Circulation-Cardiovascular Quality and Outcomes最新文献

{"title":"Enhancing Stroke Awareness and Activation Among High-Risk Populations: A Randomized Direct Mail Intervention in Diverse Healthcare Settings.","authors":"Christine C Groves, Teresa M Damush, Laura J Myers, Fitsum Baye, Joanne K Daggy, Anthony J Perkins, Holly Martin, Layne Mounsey, Daniel O Clark, Linda S Williams","doi":"10.1161/CIRCOUTCOMES.124.011425","DOIUrl":"10.1161/CIRCOUTCOMES.124.011425","url":null,"abstract":"<p><strong>Background: </strong>Many patients are unaware of their stroke risk. The purpose of this research was to compare the effect of behaviorally tailored mailed messages on patient activation to reduce stroke risk.</p><p><strong>Methods: </strong>Randomized parallel group clinical trial. We used electronic health records to construct Framingham Stroke Risk Scores in primary care patients from 1 Veterans Health Administration (VA) and 1 non-VA healthcare system, Eskenazi Health System (EHS). Four stroke risk messages were developed through patient interviews: standard, incentive ($5 gift card), salience, and incentive plus salience. The standard message served as the comparison group. Patients in the highest Framingham Stroke Risk Score quintile were randomly assigned to receive one of the messages. All letters asked the patient to call a stroke prevention coordinator, the primary outcome. Response to the messages was modeled separately in the 2 cohorts using logistic regression.</p><p><strong>Results: </strong>In total, 2084 EHS patients (mean age, 65.6; 36% male; 68% Black; mean Framingham Stroke Risk Score, 13.1) and 1759 VA patients (mean age, 75.6; 99% male; 86% White; mean Framingham Stroke Risk Score, 18.6) received a letter. Rates of calls to the coordinator were 13% among the EHS and 23% among the VA cohort. The EHS cohort was significantly more likely to respond to the incentive message compared with the standard message (odds ratio, 1.97 [95% CI, 1.17-3.09]), and the VA cohort was more likely to respond to the incentive plus salience message (odds ratio, 1.50 [95% CI, 1.02-2.22]). Among individuals calling the coordinator, 31% of the EHS cohort and 27% of the VA cohort were unaware they had stroke risk factors.</p><p><strong>Conclusions: </strong>A mailed message including a $5 incentive was more effective than a standard message in engaging high-risk patients with their healthcare system, including a salience message may also be important in some patient populations. Many primary care patients are unaware of their stroke risk.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT02721446.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011425"},"PeriodicalIF":6.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693966","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":"Improving Cardiovascular Health Through the Consideration of Social Factors in Genetics and Genomics Research: A Scientific Statement From the American Heart Association.","authors":"Shakira F Suglia, Bertha Hidalgo, Andrea A Baccarelli, Andres Cardenas, Scott Damrauer, Amber Johnson, Kaitlin Key, Mingyu Liang, Jared W Magnani, Brittany Pate, Mario Sims, Gabriel S Tajeu","doi":"10.1161/HCQ.0000000000000138","DOIUrl":"https://doi.org/10.1161/HCQ.0000000000000138","url":null,"abstract":"<p><p>Cardiovascular health (CVH) is affected by genetic, social, and genomic factors across the life course, yet little research has focused on the interrelationships among them. An extensive body of work has documented the impact of social determinants of health at both the structural and individual levels on CVH, highlighting pathways in which racism, housing, violence, and neighborhood environments adversely affect CVH and contribute to disparities in cardiovascular disease. Genetic factors have also been identified as contributors to risk for cardiovascular disease. Emerging evidence suggests that social factors can interact with genetic susceptibility to affect disease risk. Increasingly, social factors have been shown to affect epigenetic markers such as DNA methylation, which can regulate gene and protein expression. This is a potential biological mechanism through which exposure to poor social determinants of health becomes physically embodied at the molecular level, potentially contributing to the development of suboptimal CVH and chronic disease, thus reinforcing and propagating health disparities. The objective of this statement is to highlight and summarize key literature that has examined the joint associations between social, genetic, and genomic factors and CVH and cardiovascular disease.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e000138"},"PeriodicalIF":6.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694014","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":"Cost-Effectiveness of Transcatheter Versus Surgical Aortic Valve Replacement in China: Same, but Different.","authors":"Derrick Y Tam, Harindra C Wijeysundera","doi":"10.1161/CIRCOUTCOMES.125.011887","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.011887","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011887"},"PeriodicalIF":6.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651610","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":"Cost-Effectiveness of Aortic Valve Replacement in Low- and Intermediate-Risk Chinese Patients With Severe Aortic Stenosis.","authors":"Jin Peng, Xinglong Zheng, Minghuan Jiang, Xuelin Yao, Yue Ma, Mao Fu, Tao Ma, Xiaolong Shang, Yang Yan, Vinod H Thourani, Yu Fang","doi":"10.1161/CIRCOUTCOMES.124.010858","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.010858","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter aortic valve replacement (TAVR) remains debated as an alternative to surgical aortic valve replacement (SAVR). We aimed to evaluate the cost-effectiveness of aortic valve replacement strategies in low- and intermediate-risk patients with severe aortic stenosis in China.</p><p><strong>Methods: </strong>A decision-analytic model combining decision tree and Markov model was developed to compare outcomes of universal SAVR, universal TAVR, and a risk-based strategy (SAVR in low-risk patients and TAVR in intermediate-risk patients) in a hypothetical cohort of 75-year-old patients with aortic stenosis within the perspective of the Chinese health care system. A meta-analysis was performed to derive the clinical inputs; the 2019 to 2021 claims data from Shaanxi Province were used for cost analysis, and quality of life was measured using EuroQoL-5D. One-way and probabilistic (10 000 Monte Carlo simulations) sensitivity analyses were conducted to examine the robustness of model results. Primary outcomes included total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER).</p><p><strong>Results: </strong>Universal TAVR gained the most QALYs (6.76 QALYs) with the highest costs (USD 58 949). Compared with universal SAVR, the risk-based strategy gained 0.12 additional QALYs at higher costs (USD 14 046); the ICER (117 048 USD/QALY) exceeded the willingness-to-pay threshold (37 657 USD/QALY, 3-fold gross domestic product per capita in China). The ICER of universal TAVR versus universal SAVR (80 526 USD/QALY) also exceeded the willingness-to-pay threshold. Sensitivity analysis showed that universal TAVR would be cost-effective if TAVR valve costs were <USD 21 477 (>44.23% cost reduction). Subgroup analysis showed that universal TAVR and risk-based strategy remained not cost-effective compared with universal SAVR in both low-risk (ICER of 64 414 USD/QALY) and intermediate-risk (ICER of 124 851 USD/QALY) patients. In 10 000 Monte Carlo simulations, the probabilities of being cost-effective for universal SAVR, universal TAVR, and risk-based strategy were 89.81%, 10.14%, and 0.05%, respectively.</p><p><strong>Conclusions: </strong>The risk-based strategy and universal TAVR appeared not to be cost-effective versus universal SAVR in low- and intermediate-risk patients with severe aortic stenosis in China.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e010858"},"PeriodicalIF":6.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651607","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":"Racial and Ethnic Differences in Prepregnancy Hypertension by Maternal Age.","authors":"Natalie A Cameron, Stacy C Bailey, Kiarri N Kershaw, William A Grobman, Sadiya S Khan","doi":"10.1161/CIRCOUTCOMES.124.011532","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011532","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011532"},"PeriodicalIF":6.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606959","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 Between Use of WATCHMAN Device and 1-Year Mortality Using High-Dimensional Propensity Scores to Reduce Confounding.","authors":"Julie Z Zhao, Mohammed Ruzieh, Fanxing Du, Yi Lian, Andrew J Foy, Robert W Platt, Mark S Segal, Janie Coulombe, Almut G Winterstein, Tianze Jiao","doi":"10.1161/CIRCOUTCOMES.124.011188","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011188","url":null,"abstract":"<p><strong>Background: </strong>Previous observational studies showed left atrial appendage occlusions with the WATCHMAN device reduced 1-year mortality, which conflicted with evidence generated from randomized controlled trials. We proposed to use the high-dimensional propensity score (hdPS) to assist in nonactive comparator selection (prevalent user of medication) and compared 1-year mortality between patients with atrial fibrillation who received the WATCHMAN device (percutaneous left atrial appendage occlusion device [pLAAO]) and direct oral anticoagulants in 2 matched cohorts based on (1) traditional propensity score (PS) and (2) integrating traditional PS with information learned from hdPS.</p><p><strong>Methods: </strong>Patients entered the cohort once diagnosed with atrial fibrillation in the 15% of Medicare fee-for-service claims database from 2011 to 2018. Patients could enter the study cohort upon receiving WATCHMAN or at an outpatient visit with an atrial fibrillation diagnosis, respectively. We used PS matching with a 1:3 ratio for patients in pLAAO and direct oral anticoagulant groups. In cohort 2, we implemented a multistep approach with information learned from hdPS. The Cox proportional hazards model was used to estimate hazard ratios of outcomes with 95% CIs.</p><p><strong>Results: </strong>In cohort 1, we identified 1159 and 3477 patients in the pLAAO and direct oral anticoagulant groups with a mean age of 78.1 versus 77.5 years, 44.9% versus 40.8% of women, and a 1-year mortality rate of 8.02 versus 8.97/100 person-years (hazard ratio, 0.87 [95% CI, 0.69-1.09]). With the support of hdPS, in cohort 2, we excluded patients with malignant cancer and added frailty score in the PS model. We identified 953 and 2859 patients in the pLAAO and direct oral anticoagulant groups with a mean age of 78.1 versus 77.9 years, 47.2% versus 46.1% of women, and a 1-year mortality rate of 7.45 and 7.69/100 person-years (hazard ratio, 0.95 [95% CI, 0.73-1.24]).</p><p><strong>Conclusions: </strong>No association was found between pLAAO and 1-year mortality, which is consistent with existing evidence from randomized controlled trials. The hdPS approach provides an opportunity to improve nonactive comparator selection in traditional PS analysis.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011188"},"PeriodicalIF":6.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538030","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":"Predicting Mortality in Patients Hospitalized With Acute Myocardial Infarction: From the National Cardiovascular Data Registry.","authors":"Kamil F Faridi, Yongfei Wang, Karl E Minges, Nathaniel R Smilowitz, Robert L McNamara, Michael C Kontos, Tracy Y Wang, Annie C Connors, Julie M Clary, Anwar D Osborne, Lucy Pereira, Jeptha P Curtis, Kristina Blankinship, Jarrott Mayfield, J Dawn Abbott","doi":"10.1161/CIRCOUTCOMES.124.011259","DOIUrl":"10.1161/CIRCOUTCOMES.124.011259","url":null,"abstract":"<p><strong>Background: </strong>In-hospital mortality risk prediction is an important tool for benchmarking quality and patient prognostication. Given changes in patient characteristics and treatments over time, a contemporary risk model for patients with acute myocardial infarction (MI) is needed.</p><p><strong>Methods: </strong>Data from 313 825 acute MI hospitalizations between January 2019 and December 2020 for adults aged ≥18 years at 784 sites in the National Cardiovascular Data Registry Chest Pain-MI Registry were used to develop a risk-standardized model to predict in-hospital mortality. The sample was randomly divided into 70% development (n=220 014) and 30% validation (n=93 811) samples, and 23 separate registry-based patient characteristics at presentation were considered for model inclusion using stepwise logistic regression with 1000 bootstrapped samples. A simplified risk score was also developed for individual risk stratification.</p><p><strong>Results: </strong>The mean age of the study cohort was 65.3 (SD 13.1) years, and 33.6% were women. The overall in-hospital mortality rate was 5.0% (n=15 822 deaths). The final model included 14 variables, with out-of-hospital cardiac arrest, cardiogenic shock, and ST-segment elevation MI as the strongest independent predictors of mortality. The model also included age, comorbidities (dyslipidemia, diabetes, prior percutaneous coronary intervention, cerebrovascular disease, and peripheral artery disease), heart failure on admission, heart rate, systolic blood pressure, glomerular filtration rate, and hemoglobin. The model demonstrated excellent discrimination (C-statistic, 0.868 [95% CI 0.865-0.871]) and good calibration, with similar performance across subgroups based on MI type, periods before and during the COVID-19 pandemic, and hospital volume. The simplified risk score included values from 0 to 25, with mortality risk ranging from 0.3% with a score of 0 to 1 up to 49.4% with a score >11.</p><p><strong>Conclusions: </strong>This contemporary risk model accurately predicts in-hospital mortality for patients with acute MI and can be used for risk standardization across hospitals and at the bedside for patient prognostication.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011259"},"PeriodicalIF":6.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11919567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vasoactive Medications In Acute Heart Failure: What We Do Not Know Could Indeed Hurt Us.","authors":"Deepika Potarazu, Jason N Katz","doi":"10.1161/CIRCOUTCOMES.124.011825","DOIUrl":"10.1161/CIRCOUTCOMES.124.011825","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011825"},"PeriodicalIF":6.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048538","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":"Redefining the Rules of Revascularization: Lessons From ISCHEMIA for the Future of Appropriate Use Criteria.","authors":"Christopher A Rajkumar","doi":"10.1161/CIRCOUTCOMES.124.011579","DOIUrl":"10.1161/CIRCOUTCOMES.124.011579","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011579"},"PeriodicalIF":6.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505493","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":"To Reverse Rising Heart Failure Mortality, We Must Address Evidence Gaps.","authors":"William Ward, Vinay Prasad","doi":"10.1161/CIRCOUTCOMES.124.011684","DOIUrl":"10.1161/CIRCOUTCOMES.124.011684","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011684"},"PeriodicalIF":6.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544127","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}