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
76 to 98 of 98 Research Studies DisplayedPinto D, Prabhakaran S, Tipton E
Why physicians prescribe prophylactic seizure medications after intracerebral hemorrhage: an adaptive conjoint analysis.
Seizures are a morbid complication of intracerebral hemorrhage (ICH) and increase the risk for herniation, status epilepticus, and worse patient outcomes. Prophylactic levetiracetam is administered to approximately 40% of patients with ICH. It is unclear which patients are consciously selected for treatment by physicians. In this study, the investigators sought to determine how patients are selected for treatment with prophylactic levetiracetam after ICH.
AHRQ-funded; HS023437.
Citation: Pinto D, Prabhakaran S, Tipton E .
Why physicians prescribe prophylactic seizure medications after intracerebral hemorrhage: an adaptive conjoint analysis.
J Stroke Cerebrovasc Dis 2020 Apr;29(4):104628. doi: 10.1016/j.jstrokecerebrovasdis.2019.104628..
Keywords: Neurological Disorders, Medication, Prevention, Cardiovascular Conditions, Stroke, Decision Making
Pokorney SD, Black-Maier E, Hellkamp AS
Oral anticoagulation and cardiovascular outcomes in patients with atrial fibrillation and end-stage renal disease.
The objective of this study was to describe patterns of oral anticoagulant (OAC) use in end-stage renal disease (ESRD) patients with atrial fibrillation (AF) and their associations with cardiovascular outcomes. Medicare fee-for-service 5% claims data from 2007 to 2013 was analyzed in a cohort of patients with ESRD and AF. A cohort of 8,410 patients with AF and ESRD was identified, with a total of 3,043 (36.2%) patients treated with OAC during the study period. Treatment with OAC was not associated with hospitalization for stroke, or death but was associated with increased hospitalization for bleeding and intracranial hemorrhage.
AHRQ-funded; HS021092.
Citation: Pokorney SD, Black-Maier E, Hellkamp AS .
Oral anticoagulation and cardiovascular outcomes in patients with atrial fibrillation and end-stage renal disease.
J Am Coll Cardiol 2020 Mar 24;75(11):1299-308. doi: 10.1016/j.jacc.2020.01.019..
Keywords: Blood Thinners, Medication, Heart Disease and Health, Cardiovascular Conditions, Kidney Disease and Health, Chronic Conditions, Outcomes
Pereira T, Gadhoumi K, Ma M
A supervised approach to robust photoplethysmography quality assessment.
In this paper, the investigators tested the performance of algorithms selected from a body of studies on photoplethysmogram (PPG) quality assessment using a dataset of PPG recordings from patients with AFib. They then proposed machine learning approaches for PPG quality assessment in 30-s segments of PPG recording from 13 stroke patients admitted to the University of California San Francisco (UCSF) neuro intensive care unit and another dataset of 3764 patients from one of the five UCSF general intensive care units.
AHRQ-funded; HS022860.
Citation: Pereira T, Gadhoumi K, Ma M .
A supervised approach to robust photoplethysmography quality assessment.
IEEE J Biomed Health Inform 2020 Mar;24(3):649-57. doi: 10.1109/jbhi.2019.2909065..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Stroke, Diagnostic Safety and Quality
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
Brand-McCarthy SR, Delaney RK, Noseworthy PA
Can shared decision making improve stroke prevention in atrial fibrillation?: Implications of the updated guidelines.
This paper discusses the need for shared decision making (SDM) in atrial fibrillation (AF) patients not just at the beginning of treatment but throughout during ongoing care. Use of SDM can help with patient adherence to recommended anticoagulation treatment regimens and lifestyle changes. It can help build a strong partnership between clinician and patient.
AHRQ-funded; HS026379.
Citation: Brand-McCarthy SR, Delaney RK, Noseworthy PA .
Can shared decision making improve stroke prevention in atrial fibrillation?: Implications of the updated guidelines.
Circ Cardiovasc Qual Outcomes 2020 Mar;13(3):e006080. doi: 10.1161/circoutcomes.119.006080..
Keywords: Decision Making, Stroke, Heart Disease and Health, Cardiovascular Conditions, Prevention, Guidelines, Blood Thinners, Medication, Clinician-Patient Communication, Communication
Sweeney SM, Hemler JR, Baron AN
Dedicated workforce required to support large-scale practice improvement.
Facilitation is an effective approach for helping practices implement sustainable evidence-based practice improvements. Few studies examine the facilitation infrastructure and support needed for large-scale dissemination and implementation initiatives. In this paper, the authors discuss a project by the Agency for Health care Research and Quality in which it funded 7 Cooperatives, each of which worked with over 200 primary care practices to rapidly disseminate and implement improvements in cardiovascular preventive care.
AHRQ-funded; HS023940.
Citation: Sweeney SM, Hemler JR, Baron AN .
Dedicated workforce required to support large-scale practice improvement.
J Am Board Fam Med 2020 Mar-Apr;33(2):230-39. doi: 10.3122/jabfm.2020.02.190261..
Keywords: Practice Improvement, Primary Care, Cardiovascular Conditions, Healthcare Delivery, Quality Improvement, Quality of Care, Prevention, Implementation, Evidence-Based Practice
Nguyen AM, Cuthel A, Padgett DK
How practice facilitation strategies differ by practice context.
The purpose of this study was to identify contextual factors that drive facilitators' strategies to meet practice improvement goals, and how these strategies are tailored to practice context. This study was conducted as part of a larger study, HealthyHearts New York City, which evaluated the impact of practice facilitation on adoption of cardiovascular disease prevention and treatment guidelines.
AHRQ-funded; HS023922.
Citation: Nguyen AM, Cuthel A, Padgett DK .
How practice facilitation strategies differ by practice context.
J Gen Intern Med 2020 Mar;35(3):824-31. doi: 10.1007/s11606-019-05350-7..
Keywords: Quality Improvement, Evidence-Based Practice, Heart Disease and Health, Cardiovascular Conditions, Primary Care, Quality of Care, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care: Models of Care
Poon BY, Shortell SM, Rodriguez HP
Patient activation as a pathway to shared decision-making for adults with diabetes or cardiovascular disease.
Shared decision-making (SDM) is widely recognized as a core strategy to improve patient-centered care. However, the implementation of SDM in routine care settings has been slow and its impact mixed. In this study, the investigators examined the temporal association of patient activation and patients' experience with the SDM process to assess the dominant directionality of this relationship.
AHRQ-funded; HS022241.
Citation: Poon BY, Shortell SM, Rodriguez HP .
Patient activation as a pathway to shared decision-making for adults with diabetes or cardiovascular disease.
J Gen Intern Med 2020 Mar;35(3):732-42. doi: 10.1007/s11606-019-05351-6.
Keywords: Decision Making, Diabetes, Cardiovascular Conditions, Chronic Conditions, Patient-Centered Healthcare, Patient and Family Engagement
Oates GR, Juarez LD, Hansen B
Social risk factors for medication nonadherence: findings from the CARDIA study.
The purpose of this study was to investigate the combined effect of social risk factors on medication nonadherence. Using data from the Coronary Artery Risk Development in Young Adults study, the results showed that low income and chronic stress are associated with medication nonadherence, and that the odds of nonadherence increase with the accumulation of social risk factors. These findings may assist with developing risk prediction tools to identify individuals who can benefit from adherence-promoting interventions.
AHRQ-funded; HS023009.
Citation: Oates GR, Juarez LD, Hansen B .
Social risk factors for medication nonadherence: findings from the CARDIA study.
Am J Health Behav 2020 Mar 1;44(2):232-43. doi: 10.5993/ajhb.44.2.10..
Keywords: Patient Adherence/Compliance, Medication, Risk, Young Adults, Cardiovascular Conditions, Patient-Centered Outcomes Research
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
Dhruva, SS, Parzynski CS, Gamble GM
Attribution of adverse events following coronary stent placement identified using administrative claims data.
This study outlines the process used to identify adverse events following coronary stent placement identified with administrative claims data. Deterministic matching was used to link the National Cardiovascular Data Registry (NCDR) CathPCI Registry to Medicare fee-for-service claims for patients aged 65 and older who underwent percutaneous coronary interventions (PCIs) with drug-eluting stents (DESs) between July 2009 and December 2013. Out of 415,306 DES placements in 368,194 patients, 278 (1.1%) were attributed to the same coronary artery in which the DES was implanted during the index PCI. The authors concluded that more in-depth examination will be needed to accurately assess stent safety using claims data alone.
AHRQ-funded; HS022882.
Citation: Dhruva, SS, Parzynski CS, Gamble GM .
Attribution of adverse events following coronary stent placement identified using administrative claims data.
J Am Heart Assoc 2020 Feb 18;9(4):e013606. doi: 10.1161/jaha.119.013606..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Surgery, Adverse Events, Registries
Fakhri B, Fiala MA, Shah N
Measuring cardiopulmonary complications of carfilzomib treatment and associated risk factors using the SEER-Medicare database.
This study’s goal was to measure rates of cardiopulmonary complications from carfilzomib treatment in patients with recurrent myeloma. Myeloma case data was extracted from the SEER-Medicare linked database from 2000 to 2013, and corresponding claims through 2014. There were 635 patients identified as being treated with carfilzomib. Of these, median age was 72 years, 55% were male, and 79% were white. Median duration of treatment was 58 days. Overall, 66% of patients had codes identifying cardiac or pulmonary adverse events. Cardiac adverse events included hypertension, peripheral edema and heart failure. Pulmonary adverse events included dyspnea, cough, and pneumonia.
AHRQ-funded; HS019455.
Citation: Fakhri B, Fiala MA, Shah N .
Measuring cardiopulmonary complications of carfilzomib treatment and associated risk factors using the SEER-Medicare database.
Cancer 2020 Feb 15;128(4):808-13. doi: 10.1002/cncr.32601..
Keywords: Adverse Events, Medication, Cardiovascular Conditions, Risk, Cancer, Patient Safety
Bath J, Kruse RL, Smith JB
Association of postoperative glycemic control with outcomes after carotid procedures.
This study evaluated the relationship between suboptimal glucose control and adverse outcomes after carotid procedures. Patients admitted for elective carotid procedures from 2008-2015 were identified from the Cerner Healthfacts VR database using ICD-9-CM codes. Out of 4287 patients, 87% had optimal postoperative glucose control (80-180 mg/dL). Patients with suboptimal glucose control experienced higher stroke rates, more cardiac complications, longer hospital stays, higher rates of infection, and more complications overall than patients with optimal glucose control.
AHRQ-funded; HS022140.
Citation: Bath J, Kruse RL, Smith JB .
Association of postoperative glycemic control with outcomes after carotid procedures.
Vascular 2020 Feb;28(1):16-24. doi: 10.1177/1708538119866528..
Keywords: Adverse Events, Cardiovascular Conditions, Surgery, Patient-Centered Outcomes Research, Outcomes
Amin AP, Spertus JA, Kulkarni H
Improving care pathways for acute coronary syndrome: patients undergoing percutaneous coronary intervention.
This study examined ways to improve care pathways for acute coronary syndrome (ACS) patients who are low-risk with no complications. They looked at 434,172 low-risk uncomplicated ACS patients eligible for early discharge from the Premier database and identified ACS care pathways. They compared percutaneous coronary intervention (PCI) types (trans-radial intervention [TRI] vs. transfemoral intervention (TFI) and by length of stay (LOS). Associations with costs and outcomes were tested using hierarchical, mixed-effects regression and projections of cost savings were obtained using modeling. More cost-savings were associated with TRI versus TFI. There was not an increased risk of adverse outcomes with a shorter LOS.
AHRQ-funded; HS022481.
Citation: Amin AP, Spertus JA, Kulkarni H .
Improving care pathways for acute coronary syndrome: patients undergoing percutaneous coronary intervention.
Am J Cardiol 2020 Feb;125(3):354-61. doi: 10.1016/j.amjcard.2019.10.019..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Quality Improvement, Quality of Care, Healthcare Delivery, Registries, Healthcare Costs
Strobel RJ, Likosky DS, Brescia AA
The effect of hospital market competition on the adoption of transcatheter aortic valve replacement.
The use of transcatheter aortic valve replacement (TAVR) has grown rapidly. The purpose of this study was to assess whether hospital market competition was associated with the use of TAVR. The investigators concluded that market competition was positively associated with a hospital's adoption of TAVR and indicated that future studies should further examine the impact of competition on quality and appropriateness.
AHRQ-funded; HS026003.
Citation: Strobel RJ, Likosky DS, Brescia AA .
The effect of hospital market competition on the adoption of transcatheter aortic valve replacement.
Ann Thorac Surg 2020 Feb;109(2):473-79. doi: 10.1016/j.athoracsur.2019.06.025..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitals, Cardiovascular Conditions, Heart Disease and Health, Surgery
Chandanabhumma PP, Fetters MD, Pagani FD
Understanding and addressing variation in health care-associated infections after durable ventricular assist device therapy: protocol for a mixed methods study.
This paper discusses an ongoing AHRQ-funded study to understand and address variation in health care-associated infections (HAIs) after durable ventricular assist device (VAD) implantation surgery. This procedure is used only on patients with advanced heart failure who have a poor 1-year estimated survival rate. This is a sequential mixed methods study which is conducting a systematic review of HAI prevention studies, and an in-depth quantitative analyses using administration claims, in-depth clinical data, and organizational surveys of VAD centers. The last aim is to develop and disseminate a best practices toolkit for HAI prevention. Data analysis is currently underway.
AHRQ-funded; HS026003.
Citation: Chandanabhumma PP, Fetters MD, Pagani FD .
Understanding and addressing variation in health care-associated infections after durable ventricular assist device therapy: protocol for a mixed methods study.
JMIR Res Protoc 2020 Jan 7;9(1):e14701. doi: 10.2196/14701..
Keywords: Healthcare-Associated Infections (HAIs), Surgery, Medical Devices, Prevention, Heart Disease and Health, Cardiovascular Conditions, Adverse Events
Rosenbloom JI, Lewkowitz AK, Lindley KJ
Expectant management of hypertensive disorders of pregnancy and future cardiovascular morbidity.
The purpose of this study was to test the hypothesis that a longer length of time between diagnosis of hypertensive disorders of pregnancy and delivery is associated with increased risk of cardiovascular morbidity in the years after delivery. The investigators concluded that prolonged expectant management of preterm hypertensive disorders of pregnancy was associated with an increased risk of maternal cardiac disease in the ensuing years.
AHRQ-funded; HS019455.
Citation: Rosenbloom JI, Lewkowitz AK, Lindley KJ .
Expectant management of hypertensive disorders of pregnancy and future cardiovascular morbidity.
Obstet Gynecol 2020 Jan;135(1):27-35. doi: 10.1097/aog.0000000000003567..
Keywords: Blood Pressure, Pregnancy, Cardiovascular Conditions, Labor and Delivery, Risk, Women
Weerahandi H, Bao H, Herrin J
Home health care after skilled nursing facility discharge following heart failure hospitalization.
Heart failure (HF) readmission rates have plateaued despite scrutiny of hospital discharge practices. Many HF patients are discharged to skilled nursing facility (SNF) after hospitalization before returning home. Home healthcare (HHC) services received during the additional transition from SNF to home may affect readmission risk. In this study, the investigators examined whether receipt of HHC affects readmission risk during the transition from SNF to home following HF hospitalization.
AHRQ-funded; HS022882.
Citation: Weerahandi H, Bao H, Herrin J .
Home health care after skilled nursing facility discharge following heart failure hospitalization.
J Am Geriatr Soc 2020 Jan;68(1):96-102. doi: 10.1111/jgs.16179..
Keywords: Home Healthcare, Nursing Homes, Heart Disease and Health, Cardiovascular Conditions, Hospitalization, Hospital Readmissions, Transitions of Care, Elderly
Amin AP, McNeely C, Spertus JA
Incremental cost of acute kidney injury after percutaneous coronary intervention in the United States.
This study examined incremental costs of acute kidney injury (AKI) complications from percutaneous coronary intervention (PCI), which is a common and severe complication. Out of a sample of over 1.4 million PCI patients at 518 US hospitals from 2006 to 2015, AKI occurred in 5.73% of PCI patients. Those with AKI had at least double the hospitalization costs and the incremental cost was $9,448. It was also independently associated with an incremental length of stay of 3.6 days. AKI cost burden was extrapolated at 411.3 million US dollars annually.
AHRQ-funded; HS022481.
Citation: Amin AP, McNeely C, Spertus JA .
Incremental cost of acute kidney injury after percutaneous coronary intervention in the United States.
Am J Cardiol 2020 Jan;125(1):29-33. doi: 10.1016/j.amjcard.2019.09.042..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Adverse Events, Healthcare Costs, Kidney Disease and Health, Patient Safety, Registries
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)
Goyal P, Anderson TS, Bernacki GM
Physician perspectives on deprescribing cardiovascular medications for older adults.
Investigators sought to characterize and compare clinician perspectives regarding deprescribing cardiovascular medications for older adults across three specialties. Within each specialty, 750 physicians were surveyed. The investigators found that, while barriers to deprescribing cardiovascular medications were shared across specialties, reasons for deprescribing, especially in the setting of limited life expectancy, varied. They concluded that implementing deprescribing will require improved processes for both physician-physician and physician-patient communication.
AHRQ-funded; HS022982.
Citation: Goyal P, Anderson TS, Bernacki GM .
Physician perspectives on deprescribing cardiovascular medications for older adults.
J Am Geriatr Soc 2020 Jan;68(1):78-86. doi: 10.1111/jgs.16157..
Keywords: Elderly, Medication, Cardiovascular Conditions, Decision Making, Provider: Physician, Provider
Hay CC, Graham JE, Pappadis MR
The impact of one's sex and social living situation on rehabilitation outcomes after a stroke.
The goal of this retrospective observational study was to investigate sex differences and the impact of social living situation on individual functional independence measure outcomes after stroke rehabilitation. Subjects were Medicare fee-for-service beneficiaries discharged from inpatient rehabilitation facilities after a stroke. Results showed that when sociodemographic and clinical factors were controlled, females were more likely to discharge from inpatient rehabilitation at a supervision level or better for most functional independence measure items. Individuals who lived alone before their stroke had higher odds of discharging at a supervision level or better.
AHRQ-funded; HS022134.
Citation: Hay CC, Graham JE, Pappadis MR .
The impact of one's sex and social living situation on rehabilitation outcomes after a stroke.
Am J Phys Med Rehabil 2020 Jan;99(1):48-55. doi: 10.1097/phm.0000000000001276..
Keywords: Stroke, Rehabilitation, Elderly, Patient-Centered Outcomes Research, Sex Factors, Cardiovascular Conditions, Outcomes
Song J, Tark A, Larson EL
The relationship between pocket hematoma and risk of wound infection among patients with a cardiovascular implantable electronic device: an integrative review.
Pocket hematoma is a common adverse event following the insertion of cardiovascular implantable electronic devices (CIEDs), but the risk of wound infections associated with a pocket hematoma is unclear. The objective of this integrative review was to examine the relationship between pocket hematoma and risk of wound infection in a CIED population.
AHRQ-funded; HS024915.
Citation: Song J, Tark A, Larson EL .
The relationship between pocket hematoma and risk of wound infection among patients with a cardiovascular implantable electronic device: an integrative review.
Heart Lung 2020 Jan-Feb;49(1):92-98. doi: 10.1016/j.hrtlng.2019.09.009..
Keywords: Medical Devices, Cardiovascular Conditions, Surgery, Adverse Events, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Risk