Circulation-Cardiovascular Quality and Outcomes最新文献

{"title":"Electronic Health Record Alert to Promote Adoption of Limited Transthoracic Echocardiograms in Primary Care and Cardiology Clinics: A Mixed Methods Evaluation.","authors":"Neil M Kalwani, Samantha M R Kling, Stacie Vilendrer, Donn W Garvert, Darlene Veruttipong, Juliana Baratta, Erika A Saliba-Gustafsson, Eleanor Levin, Cindie Gaspar, Cati G Brown-Johnson, Sandra A Tsai, Marcy Winget","doi":"10.1161/CIRCOUTCOMES.123.010621","DOIUrl":"10.1161/CIRCOUTCOMES.123.010621","url":null,"abstract":"<p><strong>Background: </strong>A limited transthoracic echocardiogram (TTE) can be an appropriate, lower-cost substitute for a full TTE. We assessed the impact of an electronic health record alternative alert promoting the adoption of limited TTEs on the ordering practices of cardiology clinicians and primary care providers and captured their perspectives on the initiative.</p><p><strong>Methods: </strong>The alert was deployed in a cardiology clinic and 4 primary care clinics at an academic medical center. The alert provided clinical guidance on the appropriate use of limited TTEs when a clinician selected a full TTE order. We used logistic regression to estimate the change in the proportion of limited versus full TTEs ordered between the baseline and intervention periods in clinics with and without the alert. We also conducted interviews with 24 clinicians (5 cardiologists and 19 primary care providers) to identify implementation barriers and facilitators.</p><p><strong>Results: </strong>Cardiology clinicians ordered 10 654 and 3761 TTEs during the baseline and intervention periods, respectively, for 9100 patients. Primary care providers ordered 723 and 617 TTEs during the baseline and intervention periods for 1273 patients. The model estimated that the percentage of limited TTEs ordered increased by 16.1±2.3 percentage points (<i>P</i><0.0001) in the cardiology clinic with the alert and by 13.2±1.5 percentage points (<i>P</i><0.0001) in the primary care clinics with the alert from baseline to post-intervention. Ordering practices did not change in the cardiology (0.7±0.6 percentage points; <i>P</i>=0.24) or primary care (0.7±1.0 percentage points; <i>P</i>=0.52) clinics without the alert. Clinicians viewed the alert as acceptable. Cardiologists appreciated that the alert was concise, whereas primary care providers wanted more information from the alert.</p><p><strong>Conclusions: </strong>An alternative alert providing clinical guidance on the use of limited TTEs at the point of care increased the selection of this lower-cost test in cardiology and primary care clinics. Perspectives on the alert differed between specialists and nonspecialists, highlighting the importance of tailoring intervention design to clinical expertise.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":"17 11","pages":"e010621"},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11581681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677163","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":"Risk, Revelation, and Reflection: A Personal Journey Through Ethics, Risk Literacy, and Informed Consent.","authors":"Melvin R Echols","doi":"10.1161/CIRCOUTCOMES.124.010894","DOIUrl":"10.1161/CIRCOUTCOMES.124.010894","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":"17 11","pages":"e010894"},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11581682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677495","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":"International Comparison of Quality Indicators for Adults Hospitalized for Heart Failure: A Systematic Review.","authors":"Giliana Garcia Acevedo, Aisha Ahmad, Benjamin Stall, Media Mokhtarnia, John M Lapp, Amol A Verma, Jalal Ebrahim, Harriette G C Van Spall, Fahad Razak, Sarina R Isenberg, Edward Etchells, Susanna Mak, Leah Steinberg, Dennis T Ko, Stephanie Poon, Kieran L Quinn","doi":"10.1161/CIRCOUTCOMES.123.010629","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.123.010629","url":null,"abstract":"<p><strong>Background: </strong>There is limited international agreement on defining care quality for the millions of people hospitalized with heart failure worldwide. Our objective was to compare and measure agreement across existing internationally published quality indicators (QIs) for the care of adults hospitalized for heart failure.</p><p><strong>Methods: </strong>Systematic review and evidence gap map of internationally published articles reporting on QIs for adults hospitalized for heart failure, using PubMed, MEDLINE, EMBASE, and TRIP from inception to July 18, 2022. Narrative synthesis and descriptive statistics characterized included articles and QIs using the Donabedian Framework of Structural, Process, and Outcomes. The methodological quality of QI sets was assessed using the Appraisal of Indicators through Research and Evaluation instrument. Agreement about QIs was defined as having at least 3 different cardiovascular societies recommend its use. An evidence gap map displayed each QI according to its clinically relevant category, methodological quality, and reporting articles.</p><p><strong>Results: </strong>Fourteen articles from 11 societies reported 75 unique QIs; 53 QIs were process, 16 were structural, and 7 were outcome measures. There was limited agreement on individual QIs across sets as a minority were recommended by ≥3 societies (12%; 9/75 QIs). The most common QIs included postdischarge follow-up (73%, 8/11 societies), specific pharmacotherapy (64%, 7/11 societies), patient education (45%, 5/11 societies), assessment of left ventricular ejection fraction (45%, 5/11 societies), 30-day readmission rate (45%, 5/11 societies), cardiac rehabilitation (36%, 4/11 societies), and multidisciplinary management (27%, 3/11 societies).</p><p><strong>Conclusions: </strong>There was little agreement on defining high-quality care and limited agreement on measures including postdischarge follow-up, specific pharmacotherapies, patient education, assessment of left ventricular ejection fraction, 30-day readmission, cardiac rehabilitation, and multidisciplinary management. These measures may define high-quality care and highlight opportunities to improve the quality of care for adults hospitalized for heart failure.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":"17 11","pages":"e010629"},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677129","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 Sahutoglu Regarding Article, \"Adequacy of Dialysis and Incidence of Atrial Fibrillation in Patients Undergoing Hemodialysis\".","authors":"Tuncay Sahutoglu","doi":"10.1161/CIRCOUTCOMES.124.011457","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011457","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":"17 11","pages":"e011457"},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677400","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 Homelessness and Unstable Housing With Cardiovascular Care Utilization Among Veterans.","authors":"Lara J Sokoloff, Jingyi Wu, Lauren A Eberly, Ashwin S Nathan, Howard M Julien, Taisei J Kobayashi, Scott M Damrauer, Peter W Groeneveld, Jack Tsai, Sameed Ahmed M Khatana","doi":"10.1161/CIRCOUTCOMES.124.010993","DOIUrl":"10.1161/CIRCOUTCOMES.124.010993","url":null,"abstract":"<p><strong>Background: </strong>Veterans are disproportionately more likely to experience homelessness and unstable housing (HUH) compared with the general population. Cardiovascular disease is the leading cause of death among Veterans experiencing HUH. We aimed to understand whether HUH status among Veterans with preexisting cardiovascular disease was associated with disparities in cardiovascular care access and utilization.</p><p><strong>Methods: </strong>Retrospective study of all Veterans with preexisting cardiovascular disease between 2017 and 2019 using Veterans Affairs Corporate Data Warehouse and Homeless registry data. Primary outcomes were annual outpatient visits for cardiovascular disease management and visits with cardiovascular disease-related specialists. Secondary outcomes included cardiovascular disease-related procedures and emergency department visits and hospitalizations. HUH status was determined based on response to a screener, diagnostic codes, or use of homelessness services, and outcomes were assessed in the first year HUH status was determined. After applying inverse probability of treatment weighting, negative binomial and logistic regression models were fit to estimate the association between experiencing HUH and the outcomes of interest.</p><p><strong>Results: </strong>Among 1 357 973 Veterans (mean age, 71.6 [SD=10.6] years; 2.5% female) with preexisting cardiovascular disease, 56 093 were identified as experiencing HUH during the study period. Veterans experiencing HUH had fewer outpatient visits for cardiovascular disease management or with cardiovascular disease-related specialists (4.3% [95% CI, 2.5%-6.1%] and 14.1% [95% CI, 12.5%-15.8%], respectively) compared with housed Veterans. HUH status was associated with lower rates of receiving certain procedures including coronary artery bypass graft, lower extremity revascularization, and carotid artery stenosis interventions and higher rates of all-cause and cardiovascular emergency department visits and hospitalizations.</p><p><strong>Conclusions: </strong>Veterans with chronic cardiovascular conditions experiencing HUH had lower rates of outpatient visits for cardiovascular disease management and higher rates of emergency department visits and hospitalizations. Given the disproportionate burden of cardiovascular disease in this population, interventions to improve access to cardiovascular care are needed.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e010993"},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570132","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":"Trends in Transcatheter Mechanical Thrombectomy for Management of Acute Pulmonary Embolism.","authors":"Ahmed Elkaryoni, Omar Hyder, Marwan Saad, Amir Darki, Islam Y Elgendy, Shafiq T Mamdani, Matthew C Bunte, Herbert D Aronow, Peter A Soukas, J Dawn Abbott","doi":"10.1161/CIRCOUTCOMES.124.011038","DOIUrl":"10.1161/CIRCOUTCOMES.124.011038","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011038"},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570135","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":"Stakeholder Perspectives on a Heart Failure With Reduced Ejection Fraction Polypill: A Multi-Center Mixed Methods Study.","authors":"Justin C Chen, Colette DeJong, Mansi Agarwal, Amaris M Hairston, Matthew S Durstenfeld, Virginia McKay, Mark D Huffman, Priscilla Y Hsue, Anubha Agarwal","doi":"10.1161/CIRCOUTCOMES.124.011121","DOIUrl":"10.1161/CIRCOUTCOMES.124.011121","url":null,"abstract":"<p><strong>Background: </strong>A polypill containing all 4 classes of guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF) has been proposed to change the heart failure treatment paradigm. The acceptability, appropriateness, and feasibility of a HFrEF polypill-based strategy are unknown. The purpose of this study was to elicit patients' and providers' priorities in the design of HFrEF polypills.</p><p><strong>Methods: </strong>From April 2023 to December 2023, we conducted a convergent parallel mixed-methods study at Washington University in St. Louis, the University of California, San Francisco, and the American College of Cardiology. We administered physician surveys containing adapted implementation outcome measures to elicit physicians' perspectives on the acceptability, feasibility, and appropriateness of a HFrEF polypill (Likert scale ranging from 1 [low] to 5 [high]). We used a purposive sampling frame to select patients and physicians for in-depth interviews. Using semi-structured interview guides, we elicited participants' perspectives on current HFrEF care, HFrEF polypill design, and supportive strategies. The Consolidated Framework for Implementation Research v2.0 guided thematic analysis.</p><p><strong>Results: </strong>Of the 214 survey respondents across the United States, physicians agreed that HFrEF polypills are highly acceptable (mean [SD], 4.2 [0.7]), highly appropriate (4.1 [0.8]), and highly feasible (4.1 [0.7]). Key themes from 9 patient and 22 provider interviews included the following: (1) current determinants of HFrEF care, including medication adherence, variations in clinical practice, and health care access, (2) provider-level differences in preferred HFrEF polypill design, (3) cost and equity considerations in the implementation of HFrEF polypills, and (4) research priorities for evaluating polypill effectiveness and implementation.</p><p><strong>Conclusions: </strong>A HFrEF polypill-based strategy was viewed as highly acceptable, appropriate, and feasible by patients and physicians. Participants described key priorities in HFrEF polypill design, titratability, and potential impacts on health equity that will directly inform future randomized controlled trials.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011121"},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584585","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":"The Next Era of Quality Improvement: Owning the Challenge.","authors":"Steven M Bradley, Sandeep R Das","doi":"10.1161/CIRCOUTCOMES.124.010010","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.010010","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":"17 11","pages":"e010010"},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677497","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":"Quality Measures for Patients Hospitalized With Heart Failure: Less Is More?","authors":"Elizabeth Feldman, Vinay Kini","doi":"10.1161/CIRCOUTCOMES.124.011529","DOIUrl":"10.1161/CIRCOUTCOMES.124.011529","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":"17 11","pages":"e011529"},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677380","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":"Quality of Life and Quality of Evidence for Subcutaneous Versus Transvenous Implantable Cardioverter-Defibrillators.","authors":"Hope Caughron, Sanket S Dhruva","doi":"10.1161/CIRCOUTCOMES.124.011349","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011349","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":"17 11","pages":"e011349"},"PeriodicalIF":6.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677385","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}