Circulation: Cardiovascular Quality and Outcomes最新文献

{"title":"ORBITA Trials Are Not Justification to Promote a PCI-First Strategy in Nonacute Myocardial Ischemic Syndromes.","authors":"William E Boden,Raffaele De Caterina","doi":"10.1161/circoutcomes.124.011268","DOIUrl":"https://doi.org/10.1161/circoutcomes.124.011268","url":null,"abstract":"","PeriodicalId":10239,"journal":{"name":"Circulation: Cardiovascular Quality and Outcomes","volume":"65 1","pages":"e011268"},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Future of Patient-Reported Outcomes: Bringing Patients' Voices Into Health Care.","authors":"John A Spertus,Alexander T Singh,Suzanne V Arnold","doi":"10.1161/circoutcomes.124.010008","DOIUrl":"https://doi.org/10.1161/circoutcomes.124.010008","url":null,"abstract":"","PeriodicalId":10239,"journal":{"name":"Circulation: Cardiovascular Quality and Outcomes","volume":"7 1","pages":"e010008"},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Current Clinical Guidelines Set Percutaneous Coronary Intervention Up to Fail? Insights From the ORBITA-2 Trial.","authors":"Christopher A Rajkumar,Rasha K Al-Lamee","doi":"10.1161/circoutcomes.124.011201","DOIUrl":"https://doi.org/10.1161/circoutcomes.124.011201","url":null,"abstract":"","PeriodicalId":10239,"journal":{"name":"Circulation: Cardiovascular Quality and Outcomes","volume":"15 1","pages":"e011201"},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arguing Angina: ORBITA's Challenge to Conventional Wisdom on PCI.","authors":"Brahmajee K Nallamothu","doi":"10.1161/circoutcomes.124.011547","DOIUrl":"https://doi.org/10.1161/circoutcomes.124.011547","url":null,"abstract":"","PeriodicalId":10239,"journal":{"name":"Circulation: Cardiovascular Quality and Outcomes","volume":"1 1","pages":"e011547"},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unequal Management and Outcomes Among Asian American Patients With Coronary Heart Disease.","authors":"Robert C Kaplan,Kwun Chuen Gary Chan","doi":"10.1161/circoutcomes.124.011440","DOIUrl":"https://doi.org/10.1161/circoutcomes.124.011440","url":null,"abstract":"","PeriodicalId":10239,"journal":{"name":"Circulation: Cardiovascular Quality and Outcomes","volume":"11 1","pages":"e011440"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142178527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myocardial Infarction Quality of Care and Outcomes in Asian Ethnic Groups in the United States.","authors":"Aishwarya Vijay,Xiaoning Huang,Mark D Huffman,Namratha R Kandula,Donald M Lloyd-Jones,Powell O Jose,Eugene Yang,Abhinav Goyal,Sadiya S Khan,Nilay S Shah","doi":"10.1161/circoutcomes.124.011097","DOIUrl":"https://doi.org/10.1161/circoutcomes.124.011097","url":null,"abstract":"BACKGROUNDNational-level differences in myocardial infarction (MI) quality of care among Asian patients in the United States are unclear. We assessed the quality of MI care in the 6 largest US Asian ethnic groups.METHODSPatients aged ≥18 years with ST-segment-elevation MI or non-ST-segment-elevation MI in the Get With The Guidelines-Coronary Artery Disease registry (711 US hospitals, 2015-2021) were assessed. The odds of MI-related quality of care and process outcomes were evaluated in Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and other Asian adults compared with non-Hispanic White adults. Sex-stratified logistic regression models were adjusted for age and clinical characteristics.RESULTSThere were 5691 Asian patients (1520 Asian Indian, 422 Chinese, 430 Filipino, 114 Japanese, 283 Korean, 553 Vietnamese, and 2369 other Asian) and 141 271 non-Hispanic White patients, overall 30% female, and mean age of 66.5 years. Relative to non-Hispanic White adults, among patients with ST-segment-elevation MI, door-to-ECG time ≤10 minutes was less likely in Asian Indian (adjusted odds ratio [aOR], 0.64 [95% CI, 0.50-0.82]), Chinese (aOR, 0.65 [95% CI, 0.46-0.93]), and Korean (aOR, 0.57 [95% CI, 0.33-0.97]) men and in other Asian women (aOR, 0.61 [95% CI, 0.41-0.90]). Door-to-balloon time ≤90 minutes was less likely in Asian Indian men (aOR, 0.71 [95% CI, 0.56-0.90]) and Filipina women (aOR, 0.48 [95% CI, 0.24-0.98]). In patients with ST-segment-elevation MI or non-ST-segment-elevation MI, optimal medical therapy for MI was less likely in Korean men (aOR, 0.65 [95% CI, 0.47-0.90]) and more likely in Asian Indian men (aOR, 1.22 [95% CI, 1.06-1.40]) and women (aOR, 1.32 [95% CI, 1.04-1.67]) and Filipina women (aOR, 1.84 [95% CI, 1.27-2.67]).CONCLUSIONSMI quality of care varies among US Asian patients with ST-segment-elevation MI and non-ST-segment-elevation MI. Quality improvement programs must identify and address the factors that result in suboptimal MI quality of care among US Asian patients.","PeriodicalId":10239,"journal":{"name":"Circulation: Cardiovascular Quality and Outcomes","volume":"16 1","pages":"e011097"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142178528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pragmatic Trial of Messaging to Providers About Treatment of Hyperlipidemia (PROMPT-LIPID): A Randomized Clinical Trial","authors":"Nimish N. Shah, Lama Ghazi, Yu Yamamoto, Sanchit Kumar, Melissa Martin, Michael Simonov, Ralph J. Riello III, Kamil F. Faridi, Tariq Ahmad, F. Perry Wilson, Nihar R. Desai","doi":"10.1161/circoutcomes.123.010335","DOIUrl":"https://doi.org/10.1161/circoutcomes.123.010335","url":null,"abstract":"BACKGROUND:Lipid-lowering therapy (LLT) is underutilized for very high-risk atherosclerotic cardiovascular disease. PROMPT-LIPID (PRagmatic Trial of Messaging to Providers about Treatment of HyperLIPIDemia) sought to determine whether electronic health record (EHR) alerts improve 90-day LLT intensification in patients with very high-risk atherosclerotic cardiovascular disease.METHODS:PROMPT-LIPID was a pragmatic trial in which cardiovascular and internal medicine clinicians within Yale New Haven Health (New Haven, CT) were cluster-randomized to receive an EHR alert with individualized LLT recommendations or no alert for outpatients with very high-risk atherosclerotic cardiovascular disease and LDL-C (low-density lipoprotein cholesterol), ≥70 mg/dL. The primary outcome was 90-day LLT intensification (change to high-intensity statin and addition of ezetimibe or PCSK9i [proprotein subtilisin/kexin type 9 inhibitors]). Secondary outcomes included LDL-C level, proportion of patients with LDL-C of <70 or < 55 mg/dL, rate of major adverse cardiovascular events, ED visit incidence, and 6-month mortality. Results were analyzed using logistic and linear regression clustered at the provider level.RESULTS:The no-alert group included 47 clinicians and 1370 patients (median age, 71 years; 50.1% female, median LDL-C, 93 mg/dL); the alert group included 49 clinicians and 1130 patients (median age, 72 years; 47% female, median LDL-C 91, mg/dL). The primary outcome was observed in 14.1% of patients in the alert group as compared with 10.4% in the no-alert group. There were no differences in any secondary outcomes at 6 months. Among 542 patients whose clinicians (n=46) did not dismiss the EHR alert recommendations, LLT intensification was significantly greater (21.2% versus 10.4%, odds ratio, 2.33 [95% CI, 1.48–3.66]).CONCLUSIONS:With a real-time, targeted, individualized EHR alert as compared with usual care, the proportion of patients with atherosclerotic cardiovascular disease with LLT intensification was numerically higher but not statistically significant. Among clinicians who did not dismiss the alert, there was a > 2-fold increase in LLT intensification. EHR alerts, coupled with strategies to reduce clinician dismissal, may help address persistent gaps in LDL-C management.REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT04394715, https://www.clinicaltrials.gov/ct2/show/study/NCT04394715","PeriodicalId":10239,"journal":{"name":"Circulation: Cardiovascular Quality and Outcomes","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140617694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Policy Strategies to Advance Cardiovascular Health in the United States—Building on a Century of Progress","authors":"Rishi K. Wadhera, Karen E. Joynt Maddox","doi":"10.1161/circoutcomes.123.010149","DOIUrl":"https://doi.org/10.1161/circoutcomes.123.010149","url":null,"abstract":"<p>The US health care system has undergone remarkable transformation over the past century. Policy proposals to create a national health insurance system date back decades and have faced multiple political headwinds but focused on similar and consistent themes: achieving universal health care coverage, containing high and rising health care costs, and increasing competition among private plans.</p><br/><p>When President Obama came to office in 2008, his administration faced compounding health system challenges. Nearly 45 million Americans lacked health insurance coverage. Concerns that private plans were overtly prioritizing profits rather than patients had intensified. National health care costs had risen to 17% of the gross domestic product. At the same time, health outcomes in the United States were worse than comparable countries. In 2010, President Obama signed the Affordable Care Act (ACA) into law, which had 3 areas of focus: expanding coverage through public and private payers, reforming health insurance markets to be more patient-friendly, and improving quality of care and reducing spending through value-based payment programs.</p><br/><p>The ACA addressed high noninsurance rates in the United States with an individual mandate, which required most people to obtain health insurance, and by creating government-run public marketplaces (exchanges) where individuals could obtain insurance plans, often subsidized for lower income buyers. At the same time, the ACA also expanded Medicaid coverage to all adults with incomes up to 138% of the federal poverty level. Though this was intended to be a national expansion, a later Supreme Court challenge established it as optional; consequently, 25 states (including DC) expanded Medicaid in 2014, and an additional 16 subsequently elected to do so, leaving 10 states without expansion as of January 2024. As a result of these efforts, roughly 20 million adults gained health insurance coverage.</p><br/><p>Medicaid expansion has improved access to primary and preventive care, increased the diagnosis and treatment of cardiometabolic risk factors, and reduced catastrophic health expenditures while also narrowing racial inequities in coverage and access.¹ At the same time, states that expanded Medicaid experienced declines in uninsured cardiovascular hospitalizations and increases in access to advanced cardiovascular therapies. Perhaps most importantly, Medicaid expansion has likely improved health—one study estimated the first 4 years of expansion saved nearly 20 000 lives, driven by reductions in cardiovascular deaths.²</p><br/><p>Another key step forward under the ACA was the requirement that private plans provide certain preventive services with zero out-of-pocket costs. This policy change had important effects on the use of preventive services for cardiometabolic conditions. The ACA also prohibited health plans from denying coverage to patients with preexisting conditions, increasing ","PeriodicalId":10239,"journal":{"name":"Circulation: Cardiovascular Quality and Outcomes","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140608566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustainable Approach to Justice, Equity, Diversity, and Inclusion Through Better Quality Measurement","authors":"Nkem Okeke, Kerrilynn C. Hennessey, Amy M. Sitapati, Dana Weisshaar, Nishant P. Shah, Rebecca Alicki, Howard Haft","doi":"10.1161/circoutcomes.123.010791","DOIUrl":"https://doi.org/10.1161/circoutcomes.123.010791","url":null,"abstract":"The US health care industry has broadly adopted performance and quality measures that are extracted from electronic health records and connected to payment incentives that hope to improve declining life expectancy and health status and reduce costs. While the development of a quality measurement infrastructure based on electronic health record data was an important first step in addressing US health outcomes, these metrics, reflecting the average performance across diverse populations, do not adequately adjust for population demographic differences, social determinants of health, or ecosystem vulnerability. Like society as a whole, health care must confront the powerful impact that social determinants of health, race, ethnicity, and other demographic variations have on key health care performance indicators and quality metrics. Tools that are currently available to capture and report the health status of Americans lack the granularity, complexity, and standardization needed to improve health and address disparities at the local level. In this article, we discuss the current and future state of electronic clinical quality measures through a lens of equity.","PeriodicalId":10239,"journal":{"name":"Circulation: Cardiovascular Quality and Outcomes","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140608588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Institutes of Health Stroke Scale Reporting in Medicare Claims Data: Reporting in the First 3 Years","authors":"Laura K. Stein, Edwin Ortiz, Jaan Nandwani, Mandip S. Dhamoon","doi":"10.1161/circoutcomes.123.010388","DOIUrl":"https://doi.org/10.1161/circoutcomes.123.010388","url":null,"abstract":"BACKGROUND:Since 2016, hospitals have been able to document <i>International Classification of Diseases, Tenth Revision, Clinical Modification</i> (ICD-10-CM) codes for the National Institutes of Health Stroke Scale (NIHSS). As of 2023, the Centers for Medicare &amp; Medicaid Services uses NIHSS as a risk adjustment variable. We assessed associations between patient- and hospital-level variables and contemporary NIHSS reporting.METHODS:We performed a retrospective cross-sectional analysis of 2019 acute ischemic stroke admissions using deidentified, national 100% inpatient Medicare Fee-For-Service data sets. We identified index acute ischemic stroke admissions using the ICD-10-CM code I63.x and abstracted demographic information, medical comorbidities, hospital characteristics, and NIHSS. We linked Medicare and Mount Sinai Health System (New York, NY) registry data from 2016 to 2019. We calculated NIHSS documentation at the patient and hospital levels, predictors of documentation, change over time, and concordance with local data.RESULTS:There were 231 383 index acute ischemic stroke admissions in 2019. NIHSS was documented in 44.4% of admissions and by 66.5% of hospitals. Hospitals that documented ≥1 NIHSS were more commonly teaching hospitals (39.0% versus 5.5%; standardized mean difference score, 0.88), stroke certified (37.2% versus 8.0%; standardized mean difference score, 0.75), higher volume (mean, 80.8 [SD, 92.6] versus 6.33 [SD, 14.1]; standardized mean difference score, 1.12), and had intensive care unit availability (84.9% versus 23.2%; standardized mean difference score, 1.57). Adjusted odds of documentation were lower for patients with inpatient mortality (odds ratio, 0.64 [95% CI, 0.61–0.68]; <i>P</i>&lt;0.0001), in nonmetropolitan areas (odds ratio, 0.49 [95% CI, 0.40–0.61]; <i>P</i>&lt;0.0001), and male sex (odds ratio, 0.95 [95% CI, 0.93–0.97]; <i>P</i>&lt;0.0001). NIHSS was documented for 52.9% of Medicare cases versus 93.1% of registry cases, and 74.7% of Medicare NIHSS scores equaled registry admission NIHSS.CONCLUSIONS:Missing ICD-10-CM NIHSS data remain widespread 3 years after the introduction of the ICD-10-CM NIHSS code, and there are systematic differences in reporting at the patient and hospital levels. These findings support continued assessment of NIHSS reporting and caution in its application to risk adjustment models.","PeriodicalId":10239,"journal":{"name":"Circulation: Cardiovascular Quality and Outcomes","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140585399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}