OR) of admission: unadjusted SDI < median, OR 1.84 (p=0.01); adjusted for PWI, SDI < median OR 1.06 (p=0.8), PWI OR 8.76 (p=0.001). Other social factors assessed were not associated with repeat visits or hospital admission.

Conclusion: Overall ED use as well as the incidence density rate of HF-related ED encounters declined among metropolitan Detroit EDs from 12/2018-to-3/2024. In the unadjusted analysis, lower SDI (less deprivation) was associated with more ED re-visits and more admissions, but this effect was lost after adjusting for PWI in patients’ zip code. In fact, the effect of living in a zip code with a larger PWI had a markedly greater effect than SDI. Given that the pandemic changed how patients interact with the healthcare system (e.g., where, when, and from whom they seek care), further study is needed to elucidate the complex relationships between social stressors and ED attendance. Future research should also explore ways in which lack of health insurance can affect HF care (e.g., lack of options for outpatient follow-up). Investigations in other locations are likewise needed to confirm our findings.

Publications

2021

Brook RD, Dawood K, Foster B, Foust RM, Gaughan C, Kurian P, Reed B, Jones AL, Vernon B, Levy PD. Utilizing Mobile Health Units for Mass Hypertension Screening in Socially Vulnerable Communities across Detroit; Hypertension2022 Jun;79(6):e106-e108.doi: 10.1161/HYPERTENSIONAHA.122.19088. Epub 2022 Mar 16. PMID: 35291803

Brook RD, Scirica BM, Levy PD. “The doctor is out”: New tactics and soldiers for our losing battle against hypertension. Circulation2022 May 31;145(22):1629-1631. doi:10.1161/CIRCULATIONAHA.122.059674. Epub 2022 May31. PMID: 35639852

Motairek I, Chen Z, Makhlouf MH, Rajagopalan S, Al-Kindi S. Historical neighborhood redlining and contemporary environmental racism. Local Environment. 2022 Dec 10:1-1.

Al-Kindi S, Tashtish N, Rashid I, Sullivan C, Neeland IJ, Robinson M, Gross EM, Shaw L, Cainzos-Achirica M, Nasir K, Kreatsoulas C. Impact of low/no-charge coronary artery calcium scoring on statin eligibility and outcomes in women: The CLARIFY study. American Journal of Preventive Cardiology. 2022 Dec 1;12:100392.

Motairek IK, Al-Kindi SG. Ameliorating Cardiovascular Risk in Patients with Type 2 Diabetes. Endocrinology and Metabolism Clinics of North America 2022 Endocrinol Metab Clin North Am. 2023 Mar;52(1):135-147. doi:10.1016/j.ecl. 2022.07.002. Epub 2022 Nov 18.https://doi.org/10.1016/j.ecl.2022.07.002

Bevan G, Pandey A, Griggs S, Dalton JE, Zidar DA, Patel S, Khan SU, Nasir K, Rajagopalan S, Al-Kindi S. Neighborhood-Level Social Vulnerability and Prevalence of Cardiovascular Risk Factors and Coronary Heart Disease. Curr Prob Cardiol. 2022 Mar 27;101182 https://doi.org/10.1016/j.cpcardiol.2022.101182

Motairek IK, Sharara J, Makhlouf ME, Dobre M, Rahman M, Rajagopalan SR, Al-Kindi SG. Association Between Particulate Matter Pollution and CKD Mortality by Social Deprivation November 14, 2022 DOI:https://doi.org/10.1053/j.ajkd.2022.09.015

Al-Kindi SG, Brook RD, Dobre M, Rahman M, Wright JT, Rajagopalan S. Ambient Air Pollution and Pulse Wave Velocity in Patients With Hypertension Treated With Intensive Versus Standard Blood Pressure Control. Hypertension. 2022 Dec;79(12):e144-6.

Bevan G, Pandey A, Griggs S, Dalton JE, Zidar D, Patel S, Khan SU, Nasir K, Rajagopalan S, Al-Kindi S. Neighborhood-level social vulnerability and prevalence of cardiovascular risk factors and coronary heart disease. Current problems in cardiology. 2022 Mar 27:101182.

Makhlouf MH, Motairek I, Chen Z, Nasir K, Deo SV, Rajagopalan S, Al-Kindi SG. Neighborhood Walkability and Cardiovascular Risk in the United States. Current Problems in Cardiology. 2022 Dec 5:101533.

David E. Lanfear, Nosheen Reza. Myosin-Related Dilated Cardiomyopathy: Another Elephant Emerges From Darkness; https://www.sciencedirect.com/journal/journal-of-the-american-college-of-cardiology PMID: 36202535. Volume 80, Issue 15, 11 October 2022, Pages 1462-1464

Presentations

Past

American Heart Association Meeting Nov 11-13, 2023 Philadelphia PA
Phillip Levy, Detroit, MI

WAYNE STATE UNIVERSITY
Detroit, MI, United States

Community Health Workers: Extending the Clinic to the Community

Nov. 11, 2023, 10:21 AM - 10:33 AM

Phillip Levy, Detroit, MI

Driving the Van: Challenges and Victories of a Mobile Health Unit

Nov. 11, 2023, 4:00 PM - 4:12 PM

Phillip Levy, Detroit, MI

WE SPARK Health Institute 2023 Health Research Conference

"Achieving Better Health One Population at a Time”

November 2023; Windsor, Canada

American College of Cardiology Quality Summit

October 2023; Orlando, Florida

"Using the Chest Pain Guidelines to Increase Patient
Throughput and Decrease Cost of Care"

"Cardiovascular Disease Prevention at the Population Level"

Mobile Healthcare Association’s 19th Annual Mobile Health Clinics Conference

"Building an Equitable and Sustainable Mobile Health
Outreach Program"

September 2023; Pittsburgh, Pennsylvania

ACC Industry Advisory Forum July 2023

Diversity, Equity & Inclusion – Focus on Community Impact

Title: Metropolitan Experience - Phillip Levy, MD, MPH, FACC – Wayne State University

https://x.com/ACCinTouch/status/1712807931819806944?s=20

American College of Cardiology

@ACCinTouch

Moving beyond the "one patient, one provider" model of healthcare is needed to improve #CVD outcomes at the population level. Dr. Phillip Levy discusses community & institution perspectives needed to implement care pathways that will help shift the current paradigm. #ACCQuality23

Florida Lung Health Coalition Kickoff Symposium

“Applying Data Analytics to Mobile Healthcare”

June 2023; Tampa Bay, Florida

2023 Southern Emergency Medicine International Summit Forum

“Beyond Hypertensive Emergencies - Managing Patients
with Elevated BP in the ED”

April 2023; Guangzhou, China

National Arab American Medical Association 32nd International Medical Convention

“What’s Next for Population Health?”

December 2022; Marrakesh, Morocco

MedHealth Summit

“Democratizing Data for Healthcare Innovation and Action”

November 2022; Detroit, Michigan

2023 Investigator Skills Development Unit (ISDU) Webinars:

NOTE: Our Jan. 12^th Webinar has been RESCHEDULED to July 19^th due to illness. Thank you for your kind understanding.

Fri., Feb. 24^th, 11am PT (1p CT, 2p ET): Marilyn Thomas, PhD, MPH - Structural Racism and Health Disparities. Register HERE.
Thurs., March 9^th, 12pm PT (2p CT, 3p ET): Doriane Miller, MD Approaches to Community Engagement. Register HERE.
Thurs., April 6^th, 10am PT (12p CT, 1p ET): Ariel Deardorff, MLIS -- Get up to speed on the new NIH Data Management and Sharing Requirements. Register HERE.
Wed., May 3^rd, 10am PT (12p CT, 1p ET): Michael Potter, MD -- Practice-Based Research: A Focus on Community Primary Care Setting. Register HERE.
Wed., June 7^th, 11am PT (1p CT, 2p ET): Elaine Ku, MD, MAS -- Using Public Databases to Conduct Clinical Research: Focus on Hypertension. Register HERE.
Wed., July 19^th, 10am PT (12p CT, 1p ET): Damaris Javier, MA -- Navigating the NRMN Website and Resources for Early Career Investigators: MyNRMN, MyMentor, and more. Register HERE.

May-Dec. 2022 ISDU Webinars:

See our complete archive of Educational Webinars HERE!

Thurs., May 12^th 11am PDT: Orlando Gutiérrez, MD, MMSc -- Disparities in the Development and Progression of Kidney Disease in the U.S. Recording posted here.
Thurs., June 16^th 10am PDT: Edwin Charlebois, PhD, MPH -- Best Practices for Creating Poster Presentations for Scientific Conferences. Recording posted here.
Thurs., July 21^st 10am PDT: Daichi Shimbo, MD NIH K Award Info Session. Recording posted here.
Fri., Aug. 19^th, 11am PDT: Diana Redwood, PhD Addressing Health Disparities in Rural and Remote Areas: Improving Colorectal Cancer Screening among Alaska Native People. Recording posted here.
Thurs. Sept. 22^nd 11am: Rachel Shelton, ScD, MPH; Nathalie Moise, MD, MS -- Implementation Science Theories, Models, and Frameworks.Recording posted here.
Thurs., Dec. 8^th: Sara Landes, PhD -- Hybrid Effectiveness-Implementation Approaches. Recording posted here.

RESTORE Network Oversight Advisory Committee meeting in San Diego

RESTORE Network Team

Wayne State University: LEAP-HTN Team

AHA Hypertension Scientific Sessions (San Diego, CA)

Sept 8 (8:20-8:30): Neighborhood, Environment, and Hypertension

AHA Health Equity Research Network Meeting (San Diego, CA)

Sept 11 (12:15-1pm): Linkage, Empowerment, and Access to Prevent Hypertension (LEAP-HTN)

Presentation July Spotlight - Center Spotlight - Promoting Peer to Peer Learning Across The Consortium - July Spotlight - Center: ACHIEVE GREATER - Presenter: Elizabeth Towner, PhD, Wayne State University

Community Engagement CORE: To provide training and infrastructure to establish community-academic partnerships and ensure meaningful community engagement across pilot and R01 projects. The focus is on communities in the Great Lakes regionDetroit and Cleveland.

Presentation Highlights

Inclusive training programs with capacity-building curriculums for community members and early-stage investigators.
ACHIEVE GREATER's official logo was designed in collaboration with community!