Showing papers in "Circulation-cardiovascular Quality and Outcomes in 2019"
TL;DR: In this article, ischemic heart disease (IHD) has been considered the top cause of mortality globally and countries differ in their rates and there have been changes over time.
Abstract: Background: Ischemic heart disease (IHD) has been considered the top cause of mortality globally. However, countries differ in their rates and there have been changes over time. Methods and Results...
363 citations
TL;DR: The rate of adult cardiac arrests increased over time, while pediatric events remained more stable, while the number of in-hospital cardiac arrests among hospitalized patients remained the same.
Abstract: Background: Previous incidence estimates may no longer reflect the current public health burden of cardiac arrest in hospitalized adult and pediatric patients across the United States. The aim of t...
226 citations
TL;DR: This research presents a novel probabilistic approach that allows us to assess the importance of knowing the carrier and removal status of canine coronavirus, as a source of infection for other animals.
Abstract: Background: Data sharing accelerates scientific progress but sharing individual-level data while preserving patient privacy presents a barrier. Methods and Results: Using pairs of deep neural netwo...
224 citations
Brigham and Women's Hospital1, University of Alberta2, University of North Carolina at Chapel Hill3, University of Florida4, MedStar Washington Hospital Center5, Mayo Clinic6, Lehigh Valley Hospital7, Cleveland Clinic8, Cooper University Hospital9, University of California, San Diego10, University of Louisville11, New York University12, Virginia Commonwealth University13, Toronto General Hospital14, Johns Hopkins University School of Medicine15, Rush University Medical Center16, National Institutes of Health17
TL;DR: In this paper, the authors focused on acute myocardial infarction (AMI) complicated by cardiogenic shock (AMICS) in cardiac intensive care units (CICUs).
Abstract: Background Clinical investigations of shock in cardiac intensive care units (CICUs) have primarily focused on acute myocardial infarction (AMI) complicated by cardiogenic shock (AMICS). Few studies...
199 citations
TL;DR: The transgender population had a higher reported history of myocardial infarction in comparison to the cisgender population, except for transgender women compared with cisgender men, even after adjusting for cardiovascular risk factors.
Abstract: Background: As of 2016, ≈1.4 million people in the United States identify as transgender. Despite their growing number and increasing specific medical needs, there has been a lack of research on ca...
126 citations
TL;DR: In this paper, female patients have historically received less aggressive lipid management than male patients, and the potential causes for these differences are unknown, while male patients have been more aggressive in their lipid management.
Abstract: Background: Female patients have historically received less aggressive lipid management than male patients. Contemporary care patterns and the potential causes for these differences are unknown. Me...
121 citations
TL;DR: This research presents a novel probabilistic approach that allows us to assess the importance of knowing the carrier and removal status of canine coronavirus, as a source of infection for other animals.
Abstract: Background: The ECG remains the most widely used diagnostic test for characterization of cardiac structure and electrical activity. We hypothesized that parallel advances in computing power, machin...
103 citations
TL;DR: Author(s): Casey, Donald E; Thomas, Randal J; Bhalla, Vivek; Commodore-Mensah, Yvonne; Heidenreich, Paul A; Kolte, Dhaval; Muntner, Paul; Smith, Sidney C; Spertus, John A; Windle, John R; Wozniak, Gregory D; Ziaeian, Boback
Abstract: In 2018, the Task Force convened the writing committee to begin the process of revising the existing performance measures set for hypertension that had been released in 2011.3 The writing committee also was charged with the task of developing new measures to evaluate the care of patients in accordance with the 2017 Hypertension Clinical Practice Guidelines.4
The writing committee developed a comprehensive measure set for the diagnosis and treatment of high blood pressure (HBP) that includes 22 new measures: 6 performance measures, 6 process quality measures, and 10 structural quality measures. In conceptualizing these measures, the writing committee paid very close attention to the current Class of Recommendation (COR) and Level of Evidence (LOE) guideline classification scheme used by ACC and AHA in all of its guidelines, as shown in Table 1.
Table 1.
Applying Class of Recommendation and Level of Evidence to Clinical Strategies, Interventions, Treatments, or Diagnostic Testing in Patient Care (Updated August 2015)*
66 citations
TL;DR: Aortic valve replacement with bioprostheses in young adults is associated with high structural valve deterioration and reintervention rates and low, though not absent, hazards of thromboembolism and bleeding.
Abstract: Background: To support decision-making in aortic valve replacement in nonelderly adults, we aim to provide a comprehensive overview of reported outcome after bioprosthetic aortic valve replacement ...
55 citations
52 citations
TL;DR: In this paper, a clinically important difference in overall AFEQT (score range= 0 [worst] to 100 [best]) and selected subscales was defined for the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF).
Abstract: Background The Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire has recently been validated to measure the impact of atrial fibrillation on quality of life, but a clinically important difference in AFEQT score has not been well defined. Methods and Results To determine the clinically important difference in overall AFEQT (score range= 0 [worst] to 100 [best]) and selected subscales, we analyzed data in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry, a United States-based outpatient atrial fibrillation registry. AFEQT was assessed at baseline and 1 year in a subset of 1347 ORBIT-AF patients from 80 US sites participating in ORBIT-AF from June 2010 to August 2011. The mean change method was used to relate changes in 1-year AFEQT scores to clinically important changes in the physician assessment of European Heart Rhythm Association functional status (1 class improvement and separately 1 class deterioration). Clinically important differences and 95% CI corresponding to either a 1 European Heart Rhythm Association class improvement or deterioration were 5.4 (3.6-7.2) and -4.2 (-6.9 to -1.5) AFEQT points, respectively. Similarly, clinically important difference values were seen for a 1 European Heart Rhythm Association class improvement for the AFEQT subscales Activities of Daily Living and Symptoms: 5.1 (2.5-7.6) and 7.1 (5.3-9.0) AFEQT points, respectively. Conclusions Based on the anchor of 1 European Heart Rhythm Association class change, changes in AFEQT score of + or -5 points are clinically important changes in patients' health. Clinical Trial Registration URL: https://clinicaltrials.gov . Unique identifier: NCT01165710.
TL;DR: The disability-adjusted life years (DALY) is a common public health metric used to consistently estimate and compare health loss because of both fatal and nonfatal disease burden as discussed by the authors.
Abstract: Background Disability-adjusted life years (DALY) are a common public health metric used to consistently estimate and compare health loss because of both fatal and nonfatal disease burden. The annua...
TL;DR: This research presents a novel probabilistic approach that allows us to assess the importance of knowing the carrier and removal status of canine coronavirus as a source of infection for other animals.
Abstract: Background: Atherosclerotic cardiovascular disease remains a major cause of death and disability, especially for high-risk familial hypercholesterolemia individuals. PCSK9i (proprotein convertase s...
TL;DR: Among older adults hospitalized with AMI, women had a higher prevalence of age-related functional impairments and, among the STEMI subgroup, a higher incidence of overall bleeding events, which was driven by higher rates of nonmajor bleeding events and bleeding following percutaneous coronary intervention.
Abstract: Background: Studies of sex-based differences in older adults with acute myocardial infarction (AMI) have yielded mixed results. We, therefore, sought to evaluate sex-based differences in presentati...
TL;DR: In this article, the authors found that rural residence is associated with stroke incidence and mortality, but little is known about potential rural/urban differences in ambulatory stroke care, and they used this information to identify potential rural and urban differences in stroke care.
Abstract: Background: Rural residence is associated with stroke incidence and mortality, but little is known about potential rural/urban differences in ambulatory stroke care. Methods and Results: We used th...
TL;DR: Patients with critical limb ischemia have multiple comorbidities, and initial surgical bypass is associated with poorer amputation-free survival compared with an endovascular-first approach, perhaps due to increased severity of wounds at the time of presentation.
Abstract: Background: Critical limb ischemia remains a difficult disease to treat, with limited level one data. The BEST-CLI trial (Best Endovascular vs Best Open Surgical Therapy in Patients with Critical L...
TL;DR: In this article, the authors suggested an association of dog companionship with lower blood pressure levels, improved lipid levels, and lower cardiovascular risk, and reported that dog ownership has been associated with decreased cardiovascular risk.
Abstract: Background: Dog ownership has been associated with decreased cardiovascular risk. Recent reports have suggested an association of dog companionship with lower blood pressure levels, improved lipid ...
TL;DR: In this cohort of older black women, recent reports of stressful life events were related to incident CVD and resilience was unrelated to event CVD.
Abstract: Background: Empirical data on the link between stress and cardiovascular disease (CVD) risk among black women is limited. We examined associations of stressful life events and social strain with in...
TL;DR: The Centers for Disease Control and Prevention's Million Hearts initiative includes an ambitious ≥80% blood pressure control goal in US adults with hypertension by 2022 as mentioned in this paper, which is the goal of the American Heart Association.
Abstract: Background: The Centers for Disease Control and Prevention’s Million Hearts initiative includes an ambitious ≥80% blood pressure control goal in US adults with hypertension by 2022. We used the val...
TL;DR: Predictions for individual treatment effects from trial data reveal that patients may experience ARRs not simply proportional to baseline cardiovascular disease risk, and machine learning methods may improve discrimination and calibration of individualized treatment effect estimates from clinical trial data.
Abstract: Background: The absolute risk reduction (ARR) in cardiovascular events from therapy is generally assumed to be proportional to baseline risk—such that high-risk patients benefit most. Yet newer ana...
TL;DR: Although DOAC adoption has increased steadily since 2012, among a commercially insured population, black race and low household income were associated with lower use of DOACs for incident venous thromboembolism despite controlling for other clinical and socioeconomic factors.
Abstract: Background: Beginning in 2012, direct oral anticoagulants (DOACs) were approved for treatment and prevention of venous thromboembolism. Prior investigations have demonstrated slow rates of adoption...
TL;DR: This proof-of-concept study found that machine learning and ensemble methods that incorporate daily AF burden signature provided incremental prognostic value for risk stratification beyond CHA2DS2-VASc for near-term risk of stroke.
Abstract: Background: Atrial fibrillation (AF) increases the risk of stroke 5-fold and there is rising interest to determine if AF severity or burden can further risk stratify these patients, particularly fo...
TL;DR: In this article, early readmissions among older adults hospitalized for acute myocardial infarction (AMI) are costly and difficult to predict, and aging-related functional impairments may inform risk predic...
Abstract: Background: Early readmissions among older adults hospitalized for acute myocardial infarction (AMI) are costly and difficult to predict. Aging-related functional impairments may inform risk predic...
TL;DR: India is well-suited to adopt a National List of Essential Diagnostics (NLED), which comprises 113 in vitro diagnostic tests that focus on both communicable and noncommunicable diseases.
Abstract: April 2019 1 © 2019 American Heart Association, Inc. At the turn of the century, cardiovascular diseases (CVDs) became the leading cause of mortality in India. This epidemiological transition is largely because of the increase in the prevalence of CVDs and CVD risk factors in India. In 2016, the estimated prevalence of CVDs in India was estimated to be 54.5 million.1 One in 4 deaths in India are now because of CVDs with ischemic heart disease and stroke responsible for >80% of this burden.1 These diseases tend to affect patients in the most productive years of their lives and result in catastrophic social and economic consequences. One successful initiative to improve healthcare delivery in lowand middle-income countries is the World Health Organization (WHO) Essential Medicines List (EML). The Essential Medicines List was first published in 1977, and the list has grown to include >400 medications and has been adopted by over 100 countries.2 According to WHO, this list includes “drugs that satisfy the health care needs of the population [and]... are intended to be available at all times... at a price the individual and community can afford.”3 India adopted its own National List of Essential Medicines (NLEM) in 1996. Since its implementation, India’s NLEM has been expanded to include medical devices and procedures. One example is the unprecedented decision to add stents to an NLEM in 2016, thus enabling price capping. Historically, stents were subject to substantial price markups by intermediate distributors and were in some cases 4 times greater than their original value. The decision to add stents to their NLEM resulted in price reductions of up to 85%.4 More recently, joint replacements have also been included on India’s NLEM. This has led to reported price reductions in knee replacement systems of up to 69%.5 Like medications, diagnostic tests are crucial to improving healthcare delivery. As patient access to medicines has benefitted from the Essential Medicines List, patient access to high-quality diagnostic services would likely benefit from an Essential Diagnostics List (EDL).6 Recognizing this, on May 15, 2018, WHO released the first edition of the Model List of Essential In Vitro Diagnostics.7 It comprises 113 in vitro diagnostic tests that focus on both communicable and noncommunicable diseases. The WHO EDL is intended to set a reference for the development and update of national EDLs adopted at the country level. India is well-suited to adopt a National List of Essential Diagnostics (NLED).8 In 2015, India’s Ministry of Health announced the National Free Diagnostic Service Initiative. This project aims to provide free diagnostic testing to those visiting public health facilities, and similar to an EDL, included a set of tests at different tiers in the health system. On December 11, 2018, India published the first draft of their NLED, a very important step towards official adoption and implementation.9 Currently, tests proposed in the WHO EDL are limited to in vitro diagnostics and do not include other modalities such as coronary angiography or noninvasive imaging. Furthermore, there are additional in vitro diagnostics that will be addCirculation: Cardiovascular Quality and Outcomes
TL;DR: Text messages supporting secondary prevention among patients with coronary heart disease did not lead to a greater reduction in blood pressure at 6 months, and mobile phone text messaging for secondary prevention was feasible and highly acceptable to patients.
Abstract: Background: Mobile health technologies are low cost, scalable interventions with the potential to promote patient engagement and behavior change. We aimed to test whether a culturally sensitive tex...
TL;DR: In this article, the necessity for rapid evaluation and treatment of acute ischemic stroke with intravenous tPA (tissue-type plasminogen activator) may increase the risk of administrating tPA to patient.
Abstract: Background: The necessity for rapid evaluation and treatment of acute ischemic stroke with intravenous tPA (tissue-type plasminogen activator) may increase the risk of administrating tPA to patient...
TL;DR: Considerable variations in FI were observed among cardiovascular trials, suggesting the need for careful interpretation of results, particularly when number of patients lost to follow-up exceeds FI.
Abstract: Background: Efficacy of an intervention is commonly evaluated using P values, in addition to effect size measures such as absolute risk reduction, relative risk reduction, and numbers needed to tre...
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TL;DR: In this paper, the authors review methodological and practical aspects of tree-based methods, with a focus on diagnostic classification (binary outcome) and prognostication (censored survival outcome).
Abstract: Tree-based methods have become one of the most flexible, intuitive, and powerful data analytic tools for exploring complex data structures. Tree-based methods provide a natural framework for creating patient subgroups for risk classification. In this article, we review methodological and practical aspects of tree-based methods, with a focus on diagnostic classification (binary outcome) and prognostication (censored survival outcome). Creating an ensemble of trees improves prediction accuracy and addresses instability in a single tree. Ensemble methods are described that rely on resampling from the original data. Finally, we present methods to identify a representative tree from the ensemble that can be used for clinical decision-making. The methods are illustrated using data on ischemic heart disease classification, and data from the SPRINT trial (Systolic Blood Pressure Intervention Trial) on adverse events in patients with high blood pressure.
TL;DR: In this paper, the authors determined the impact of data volume and diversity and training conditions on recurrent neural network (RNN) methods compared with traditional machine learning methods and found that RNN outperformed traditional machine-learning methods.
Abstract: Background: We determined the impact of data volume and diversity and training conditions on recurrent neural network methods compared with traditional machine learning methods. Methods and Results...
TL;DR: In this article, unplanned readmissions after hospitalization for acute myocardial infarction are among the leading causes of preventable morbidity, mortality, and healthcare costs.
Abstract: Background: Unplanned readmissions after hospitalization for acute myocardial infarction are among the leading causes of preventable morbidity, mortality, and healthcare costs. Digital health inter...