National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 55 Research Studies DisplayedFunk 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
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
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
Kuzel AJ, Cuellar A, Nichols L
The EvidenceNOW practice support initiative: the Heart of Virginia Healthcare.
The purpose of this study was for The Heart of Virginia Health care (HVH) collaborative (one of the Agency for Healthcare Research and Quality's (AHRQ) Evidence Now project’s 7 collaboratives) to test different ways to improve performance and outcomes on ABCS clinical quality measures (appropriate Aspirin use, Blood pressure control, Cholesterol control, and Smoking cessation counseling) within small primary care practices. The researchers recruited 264 eligible practices and randomized them to 3 cohorts in a stepped wedge design, with 173, utilizing 16 different EHRs, participated through the entire initiative. Trained coaches delivered the practice support curriculum to improve performance on the ABCS measures. The program included an initial kickoff meeting, 3 months of focused support, 9 months of continued support, and access to online materials and faculty. The intervention phase was shortened due to difficulty in recruiting a sufficient number of practices. The study found that the short HVH intervention had a small but statistically significant positive average effects on appropriate use of aspirin and other anti-thrombotics, small negative effects on blood pressure control, except for those practices which did not attend the kickoff, and small negative effects on smoking cessation counseling. The researchers concluded that the truncation of the intervention contributed to the lack of substantial improvements in the ABCS.
AHRQ-funded; HS023913.
Citation: Kuzel AJ, Cuellar A, Nichols L .
The EvidenceNOW practice support initiative: the Heart of Virginia Healthcare.
J Am Board Fam Med 2022 Oct 18;35(5):979-89. doi: 10.3122/jabfm.2022.05.210021..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Evidence-Based Practice, Primary Care, Patient-Centered Outcomes Research, Quality Improvement, Quality of Care, Healthcare Delivery
Harris S, Inoue S
AHRQ Author: Harris S
Behavioral counseling interventions to promote a healthy diet and physical activity for CVD prevention in adults without CVD risk factors.
In this Putting Prevention into Practice case study to increase understanding of the USPSTF final recommendation on behavioral counseling interventions to promote a healthy diet and physical activity for CVD prevention in adults without CVD risk factors, a 49-year old patient presents for a wellness visit. The patient’s vital signs are described as well as their daily habits, diet, and other medical history. Three multiple-choice questions are presented regarding risk factors, interventions to be recommended, and the benefits of behavioral counseling to promote a healthy diet and physical activity, followed by their answers.
AHRQ-authored.
Citation: Harris S, Inoue S .
Behavioral counseling interventions to promote a healthy diet and physical activity for CVD prevention in adults without CVD risk factors.
Am Fam Physician 2022 Oct;106(4):439-40..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Prevention, Nutrition, Lifestyle Changes
Yang G, Zhang M, Zhou S
Incompleteness of health-related quality of life assessments before left ventricular assist device implant: a novel quality metric.
Investigators hypothesized that pre-implant health-related quality of life (HRQOL) incompleteness in The Society of Thoracic Surgeons' Intermacs registry for patients undergoing left ventricular assist device (LVAD) implantation predicts 90-day outcomes. They found that HRQOL incompleteness at high-rate hospitals was more often due to administrative reasons and less likely due to patient reasons. Increases in the adjusted pre-implant incompleteness rates were significantly associated with higher risk of infection-related mortality, infection, and renal dysfunction. They concluded that hospital adjusted pre-implant HRQOL incompleteness was predictive of 90-day post-implant outcomes and may serve as a novel quality metric.
AHRQ-funded; HS026003.
Citation: Yang G, Zhang M, Zhou S .
Incompleteness of health-related quality of life assessments before left ventricular assist device implant: a novel quality metric.
J Heart Lung Transplant 2022 Oct;41(10):1520-28. doi: 10.1016/j.healun.2022.07.001..
Keywords: Quality of Life, Medical Devices, Heart Disease and Health, Cardiovascular Conditions
Kim KD, Funk RJ, Hou H
Association between care fragmentation and total spending after durable left ventricular device implant: a mediation analysis of health care-associated infections within a national Medicare-Society of Thoracic Surgeons INTERMACS linked dataset.
The purpose of this study was to examine the relationship between care fragmentation and total spending for durable left ventricular assisted device (LVAD) implant, and whether this relationship is mediated by infections. The researchers developed a measure of care fragmentation based on the number of shared medical professionals providing care to 4,987 Medicare beneficiaries undergoing LVAD implantation. The study found that the indirect effect of care fragmentation, through infections, was positive and statistically significant. The researchers concluded that higher care fragmentation associated with durable LVAD implantation is related with a greater incidence of infections and higher Medicare beneficiary payments.
AHRQ-funded; HS026003.
Citation: Kim KD, Funk RJ, Hou H .
Association between care fragmentation and total spending after durable left ventricular device implant: a mediation analysis of health care-associated infections within a national Medicare-Society of Thoracic Surgeons INTERMACS linked dataset.
Circ Cardiovasc Qual Outcomes 2022 Sep;15(9):e008592. doi: 10.1161/circoutcomes.121.008592..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Healthcare Costs, Healthcare-Associated Infections (HAIs), Medicare, Medical Devices, Healthcare Delivery
Gallo T, Heise CW, Woosley RL
Clinician satisfaction with advanced clinical decision support to reduce the risk of torsades de pointes.
The purpose of this study was to create an advanced torsades de pointes (TdP) clinical decision support (CDS) advisory that provides relevant, patient-specific information, including 1-click management options, and to evaluate clinician satisfaction with the CDS. The researchers implemented the advanced TdP CDS across a health system comprising 29 hospitals. A brief electronic survey was developed to collect clinician feedback on the advisory and was emailed to 442 clinicians who received the advisory. Feedback was generally positive across the 38 responding providers, with 79% of respondents reporting that the advisory assisted with their care for their patients and 87% responding that the alerts clearly specified alternative actions. The researchers concluded that providers who receive an advanced TdP risk CDS alert generally view the alert favorably.
AHRQ-funded; HS026662.
Citation: Gallo T, Heise CW, Woosley RL .
Clinician satisfaction with advanced clinical decision support to reduce the risk of torsades de pointes.
J Patient Saf 2022 Sep 1;18(6):e1010-e13. doi: 10.1097/pts.0000000000000996..
Keywords: Clinical Decision Support (CDS), Decision Making, Risk, Provider: Clinician, Heart Disease and Health, Cardiovascular Conditions
Kilaru AS, Illenberger N, Meisel ZF
Incidence of timely outpatient follow-up care after emergency department encounters for acute heart failure.
The purpose of this retrospective cohort study was to explore the incidence of outpatient follow-up care after presentation for acute heart failure at the emergency department (ED), and to present patient characteristics associated with receiving timely follow-up care. Using an administrative claims database from a United States commercial insurer, the researchers reviewed 52,732 adult patients with a mean age of 73.9 years discharged from the ED with the principal diagnosis of acute heart failure. The study found that within 30 days of the ED encounter, 23.2% of patients attended an outpatient clinic visit for heart failure, with 15.9% patients hospitalized before they could obtain an outpatient clinic visit. Patients that were younger, women, reporting non-Hispanic Black race, and had fewer previous clinic visits were less likely to obtain outpatient follow-up care. The study concluded that almost 20% of patients require hospitalization within 30 days of an ED for visit for heart failure, and few obtain timely outpatient follow-up after the initial visit.
AHRQ-funded; HS026372.
Citation: Kilaru AS, Illenberger N, Meisel ZF .
Incidence of timely outpatient follow-up care after emergency department encounters for acute heart failure.
Circ Cardiovasc Qual Outcomes 2022 Sep;15(9):e009001. doi: 10.1161/circoutcomes.122.009001..
Keywords: Ambulatory Care and Surgery, Emergency Department, Heart Disease and Health, Cardiovascular Conditions
Czosek RJ, Spar DS, Anderson JB
Predictors and outcomes of arrhythmia on stage I palliation of single ventricle patients.
This study investigated associated risks for arrhythmias in pediatric patients with single ventricle disease undergoing stage I palliation (S1P). The NPC-QIC (National Pediatric Cardiology Quality Improvement Collaborative) database was used to obtain retrospective patient, surgical, medication, and arrhythmia data. Bivariate analysis of variables associated with arrhythmias and survival was performed at the time of stage II palliation. Of the 2,048 included patients, 36% had arrhythmia noted in their S1P hospitalization, with supraventricular tachycardia (12%) and focal atrial tachycardia (11%) the most common. At discharge, 11% of patients were on an antiarrhythmic medication. Increased risk of arrhythmias were associated with heterotaxy syndrome, younger age at S1P, male sex, and additional anomalies. Increased mortality was associated with female sex, while decreased mortality was associated with antiarrhythmic medication and digoxin use.
AHRQ-funded; HS021114.
Citation: Czosek RJ, Spar DS, Anderson JB .
Predictors and outcomes of arrhythmia on stage I palliation of single ventricle patients.
JACC Clin Electrophysiol 2022 Sep;8(9):1136-44. doi: 10.1016/j.jacep.2022.06.010..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Outcomes, Children/Adolescents
Blakeslee-Carter J, Potter HA, Banks CA
Aortic visceral segment instability is evident following thoracic endovascular aortic repair for acute and subacute type B aortic dissection.
The purpose of this multicenter retrospective study was to investigate the visceral aortic behavior after thoracic endovascular aortic repair (TEVAR) for acute or subacute type B aortic dissection (TBAD) to identify any correlations with the clinical outcomes. The researchers reviewed all imaging studies for all patients from 2006 to 2020 who had undergone TEVAR for acute (0-14 days) and subacute (14-90 days) nontraumatic TBAD, identifying a total of 82 patients. The study found that VSI was present in 55% of the cohort, with an average maximal increase in the TAD of 10.4 ± 6.3 mm during a median follow-up of 2.1 years. Approximately one third of the cohort had experienced rapid VSI (growth ≥5 mm in the first year), and 4.8% of the cohort had developed a large paravisceral aortic aneurysm (TAD ≥5 cm) secondary to VSI. The preoperative factor most strongly associated with VSI was a cumulative number of zones dissected of six or more. The odds for aortic reintervention were significantly increased for cases in which VSI led to the development of a paravisceral aortic aneurysm of greater than or equal to 5 cm. The researchers concluded that VSI was identified in most patients who had undergone TEVAR for management of acute and subacute TBAD, and also identified a subset of patients who might have an increased risk of reintervention. The study results emphasize the importance of ongoing and lifelong monitoring after TEVAR.
AHRQ-funded; HS013852.
Citation: Blakeslee-Carter J, Potter HA, Banks CA .
Aortic visceral segment instability is evident following thoracic endovascular aortic repair for acute and subacute type B aortic dissection.
J Vasc Surg 2022 Aug;76(2):389-99.e1. doi: 10.1016/j.jvs.2022.02.046..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Surgery
Ofoma UR, Drewry AM, Maddox TM
Outcomes of in-hospital cardiac arrest among hospitals with and without telemedicine critical care.
This study compared survival rates for inpatients who suffered in-hospital cardiac arrest (IHCA) who had access to Telemedicine Critical Care (TCC) during nights and weekends (off-hours) compared to those who did not. The authors identified 44,585 adults at 280 U.S. hospitals in the Get With The Guidelines® - Resuscitation registry who suffered IHCA in an Intensive Care Unit (ICU) or hospital ward between July 2017 and December 2019. The majority (60.6%) of IHCAs occurred in an ICU, and 32.2% participants suffered IHCA at hospitals with TCC. No difference was found in acute resuscitation survival rates or survival to discharge rates for either IHCA between TCC and non-TCC hospitals. Timing of cardiac arrest did not modify the association between TCC availability and acute resuscitation survival or survival to discharge.
AHRQ-funded; HS019455.
Citation: Ofoma UR, Drewry AM, Maddox TM .
Outcomes of in-hospital cardiac arrest among hospitals with and without telemedicine critical care.
Resuscitation 2022 Aug;177:7-15. doi: 10.1016/j.resuscitation.2022.06.008..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Telehealth, Health Information Technology (HIT), Outcomes, Critical Care, Intensive Care Unit (ICU)
Ahmad FS, Jackson KL, Yount SE
The development and initial validation of the PROMIS®+HF-27 and PROMIS+HF-10 profiles.
This paper describes the continued refinement of the PROMIS®-Plus-HF (PROMIS+HF) profile measure, including universal and HF-specific items, to develop shorter PROMIS+HF profiles intended for research and clinical use. The authors developed the PROMIS+HF-27 and PROMIS+HF-10 profiles with summary scores (0-100) for overall, physical, mental, and social health. In a cross-sectional sample (n = 600), they measured internal consistency reliability (Cronbach's alpha and Spearman-Brown), test-retest reliability (intraclass coefficient; n = 100), known-groups validity via New York Heart Association (NYHA) class, and convergent validity with Kansas City Cardiomyopathy Questionnaire (KCCQ) scores. They also evaluated responsiveness of baseline/follow-up scores in a longitudinal sample of 75 by calculating mean differences and Cohen’s d and comparing with paired t-tests. PROMIS+HF-27 scores showed good to excellent internal consistency and acceptable to good for PROMIS+HF-10 scores. Good psychometric characteristics were shown for both measures with evidence of responsiveness for overall and physical health.
AHRQ-funded; HS026385.
Citation: Ahmad FS, Jackson KL, Yount SE .
The development and initial validation of the PROMIS®+HF-27 and PROMIS+HF-10 profiles.
ESC Heart Fail 2022 Jul 15;9(5):3380-92. doi: 10.1002/ehf2.14061..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Quality of Life, Patient-Centered Outcomes Research
Gallo T, Heise CW, Woosley RL
Clinician responses to a clinical decision support advisory for high risk of Torsades de pointes.
The purpose of this study was to assess provider actions taken in response to a Clinical decision support (CDS) advisory for Torsade de pointes (TdP) that uses a modified Tisdale QT risk score and presents single click management options. The researchers implemented an inpatient TdP risk advisory across a large, 30 hospital health care system. The CDS advisory was programmed to appear when prescribers attempted to order medications with a known risk of TdP in a patient. The CDS advisory displayed patient-specific information and offered related management options including canceling the requested medication and ordering relevant protocols. The study found that 7794 TdP risk advisories were issued during an 8-month period. The most frequent advisory trigger was antibiotics (33.1%.) The most frequent action taken as a result of the advisory was ordering an ECG (20.3%). Incoming medication orders were canceled in 10.2% of the advisories. The researchers concluded that a single-click, modified Tisdale QT risk score-based CDS resulted in a high action/response rate.
AHRQ-funded; HS026662.
Citation: Gallo T, Heise CW, Woosley RL .
Clinician responses to a clinical decision support advisory for high risk of Torsades de pointes.
J Am Heart Assoc 2022 Jun 7;11(11):e024338. doi: 10.1161/jaha.122.024338..
Keywords: Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT), Heart Disease and Health, Cardiovascular Conditions
Kowitt SD, Goldstein AO, Cykert S
A heart healthy intervention improved tobacco screening rates and cessation support in primary care practices.
This study investigated the outcomes of an evidence-based cardiovascular disease risk reduction tool called Heart Health Now to improve rates for tobacco cessation screening and counseling in small primary care practices in North Carolina. This tool was developed as part of AHRQ’s EvidenceNow initiative. This stepped wedge, stratified, cluster randomized trial looked at 28 practices that were staffed by 10 or fewer clinicians and had an electronic health record. Heart Health Now consisted of education tools, onsite practice facilitation for a year, and a practice-specific cardiovascular population management dashboard that included monthly, measure-specific run charts to help guide quality improvement. The practices included in their analyses consisted of 78,120 patients, and 17,687 smokers. From pre- to post-intervention, screening rates significantly increased from 82.7 to 96.2%. Cessation support rates also significantly increased from 44.3% to 50.1%. Some of the practices associated with improvement included being in an academic health center or faculty, having more clinicians, and having a lower percentage of White patients.
AHRQ-funded; HS023912.
Citation: Kowitt SD, Goldstein AO, Cykert S .
A heart healthy intervention improved tobacco screening rates and cessation support in primary care practices.
J Prev 2022 Jun;43(3):375-86. doi: 10.1007/s10935-022-00672-5..
Keywords: Tobacco Use, Tobacco Use: Smoking Cessation, Screening, Primary Care, Evidence-Based Practice, Heart Disease and Health, Cardiovascular Conditions
Rao BR, Speight CD, Allen LA
Impact of financial considerations on willingness to take sacubitril/valsartan for heart failure.
This survey’s objective was to evaluate the impact of out-of-pocket costs and a novel cost-priming intervention on willingness to take sacubitril/valsartan for heart failure with reduced ejection fraction, as these medications carry higher out-of-pocket costs relative to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Participants with self-reported heart disease were surveyed using the online Ipsos Knowledge Panel. Participants were presented with a modified decision aid for sacubitril/valsartan and then, in a 3×2 factorial design, randomly assigned to 1 of 3 cost conditions ($10, $50, or $100/month) and to a control group or cost-priming intervention. Cost-priming intervention is defined by being asked questions about their financial situation before learning about the benefits of sacubitril/valsartan. Of the 1013 participants included in the analysis, 85% of respondents were willing to take sacubitril/valsartan at $10, 62% at $50, and 33% at $100. In a multivariable logistic regression model, participants were more likely to take sacubitril/valsartan at $10 versus $100 and $50 compared with $100. Overall, participants in the cost-primed group were more willing to take sacubitril/valsartan than those not primed to consider their financial situation (63% versus 56%), but there was no statistically significant interaction between cost conditions and cost priming. The perceived benefit of sacubitril/valsartan over angiotensin-converting enzyme inhibitors or angiotensin receptor blockers decreased as cost increased but did not vary by cost priming.
AHRQ-funded; HS026081.
Citation: Rao BR, Speight CD, Allen LA .
Impact of financial considerations on willingness to take sacubitril/valsartan for heart failure.
J Am Heart Assoc 2022 Jun;11(12):e023789. doi: 10.1161/jaha.121.023789.
Keywords: Healthcare Costs, Medication, Heart Disease and Health, Cardiovascular Conditions
Tracer H, VanHouten JP
AHRQ Author: Tracer H
Screening for atrial fibrillation.
This purpose of this Putting Prevention Into Practice (PPIP) case study and quiz is to provide an overview of practice recommendations regarding atrial fibrillation screening. It is based on the recommendations of the United States Preventive Services Task Force, with Howard Tracer, MD, Medical Officer, U.S. Preventive Services Task Force Program, Agency for Healthcare Research and Quality, as lead author.
AHRQ-authored.
Citation: Tracer H, VanHouten JP .
Screening for atrial fibrillation.
Am Fam Physician 2022 Jun;105(6):659-60..
Keywords: U.S. Preventive Services Task Force (USPSTF), Heart Disease and Health, Cardiovascular Conditions, Screening, Prevention, Case Study
Shields AD, Battistelli J, Kavanagh L
Staying current: developing just-in-time evidence-ased learning objectives for a maternal cardiac arrest simulation curriculum.
The authors’ objective was to review the latest evidence on resuscitation care for maternal cardiac arrest (MCA) and to gain expert consensus on best practices to inform an evidence-based curriculum. A multidisciplinary panel of stakeholders in MCA developed an evidence-based simulation training, Obstetric Life Support™ (OBLS). The researchers found that a novel three-step process including reaffirmation of evidence process, systematic review, and a modified Research and Development technique resulted in unanimous consensus from experts in MCA resuscitation on existing and new just-in-time best practices to inform the learning objectives for an evidence-based curriculum.
AHRQ-funded; HS026169.
Citation: Shields AD, Battistelli J, Kavanagh L .
Staying current: developing just-in-time evidence-ased learning objectives for a maternal cardiac arrest simulation curriculum.
Cardiol Cardiovasc Med 2022 Jun;6(3):245-54. doi: 10.26502/fccm.92920260..
Keywords: Evidence-Based Practice, Education: Curriculum, Simulation, Heart Disease and Health, Cardiovascular Conditions, Women, Education: Academic
Khodneva Y, Goyal P, Levitan EB
Depressive symptoms and incident hospitalization for heart failure: findings From the REGARDS Study.
The purpose of this study was to determine whether depressive symptoms are associated with incident heart failure (HF), including hospitalization for HF overall or by subtype: HF with preserved (HFpEF) or reduced ejection fraction (HFrEF). The study found that over a median of 9.2 years of follow-up, there were 872 incident HF hospitalizations, 526 among those without CHD and 334 among those with CHD. The age-adjusted HF hospitalization incidence rates per 1000 person-years were 4.9 for participants with depressive symptoms compared with 3.2 for participants without depressive symptoms. For overall HF, the elevated risk lessened after controlling for covariates. Among those without baseline CHD, when HFpEF was evaluated separately, after controlling for all covariates, depressive symptoms were related with incident hospitalization. In contrast, depressive symptoms were not related with incident HFrEF hospitalizations. The researchers concluded that among individuals without CHD at baseline, depressive symptoms were related with incident hospitalization for HFpEF, but not for those with baseline CHD or HFrEF.
AHRQ-funded; HS013852.
Citation: Khodneva Y, Goyal P, Levitan EB .
Depressive symptoms and incident hospitalization for heart failure: findings From the REGARDS Study.
J Am Heart Assoc 2022 Apr 5;11(7):e022818. doi: 10.1161/jaha.121.022818..
Keywords: Depression, Behavioral Health, Heart Disease and Health, Cardiovascular Conditions, Hospitalization, Risk
Dixon DD, Xu M, Akwo EA
Depressive symptoms and incident heart failure risk in the Southern Community Cohort Study.
This study’s aim was to examine whether greater frequency of depressive symptoms associates with increased risk of incident heart failure (HF). The authors studied 23,937 Black or White Southern Community Cohort Study participants (median age: 53 years, 70% Black, 64% women) enrolled between 2002 and 2009, without prevalent HF, who were receiving Centers for Medicare and Medicaid Services coverage. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD-10) and incident HF ascertained from the Centers for Medicare and Medicaid Services International Classification of Diseases-9th Revision (ICD-9) (code: 428.x) and ICD-10 (codes: I50, I110) codes through December 31, 2016. The median CESD-10 score was 9. Over a median 11-year follow-up, 25% of participants developed HF. The strongest correlates of depressive symptoms were antidepressant medication use, age, and socioeconomic factors, rather than traditional HF risk factors. Greater frequency of depressive symptoms was associated with increased incident HF risk without variation by race or sex.
AHRQ-funded; HS026395.
Citation: Dixon DD, Xu M, Akwo EA .
Depressive symptoms and incident heart failure risk in the Southern Community Cohort Study.
JACC Heart Fail 2022 Apr;10(4):254-62. doi: 10.1016/j.jchf.2021.11.007..
Keywords: Depression, Heart Disease and Health, Cardiovascular Conditions, Risk
Pienta MJ, Shore S, Watt TMF
Patient factors associated with left ventricular assist device infections: a scoping review.
This article is a scoping review that systematically summarized all existing studies examining patient-related factors associated with infections after left ventricular assist device (LVAD) implantation. Studies published between January 2006 and February 2019 were used, with 31 studies meeting inclusion criteria. All included studies were observational, and 17 focused on driveline infections. Other factors most commonly studied included body composition (n = 8), diabetes and other comorbidities (n = 8), and psychosocial/socio-economic factors (n = 6). Studies were frequently single-center, and patient race and sex did not correlate with infection risk. There was also no consistent association noted between obesity, diabetes, or psychosocial/socio-economic factors and LVAD recipient infections. Two studies did report a significant association between malnutrition and hypoalbuminemia and post implant infections.
AHRQ-funded; HS026003.
Citation: Pienta MJ, Shore S, Watt TMF .
Patient factors associated with left ventricular assist device infections: a scoping review.
J Heart Lung Transplant 2022 Apr; 41(4):425-33. doi: 10.1016/j.healun.2022.01.011..
Keywords: Medical Devices, Healthcare-Associated Infections (HAIs), Heart Disease and Health, Cardiovascular Conditions
Fitzgerald DC, Simpson AN, Baker RA DC, Simpson AN, Baker RA
Determinants of hospital variability in perioperative red blood cell transfusions during coronary artery bypass graft surgery.
This observational cohort study’s objective was to identify to what extent distinguishing patient and procedural characteristics can explain center-level transfusion variation during coronary artery bypass grafting (CABG) surgery. The study used patients from the Perfusion Measures and Outcomes Registry from 43 adult cardiac surgical programs from July 2011 through June 2017. Of the 22,272 adult patients undergoing isolate CABG surgery using cardiopulmonary bypass, 7241 (32.5%) received at least 1 U allogeneic red blood cells. Patients who received transfusions were older (68 vs 64 years), were women (41.5% vs 15.9%), and had a lower body surface area, respectively. The majority of center-level transfusion variations could not be explained through models containing both patient and intraoperative factors.
AHRQ-funded; HS026003.
Citation: Fitzgerald DC, Simpson AN, Baker RA DC, Simpson AN, Baker RA .
Determinants of hospital variability in perioperative red blood cell transfusions during coronary artery bypass graft surgery.
J Thorac Cardiovasc Surg 2022 Mar;163(3):1015-24.e1. doi: 10.1016/j.jtcvs.2020.04.141..
Keywords: Surgery, Heart Disease and Health, Cardiovascular Conditions, Hospitals, Practice Patterns, Disparities