National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- Arthritis (1)
- Blood Thinners (4)
- Cancer: Skin Cancer (1)
- (-) Cardiovascular Conditions (27)
- Care Management (1)
- Children/Adolescents (1)
- Diagnostic Safety and Quality (1)
- Disparities (2)
- Elderly (4)
- Emergency Medical Services (EMS) (1)
- Evidence-Based Practice (3)
- Guidelines (1)
- Healthcare Delivery (1)
- Healthcare Utilization (1)
- (-) Heart Disease and Health (27)
- Hospitalization (1)
- Hospital Readmissions (1)
- Medical Devices (1)
- Medication (10)
- Mortality (2)
- Patient-Centered Outcomes Research (6)
- Patient Adherence/Compliance (2)
- Patient Safety (1)
- Racial and Ethnic Minorities (2)
- Registries (4)
- Risk (5)
- Sex Factors (2)
- Stroke (3)
- Surgery (1)
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 27 Research Studies DisplayedDesai NR, Parzynski CS, Krumholz HM
Patterns of institutional review of percutaneous coronary intervention appropriateness and the effect on quality of care and clinical outcomes.
The researchers sought to determine whether internal review of percutaneous coronary intervention (PCI) appropriateness using appropriate use criteria is associated with differences in procedural appropriateness, quality of care, and patient outcomes. They concluded that there was a modest association between procedural appropriateness and clinical outcomes and a similarly modest correlation between nonacute PCI volume and procedural appropriateness.
AHRQ-funded; HS023000
Citation: Desai NR, Parzynski CS, Krumholz HM .
Patterns of institutional review of percutaneous coronary intervention appropriateness and the effect on quality of care and clinical outcomes.
JAMA Intern Med. 2015 Dec;175(12):1988-90.
Keywords: Cardiovascular Conditions, Patient-Centered Outcomes Research, Heart Disease and Health, Registries
O'Brien EC, Simon DN, Thomas LE
The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation.
The researchers sought to develop and validate a novel bleeding risk score using routinely available clinical information to predict major bleeding in a large, community-based in atrial fibrillation (AF) population. They concluded that their five-element ORBIT bleeding risk score had better ability to predict major bleeding in AF patients when compared with HAS-BLED and ATRIA risk scores.
AHRQ-funded; HS021092.
Citation: O'Brien EC, Simon DN, Thomas LE .
The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation.
Eur Heart J 2015 Dec 7;36(46):3258-64. doi: 10.1093/eurheartj/ehv476.
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Keywords: Blood Thinners, Heart Disease and Health, Cardiovascular Conditions, Adverse Drug Events (ADE), Adverse Events, Risk, Registries, Patient-Centered Outcomes Research, Evidence-Based Practice
Desai NR, Bradley SM, Parzynski CS
Appropriate use criteria for coronary revascularization and trends in utilization, patient selection, and appropriateness of percutaneous coronary intervention.
The researchers examined trends in percutaneous coronary intervention (PCI) utilization, patient selection, and procedural appropriateness following the introduction of Appropriate Use Criteria. They concluded that there have been significant reductions in the volume of nonacute PCI. The proportion of nonacute PCIs classified as inappropriate has declined, although hospital-level variation in inappropriate PCI persists.
AHRQ-funded; HS023000.
Citation: Desai NR, Bradley SM, Parzynski CS .
Appropriate use criteria for coronary revascularization and trends in utilization, patient selection, and appropriateness of percutaneous coronary intervention.
JAMA 2015 Nov 17;314(19):2045-53. doi: 10.1001/jama.2015.13764.
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Keywords: Heart Disease and Health, Cardiovascular Conditions, Healthcare Utilization
Cooper LB, Hammill BG, Peterson ED
Consistency of laboratory monitoring during initiation of mineralocorticoid receptor antagonist therapy in patients with heart failure.
No large studies have examined whether laboratory monitoring occurs routinely in community practice. The researchers observed low rates of monitoring in clinical practice: after initiation of mineralocorticoid receptor antagonist therapy in a large cohort, only 1,384 patients (13.3 percent) and 3,122 patients (29.9 percent) received appropriate testing in early and extended follow-up, respectively.
AHRQ-funded; HS021092.
Citation: Cooper LB, Hammill BG, Peterson ED .
Consistency of laboratory monitoring during initiation of mineralocorticoid receptor antagonist therapy in patients with heart failure.
JAMA 2015 Nov 10;314(18):1973-5. doi: 10.1001/jama.2015.11904..
Keywords: Heart Disease and Health, Cardiovascular Conditions
Zhou M, Chang HY, Segal JB
Adherence to a novel oral anticoagulant among patients with atrial fibrillation.
The researchers examined adherence and persistence to dabigatran among adults with atrial fibrillation. Among those using dabigatran alone (n = 2,713), 41 percent were nonadherent with therapy, and 32 percent had gaps of 60 days or greater. Among those observed for 9 months who used dabigatran alone, rates of nonadherence were 47 percent, whereas 48 percent discontinued therapy during follow-up.
AHRQ-funded; HS018960.
Citation: Zhou M, Chang HY, Segal JB .
Adherence to a novel oral anticoagulant among patients with atrial fibrillation.
J Manag Care Spec Pharm 2015 Nov;21(11):1054-62. doi: 10.18553/jmcp.2015.21.11.1054.
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Keywords: Blood Thinners, Patient Adherence/Compliance, Heart Disease and Health, Cardiovascular Conditions, Medication
Tataris KL, Mercer MP, Govindarajan P
Prehospital aspirin administration for acute coronary syndrome (ACS) in the USA: an EMS quality assessment using the NEMSIS 2011 database.
The researchers sought to determine (1) the proportion of patients with suspected cardiac ischaemia who received aspirin and (2) patient and prehospital characteristics that independently predicted administration of aspirin. Patients living in the Southern region of the USA and patients with governmental (federally administered such as Veteran's Health Care, but not Medicare or Medicaid) insurance had the lowest odds of receiving aspirin.
AHRQ-funded; HS017965.
Citation: Tataris KL, Mercer MP, Govindarajan P .
Prehospital aspirin administration for acute coronary syndrome (ACS) in the USA: an EMS quality assessment using the NEMSIS 2011 database.
Emerg Med J 2015 Nov;32(11):876-81. doi: 10.1136/emermed-2014-204299.
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Keywords: Cardiovascular Conditions, Care Management, Emergency Medical Services (EMS), Heart Disease and Health, Healthcare Delivery, Medication
Silverberg JI
Association between adult atopic dermatitis, cardiovascular disease, and increased heart attacks in three population-based studies.
The authors sought to determine whether adult eczema is associated with increased cardiovascular and cerebrovascular disease. They concluded that adults with atopic dermatitis may have increased cardiovascular disease, heart attack, and stroke.
AHRQ-funded; HS023011.
Citation: Silverberg JI .
Association between adult atopic dermatitis, cardiovascular disease, and increased heart attacks in three population-based studies.
Allergy 2015 Oct;70(10):1300-8. doi: 10.1111/all.12685.
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Keywords: Cardiovascular Conditions, Heart Disease and Health, Cancer: Skin Cancer
Burns KM, Encinosa WE, Pearson GD
AHRQ Author: Encinosa WE
Electrocardiogram in preparticipation athletic evaluations among insured youths.
The researchers retrospectively characterized electrocardiogram (ECG) use among preparticipation history and examinations (PPEs). They found that thirteen percent of PPEs with ECG and 0.5 percent of PPEs alone led to a cardiology referral. After PPEs with ECG, cardiac disease was identified in 18 percent (2 percent sports-limiting); after PPEs alone, cardiac disease was identified in 0.5 percent (0.03 percent sports-limiting).
AHRQ-authored.
Citation: Burns KM, Encinosa WE, Pearson GD .
Electrocardiogram in preparticipation athletic evaluations among insured youths.
J Pediatr 2015 Oct;167(4):804-09.e1. doi: 10.1016/j.jpeds.2015.06.011..
Keywords: Children/Adolescents, Heart Disease and Health, Cardiovascular Conditions, Diagnostic Safety and Quality
Doll JA, Hellkamp A, Ho PM
Participation in cardiac rehabilitation programs among older patients after acute myocardial infarction.
This study identified opportunities to improve the use of cardiac rehabilitation by older adults. It concluded that quality improvement efforts should focus not only on increasing referral rates but also on addressing barriers to attending rehabilitation sessions, such as travel distance, copayments, and lack of coordination between inpatient and outpatient clinicians.
AHRQ-funded; HS021092.
Citation: Doll JA, Hellkamp A, Ho PM .
Participation in cardiac rehabilitation programs among older patients after acute myocardial infarction.
JAMA Intern Med 2015 Oct;175(10):1700-2. doi: 10.1001/jamainternmed.2015.3819..
Keywords: Elderly, Heart Disease and Health, Cardiovascular Conditions
Hess CN, Peterson ED, Peng SA
Use and outcomes of triple therapy among older patients with acute myocardial infarction and atrial fibrillation.
The authors sought to determine appropriate antithrombotic therapy for acute myocardial infarction (MI) patients with atrial fibrillation (AF) treated with percutaneous coronary intervention (PCI). They found that approximately 1 in 4 older AF patients undergoing PCI for MI were discharged on triple therapy. Those receiving triple therapy versus dual antiplatelet therapy had higher rates of major bleeding without a measurable difference in composite MI, death, or stroke.
AHRQ-funded; HS021092.
Citation: Hess CN, Peterson ED, Peng SA .
Use and outcomes of triple therapy among older patients with acute myocardial infarction and atrial fibrillation.
J Am Coll Cardiol 2015 Aug 11;66(6):616-27. doi: 10.1016/j.jacc.2015.05.062.
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Keywords: Blood Thinners, Heart Disease and Health, Cardiovascular Conditions, Medication
Kaplan RM, Irvin VL
AHRQ Author: Kaplan RM
Likelihood of null effects of large NHLBI clinical trials has increased over time.
This study explores whether the number of null results in large National Heart Lung, and Blood Institute (NHLBI) funded trials has increased over time. It found that the number NHLBI trials reporting positive results declined after the year 2000. Prospective declaration of outcomes in RCTs, and the adoption of transparent reporting standards, as required by clinicaltrials.gov, may have contributed to the trend toward null findings.
AHRQ-authored
Citation: Kaplan RM, Irvin VL .
Likelihood of null effects of large NHLBI clinical trials has increased over time.
PLoS One 2015 Aug 5;10(8):e0132382. doi: 10.1371/journal.pone.0132382..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Registries
Kabra R, Cram P, Girotra S
Effect of race on outcomes (stroke and death) in patients >65 years with atrial fibrillation.
The researchers sought to determine whether there are any racial differences in the outcomes of death and stroke in patients with newly diagnosed AF in patients >65 years. They found that the risks of death and stroke are higher in blacks and Hispanics compared with whites. The increased risk was eliminated or significantly reduced after adjusting for preexisting co-morbidities.
AHRQ-funded; HS021992.
Citation: Kabra R, Cram P, Girotra S .
Effect of race on outcomes (stroke and death) in patients >65 years with atrial fibrillation.
Am J Cardiol 2015 Jul 15;116(2):230-5. doi: 10.1016/j.amjcard.2015.04.012..
Keywords: Elderly, Heart Disease and Health, Cardiovascular Conditions, Racial and Ethnic Minorities, Stroke, Mortality, Risk
Bhave PD, Lu X, Girotra S
Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation.
The researchers sought to determine whether significant race and sex differences exist in the treatment of newly diagnosed AF in Medicare beneficiaries. They found that there were statistically significant differences in the use of AF-related services by both race and sex, with white patients and male patients receiving the most care.
AHRQ-funded; HS021992.
Citation: Bhave PD, Lu X, Girotra S .
Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation.
Heart Rhythm 2015 Jul;12(7):1406-12. doi: 10.1016/j.hrthm.2015.03.031..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Racial and Ethnic Minorities, Sex Factors, Disparities
Allen LA, Fonarow GC, Simon DN
Digoxin use and subsequent outcomes among patients in a contemporary atrial fibrillation cohort.
This study sought to describe digoxin use over time in patients with AF who were stratified by the presence or absence of heart failure (HF), to characterize the predictors of digoxin use and initiation, and to correlate digoxin use with outcomes. It found that, after adjustment for detailed clinical factors, digoxin use in registry patients with AF had a neutral association with outcomes under most circumstances.
AHRQ-funded; HS021092.
Citation: Allen LA, Fonarow GC, Simon DN .
Digoxin use and subsequent outcomes among patients in a contemporary atrial fibrillation cohort.
J Am Coll Cardiol 2015 Jun 30;65(25):2691-8. doi: 10.1016/j.jacc.2015.04.045..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Medication
Lopes RD, Gharacholou SM, Holmes DN
Cumulative incidence of death and rehospitalization among the elderly in the first year after NSTEMI.
The researchers evaluated mortality and cause-specific rehospitalization rates in elderly non-ST-segment elevation myocardial infarction survivors with ischemic heart disease. They found that rehospitalization rates do not rise substantially with advancing age, and rehospitalization is often for noncardiac diagnoses.
AHRQ-funded; HS021092.
Citation: Lopes RD, Gharacholou SM, Holmes DN .
Cumulative incidence of death and rehospitalization among the elderly in the first year after NSTEMI.
Am J Med 2015 Jun;128(6):582-90. doi: 10.1016/j.amjmed.2014.12.032.
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Keywords: Elderly, Mortality, Heart Disease and Health, Cardiovascular Conditions, Hospital Readmissions
Solomon DH, Reed GW, Kremer JM
Disease activity in rheumatoid arthritis and the risk of cardiovascular events.
The researchers studied whether time-averaged disease activity in rheumatoid arthritis (RA) correlates with cardiovascular (CV) events. They found that reduced time-averaged disease activity in RA is associated with fewer CV events.
AHRQ-funded; HS018517.
Citation: Solomon DH, Reed GW, Kremer JM .
Disease activity in rheumatoid arthritis and the risk of cardiovascular events.
Arthritis Rheumatol 2015 Jun;67(6):1449-55. doi: 10.1002/art.39098.
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Keywords: Cardiovascular Conditions, Heart Disease and Health, Arthritis, Risk, Stroke
Heidenreich PA, Tsai V, Bao H
Does age influence cardiac resynchronization therapy use and outcome?
This study sought to describe the use of cardiac resynchronization therapy with defibrillator (CRT-D) and its association with survival for older patients. It found that receipt of CRT-D was associated with better survival at 1 year (82.1 percent vs. 77.1 percent, respectively) and 4 years (54.0 percent vs. 46.2 percent , respectively) than in those receiving only an implantable cardiac defibrillator.
AHRQ-funded; HS019814.
Citation: Heidenreich PA, Tsai V, Bao H .
Does age influence cardiac resynchronization therapy use and outcome?
JACC Heart Fail 2015 Jun;3(6):497-504. doi: 10.1016/j.jchf.2015.01.012..
Keywords: Medical Devices, Cardiovascular Conditions, Heart Disease and Health, Elderly, Patient-Centered Outcomes Research
Holmqvist F, Simon D, Steinberg BA
Catheter ablation of atrial fibrillation in U.S. community practice--results from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF).
The objective of the study was to describe the utilization of catheter ablation in a contemporary U.S. clinical practice and describe the characteristics and subsequent outcomes in patients undergoing AF ablation in community practice. It found that there were no clinically relevant differences in oral anticoagulation post-AF ablation or differences in outcomes in patients with or without previous AF catheter ablation.
AHRQ-funded; HS021092.
Citation: Holmqvist F, Simon D, Steinberg BA .
Catheter ablation of atrial fibrillation in U.S. community practice--results from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF).
J Am Heart Assoc 2015 May;4(5):e001901. doi: 10.1161/jaha.115.001901..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Patient-Centered Outcomes Research, Registries, Evidence-Based Practice
Allen LaPointe NM, Dai D, Thomas L
Comparisons of hospitalization rates among younger atrial fibrillation patients receiving different antiarrhythmic drugs.
The purpose of this study was to compare hospitalization rates after the initiation of different anti-arrhythmic drugs (AADs) in clinical practice among AF patients <65 years of age who did not have coronary artery disease (CAD) or heart failure. Differences in hospitalization rates were found between AADs in younger AF patients without structural heart disease, with amiodarone having the lowest risk of AF hospitalization.
AHRQ-funded; HS021092.
Citation: Allen LaPointe NM, Dai D, Thomas L .
Comparisons of hospitalization rates among younger atrial fibrillation patients receiving different antiarrhythmic drugs.
Circ Cardiovasc Qual Outcomes 2015 May;8(3):292-300. doi: 10.1161/circoutcomes.114.001499..
Keywords: Hospitalization, Heart Disease and Health, Medication, Cardiovascular Conditions
O'Brien EC, Kim S, Hess PL
Effect of the 2014 atrial fibrillation guideline revisions on the proportion of patients recommended for oral anticoagulation.
Researchers assessed the potential effect of a new guideline for atrial fibrillation (AF) by comparing the proportion of patients with AF recommended for oral anticoagulation (OAC) under the 2011 and 2014 guidelines. They found that two-thirds of patients with AF who were previously not recommended for OAC are newly recommended under the 2014 guideline. They advised future studies evaluating longitudinal changes in anticoagulation treatment patterns and outcomes among patients reclassified by the new guidelines.
AHRQ-funded; HS021092.
Citation: O'Brien EC, Kim S, Hess PL .
Effect of the 2014 atrial fibrillation guideline revisions on the proportion of patients recommended for oral anticoagulation.
JAMA Intern Med 2015 May;175(5):848-50. doi: 10.1001/jamainternmed.2015.13.
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Keywords: Heart Disease and Health, Blood Thinners, Guidelines, Medication, Cardiovascular Conditions, Evidence-Based Practice, Patient-Centered Outcomes Research
D'Onofrio G, Safdar B, Lichtman JH
Sex differences in reperfusion in young patients with ST-segment-elevation myocardial infarction: results from the VIRGO study.
Sex disparities in reperfusion therapy for patients with acute ST-segment-elevation myocardial infarction have been documented. The authors tested these patterns in the comparison of young women with men.They found that young women with ST-segment-elevation myocardial infarction are less likely to receive reperfusion therapy and more likely to have reperfusion delays than similarly aged men.
AHRQ-funded; HS023000.
Citation: D'Onofrio G, Safdar B, Lichtman JH .
Sex differences in reperfusion in young patients with ST-segment-elevation myocardial infarction: results from the VIRGO study.
Circulation 2015 Apr 14;131(15):1324-32. doi: 10.1161/circulationaha.114.012293.
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Keywords: Cardiovascular Conditions, Disparities, Heart Disease and Health, Patient-Centered Outcomes Research, Sex Factors
Brooks JM, Cook E, Chapman CG
Statin use after acute myocardial infarction by patient complexity: are the rates right?
The researchers assessed the benefits and risks associated with higher rates of statin use after AMI by baseline patient complexity. Their results provide strong evidence that providers were attempting to individualize statin prescribing to patients after AMI. Statin users after AMI were less complex and had higher rates of prior statin use.
AHRQ-funded; HS019574.
Citation: Brooks JM, Cook E, Chapman CG .
Statin use after acute myocardial infarction by patient complexity: are the rates right?
Med Care 2015 Apr;53(4):324-31. doi: 10.1097/mlr.0000000000000322..
Keywords: Patient Safety, Risk, Cardiovascular Conditions, Heart Disease and Health, Medication
Bangalore S, Guo Y, Samadashvili Z
Everolimus-eluting stents or bypass surgery for multivessel coronary disease.
Previous studies have shown lower long-term mortality after coronary-artery bypass grafting (CABG) than after percutaneous coronary intervention (PCI) among patients with multivessel disease. The authors evaluated PCI with second-generation drug-eluting stents. They found that the risk of death associated with PCI with everolimus-eluting stents was similar to that associated with CABG. PCI was associated with a higher risk of myocardial infarction (among patients with incomplete revascularization) and repeat revascularization but with a lower risk of stroke.
AHRQ-funded; HS023683.
Citation: Bangalore S, Guo Y, Samadashvili Z .
Everolimus-eluting stents or bypass surgery for multivessel coronary disease.
N Engl J Med 2015 Mar 26;372(13):1213-22. doi: 10.1056/NEJMoa1412168.
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Keywords: Cardiovascular Conditions, Medication, Heart Disease and Health, Surgery
Navar-Boggan AM, Peterson ED, D'Agostino RB
Hyperlipidemia in early adulthood increases long-term risk of coronary heart disease.
The researchers evaluated the association between years of exposure to high cholesterol levels in early adulthood and future coronary heart disease (CHD) risk. They found that cumulative exposure to hyperlipidemia in the fourth and fifth decades of life is associated with a substantially increased risk of CHD in a dose-responsive fashion, even among adults otherwise predicted to have low risk of cardiovascular disease.
AHRQ-funded; HS021092
Citation: Navar-Boggan AM, Peterson ED, D'Agostino RB .
Hyperlipidemia in early adulthood increases long-term risk of coronary heart disease.
Circulation. 2015 Feb 3;131(5):451-8. doi: 10.1161/circulationaha.114.012477..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Risk
Allen LaPointe NM, Dai D, Thomas L
Antiarrhythmic drug use in patients <65 years with atrial fibrillation and without structural heart disease.
The purpose of this study was to evaluate the use of class Ic and class III antiarrhythmic drugs (AAD) in clinical practice in younger patients with atrial fibrillation (AF)but without either concomitant coronary artery disease (CAD) or heart failure. The researchers found a high use of amiodarone that may be inconsistent with guideline recommendations, rapid adoption of dronedarone, and a very high rate of AAD change and discontinuation in the first year after AAD initiation.
AHRQ-funded; HS021092.
Citation: Allen LaPointe NM, Dai D, Thomas L .
Antiarrhythmic drug use in patients <65 years with atrial fibrillation and without structural heart disease.
Am J Cardiol 2015 Feb 1;115(3):316-22. doi: 10.1016/j.amjcard.2014.11.005..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Medication