National Healthcare Quality and Disparities Report
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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
76 to 99 of 99 Research Studies DisplayedTarbunou YA, Smith JB, Kruse RL
Outcomes associated with hyperglycemia after abdominal aortic aneurysm repair.
This study evaluated the association between postoperative hyperglycemia and outcomes after abdominal aortic aneurysm (AAA) repair. Once patients who underwent open or endovascular repair of a nonruptured AAA were identified, researchers evaluated the association between postoperative hyperglycemia and infections, in-hospital mortality, readmission, patients' characteristics, length of hospital stay, and medications. Multivariable logistic models were used examined the association of postoperative hyperglycemia with in-hospital infection and mortality. The results of the study show that patients who received endovascular repair and who had postoperative hyperglycemia had greater risk of infection and death. A diabetes diagnosis was associated with lower odds of both infection and in-hospital mortality, after controlling for insulin administration and postoperative hyperglycemia. The researchers conclude that hyperglycemia may be used as a clinical marker, since it was found to be significantly associated with inferior outcomes after elective AAA repair, but note that their study cannot imply causation.
AHRQ-funded; HS022140.
Citation: Tarbunou YA, Smith JB, Kruse RL .
Outcomes associated with hyperglycemia after abdominal aortic aneurysm repair.
J Vasc Surg 2019 Mar;69(3):763-73.e3. doi: 10.1016/j.jvs.2018.05.240..
Keywords: Cardiovascular Conditions, Outcomes, Patient-Centered Outcomes Research, Surgery
Desai NR, Udell JA, Wang Y
Trends in performance and opportunities for improvement on a composite measure of acute myocardial infarction care.
This study sought to examine trends in patient- and hospital-level performance on a composite defect-free care measure, identify disparities in the performance across sociodemographic groups, and identify opportunities to improve quality and outcomes. Using data from the Chest Pain - Myocardial Infarction Registry, the researchers found that, despite improvements in the proportion of patients with acute myocardial infarction receiving defect-free care overall and across sociodemographic groups, nearly 1 in 4 patients did not receive optimal care; absolute performance was consistently lower among older patients, women, black, and Hispanic patients. They conclude that composite measures of cardiovascular care can illuminate opportunities to improve quality of care.
AHRQ-funded; HS023000.
Citation: Desai NR, Udell JA, Wang Y .
Trends in performance and opportunities for improvement on a composite measure of acute myocardial infarction care.
Circ Cardiovasc Qual Outcomes 2019 Mar;12(3):e004983. doi: 10.1161/circoutcomes.118.004983..
Keywords: Cardiovascular Conditions, Disparities, Heart Disease and Health, Quality of Care, Quality Improvement
Valero-Elizondo J, Khera R, Saxena A
Financial hardship from medical bills among nonelderly U.S. Adults with atherosclerotic cardiovascular disease.
This study assessed the national burden of financial hardship from medical bills among individuals with atherosclerotic cardiovascular disease (ASCVD) in a representative sample of nonelderly U.S. adults with ASCVD. The relationship with potential consequences such as financial distress, food insecurity, and cost-related medication nonadherence was also considered. Data from the National Health Interview Survey (NHIS) was used. The authors conclude that the current health care system fails to protect a significant proportion of nonelderly ASCVD patients from financial hardship and its consequences.
AHRQ-funded; HS023000.
Citation: Valero-Elizondo J, Khera R, Saxena A .
Financial hardship from medical bills among nonelderly U.S. Adults with atherosclerotic cardiovascular disease.
J Am Coll Cardiol 2019 Feb 19;73(6):727-32. doi: 10.1016/j.jacc.2018.12.004..
Keywords: Cardiovascular Conditions, Healthcare Costs
Alapati V, Tang F, Charlap E
Discharge heart rate after hospitalization for myocardial infarction and long-term mortality in 2 US registries.
In this study, researchers evaluated the association of discharge and admission heart rates with 3-year mortality. They concluded that a higher discharge heart rate after AMI was more strongly associated with 3-year mortality than a high heart rate at admissions.
AHRQ-funded; HS011282.
Citation: Alapati V, Tang F, Charlap E .
Discharge heart rate after hospitalization for myocardial infarction and long-term mortality in 2 US registries.
J Am Heart Assoc 2019 Feb 5;8(3):e010855. doi: 10.1161/jaha.118.010855..
Keywords: Cardiovascular Conditions, Hospital Discharge, Mortality, Heart Disease and Health, Registries
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
Dunn T, Saeed MJ, Shpigel A
The association of preoperative cardiac stress testing with 30-day death and myocardial infarction among patients undergoing kidney transplantation.
This study examined whether the use of preoperative cardiac stress testing of patients undergoing kidney transplantation reduced 30-day- death and myocardial infarction post-transplantation. ESRD patients 40 years or older with primary Medicare insurance between 2006 and 2013 were identified using the United States Renal Data System. In a matched cohort of 17,304 patients, there was little difference in 30-day post-transplantation mortality and myocardial infarction between those receiving a stress test and those who did not.
AHRQ-funded; HS019455.
Citation: Dunn T, Saeed MJ, Shpigel A .
The association of preoperative cardiac stress testing with 30-day death and myocardial infarction among patients undergoing kidney transplantation.
PLoS One 2019 Feb;14(2):e0211161. doi: 10.1371/journal.pone.0211161..
Keywords: Transplantation, Kidney Disease and Health, Heart Disease and Health, Cardiovascular Conditions, Chronic Conditions, Risk, Surgery
Cykert S, DeWalt DA, Weiner BJ
A population approach using cholesterol imputation to identify adults with high cardiovascular risk: a report from AHRQ's EvidenceNow initiative.
Investigators estimated cholesterol scores for patients between the ages of 40 and 79 in large practice electronic health networks who did not have that in their electronic health record (EHR). This data was used to calculate 10-year Assessment of Cardiovascular Disease Risk (ASCVD) risk scores for patients in 219 practices. They estimated the scores using both “good value’ estimation methodology and formal imputation. The “good value” estimation methodology resulted in less patients with risk scores than imputation but it had higher specificity and a lower false positive rate.
AHRQ-funded; HS023912.
Citation: Cykert S, DeWalt DA, Weiner BJ .
A population approach using cholesterol imputation to identify adults with high cardiovascular risk: a report from AHRQ's EvidenceNow initiative.
J Am Med Inform Assoc 2019 Feb;26(2):155-58. doi: 10.1093/jamia/ocy151..
Keywords: Cardiovascular Conditions, Electronic Health Records (EHRs), Heart Disease and Health, Evidence-Based Practice, Health Information Technology (HIT), Patient-Centered Outcomes Research, Quality Improvement
Althoff KN, Gebo KA, Moore RD
Contributions of traditional and HIV-related risk factors on non-AIDS-defining cancer, myocardial infarction, and end-stage liver and renal diseases in adults with HIV in the USA and Canada: a collaboration of cohort studies.
Adults with HIV have an increased burden of non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, and end-stage renal disease. The objective of this study was to estimate the population attributable fractions (PAFs) of preventable or modifiable HIV-related and traditional risk factors for non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, and end-stage renal disease outcomes.
AHRQ-funded; 90047713.
Citation: Althoff KN, Gebo KA, Moore RD .
Contributions of traditional and HIV-related risk factors on non-AIDS-defining cancer, myocardial infarction, and end-stage liver and renal diseases in adults with HIV in the USA and Canada: a collaboration of cohort studies.
Lancet HIV 2019 Feb;6(2):e93-e104. doi: 10.1016/s2352-3018(18)30295-9.
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Keywords: Cancer, Cardiovascular Conditions, Chronic Conditions, Kidney Disease and Health, Human Immunodeficiency Virus (HIV), Heart Disease and Health, Risk
Yuo TH, Wallace JR, Fish L
Editor's choice - comparison of outcomes after open surgical and endovascular lower extremity revascularisation among end stage renal disease patients on dialysis.
This study compared outcomes of different revascularization surgeries among end stage renal disease (ESRD) patients with peripheral arterial disease (PAD). There is a high risk of complications for this surgery. Outcomes of endovascular revascularization (ER) and open surgical revascularisation (OSR) were compared. Outcomes measured included mortality and major amputation. There is a lower mortality risk for ER versus OSR. OSR has better 30-day limb salvage although there are similar long-term outcomes.
AHRQ-funded; HS019486.
Citation: Yuo TH, Wallace JR, Fish L .
Editor's choice - comparison of outcomes after open surgical and endovascular lower extremity revascularisation among end stage renal disease patients on dialysis.
Eur J Vasc Endovasc Surg 2019 Feb;57(2):248-57. doi: 10.1016/j.ejvs.2018.09.008..
Keywords: Adverse Events, Cardiovascular Conditions, Comparative Effectiveness, Dialysis, Evidence-Based Practice, Kidney Disease and Health, Mortality, Outcomes, Patient-Centered Outcomes Research, Risk, Surgery
Sterling MR, Jannat-Khah D, Bryan J
The prevalence of cognitive impairment among adults with incident heart failure: the "Reasons for Geographic and Racial Differences in Stroke" (REGARDS) study.
The REGARDS study determined the prevalence of cognitive impairment (CI) among adults aged 45 and older with incident heart failure (HF) in order to improve understanding of cognition in HF. Cognitive function was assessed using the Six-Item Screener, and the prevalence of CI among those with incident HF was compared with the prevalence of CI among a matching cohort without HF. The study results indicated that 14.9 percent of the adults with incident HF had CI, suggesting that the majority of cognitive decline occurs after HF diagnosis. The authors suggest that increased awareness of CI among newly diagnosed patients and ways to mitigate it in the context of HF management are warranted.
AHRQ-funded; HS000066.
Citation: Sterling MR, Jannat-Khah D, Bryan J .
The prevalence of cognitive impairment among adults with incident heart failure: the "Reasons for Geographic and Racial Differences in Stroke" (REGARDS) study.
J Card Fail 2019 Feb;25(2):130-36. doi: 10.1016/j.cardfail.2018.12.006..
Keywords: Cardiovascular Conditions, Dementia, Heart Disease and Health, Neurological Disorders
Likosky DS, Baker RA, Newland RF
Is conventional bypass for coronary artery bypass graft surgery a misnomer?
In this study, the investigators identify and subsequently describe regional and center-level differences in the techniques and equipment used for conducting cardiopulmonary bypass (CPB) in the setting of coronary artery bypass grafting (CABG) surgery. They conclude that their findings suggest that the term "conventional bypass" may not adequately reflect real-world experiences. They suggest that instead of using this term, authors should provide key details of the CPB practices used in their patients.
AHRQ-funded; HS022535.
Citation: Likosky DS, Baker RA, Newland RF .
Is conventional bypass for coronary artery bypass graft surgery a misnomer?
J Extra Corpor Technol 2018 Dec;50(4):225-30..
Keywords: Cardiovascular Conditions, Surgery
Chui PW, Parzynski CS, Ross JS
Association of statewide certificate of need regulations with percutaneous coronary intervention appropriateness and outcomes.
This study sought to characterize the association between state certificate of need (CON) regulations and percutaneous coronary interventions (PCI) appropriateness. The investigators found that states with CON had lower proportions of rarely appropriate PCI s, but the absolute differences were small. The investigators note that the findings suggest that CON regulations alone may not limit rarely appropriate PCI among patients with and without acute coronary syndrome.
AHRQ-funded; HS023000.
Citation: Chui PW, Parzynski CS, Ross JS .
Association of statewide certificate of need regulations with percutaneous coronary intervention appropriateness and outcomes.
J Am Heart Assoc 2019 Jan 22;8(2):e010373. doi: 10.1161/jaha.118.010373..
Keywords: Cardiovascular Conditions, Outcomes, Patient-Centered Outcomes Research, Heart Disease and Health, Policy, Surgery
Mills J, Thomas A
AHRQ Author: Mills J
Risk assessment for cardiovascular disease with nontraditional risk factors.
This case study considers a 46-year-old Asian American woman who is concerned about risk of cardiovascular disease because of her new, less active working conditions. She has no personal history of hypertension or hypercholesterolemia, but does have a family history. The case study questions are based on USPSTF recommendations for nontraditional cardiovascular risk factors for CVD in asymptomatic adults.
AHRQ-authored.
Citation: Mills J, Thomas A .
Risk assessment for cardiovascular disease with nontraditional risk factors.
Am Fam Physician 2019 Jan 15;99(2):123-24.
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Keywords: Cardiovascular Conditions, Case Study, Diagnostic Safety and Quality, Risk, U.S. Preventive Services Task Force (USPSTF)
Smith GH, Shore S, Allen LA
Discussing out-of-pocket costs with patients: shared decision making for sacubitril-valsartan in heart failure.
This study examined how prescription costs can greatly impact decision-making in patients with serious medical conditions. Forty-nine patients with heart failure with reduced ejection fracture were recruited and interviewed about a drug sacrubitril-valsartan. The drug is considered effective but can be costly. Most patients (45/49) said they would take the medicine if the out-of-pocket cost was only $5 per month more than their current medication. But if the costs increased to $100 more per month then only 43% would switch to sacrubritil-valsartan. Only 20% of participants said their physician had discussed medication costs in the past year.
AHRQ-funded; HS026081.
Citation: Smith GH, Shore S, Allen LA .
Discussing out-of-pocket costs with patients: shared decision making for sacubitril-valsartan in heart failure.
J Am Heart Assoc 2019 Jan 8;8(1):e010635. doi: 10.1161/jaha.118.010635..
Keywords: Healthcare Costs, Shared Decision Making, Heart Disease and Health, Cardiovascular Conditions, Medication, Chronic Conditions
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
Hsu YJ, Kosinski AS, Wallace AS
Using a society database to evaluate a patient safety collaborative: the Cardiovascular Surgical Translational Study.
The authors assessed the utility of using external databases for quality improvement (QI) evaluations in the context of an innovative QI collaborative aimed to reduce three infections and improve patient safety across the cardiac surgery service line. They compared changes in each outcome between 15 intervention hospitals and 52 propensity score-matched hospitals, and found that improvement trends in several outcomes among the studied intervention hospitals were not statistically different from those in comparison hospitals. They conclude that using external databases may permit comparative effectiveness assessment by providing concurrent comparison groups, additional outcome measures, and longer follow-up.
AHRQ-funded; HS019934.
Citation: Hsu YJ, Kosinski AS, Wallace AS .
Using a society database to evaluate a patient safety collaborative: the Cardiovascular Surgical Translational Study.
J Comp Eff Res 2019 Jan;8(1):21-32. doi: 10.2217/cer-2018-0051..
Keywords: Patient Safety, Quality Improvement, Quality Indicators (QIs), Quality of Care, Surgery, Cardiovascular Conditions, Comparative Effectiveness, Data, Hospitals, Research Methodologies, Patient-Centered Outcomes Research
Ahmad T, Freeman JV, Asselbergs FW
Can advanced analytics fix modern medicine's problem of uncertainty, imprecision, and inaccuracy?
This is an editorial comment on the article “Machine learning-based phenogrouping in heart failure to identify responders to cardiac resynchronization therapy” by M. Cikes et al. published in the same journal issue on pages 74-85. It endorses the work done by Cikes and colleagues.
AHRQ-funded; HS023000.
Citation: Ahmad T, Freeman JV, Asselbergs FW .
Can advanced analytics fix modern medicine's problem of uncertainty, imprecision, and inaccuracy?
Eur J Heart Fail 2019 Jan;21(1):86-89. doi: 10.1002/ejhf.1370..
Keywords: Cardiovascular Conditions, Heart Disease and Health
Parikh KS, Sheng S, Hammill BG
Characteristics of acute heart failure hospitalizations based on presenting severity.
This study tracked patients who were hospitalized for acute heart failure (HF) after they were discharged. Out of 165,000 hospitalizations, 2% were considered high-risk and 32% intermediate-risk for in-hospital mortality which is not much different than 15 years ago. The 1-year mortality rate was 40% among Medicare beneficiaries in the Get With the Guidelines-Heart Failure (GWTG-HF) registry between 2011 and 2016.
AHRQ-funded; HS021092.
Citation: Parikh KS, Sheng S, Hammill BG .
Characteristics of acute heart failure hospitalizations based on presenting severity.
Circ Heart Fail 2019 Jan;12(1):e005171. doi: 10.1161/circheartfailure.118.005171..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Hospitalization, Outcomes, Patient-Centered Outcomes Research
Lam L, Ahn HJ, Okajima K
Gender differences in the rate of 30-day readmissions after percutaneous coronary intervention for acute coronary syndrome.
This study investigated whether women have higher 30-day hospital readmission rates than men who have undergone percutaneous coronary intervention (PCI) after acute coronary syndrome (ACS). In general, women have been reported having higher readmission rates than men after ACS. Statewide hospitalization data for 2010 to 2015 in Hawaii was analyzed to compare gender differences. Overall, the women in the study were older, more identified as Native Hawaiian and have more cardiovascular risk factors compared with the men. Readmission rates were found to be higher than for men after undergoing PCI, but as shown above there were more risk factors for these women.
AHRQ-funded; HS019990.
Citation: Lam L, Ahn HJ, Okajima K .
Gender differences in the rate of 30-day readmissions after percutaneous coronary intervention for acute coronary syndrome.
Womens Health Issues 2019 Jan-Feb;29(1):17-22. doi: 10.1016/j.whi.2018.09.002..
Keywords: Cardiovascular Conditions, Hospital Readmissions, Heart Disease and Health, Sexual Health, Surgery
Calkins H, Gliklich RE, Leavy MB
Harmonized outcome measures for use in atrial fibrillation patient registries and clinical practice: endorsed by the Heart Rhythm Society Board of Trustees.
This study used AHRQ’s Outcome Measures Framework (OMF) to create standards so that different registries for atrial fibrillation (AF) can be linked and their data compared. One-hundred outcome measures from 13 different registries were curated and then harmonized according to OMF standards. Twenty measures were created to represent a minimum set of outcomes for research and clinical practice.
AHRQ-funded; 290201400004C.
Citation: Calkins H, Gliklich RE, Leavy MB .
Harmonized outcome measures for use in atrial fibrillation patient registries and clinical practice: endorsed by the Heart Rhythm Society Board of Trustees.
Heart Rhythm 2019 Jan;16(1):e3 - e16. doi: 10.1016/j.hrthm.2018.09.021..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Outcomes, Patient-Centered Outcomes Research, Registries
Mokhateb-Rafii T, Bakar A, Gangadharan S
Hemodynamic impact of oxygen desaturation during tracheal intubation among critically ill children with cyanotic and noncyanotic heart disease.
The objective of this study was to determine a level of oxygen desaturation associated with increased risk of tracheal intubation events in children in a pediatric or cardiac ICU with cyanotic and noncyanotic heart disease. Oxygen desaturation was measured by a fall in pulse oximetry from baseline after pre-oxygenation. The primary outcome was occurrence of hemodynamic tracheal intubation associated events defined as cardiac arrest, hypotension, or dysrhythmia. Results indicate that oxygen desaturation by 30% or more is associated with increased odds for adverse hemodynamic events, after adjusting for confounders. Oxygen desaturation was observed more often in children with cyanotic than those with noncyanotic heart disease, but hemodynamic tracheal intubation associated event rates were similar.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Mokhateb-Rafii T, Bakar A, Gangadharan S .
Hemodynamic impact of oxygen desaturation during tracheal intubation among critically ill children with cyanotic and noncyanotic heart disease.
Pediatr Crit Care Med 2019 Jan;20(1):19-26. doi: 10.1097/pcc.0000000000001766..
Keywords: Adverse Events, Cardiovascular Conditions, Children/Adolescents, Heart Disease and Health, Respiratory Conditions, Intensive Care Unit (ICU), Patient Safety, Risk
Hickson RP, Cole AL, Dusetzina SB
Implications of removing rosiglitazone's black box warning and restricted access program on the uptake of thiazolidinediones and dipeptidyl peptidase-4 inhibitors among patients with type 2 diabetes.
The purpose of this study was to describe trends over time in the initiation of rosiglitazone and pioglitazone-both in the thiazolidinedione (TZD) class-and medications from the dipeptidyl peptidase-4 (DPP-4) inhibitor class before and after the FDA removed a black box warning and restricted access program for rosiglitazone regarding an increased risk of myocardial infarction.
AHRQ-funded; HS000032.
Citation: Hickson RP, Cole AL, Dusetzina SB .
Implications of removing rosiglitazone's black box warning and restricted access program on the uptake of thiazolidinediones and dipeptidyl peptidase-4 inhibitors among patients with type 2 diabetes.
J Manag Care Spec Pharm 2019 Jan;25(1):72-79. doi: 10.18553/jmcp.2019.25.1.072..
Keywords: Adverse Drug Events (ADE), Adverse Events, Cardiovascular Conditions, Diabetes, Medication, Heart Disease and Health, Patient Safety
O'Brien EC, Holmes DN, Thomas L
Incremental prognostic value of renal function for stroke prediction in atrial fibrillation.
This study investigated whether renal function predicted stroke in patients diagnosed with atrial fibrillation (AF). Data from the Outcomes Registry for Better Informed Treatment (ORBIT-AF) was used. Investigators concluded that renal dysfunction was not independently associated with embolic risk in either treated or untreated patients.
AHRQ-funded; HS021092.
Citation: O'Brien EC, Holmes DN, Thomas L .
Incremental prognostic value of renal function for stroke prediction in atrial fibrillation.
Int J Cardiol 2019 Jan 1;274:152-57. doi: 10.1016/j.ijcard.2018.07.113..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Risk, Stroke
Anderson JB, Brown DW, Lihn S
Power of a learning network in congenital heart disease.
This paper discusses the efforts of the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC). The collaborative formed to improve outcomes in infants with hypoplastic left heart syndrome. It sought to (1) decrease mortality, (2) reduce growth failure, and (3) reduce hospital readmissions due to major medical problems during the interstage period between discharge following stage 1 palliation (S1P) and admission for stage 2 palliation (S2P).
AHRQ-funded; HS016957.
Citation: Anderson JB, Brown DW, Lihn S .
Power of a learning network in congenital heart disease.
World J Pediatr Congenit Heart Surg 2019 Jan;10(1):66-71. doi: 10.1177/2150135118815023..
Keywords: Cardiovascular Conditions, Children/Adolescents, Education: Continuing Medical Education, Palliative Care, Quality Improvement, Registries