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 110 Research Studies DisplayedRoss SM, Wang A, Anthony L
Is more better? The impact of implementing more interventions for hypertension control in a practice facilitation study for small- and medium-sized practices.
The purpose of this study was to research the effects of interventions for blood pressure in small- and medium-sized practices. The researchers utilized retrospective analysis on data from Healthy Hearts in the Heartland (H3), a research program conducted in 2016-2018 as part of the Agency for Healthcare Research and Quality's EvidenceNOW initiative, to examine the impact of implementing more interventions for BP control in these settings. The study included 38 H3 practices which met inclusion criteria and researchers assigned each practice to an implementer group (high or low) based on the number of interventions implemented. Practices in the high-implementer group implemented an average of 2.2 additional interventions relative to the low-implementer group. Groups were compared on two measures of BP control: (1) mean percentage of hypertensive patients with a most recent BP below 140/90, and (2) mean systolic and diastolic BP of hypertensive patients. In the first measure, practices in the high-implementer group had better improvement between baseline and the end of the study. Among the 10,150 patients included in the second measure, reductions in mean SBP and DBP were better for the high-implementer group.
AHRQ-funded; HS000078; HS000084; HS023921.
Citation: Ross SM, Wang A, Anthony L .
Is more better? The impact of implementing more interventions for hypertension control in a practice facilitation study for small- and medium-sized practices.
J Hum Hypertens 2023 Nov; 37(11):1007-14. doi: 10.1038/s41371-023-00813-1..
Keywords: Blood Pressure, Cardiovascular Conditions, Patient-Centered Outcomes Research, Evidence-Based Practice, Practice Improvement
Krefman AE, Ciolino Jd, Kan AK
Rationale and design for Healthy Hearts for Michigan (HH4M): a pragmatic single-arm hybrid effectiveness-implementation study.
The objective of the Healthy Hearts for Michigan (HH4M) study is to promote hypertension management and smoking cessation through practice facilitation and quality improvement efforts. This three-year research program evaluates rural and medically underserved primary care practices’ ability to implement the quality improvement model and tests whether the model improves blood pressure control and tobacco use screening and cessation. Primary care practices in rural and underserved areas of Michigan were recruited to join HH4M. HH4M is part of the multi-state EvidenceNOW: Building State Capacity initiative to provide external support to primary care practices to improve care delivery.
AHRQ-funded; HS027954.
Citation: Krefman AE, Ciolino Jd, Kan AK .
Rationale and design for Healthy Hearts for Michigan (HH4M): a pragmatic single-arm hybrid effectiveness-implementation study.
Contemp Clin Trials Commun 2023 Oct; 35:101199. doi: 10.1016/j.conctc.2023.101199..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Evidence-Based Practice, Patient-Centered Outcomes Research, Primary Care
Roberts MM, Marino M, Wells R
Differences in use of clinical decision support tools and implementation of aspirin, blood pressure control, cholesterol management, and smoking cessation quality metrics in small practices by race and sex.
The objective of this cross-sectional study was to evaluate the association between population-based clinical decision support (CDS) tools and racial and sex disparities in the aspirin use, blood pressure control, cholesterol management, and smoking cessation (ABCS) care quality metrics among smaller primary care practices. Researchers used practice-level data from the EvidenceNOW initiative, from practices that submitted both survey data and electronic health record (EHR)-derived ABCS data stratified by race and sex. Their findings suggested that practices using CDS tools had small disparities but were not statistically significant; however, CDS tools were not associated with reductions in disparities. They concluded that more research was needed on effective practice-level interventions to mitigate disparities.
AHRQ-funded; HS023940.
Citation: Roberts MM, Marino M, Wells R .
Differences in use of clinical decision support tools and implementation of aspirin, blood pressure control, cholesterol management, and smoking cessation quality metrics in small practices by race and sex.
JAMA Netw Open 2023 Aug; 6(8):e2326905. doi: 10.1001/jamanetworkopen.2023.26905..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Cardiovascular Conditions, Tobacco Use, Tobacco Use: Smoking Cessation, Primary Care, Evidence-Based Practice, Prevention
Lindner SR, Balasubramanian B, Marino M
Estimating the cardiovascular disease risk reduction of a quality improvement initiative in primary care: findings from EvidenceNOW.
The purpose of this study was to estimate decreases in 10-year atherosclerotic cardiovascular disease (ASCVD) risk associated with EvidenceNOW, an initiative spanning multiple states that sought to improve cardiovascular preventive care by providing supportive interventions such as practice facilitation to address the “ABCS”: (A)spirin for high-risk patients, (B)lood pressure control for hypertensive people, (C)holesterol management, and (S)moking screening and cessation counseling. The researchers conducted an analytic modeling study that combined 1) data from 1,278 EvidenceNOW practices collected from 2015 to 2017; (2) patient-level information of 1,295 individuals who participated in the 2015 to 2016 National Health and Nutrition Examination Survey; and (3) 10-year ASCVD risk prediction equations. The study found the average 10-year ASCVD risk of these patients before intervention was 10.11%. Improvements in ABCS due to EvidenceNOW reduced their 10-year ASCVD risk to 10.03% which would prevent 3,169 ASCVD events over 10 years and $150 million in 90-day direct medical costs.
AHRQ-funded; HS023940.
Citation: Lindner SR, Balasubramanian B, Marino M .
Estimating the cardiovascular disease risk reduction of a quality improvement initiative in primary care: findings from EvidenceNOW.
J Am Board Fam Med 2023 May 8; 36(3):462-76. doi: 10.3122/jabfm.2022.220331R1..
Keywords: Cardiovascular Conditions, Primary Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Quality Improvement, Quality of Care, Blood Pressure
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
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
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
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
Tracer H, Justus M
AHRQ Author: Tracer H
Vitamin, mineral, and multivitamin supplementation to prevent cardiovascular disease and cancer.
This Putting Prevention into Practice case study is used to increase understanding of the USPSTF final recommendation on vitamin, mineral, and multivitamin supplementation to prevent cardiovascular disease and cancer. A case study was presented using a 53-year-old-patient with no significant history presenting for a wellness visit. The patient’s 10-year cardiovascular risk and BMI are described. Three multiple-choice questions are presented regarding harms and benefits, and recommendations not to use supplementation to prevent cardiovascular disease and cancer.
AHRQ-authored.
Citation: Tracer H, Justus M .
Vitamin, mineral, and multivitamin supplementation to prevent cardiovascular disease and cancer.
Am Fam Physician 2022 Nov;106(5):565-66..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cardiovascular Conditions, Cancer, Prevention, Evidence-Based Practice, Guidelines
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
Tracer H, Newhouse CN
AHRQ Author: Tracer H
Aspirin use to prevent cardiovascular disease.
This Putting Prevention into Practice case study involves a 56-year-old man, a wellness visit, and aspirin usage to prevent cardiovascular disease. Three questions based on U.S. Preventative Serices Task Force recommendations are presented, followed by the answers.
AHRQ-authored.
Citation: Tracer H, Newhouse CN .
Aspirin use to prevent cardiovascular disease.
Am Fam Physician 2022 Sep;106(3):327-28..
Keywords: Medication, Cardiovascular Conditions, Prevention, Guidelines, Evidence-Based Practice
Chou R, Cantor A, Dana T
Statin use for the primary prevention of cardiovascular disease in adults: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to update the 2016 review on statins for the primary prevention of cardiovascular disease to inform the US Preventive Services Task Force (USPSTF). The researchers utilized the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews (to November 2021), Ovid, and MEDLINE, and selected 26 randomized clinical trials on statins vs placebo or no statin and statin intensity in adults without prior cardiovascular events. The researchers found that statins were significantly associated with decreased risk of all-cause mortality absolute risk difference [ARD], stroke, myocardial infarction, and composite cardiovascular outcomes. The association with cardiovascular mortality was determined not to be statistically significant. Statin therapy was not significantly associated with increased risk of serious adverse events, myalgias, or elevated alanine aminotransferase level. Statin therapy was not significantly associated with increased diabetes risk overall, although 1 trial found high-intensity statin therapy was significantly associated with increased risk. The researchers concluded that statin therapy for primary prevention of CVD was associated with reduced risk of all-cause mortality and CVD events for adults with increased of risk of CVD, but without prior CVD events.
AHRQ-funded; 290201500007I.
Citation: Chou R, Cantor A, Dana T .
Statin use for the primary prevention of cardiovascular disease in adults: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2022 Aug 23;328(8):754-71. doi: 10.1001/jama.2022.12138..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cardiovascular Conditions, Medication, Prevention, Evidence-Based Practice
Rastogi V, Kim NH, Marcaccio CL
Retroperitoneal versus transperitoneal approach for open repair of complex abdominal aortic aneurysms.
This retrospective analysis compared the outcomes of a transperitoneal approach (TP) versus the retroperitoneal approach (RP) for infrarenal abdominal aortic aneurysm (AAA) repair. Several studies have found an advantage for the RP approach. Among a cohort of 1,195 patients identified 729 (61%) underwent cAAA repair via a TP approach and 39% via an RP approach. After adjustment, the RP approach was associated with lower odds of peri-operative death (4.0% versus 7.2%) and lower odds of any major, cardiac, or wound complications and post-operative sepsis. Despite this, the proportion of repairs using an RP approach decreased between 2011 to 2015 and 2016 to 2019.
AHRQ-funded; HS027285.
Citation: Rastogi V, Kim NH, Marcaccio CL .
Retroperitoneal versus transperitoneal approach for open repair of complex abdominal aortic aneurysms.
Eur J Vasc Endovasc Surg 2022 Jul;64(1):23-31. doi: 10.1016/j.ejvs.2022.05.030..
Keywords: Cardiovascular Conditions, Surgery, Comparative Effectiveness, Evidence-Based Practice
O'Connor EA, Evans CV, Ivlev I
Vitamin and mineral supplements for the primary prevention of cardiovascular disease and cancer: updated evidence report and systematic review for the US Preventive Services Task Force.
This evidence report and systematic review updated the 2013 USPSTF final recommendation to assess benefits and harms of using vitamin and mineral supplements for the primary prevention of cardiovascular disease and cancer. After an extensive literature review, 84 studies were included. While multivitamin use was significantly associated with a lower incidence of any cancer and lung cancer, the evidence had serious limitations. Beta carotene was significantly associated with an increased risk of lung cancer and cardiovascular mortality. Vitamins D and E were not significantly associated with all-cause mortality, cardiovascular disease events, or cancer incidence. Evidence for the benefit of other supplements was equivocal, minimal, or absent. There was limited evidence that suggested some supplements may be associated with higher risk of serious harms (hip fracture [vitamin A], hemorrhagic stroke [vitamin E], and kidney stones [vitamin C, calcium]).
AHRQ-funded; 290201500007I.
Citation: O'Connor EA, Evans CV, Ivlev I .
Vitamin and mineral supplements for the primary prevention of cardiovascular disease and cancer: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2022 Jun 21;327(23):2334-47. doi: 10.1001/jama.2021.15650..
Keywords: U.S. Preventive Services Task Force (USPSTF), Prevention, Cardiovascular Conditions, Cancer, Evidence-Based Practice, Guidelines
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
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
Guirguis-Blake JM, Evans CV, Perdue LA
Aspirin use to prevent cardiovascular disease and colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force.
This evidence summary reviewed the benefits and harms of aspirin in primary cardiovascular disease (CVD) and colorectal cancer (CRC) prevention to accompany the final recommendation and evidence review of the US Preventive Services Task Force. A literature review was conducted of English-language randomized clinical trials (RCTs) of low-dose aspirin compared with placebo or no intervention in primary prevention populations. Aspirin was found not to be significantly associated with reductions in CVD mortality or all-cause mortality. There was limited trial evidence on benefits for CRC, with the findings highly variable by length of follow-up and statistically significant only when considering long-term observational follow-up beyond randomized trial periods. Low-dose aspirin was associated with significant increases in total major bleeding and in site-specific bleeding.
AHRQ-funded; 290201500007I.
Citation: Guirguis-Blake JM, Evans CV, Perdue LA .
Aspirin use to prevent cardiovascular disease and colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2022 Apr 26;327(16):1585-97. doi: 10.1001/jama.2022.3337..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cardiovascular Conditions, Cancer: Colorectal Cancer, Cancer, Prevention, Evidence-Based Practice
Dehmer SP, O'Keefe LR, Evans CV
Aspirin use to prevent cardiovascular disease and colorectal cancer: updated modeling study for the US Preventive Services Task Force.
The purpose of the study was to develop, model, and report estimates of the harms from and benefits of the use of low-dose aspirin for the prevention of cardiovascular disease (CVD) and colorectal cancer (CRC.) The researchers developed and used a simulation model to provide estimates for hypothetical United States cohorts of men and women between the ages of forty and seventy-nine years without a previous history of elevated bleeding risks or CVD, and up to a 20% 10-year risk for a CVD event. The model focused on the routine, lifetime use of low-dose aspirin with 5-year intervals of no use between 65 and 85 years of age. The study’s primary outcome was lifetime net benefit which was measured in life-years and quality-adjusted life-years (QALYs.) Harms included an increase in nonfatal intracranial hemorrhage and gastrointestinal bleeding, and benefits included a reduction in nonfatal ischemic stroke and myocardial infarction. The study found that the estimated lifetime net quality-adjusted life-years was positive for men and women with 5% or more 10-year CVD risk when they started use between the ages of 40-59 years, and for men and women with 10% or greater 10-year CVD risk when starting between the ages of 60 and 69 years. The estimated lifetime net life-years were mostly negative for those starting low-dose aspirin use between 60 and 79 years of age. Five-year intervals of stopping use between 65 and 85 years of age did not provide a significant advantage to lifetime use. The researchers concluded that the routine, lifetime use of low-dose aspirin may benefit several population groups, with the largest estimated benefit in those with greater 10-year CVD risk who begin routine, low-dose aspirin dosage at younger ages.
AHRQ-funded; 290201500007I.
Citation: Dehmer SP, O'Keefe LR, Evans CV .
Aspirin use to prevent cardiovascular disease and colorectal cancer: updated modeling study for the US Preventive Services Task Force.
JAMA 2022 Apr 26;327(16):1598-607. doi: 10.1001/jama.2022.3385..
Keywords: U.S. Preventive Services Task Force (USPSTF), Prevention, Cardiovascular Conditions, Cancer: Colorectal Cancer, Cancer, Prevention, Evidence-Based Practice
Commodore-Mensah Y, Loustalot F, Himmelfarb CD CD
AHRQ Author: McNellis R
Proceedings from a National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention workshop to control hypertension.
In order to address the rapid decline in hypertension control, the National Heart, Lung, and Blood Institute and the Division for Heart Disease and Stroke Prevention of the Centers for Disease Control and Prevention convened a virtual workshop with multidisciplinary national experts. The presentations and discussions included potential reasons for the decline and challenges in hypertension control, possible "big ideas," and multisector approaches that could reverse the current trend while addressing knowledge gaps and research priorities.
AHRQ-authored.
Citation: Commodore-Mensah Y, Loustalot F, Himmelfarb CD CD .
Proceedings from a National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention workshop to control hypertension.
Am J Hypertens 2022 Mar 8;35(3):232-43. doi: 10.1093/ajh/hpab182..
Keywords: Blood Pressure, Prevention, Evidence-Based Practice, Cardiovascular Conditions
Mills J, O'Dowd N
AHRQ Author: Mills J
Healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors.
This “Putting Prevention into Practice: An Evidence Based Approach” paper is a case study with questions and answers related to healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors.
AHRQ-authored.
Citation: Mills J, O'Dowd N .
Healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors.
Am Fam Physician 2021 Oct 1;104(4):411-12..
Keywords: U.S. Preventive Services Task Force (USPSTF), Heart Disease and Health, Cardiovascular Conditions, Prevention, Lifestyle Changes, Risk, Evidence-Based Practice, Guidelines, Case Study
Berry CA, Nguyen AM, Cuthel AM
Measuring implementation strategy fidelity in HealthyHearts NYC: a complex intervention using practice facilitation in primary care.
This study measured implementation strategy fidelity for the HealthyHearts NYC intervention program, an AHRQ-funded program that uses practice facilitation (PF) to improve adoption of cardiovascular disease evidence-based guidelines in primary care practices. Data from 257 practices measured fidelity using 4 categories: frequency, duration, content, and coverage. Almost all (94.2%) of practices received at least the 13 PF visits with an average 26.3 hours spent at each site by facilitators. Most practices (95.7%) completed all Task List items, and 71.2% were educated on all Chronic Care Models, with the majority (65.8%) receiving full coverage.
AHRQ-funded; HS023922.
Citation: Berry CA, Nguyen AM, Cuthel AM .
Measuring implementation strategy fidelity in HealthyHearts NYC: a complex intervention using practice facilitation in primary care.
Am J Med Qual 2021 Jul-Aug;36(4):270-76. doi: 10.1177/1062860620959450..
Keywords: Implementation, Heart Disease and Health, Cardiovascular Conditions, Primary Care, Practice Improvement, Quality Improvement, Quality of Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Primary Care: Models of Care
Pham-Singer H, Onakomaiya M, Cuthel A
Using a customer relationship management system to manage a quality improvement intervention.
HealthyHearts New York City (HHNYC), one of 7 cooperatives funded through the Agency for Healthcare Research and Quality's EvidenceNOW initiative, evaluated the impact of practice facilitation on implementation of the Million Hearts guidelines for cardiovascular disease prevention and treatment. Tracking the intervention required a system to facilitate process data collection that was also user-friendly and flexible. Coupled with protocols and training, a strategically planned and customizable customer relationship management system (CRMS) was implemented to support the quality improvement intervention with 257 small independent practices.
AHRQ-funded; HS023922.
Citation: Pham-Singer H, Onakomaiya M, Cuthel A .
Using a customer relationship management system to manage a quality improvement intervention.
Am J Med Qual 2021 Jul-Aug;36(4):247-54. doi: 10.1177/1062860620953214..
Keywords: Quality Improvement, Quality of Care, Implementation, Evidence-Based Practice, Cardiovascular Conditions, Heart Disease and Health, Primary Care
Cohen DJ, Sweeney SM, Miller WL
Improving smoking and blood pressure outcomes: the interplay between operational changes and local context.
This study identified conditions and operational changes linked to improvements in smoking and blood pressure (BP) outcomes in primary care using samples and interviews from a subset of 104 practices participating in EvidenceNOW, a multisite cardiovascular disease prevention initiative. The authors calculated Clinical Quality Measure improvements, with targets of 10-point or greater absolute improvements in the proportion of patients with smoking screening, and if relevant, counseling and the proportion of hypertensive patients with adequately controlled BP. Primary care staff were surveyed and interviewed. In clinician-owned practices, implementing a workflow to routinely screen and counsel patients on smoking cessation resources, or implementing a documentation change or a referral to a resource alone led to an improvement of at least 10 points in the smoking outcome. These improvements did not occur though in health- or hospital system-owned practices or in Federally Qualified Health Centers. BP outcome improved by at least 10 points among solo practices after medical assistants learned how to take an accurate BP. Among larger, clinician-owned practices, BP outcomes improvement took place when staff took a second BP measurement after the first measurement was elevated and when staff learned where to document this information in the electronic health record. For larger and health- and hospital system-owned practices, 50 or more hours of facilitation was needed to improve BP outcomes.
AHRQ-funded; HS023940.
Citation: Cohen DJ, Sweeney SM, Miller WL .
Improving smoking and blood pressure outcomes: the interplay between operational changes and local context.
Ann Fam Med 2021 May-Jun;19(3):240-48. doi: 10.1370/afm.2668..
Keywords: Blood Pressure, Tobacco Use, Primary Care, Quality Improvement, Cardiovascular Conditions, Quality of Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Prevention, Outcomes
Carey RM, Wright JT, Taler SJ
Guideline-driven management of hypertension: an evidence-based update.
This paper is an evidence-based update to the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline. The authors conducted a literature review of relevant observational studies, randomized clinical trials, and meta-analyses published between January 2018 and March 2021. Topics included blood pressure (BP) measurement, patient evaluation, patient evaluation for secondary hypertension, cardiovascular disease risk assessment and BP threshold for drug therapy, lifestyle and pharmacological management, treatment target BP goal, management of hypertension in older adults, diabetes, chronic kidney disease, resistant hypertension, and optimization of care using patient, provider, and health system approaches.
AHRQ-funded; HS027944.
Citation: Carey RM, Wright JT, Taler SJ .
Guideline-driven management of hypertension: an evidence-based update.
Circ Res 2021 Apr 2;128(7):827-46. doi: 10.1161/circresaha.121.318083..
Keywords: Blood Pressure, Guidelines, Evidence-Based Practice, Cardiovascular Conditions, Chronic Conditions
Brown CS, Osborne NH, Kim GY
Effect of concomitant deep venous reflux on truncal endovenous ablation outcomes in the Vascular Quality Initiative.
This study looked at outcomes for patients with varicose veins (C2 disease) undergoing truncal endovenous ablation with and without deep venous reflux. Data from the Vascular Quality Initiative was analyzed from 2015 to 2019. A total of 4881 patients were included, with 46.2% having combined deep and superficial reflux. Follow-up around a year later (median 336.5 days) was conducted after. Patients with deep reflux were less likely to be female, more likely to be Caucasian, and had no difference in BMI. Additionally, there were no differences in rates of prior varicose vein treatments, number of pregnancies, or history of deep venous thrombosis. However, patients without deep reflux were more likely to use anticoagulants at the time of the procedure. Patients without deep reflux had slightly higher median preprocedural Venous Clinician Severity Score (VCSS) scores as well as postprocedural VCSS scores. Total symptom score was higher for patients without deep reflux before and after the procedure, but there was no change in symptom score after the procedure. Patients with deep reflux had substantially higher rates of complications with a particular increase in proximal thrombus extension.
AHRQ-funded; HS000053.
Citation: Brown CS, Osborne NH, Kim GY .
Effect of concomitant deep venous reflux on truncal endovenous ablation outcomes in the Vascular Quality Initiative.
J Vasc Surg Venous Lymphat Disord 2021 Mar;9(2):361-68.e3. doi: 10.1016/j.jvsv.2020.04.031..
Keywords: Cardiovascular Conditions, Chronic Conditions, Surgery, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice