Kent Hospital is a community teaching hospital located in Warwick, Rhode Island. It was a founding member of the Care New England in 1996, along with Women & Infants Hospital and Butler Hospital.
Background: Health disparities regarding heart failure (HF) incidence by age, race, sex at birth, socioeconomic status (SES) and their intersections remain under-researched. Methods: We harmonized data from nine cohorts (WHI, FOHS, ARIC, Health ABC, REGARDS, CARDIA, JHS, CHS, and MESA). We performed a descriptive study of the cohort calculating incidence rates (IR) and incidence rate ratios (IRR). Age was defined at time zero for each cohort. Participants who identified as Black or white were included. SES was categorized as low or high based on both an educational attainment of some college/vocational training or less and an income, using household size and Official Poverty Measure (OPM) less than 200%. We stratified by age (≤65 vs. >65 years) and evaluated IRs and IRRs, standardized by age (using 10-year intervals), sex, and race, depending on the comparison. Results: A total of 9700 incident HF cases occurred among 96000 participants free of HF at baseline followed up for a median of 13.7 years. Black participants had a slightly lower overall incidence of HF than Whites (IRR: 0.93, 95% CI: 0.89-0.97). We observed a higher risk of HF among Black participants≤65 years of age (IRR: 1.22, 95% CI: 1.14-1.31) compared to Whites. Conversely, Black individuals >65 years of age had a lower incidence than Whites (IRR: 0.75, 95% CI: 0.71-0.80). Women had a lower incidence of HF than men (IRR: 0.66, 95% CI: 0.63-0.68), overall and in age strata. Low, as compared to high SES individuals had a higher incidence of HF (IRR: 1.67, 95% CI: 1.60-1.74. Among those ≤65, low SES Black men (IRR: 2.16, 95% CI: 1.81, 2.56) and low SES White men (IRR: 1.60, 95% CI: 1.35,1.91) had the highest incidence rate of HF compared to high SES White men. Conclusion: Both Black and White low SES groups are at the highest HF risk. Effect modification by age is apparent for race differences but a limitation of present descriptive analysis is that competing risk of death is not accounted for. 10-year cumulative incidence risk and its differences based on race, sex, and/or SES by accounting for competing risk of death are planned.
817 Background: Cancer screening ingastrointestinal (GI) malignancies has translated into an improvement in overall survival due to detection at an earlier stage. The majority of survivors (up to 67%) are over the age of 65. The impact of metabolic profiles on cerebrovascular events amongst this population of cancer survivors is unclear. Methods: Data from the NIS database from 2016 to 2020 were reviewed for patients with seven GI malignancies. Analysis was performed based on the presence or absence of prediabetes using ICD-10 codes. Baseline characteristics, comorbidities, and cerebrovascular outcomes were studied in these 2 cohorts. Results: 1,532,250 hospitalizations of patients with seven GI malignancies, namely colorectal cancer (CRC), pancreatic cancer, hepatocellular carcinoma (HCC), gastric cancer, small intestinal cancer, cholangiocarcinoma, and esophageal cancer, were evaluated and divided into two subgroups: prediabetics (15,610) and non-prediabetics (1,516,640). Prediabetics with GI malignancies as compared to non-prediabetics with GI malignancies were noted to be older (67.7 years vs. 65.64 years), with higher total hospitalization charges (USD 87,267 vs. USD 80,173), greater rates of elective admissions (34.92% vs. 25.89%) but a lower length of stay (6.018 days vs. 6.53 days). Prediabetic patients with GI malignancies were noted to have a higher prevalence of obesity (18.64% vs. 7.69%), dyslipidemia (52.99% vs. 26.16%), and hypertension (49.59% vs. 39.37%). Prediabetics with CRC, as compared to non-prediabetics, had higher adjusted odds ratios (aORs) of occlusion/stenosis of precerebral or cerebral arteries not leading to cerebral infarction, and cerebral infarction, with aORs of 2.03 (95% CI 1.24-3.30, p 0.004), and 1.63 (95% CI 1.01-2.63, p 0.045) respectively. Additionally, prediabetics with pancreatic cancer had a higher aOR of cerebral infarction as compared to non-prediabetics, with aOR of 2.42 (95% CI 1.70-3.44, p<0.001). Conclusions: Prediabetic patients with CRC had higher aORs of cerebral infarction and occlusion/stenosis of precerebral arteries not leading up to cerebral infarction, and prediabetics with pancreatic cancer had twice the risk of cerebral infarction as compared to non-prediabetics. This study highlights the impact of prediabetes, a modifiable risk factor, on cerebrovascular outcomes in patients with GI malignancies.
Rationale: COPD management by protocol implementation to standardized care in the emergency department (ED) and on medical floors remains a clinical challenge. Kent County Memorial Hospital is the second largest hospital in Rhode Island, with 55,400 emergency department (ED) visits annually, including 1,788 COPD visits requiring 966 inpatient admissions. COPD management is not standardized, with treatment plans differing across the continuum, impacting patient care, length of stay, and readmissions. This project aims to improve the care for COPD patients by standardizing care processes through a collaborative effort, including active assessment by a Respiratory Therapist (RT), inhaler utilization techniques, and education to reduce the length of stay across various clinical settings. Methods: COPD-specific PowerPlans were created for the ED and inpatient hospital settings to standardize care and management for COPD patients. The PowerPlans were embedded within the initial Respiratory PowerPlan as sub-phases based on the patient's presenting conditions for COPD and Asthma, which were often interchangeable pending patients’ workup. The PowerPlans include antibiotic and corticosteroid regimens, a bronchodilator protocol, RT assessment and interventions, and patient education. The data was analyzed for patients with and without PowerPlans utilization in ED and inpatient settings and the impact of PowerPlans on ED revisits. Results: Data was reviewed on 1,788 ED visits and 966 inpatient admissions for patients with a primary or secondary ICD-10 code of COPD ( The ICD-10-CM diagnosis, J44.0, J44.1, J44.9, J44.89) between July 2023 and June 2024. During this period, the PowerPlans were initiated on 536 ED patients, yielding a 29.9% utilization rate, and on 259 admitted patients, yielding a 26.3% utilization rate. Implementing PowerPlans in the ED and inpatient settings reduced the length of stay. For the ED, the average stay decreased from 7.96 hours to 6.62 hours, and for the inpatient, it decreased from 5.94 days to 3.94 days. There was also a reduction in ED revisits at 3 days with PowerPlans (1.8 vs. 0.7 %), 7 days ( 2.6 vs. 1.5 %), and at 30 days ( 7.2 vs. 4.0 %) Conclusion: Implementation of PowerPlans remains a significant constraint in our quality improvement project. Using standardized PowerPlans, we observed a reduced length of stay for COPD patients in the ED, inpatient admissions, and reduced ED revisits at 3, 7, and 30 days.
