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
1 to 25 of 86 Research Studies DisplayedAklilu AM, Kumar S, Yamamoto Y
Outcomes associated with sodium-glucose cotransporter-2 inhibitor use in acute heart failure hospitalizations complicated by AKI.
This retrospective study examined the association of sodium-glucose cotransporter-2 inhibitor (SGLT2i) use with patients who have KDIGO-defined acute kidney injury (AKI) during acute heart failure (AHF) hospitalizations and their kidney function recovery at 14 days and 30 days using time-varying multivariable Cox-regression analyses. The study looked at 3305 adults hospitalized across 5 Yale New Haven Health Systems between January 2020 and May 2022 with AHF complicated by KDIGO-defined AKI. Of those individuals hospitalized with AHF and AKI, 356 received SGLT2i following AKI diagnosis either as initiation or continuation. The rate of renal recovery was not significantly different among those exposed and unexposed to SGLT2i following AKI (adjusted HR 0.94). SGLT2i exposure was associated with lower risk of 30-day mortality (adjusted HR 0.45). Rates of renal recovery were similar between the exposed and nonexposed cohorts regardless of the proximity of SGLT2i exposure to AKI diagnosis.
AHRQ-funded; HS027626.
Citation: Aklilu AM, Kumar S, Yamamoto Y .
Outcomes associated with sodium-glucose cotransporter-2 inhibitor use in acute heart failure hospitalizations complicated by AKI.
Kidney360 2023 Oct; 4(10):1371-81. doi: 10.34067/kid.0000000000000250..
Keywords: Kidney Disease and Health, Heart Disease and Health, Cardiovascular Conditions, Inpatient Care, Medication, Outcomes
Troy AL, Herzig SJ, Trivedi S
Initiation of oral anticoagulation in US older adults newly diagnosed with atrial fibrillation during hospitalization.
This study investigated prevalence of oral anticoagulant initiation for newly diagnosed US older adults with atrial fibrillation within 7 days of hospital discharge. The authors used a 20% national sample of Medicare fee-for-service beneficiaries, identifying patients aged 65 years or older newly diagnosed with atrial fibrillation while hospitalized in 2016. Among 38,379 older adults newly diagnosed with atrial fibrillation while hospitalized (mean age 78.2; 51.8% female; 83.3% white), 36,633 (95.4%) had an indication for anticoagulation and 24.6% (9011) of those initiated an oral anticoagulant following discharge. Higher CHA(2) DS(2) -VASc score was associated with a small increase in oral anticoagulant initiation (predicted probability 20.5% for scores <2 and 24.9% for ≥4). Elevated HAS-BLED score was associated with a small decrease in probability of anticoagulant initiation (25.4% for score <2 and 23.1% for ≥3). Frailty was associated with decreased likelihood of oral anticoagulant initiation (24.7% for non-frail and 18.1% for moderately-severely frail). Anticoagulant initiation varied by primary reason for hospitalization, with predicted probability highest among patients with a primary diagnosis of atrial fibrillation (46.1%) and lowest among those with non-cardiovascular conditions (13.8%) and bleeds (3.6%).
AHRQ-funded; HS026215.
Citation: Troy AL, Herzig SJ, Trivedi S .
Initiation of oral anticoagulation in US older adults newly diagnosed with atrial fibrillation during hospitalization.
J Am Geriatr Soc 2023 Sep; 71(9):2748-58. doi: 10.1111/jgs.18375..
Keywords: Elderly, Blood Thinners, Medication, Heart Disease and Health, Cardiovascular Conditions, Stroke
Niederdeppe J, Avery RJ, Liu J
Is exposure to pharmaceutical direct-to-consumer advertising for heart disease and diabetes associated with physical activity and dietary behavior?
This study examined associations between estimated exposure to direct consumer-to-advertising (DTCA) for drugs focused on heart disease/cholesterol and diabetes and self-reported exercise and consumption of a variety of unhealthy foods (candy, sugary drinks, alcohol, and fast food). The authors estimated exposure to DTCA by combining data from Kantar Media Intelligence (Kantar) on televised pharmaceutical DTCA airings in the U.S. from January 2003 to August 2016 (n = 7,696,851 airings) with thirteen years of data from the Simmons National Consumer Survey (Simmons), a mailed survey on television viewing patterns. They estimated associations between exposure to advertising (both overall and for advertisements with specific content) and self-reported physical activity and dietary behavior using Simmons data from January 2004 to December 2016 (n = 288,483 respondents from n = 157,621 unique households in the U.S.). They found that higher estimated exposure to DTCA for heart disease and diabetes drugs were not consistently associated with meaningful differences in the frequency of engaging in regular physical activity. However, greater estimated exposure to DTCA for both diseases were linked to small but consistently higher volume of consumption of candy, sugar-sweetened beverages, alcohol, and fast food.
AHRQ-funded; HS025983.
Citation: Niederdeppe J, Avery RJ, Liu J .
Is exposure to pharmaceutical direct-to-consumer advertising for heart disease and diabetes associated with physical activity and dietary behavior?
Soc Sci Med 2023 Aug; 330:116062. doi: 10.1016/j.socscimed.2023.116062..
Keywords: Communication, Diabetes, Heart Disease and Health, Medication
Derington CG, Goodrich GK, Xu S
Association of direct oral anticoagulation management strategies with clinical outcomes for adults with atrial fibrillation.
This study investigated the impact of an anticoagulation management service (AMS) on clinical outcomes of adults with atrial fibrillation (AF). This retrospective cohort study was conducted in 3 Kaiser Permanente regions, with each region taking a slightly different approach to direct oral anticoagulant (DOAC) care. These approaches included (1) usual care (UC) by the prescribing clinician, (2) UC plus an automated population management tool (PMT), or (3) pharmacist-managed AMS care. The study included 44,746 adults with a diagnosis of AF who initiated DOAC or warfarin between August 2016 and January 1, 2020, 6182 in the UC model, 33,624 in the UC plus PMT care model, and 4939 in the AMS care model. Baseline characteristics (mean age, 73.1 years, 56.1% male, 67.2% non-Hispanic White, median CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65-74 years, female sex] score of 3 [IQR, 2-5]) were well balanced after inverse probability of treatment weighting (IPTW). The cohort was followed over a median of 2 years, and patients who received the UC plus PMT or AMS care model did not have significantly better outcomes than those who received only UC.
AHRQ-funded; HS026156.
Citation: Derington CG, Goodrich GK, Xu S .
Association of direct oral anticoagulation management strategies with clinical outcomes for adults with atrial fibrillation.
JAMA Netw Open 2023 Jul; 6(7):e2321971. doi: 10.1001/jamanetworkopen.2023.21971..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Blood Thinners, Medication, Outcomes, Stroke
Gamyroulas EM, Jones AE, Saunders JA
Trends in antiplatelet strategies 12-months following coronary stent placement in anticoagulated patients.
The guidelines for antithrombotic management in individuals undergoing percutaneous coronary interventions (PCIs) who also necessitate anticoagulant treatment are continually developing. The purpose of this study is to examine adjustments to antithrombotic regimens and correlated outcomes within a year following PCI in patients needing continued anticoagulation therapy. Data from patients discovered through electronic medical record searches were manually assessed to validate alterations in antithrombotic treatment from discharge up to one year post-PCI, as well as episodes of significant bleeding, clinically relevant non-major bleeding (CRNMB), major adverse cardiovascular or neurological events (MACNE), and all-cause mortality outcomes during an extra six-month follow-up period. The study found that one year after PCI, patients (n = 120) undergoing anticoagulation treatment were categorized based on their antiplatelet therapy status: no antiplatelet therapy (n = 16), single antiplatelet therapy (SAPT) (n = 85), or dual antiplatelet therapy (DAPT) (n = 19). Between 12 and 18 months post-PCI, there were two significant bleeds, seven CRNMB events, six MACNE incidents, two venous thromboembolisms, and five fatalities. All but one bleeding occurrence transpired in the SAPT group. The likelihood of maintaining DAPT at 12 months was elevated in patients who underwent PCI for acute coronary syndrome and those who experienced MACNE within one year post-PCI; however, these associations did not reach statistical significance.
AHRQ-funded; HS027960
Citation: Gamyroulas EM, Jones AE, Saunders JA .
Trends in antiplatelet strategies 12-months following coronary stent placement in anticoagulated patients.
BMC Cardiovasc Disord 2023 Mar 8;23(1):117. doi: 10.1186/s12872-023-03161-7.
Keywords: Blood Thinners, Medication, Heart Disease and Health, Cardiovascular Conditions, Adverse Drug Events (ADE), Adverse Events
Rao BR, Speight CD, Allen LA
Impact of financial considerations on willingness to take sacubitril/valsartan for heart failure.
This survey’s objective was to evaluate the impact of out-of-pocket costs and a novel cost-priming intervention on willingness to take sacubitril/valsartan for heart failure with reduced ejection fraction, as these medications carry higher out-of-pocket costs relative to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Participants with self-reported heart disease were surveyed using the online Ipsos Knowledge Panel. Participants were presented with a modified decision aid for sacubitril/valsartan and then, in a 3×2 factorial design, randomly assigned to 1 of 3 cost conditions ($10, $50, or $100/month) and to a control group or cost-priming intervention. Cost-priming intervention is defined by being asked questions about their financial situation before learning about the benefits of sacubitril/valsartan. Of the 1013 participants included in the analysis, 85% of respondents were willing to take sacubitril/valsartan at $10, 62% at $50, and 33% at $100. In a multivariable logistic regression model, participants were more likely to take sacubitril/valsartan at $10 versus $100 and $50 compared with $100. Overall, participants in the cost-primed group were more willing to take sacubitril/valsartan than those not primed to consider their financial situation (63% versus 56%), but there was no statistically significant interaction between cost conditions and cost priming. The perceived benefit of sacubitril/valsartan over angiotensin-converting enzyme inhibitors or angiotensin receptor blockers decreased as cost increased but did not vary by cost priming.
AHRQ-funded; HS026081.
Citation: Rao BR, Speight CD, Allen LA .
Impact of financial considerations on willingness to take sacubitril/valsartan for heart failure.
J Am Heart Assoc 2022 Jun;11(12):e023789. doi: 10.1161/jaha.121.023789.
Keywords: Healthcare Costs, Medication, Heart Disease and Health, Cardiovascular Conditions
Villa-Zapata L, Carhart BS, Horn JR
Serum potassium changes due to concomitant ACEI/ARB and spironolactone therapy: a systematic review and meta-analysis.
The purpose of this study was to provide evidence of serum potassium changes in individuals taking angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers (ARBs) concomitantly with spironolactone compared to ACEI/ARB therapy alone. The investigators concluded that treatment with spironolactone in combination with ACEI/ARB therapy increases the mean serum potassium concentration by less than 0.20 mEq/L compared to ACEI/ARB therapy alone.
AHRQ-funded; HS025984.
Citation: Villa-Zapata L, Carhart BS, Horn JR .
Serum potassium changes due to concomitant ACEI/ARB and spironolactone therapy: a systematic review and meta-analysis.
Am J Health Syst Pharm 2021 Dec 9;78(24):2245-55. doi: 10.1093/ajhp/zxab215..
Keywords: Medication, Comparative Effectiveness, Heart Disease and Health, Cardiovascular Conditions
Feng Y, Pai CW, Seiler K
Adverse outcomes associated with inappropriate direct oral anticoagulant starter pack prescription among patients with atrial fibrillation: a retrospective claims-based study.
This retrospective analysis investigated the risk for bleeding events with higher dosing of direct oral anticoagulant (DOAC) in the first 1-3 weeks of treatment for patients with atrial fibrillation (AF). Findings showed that patients who received an inappropriate DOAC prescription were more likely to identify as Black. Rates of ED visits, hospitalizations, and deaths overall were numerically lower in patients with starter pack DOAC prescriptions. In contrast, rates of ED visits and hospitalizations related to significant bleeding were numerically higher in patients with starter pack DOAC prescriptions. Among patients with AF but without acute venous thromboembolism, those who received an inappropriate DOAC starter pack had numerically higher rates of severe bleeding leading to ED visits and hospitalizations compared to those prescribed an appropriate non-starter pack DOAC anticoagulant.
AHRQ-funded; HS026874.
Citation: Feng Y, Pai CW, Seiler K .
Adverse outcomes associated with inappropriate direct oral anticoagulant starter pack prescription among patients with atrial fibrillation: a retrospective claims-based study.
J Thromb Thrombolysis 2021 May;51(4):1144-49. doi: 10.1007/s11239-020-02358-3..
Keywords: Blood Thinners, Medication, Medication: Safety, Medical Errors, Adverse Drug Events (ADE), Adverse Events, Heart Disease and Health, Cardiovascular Conditions
Rhee TG, Kumar M, Ross JS
Age-related trajectories of cardiovascular risk and use of aspirin and statin among U.S. Adults Aged 50 or older, 2011-2018.
The purpose of this study was to examine age-related trajectories of cardiovascular risk and use of aspirin and statin among U.S. adults aged 50 or older. The investigators concluded that while adults aged ≥75 do not benefit from the use of aspirin to prevent the first CVD, many continue to take aspirin on a regular basis. In spite of the clear benefit of statin use to prevent a subsequent CVD event, many older adults in this risk category are not taking a statin.
AHRQ-funded; HS022882.
Citation: Rhee TG, Kumar M, Ross JS .
Age-related trajectories of cardiovascular risk and use of aspirin and statin among U.S. Adults Aged 50 or older, 2011-2018.
J Am Geriatr Soc 2021 May;69(5):1272-82. doi: 10.1111/jgs.17038..
Keywords: Elderly, Blood Thinners, Cardiovascular Conditions, Heart Disease and Health, Risk, Medication
Savitz ST, Bailey SC, Dusetzina SB
Treatment selection and medication adherence for stable angina: the role of area-based health literacy.
Clinical studies show equivalent health outcomes from interventional procedures and treatment with medication only for stable angina patients. However, patients may be subject to overuse or access barriers for interventional procedures and may exhibit suboptimal adherence to medications. The objective of the study was to evaluate whether community-level health literacy was associated with treatment selection and medication adherence patterns.
AHRQ-funded; HS000032.
Citation: Savitz ST, Bailey SC, Dusetzina SB .
Treatment selection and medication adherence for stable angina: the role of area-based health literacy.
J Eval Clin Pract 2020 Dec;26(6):1711-21. doi: 10.1111/jep.13341..
Keywords: Medication, Patient Adherence/Compliance, Health Literacy, Heart Disease and Health, Cardiovascular Conditions
Zullo AR, Riester MR, Erqou S
Comparative effectiveness of angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors in older nursing home residents after myocardial infarction: a retrospective cohort study.
Evidence regarding differences in outcomes between angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) among older nursing home (NH) residents after acute myocardial infarction (AMI) is limited. The purpose of this study was to estimate the post-AMI effects of ARBs versus ACEIs on mortality, rehospitalization, and functional decline outcomes in this important population.
AHRQ-funded; HS022998.
Citation: Zullo AR, Riester MR, Erqou S .
Comparative effectiveness of angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors in older nursing home residents after myocardial infarction: a retrospective cohort study.
Drugs Aging 2020 Oct;37(10):755-66. doi: 10.1007/s40266-020-00791-w..
Keywords: Elderly, Nursing Homes, Heart Disease and Health, Medication, Evidence-Based Practice, Comparative Effectiveness, Patient-Centered Outcomes Research, Outcomes
O'Halloran JA, Sahrmann J, Butler AM
Brief report: integrase strand transfer inhibitors are associated with lower risk of incident cardiovascular disease in people living with HIV.
AHRQ-funded; HS019455.
Citation: O'Halloran JA, Sahrmann J, Butler AM .
Brief report: integrase strand transfer inhibitors are associated with lower risk of incident cardiovascular disease in people living with HIV.
J Acquir Immune Defic Syndr 2020 Aug 1;84(4):396-99. doi: 10.1097/qai.0000000000002357..
Keywords: Human Immunodeficiency Virus (HIV), Cardiovascular Conditions, Medication, Stroke, Heart Disease and Health, Risk
Jackson LR, Kim S, Blanco R
Discontinuation rates of warfarin versus direct acting oral anticoagulants in US clinical practice: results from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II (ORBIT-AF II).
The objective of this study was to evaluate discontinuation rates among patients on warfarin and direct oral anticoagulants (DOACs) in clinical practice. Over 10,000 AF patients were enrolled from the ORBIT-AF II Registry as subjects. Findings showed that, in a community based atrial fibrillation cohort, adjusted rates of discontinuation at 12 months were higher in DOAC-treated versus vitamin K antagonist-treated patients. Discontinuation of oral anticoagulation was associated with increased absolute risk of all-cause mortality and cardiovascular death.
AHRQ-funded; HS021092.
Citation: Jackson LR, Kim S, Blanco R .
Discontinuation rates of warfarin versus direct acting oral anticoagulants in US clinical practice: results from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II (ORBIT-AF II).
Am Heart J 2020 Aug;226:85-93. doi: 10.1016/j.ahj.2020.04.016..
Keywords: Blood Thinners, Medication, Registries, Stroke, Heart Disease and Health, Cardiovascular Conditions, Outcomes
Fudim M, Kelly JP, Brophy TJ
Trends in treatment for patients hospitalized with heart failure with preserved ejection fraction before and after Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT).
This study examined treatment trends for patients hospitalized for heart failure with preserved ejection fraction (HFpEF) after the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, which investigated spironolactone treatment vs placebo in HFpEF patients. This retrospective analysis looked at discharge prescribing data in the Get With The Guidelines-Heart Failure Registry among patients with left ventricular ejection fraction ≥50% discharged between 2009-2016. About 13% of the cohort of 142,201 patients were prescribed mineralocorticoid receptor antagonists (MRAs) at discharge. MRA prescribing increased modestly over time, but the TOPCAT trial did not seem to have an impact.
AHRQ-funded; HS021092.
Citation: Fudim M, Kelly JP, Brophy TJ .
Trends in treatment for patients hospitalized with heart failure with preserved ejection fraction before and after Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT).
Am J Cardiol 2020 Jun 1;125(11):1655-60. doi: 10.1016/j.amjcard.2020.02.038..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Stroke, Medication, Hospitalization, Inpatient Care, Practice Patterns
Hansen JE, Brown DW, Hanke SP
Angiotensin-converting enzyme inhibitor prescription for patients with single ventricle physiology enrolled in the NPC-QIC registry.
This study examined trends in the routine use of angiotension-converting enzyme inhibitors (ACEI) during palliation of hypoplastic left heart syndrome, which is considered controversial. The authors used patients enrolled in the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) registry from 2008 to 2016 who had been prescribed ACEI between stage 1 palliation (stage I Norwood procedure) discharge and stage 2 palliation (stage II superior cavopulmonary anastomosis procedure) admission. ACEI prescriptions declined from 45% in the pre-2010 period to 36.8% from 2011 to 2016. No difference was found in interstage mortality, change in atrioventricular valve regurgitation, or change in ventricular dysfunction between groups. Atrioventricular septal defect, and preoperative mechanical ventilation were associated with increased ACEI prescription.
AHRQ-funded; HS021114.
Citation: Hansen JE, Brown DW, Hanke SP .
Angiotensin-converting enzyme inhibitor prescription for patients with single ventricle physiology enrolled in the NPC-QIC registry.
J Am Heart Assoc 2020 May 18;9(10):e014823. doi: 10.1161/jaha.119.014823..
Keywords: Newborns/Infants, Medication, Heart Disease and Health, Cardiovascular Conditions, Practice Patterns, Registries, Quality Improvement, Quality of Care
Spellberg B, Chambers HF, Musher DM
Evaluation of a paradigm shift from intravenous antibiotics to oral step-down therapy for the treatment of infective endocarditis: a narrative review.
The requirement of prolonged intravenous antibiotic courses to treat infective endocarditis (IE) is a time-honored dogma of medicine. However, numerous antibiotics are now available that achieve adequate levels in the blood after oral administration to kill bacteria. Moreover, prolonged intravenous antibiotic regimens are associated with high rates of adverse events. In this study, PubMed was reviewed to determine whether evidence supports the notion that oral step-down antibiotic therapy for IE is associated with inferior outcomes compared with intravenous-only therapy.
AHRQ-funded; HS025690.
Citation: Spellberg B, Chambers HF, Musher DM .
Evaluation of a paradigm shift from intravenous antibiotics to oral step-down therapy for the treatment of infective endocarditis: a narrative review.
JAMA Intern Med 2020 May;180(5):769-77. doi: 10.1001/jamainternmed.2020.0555..
Keywords: Antibiotics, Medication, Evidence-Based Practice, Cardiovascular Conditions, Heart Disease and Health
Pokorney SD, Black-Maier E, Hellkamp AS
Oral anticoagulation and cardiovascular outcomes in patients with atrial fibrillation and end-stage renal disease.
The objective of this study was to describe patterns of oral anticoagulant (OAC) use in end-stage renal disease (ESRD) patients with atrial fibrillation (AF) and their associations with cardiovascular outcomes. Medicare fee-for-service 5% claims data from 2007 to 2013 was analyzed in a cohort of patients with ESRD and AF. A cohort of 8,410 patients with AF and ESRD was identified, with a total of 3,043 (36.2%) patients treated with OAC during the study period. Treatment with OAC was not associated with hospitalization for stroke, or death but was associated with increased hospitalization for bleeding and intracranial hemorrhage.
AHRQ-funded; HS021092.
Citation: Pokorney SD, Black-Maier E, Hellkamp AS .
Oral anticoagulation and cardiovascular outcomes in patients with atrial fibrillation and end-stage renal disease.
J Am Coll Cardiol 2020 Mar 24;75(11):1299-308. doi: 10.1016/j.jacc.2020.01.019..
Keywords: Blood Thinners, Medication, Heart Disease and Health, Cardiovascular Conditions, Kidney Disease and Health, Chronic Conditions, Outcomes
Brand-McCarthy SR, Delaney RK, Noseworthy PA
Can shared decision making improve stroke prevention in atrial fibrillation?: Implications of the updated guidelines.
This paper discusses the need for shared decision making (SDM) in atrial fibrillation (AF) patients not just at the beginning of treatment but throughout during ongoing care. Use of SDM can help with patient adherence to recommended anticoagulation treatment regimens and lifestyle changes. It can help build a strong partnership between clinician and patient.
AHRQ-funded; HS026379.
Citation: Brand-McCarthy SR, Delaney RK, Noseworthy PA .
Can shared decision making improve stroke prevention in atrial fibrillation?: Implications of the updated guidelines.
Circ Cardiovasc Qual Outcomes 2020 Mar;13(3):e006080. doi: 10.1161/circoutcomes.119.006080..
Keywords: Shared Decision Making, Stroke, Heart Disease and Health, Cardiovascular Conditions, Prevention, Guidelines, Blood Thinners, Medication, Clinician-Patient Communication, Communication
Goyal P, Gorodeski EZ, Marcum ZA
Cardiac rehabilitation to optimize medication regimens in heart failure.
This paper discusses the use of cardiac rehabilitation (CR) to optimize medication regimens for older adults with heart failure. Challenges in CR are discussed length and strategies were offered for leveraged CR.
AHRQ-funded; HS022982.
Citation: Goyal P, Gorodeski EZ, Marcum ZA .
Cardiac rehabilitation to optimize medication regimens in heart failure.
Clin Geriatr Med 2019 Nov;35(4):549-60. doi: 10.1016/j.cger.2019.06.001..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Rehabilitation, Medication, Patient-Centered Healthcare, Patient Adherence/Compliance, Chronic Conditions
Blecker S, Austrian JS, Horwitz LI
Interrupting providers with clinical decision support to improve care for heart failure.
The goal of this study was to develop a clinical decision support (CDS) system to recommend an angiotenson converting enzyme (ACE) inhibitor during hospitalization so it could be promoted for continuation at discharge. Patients who were hospitalized with reduced ejection fraction were pseudo-randomized to deliver interruptive or non-interruptive CDS alerts to providers based on the patients’ even or odd medical record number. The utilization rate was higher for interruptive alert versus non-interruptive alert hospitalizations for a sample of 958. This resulted in improved quality of care for heart failure patients.
AHRQ-funded; HS023683.
Citation: Blecker S, Austrian JS, Horwitz LI .
Interrupting providers with clinical decision support to improve care for heart failure.
Int J Med Inform 2019 Nov;131:103956. doi: 10.1016/j.ijmedinf.2019.103956..
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Heart Disease and Health, Cardiovascular Conditions, Medication, Medication: Safety, Patient Safety, Quality Improvement, Quality of Care
Ngo-Metzger Q, Zuvekas S, Shafer P
AHRQ Author: Ngo-Metzger Q, Zuvekas S, Shafer P, Tracer H, Borsky AE, Bierman AS
Ngo-Metzger Q, Zuvekas S, Shafer P, Tracer H, Borsky AE, Bierman AS. Statin use in the U.S. for secondary prevention of cardiovascular disease remains suboptimal.
Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality in the United States. The purpose of this study was to examine the rates of statin use for secondary prevention of ASCVD events in the United States over the last decade and determine whether disparities in the treatment of ASCVD still persist among women and racial/ethnic minorities.
AHRQ-authored.
Citation: Ngo-Metzger Q, Zuvekas S, Shafer P .
Ngo-Metzger Q, Zuvekas S, Shafer P, Tracer H, Borsky AE, Bierman AS. Statin use in the U.S. for secondary prevention of cardiovascular disease remains suboptimal.
J Am Board Fam Med 2019 Nov-Dec;32(6):807-17. doi: 10.3122/jabfm.2019.06.180313..
Keywords: Medical Expenditure Panel Survey (MEPS), Cardiovascular Conditions, Medication, Healthcare Utilization, Prevention, Heart Disease and Health, Disparities
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
Wang SV, Rogers JR, Jin Y
Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.
Clinical guidelines recommend anticoagulation for patients with atrial fibrillation (AF) at high risk of stroke; however, studies report 40% of this population is not anticoagulated. The purpose of this study was to evaluate a population health intervention to increase anticoagulation use in high-risk patients with AF. The investigators concluded that algorithms to identify underuse of anticoagulation among patients with AF in healthcare databases may not capture clinical subtleties or patient preferences and may overestimate the extent of undertreatment.
AHRQ-funded; HS022193.
Citation: Wang SV, Rogers JR, Jin Y .
Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.
BMJ Qual Saf 2019 Oct;28(10):835-42. doi: 10.1136/bmjqs-2019-009367..
Keywords: Blood Thinners, Heart Disease and Health, Cardiovascular Conditions, Medication, Health Information Technology (HIT), Shared Decision Making, Electronic Health Records (EHRs), Practice Patterns, Healthcare Utilization
Durstenfeld MS, Katz SD, Park H
Mineralocorticoid receptor antagonist use after hospitalization of patients with heart failure and post-discharge outcomes: a single-center retrospective cohort study.
The purpose of this paper was to describe contemporary mineralocorticoid receptor antagonists (MRA) prescription for heart failure patients before and after the full scope of hospitalizations and the association between MRA discharge prescription and post-hospitalization outcomes. Results showed that, among hospitalized patients with heart failure with a reduced ejection fraction, 75% did not receive MRA before or after hospitalization, and nearly 90% of eligible patients did not have MRA initiated. These results suggest that hospitalization may represent an opportunity to initiate guideline-directed heart failure therapy.
AHRQ-funded; HS023683.
Citation: Durstenfeld MS, Katz SD, Park H .
Mineralocorticoid receptor antagonist use after hospitalization of patients with heart failure and post-discharge outcomes: a single-center retrospective cohort study.
BMC Cardiovasc Disord 2019 Aug 9;19(1):194. doi: 10.1186/s12872-019-1175-3..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Medication, Practice Patterns, Outcomes
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