Featured Publications
Aging Hearts in a Hotter, More Turbulent World: The Impacts of Climate Change on the Cardiovascular Health of Older Adults
Chang A, Tan A, Nadeau K, Odden M. Aging Hearts in a Hotter, More Turbulent World: The Impacts of Climate Change on the Cardiovascular Health of Older Adults. Current Cardiology Reports 2022, 24: 749-760. PMID: 35438387, PMCID: PMC9017408, DOI: 10.1007/s11886-022-01693-6.Peer-Reviewed Original ResearchConceptsOlder adultsDisproportionate health burdenLow socioeconomic statusAging populationPolicy-level interventionsEthnic minority groupsCardiovascular risk factorsMultiple environmental hazardsSocioeconomic statusCardiovascular healthHeart healthHealth burdenRisk factorsCardiovascular wellbeingCardiovascular diseaseReviewClimate changeMinority groupsPhysiological vulnerabilityIntensifying air pollutionAdultsHealthImpacts of climate changeData sourcesPoor outcomeAir pollutionMortality Along the Rheumatic Heart Disease Cascade of Care in Uganda
Chang A, Barry M, Bendavid E, Watkins D, Beaton A, Lwabi P, Ssinabulya I, Longenecker C, Okello E. Mortality Along the Rheumatic Heart Disease Cascade of Care in Uganda. Circulation Cardiovascular Quality And Outcomes 2022, 15: e008445. PMID: 35041475, DOI: 10.1161/circoutcomes.121.008445.Peer-Reviewed Original ResearchThe Need to Expand the Framework of Environmental Determinants of Cardiovascular Health From Climate Change to Planetary Health
Chang A, Barry M, Harrington R. The Need to Expand the Framework of Environmental Determinants of Cardiovascular Health From Climate Change to Planetary Health. Circulation 2021, 143: 2029-2031. PMID: 34029138, DOI: 10.1161/circulationaha.120.051892.Peer-Reviewed Original ResearchOutcomes and Care Quality Metrics for Women of Reproductive Age Living With Rheumatic Heart Disease in Uganda
Chang A, Nabbaale J, Okello E, Ssinabulya I, Barry M, Beaton A, Webel A, Longenecker C. Outcomes and Care Quality Metrics for Women of Reproductive Age Living With Rheumatic Heart Disease in Uganda. Journal Of The American Heart Association 2020, 9: e015562. PMID: 32295465, PMCID: PMC7428530, DOI: 10.1161/jaha.119.015562.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAge FactorsAnticoagulantsComorbidityFemaleHealthcare DisparitiesHumansMaleMedication AdherenceOutcome and Process Assessment, Health CareQuality Indicators, Health CareRegistriesReproductive HealthRetention in CareRetrospective StudiesRheumatic Heart DiseaseRisk AssessmentRisk FactorsSex FactorsTime FactorsTreatment OutcomeUgandaWomen's HealthYoung AdultConceptsRheumatic heart diseaseWomen of reproductive ageHeart diseaseReproductive ageClinical rheumatic heart diseaseRheumatic Heart Disease RegistryAdherence to guideline-based therapyNew York Heart Association class III-IV heart failurePrescription of warfarinRisk of cardiovascular complicationsCox proportional hazards modelsProportional hazards modelRetrospective cohort studyGuideline-based therapyAdherence ratesDisease RegistryCohort studyAnticoagulant prescriptionSub-Saharan AfricaAnticoagulant useCardiovascular complicationsClinical outcomesCompare comorbiditiesHazards modelHeart failureMotivations of women in Uganda living with rheumatic heart disease: A mixed methods study of experiences in stigma, childbearing, anticoagulation, and contraception
Chang A, Nabbaale J, Nalubwama H, Okello E, Ssinabulya I, Longenecker C, Webel A. Motivations of women in Uganda living with rheumatic heart disease: A mixed methods study of experiences in stigma, childbearing, anticoagulation, and contraception. PLOS ONE 2018, 13: e0194030. PMID: 29590159, PMCID: PMC5874006, DOI: 10.1371/journal.pone.0194030.Peer-Reviewed Original ResearchConceptsWomen of childbearing ageRheumatic heart diseaseFocus groupsLack of health system resourcesLimited health literacyQualitative descriptive methodologyHealth system resourcesHeart diseaseMixed methods studyMiddle-income countriesMale partnersChildbearing ageHealth literacyPatient empowermentWomen of reproductive ageAbandonment of patientsHealth programsPremature mortalitySide effects of contraceptivesDescriptive methodologyConsiderable stigmaIncreased risk of cardiovascular complicationsQualitative studyRisk of cardiovascular complicationsLMICsThe impact of novel coronavirus COVID‐19 on noncommunicable disease patients and health systems: a review
Chang A, Cullen M, Harrington R, Barry M. The impact of novel coronavirus COVID‐19 on noncommunicable disease patients and health systems: a review. Journal Of Internal Medicine 2020, 289: 450-462. PMID: 33020988, PMCID: PMC7675448, DOI: 10.1111/joim.13184.Peer-Reviewed Original ResearchConceptsHealth system factorsNoncommunicable disease patientsNoncommunicable diseasesHealth systemLevels of health systemsSystemic factorsCare of patientsDisease-specific factorsPublic health measuresCare providersNCD patientsDisproportionate burdenHealth measuresCOVID-19Society statementEndocrine disordersPatientsCareLong-term effectsDisease patientsHealthDiseasePandemic disruptionCoronavirus diseaseProvidersCost-effectiveness of Canakinumab for Prevention of Recurrent Cardiovascular Events
Sehested T, Bjerre J, Ku S, Chang A, Jahansouz A, Owens D, Hlatky M, Goldhaber-Fiebert J. Cost-effectiveness of Canakinumab for Prevention of Recurrent Cardiovascular Events. JAMA Cardiology 2019, 4: 128-135. PMID: 30649147, PMCID: PMC6439626, DOI: 10.1001/jamacardio.2018.4566.Peer-Reviewed Original ResearchConceptsQuality-adjusted life yearsCost-effectiveness ratioIncremental cost-effectiveness ratioRecurrent cardiovascular eventsHealth-related quality of lifeStandard of careCanakinumab Anti-inflammatory Thrombosis Outcomes StudyHs-CRP levelsLung cancer incidenceHealth-related qualityMyocardial infarctionCardiovascular eventsRate of recurrent MIHealth care sector perspectiveReduced all-cause mortalityQuality of lifeAll-cause mortalityCost-effectiveUS health care sector perspectiveHs-CRPCancer incidenceRisk of recurrent cardiovascular eventsMain OutcomesHigh-sensitivity C-reactive proteinSubstantial price reductions
2023
Clinical Profile and Outcomes of Rheumatic Heart Disease Patients Undergoing Surgical Valve Procedures in Uganda
Rwebembera J, Chang A, Kitooleko S, Kaudha G, de Loizaga S, Nalule M, Ahabwe K, Zhang W, Okello E, Sinha P, Mwambu T, Sable C, Beaton A, Longenecker C. Clinical Profile and Outcomes of Rheumatic Heart Disease Patients Undergoing Surgical Valve Procedures in Uganda. Global Heart 2023, 18: 62. PMID: 38028964, PMCID: PMC10655755, DOI: 10.5334/gh.1260.Peer-Reviewed Original ResearchConceptsRheumatic heart diseaseAcute rheumatic feverComplication of acute rheumatic feverHeart diseaseValve surgery proceduresPost-operative survivalCohort of patientsProportion of patientsOutcome of operated patientsRetrospective cohort studyFifteen-year survivalValvular heart diseaseChronic valvular heart diseaseLong-term complicationsMortality of patientsValve surgeryValve repairValvular operationsValve proceduresPublic health problemRe-operationValve replacementSurgical managementUgandan patientsValvular interventionsEffectiveness of a community health worker-led low-sodium salt intervention to reduce blood pressure in rural Bangladesh: protocol for a cluster randomized controlled trial
Chang A, Rahman M, Talukder A, Shah H, Mridha M, Hasan M, Sarker M, Geldsetzer P. Effectiveness of a community health worker-led low-sodium salt intervention to reduce blood pressure in rural Bangladesh: protocol for a cluster randomized controlled trial. Trials 2023, 24: 480. PMID: 37501102, PMCID: PMC10375753, DOI: 10.1186/s13063-023-07518-3.Peer-Reviewed Original ResearchConceptsLow-sodium salt substituteCommunity health workersCluster randomized controlled trialHealth workersRural BangladeshImplementing health interventionsBackgroundHigh blood pressureMonths post-interventionBlood pressureExcessive salt consumptionMiddle-income countriesRandomized controlled trialsBlood pressure improvementPublic health problemHigh blood pressureLow-sodium saltPost-interventionCommunity healthHealth interventionsMortality reductionSalt consumptionHealth consequencesHealth problemsBlood pressure-lowering interventionsControlled trialsImpact of a Multidisciplinary Curriculum Training Students and Residents in Tobacco Cessation Strategies for Adult Caregivers of Children
Gribben V, Chang A, Ling P, Rasmussen J, Tebb K, Fuentes-Afflick E, Marbin J. Impact of a Multidisciplinary Curriculum Training Students and Residents in Tobacco Cessation Strategies for Adult Caregivers of Children. MedEdPORTAL 2023, 19: 11313. PMID: 37228253, PMCID: PMC10203095, DOI: 10.15766/mep_2374-8265.11313.Peer-Reviewed Original ResearchConceptsClinical Effort Against Secondhand Smoke ExposureNicotine replacement therapyAdult caregiversCeased trainingPrescription of nicotine replacement therapyChildren's exposure to secondhand smokePediatric residentsAdult caregivers of childrenExposure to secondhand smokeGroup of pediatric residentsCaregivers of ChildrenSmoking cessation skillsTrained pediatric providersNurse practitioner studentsSecondhand smoke exposureHealth professions studentsSmoking cessation techniquesFamily medicine residentsSurveys measuring changesSelf-perceived knowledgeTobacco cessation strategiesUrban academic centerPhysician championsState quitlinesPractitioner studentsWhat We Lost in the Fire: Endemic Tropical Heart Diseases in the Time of COVID-19.
Chang A, Zühlke L, Ribeiro A, Barry M, Okello E, Longenecker C. What We Lost in the Fire: Endemic Tropical Heart Diseases in the Time of COVID-19. American Journal Of Tropical Medicine And Hygiene 2023, 108: 462-464. PMID: 36746666, PMCID: PMC9978545, DOI: 10.4269/ajtmh.22-0514.Peer-Reviewed Original ResearchConceptsHeart diseaseMiddle-income countriesGlobal health equityCOVID-19 pandemicHealth equityHealth disparitiesHealthcare providersCare systemMalaria control initiativesRheumatic heart diseaseGroup of disordersControl statusCOVID-19Time of COVID-19Control initiativesFunding increasesEndomyocardial fibrosisSubstantial mortalityDiseaseEndemic illnessOutcomesChagas diseasePeopleCareHealthcare
2022
Impacts of a Multicenter Medical Education Curriculum for Training Pediatric Residents on Tobacco Cessation for Adult Caregivers of Pediatric Patients
Gribben V, Kosack A, Garell C, Shaikh U, Huang M, Chang A, Rasmussen J, Tebb K, Marbin J. Impacts of a Multicenter Medical Education Curriculum for Training Pediatric Residents on Tobacco Cessation for Adult Caregivers of Pediatric Patients. Clinical Pediatrics 2022, 62: 115-120. PMID: 35891607, DOI: 10.1177/00099228221113783.Peer-Reviewed Original ResearchConceptsClinical Effort Against Secondhand Smoke ExposureSecondhand smoke exposureAdult caregivers of pediatric patientsSmoking cessationPediatric residentsCaregivers of pediatric patientsPost-training knowledgeTraining pediatric residentsMedical education curriculumPediatric residents' attitudesSelf-efficacy itemsEvidence-based frameworkPhysician championsTobacco cessationPatients' caregiversEducation curriculumAdult caregiversLongitudinal curriculumProviders' abilityUntrained residentsSmokers' QuitlineAnonymous surveySmoke exposureDidactic trainingPediatric patients
2021
Preoperative Computed Tomography Angiography Reveals Leaflet-Specific Calcification and Excursion Patterns in Aortic Stenosis
Chen I, Vedula V, Malik S, Liang T, Chang A, Chung K, Sayed N, Tsao P, Giacomini J, Marsden A, Wu J. Preoperative Computed Tomography Angiography Reveals Leaflet-Specific Calcification and Excursion Patterns in Aortic Stenosis. Circulation Cardiovascular Imaging 2021, 14: 1122-1132. PMID: 34915729, PMCID: PMC9206593, DOI: 10.1161/circimaging.121.012884.Peer-Reviewed Original ResearchConceptsAortic valve areaAortic stenosisNoncoronary cuspMale patientsCalcium scoreCoronary cuspValve areaNormal valvesEvaluation of aortic stenosisTranscatheter aortic valve replacementAortic valve replacementComputed tomography angiogramRight coronary cuspLeft coronary cuspNormal aortic valveRight coronary arteryAS severityValve replacementLeaflet thickeningOstial occlusionCalcification loadAortic valveLeaflet excursionCoronary arteryPatientsN‐Terminal Pro‐B‐Type Natriuretic Peptide as a Biomarker for the Severity and Outcomes With COVID‐19 in a Nationwide Hospitalized Cohort
O’Donnell C, Ashland M, Vasti E, Lu Y, Chang A, Wang P, Daniels L, de Lemos J, Morrow D, Rodriguez F, O’Brien C. N‐Terminal Pro‐B‐Type Natriuretic Peptide as a Biomarker for the Severity and Outcomes With COVID‐19 in a Nationwide Hospitalized Cohort. Journal Of The American Heart Association 2021, 10: e022913. PMID: 34889112, PMCID: PMC9075235, DOI: 10.1161/jaha.121.022913.Peer-Reviewed Original ResearchConceptsElevated NT-proBNPCardiovascular risk factorsNT-proBNPHospital mortalityHeart failureRisk factorsCOVID-19N-terminal pro-B-type natriuretic peptidePro-B-type natriuretic peptideElevated NT-proBNP concentrationsElevated NT-proBNP levelsIntensive care unit admissionLog-transformed NT-proBNPMajor adverse cardiac eventsMore cardiovascular risk factorsPrior heart failureAdverse cardiac eventsCare unit admissionNT-proBNP levelsNT-proBNP concentrationsObservational cohort studyShorter median timeRisk of deathUnit admissionCardiac eventsHealth system and patient-level factors serving as facilitators and barriers to rheumatic heart disease care in Sudan
Edwards J, Barry M, Essam D, Elsayed M, Abdulkarim M, Elhossein B, Mohammed Z, Elnogomi A, Elfaki A, Elsayed A, Chang A. Health system and patient-level factors serving as facilitators and barriers to rheumatic heart disease care in Sudan. Global Health Research And Policy 2021, 6: 35. PMID: 34598719, PMCID: PMC8486630, DOI: 10.1186/s41256-021-00222-2.Peer-Reviewed Original ResearchConceptsBenzathine penicillin GRheumatic heart disease careTreatment adherenceHealth system factorsHealth system levelHealth service factorsPatient self-efficacyHealth system infrastructureProphylaxis adherenceFactors associated with increased likelihoodPatient-level factorsAssociated with increased oddsCross-sectional surveyLocal healthcare systemMixed-methods studyFocus group discussionsHeart disease careImprove treatment adherenceHealthcare staffingRHD careBackgroundRheumatic heart diseaseFacility staffingDisease careHealthcare accessPatient knowledgeClinical Outcomes, Echocardiographic Findings, and Care Quality Metrics for People Living With Human Immunodeficiency Virus (HIV) and Rheumatic Heart Disease in Uganda
Chang A, Rwebembera J, Bendavid E, Okello E, Barry M, Beaton A, Haeffele C, Webel A, Kityo C, Longenecker C. Clinical Outcomes, Echocardiographic Findings, and Care Quality Metrics for People Living With Human Immunodeficiency Virus (HIV) and Rheumatic Heart Disease in Uganda. Clinical Infectious Diseases 2021, 74: 1543-1548. PMID: 34382644, DOI: 10.1093/cid/ciab681.Peer-Reviewed Original ResearchConceptsHuman immunodeficiency virusRheumatic heart diseaseEchocardiographic findingsImmunodeficiency virusHeart diseaseClinical outcomesDiagnosis of human immunodeficiency virusPrescription ratesAge- and sex-matched cohortMedication prescription ratesLongitudinal outcomes of patientsCare quality metricsOutcomes of patientsMiddle-income countriesEpidemiology of patientsSex-matched cohortAll-cause mortalityStroke/transient ischemic attackRate of strokeMedian ageClinical careCardiovascular complicationsClinical characteristicsMultivariable adjustmentConcurrent diagnosis
2020
Breast cancer induces systemic immune changes on cytokine signaling in peripheral blood monocytes and lymphocytes
Wang L, Simons D, Lu X, Tu T, Avalos C, Chang A, Dirbas F, Yim J, Waisman J, Lee P. Breast cancer induces systemic immune changes on cytokine signaling in peripheral blood monocytes and lymphocytes. EBioMedicine 2020, 52: 102631. PMID: 31981982, PMCID: PMC6992943, DOI: 10.1016/j.ebiom.2020.102631.Peer-Reviewed Original ResearchConceptsSystemic immune changesPeripheral blood monocytesBreast Cancer Research FoundationBreast Cancer Research ProgramBC patientsImmune changesBlood monocytesPeripheral bloodImmune cellsNon-metastatic BC patientsPeripheral blood immune cellsPeripheral blood T cellsCancer patients' peripheral bloodBlood immune cellsBreast cancer patientsOverall immune statusBlood T cellsPatients' peripheral bloodTumor-infiltrating macrophagesDefense Breast Cancer Research ProgramCancer Research ProgramCancer Research FoundationConcurrent cytokineLocalized diseaseImmune status
2018
Association of Healthcare Plan with atrial fibrillation prescription patterns
Chang A, Askari M, Fan J, Heidenreich P, Ho P, Mahaffey K, Ullal A, Perino A, Turakhia M. Association of Healthcare Plan with atrial fibrillation prescription patterns. Clinical Cardiology 2018, 41: 1136-1143. PMID: 30098034, PMCID: PMC6489790, DOI: 10.1002/clc.23042.Peer-Reviewed Original ResearchConceptsNon-vitamin K-dependent oral anticoagulantsPrimary care physiciansAtrial fibrillationHealthcare planningOral anticoagulantsPlanned patientsOdds of OAC prescriptionAF diagnosisPrescription of oral anticoagulantsRhythm control agentsRhythm control medicationsRetrospective cohort studyAF treatment strategiesReceipt of therapyPharmaceutical claims databaseAssociated with lower useIndex AF diagnosisReceipt of medicationsOAC prescriptionMedian timeLogistic regression modelsAF therapyPrescription patternsTreatment strategiesCohort studyPatient and facility variation in costs of catheter ablation for atrial fibrillation
Perino A, Fan J, Schmitt S, Kaiser D, Heidenreich P, Narayan S, Wang P, Chang A, Turakhia M. Patient and facility variation in costs of catheter ablation for atrial fibrillation. Journal Of Cardiovascular Electrophysiology 2018, 29: 1081-1088. PMID: 29864193, PMCID: PMC6469652, DOI: 10.1111/jce.13655.Peer-Reviewed Original Research
2017
IL6 Signaling in Peripheral Blood T Cells Predicts Clinical Outcome in Breast Cancer
Wang L, Miyahira A, Simons D, Lu X, Chang A, Wang C, Suni M, Maino V, Dirbas F, Yim J, Waisman J, Lee P. IL6 Signaling in Peripheral Blood T Cells Predicts Clinical Outcome in Breast Cancer. Cancer Research 2017, 77: 1119-1126. PMID: 27879265, PMCID: PMC5334262, DOI: 10.1158/0008-5472.can-16-1373.Peer-Reviewed Original ResearchConceptsPeripheral blood T cellsBreast cancer patientsBlood T cellsCancer patientsT cellsIL6 levelsWorse relapse-free survivalPlasma IL6 levelsCancer cellsRelapse-free survivalSerum IL6 levelsAnti-inflammatory propertiesHost immune responseInvolved downregulationClinical outcomesPredictive biomarkersImmune responsePleiotropic cytokinePatientsIL6Cancer ResCancer progressionSurvivalDiagnosisCells