242 results on '"Heidenreich, Paul A."'
Search Results
2. The importance of low-density lipoprotein cholesterol measurement and control as performance measures: A joint Clinical Perspective from the National Lipid Association and the American Society for Preventive Cardiology.
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Virani, Salim S., Aspry, Karen, Dixon, Dave L., Ferdinand, Keith C., Heidenreich, Paul A., Jackson, Elizabeth J., Jacobson, Terry A., McAlister, Janice L., Neff, David R., Gulati, Martha, and Ballantyne, Christie M.
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CARDIOVASCULAR disease prevention ,CARDIOVASCULAR disease related mortality ,CARDIOVASCULAR diseases risk factors ,LDL cholesterol ,MEDICAL care costs ,DISEASES ,QUALITY assurance ,HEALTH equity - Abstract
• National metrics do not include LDL-C measurement as a necessary performance metric. • This clinical perspective reviews history of LDL-C as a quality/performance metric. • Lipid monitoring is essential for assessing lipid-lowering pharmacotherapy. • Evidence favors LDL-C measurement to improve population-wide lipid control. Despite the established role of low-density lipoprotein cholesterol (LDL-C) as a major risk factor for cardiovascular disease (CVD), and the persistence of CVD as the leading cause of morbidity and mortality in the United States, national quality assurance metrics no longer include LDL-C measurement as a required performance metric. This clinical perspective reviews the history of LDL-C as a quality and performance metric and the events that led to its replacement. It also presents patient, healthcare provider, and health system rationales for re-establishing LDL-C measurement as a performance measure to improve cholesterol control in high-risk groups and to stem the rising tide of CVD morbidity and mortality, cardiovascular care disparities, and related healthcare costs. [ABSTRACT FROM AUTHOR]
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- 2023
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3. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
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Heidenreich, Paul A., Bozkurt, Biykem, Aguilar, David, Allen, Larry A., Byun, Joni J., Colvin, Monica M., Deswal, Anita, Drazner, Mark H., Dunlay, Shannon M., Evers, Linda R., Fang, James C., Fedson, Savitri E., Fonarow, Gregg C., Hayek, Salim S., Hernandez, Adrian F., Khazanie, Prateeti, Kittleson, Michelle M., Lee, Christopher S., Link, Mark S., and Milano, Carmelo A.
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HEART failure treatment , *CARDIOLOGY , *REPORT writing , *CARDIOVASCULAR system , *HEART failure - Abstract
Aim: The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure.Methods: A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses. [ABSTRACT FROM AUTHOR]- Published
- 2022
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4. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
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Heidenreich, Paul A., Bozkurt, Biykem, Aguilar, David, Allen, Larry A., Byun, Joni J., Colvin, Monica M., Deswal, Anita, Drazner, Mark H., Dunlay, Shannon M., Evers, Linda R., Fang, James C., Fedson, Savitri E., Fonarow, Gregg C., Hayek, Salim S., Hernandez, Adrian F., Khazanie, Prateeti, Kittleson, Michelle M., Lee, Christopher S., Link, Mark S., and Milano, Carmelo A.
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HEART failure treatment , *CARDIOLOGY , *REPORT writing , *CARDIOVASCULAR system , *HEART failure - Abstract
Aim: The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure.Methods: A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses. [ABSTRACT FROM AUTHOR]- Published
- 2022
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5. Variability in Coronary Artery Disease Testing for Patients With New-Onset Heart Failure.
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Zheng, Jimmy, Heidenreich, Paul A., Kohsaka, Shun, Fearon, William F., and Sandhu, Alexander T.
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CORONARY artery disease , *HEART failure patients , *HEART failure , *CARDIOGENIC shock , *BUSINESS insurance , *RESEARCH funding , *MEDICARE - Abstract
Background: Coronary artery disease (CAD) is the most common cause of new-onset heart failure (HF). Although guidelines recommend ischemic evaluation in this population, testing has historically been underutilized.Objectives: This study aimed to identify contemporary trends in CAD testing for patients with new-onset HF, particularly after publication of the STICHES (Surgical Treatment for Ischemic Heart Failure Extension Study), and to characterize geographic and clinician-level variability in testing patterns.Methods: We determined the proportion of patients with incident HF who received CAD testing from 2004 to 2019 using an administrative claims database covering commercial insurance and Medicare. We identified demographic and clinical predictors of CAD testing during the 90 days before and after initial diagnosis. Patients were grouped by their county of residence to assess national variation. Patients were then linked to their primary care physician and/or cardiologist to evaluate variation across clinicians.Results: Among 558,322 patients with new-onset HF, 34.8% underwent CAD testing and 9.3% underwent revascularization. After multivariable adjustment, patients who underwent CAD testing were more likely to be younger, male, diagnosed in an acute care setting, and have systolic dysfunction or recent cardiogenic shock. Incidence of CAD testing remained flat without significant change post-STICHES. Covariate-adjusted testing rates varied from 20% to 45% across counties. The likelihood of testing was higher among patients co-managed by a cardiologist (adjusted OR: 5.12; 95% CI: 4.98-5.27) but varied substantially across cardiologists (IQR: 50.9%-62.4%).Conclusions: Most patients with new-onset HF across inpatient and outpatient settings did not receive timely testing for CAD. Substantial variability in testing persists across regions and clinicians. [ABSTRACT FROM AUTHOR]- Published
- 2022
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6. Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study.
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Rentsch, Christopher T., Beckman, Joshua A., Tomlinson, Laurie, Gellad, Walid F., Alcorn, Charles, Kidwai-Khan, Farah, Skanderson, Melissa, Brittain, Evan, King Jr, Joseph T., Yuk-Lam Ho, Eden, Svetlana, Kundu, Suman, Lann, Michael F., Greevy Jr, Robert A., Ho, P. Michael, Heidenreich, Paul A., Jacobson, Daniel A., Douglas, J., Tate, Janet P., and Evans, Stephen J. W.
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HEMORRHAGE risk factors ,VETERANS' hospitals ,ENOXAPARIN ,COVID-19 ,SCIENTIFIC observation ,CONFIDENCE intervals ,ANTICOAGULANTS ,RISK assessment ,TREATMENT effectiveness ,HOSPITAL mortality ,DESCRIPTIVE statistics ,HEPARIN ,EARLY medical intervention ,LONGITUDINAL method - Published
- 2021
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7. Association of Left Ventricular Ejection Fraction and Symptoms With Mortality After Elective Noncardiac Surgery Among Patients With Heart Failure.
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Lerman, Benjamin J., Popat, Rita A., Assimes, Themistocles L., Heidenreich, Paul A., and Wren, Sherry M.
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HEART ventricle diseases ,LEFT heart ventricle ,HEART failure ,VETERANS ,POSTOPERATIVE period ,ELECTIVE surgery ,RETROSPECTIVE studies ,STROKE volume (Cardiac output) ,DISEASE complications - Abstract
Importance: Heart failure is an established risk factor for postoperative mortality, but how left ventricular ejection fraction and heart failure symptoms affect surgical outcomes is not fully described.Objectives: To determine the risk of postoperative mortality among patients with heart failure at various levels of echocardiographic (left ventricular systolic dysfunction) and clinical (symptoms) severity compared with those without heart failure and to evaluate how risk varies across levels of surgical complexity.Design, Setting, and Participants: US multisite retrospective cohort study of all adult patients receiving elective, noncardiac surgery in the Veterans Affairs Surgical Quality Improvement Project database from 2009 through 2016. A total of 609 735 patient records were identified and analyzed with 1 year of follow-up after having surgery (final study follow-up: September 1, 2017).Exposures: Heart failure, left ventricular ejection fraction, and presence of signs or symptoms of heart failure within 30 days of surgery.Main Outcome and Measure: The primary outcome was postoperative mortality at 90 days.Results: Outcome data from 47 997 patients with heart failure (7.9%; mean [SD] age, 68.6 [10.1] years; 1391 women [2.9%]) and 561 738 patients without heart failure (92.1%; mean [SD] age, 59.4 [13.4] years; 50 862 women [9.1%]) were analyzed. Compared with patients without heart failure, those with heart failure had a higher risk of 90-day postoperative mortality (2635 vs 6881 90-day deaths; crude mortality risk, 5.49% vs 1.22%; adjusted absolute risk difference [RD], 1.03% [95% CI, 0.91%-1.15%]; adjusted odds ratio [OR], 1.67 [95% CI, 1.57-1.76]). Compared with patients without heart failure, symptomatic patients with heart failure (n = 5906) had a higher risk (597 deaths [10.11%]; adjusted absolute RD, 2.37% [95% CI, 2.06%-2.57%]; adjusted OR, 2.37 [95% CI, 2.14-2.63]). Asymptomatic patients with heart failure (n = 42 091) (2038 deaths [crude risk, 4.84%]; adjusted absolute RD, 0.74% [95% CI, 0.63%-0.87%]; adjusted OR, 1.53 [95% CI, 1.44-1.63]), including the subset with preserved left ventricular systolic function (1144 deaths [4.42%]; adjusted absolute RD, 0.66% [95% CI, 0.54%-0.79%]; adjusted OR, 1.46 [95% CI, 1.35-1.57]), also experienced elevated risk.Conclusions and Relevance: Among patients undergoing elective noncardiac surgery, heart failure with or without symptoms was significantly associated with 90-day postoperative mortality. These data may be helpful in preoperative discussions with patients with heart failure undergoing noncardiac surgery. [ABSTRACT FROM AUTHOR]- Published
- 2019
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8. A Validated Risk Model for 30-Day Readmission for Heart Failure.
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Mahajan, Satish M., Burman, Prabir, Newton, Ana, and Heidenreich, Paul A.
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INDIVIDUALIZED medicine ,HEART failure patients ,ELECTRONIC health records ,DATA science - Abstract
One of the goals of the Precision Medicine Initiative launched in the United States in 2016 is to use innovative tools and sources in data science. We realized this goal by implementing a use case that identified patients with heart failure at Veterans Health Administration using data from the Electronic Health Records from multiple health domains between 2005 and 2013. We applied a regularized logistic regression model and predicted 30-day readmission risk for 1210 unique patients. Our validation cohort resulted in a Cstatistic of 0.84. Our top predictors of readmission were prior diagnosis of heart failure, vascular and renal diseases, and malnutrition as comorbidities, compliance with outpatient follow-up, and low socioeconomic status. This validated risk prediction scheme delivered better performance than the published models so far (C-Statistics: 0.69). It can be used to stratify patients for readmission and to aid clinicians in delivering precise health interventions. [ABSTRACT FROM AUTHOR]
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- 2017
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9. Age Differences in Hospital Mortality for Acute Myocardial Infarction: Implications for Hospital Profiling.
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Dharmarajan, Kumar, McNamara, Robert L., Yongfei Wang, Masoudi, Frederick A., Ross, Joseph S., Spatz, Erica E., Desai, Nihar R., de Lemos, James A., Fonarow, Gregg C., Heidenreich, Paul A., Bhatt, Deepak L., Bernheim, Susannah M., Slattery, Lara E., Khan, Yosef M., Curtis, Jeptha P., and Wang, Yongfei
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MYOCARDIAL infarction-related mortality ,HOSPITAL statistics ,AGE distribution ,HOSPITALS ,HEALTH outcome assessment ,RETROSPECTIVE studies ,HOSPITAL mortality - Abstract
Background: Publicly reported hospital risk-standardized mortality rates (RSMRs) for acute myocardial infarction (AMI) are calculated for Medicare beneficiaries. Outcomes for older patients with AMI may not reflect general outcomes.Objective: To examine the relationship between hospital 30-day RSMRs for older patients (aged ≥65 years) and those for younger patients (aged 18 to 64 years) and all patients (aged ≥18 years) with AMI.Design: Retrospective cohort study.Setting: 986 hospitals in the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry-Get With the Guidelines.Participants: Adults hospitalized for AMI from 1 October 2010 to 30 September 2014.Measurements: Hospital 30-day RSMRs were calculated for older, younger, and all patients using an electronic health record measure of AMI mortality endorsed by the National Quality Forum. Hospitals were ranked by their 30-day RSMRs for these 3 age groups, and agreement in rankings was plotted. The correlation in hospital AMI achievement scores for each age group was also calculated using the Hospital Value-Based Purchasing (HVBP) Program method computed with the electronic health record measure.Results: 267 763 and 276 031 AMI hospitalizations among older and younger patients, respectively, were identified. Median hospital 30-day RSMRs were 9.4%, 3.0%, and 6.2% for older, younger, and all patients, respectively. Most top- and bottom-performing hospitals for older patients were neither top nor bottom performers for younger patients. In contrast, most top and bottom performers for older patients were also top and bottom performers for all patients. Similarly, HVBP achievement scores for older patients correlated weakly with those for younger patients (R = 0.30) and strongly with those for all patients (R = 0.92).Limitation: Minority of U.S. hospitals.Conclusion: Hospital mortality rankings for older patients with AMI inconsistently reflect rankings for younger patients. Incorporation of younger patients into assessment of hospital outcomes would permit further examination of the presence and effect of age-related quality differences.Primary Funding Source: American College of Cardiology. [ABSTRACT FROM AUTHOR]- Published
- 2017
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10. Safety and Clinical Outcomes of Catheter Ablation of Atrial Fibrillation in Patients With Chronic Kidney Disease.
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ULLAL, ADITYA J., KAISER, DANIEL W., FAN, JUN, SCHMITT, SUSAN K., THAN, CLAIRE T., WINKELMAYER, WOLFGANG C., HEIDENREICH, PAUL A., PICCINI, JONATHAN P., PEREZ, MARCO V., WANG, PAUL J., and TURAKHIA, MINTU P.
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ATRIAL fibrillation treatment ,TREATMENT effectiveness ,CATHETER ablation ,CHI-squared test ,CHRONIC kidney failure ,CONFIDENCE intervals ,ELECTRIC countershock ,FISHER exact test ,HEART failure ,MULTIVARIATE analysis ,NOSOLOGY ,RESEARCH funding ,STATISTICAL sampling ,STROKE ,T-test (Statistics) ,COMORBIDITY ,HEALTH insurance reimbursement ,PROPORTIONAL hazards models ,DESCRIPTIVE statistics ,KAPLAN-Meier estimator - Abstract
Introduction: Data regarding catheter ablation of atrial fibrillation (AF) in patients with chronic kidney disease (CKD) is limited. We therefore assessed the association of CKD with common safety and clinical outcomes in a nationwide sample of ablation recipients. Methods: UsingMarketScanR® Commercial Claims and Medicare Supplemental Databases, we evaluated 30-day safety and 1-year clinical outcomes in patients who underwent a first AF ablation procedure between 2007 and 2011. We calculated frequency of common 30-day complications and calculated frequencies, incidence rates, and Cox proportional hazards for outcomes at 1-year postablation. Results: Of 21,091 patients included, 1,593 (7.6%) had CKD. Patients with CKD were older (64 years vs. 59 years, P < 0.001) with higher CHA2DS2-VASc scores (3.2 vs. 1.8, P < 0.001). At 30 days postablation, patients with CKD had similar rates of stroke/TIA (0.13% vs. 0.13%, P = 0.99), perforation/tamponade (3.2% vs. 3.1%, P = 0.83), and vascular complications (2.4% vs. 2.2%, P = 0.59) as patients without CKD, but were more likely to be hospitalized for heart failure (2.1% vs. 0.4%, P < 0.001). In multivariate analysis, there were no significant differences in hazards of AF hospitalization (adjusted HR: 1.02, 95%CI: 0.87-1.20), cardioversion (adjusted HR: 0.99, 95%CI: 0.87-1.12), or repeat AF ablation (adjusted HR: 0.89, 95%CI: 0.76-1.06) at 1 year. Conclusions: Among patients selected for AF ablation, those with and without CKD had similar rates of postprocedural complications although they were more likely to be re-admitted for heart failure. CKD was not independently associated with AF hospitalization, cardioversion, and repeat ablation. These findings can inform clinical decision-making in patients with AF and CKD. [ABSTRACT FROM AUTHOR]
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- 2017
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11. Guideline-Appropriate Care and In-Hospital Outcomes in Patients With Heart Failure in Teaching and Nonteaching Hospitals: Findings From Get With The Guidelines-Heart Failure.
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Patel, Dhavalkumar B., Shah, Rachit M., Bhatt, Deepak L., Li Liang, Schulte, Phillip J., DeVore, Adam D., Hernandez, Adrian F., Heidenreich, Paul A., Yancy, Clyde W., Fonarow, Gregg C., and Liang, Li
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HEART failure treatment ,CARDIOVASCULAR agents ,ACADEMIC medical centers ,CLINICAL medicine ,COMPARATIVE studies ,COUNSELING ,HEALTH facilities ,HEART failure ,RESEARCH methodology ,EVALUATION of medical care ,MEDICAL cooperation ,MEDICAL protocols ,MULTIVARIATE analysis ,QUALITY assurance ,RESEARCH ,SMOKING cessation ,TIME ,LOGISTIC regression analysis ,DEPARTMENTS ,EVALUATION research ,KEY performance indicators (Management) ,TREATMENT effectiveness ,ODDS ratio ,STANDARDS ,DIAGNOSIS ,THERAPEUTICS - Abstract
Background: Despite increasing awareness regarding evidence-based guidelines, considerable gaps exist for heart failure (HF) quality of care at teaching hospitals (TH) and nonteaching hospitals (NTH). We analyzed data from Get With The Guidelines (GWTG)-HF to compare the rates and trends of guideline-recommended care at TH and NTH for patients with HF.Method and Results: Baseline patient characteristics, performance measures, and in-hospital outcomes were compared between 197 187 HF patients admitted to TH and 106 924 patients admitted to NTH between 2005 and 2014. Patients treated in TH were younger and were more likely to be black and uninsured. Defect-free care (defined as 100% compliance with performance measures) was similar in both group of hospitals (crude rates: 88% at TH versus 86% at NTH, adjusted odds ratio 0.99, 95% confidence interval 0.73-1.34) as were individual performance measures: discharge instruction, documentation of ejection fraction, use of angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists, use of β-blocker, and smoking cessation counseling. During the study period, there was improvement in adherence with performance measures over time, with no significant difference at TH (adjusted odds ratio 1.20, 95% confidence interval 1.11-1.30; P<0.01) and NTH (adjusted odds ratio 1.09, 95% confidence interval 1.02-1.17; P=0.01; interaction P value 0.07).Conclusions: Data from the GWTG-HF program suggest that there was improving and comparable adherence with HF performance measures and use of guideline-recommended therapies irrespective of hospital teaching status. [ABSTRACT FROM AUTHOR]- Published
- 2016
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12. Age and receipt of guideline-recommended medications for heart failure: a nationwide study of veterans.
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Steinman, Michael, Harlow, John, Massie, Barry, Kaboli, Peter, Fung, Kathy, Heidenreich, Paul, Steinman, Michael A, Harlow, John B, Massie, Barry M, Kaboli, Peter J, Fung, Kathy Z, and Heidenreich, Paul A
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OLDER patients ,HEART failure treatment ,MEDICAL care of veterans ,OUTPATIENT medical care ,ACE inhibitors ,CARDIOTONIC agents ,AGE distribution ,COMPARATIVE studies ,HEART failure ,LONGITUDINAL method ,VETERANS ,RESEARCH methodology ,MEDICAL cooperation ,MEDICAL protocols ,RESEARCH ,RESEARCH funding ,EVALUATION research ,RETROSPECTIVE studies ,THERAPEUTICS - Abstract
Background: Older patients often receive less guideline-concordant care for heart failure than younger patients.Objective: To determine whether age differences in heart failure care are explained by patient, provider, and health system characteristics and/or by chart-documented reasons for non-adherence to guidelines.Design and Patients: Retrospective cohort study of 2,772 ambulatory veterans with heart failure and left ventricular ejection fraction <40% from a 2004 nationwide medical record review program (the VA External Peer Review Program).Main Measures: Ambulatory use of ACE inhibitors, angiotensin receptor blockers (ARBs), and beta blockers.Results: Among 2,772 patients, mean age was 73 +/- 10 years, 87% received an ACE inhibitor or ARB, and 82% received a beta blocker. When patients with explicit chart-documented reasons for not receiving these drugs were excluded, 95% received an ACE inhibitor or ARB and 89% received a beta blocker. In multivariable analyses controlling for a variety of patient and health system characteristics, the adjusted odds ratio for ACE-inhibitor and ARB use was 0.43 (95% CI 0.24-0.78) for patients age 80 and over vs. those age 50-64 years, and the adjusted odds ratio for beta blocker use was 0.66 (95% CI 0.48-0.93) between the two age groups. The magnitude of these associations was similar but not statistically significant after excluding patients with chart-documented reasons for not prescribing ACE inhibitors or ARBs and beta blockers.Conclusions: A high proportion of veterans receive guideline-recommended medications for heart failure. Older veterans are consistently less likely to receive these drugs, although these differences were no longer significant when accounting for patients with chart-documented reasons for not prescribing these drugs. Closely evaluating reasons for non-prescribing in older adults is essential to assessing whether non-treatment represents good clinical judgment or missed opportunities to improve care. [ABSTRACT FROM AUTHOR]- Published
- 2011
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13. US Department of Justice Investigations of Implantable Cardioverter-Defibrillators and Quality Improvement in Health Care.
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Heidenreich, Paul A.
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IMPLANTABLE cardioverter-defibrillators , *UNITED States governmental investigations , *PRIMARY care , *IMPLANTED cardiovascular instruments - Abstract
The author discusses research that examined the relationship between the U.S. Department of Justice's 2010 investigation of implantable cardioverter-defibrillators (ICD) and appropriate ICD implantation for primary prevention, conducted by N. R. Desai and colleagues and published within the issue. Topics covered include decrease in primary care ICDs from 2007 to 2012, increase in the number of hospitals performing ICDs, and the strengths and limitations of the study.
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- 2018
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14. Depression and Outcome among Veterans with Implantable Cardioverter Defibrillators with or without Cardiac Resynchronization Therapy Capability.
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SHALABY, ALAA A., BRUMBERG, GENEVIEVE E., POINTER, LAUREN, BEKELMAN, DAVID B., RUMSFELD, JOHN S., YANG, YANFEI, PELLEGRINI, CARA N., HEIDENREICH, PAUL A., KEUNG, EDMUND, MASSIE, BARRY M., and VAROSY, PAUL D.
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HEART failure treatment ,AGE distribution ,CARDIAC pacing ,CHI-squared test ,CONFIDENCE intervals ,MENTAL depression ,IMPLANTABLE cardioverter-defibrillators ,VETERANS ,HEALTH outcome assessment ,SEX distribution ,STATISTICS ,SURVIVAL analysis (Biometry) ,DATA analysis ,MULTIPLE regression analysis ,TREATMENT effectiveness ,DISEASE prevalence ,DATA analysis software ,DESCRIPTIVE statistics ,ODDS ratio - Abstract
Background The impact of depression on outcome in implantable cardioverter defibrillator (ICD) recipients has not been fully appreciated. We assessed the prevalence of depression and its association with heart failure (HF) outcome among veterans with ICDs. Methods and Results Patients enrolled between January 2005 and January 2010 in the Outcomes among Veterans with Implantable Defibrillators Registry were studied. We examined the cross-sectional association of depression with severity of HF functional class as well as the association of depression with the composite outcome of mortality or HF hospitalization over a mean follow-up time of 2.7 years. There were 3,862 patients enrolled. Patients with depression (1,162, 43%) were younger (63.1 ± 9.4 years vs 66.6 ± 9.9 years, P < 0.001), more likely to have a history of tobacco or alcohol abuse (P < 0.0001) or atrial fibrillation (P = 0.05) while having a higher ejection fraction (28.3% vs 27.4%, P = 0.03). Depression was associated with advanced HF class at time of implant; odds ratio (OR; vs class I) for class III: 1.65 (confidence interval [CI] 1.17-2.33), class IV: 1.73 (95% CI 1.08-2.76). Death or HF hospitalization was more likely to occur in patients with depression (35.2% vs 32.0%, HR: 1.15 [95% CI 0.99-1.33]). The predictive value of depression was stronger after multivariable adjustment; HR: 1.25 (95% CI 1.05-1.49). Conclusion Depression was prevalent among veterans with ICDs. Depression was associated with severity of HF. The predictive value of associated depression was significant after multivariable adjustment. [ABSTRACT FROM AUTHOR]
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- 2014
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15. Differential effects of professional leaders on health care teams in chronic disease management groups.
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Wholey, Douglas R., Disch, Joanne, White, Katie M., Powell, Adam, Rector, Thomas S., Sahay, Anju, and Heidenreich, Paul A.
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HEART failure treatment ,MEDICAL personnel classification ,HYPOTHESIS ,COMPARATIVE studies ,STATISTICAL correlation ,GOAL (Psychology) ,HEALTH care teams ,INTERPROFESSIONAL relations ,JOB satisfaction ,LEADERSHIP ,MEDICAL protocols ,NURSES ,PHYSICIANS ,QUESTIONNAIRES ,REGRESSION analysis ,RESEARCH funding ,RESPECT ,STATISTICS ,DISEASE management ,OCCUPATIONAL roles ,SECONDARY analysis ,SOCIAL services case management ,INTER-observer reliability ,CROSS-sectional method ,RETROSPECTIVE studies ,DESCRIPTIVE statistics - Abstract
Background: Leadership by health care professionals is likely to vary because of differences in the social contexts within which they are situated, socialization processes and societal expectations, education and training, and the way their professions define and operationalize key concepts such as teamwork, collaboration, and partnership. This research examines the effect of the nurse and physician leaders on interdependence and encounter preparedness in chronic disease management practice groups. Purpose: The aim of this study was to examine the effect of complementary leadership by nurses and physicians involved in jointly producing a health care service on care team functioning. Methodology: The design is a retrospective observational study based on survey data. The unit of analysis is heart failure care groups in U.S. Veterans Health Administration medical centers. Survey and administrative data were collected in 2009 from 68 Veterans Health Administration medical centers. Key variables include nurse and physician leadership, interdependence, psychological safety, coordination, and encounter preparedness. [ABSTRACT FROM AUTHOR]
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- 2014
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16. ACC/AHA Statement on Cost/Value Methodology in Clinical Practice Guidelines and Performance Measures.
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Anderson, Jeffrey L., Heidenreich, Paul A., Barnett, Paul G., Creager, Mark A., Fonarow, Gregg C., Gibbons, Raymond J., Halperin, Jonathan L., Hlatky, Mark A., Jacobs, Alice K., Mark, Daniel B., Masoudi, Frederick A., Peterson, Eric D., and Shaw, Leslee J.
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CLINICAL medicine , *MEDICAL care , *PHYSICIAN practice patterns , *UTILIZATION review (Medical care) - Abstract
The article presents the Statement on Cost/Value Methodology in Clinical Practice Guideline and Performance Measures issued by the American College of Cardiology and the American Heart Association (ACC/AHA). Topics discussed in the statement include the sustainability of the healthcare system in the U.S., the arguments in favor of incorporating resource and value considerations, and the recommendations for value assessment.
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- 2014
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17. Get With The Guidelines Program Participation, Process of Care, and Outcome for Medicare Patients Hospitalized With Heart Failure.
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Heidenreich, Paul A., Hernandez, Adrian F., Liang Li, Peterson, Eric D., Fonarow, Gregg C., and Yancy, Clyde W.
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HOSPITAL care ,HEALTH outcome assessment ,MEDICAL care ,HEART failure - Abstract
The article discusses research on the process of care and outcomes in U.S. hospitals enrolled in the Get With the Guidelines Program for Heart Failure (GWTG-HF) of the American Heart Association (AHA). The study made use of various data from the Center for Medicare and Medicaid Services (CMS), including risk-adjusted 30-day mortality and readmission after heart failure hospitalization. It found that these hospitals provided better processes of care.
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- 2012
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18. Age Differences in Primary Prevention Implantable Cardioverter-Defibrillator Use in U.S. Individuals.
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Tsai, Vivian, Goldstein, Mary K., Hsia, Henry H., Wang, Yongfei, Curtis, Jeptha, and Heidenreich, Paul A.
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ARRHYTHMIA treatment ,MORTALITY risk factors ,AGE distribution ,ANALYSIS of variance ,CHI-squared test ,REPORTING of diseases ,IMPLANTABLE cardioverter-defibrillators ,MEDICAL errors ,PREVENTIVE health services ,RISK assessment ,UNNECESSARY surgery ,LOGISTIC regression analysis ,RETROSPECTIVE studies ,DATA analysis software ,DESCRIPTIVE statistics - Abstract
OBJECTIVES: To estimate the potentially inappropriate use of implantable cardioverter-defibrillator ICDs in older U.S. adults. DESIGN: Retrospective study. SETTING: The National Cardiovascular Data ICD Registry. PARTICIPANTS: Forty-four thousand eight hundred five individuals in the National Cardiovascular Data's ICD Registry
™ who had received ICDs for primary prevention from January 2006 to December 2008. Individuals with a prior myocardial infarction and ejection fraction less than 30% were included. MEASUREMENTS: Mortality risk was categorized using the Multicenter Automatic Defibrillator Implantation (MADIT) II risk-stratification system. Low-risk and very-high-risk individuals were considered potentially inappropriate recipients. RESULTS: Of 44,805 individuals, 67% (n=29,893) were aged 65 and older, of whom 51% were aged 75 and older. A significant proportion of ICD recipients had a low risk of death (16%, n=6,969) or very high risk of nonarrhythmic death (8%, n=3,693). Potentially inappropriate ICD use was 10% in those aged 75 and older, much less than in younger groups (40%, <65; 21%, 65-74, P<.001). Although age was associated with a high risk of nonarrhythmic death, its influence was markedly attenuated after adjusting for comorbidities and timing of ICD implantation (odds ratio=1.02, 95% confidence interval=1.02-1.03, P<.001). CONCLUSION: Potentially inappropriate ICD use appears significantly less-and at modest rates-in older Americans than in younger age groups. Overall, almost one-quarter of individuals may have received ICDs inappropriately based on their risk of death. Physicians appear to be conservatively referring older adults and wisely deferring those with high comorbid burden. [ABSTRACT FROM AUTHOR]- Published
- 2011
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19. Real World Evaluation of Dual-Zone ICD and CRT-D Programming Compared to Single-Zone Programming: The ALTITUDE REDUCES Study.
- Author
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GILLIAM, F. ROOSEVELT, HAYES, DAVID L., BOEHMER, JOHN P., DAY, JOHN, HEIDENREICH, PAUL A., SETH, MILAN, JONES, PAUL W., STEIN, KENNETH M., and SAXON, LESLIE A.
- Subjects
VENTRICULAR fibrillation treatment ,VENTRICULAR tachycardia ,CARDIAC pacing ,PATIENT monitoring ,ANALYSIS of variance ,COMPARATIVE studies ,ELECTRIC countershock ,IMPLANTABLE cardioverter-defibrillators ,HEALTH outcome assessment ,SURVIVAL analysis (Biometry) ,TREATMENT effectiveness ,RETROSPECTIVE studies ,THERAPEUTICS - Abstract
Tachycardia Detection, ICD, CRT-D Devices, Appropriate and Inappropriate Shock. Introduction: We evaluated the frequency of appropriate and inappropriate shocks and survival in patients using dual-zone programming versus single-zone programming. Methods and Results: For the ALTITUDE REDUCES study, patients were followed for 1.6 ± 1.1 years. The 12-month incidence of any shock was lower for dual-versus single-zone programmed detection at rates ≤170 bpm and between 170-200 bpm (P < 0.001). Appropriate shock rates at 1 year were also lower with dual-zone programming in these rate intervals (single zone 9.1%, 5.4%, P < 0.001, dual zone 6.7%, 4.7%, P < 0.02). There were no detectable differences between single- and dual-zone shock incidence at detection rates ≥ 200 bpm (P = 0.14). Inappropriate shock incidence was less with dual- versus single-zone detection at all detect rates <200 bpm, but not at rates ≥200 bpm (P < 0.001, P = 0.37). The lowest risk of appropriate and inappropriate shock was associated with dual-zone programming and detection rates ≥200 bpm (2.1%). Dual-zone detection was associated with more nonsustained and diverted therapy episodes but these patients did not have an increased risk of death compared to patients with single-zone programming. Patients programmed to low detection rate, single-zone detection and shock-only therapy also had the highest preshock mortality risk (P = 0.05). Conclusions: Shock incidence is lowest with either single- or dual-zone detection ≥200 bpm. For detection rates <200 bpm, dual-zone programming is associated with a reduction in the incidence of total shocks, appropriate shocks, and inappropriate shocks. (J Cardiovasc Electrophysiol, Vol. 22, pp. 1023-1029, September 2011) [ABSTRACT FROM AUTHOR]
- Published
- 2011
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20. Regional Variation in the Use of Implantable Cardioverter-Defibrillators for Primary Prevention.
- Author
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Matlock, Dan D., Peterson, Pamela N., Heidenreich, Paul A., Lucas, F. Lee, Malenka, David J., Yongfei Wang, Curtis, Jeptha P., Kutner, Jean S., Fisher, Elliott S., and Masoudi, Frederick A.
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IMPLANTABLE cardioverter-defibrillators ,PREVENTION of heart diseases ,CARDIAC arrest ,CARDIAC patients ,PHYSICIAN supply & demand - Abstract
The article discusses as study which examined regional variations in the utilization of primary prevention implantable cardioverter-defibrillators (ICD) for the primary prevention of sudden cardiac death in the U.S. Results showed substantial variation across quantiles of rate ratios of ICD implantation, ranging from 0.39 to 1.77. In addition, 13% of patients receiving ICDs did not meet trial criteria. It concluded that marked geographic variation in the use of primary prevention ICDs exists which is not correlated with physician supply.
- Published
- 2011
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21. Reprint--AACVPR/ACCF/AHA 2010 Update: Performance Measures on Cardiac Rehabilitation for Referral to Cardiac Rehabilitation/Secondary Prevention Services.
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Thomas, Randal J., King, Marjorie, Lui, Karen, Oldridge, Neil, Piña, Ileana L., Spertus, John, Masoudi, Frederick A., DeLong, Elizabeth, Erwin III, John P., Goff Jr., David C., Grady, Kathleen, Green, Lee A., Heidenreich, Paul A., Jenkins, Kathy J., Loth, Ann R., Peterson, Eric D., and Shahian, David M.
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CARDIOVASCULAR disease prevention ,QUALITY assurance standards ,BENCHMARKING (Management) ,CARDIAC rehabilitation ,CARDIOLOGY ,MEDICAL quality control ,MEDICAL referrals ,MEDICAL societies ,PROFESSIONAL associations - Abstract
A reprint of the report "AACVPR/ACCF/AHA 2010 Update: Performance Measures on Cardiac Rehabilitation for Referral to Cardiac Rehabilitation /Secondary Prevention Services," by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) and the American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) Task Force on Performance Measures, is presented. It focuses on the leadership role taken by these associations in developing measures of the quality of care for cardiovascular disease (CVD).
- Published
- 2010
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22. Divergent Trends in Survival and Readmission Following a Hospitalization for Heart Failure in the Veterans Affairs Health Care System 2002 to 2006
- Author
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Heidenreich, Paul A., Sahay, Anju, Kapoor, John R., Pham, Michael X., and Massie, Barry
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HOSPITAL care , *HEART failure patients , *VETERANS affairs offices , *HEALTH outcome assessment , *ANGIOTENSIN converting enzyme , *HEART disease related mortality , *HOSPITAL admission & discharge , *MEDICAL quality control , *MEDICAL care - Abstract
Objectives: This study sought to determine recent trends over time in heart failure hospitalization, patient characteristics, treatment, rehospitalization, and mortality within the Veterans Affairs health care system. Background: Use of recommended therapies for heart failure has increased in the U.S. However, it is unclear to what extent hospitalization rates and the associated mortality have improved. Methods: We compared rates of hospitalization for heart failure, 30-day rehospitalization for heart failure, and 30-day mortality following discharge from 2002 to 2006 in the Veterans Affairs Health Care System. Odds ratios for outcome were adjusted for patient diagnoses within the past year, laboratory data, and for clustering of patients within hospitals. Results: We identified 50,125 patients with a first hospitalization for heart failure from 2002 to 2006. Mean age did not change (70 years), but increases were noted for most comorbidities (mean Charlson score increased from 1.72 to 1.89, p < 0.0001). Heart failure admission rates remained constant at about 5 per 1,000 veterans. Mortality at 30 days decreased (7.1% to 5.0%, p < 0.0001), whereas rehospitalization for heart failure at 30 days increased (5.6% to 6.1%, p = 0.11). After adjustment for patient characteristics, the odds ratio for rehospitalization in 2006 (vs. 2002) was 0.54 (95% confidence interval [CI]: 0.47 to 0.61) for mortality, but 1.21 (95% CI: 1.04 to 1.41) for heart failure rehospitalization at 30 days. Conclusions: Recent mortality and rehospitalization rates in the Veterans Affairs Health Care System have trended in opposite directions. These results have implications for using rehospitalization as a measure of quality of care. [Copyright &y& Elsevier]
- Published
- 2010
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23. Cost-Effectiveness of Preparticipation Screening for Prevention of Sudden Cardiac Death in Young Athletes.
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Wheeler, Matthew T., Heidenreich, Paul A., Froelicher, Victor F., Hlatky, Mark A., and Ashley, Euan A.
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ELECTROCARDIOGRAPHY , *COLLEGE athletes , *PSYCHIATRIC epidemiology , *COST effectiveness , *ELECTRIC properties of hearts , *DIAGNOSTIC imaging , *PHYSIOLOGY - Abstract
Background: Inclusion of 12-lead electrocardiography (ECG) in preparticipation screening of young athletes is controversial because of concerns about cost-effectiveness. Objective: To evaluate the cost-effectiveness of ECG plus cardiovascular-focused history and physical examination compared with cardiovascular-focused history and physical examination alone for preparticipation screening. Design: Decision-analysis, cost-effectiveness model. Data Sources: Published epidemiologic and preparticipation screening data, vital statistics, and other publicly available data. Target Population: Competitive athletes in high school and college aged 14 to 22 years. Time Horizon: Lifetime. Perspective: Societal. Intervention: Nonparticipation in competitive athletic activity and disease-specific treatment for identified athletes with heart disease. Outcome Measure: Incremental health care cost per life-year gained. Results of Base-Case Analysis: Addition of ECG to preparticipation screening saves 2.06 life-years per 1000 athletes at an incremental total cost of $89 per athlete and yields a cost-effectiveness ratio of $42 900 per life-year saved (95% CI, $21 200 to $71 300 per life-year saved) compared with cardiovascular-focused history and physical examination alone. Compared with no screening, ECG plus cardiovascular-focused history and physical examination saves 2.6 life-years per 1000 athletes screened and costs $199 per athlete, yielding a cost-effectiveness ratio of $76 100 per life-year saved ($62 400 to $130 000). Results of Sensitivity Analysis: Results are sensitive to the relative risk reduction associated with nonparticipation and the cost of initial screening. Limitations: Effectiveness data are derived from 1 major European study. Patterns of causes of sudden death may vary among countries. Conclusion: Screening young athletes with 12-lead ECG plus cardiovascular-focused history and physical examination may be cost-effective. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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24. Commentary: Measuring the Quality of the VA Health Care System.
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Heidenreich, Paul A.
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ACE inhibitors , *MEDICAL care , *MEDICAL records , *HOSPITAL records - Abstract
Focuses on the U.S. Veterans Administration's (VA) history of measuring the quality of care it provides. Development of prospective data registries, a state of the art electronic medical record, and patient safety programs; Finding that VA patients were more likely to receive recommended medications including thrombolytics, beta-blockers, aspirin and angiotensin converting enzyme inhibitors than were patients treated in the Medicare system.
- Published
- 2004
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25. The Effect of Ethnicity on Survival in Male Veterans Referred for Electrocardiography and Treadmill Testing.
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Prakash, Manish, Partington, Sara, Froelicher, Victor F., Heidenreich, Paul A., and Myers, Jonathan
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HEALTH services accessibility ,MEDICAL economics ,MEDICAL care ,DEATH rate ,ELECTROCARDIOGRAPHY ,AMERICANS ,HEALTH - Abstract
Background: Ethnic differences in the relationship between access to health care and survival are difficult to define because of many confounding factors, such as socioeconomic status and baseline differences in health. Because the Veterans Affairs health care system offers health care largely without financial considerations, it provides an ideal setting in which to identify and understand ethnic differences in health outcomes. Previous studies in this area have lacked clinical and cardiovascular data with which to adjust for baseline differences in patients' health. Methods: Data were collected from consecutive men referred for resting electrocardiography (ECG) (n = 41 087) or exercise testing (n = 6213) during 12 years. We compared ethnic differences in survival between whites, blacks, and Hispanics after considering baseline differences in age and hospitalization status. We also adjusted for electrocardiogram abnormalities and cardiac risk factors, exercise test results, and cardiovascular comorbidities. Results: White patients tended to be older and had more baseline comorbidities and cardiovascular interventions when they presented for testing. White patients had increased mortality rates compared with blacks and Hispanics. In the ECG population, after adjusting for demographics and baseline electrocardiogram abnormalities, Hispanics had improved survival compared with whites and blacks. In the exercise test population, after adjusting for the same factors, as well as adjusting for the presence of cardiovascular comorbidities, cardiac risk factors, and exercise test findings, Hispanics also exhibited improved survival compared with the other 2 ethnicities. There were no differences in mortality rates between whites and blacks. Conclusion: Our findings demonstrate that the health care provided to veterans referred for routine ECG or exercise testing is not associated with poorer survival in ethnic minorities. [ABSTRACT FROM AUTHOR]
- Published
- 2003
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26. The relation between managed care market share and the treatment of elderly fee-for-service patients with myocardial infarction.
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Heidenreich, Paul A, McClellan, Mark, Frances, Craig, and Baker, Laurence C
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MANAGED care programs , *MARKET share , *FEE for service (Medical fees) , *MEDICAL care for older people , *MYOCARDIAL infarction , *MYOCARDIAL infarction treatment , *SEVERITY of illness index , *PATIENTS , *ADRENERGIC beta blockers , *MEDICARE , *ECONOMIC impact , *NONSTEROIDAL anti-inflammatory agents , *MANAGED care plan statistics , *COMPARATIVE studies , *HOSPITAL care , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *LOGISTIC regression analysis , *EVALUATION research , *DISCHARGE planning ,MYOCARDIAL infarction-related mortality - Abstract
Purpose: To determine if greater managed care market share is associated with greater use of recommended therapies for fee-for-service patients with acute myocardial infarction.Subjects and Methods: We examined the care of 112,900 fee-for-service Medicare beneficiaries aged > or = 65 years who resided in one of 320 metropolitan statistical areas and who were admitted with an acute myocardial infarction between February 1994 through July 1995. Use of recommended medical treatments and 30-day survival were determined for areas with low (<10%), medium (10% to 30%), and high (>30%) managed care market share.Results: After adjustment for severity of illness, teaching status of the admission hospital, and area characteristics, areas with high levels of managed care had greater use of beta-blockers (relative risk [RR] for greater use = 1.18; 95% confidence interval [CI]: 1.06 to 1.29) and aspirin at discharge (RR = 1.05; 95% CI: 1.02 to 1.07), but less appropriate coronary angiography (RR = 0.93; 95% CI: 0.86 to 1.01) and reperfusion (RR = 0.95; 95% CI: 0.85 to 1.03) when compared with areas with low levels of managed care.Conclusions: Medicare beneficiaries with fee-for-service insurance who resided in areas with high managed care activity were more likely to have received appropriate treatment with beta-blockers and aspirin, and less likely to have undergone coronary angiography following admission for myocardial infarction. Thus, the effects of managed care may not be limited to managed care enrollees. [ABSTRACT FROM AUTHOR]- Published
- 2002
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27. Forecasting the Economic Burden of Cardiovascular Disease and Stroke in the United States Through 2050: A Presidential Advisory From the American Heart Association.
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Kazi, Dhruv S., Elkind, Mitchell S. V., Deutsch, Anne, Dowd, William N., Heidenreich, Paul, Khavjou, Olga, Mark, Daniel, Mussolino, Michael E., Ovbiagele, Bruce, Patel, Sonali S., Poudel, Remy, Weittenhiller, Ben, Powell-Wiley, Tiffany M., and Maddox, Karen E. Joynt
- Subjects
- *
ECONOMIC forecasting , *STROKE , *CARDIOVASCULAR diseases , *STROKE units , *HEART failure , *CARDIOVASCULAR diseases risk factors , *MEDICAL care costs , *CORONARY disease - Abstract
BACKGROUND: Quantifying the economic burden of cardiovascular disease and stroke over the coming decades may inform policy, health system, and community-level interventions for prevention and treatment. METHODS: We used nationally representative health, economic, and demographic data to project health care costs attributable to key cardiovascular risk factors (hypertension, diabetes, hypercholesterolemia) and conditions (coronary heart disease, stroke, heart failure, atrial fibrillation) through 2050. The human capital approach was used to estimate productivity losses from morbidity and premature mortality due to cardiovascular conditions. RESULTS: One in 3 US adults received care for a cardiovascular risk factor or condition in 2020. Annual inflation-adjusted (2022 US dollars) health care costs of cardiovascular risk factors are projected to triple between 2020 and 2050, from $400 billion to $1344 billion. For cardiovascular conditions, annual health care costs are projected to almost quadruple, from $393 billion to $1490 billion, and productivity losses are projected to increase by 54%, from $234 billion to $361 billion. Stroke is projected to account for the largest absolute increase in costs. Large relative increases among the Asian American population (497%) and Hispanic American population (489%) reflect the projected increases in the size of these populations. CONCLUSIONS: The economic burden of cardiovascular risk factors and overt cardiovascular disease in the United States is projected to increase substantially in the coming decades. Development and deployment of cost-effective programs and policies to promote cardiovascular health are urgently needed to rein in costs and to equitably enhance population health. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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28. Measuring Value From the Patient's Perspective.
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Heidenreich, Paul A.
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ANGIOPLASTY ,CORONARY restenosis ,REVASCULARIZATION (Surgery) ,COST effectiveness - Abstract
The author reflects on the disadvantages of percutaneous coronary intervention (PCI) process in the U.S. He mentions the need for repeat procedures due to restenosis as one of the drawbacks of PCI as a method of revascularization. He claims that PCI leads to symptoms such as worsening angina, reduced quality of life and significant expense for evaluation. He explains the use of traditional cost-effective analysis or a cost-benefit analysis in determining value of eliminating restenosis.
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- 2011
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29. A perspective on the American Heart Association/American College of Cardiology science advisory on thiazolidinedione drugs and cardiovascular risks.
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Heidenreich, Paul A. and Krumholz, Harlan M.
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BLOOD sugar monitoring ,CARDIOVASCULAR diseases risk factors ,DRUG side effects ,ROSIGLITAZONE ,CARDIOVASCULAR diseases ,HYPOGLYCEMIC agents ,MEDICAL protocols ,TYPE 2 diabetes ,POLICY sciences ,EVIDENCE-based medicine ,THIAZOLIDINEDIONES ,THERAPEUTICS - Abstract
In this article the author discusses an advisory from the American Heart Association/American College of Cardiology Foundation Science on the relationship between thiazolidinedione drugs used to control blood glucose levels and cardiovascular risk. He cites the difficulty of detecting cardiovascular risk in patients taking these drugs since cardiovascular diseases are common. In the light of inconclusive evidence linking rosiglitazone to increased cardiovascular risk, it suggests avoiding the drugs until reassuring evidence for the drug is available.
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- 2010
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30. Association Between Hospital Volume, Processes of Care, and Outcomes in Patients Admitted With Heart Failure: Insights From Get With The Guidelines-Heart Failure.
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Kumbhani, Dharam J., Fonarow, Gregg C., Heidenreich, Paul A., Schulte, Phillip J., Di Lu, Hernandez, Adrian, Yancy, Clyde, Bhatt, Deepak L., and Lu, Di
- Subjects
- *
HEART failure treatment , *HEART failure patients , *HOSPITAL care , *HEALTH outcome assessment , *MEDICAL care , *CLINICAL medicine , *COMPARATIVE studies , *HEART failure , *HOSPITALS , *HOSPITAL admission & discharge , *LONGITUDINAL method , *RESEARCH methodology , *EVALUATION of medical care , *MEDICAL cooperation , *MEDICAL protocols , *MEDICARE , *PATIENTS , *RESEARCH , *TIME , *EVALUATION research , *KEY performance indicators (Management) , *TREATMENT effectiveness , *ACQUISITION of data , *PATIENT readmissions , *HOSPITAL mortality , *STANDARDS - Abstract
Background: Hospital volume is frequently used as a structural metric for assessing quality of care, but its utility in patients admitted with acute heart failure (HF) is not well characterized. Accordingly, we sought to determine the relationship between admission volume, process-of-care metrics, and short- and long-term outcomes in patients admitted with acute HF.Methods: Patients enrolled in the Get With The Guidelines-HF registry with linked Medicare inpatient data at 342 hospitals were assessed. Volume was assessed both as a continuous variable, and quartiles based on the admitting hospital annual HF case volume, as well: 5 to 38 (quartile 1), 39 to 77 (quartile 2), 78 to 122 (quartile 3), 123 to 457 (quartile 4). The main outcome measures were (1) process measures at discharge (achievement of HF achievement, quality, reporting, and composite metrics); (2) 30-day mortality and hospital readmission; and (3) 6-month mortality and hospital readmission. Adjusted logistic and Cox proportional hazards models were used to study these associations with hospital volume.Results: A total of 125 595 patients with HF were included. Patients admitted to high-volume hospitals had a higher burden of comorbidities. On multivariable modeling, lower-volume hospitals were significantly less likely to be adherent to HF process measures than higher-volume hospitals. Higher hospital volume was not associated with a difference in in-hospital (odds ratio, 0.99; 95% confidence interval [CI], 0.94-1.05; P=0.78) or 30-day mortality (hazard ratio, 0.99; 95% CI, 0.97-1.01; P=0.26), or 30-day readmissions (hazard ratio, 0.99; 95% CI, 0.97-1.00; P=0.10). There was a weak association of higher volumes with lower 6-month mortality (hazard ratio, 0.98; 95% CI, 0.97-0.99; P=0.001) and lower 6-month all-cause readmissions (hazard ratio, 0.98; 95%, CI 0.97-1.00; P=0.025).Conclusions: Our analysis of a large contemporary prospective national quality improvement registry of older patients with HF indicates that hospital volume as a structural metric correlates with process measures, but not with 30-day outcomes, and only marginally with outcomes up to 6 months of follow-up. Hospital profiling should focus on participation in systems of care, adherence to process metrics, and risk-standardized outcomes rather than on hospital volume itself. [ABSTRACT FROM AUTHOR]- Published
- 2018
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31. Patient-centered disease management (PCDM) for heart failure: study protocol for a randomised controlled trial.
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Bekelman, David B, Plomondon, Mary E, Sullivan, Mark D, Nelson, Karin, Hattler, Brack, McBryde, Connor, Lehmann, Kenneth G, Potfay, Jonathan, Heidenreich, Paul, and Rumsfeld, John S
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HEART failure treatment ,HEART failure ,LONGITUDINAL method ,QUESTIONNAIRES ,DISEASE management ,TREATMENT effectiveness ,PATIENT-centered care ,DIAGNOSIS - Abstract
Background: Chronic heart failure (HF) disease management programs have reported inconsistent results and have not included comorbid depression management or specifically focused on improving patient-reported outcomes. The Patient Centered Disease Management (PCDM) trial was designed to test the effectiveness of collaborative care disease management in improving health status (symptoms, functioning, and quality of life) in patients with HF who reported poor HF-specific health status.Methods/design: Patients with a HF diagnosis at four VA Medical Centers were identified through population-based sampling. Patients with a Kansas City Cardiomyopathy Questionnaire (KCCQ, a measure of HF-specific health status) score of < 60 (heavy symptom burden and impaired quality of life) were invited to enroll in the PCDM trial. Enrolled patients were randomized to receive usual care or the PCDM intervention, which included: (1) collaborative care management by VA clinicians including a nurse, cardiologist, internist, and psychiatrist, who worked with patients and their primary care providers to provide guideline-concordant care management, (2) home telemonitoring and guided patient self-management support, and (3) screening and treatment for comorbid depression. The primary study outcome is change in overall KCCQ score. Secondary outcomes include depression, medication adherence, guideline-based care, hospitalizations, and mortality.Discussion: The PCDM trial builds on previous studies of HF disease management by prioritizing patient health status, implementing a collaborative care model of health care delivery, and addressing depression, a key barrier to optimal disease management. The study has been designed as an 'effectiveness trial' to support broader implementation in the healthcare system if it is successful.Trial Registration: Unique identifier: NCT00461513. [ABSTRACT FROM AUTHOR]- Published
- 2013
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32. Assessing the Impact of the American Heart Association's Research Portfolio: A Scientific Statement From the American Heart Association.
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Creager, Mark A., Hernandez, Adrian F., Bender, Jeffrey R., Foster, Mary H., Heidenreich, Paul A., Houser, Steven R., Lloyd-Jones, Donald M., Roach Jr, William H., Roger, Véronique L., Roach, William H Jr, and American Heart Association Research Committee
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FERRANS & Powers Quality of Life Index , *IMPACT of Event Scale , *POLICY sciences - Abstract
A task force composed of American Heart Association (AHA) Research Committee members established processes to measure the performance of the AHA's research portfolio and evaluated key outcomes that are fundamental to the overall success of the program. This report reviews progress that the AHA research program has had in achieving its goals relevant to the research programs in the AHA's research portfolio from 2008 to 2017. Comprehensive performance metrics were identified to assess the impact of AHA funding on researchers' career progress and research outcomes. Metrics included bibliometric analysis (ie, tracking of publications and their impact) and career development measures (ie, subsequent grant funding, intellectual property, faculty appointment/promotion, or industry position). Publication rates ranged from ≈0.5 to 4 publications per year, with a strong correlation between number of publications per year and later career stage. The Field-Weighted Citation Index, a metric of bibliometric impact, was between 1.5 and 3.0 for all programs, indicating that AHA awardee publications had a higher citation impact compared with similar publications. To gain insight into the career progression of AHA awardees, a 2-year postaward survey was distributed. Of the Postdoctoral Fellowship recipient respondents, 72% obtained academic research positions, with the remaining working in industry or government research settings; 72% of those in academic positions obtained additional funding. Among respondents who were Beginning Grant-in-Aid and Scientist Development Grant awardees, 45% received academic promotions and 83% obtained additional funding. Measuring performance of the AHA's research portfolio is critical to ensure that its strategic goals are met and to show the AHA's commitment to high-quality, impactful research. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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33. PRICE VARIABILITY OF HEART TRANSPLANT AND VENTRICULAR ASSIST PROCEDURES ACROSS THE UNITED STATES.
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Paranjpe, Ishan, Wei, Chen, Sharma, Pranav, Juthani, Prerak, Lan, Roy, Sahu, Maitreyi, Heidenreich, Paul A., Dieleman, Joseph, Schulman, Kevin, and Sandhu, Alex
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HEART transplantation , *HEART assist devices , *PRICES - Published
- 2024
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34. Kidney Function and Outcomes in Patients Hospitalized With Heart Failure.
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Patel, Ravi B., Fonarow, Gregg C., Greene, Stephen J., Zhang, Shuaiqi, Alhanti, Brooke, DeVore, Adam D., Butler, Javed, Heidenreich, Paul A., Huang, Joanna C., Kittleson, Michelle M., Joynt Maddox, Karen E., McDermott, James J., Owens, Anjali Tiku, Peterson, Pamela N., Solomon, Scott D., Vardeny, Orly, Yancy, Clyde W., and Vaduganathan, Muthiah
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HEART failure patients , *KIDNEY physiology , *EPIDERMAL growth factor receptors , *HEART failure , *ACE inhibitors , *CHRONIC kidney failure , *GLOMERULAR filtration rate , *LEFT heart ventricle , *KIDNEYS , *ACQUISITION of data , *RETROSPECTIVE studies , *HOSPITAL care , *QUALITY assurance , *HEART physiology , *COMORBIDITY , *LONGITUDINAL method - Abstract
Background: Few contemporary data exist evaluating care patterns and outcomes in heart failure (HF) across the spectrum of kidney function.Objectives: This study sought to characterize differences in quality of care and outcomes in patients hospitalized for HF by degree of kidney dysfunction.Methods: Guideline-directed medical therapies were evaluated among patients hospitalized with HF at 418 sites in the GWTG-HF (Get With The Guidelines-Heart Failure) registry from 2014 to 2019 by discharge CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)-derived estimated glomerular filtration rate (eGFR). We additionally evaluated the risk-adjusted association of admission eGFR with in-hospital mortality.Results: Among 365,494 hospitalizations (age 72 ± 15 years, left ventricular ejection fraction [EF]: 43 ± 17%), median discharge eGFR was 51 ml/min/1.73 m2 (interquartile range: 34 to 72 ml/min/1.73 m2), 234,332 (64%) had eGFR <60 ml/min/1.73 m2, and 18,869 (5%) were on dialysis. eGFR distribution remained stable from 2014 to 2019. Among 157,439 patients with HF with reduced EF (≤40%), discharge guideline-directed medical therapies, including beta-blockers, were lowest in discharge eGFR <30 mL/min/1.73 m2 or dialysis (p < 0.001). "Triple therapy" with angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor + beta-blocker + mineralocorticoid receptor antagonist was used in 38%, 33%, 25%, 15%, 5%, and 3% for eGFR ≥90, 60 to 89, 45 to 59, 30 to 44, <30 ml/min/1.73 m2, and dialysis, respectively; p < 0.001. Mortality was higher in a graded fashion at lower admission eGFR groups (1.1%, 1.5%, 2.0%, 3.0%, 5.0%, and 4.2%, respectively; p < 0.001). Steep covariate-adjusted associations between admission eGFR and mortality were observed across EF subgroups, but was slightly stronger for HF with reduced EF compared with HF with mid-range or preserved EF (pinteraction = 0.045).Conclusions: Despite facing elevated risks of mortality, patients with comorbid HF with reduced EF and kidney disease are not optimally treated with evidence-based medical therapies, even at levels of eGFR where such therapies would not be contraindicated by kidney dysfunction. Further efforts are required to mitigate risk in comorbid HF and kidney disease. [ABSTRACT FROM AUTHOR]- Published
- 2021
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35. Heart Failure With Preserved Ejection Fraction and Diabetes: JACC State-of-the-Art Review.
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McHugh, Kelly, DeVore, Adam D., Wu, Jingjing, Matsouaka, Roland A., Fonarow, Gregg C., Heidenreich, Paul A., Yancy, Clyde W., Green, Jennifer B., Altman, Natasha, and Hernandez, Adrian F.
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HEART failure , *HEART , *THERAPEUTICS , *DIABETES , *DISEASE management , *COMORBIDITY , *STROKE volume (Cardiac output) - Abstract
Heart failure with preserved ejection fraction (HFpEF) is now the most common form of HF, affecting over 3 million adults in the United States alone. HFpEF is a heterogenous syndrome. One important phenotype may be related to comorbid conditions, including diabetes mellitus (DM). DM has a prevalence of approximately 45% in HFpEF, but characteristics and outcomes of this population are poorly understood. In this review, the authors summarize data from several clinical trials of HFpEF therapeutics and provide original data from a large cohort using the Get With The Guidelines-HF registry, which together suggest that DM is associated with increased morbidity and long-term mortality in HFpEF. The authors then discuss several common pathological mechanisms in HFpEF and DM, including sodium retention, metabolic derangements, impaired skeletal muscle function, and potential therapeutic targets. As the understanding of comorbid HFpEF and DM improves, it is hoped clinicians will be better equipped to offer effective, patient-centered treatments. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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36. Treating Specialty and Outcomes in Newly Diagnosed Atrial Fibrillation: From the TREAT-AF Study.
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Perino, Alexander C., Fan, Jun, Schmitt, Susan K., Askari, Mariam, Kaiser, Daniel W., Deshmukh, Abhishek, Heidenreich, Paul A., Swan, Christopher, Narayan, Sanjiv M., Wang, Paul J., and Turakhia, Mintu P.
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ATRIAL fibrillation diagnosis , *SUPRAVENTRICULAR tachycardia , *ATRIAL fibrillation treatment , *CARDIOLOGY , *DIURETICS , *THERAPEUTICS , *DISEASE risk factors , *ATRIAL fibrillation , *COMPARATIVE studies , *CAUSES of death , *LONGITUDINAL method , *RESEARCH methodology , *MEDICAL cooperation , *HEALTH outcome assessment , *RESEARCH , *RESEARCH funding , *RISK assessment , *SURVIVAL , *TIME , *EVALUATION research , *DISEASE incidence , *RETROSPECTIVE studies - Abstract
Background: Atrial fibrillation (AF) occurs in many clinical contexts and is diagnosed and treated by clinicians across many specialties. This approach has resulted in treatment variations.Objectives: The goal of this study was to evaluate the association between treating specialty and AF outcomes among patients newly diagnosed with AF.Methods: Using data from the TREAT-AF (Retrospective Evaluation and Assessment of Therapies in AF) study from the Veterans Health Administration, patients with newly diagnosed, nonvalvular AF between 2004 and 2012 were identified who had at least 1 outpatient encounter with primary care or cardiology within 90 days of the AF diagnosis. Cox proportional hazards regression was used to evaluate the association between treating specialty and AF outcomes.Results: Among 184,161 patients with newly diagnosed AF (age 70 ± 11 years; 1.7% women; CHA2DS2-VASc score 2.6 ± 1.7), 40% received cardiology care and 60% received primary care only. After adjustment for covariates, cardiology care was associated with reductions in stroke (hazard ratio [HR]: 0.91; 95% confidence interval [CI]: 0.86 to 0.96; p < 0.001) and death (HR: 0.89; 95% CI: 0.88 to 0.91; p < 0.0001) and increases in hospitalizations for AF/supraventricular tachycardia (HR: 1.38; 95% CI: 1.35 to 1.42; p < 0.0001) and myocardial infarction (HR: 1.03; 95% CI: 1.00 to 1.05; p < 0.04). The propensity-matched cohort had similar results. In mediation analysis, oral anticoagulation prescription within 90 days of diagnosis may have mediated reductions in stroke but did not mediate reductions in survival.Conclusions: In patients with newly diagnosed AF, cardiology care was associated with improved outcomes, potentially mediated by early prescription of oral anticoagulation therapy. Although hypothesis-generating, these data warrant serious consideration and study of health care system interventions at the time of new AF diagnosis. [ABSTRACT FROM AUTHOR]- Published
- 2017
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37. METHAMPHETAMINE ASSOCIATED HEART FAILURE HOSPITALIZATIONS AMONG VETERANS IN THE UNITED STATES.
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Manja, Veena, Sandhu, Alex, Chen, Cheng, Asch, Steven, Frayne, Susan, and Heidenreich, Paul A.
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HEART failure , *METHAMPHETAMINE , *VETERANS , *HOSPITAL care - Published
- 2023
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38. The Heart of 25 by 25: Achieving the Goal of Reducing Global and Regional Premature Deaths From Cardiovascular Diseases and Stroke: A Modeling Study From the American Heart Association and World Heart Federation.
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Sacco, Ralph L., Roth, Gregory A., Reddy, K. Srinath, Arnett, Donna K., Bonita, Ruth, Gaziano, Thomas A., Heidenreich, Paul A., Huffman, Mark D., Mayosi, Bongani M., Mendis, Shanthi, Murray, Christopher J. L., Perel, Pablo, Piñeiro, Daniel J., Smith, Jr., Sidney C., Taubert, Kathryn A., Wood, David A., Dong Zhao, Zoghbi, William A., Smith, Sidney C Jr, and Zhao, Dong
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- *
CARDIOVASCULAR diseases risk factors , *PREMATURE infants , *EARLY death , *MORTALITY prevention , *HEALTH risk assessment , *PREVENTION , *CARDIOVASCULAR disease diagnosis , *CARDIOVASCULAR disease treatment , *STROKE diagnosis , *STROKE treatment , *STROKE-related mortality , *AGE distribution , *BIOLOGICAL models , *CARDIOLOGY , *COMPARATIVE studies , *CAUSES of death , *INTERPROFESSIONAL relations , *RESEARCH methodology , *MEDICAL cooperation , *PROGNOSIS , *RESEARCH , *RISK assessment , *TIME , *WORLD health , *EVALUATION research ,STROKE risk factors ,CARDIOVASCULAR disease related mortality - Abstract
In 2011, the United Nations set key targets to reach by 2025 to reduce the risk of premature noncommunicable disease death by 25% by 2025. With cardiovascular disease being the largest contributor to global mortality, accounting for nearly half of the 36 million annual noncommunicable disease deaths, achieving the 2025 goal requires that cardiovascular disease and its risk factors be aggressively addressed. The Global Cardiovascular Disease Taskforce, comprising the World Heart Federation, American Heart Association, American College of Cardiology Foundation, European Heart Network, and European Society of Cardiology, with expanded representation from Asia, Africa, and Latin America, along with global cardiovascular disease experts, disseminates information and approaches to reach the United Nations 2025 targets. The writing committee, which reflects Global Cardiovascular Disease Taskforce membership, engaged the Institute for Health Metrics and Evaluation, University of Washington, to develop region-specific estimates of premature cardiovascular mortality in 2025 based on various scenarios. Results show that >5 million premature CVD deaths among men and 2.8 million among women are projected worldwide by 2025, which can be reduced to 3.5 million and 2.2 million, respectively, if risk factor targets for blood pressure, tobacco use, diabetes mellitus, and obesity are achieved. However, global risk factor targets have various effects, depending on region. For most regions, United Nations targets for reducing systolic blood pressure and tobacco use have more substantial effects on future scenarios compared with maintaining current levels of body mass index and fasting plasma glucose. However, preventing increases in body mass index has the largest effect in some high-income countries. An approach achieving reductions in multiple risk factors has the largest impact for almost all regions. Achieving these goals can be accomplished only if countries set priorities, implement cost-effective population wide strategies, and collaborate in public-private partnerships across multiple sectors. [ABSTRACT FROM AUTHOR]
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- 2016
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39. Estimation of Eligibility for Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors and Associated Costs Based on the FOURIER Trial (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk): Insights From the Department of Veterans Affairs
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Virani, Salim S., Akeroyd, Julia M., Nambi, Vijay, Heidenreich, Paul A., Morris, Pamela B., Nasir, Khurram, Michos, Erin D., Bittner, Vera A., Petersen, Laura A., and Ballantyne, Christie M.
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THERAPEUTIC use of protease inhibitors , *ATHEROSCLEROSIS treatment , *CARDIOVASCULAR disease treatment , *PROPROTEIN convertases , *STATINS (Cardiovascular agents) ,DISEASES in veterans - Abstract
The article discusses a study on the eligibility of U.S. veterans with atherosclerotic cardiovascular disease (ASCVD) for treatment with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and related costs based on the Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) trial. It describes the results of the FOURIER trial which examined evolocumab therapy for ASCVD. It also analyzed the effects of statin use on eligibility.
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- 2017
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40. Cardiovascular Care Facts: A Report From the National Cardiovascular Data Registry: 2011.
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Masoudi, Frederick A., Ponirakis, Angelo, Yeh, Robert W., Maddox, Thomas M., Beachy, Jim, Casale, Paul N., Curtis, Jeptha P., De Lemos, James, Fonarow, Gregg, Heidenreich, Paul, Koutras, Christina, Kremers, Mark, Messenger, John, Moussa, Issam, Oetgen, William J., Roe, Matthew T., Rosenfield, Kenneth, Shields, Thomas P., Spertus, John A., and Wei, Jessica
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- *
CARDIOVASCULAR system physiology , *HEART , *MEDICAL registries , *HEALTH outcome assessment , *OUTPATIENT medical care , *HYGIENE - Abstract
Objectives: The aim of this report was to characterize the patients, participating centers, and measures of quality of care and outcomes for 5 NCDR (National Cardiovascular Data Registry) programs: 1) ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry–GWTG (Get With The Guidelines) for acute coronary syndromes; 2) CathPCI Registry for coronary angiography and percutaneous coronary intervention; 3) CARE (Carotid Artery Revascularization and Endarterectomy) Registry for carotid revascularization; 4) ICD Registry for implantable cardioverter defibrillators; and the 5) PINNACLE (Practice INNovation And CLinical Excellence) Registry for outpatients with cardiovascular disease (CVD). Background: CVD is a leading cause of death and disability in the United States. The quality of care for patients with CVD is suboptimal. National registry programs, such as NCDR, permit assessments of the quality of care and outcomes for broad populations of patients with CVD. Methods: For the year 2011, we assessed for each of the 5 NCDR programs: 1) demographic and clinical characteristics of enrolled patients; 2) key characteristics of participating centers; 3) measures of processes of care; and 4) patient outcomes. For selected variables, we assessed trends over time. Results: In 2011 ACTION Registry–GWTG enrolled 119,967 patients in 567 hospitals; CathPCI enrolled 632,557 patients in 1,337 hospitals; CARE enrolled 4,934 patients in 130 hospitals; ICD enrolled 139,991 patients in 1,435 hospitals; and PINNACLE enrolled 249,198 patients (1,436,328 individual encounters) in 74 practices (1,222 individual providers). Data on performance metrics and outcomes, in some cases risk-adjusted with validated NCDR models, are presented. Conclusions: The NCDR provides a unique opportunity to understand the characteristics of large populations of patients with CVD, the centers that provide their care, quality of care provided, and important patient outcomes. [Copyright &y& Elsevier]
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- 2013
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41. The Importance of Consistent, High-Quality Acute Myocardial Infarction and Heart Failure Care: Results From the American Heart Association’s Get With The Guidelines Program
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Wang, Tracy Y., Dai, David, Hernandez, Adrian F., Bhatt, Deepak L., Heidenreich, Paul A., Fonarow, Gregg C., and Peterson, Eric D.
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HOSPITAL care , *MYOCARDIAL infarction , *HEART failure , *GUIDELINES , *HEALTH outcome assessment , *MORTALITY , *CORONARY disease , *PATIENTS - Abstract
Objectives: This study examined the degree to which hospital performance for acute myocardial infarction (AMI) and heart failure (HF) care processes are correlated. Background: Although AMI and HF care processes may be amenable to similar quality improvement interventions, whether these are indeed correlated and whether hospitals with consistently superior performance for both care metrics have the best outcomes remains unknown. Methods: We compared hospital performance of the Centers for Medicare & Medicaid Services AMI and HF core measures in 283 hospitals submitting 10 or more patients to the Get With The Guidelines AMI and HF programs between January 2005 and April 2009. Results: Median hospital adherence to AMI and HF composite measures were 93% (interquartile range: 87% to 97%) and 92% (interquartile range: 85% to 96%), respectively, with only a modest correlation between hospital performance on these 2 composite metrics (r = 0.50; 95% confidence interval: 0.41 to 0.58). Hospitals with superior performance to both AMI and HF processes had significantly longer duration of Get With The Guidelines participation and lower adjusted in-hospital mortality (odds ratio: 0.79; 95% confidence interval: 0.63 to 0.99) for AMI and HF patients, whereas hospitals with superior adherence to either alone had similar mortality rates as hospitals with superior adherence to neither measure. Conclusions: Hospitals that had consistent, superior performance for both AMI and HF care had significantly lower risk-adjusted mortality than those with superior performance either alone or for neither measure. Whether a single scoring system to assess global, rather than condition-specific, quality of cardiovascular care would facilitate care quality improvement more consistently and would optimize patient outcomes merits further investigation. [ABSTRACT FROM AUTHOR]
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- 2011
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42. Heart Failure With Preserved, Borderline, and Reduced Ejection Fraction: 5-Year Outcomes.
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Shah, Kevin S, Xu, Haolin, Matsouaka, Roland A, Bhatt, Deepak L, Heidenreich, Paul A, Hernandez, Adrian F, Devore, Adam D, Yancy, Clyde W, and Fonarow, Gregg C
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HEART failure treatment , *AGE distribution , *COMPARATIVE studies , *HEART failure , *HOSPITAL care , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *SURVIVAL , *TIME , *EVALUATION research , *RETROSPECTIVE studies , *STROKE volume (Cardiac output) - Abstract
Background: Patients with heart failure (HF) have a poor prognosis and are categorized by ejection fraction (EF).Objectives: This study sought to characterize differences in outcomes in patients hospitalized with heart failure with preserved ejection fraction (HFpEF) (EF ≥50%), heart failure with borderline ejection fraction (HFbEF) (EF 41% to 49%), and heart failure with reduced ejection fraction (HFrEF) (EF ≤40%).Methods: Data from GWTG-HF (Get With The Guidelines-Heart Failure) were linked to Medicare data for longitudinal follow-up. Multivariable models were constructed to examine 5-year outcomes and to compare survival to median survival of the U.S.Population: Results: A total of 39,982 patients from 254 hospitals who were admitted for HF between 2005 and 2009 were included: 18,299 (46%) had HFpEF, 3,285 (8.2%) had HFbEF, and 18,398 (46%) had HFrEF. Overall, median survival was 2.1 years. In risk-adjusted survival analysis, all 3 groups had similar 5-year mortality (HFrEF 75.3% vs. HFpEF 75.7%; hazard ratio: 0.99 [95% confidence interval: 0.958 to 1.022]; HFbEF 75.7% vs. HFpEF 75.7%; hazard ratio: 0.99 [95% confidence interval: 0.947 to 1.046]). In risk-adjusted analyses, the composite of mortality and rehospitalization was similar for all subgroups. Cardiovascular and HF readmission rates were higher in those with HFrEF and HFbEF compared with those with HFpEF. When compared with the U.S. population, HF patients across all age and EF groups had markedly lower median survival.Conclusions: Among patients hospitalized with HF, patients across the EF spectrum have a similarly poor 5-year survival with an elevated risk for cardiovascular and HF admission. These findings underscore the need to improve treatment of patients with HF. [ABSTRACT FROM AUTHOR]- Published
- 2017
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43. Cause-Specific Health Care Costs Following Hospitalization for Heart Failure and Cost Offset With SGLT2i Therapy.
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Kittipibul V, Vaduganathan M, Ikeaba U, Chiswell K, Butler J, DeVore AD, Heidenreich PA, Huang JC, Kittleson MM, Joynt Maddox KE, Linganathan KK, McDermott JJ, Owens AT, Peterson PN, Solomon SD, Vardeny O, Yancy CW, Fonarow GC, and Greene SJ
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- Humans, Aged, Female, Male, United States, Stroke Volume physiology, Aged, 80 and over, Registries, Sodium-Glucose Transporter 2 Inhibitors therapeutic use, Sodium-Glucose Transporter 2 Inhibitors economics, Heart Failure economics, Heart Failure therapy, Heart Failure drug therapy, Hospitalization economics, Health Care Costs statistics & numerical data, Medicare economics
- Abstract
Background: Little is known regarding differences in cause-specific costs between heart failure (HF) with ejection fraction (EF) ≤40% vs >40%, and potential cost implications of sodium glucose co-transporter 2 inhibitor (SGLT2i) therapy., Objectives: This study sought to compare cause-specific health care costs following hospitalization for HF with EF ≤40% vs >40% and estimate the cost offset with implementation of SGLT2i therapy., Methods: This study examined Medicare beneficiaries hospitalized for HF in the Get With The Guidelines-Heart Failure registry from 2016 to 2020. Mean per-patient total (excluding drug costs) and cause-specific costs from discharge through 1-year follow-up were calculated and compared between EF ≤40% vs >40%. Next, risk reductions on total all-cause and HF hospitalizations were estimated in a trial-level meta-analysis of 5 pivotal trials of SGLT2is in HF. Finally, these relative treatment effects were applied to Medicare beneficiaries eligible for SGLT2i therapy to estimate the projected cost offset with implementation of SGLT2i, excluding drug costs., Results: Among 146,003 patients, 50,598 (34.7%) had EF ≤40% and 95,405 (65.3%) had EF >40%. Mean total cost through 1 year was $40,557. Total costs were similar between EF groups overall but were higher for EF ≤40% among patients surviving the 1-year follow-up period. Patients with EF >40% had higher costs caused by non-HF and noncardiovascular hospitalizations, and skilled nursing facilities (all P < 0.001). Trial-level meta-analysis of the 5 SGLT2i clinical trials estimated 11% (rate ratio: 0.89; 95% CI: 0.84-0.93; P < 0.001) and 29% (rate ratio: 0.71; 95% CI: 0.66-0.76; P < 0.001) relative reductions in rates of total all-cause and HF hospitalizations, respectively, regardless of EF. Reductions in all-cause and HF hospitalizations were projected to reduce annual costs of readmission by $2,451 to $2,668 per patient with EF ≤40% and $1,439 to $2,410 per patient with EF >40%., Conclusions: In this large cohort of older U.S. adults hospitalized for HF, cause-specific costs of care differed among patients with EF ≤40% vs >40%. SGLT2i significantly reduced the rate of HF and all-cause hospitalizations irrespective of EF in clinical trials, and implementation of SGLT2i therapy in clinical practice is projected to reduce costs by $1,439 to $2,668 per patient over the 1 year post-discharge, excluding drug costs., Competing Interests: Funding Support and Author Disclosures This analysis, as a part of the TRANSLATE-HF research series, was supported by AstraZeneca. The Get With The Guidelines–Heart Failure (GWTG-HF) program is provided by the American Heart Association. GWTG-HF is sponsored, in part, by Novartis, Boehringer Ingelheim, Novo Nordisk, Bayer, and Bristol Myers Squibb. Dr Vaduganathan has received research grant support, served on advisory boards, or had speaker engagements with American Regent, Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, BMS, Boehringer Ingelheim, Chiesi, Cytokinetics, Lexicon Pharmaceuticals, Merck, Novartis, Novo Nordisk, Pharmacosmos, Relypsa, Roche Diagnostics, Sanofi, and Tricog Health; and participated on clinical trial committees for studies sponsored by AstraZeneca, Galmed, Novartis, Bayer AG, Occlutech, and Impulse Dynamics. Dr Butler has served as a consultant for Abbott, Adrenomed, Amgen, Array, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CVRx, G3 Pharmaceutical, Impulse Dynamics, Innolife, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, Novo Nordisk, Relypsa, Roche, V-Wave Limited, and Vifor. Drs Huang, Linganathan, and McDermott are employees of AstraZeneca and may own stock options with the company. Dr Vardeny has served as a consultant for Bayer, AstraZeneca, Moderna, and Cardior; and has received institutional research support from Bayer and Cardurion. Dr Fonarow has served as a consultant for Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cytokinetics, Eli Lilly, Janssen, Medtronic, Merck, Novartis, and Pfizer. Dr Greene has received research support from the Duke University Department of Medicine Chair’s Research Award, American Heart Association, Amgen, AstraZeneca, Boehinger Ingelheim, Bristol Myers Squibb, Cytokinetics, Merck, Novartis, Pfizer, and Sanofi; served on advisory boards or as a consultant for Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Corteria Pharmaceuticals, CSL Vifor, Cytokinetics, Eli Lilly, Lexicon, Merck, Novo Nordisk, Roche Diagnostics, Sanofi, scPharmaceuticals, Tricog Health, and Urovant Pharmaceuticals; and has received speaker fees from Bayer, Boehringer Ingelheim, Cytokinetics, Lexicon, and Roche Diagnostics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2024
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44. Kidney Outcomes Among Medicare Beneficiaries After Hospitalization for Heart Failure.
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Ostrominski JW, Greene SJ, Patel RB, Solomon NC, Chiswell K, DeVore AD, Butler J, Heidenreich PA, Huang JC, Kittleson MM, Joynt Maddox KE, Linganathan KK, McDermott JJ, Owens AT, Peterson PN, Solomon SD, Vardeny O, Yancy CW, Fonarow GC, and Vaduganathan M
- Subjects
- Humans, Male, Female, United States epidemiology, Aged, Retrospective Studies, Aged, 80 and over, Renal Dialysis statistics & numerical data, Registries, Heart Failure therapy, Heart Failure epidemiology, Hospitalization statistics & numerical data, Medicare, Glomerular Filtration Rate, Acute Kidney Injury therapy, Acute Kidney Injury epidemiology
- Abstract
Importance: Kidney health has received increasing focus as part of comprehensive heart failure (HF) treatment efforts. However, the occurrence of clinically relevant kidney outcomes in contemporary populations with HF has not been well studied., Objective: To examine rates of incident dialysis and acute kidney injury (AKI) among Medicare beneficiaries after HF hospitalization., Design, Setting, and Participants: This retrospective cohort study evaluated adults aged 65 years or older who were hospitalized for HF across 372 sites in the Get With The Guidelines-Heart Failure registry in the US between January 1, 2014, and December 31, 2018. Patients younger than 65 years or requiring dialysis either during or prior to hospitalization were excluded. Data were analyzed from May 4, 2021, to March 8, 2024., Main Outcomes and Measures: The primary outcome was inpatient dialysis initiation in the year after HF hospitalization and was ascertained via linkage with Medicare claims data. Other all-cause and cause-specific hospitalizations were also evaluated. The covariate-adjusted association between discharge estimated glomerular filtration rate (eGFR) and 1-year postdischarge outcomes was examined using Cox proportional hazards regression models., Results: Overall, among 85 298 patients included in the analysis (mean [SD] age, 80 [9] years; 53% women) mean (SD) left ventricular ejection fraction was 47% (16%) and mean (SD) eGFR was 53 (29) mL/min per 1.73 m2; 54 010 (63%) had an eGFR less than 60 mL/min per 1.73 m2. By 1 year after HF hospitalization, 6% had progressed to dialysis, 7% had progressed to dialysis or end-stage kidney disease, and 7% had been readmitted for AKI. Incident dialysis increased steeply with lower discharge eGFR category: compared with patients with an eGFR of 60 mL/min per 1.73 m2 or more, individuals with an eGFR of 45 to less than 60 and of less than 30 mL/min per 1.73 m2 had higher rates of dialysis readmission (45 to <60: adjusted hazard ratio [AHR], 2.16 [95% CI, 1.86-2.51]; <30: AHR, 28.46 [95% CI, 25.25-32.08]). Lower discharge eGFR (per 10 mL/min per 1.73 m2 decrease) was independently associated with a higher rate of readmission for dialysis (AHR, 2.23; 95% CI, 2.14-2.32), dialysis or end-stage kidney disease (AHR, 2.34; 95% CI, 2.24-2.44), and AKI (AHR, 1.25; 95% CI, 1.23-1.27), with similar findings for all-cause mortality, all-cause readmission, and HF readmission. Baseline left ventricular ejection fraction did not modify the covariate-adjusted association between lower discharge eGFR and kidney outcomes., Conclusions and Relevance: In this study, older adults with HF had substantial risk of kidney complications, with an estimated 6% progressing to dialysis in the year after HF hospitalization. These findings emphasize the need for health care approaches prioritizing kidney health in this high-risk population.
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- 2024
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45. National Trends in Hospital Performance in Guideline-Recommended Pharmacologic Treatment for Heart Failure at Discharge.
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Hess PL, Langner P, Heidenreich PA, Essien U, Leonard C, Swat SA, Polsinelli V, Orlando ST, Grunwald GK, and Ho PM
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- Humans, Female, Male, United States, Aged, Practice Guidelines as Topic, Mineralocorticoid Receptor Antagonists therapeutic use, Middle Aged, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Hospitals, Veterans, Anticoagulants therapeutic use, Aged, 80 and over, Heart Failure drug therapy, Patient Discharge trends, Guideline Adherence, Angiotensin Receptor Antagonists therapeutic use, Adrenergic beta-Antagonists therapeutic use
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Background: The use of recommended heart failure (HF) medications has improved over time, but opportunities for improvement persist among women and at rural hospitals., Objectives: This study aims to characterize national trends in performance in the use of guideline-recommended pharmacologic treatment for HF at U.S. Department of Veterans Affairs (VA) hospitals, at which medication copayments are modest., Methods: Among patients discharged from VA hospitals with HF between January 1, 2013, and December 31, 2019, receipt of all guideline-recommended HF pharmacotherapy among eligible patients was assessed, consisting of evidence-based beta-blockers; angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor neprilysin inhibitors; mineralocorticoid receptor antagonists; and oral anticoagulation., Results: Of 55,560 patients at 122 hospitals, 32,304 (58.1%) received all guideline-recommended HF medications for which they were eligible. The proportion of patients receiving all recommended medications was higher in 2019 relative to 2013 (OR: 1.54; 95% CI: 1.44-1.65). The median of hospital performance was 59.1% (Q1-Q3: 53.2%-66.2%), improving with substantial variation across sites from 2013 (median 56.4%; Q1-Q3: 50.0%-62.0%) to 2019 (median 65.7%; Q1-Q3: 56.3%-73.5%). Women were less likely to receive recommended therapies than men (adjusted OR [aOR]: 0.84; 95% CI: 0.74-0.96). Compared with non-Hispanic White patients, non-Hispanic Black patients were less likely to receive recommended therapies (aOR: 0.83; 95% CI: 0.79-0.87). Urban hospital location was associated with lower likelihood of medication receipt (aOR: 0.73; 95% CI: 0.59-0.92)., Conclusions: Forty-two percent of patients did not receive all recommended HF medications at discharge, particularly women, minority patients, and those receiving care at urban hospitals. Rates of use increased over time, with variation in performance across hospitals., Competing Interests: Funding Support and Author Disclosures This research was funded by VA Career Development Award HX002621 from the VA Health Services and Research Development Service and Career Development Award 19CDA347670126 from the American Heart Association. Dr Swat was funded by National Institutes of Health T32 training grant 5T32-HL-007822-22. The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Published by Elsevier Inc.)
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- 2024
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46. Equity in the Setting of Heart Failure Diagnosis: An Analysis of Differences Between and Within Clinician Practices.
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Gupta A, Tisdale RL, Calma J, Stafford RS, Maron DJ, Hernandez-Boussard T, Ambrosy AP, Heidenreich PA, and Sandhu AT
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- Humans, Female, Male, United States epidemiology, Aged, Practice Patterns, Physicians' statistics & numerical data, Healthcare Disparities ethnology, Aged, 80 and over, Fee-for-Service Plans, Heart Failure diagnosis, Heart Failure ethnology, Heart Failure epidemiology, Medicare
- Abstract
Background: Timely heart failure (HF) diagnosis can lead to earlier intervention and reduced morbidity. Among historically marginalized patients, new-onset HF diagnosis is more likely to occur in acute care settings (emergency department or inpatient hospitalization) than outpatient settings. Whether inequity within outpatient clinician practices affects diagnosis settings is unknown., Methods: We determined the setting of incident HF diagnosis among Medicare fee-for-service beneficiaries between 2013 and 2017. We identified sociodemographic and medical characteristics associated with HF diagnosis in the acute care setting. Within each outpatient clinician practice, we compared acute care diagnosis rates across sociodemographic characteristics: female versus male sex, non-Hispanic White versus other racial and ethnic groups, and dual Medicare-Medicaid eligible (a surrogate for low income) versus nondual-eligible patients. Based on within-practice differences in acute diagnosis rates, we stratified clinician practices by equity (high, intermediate, and low) and compared clinician practice characteristics., Results: Among 315 439 Medicare patients with incident HF, 173 121 (54.9%) were first diagnosed in acute care settings. Higher adjusted acute care diagnosis rates were associated with female sex (6.4% [95% CI, 6.1%-6.8%]), American Indian (3.6% [95% CI, 1.1%-6.1%]) race, and dual eligibility (4.1% [95% CI, 3.7%-4.5%]). These differences persisted within clinician practices. With clinician practice adjustment, dual-eligible patients had a 4.9% (95% CI, 4.5%-5.4%) greater acute care diagnosis rate than nondual-eligible patients. Clinician practices with greater equity across dual eligibility also had greater equity across sex and race and ethnicity and were more likely to be composed of predominantly primary care clinicians., Conclusions: Differences in HF diagnosis rates in the acute care setting between and within clinician practices highlight an opportunity to improve equity in diagnosing historically marginalized patients., Competing Interests: Disclosures Dr Sandhu has consulted for Lexicon Pharmaceuticals and received research funding from Novartis. Dr Stafford serves as a medical advisor to Age Bold Inc, which is developing online programming for patients with heart failure. The other authors report no conflicts.
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- 2024
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47. Identification and outcomes of KDIGO-defined chronic kidney disease in 1.4 million U.S. Veterans with heart failure.
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Patel SS, Raman VK, Zhang S, Deedwania P, Zeng-Treitler Q, Wu WC, Lam PH, Bakris G, Moore H, Heidenreich PA, Rangaswami J, Morgan CJ, Cheng Y, Sheriff HM, Faselis C, Mehta RL, Anker SD, Fonarow GC, and Ahmed A
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- Humans, Male, Female, Aged, United States epidemiology, Middle Aged, Creatinine blood, Retrospective Studies, Heart Failure physiopathology, Heart Failure epidemiology, Renal Insufficiency, Chronic epidemiology, Renal Insufficiency, Chronic physiopathology, Veterans statistics & numerical data, Glomerular Filtration Rate
- Abstract
Aims: According to the Kidney Disease: Improving Global Outcomes (KDIGO) guideline, the definition of chronic kidney disease (CKD) requires the presence of abnormal kidney structure or function for >3 months with implications for health. CKD in patients with heart failure (HF) has not been defined using this definition, and less is known about the true health implications of CKD in these patients. The objective of the current study was to identify patients with HF who met KDIGO criteria for CKD and examine their outcomes., Methods and Results: Of the 1 419 729 Veterans with HF not receiving kidney replacement therapy, 828 744 had data on ≥2 ambulatory serum creatinine >90 days apart. CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m
2 (n = 185 821) or urinary albumin-to-creatinine ratio (uACR) >30 mg/g (n = 32 730) present twice >3 months apart. Normal kidney function (NKF) was defined as eGFR ≥60 ml/min/1.73 m2 , present for >3 months, without any uACR >30 mg/g (n = 365 963). Patients with eGFR <60 ml/min/1.73 m2 were categorized into four stages: 45-59 (n = 72 606), 30-44 (n = 74 812), 15-29 (n = 32 077), and <15 (n = 6326) ml/min/1.73 m2 . Five-year all-cause mortality occurred in 40.4%, 57.8%, 65.6%, 73.3%, 69.7%, and 47.5% of patients with NKF, four eGFR stages, and uACR >30mg/g (albuminuria), respectively. Compared with NKF, hazard ratios (HR) (95% confidence intervals [CI]) for all-cause mortality associated with the four eGFR stages and albuminuria were 1.63 (1.62-1.65), 2.00 (1.98-2.02), 2.49 (2.45-2.52), 2.28 (2.21-2.35), and 1.22 (1.20-1.24), respectively. Respective age-adjusted HRs (95% CIs) were 1.13 (1.12-1.14), 1.36 (1.34-1.37), 1.87 (1.84-1.89), 2.24 (2.18-2.31) and 1.19 (1.17-1.21), and multivariable-adjusted HRs (95% CIs) were 1.11 (1.10-1.12), 1.24 (1.22-1.25), 1.46 (1.43-1.48), 1.42 (1.38-1.47), and 1.13 (1.11-1.16). Similar patterns were observed for associations with hospitalizations., Conclusion: Data needed to define CKD using KDIGO criteria were available in six out of ten patients, and CKD could be defined in seven out of ten patients with data. HF patients with KDIGO-defined CKD had higher risks for poor outcomes, most of which was not explained by abnormal kidney structure or function. Future studies need to examine whether CKD defined using a single eGFR is characteristically and prognostically different from CKD defined using KDIGO criteria., (© 2024 European Society of Cardiology This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)- Published
- 2024
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48. Contemporary American and European Guidelines for Heart Failure Management: JACC: Heart Failure Guideline Comparison.
- Author
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Ostrominski JW, DeFilippis EM, Bansal K, Riello RJ 3rd, Bozkurt B, Heidenreich PA, and Vaduganathan M
- Subjects
- Humans, Europe, United States, Cardiology, American Heart Association, Disease Management, Societies, Medical, Heart Failure therapy, Practice Guidelines as Topic
- Abstract
This review serves to compare contemporary clinical practice recommendations for the management of heart failure (HF), as codified in the 2021 European Society of Cardiology (ESC) guideline, the 2022 American College of Cardiology (ACC)/American Heart Association (AHA)/Heart Failure Society of America (HFSA) guideline, and the 2023 focused update of the 2021 ESC document. Overall, these guidelines aim to solidify significant advances throughout the HF continuum since the publication of previous full guideline iterations (2013 and 2016 for the ACC/AHA and ESC, respectively). All guidelines provide new recommendations for an increasingly complex landscape of HF care, with focus on primary HF prevention, HF stages, rapid initiation and optimization of evidence-based pharmacotherapies, overlapping cardiac and noncardiac comorbidities, device-based therapies, and management pathways for special groups of patients, including those with cardiac amyloidosis. Importantly, the ACC/AHA/HFSA document features special emphasis on HF risk prediction and screening, cost/value, social determinants of health, and health care disparities. The review discusses major similarities and differences between these recent guidelines and guideline updates, as well as their potential downstream implications for clinical care., Competing Interests: Funding Support and Author Disclosures Dr DeFilippis serves on a clinical trial committee for Abiomed and has had speaker engagements with AstraZeneca. Dr Riello has served as a consultant for Alexion AstraZeneca, Boehringer Ingelheim, Janssen, Johnson & Johnson, PhaseBio, and Portola. Dr Bozkurt has received personal fees from Vifor for serving on the steering committee for the Care HF Trial; has received personal fees from Amgen, AstraZeneca, and Baxter for serving on advisory committees or for consulting outside the submitted work; has received consulting fees from Bristol Myers Squibb, scPharmaceuticals, Baxter Healthcare Corporation, Sanofi Aventis, Relypsa, and Amgen; has served on the clinical event committee for the GUIDE HF Trial sponsored by Abbott Vascular; and has served on the data safety monitoring committee of the ANTHEM trial sponsored by LivaNova. Dr Vaduganathan has received research grant support from, has served on advisory boards of, or has had speaker engagements with American Regent, Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, Boehringer Ingelheim, Bristol Myers Squibb, Chiesi, Cytokinetics, Lexicon Pharmaceuticals, Merck, Novartis, Novo Nordisk, Pharmacosmos, Relypsa, Roche Diagnostics, Sanofi, and Tricog Health; and has participated on clinical trial committees for studies sponsored by AstraZeneca, Galmed, Novartis, Bayer AG, Occlutech, and Impulse Dynamics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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49. Is Equity Being Traded for Access to Heart Transplant?
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Heidenreich PA, Lewis EF, and Khush KK
- Subjects
- Female, Humans, Male, Asian statistics & numerical data, Black or African American statistics & numerical data, Ethnicity, Health Services Accessibility statistics & numerical data, Hispanic or Latino statistics & numerical data, Race Factors, Sex Factors, Social Class, United States epidemiology, Waiting Lists, White statistics & numerical data, Health Equity statistics & numerical data, Healthcare Disparities ethnology, Healthcare Disparities statistics & numerical data, Heart Failure epidemiology, Heart Failure ethnology, Heart Failure surgery, Heart Transplantation statistics & numerical data, Tissue and Organ Procurement ethics, Tissue and Organ Procurement statistics & numerical data
- Published
- 2024
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50. Bundled Payments for Care Improvement and Quality of Care and Outcomes in Heart Failure.
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Oddleifson DA, Holmes DN, Alhanti B, Xu X, Heidenreich PA, Wadhera RK, Allen LA, Greene SJ, Fonarow GC, Spatz ES, and Desai NR
- Subjects
- Humans, Male, Female, Aged, United States, Cross-Sectional Studies, Hospitals, Quality of Health Care, Medicare, Heart Failure
- Abstract
Importance: The Centers for Medicare & Medicaid Services (CMS) Bundled Payments for Care Improvement (BPCI) program was launched in 2013 with a goal to improve care quality while lowering costs to Medicare., Objective: To compare changes in the quality and outcomes of care for patients hospitalized with heart failure according to hospital participation in the BPCI program., Design, Setting, and Participants: This cross-sectional study used a difference-in-difference approach to evaluate the BPCI program in 18 BPCI hospitals vs 211 same-state non-BPCI hospitals for various process-of-care measures and outcomes using American Heart Association Get With The Guidelines-Heart Failure registry and CMS Medicare claims data from November 1, 2008, to August 31, 2018. Data were analyzed from May 2022 to May 2023., Exposures: Hospital participation in CMS BPCI Model 2 Heart Failure, which paid hospitals in a fee-for-service process and then shared savings or required reimbursement depending on how the total cost of an episode of care compared with a target price., Main Outcomes and Measures: Primary end points included 7 quality-of-care measures. Secondary end points included 9 outcome measures, including in-hospital mortality and hospital-level risk-adjusted 30-day and 90-day all-cause readmission rate and mortality rate., Results: During the study period, 8721 patients were hospitalized in the 23 BPCI hospitals and 94 530 patients were hospitalized in the 224 same-state non-BPCI hospitals. Less than a third of patients (30 723 patients, 29.8%) were 75 years or younger; 54 629 (52.9%) were female, and 48 622 (47.1%) were male. Hospital participation in BPCI Model 2 was not associated with significant differential changes in the odds of various process-of-care measures, except for a decreased odds of evidence-based β-blocker at discharge (adjusted odds ratio [aOR], 0.63; 95% CI, 0.41-0.98; P = .04). Participation in the BPCI was not associated with a significant differential change in the odds of receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors at discharge, receiving an aldosterone antagonist at discharge, having a cardiac resynchronization therapy (CRT)-defibrillator or CRT pacemaker placed or prescribed at discharge, having implantable cardioverter-defibrillator (ICD) counseling or an ICD placed or prescribed at discharge, heart failure education being provided among eligible patients, or having a follow-up visit within 7 days or less. Participation in the BPCI was associated with a significant decrease in odds of in-hospital mortality (aOR, 0.67; 95% CI, 0.51-0.86; P = .002). Participation was not associated with a significant differential change in hospital-level risk-adjusted 30-day or 90-day all-cause readmission rate and 30-day or 90-day all-cause mortality rate., Conclusion and Relevance: In this study, hospital participation in the BPCI Model 2 Heart Failure program was not associated with improvement in process-of-care quality measures or 30-day or 90-day risk-adjusted all-cause mortality and readmission rates.
- Published
- 2024
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