National Healthcare Quality and Disparities Report
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- Adverse Drug Events (ADE) (1)
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- (-) Heart Disease and Health (26)
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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 26 Research Studies DisplayedBlecker S, Ladapo JA, Doran KM
Emergency department visits for heart failure and subsequent hospitalization or observation unit admission.
The purpose of this study was to examine trends in ED visits for heart failure and disposition following such visits. The investigators found that the number of ED visits for heart failure and the high proportion of ED visits with subsequent inpatient hospitalization have not changed in the last decade. They suggest that opportunities may exist to reduce hospitalizations by increasing short-term management of heart failure in the ED or observation unit.
AHRQ-funded; HS023683.
Citation: Blecker S, Ladapo JA, Doran KM .
Emergency department visits for heart failure and subsequent hospitalization or observation unit admission.
Am Heart J 2014 Dec;168(6):901-8.e1. doi: 10.1016/j.ahj.2014.08.002..
Keywords: Cardiovascular Conditions, Emergency Department, Heart Disease and Health, Hospitalization
Steinberg BA, Al-Khatib SM, Edwards R
Outcomes of implantable cardioverter-defibrillator use in patients with comorbidities: results from a combined analysis of 4 randomized clinical trials.
The researchers aimed to determine if the benefit of implantable cardioverter-defibrillators (ICDs) is modulated by medical comorbidity. They concluded that patients with extensive comorbid medical illnesses may experience less benefit from primary prevention ICDs than those with less comorbidity, and that implantation should be carefully considered in sick patients. They recommended further study of ICDs in medically complex patients.
AHRQ-funded; HS018505.
Citation: Steinberg BA, Al-Khatib SM, Edwards R .
Outcomes of implantable cardioverter-defibrillator use in patients with comorbidities: results from a combined analysis of 4 randomized clinical trials.
JACC Heart Fail 2014 Dec;2(6):623-9. doi: 10.1016/j.jchf.2014.06.007.
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Keywords: Adverse Events, Heart Disease and Health, Medical Devices, Patient-Centered Outcomes Research
King HA, Jeffreys AS, McVay MA
Spouse health behavior outcomes from a randomized controlled trial of a spouse-assisted lifestyle change intervention to improve patient low-density lipoprotein cholesterol.
The authors evaluated spouse health behavior outcomes from a randomized controlled trial of a spouse-assisted lifestyle intervention to reduce patient low-density lipoprotein cholesterol and improve patient health behaviors. Participants were 251 spouses of patients from the Durham Veterans Affairs Medical Center. At 11 months, there were no differences in spouse outcomes between intervention and usual care groups for moderate intensity physical activity or dietary intake. To improve spouse outcomes, the authors recommended couple interventions to include spouse behavior change goals and reciprocal support between patients and spouses.
AHRQ-funded; HS000079.
Citation: King HA, Jeffreys AS, McVay MA .
Spouse health behavior outcomes from a randomized controlled trial of a spouse-assisted lifestyle change intervention to improve patient low-density lipoprotein cholesterol.
J Behav Med 2014 Dec;37(6):1102-7. doi: 10.1007/s10865-014-9559-4.
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Keywords: Heart Disease and Health, Family Health and History, Lifestyle Changes, Patient-Centered Outcomes Research
Khazanie P, Hammill BG, Qualls LG
Clinical effectiveness of cardiac resynchronization therapy versus medical therapy alone among patients with heart failure: analysis of the ICD Registry and ADHERE.
The researchers examined associations between cardiac resynchronization therapy with defibrillator (CRT-D) and mortality and readmission among patients with heart failure who received CRT-D in clinical practice, compared with those who received medical therapy alone. They found that CRT-D was associated with lower risks of mortality and readmission than medical therapy alone.
AHRQ-funded; HS021092
Citation: Khazanie P, Hammill BG, Qualls LG .
Clinical effectiveness of cardiac resynchronization therapy versus medical therapy alone among patients with heart failure: analysis of the ICD Registry and ADHERE.
Circ Heart Fail. 2014 Nov;7(6):926-34. doi: 10.1161/circheartfailure.113.000838..
Keywords: Comparative Effectiveness, Heart Disease and Health, Medical Devices, Hospital Readmissions, Outcomes
Zhang Y, Kaplan CM, Baik SH
Medication adherence and readmission after myocardial infarction in the Medicare population.
This study examines the relationship between 6-month medication adherence following a hospitalization for heart attack and a subsequent readmission occurring between 6 and 12 months after the heart attack. It found that the probability of having a preventable readmission 6 to 12 months after a heart attack discharge was much lower for Medicare beneficiaries with good adherence to all heart attack-related medications, compared to those with poor adherence.
AHRQ-funded; HS018657
Citation: Zhang Y, Kaplan CM, Baik SH .
Medication adherence and readmission after myocardial infarction in the Medicare population.
Am J Manag Care 2014 Nov; 20(11):e498-505..
Keywords: Heart Disease and Health, Medication, Patient Adherence/Compliance, Hospital Readmissions
Spangler EL, Goodney PP, Schanzer A
Outcomes of carotid endarterectomy versus stenting in comparable medical risk patients.
The purpose of this study was to compare risk-stratified outcomes of carotid artery stenting (CAS) and carotid endarterectomy (CEA). Included in the study group were 11,336 patients who underwent isolated primary CEA and 544 who underwent primary CAS. The researchers found that asymptomatic normal- and high-risk patients do equally well after CEA or CAS. However, normal- and high-risk symptomatic patients have substantially worse outcomes with CAS compared with CEA.
AHRQ-funded; HS021581.
Citation: Spangler EL, Goodney PP, Schanzer A .
Outcomes of carotid endarterectomy versus stenting in comparable medical risk patients.
J Vasc Surg 2014 Nov;60(5):1227-31, 31.e1. doi: 10.1016/j.jvs.2014.05.044..
Keywords: Outcomes, Comparative Effectiveness, Risk, Cardiovascular Conditions, Heart Disease and Health
Voils CI, Sleath B, Maciejewski ML
Patient perspectives on having multiple versus single prescribers of chronic disease medications: results of a qualitative study in a veteran population.
The researchers sought to understand the reasons why patients have increasing numbers of prescribers of medications and to understand patient perspectives on advantages and disadvantages of having multiple prescribers, including effects on medication supply. They found that, with patients from a Veterans Affairs (VA) Medical Center, multiple prescribers arose through referrals and patients actively seeking non-VA prescribers to maximize timeliness and access to medications, to provide access to medications not on the VA formulary, and to minimize out-of-pocket costs.
AHRQ-funded; HS019445.
Citation: Voils CI, Sleath B, Maciejewski ML .
Patient perspectives on having multiple versus single prescribers of chronic disease medications: results of a qualitative study in a veteran population.
BMC Health Serv Res 2014 Oct 25;14:490. doi: 10.1186/s12913-014-0490-8.
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Keywords: Chronic Conditions, Medication, Diabetes, Blood Pressure, Heart Disease and Health
Chaudhry SI, Khan RF, Chen J
National trends in recurrent AMI hospitalizations 1 year after acute myocardial infarction in Medicare beneficiaries: 1999-2010.
The investigators evaluated changes in the incidence of 1-year recurrent acute myocardial infarction (AMI) hospitalization and mortality. In a national sample of Medicare beneficiaries hospitalized for AMI from 1999 to 2010, they found that hospitalization for recurrent AMI decreased, as did subsequent mortality, albeit to a lesser extent. The risk of recurrent AMI hospitalization declined less in black patients than in whites, increasing observed racial disparities by the end of the study period.
AHRQ-funded; HS018781.
Citation: Chaudhry SI, Khan RF, Chen J .
National trends in recurrent AMI hospitalizations 1 year after acute myocardial infarction in Medicare beneficiaries: 1999-2010.
J Am Heart Assoc 2014 Oct;3(5):e001197. doi: 10.1161/jaha.114.001197.
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Keywords: Hospitalization, Medicare, Mortality, Heart Disease and Health, Risk
Eapen ZJ, Liang L, Shubrook JH
Current quality of cardiovascular prevention for Million Hearts: an analysis of 147,038 outpatients from The Guideline Advantage.
This study examined adherence to clinical quality measures focusing on antiplatelet drugs for ischemic vascular disease, blood pressure control for hypertension, cholesterol control for diabetes, and tobacco use screening among 145,038 patients from 25 U.S. practices. It found that black and people of color races were associated with a lower likelihood of blood pressure and cholesterol control.
AHRQ-funded; HS021092
Citation: Eapen ZJ, Liang L, Shubrook JH .
Current quality of cardiovascular prevention for Million Hearts: an analysis of 147,038 outpatients from The Guideline Advantage.
Am Heart J. 2014 Sep;168(3):398-404. doi: 10.1016/j.ahj.2014.06.007..
Keywords: Electronic Health Records (EHRs), Health Promotion, Heart Disease and Health, Quality Improvement, Racial and Ethnic Minorities
Brown JR, Solomon RJ, Sarnak MJ
Reducing contrast-induced acute kidney injury using a regional multicenter quality improvement intervention.
The researchers sought to determine whether a 6-year regional multicenter quality improvement intervention could reduce contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary interventions. They found that benchmark hospitals had no significant changes in CI-AKI, while rates of CI-AKI were significantly reduced in hospitals receiving the intervention. Key qualitative system factors associated with improvement included multidisciplinary teams, limiting contrast volume, standardized fluid orders, intravenous fluid bolus, and patient education about oral hydration.
AHRQ-funded; HS018443.
Citation: Brown JR, Solomon RJ, Sarnak MJ .
Reducing contrast-induced acute kidney injury using a regional multicenter quality improvement intervention.
Circ Cardiovasc Qual Outcomes 2014 Sep;7(5):693-700. doi: 10.1161/circoutcomes.114.000903.
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Keywords: Adverse Drug Events (ADE), Injuries and Wounds, Patient Safety, Heart Disease and Health, Quality Improvement
Baillargeon J, Urban RJ, Kuo YF
Risk of myocardial infarction in older men receiving testosterone therapy.
The purpose of this paper was to examine the risk of myocardial infarction (MI) in a population-based cohort of older men receiving intramuscular testosterone. The investigators found that older men who were treated with intramuscular testosterone did not appear to have an increased risk of MI. For men with high MI risk, testosterone use was modestly protective against MI.
AHRQ-funded; HS022134.
Citation: Baillargeon J, Urban RJ, Kuo YF .
Risk of myocardial infarction in older men receiving testosterone therapy.
Ann Pharmacother 2014 Sep;48(9):1138-44. doi: 10.1177/1060028014539918..
Keywords: Cardiovascular Conditions, Elderly, Men's Health, Heart Disease and Health, Risk
Zhang R, Lee JY, Jean-Jacques M
Factors influencing the increasing disparity in LDL cholesterol control between white and black patients with diabetes in a context of active quality improvement.
The authors conducted a retrospective analysis of black and white patients treated continuously between 2008 and 2010 in order to examine possible causes of an increased disparity in low-density lipoprotein (LDL) cholesterol control following a multifaceted physician-directed quality improvement (QI) initiative. They found that physician-facing, general QI interventions may be insufficient to produce equity in LDL cholesterol control, and that helping patients maintain prior success controlling cholesterol appears as important in addressing this disparity as is helping uncontrolled patients achieve control.
AHRQ-funded; HS021141.
Citation: Zhang R, Lee JY, Jean-Jacques M .
Factors influencing the increasing disparity in LDL cholesterol control between white and black patients with diabetes in a context of active quality improvement.
Am J Med Qual 2014 Jul-Aug;29(4):308-14. doi: 10.1177/1062860613498112.
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Keywords: Heart Disease and Health, Diabetes, Disparities, Quality Improvement, Racial and Ethnic Minorities
Setoguchi SR, Warner Stevenson L, Stewart GC
Influence of healthy candidate bias in assessing clinical effectiveness for implantable cardioverter-defibrillators: cohort study of older patients with heart failure.
This study assessed the potential contribution of unmeasured general health status to patient selection in assessments of implantable cardioverter-defibrillator (ICD) therapy. In a group of heart failure patients, those who received ICD therapy were younger and had lower ejection fraction and more cardiac admissions to hospital but fewer non-cardiac admissions. The lower risks of measured outcomes likely reflect unmeasured differences in comorbidity and frailty.
AHRQ-funded; 29020050016I; HS017731
Citation: Setoguchi SR, Warner Stevenson L, Stewart GC .
Influence of healthy candidate bias in assessing clinical effectiveness for implantable cardioverter-defibrillators: cohort study of older patients with heart failure.
BMJ. 2014 May 8;348:g2866. doi: 10.1136/bmj.g2866..
Keywords: Medical Devices, Outcomes, Registries, Heart Disease and Health, Medicare
Crane HM, Heckbert SR, Drozd DR
Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts.
In this study, a team of researchers developed, implemented, and evaluated a myocardial infarction (MI) adjudication protocol for cohort research of human immunodeficiency virus. They found that central adjudication is crucial and that clinical diagnoses alone are insufficient for ascertainment of MI. Over half the events ultimately determined to be MIs were not identified by clinical diagnoses.
AHRQ-funded; HS019515
Citation: Crane HM, Heckbert SR, Drozd DR .
Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts.
Am J Epidemiol. 2014 Apr 15;179(8):996-1005. doi: 10.1093/aje/kwu010..
Keywords: Human Immunodeficiency Virus (HIV), Heart Disease and Health, Clinical Decision Support (CDS), Diagnostic Safety and Quality
Black JT, Romano PS, Sadeghi B
A remote monitoring and telephone nurse coaching intervention to reduce readmissions among patients with heart failure: study protocol for the Better
The objective of this randomized controlled comparative effectiveness study was to evaluate the effectiveness of a care transition intervention that included pre-discharge education about heart failure and post-discharge telephone nurse coaching combined with home telemonitoring of weight, blood pressure, heart rate, and symptoms in reducing all-cause 180-day hospital readmissions for older adults hospitalized with heart failure.
AHRQ-funded; HS019311.
Citation: Black JT, Romano PS, Sadeghi B .
A remote monitoring and telephone nurse coaching intervention to reduce readmissions among patients with heart failure: study protocol for the Better
Trials 2014 Apr 13;15:124. doi: 10.1186/1745-6215-15-124..
Keywords: Cardiovascular Conditions, Comparative Effectiveness, Health Information Technology (HIT), Heart Disease and Health, Hospital Readmissions, Telehealth, Transitions of Care
Kavalieratos D, Kamal AH, Abernethy AP
Comparing unmet needs between community-based palliative care patients with heart failure and patients with cancer.
This study characterized the unresolved symptom and treatment needs which patients with heart failure and those with cancer present to palliative care. It found that patients with HF presented with fewer unresolved symptoms; however, they were more likely to report dyspnea and more commonly experienced dyspnea-related treatment gaps.
AHRQ-funded; HS000032; HS017587
Citation: Kavalieratos D, Kamal AH, Abernethy AP .
Comparing unmet needs between community-based palliative care patients with heart failure and patients with cancer.
J Palliat Med. 2014 Apr;17(4):475-81. doi: 10.1089/jpm.2013.0526..
Keywords: Palliative Care, Cancer, Heart Disease and Health, Chronic Conditions
O'Brien EC, Holmes DN, Ansell JE
Physician practices regarding contraindications to oral anticoagulation in atrial fibrillation: findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry.
This study describes the frequencies of and factors associated with oral anticoagulation (OAC) contraindications in clinical practice for patients with atrial fibrillation (AF). Contraindications to OAC therapy among patients with AF are common but subjective. Many patients with reported contraindications were receiving OAC, suggesting that the perceived benefits outweighed the potential harm posed by the relative contraindication.
AHRQ-funded; HS021092
Citation: O'Brien EC, Holmes DN, Ansell JE .
Physician practices regarding contraindications to oral anticoagulation in atrial fibrillation: findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry.
Am Heart J. 2014 Apr;167(4):601-609.e1. doi: 10.1016/j.ahj.2013.12.014..
Keywords: Heart Disease and Health, Blood Thinners, Medication, Registries, Cardiovascular Conditions, Patient-Centered Outcomes Research, Evidence-Based Practice, Practice Patterns
Eapen ZJ, Grau-Sepulveda MV, Fonarow GC
Prescribing warfarin at discharge for heart failure patients: findings from the Get With The Guidelines-Heart Failure Registry
The researchers used data from a heart failure (HF) registry to determine the prevalence and variation, as well as patient characteristics, in warfarin prescription among real-world HF population. They found that warfarin was prescribed at discharge for more than 1 out of 10 patients hospitalized for HF without evident indications or contraindications for anticoagulation.
AHRQ-funded; HS021092
Citation: Eapen ZJ, Grau-Sepulveda MV, Fonarow GC .
Prescribing warfarin at discharge for heart failure patients: findings from the Get With The Guidelines-Heart Failure Registry
Int J Cardiol. 2014 Mar 15;172(2):e322-3. doi: 10.1016/j.ijcard.2013.12.161..
Keywords: Heart Disease and Health, Registries, Comparative Effectiveness, Blood Thinners, Medication
Ballesca MA, LaGuardia JC, Le PC
An electronic order set for acute myocardial infarction is associated with improved patient outcomes through better adherence to clinical practice guidelines.
The researchers investigated the association between the use of an evidence-based, electronic order set (OS) for acute myocardial infarction (AMI) and better adherence to clinical practice guidelines among 5,789 patients hospitalized with AMI. They found that use of the electronic OS is associated with increased adherence to evidence-based therapies and lower 30-day mortality.
AHRQ-funded; HS018480
Citation: Ballesca MA, LaGuardia JC, Le PC .
An electronic order set for acute myocardial infarction is associated with improved patient outcomes through better adherence to clinical practice guidelines.
J Hosp Med 2014 Mar;9(3):155-61. doi: 10.1002/jhm.2149..
Keywords: Health Information Technology (HIT), Heart Disease and Health, Outcomes, Guidelines, Critical Care
Al-Khatib SM, Han JY, Edwards R
Do patients with a left ventricular ejection fraction between 30% and 35% benefit from a primary prevention implantable cardioverter defibrillator?
The researchers used data from randomized clinical trials involving patients with systolic heart failure who had received implantable cardioverter-defibrillators and compared outcomes for those whose left ventricular ejection fractions (LVEFs) was between 30 percent and 35 percent with those whose LVEF was less than 30 percent. The sample size was too small to permit any important conclusions.
AHRQ-funded; HS018505
Citation: Al-Khatib SM, Han JY, Edwards R .
Do patients with a left ventricular ejection fraction between 30% and 35% benefit from a primary prevention implantable cardioverter defibrillator?
Int J Cardiol. 2014 Mar 1;172(1):253-4. doi: 10.1016/j.ijcard.2013.12.278..
Keywords: Comparative Effectiveness, Outcomes, Medical Devices, Heart Disease and Health, Chronic Conditions
Kesselheim AS, Xu S
Clinicians' contributions to the development of coronary artery stents: a qualitative study of transformative device innovation.
In order to better understand medical device innovation, the researchers conducted interviews with the innovators whose work contributed to the development of coronary artery stents. They found that individual physician-inventors saw the need for coronary artery stents in their clinical practice and then developed prototypes with the support of academic medical centers, followed by early validation studies.
AHRQ-funded; HS018465
Citation: Kesselheim AS, Xu S .
Clinicians' contributions to the development of coronary artery stents: a qualitative study of transformative device innovation.
PLoS One. 2014 Feb 12;9(2):e88664. doi: 10.1371/journal.pone.0088664..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Medical Devices
Carey K, Lin MY
Hospital length of stay and readmission: an early investigation.
This study is a retrospective examination of the association between length of stay in an index hospitalization and readmission within 7 days and within 30 days of discharge. It found negative associations between length of stay and readmission probability, particularly for heart attack patients; however, the magnitude of the effect was modest for heart attack.
AHRQ-funded; HS020995.
Citation: Carey K, Lin MY .
Hospital length of stay and readmission: an early investigation.
Med Care Res Rev 2014 Feb;71(1):99-111. doi: 10.1177/1077558713504998..
Keywords: Healthcare Cost and Utilization Project (HCUP), Heart Disease and Health, Hospital Readmissions, Hospitalization, Hospital Discharge
Ezaz G, Long JB, Gross CP
Risk prediction model for heart failure and cardiomyopathy after adjuvant trastuzumab therapy for breast cancer.
The investigators sought to develop a clinical risk score that identifies older women with breast cancer who are at higher risk of heart failure or cardiomyopathy after trastuzumab. That found that a 7-factor risk score was able to stratify 3-year risk of heart failure/cardiomyopathy after trastuzumab between the lowest and highest risk groups by more than 2-fold in a Medicare population.
AHRQ-funded; HS018781.
Citation: Ezaz G, Long JB, Gross CP .
Risk prediction model for heart failure and cardiomyopathy after adjuvant trastuzumab therapy for breast cancer.
J Am Heart Assoc 2014 Feb;3(1):e000472. doi: 10.1161/jaha.113.000472.
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Keywords: Cancer: Breast Cancer, Heart Disease and Health, Medication, Patient Safety, Risk
Blecker S, Agarwal SK, Chang PP
Quality of care for heart failure patients hospitalized for any cause.
This study sought to assess the quality of care for heart failure patients who are hospitalized for all causes. The investigators found that compared with individuals hospitalized with a principal diagnosis of heart failure, heart failure patients hospitalized for other causes were less likely to receive guideline recommended care.
AHRQ-funded; HS023683.
Citation: Blecker S, Agarwal SK, Chang PP .
Quality of care for heart failure patients hospitalized for any cause.
J Am Coll Cardiol 2014 Jan 21;63(2):123-30. doi: 10.1016/j.jacc.2013.08.1628..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Hospitalization, Quality of Care
Goldberger ZD, Alexander GC
Digitalis use in contemporary clinical practice: refitting the foxglove.
The researchers hypothesized that digoxin use for systolic heart failure (HF) has decreased during the past 15 years, despite clinical guidelines supporting its use. They fund that there has been a marked reduction in ambulatory digoxin use in the United States since 1997, with the largest declines in use observed from 1997 through 2001, and especially for patients with HF.
AHRQ-funded; HS018960.
Citation: Goldberger ZD, Alexander GC .
Digitalis use in contemporary clinical practice: refitting the foxglove.
JAMA Intern Med 2014 Jan;174(1):151-4. doi: 10.1001/jamainternmed.2013.10432..
Keywords: Heart Disease and Health, Medication, Ambulatory Care and Surgery, Practice Patterns