Circulation-Cardiovascular Quality and Outcomes最新文献

{"title":"Understanding Contemporary Atrial Fibrillation Trends in the United States: The Importance of Different Perspectives.","authors":"T Jared Bunch, Mintu P Turakhia","doi":"10.1161/CIRCOUTCOMES.125.012082","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.012082","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012082"},"PeriodicalIF":6.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781863","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":"Comparing Cardiovascular Mortality Estimates From Global Burden of Disease and From the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research.","authors":"Abdul Mannan Khan Minhas, Sadeer Al-Kindi, Harriette G C Van Spall, Dmitry Abramov","doi":"10.1161/CIRCOUTCOMES.124.011459","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011459","url":null,"abstract":"<p><strong>Background: </strong>Several sources of data, including the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) and the Global Burden of Disease (GBD) data set, report causes of mortality in the United States. While CDC WONDER contains data based on death certificate codes, the GBD mortality data undergo additional processing, such as cause-of-death reassignment before reporting. Potential differences in reported mortality from cardiovascular disease in the United States between these 2 data sources have not been characterized.</p><p><strong>Methods: </strong>US nationwide cardiovascular cause-of-death data for each year between 2000 and 2019 were obtained from the GBD and the Multiple Cause-of-Death files using CDC WONDER in this longitudinal study. In addition to mortality from cardiovascular disease, mortality from key components of cardiovascular disease, including ischemic heart disease, stroke, and atrial fibrillation/flutter, was determined from each data set. Absolute and crude mortality rates per 100 000 are reported for each data set. Percent differences in cardiovascular mortality from GBD and CDC WONDER and percent changes in cardiovascular mortality across years were calculated.</p><p><strong>Results: </strong>In 2019, GBD reported 957 455 (95% uncertainty interval, 855 065-1 013 175) cardiovascular deaths, while CDC WONDER reported 859 290 cardiovascular deaths in the United States. Between 2000 and 2019, the reported crude mortality rates from cardiovascular causes in GBD decreased from 327 (297-341) to 292 (261-309), a reduction of 10.7%, and decreased in CDC WONDER from 335 (334-335) to 267 (266-267), a reduction of 20.3%. In 2019, the reported mortality rates for components of cardiovascular disease were higher in GBD compared with CDC WONDER for ischemic heart disease (percent difference, 54.5%), stroke (percent difference, 26.1%), and atrial fibrillation/flutter (percent difference, 25.0%).</p><p><strong>Conclusions: </strong>There are prominent differences in reported cardiovascular mortality between GBD and CDC WONDER data.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011459"},"PeriodicalIF":6.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781810","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":"Incidence, Prevalence, and Trends in Mortality and Stroke among Medicare Beneficiaries With Atrial Fibrillation: 2013 to 2019.","authors":"Nichole M Rogovoy, Stephen Kearing, Weiping Zhou, James V Freeman, Jonathan P Piccini, Sana M Al-Khatib, Emily P Zeitler","doi":"10.1161/CIRCOUTCOMES.124.011365","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011365","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is known to be associated with increased risks of stroke and death, but contemporary studies of this association are lacking. We evaluated trends in stroke and death among Medicare beneficiaries with AF between 2013 and 2019.</p><p><strong>Methods: </strong>Medicare fee-for-service beneficiaries >65 years old (2011-2019) were included. AF incidence and prevalence were calculated overall and by age group, sex, race, and rurality. Within incident cohorts, the 1-year stroke rate was assessed. Age- and sex-adjusted mortality at 30 days, 1 year, and 3 years was calculated in each incident cohort.</p><p><strong>Results: </strong>The mean number of Medicare beneficiaries with incident AF per year was 572 630 from 2013 to 2019 (30.44 per 1000 patient-years). The study cohort on average was 79±7.7 years old, 52% female, 88% white, and 83% urban dwelling. Incidence and prevalence of AF increased with age and was highest among White beneficiaries; the incidence was greater in male compared with female beneficiaries. Differences by rurality were not seen. Overall AF prevalence per 1000 beneficiaries increased minimally but steadily from 2013 to 2019 reflecting an increase among male (104-109 per 1000) but not female beneficiaries (82.5 per 1000). The 1-year rate of stroke after incident AF peaked in the 2015 cohort (50.5 per 1000); the rate was at its lowest among the 2018 cohort (41.89 per 1000). Incident AF was associated with mortality that was 3.2× greater than expected at 1 year, but overall mortality and the magnitude of the AF-related mortality risk decreased steadily over time from 22% to 20%.</p><p><strong>Conclusions: </strong>From 2013 to 2019, AF incidence and prevalence among Medicare beneficiaries were relatively stable but have varied by important demographic subgroups with age and sex remaining powerful risk factors. In contrast, mortality and stroke after incident AF have decreased significantly throughout this era.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011365"},"PeriodicalIF":6.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781860","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":"Understanding Cardiovascular Mortality: A Deep Dive Into the Differences Between GBD and CDC WONDER.","authors":"Maryam Hashemian, Véronique L Roger","doi":"10.1161/CIRCOUTCOMES.125.011926","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.011926","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011926"},"PeriodicalIF":6.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781862","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":"Impact of In-Hospital Quality of Care Improvement Initiative on Secondary Prevention of Acute Coronary Syndrome in Six Months After Patient Discharge: A Large Stepped Wedge- and Cluster-Randomized Controlled Trial.","authors":"Gaoqiang Xie, Anushka Patel, Xin Du, Yihong Sun, Xian Li, Tao Wu, Zhixin Hao, Runlin Gao, Yangfeng Wu","doi":"10.1161/CIRCOUTCOMES.124.011441","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011441","url":null,"abstract":"<p><strong>Background: </strong>Patients discharged after acute coronary syndrome experience a high risk of major adverse cardiovascular events (MACE) within the first 6 months. We examined whether a quality of care improvement initiative implemented in hospitals affects clinical preventive management and outcomes after discharge.</p><p><strong>Methods: </strong>We used data from the third phase of the CPACS-3 study (Clinical Pathways for Acute Coronary Syndromes in China), a large stepped wedge- and cluster-randomized trial conducted from 2011 to 2015, to evaluate the effectiveness of an in-hospital quality of care improvement program on the composite score of preventive medication use and the risk of MACE in 6 months after discharge among acute coronary syndrome survivors. The intervention included establishing a quality of care improvement team, training clinical staff, implementing acute coronary syndrome clinical pathways, performance assessment and feedback, online technical support, and patient education. A total of 101 hospitals were randomized into 4 wedges, and the intervention was initiated randomly by wedge and step. Participants recruited before (control) and after (intervention) the intervention initiation were compared with generalized estimating equations, adjusting for clustering and time trend.</p><p><strong>Results: </strong>A total of 23 258 patients (11 224 in the intervention group and 12 034 in the control group), with a mean age of 63.6±11.6 years and 39% women, had available follow-up data on MACE and 14 826 patients (6813 in the intervention group and 8013 in the control group) had available data on preventive medication use at 6 months were analyzed. Compared with the control period, the mean preventive medication use score during the intervention period was higher at 6 months (65.8 versus 60.4 for intervention and control periods, adjusted mean difference, 3.7 [95% CI, 0.3-7.0]), but the 6-month incidence of MACE showed no difference (5.8% versus 6.6%, adjusted odds ratio, 1.04 [95% CI, 0.83-1.29]).</p><p><strong>Conclusions: </strong>The in-hospital multifaceted quality of care improvement intervention in resource-constrained Chinese hospitals increased preventive medication use among acute coronary syndrome survivors in the 6 months after discharge, but this did not translate into a reduction in MACE.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01398228.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011441"},"PeriodicalIF":6.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781859","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":"Reserve and Resilience: A Framework to Inform Cardiovascular Disease Outcomes Research Among Older Adults.","authors":"Ene M Enogela, C Barrett Bowling, Emily B Levitan, Monika M Safford, Madeline R Sterling","doi":"10.1161/CIRCOUTCOMES.124.011396","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011396","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011396"},"PeriodicalIF":6.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781861","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":"Nativity and Cardiovascular Health Among Disaggregated Racial and Ethnic Groups in the United States.","authors":"Michael M Hammond, Cheryl N Mensah, Ruth-Alma Turkson-Ocran, Sadiya S Khan, Nilay S Shah","doi":"10.1161/CIRCOUTCOMES.124.011537","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011537","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011537"},"PeriodicalIF":6.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765570","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":"Validation of Medicare Advantage Claims for Long-Term Outcome Assessment in Low-Risk Aortic Valve Replacement.","authors":"Christina Lalani, Frank Medina, Andrew S Oseran, Lichen Liang, Yang Song, Neel M Butala, Dhruv S Kazi, David J Cohen, Jordan B Strom, Rishi K Wadhera, Robert W Yeh","doi":"10.1161/CIRCOUTCOMES.125.011991","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.011991","url":null,"abstract":"<p><strong>Background: </strong>Although Medicare Advantage (MA) plans provide coverage to >50% of Medicare beneficiaries, it is unclear whether MA claims can be used similarly to Medicare Fee-For-Service (FFS) claims for clinical outcomes assessment. In this study, we evaluate the accuracy of claims algorithms previously validated in FFS to assess comorbidities and outcomes in MA patients after aortic valve replacement.</p><p><strong>Methods: </strong>We compared the concordance of 11 claims-based covariates (diabetes, hypertension, atrial flutter/fibrillation, myocardial infarction) and outcomes (stroke, disabling stroke, transient ischemic attack, major vascular complication, bleeding, permanent pacemaker implantation, death) among FFS and MA patients with the covariates and adjudicated outcomes in the multinational Evolut Low-Risk Trial (2016-2018). We used claims algorithms for 1-year outcomes and calculated sensitivity, specificity, positive predictive value, negative predictive value, and kappa, using adjudicated outcomes as the reference. We compared the kappa for MA versus FFS using the 2-sample <i>z</i>-test with a significance level of <i>P</i><0.05.</p><p><strong>Results: </strong>Among 1139 US patients aged 65+ years old in the Evolut Low-Risk Trial, 782 patients (175 MA and 607 FFS) were linked to claims data and had complete comorbidity data. Among all covariates, claims algorithms for covariates had sensitivities ≥85% for identifying diabetes, atrial flutter/fibrillation, and hypertension in MA and FFS. For the outcomes, sensitivities were ≥85% for bleeding (comprehensive), permanent pacemaker implantation, and death. The kappa was higher in MA versus FFS for diabetes (<i>P</i>=0.03) and hypertension (<i>P</i>=0.025) but was lower in myocardial infarction (<i>P</i><0.0001). There was no statistically significant difference in the kappa agreement between MA versus FFS for any of the selected outcomes.</p><p><strong>Conclusions: </strong>Medicare claims have a similar level of kappa agreement in MA versus FFS for most covariates and outcomes. As patients shift to MA, ascertainment of outcomes using Medicare claims in postapproval studies remains valid for select outcomes.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011991"},"PeriodicalIF":6.2,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744364","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":"Clinical Features of Myocardial Infarction in Women With a History of Preeclampsia: A Population-Based Cohort Study.","authors":"Neja Mudrovcic, Elin Tegnesjö, Rasmus Walter Green, Maria Jonsson, Christina Christersson, Lina Bergman, Karl Bergman, Anna-Karin Wikström, Susanne Hesselman","doi":"10.1161/CIRCOUTCOMES.124.011442","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011442","url":null,"abstract":"<p><strong>Background: </strong>Preeclampsia is associated with an increased lifetime risk of myocardial infarction. This study explored whether there is a difference in the clinical features and severity of myocardial infarction in women with previous preeclampsia compared with women with no history of preeclampsia.</p><p><strong>Methods: </strong>This register-based cohort study combined data from the Swedish Medical Birth Register with data from the quality register the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies. Women with a first singleton birth between 1973 and 2019 were included. The outcome of myocardial infarction was categorized as severe if it resulted in death within 7 days, cardiogenic shock, cardiac arrest, impaired left ventricular systolic function, mechanical complication, or ST-segment-elevation myocardial infarction. The association between preeclampsia and myocardial infarction was investigated using cause-specific hazard models.</p><p><strong>Results: </strong>Among 1 966 096 women with a first singleton birth, 82 980 (4.2%) had preeclampsia. Myocardial infarction was registered in 10 758 (0.5%) of the total population. One-third (n=3672, 34.1%) of myocardial infarctions had severe features and two-thirds (n=6996, 69.1%) were nonsevere. Preeclampsia was associated with increased risk of myocardial infarction, with an adjusted hazard ratio (HR) of 1.71 (95% CI, 1.50-1.94) for severe and 1.86 (95% CI, 1.71-2.04) for nonsevere myocardial infarction. Myocardial infarction in women with prior preeclampsia compared with women without preeclampsia was associated with a higher risk of death (HR, 3.00 [95% CI, 1.10-8.14]), cardiogenic shock (HR, 1.69 [95% CI, 1.11-2.58]), and impaired left ventricular systolic function (HR, 1.69 [95% CI, 1.11-2.58]), while no association was observed for cardiac arrest (HR, 1.37 [95% CI, 0.98-1.93]), ST-segment-elevation myocardial infarction (HR, 1.01 [95% CI, 0.86-1.18]), or mechanical complication (HR, 0.57 [95% CI, 0.08-4.15]).</p><p><strong>Conclusions: </strong>Women with a history of preeclampsia have almost twice the risk of myocardial infarction. Myocardial infarction among women with prior preeclampsia more often results in death, cardiogenic shock, and impaired left ventricular systolic function than among women without preeclampsia.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011442"},"PeriodicalIF":6.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732645","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":"Evaluating Patient and Provider Experiences of Enrolling in a Remote Cardiovascular Health Program: A Qualitative Interview Study.","authors":"Wesley Alexandra Spacht, Simin Gharib Lee, Matthew Varugheese, Samantha Subramaniam, Marian McPartlin, Michela R Tucci, Benjamin M Scirica","doi":"10.1161/CIRCOUTCOMES.123.010394","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.123.010394","url":null,"abstract":"<p><strong>Background: </strong>Remote health management programs utilizing evidence-based algorithm-driven virtual care solutions for chronic disease management offer a novel approach to addressing implementation gaps for conditions such as hypertension. However, little is known about how to optimize patient enrollment.</p><p><strong>Methods: </strong>Through structured interviews, we conducted a qualitative analysis of patient and primary care physician attitudes toward enrollment in a remote hypertension management program at Mass General Brigham (Boston, MA). We selectively recruited a sampling of patients who had enrolled, declined, or were eligible for Mass General Brigham's remote hypertension management program, which utilized interdisciplinary teams to implement clinical guideline-based algorithmic management of hypertension. We analyzed the data using thematic analysis to identify common themes related to enrollment and engagement.</p><p><strong>Results: </strong>Between July and August 2022, we performed 20 patient interviews and 6 provider interviews. Most patient participants were male (n=12) and identified their race and ethnicity as White (n=15). Most provider participants were female (n=4), and all were medical doctors. Six themes related to hypertension care and remote hypertension management programs were identified: (1) strong connections between patients and care teams drive engagement; (2) there is widespread comfort with hybrid care delivery; (3) provider guidance facilitates home blood pressure monitoring; (4) the decision to enroll hinges on provider endorsement; (5) a clearly articulated program structure; and (6) working with trained nonlicensed navigators is an acceptable element of remote hypertension management programs.</p><p><strong>Conclusions: </strong>Enrollment in remote hypertension management programs depends on several key factors. As in traditional care settings, providers significantly influence patient engagement with remote hypertension programs. Key challenges include nonlicensed navigator training and communication clarity about program structure. Building upon facilitators and addressing core challenges are essential for expansion of innovative hypertension care delivery programs to improve patient outcomes at scale.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e010394"},"PeriodicalIF":6.2,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721981","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}