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
2024
Exploring the health impacts of climate change: Challenges and considerations for health services research.
Schulman EB, Chen K, Chang AY. Exploring the health impacts of climate change: Challenges and considerations for health services research. Health Serv Res 2024 PMID: 39539050, DOI: 10.1111/1475-6773.14408.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsExtreme heat and cardiovascular mortality among structurally marginalized populations in the United States: A scoping review
Sejo C, Mehta N, Wilairat S, Barry M, Odden M, Chang A. Extreme heat and cardiovascular mortality among structurally marginalized populations in the United States: A scoping review. The Journal Of Climate Change And Health 2024, 20: 100343. DOI: 10.1016/j.joclim.2024.100343.Peer-Reviewed Original ResearchScoping reviewCardiovascular mortalityStructurally marginalized populationsMarginalized populationsLow socioeconomic statusAsian American/Pacific Islander populationsWeb of ScienceDatabases of PubMedMedical Subject HeadingsOlder adultsSocioeconomic statusQuantitative research studyEnglish language manuscriptsCause of deathCohort studySystematic reviewInclusion criteriaUnited StatesExtreme heatSystematic searchMeta-analysisNarrative reviewRisk factorsPrimary researchSubject headingsPreintervention Wait Time and Survival in People With Rheumatic Heart Disease in Uganda
Doh C, An C, Chang A, Rwebembera J, Mwambu T, Beaton A, Nakagaayi D, Ruda Vega P, Sable C, Longenecker C, Lwabi P. Preintervention Wait Time and Survival in People With Rheumatic Heart Disease in Uganda. The Annals Of Thoracic Surgery 2024, 118: 941-948. PMID: 38908768, DOI: 10.1016/j.athoracsur.2024.06.009.Peer-Reviewed Original ResearchRheumatic heart diseaseSurgical interventionRisk factors associated with timeClinical rheumatic heart diseaseFactors associated with timeAtrial fibrillationNew York Heart Association functional class III/IVYears of follow-upHeart diseaseCox proportional hazards modelsHistory of infective endocarditisHistory of atrial fibrillationMultivariate Cox proportional hazards modelFunctional class III/IVPre-interventionRight ventricular dysfunctionProportional hazards modelAssociated with increased probabilityProbability of deathEducation levelKaplan-Meier estimatesSurgical burdenPreoperative mortalityValve surgeryClass III/IVATRIAL FIBRILLATION AND RHEUMATIC HEART DISEASE IN UGANDA: AN ANALYSIS OF OUTCOMES AND QUALITY CARE METRICS
Opara C, Lan R, Rwebembera J, Okello E, Watkins D, Chang A, Longenecker C. ATRIAL FIBRILLATION AND RHEUMATIC HEART DISEASE IN UGANDA: AN ANALYSIS OF OUTCOMES AND QUALITY CARE METRICS. Journal Of The American College Of Cardiology 2024, 83: 2461. DOI: 10.1016/s0735-1097(24)04451-6.Peer-Reviewed Original ResearchInterviewer biases in medical survey data: The example of blood pressure measurements
Geldsetzer P, Chang A, Meijer E, Sudharsanan N, Charu V, Kramlinger P, Haarburger R. Interviewer biases in medical survey data: The example of blood pressure measurements. PNAS Nexus 2024, 3: pgae109. PMID: 38525305, PMCID: PMC10959064, DOI: 10.1093/pnasnexus/pgae109.Peer-Reviewed Original ResearchBlood pressure measurementsHealth SurveyGlobal health indicatorsMiddle-income countriesInterviewer effectsHypertension prevalenceBlood pressureHealth agenciesLinear mixed modelsHealth indicatorsPhysical measurementsPrevalence estimatesSystolic blood pressurePressure measurementsGlobal SouthHealthInterviewsSubdistrict levelIndividual factorsSurvey dataMedical survey dataInterview techniquesMixed modelsRandom effectsProportion of variationOutcomes and care quality metrics for people living with rheumatic heart disease and atrial fibrillation in Uganda
Opara C, Lan R, Rwebembera J, Okello E, Watkins D, Chang A, Longenecker C. Outcomes and care quality metrics for people living with rheumatic heart disease and atrial fibrillation in Uganda. Heart Rhythm O2 2024, 5: 201-208. PMID: 38690140, PMCID: PMC11056452, DOI: 10.1016/j.hroo.2024.02.002.Peer-Reviewed Original ResearchRheumatic heart diseaseCare retentionAtrial fibrillationFactors associated with retentionCare quality metricsNearest health centerNew York Heart Association functional class III/IVComplications of rheumatic heart diseaseLower-resource settingsHeart diseaseFunctional class III/IVMultivariate logistic regressionMedian follow-upCare metricsHealth centersPrescription ratesCareConcurrent AFAnticoagulant prescriptionLogistic regressionClass III/IVAF participantsMedian ageAtrial flutterCharacterize demographics
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 interventionsAbstract 14916: Clinical and Socioeconomic Factors Associated With Time to Surgery and Preoperative Mortality in Surgery-Eligible Patients With Rheumatic Valvular Heart Disease in Uganda
Doh C, An C, Chang A, Rwebembera J, Mwambu T, Beaton A, Nakagaayi D, Vega P, Sable C, Lwabi P, Longenecker C. Abstract 14916: Clinical and Socioeconomic Factors Associated With Time to Surgery and Preoperative Mortality in Surgery-Eligible Patients With Rheumatic Valvular Heart Disease in Uganda. Circulation 2023, 148: a14916-a14916. DOI: 10.1161/circ.148.suppl_1.14916.Peer-Reviewed Original ResearchRheumatic heart diseaseFactors associated with timeLikelihood of surgeryPreoperative mortalitySurgical indicationsAwaiting surgeryAtrial fibrillationIncreased likelihood of surgeryValvular rheumatic heart diseaseHistory of infective endocarditisHistory of atrial fibrillationMultivariate Cox proportional hazards modelAdvanced rheumatic heart diseaseHeart diseaseRate of surgical interventionRheumatic valvular heart diseaseNYHA class I/IISurgery-eligible patientsNYHA class III/IVMedian follow-upAssociated with increased mortalityTime to surgeryCohort of patientsReceipt of surgeryValvular heart diseaseHealthcare provider-targeted mobile applications to diagnose, screen, or monitor communicable diseases of public health importance in low- and middle-income countries: A systematic review
Geldsetzer P, Flores S, Flores B, Rogers A, Chang A. Healthcare provider-targeted mobile applications to diagnose, screen, or monitor communicable diseases of public health importance in low- and middle-income countries: A systematic review. PLOS Digital Health 2023, 2: e0000156. PMID: 37801442, PMCID: PMC10558072, DOI: 10.1371/journal.pdig.0000156.Peer-Reviewed Original ResearchMiddle-income countriesCommunicable diseasesMHealth technologiesRandomized clinical trialsCochrane Central for studiesTargeting health professionalsSelf-management toolsPaper-based toolsPatient self-management toolsCountry of developmentDiseases of public health importanceSystematically searched PubMedWeb of ScienceHealth professionalsPublic health importanceMethod of screeningSample sizeTablet-basedInclusion criteriaLMICsPriority diseasesExtract dataClinical calculatorsHealth importanceCommunication facilitatorEffectiveness 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 diseasePeopleCareHealthcareCigarettes: A toxic lifelong cycle
Gribben V, Chang A. Cigarettes: A toxic lifelong cycle. 2023, 388-399. DOI: 10.1016/b978-0-12-818872-9.00138-2.Peer-Reviewed Original ResearchAdult caregiversGlobal tobacco useStructural competency frameworkHealth effects of cigarettesThirdhand smoke exposurePublic policy levelsReduce cigarette useNegative health effectsHealth providersCigarette smoking behaviorEffects of cigarettesTobacco useTobacco smokeSmoking behaviorDisproportionate riskSmoke exposureCigarette useLife courseCigarette smokingCompetency frameworkSmokingPolicy levelCaregiversCigaretteSpecial risk