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 18 of 18 Research Studies DisplayedPatel SA, Krasnow M, Long K
Excess 30-day heart failure readmissions and mortality in black patients increases with neighborhood deprivation.
Researchers examined whether neighborhood environment modifies the disparity in 30-day heart failure (HF) readmissions and mortality between Black and White patients in the Southeastern United States. They created a geocoded retrospective cohort of patients hospitalized for acute HF from 2010-2018 within Emory Healthcare. They found that excess 30-day HF readmissions and mortality were present among Black patients in every neighborhood strata and increased with progressive neighborhood socioeconomic deprivation.
AHRQ-funded; HS026081.
Citation: Patel SA, Krasnow M, Long K .
Excess 30-day heart failure readmissions and mortality in black patients increases with neighborhood deprivation.
Circ Heart Fail 2020 Dec;13(12):e007947. doi: 10.1161/circheartfailure.120.007947..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Hospital Readmissions, Racial and Ethnic Minorities, Mortality, Social Determinants of Health, Low-Income, Disparities
Khera R, Kondamudi N, Zhong L
Temporal trends in heart failure incidence among Medicare
This retrospective, national cohort study looked at temporal trends in heart failure (HF) incidence among Medicare beneficiaries from 2011 to 2016. There had been a decline in claims during that time period. Five percent of all fee-for-service Medicare beneficiaries with no prior HF diagnosis were followed up from 2011-2016. Annual trends were examined in HF incidence among groups with and without primary HF risk factors (hypertension, diabetes, and obesity) and predisposing cardiovascular conditions (acute myocardial infarction (MI) and atrial fibrillation (AF). Of the approximately 1.8 million Medicare beneficiaries at risk for HF, 249,832 had a new diagnosis of HF. The prevalence of all 5 risk factors had increased during the 5-year study period. There was a relative decline in HF incidence among beneficiaries with primary HF risk factors, but incidence increased among individuals with acute MI and AF.
AHRQ-funded; HS022418.
Citation: Khera R, Kondamudi N, Zhong L .
Temporal trends in heart failure incidence among Medicare
JAMA Netw Open 2020 Oct;3(10):e2022190. doi: 10.1001/jamanetworkopen.2020.22190.
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Keywords: Heart Disease and Health, Cardiovascular Conditions, Medicare, Risk, Elderly, Mortality
Jannat-Khah DP, Khodneva Y, Bryant K
Depressive symptoms do not discriminate: racial and economic influences between time-varying depressive symptoms and mortality among REGARDS participants.
This study examined whether time-varying depressive symptoms (TVDS) predict mortality and if racial and income differences moderate the association in a large cohort. The cohort from the REGARDS study was used to look at that determination. The REGARDS study used community-dwelling U.S. adults aged 45 years or older. They found that there was similar and statistically significant differences with white, black, and low-income ($35,000 or less) participants for the association between TVDS and mortality. High-income participants were found to have a lower hazard.
AHRQ-funded; HS025198.
Citation: Jannat-Khah DP, Khodneva Y, Bryant K .
Depressive symptoms do not discriminate: racial and economic influences between time-varying depressive symptoms and mortality among REGARDS participants.
Ann Epidemiol 2020 Jun;46:31-40.e2. doi: 10.1016/j.annepidem.2020.04.004..
Keywords: Depression, Behavioral Health, Racial and Ethnic Minorities, Cardiovascular Conditions, Cancer, Low-Income, Social Determinants of Health, Mortality
Basciotta M, Zhou W, Ngo L
Antipsychotics and the risk of mortality or cardiopulmonary arrest in hospitalized adults.
Investigators sought to evaluate the risk of death or nonfatal cardiopulmonary arrest in hospitalized adults exposed to antipsychotics. They found that, in hospitalized adults, typical antipsychotics were associated with increased mortality or cardiopulmonary arrest, whereas atypical antipsychotics were only associated with increased risk among adults age 65 years and older. They recommended that providers be thoughtful when prescribing antipsychotic medications, especially to older adults in settings where data regarding benefit are lacking.
AHRQ-funded; HS026215.
Citation: Basciotta M, Zhou W, Ngo L .
Antipsychotics and the risk of mortality or cardiopulmonary arrest in hospitalized adults.
J Am Geriatr Soc 2020 Mar;68(3):544-50. doi: 10.1111/jgs.16246..
Keywords: Medication, Risk, Hospitalization, Cardiovascular Conditions, Mortality, Elderly
Dhruva SS, Ross JS, Mortazavi BJ
Association of use of an intravascular microaxial left ventricular assist device vs intra-aortic balloon pump with in-hospital mortality and major bleeding among patients with acute myocardial infarction complicated by cardiogenic shock.
This study examines outcomes among patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) complicated by cardiogenic shock. Two interventions are compared: intravascular microaxial left ventricular assist devices (LVADs) versus intra-aortic balloon pumps (IABPs). The American College of Cardiology’s National Cardiovascular Data Registry was used to identify patients with AMI complicated by cardiogenic shock from hospitals participating in the CathPCI and Chest Pain-MI registries and identified 28,304 patients. Over the study period (2015 to 2017), LVAD was used in 6.2% of patients and IABP in 29.9%. LVAD was shown to have higher rates of in-hospital death and major bleeding complications compared to IABP.
AHRQ-funded; HS022882; HS025402; HS025517; HS026379.
Citation: Dhruva SS, Ross JS, Mortazavi BJ .
Association of use of an intravascular microaxial left ventricular assist device vs intra-aortic balloon pump with in-hospital mortality and major bleeding among patients with acute myocardial infarction complicated by cardiogenic shock.
JAMA 2020 Feb 25;323(8):734-45. doi: 10.1001/jama.2020.0254..
Keywords: Medical Devices, Heart Disease and Health, Cardiovascular Conditions, Mortality, Adverse Events, Registries, Patient Safety, Patient-Centered Outcomes Research, Evidence-Based Practice
Angraal S, Mortazavi BJ, Gupta A
Machine learning prediction of mortality and hospitalization in heart failure with preserved ejection fraction.
This study developed models to predict the risk of death and hospitalization in patients with heart failure (HF) with preserved ejection fraction (HFpEF). Data was used from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) clinical trial. Five methods: logistic regression with a forward selection of variables; logistic regression with a lasso regularization for variable selection; random forest (RF); gradient descent boosting; and support vector machine, were used to train models for assessing risks of mortality and HF hospitalization through 3 years of follow-up and were validated using 5-fold cross-validation. RF was found to be the best performing model for predicting mortality and HF hospitalization. Blood urea nitrogen levels, body mass index, and Kansas City Cardiomyopathy Questionnaire (KCCQ) subscale scores were strongly associated with mortality, while hemoglobin level, blood urea nitrogen, time since previous HF hospitalization, and KCCQ scores were the most significant predictors of HF hospitalization.
AHRQ-funded; HS023000.
Citation: Angraal S, Mortazavi BJ, Gupta A .
Machine learning prediction of mortality and hospitalization in heart failure with preserved ejection fraction.
JACC Heart Fail 2020 Jan;8(1):12-21. doi: 10.1016/j.jchf.2019.06.013..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Mortality, Hospitalization, Risk, Health Status, Health Information Technology (HIT)
Huckfeldt P, Escarce J, Wilcock A
HF mortality trends under Medicare readmissions reduction program at penalized and nonpenalized hospitals.
After announcement and implementation of the Medicare Hospital Readmissions Reduction Program (HRRP), 30-day readmissions declined rapidly among seniors with heart failure (HF) while 30-day mortality rose. This raised questions about whether the policy was responsible, because lower HF readmission rates have historically been associated with higher mortality. In this study, the investigators compared trends in heart failure (HF) mortality at penalized and nonpenalized hospitals nationally.
AHRQ-funded; HS024284.
Citation: Huckfeldt P, Escarce J, Wilcock A .
HF mortality trends under Medicare readmissions reduction program at penalized and nonpenalized hospitals.
J Am Coll Cardiol 2018 Nov 13;72(20):2539-40. doi: 10.1016/j.jacc.2018.08.2174..
Keywords: Mortality, Heart Disease and Health, Cardiovascular Conditions, Hospital Readmissions, Medicare, Hospitals, Provider Performance, Payment
Desai NR, Ott LS, George EJ
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
The objectives of this study were to investigate the association between hospital-level 30-day risk-standardized mortality rates (RSMRs) and 30-day risk-standardized payments (RSPs) for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PNA); to characterize patterns of value in care; and to identify hospital characteristics associated with high-value care (defined by having lower than median RSMRs and RSPs).
AHRQ-funded; HS023000.
Citation: Desai NR, Ott LS, George EJ .
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
JAMA Netw Open 2018 Oct 5;1(6):e183519. doi: 10.1001/jamanetworkopen.2018.3519..
Keywords: Cardiovascular Conditions, Elderly, Hospitalization, Hospitals, Heart Disease and Health, Inpatient Care, Medicare, Mortality, Pneumonia
Silber JH, Arriaga AF, Niknam BA
Failure-to-rescue after acute myocardial infarction.
The purpose of this study is to develop a failure-to-rescue (FTR) metric modified to analyze acute myocardial infarction (AMI) outcomes. The subjects were older Medicare beneficiaries who were admitted to short-term acute-care hospitals for AMI between 2009 and 2011. Measures included thirty-day mortality and FTR rates, as well as in-hospital complication rates. The study concludes that a modified FTR metric can be created that may aid in studying the quality of care of AMI admissions and has the advantageous properties of surgical FTR.
AHRQ-funded; HS023560.
Citation: Silber JH, Arriaga AF, Niknam BA .
Failure-to-rescue after acute myocardial infarction.
Med Care 2018 May;56(5):416-23. doi: 10.1097/mlr.0000000000000904..
Keywords: Adverse Events, Cardiovascular Conditions, Quality of Care, Mortality, Heart Disease and Health
Goldstone AB, Chiu P, Baiocchi M
Second arterial versus venous conduits for multi-vessel coronary artery bypass surgery in California.
This study sought to determine whether a second arterial conduit improves outcomes after multi-vessel coronary artery bypass grafting. It concluded that second arterial conduit use in California is low and declining, but arterial grafts were associated with significantly lower mortality and fewer cardiovascular events. A right internal thoracic artery graft offered no benefit over that of a radial artery, but did increase risk of sternal wound infection.
AHRQ-funded; HS022192.
Citation: Goldstone AB, Chiu P, Baiocchi M .
Second arterial versus venous conduits for multi-vessel coronary artery bypass surgery in California.
Circulation 2018 Apr 17;137(16):1698-707. doi: 10.1161/circulationaha.117.030959.
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Keywords: Cardiovascular Conditions, Comparative Effectiveness, Mortality, Patient-Centered Outcomes Research, Surgery
Kalbaugh CA, Loehr L, Wruck L
Frequency of care and mortality following an incident diagnosis of peripheral artery disease in the inpatient or outpatient setting: the ARIC (Atherosclerosis Risk in Communities) study.
Researchers analyzed frequency of care and mortality date for patients with an initial peripheral artery disease (PAD) diagnosis in the outpatient or inpatient setting. Data was analyzed from the ARIC (Atherosclerosis Risk in Communities) study cohort linked with Centers for Medicare and Medicaid Services fee-for-services claims data for 2002-2012. Patients diagnosed in the outpatient setting had higher follow-up rates with lower hospitalizations and mortality than those diagnosed in the inpatient setting.
AHRQ-funded; HS000032; HS023728.
Citation: Kalbaugh CA, Loehr L, Wruck L .
Frequency of care and mortality following an incident diagnosis of peripheral artery disease in the inpatient or outpatient setting: the ARIC (Atherosclerosis Risk in Communities) study.
J Am Heart Assoc 2018 Apr 13;7(8). doi: 10.1161/jaha.117.007332..
Keywords: Cardiovascular Conditions, Healthcare Utilization, Hospitalization, Mortality, Outcomes
Hirayama A, Goto T, Shimada YJ
Association of obesity with severity of heart failure exacerbation: a population-based study.
Researchers investigate the associations of obesity with severity of heart failure exacerbation and in-hospital mortality using population-based data from the State Inpatient Databases. Subjects were adults hospitalized for heart failure exacerbation in seven States from 2012 to 2013. The researchers found that, based on large population-based data sets of patients with heart failure exacerbation, obesity was associated with higher acute severity measures but lower in-hospital mortality.
AHRQ-funded; HS023305.
Citation: Hirayama A, Goto T, Shimada YJ .
Association of obesity with severity of heart failure exacerbation: a population-based study.
J Am Heart Assoc 2018 Mar 15;7(6). doi: 10.1161/jaha.117.008243..
Keywords: Healthcare Cost and Utilization Project (HCUP), Obesity, Heart Disease and Health, Cardiovascular Conditions, Hospitalization, Mortality
Lopes RD, Rordorf R, De Ferrari GM
Digoxin and mortality in patients with atrial fibrillation.
This study examined whether digoxin was independently associated with mortality in patients with atrial fibrillation (AF). Digoxin is a widely used medication for AF. The association was assessed in 17,897 patients who were score-matched with control participants. Baseline digoxin was not associated with increased mortality, but patients with a serum digoxin concentration of greater or equal to 1.2 ng/ml had a 56% increased hazard of mortality.
AHRQ-funded; HS024310.
Citation: Lopes RD, Rordorf R, De Ferrari GM .
Digoxin and mortality in patients with atrial fibrillation.
J Am Coll Cardiol 2018 Mar 13;71(10):1063-74. doi: 10.1016/j.jacc.2017.12.060..
Keywords: Adverse Drug Events (ADE), Adverse Events, Cardiovascular Conditions, Heart Disease and Health, Medication, Mortality, Risk
Chen LM, Levine DA, Hayward R
Relationship between hospital 30-day mortality rates for heart failure and patterns of early inpatient comfort care.
This study describes the use of early comfort care for patients with heart failure (HF), and whether hospitals that more commonly initiate comfort care have higher 30-day mortality rates. It found that hospital use of early comfort care for HF varies, has not increased over time, and on average, is not correlated with 30-day risk-standardized mortality rates.
AHRQ-funded; HS020671.
Citation: Chen LM, Levine DA, Hayward R .
Relationship between hospital 30-day mortality rates for heart failure and patterns of early inpatient comfort care.
J Hosp Med 2018 Mar;13(3):170-76. doi: 10.12788/jhm.2862.
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Keywords: Cardiovascular Conditions, Elderly, Heart Disease and Health, Inpatient Care, Mortality, Palliative Care
Spatz ES, Wang Y, Beckman AL
Traditional Chinese medicine for acute myocardial infarction in western medicine hospitals in China.
This study examined the use of traditional Chinese medicine (TCM) in patients admitted for acute myocardial infarction (AMI) in China during the first 24 hours of hospitalization. The data came from the China Patient-centered Evaluative Assessment of Cardiac Events Retrospective Study of Acute Myocardial Infarction. A chart review was done of randomly sampled patients in 2001, 2006 and 2011 in 162 Western medicine hospitals across China. Nearly all (99%) hospitals used some form of TCM, with Salvia miltiorrhiza being the most commonly prescribed. This TCM treatment (and others) was used intravenously and use has increased over the span of the study, despite lack of evidence of benefit or harm.
AHRQ-funded; HS023000.
Citation: Spatz ES, Wang Y, Beckman AL .
Traditional Chinese medicine for acute myocardial infarction in western medicine hospitals in China.
Circ Cardiovasc Qual Outcomes 2018 Mar;11(3):e004190. doi: 10.1161/circoutcomes.117.004190..
Keywords: Adverse Events, Cardiovascular Conditions, Complementary and Alternative Medicine, Heart Disease and Health, Hospitals, Mortality, Outcomes, Patient-Centered Outcomes Research, Patient Safety, Practice Patterns, Risk
Bachmann JM, Duncan MS, Shah AS
Association of cardiac rehabilitation with decreased hospitalizations and mortality after ventricular assist device implantation.
This study examined whether outcomes of cardiac patients who had received ventricular assist device (VAD) implementation had decreased hospitalization and mortality with cardiac rehabilitation (CR). Medicare beneficiaries enrolled for disability or aged 65 years and older in 2014 were included. The investigators identified VAD recipients by diagnosis codes. It was found that each 5-year increase in age was associated with attending an additional 1.6 CR sessions and there was a 23% lower 1-year hospitalization risk and a 47% lower 1-year mortality risk.
AHRQ-funded; HS022990.
Citation: Bachmann JM, Duncan MS, Shah AS .
Association of cardiac rehabilitation with decreased hospitalizations and mortality after ventricular assist device implantation.
JACC Heart Fail 2018 Feb;6(2):130-39. doi: 10.1016/j.jchf.2017.11.002..
Keywords: Cardiovascular Conditions, Rehabilitation, Heart Disease and Health, Medical Devices, Surgery, Patient-Centered Outcomes Research, Outcomes, Mortality, Evidence-Based Practice, Hospitalization
Charytan DM, Skali H, Shah NR
Coronary flow reserve is predictive of the risk of cardiovascular death regardless of chronic kidney disease stage.
Microvascular rarefaction is found in experimental uremia, but data from patients with chronic kidney disease (CKD) are limited. The investigators, therefore, quantified absolute myocardial blood flow and coronary flow reserve (the ratio of peak to resting flow) from myocardial perfusion positron emission tomography scans at a single institution and classified individuals into standard CKD categories based on the estimated glomerular filtration rate.
AHRQ-funded; HS022998.
Citation: Charytan DM, Skali H, Shah NR .
Coronary flow reserve is predictive of the risk of cardiovascular death regardless of chronic kidney disease stage.
Kidney Int 2018 Feb;93(2):501-09. doi: 10.1016/j.kint.2017.07.025..
Keywords: Cardiovascular Conditions, Kidney Disease and Health, Mortality
Lee AK, Warren B, Lee CJ
The association of severe hypoglycemia with incident cardiovascular events and mortality in adults with type 2 diabetes.
There is suggestive evidence linking hypoglycemia with cardiovascular disease, but few data have been collected in a community-based setting. This study found that hypoglycemia was not associated with stroke, heart failure, atrial fibrillation, or noncardiovascular and noncancer death. Results were robust within subgroups defined by age, sex, race, diabetes duration, and baseline cardiovascular risk.
AHRQ-funded; HS018542.
Citation: Lee AK, Warren B, Lee CJ .
The association of severe hypoglycemia with incident cardiovascular events and mortality in adults with type 2 diabetes.
Diabetes Care 2018 Jan;41(1):104-11. doi: 10.2337/dc17-1669.
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Keywords: Adverse Events, Cardiovascular Conditions, Diabetes, Mortality