National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- Arthritis (1)
- Blood Clots (1)
- Blood Pressure (1)
- Blood Thinners (6)
- Cardiovascular Conditions (16)
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- Comparative Effectiveness (1)
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- Human Immunodeficiency Virus (HIV) (1)
- Inpatient Care (1)
- Medication (8)
- Mortality (1)
- Outcomes (4)
- Patient-Centered Outcomes Research (3)
- Practice Patterns (1)
- Prevention (2)
- Racial and Ethnic Minorities (5)
- Registries (2)
- Risk (9)
- (-) Stroke (20)
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 20 of 20 Research Studies DisplayedTroy AL, Herzig SJ, Trivedi S
Initiation of oral anticoagulation in US older adults newly diagnosed with atrial fibrillation during hospitalization.
This study investigated prevalence of oral anticoagulant initiation for newly diagnosed US older adults with atrial fibrillation within 7 days of hospital discharge. The authors used a 20% national sample of Medicare fee-for-service beneficiaries, identifying patients aged 65 years or older newly diagnosed with atrial fibrillation while hospitalized in 2016. Among 38,379 older adults newly diagnosed with atrial fibrillation while hospitalized (mean age 78.2; 51.8% female; 83.3% white), 36,633 (95.4%) had an indication for anticoagulation and 24.6% (9011) of those initiated an oral anticoagulant following discharge. Higher CHA(2) DS(2) -VASc score was associated with a small increase in oral anticoagulant initiation (predicted probability 20.5% for scores <2 and 24.9% for ≥4). Elevated HAS-BLED score was associated with a small decrease in probability of anticoagulant initiation (25.4% for score <2 and 23.1% for ≥3). Frailty was associated with decreased likelihood of oral anticoagulant initiation (24.7% for non-frail and 18.1% for moderately-severely frail). Anticoagulant initiation varied by primary reason for hospitalization, with predicted probability highest among patients with a primary diagnosis of atrial fibrillation (46.1%) and lowest among those with non-cardiovascular conditions (13.8%) and bleeds (3.6%).
AHRQ-funded; HS026215.
Citation: Troy AL, Herzig SJ, Trivedi S .
Initiation of oral anticoagulation in US older adults newly diagnosed with atrial fibrillation during hospitalization.
J Am Geriatr Soc 2023 Sep; 71(9):2748-58. doi: 10.1111/jgs.18375..
Keywords: Elderly, Blood Thinners, Medication, Heart Disease and Health, Cardiovascular Conditions, Stroke
Derington CG, Goodrich GK, Xu S
Association of direct oral anticoagulation management strategies with clinical outcomes for adults with atrial fibrillation.
This study investigated the impact of an anticoagulation management service (AMS) on clinical outcomes of adults with atrial fibrillation (AF). This retrospective cohort study was conducted in 3 Kaiser Permanente regions, with each region taking a slightly different approach to direct oral anticoagulant (DOAC) care. These approaches included (1) usual care (UC) by the prescribing clinician, (2) UC plus an automated population management tool (PMT), or (3) pharmacist-managed AMS care. The study included 44,746 adults with a diagnosis of AF who initiated DOAC or warfarin between August 2016 and January 1, 2020, 6182 in the UC model, 33,624 in the UC plus PMT care model, and 4939 in the AMS care model. Baseline characteristics (mean age, 73.1 years, 56.1% male, 67.2% non-Hispanic White, median CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65-74 years, female sex] score of 3 [IQR, 2-5]) were well balanced after inverse probability of treatment weighting (IPTW). The cohort was followed over a median of 2 years, and patients who received the UC plus PMT or AMS care model did not have significantly better outcomes than those who received only UC.
AHRQ-funded; HS026156.
Citation: Derington CG, Goodrich GK, Xu S .
Association of direct oral anticoagulation management strategies with clinical outcomes for adults with atrial fibrillation.
JAMA Netw Open 2023 Jul; 6(7):e2321971. doi: 10.1001/jamanetworkopen.2023.21971..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Blood Thinners, Medication, Outcomes, Stroke
O'Halloran JA, Sahrmann J, Butler AM
Brief report: integrase strand transfer inhibitors are associated with lower risk of incident cardiovascular disease in people living with HIV.
AHRQ-funded; HS019455.
Citation: O'Halloran JA, Sahrmann J, Butler AM .
Brief report: integrase strand transfer inhibitors are associated with lower risk of incident cardiovascular disease in people living with HIV.
J Acquir Immune Defic Syndr 2020 Aug 1;84(4):396-99. doi: 10.1097/qai.0000000000002357..
Keywords: Human Immunodeficiency Virus (HIV), Cardiovascular Conditions, Medication, Stroke, Heart Disease and Health, Risk
Jackson LR, Kim S, Blanco R
Discontinuation rates of warfarin versus direct acting oral anticoagulants in US clinical practice: results from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II (ORBIT-AF II).
The objective of this study was to evaluate discontinuation rates among patients on warfarin and direct oral anticoagulants (DOACs) in clinical practice. Over 10,000 AF patients were enrolled from the ORBIT-AF II Registry as subjects. Findings showed that, in a community based atrial fibrillation cohort, adjusted rates of discontinuation at 12 months were higher in DOAC-treated versus vitamin K antagonist-treated patients. Discontinuation of oral anticoagulation was associated with increased absolute risk of all-cause mortality and cardiovascular death.
AHRQ-funded; HS021092.
Citation: Jackson LR, Kim S, Blanco R .
Discontinuation rates of warfarin versus direct acting oral anticoagulants in US clinical practice: results from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II (ORBIT-AF II).
Am Heart J 2020 Aug;226:85-93. doi: 10.1016/j.ahj.2020.04.016..
Keywords: Blood Thinners, Medication, Registries, Stroke, Heart Disease and Health, Cardiovascular Conditions, Outcomes
Fudim M, Kelly JP, Brophy TJ
Trends in treatment for patients hospitalized with heart failure with preserved ejection fraction before and after Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT).
This study examined treatment trends for patients hospitalized for heart failure with preserved ejection fraction (HFpEF) after the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, which investigated spironolactone treatment vs placebo in HFpEF patients. This retrospective analysis looked at discharge prescribing data in the Get With The Guidelines-Heart Failure Registry among patients with left ventricular ejection fraction ≥50% discharged between 2009-2016. About 13% of the cohort of 142,201 patients were prescribed mineralocorticoid receptor antagonists (MRAs) at discharge. MRA prescribing increased modestly over time, but the TOPCAT trial did not seem to have an impact.
AHRQ-funded; HS021092.
Citation: Fudim M, Kelly JP, Brophy TJ .
Trends in treatment for patients hospitalized with heart failure with preserved ejection fraction before and after Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT).
Am J Cardiol 2020 Jun 1;125(11):1655-60. doi: 10.1016/j.amjcard.2020.02.038..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Stroke, Medication, Hospitalization, Inpatient Care, Practice Patterns
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
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
Mentias A, Shantha G, Adeola O
Role of diabetes and insulin use in the risk of stroke and acute myocardial infarction in patients with atrial fibrillation: a Medicare analysis.
This study examined the role of diabetes and insulin use in the risk of stroke and acute myocardial infarction (AMI) in patients with atrial fibrillation (AF). A cohort of Medicare beneficiaries newly diagnoses with AF from 2011 to 2013 were identified. The cohort was divided into those with diabetes requiring insulin (6.7%), those with diabetes not requiring insulin (31.3%) and non-diabetics (62%). Diabetics requiring insulin were at the greatest risk of stroke and AMI, and diabetics not requiring insulin were at slightly lower risk, but non-diabetics had the lowest risk.
AHRQ-funded; HS023104.
Citation: Mentias A, Shantha G, Adeola O .
Role of diabetes and insulin use in the risk of stroke and acute myocardial infarction in patients with atrial fibrillation: a Medicare analysis.
Am Heart J 2019 Aug;214:158-66. doi: 10.1016/j.ahj.2019.05.003..
Keywords: Diabetes, Stroke, Heart Disease and Health, Cardiovascular Conditions, Risk, Chronic Conditions, Elderly
O'Brien EC, Holmes DN, Thomas L
Incremental prognostic value of renal function for stroke prediction in atrial fibrillation.
This study investigated whether renal function predicted stroke in patients diagnosed with atrial fibrillation (AF). Data from the Outcomes Registry for Better Informed Treatment (ORBIT-AF) was used. Investigators concluded that renal dysfunction was not independently associated with embolic risk in either treated or untreated patients.
AHRQ-funded; HS021092.
Citation: O'Brien EC, Holmes DN, Thomas L .
Incremental prognostic value of renal function for stroke prediction in atrial fibrillation.
Int J Cardiol 2019 Jan 1;274:152-57. doi: 10.1016/j.ijcard.2018.07.113..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Risk, Stroke
Borre ED, Goode A, Raitz G
Predicting thromboembolic and bleeding event risk in patients with non-valvular atrial fibrillation: a systematic review.
This systematic review compared the strength of tools to predict stroke and bleeding risk in patients with atrial fibrillation (AF) taking blood thinners. Sixty-one studies were found to predict thromboembolic risk and 38 to predict bleeding risk.
AHRQ-funded; 290201500004I.
Citation: Borre ED, Goode A, Raitz G .
Predicting thromboembolic and bleeding event risk in patients with non-valvular atrial fibrillation: a systematic review.
Thromb Haemost 2018 Dec;118(12):2171-87. doi: 10.1055/s-0038-1675400..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Stroke, Blood Clots, Blood Thinners, Medication, Adverse Drug Events (ADE), Adverse Events, Risk, Patient-Centered Outcomes Research, Evidence-Based Practice
Sterling MR, Durant RW, Bryan J
N-terminal pro-B-type natriuretic peptide and microsize myocardial infarction risk in the reasons for geographic and racial differences in stroke study.
Researchers compared the association of N-terminal pro B-type peptide (NT-proBNP) with risk of incident typical myocardial infarction (MI) and microsize MI in the REasons for Geographic and Racial Differences in Stroke Study. Over a median of 5 years of follow-up, there were 315 typical MI, 139 microsize MI, and 195 incident fatal coronary heart disease (CHD). NT-proBNP was independently and strongly associated with all CHD endpoints, with significantly greater risk observed for incident microsize MI.
AHRQ-funded; HS000066.
Citation: Sterling MR, Durant RW, Bryan J .
N-terminal pro-B-type natriuretic peptide and microsize myocardial infarction risk in the reasons for geographic and racial differences in stroke study.
BMC Cardiovasc Disord 2018 Apr 16;18(1):66. doi: 10.1186/s12872-018-0806-4.
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Keywords: Heart Disease and Health, Racial and Ethnic Minorities, Risk, Stroke
Fudim M, Liu PR, Shrader P
Mineralocorticoid receptor antagonism in patients with atrial fibrillation: findings from the ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry.
Mineralocorticoid receptor antagonist (MRA) therapy may be beneficial to patients with atrial fibrillation (AF), but little is known about their use in patients with AF and subsequent outcomes. In order to better understand MRA use and subsequent outcomes, the investigators performed a retrospective cohort study of the contemporary ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry.
AHRQ-funded; HS021092.
Citation: Fudim M, Liu PR, Shrader P .
Mineralocorticoid receptor antagonism in patients with atrial fibrillation: findings from the ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry.
J Am Heart Assoc 2018 Apr 13;7(8). doi: 10.1161/jaha.117.007987..
Keywords: Cardiovascular Conditions, Evidence-Based Practice, Heart Disease and Health, Medication, Outcomes, Patient-Centered Outcomes Research, Prevention, Registries, Stroke
Mefford MT, Rosenson RS, Cushman M
PCSK9 variants, low-density lipoprotein cholesterol, and neurocognitive impairment: Reasons for Geographic and Racial Differences in Stroke Study(REGARDS).
Researchers examined if there was an association between low lifelong exposure to PCSK9 levels and lower levels of low-density lipoprotein cholesterol with neurocognitive function in blacks. Data was analyzed from subjects in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. The mean sample age was 64, with 62% women but a low prevalence of neurocognitive impairments at any level (6.3% by CERAD battery, and 15.4% by SIS definitions). No association with found.
AHRQ-funded; HS013852.
Citation: Mefford MT, Rosenson RS, Cushman M .
PCSK9 variants, low-density lipoprotein cholesterol, and neurocognitive impairment: Reasons for Geographic and Racial Differences in Stroke Study(REGARDS).
Circulation 2018 Mar 20;137(12):1260-69. doi: 10.1161/circulationaha.117.029785..
Keywords: Heart Disease and Health, Racial and Ethnic Minorities, Risk, Stroke
Tam MC, Lee R, Cascino TM
Current perspectives on systemic hypertension in heart failure with preserved ejection fraction.
Heart failure with preserved ejection fraction (HFpEF) is a prevalent but incompletely understood syndrome. Traditional models of HFpEF pathophysiology revolve around systemic hypertension (HTN) and other causes of increased left ventricular afterload leading to left ventricular hypertrophy (LVH) and diastolic dysfunction. However, emerging models attribute the development of HFpEF to systemic proinflammatory changes secondary to common comorbidities which include HTN.
AHRQ-funded; HS024567.
Citation: Tam MC, Lee R, Cascino TM .
Current perspectives on systemic hypertension in heart failure with preserved ejection fraction.
Curr Hypertens Rep 2017 Feb;19(2):12. doi: 10.1007/s11906-017-0709-2.
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Keywords: Blood Pressure, Heart Disease and Health, Cardiovascular Conditions, Stroke, Outcomes
Kabra R, Girotra S, Vaughan Sarrazin M
Refining stroke prediction in atrial fibrillation patients by addition of African-American ethnicity to CHA2DS2-VASc score.
The authors hypothesized that the addition of African-American ethnicity to the CHA2DS2-VASc score might improve stroke prediction in patients with atrial fibrillation (AF). They found that, in patients over age 65 with newly diagnosed AF, the addition of ethnicity to CHA2DS2-VASc score significantly improved stroke prediction.
AHRQ-funded; HS023104.
Citation: Kabra R, Girotra S, Vaughan Sarrazin M .
Refining stroke prediction in atrial fibrillation patients by addition of African-American ethnicity to CHA2DS2-VASc score.
J Am Coll Cardiol 2016 Aug 2;68(5):461-70. doi: 10.1016/j.jacc.2016.05.044.
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Keywords: Stroke, Heart Disease and Health, Racial and Ethnic Minorities, Risk, Cardiovascular Conditions
Kabra R, Cram P, Girotra S
Effect of race on outcomes (stroke and death) in patients >65 years with atrial fibrillation.
The researchers sought to determine whether there are any racial differences in the outcomes of death and stroke in patients with newly diagnosed AF in patients >65 years. They found that the risks of death and stroke are higher in blacks and Hispanics compared with whites. The increased risk was eliminated or significantly reduced after adjusting for preexisting co-morbidities.
AHRQ-funded; HS021992.
Citation: Kabra R, Cram P, Girotra S .
Effect of race on outcomes (stroke and death) in patients >65 years with atrial fibrillation.
Am J Cardiol 2015 Jul 15;116(2):230-5. doi: 10.1016/j.amjcard.2015.04.012..
Keywords: Elderly, Heart Disease and Health, Cardiovascular Conditions, Racial and Ethnic Minorities, Stroke, Mortality, Risk
Sims M, Redmond N, Khodneva Y
Depressive symptoms are associated with incident coronary heart disease or revascularization among blacks but not among whites in the Reasons for Geographical and Racial Differences in Stroke study.
The authors examined the association of depressive symptoms with coronary heart disease (CHD) end points by race and income. They found that high depressive symptoms were associated with higher risk of CHD or revascularization for blacks but not whites.
AHRQ-funded; HS023009.
Citation: Sims M, Redmond N, Khodneva Y .
Depressive symptoms are associated with incident coronary heart disease or revascularization among blacks but not among whites in the Reasons for Geographical and Racial Differences in Stroke study.
Ann Epidemiol 2015 Jun;25(6):426-32. doi: 10.1016/j.annepidem.2015.03.014.
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Keywords: Depression, Disparities, Heart Disease and Health, Racial and Ethnic Minorities, Stroke
Solomon DH, Reed GW, Kremer JM
Disease activity in rheumatoid arthritis and the risk of cardiovascular events.
The researchers studied whether time-averaged disease activity in rheumatoid arthritis (RA) correlates with cardiovascular (CV) events. They found that reduced time-averaged disease activity in RA is associated with fewer CV events.
AHRQ-funded; HS018517.
Citation: Solomon DH, Reed GW, Kremer JM .
Disease activity in rheumatoid arthritis and the risk of cardiovascular events.
Arthritis Rheumatol 2015 Jun;67(6):1449-55. doi: 10.1002/art.39098.
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Keywords: Cardiovascular Conditions, Heart Disease and Health, Arthritis, Risk, Stroke
Lauffenburger JC, Farley JF, Gehi AK
Effectiveness and safety of dabigatran and warfarin in real-world US patients with non-valvular atrial fibrillation: a retrospective cohort study.
The researchers compared the effectiveness and safety of the new oral anticoagulant, dabigatran, with warfarin in clinical practice among a large nationally representative retrospective cohort of commercially insured patients in the United States. They found that compared with warfarin, dabigatran was associated with a lower risk of ischemic stroke or systemic embolism, hemorrhagic stroke, and acute myocardial infarction.
AHRQ-funded; HS023099.
Citation: Lauffenburger JC, Farley JF, Gehi AK .
Effectiveness and safety of dabigatran and warfarin in real-world US patients with non-valvular atrial fibrillation: a retrospective cohort study.
J Am Heart Assoc 2015 Apr 10;4(4):e001798. doi: 10.1161/jaha.115.001798..
Keywords: Comparative Effectiveness, Blood Thinners, Patient-Centered Outcomes Research, Stroke, Heart Disease and Health
Navar-Boggan AM, Rymer JA, Piccini JP
Accuracy and validation of an automated electronic algorithm to identify patients with atrial fibrillation at risk for stroke.
The goal of this study is to create and validate an algorithm for identifying patients with atrial fibrillation (AF) as well as to identify those at moderate to high risk of stroke using administrative data. The researchers concluded that automated methods can be used to identify patients with prevalent AF indicated for anticoagulation but such methods may result in misclassification of up to 12 percent.
AHRQ-funded; HS021092.
Citation: Navar-Boggan AM, Rymer JA, Piccini JP .
Accuracy and validation of an automated electronic algorithm to identify patients with atrial fibrillation at risk for stroke.
Am Heart J 2015 Jan;169(1):39-44.e2. doi: 10.1016/j.ahj.2014.09.014..
Keywords: Heart Disease and Health, Stroke, Cardiovascular Conditions