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Hardeep Singh

Publications and source records attributed to Hardeep Singh.

7 recordsLinked to original sources
PubMed2005

Variation by race in factors contributing to heart failure hospitalizations.

BACKGROUND: Previous studies have shown a paradox of lower mortality in black compared with white patients after hospitalization for heart failure, in contrast to the overall higher mortality reported for nonhospitalized black patients with heart failure. We examined racial differences in factors contributing to hospitalization and in severity of illness in a cohort of black and white patients with heart failure who were hospitalized within a financially "equal access" health care system. METHODS AND RESULTS: We performed a retrospective cohort study on 100 black or white male veterans admitted with heart failure to a VA Medical Center (black, n=52; white, n=48). Severity of illness as measured by the APACHE II score, a generic severity score, was similar between black and white patients (P=.72). However, using a recently developed heart failure-specific risk score, we found that white patients had higher severity of illness (P=.03). White patients had a higher number of coexisting comorbidities than black patients (P=.01), while black patients more frequently had uncontrolled hypertension at the time of admission (P=.004). Nonclinical factors contributing to hospitalization-such as nonadherence with medications or diet, inadequate outpatient follow-up, poor social support, and substance abuse-were documented more frequently for black patients compared with white patients. CONCLUSIONS: At the time of hospitalization for heart failure, black patients may have an overall lower burden of disease and may more frequently have heart failure exacerbation precipitated by nonclinical factors. These findings may partly account for better long-term survival after hospitalization in black patients compared with white patients.

APACHE↗
PubMed2005

Prescribing patterns of diuretics in multi-drug antihypertensive regimens.

Recent literature suggests that most hypertensives will require two or more drugs to achieve target blood pressure. Our objective was to estimate the proportion of patients receiving diuretics, including thiazides, for blood pressure control among those receiving two or more drugs. We studied 25,052 hypertensives in a tertiary care Veterans Affairs facility and identified individuals taking any thiazide or loop diuretic among patients receiving two, three, four, or more drugs. Rates of any diuretic use were 50%, 73%, and 89%, and decreased to 39.0%, 59.0%, and 72.5% for thiazide use, respectively. Rates of thiazide use were statistically significantly higher among African Americans compared with the general study population, but did not differ significantly in the elderly. Though overall diuretic use seems to be increasing as compared with previous studies, there is room for improvement in the use of thiazides in multi-drug hypertension regimens.

Aged↗
PubMed2005

Patterns of antihypertensive therapy among patients with diabetes.

BACKGROUND: Hypertension is extremely prevalent in patients with diabetes. Limited data exist on whether patterns of antihypertensive use in this population are consistent with evidence-based practice guidelines. OBJECTIVE: To evaluate utilization patterns of antihypertensive agents and blood pressure (BP) control among diabetic patients with hypertension. DESIGN: Retrospective cohort study. PATIENTS/PARTICIPANTS: In all, 9,975 patients with diabetes and hypertension as of March 2001 from an outpatient medical center of the Department of Veterans Affairs. MEASURES: Proportions of use of 6 different antihypertensive drug classes were compared for all patients receiving 1, 2, 3, or 4 or more drugs, and separately among patients with and without coronary artery disease (CAD). Blood pressure control (<130/85 mmHg) was compared for untreated patients, those on monotherapy, and patients on multi-drug regimens. RESULTS: Over 60% of patients were receiving angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blocker (ARB), followed by diuretics (38.1%), calcium channel blockers (35.3%) and beta-blockers (28.5%) with 19.1% of patients untreated. Patients on monotherapy were mostly receiving ACEI/ARB (59.5%). The majority (70.7%) of treated patients were on multidrug regimens. In patients with CAD, beta-blocker and ACEI/ARB use was higher, and 70.5% of patients on single-drug regimens received either ACEI/ARB or beta-blockers. The proportions of patients not on medications, on monotherapy, or multidrug regimens achieving BP control were 23.4%, 27.4%, and 24.9%, respectively. CONCLUSIONS: Patterns of anti-hypertensive therapy were generally consistent with evidence-based practice guidelines. Areas of improvement include increasing ACEI/ARB and diuretic use, decreasing the number of untreated patients, and increasing the proportion of patients with controlled BP in this population.

Aged↗
PubMed2003

6-thioguanine can cause serious liver injury in inflammatory bowel disease patients.

BACKGROUND & AIMS: Thioguanine (6-TG) has been studied as an alternative thiopurine in inflammatory bowel disease (IBD). Short-term safety and efficacy data were favorable. Experience with 6-TG in patients with acute lymphoblastic leukemia raised long-term safety concerns when implicated in nodular regenerative hyperplasia (NRH) of the liver and portal hypertension. The aim of this study was to describe the association between 6-TG and NRH in IBD. METHODS: Liver chemistries and complete blood counts were monitored, and patients were encouraged to undergo liver biopsy. Clinical data were collected by chart review, and associations were tested by univariate and multivariable analyses. Patients were classified based on the presence (group 1) or absence (group 2) of laboratory abnormalities. RESULTS: Laboratory abnormalities occurred in 29 of 111 patients (26%). Elevations of liver enzymes and a decrease in platelet counts (<200,000) were most commonly observed. Male gender (odds ratio, 2.9; 95% CI, 1.1-7.3; P < 0.03) and preferential 6-methylmercaptopurine production on 6-mercaptopurine/azathioprine (odds ratio, 3.0; 95% CI, 1.2-7.4; P < 0.04) were independently associated with laboratory abnormalities. No association was seen with duration of 6-TG treatment, cumulative dose, or 6-TG nucleotide levels. The median increase in alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase levels was 39, 30, and 75 U/L, respectively, in group 1, and the median decrease in platelet count was 115,000 in group 1 versus 7000 in group 2 (P < 0.001). NRH occurred in 76% of patients undergoing biopsy in group 1 and 33% in group 2. CONCLUSIONS: NRH is a common finding in 6-TG-treated patients with IBD. The progression or reversibility of NRH remains unknown. Our findings suggest that 6-TG should not be considered as therapy for patients with IBD.

Adolescent↗
PubMedDate not supplied

Quality of care for hypertension and diabetes in federal- versus commercial-managed care organizations.

Initiatives to improve quality in primary care include use of performance measures to benchmark health care organizations. We looked for an objective way to compare primary care quality in the Veterans Affairs (VA) with that of private sector. We analyzed performance measures of the Health Plan and Employer Data Information Set (HEDIS) used in ambulatory care for hypertension and diabetes and compared a sample data from a network of VA hospitals with those from National Committee for Quality Assurance's The State of Health Care Quality 2002 Report. The VA data were comparable to the national data. Performance on the hypertension control measure was slightly below the HEDIS national average but better than the regional commercial average. VA's performance on all diabetes measures was higher. Although the VA network had a large influx in patient base recently, the quality of outpatient care in hypertension and diabetes as measured by standardized performance indicators in the network compared favorably with commercial Health Maintenance Organizations in the private sector.

Diabetes Mellitus↗