Lara C. Kovell

Worldwide, there are differences in hypertension control by sex. The use of home blood pressure monitoring (HBPM) is associated with lower average blood pressures and higher medication adherence. However, little is known about adherence trajectories and sex differences in HBPM. This study characterizes adherence to HBPM among those with and without hypertension. Electronic Framingham Heart Study participants were instructed to perform HBPM weekly for 1 year. Adherence was defined as having ≥1 measurement per week averaged over 4-week segments. Primary exposures of hypertension status and sex were self-reported. Group-based trajectory modeling was used to identify adherence trajectories. Logistic regression was applied to investigate factors associated with membership in each trajectory group in the sex-stratified and whole cohorts. Among 990 participants (58% women, age 53 ± 9 years, 26% hypertension), three groups with distinct HBPM adherence patterns were identified: “early discontinuation”, “gradual decrease”, and “high adherence”. Participants with hypertension were more likely to maintain “high adherence” compared to those without (OR 1.55; 95% CI 1.08–2.23), with similar findings seen among women with hypertension (OR 2.24; 95% CI 1.35–3.72) but not men. In women, these findings remained significant when adjusting for anxiety, depression, and blood pressure, but were attenuated by adjusting for age and income. This study highlights HBPM adherence trajectories and shows that women with hypertension were more likely to be in the high adherence group, though these associations were attenuated after adjusting for demographic factors and co-morbidities. Future studies should explore strategies to enhance adherence in populations at risk of early discontinuation.

Background: Atrial fibrillation/flutter (AF/AFL) and supraventricular tachycardia (SVT) are common arrhythmias in pregnancy. While known to contribute to adverse outcomes, large studies have not evaluated cardiac and perinatal outcomes in individuals with these arrhythmias. Objective: To characterize the cardiac/perinatal outcomes of patients with AF/AFL and SVT in pregnancy. Methods: We performed a retrospective cohort study utilizing Epic Cosmos, a dataset from over 1,500 US hospitals. We identified pregnancies between October 25, 2021 and October 24, 2024 of patients with a diagnosis of AF/AFL and SVT using simultaneous diagnoses codes for each arrhythmia and pregnancy. A control group of pregnancies without arrhythmias was also identified. Descriptive statistics were calculated, and comparisons were made with ANOVA or Chi-square tests, as appropriate. Results: During the study period, there were 8,642 pregnant patients with AF/AFL, 29,638 with SVT, and 5,372,171 healthy pregnant controls. Patients with these arrhythmias were older (AF/AFL: 33±6, SVT: 32±6, control: 31±6, p p <0.0001). Patients with AF/AFL had 23.9 times higher odds of stroke compared to the control group (95% CI 21.3-27.0). Conclusions: While both AF/AFL and SVT are associated with adverse cardiac and perinatal outcomes, AF/AFL was associated with the highest risk of heart failure and stroke. Further research is needed to understand optimal perinatal AF/AFL management, especially anticoagulation therapy given the high rate of maternal stroke.

Objective: To examine storytelling interventions as health promotion tools in underserved populations across disease states, including hypertension, diabetes, overall chronic disease, obstetric care, and preventative health to assess intervention design and cultural tailoring and analyze reported quantitative and qualitative health outcomes. Data Source: A comprehensive literature search was performed in PUBMED. Study Inclusion and Exclusion Criteria: Studies were included if they implemented a storytelling intervention to promote health knowledge, behavior change, or health-related outcomes. Excluded studies lacked an evaluated intervention or reported outcomes. Reviews, commentaries, editorials, protocols without outcome data, and duplicate publications without novel findings were excluded. Only English-language studies were included due to reviewer fluency. Data Extraction: Twenty-five studies were included and categorized based on disease focus. Data Synthesis: A narrative synthesis and inductive content analysis was performed. Studies were grouped by disease state and analyzed for population demographics, intervention development and delivery, cultural tailoring, storytelling theory, and measured outcomes. Results: Storytelling, in digital and oral formats, improved health knowledge, self-efficacy, and preventive behaviors. Several methods were employed to culturally tailor interventions. Interventions were based on multiple behavioral theories. Conclusions: When culturally tailored and rooted in theory, regardless of delivery format, storytelling can foster behavior change across diverse health conditions.

There has been minimal formal evaluation of residency research programs. This study was designed to assess the impact of an internal medicine residency research track on residents’ confidence and attitudes about research skills. In 2022, a research track was started within the UMass Chan internal medicine residency. Ten residents (five PGY-2 and five PGY-3) were selected to participate. Pre- and post-program surveys were created distributed electronically at baseline and one year, with 100% response rate. Survey questions, ranked on a Likert scale (1–5), assessed residents' confidence and self-perceived importance of research skills. Change scores were utilized to compare post-survey responses to baseline using paired t-tests. At baseline, residents reported mean (SD) 5.8 (5.7) publications, which increased by 1.4 (1.8) in one year (p = 0.02). IRB submission, conducting basic analyses, and grant writing had the lowest baseline scores. After one-year, mean confidence scores significantly increased for writing study protocols (pre-score (SD): 3.0 (1.2), Δ: 0.6), IRB submissions (2.6 (1.1), Δ: 0.9), designing survey questions (2.9 (1.3), Δ: 0.9), writing methods (3.4 (1.0), Δ: 0.5), and designing blank tables (3.4 (1.5), Δ: 0.4, all p < 0.05). No significant score reductions were noted. Implementation of research tracks can improve research skills and overcome some barriers to research during residency training. Our study demonstrates improved confidence in research skills through completion of research didactics and close mentorship. Future curricula should conduct needs assessments and provide an individualized approach to maintain research scholarship during residency.

Background: Mechanisms of injury due to hypertension (HTN) in pregnancy remain poorly characterized. This study examined trends in markers of cardiac injury (high-sensitivity troponin I, hs-cTnI), strain (N-terminal pro–B-type natriuretic peptide, NT-proBNP), and inflammation (high-sensitivity C-reactive protein, hs-CRP) in pregnancies with and without HTN. Methods: This prospective, 1:1 case-control study enrolled pregnant women with and without HTN (24–32 weeks gestation) from 2019 to 2022. HTN was defined by a clinical diagnosis of HTN or baseline blood pressure (BP) ≥ 140/90 mm Hg. Serum was collected at baseline, predelivery, and postpartum day 1. Mixed effects tobit models compared log-transformed hs-cTnI, NT-proBNP, and hs-CRP across HTN groups and over time, adjusted for age and body mass index. Results: Mean baseline BP was 130.5 (17.5)/88.2 (13.5) mm Hg for the HTN group (n = 38, 86.8% chronic, 13.2% gestational HTN), and 112.0 (9.8)/70.9 (8.2) mm Hg for those without HTN (n = 38). Over pregnancy, the HTN group had higher hs-cTnI than those without HTN (2.12 [0.43] vs. 1.07 [0.25], Δ1.05 [95%CI: 0.07–2.03] ng/l). Compared to baseline, hs-cTnI increased at predelivery and postpartum for both groups. Overall, the two groups had similar NT-proBNP (HTN: 39.0 [4.5] vs. no HTN: 35.6 [4.3] pg/mL) and hs-CRP (HTN: 12.0 [1.7] vs. no HTN: 9.9 [1.5] mg/L). For both groups, NT-proBNP and hs-CRP increased from baseline to postpartum (NT-proBNP, HTN: 127% [58–227%], no HTN: 120% [51–219%]; hs-CRP: HTN: 550% [343–853%], no HTN: 664% [415–1,034%]). Conclusion: HTN was associated with markers of cardiac injury during pregnancy, while delivery alone led to increases in markers of strain and inflammation. These biomarker changes associated with HTN in pregnancy may represent potential mechanisms to explain adverse cardiovascular events.

Background Worldwide, there are differences in hypertension control by sex. The use of home blood pressure monitoring (HBPM) is associated with lower average blood pressures and higher medication adherence. However, little is known about adherence trajectories and sex differences in HBPM. This study characterizes adherence to HBPM among those with and without hypertension. Methods Electronic Framingham Heart Study participants were instructed to perform HBPM weekly for 1 year. Adherence was defined as having ≥1 measurement per week averaged over 4-week segments. Primary exposures of hypertension status and sex were self-reported. Group-based trajectory modeling was used to identify adherence trajectories. Logistic regression was applied to investigate factors associated with membership in each trajectory group in the sex-stratified and whole cohorts. Results Among 990 participants (58% women, age 53±9 years, 26% hypertension), three groups with distinct HBPM adherence patterns were identified: “early discontinuation”, “gradual decrease”, and “high adherence”. Participants with hypertension were more likely to maintain “high adherence” compared to those without (OR 1.55; 95% CI 1.08-2.23), with similar findings seen among women with hypertension (OR 2.24; 95% CI 1.35-3.72) but not men. In women, these findings remained significant when adjusting for anxiety, depression, and blood pressure, but were attenuated by adjusting for age and income. Conclusions This study highlights HBPM adherence trajectories and shows that women with hypertension were more likely to be in the high adherence group, though these associations were attenuated after adjusting for demographic factors and co-morbidities. Future studies should explore strategies to enhance adherence in populations at risk of early discontinuation.