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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
101 to 125 of 452 Research Studies DisplayedJackson 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
Halladay JR, Weiner BJ, In Kim J
Practice level factors associated with enhanced engagement with practice facilitators; findings from the Heart Health Now study.
In this analysis, the authors explored the practice and facilitator factors associated with greater team engagement at the mid-point of a 12-month practice facilitation intervention focused on implementing cardiovascular prevention activities in practice. Using data from the EvidenceNow initiative's NC Cooperative, named Heart Health Now, they found that their analysis provided information for practice facilitation stakeholders to consider when determining which practices may be more amendable to embracing facilitation services.
AHRQ-funded; HS023912.
Citation: Halladay JR, Weiner BJ, In Kim J .
Practice level factors associated with enhanced engagement with practice facilitators; findings from the Heart Health Now study.
BMC Health Serv Res 2020 Jul 28;20(1):695. doi: 10.1186/s12913-020-05552-4.
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Keywords: Heart Disease and Health, Cardiovascular Conditions, Primary Care, Primary Care: Models of Care, Patient-Centered Healthcare, Evidence-Based Practice, Teams
Moon J, Shen L, Likosky DS
Relationship of ventricular morphology and atrioventricular valve function to long-term outcomes following fontan procedures.
This study hypothesized that dysfunction of the single right ventricle (RV) and right atrioventricular valve regurgitation (AVVR) increases over time and adversely impacts late outcomes following a Fontan operation. Through a single-center retrospective study, findings showed that morphologic RV is negatively associated with the long-term survival following the Fontan, possibly due to a tendency toward progressive AVVR and deterioration of the single ventricle function. Additional volume overload caused by AVVR may be one of the main factors accelerating the dysfunction of the single RV, implying that early valve intervention may be warranted.
AHRQ-funded; HS026003.
Citation: Moon J, Shen L, Likosky DS .
Relationship of ventricular morphology and atrioventricular valve function to long-term outcomes following fontan procedures.
J Am Coll Cardiol 2020 Jul 28;76(4):419-31. doi: 10.1016/j.jacc.2020.05.059..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Surgery, Outcomes
Khazanie P, Wynia MK, Dickert NW. P, Wynia MK, Dickert NW
Forced choices: ethical challenges in cardiology during the COVID-19 pandemic.
This article discusses the ethical dilemmas that cardiologists may face with cardiac patients due to the COVID-19 pandemic. The influx of patients threatens to exhaust resources in many hospitals and creates many challenges. These include determining the urgency of subacute and chronic cardiovascular diseases. Another challenge is critical care triage in cardiac patients. Protocols were developed during the 2009 H1N1 pandemic which are now adapted for the COVID-19 pandemic. The largest challenge has been interacting with patients and their families. A cardiac patient may not be able to go to an intensive care unit due to severe scarcity of beds and to minimize risks to them and the medical staff.
AHRQ-funded; R01 HS026081.
Citation: Khazanie P, Wynia MK, Dickert NW. P, Wynia MK, Dickert NW .
Forced choices: ethical challenges in cardiology during the COVID-19 pandemic.
Circulation 2020 Jul 21;142(3):194-96. doi: 10.1161/circulationaha.120.047681..
Keywords: COVID-19, Cardiovascular Conditions, Heart Disease and Health, Public Health, Healthcare Delivery
Cornet VP, Toscos T, Bolchini D
Untold stories in user-centered design of mobile health: practical challenges and strategies learned from the design and evaluation of an app for older adults with heart failure.
This study’s goal was to characterize the practical challenges encountered and propose strategies when implementing user-centered design (UCD) for mHealth. Challenges identified included the timing of stakeholder involvement, overcoming designers' assumptions, adapting methods to end users, and managing heterogeneity among stakeholders. To address these challenges, this article provided practical recommendations to UCD researchers and practitioners.
AHRQ-funded; HS025232.
Citation: Cornet VP, Toscos T, Bolchini D .
Untold stories in user-centered design of mobile health: practical challenges and strategies learned from the design and evaluation of an app for older adults with heart failure.
JMIR Mhealth Uhealth 2020 Jul 21;8(7):e17703. doi: 10.2196/17703..
Keywords: Elderly, Heart Disease and Health, Cardiovascular Conditions, Telehealth, Health Information Technology (HIT)
Hadler RA, Curtis BR, Ikejiani DZ
"I'd have to basically be on my deathbed": heart failure patients' perceptions of and preferences for palliative care.
This cohort study examined individuals with New York Heart Association Class II-IV disease attitude towards palliative care (PC). Participants were recruited from inpatient and outpatient settings at an academic quaternary care hospital. They were given semistructured interviews discussing perceptions, knowledge, and preferences regarding PC, and also barriers to to PC delivery by facilitators. They interviewed 27 adults with heart failure (mean age 63, 85% white, 63% male). Participants frequently confused PC with hospice but once corrected they expressed variable preferences for primary versus specialist services. Preferences for primary versus specialist PC were based on different factors. Although there was more understanding of PC after the interviews, triggers for initiation remained focused on late-stage disease.
AHRQ-funded; HS022989.
Citation: Hadler RA, Curtis BR, Ikejiani DZ .
"I'd have to basically be on my deathbed": heart failure patients' perceptions of and preferences for palliative care.
J Palliat Med 2020 Jul;23(7):915-21. doi: 10.1089/jpm.2019.0451..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Palliative Care, Clinician-Patient Communication, Communication, Chronic Conditions
Haynes SC, Tancredi DJ, Tong K
Association of adherence to weight telemonitoring with health care use and death: a secondary analysis of a randomized clinical trial.
This study examined if heart failure patients who had lower adherence to weight telemonitoring had higher hospitalization and death rates. This study was a post hoc secondary analysis of the Better Effectiveness After Transition-Heart Failure randomized clinical trial which included patients from 6 academic medical centers in California. Criteria for eligibility was if they were hospitalized for decompensated heart failure. Exclusion criteria included if they were discharged to a skilled nursing facility, were expected to improve because of a medical procedure, or did not have the cognitive or physical ability to participate. The trial compared a telemonitoring intervention with usual care for patients with heart failure after hospital discharge from October 12, 2011 to September 30, 2013. The cohort of 538 eligible participants had a mean age of 70.9, was 53.8% male and 50.7% white. Adherence got better from week to week, and they found that every increase in adherence by 1 day was associated with a 19% decrease in the rate of death the following week and an 11% decrease in the rate of hospitalization. However, weight adherence is unlikely to be a result of the telemonitoring intervention.
AHRQ-funded; HS019311.
Citation: Haynes SC, Tancredi DJ, Tong K .
Association of adherence to weight telemonitoring with health care use and death: a secondary analysis of a randomized clinical trial.
JAMA Netw Open 2020 Jul;3(7):e2010174. doi: 10.1001/jamanetworkopen.2020.10174..
Keywords: Telehealth, Health Information Technology (HIT), Patient Adherence/Compliance, Obesity: Weight Management, Obesity, Heart Disease and Health, Cardiovascular Conditions, Hospitalization
Martsolf GR, Nuckols TK, Fingar KR
AHRQ Author: Stocks C, Owens PL
Nonspecific chest pain and hospital revisits within 7 days of care: variation across emergency department, observation and inpatient visits.
The purpose of this study was to compare the rate at which patients with nonspecific chest pain return to the hospital within 7 days after index observation visits versus after index emergency department and inpatient visits. Findings showed that up to 1 in 10 patients discharged with nonspecific chest pain returned to the hospital within 1week. Compared with emergency department and inpatient care, observation visits were associated with lower revisit rates. Recommendations include further research to refine clinical standards of care for nonspecific chest pain as well as to investigate the healthcare delivery and patient factors that influence 7-day revisit rates.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Martsolf GR, Nuckols TK, Fingar KR .
Nonspecific chest pain and hospital revisits within 7 days of care: variation across emergency department, observation and inpatient visits.
BMC Health Serv Res 2020 Jun 8;20(1):516. doi: 10.1186/s12913-020-05200-x..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Pain, Healthcare Utilization, Hospitals, Heart Disease and Health, Cardiovascular Conditions
Ahmad FS, Ricket IM, Hammill BG BG
Computable phenotype implementation for a national, multicenter pragmatic clinical trial: lessons learned from ADAPTABLE.
This methods paper provides an overview of the development and implementation of a computable phenotype in ADAPTABLE (Aspirin Dosing: a Patient-Centric Trial Assessing Benefits and Long-Term Effectiveness)--a pragmatic, randomized, open-label clinical trial testing the optimal dose of aspirin for secondary prevention of atherosclerotic cardiovascular disease events. Lessons learned included the following: the accuracy and utility of a computable phenotype are dependent on the quality of the source data; local validation and modification were required based on site factors; and sustained collaboration among a diverse team of researchers is needed during development and implementation. The ADAPTABLE computable phenotype served as an efficient method to recruit patients in a multisite pragmatic clinical trial.
AHRQ-funded; HS026385.
Citation: Ahmad FS, Ricket IM, Hammill BG BG .
Computable phenotype implementation for a national, multicenter pragmatic clinical trial: lessons learned from ADAPTABLE.
Circ Cardiovasc Qual Outcomes 2020 Jun;13(6):e006292. doi: 10.1161/circoutcomes.119.006292..
Keywords: Patient-Centered Outcomes Research, Research Methodologies, Heart Disease and Health, Cardiovascular Conditions
Prasada S, Rivera A, Nishtala A
Differential associations of chronic inflammatory diseases with incident heart failure.
The purpose of this study was to compare the risks of incident heart failure (HF) among a variety of chronic inflammatory diseases (CIDs) and to determine whether risks varied by severity of inflammation within each CID. Electronic health records from a large urban medical system were examined. Findings showed that systemic sclerosis and systemic lupus erythematosus were associated with the highest risks of HF, followed by rheumatoid arthritis and HIV. Measurements of inflammation were associated with HF risk across different CIDs.
AHRQ-funded; HS026385.
Citation: Prasada S, Rivera A, Nishtala A .
Differential associations of chronic inflammatory diseases with incident heart failure.
JACC Heart Fail 2020 Jun;8(6):489-98. doi: 10.1016/j.jchf.2019.11.013..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Chronic Conditions, Risk
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
Hansen JE, Brown DW, Hanke SP
Angiotensin-converting enzyme inhibitor prescription for patients with single ventricle physiology enrolled in the NPC-QIC registry.
This study examined trends in the routine use of angiotension-converting enzyme inhibitors (ACEI) during palliation of hypoplastic left heart syndrome, which is considered controversial. The authors used patients enrolled in the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) registry from 2008 to 2016 who had been prescribed ACEI between stage 1 palliation (stage I Norwood procedure) discharge and stage 2 palliation (stage II superior cavopulmonary anastomosis procedure) admission. ACEI prescriptions declined from 45% in the pre-2010 period to 36.8% from 2011 to 2016. No difference was found in interstage mortality, change in atrioventricular valve regurgitation, or change in ventricular dysfunction between groups. Atrioventricular septal defect, and preoperative mechanical ventilation were associated with increased ACEI prescription.
AHRQ-funded; HS021114.
Citation: Hansen JE, Brown DW, Hanke SP .
Angiotensin-converting enzyme inhibitor prescription for patients with single ventricle physiology enrolled in the NPC-QIC registry.
J Am Heart Assoc 2020 May 18;9(10):e014823. doi: 10.1161/jaha.119.014823..
Keywords: Newborns/Infants, Medication, Heart Disease and Health, Cardiovascular Conditions, Practice Patterns, Registries, Quality Improvement, Quality of Care
Spellberg B, Chambers HF, Musher DM
Evaluation of a paradigm shift from intravenous antibiotics to oral step-down therapy for the treatment of infective endocarditis: a narrative review.
The requirement of prolonged intravenous antibiotic courses to treat infective endocarditis (IE) is a time-honored dogma of medicine. However, numerous antibiotics are now available that achieve adequate levels in the blood after oral administration to kill bacteria. Moreover, prolonged intravenous antibiotic regimens are associated with high rates of adverse events. In this study, PubMed was reviewed to determine whether evidence supports the notion that oral step-down antibiotic therapy for IE is associated with inferior outcomes compared with intravenous-only therapy.
AHRQ-funded; HS025690.
Citation: Spellberg B, Chambers HF, Musher DM .
Evaluation of a paradigm shift from intravenous antibiotics to oral step-down therapy for the treatment of infective endocarditis: a narrative review.
JAMA Intern Med 2020 May;180(5):769-77. doi: 10.1001/jamainternmed.2020.0555..
Keywords: Antibiotics, Medication, Evidence-Based Practice, Cardiovascular Conditions, Heart Disease and Health
Mahtta D, Ahmed ST, Shah NR
Facility-level variation in cardiac stress test use among patients with diabetes: findings from the Veterans Affairs national database.
The authors evaluate facility-level variation in cardiac stress test use among patients with diabetes mellitus (DM) across the Veterans Affairs (VA) health care system. Their results suggest that significant residual variation in overall stress test use exists among veterans with DM. They recommend future studies to assess system-wide appropriateness of stress testing, to assess patient-level symptom data, and to conduct qualitative analyses in order to understand individual provider-level drivers behind such variation.
AHRQ-funded; HS022998.
Citation: Mahtta D, Ahmed ST, Shah NR .
Facility-level variation in cardiac stress test use among patients with diabetes: findings from the Veterans Affairs national database.
Diabetes Care 2020 May;43(5):e58-e60. doi: 10.2337/dc19-2160..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Diabetes, Decision Making, Diagnostic Safety and Quality, Chronic Conditions
Mefford MT, Goyal P, Howard G
The association of hypertension, hypertension duration, and control with incident heart failure in black and white adults.
Associations between hypertension and some cardiovascular diseases are stronger in black vs white adults. In this study, the investigators examined associations of hypertension, hypertension duration, and control with incident heart failure (HF) in black and white REasons for Geographic And Racial Differences in Stroke study participants (n = 25 770) who were followed for incident HF hospitalization (n = 947) from enrollment in 2003-2007 through 2015.
AHRQ-funded; HS013852.
Citation: Mefford MT, Goyal P, Howard G .
The association of hypertension, hypertension duration, and control with incident heart failure in black and white adults.
J Clin Hypertens 2020 May;22(5):857-66. doi: 10.1111/jch.13856..
Keywords: Blood Pressure, Heart Disease and Health, Cardiovascular Conditions, Racial and Ethnic Minorities
Moise N, Thanataveerat A, Florez-Salamanca L
Willingness to engage in traditional and novel depression treatment modalities among myocardial infarction survivors.
The authors assessed depression treatment attitudes, acceptability, and willingness by modality among myocardial infarction survivors with elevated depressive symptoms. They found that, despite positive attitudes and general willingness, only 20% were currently in therapy, perhaps due to suboptimal guideline implementation/symptom recognition, low motivation, and access/cost. Additionally, interest in self-help apps was low. The authors recommend further study to understand gaps between generally positive treatment attitudes and low treatment initiation rates.
AHRQ-funded; HS025198.
Citation: Moise N, Thanataveerat A, Florez-Salamanca L .
Willingness to engage in traditional and novel depression treatment modalities among myocardial infarction survivors.
J Gen Intern Med 2020 May;35(5):1620-22. doi: 10.1007/s11606-019-05406-8..
Keywords: Depression, Behavioral Health, Heart Disease and Health, Cardiovascular Conditions, Patient Adherence/Compliance
Wang Y, Eldridge N, Metersky ML
AHRQ Author: Eldridge N, Rodrick D
Association between Medicare expenditures and adverse events for patients with acute myocardial infarction, heart failure, or pneumonia in the United States.
The purpose of this study was to evaluate whether hospital-specific adverse event rates were associated with hospital-specific risk-standardized 30-day episode-of-care Medicare expenditures for fee-for-service patients discharged with acute myocardial infarction (AMI), heart failure (HF), or pneumonia. Investigators concluded that hospitals with high adverse event rates were more likely to have high 30-day episode-of-care Medicare expenditures for patients discharged with AMI, HF, or pneumonia.
AHRQ-authored; AHRQ-funded; 290201200003C.
Citation: Wang Y, Eldridge N, Metersky ML .
Association between Medicare expenditures and adverse events for patients with acute myocardial infarction, heart failure, or pneumonia in the United States.
JAMA Netw Open 2020 Apr;3(4):e202142. doi: 10.1001/jamanetworkopen.2020.2142..
Keywords: Adverse Events, Patient Safety, Heart Disease and Health, Cardiovascular Conditions, Pneumonia, Medicare, Healthcare Costs
Chen J, Sadasivam R, Blok AC
The association between patient-reported clinical factors and 30-day acute care utilization in chronic heart failure.
The purpose of this study was to identify post-discharge patient-reported clinical factors associated with repeat acute care use. Through phone surveys with patients with chronic heart failure, findings indicated that patient-reported poor health status, pain, and poor appetite were positively associated with 30-day acute care utilization. Recommendations included further study before incorporation into risk prediction to drive quality improvement efforts.
AHRQ-funded; HS017786.
Citation: Chen J, Sadasivam R, Blok AC .
The association between patient-reported clinical factors and 30-day acute care utilization in chronic heart failure.
Med Care 2020 Apr;58(4):336-43. doi: 10.1097/mlr.0000000000001258..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Hospital Readmissions, Emergency Department, Chronic Conditions
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
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
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
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
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