National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 55 Research Studies DisplayedRastogi V, Guetter CR, Patel PB
Clinical presentation, outcomes, and threshold for repair by sex in degenerative saccular vs fusiform aneurysms in the descending thoracic aorta.
The purpose of this study was to explore variations in presentation, treatment, and outcomes between saccular thoracic aortic aneurysms (TAAs) and fusiform TAAs in the descending thoracic aorta. The researchers also explored the need for sex-specific treatment thresholds for TAAs. The study found that among 655 emergent/urgent thoracic endovascular aneurysm repairs (TEVARs), 37% were performed for saccular TAAs, whereas among 1352 elective TEVARs, 35% had saccular TAA morphology. Compared with fusiform TAAs, saccular TAAs more frequently underwent emergent/urgent (ruptured/symptomatic) TEVAR below the repair threshold in both females and males. Among patients with emergent/urgent fusiform TAAs, females presented at smaller diameters compared with males, yet there was no variance in preoperative aneurysm diameter among patients with saccular TAAs. Emergent/urgent treated saccular TAAs had similar postoperative outcomes and 5-year mortality compared with fusiform TAAs. In the elective cohort, patients with saccular TAAs had comparable postoperative mortality compared with those with fusiform TAAs, but a lower rate of postoperative spinal cord ischemia. additionally, patients with saccular TAAs had a higher rate of 5-year mortality compared with their fusiform counterparts.
AHRQ-funded; HS027285.
Citation: Rastogi V, Guetter CR, Patel PB .
Clinical presentation, outcomes, and threshold for repair by sex in degenerative saccular vs fusiform aneurysms in the descending thoracic aorta.
J Vasc Surg 2023 Dec; 78(6):1392-401.e1. doi: 10.1016/j.jvs.2023.06.104..
Keywords: Outcomes, Cardiovascular Conditions
Urdaneta A, Fisk C, Tandel MD
Air medical transport for acute ischemic stroke patients: a retrospective cohort study of national trends over an 8-year period.
This study examined patterns of air transport for acute ischemic stroke patients over a period of 8 years (2007-2014). The authors abstracted a 20% national sample of Medicare data from patients ≥ 66 years of age hospitalized with a primary diagnosis of acute ischemic stroke who presented to the emergency department by ambulance (air or ground). They analyzed data from 149,751 hospitalized stroke patients who had a mean age of 81.6 years (standard deviation = 8.0 years), 62.1% female (n = 93,007), and 86.3% White (n = 129,268). Of these, 3.7% used any form of air ambulance. Air ambulance use (2007: 2.5%, 2014: 4.9%) and arrival at certified stroke centers (2007: 40.3%, 2014: 63.2%) increased over time. Air ambulance use was less likely among older patients (76-85 years and >85 years vs. 66-75 years; odds ratio [OR] = 0.68 and OR = 0.34, respectively) and all racial minorities except American Natives (OR = 2.07) and more likely among sicker patients (Charlson Comorbidity Index ≥ 2 vs. 1, OR = 1.23) and rural residents (OR = 1.34). After adjustment for covariates, air ambulance use was associated with higher odds of thrombolysis (adjusted OR = 2.57).
AHRQ-funded; HS026207.
Citation: Urdaneta A, Fisk C, Tandel MD .
Air medical transport for acute ischemic stroke patients: a retrospective cohort study of national trends over an 8-year period.
Air Med J 2023 Nov-Dec; 42(6):423-28. doi: 10.1016/j.amj.2023.06.007..
Keywords: Stroke, Cardiovascular Conditions, Emergency Medical Services (EMS)
Bauer TM, Yaser JM, Daramola T
Cardiac rehabilitation reduces two-year mortality after coronary artery bypass grafting.
This study analyzed the outcome of cardiac rehabilitation (CR) use for patients who have undergone coronary revascularization procedures. The study looked at Medicare fee-for-service claims linked to surgical data patients discharged alive following isolated coronary artery bypass grafting (CABG) from January 2015 to October 2019. A total of 3,848/6,412 (60.0%) of patients were enrolled in CR for an average of 23.2 sessions with 770/6,412 (12.0%) completing all recommended 36 sessions. Predictors of post-discharge CR use included increasing age, discharge to home (vs extended care facility), and shorter length of stay. Unadjusted and inverse probability treatment weighting (IPTW) analyses showed significant reduction in 2-year mortality in CR users as compared to CR non-users (unadjusted 9.4%).
AHRQ-funded; HS027830.
Citation: Bauer TM, Yaser JM, Daramola T .
Cardiac rehabilitation reduces two-year mortality after coronary artery bypass grafting.
Ann Thorac Surg 2023 Nov; 116(5):1099-105. doi: 10.1016/j.athoracsur.2023.05.044..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Surgery, Mortality, Outcomes
Ross SM, Wang A, Anthony L
Is more better? The impact of implementing more interventions for hypertension control in a practice facilitation study for small- and medium-sized practices.
The purpose of this study was to research the effects of interventions for blood pressure in small- and medium-sized practices. The researchers utilized retrospective analysis on data from Healthy Hearts in the Heartland (H3), a research program conducted in 2016-2018 as part of the Agency for Healthcare Research and Quality's EvidenceNOW initiative, to examine the impact of implementing more interventions for BP control in these settings. The study included 38 H3 practices which met inclusion criteria and researchers assigned each practice to an implementer group (high or low) based on the number of interventions implemented. Practices in the high-implementer group implemented an average of 2.2 additional interventions relative to the low-implementer group. Groups were compared on two measures of BP control: (1) mean percentage of hypertensive patients with a most recent BP below 140/90, and (2) mean systolic and diastolic BP of hypertensive patients. In the first measure, practices in the high-implementer group had better improvement between baseline and the end of the study. Among the 10,150 patients included in the second measure, reductions in mean SBP and DBP were better for the high-implementer group.
AHRQ-funded; HS000078; HS000084; HS023921.
Citation: Ross SM, Wang A, Anthony L .
Is more better? The impact of implementing more interventions for hypertension control in a practice facilitation study for small- and medium-sized practices.
J Hum Hypertens 2023 Nov; 37(11):1007-14. doi: 10.1038/s41371-023-00813-1..
Keywords: Blood Pressure, Cardiovascular Conditions, Patient-Centered Outcomes Research, Evidence-Based Practice, Practice Improvement
Thompson MP, Hou H, Stewart JW
Relationship between community-level distress and cardiac rehabilitation participation, facility access, and clinical outcomes after inpatient coronary revascularization.
The purpose of this retrospective cohort study was to assess the association between community-level distress and cardiac rehabilitation (CR) participation, access to CR facilities, and clinical outcomes. The study included a 100% sample of Medicare beneficiaries undergoing inpatient coronary revascularization between July 2016 and December 2018. Community-level distress was defined by the researchers as using the Distressed Community Index quintile at the beneficiary zip code level, with the first and fifth quintiles representing prosperous and distressed communities, respectively. The study found that any CR use was lower for beneficiaries in distressed compared with prosperous communities (26.0% versus 46.1%), which was significant after multivariable adjustment. 23.7% of beneficiaries had a CR facility within their zip code, which increased from 16.3% in prosperous communities to 26.6% in distressed communities. Any CR utilization was related with absolute reductions in mortality, all-cause hospitalization, and acute myocardial infarction hospitalization, which were comparable across each Distressed Community Index quintiles.
AHRQ-funded; HS027830.
Citation: Thompson MP, Hou H, Stewart JW .
Relationship between community-level distress and cardiac rehabilitation participation, facility access, and clinical outcomes after inpatient coronary revascularization.
Circ Cardiovasc Qual Outcomes 2023 Nov; 16(11):e010148. doi: 10.1161/circoutcomes.123.010148..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Outcomes
Shields AD, Vidosh J, Thomson BA
Validation of a simulation-based resuscitation curriculum for maternal cardiac arrest.
The purpose of this study was to evaluate the knowledge, skills, and self-efficacy of health care participants completing a simulation-based blended learning training curriculum on managing maternal medical emergencies and maternal cardiac arrest. The study included a formative assessment of the Obstetric Life Support curriculum. The training consisted of self-guided pre-course work and an instructor-led simulation course using a customized low-fidelity simulator. Eighty-five participants consented to participation in the training (out of 88 invited); 77 participants completed the training over eight sessions. The study found that at baseline, less than 50% of participants were able to achieve a passing score on the cognitive assessment. After the course, mean cognitive assessment scores improved by 13 points, from 69.4% at baseline to 82.4% after the course. The researchers observed significant improvements in participant self-efficacy, and 92.6% of participants agreed or strongly agreed that the course met its educational objectives.
AHRQ-funded; HS026169.
Citation: Shields AD, Vidosh J, Thomson BA .
Validation of a simulation-based resuscitation curriculum for maternal cardiac arrest.
Obstet Gynecol 2023 Nov 1; 142(5):1189-98. doi: 10.1097/aog.0000000000005349..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Maternal Care, Simulation, Training, Education: Continuing Medical Education, Women
Thompson MP, Stewart JW, Hou H
Determinants and outcomes associated with skilled nursing facility use after coronary artery bypass grafting: a statewide experience.
The purpose of this study was to assess determinants and outcomes related with Skilled nursing facility (SNF) use after isolated coronary artery bypass grafting. The study sample included 8,614 patients, with an average age of 73.3 years. A skilled nursing facility (SNF) was used by 22.3% of patients within 90 days of discharge and ranged from 3.2% to 58.3% across the 33 hospitals. Patients utilizing SNFs had a greater likelihood of being female, older, non-White, with greater comorbidities, worse cardiovascular function, a perioperative morbidity, and longer hospital lengths of stay. Outcomes were significantly worse for users of SNFs, including higher rates of 90-day readmissions and ED visits and lower use of home health and rehabilitation services. Compared with non-SNF users, users of SNFs had a greater risk-adjusted hazard of mortality and had 2.7-percentage point greater 5-year mortality rate in a propensity-matched cohort of patients.
AHRQ-funded; HS027830.
Citation: Thompson MP, Stewart JW, Hou H .
Determinants and outcomes associated with skilled nursing facility use after coronary artery bypass grafting: a statewide experience.
Circ Cardiovasc Qual Outcomes 2023 Oct; 16(10):e009639. doi: 10.1161/circoutcomes.122.009639..
Keywords: Elderly, Nursing Homes, Heart Disease and Health, Cardiovascular Conditions, Medicare, Surgery
Romijn AC, Rastogi V, Proaño-Zamudio JA
Early versus delayed thoracic endovascular aortic repair for blunt thoracic aortic injury: a propensity score-matched analysis.
This study examined the outcomes of ≤24 h) versus delayed (>24 h) thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI), taking the aortic injury severity into consideration. Current trauma surgery guidelines recommend delayed TEVAR. Patients undergoing TEVAR for BTAI in the American College of Surgeons Trauma Quality Improvement Program between 2016 and 2019 were included and then stratified into early (≤24 h) or delayed (>24 h). The cohort looked at included 1339 patients, of whom 1054 (79%) underwent early TEVAR. Compared with the delayed group, the early group had significantly less severe head injuries (early vs delayed; 25% vs 32%), fewer early interventions for AAS grade 1 occurred, and AAS grade 3 aortic injuries often were intervened upon within 24 hours (grade 1: 28% vs 47%; grade 3: 49% vs 23%). Compared with the delayed group, the early group had significantly higher in-hospital mortality (8.8% vs 4.4%, relative risk: 2.2, 95% CI: 1.1-4.4), alongside a shorter length of hospital stay (5.0 vs 10 days), a shorter intensive care unit length of stay (4.0 vs 11 days) and fewer days on the ventilator (4.0 vs 6.5 days). Regardless of the higher risk of acute kidney injury in the delayed group (3.3% vs 7.7%), no other differences in in-hospital complications were observed between the early and delayed group.
AHRQ-funded; HS027285.
Citation: Romijn AC, Rastogi V, Proaño-Zamudio JA .
Early versus delayed thoracic endovascular aortic repair for blunt thoracic aortic injury: a propensity score-matched analysis.
Ann Surg 2023 Oct 1; 278(4):e848-e54. doi: 10.1097/sla.0000000000005817..
Keywords: Surgery, Cardiovascular Conditions, Risk, Outcomes
Zachrison KS, Hsia RY, Schwamm LH
Insurance-based disparities in stroke center access in california: a network science approach.
The purpose of this study was to examine whether there is a relationship between ischemic stroke patient insurance and probability of transfer to a stroke center overall as well as whether hospital cluster modified the relationship between insurance and likelihood of stroke center transfer. The study included 332,995 total ischemic stroke encounters, with 3.5% transferred from the initial ED. The study found that of 52,316 participants presenting to a non-stroke center, 7.1% were transferred. Compared to privately insured patients, there were lower odds of transfer and of transfer to a stroke center among all groups. Within the 14 identified hospital clusters, there was variation in insurance-based disparities in transfer. The largest hospital was also the lowest performing cluster which fully explained the insurance-based disparity in odds of stroke center transfer. The study concluded that uninsured patients had lower stroke center access through transfer than patients with insurance, with the variation primarily explained by patterns in 1 specific hospital cluster.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Hsia RY, Schwamm LH .
Insurance-based disparities in stroke center access in california: a network science approach.
Circ Cardiovasc Qual Outcomes 2023 Oct; 16(10):e009868. doi: 10.1161/circoutcomes.122.009868..
Keywords: Access to Care, Stroke, Cardiovascular Conditions, Disparities, Health Insurance, Uninsured
Aklilu AM, Kumar S, Yamamoto Y
Outcomes associated with sodium-glucose cotransporter-2 inhibitor use in acute heart failure hospitalizations complicated by AKI.
This retrospective study examined the association of sodium-glucose cotransporter-2 inhibitor (SGLT2i) use with patients who have KDIGO-defined acute kidney injury (AKI) during acute heart failure (AHF) hospitalizations and their kidney function recovery at 14 days and 30 days using time-varying multivariable Cox-regression analyses. The study looked at 3305 adults hospitalized across 5 Yale New Haven Health Systems between January 2020 and May 2022 with AHF complicated by KDIGO-defined AKI. Of those individuals hospitalized with AHF and AKI, 356 received SGLT2i following AKI diagnosis either as initiation or continuation. The rate of renal recovery was not significantly different among those exposed and unexposed to SGLT2i following AKI (adjusted HR 0.94). SGLT2i exposure was associated with lower risk of 30-day mortality (adjusted HR 0.45). Rates of renal recovery were similar between the exposed and nonexposed cohorts regardless of the proximity of SGLT2i exposure to AKI diagnosis.
AHRQ-funded; HS027626.
Citation: Aklilu AM, Kumar S, Yamamoto Y .
Outcomes associated with sodium-glucose cotransporter-2 inhibitor use in acute heart failure hospitalizations complicated by AKI.
Kidney360 2023 Oct; 4(10):1371-81. doi: 10.34067/kid.0000000000000250..
Keywords: Kidney Disease and Health, Heart Disease and Health, Cardiovascular Conditions, Inpatient Care, Medication, Outcomes
Krefman AE, Ciolino Jd, Kan AK
Rationale and design for Healthy Hearts for Michigan (HH4M): a pragmatic single-arm hybrid effectiveness-implementation study.
The objective of the Healthy Hearts for Michigan (HH4M) study is to promote hypertension management and smoking cessation through practice facilitation and quality improvement efforts. This three-year research program evaluates rural and medically underserved primary care practices’ ability to implement the quality improvement model and tests whether the model improves blood pressure control and tobacco use screening and cessation. Primary care practices in rural and underserved areas of Michigan were recruited to join HH4M. HH4M is part of the multi-state EvidenceNOW: Building State Capacity initiative to provide external support to primary care practices to improve care delivery.
AHRQ-funded; HS027954.
Citation: Krefman AE, Ciolino Jd, Kan AK .
Rationale and design for Healthy Hearts for Michigan (HH4M): a pragmatic single-arm hybrid effectiveness-implementation study.
Contemp Clin Trials Commun 2023 Oct; 35:101199. doi: 10.1016/j.conctc.2023.101199..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Evidence-Based Practice, Patient-Centered Outcomes Research, Primary Care
Reistetter T, Hreha K, Dean JM
The pre-adaptation of a stroke-specific self-management program among older adults.
To understand the management of multimorbidity in aging stroke survivors and to examine the complex relationships between comorbidities, researchers used visual analytics to identify patient subgroup. Five significant subgroups of comorbidities such as obesity and cancer were identified. An interdisciplinary team constructed six vignettes that highlighted multimorbidity to customize a self-management program that fitted the needs of older adult stroke survivors.
AHRQ-funded; HS026133.
Citation: Reistetter T, Hreha K, Dean JM .
The pre-adaptation of a stroke-specific self-management program among older adults.
J Aging Health 2023 Oct; 35(9):632-42. doi: 10.1177/08982643231152520..
Keywords: Stroke, Cardiovascular Conditions, Elderly, Patient Self-Management
Movahedi F, Kanwar MK, Antaki JF
Timelines of adverse event journeys of LVAD patients.
The objective of this study was to investigate the timelines of adverse events (AEs) in the INTERMACS database to obtain insights into the "AE journeys" of left ventricular assist device (LVAD) patients. The characteristics of the timelines were investigated via six descriptive research questions. The analysis revealed time-related characteristics and patterns of the AE journey after LVAD, including the most common time of occurrences, duration, and time intervals between AEs. The authors concluded that the INTERMACS Event dataset is a valuable resource for research about the timeline of AE journeys of LVAD patients and noted that future studies should consider the time-related characteristics of the dataset to choose an appropriate scope of time and time granularity.
AHRQ-funded; HS027784.
Citation: Movahedi F, Kanwar MK, Antaki JF .
Timelines of adverse event journeys of LVAD patients.
Artif Organs 2023 Oct; 47(10):1604-12. doi: 10.1111/aor.14596..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Adverse Events, Medical Devices
Franklin MK, Karpyn A, Christofferson J
Barriers and facilitators to discussing parent mental health within child health care: perspectives of parents raising a child with congenital heart disease.
This study’s objective was to identify barriers and facilitators to the discussion of parental mental health within child health care for children with congenital heart disease (CHD). Participants were parents of young children with CHD who received care across 40 hospitals in the US. They responded to questions about discussing their mental health with their child's health care providers and described multiple barriers including perceived expectation to "stay strong," and fear of negative judgment or repercussions. Facilitators included care team ability to provide support and personal connections with health care providers. The authors concluded that is important that health care providers normalize the impact of child illness on the family and create an environment in which parents feel comfortable discussing mental health challenges.
AHRQ-funded; HS026393.
Citation: Franklin MK, Karpyn A, Christofferson J .
Barriers and facilitators to discussing parent mental health within child health care: perspectives of parents raising a child with congenital heart disease.
J Child Health Care 2023 Sep; 27(3):360-73. doi: 10.1177/13674935211058010..
Keywords: Children/Adolescents, Behavioral Health, Heart Disease and Health, Cardiovascular Conditions
Zhou S, Yang G, Hou H
Infections following left ventricular assist device implantation and 1-year health-related quality of life.
This study examined number and types of infection following left ventricular assist device (LVAD) implantation and its adverse effects on patient-reported health-related quality of life (HRQOL). Participants were patients from the Society of Thoracic Surgeons' Interagency Registry for Mechanically Assisted Circulatory Support who had received a primary LVAD. The results showed that each additional infection within the first post-implantation year was associated with an incremental negative effect on patient survival free of impaired HRQOL.
AHRQ-funded; HS026003.
Citation: Zhou S, Yang G, Hou H .
Infections following left ventricular assist device implantation and 1-year health-related quality of life.
J Heart Lung Transplant 2023 Sep; 42(9):1307-15. doi: 10.1016/j.healun.2023.05.006..
Keywords: Heart Disease and Health, Medical Devices, Cardiovascular Conditions, Quality of Care
Troy AL, Herzig SJ, Trivedi S
Initiation of oral anticoagulation in US older adults newly diagnosed with atrial fibrillation during hospitalization.
This study investigated prevalence of oral anticoagulant initiation for newly diagnosed US older adults with atrial fibrillation within 7 days of hospital discharge. The authors used a 20% national sample of Medicare fee-for-service beneficiaries, identifying patients aged 65 years or older newly diagnosed with atrial fibrillation while hospitalized in 2016. Among 38,379 older adults newly diagnosed with atrial fibrillation while hospitalized (mean age 78.2; 51.8% female; 83.3% white), 36,633 (95.4%) had an indication for anticoagulation and 24.6% (9011) of those initiated an oral anticoagulant following discharge. Higher CHA(2) DS(2) -VASc score was associated with a small increase in oral anticoagulant initiation (predicted probability 20.5% for scores <2 and 24.9% for ≥4). Elevated HAS-BLED score was associated with a small decrease in probability of anticoagulant initiation (25.4% for score <2 and 23.1% for ≥3). Frailty was associated with decreased likelihood of oral anticoagulant initiation (24.7% for non-frail and 18.1% for moderately-severely frail). Anticoagulant initiation varied by primary reason for hospitalization, with predicted probability highest among patients with a primary diagnosis of atrial fibrillation (46.1%) and lowest among those with non-cardiovascular conditions (13.8%) and bleeds (3.6%).
AHRQ-funded; HS026215.
Citation: Troy AL, Herzig SJ, Trivedi S .
Initiation of oral anticoagulation in US older adults newly diagnosed with atrial fibrillation during hospitalization.
J Am Geriatr Soc 2023 Sep; 71(9):2748-58. doi: 10.1111/jgs.18375..
Keywords: Elderly, Blood Thinners, Medication, Heart Disease and Health, Cardiovascular Conditions, Stroke
Osmanlliu E, Kalwani NM, Parameswaran V
Sociodemographic disparities in the use of cardiovascular ambulatory care and telemedicine during the COVID-19 pandemic.
Researchers examined adult cardiology visits at an academic and affiliated community practice in Northern California to assess the persistence sociodemographic disparities in telemedicine use before and during the COVID pandemic. Results indicated that sociodemographic characteristics of patients receiving cardiovascular care remained stable during both periods, but the modality of care diverged across groups. Observed disparities in the use of video-based telemedicine were greatest for patients 80 years or older, Black, with limited English proficiency, or on Medicaid. The researchers recommended that future studies examine barriers and outcomes in digital healthcare access across diverse patient groups.
AHRQ-funded; HS026128.
Citation: Osmanlliu E, Kalwani NM, Parameswaran V .
Sociodemographic disparities in the use of cardiovascular ambulatory care and telemedicine during the COVID-19 pandemic.
Am Heart J 2023 Sep; 263:169-76. doi: 10.1016/j.ahj.2023.06.011..
Keywords: COVID-19, Cardiovascular Conditions, Telehealth, Health Information Technology (HIT), Disparities, Ambulatory Care and Surgery
Roberts MM, Marino M, Wells R
Differences in use of clinical decision support tools and implementation of aspirin, blood pressure control, cholesterol management, and smoking cessation quality metrics in small practices by race and sex.
The objective of this cross-sectional study was to evaluate the association between population-based clinical decision support (CDS) tools and racial and sex disparities in the aspirin use, blood pressure control, cholesterol management, and smoking cessation (ABCS) care quality metrics among smaller primary care practices. Researchers used practice-level data from the EvidenceNOW initiative, from practices that submitted both survey data and electronic health record (EHR)-derived ABCS data stratified by race and sex. Their findings suggested that practices using CDS tools had small disparities but were not statistically significant; however, CDS tools were not associated with reductions in disparities. They concluded that more research was needed on effective practice-level interventions to mitigate disparities.
AHRQ-funded; HS023940.
Citation: Roberts MM, Marino M, Wells R .
Differences in use of clinical decision support tools and implementation of aspirin, blood pressure control, cholesterol management, and smoking cessation quality metrics in small practices by race and sex.
JAMA Netw Open 2023 Aug; 6(8):e2326905. doi: 10.1001/jamanetworkopen.2023.26905..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Cardiovascular Conditions, Tobacco Use, Tobacco Use: Smoking Cessation, Primary Care, Evidence-Based Practice, Prevention
Fuery MA, Kadhim B, Samsky MD
Electronic health record embedded strategies for improving care of patients with heart failure.
This article reviews recent findings from randomized clinical trials examining the impact of electronic health record (HER) alerts (called nudges) on quality of care for heart failure patients. These clinical trials demonstrated that some EHR alerts can improve care for heart failure patients. The trials described utilized default options, involved clinicians in the alert design process, provided actionable recommendations, and aimed to minimize disruptions to typical workflow.
AHRQ-funded; HS027626.
Citation: Fuery MA, Kadhim B, Samsky MD .
Electronic health record embedded strategies for improving care of patients with heart failure.
Curr Heart Fail Rep 2023 Aug; 20(4):280-86. doi: 10.1007/s11897-023-00614-0..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Heart Disease and Health, Cardiovascular Conditions, Chronic Conditions
Tarnutzer AA, Gold D, Wang Z
Impact of clinician training background and stroke location on bedside diagnostic test accuracy in the acute vestibular syndrome - a meta-analysis.
Researchers conducted a systematic review to assess the accuracy of bedside diagnosis of acute dizziness/vertigo to differentiate peripheral vestibular from central neurologic causes. Their review indicated that the Head Impulse, Nystagmus, Test of Skew (HINTS) examination by trained clinicians can differentiate peripheral from central causes and show higher diagnostic accuracy for stroke in the first 24-48 hours than MRI diffusion-weighted imaging. They concluded that these techniques should be disseminated to clinicians evaluating dizziness/vertigo.
AHRQ-funded; HS029350.
Citation: Tarnutzer AA, Gold D, Wang Z .
Impact of clinician training background and stroke location on bedside diagnostic test accuracy in the acute vestibular syndrome - a meta-analysis.
Ann Neurol 2023 Aug; 94(2):295-308. doi: 10.1002/ana.26661..
Keywords: Diagnostic Safety and Quality, Training, Education: Continuing Medical Education, Provider: Clinician, Stroke, Cardiovascular Conditions
Zhou S, Yang G, Zhang M
Mortality following durable left ventricular assist device implantation by timing and type of first infection.
Researchers examined the relationship between timing and type of first infection regarding mortality following left ventricular assist device implantation. The study cohort included nearly 13,000 Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support patients at 166 centers. The results showed that patients with any post-implantation infection had an increased risk of death; ventricular assist device-related infections and infections occurring in the intermediate interval (91-180 days after implantation) were associated with the largest increase in risk. The researchers recommended that infection prevention strategies should target non-ventricular assist device infections in the first 90 days, then shift to surveillance/prevention of driveline infections after 90 days.
AHRQ-funded; HS026003.
Citation: Zhou S, Yang G, Zhang M .
Mortality following durable left ventricular assist device implantation by timing and type of first infection.
J Thorac Cardiovasc Surg 2023 Aug; 166(2):570-79.e4. doi: 10.1016/j.jtcvs.2021.10.056..
Keywords: Mortality, Cardiovascular Conditions, Medical Devices, Heart Disease and Health
Montembeau SC, Merchant FM, Speight C
Patients' perspectives regarding generator exchanges of implantable cardioverter defibrillators.
This study explored how patients make implantable cardioverter defibrillator (ICD) generator exchange decisions. Fifty patients from Emory Healthcare with primary prevention ICDs implanted from 2013 to 2021 completed in-depth interviews exploring perspectives regarding generator exchanges. Patients were presented standard-gamble type hypothetical scenarios where their ICD battery was depleted but their 5-year risk of sudden cardiac death at that time varied (10%, 5%, and 1%). Among these patients, 18 had a prior generator exchange, 16 had received ICD therapy, and 17 had improved left ventricular ejection fraction. As sudden cardiac death risk decreased from 10% to 5% to 1%, the number of participants willing to undergo a generator exchange decreased from 48 to 42 to 33. Doctor recommendations were also likely to substantially impact patients’ decision making. Therapeutic inertia and common misconceptions about ICD therapy represented substantive barriers to effective shared decision-making.
AHRQ-funded; HS028558.
Citation: Montembeau SC, Merchant FM, Speight C .
Patients' perspectives regarding generator exchanges of implantable cardioverter defibrillators.
Circ Cardiovasc Qual Outcomes 2023 Aug; 16(8):509-18. doi: 10.1161/circoutcomes.122.009827..
Keywords: Medical Devices, Heart Disease and Health, Cardiovascular Conditions
Patel PB, Marcaccio CL, Swerdlow NJ
Thoracoabdominal aortic aneurysm life-altering events following endovascular aortic repair in the Vascular Quality Initiative.
This study’s objective was to examine the rates of postoperative mortality and morbidity stratified by type of endovascular aortic aneurysm repair (EVAR). The authors identified all patients who underwent EVAR in the Vascular Quality Initiative registry from January 2011 to May 2022. Patients were then stratified by repair type: infrarenal EVAR, complex EVAR, thoracic endovascular aortic repair (TEVAR), extent I to III thoracoabdominal aortic aneurysm (TAAA) repair, or aortic arch repair. Primary outcomes across the different treatment groups was postoperative thoracoabdominal aortic aneurysm life-altering events (TALE). They identified a total of 52,592 EVARs, 3768 complex EVARs, 3899 TEVARs, 1139 extent I to III TAAA repairs, and 479 arch repairs, with TALE observed in 1.2% of EVARs, 4.8% of complex EVARs, 6.0% of TEVARs, 10% of extent I to III TAAA repairs, and 14% of arch repairs. More proximal landing zone was associated with higher odds of TALE after complex EVAR, TEVAR, and extent I to III TAAA repair. Aortic diameter >65 mm was associated with higher odds of TALE after infrarenal EVAR, complex EVAR, TEVAR, and arch repair. The use of parallel grafting technique (chimney/snorkel/periscope) during extent I to III TAAA repair was also associated with higher odds of TALE. Preoperative chronic kidney disease was also associated with higher odds of TALE after infrarenal EVAR, complex EVAR, TEVAR, and extent I to III TAAA repair.
AHRQ-funded; HS027285.
Citation: Patel PB, Marcaccio CL, Swerdlow NJ .
Thoracoabdominal aortic aneurysm life-altering events following endovascular aortic repair in the Vascular Quality Initiative.
J Vasc Surg 2023 Aug; 78(2):269-77.e3. doi: 10.1016/j.jvs.2023.03.499..
Keywords: Surgery, Stroke, Cardiovascular Conditions
Derington CG, Goodrich GK, Xu S
Association of direct oral anticoagulation management strategies with clinical outcomes for adults with atrial fibrillation.
This study investigated the impact of an anticoagulation management service (AMS) on clinical outcomes of adults with atrial fibrillation (AF). This retrospective cohort study was conducted in 3 Kaiser Permanente regions, with each region taking a slightly different approach to direct oral anticoagulant (DOAC) care. These approaches included (1) usual care (UC) by the prescribing clinician, (2) UC plus an automated population management tool (PMT), or (3) pharmacist-managed AMS care. The study included 44,746 adults with a diagnosis of AF who initiated DOAC or warfarin between August 2016 and January 1, 2020, 6182 in the UC model, 33,624 in the UC plus PMT care model, and 4939 in the AMS care model. Baseline characteristics (mean age, 73.1 years, 56.1% male, 67.2% non-Hispanic White, median CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65-74 years, female sex] score of 3 [IQR, 2-5]) were well balanced after inverse probability of treatment weighting (IPTW). The cohort was followed over a median of 2 years, and patients who received the UC plus PMT or AMS care model did not have significantly better outcomes than those who received only UC.
AHRQ-funded; HS026156.
Citation: Derington CG, Goodrich GK, Xu S .
Association of direct oral anticoagulation management strategies with clinical outcomes for adults with atrial fibrillation.
JAMA Netw Open 2023 Jul; 6(7):e2321971. doi: 10.1001/jamanetworkopen.2023.21971..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Blood Thinners, Medication, Outcomes, Stroke
Yadavalli SD, Romijn AC, Rastogi V
Outcomes following thoracic endovascular aortic repair for blunt thoracic aortic injury stratified by Society for Vascular Surgery grade.
Researchers analyzed data on patients undergoing thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) within the Society for Vascular Surgery aortic injury grading system to assess its association with outcomes. Their findings indicated higher perioperative and 5-year mortality in TEVAR patients with grade 4 BTAI, but no association with the aortic injury grade after risk adjustment. More than 5% of TEVAR patients with BTAI had a grade 1 injury, with a significant rate of spinal cord ischemia potentially attributable to TEVAR; this proportion did not decrease over time. The researchers suggested that future efforts should focus on careful selection of patients with BTAI who will experience more benefit than harm from operative repair and prevent inadvertent use of TEVAR in low-grade injuries.
AHRQ-funded; HS027285.
Citation: Yadavalli SD, Romijn AC, Rastogi V .
Outcomes following thoracic endovascular aortic repair for blunt thoracic aortic injury stratified by Society for Vascular Surgery grade.
J Vasc Surg 2023 Jul; 78(1):38-47.e2. doi: 10.1016/j.jvs.2023.03.021..
Keywords: Outcomes, Cardiovascular Conditions