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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 624 Research Studies DisplayedMarcaccio 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 / 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 / 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
Solomon Y, Rastogi V, Marcaccio CL
Outcomes after transcarotid artery revascularization stratified by preprocedural symptom status.
In this study, researchers examined contemporary perioperative outcomes in patients who underwent transcarotid artery revascularization (TCAR) stratified by specific preprocedural symptom status. Using data from the Vascular Quality Initiative, they found that, after TCAR, compared with asymptomatic status, a recent stroke and a recent hemispheric TIA were associated with higher stroke/death rates, whereas a recent ocular TIA was associated with similar stroke/death rates. In addition, a formerly symptomatic status was associated with higher stroke/death rates compared with an asymptomatic status. The researchers concluded that their findings suggested that classifying patients undergoing TCAR as symptomatic versus asymptomatic may be an oversimplification and that patients' specific preoperative neurologic symptoms should instead be used in risk assessment and outcome reporting for TCAR.
AHRQ-funded; HS027285.
Citation: Solomon Y, Rastogi V, Marcaccio CL .
Outcomes after transcarotid artery revascularization stratified by preprocedural symptom status.
J Vasc Surg 2022 Nov;76(5):1307-15.e1. doi: 10.1016/j.jvs.2022.05.024..
Keywords: Cardiovascular Conditions, Surgery, Stroke, Outcomes
Anjorin AC, Marcaccio CL, Patel PB
Racial and ethnic disparities in 3-year outcomes following infrainguinal bypass for chronic limb-threatening ischemia.
This study’s objective was to determine the differences in 3-year outcomes after open infrainguinal bypass for chronic limb-threatening ischemia (CLTI) stratified by race/ethnicity and explored the potential factors contributing to these differences to help determine reasons why outcomes are worse for racial and ethnic minorities. The authors identified all CLTI patients who had undergone primary open infrainguinal bypass in the Vascular Quality Initiative registry from 2003 to 2017 with linkage to Medicare claims through 2018 for the 3-year outcomes. Primary outcomes were the 3-year rates of major amputation, reintervention, and mortality. They also recorded 30-day major adverse limb events (MALE) defined as major amputation or reintervention. Of the 7108 patients with CLTI 79% were non-Hispanic White, 15% were Black, 1% were Asian, and 6% were Hispanic. Compared with White patients, Black patients had higher rates of 3-year major amputation (Black vs White, 32% vs 19%), reintervention (Black vs White, 61% vs 57%), and 30-day MALE (Black vs White, 8.1% vs 4.9%) but lower mortality (Black vs White, 38% vs 42%). Hispanic patients also experienced higher rates of amputation (Hispanic vs White, 27% vs 19%), reintervention (Hispanic vs White, 70% vs 57%), and MALE (Hispanic vs White, 8.7% vs 4.9%). However, mortality was similar between Hispanic vs White groups. A higher presence of comorbidities in Black and Hispanic patients with CLTI is considered the greatest contributing factors to higher amputation and reintervention rates.
AHRQ-funded; HS027285.
Citation: Anjorin AC, Marcaccio CL, Patel PB .
Racial and ethnic disparities in 3-year outcomes following infrainguinal bypass for chronic limb-threatening ischemia.
J Vasc Surg 2022 Nov;76(5):1335-46.e7. doi: 10.1016/j.jvs.2022.06.026..
Keywords: Racial / Ethnic Minorities, Disparities, Outcomes, Surgery, Cardiovascular Conditions
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
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
Tracer H, Newhouse CN
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
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
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
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)
Lai LY, Oerline MK, Caram MEV
Risk of metabolic and cardiovascular adverse events with abiraterone or enzalutamide among men with advanced prostate cancer.
Investigators examined the association between the use of abiraterone or enzalutamide and the risk of metabolic or cardiovascular adverse events while on treatment for advanced prostate cancer. They found that, compared with men not receiving abiraterone, men receiving abiraterone were at increased risk of both a major composite adverse event and a minor composite adverse event. Compared with men not receiving enzalutamide, men receiving enzalutamide were at an increased risk of a major composite adverse event but not a minor composite adverse event. They recommended careful monitoring and management of men on abiraterone or enzalutamide through team-based approaches.
AHRQ-funded; HS027507.
Citation: Lai LY, Oerline MK, Caram MEV .
Risk of metabolic and cardiovascular adverse events with abiraterone or enzalutamide among men with advanced prostate cancer.
J Natl Cancer Inst 2022 Aug 8;114(8):1127-34. doi: 10.1093/jnci/djac081..
Keywords: Cardiovascular Conditions, Cancer: Prostate Cancer, Cancer, Risk, Adverse Events, Medication, Adverse Drug Events (ADE), Medication: Safety, Patient Safety
Patnode CD, Redmond N, Iacocca MO
Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults without known cardiovascular disease risk factors: updated evidence report and systematic review for the US Preventive Serv
This paper’s objective was to synthesize the evidence on benefits and harms of behavioral counseling interventions to promote a healthy diet and physical activity in adults without known cardiovascular disease (CVD) risk factors to inform a USPSTF recommendation. Findings showed that healthy diet and physical activity behavioral counseling interventions for persons without a known risk of CVD were associated with small but statistically significant benefits across a variety of important intermediate health outcomes and small to moderate effects on dietary and physical activity behaviors.
AHRQ-funded; 290201500007I.
Citation: Patnode CD, Redmond N, Iacocca MO .
Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults without known cardiovascular disease risk factors: updated evidence report and systematic review for the US Preventive Serv
JAMA 2022 Jul 26;328(4):375-88. doi: 10.1001/jama.2022.7408..
Keywords: U.S. Preventive Services Task Force (USPSTF), Lifestyle Changes, Cardiovascular Conditions, Risk, Prevention, Nutrition
Saxena FE, Bierman AS, Glazier RH
Association of Early Physician Follow-up With Readmission Among Patients Hospitalized for Acute Myocardial Infarction, Congestive Heart Failure, or Chronic Obstructive Pulmonary Disease.
Investigators assessed whether hospitalized patients with early physician follow-up after discharge had lower rates of overall and condition-specific readmissions within 30 days and 90 days of discharge. Studying adults in Ontario, Canada, with first admission for acute myocardial infarction, congestive heart failure, or chronic obstructive pulmonary disease, the findings suggested that early follow-up in conjunction with a comprehensive transitional care strategy for hospitalized patients with medically complex conditions coupled with ongoing effective chronic disease management may be associated with reduced 90-day readmissions.
AHRQ-authored.
Citation: Saxena FE, Bierman AS, Glazier RH .
Association of Early Physician Follow-up With Readmission Among Patients Hospitalized for Acute Myocardial Infarction, Congestive Heart Failure, or Chronic Obstructive Pulmonary Disease.
JAMA Netw Open 2022 Jul;5(7):e2222056. doi: 10.1001/jamanetworkopen.2022.22056..
Keywords: Hospital Readmissions, Hospitalization, Cardiovascular Conditions, Respiratory Conditions, Transitions of Care
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), Vitamins and Supplements, Cardiovascular Conditions, Cancer, Prevention, Evidence-Based Practice
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
Villa Zapata L, Boyce RD, Chou E
QTc prolongation with the use of hydroxychloroquine and concomitant arrhythmogenic medications: a retrospective study using electronic health records data.
The purpose of this AHRQ-funded retrospective study of electronic health records was to assess changes in the QTc interval in patients taking hydroxychloroquine (with or without concomitant QT-prolonging medications.) Patients were placed into one of 6 cohorts, depending upon their monotherapy with one of 3 different medications: hydroxychloroquine, methotrexate, or sulfasalazine, or, based on their exposure to any combination of those drugs with any other drug known to increase the QT interval. The study concluded that compared to sulfasalazine or methotrexate, hydroxychloroquine was related with an increase in the QTc interval.
AHRQ-funded; HS025984.
Citation: Villa Zapata L, Boyce RD, Chou E .
QTc prolongation with the use of hydroxychloroquine and concomitant arrhythmogenic medications: a retrospective study using electronic health records data.
Drugs Real World Outcomes 2022 Jun 5:1-9. doi: 10.1007/s40801-022-00307-5..
Keywords: Medication, Cardiovascular Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Yu J, Wang AA, Zimmerman LP
A cohort analysis of statin treatment patterns among small-sized primary care practices.
The purpose of this retrospective cohort analysis study was to describe statin treatment patterns in small-sized primary care practices and explore the patient and practice factors that are related to lack of statin treatment. The researchers included all statin-eligible adults (13,330) who received care at one of 53 Healthy Hearts in the Heartland (H3) practices, a cardiovascular care quality improvement initiative, between 2013 and 2016. The study found that among 43% of patients (5,780), there was no record of moderate- to high-intensity statin therapy. A lack of appropriate intensity statin therapy was independently associated with the female sex, a younger age, and lower low-density lipoprotein cholesterol (LDL-C). Also associated with lower appropriate intensity statin use was a higher proportion of patients insured by Medicaid and having only family medicine trained physicians (vs. having at least one internal medicine trained physician) at the practice. A lack of appropriate intensity statin therapy was greater in independent practices than in Federally Qualified Health Centers (FQHCs). The study concluded that factors influencing lack of statin treatment vary by practice setting, emphasizing the role of approaches that are customized to individual settings.
AHRQ-funded; HS023921.
Citation: Yu J, Wang AA, Zimmerman LP .
A cohort analysis of statin treatment patterns among small-sized primary care practices.
J Gen Intern Med 2022 Jun;37(8):1845-52. doi: 10.1007/s11606-021-07191-9..
Keywords: Cardiovascular Conditions, Medication, Practice Patterns, Primary Care
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
