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Biomedical subjects

L J Haywood

Publications and source records attributed to L J Haywood.

At least 19 recordsLinked to original sources
PubMed1997

Under use of coronary angiography: application of a clinical method.

OBJECTIVE: To estimate the extent of under use of coronary angiography and to determine whether women, ethnic minorities and poor and uninsured patients are less likely than their counterparts to receive necessary coronary angiography. DESIGN: Retrospective cohort study employing chart review and patient interviews. SETTING: Four teaching hospitals: three government owned (public) and one private university medical center in Los Angeles, California. PATIENTS: Three hundred and fifty two patients who had a positive exercise stress test between 1 January 1990 and 30 June 1991 and met explicitly defined criteria for the necessity of coronary angiography established by a multidisciplinary expert panel. MAIN OUTCOME MEASURES: Percentage of patients who received necessary coronary angiography within 3 and 12 months following exercise stress testing, adjusted for demographic and clinical characteristics using logistic regression. RESULTS: Overall 43% received necessary coronary angiography within 3 months and 56% within 12 months of the stress test. Women were less likely than men to receive necessary coronary angiography. Adjusted odds ratio (AOR) 0.54, 95% confidence interval (CI) 0.34-0.90 for angiography within 3 months of the stress test; AOR 0.47, 95% CI 0.29-0.77 for angiography within 12 months of the stress test. Public hospital patients underwent necessary coronary angiography less often than private hospital patients. AOR 0.40, 95% CI 0.23-0.79 for within 3 months; AOR 0.52, 95% CI 0.30-0.91 for within 12 months. CONCLUSIONS: Under use of coronary angiography can be measured and occurs to a significant degree. It is important to develop standards of quality to address and safeguard against under use of necessary medical care.

Aged↗
PubMed1997

Recurrent myocardial infarction with patent coronary arteries.

Two separate episodes of severe chest pain occurred several years apart in a 25-year-old male patient with typical clinical findings of acute myocardial infarction with each episode. Cardiac catheterization following the second infarction confirmed the presence of myocardial dysfunction with apical akinesis and dyskinesis. Both coronary arteries were radiologically patent; however, there was evidence of probable recanalization of the right coronary artery. Several months later, the patient developed flank pain, hematuria, progressive renal failure, and cardiac decompensation, and died with intractable arrhythmias. At autopsy, a large apical mitral thrombosis was found and was the presumptive source of multiple systemic emboli.

Adult↗
PubMed1997

Early radionuclide scans for risk assessment in suspected acute myocardial infarction.

First-day thallium-201 myocardial perfusion scans and technetium-99m RBC gated scintiangiography were performed during the initial clinical and prognostic evaluation of 69 patients with suspected acute myocardial infarction. Patients were monitored for clinical course, diagnosis confirmation, and use of specialty services (cardiac catheterization, percutaneous balloon angioplasty, and cardiac surgery) during hospitalization. Myocardial infarction, confirmed in 20 patients, was associated with significantly more left ventricular dilatation, lower ejection fractions, lower peak left ventricular filling rates, wall motion abnormalities, and thallium-201 perfusion defects than nonmyocardial infarction patients. Among all patients, left ventricular dilatation carried a relative risk of myocardial infarction of 5.8; low ejection fraction and right ventricular dilatation were strongly associated with myocardial infarction. A logistic model for congestive heart failure included: left ventricular dilation, lower mean left ventricular filling rates and time to peak filling rates, and abnormal thallium-201 lung:heart uptakes. Among nonmyocardial infarction patients, subsequent cardiac catheterization was predicted by the presence of anterior thallium-201 perfusion defects, Killip functional class II-III, and ischemia on ECG. These findings suggest that early detection of myocardial perfusion defects and cardiac dysfunction by radionuclide scans enhances initial evaluation of suspected acute myocardial infarction patients. Additional studies are needed to confirm these findings.

Analysis of Variance↗
PubMed1996

Myocardial infarction in sickle cell disease.

Gross and microscopic findings consistent with acute (three patients) and healed (four patients) myocardial infarction were found in seven (9.7%) of 72 consecutive hearts from patients with sickle cell disease studied after autopsy between 1950 and 1982. Gross obstructive and atherosclerotic lesions were absent in all seven patients, while microthrombi were present in the arterioles of infarcted tissue in two patients. Pathophysiological mechanisms responsible for the infarction are unclear, but anemia, platelet thrombi, coronary vasospasm, and abnormal rheology related to sickle cells may all be important. Chest pain occurred clinically in six of the seven patients and ECG findings typical of infarction were found in two patients. One patient died suddenly. These findings suggest that ischemic heart disease may be present in a significant number of patients with sickle cell disease and should be considered in all patients who complain of chest pain, whether or not the patient is in crisis.

Adult↗
PubMed1996

Congestive heart failure revisited: new concepts in treatment.

Congestive heart failure is a major cause of morbidity and mortality as the population ages. This article reviews the progress made in treating the two major causes of heart failure--mechanical and myocardial. New approaches to relieving mitral stenosis and guidelines for the treatment of congestive heart failure are reviewed. Appropriate assessment and management leads to major improvement in prognosis.

Cardiomyopathies↗
PubMed1995

Effect of physician specialty on use of necessary coronary angiography.

OBJECTIVES: This study sought to determine whether having a cardiologist as a regular source of care influences likelihood of undergoing necessary coronary angiography. BACKGROUND: An important element of the current health policy debate is the respective roles of primary care and specialist physicians. However, there are few data on interspecialty differences in quality of care for patients with ischemic heart disease. METHODS: We contacted 243 patients by telephone (response rate 72%) who had positive (or very positive) exercise stress test results and met additional clinical criteria for necessary coronary angiography. Study patients were randomly sampled from those undergoing exercise stress testing at one university and three public hospitals in Los Angeles between January 1, 1990 and June 30, 1991. Patients were asked whether they had a regular source of care during the time after their exercise stress test and, if so, whether that provider was a cardiologist or cardiology clinic. RESULTS: Among survey responders, 47% underwent necessary coronary angiography within 3 months of exercise testing and 61% within 12 months. After adjustment for sociodemographics and clinical presentation, patients with a cardiologist as a regular source of care were more likely than all other patients to have undergone necessary angiography within 3 months (52% vs. 38%, p = 0.05) and within 12 months (74% vs. 44%, p = 0.0001) of the exercise test. At 3 months, there was a trend toward a more pronounced effect of ongoing cardiologic care within the public hospitals compared with the private hospital (p = 0.09 for interaction between hospital types). CONCLUSIONS: Patients with a cardiologist as a regular source of care were more likely than all other patients to undergo clinically necessary coronary angiography within both 3 and 12 months of exercise stress testing.

Cardiology↗
PubMed1995

Differential perceptions, behaviors, and motivations among African Americans, Latinos, and whites suspected of heart attacks in two hospital populations.

To evaluate the hypothesis that socioeconomic status would exert greater influence on patients' care-seeking behavior than racial/ethnic group status, we undertook a sequential study of African-American, Latino, and white patients hospitalized for acute chest pain from August 1988 through July 1990 at two sites. The study took place in an urban public medical center and an urban private health maintenance organization medical center, which provide care to mixed racial/ethnic groups of lower and middle socioeconomic status, respectively, in Los Angeles. Three concurrent case series of African-American, Latino, and white patients hospitalized for acute chest pain were recruited. The racial/ethnic distribution of the total group was African Americans, 448; Latinos, 487; and whites, 499. The main outcome measure was the length of time patients spent in deciding to seek emergency medical care for acute chest pain and the associated perceptions, behaviors, and motivations involved in deciding to seek care. For the total group, public hospital site and lack of health insurance were the strongest significant predictors of a longer decision phase, whereas differential symptom perceptions, consultation with medical professionals, and use of paramedic transport were significant predictors of shorter duration. Multiple regression results were similar in separate analyses demonstrated significant differences in patients' perceptions of symptom intensity and incapacitation within racial/ethnic groups related to socioeconomic status, as well as in specific behavior and motivation in seeking care. The study concluded that socioeconomic status as determined by hospital site exerted a stronger influence on patients' care-seeking behavior for acute chest pain than racial/ethnic status. Specific care-seeking behaviors of minority and lower-socioeconomic-status patients in the use of medications and paramedics in the face of acute symptoms should be targeted in future educational programs.

Adult↗
PubMed1994

MRI-derived ventricular volume curves for the assessment of left ventricular function.

To assess the utility of double oblique, ECG-gated 1H magnetic resonance (MR) derived volume curves for assessing LV function, cardiac short axis images were acquired with a fast field echo technique. We applied this methodology to assess left ventricular function in three groups: normals, patients with left ventricular hypertrophy, and dilated cardiomyopathy. Six slices with 16-20 phases per RR interval were analyzed, representing the initial 75-80% of the cardiac cycle. For each slice, the endocardial border of the left ventricular (LV) chamber was manually traced. Using Simpson's rule, the total LV volume at a given phase was determined considering the traced area, thickness and position in three-dimensional space of each of the six constituent slices. The calculated volumes were plotted against time and the stroke volume, ejection fraction and cardiac output were determined. The volume vs time plots for the systolic and diastolic portions of the curve were individually fit to third degree polynomials using a least squares approximation. From the fit curves, the following data were extracted: the mean slope (dV/dT) during filling and emptying, and the time to 1/4, 1/3 and 1/2 filling and emptying. These parameters are valuable indices of the functional status of the myocardium; thus, accurate and useful estimates of LV function can be obtained using MRI derived volume curves in normal and abnormal states.

Cardiac Volume↗
PubMed1994

Task Force 1: The underserved.

The ACC has affirmed its commitment to universal access to health care. Underserved populations exist in urban and rural centers. Common to each is a paucity of personnel trained in cardiovascular care and a lack of access to preventive and highly technologic services. These factors contribute to a poor health outcome (75). Part of the rural problem can be corrected by the transfer of information to local providers by the use of new information systems. Included would be real-time electronic consultation, on-site subspecialty visits and the appropriate use of nonphysician providers (15). The urban problem requires changes in priorities and responsibilities of the academic health centers toward the communities they serve. Curricula changes of cardiovascular specialists, internists, generalists and nonphysician health care personnel must include diversity in training, physician training of ethnically matched providers in addition to technical excellence and research into methods of patient education and motivation for a healthier life-style (51). Reimbursement must appropriately reward those caring for underserved patients and those providing evaluation and management services (43,52).

Academic Medical Centers↗
PubMed1994

Acute chest pain in African Americans: factors in the delay in seeking emergency care.

OBJECTIVES: African Americans have been shown to have longer delay times than the majority population in seeking care for acute cardiac problems. The purpose of this study was to determine whether socioeconomic factors affect delay times. METHODS: Structured interviews were administered to 254 African Americans admitted to a public hospital and 194 African Americans admitted to a private hospital for suspected acute myocardial infarction. RESULTS: Patient characteristics found by multiple regression analysis to affect decision-making and travel time for care-seeking were structural access to care, persistence of symptoms, degree of incapacitation, consultation with a layperson, consultation with medical professionals, and mode of transportation. CONCLUSIONS: Within-group differences were found to be related to socioeconomic status. Strategies to increase knowledge about heart attack symptoms, improve access to care, and improve the socioeconomic status of at-risk African Americans are indicated.

Acute Disease↗
PubMed1993

Risk factors and mortality among black, Caucasian, and Latina women with acute myocardial infarction.

The purpose of this study was to examine the clinical outcome of acute myocardial infarction among women of three ethnic/racial groups and to determine whether observed differences in outcome are explained by differences in associated risk factors. Nine hundred seventeen (917) consecutive admissions occurred among 810 women, of whom 347 (42.8%) were Caucasian, 258 (31.9%) were black, and 205 (25.3%) were Latina. The overall mortality rate was 13%; the Caucasian rate was significantly higher than the Latina rate (16.9% vs 7%, p < 0.01), as was the black rate (13.8% vs 7%, p < 0.05). Comparing survivors with nonsurvivors among the three groups, hypertension was more common for survivors among blacks, as was a history of angina; in-hospital congestive failure was associated with a higher mortality for blacks and Caucasians, as was in-hospital angina for Caucasians. Univariate and multivariate logistic regression for the outcome variables of congestive failure, in-hospital angina, and mortality, showed race to be a significant factor in the lower mortality rate for Latinas in the univariate analysis. In the multivariate analysis, only in-hospital angina and congestive failure significantly influenced mortality. In this study of myocardial infarction among women of lower socioeconomic status, factors other than race were the primary influences on outcome.

Aged↗
PubMed1993

Altered muscle metabolism shown by magnetic resonance spectroscopy in sickle cell disease with leg ulcers.

We performed 31P magnetic resonance spectroscopy of gastrocnemius muscle at rest in 7 normal volunteers and 12 patients with sickle cell disease (7 with leg ulcers and 5 without leg ulcers but with painful crises). We measured intracellular pH and ratios of Pi to ATP, PCr to ATP and PCr to Pi (Pi = inorganic phosphate, ATP = adenosine triphosphate, and PCr = phosphocreatine). Magnetic resonance arteriograms were also performed. Significant differences were found for PCr/Pi ratios between normals and sickle cell disease patients with leg ulcers (p < 0.008). Magnetic resonance arteriograms were normal in volunteers and patients with sickle cell disease. The altered high energy phosphate metabolism in sickle cell disease with leg ulcers is consistent with muscle ischemia or hypoxia.

Adult↗
PubMed1993

Rose Questionnaire responses among black, Latino, and white subjects in two socioeconomic strata.

We administered the Rose Questionnaire to 1442 black, white, and Latino patients (approximately equal numbers) who sought care for acute chest pain at two medical centers. Of these, 718 subjects were enrolled at a large public hospital serving a low-socioeconomic status population and 724 at a large health maintenance organization hospital serving a middle-class clientele. Using the standard definition of Rose angina, multivariate logistic regression analysis identified five factors that contributed to the relative risk of a positive response: family history of myocardial infarction (2.48), history of peripheral vascular disease (1.41), history of high blood pressure (1.29), history of high cholesterol (1.26), and low-socioeconomic status hospital (0.78). Inquiring about shortness of breath as a substitute for chest pain or an alternative complaint in set one of the Rose Questionnaire did not increase the number of positive responses or differentiate between the socioeconomic groups or race-ethnic subgroups. Having a prior history of self-reported risk factors clearly defined a group with greater likelihood of a positive response to the Rose Questionnaire. Receiving care at a large public hospital (ie, being in a low-socioeconomic status group) was associated with reduced likelihood of having "typical" angina in comparison to receiving care at a health maintenance organization (middle socioeconomic status) for white subjects but not for Latinos and blacks.

Black or African American↗
PubMed1993

Chest pain admissions: characteristics of black, Latino, and white patients in low- and mid-socioeconomic strata.

To assess the potential impact of socioeconomic status (SES) factors on health-care seeking behavior for suspected acute coronary artery disease symptoms, equal numbers of black, Latino, and white patients seeking care for chest pain at two large hospital emergency rooms were studied. Differences between low and middle SES groups with respect to pre-attack health, health history, ethnicity, gender, and modes of transportation to the hospital were explored. Highly significant self-reported differences between low SES and middle SES patients were found as follows: low SES subjects were more likely to describe themselves as being in fair to poor general health (68% versus 18%), had more frequent chest pain, reported other types of heart disease, were more often current smokers, more likely to be black or Latino, and to be younger. Members of the low SES group also were less [corrected] likely to have known cholesterol levels, to have used estrogen, to have had a prior ECG or cardiac surgery, to be nonsmokers, to have had a stress test, and to have typical angina. Middle SES subjects more often described typical angina, prior use of estrogen (females), congenital, rheumatic, or family history of heart disease, prior knowledge of high cholesterol, were more likely to be of the male gender, and to be older than the low SES cohort. The data reveal that low SES subjects, with markedly less health-care resources compared with middle SES subjects, have a worse general health and cardiac risk profile despite the fact that they were significantly younger (mean age 53.4 versus 60.7, P < .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Black or African American↗