66 results on '"Curtis LH"'
Search Results
2. Relationship between cardiac rehabilitation and long-term risks of death and myocardial infarction among elderly Medicare beneficiaries.
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Hammill BG, Curtis LH, Schulman KA, Whellan DJ, Hammill, Bradley G, Curtis, Lesley H, Schulman, Kevin A, and Whellan, David J
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- 2010
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3. External validity of the cardiovascular health study: a comparison with the Medicare population.
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DiMartino LD, Hammill BG, Curtis LH, Gottdiener JS, Manolio TA, Powe NR, Schulman KA, DiMartino, Lisa D, Hammill, Bradley G, Curtis, Lesley H, Gottdiener, John S, Manolio, Teri A, Powe, Neil R, and Schulman, Kevin A
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- 2009
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4. The insurance effect on prescription drug expenditures among the elderly: findings from the 1997 Medical Expenditure Panel Survey.
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Curtis LH, Law AW, Anstrom KJ, Schulman KA, Curtis, Lesley H, Law, Amy W, Anstrom, Kevin J, and Schulman, Kevin A
- Abstract
Background: Despite continuing debate over a prescription drug benefit for the Medicare program, there has been relatively little research estimating the potential cost of providing such a benefit.Objective: The objective of this study was to estimate the effect of prescription drug insurance on outpatient prescription drug expenditures among the elderly.Research Design: We studied respondents aged > or =65 years to the 1997 Medical Expenditure Panel Survey, a representative survey of the U.S. noninstitutionalized population. Survey-weighted linear regression models were used to estimate the probability of any expenditures and total expenditures while controlling for sociodemographic characteristics, chronic conditions, and health status.Measures: We used prescription drug insurance status and outpatient prescription drug expenditures.Results: An estimated 34 million elderly people filled 630 million prescriptions in 1997. Thirty-seven percent did not have prescription drug insurance. Total prescription drug expenditures exceeded $23 billion. Persons without prescription drug insurance spent slightly less than $7 billion; those with insurance spent more than $16 billion. After controlling for health status, comorbidity, and demographic characteristics, prescription drug insurance increased expenditures by $183 per person. The marginal increase in total expenditures of extending the average observed benefit to those currently uninsured is $2.3 billion (95% confidence interval, $1.2-3.5 billion).Conclusions: Proposals for a Medicare drug benefit provide high copayments to protect against insurance effects and to address uncertainty in cost estimates of the proposed benefit. By quantifying the insurance effect on expenditures among the elderly, the data reported here could reduce uncertainty in the budget estimation process. [ABSTRACT FROM AUTHOR]- Published
- 2004
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5. The value of patient-reported health status in predicting short-term outcomes after coronary artery bypass graft surgery.
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Curtis LH, Phelps CE, McDermott MP, Rubin HR, Curtis, Lesley H, Phelps, Charles E, McDermott, Michael P, and Rubin, Haya R
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Background: Risk stratification for comparison of outcomes after coronary artery bypass grafting (CABG) typically includes only clinical measures of risk. Patient-reported health status may be an important independent predictor of short-term health outcomes.Objective: To determine whether patient-reported health status, as measured by the Physical and Mental Component Summary scores of the SF-36, predicts in-hospital mortality and prolonged length of stay after CABG, after controlling for other clinical predictors of those outcomes.Research Design: Prospective cohort study conducted from September 1993 to November 1995.Subjects: One thousand seven hundred seventy-eight adults who underwent isolated CABG for myocardial ischemia.Measures: In-hospital mortality and prolonged length of stay (> 14 days).Results: There were 27 deaths and 223 patients with prolonged length of stay in the study sample. A 10-point decrease in the Physical Component Summary (PCS) score increased the odds of in-hospital mortality by 61% (OR, 1.61; 95% CI, 1.04-2.49), independent of established clinical risk factors. Similarly, a 10-point decrease in the PCS score increased the odds of prolonged length of stay by 33% (OR, 1.33; 95% CI, 1.13-1.57). A 10-point decrease in the Mental Component Summary score (MCS) decreased the odds of mortality by 36% (OR, 0.64; 95% CI, 0.43-0.95).Conclusions: The PCS score is independently and significantly associated with in-hospital mortality and prolonged length of stay, after controlling for clinical risk factors. The MCS score is independently and significantly associated only with mortality, though the direction of the effect is unexpected. The result likely reflects a property of the scoring of the MCS and not a finding of clinical substance. Although caution must be taken when interpreting the summary scores, the SF-36 yields information not otherwise captured by clinical data and may be useful in risk stratification for in-hospital mortality and prolonged length of stay after CABG. [ABSTRACT FROM AUTHOR]- Published
- 2002
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6. Using inverse probability-weighted estimators in comparative effectiveness analyses with observational databases.
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Curtis LH, Hammill BG, Eisenstein EL, Kramer JM, and Anstrom KJ
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- 2007
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7. Computable Phenotype Implementation for a National, Multicenter Pragmatic Clinical Trial: Lessons Learned From ADAPTABLE.
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Ahmad FS, Ricket IM, Hammill BG, Eskenazi L, Robertson HR, Curtis LH, Dobi CD, Girotra S, Haynes K, Kizer JR, Kripalani S, Roe MT, Roumie CL, Waitman R, Jones WS, and Weiner MG
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- Aspirin adverse effects, Cardiovascular Diseases diagnosis, Cardiovascular Diseases physiopathology, Data Mining, Humans, Multicenter Studies as Topic, Phenotype, Platelet Aggregation Inhibitors adverse effects, Pragmatic Clinical Trials as Topic, Algorithms, Aspirin administration & dosage, Cardiovascular Diseases drug therapy, Electronic Health Records, Patient Selection, Platelet Aggregation Inhibitors administration & dosage
- Abstract
Background: Many large-scale cardiovascular clinical trials are plagued with escalating costs and low enrollment. Implementing a computable phenotype, which is a set of executable algorithms, to identify a group of clinical characteristics derivable from electronic health records or administrative claims records, is essential to successful recruitment in large-scale pragmatic clinical trials. 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., Methods and Results: A multidisciplinary team developed and tested the computable phenotype to identify adults ≥18 years of age with a history of atherosclerotic cardiovascular disease without safety concerns around using aspirin and meeting trial eligibility criteria. Using the computable phenotype, investigators identified over 650 000 potentially eligible patients from the 40 participating sites from Patient-Centered Outcomes Research Network-a network of Clinical Data Research Networks, Patient-Powered Research Networks, and Health Plan Research Networks. Leveraging diverse recruitment methods, sites enrolled 15 076 participants from April 2016 to June 2019. During the process of developing and implementing the ADAPTABLE computable phenotype, several key lessons were learned. The accuracy and utility of a computable phenotype are dependent on the quality of the source data, which can be variable even with a common data model. Local validation and modification were required based on site factors, such as recruitment strategies, data quality, and local coding patterns. Sustained collaboration among a diverse team of researchers is needed during computable phenotype development and implementation., Conclusions: The ADAPTABLE computable phenotype served as an efficient method to recruit patients in a multisite pragmatic clinical trial. This process of development and implementation will be informative for future large-scale, pragmatic clinical trials. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02697916.
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- 2020
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8. Data Quarantine in the Time of the COVID-19 Pandemic.
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Shah RU and Curtis LH
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- COVID-19, Common Data Elements, Humans, Pandemics, Public Health, Quarantine, SARS-CoV-2, Betacoronavirus, Coronavirus Infections epidemiology, Data Collection, Electronic Health Records, Health Information Systems, Pneumonia, Viral epidemiology
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- 2020
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9. Use of Medicare Claims to Identify Adverse Clinical Outcomes After Mitral Valve Repair.
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Lowenstern A, Lippmann SJ, Brennan JM, Wang TY, Curtis LH, Feldman T, Glower DD, Hammill BG, and Vemulapalli S
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- Aged, Aged, 80 and over, Cardiac Catheterization mortality, Cardiac Surgical Procedures mortality, Databases, Factual, Female, Hemodynamics, Humans, Incidence, Male, Mitral Valve physiopathology, Mitral Valve Insufficiency mortality, Mitral Valve Insufficiency physiopathology, Postoperative Complications mortality, Postoperative Complications therapy, Risk Assessment, Risk Factors, Severity of Illness Index, Time Factors, Treatment Outcome, United States epidemiology, Administrative Claims, Healthcare, Cardiac Catheterization adverse effects, Cardiac Surgical Procedures adverse effects, Medicare, Mitral Valve surgery, Mitral Valve Insufficiency surgery, Postoperative Complications epidemiology
- Abstract
Background: Clinical event committees are commonly employed for event validation in clinical studies, but little is known about the comparative performance of administrative claims data versus clinician-triggered event adjudication for ascertainment of adverse events in structural heart disease studies., Methods and Results: Medicare claims were linked to 418 patients >65 years of age who underwent transcatheter mitral valve repair (MitraClip) for severe mitral regurgitation from 2007 to 2013 as part of the EVEREST II (Endovascular Valve Edge-to-Edge Repair Study II) High-Risk Registry or the REALISM (Real World Expanded Multicenter Study of the MitraClip System) Continued-Access Registry. Each registry adjudicated mortality, heart failure hospitalization, renal failure, ventilation, and bleeding/transfusion within 1 year. Concordance of claims-based outcomes with events was assessed in 3 ways: 1-year occurrence, cumulative incidence, and synchrony of first events. For event occurrence, positive predictive value (PPV) of claims versus adjudication was the highest for mortality (PPV=97%) and heart failure hospitalization (PPV=69%) but lower for bleeding (PPV=40%) and renal failure (PPV=19%). Whereas claims-based cumulative incidence for mortality, heart failure hospitalization, and renal failure were consistent with clinician-triggered adjudication, incidence curves for bleeding events and ventilation diverged, with claims identifying a greater number of events. When events were detected by both methods, however, over 75% of event dates matched exactly. Mitral valve reinterventions were identified through claims with perfect sensitivity and specificity relative to physician adjudication., Conclusions: Ascertainment of mortality, heart failure hospitalization, and renal failure was highly concordant between physician adjudication and administrative claims. Further work is necessary to determine the role of administrative claims in event ascertainment in both prospective and retrospective studies of structural heart disease.
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- 2019
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10. Association Between Prompt Defibrillation and Epinephrine Treatment With Long-Term Survival After In-Hospital Cardiac Arrest.
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Patel KK, Spertus JA, Khariton Y, Tang Y, Curtis LH, and Chan PS
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- Adrenergic Agonists adverse effects, Aged, Aged, 80 and over, Defibrillators, Epinephrine adverse effects, Female, Heart Arrest diagnosis, Heart Arrest mortality, Heart Arrest physiopathology, Hospital Mortality, Humans, Male, Medicare, Recovery of Function, Registries, Risk Factors, Time Factors, Treatment Outcome, United States, Adrenergic Agonists administration & dosage, Electric Countershock adverse effects, Electric Countershock instrumentation, Electric Countershock mortality, Epinephrine administration & dosage, Heart Arrest therapy, Hospitalization, Inpatients, Time-to-Treatment
- Abstract
Background: Prior studies have reported higher in-hospital survival with prompt defibrillation and epinephrine treatment in patients with in-hospital cardiac arrest (IHCA). Whether this survival benefit persists after discharge is unknown., Methods: We linked data from a national IHCA registry with Medicare files and identified 36 961 patients ≥65 years of age with an IHCA at 517 hospitals between 2000 and 2011. Patients with IHCA caused by pulseless ventricular tachycardia or ventricular fibrillation were stratified by prompt (≤2 minutes) versus delayed (>2 minutes) defibrillation, whereas patients with IHCA caused by asystole or pulseless electric activity were stratified by prompt (≤5 minutes) versus delayed (>5 minutes) epinephrine treatment. The association between prompt treatment and long-term survival for each rhythm type was assessed with multivariable hierarchical modified Poisson regression models., Results: Of 8119 patients with an IHCA caused by ventricular tachycardia or ventricular fibrillation, the rate of 1-year survival was higher in those treated with prompt defibrillation than with delayed defibrillation (25.7% [1466 of 5714] versus 15.5% [373 of 2405]; adjusted relative risk [RR], 1.49; 95% confidence interval [CI] 1.32-1.69; P <0.0001). This survival advantage persisted at 3 years (19.1% versus 11.0%; adjusted RR, 1.45; 95% CI, 1.23-1.69; P <0.0001) and at 5 years (14.7% versus 7.9%; adjusted RR, 1.50; 95% CI, 1.22-1.83; P <0.0001). Of 28 842 patients with an IHCA caused by asystole/pulseless electric activity, the rate of 1-year survival with prompt epinephrine treatment was higher than with delayed treatment (5.4% [1341 of 24 885] versus 4.3% [168 of 3957]; adjusted RR, 1.20; 95% CI, 1.02-1.41; P =0.02), but this survival benefit was no longer present at 3 years (3.5% versus 2.9%; adjusted RR, 1.17; 95% CI, 0.95-1.45; P =0.15) and at 5 years (2.3% versus 1.9%; adjusted RR, 1.18; 95% CI, 0.88-1.58; P =0.27)., Conclusions: Prompt defibrillation for IHCA caused by ventricular tachycardia or ventricular fibrillation was associated with higher rates of long-term survival throughout 5 years of follow-up, whereas prompt epinephrine treatment for asystole/pulseless electric activity was associated with greater survival at 1 year but not at 3 or 5 years. By quantifying the greater survival associated with timely defibrillation and epinephrine administration, these findings provide important insights into the durability of survival benefits for 2 process-of-care measures in current resuscitation guidelines., (© 2017 American Heart Association, Inc.)
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- 2018
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11. Representativeness of Medicare Participants in the Jackson Heart Study for African American Medicare Beneficiaries.
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Parikh KS, Greiner MA, Wang W, Min YI, Correa A, Banahan BF, Curtis LH, Hernandez AF, O'Brien EC, and Mentz RJ
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- Age Factors, Aged, Aged, 80 and over, Cardiovascular Diseases epidemiology, Female, Health Care Costs statistics & numerical data, Humans, Male, Medicare economics, Mississippi epidemiology, Proportional Hazards Models, Retrospective Studies, Risk Factors, Sex Factors, United States epidemiology, Black or African American statistics & numerical data, Cardiovascular Diseases etiology, Medicare statistics & numerical data
- Abstract
Background: The Jackson Heart Study (JHS) assesses cardiovascular disease risk factors among African Americans in Jackson, Mississippi. Whether characteristics of JHS participants differ from those of a broader African American population are unknown., Methods: In a retrospective observational analysis, we compared characteristics and outcomes of JHS participants 65 years old and older and enrolled in Medicare (n = 1,105) to regional (n = 57,489) and national (n = 95,494) cohorts of African American Medicare beneficiaries. We weighted the regional and national cohorts to match the age and sex distributions of the JHS-Medicare cohort for pairwise baseline comparisons. Outcomes of interest included mortality and Medicare costs. We used Cox proportional hazards models to test associations between cohorts and outcomes., Results: The JHS-Medicare cohort was younger, included more women, and had fewer beneficiaries with dual Medicare-Medicaid eligibility, compared with regional and national Medicare cohorts. The cohort also had lower risks of stroke, lung disease, heart failure, diabetes, and renal disease. Mean Medicare costs were lower ($5,066 [SD = $11,932]) than in the regional ($7,419 [SD = $17,574]) and national ($8,013 [SD = $19,378]) cohorts. The regional and national cohorts had higher mortality (adjusted hazard ratios = 1.52; 95% confidence interval [CI] = 1.31, 1.76; and 1.49; 95% CI = 1.29, 1.73, respectively). Subgroup analysis for dual Medicare-Medicaid eligibility attenuated mortality differences., Conclusion: JHS-Medicare participants had fewer comorbid conditions, better survival, and lower Medicare costs compared with regional and national cohorts. Observed differences may reflect healthy volunteer bias and higher socioeconomic status.See video abstract at, http://links.lww.com/EDE/B235.
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- 2017
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12. Putting Prognosis Into Perspective.
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Curtis LH and Rao SV
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- Humans, Prognosis, Percutaneous Coronary Intervention
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- 2017
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13. The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association.
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Maddox TM, Albert NM, Borden WB, Curtis LH, Ferguson TB Jr, Kao DP, Marcus GM, Peterson ED, Redberg R, Rumsfeld JS, Shah ND, and Tcheng JE
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- American Heart Association, Humans, United States, Cardiovascular Diseases, Delivery of Health Care
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The learning healthcare system uses health information technology and the health data infrastructure to apply scientific evidence at the point of clinical care while simultaneously collecting insights from that care to promote innovation in optimal healthcare delivery and to fuel new scientific discovery. To achieve these goals, the learning healthcare system requires systematic redesign of the current healthcare system, focusing on 4 major domains: science and informatics, patient-clinician partnerships, incentives, and development of a continuous learning culture. This scientific statement provides an overview of how these learning healthcare system domains can be realized in cardiovascular disease care. Current cardiovascular disease care innovations in informatics, data uses, patient engagement, continuous learning culture, and incentives are profiled. In addition, recommendations for next steps for the development of a learning healthcare system in cardiovascular care are presented., (© 2017 American Heart Association, Inc.)
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- 2017
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14. Prescriber Continuity and Disease Control of Older Adults.
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Maciejewski ML, Hammill BG, Bayliss EA, Ding L, Voils CI, Curtis LH, and Wang V
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- Aged, Aged, 80 and over, Comorbidity, Cross-Sectional Studies, Disease Management, Female, Humans, Male, Medicare, Medication Adherence statistics & numerical data, Polypharmacy, Retrospective Studies, United States, Veterans, Continuity of Patient Care statistics & numerical data, Diabetes Mellitus drug therapy, Dyslipidemias drug therapy, Hypoglycemic Agents therapeutic use, Hypolipidemic Agents therapeutic use, Medication Therapy Management, Practice Patterns, Physicians' statistics & numerical data
- Abstract
Background: Medicare beneficiaries with multiple chronic conditions are typically seen by multiple providers, particularly specialists. Clinically appropriate referrals to multiple specialists may compromise the continuity of care for multiple chronic condition beneficiaries and create care plans that patients may find challenging to reconcile, which may impact patient outcomes., Objective: The objective was to examine whether glycemic control or lipid control was associated with the number of prescribers of cardiometabolic medications., Research Design, Subjects, and Measures: A retrospective cross-sectional cohort analysis of 51,879 elderly Medicare fee-for-service beneficiaries with diabetes and 129,762 beneficiaries with dyslipidemia living in 10 east coast states. Glycemic control was defined as having an HbA1c<7.5. Lipid control was defined as an low-density lipoprotein<100 for beneficiaries with heart disease or diabetes or an low-density lipoprotein<130 for all other beneficiaries. We examined the association between the number of prescribers of cardiometabolic medications and disease or lipid control in 2011 through logistic regression, controlling for age, sex, race, Medicaid enrollment, 17 chronic conditions and state-fixed effects., Results: Among beneficiaries with diabetes, 76% with one prescriber had well-controlled diabetes in 2011, which decreased to 65% for beneficiaries with 5+ prescribers. In adjusted analyses, Medicare beneficiaries with 3 or more prescribers were less likely to have glycemic control than beneficiaries with a single prescriber. Among those with dyslipidemia, nearly all (91%-92%) beneficiaries had lipid control. After adjustment for demographics and comorbidity burden, beneficiaries with 3 prescribers were less likely to have lipid control than beneficiaries with a single prescriber., Conclusions: Multiple prescribers were associated with worse disease control, possibly because patients with more severe diabetes or dyslipidemia have multiple prescribers or because care fragmentation is associated with worse disease control.
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- 2017
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15. Characterization of Mineralocorticoid Receptor Antagonist Therapy Initiation in High-Risk Patients With Heart Failure.
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Cooper LB, Hammill BG, Peterson ED, Pitt B, Maciejewski ML, Curtis LH, and Hernandez AF
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- Acute Kidney Injury etiology, Acute Kidney Injury physiopathology, Administrative Claims, Healthcare, Aged, Aged, 80 and over, Biomarkers blood, Databases, Factual, Drug Monitoring, Female, Guideline Adherence, Heart Failure blood, Heart Failure complications, Heart Failure physiopathology, Hospitalization, Humans, Hyperkalemia blood, Hyperkalemia chemically induced, Hyperkalemia diagnosis, Kidney drug effects, Kidney physiopathology, Male, Medicare, Mineralocorticoid Receptor Antagonists adverse effects, Potassium blood, Practice Guidelines as Topic, Practice Patterns, Physicians', Renal Insufficiency complications, Renal Insufficiency physiopathology, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, United States, Heart Failure drug therapy, Mineralocorticoid Receptor Antagonists therapeutic use
- Abstract
Background: Heart failure guidelines recommend routine monitoring of serum potassium, and renal function in patients treated with a mineralocorticoid receptor antagonist (MRA). How these recommendations are implemented in high-risk patients or according to setting of drug initiation is poorly characterized., Methods and Results: We conducted a retrospective cohort study of Medicare beneficiaries linked to laboratory data in 10 states with prevalent heart failure as of July 1, 2011, and incident MRA use between May 1 and September 30, 2011. Outcomes included laboratory testing before MRA initiation and in the early (days 1-10) and extended (days 11-90) post-initiation periods, based on setting of drug initiation and the presence of renal insufficiency. Additional outcomes included abnormal laboratory results and adverse events proximate to MRA initiation. Of 10 443 Medicare beneficiaries with heart failure started on an MRA, 19.7% were initiated during a hospitalization. Appropriate follow-up laboratory testing across all time periods occurred in 25.2% of patients with inpatient initiation compared with 2.8% of patients begun as an outpatient. Patients with chronic kidney disease had higher rates of both hyperkalemia and acute kidney failure in the early (1.3% and 2.7%, respectively) and extended (5.6% and 9.8%, respectively) post-initiation periods compared with those without chronic kidney disease., Conclusions: Patients initiated on MRA therapy as an outpatient had extremely poor rates of guideline indicated follow-up laboratory monitoring after drug initiation. In particular, patients with chronic kidney disease are at high risk for adverse events after MRA initiation. Quality improvement initiatives focused on systems to improve appropriate laboratory monitoring are needed., Competing Interests: Disclosures: Dr Peterson reported receiving research grants from Eli Lilly and Janssen; and serving as a consultant for Astra Zeneca, Boehringer Ingelheim, Janssen, and Sanofi. Dr Pitt reported serving as a consultant to Bayer, Pfizer, and Relypsa; owning stock in Relypsa; and having a patent pending regarding site-specific delivery of eplerenone to the myocardium. Dr Maciejewski reported receiving research support from the Agency for Healthcare Research and Quality, the Veterans Health Administration and the National Center for Quality Assurance, and owning stock in Amgen. Dr Curtis reported receiving research support from Boston Scientific, Bristol-Myers Squibb, GE Healthcare, GlaxoSmithKline, Johnson & Johnson, Medtronic, Merck, and Novartis. Dr Hernandez reported receiving research grants from Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, GlaxoSmithKline, Merck, Novartis and Portola Pharmaceuticals; and serving as a consultant for Amgen, Bristol Myers Squibb, Gilead, Janssen, Novartis, Pleuristem Therapeutics, and Sensible. No other disclosures were reported., (© 2017 American Heart Association, Inc.)
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- 2017
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16. Few Disparities in Baseline Laboratory Testing After the Diuretic or Digoxin Initiation by Medicare Fee-For-Service Beneficiaries.
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Maciejewski ML, Mi X, Curtis LH, Ng J, Haffer SC, and Hammill BG
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- Age Factors, Aged, Biomarkers blood, Blood Chemical Analysis standards, Cardiovascular Agents adverse effects, Cardiovascular Diseases blood, Cardiovascular Diseases diagnosis, Cardiovascular Diseases ethnology, Creatinine blood, Databases, Factual, Digoxin adverse effects, Diuretics adverse effects, Drug Monitoring methods, Female, Guideline Adherence standards, Humans, Male, Odds Ratio, Potassium blood, Practice Guidelines as Topic standards, Predictive Value of Tests, Racial Groups, Sex Factors, United States epidemiology, Cardiovascular Agents therapeutic use, Cardiovascular Diseases drug therapy, Digoxin therapeutic use, Diuretics therapeutic use, Drug Monitoring standards, Fee-for-Service Plans standards, Healthcare Disparities standards, Insurance Benefits standards, Medicare standards, Practice Patterns, Physicians' standards
- Abstract
Background: Despite the persistence of significant disparities, few evaluations examine disparities in laboratory testing by race/ethnicity, age, sex, Medicaid eligibility, and number of chronic conditions for Medicare fee-for-service beneficiaries' newly prescribed medications. In Medicare beneficiaries initiating diuretics or digoxin, this study examined disparities in guideline-appropriate baseline laboratory testing and abnormal laboratory values., Methods and Results: To evaluate guideline-concordant testing for serum creatinine and serum potassium within 180 days before or 14 days after the index prescription fill date, we constructed retrospective cohorts from 10 states of 99 711 beneficiaries who had heart failure or hypertension initiating diuretic in 2011 and 8683 beneficiaries who had heart failure or atrial fibrillation initiating digoxin. Beneficiaries initiating diuretics were less likely to have testing if they were non-Hispanic Black (relative risk [RR], 0.99; 95% confidence interval [CI], 0.98-0.99) than non-Hispanic White. Beneficiaries initiating diuretics and beneficiaries initiating digoxin were more likely to have testing if they had multiple chronic conditions relative to 0 to 1 conditions. Beneficiaries initiating diuretics with laboratory values were more likely to have an abnormal serum creatinine value at baseline if they were non-Hispanic Black (RR, 2.57; 95% CI, 1.91-3.44), other race (RR, 2.11; 95% CI, 1.08-4.10), or male (RR, 2.75; 95% CI, 2.14-3.52) or an abnormal serum potassium value if they were aged ≥76 years (RR, 1.29; 95% CI, 1.09-1.51) or male (RR, 1.17; 95% CI, 1.03-1.33)., Conclusions: Testing rates were consistently high, so there were negligible disparities in guideline-concordant testing of creatinine and potassium after the initiation of digoxin or diuretics by Medicare beneficiaries., (© 2016 American Heart Association, Inc.)
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- 2016
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17. Antihyperglycemic Medication Use Among Medicare Beneficiaries With Heart Failure, Diabetes Mellitus, and Chronic Kidney Disease.
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Patel PA, Liang L, Khazanie P, Hammill BG, Fonarow GC, Yancy CW, Bhatt DL, Curtis LH, and Hernandez AF
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- Aged, Aged, 80 and over, Comorbidity, Contraindications, Diabetes Mellitus diagnosis, Diabetes Mellitus epidemiology, Disease Progression, Drug Utilization Review, Female, Glomerular Filtration Rate, Guideline Adherence, Heart Failure diagnosis, Heart Failure therapy, Hospitalization, Humans, Kidney physiopathology, Male, Practice Guidelines as Topic, Practice Patterns, Physicians', Prognosis, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic physiopathology, Renal Insufficiency, Chronic therapy, Risk Assessment, Risk Factors, United States epidemiology, Diabetes Mellitus drug therapy, Heart Failure epidemiology, Hypoglycemic Agents, Insurance Benefits, Kidney drug effects, Medicare Part D, Renal Insufficiency, Chronic epidemiology
- Abstract
Background: Diabetes mellitus, heart failure (HF), and chronic kidney disease are common comorbidities, but overall use and safety of antihyperglycemic medications (AHMs) among patients with these comorbidities are poorly understood., Methods and Results: Using Get With the Guidelines-Heart Failure and linked Medicare Part D data, we assessed AHM use within 90 days of hospital discharge among HF patients with diabetes mellitus discharged from Get With the Guidelines-Heart Failure hospitals between January 1, 2006, and October 1, 2011. We further summarized use by renal function and assessed renal contraindicated AHM use for patients with estimated glomerular filtration rate <30 mL/min/1.73m(2). Among 8791 patients meeting inclusion criteria, the median age was 77 (interquartile range 71-83), 62.3% were female, median body mass index was 29.7 (interquartile range 25.5-35.3), median hemoglobin A1c was 6.8 (interquartile range 6.2-7.8), and 34% had ejection fraction <40%. 74.9% of patients filled a prescription for an AHM, with insulin (39.5%), sulfonylureas (32.4%), and metformin (17%) being the most commonly used AHMs. Insulin use was higher and sulfonylurea/metformin use was lower among patients with lower renal function classes. Among 1512 patients with estimated glomerular filtration rate <30 mL/min/1.73m(2), 35.4% filled prescriptions for renal contraindicated AHMs per prescribing information, though there was a trend toward lower renal contraindicated AHM use over time (Cochran-Mantel-Haenszel row-mean score test P=0.048). Although use of other AHMs was low overall, thiazolidinediones were used in 6.6% of HF patients, and dipeptidyl peptidase-4 inhibitors were used in 5.1%, with trends for decreasing thiazolidinedione use and increased dipeptidyl peptidase-4 inhibitor use over time (P<0.001)., Conclusions: Treatment of diabetes mellitus in patients with HF and chronic kidney disease is complex, and these patients are commonly treated with renal contraindicated AHMs, including over 6% receiving a thiazolidinedione, despite known concerns regarding HF. More research regarding safety and efficacy of various AHMs among HF patients is needed., (© 2016 American Heart Association, Inc.)
- Published
- 2016
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18. Comparative Effectiveness of Cardiac Resynchronization Therapy Among Patients With Heart Failure and Atrial Fibrillation: Findings From the National Cardiovascular Data Registry's Implantable Cardioverter-Defibrillator Registry.
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Khazanie P, Greiner MA, Al-Khatib SM, Piccini JP, Turakhia MP, Varosy PD, Masoudi FA, Curtis LH, and Hernandez AF
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- Aged, Aged, 80 and over, Atrial Fibrillation diagnosis, Atrial Fibrillation mortality, Atrial Fibrillation physiopathology, Chi-Square Distribution, Comparative Effectiveness Research, Death, Sudden, Cardiac etiology, Electric Countershock adverse effects, Electric Countershock mortality, Female, Heart Failure diagnosis, Heart Failure mortality, Heart Failure physiopathology, Humans, Kaplan-Meier Estimate, Logistic Models, Male, Medicare, Patient Readmission, Propensity Score, Proportional Hazards Models, Registries, Risk Factors, Time Factors, Treatment Outcome, United States, Atrial Fibrillation therapy, Cardiac Resynchronization Therapy adverse effects, Cardiac Resynchronization Therapy mortality, Cardiac Resynchronization Therapy Devices, Death, Sudden, Cardiac prevention & control, Defibrillators, Implantable, Electric Countershock instrumentation, Heart Failure therapy, Primary Prevention instrumentation
- Abstract
Background: Atrial fibrillation is common in patients with heart failure, but outcomes of patients with both conditions who receive cardiac resynchronization therapy with defibrillator (CRT-D) compared with an implantable cardioverter-defibrillator (ICD) alone are unclear., Methods and Results: Using the National Cardiovascular Data Registry's ICD Registry linked with Medicare claims, we identified 8951 patients with atrial fibrillation who were eligible for CRT-D and underwent first-time device implantation for primary prevention between April 2006 and December 2009. We used Cox proportional hazards models and inverse probability-weighted estimates to compare outcomes with CRT-D versus ICD alone. Cumulative incidence of mortality (744 [33%] for ICD; 1893 [32%] for CRT-D) and readmission (1788 [76%] for ICD; 4611 [76%] for CRT-D) within 3 years and complications within 90 days were similar between groups. After inverse weighting for the probability of receiving CRT-D, risks of mortality (hazard ratio, 0.83; 95% confidence interval, 0.75-0.92), all-cause readmission (hazard ratio, 0.86; 95% confidence interval, 0.80-0.92), and heart failure readmission (hazard ratio, 0.68; 95% confidence interval, 0.62-0.76) were lower with CRT-D compared with ICD alone. There was no significant difference in the 90-day complication rate (hazard ratio, 0.88; 95% confidence interval, 0.60-1.29). We observed hospital-level variation in the use of CRT-D among patients with atrial fibrillation., Conclusions: Among eligible patients with heart failure and atrial fibrillation, CRT-D was associated with lower risks of mortality, all-cause readmission, and heart failure readmission, as well as with a similar risk of complications compared with ICD alone., (© 2016 American Heart Association, Inc.)
- Published
- 2016
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19. Report of the National Heart, Lung, and Blood Institute Working Group: An Integrated Network for Congenital Heart Disease Research.
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Pasquali SK, Jacobs JP, Farber GK, Bertoch D, Blume ED, Burns KM, Campbell R, Chang AC, Chung WK, Riehle-Colarusso T, Curtis LH, Forrest CB, Gaynor WJ, Gaies MG, Go AS, Henchey P, Martin GR, Pearson G, Pemberton VL, Schwartz SM, Vincent R, and Kaltman JR
- Subjects
- Clinical Trials as Topic, Data Collection, Data Curation, Electronic Health Records, Health Information Systems economics, Humans, Medical Informatics, Medical Record Linkage, National Heart, Lung, and Blood Institute (U.S.), Registries, United States epidemiology, Biomedical Research organization & administration, Data Mining, Databases, Factual, Health Information Systems organization & administration, Heart Defects, Congenital epidemiology
- Abstract
The National Heart, Lung, and Blood Institute convened a working group in January 2015 to explore issues related to an integrated data network for congenital heart disease research. The overall goal was to develop a common vision for how the rapidly increasing volumes of data captured across numerous sources can be managed, integrated, and analyzed to improve care and outcomes. This report summarizes the current landscape of congenital heart disease data, data integration methodologies used across other fields, key considerations for data integration models in congenital heart disease, and the short- and long-term vision and recommendations made by the working group., (© 2016 American Heart Association, Inc.)
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- 2016
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20. Further Evolution of the ACC/AHA Clinical Practice Guideline Recommendation Classification System: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
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Halperin JL, Levine GN, Al-Khatib SM, Birtcher KK, Bozkurt B, Brindis RG, Cigarroa JE, Curtis LH, Fleisher LA, Gentile F, Gidding S, Hlatky MA, Ikonomidis J, Joglar J, Pressler SJ, and Wijeysundera DN
- Subjects
- Advisory Committees, American Heart Association, Cardiology organization & administration, Classification, Societies, Medical, United States, Evidence-Based Medicine classification, Evidence-Based Medicine standards, Practice Guidelines as Topic standards
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- 2016
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21. Good Clinical Practice Guidance and Pragmatic Clinical Trials: Balancing the Best of Both Worlds.
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Mentz RJ, Hernandez AF, Berdan LG, Rorick T, O'Brien EC, Ibarra JC, Curtis LH, and Peterson ED
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- Clinical Trials as Topic methods, Humans, Research Design standards, Clinical Trials as Topic standards, Practice Guidelines as Topic standards
- Abstract
Randomized, clinical trials are commonly regarded as the highest level of evidence to support clinical decisions. Good Clinical Practice guidelines have been constructed to provide an ethical and scientific quality standard for trials that involve human subjects in a manner aligned with the Declaration of Helsinki. Originally designed to provide a unified standard of trial data to support submission to regulatory authorities, the principles may also be applied to other studies of human subjects. Although the application of Good Clinical Practice principles generally led to improvements in the quality and consistency of trial operations, these principles have also contributed to increasing trial complexity and costs. Alternatively, the growing availability of electronic health record data has facilitated the possibility for streamlined pragmatic clinical trials. The central tenets of Good Clinical Practice and pragmatic clinical trials represent potential tensions in trial design (stringent quality and highly efficient operations). In the present article, we highlight potential areas of discordance between Good Clinical Practice guidelines and the principles of pragmatic clinical trials and suggest strategies to streamline study conduct in an ethical manner to optimally perform clinical trials in the electronic age., (© 2016 American Heart Association, Inc.)
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- 2016
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22. Surgery for Aortic Dilatation in Patients With Bicuspid Aortic Valves: A Statement of Clarification From the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
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Hiratzka LF, Creager MA, Isselbacher EM, Svensson LG, Nishimura RA, Bonow RO, Guyton RA, Sundt TM 3rd, Halperin JL, Levine GN, Anderson JL, Albert NM, Al-Khatib SM, Birtcher KK, Bozkurt B, Brindis RG, Cigarroa JE, Curtis LH, Fleisher LA, Gentile F, Gidding S, Hlatky MA, Ikonomidis J, Joglar J, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, and Wijeysundera DN
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- Aortic Diseases diagnosis, Aortic Diseases surgery, Aortic Valve surgery, Bicuspid Aortic Valve Disease, Cardiology methods, Heart Valve Diseases diagnosis, Humans, United States, Advisory Committees standards, American Heart Association, Aortic Valve abnormalities, Cardiology standards, Heart Valve Diseases surgery, Practice Guidelines as Topic standards
- Abstract
Two guidelines from the American College of Cardiology (ACC), the American Heart Association (AHA), and collaborating societies address the risk of aortic dissection in patients with bicuspid aortic valves and severe aortic enlargement: the "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease" (Circulation. 2010;121:e266-e369) and the "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease" (Circulation. 2014;129:e521-e643). However, the 2 guidelines differ with regard to the recommended threshold of aortic root or ascending aortic dilatation that would justify surgical intervention in patients with bicuspid aortic valves. The ACC and AHA therefore convened a subcommittee representing members of the 2 guideline writing committees to review the evidence, reach consensus, and draft a statement of clarification for both guidelines. This statement of clarification uses the ACC/AHA revised structure for delineating the Class of Recommendation and Level of Evidence to provide recommendations that replace those contained in Section 9.2.2.1 of the thoracic aortic disease guideline and Section 5.1.3 of the valvular heart disease guideline., (© 2015 American College of Cardiology Foundation and American Heart Association, Inc.)
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- 2016
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23. Clinical Effectiveness of Hydralazine-Isosorbide Dinitrate Therapy in Patients With Heart Failure and Reduced Ejection Fraction: Findings From the Get With The Guidelines-Heart Failure Registry.
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Khazanie P, Liang L, Curtis LH, Butler J, Eapen ZJ, Heidenreich PA, Bhatt DL, Peterson ED, Yancy CW, Fonarow GC, and Hernandez AF
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- Aged, Aged, 80 and over, Chi-Square Distribution, Disease Progression, Drug Combinations, Female, Heart Failure diagnosis, Heart Failure mortality, Heart Failure physiopathology, Humans, Hydralazine adverse effects, Isosorbide Dinitrate adverse effects, Kaplan-Meier Estimate, Logistic Models, Male, Medicare Part D, Patient Discharge, Patient Readmission, Proportional Hazards Models, Registries, Risk Factors, Time Factors, Treatment Outcome, United States, Guideline Adherence standards, Heart Failure drug therapy, Hydralazine therapeutic use, Isosorbide Dinitrate therapeutic use, Practice Guidelines as Topic standards, Practice Patterns, Physicians' standards, Stroke Volume drug effects
- Abstract
Background: In clinical trials, hydralazine-isosorbide dinitrate (H-ISDN) for heart failure with reduced ejection fraction reduced morbidity and mortality among black patients and patients with intolerance to angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. The effectiveness of H-ISDN in clinical practice is unknown., Methods and Results: Using data from a clinical registry linked with Medicare claims, we examined the use and outcomes of H-ISDN between 2005 and 2011 among older patients hospitalized with heart failure and reduced ejection fraction. We adjusted for demographic and clinical characteristics using Cox proportional hazards models and inverse probability weighting. Among 4663 eligible patients, 22.7% of black patients and 18.2% of patients not on an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker were newly prescribed H-ISDN therapy at discharge. By 3 years, the cumulative incidence rates of mortality and readmission were similar between treated and untreated patients. After multivariable adjustment, 3-year outcomes remained similar for mortality [black patients: hazard ratio (HR), 0.92; 95% confidence interval (CI), 0.75-1.13; other patients: HR, 0.93; 95% CI, 0.79-1.09], all-cause readmission (black patients: HR, 0.98; 95% CI, 0.84-1.13; other patients: HR, 1.02; 95% CI, 0.90-1.17), and cardiovascular readmission (black patients: HR, 0.99; 95% CI, 0.82-1.19; other patients: HR, 0.94; 95% CI, 0.81-1.09). A post hoc analysis of Medicare Part D data revealed low postdischarge adherence to therapy., Conclusions: Guideline-recommended initiation of H-ISDN therapy at hospital discharge was uncommon, and adherence was low. For both black patients and patients of other races, there were no differences in outcomes between those treated and untreated at discharge., (© 2016 American Heart Association, Inc.)
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- 2016
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24. Study of Cardiovascular Health Outcomes in the Era of Claims Data: The Cardiovascular Health Study.
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Psaty BM, Delaney JA, Arnold AM, Curtis LH, Fitzpatrick AL, Heckbert SR, McKnight B, Ives D, Gottdiener JS, Kuller LH, and Longstreth WT Jr
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- Blood Glucose analysis, Cardiovascular Diseases diagnosis, Cardiovascular Diseases therapy, Female, Follow-Up Studies, Health Surveys, Hospitalization statistics & numerical data, Hospitals, Veterans statistics & numerical data, Humans, Insurance Claim Review, International Classification of Diseases, Lipids blood, Male, Managed Care Programs statistics & numerical data, Risk Factors, Sampling Studies, Treatment Outcome, United States epidemiology, Cardiovascular Diseases epidemiology, Medicare statistics & numerical data
- Abstract
Background: Increasingly, the diagnostic codes from administrative claims data are being used as clinical outcomes., Methods and Results: Data from the Cardiovascular Health Study (CHS) were used to compare event rates and risk factor associations between adjudicated hospitalized cardiovascular events and claims-based methods of defining events. The outcomes of myocardial infarction (MI), stroke, and heart failure were defined in 3 ways: the CHS adjudicated event (CHS[adj]), selected International Classification of Diseases, Ninth Edition diagnostic codes only in the primary position for Medicare claims data from the Center for Medicare & Medicaid Services (CMS[1st]), and the same selected diagnostic codes in any position (CMS[any]). Conventional claims-based methods of defining events had high positive predictive values but low sensitivities. For instance, the positive predictive value of International Classification of Diseases, Ninth Edition code 410.x1 for a new acute MI in the first position was 90.6%, but this code identified only 53.8% of incident MIs. The observed event rates for CMS[1st] were low. For MI, the incidence was 14.9 events per 1000 person-years for CHS[adj] MI, 8.6 for CMS[1st] MI, and 12.2 for CMS[any] MI. In general, cardiovascular disease risk factor associations were similar across the 3 methods of defining events. Indeed, traditional cardiovascular disease risk factors were also associated with all first hospitalizations not resulting from an MI., Conclusions: The use of diagnostic codes from claims data as clinical events, especially when restricted to primary diagnoses, leads to an underestimation of event rates. Additionally, claims-based events data represent a composite end point that includes the outcome of interest and selected (misclassified) nonevent hospitalizations., (© 2015 American Heart Association, Inc.)
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- 2016
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25. 2015 ACC/AHA Focused Update of Secondary Prevention Lipid Performance Measures: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures.
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Drozda JP Jr, Ferguson TB Jr, Jneid H, Krumholz HM, Nallamothu BK, Olin JW, Ting HH, Heidenreich PA, Albert NM, Chan PS, Curtis LH, Ferguson TB Jr, Fonarow GC, Ho PM, O'Brien S, Russo AM, Thomas RJ, Ting HH, and Varosy PD
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- Advisory Committees, American Heart Association, Cardiology methods, Cardiology standards, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Medication Adherence, Practice Guidelines as Topic, Secondary Prevention methods, United States, Cardiovascular Diseases prevention & control, Hyperlipidemias drug therapy, Secondary Prevention standards
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- 2016
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26. ACC/AHA/STS Statement on the Future of Registries and the Performance Measurement Enterprise: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and The Society of Thoracic Surgeons.
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Bhatt DL, Drozda JP Jr, Shahian DM, Chan PS, Fonarow GC, Heidenreich PA, Jacobs JP, Masoudi FA, Peterson ED, Welke KF, Heidenreich PA, Albert NM, Chan PS, Curtis LH, Ferguson TB Jr, Fonarow GC, Ho PM, Jurgens C, O'Brien S, Russo AM, Thomas RJ, Ting HH, and Varosy PD
- Subjects
- Cardiology ethics, Cardiovascular Diseases diagnosis, Conflict of Interest, Delivery of Health Care, Integrated ethics, Evidence-Based Medicine ethics, Health Care Sector ethics, Health Care Sector standards, Humans, Interinstitutional Relations, Process Assessment, Health Care ethics, Quality Improvement, Quality Indicators, Health Care ethics, Registries ethics, Treatment Outcome, Cardiology standards, Cardiovascular Diseases therapy, Delivery of Health Care, Integrated standards, Evidence-Based Medicine standards, Process Assessment, Health Care standards, Quality Indicators, Health Care standards, Registries standards
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- 2015
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27. Linkage of Laboratory Results to Medicare Fee-for-Service Claims.
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Hammill BG, Curtis LH, Qualls LG, Hastings SN, Wang V, and Maciejewski ML
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- Clinical Laboratory Services economics, Female, Humans, Male, Medicare economics, Quality Assurance, Health Care, Reimbursement Mechanisms statistics & numerical data, United States, Clinical Laboratory Services standards, Fee-for-Service Plans statistics & numerical data, Insurance Claim Reporting statistics & numerical data, Medicare statistics & numerical data
- Abstract
Background: Medicare is the single largest purchaser of laboratory testing in the United States, yet test results associated with Medicare laboratory claims have historically not been available., Objective: The purpose of this study was to describe both the linkage of laboratory results data to Medicare claims and the completeness of these results data. In a subgroup of beneficiaries initiating angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, we also demonstrate the generalizability of Medicare beneficiaries with laboratory values compared with those without laboratory values. We end with a discussion of the limitations and potential uses of these linked data., Methods: We obtained information about laboratory orders and results for all Medicare fee-for-service beneficiaries in 10 eastern states who had outpatient laboratory tests conducted by a large national laboratory services vendor in 2011. Using a combination of direct identifiers and patient demographic characteristics, we linked patients in these laboratory data to Medicare beneficiaries, enabling us to associate test results with existing claims., Results: Nearly all patients in the laboratory data were able to be linked to Medicare beneficiaries. There were over 2 million distinct beneficiaries with nearly 125 million specific test results in the laboratory data. For specific tests ordered in an outpatient or office setting in these 10 states, between 5% and 15% of them had linked laboratory data. Medicare beneficiaries initiating angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers who had laboratory results data had similar patient characteristics to those without results data., Conclusions: This novel linkage of laboratory results data to Medicare claims creates unprecedented opportunities for conducting comparative effectiveness research related to patient safety and quality.
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- 2015
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28. Depressive Symptoms and Risk of Cardiovascular Events in Blacks: Findings From the Jackson Heart Study.
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O'Brien EC, Greiner MA, Sims M, Hardy NC, Wang W, Shahar E, Hernandez AF, and Curtis LH
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- Adaptation, Psychological, Adult, Aged, Aged, 80 and over, Antidepressive Agents therapeutic use, Chi-Square Distribution, Coronary Disease diagnosis, Coronary Disease psychology, Depression diagnosis, Depression drug therapy, Depression psychology, Female, Health Behavior ethnology, Humans, Incidence, Kaplan-Meier Estimate, Male, Middle Aged, Mississippi epidemiology, Multivariate Analysis, Proportional Hazards Models, Risk Assessment, Risk Factors, Stroke diagnosis, Stroke psychology, Time Factors, Young Adult, Black or African American psychology, Coronary Disease ethnology, Depression ethnology, Stroke ethnology
- Abstract
Background: Most studies of depression and cardiovascular risk have been conducted in white populations. We investigated this association in a community-based cohort of blacks., Methods and Results: We used data from the Jackson Heart Study to investigate associations of baseline depressive symptoms between 2000 and 2004 with incident stroke and coronary heart disease (CHD) during 10 years. We used Kaplan-Meier estimates and Cox proportional hazards models to assess cardiovascular event risk using 3 exposure variables: any depressive symptoms (Center for Epidemiological Studies Depression score ≥16); none (score <16), minor (score 16 to <21), and major depression (score≥21); and Center for Epidemiological Studies Depression score per 1-SD increase. Models were adjusted for a stroke or CHD risk score and behavioral risk factors. Of 3309 participants with no stroke history, 738 (22.3%) had baseline depressive symptoms. A similar proportion with no previous CHD had baseline depressive symptoms (21.8%). The unadjusted 10-year risk of stroke was similar among participants with any compared with no depressive symptoms (3.7% versus 2.6%; P=0.12). Unadjusted CHD rates were higher among participants with depressive symptoms (5.6% versus 3.6%; P=0.03), and differences persisted after adjustment for clinical and behavioral risk factors but not after adjustment for coping strategies. In adjusted models comparing major versus no depressive symptoms, patients with major depressive symptoms had a 2-fold greater hazard of stroke (hazard ratio, 1.95; 95% confidence interval, 1.02-3.71; P=0.04). In continuous models, a 1-SD increase in Center for Epidemiological Studies Depression score was associated with a 30% increase in adjusted incident stroke risk (P=0.04). Similar associations were observed for incident CHD in models adjusted for clinical and behavioral risk factors, but associations were not significant after adjustment for coping strategies., Conclusions: In a community-based cohort of blacks, major depressive symptoms were associated with greater risks of incident stroke and CHD after adjustment for clinical and behavioral risk factors., (© 2015 American Heart Association, Inc.)
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- 2015
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29. Ventricular conduction and long-term heart failure outcomes and mortality in African Americans: insights from the Jackson Heart Study.
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Mentz RJ, Greiner MA, DeVore AD, Dunlay SM, Choudhary G, Ahmad T, Khazanie P, Randolph TC, Griswold ME, Eapen ZJ, O'Brien EC, Thomas KL, Curtis LH, and Hernandez AF
- Subjects
- Adult, Black or African American statistics & numerical data, Female, Heart Failure mortality, Heart Failure physiopathology, Humans, Hypertrophy, Left Ventricular epidemiology, Male, Middle Aged, Observational Studies as Topic, Proportional Hazards Models, Risk Factors, Stroke Volume, Treatment Outcome, Ventricular Dysfunction, Left physiopathology, Heart Conduction System physiopathology, Heart Failure ethnology, Ventricular Dysfunction, Left epidemiology
- Abstract
Background: QRS prolongation is associated with adverse outcomes in mostly white populations, but its clinical significance is not well established for other groups. We investigated the association between QRS duration and mortality in African Americans., Methods and Results: We analyzed data from 5146 African Americans in the Jackson Heart Study stratified by QRS duration on baseline 12-lead ECG. We defined QRS prolongation as QRS≥100 ms. We assessed the association between QRS duration and all-cause mortality using Cox proportional hazards models and reported the cumulative incidence of heart failure hospitalization. We identified factors associated with the development of QRS prolongation in patients with normal baseline QRS. At baseline, 30% (n=1528) of participants had QRS prolongation. The cumulative incidences of mortality and heart failure hospitalization were greater with versus without baseline QRS prolongation: 12.6% (95% confidence interval [CI], 11.0-14.4) versus 7.1% (95% CI, 6.3-8.0) and 8.2% (95% CI, 6.9-9.7) versus 4.4% (95% CI, 3.7-5.1), respectively. After risk adjustment, QRS prolongation was associated with increased mortality (hazard ratio, 1.27; 95% CI, 1.03-1.56; P=0.02). There was a linear relationship between QRS duration and mortality (hazard ratio per 10 ms increase, 1.06; 95% CI, 1.01-1.12). Older age, male sex, prior myocardial infarction, lower ejection fraction, left ventricular hypertrophy, and left ventricular dilatation were associated with the development of QRS prolongation., Conclusions: QRS prolongation in African Americans was associated with increased mortality and heart failure hospitalization. Factors associated with developing QRS prolongation included age, male sex, prior myocardial infarction, and left ventricular structural abnormalities., (© 2015 American Heart Association, Inc.)
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- 2015
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30. Primary prevention implantable cardioverter-defibrillators in older racial and ethnic minority patients.
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Pokorney SD, Hellkamp AS, Yancy CW, Curtis LH, Hammill SC, Peterson ED, Masoudi FA, Bhatt DL, Al-Khalidi HR, Heidenreich PA, Anstrom KJ, Fonarow GC, and Al-Khatib SM
- Subjects
- Age Factors, Aged, Aged, 80 and over, Comparative Effectiveness Research, Death, Sudden, Cardiac ethnology, Electric Countershock adverse effects, Electric Countershock mortality, Humans, Medicare, Primary Prevention methods, Registries, Risk Factors, Time Factors, Treatment Outcome, United States epidemiology, Death, Sudden, Cardiac prevention & control, Defibrillators, Implantable, Electric Countershock instrumentation, Ethnicity, Healthcare Disparities ethnology, Minority Groups, Primary Prevention instrumentation, Racial Groups
- Abstract
Background: Racial and ethnic minorities are under-represented in clinical trials of primary prevention implantable cardioverter-defibrillators (ICDs). This analysis investigates the association between primary prevention ICDs and mortality among Medicare, racial/ethnic minority patients., Methods and Results: Data from Get With The Guidelines-Heart Failure Registry and National Cardiovascular Data Registry's ICD Registry were used to perform an adjusted comparative effectiveness analysis of primary prevention ICDs in Medicare, racial/ethnic minority patients (nonwhite race or Hispanic ethnicity). Mortality data were obtained from the Medicare denominator file. The relationship of ICD with survival was compared between minority and white non-Hispanic patients. Our analysis included 852 minority patients, 426 ICD and 426 matched non-ICD patients, and 2070 white non-Hispanic patients (1035 ICD and 1035 matched non-ICD patients). Median follow-up was 3.1 years. Median age was 73 years, and median ejection fraction was 23%. Adjusted 3-year mortality rates for minority ICD and non-ICD patients were 44.9% (95% confidence interval [CI], 44.2%-45.7%) and 54.3% (95% CI, 53.4%-55.1%), respectively (adjusted hazard ratio, 0.79; 95% CI, 0.63-0.98; P=0.034). White non-Hispanic patients receiving an ICD had lower adjusted 3-year mortality rates of 47.8% (95% CI, 47.3%-48.3%) compared with 57.3% (95% CI, 56.8%-57.9%) for those with no ICD (adjusted hazard ratio, 0.75; 95% CI, 0.67%-0.83%; P<0.0001). There was no significant interaction between race/ethnicity and lower mortality risk with ICD (P=0.70)., Conclusions: Primary prevention ICDs are associated with lower mortality in nonwhite and Hispanic patients, similar to that seen in white, non-Hispanic patients. These data support a similar approach to ICD patient selection, regardless of race or ethnicity., (© 2014 American Heart Association, Inc.)
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- 2015
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31. Readmission rates and long-term hospital costs among survivors of an in-hospital cardiac arrest.
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Chan PS, Nallamothu BK, Krumholz HM, Curtis LH, Li Y, Hammill BG, and Spertus JA
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- Aged, Aged, 80 and over, Female, Hospital Mortality trends, Humans, Male, Patient Readmission economics, Registries, Retrospective Studies, Survival Rate trends, Survivors, United States epidemiology, Heart Arrest economics, Hospital Costs statistics & numerical data, Patient Readmission statistics & numerical data
- Abstract
Background: Although an in-hospital cardiac arrest is common, little is known about readmission patterns and an inpatient resource use among survivors of an in-hospital cardiac arrest., Methods and Results: Within a large national registry, we examined long-term inpatient use among 6972 adults aged ≥65 years who survived an in-hospital cardiac arrest. We examined 30-day and 1-year readmission rates and inpatient costs, overall and by patient demographics, hospital disposition (discharge destination), and neurological status at discharge. The mean age was 75.8±7.0 years, 56% were men, and 12% were black. There were a total of 2005 readmissions during the first 30 days (cumulative incidence rate, 35 readmissions/100 patients; 95% confidence interval, 33-37) and 8751 readmissions at 1 year (cumulative incidence rate, 185 readmissions/100 patients; 95% confidence interval, 177-190). Overall, mean inpatient costs were $7741±$2323 at 30 days and $18 629±$9411 at 1 year. Thirty-day inpatient costs were higher in patients of younger age (≥85 years, $6052 [reference]; 75-84 years, $7444 [adjusted cost ratio, 1.23; 1.06-1.42; 65-74 years, $8291 [adjusted cost ratio, 1.37; 1.19-1.59; both P<0.001) and black race (whites, $7413; blacks, $9044; adjusted cost ratio, 1.22; 1.05-1.42; P<0.001), as well as those discharged with severe neurological disability or to skilled nursing or rehabilitation facilities. These differences in resource use persisted at 1 year and were largely because of higher readmission rates., Conclusions: Survivors of an in-hospital cardiac arrest have frequent readmissions and high follow-up inpatient costs. Readmissions and inpatient costs were higher in certain subgroups, including patients of younger age and black race., (© 2014 American Heart Association, Inc.)
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- 2014
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32. Clinical effectiveness of cardiac resynchronization therapy versus medical therapy alone among patients with heart failure: analysis of the ICD Registry and ADHERE.
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Khazanie P, Hammill BG, Qualls LG, Fonarow GC, Hammill SC, Heidenreich PA, Al-Khatib SM, Piccini JP, Masoudi FA, Peterson PN, Curtis JP, Hernandez AF, and Curtis LH
- Subjects
- Cardiac Resynchronization Therapy, Heart Failure drug therapy, Heart Failure mortality, Hospitalization statistics & numerical data, Humans, Multivariate Analysis, Registries, Treatment Outcome, Defibrillators, Implantable, Heart Failure therapy
- Abstract
Background: Cardiac resynchronization therapy with defibrillator (CRT-D) reduces morbidity and mortality among selected patients with heart failure in clinical trials. The effectiveness of this therapy in clinical practice has not been well studied., Methods and Results: We compared a cohort of 4471 patients from the National Cardiovascular Data Registry's Implantable Cardioverter-Defibrillator (ICD) Registry hospitalized primarily for heart failure and who received CRT-D between April 1, 2006, and December 31, 2009, to a historical control cohort of 4888 patients with heart failure without CRT-D from the Acute Decompensated Heart Failure National Registry (ADHERE) hospitalized between January 1, 2002, and March 31, 2006. Both registries were linked with Medicare claims to evaluate longitudinal outcomes. We included patients from the ICD Registry with left ventricular ejection fraction ≤35% and QRS duration ≥120 ms who were admitted for heart failure. We used Cox proportional hazards models to compare outcomes with and without CRT-D after adjustment for important covariates. After multivariable adjustment, CRT-D was associated with lower 3-year risks of death (hazard ratio, 0.52; 95% confidence interval, 0.48-0.56; P<0.001), all-cause readmission (hazard ratio, 0.69; 95% confidence interval, 0.65-0.73; P<0.001), and cardiovascular readmission (hazard ratio, 0.60; 95% confidence interval, 0.56-0.64; P<0.001). The association of CRT-D with mortality did not vary significantly among subgroups defined by age, sex, race, QRS duration, and optimal medical therapy., Conclusions: CRT-D was associated with lower risks of mortality, all-cause readmission, and cardiovascular readmission than medical therapy alone among patients with heart failure in community practice., (© 2014 The Authors. published on behalf of the American Heart Association, Inc., by Wolters Kluwer.)
- Published
- 2014
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33. Survival after primary prevention implantable cardioverter-defibrillator placement among patients with chronic kidney disease.
- Author
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Hess PL, Hellkamp AS, Peterson ED, Sanders GD, Al-Khalidi HR, Curtis LH, Hammill BG, Pun PH, Curtis JP, Anstrom KJ, Hammill SC, and Al-Khatib SM
- Subjects
- Aged, Cause of Death, Chi-Square Distribution, Comorbidity, Electric Countershock adverse effects, Female, Glomerular Filtration Rate, Heart Failure diagnosis, Humans, Kaplan-Meier Estimate, Kidney physiopathology, Linear Models, Male, Middle Aged, Multivariate Analysis, Patient Selection, Proportional Hazards Models, Prosthesis Design, Registries, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic physiopathology, Risk Assessment, Risk Factors, Severity of Illness Index, Time Factors, Treatment Outcome, United States epidemiology, Death, Sudden, Cardiac prevention & control, Defibrillators, Implantable, Electric Countershock instrumentation, Electric Countershock mortality, Heart Failure mortality, Heart Failure therapy, Primary Prevention instrumentation, Renal Insufficiency, Chronic mortality
- Abstract
Background: Guidelines recommend that implantable cardioverter-defibrillator (ICD) candidates have an estimated longevity of ≥1 year. Longevity can be affected by chronic kidney disease (CKD)., Methods and Results: Using the National Cardiovascular Data Registry ICD registry linked with the Social Security Death Master File, we assessed the rate of death after primary prevention ICD placement between January 1, 2006, and December 31, 2007, according to CKD stage. Using Cox models, we identified factors associated with death among patients with CKD. Compared with patients without CKD (n=26,056), those with CKD (n=21,226) were older, less commonly men, more often white, and more frequently had comorbid illness. Compared with patients without CKD, patients with a glomerular filtration rate 30 to 60, glomerular filtration rate <30, and end-stage renal disease on dialysis had a higher risk of death after ICD placement (hazard ratio, 2.08; 95% confidence interval, 1.99-2.18; P<0.0001; hazard ratio, 4.20; 95% confidence interval, 3.92-4.50; P<0.0001; and hazard ratio, 4.80; 95% confidence interval, 4.46-5.17; P<0.0001, respectively). Corresponding 1-year death rates were 4.4%, 9.1%, 20.2%, and 22.4%. Among patients with CKD, factors associated with increased risk of death included CKD severity, age >65 years, heart failure symptoms, diabetes mellitus, lung disease, serum sodium <140 mEq/L, atrial fibrillation or flutter, and a lower ejection fraction., Conclusions: The risk of death after primary prevention ICD placement is proportional to CKD severity. Among patients with CKD, several factors are prognostically significant and could inform clinical decision making on primary prevention ICD candidacy., (© 2014 American Heart Association, Inc.)
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- 2014
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34. The evolution and future of ACC/AHA clinical practice guidelines: a 30-year journey: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines.
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Jacobs AK, Anderson JL, Halperin JL, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Fleisher LA, Gidding S, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, and Wijeysundera DN
- Subjects
- Cardiology trends, Humans, United States, Advisory Committees standards, American Heart Association, Cardiology standards, Cardiovascular Diseases therapy, Practice Guidelines as Topic standards
- Published
- 2014
- Full Text
- View/download PDF
35. Associations between anticoagulation therapy and risks of mortality and readmission among patients with heart failure and atrial fibrillation.
- Author
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Hernandez AF, Liang L, Fonarow GC, Hammill BG, Hammill SC, Heidenreich PA, Masoudi FA, Qualls LG, Al-Khatib SM, Piccini JP, and Curtis LH
- Subjects
- Aged, Aged, 80 and over, Anticoagulants therapeutic use, Atrial Fibrillation drug therapy, Female, Follow-Up Studies, Heart Failure drug therapy, Humans, Male, Observer Variation, Outcome and Process Assessment, Health Care, Survival Analysis, Treatment Outcome, United States, Atrial Fibrillation epidemiology, Heart Failure epidemiology, Patient Readmission statistics & numerical data
- Abstract
Background: Patients with heart failure and atrial fibrillation are at higher risk of thromboembolic events than patients with heart failure alone. Yet, the use of anticoagulation therapy varies in clinical practice, especially among older patients, for whom its effectiveness is poorly understood., Methods and Results: Using clinical registry data linked to Medicare claims from 2005 to 2011, we examined outcomes of older patients hospitalized with heart failure and atrial fibrillation who newly initiated anticoagulation therapy at discharge. We used Cox proportional hazards models and inverse probability-weighted treatment estimates to adjust for selection bias. Main outcomes were mortality and readmission at 1 and 3 years. Among 5105 patients in 195 hospitals, 1623 (31.8%) started anticoagulation therapy at discharge. Treated patients had lower unadjusted rates of all-cause mortality (26.4% versus 42.8%; P<0.001) and all-cause readmission (58.4% versus 63.7%; P<0.001) at 1 year. After inverse weighting for the probability of treatment and adjustment for other discharge medications, anticoagulation therapy was associated with significantly lower 1-year mortality (hazard ratio, 0.70; 99% confidence interval, 0.59-0.82), but there was no statistically significant difference in the risk of all-cause readmission (hazard ratio, 0.89; 99% confidence interval, 0.78-1.01) or other readmission outcomes. Results were similar at 3 years., Conclusions: Initiation of anticoagulation therapy at hospital discharge was associated with improved mortality at 1 and 3 years but was not associated with improved cardiovascular readmission among older patients with heart failure and atrial fibrillation., (© 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wolters Kluwer.)
- Published
- 2014
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36. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
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Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, Lee IM, Lichtenstein AH, Loria CM, Millen BE, Nonas CA, Sacks FM, Smith SC Jr, Svetkey LP, Wadden TA, Yanovski SZ, Kendall KA, Morgan LC, Trisolini MG, Velasco G, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr, and Tomaselli GF
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- American Heart Association, Diet, Humans, Motor Activity, Risk Factors, United States, Cardiovascular Diseases prevention & control, Disease Management, Life Style
- Published
- 2014
- Full Text
- View/download PDF
37. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
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Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PW, Eddleman KM, Jarrett NM, LaBresh K, Nevo L, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr, and Tomaselli GF
- Subjects
- American Heart Association, Humans, Primary Prevention, Risk Factors, Secondary Prevention, United States, Anticholesteremic Agents therapeutic use, Atherosclerosis prevention & control, Hypercholesterolemia drug therapy
- Published
- 2014
- Full Text
- View/download PDF
38. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
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Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB, Gibbons R, Greenland P, Lackland DT, Levy D, O'Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith SC Jr, Sorlie P, Stone NJ, Wilson PW, Jordan HS, Nevo L, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr, and Tomaselli GF
- Subjects
- American Heart Association, Cardiovascular Diseases diagnosis, Female, Humans, Male, Racial Groups, Risk Assessment, Sex Factors, Time Factors, United States, Cardiovascular Diseases classification, Cardiovascular Diseases epidemiology
- Published
- 2014
- Full Text
- View/download PDF
39. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society.
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Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, Hu FB, Hubbard VS, Jakicic JM, Kushner RF, Loria CM, Millen BE, Nonas CA, Pi-Sunyer FX, Stevens J, Stevens VJ, Wadden TA, Wolfe BM, Yanovski SZ, Jordan HS, Kendall KA, Lux LJ, Mentor-Marcel R, Morgan LC, Trisolini MG, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr, and Tomaselli GF
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- American Heart Association, Diet, Reducing, Humans, Life Style, Motor Activity, United States, Disease Management, Obesity therapy, Overweight therapy, Weight Reduction Programs methods
- Published
- 2014
- Full Text
- View/download PDF
40. Peripheral arterial testing before lower extremity amputation among Medicare beneficiaries, 2000 to 2010.
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Vemulapalli S, Greiner MA, Jones WS, Patel MR, Hernandez AF, and Curtis LH
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- Adult, Aged, Aged, 80 and over, Angiography, Ankle Brachial Index, Female, Health Personnel, Humans, Magnetic Resonance Angiography, Male, Mass Screening methods, Middle Aged, Peripheral Arterial Disease epidemiology, Retrospective Studies, Rural Population, Sex Factors, Ultrasonography, Doppler, Duplex, United States epidemiology, Urban Population, Amputation, Surgical statistics & numerical data, Lower Extremity surgery, Mass Screening statistics & numerical data, Medicare statistics & numerical data, Peripheral Arterial Disease complications, Peripheral Arterial Disease diagnosis, Preoperative Care statistics & numerical data
- Abstract
Background: Despite mild reductions in rates of lower extremity amputation over the past decade, few data exist on the use of arterial testing in patients before amputation., Methods and Results: Using Medicare claims from 2000 through 2010, we examined rates of preamputation arterial testing between 0 to 12 and 0 to 24 months before amputation. We used multivariable, modified Poisson regression models to identify patient and clinical predictors of preamputation arterial testing. The main outcome measures were rates of preamputation arterial testing. Among 17 463 patients undergoing nontraumatic amputation, 68.4% underwent some type of arterial testing. Of these patients, 47.5% underwent ankle-brachial index measurement, 38.7% duplex ultrasound, 31.1% invasive angiography, 6.7% computed tomographic angiography, and 5.6% magnetic resonance angiography. Temporal analysis revealed an increase in testing from 65.7% in 2002 to 69.2% in 2010 (P<0.001). The use of preamputation arterial testing varied significantly by location of amputation and was lowest for foot amputation (62.5%), followed by above-knee amputation (69.0%) and below-knee amputation (76.7%; P<0.001). After multivariable adjustment, older age, male sex, black race, renal disease, diabetes mellitus, known peripheral arterial disease, evaluation by a vascular specialist, and living in the East North Central region were associated with greater rates of preamputation arterial testing., Conclusions: Rates of evaluation for peripheral arterial disease before amputation were low, and testing varied by patient, provider, and regional characteristics.
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- 2014
- Full Text
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41. Putting the vascular back into cardiovascular research: ST-segment-elevation myocardial infarction as a blueprint for improving care in patients with acute limb ischemia.
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Vemulapalli S and Curtis LH
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- Female, Humans, Male, Databases, Factual trends, Hospital Mortality trends, Lower Extremity blood supply, Thromboembolism mortality, Thromboembolism therapy
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- 2013
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42. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
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Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, and Shen WK
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- Disease Management, Humans, Peripheral Arterial Disease diagnosis, Peripheral Arterial Disease epidemiology, Research Report standards, United States epidemiology, Advisory Committees standards, American Heart Association, Cardiology standards, Foundations standards, Peripheral Arterial Disease therapy, Practice Guidelines as Topic standards
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- 2013
- Full Text
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43. Costs of newly diagnosed neovascular age-related macular degeneration among medicare beneficiaries, 2004-2008.
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Qualls LG, Hammill BG, Wang F, Lad EM, Schulman KA, Cousins SW, and Curtis LH
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- Aged, Aged, 80 and over, Angiogenesis Inhibitors economics, Databases, Factual, Female, Health Services Research, Humans, Male, Retrospective Studies, United States, Vascular Endothelial Growth Factor A antagonists & inhibitors, Wet Macular Degeneration diagnosis, Wet Macular Degeneration drug therapy, Direct Service Costs statistics & numerical data, Health Expenditures statistics & numerical data, Medicare Part B economics, Wet Macular Degeneration economics
- Abstract
Purpose: To examine associations between newly diagnosed neovascular age-related macular degeneration and direct medical costs., Methods: This retrospective observational study matched 23,133 Medicare beneficiaries diagnosed with neovascular age-related macular degeneration between 2004 and 2008 with a control group of 92,532 beneficiaries on the basis of age, sex, and race. The index date for each case-control set corresponded to the first diagnosis for the case. Main outcome measures were total costs per patient and age-related macular degeneration-related costs per case 1 year before and after the index date., Results: Mean cost per case in the year after diagnosis was $12,422, $4,884 higher than the year before diagnosis. Postindex costs were 41% higher for cases than controls after adjustment for preindex costs and comorbid conditions. Age-related macular degeneration-related costs represented 27% of total costs among cases in the postindex period and were 50% higher for patients diagnosed in 2008 than in 2004. This increase was attributable primarily to the introduction of intravitreous injections of vascular endothelial growth factor antagonists. Intravitreous injections averaged $203 for patients diagnosed in 2004 and $2,749 for patients diagnosed in 2008., Conclusion: Newly diagnosed neovascular age-related macular degeneration was associated with a substantial increase in total medical costs. Costs increased over time, reflecting growing use of anti-vascular endothelial growth factor therapies.
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- 2013
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44. Follow-up of patients with new cardiovascular implantable electronic devices: are experts' recommendations implemented in routine clinical practice?
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Al-Khatib SM, Mi X, Wilkoff BL, Qualls LG, Frazier-Mills C, Setoguchi S, Hess PL, and Curtis LH
- Subjects
- Black or African American, Aged, Aged, 80 and over, Chi-Square Distribution, Equipment Design, Female, Follow-Up Studies, Guideline Adherence trends, Humans, Male, Medicare, Practice Guidelines as Topic, Time Factors, Treatment Outcome, United States, White People, Aftercare trends, Cardiac Resynchronization Therapy, Cardiac Resynchronization Therapy Devices, Continuity of Patient Care trends, Defibrillators, Implantable, Electric Countershock instrumentation, Practice Patterns, Physicians' trends
- Abstract
Background: A 2008 expert consensus statement outlined the minimum frequency of follow-up of patients with cardiovascular implantable electronic devices (CIEDs)., Methods and Results: We studied 38 055 Medicare beneficiaries who received a new CIED between January 1, 2005, and June 30, 2009. The main outcome measure was variation of follow-up by patient factors and year of device implantation. We determined the number of patients who were eligible for and attended an in-person CIED follow-up visit within 2 to 12 weeks, 0 to 16 weeks, and 1 year after implantation. Among eligible patients, 42.4% had an initial in-person visit within 2 to 12 weeks. This visit was significantly more common among white patients than black patients and patients of other races (43.0% versus 36.8% versus 40.5%; P<0.001). Follow-up within 2 to 12 weeks improved from 40.3% in 2005 to 55.1% in 2009 (P<0.001 for trend). The rate of follow-up within 0 to 16 weeks was 65.1% and improved considerably from 2005 to 2009 (62.3%-79.6%; P<0.001 for trend). Within 1 year, 78.0% of the overall population had at least 1 in-person CIED follow-up visit., Conclusions: Although most Medicare beneficiaries who received a new CIED between 2005 and 2009 did not have an initial in-person CIED follow-up visit within 2 to 12 weeks after device implantation, the rate of initial follow-up improved appreciably over time. This CIED follow-up visit was significantly more common in white patients than in patients of other races.
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- 2013
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45. National survey of hospital strategies to reduce heart failure readmissions: findings from the Get With the Guidelines-Heart Failure registry.
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Kociol RD, Peterson ED, Hammill BG, Flynn KE, Heidenreich PA, Piña IL, Lytle BL, Albert NM, Curtis LH, Fonarow GC, and Hernandez AF
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- Continuity of Patient Care, Data Collection, Humans, Linear Models, Quality Improvement, Quality of Health Care, United States, Guidelines as Topic, Heart Failure, Patient Readmission statistics & numerical data, Registries statistics & numerical data, Risk Reduction Behavior
- Abstract
Background: Reducing 30-day heart failure readmission rates is a national priority. Yet, little is known about how hospitals address the problem and whether hospital-based processes of care are associated with reductions in readmission rates., Methods and Results: We surveyed 100 randomly selected hospitals participating in the Get With the Guidelines-Heart Failure quality improvement program regarding common processes of care aimed at reducing readmissions. We grouped processes into 3 domains (ie, inpatient care, discharge and transitional care, and general quality improvement) and scored hospitals on the basis of survey responses using processes selected a priori. We used linear regression to examine associations between these domain scores and 30-day risk-standardized readmission rates. Of the 100 participating sites, 28% were academic centers and 64% were community hospitals. The median readmission rate among participating sites (24.0%; 95% CI, 22.6%-25.7%) was comparable with the national average (24.6%; 23.5-25.9). Sites varied substantially in care processes used for inpatient care, education, discharge process, care transitions, and quality improvement. Overall, neither inpatient care nor general quality improvement domains were associated with 30-day readmission rates. Hospitals in the lowest readmission rate quartile had modestly higher discharge and transitional care domain scores (P=0.03)., Conclusions: A variety of strategies are used by hospitals in an attempt to improve 30-day readmission rates for patients hospitalized with heart failure. Although more complete discharge and transitional care processes may be modestly associated with lower 30-day readmission rates, most current strategies are not associated with lower readmission rates.
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- 2012
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46. Outcomes of Medicare beneficiaries undergoing catheter ablation for atrial fibrillation.
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Piccini JP, Sinner MF, Greiner MA, Hammill BG, Fontes JD, Daubert JP, Ellinor PT, Hernandez AF, Walkey AJ, Heckbert SR, Benjamin EJ, and Curtis LH
- Subjects
- Age Factors, Aged, Aged, 80 and over, Atrial Flutter epidemiology, Catheter Ablation adverse effects, Comorbidity, Female, Heart Failure epidemiology, Hospital Mortality, Humans, Incidence, Kaplan-Meier Estimate, Male, Middle Aged, Patient Readmission statistics & numerical data, Pericardial Effusion epidemiology, Pericardial Effusion etiology, Postoperative Complications epidemiology, Proportional Hazards Models, Recurrence, Renal Insufficiency epidemiology, Reoperation statistics & numerical data, Risk Factors, Stroke epidemiology, Stroke etiology, Treatment Outcome, United States epidemiology, Atrial Fibrillation surgery, Catheter Ablation statistics & numerical data, Medicare statistics & numerical data
- Abstract
Background: Atrial fibrillation is common among older persons. Catheter ablation is increasingly used in patients for whom medical therapy has failed., Methods and Results: We conducted a retrospective cohort study of all fee-for-service Medicare beneficiaries ≥65 years of age who underwent catheter ablation for atrial fibrillation between July 1, 2007, and December 31, 2009. The main outcome measures were major complications within 30 days and mortality, heart failure, stroke, hospitalization, and repeat ablation within 1 year. A total of 15 423 patients underwent catheter ablation for atrial fibrillation. Mean age was 72 years; 41% were women; and >95% were white. For every 1000 procedures, there were 17 cases of hemopericardium requiring intervention, 8 cases of stroke, and 8 deaths within 30 days. More than 40% of patients required hospitalization within 1 year; however, atrial fibrillation or flutter was the primary discharge diagnosis in only 38.4% of cases. Eleven percent of patients underwent repeat ablation within 1 year. Renal impairment (hazard ratio, 2.07; 95% confidence interval, 1.66-2.58), age ≥80 years (hazard ratio, 3.09; 95% confidence interval, 2.32-4.11), and heart failure (hazard ratio, 2.54; 95% confidence interval, 2.07-3.13) were major risk factors for 1-year mortality. Advanced age was a major risk factor for all adverse outcomes., Conclusions: Major complications after catheter ablation for atrial fibrillation were associated with advanced age but were fairly infrequent. Few patients underwent repeat ablation. Randomized trials are needed to inform risk-benefit calculations for older persons with drug-refractory, symptomatic atrial fibrillation.
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- 2012
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47. Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993-2007.
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Piccini JP, Hammill BG, Sinner MF, Jensen PN, Hernandez AF, Heckbert SR, Benjamin EJ, and Curtis LH
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- Aged, Aged, 80 and over, Atrial Fibrillation diagnosis, Atrial Fibrillation mortality, Female, Humans, Incidence, Male, Prevalence, Retrospective Studies, Sex Factors, Survival Analysis, Treatment Outcome, United States, Atrial Fibrillation epidemiology, Medicare
- Abstract
Background: Atrial fibrillation (AF) is a common and costly problem among older persons. The frequency of AF increases with age, but representative national data about incidence and prevalence are limited. We examined the annual incidence, prevalence, and mortality associated with AF among older persons., Methods and Results: In a retrospective cohort study of Medicare beneficiaries 65 years and older diagnosed with AF between 1993 and 2007, we measured annual age- and sex-adjusted incidence and prevalence of AF and mortality following an AF diagnosis. Among 433,123 patients with incident AF, the mean age was 80 years, 55% were women, and 92% were white. The incidence of AF remained steady during the 14-year study period, ranging from 27.3 to 28.3 per 1000 person-years. Incidence rates were consistently higher among men and white beneficiaries. The prevalence of AF increased across the study period (mean, 5% per year) and was robust to sensitivity analyses. Among beneficiaries with incident AF in 2007, 36% had heart failure, 84% had hypertension, 30% had cerebrovascular disease, and 8% had dementia. Mortality after AF diagnosis declined slightly over time but remained high. In 2007, the age- and sex-adjusted mortality rates were 11% at 30 days and 25% at 1 year., Conclusions: Among older Medicare beneficiaries, incident AF is common and has remained relatively stable for more than a decade. Incident AF is associated with significant comorbidity and mortality; death occurs in one-quarter of beneficiaries within 1 year.
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- 2012
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48. Discharge to a skilled nursing facility and subsequent clinical outcomes among older patients hospitalized for heart failure.
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Allen LA, Hernandez AF, Peterson ED, Curtis LH, Dai D, Masoudi FA, Bhatt DL, Heidenreich PA, and Fonarow GC
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- Aged, Aged, 80 and over, Female, Hospitalization, Humans, Male, Medicare, Patient Discharge, Patient Readmission, Registries, Residence Characteristics, Treatment Outcome, United States, Heart Failure mortality, Skilled Nursing Facilities statistics & numerical data
- Abstract
Background: Heart failure (HF) is the leading cause of hospitalization among older Americans. Subsequent discharge to skilled nursing facilities (SNF) is not well described., Methods and Results: We performed an observational analysis of Medicare beneficiaries ≥65 years of age, discharged alive to SNF or home after ≥3-day hospitalization for HF in 2005 and 2006 within the Get With The Guidelines-HF Program. Among 15 459 patients from 149 hospitals, 24.1% were discharged to an SNF, 22.3% to home with home health service, and 53.6% to home with self-care. SNF use varied significantly among hospitals (median, 10.2% versus 33.9% in low versus high tertiles), with rates highest in the Northeast. Patient factors associated with discharge to SNF included longer length of stay, advanced age, female sex, hypotension, higher ejection fraction, absence of ischemic heart disease, and a variety of comorbidities. Performance measures were modestly lower for patients discharged to SNF. Unadjusted absolute event rates were higher at 30 days (death, 14.4% versus 4.1%; rehospitalization, 27.0% versus 23.5%) and 1 year (death, 53.5% versus 29.1%; rehospitalization, 76.1% versus 72.2%) after discharge to SNF versus home, respectively (P<0.0001 for all). After adjustment for measured patient characteristics, discharge to SNF remained associated with increased death (hazard ratio, 1.76; 95% confidence interval, 1.66 to 1.87) and rehospitalization (hazard ratio, 1.08; 95% confidence interval, 1.03 to 1.14)., Conclusions: Discharge to SNF is common among Medicare patients hospitalized for HF, and these patients face substantial risk for adverse events, with more than half dead within 1 year. These findings highlight the need to better characterize this unique patient population and understand the SNF care they receive.
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- 2011
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49. Incremental value of clinical data beyond claims data in predicting 30-day outcomes after heart failure hospitalization.
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Hammill BG, Curtis LH, Fonarow GC, Heidenreich PA, Yancy CW, Peterson ED, and Hernandez AF
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- Aged, Aged, 80 and over, Female, Hospitalization, Humans, Male, Medicare, Patient Readmission statistics & numerical data, Risk Adjustment, United States, Heart Failure mortality, Outcome Assessment, Health Care
- Abstract
Background: Administrative claims data are used routinely for risk adjustment and hospital profiling for heart failure outcomes. As clinical data become more readily available, the incremental value of adding clinical data to claims-based models of mortality and readmission is unclear., Methods and Results: We linked heart failure hospitalizations from the Get With The Guidelines-Heart Failure registry with Medicare claims data for patients discharged between January 1, 2004, and December 31, 2006. We evaluated the performance of claims-only and claims-clinical regression models for 30-day mortality and readmission, and compared hospital rankings from both models. There were 25 766 patients from 308 hospitals in the mortality analysis, and 24 163 patients from 307 hospitals in the readmission analysis. The claims-clinical mortality model (area under the curve [AUC], 0.761; generalized R(2)=0.172) had better fit than the claims-only mortality model (AUC, 0.718; R(2)=0.113). The claims-only readmission model (AUC, 0.587; R(2)=0.025) and the claims-clinical readmission model (AUC, 0.599; R(2)=0.031) had similar performance. Among hospitals ranked as top or bottom performers by the claims-only mortality model, 12% were not ranked similarly by the claims-clinical model. For the claims-only readmission model, 3% of top or bottom performers were not ranked similarly by the claims-clinical model., Conclusions: Adding clinical data to claims data for heart failure hospitalizations significantly improved prediction of mortality, and shifted mortality performance rankings for a substantial proportion of hospitals. Clinical data did not meaningfully improve the discrimination of the readmission model, and had little effect on performance rankings.
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- 2011
- Full Text
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50. Assessment of left ventricular function in older Medicare beneficiaries with newly diagnosed heart failure.
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Curtis LH, Greiner MA, Shea AM, Whellan DJ, Hammill BG, Schulman KA, and Douglas PS
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- Aged, Aged, 80 and over, Female, Humans, Logistic Models, Male, Medicare, United States, Heart Failure physiopathology, Outcome and Process Assessment, Health Care, Ventricular Function, Left
- Abstract
Background: Assessment of left ventricular function is a recommended performance measure for the care of patients with newly diagnosed heart failure. Little is known about the extent to which left ventricular function is assessed in real-world settings., Methods and Results: We analyzed a 5% national sample of data from the Centers for Medicare and Medicaid Services from 1991 through 2008. Patients were 65 years or older, with incident heart failure in 1995, 1999, 2003, or 2007. We searched for evidence of tests of left ventricular function from 30 days before through 60 days after an incident heart failure diagnosis. We used logistic regression to identify patient characteristics associated with assessment of left ventricular function. There were 45 005 patients with incident heart failure in 1995, 38 425 in 1999, 39 529 in 2003, and 32 629 in 2007. Assessment of left ventricular function increased from 46% to 60%, with rest echocardiography being the predominant mode. Patients diagnosed with heart failure during a hospitalization had the highest assessment rates (58% in 1995, 64% in 1999, 69% in 2003, and 73% in 2007). After adjustment for other patient characteristics, odds of assessment were 4 times higher among patients diagnosed in inpatient settings., Conclusions: Nearly 40% of Medicare beneficiaries do not undergo assessment of left ventricular function when newly diagnosed with heart failure. Quality-improvement strategies are needed to optimize the care of these patients, especially in outpatient settings.
- Published
- 2011
- Full Text
- View/download PDF
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