Circulation-Cardiovascular Quality and Outcomes最新文献

{"title":"Association Between Market-Level Characteristics and Cardiologists Acquired by Private Equity in the United States.","authors":"Hamid Torabzadeh, Yashaswini Singh","doi":"10.1161/CIRCOUTCOMES.125.012086","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.012086","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012086"},"PeriodicalIF":6.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187337","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":"Holding Ourselves to a Higher Standard: Dynamic Prediction Modeling in Cardiac Surgery.","authors":"J Trent Magruder, Vinod H Thourani","doi":"10.1161/CIRCOUTCOMES.125.012469","DOIUrl":"10.1161/CIRCOUTCOMES.125.012469","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012469"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144734894","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 Outcomes of Switching From Warfarin to Apixaban or Rivaroxaban in Patients With Atrial Fibrillation: A Nationwide Multidatabase Study.","authors":"Dae Hyun Kim, Darae Ko, Daniel E Singer, Alexander Cervone, Yichi Zhang, Qiaoxi Chen, Kueiyu Joshua Lin","doi":"10.1161/CIRCOUTCOMES.124.011890","DOIUrl":"10.1161/CIRCOUTCOMES.124.011890","url":null,"abstract":"<p><strong>Background: </strong>The benefits of switching from warfarin to direct oral anticoagulants in atrial fibrillation remain unclear.</p><p><strong>Methods: </strong>This retrospective study used the Medicare fee-for-service (2013-2020) and Optum Deidentified Clinformatics Data Mart databases (2013-2023). Among patients with atrial fibrillation who received warfarin for at least 180 days, we created 2 cohorts: (1) patients switching to apixaban versus continuing warfarin (the apixaban cohort) and (2) patients switching to rivaroxaban versus continuing warfarin (the rivaroxaban cohort). The index date was the switch date for switchers and a matched date based on warfarin duration for warfarin continuers. After 1:1 propensity score matching, we estimated the rate ratios (RR) for a composite of ischemic stroke, major bleeding, and death in each database and pooled the results using meta-analysis. Subgroup analyses by claims-based frailty and by follow-up time (first 60 days versus beyond 60 days) were performed.</p><p><strong>Results: </strong>In the apixaban cohort (n=164 480; mean age, 80.5 years; 55.5% female; median follow-up, 354 days), switching to apixaban was associated with a lower rate of composite outcome (97.1 versus 104.9 per 1000 person-years; rate ratio, 0.92 [95% CI, 0.89-0.95]) compared with continuing warfarin. In the rivaroxaban cohort (n=96 030, mean age 79.7 years, 54.8% female, median follow-up 365 days), switching to rivaroxaban was associated with an increased rate of composite outcome (105.8 versus 99.3 per 1000 person-years; rate ratio, 1.08 [95% CI, 1.04-1.13]). No heterogeneity by frailty levels was observed. However, switching was associated with an initial risk increase within the first 60 days, followed by risk attenuation beyond 60 days, for both apixaban and rivaroxaban.</p><p><strong>Conclusions: </strong>In patients with atrial fibrillation on warfarin therapy, switching to apixaban may reduce the risk of ischemic stroke, major bleeding, and death, whereas switching to rivaroxaban may increase the risk. For both apixaban and rivaroxaban, switching may temporarily increase risk during the first 60 days.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011890"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975905","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":"Dynamic Updating Strategies to Assess Hospital Performance of Surgical Aortic Valve Replacement.","authors":"Jackie Pollack, Wei Yang, George J Arnaoutakis, Michael J Kallan, Stephen E Kimmel","doi":"10.1161/CIRCOUTCOMES.124.011608","DOIUrl":"10.1161/CIRCOUTCOMES.124.011608","url":null,"abstract":"<p><strong>Background: </strong>Prediction models determining expected outcomes are infrequently updated (ie, static), which may reduce accuracy and misclassify hospital performance over time. Dynamic models incorporate changes over time and may improve accuracy and fairness in hospital comparisons. This study evaluated whether dynamic updating, compared with a static model, altered hospital rankings and outlier detection among surgical aortic valve replacement patients.</p><p><strong>Methods: </strong>This retrospective cohort study assessed performance across 53 hospitals using claims data from the Pennsylvania Health Care Cost Containment Council. A multivariable logistic regression model using clinical and demographic variables was developed on data from 1999 to 2006 to predict 30-day postoperative mortality, then applied to testing data from 2007 to 2018 to compare 4 strategies: (1) a static model with fixed parameters, (2) an annual correction factor based on The Society of Thoracic Surgeons methodology, (3) calibration regression for annual recalibration, and (4) dynamic logistic state space model to continuously update model coefficients. Performance was evaluated using observed-to-expected ratios and <i>Z</i> scores. Lower values indicate better-than-expected outcomes.</p><p><strong>Results: </strong>The training sample included 14 070 patients (mean age 66.6; 43.1% women); the testing sample included 29 127 patients (mean age 67.4; 39.1% women). The static model had the widest <i>Z</i> score variability (range -6.97 to 1.38), compared with calibration regression (-3.04 to 2.85), correction factor (-2.87 to 3.24), and dynamic logistic state space model (-2.57 to 3.03). The static model labeled 15 hospitals as significantly better-than-expected; only 3 (20.0%) maintained this classification with the correction factor and dynamic logistic state space model, and 5 (33.3%) with calibration regression. No hospitals were classified as significantly worse-than-expected under the static model, whereas calibration regression identified 6, and both dynamic logistic state space model and the correction factor identified 7.</p><p><strong>Conclusions: </strong>Static models may misclassify hospital performance and rankings. Dynamic strategies influence outlier detection and change hospital rankings over time. Regular model updates may better reflect current performance, supporting fairer hospital comparisons.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011608"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12221213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369459","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":"Estimating the Stroke Risk Threshold for Initiating Non-Vitamin K Antagonist Oral Anticoagulation in Atrial Fibrillation: Markov Decision Model Analysis.","authors":"Aleksi K Winstén, Ville Langén, K E Juhani Airaksinen, Konsta Teppo","doi":"10.1161/CIRCOUTCOMES.125.012090","DOIUrl":"10.1161/CIRCOUTCOMES.125.012090","url":null,"abstract":"<p><strong>Background: </strong>Randomized trials have clearly demonstrated the benefits of anticoagulant therapy in patients with atrial fibrillation who are at high risk of ischemic stroke. However, less is known about the benefit of anticoagulation in low-risk patients, and exactly how low baseline stroke risk justifies further attempts to reduce it with direct oral anticoagulants (DOACs) remains unclear.</p><p><strong>Methods: </strong>We developed a Markov decision model to estimate the impact of initiating DOACs on quality-adjusted life years (QALYs) on a 20-year time horizon in patients with atrial fibrillation across a range of nonanticoagulated ischemic stroke risk. The model incorporated data from randomized controlled trials on the effects of DOACs on the severity and risk of ischemic stroke, major bleeding, and mortality, as well as previous evidence on their impact on quality of life. Nonanticoagulated event rates were averaged from previous observational studies.</p><p><strong>Results: </strong>The tipping point in the annual nonanticoagulated ischemic stroke rate, at which DOAC treatment resulted in equal cumulative QALYs as withholding therapy, was 0.65%. Below this risk threshold, DOAC therapy yielded slightly fewer QALYs, while, above it, DOAC therapy resulted in increasingly higher QALYs. At nonanticoagulated stroke risk levels of 1%, 2%, and 3%, the mean QALY gains with DOACs per patient during a 20-year simulation were 0.13, 0.53, and 1.00, respectively, whereas, at the stroke risk level of 0.4%, DOAC therapy resulted in 0.01 lower QALYs per patient.</p><p><strong>Conclusions: </strong>In this simulation, DOAC therapy versus no anticoagulation was associated with a net benefit on QALYs in patients with atrial fibrillation with an annual nonanticoagulated stroke risk >0.65%, with the magnitude of benefit increasing with higher stroke risk.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012090"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12442775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975995","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":"AI and Digital Health: Personalizing Physical Activity to Improve Population Health.","authors":"Daniel Seung Kim, Fatima Rodriguez, Euan A Ashley","doi":"10.1161/CIRCOUTCOMES.125.012416","DOIUrl":"10.1161/CIRCOUTCOMES.125.012416","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012416"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12338062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800703","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":"Core Outcome Set for Studies on Cardiac Disease in Pregnancy (COSCarP): An International Delphi Consensus Study.","authors":"Rizwana Ashraf, Yun Zhi He, Candice K Silversides, Samuel C Siu, Mathew Sermer, Anish Keepanasseril, Meron Seyoum, Isabelle Malhamé, Rohan D'Souza","doi":"10.1161/CIRCOUTCOMES.124.011754","DOIUrl":"10.1161/CIRCOUTCOMES.124.011754","url":null,"abstract":"<p><strong>Background: </strong>Outcome reporting in cardio-obstetrics studies is inconsistent. The objective of the COSCarP (Core Outcome Set on Cardiac Diseases in Pregnancy) study was to develop a core outcome set through international consensus and harmonize outcome reporting in cardio-obstetrics studies.</p><p><strong>Methods: </strong>We conducted a multimethod study between February 2021 and April 2023 that included an online 2-round Delphi survey, 3 small group discussions and a consensus meeting with health service users (people with lived experience of pregnancy and heart disease) and health care professionals.</p><p><strong>Results: </strong>A total of 110 participants (22 health service users and 88 health care professionals) from 13 countries in Africa, Asia, Europe, and North America scored 71 candidate items obtained through literature reviews and qualitative interviews. Participants identified 12 core outcomes and 12 core reporting checklist items (which may not always represent outcomes) for inclusion in all cardio-obstetrics studies. Core outcomes included: maternal mortality, cardiac arrest, cerebrovascular events, heart failure, arrhythmias requiring treatment or change in treatment, thromboembolism, syncope, maternal intensive care unit admission, cardiovascular interventions, fetal/neonatal loss (miscarriage, stillbirth, neonatal death), severe neonatal morbidity, and prolonged neonatal intensive care unit admission. Reporting checklist items included: hypertensive disorders, major bleeding, anesthetic complications, adverse reactions, labor and birth details, maternal hospitalization and re-admissions, treatment compliance, fetal growth restriction, congenital malformations, gestational age at birth, and nonsevere neonatal morbidity. Participants also identified 7 condition-specific outcomes and 7 other patient-important outcomes, which may be challenging to measure in all studies and should be reported when feasible and relevant.</p><p><strong>Conclusions: </strong>The COSCarP study has identified core outcomes, reporting checklist items, and patient-important outcomes, which researchers are encouraged to measure and report in future cardio-obstetrics studies. Widespread use of the COSCarP checklists could support data harmonization, enable meaningful comparisons between studies, facilitate meta-analyses, and ensure that future guidelines incorporate patient-important outcomes while making clinical practice recommendations.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011754"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785777","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":"Predictors of Neurodevelopmental and Mental Health Diagnoses in Congenital Heart Disease: A Danish Population-Based Cohort Study.","authors":"Kimberley G Miles, Dana B Gal, Dóra Körmendiné Farkas, Kristina Laugesen, Henrik Toft Sørensen, Nadine A Kasparian, Nicolas L Madsen","doi":"10.1161/CIRCOUTCOMES.125.011944","DOIUrl":"10.1161/CIRCOUTCOMES.125.011944","url":null,"abstract":"<p><strong>Background: </strong>Over 35% of Danish children with congenital heart disease (CHD) are diagnosed with or treated for a neurodevelopmental or mental health condition. We examined child clinical, parent socioeconomic, and family health factors associated with 4 common diagnostic groups in children with CHD: developmental disorders, intellectual disability, attention-deficit/hyperactivity disorder, and anxiety and mood disorders.</p><p><strong>Methods: </strong>This population-based cohort study identified children aged <18 years with CHD from 1996 to 2017 by linking individual-level data across Danish health and social registries, excluding children with a neurodevelopmental or mental health diagnosis, by <i>International Classification of Diseases, Tenth Revision</i> codes, before the index date (ie, CHD diagnosis). Using age as a time scale, we computed cumulative incidence by the age of 18 years, incidence rates, and crude and adjusted hazard ratios for each diagnostic group. Hazard ratios were adjusted for child sex and year of CHD diagnosis. In addition, cumulative days in hospital were adjusted for CHD complexity.</p><p><strong>Results: </strong>In 16 473 children with CHD (male, 50.9%; median age at index date, 0.1 [interquartile range, 0.0-1.3] years), the cumulative incidence by the age of 18 years was 7.5% (95% CI, 7.0%-8.1%), 5.0% (95% CI, 4.6%-5.5%), 5.8% (95% CI, 5.3%-6.3%), and 10.3% (95% CI, 9.6%-11.1%) for these 4 diagnostic groups, respectively. Cumulative days in hospital within the first year after CHD diagnosis were the strongest clinical predictor of neurodevelopmental and mental health diagnoses, followed by sex, the presence of a genetic syndrome, and small for gestational age birthweight. Multiple socioeconomic metrics, including maternal or paternal age <25 years, low education (9-10 years), unemployment, and maternal marital status (eg, single or divorced), were predictors, particularly for attention-deficit/hyperactivity disorder and intellectual disability. Maternal and paternal mental health diagnoses were predictors of all 4 diagnostic groups.</p><p><strong>Conclusions: </strong>We identified clinical, socioeconomic, and parent mental health factors associated with neurodevelopmental and mental health diagnoses in children with CHD. These data may inform early identification of these conditions and guide prevention and resource allocation.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011944"},"PeriodicalIF":6.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602007","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":"American Heart Association National Integrated ASCVD Initiative: An Implementation Initiative to Improve Lipid Management Among Patients With ASCVD.","authors":"Chiadi E Ndumele, Ankeet S Bhatt, Lynne T Braun, Steven Chen, Seth S Martin, Michael T Mullen, Nishant P Shah, Stephen L Sigal, Tracy Yu-Ping Wang, Rebecca Alicki, Chandler Beon, Haoyun Hong, Sara O'Kane, Katherine J Overton, Kathie Thomas, Howard Haft","doi":"10.1161/CIRCOUTCOMES.124.011627","DOIUrl":"10.1161/CIRCOUTCOMES.124.011627","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":"18 8","pages":"e011627"},"PeriodicalIF":6.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876372","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":"Quantifying Patient Preferences About Features of Nonstatin Lipid-Lowering Therapies: A Discrete Choice Experiment in the United States.","authors":"Shelby D Reed, Jessie Sutphin, Juan Marcos Gonzalez, Matthew J Wallace, Judith J Stephenson, Batul Electricwala, Hayden B Bosworth, Neha Pagidipati","doi":"10.1161/CIRCOUTCOMES.124.011804","DOIUrl":"10.1161/CIRCOUTCOMES.124.011804","url":null,"abstract":"<p><strong>Background: </strong>Despite the growing number of nonstatin lipid-lowering treatments (NS-LLTs), data are lacking on how patients value their various features and outcomes. Study objectives were to quantify patients' preferences across levels of efficacy, treatment regimens, side effects, and out-of-pocket costs of NS-LLTs and compare approaches with framing treatment efficacy.</p><p><strong>Methods: </strong>A discrete choice experiment survey was administered to US adults aged ≥40 years with medical claims indicating statin use and atherosclerotic cardiovascular disease. Each participant was administered 12 sets of experimentally designed pairs of add-on NS-LLT profiles that varied in efficacy, administration regimen, injection-site reaction, joint pain, out-of-pocket cost, and a no-additional treatment option. Random-parameter logit models were used to estimate preference weights, and tradeoffs across attributes were reported as willingness-to-pay estimates.</p><p><strong>Results: </strong>A total of 1193 participants completed the survey (36% female; 90% White; mean age, 68.2±9.7 years). Across treatment features assessed, out-of-pocket cost ranging from $0 to $200 per month was the most important factor. All else being equal, a daily oral dosing regimen was the most preferred regimen. Among injectable regimens, participants preferred dosing every 6 months versus every 2 weeks (<i>P</i><0.001) or every month (<i>P</i><0.001). Efficacy presented as 25% to 60% reductions in LDL-C (low-density lipoprotein-cholesterol) levels was valued greater than equivalent reductions in 5-year cardiovascular risks. Among those reporting annual household incomes <$150 000 (93.5%), the average maximum willingness to pay for an add-on NS-LLT as a daily, oral medication without side effects ranged from $131 to $175 per month with efficacy framed as a 25% reduction in LDL-C levels versus $89 to $124 with efficacy framed as corresponding reductions in 5-year cardiovascular risk.</p><p><strong>Conclusions: </strong>Among treatment features assessed, out-of-pocket costs were the primary factor driving choices. Those opting for an add-on NS-LLT were willing to trade off additional efficacy for less frequent injections or a daily oral medication.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011804"},"PeriodicalIF":6.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610143","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}