Circulation-Cardiovascular Quality and Outcomes最新文献

{"title":"Care Innovations: Introducing the OUTPACE Framework for Health Care Quality Improvement.","authors":"Michele Bolles, Heather M Alger, Mitchell S V Elkind, Howard Haft, Sabra C Lewsey, Mariell Jessup, Karen E Joynt Maddox, Chiadi E Ndumele, Clyde W Yancy, Christine Rutan, Michelle Congdon, Katherine Overton, Lynn Serdynski, Kathie Thomas, Gregg C Fonarow","doi":"10.1161/CIRCOUTCOMES.125.012211","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.012211","url":null,"abstract":"<p><p>Equitable, timely, and evidence-based care remains a central goal across health care ecosystems, yet significant quality gaps, care variability, and health disparities persist. Professional societies, including the American Heart Association, have long developed clinical practice guidelines to provide standardized, evidence-based recommendations across the cardiovascular care continuum. These guidelines are operationalized into quality measures to monitor care, identify gaps, and guide improvement. Professional societies, agencies, and health systems have applied implementation science strategies, such as education, data sharing, and evaluation, to improve care quality and achieve quality measures defined in the clinical practice guidelines. American Heart Association's Get With The Guidelines programs target inpatient quality measures for stroke, heart failure, atrial fibrillation, resuscitation, and coronary artery disease, complemented by ambulatory quality improvement programs to support seamless care transitions. Decades of Get With The Guidelines implementation have enabled American Heart Association teams and volunteers to refine these programs, improving guideline adherence at local, regional, and national levels. Lessons learned informed the development of the Observe, Uncover, Trial, Personalize, Accelerate, Check, Expand Framework, designed to guide successful quality improvement initiatives. While existing quality improvement frameworks provide structured approaches, many are costly, slow, or siloed, limiting rapid-cycle, data-driven innovation across diverse health systems. The Observe, Uncover, Trial, Personalize, Accelerate, Check, Expand framework addresses these limitations as an adaptable model, applicable across care settings, disease areas, patient populations, system size, budgets, and target end points. Here, we illustrate the Observe, Uncover, Trial, Personalize, Accelerate, Check, Expand framework through 2 recent American Heart Association programs: Target: Aortic Stenosis and the IMPLEMENT-HF initiative, demonstrating its utility in guiding effective, scalable quality improvement.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012211"},"PeriodicalIF":6.7,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Component Strategies of the Target Stroke Phase 3 Nationwide Quality Improvement Program With Accelerated Door-to-Puncture and Door-In-Door-Out Times for Ischemic Stroke Endovascular Thrombectomy in the United States.","authors":"Brian Mac Grory, Kaiz S Asif, Haolin Xu, Brooke Alhanti, Jay Lusk, David Hasan, Soojin Park, Amelia K Boehme, Kori S Zachrison, Mayank Goyal, Andrew M Southerland, Ashutosh Jadhav, Santiago Ortega Gutierrez, Ameer Hassan, Kyle Fargen, Kevin N Sheth, Edward C Jauch, Ying Xian, Eric D Peterson, Eric E Smith, Steven R Messe, Lee H Schwamm, Peter Panagos, Charles Wira, Jeffrey L Saver, Gregg C Fonarow","doi":"10.1161/CIRCOUTCOMES.125.012456","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.012456","url":null,"abstract":"<p><strong>Background: </strong>The Target Stroke Phase III program is a national quality improvement initiative led by the American Heart Association, which sought to improve the quality of care for patients with acute stroke undergoing acute reperfusion therapy including endovascular thrombectomy (EVT).</p><p><strong>Methods: </strong>A retrospective, observational cohort study was performed using data from the American Heart Association Get With The Guidelines-Stroke Program between January 1, 2017, and March 31, 2022. Three categories of patients were analyzed: (1) patients who arrived directly at the thrombectomy hospital and had EVT, (2) patients who were transferred in from a nonthrombectomy hospital and had EVT, and (3) patients at a nonthrombectomy hospital who were potentially eligible for EVT, received intravenous thrombolysis, and were transferred out. The primary end point of this study for thrombectomy hospitals was door-to-puncture time.</p><p><strong>Results: </strong>In direct-arriving EVT patients, 2 Target Stroke Phase III strategies were independently associated with shorter door-to-puncture time: (1) alerting the neurointerventional team based on emergency medical services prenotification (-21.9 [95% CI, -42.5 to -1.3] minutes) and (2) performance of a brain computed tomography and computed tomography angiography in all patients presenting ≤24 hours from time last known well (-6.6 [95% CI, -11.8 to -1.5] minutes). In transfer-in EVT patients, 2 Target Stroke Phase III strategies were independently associated with a shorter door-to-puncture time: (1) increased use of stroke screening tools (-3.5 [95% CI, -6.4 to -0.6] minutes per 25% increase in use of the screening tool) and (2) increased use of a camera during telestroke consultations (-5.8 [95% CI, -10.7 to -0.9] minutes per 25% increase in camera use).</p><p><strong>Conclusions: </strong>Several Target Stroke Phase III strategies are associated with more timely care, which are distinctly different for thrombectomy and nonthrombectomy hospitals and for patients arriving by emergency medical services compared with interfacility transfer.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012456"},"PeriodicalIF":6.7,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural-Urban Disparities in the Management and Outcomes of Atrial Fibrillation in Emergency Departments in Canada.","authors":"Mohammed Shurrab, Andrew C T Ha, Jason G Andrade, Christopher C Cheung, Guy Amit, Allan Skanes, Girish M Nair, Feng Qiu, Olivia Haldenby, Paul Angaran, Damian P Redfearn, Ratika Parkash, Jeff S Healey, Dennis T Ko","doi":"10.1161/CIRCOUTCOMES.125.012366","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.012366","url":null,"abstract":"<p><strong>Background: </strong>In a universal health care system, geographic disparities in atrial fibrillation (AF) outcomes remain poorly understood. This study aimed to evaluate rural-urban differences in clinical outcomes among patients presenting to the emergency department (ED) with AF.</p><p><strong>Methods: </strong>We conducted a population-based retrospective cohort study of all adults (aged ≥18 years) presenting to an ED in Ontario, Canada, with a primary diagnosis of AF between April 1, 2012, and March 31, 2022. Rural residence was defined as living in a community with a population of ≤10 000. The primary outcome was a composite of all-cause mortality or hospital admission within 1 year; secondary outcomes included the individual components of the primary outcome and all-cause ED visits. Comparisons were adjusted for demographics and baseline comorbidities using inverse probability of treatment weighting. Cox regression was used for end points that included death.</p><p><strong>Results: </strong>Among 104 195 eligible patients, 16 860 (16.2%) resided in rural communities. After inverse probability of treatment weighting, baseline characteristics were well balanced (standardized differences <0.1) as the mean age was 69.4 years in rural and urban groups; 47.2% were women in the rural group versus 47.1% in the urban group. Within 1 year, patients with AF presenting to the ED in rural Ontario had higher rate of all-cause mortality or admission compared with the urban group (34.6% versus 33.5%; hazard ratio, 1.04 [95% CI, 1.01-1.07]), driven primarily by increased hospital admission rates (31.3% versus 29.7%; hazard ratio, 1.06 [95% CI, 1.03-1.09]). ED visit rates were higher in rural patients (63.8% versus 55.3%; hazard ratio, 1.27 [95% CI, 1.25-1.30]), while mortality was similar (9.8% versus 9.9%; hazard ratio, 1.00 [95% CI, 0.95-1.04]).</p><p><strong>Conclusions: </strong>Despite universal health care coverage, rural-urban disparities in AF outcomes persist. Rural patients with AF had higher acute care utilization compared with urban patients. System interventions are needed to address inequities for rural populations.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012366"},"PeriodicalIF":6.7,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diastolic Blood Pressure and Cognitive Function in Adults With Achieved Systolic Blood Pressure Below 130 mm Hg: Insights From the SPRINT-MIND Trial.","authors":"Ruixue Yang, Zhou Fang, Daman Yang, Lei Zhang, Qiaoxi Yang, Qianhui Ling, Xilan Dong, Miaomiao Zhuang, Tianchen Guo, Sifei Chen, Yufei Ji, Jun Cai","doi":"10.1161/CIRCOUTCOMES.124.011902","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011902","url":null,"abstract":"<p><strong>Background: </strong>The potential J-shaped relationship whereby lower diastolic blood pressure (DBP) is associated with a higher risk of adverse cognitive outcomes has raised concerns regarding intensive systolic blood pressure (SBP) lowering. However, the current guidelines advocate a stricter SBP target of <130 mm Hg, with no clear consensus on a DBP target, especially with respect to brain health. The present study aimed to determine the relationship between treated DBP and cognitive function, as well as cerebral perfusion and structure, in adults who achieved an SBP <130 mm Hg.</p><p><strong>Methods: </strong>This secondary analysis of SPRINT-MIND (Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension) included hypertensive participants with achieved SBP <130 mm Hg, irrespective of their original assignment to the intensive or standard treatment arm. We evaluated cognitive outcomes (probable dementia and mild cognitive impairment) and changes in cerebral blood flow, white matter lesions, and total brain volume according to achieved DBP category (<60, 60-69, 70-79, and ≥80 mm Hg) and achieved DBP as a continuous variable. Cox regression models and linear mixed models were used in analyses.</p><p><strong>Results: </strong>In total, 4424 participants (67.4±9.1 years; 2875 [65.0%] men) were included. In the crude model, low on-treatment DBP was significantly associated with increased risks of probable dementia and mild cognitive impairment. However, after correction for all potential covariates, the statistical significance of the association was lost (all <i>P</i>>0.05). Treated DBP was not associated with changes in white matter lesions or total brain volume; however, there was a significant inverse relationship between achieved DBP and cerebral blood flow changes (<i>P</i> for trend =0.029; difference in change, -1.94 mL/100 g per minute [95% CI, -3.50 to -0.39] per 5-mm Hg increase).</p><p><strong>Conclusions: </strong>In patients achieving an SBP <130 mm Hg, treated DBP was not associated with dementia, mild cognitive impairment, or changes in white matter lesions and total brain volume. However, there was an increased risk of impaired cerebral perfusion in patients with elevated on-treatment DBP.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011902"},"PeriodicalIF":6.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Is the Value of Routine Cardiovascular Care? Potential Lessons From the COVID-19 Pandemic.","authors":"Joseph S Wallins, Vinay Kini","doi":"10.1161/CIRCOUTCOMES.125.012788","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.012788","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012788"},"PeriodicalIF":6.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Guideline-Directed Medical Therapies and Clinical Management in Patients With Prevalent Versus Incident Heart Failure: A Danish Nationwide Study From 1996 to 2022.","authors":"Emma Kidholm Boysen, Lars Køber, Mads Kristian Ersbøll, Trine Kiilerich Lauridsen, Jesper Jensen, Emil Wolsk, Jens Jakob Thune, Mette Rauhe Mouridsen, Christian Ditlev Tuxen, Peter Godsk Jørgensen, Morten Lamberts, Emil Fosbøl, Nadia Dridi, Morten Petersen, Nis Ottesen Stride, Anders Barasa, Caroline Garred, Simon Larsen, Morten Schou, Mariam Elmegaard","doi":"10.1161/CIRCOUTCOMES.125.012117","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.012117","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012117"},"PeriodicalIF":6.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter by Xu et al Regarding Article \"Predictors of Neurodevelopmental and Mental Health Diagnoses in Congenital Heart Disease: A Danish Population-Based Cohort Study.","authors":"Can Xu, Xinyu Nie, Dongjin Wang","doi":"10.1161/CIRCOUTCOMES.125.012612","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.012612","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012612"},"PeriodicalIF":6.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Risk Factor Management in Medicare Advantage and Traditional Medicare.","authors":"Andrew S Oseran, Rahul Aggarwal, Rishi K Wadhera","doi":"10.1161/CIRCOUTCOMES.125.012143","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.012143","url":null,"abstract":"<p><strong>Background: </strong>Although cardiovascular disease is the leading cause of death in the United States among Medicare beneficiaries, management of modifiable risk factors remains suboptimal. Medicare Advantage (MA) enrollment has increased substantially; therefore, understanding the quality of cardiovascular risk factor management in MA is critical. In this study, we evaluated whether cardiovascular risk factor management was better among MA compared with traditional Medicare (TM) beneficiaries.</p><p><strong>Methods: </strong>We linked physical examination and laboratory data from the National Health and Nutrition Examination Survey (2015-2018) to Medicare enrollment data. We calculated age- and sex-standardized differences for treatment and control rates of hypertension, diabetes, and hyperlipidemia among adults ≥65 years enrolled in MA compared with TM. National Health and Nutrition Examination Survey weights were used to calculate nationally representative estimates.</p><p><strong>Results: </strong>The weighted study population included 45 426 712 adults (34.4% MA, 65.6% TM). The mean age was 72.9 years and 55.3% were female. MA beneficiaries were more likely to be female (58.5% versus 53.5%), less likely to be White (71.7% versus 81.7%), and more likely to have household incomes <100% poverty (11.4% versus 7.0%). Treatment rates for hypertension (82.3% versus 79.1%; SD, 3.4 percentage points [pp; 95% CI, -1.1 to 7.9]), hyperlipidemia (56.4% versus 56.0%; SD, 0.5 pp [95% CI, -5.7 to 6.8]), and diabetes (76.3% versus 82.5%; SD, -5.0 pp [95% CI, -13.1 to 3.1]) did not significantly differ between MA and TM beneficiaries. There were also no differences in control rates for hypertension (43.6% versus 46.1%; SD, -1.2 pp [95% CI, -8.8 to 6.4]), hyperlipidemia (51.5% versus 48.0%; SD, 4.0 pp [95% CI, -1.7 to 9.7]), and diabetes (61.5% versus 55.3%; SD, 4.4 pp [95% CI, -6.3 to 15.1]).</p><p><strong>Conclusions: </strong>Despite the rapid rise in MA enrollment among individuals with cardiovascular risk factors and disease over the past decade, treatment and control rates for hypertension, diabetes, and hyperlipidemia were similar between MA and TM beneficiaries.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012143"},"PeriodicalIF":6.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response by Gal et al to Letter Regarding Article, \"Predictors of Neurodevelopmental and Mental Health Diagnoses in Congenital Heart Disease: A Danish Population-Based Cohort Study\".","authors":"Dana B Gal, Dóra Körmendiné Farkas, Kristina Laugesen, Henrik Toft Sørensen, Nadine A Kasparian, Nicolas L Madsen, Kimberley G Miles","doi":"10.1161/CIRCOUTCOMES.125.012690","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.012690","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012690"},"PeriodicalIF":6.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter by Fauchier et al Regarding Article, \"Incidence, Prevalence and Trends in Mortality and Stroke Among Medicare Beneficiaries With Atrial Fibrillation: 2013 to 2019\".","authors":"Laurent Fauchier, Lisa Lochon, Arnaud Bisson","doi":"10.1161/CIRCOUTCOMES.125.012601","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.012601","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012601"},"PeriodicalIF":6.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}