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AHRQ Research Studies Date
Topics
- Access to Care (1)
- Adverse Drug Events (ADE) (1)
- Adverse Events (4)
- Blood Thinners (1)
- (-) Cardiovascular Conditions (15)
- Care Coordination (1)
- Care Management (1)
- Communication (1)
- Comparative Effectiveness (1)
- Diagnostic Safety and Quality (1)
- Elderly (1)
- Evidence-Based Practice (3)
- Healthcare-Associated Infections (HAIs) (2)
- Healthcare Cost and Utilization Project (HCUP) (1)
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- Heart Disease and Health (8)
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- Hospital Readmissions (2)
- Imaging (1)
- Medical Devices (3)
- Medicare (2)
- Medication (1)
- Mortality (2)
- Outcomes (4)
- Patient-Centered Outcomes Research (4)
- Patient Safety (3)
- Payment (2)
- Pneumonia (2)
- Provider Performance (1)
- Quality Measures (1)
- Registries (1)
- Rehabilitation (2)
- Risk (2)
- (-) Surgery (15)
- Teams (1)
- Transplantation (1)
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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
1 to 15 of 15 Research Studies DisplayedVogel TR, Smith JB, Kruse RL
Risk factors for thirty-day readmissions after lower extremity amputation in patients with vascular disease.
This retrospective cohort study evaluated factors associated with all-cause 30-day readmission after lower extremity amputation procedures. The investigators asserted that the finding- that acute arterial embolism or thrombosis and a below the knee amputation during the index admission was highly associated with readmission, combined with the high rates of 30-day conversion to an above the knee amputation when readmitted- suggests these patients more often develop stump complications or may be undertreated during the initial hospitalization.
AHRQ-funded; HS022140.
Citation: Vogel TR, Smith JB, Kruse RL .
Risk factors for thirty-day readmissions after lower extremity amputation in patients with vascular disease.
PM R 2018 Dec;10(12):1321-29. doi: 10.1016/j.pmrj.2018.05.017..
Keywords: Cardiovascular Conditions, Hospital Readmissions, Risk, Surgery
Amin AP, Miller S, Rahn B
Reversing the "risk-treatment paradox" of bleeding in patients undergoing percutaneous coronary intervention: risk-concordant use of bleeding avoidance strategies is associated with reduced bleeding and lower costs.
Bleeding avoidance strategies (BAS) are effective, but are paradoxically used less often with patients at high risk of bleeding. This article describes the implementation of an intervention in a St. Louis, MO, hospital intended to reverse the bleeding risk-treatment paradox. Temporal trends in BAS use and the association of risk-concordant BAS use with bleeding as well as hospital costs of percutaneous coronary intervention were examined. Patient-centered care that aimed directly toward making treatment-related decisions based on predicted risk of bleeding led to a more risk-concordant use of BAS and a reversal of the risk-treatment paradox. The authors conclude that larger multicentered studies will be needed to corroborate these results.
AHRQ-funded; HS022481.
Citation: Amin AP, Miller S, Rahn B .
Reversing the "risk-treatment paradox" of bleeding in patients undergoing percutaneous coronary intervention: risk-concordant use of bleeding avoidance strategies is associated with reduced bleeding and lower costs.
J Am Heart Assoc 2018 Nov 6;7(21):e008551. doi: 10.1161/jaha.118.008551..
Keywords: Adverse Events, Patient Safety, Heart Disease and Health, Risk, Surgery, Cardiovascular Conditions, Healthcare Costs
Thompson MP, Cabrera L, Strobel RJ
Association between postoperative pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery.
Postoperative pneumonia is the most common healthcare-associated infection in cardiac surgical patients, yet their impact across a 90-day episode of care remains unknown. The objective of this study was to examine the relationship between pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery. The investigators concluded that postoperative pneumonia was associated with significantly higher 90-day episode payments and inferior outcomes at the patient and hospital level.
AHRQ-funded; HS022535.
Citation: Thompson MP, Cabrera L, Strobel RJ .
Association between postoperative pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery.
Circ Cardiovasc Qual Outcomes 2018 Sep;11(9):e004818. doi: 10.1161/circoutcomes.118.004818..
Keywords: Elderly, Surgery, Medicare, Cardiovascular Conditions, Heart Disease and Health, Pneumonia, Payment, Healthcare Costs, Outcomes, Healthcare-Associated Infections (HAIs), Health Insurance
Bates J, Parzynski CS, Dhruva SS
Quantifying the utilization of medical devices necessary to detect postmarket safety differences: a case study of implantable cardioverter defibrillators.
The purpose of this study was to estimate medical device utilization needed to detect safety differences among implantable cardioverter defibrillators (ICDs) generator models and compare these estimates to utilization in practice. The investigators concluded that small safety differences among ICD generator models are unlikely to be detected through routine surveillance given current ICD utilization in practice, but large safety differences can be detected for most patients at anticipated average adverse event rates.
AHRQ-funded; HS022882.
Citation: Bates J, Parzynski CS, Dhruva SS .
Quantifying the utilization of medical devices necessary to detect postmarket safety differences: a case study of implantable cardioverter defibrillators.
Pharmacoepidemiol Drug Saf 2018 Aug;27(8):848-56. doi: 10.1002/pds.4565..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Medical Devices, Patient Safety, Registries, Surgery
Patel S, Poorjary P, Pawar S
National landscape of unplanned 30-day readmissions in patients with left ventricular assist device implantation.
This study tracked unplanned 30-day readmissions in patients who had undergone left ventricular assist device (LVAD) implantation during 2013. Data from the Healthcare Cost and Utilization Project (HCUP) National Readmission Database was used. Out of 2,235 patients who had an LVAD implantation, 29.7% had at least 1 unplanned readmission within 30 days. The top reasons for readmission were implant complications (14.9%), congestive heart failure (11.7%), and gastrointestinal bleeding (8.4%). Predictors of readmission included a prolonged length stay during the primary admission, Medicare insurance, and discharge to a short-term facility.
AHRQ-funded; HS023000.
Citation: Patel S, Poorjary P, Pawar S .
National landscape of unplanned 30-day readmissions in patients with left ventricular assist device implantation.
Am J Cardiol 2018 Jul 15;122(2):261-67. doi: 10.1016/j.amjcard.2018.03.363..
Keywords: Healthcare Cost and Utilization Project (HCUP), Heart Disease and Health, Cardiovascular Conditions, Surgery, Medical Devices, Adverse Events
Suckow BD, Goodney PP, Columbo JA
National trends in open surgical, endovascular, and branched-fenestrated endovascular aortic aneurysm repair in Medicare patients.
Open repair effectively prevents rupture for patients with abdominal aortic aneurysm (AAA) and is commonly studied as a metric reflecting hospital and surgeon expertise in cardiovascular care. However, given recent advances in endovascular aneurysm repair (EVAR), such as branched-fenestrated EVAR, it is unknown how commonly open surgical repair is still used in everyday practice. This study analyzed trends in open AAA repair, EVAR, and branched-fenestrated EVAR for AAA in Medicare beneficiaries from 2003 to 2013.
AHRQ-funded; HS021581.
Citation: Suckow BD, Goodney PP, Columbo JA .
National trends in open surgical, endovascular, and branched-fenestrated endovascular aortic aneurysm repair in Medicare patients.
J Vasc Surg 2018 Jun;67(6):1690-97.e1. doi: 10.1016/j.jvs.2017.09.046..
Keywords: Cardiovascular Conditions, Medicare, Provider Performance, Quality Measures, Surgery
Hsu HE, Kawai AT, Wang R
The impact of the Medicaid healthcare-associated condition program on mediastinitis following coronary artery bypass graft.
This study aimed to evaluate the impact of a program that eliminated additional Medicare payment for mediastinitis following coronary artery bypass graft (CABG) to include Medicaid on mediastinitis rates reported by the National Healthcare Safety Network (NHSN). It found that the 2012 Medicaid program to eliminate additional payments for mediastinitis following CABG had no impact on reported mediastinitis rates.
AHRQ-funded; HS025008; HS018414; HS000063.
Citation: Hsu HE, Kawai AT, Wang R .
The impact of the Medicaid healthcare-associated condition program on mediastinitis following coronary artery bypass graft.
Infect Control Hosp Epidemiol 2018 Jun;39(6):694-700. doi: 10.1017/ice.2018.69.
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Keywords: Cardiovascular Conditions, Payment, Healthcare-Associated Infections (HAIs), Patient Safety, Surgery
Goldstone AB, Chiu P, Baiocchi M
Second arterial versus venous conduits for multi-vessel coronary artery bypass surgery in California.
This study sought to determine whether a second arterial conduit improves outcomes after multi-vessel coronary artery bypass grafting. It concluded that second arterial conduit use in California is low and declining, but arterial grafts were associated with significantly lower mortality and fewer cardiovascular events. A right internal thoracic artery graft offered no benefit over that of a radial artery, but did increase risk of sternal wound infection.
AHRQ-funded; HS022192.
Citation: Goldstone AB, Chiu P, Baiocchi M .
Second arterial versus venous conduits for multi-vessel coronary artery bypass surgery in California.
Circulation 2018 Apr 17;137(16):1698-707. doi: 10.1161/circulationaha.117.030959.
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Keywords: Cardiovascular Conditions, Comparative Effectiveness, Mortality, Patient-Centered Outcomes Research, Surgery
Bachmann JM, Shah AS, Duncan MS
Cardiac rehabilitation and readmissions after heart transplantation.
Cardiac transplant recipients always are referred to cardiac rehabilitation (CR) after transplantation, and is associated with a lower 1-year readmission risk. This study’s objective was to determine rates of CR for heart transplant recipients in the US and also 1-year readmission rates using 2013-2014 Medicare data. Out of the 2,531 heart transplant patients in the US in 2013, about 24% received Medicare coverage and were included in the study. Rates of CR utilization was only, with only 55% participating in the program. Younger transplant patients ages 35 to 49 years were less likely to initiate CR than patients 65 and older. In all groups patients did not attend all 36 prescribed sessions, with a mean of 26.7 sessions attended. The 1-year readmission risk was 29% lower for CR participation patients.
AHRQ-funded; HS022990.
Citation: Bachmann JM, Shah AS, Duncan MS .
Cardiac rehabilitation and readmissions after heart transplantation.
J Heart Lung Transplant 2018 Apr;37(4):467-76. doi: 10.1016/j.healun.2017.0.017.
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Keywords: Transplantation, Surgery, Rehabilitation, Cardiovascular Conditions, Heart Disease and Health, Hospital Readmissions, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Everson J, Funk RJ, Kaufman SR
Repeated, close physician coronary artery bypass grafting teams associated with greater teamwork.
This study sought to determine whether observed patterns of physician interaction around shared patients are associated with higher levels of teamwork as perceived by physicians. It found that in hospitals where physicians repeatedly cared for patients with the same colleagues, physicians perceived better teamwork. When physicians who worked together also had other colleagues in common, the reported teamwork was stronger.
AHRQ-funded; HS024525; HS024728.
Citation: Everson J, Funk RJ, Kaufman SR .
Repeated, close physician coronary artery bypass grafting teams associated with greater teamwork.
Health Serv Res 2018 Apr;53(2):1025-41. doi: 10.1111/1475-6773.12703.
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Keywords: Cardiovascular Conditions, Care Coordination, Communication, Surgery, Teams
Likosky DS, Sukul D, Seth M
Association between Medicaid expansion and cardiovascular interventions in Michigan.
This study evaluated Michigan’s Medicaid expansion as it relates to access and outcomes for 7,558 coronary artery bypass grafting operations at 33 hospitals and 45,183 percutaneous coronary interventions at 47 hospitals. Most of the change in access to revascularization occurred within the first quarter following expansion. Michigan’s Medicaid expansion was associated with changes in the demographic of those using specialty cardiovascular services (i.e., reduction in uninsured patients undergoing coronary rrevascularization).
AHRQ-funded; HS022535.
Citation: Likosky DS, Sukul D, Seth M .
Association between Medicaid expansion and cardiovascular interventions in Michigan.
J Am Coll Cardiol 2018 Mar 6;71(9):1050-51. doi: 10.1016/j.jacc.2017.12.044.
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Keywords: Access to Care, Cardiovascular Conditions, Heart Disease and Health, Surgery, Uninsured
Bachmann JM, Duncan MS, Shah AS
Association of cardiac rehabilitation with decreased hospitalizations and mortality after ventricular assist device implantation.
This study examined whether outcomes of cardiac patients who had received ventricular assist device (VAD) implementation had decreased hospitalization and mortality with cardiac rehabilitation (CR). Medicare beneficiaries enrolled for disability or aged 65 years and older in 2014 were included. The investigators identified VAD recipients by diagnosis codes. It was found that each 5-year increase in age was associated with attending an additional 1.6 CR sessions and there was a 23% lower 1-year hospitalization risk and a 47% lower 1-year mortality risk.
AHRQ-funded; HS022990.
Citation: Bachmann JM, Duncan MS, Shah AS .
Association of cardiac rehabilitation with decreased hospitalizations and mortality after ventricular assist device implantation.
JACC Heart Fail 2018 Feb;6(2):130-39. doi: 10.1016/j.jchf.2017.11.002..
Keywords: Cardiovascular Conditions, Rehabilitation, Heart Disease and Health, Medical Devices, Surgery, Patient-Centered Outcomes Research, Outcomes, Mortality, Evidence-Based Practice, Hospitalization
Brescia AA, Rankin JS, Cyr DD
Determinants of variation in pneumonia rates after coronary artery bypass grafting.
In this study, investigators determined to what extent patient risk factors account for hospital variation in pneumonia rates. Their findings suggested that patient risk profiles only account for a fraction of hospital variation in pneumonia rates. The investigators assert that enhanced understanding of other contributory factors (eg, processes of care) is required to lessen the likelihood of such nosocomial infections.
AHRQ-funded; HS022535.
Citation: Brescia AA, Rankin JS, Cyr DD .
Determinants of variation in pneumonia rates after coronary artery bypass grafting.
Ann Thorac Surg 2018 Feb;105(2):513-20. doi: 10.1016/j.athoracsur.2017.08.012..
Keywords: Adverse Events, Cardiovascular Conditions, Pneumonia, Surgery
Bravo PE, Bergmark BA, Vita T
Diagnostic and prognostic value of myocardial blood flow quantification as non-invasive indicator of cardiac allograft vasculopathy.
Cardiac allograft vasculopathy (CAV) is a leading cause of death in orthotopic heart transplant (OHT) survivors. Effective non-invasive screening methods are needed. The aim of this study was to investigate the added diagnostic and prognostic value of myocardial blood flow (MBF) to standard myocardial perfusion imaging (MPI) with positron emission tomography (PET) for CAV detection.
AHRQ-funded; HS022998.
Citation: Bravo PE, Bergmark BA, Vita T .
Diagnostic and prognostic value of myocardial blood flow quantification as non-invasive indicator of cardiac allograft vasculopathy.
Eur Heart J 2018 Jan 21;39(4):316-23. doi: 10.1093/eurheartj/ehx683..
Keywords: Adverse Events, Cardiovascular Conditions, Diagnostic Safety and Quality, Evidence-Based Practice, Heart Disease and Health, Imaging, Patient-Centered Outcomes Research, Surgery
Childers CP, Maggard-Gibbons M, Ulloa JG
Perioperative management of antiplatelet therapy in patients undergoing non-cardiac surgery following coronary stent placement: a systematic review.
Researchers conducted a systematic review on the use of antiplatelet therapy (APT) after non-cardiac surgery (NCS) following stent placement surgery done previously. There has been some debate among the American College of Cardiology and American Heart Association as to the guidelines of how long to delay NCS after stent placement. Out of 4,882 articles, only 16 were included in the review. All of them were small. Reviewers looked for rates of cardiac events and/or bleeding events with the different APT strategies used. There did not seem to be much difference in outcomes between the different strategies.
AHRQ-funded; HS025079.
Citation: Childers CP, Maggard-Gibbons M, Ulloa JG .
Perioperative management of antiplatelet therapy in patients undergoing non-cardiac surgery following coronary stent placement: a systematic review.
Syst Rev 2018 Jan 10;7(1):4. doi: 10.1186/s13643-017-0635-z..
Keywords: Adverse Drug Events (ADE), Blood Thinners, Cardiovascular Conditions, Care Management, Medication, Outcomes, Surgery