National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (2)
- Adverse Events (2)
- Blood Thinners (1)
- (-) Cardiovascular Conditions (13)
- Chronic Conditions (2)
- Diabetes (1)
- (-) Elderly (13)
- Healthcare Costs (1)
- Heart Disease and Health (11)
- Hospital Discharge (1)
- Hospitalization (4)
- Medical Devices (1)
- Medicare (4)
- Medication (5)
- Men's Health (1)
- Mortality (3)
- Nursing Homes (1)
- Outcomes (2)
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- Patient-Centered Outcomes Research (2)
- Patient Adherence/Compliance (1)
- Patient Safety (1)
- Practice Patterns (2)
- Prevention (2)
- Registries (1)
- Rehabilitation (1)
- Risk (5)
- Stroke (1)
- Surgery (3)
- Treatments (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 13 of 13 Research Studies DisplayedPatel DK, Duncan MS, Shah AS
Association of cardiac rehabilitation with decreased hospitalization and mortality risk after cardiac valve surgery.
Investigators sought to characterize cardiac rehabilitation (CR) enrollment after cardiac valve surgery and its association with outcomes, including hospitalizations and mortality. Subjects were all fee-for-service Medicare beneficiaries undergoing open cardiac valve surgery in 2014, identified by inpatient diagnosis codes for open aortic, mitral, tricuspid, and pulmonary valve surgery. They found that fewer than half of Medicare beneficiaries undergoing cardiac valve surgery enrolled in CR programs, and there were marked racial/ethnic disparities among those who do. They recommend further study on barriers to CR enrollment in this population.
AHRQ-funded; HS022990.
Citation: Patel DK, Duncan MS, Shah AS .
Association of cardiac rehabilitation with decreased hospitalization and mortality risk after cardiac valve surgery.
JAMA Cardiol 2019 Dec;4(12):11887-1301. doi: 10.1001/jamacardio.2019.4032..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Rehabilitation, Hospitalization, Surgery, Mortality, Risk, Elderly
Angraal S, Nuti SV, Masoudi FA
Digoxin use and associated adverse events among older adults.
The authors describe national-level trends of digoxin use, hospitalizations for toxicity, and subsequent outcomes over the past two decades. They found that, while digoxin prescriptions have decreased, the drug is still widely prescribed. However, the rate of hospitalizations for digoxin toxicity and adverse outcomes associated with these hospitalizations have decreased. They concluded that these findings reflect the changing clinical practice of digoxin use, aligned with the changes in clinical guidelines.
AHRQ-funded; HS025164; HS025402; HS025517.
Citation: Angraal S, Nuti SV, Masoudi FA .
Digoxin use and associated adverse events among older adults.
Am J Med 2019 Oct;132(10):1191-98. doi: 10.1016/j.amjmed.2019.04.022.
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Keywords: Medication, Elderly, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Heart Disease and Health, Cardiovascular Conditions, Hospitalization, Practice Patterns
Kundi H, Popma JJ, Valsdottir LR
The value of claims-based nontraditional risk factors in predicting long-term mortality after MitraClip procedure.
The goals of this study were to identify nontraditional risk factors coded in administrative claims data and to evaluate their ability to improve prediction of long-term mortality in patients undergoing percutaneous mitral valve repair. Patients undergoing transcatheter mitral valve repair using MitraClip implantation were identified among Medicare fee-for-service beneficiaries; researchers used nested Cox regression models to identify claims codes predictive of long-term mortality. Four groups of variables were introduced: cardiac, noncardiac, and nontraditional risk factors, and presentation characteristics. The authors conclude that risk-prediction models, which include nontraditional risk factors as identified in claims data, can be used to predict long-term mortality risk more accurately in patients who have undergone MitraClip procedures.
AHRQ-funded; HS024520.
Citation: Kundi H, Popma JJ, Valsdottir LR .
The value of claims-based nontraditional risk factors in predicting long-term mortality after MitraClip procedure.
Can J Cardiol 2018 Dec;34(12):1648-54. doi: 10.1016/j.cjca.2018.10.002..
Keywords: Cardiovascular Conditions, Elderly, Mortality, Heart Disease and Health, Medicare, Risk, Surgery
Mentias A, Shantha G, Adeola O
Role of diabetes and insulin use in the risk of stroke and acute myocardial infarction in patients with atrial fibrillation: a Medicare analysis.
This study examined the role of diabetes and insulin use in the risk of stroke and acute myocardial infarction (AMI) in patients with atrial fibrillation (AF). A cohort of Medicare beneficiaries newly diagnoses with AF from 2011 to 2013 were identified. The cohort was divided into those with diabetes requiring insulin (6.7%), those with diabetes not requiring insulin (31.3%) and non-diabetics (62%). Diabetics requiring insulin were at the greatest risk of stroke and AMI, and diabetics not requiring insulin were at slightly lower risk, but non-diabetics had the lowest risk.
AHRQ-funded; HS023104.
Citation: Mentias A, Shantha G, Adeola O .
Role of diabetes and insulin use in the risk of stroke and acute myocardial infarction in patients with atrial fibrillation: a Medicare analysis.
Am Heart J 2019 Aug;214:158-66. doi: 10.1016/j.ahj.2019.05.003..
Keywords: Diabetes, Stroke, Heart Disease and Health, Cardiovascular Conditions, Risk, Chronic Conditions, Elderly
Kundi H, Popma JJ, Reynolds MR
Frailty and related outcomes in patients undergoing transcatheter valve therapies in a nationwide cohort.
In this study, the investigators sought to identify the prevalence and related outcomes of frail individuals undergoing transcatheter mitral valve repair and transcatheter aortic valve replacement (TAVR). Patients aged 65 and older were included in the study if they had at least one procedural code for transcatheter mitral valve repair or TAVR between 1 January 2016 and 31 December 2016 in the Centers for Medicare and Medicaid Services Medicare Provider and Review database.
Citation: Kundi H, Popma JJ, Reynolds MR .
Frailty and related outcomes in patients undergoing transcatheter valve therapies in a nationwide cohort.
Eur Heart J 2019 Jul 14;40(27):2231-39. doi: 10.1093/eurheartj/ehz187.
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Keywords: Elderly, Heart Disease and Health, Cardiovascular Conditions, Surgery, Outcomes, Treatments
Hajduk AM, Gurwitz JH, Tabada G
Influence of multimorbidity on burden and appropriateness of implantable cardioverter-defibrillator therapies.
Researchers sought to determine whether burden of multiple chronic conditions (MCCs) influences the risk of receiving inappropriate vs appropriate device therapies. They studied adults with left ventricular systolic dysfunction receiving an implantable cardioverter-defibrillator (ICD) for primary prevention. In these patients, they found that MCC burden was independently associated with an increased risk of inappropriate but not appropriate device therapies. They recommended considering comorbidity burden when engaging patients in shared decision making about ICD implantation.
AHRQ-funded; 290050033.
Citation: Hajduk AM, Gurwitz JH, Tabada G .
Influence of multimorbidity on burden and appropriateness of implantable cardioverter-defibrillator therapies.
J Am Geriatr Soc 2019 Jul;67(7):1370-78. doi: 10.1111/jgs.15839..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Chronic Conditions, Medical Devices, Prevention, Elderly, Risk, Patient-Centered Outcomes Research
Mentias A, Briasoulis A, Shantha G
Impact of heart failure type on thromboembolic and bleeding risk in patients with atrial fibrillation on oral anticoagulation.
Differential impact of heart failure (HF) category on thromboembolic and bleeding risk in atrial fibrillation (AF) patients on oral anticoagulation (OAC) is unknown. In this study, the investigators used Medicare data for beneficiaries with new AF diagnosed between 2011 and 2013 to identify patients with HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF), and no HF. The investigators concluded that in AF patients, HFrEF and HFpEF are both associated with higher risk of ischemic stroke, HF and AMI admissions, even after adjusting for OAC use, compared with patients without HF.
AHRQ-funded; HS023104.
Citation: Mentias A, Briasoulis A, Shantha G .
Impact of heart failure type on thromboembolic and bleeding risk in patients with atrial fibrillation on oral anticoagulation.
Am J Cardiol 2019 May 15;123(10):1649-53. doi: 10.1016/j.amjcard.2019.02.027..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Blood Thinners, Medication, Adverse Drug Events (ADE), Adverse Events, Risk, Elderly, Patient-Centered Healthcare, Registries
Zullo AR, Mogul A, Corsi K
Association between secondary prevention medication use and outcomes in frail older adults after acute myocardial infarction.
In order to examine the effect of using more guideline-recommended medications after myocardial infarction on mortality, rehospitalization, and functional decline in the frailest and oldest segment of long-stay nursing home residents, researchers conducted a retrospective cohort study of U.S. nursing home residents aged 65 years or older. Exposure was the number of secondary prevention medications initiated after myocardial infarction; outcomes were 90-day death, rehospitalization, or functional decline. The results of the study indicate that the use of more guideline-recommended medications after myocardial infarction was associated with decreased mortality in older, predominantly frail adults, but there was no difference in rehospitalization. Functional decline outcomes were discordant and the researchers note that this does not rule out an increased risk associated with more medication use.
AHRQ-funded; HS022998.
Citation: Zullo AR, Mogul A, Corsi K .
Association between secondary prevention medication use and outcomes in frail older adults after acute myocardial infarction.
Circ Cardiovasc Qual Outcomes 2019 Apr;12(4):e004942. doi: 10.1161/circoutcomes.118.004942..
Keywords: Cardiovascular Conditions, Elderly, Heart Disease and Health, Medication, Nursing Homes, Outcomes, Patient-Centered Outcomes Research, Prevention
Nuti SV, Li SX, Xu X
Association of in-hospital resource utilization with post-acute spending in Medicare beneficiaries hospitalized for acute myocardial infarction: a cross-sectional study.
This study compared costs among Medicare fee-for-service beneficiaries aged 65 and over hospitalized with acute myocardial infarction (AMI) from 2010 to 2013 in the Premiere Healthcare Database. The association of in-hospital and post-acute care resource utilization and outcomes was examined. Researchers concluded that greater resource utilization during hospitalization was not associated with meaning differences in costs or mortality rates after hospitalization.
AHRQ-funded; HS023000.
Citation: Nuti SV, Li SX, Xu X .
Association of in-hospital resource utilization with post-acute spending in Medicare beneficiaries hospitalized for acute myocardial infarction: a cross-sectional study.
BMC Health Serv Res 2019 Mar 25;19(1):190. doi: 10.1186/s12913-019-4018-0..
Keywords: Cardiovascular Conditions, Elderly, Healthcare Costs, Hospitalization, Medicare
Huckfeldt P, Escarce J, Sood N
Thirty-day postdischarge mortality among black and white patients 65 years and older in the Medicare Hospital Readmissions Reduction Program.
The goal of this cohort study was to determine whether short-term mortality rates increased among black and white adults 65 years and older after initiation of the Medicare Hospital Readmissions Reduction Program (HRRP) and whether trends differed by race. Using an interrupted time-series analysis, the researchers found that short-term post-discharge mortality did not appear to increase for black patients under the HRRP, suggesting that certain value-based payment policies can be implemented without harming black populations. However, mortality seemed to increase for white patients with heart failure; this situation warrants investigation.
AHRQ-funded; HS025394.
Citation: Huckfeldt P, Escarce J, Sood N .
Thirty-day postdischarge mortality among black and white patients 65 years and older in the Medicare Hospital Readmissions Reduction Program.
JAMA Netw Open 2019 Mar;2(3):e190634. doi: 10.1001/jamanetworkopen.2019.0634..
Keywords: Medicare, Elderly, Mortality, Heart Disease and Health, Cardiovascular Conditions, Hospital Discharge
Morden NE, Woloshin S, Brooks CG
Trends in testosterone prescribing for age-related hypogonadism in men with and without heart disease.
A study in 2010 (Basaria et al) revealed more cardiovascular events in men randomized to take testosterone than among men receiving a placebo. By 2015 the FDA had revised testosterone labels to highlight lack of efficacy evidence and possible increased cardiovascular risk. This study examines trends in testosterone use among Medicare-insured men over the age of 50 with and without coronary artery disease (CAD). A random sample was used of Medicare fee-for-service recipients from January 1, 2007 to December 31, 2016 using prescription fills under Medicare Parts B and D. Results showed that testosterone use was consistently higher among men with CAD than for men without CAD. Prescription rates had lowered after the warnings in 2013 but has remained higher than in 2007 and was largely off-label.
AHRQ-funded; HS024075.
Citation: Morden NE, Woloshin S, Brooks CG .
Trends in testosterone prescribing for age-related hypogonadism in men with and without heart disease.
JAMA Intern Med 2019 Mar;179(3):446-48. doi: 10.1001/jamainternmed.2018.6505..
Keywords: Elderly, Heart Disease and Health, Cardiovascular Conditions, Practice Patterns, Men's Health, Medication
Doll JA, Hellkamp AS, Thomas L
The association of pre- and posthospital medication adherence in myocardial infarction patients.
Nonadherence to optimal medical therapy following myocardial infarction (MI) is associated with adverse clinical outcomes such as stent thrombosis, recurrent cardiovascular events, and death. Whether adherence to medications prior to MI predicts post-MI medication adherence is unknown. In this study, the investigators assessed adherence to P2Y12 inhibitors and statins before and after admission for MI among 8,147 MI patients who had Medicare insurance with Part D prescription coverage.
AHRQ-funded; HS021092.
Citation: Doll JA, Hellkamp AS, Thomas L .
The association of pre- and posthospital medication adherence in myocardial infarction patients.
Am Heart J 2019 Feb;208:74-80. doi: 10.1016/j.ahj.2018.11.004..
Keywords: Cardiovascular Conditions, Elderly, Heart Disease and Health, Medicare, Medication, Patient Adherence/Compliance
Hornsby WE, Sareini MA, Golbus JR
Lower extremity function is independently associated with hospitalization burden in heart failure with preserved ejection fraction.
Frailty reflects decreased resilience to physiological stressors; its prevalence and prognosis are not fully defined in heart failure with preserved ejection fraction (HFpEF). Using the Short Physical Performance Battery, the results of this study showed that lower extremity function independently predicted hospitalization burden in outpatients with HFpEF. Recommendations include additional studies to explore shared mechanisms and treatment implications of frailty in HFpEF.
AHRQ-funded; HS024567.
Citation: Hornsby WE, Sareini MA, Golbus JR .
Lower extremity function is independently associated with hospitalization burden in heart failure with preserved ejection fraction.
J Card Fail 2019 Jan;25(1):2-9. doi: 10.1016/j.cardfail.2018.09.002..
Keywords: Cardiovascular Conditions, Elderly, Hospitalization