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":"10.1161/CIRCOUTCOMES.125.012082","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012082"},"PeriodicalIF":6.2,"publicationDate":"2025-05-01","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":"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":"2025-05-01","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":"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":"10.1161/CIRCOUTCOMES.125.011926","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011926"},"PeriodicalIF":6.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092173/pdf/","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":"OA","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":"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":6.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092179/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computational Phenomapping of Randomized Clinical Trial Participants to Enable Assessment of Their Real-World Representativeness and Personalized Inference.","authors":"Phyllis M Thangaraj, Evangelos K Oikonomou, Lovedeep S Dhingra, Arya Aminorroaya, Rahul H Jayaram, Marc A Suchard, Rohan Khera","doi":"10.1161/CIRCOUTCOMES.124.011306","DOIUrl":"10.1161/CIRCOUTCOMES.124.011306","url":null,"abstract":"<p><strong>Background: </strong>Assessing the generalizability of randomized clinical trials (RCTs) to real-world patients remains challenging. We propose a multidimensional metric to quantify the representativeness of an RCT cohort in an electronic health record (EHR) population and estimate real-world effects based on individualized treatment effects observed in the RCT.</p><p><strong>Methods: </strong>We identified 65 clinical prerandomization characteristics of patients with heart failure with preserved ejection fraction within the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial) and extracted those features in similar patients in EHR data from 4 hospitals in the Yale New Haven Health System. We then assessed the real-world generalizability of TOPCAT by developing a novel statistic, the phenotypic distance metric, to quantify the representation of TOPCAT participants within EHR patients. Finally, applying a machine learning method to learn individualized treatment effect in TOPCAT participants stratified by region, the United States (US) and Eastern Europe (EE), we predicted spironolactone benefit within the EHR cohorts.</p><p><strong>Results: </strong>There were 3445 patients in TOPCAT (median age 69, interquartile range [IQR], 61-76 years, 52% women) and 8121 patients with heart failure with preserved ejection fraction across 4 hospitals (median age range 77, IQR, 68-86; years to 85; IQR, 77-91 years, 54% to 62% women). Across covariates, the EHR patients were more similar to each other than the TOPCAT-US participants (median standardized mean difference 0.065, IQR, 0.011-0.144 versus median standardized mean difference 0.186, IQR, 0.040-0.479). The phenotypic distance metric found a higher generalizability of the TOPCAT-US participants to the EHR patients than the TOPCAT-EE participants. Using a TOPCAT-US-derived model of individualized treatment effect, all EHR patients were predicted to derive benefit from spironolactone treatment, while a TOPCAT-EE-derived model predicted 13% of EHR patients to derive benefit.</p><p><strong>Conclusions: </strong>This novel multidimensional metric evaluates the real-world representativeness of RCT participants against corresponding patients in the EHR, enabling the evaluation of an RCT's implication for real-world patients.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011306"},"PeriodicalIF":6.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058774","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":"Multidimensional Sleep Health: Definitions and Implications for Cardiometabolic Health: A Scientific Statement From the American Heart Association.","authors":"Marie-Pierre St-Onge, Brooke Aggarwal, Julio Fernandez-Mendoza, Dayna Johnson, Christopher E Kline, Kristen L Knutson, Nancy Redeker, Michael A Grandner","doi":"10.1161/HCQ.0000000000000139","DOIUrl":"10.1161/HCQ.0000000000000139","url":null,"abstract":"<p><p>Poor sleep health is associated with cardiometabolic disease and related risk factors, including heart disease, stroke, elevated blood pressure and lipid levels, inflammation, glucose intolerance, obesity, physical inactivity, poor diet, unhealthy substance use, poor mental health, and increased all-cause and cardiovascular mortality, and is associated with social determinants of cardiovascular health and health disparities. Therefore, sleep duration has been recognized by the American Heart Association as one of Life's Essential 8. Although chronic sleep duration is the sole metric used in Life's Essential 8, sleep health represents a multidimensional construct. This scientific statement outlines the concept of multidimensional sleep health (sleep duration, continuity, timing, regularity, sleep-related daytime functioning, architecture, and absence of sleep disorders) as it applies to cardiometabolic health. Considerations of how these dimensions are related to cardiometabolic health and patterned by sociodemographic status are explained, and knowledge gaps are highlighted. Additional data are needed to understand better how these various dimensions of sleep should be assessed and how interventions targeting sleep health in clinical and community settings can be leveraged to improve health.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e000139"},"PeriodicalIF":6.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989495","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":"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":6.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084010/pdf/","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":"OA","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":"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":6.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13333083/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Differences in Cardiovascular Mortality Among Patients With Immune Mediated Inflammatory Diseases.","authors":"Issam Motairek, Farah Abdulhai, Osamah Badwan, Rochell Issa, Tess Calcagno, Saeid Mirzai, Jacqueline E Tamis-Holland, M Elaine Husni, Heba S Wassif","doi":"10.1161/CIRCOUTCOMES.124.011833","DOIUrl":"10.1161/CIRCOUTCOMES.124.011833","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011833"},"PeriodicalIF":6.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058346","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":"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":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084016/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}