National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (10)
- Adverse Drug Events (ADE) (23)
- Adverse Events (64)
- Ambulatory Care and Surgery (7)
- Antibiotics (2)
- Arthritis (4)
- Behavioral Health (12)
- Blood Clots (5)
- Blood Pressure (37)
- Blood Thinners (33)
- Cancer (14)
- Cancer: Breast Cancer (1)
- Cancer: Colorectal Cancer (7)
- Cancer: Prostate Cancer (4)
- Cancer: Skin Cancer (1)
- (-) Cardiovascular Conditions (715)
- Care Coordination (3)
- Caregiving (6)
- Care Management (10)
- Case Study (11)
- Centers for Education and Research on Therapeutics (CERTs) (1)
- Children/Adolescents (27)
- Chronic Conditions (42)
- Clinical Decision Support (CDS) (7)
- Clinician-Patient Communication (5)
- Colonoscopy (1)
- Communication (8)
- Community-Based Practice (4)
- Community Partnerships (1)
- Comparative Effectiveness (34)
- Complementary and Alternative Medicine (1)
- COVID-19 (11)
- Critical Care (10)
- Cultural Competence (1)
- Data (7)
- Dementia (1)
- Dental and Oral Health (1)
- Depression (11)
- Diabetes (34)
- Diagnostic Safety and Quality (26)
- Dialysis (2)
- Digestive Disease and Health (1)
- Disabilities (2)
- Disparities (24)
- Education: Academic (2)
- Education: Continuing Medical Education (4)
- Education: Curriculum (2)
- Education: Patient and Caregiver (6)
- Elderly (53)
- Electronic Health Records (EHRs) (17)
- Emergency Department (18)
- Emergency Medical Services (EMS) (17)
- Evidence-Based Practice (110)
- Eye Disease and Health (1)
- Genetics (1)
- Guidelines (27)
- Healthcare-Associated Infections (HAIs) (11)
- Healthcare Cost and Utilization Project (HCUP) (20)
- Healthcare Costs (29)
- Healthcare Delivery (22)
- Healthcare Utilization (19)
- Health Information Technology (HIT) (51)
- Health Insurance (4)
- Health Literacy (4)
- Health Promotion (4)
- Health Services Research (HSR) (1)
- Health Status (11)
- Heart Disease and Health (320)
- Home Healthcare (4)
- Hospital Discharge (6)
- Hospitalization (45)
- Hospital Readmissions (22)
- Hospitals (30)
- Human Immunodeficiency Virus (HIV) (5)
- Imaging (13)
- Implementation (15)
- Infectious Diseases (1)
- Injuries and Wounds (3)
- Inpatient Care (13)
- Intensive Care Unit (ICU) (6)
- Kidney Disease and Health (19)
- Labor and Delivery (3)
- Lifestyle Changes (11)
- Long-Term Care (3)
- Low-Income (4)
- Maternal Care (5)
- Medicaid (3)
- Medical Devices (33)
- Medical Errors (3)
- Medical Expenditure Panel Survey (MEPS) (4)
- Medicare (39)
- Medication (122)
- Medication: Safety (12)
- Men's Health (3)
- Mortality (54)
- Neurological Disorders (12)
- Newborns/Infants (3)
- Nursing (1)
- Nursing Homes (11)
- Nutrition (8)
- Obesity (6)
- Obesity: Weight Management (2)
- Opioids (1)
- Orthopedics (1)
- Outcomes (111)
- Pain (1)
- Palliative Care (10)
- Patient-Centered Healthcare (20)
- Patient-Centered Outcomes Research (127)
- Patient Adherence/Compliance (16)
- Patient and Family Engagement (7)
- Patient Experience (1)
- Patient Safety (41)
- Patient Self-Management (6)
- Payment (7)
- Pneumonia (7)
- Policy (8)
- Practice Improvement (7)
- Practice Patterns (18)
- Pregnancy (5)
- Prevention (73)
- Primary Care (53)
- Primary Care: Models of Care (8)
- Provider (2)
- Provider: Clinician (3)
- Provider: Health Personnel (1)
- Provider: Physician (2)
- Provider Performance (9)
- Public Health (2)
- Public Reporting (2)
- Quality Improvement (42)
- Quality Indicators (QIs) (6)
- Quality Measures (9)
- Quality of Care (49)
- Quality of Life (10)
- Racial and Ethnic Minorities (41)
- Registries (33)
- Rehabilitation (18)
- Research Methodologies (10)
- Respiratory Conditions (13)
- Risk (125)
- Rural Health (4)
- Screening (11)
- Sepsis (2)
- Sex Factors (20)
- Sexual Health (1)
- Shared Decision Making (23)
- Simulation (4)
- Skin Conditions (2)
- Sleep Problems (3)
- Social Determinants of Health (15)
- Stress (2)
- Stroke (89)
- Surgery (108)
- Teams (6)
- Telehealth (23)
- Tobacco Use (5)
- Tobacco Use: Smoking Cessation (2)
- Training (4)
- Transitions of Care (9)
- Transplantation (4)
- Treatments (6)
- U.S. Preventive Services Task Force (USPSTF) (29)
- Uninsured (2)
- Urban Health (5)
- Vulnerable Populations (2)
- Women (9)
- Workflow (1)
- Young Adults (2)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
51 to 75 of 715 Research Studies DisplayedDuncan MS, Robbins NN, Wernke SA
Geographic variation in access to cardiac rehabilitation.
Considerable regional disparities exist in the commencement of cardiac rehabilitation (CR), with only 10% to 40% of eligible patients at the state level participating. The potential factors contributing to these discrepancies, such as accessibility to CR facilities, remain insufficiently explored. The purpose of this study was to assess the impact of CR center availability on CR initiation among Medicare beneficiaries. The researchers utilized Medicare records to pinpoint CR-eligible Medicare beneficiaries and compute CR initiation rates at the hospital referral region (HRR) level. Linear regression was applied to evaluate the percentage variance in CR initiation explained by CR accessibility across HRRs. Geospatial hotspot analysis was performed to detect CR deserts, or counties where the patient-to-CR center ratio is notably high. The study found that between 2014 and 2017, 1,133,657 Medicare beneficiaries were eligible for CR, with 263,310 (23%) initiating CR. The West North Central Census Division exhibited the highest adjusted CR initiation rate (35.4%) and the greatest concentration of CR programs (6.58 per 1,000 CR-eligible Medicare beneficiaries). CR program density accounted for 21.2% of the regional variation in CR initiation at the HRR level. A total of 40 predominantly urban counties, encompassing 14% of the U.S. population aged ≥65 years, were identified as CR deserts due to limited CR access.
AHRQ-funded; HS022990
Citation: Duncan MS, Robbins NN, Wernke SA .
Geographic variation in access to cardiac rehabilitation.
J Am Coll Cardiol 2023 Mar 21;81(11):1049-60. doi: 10.1016/j.jacc.2023.01.016.
Keywords: Rehabilitation, Access to Care, Cardiovascular Conditions
Tan MS, Heise CW, Gallo T
Relationship between a risk score for QT interval prolongation and mortality across rural and urban inpatient facilities.
The objectives of this retrospective observational study were to evaluate the relationship between a modified Tisdale QTc-risk score (QTc-RS), inpatient mortality, and length of stay in a broad inpatient population with an order for a medication with a known risk of torsades de pointes (TdP). Inpatient data from 28 healthcare facilities in the western US were used. The results indicated that there is a strong relationship between increased mortality as well as longer duration of hospitalization with an increasing QTc-RS.
AHRQ-funded; HS026662.
Citation: Tan MS, Heise CW, Gallo T .
Relationship between a risk score for QT interval prolongation and mortality across rural and urban inpatient facilities.
J Electrocardiol 2023 Mar;77:4-9. doi: 10.1016/j.jelectrocard.2022.11.008.
Keywords: Heart Disease and Health, Cardiovascular Conditions, Mortality, Rural Health, Urban Health, Risk
Liberman AL, Holl JL, Romo E
Risk assessment of the acute stroke diagnostic process using failure modes, effects, and criticality analysis.
The authors conducted a failure modes, effects, and criticality analysis (FMECA) of the emergency department (ED)-based acute stroke diagnostic process at three health systems in Chicago. The FMECA was designed to identify and rank order failures in the processes of care. The authors found that failure to use existing screening scales to identify patients with large-vessel occlusions early in the ED course ranked highest; other highly ranked failures were obtaining an accurate history of the index event, suspecting acute stroke in triage, and using established stroke screening tools at ED arrival to identify potential stroke patients. They concluded that these results highlight the crucial importance of the first steps in the diagnostic process.
AHRQ-funded; HS025359; HS027264.
Citation: Liberman AL, Holl JL, Romo E .
Risk assessment of the acute stroke diagnostic process using failure modes, effects, and criticality analysis.
Acad Emerg Med 2023 Mar; 30(3):187-95. doi: 10.1111/acem.14648..
Keywords: Stroke, Cardiovascular Conditions, Diagnostic Safety and Quality
Gay HC, Yu J, Persell SD
Comparison of sodium-glucose cotransporter-2 inhibitor and glucagon-like peptide-1 receptor agonist prescribing in patients with diabetes mellitus with and without cardiovascular disease.
Researchers sought to describe trends in prescribing for sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP1-RAs) to reduce cardiovascular events and mortality in adult patients with type 2 diabetes mellitus (T2DM) in diverse care settings. Their focus was on outpatient clinics in a midwestern integrated health system and small- and medium-sized community-based primary care practices and health centers in three Midwestern states. Results showed that an increase in prescription rates was greater for SGLT2is than for GLP1-RAs in a large integrated medical center and community primary care practices; overall, prescription rates for eligible patients were low, and the researchers observed racial disparities.
AHRQ-funded; HS026385; HS023921.
Citation: Gay HC, Yu J, Persell SD .
Comparison of sodium-glucose cotransporter-2 inhibitor and glucagon-like peptide-1 receptor agonist prescribing in patients with diabetes mellitus with and without cardiovascular disease.
Am J Cardiol 2023 Feb 15; 189:121-30. doi: 10.1016/j.amjcard.2022.10.041..
Keywords: Diabetes, Cardiovascular Conditions, Chronic Conditions, Medication, Primary Care
De Roo AC, Ha J, Regenbogen SE
Impact of Medicare eligibility on informal caregiving for surgery and stroke.
The purpose of this study was to assess whether the intensity of family and friend care changes after older individuals enroll in Medicare at 65. Researchers used Health and Retirement Study survey data covering a 20-year period to compare informal care received by patients who had been hospitalized for stroke, heart surgery, or joint surgery, and who were stratified into propensity-weighted pre- and post-Medicare eligibility cohorts. Their results showed that onset of Medicare eligibility was associated with a substantial decrease in family and friend caregiving use received by stroke patients, but not in the other acute care cohorts. They concluded that this effect of Medicare coverage on informal caregiving had implications for patient function and caregiver burden, and should be considered in episode-based reimbursement models that alter professional rehabilitative care intensity.
AHRQ-funded; HS000053.
Citation: De Roo AC, Ha J, Regenbogen SE .
Impact of Medicare eligibility on informal caregiving for surgery and stroke.
Health Serv Res 2023 Feb; 58(1):128-39. doi: 10.1111/1475-6773.14019..
Keywords: Medicare, Caregiving, Surgery, Stroke, Cardiovascular Conditions
Bartels K, Howard-Quijano K, Prin M
Meeting report: first Cardiovascular Outcomes Research in Perioperative Medicine conference.
This article summarized the background and objectives of the first Cardiovascular Outcomes Research in Perioperative Medicine (COR-PM) conference. It also described the conduct of the conference and outlined future directions for scientific meetings which are focused on the fostering of high-quality clinical research in the broader perioperative medicine community.
AHRQ-funded; HS027795.
Citation: Bartels K, Howard-Quijano K, Prin M .
Meeting report: first Cardiovascular Outcomes Research in Perioperative Medicine conference.
Anesth Analg 2023 Feb; 136(2):418-20. doi: 10.1213/ane.0000000000006248..
Keywords: Cardiovascular Conditions, Surgery, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
O'Donnell TFX,, Dansey KD, Marcaccio CL
Racial disparities in treatment of ruptured abdominal aortic aneurysms.
This study evaluated regional center transfer rates, turndown rates, and outcomes for Black vs White patients presenting with ruptured abdominal aortic aneurysms (rAAAs) in two large databases. All rAAA repairs in the Vascular Quality Initiative from 2003 to 2020 was used. The authors used the National Inpatient Sample from 2004 to 2015 to examine turndown rates for repair. They identified 4935 patients with rAAAs in the Vascular Quality Initiative (6.2% Black) and 48,489 in the National Inpatient Sample (6.0% Black). Transfer rates were high; however, Black patients were significantly less likely to undergo transfer before repair compared with White patients (49% Black vs 62% White). No significant differences were found in perioperative mortality or complications. However, Black patients were significantly more likely to be turned down for repair (37% vs 28%). This difference was mostly found to be due to insurance status. Patients with private insurance had undergone surgery at a similar rate. However, among patients with Medicare or Medicaid/self-pay, Black patients were less likely than were White patients to undergo repair (Medicare, 64% vs 72%; Medicaid/self-pay, 43% vs 61%). Medicaid/self-pay patients were less likely to undergo repair than were patients of the same race with either Medicare or private insurance.
AHRQ-funded; HS027285.
Citation: O'Donnell TFX,, Dansey KD, Marcaccio CL .
Racial disparities in treatment of ruptured abdominal aortic aneurysms.
J Vasc Surg 2023 Feb; 77(2):406-14. doi: 10.1016/j.jvs.2022.08.009..
Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Racial and Ethnic Minorities, Cardiovascular Conditions
Stockdill ML, Dionne-Odom JN, Wells R
African American recruitment in early heart failure palliative care trials: outcomes and comparison with the ENABLE CHF-PC randomized trial.
This study examined African American (AA) clinical trial recruitment and enrollment in a palliative care randomized controlled trial (RCT) for heart failure (HF) patients and compared patient baseline characteristics to other HF palliative care RCTs. The authors used the ENABLE CHF-PC (Educate, Nurture, Advise, Before Life Ends: Comprehensive Heartcare for Patients and Caregivers) RCT using bivariate statistics to compare racial and patient characteristics and differences through recruitment stages. They then compared the baseline sample characteristics among three palliative HF trials. They screened 785 patients, of whom 566 with NYHA classification III-IV were approached, with 461 enrolled and then 415 randomized. African Americans were more likely to consent than Caucasians (55%), were younger, had a lower ejection fraction, were more likely to be single, and lack an advanced directive. AAs reported higher goal setting, care coordination, and used more “denial” coping strategies. Compared to two recent HF RCTs, the ENABLE CHF-PC sample had a higher proportion of AAs.
AHRQ-funded; HS013852.
Citation: Stockdill ML, Dionne-Odom JN, Wells R .
African American recruitment in early heart failure palliative care trials: outcomes and comparison with the ENABLE CHF-PC randomized trial.
J Palliat Care 2023 Jan;38(1):52-61. doi: 10.1177/0825859720975978..
Keywords: Racial and Ethnic Minorities, Palliative Care, Heart Disease and Health, Cardiovascular Conditions
Likosky DS, Strobel RJ, Wu X
Interhospital failure to rescue after coronary artery bypass grafting.
Researchers conducted an observational study to evaluate whether interhospital variation in mortality rates for coronary artery bypass grafting was driven by complications and failure to rescue. Subjects were patients undergoing grafting surgery across 90 hospitals between 2011 and 2017. Results indicated the predicted mortality risk was similar across hospital observed:expected mortality terciles. Observed and expected failure to rescue rates were positively correlated among patients with major and overall complications. The researchers concluded that interhospital variability in successful rescue after coronary artery bypass grafting supports the importance of identifying best practices at high-performing hospitals; this includes early recognition and management of complications.
AHRQ-funded; HS026003.
Citation: Likosky DS, Strobel RJ, Wu X .
Interhospital failure to rescue after coronary artery bypass grafting.
J Thorac Cardiovasc Surg 2023 Jan;165(1):134-43.e3. doi: 10.1016/j.jtcvs.2021.01.064..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Surgery, Hospitals, Adverse Events
de Guerre L, Rice J, Cheng J
Racial differences in isolated aortic, concomitant aortoiliac, and isolated iliac aneurysms: this is a retrospective observational study.
The purpose of this research was to investigate racial and ethnic disparities in the clinical presentation, foundational and operative features, and outcomes following aortoiliac aneurysm repair. Prior research has revealed variations in the incidence of abdominal aortic aneurysms across racial and ethnic groups, along with more intricate iliac anatomical structures in Asian individuals. The researchers analyzed White, Black, Asian, and Hispanic patients who underwent aortoiliac aneurysm repair in the VQI between 2003 and 2019, and examined baseline comorbidities, operative attributes, and perioperative outcomes according to race and ethnicity. They study found that within the 60,435-patient sample, Black and Asian patients were most likely to receive repair for aortoiliac and isolated iliac aneurysms, while White and Hispanic patients predominantly underwent isolated aortic aneurysm repair. Black patients were more prone to symptomatic repair and experienced rupture repair at a reduced aortic diameter. The iliac aneurysm diameter was largest in Black and Asian patients. Asian individuals were most likely to exhibit aortic neck angulation greater than 60 degrees, over 20% graft oversizing, and postoperative endoleaks. Additionally, Asian patients had a higher likelihood of hypogastric artery aneurysm and hypogastric coiling procedures. The study concluded that Asian and Black patients demonstrated a higher likelihood of undergoing repair for aortoiliac and isolated iliac aneurysms, while White and Hispanic patients predominantly received repair for isolated aortic aneurysms.
AHRQ-funded; HS027285
Citation: de Guerre L, Rice J, Cheng J .
Racial differences in isolated aortic, concomitant aortoiliac, and isolated iliac aneurysms: this is a retrospective observational study.
Ann Surg 2023 Jan 1;277(1):165-72. doi: 10.1097/sla.0000000000004731.
Keywords: Racial and Ethnic Minorities, Cardiovascular Conditions
Anjorin AC, Marcaccio CL, Rastogi V
Statin therapy is associated with improved perioperative outcomes and long-term mortality following carotid revascularization in the Vascular Quality Initiative.
This study evaluated the outcomes of carotid artery stenosis (CAS) patients using statin therapy before undergoing carotid revascularization in the Vascular Quality Initiative registry. The authors identified all patients who underwent carotid endarterectomy (CEA), transfemoral carotid artery stenting (tfCAS), or transcarotid artery revascularization (TCAR) in the Vascular Quality Initiative registry from January 2016 to September 2021. Compared with statin use, no statin use was associated with a higher risk of in-hospital stroke or death and 5-year mortality among CEA and tfCAS patients, although there was no significant difference in outcomes among TCAR patients.
AHRQ-funded; HS027285.
Citation: Anjorin AC, Marcaccio CL, Rastogi V .
Statin therapy is associated with improved perioperative outcomes and long-term mortality following carotid revascularization in the Vascular Quality Initiative.
J Vasc Surg 2023 Jan;77(1):158-69.e8. doi: 10.1016/j.jvs.2022.08.019..
Keywords: Cardiovascular Conditions, Medication, Stroke, Surgery, Outcomes
Rastogi V, Marcaccio CL, Kim NH
The effect of supraceliac versus infraceliac landing zone on outcomes following fenestrated endovascular repair of juxta-/pararenal aortic aneurysms.
The purpose of this study was to assess perioperative outcomes in patients in the Vascular Quality Initiative who underwent juxta-/pararenal FEVAR with supraceliac vs infraceliac sealing. 1,486 Patients who received an elective FEVAR for juxta-/pararenal aortic aneurysms in the Vascular Quality Initiative between 2014 and 2021were identified and included.
The researchers defined supraceliac sealing as proximal sealing in aortic zone 5, or zone 6 with a celiac scallop/fenestration/branch or celiac occlusion. The study’s primary outcomes were perioperative and 3-year mortality, and secondary outcomes were completion endoleaks, in-hospital complications, and variables related with 3-year mortality. The study found that of the included patients, 84% underwent infraceliac sealing, and 16% underwent supraceliac sealing. Of the supraceliac patients, 60% had a celiac fenestration/branch, 31% had a celiac scallop, and 9.2% had a celiac occlusion (intentional or unintentional). Compared with infraceliac sealing, there were no differences after risk-adjusted analysis in perioperative mortality following supraceliac sealing. Supraceliac sealing was associated with lower odds of type-IA completion endoleaks, but higher odds of any complication including cardiac complications, lower extremity ischemia and acute kidney injury when compared with infraceliac sealing. The researchers concluded that supraceliac sealing was associated with lower risk of type IA endoleaks and similar mortality compared with sealing at an infraceliac level. The researchers advise that providers should be aware that supraceliac sealing was related with higher perioperative morbidity.
The researchers defined supraceliac sealing as proximal sealing in aortic zone 5, or zone 6 with a celiac scallop/fenestration/branch or celiac occlusion. The study’s primary outcomes were perioperative and 3-year mortality, and secondary outcomes were completion endoleaks, in-hospital complications, and variables related with 3-year mortality. The study found that of the included patients, 84% underwent infraceliac sealing, and 16% underwent supraceliac sealing. Of the supraceliac patients, 60% had a celiac fenestration/branch, 31% had a celiac scallop, and 9.2% had a celiac occlusion (intentional or unintentional). Compared with infraceliac sealing, there were no differences after risk-adjusted analysis in perioperative mortality following supraceliac sealing. Supraceliac sealing was associated with lower odds of type-IA completion endoleaks, but higher odds of any complication including cardiac complications, lower extremity ischemia and acute kidney injury when compared with infraceliac sealing. The researchers concluded that supraceliac sealing was associated with lower risk of type IA endoleaks and similar mortality compared with sealing at an infraceliac level. The researchers advise that providers should be aware that supraceliac sealing was related with higher perioperative morbidity.
AHRQ-funded; HS027285.
Citation: Rastogi V, Marcaccio CL, Kim NH .
The effect of supraceliac versus infraceliac landing zone on outcomes following fenestrated endovascular repair of juxta-/pararenal aortic aneurysms.
J Vasc Surg 2023 Jan;77(1):9-19.e2. doi: 10.1016/j.jvs.2022.08.007..
Keywords: Cardiovascular Conditions, Surgery, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes, Comparative Effectiveness, Treatments
Kravchenko OV, Boyce RD, Gomez-Lumbreras A
Drug-drug interaction between dexamethasone and direct-acting oral anticoagulants: a nested case-control study in the national COVID cohort collaborative (N3C).
This study examined whether there is an association between thromboembolotic events (TEEs) and concomitant use of dexamethasone with either apixaban or rivaroxaban (both direct oral anticoagulants or DOACs) during treatment for COVID-19. The authors used data from the National COVID Cohort Collaborative (N3C) to conduct a nested case-control study. Eligible participants were adults over 18 years who were exposed to a DOAC for 10 or more consecutive days and exposure to dexamethasone at least 5 or more consecutive days. The study did not find a discernible association of TEE in patients concomitantly exposed to dexamethasone and a DOAC.
AHRQ-funded; HS025984.
Citation: Kravchenko OV, Boyce RD, Gomez-Lumbreras A .
Drug-drug interaction between dexamethasone and direct-acting oral anticoagulants: a nested case-control study in the national COVID cohort collaborative (N3C).
BMJ Open 2022 Dec 29; 12(12):e066846. doi: 10.1136/bmjopen-2022-066846..
Keywords: COVID-19, Blood Thinners, Medication, Adverse Drug Events (ADE), Adverse Events, Cardiovascular Conditions, Medication: Safety, Patient Safety
Coburn SB, Lang R, Zhang J
Statins utilization in adults with HIV: the treatment gap and predictors of statin initiation.
The purpose of this study was to describe trends in statin eligibility and subsequent statin initiation among people with HIV (PWH) from and identify the predictors of statin initiation. The researchers collected data from 12 United States cohorts between 2001 and 2017. The study found that among 16,409 PWH, 45% met statin eligibility criteria per guidelines for the time period from 2001 to 2017. Statin eligibility ranged from 22% to 25% from 2001 to 2013, and initiation increased from 13% to 45%. In 2014, 51% were statin-eligible, among whom 25% initiated statins, which increased to 32% by 2017. The researchers concluded that there is a substantial statin treatment gap, expanded by the 2013 ACC/AHA guidelines.
AHRQ-funded; 90047713.
Citation: Coburn SB, Lang R, Zhang J .
Statins utilization in adults with HIV: the treatment gap and predictors of statin initiation.
J Acquir Immune Defic Syndr 2022 Dec 15;91(5):469-78. doi: 10.1097/qai.0000000000003083..
Keywords: Medication, Human Immunodeficiency Virus (HIV), Access to Care, Practice Patterns, Cardiovascular Conditions
Funk RJ, Pagani FD, Hou H
Care fragmentation predicts 90-day durable ventricular assist device outcomes.
The purpose of this cohort study was to investigate the relationship between care fragmentation and in-hospital as well as 90-day post-operative outcomes for patients receiving durable ventricular assist device (VAD) implants. The research utilized Medicare claims connected to the Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) for patients who underwent VAD implantation from July 2009 to April 2017. Medicare information was employed to assess the fragmentation of the multidisciplinary care delivery network at the treating hospital, based on the providers' patient-sharing history within the preceding year. The STS Intermacs database was utilized for risk adjustment and outcome determination. Hospitals were categorized into terciles according to the level of network fragmentation, measured by the average number of connections separating providers in the network. Multivariable regression analysis was conducted to examine the association between network fragmentation and the risk of death or infection within 90 days. The study included 5159 patients who received VAD implants, and found 11.2% mortality and 27.6% infection incidence within 90 days following implantation. After adjusting for confounders, a one-unit increase in network fragmentation correlated with a 0.179 rise in in-hospital infection probability and a 0.183 increase in the likelihood of 90-day infection. Comparable findings were observed in models assessing the number of in-hospital and 90-day infections. While network fragmentation was a predictor of 90-day mortality probability, this association was not significant after adjustment.
AHRQ-funded; HS026003
Citation: Funk RJ, Pagani FD, Hou H .
Care fragmentation predicts 90-day durable ventricular assist device outcomes.
Am J Manag Care 2022 Dec;28(12):e444-e51. doi: 10.37765/ajmc.2022.89280.
Keywords: Medical Devices, Heart Disease and Health, Cardiovascular Conditions
A Wehbe, RM Wu, T
AHRQ Author: Tibrewala
Hyponatremia is a powerful predictor of poor prognosis in left ventricular assist device patients.
Researchers sought to investigate the prognostic value of serum sodium in left ventricular assist device (LVAD) patients and whether hyponatremia reflects worsening heart failure or an alternative mechanism. Heart failure patients who had undergone LVAD implantation 2008-2019 were identified; the researchers assessed for differences in hyponatremia before and after implantation. The findings suggested that hyponatremia in LVAD patients was associated with a significantly higher risk of all-cause mortality and recurrent heart failure hospitalizations. The researchers concluded that hyponatremia may be a marker of ongoing neurohormonal activation more sensitive than other lab values, echocardiography parameters, and hemodynamic measurements.
AHRQ-funded; HS026385.
Citation: A Wehbe, RM Wu, T .
Hyponatremia is a powerful predictor of poor prognosis in left ventricular assist device patients.
ASAIO J 2022 Dec;68(12):1475-82. doi: 10.1097/mat.0000000000001691.
Keywords: Medical Devices, Heart Disease and Health, Cardiovascular Conditions
Marcaccio CL, Anjorin A, Patel PB
In-hospital outcomes after upper extremity versus transfemoral and transcarotid access for carotid stenting in the Vascular Quality Initiative.
This comparative study examined outcomes for treatment of patients at high risk of carotid endarterectomy using different approaches of carotid artery stenting (CAS). The study compared the effects of transradial or transbrachial (tr/tbCAS) versus more established transfemoral (tfCAS) or transcarotid (TCAR) CAS procedures. Patients were identified from the Quality Initiative registry from January 2016 to December 2021. Among 40,835 CAS identified patients, 962 underwent tr/tbCAS, 28,850 underwent tfCAS, and 21,033 underwent TCAR. Among matched patients who underwent tr/tbCAS versus tfCAS, there was no significant difference in the risk of stroke/death (4.1% vs 2.9), but tr/tbCAS was associated with a higher risk of death (2.4% vs 1.3). In the symptomatic subgroup, tr/tbCAS was associated with a higher risk of stroke/death (6.1% vs 3.9%) and death (3.6% vs 1.7%), but there were no differences in asymptomatic patients. After adjustment for Modified Rankin Scale in patients with preoperative stroke, there were no significant differences in stroke/death or death between groups.
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Anjorin A, Patel PB .
In-hospital outcomes after upper extremity versus transfemoral and transcarotid access for carotid stenting in the Vascular Quality Initiative.
J Vasc Surg 2022 Dec;76(6):1603-14.e7. doi: 10.1016/j.jvs.2022.05.030..
Keywords: Stroke, Cardiovascular Conditions, Outcomes, Evidence-Based Practice, Comparative Effectiveness, Patient-Centered Outcomes Research
Lewinski AA, Jazowski SA, Goldstein KM
Intensifying approaches to address clinical inertia among cardiovascular disease risk factors: a narrative review.
Researchers conducted a narrative literature review to identify individual-level and multifactorial interventions that have been successful in addressing clinical inertia. They found that, in order to reduce clinical inertia and achieve optimal cardiovascular disease risk factor control, interventions should consider the role of multiple representatives, be feasible for implementation in healthcare systems, and be flexible for an individual patient's adherence needs.
AHRQ-funded; HS026122.
Citation: Lewinski AA, Jazowski SA, Goldstein KM .
Intensifying approaches to address clinical inertia among cardiovascular disease risk factors: a narrative review.
Patient Educ Couns 2022 Dec;105(12):3381-88. doi: 10.1016/j.pec.2022.08.005..
Keywords: Cardiovascular Conditions, Risk
Schroeder MC, Chapman CG, Chrischilles EA
Generating practice-based evidence in the use of guideline-recommended combination therapy for secondary prevention of acute myocardial infarction.
This study’s goal was to determine if variation in real-world practice of guideline-recommended combination therapy for secondary prevention of acute myocardial infarction (AMI) reflects poor quality-of-care or a balance of outcome tradeoffs among patients. Medicare fee-for-service beneficiaries hospitalized 2007-2008 for AMI were included. Treatment within 30-days post-discharge was grouped into one of eight possible combinations for the three drug classes: beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers, and statins. Outcomes looked at included one-year overall survival, one-year cardiovascular-event-free survival, and 90-day adverse events. Results were found that each drug combination was observed in the final sample (N = 124,695), with 35.7% having all three, and 13.5% having none. There were both treatment benefits and harms in patients with AMIs with higher rates of guideline-recommended treatment.
AHRQ-funded; HS018381.
Citation: Schroeder MC, Chapman CG, Chrischilles EA .
Generating practice-based evidence in the use of guideline-recommended combination therapy for secondary prevention of acute myocardial infarction.
Pharmacy 2022 Nov 3;10(6). doi: 10.3390/pharmacy10060147..
Keywords: Evidence-Based Practice, Guidelines, Heart Disease and Health, Cardiovascular Conditions, Comparative Effectiveness, Patient-Centered Outcomes Research, Prevention
Marcaccio CL, Patel PB, de Guerre L
Disparities in 5-year outcomes and imaging surveillance following elective endovascular repair of abdominal aortic aneurysm by sex, race, and ethnicity.
The purpose of this study was to identify variations in 5-year outcomes and imaging surveillance after elective endovascular aortic aneurysm repair (EVAR) by sex, race, and ethnicity and to examine possible mechanisms contributing to these variations. The primary outcome was 5-year aneurysm rupture. Secondary outcomes were 5-year reintervention and mortality, and having no aortic imaging follow-up from 6 to 24 months after EVAR. The study found that among 16,040 patients, 73% were White males, 18% were White females, 2.6% were Black males, 1.1% were Black females, 0.9% were Asian males, 0.2% were Asian females, 1.7% were Hispanic males, and 0.4% were Hispanic females. At 5 years, Black females had the highest rupture rates at 6.4% and white males had the lowest at 2.3%. Compared with White males, rupture rates were higher in White females, Black females, and Asian females. Among other groups, Black males had higher reintervention and both Black and Hispanic males had higher rates of no imaging follow-up. In adjusted analyses, White, Black, and Asian females remained at significantly higher risk for 5-year rupture. The researchers concluded that Black females had higher 5-year aneurysm rupture, reintervention, and mortality rates after elective EVAR as compared with White male patients, whereas White females had higher rupture, mortality and loss-to-imaging-follow-up compared to White male patients. Black males had higher reintervention and no imaging follow-up, and Asian females had higher rupture rates.
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Patel PB, de Guerre L .
Disparities in 5-year outcomes and imaging surveillance following elective endovascular repair of abdominal aortic aneurysm by sex, race, and ethnicity.
J Vasc Surg 2022 Nov;76(5):1205-15.e4. doi: 10.1016/j.jvs.2022.03.886..
Keywords: Disparities, Racial and Ethnic Minorities, Sex Factors, Outcomes, Imaging, Heart Disease and Health, Cardiovascular Conditions
Marcaccio CL, O'Donnell TFX, Dansey KD
Disparities in reporting and representation by sex, race, and ethnicity in endovascular aortic device trials.
The purpose of this study was to examine the demographics of patients enrolled in critical U.S. endovascular aortic device trials to explore the representation of vulnerable populations, including women and racial and ethnic minorities. The primary outcomes included the percentage of trials reporting participant sex, race, and ethnicity and the percentage of participants across sex, racial, and ethnic groups. The study found that the Food and Drug Administration (FDA) provided 29 approvals from 29 trials of 24 devices with a total of 4046 patients: 52% (15) were EVAR devices, 41% (12) were TEVAR devices, and 3.4% (1) was a FEVAR device, with 1 dissection stent (3.4%). Fifty-two percent of the trials reported the three most common racial groups (White, Black, Asian), and 48% reported Hispanic ethnicity. The TEVAR trials were the most likely to report all three racial groups and Hispanic ethnicity (92% and 75%, respectively), while the EVAR trials had the lowest reporting rates (13% and 20%, respectively). The median female enrollment was 21%, with the EVAR trials having the lowest female enrollment compared with 41% in the TEVAR trials, 21% in the FEVAR trial, and 34% in the dissection stent trial. The study concluded that in critical aortic device trials that led to FDA approval, female patients were underrepresented, especially for EVAR, and racial and ethnic minority groups were under-represented and underreported.
AHRQ-funded; HS027285.
Citation: Marcaccio CL, O'Donnell TFX, Dansey KD .
Disparities in reporting and representation by sex, race, and ethnicity in endovascular aortic device trials.
J Vasc Surg 2022 Nov;76(5):1244-52.e2. doi: 10.1016/j.jvs.2022.05.003..
Keywords: Disparities, Racial and Ethnic Minorities, Heart Disease and Health, Cardiovascular Conditions, Medical Devices, Sex Factors
Thompson MP, Yaser JM, Forrest A
Evaluating the feasibility of a statewide collaboration to improve cardiac rehabilitation participation: the Michigan Cardiac Rehab Network.
The purpose of this study as to assess the feasibility of the Michigan Cardiac Rehab Network to improve Cardiac Rehabilitation (CR) participation. The researchers utilized Multipayer claims data from the Michigan Value Collaborative to identify 95 hospitals and 84 CR facilities and convene a multidisciplinary group of advisors. Three CR facilities were selected for virtual site visits to identify areas of success and barriers to improvement. The study found that 51% of hospitals provided interventional cardiology services and 35% provided cardiac surgical services. The multidisciplinary group of advisors was convened and represented a broad range of roles within 13 institutions. CR enrollment statewide among eligible admissions was 33.4%, with broad differences in CR performance measures among participating hospitals and eligible admissions. Virtual site visits highlighted successes in increasing CR participation but an array of barriers to participation associated with referrals, capacity and staffing constraints, and geographic and financial barriers.
AHRQ-funded; HS027830.
Citation: Thompson MP, Yaser JM, Forrest A .
Evaluating the feasibility of a statewide collaboration to improve cardiac rehabilitation participation: the Michigan Cardiac Rehab Network.
J Cardiopulm Rehabil Prev 2022 Nov 1;42(6):e75-e81. doi: 10.1097/hcr.0000000000000706..
Keywords: Cardiovascular Conditions, Rehabilitation, Quality Improvement, Quality of Care
Likosky DS, Yang G, Zhang M
Interhospital variability in health care-associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries.
The purpose of this study was to examine differences in durable ventricular assist device implantation infection rates and associated costs across hospitals. The researchers utilized clinical data for 8,688 patients who received primary durable ventricular assist devices from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) hospitals (n = 120) and merged that data with post-implantation 90-day Medicare claims. The primary outcome included infections within 90 days of implantation and Medicare payments. The study found that 27.8% of patients developed 3982 identified infections. The median adjusted incidence of infections (per 100 patient-months) across hospitals was 14.3 and differed according to hospital. Total Medicare payments from implantation to 90 days were 9.0% more in high versus low infection tercile hospitals. The researchers concluded that health-care-associated infection rates post durable ventricular assist device implantation varied according to hospital and were associated with increased 90-day Medicare expenditures.
AHRQ-funded; HS026003.
Citation: Likosky DS, Yang G, Zhang M .
Interhospital variability in health care-associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries.
J Thorac Cardiovasc Surg 2022 Nov;164(5):1561-68. doi: 10.1016/j.jtcvs.2021.04.074..
Keywords: Healthcare-Associated Infections (HAIs), Medical Devices, Medicare, Heart Disease and Health, Cardiovascular Conditions, Hospitals, Payment, Healthcare Costs
Solomon Y, Rastogi V, Marcaccio CL
Outcomes after transcarotid artery revascularization stratified by preprocedural symptom status.
In this study, researchers examined contemporary perioperative outcomes in patients who underwent transcarotid artery revascularization (TCAR) stratified by specific preprocedural symptom status. Using data from the Vascular Quality Initiative, they found that, after TCAR, compared with asymptomatic status, a recent stroke and a recent hemispheric TIA were associated with higher stroke/death rates, whereas a recent ocular TIA was associated with similar stroke/death rates. In addition, a formerly symptomatic status was associated with higher stroke/death rates compared with an asymptomatic status. The researchers concluded that their findings suggested that classifying patients undergoing TCAR as symptomatic versus asymptomatic may be an oversimplification and that patients' specific preoperative neurologic symptoms should instead be used in risk assessment and outcome reporting for TCAR.
AHRQ-funded; HS027285.
Citation: Solomon Y, Rastogi V, Marcaccio CL .
Outcomes after transcarotid artery revascularization stratified by preprocedural symptom status.
J Vasc Surg 2022 Nov;76(5):1307-15.e1. doi: 10.1016/j.jvs.2022.05.024..
Keywords: Cardiovascular Conditions, Surgery, Stroke, Outcomes
Anjorin AC, Marcaccio CL, Patel PB
Racial and ethnic disparities in 3-year outcomes following infrainguinal bypass for chronic limb-threatening ischemia.
This study’s objective was to determine the differences in 3-year outcomes after open infrainguinal bypass for chronic limb-threatening ischemia (CLTI) stratified by race/ethnicity and explored the potential factors contributing to these differences to help determine reasons why outcomes are worse for racial and ethnic minorities. The authors identified all CLTI patients who had undergone primary open infrainguinal bypass in the Vascular Quality Initiative registry from 2003 to 2017 with linkage to Medicare claims through 2018 for the 3-year outcomes. Primary outcomes were the 3-year rates of major amputation, reintervention, and mortality. They also recorded 30-day major adverse limb events (MALE) defined as major amputation or reintervention. Of the 7108 patients with CLTI 79% were non-Hispanic White, 15% were Black, 1% were Asian, and 6% were Hispanic. Compared with White patients, Black patients had higher rates of 3-year major amputation (Black vs White, 32% vs 19%), reintervention (Black vs White, 61% vs 57%), and 30-day MALE (Black vs White, 8.1% vs 4.9%) but lower mortality (Black vs White, 38% vs 42%). Hispanic patients also experienced higher rates of amputation (Hispanic vs White, 27% vs 19%), reintervention (Hispanic vs White, 70% vs 57%), and MALE (Hispanic vs White, 8.7% vs 4.9%). However, mortality was similar between Hispanic vs White groups. A higher presence of comorbidities in Black and Hispanic patients with CLTI is considered the greatest contributing factors to higher amputation and reintervention rates.
AHRQ-funded; HS027285.
Citation: Anjorin AC, Marcaccio CL, Patel PB .
Racial and ethnic disparities in 3-year outcomes following infrainguinal bypass for chronic limb-threatening ischemia.
J Vasc Surg 2022 Nov;76(5):1335-46.e7. doi: 10.1016/j.jvs.2022.06.026..
Keywords: Racial and Ethnic Minorities, Disparities, Outcomes, Surgery, Cardiovascular Conditions