Publications by authors named "Joseph Igwe"

3 Publications

  • Page 1 of 1

Trends, Predictors and Outcomes of Ischemic Stroke Among Patients Hospitalized with Takotsubo Cardiomyopathy.

J Stroke Cerebrovasc Dis 2021 Jul 28;30(10):106005. Epub 2021 Jul 28.

Department of Medicine, Morehouse School of Medicine, 720 Westview Drive S.W., Atlanta, GA 30310, United States. Electronic address:

Objectives: This study assessed the temporal trends in the incidence of ischemic stroke among patients hospitalized with takotsubo cardiomyopathy (TCM) stratified by the subtypes of ischemic stroke (cardioembolic versus thrombotic).Predictors of each stroke subtype, the association with atrial fibrillation (AF), the occurrence of ventricular fibrillation/ventricular tachycardia (VF/VT),cardiogenic shock (CS), in-hospital mortality, length of stay (LOS), and total healthcare cost were also assessed.

Background: Ischemic stroke in TCM is thought to be primarily cardioembolic from left ventricular mural thromboembolism. limited data are available on the incidence of thrombotic ischemic stroke in TCM.

Materials And Methods: We identified 27,970 patients hospitalized with the primary diagnosis of TCM from the 2008 to 2017 National Inpatient Sample, of which 751 (3%) developed ischemic stroke. Of those with ischemic stroke, 571 (76%) had thrombotic stroke while 180 (24%) had cardioembolic stroke. Cochrane armitage test was used to assess the incidence of thrombotic and cardioembolic strokes and multivariate regression was used to identify risk factors associated with each stroke subtype. We compared the incidence of AF, VF/VT, CS, LOS, in-hospital mortality and total cost between hospitalized patients with TCM alone to those with cardioembolic and thrombotic strokes.

Results: From 2008 - 2017, the incidence of thrombotic stroke (4.7%-9.5% (p< 0.0001) increased while it was unchanged for cardioembolic stroke (0.5%-0.7% P=0.5). In the multivariate regression, peripheral artery disease, prior history of stroke, and hyperlipidemia were significantly associated with thrombotic stroke, while CS, AF, and Asian race (compared to White race) were associated with cardioembolic stroke. Both cardioembolic and thrombotic strokes were associated with higher odds of IHM, AF, CS, longer LOS and increased cost. Trends in in-hospital mortality and the utilization of thrombolysis, cerebral angiography, and mechanical thrombectomy among patients with TCM and ischemic stroke were unchanged from 2008 to 2017.

Conclusion: Among patients with TCM and ischemic stroke, thrombotic stroke was more common compared to cardioembolic stroke. Ischemic stroke was associated with poorer outcomes, including higher in-hospital mortality and increased healthcare resource utilization in TCM.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.106005DOI Listing
July 2021

Virtually Serving the Underserved: Resident Perceptions of Telemedicine Use While Training During Coronavirus Disease 2019.

Telemed J E Health 2021 Jun 1. Epub 2021 Jun 1.

Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA.

To adapt during the coronavirus disease 2019 (COVID-19) pandemic, a large safety-net hospital in Atlanta, Georgia and other hospitals across the United Sates, increased telemedicine (TM) for outpatient visits. The impact on resident physicians, including minority providers, had not yet been reported. We aimed to assess how primary care residents perceived increased TM in clinics during the pandemic, and assess resident burnout. An online survey was sent to 60 internal medicine (IM) and 18 family medicine (FM) residents who used TM to treat underserved patients, from March to May 2020, at the onset of the COVID-19 pandemic. The questionnaire included questions on resident demographics, satisfaction with TM, screening capability for COVID-19, effectiveness for patient education on COVID-19, impact on patient interactions and time management. Burnout was assessed with the Abbreviated Maslach Burnout Inventory. A majority (62 of 78) eligible residents (79.5%) responded to the survey. Ninety-one percent of residents agreed that TM was a secure alternative to face-to-face encounters. Seventy-nine percent used it to screen for signs/symptoms of COVID-19 and 93% provided patient education on COVID-19. Average visit length decreased by 10-20 min with TM. Post-TM, scores for overall burnout were decreased ( = 0.0003) and less residents in total exhibited burnout ( = 0.0156). IM and FM residents viewed TM as an efficient way to screen for and provide education on COVID-19, as well as a secure alternative to face-to-face encounters. With increased used of TM during COVID-19, there was decreased burnout among primary care residents.
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http://dx.doi.org/10.1089/tmj.2021.0112DOI Listing
June 2021

Cardiovascular complications in COVID-19 patients with or without diabetes mellitus.

Endocrinol Diabetes Metab 2020 Dec 25:e00218. Epub 2020 Dec 25.

Department of Cardiovascular Disease Morehouse School of Medicine Atlanta GA USA.

Introduction: Coronavirus disease 2019 (COVID-19) has become a major global crisis. Preliminary reports have, in general, indicated worse outcomes in diabetes mellitus (DM) patients, but the magnitude of cardiovascular (CV) complications in this subgroup has not been elucidated.

Methods: We included 142 patients admitted with laboratory-confirmed COVID-19 from April 1st to May 30th 2020; 71 (50%) had DM. We compared baseline demographics and study outcomes between those with or without DM using descriptive statistics. Multivariate logistic regression was used to estimate the adjusted odds ratio for the study outcomes in DM patients, compared to those without DM, stratified by age, sex and glycaemic control. CV outcomes of interest include acute myocarditis, acute heart failure, acute myocardial infarction, new-onset atrial fibrillation and composite cardiovascular end-point consisting of all individual outcomes above.

Result: Mean age was 58 years. The unadjusted rates were higher in DM patients compared to non-diabetics for the composite cardiovascular end-point (73.2% vs. 40.6%  < .0001), acute myocarditis (36.6% vs. 15.5%  = .004), acute heart failure (25.3% vs. 5.6%  = .001), acute myocardial infarction (9.9% vs. 1.4%  = .03) and new-onset atrial fibrillation (12.7% vs. 1.4%  = .009). After controlling for relevant confounding variables, diabetic patients had higher odds of composite cardiovascular end-point, acute heart failure and new-onset atrial fibrillation.
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http://dx.doi.org/10.1002/edm2.218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883043PMC
December 2020
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