Circulation-Cardiovascular Quality and Outcomes最新文献

{"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":"10.1161/CIRCOUTCOMES.124.011396","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011396"},"PeriodicalIF":6.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092183/pdf/","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":"OA","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":"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":"2025-05-01","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":"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":"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":6.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092182/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Percutaneous Coronary Intervention Safety, Quality, and Appropriateness Across Michigan Using Blinded Cross-Institutional Peer Review.","authors":"Stephanie M Spehar, Milan Seth, John F Collins, Simon R Dixon, Elizabeth Pielsticker, Daniel Lee, Mark Zainea, Thomas LaLonde, Dilip Arora, Devraj Sukul, Hitinder S Gurm","doi":"10.1161/CIRCOUTCOMES.124.011031","DOIUrl":"10.1161/CIRCOUTCOMES.124.011031","url":null,"abstract":"<p><strong>Background: </strong>Several quality improvement initiatives have focused on the quality gap in percutaneous coronary intervention (PCI), yet significant variations in quality persist. Our objective was to use a novel blinded peer review system to evaluate PCI quality, safety, and appropriateness across Michigan.</p><p><strong>Methods: </strong>Single-vessel PCI cases were randomly selected from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry across Michigan (2018-2020), and anonymized angiograms and pertinent case records were uploaded to a secure server. Cases were reviewed by blinded interventional cardiologists internal and external to the institution, using a standardized peer review form and rated on procedural quality, safety, and appropriateness. We compared appropriateness ratings between reviewers and registry-based appropriateness criteria.</p><p><strong>Results: </strong>We conducted 1627 independent peer reviews of 961 cases; 23.7% of cases were for non-ST-segment-elevation myocardial infarction, and 36.4% were for ST-segment-elevation myocardial infarction. The majority (96.4%) of reviewers rated angiogram quality as excellent or adequate. Reviewers noted a complication or suboptimal result in 11.1% of reviews; 44.0% of these were deemed avoidable. Most PCI procedures were considered appropriate or may be appropriate, (87.1%) by all those reviewing. Reviewers were less likely to categorize PCI cases as appropriate compared with registry-based appropriate use criteria definitions (73.1% versus 93.3%). The percentage of cases rated as both appropriate/may be appropriate and technically competent ranged from 76.7% to 100% across sites.</p><p><strong>Conclusions: </strong>While the overall quality and appropriateness of PCI in Michigan are high, key opportunities to improve care were identified. Additional studies are needed to assess the utility of expanding this approach across the United States.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011031"},"PeriodicalIF":6.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505488","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":"Variations in the Medical Device Authorization and Reimbursement Landscape: A Case Study of 2 Cardiovascular Devices Across 4 Countries.","authors":"Marta M Williams, Nathan R Smith, Carin A Uyl-de Groot, Corstiaan A den Uil, Joseph S Ross, Mohamed O Mohamed, Mamas A Mamas, Amitava Banerjee, Dennis T Ko, Bruce Landon, Peter Cram","doi":"10.1161/CIRCOUTCOMES.124.011636","DOIUrl":"10.1161/CIRCOUTCOMES.124.011636","url":null,"abstract":"<p><strong>Background: </strong>The authorization process and coverage/reimbursement mechanisms for medical devices play critical roles in device adoption and usage. However, international variation in these processes remains poorly characterized, especially with regard to data transparency and the effects of reimbursement on usage.</p><p><strong>Methods: </strong>This study examined publicly available databases, governmental agency recommendations and policies, and press releases from the United States, Canada, the United Kingdom, and the Netherlands to compare the regulatory approval processes and coverage/reimbursement mechanisms for 2 novel cardiovascular devices introduced in the early and late 2000's: the Watchman left atrial appendage occlusion device and the Impella percutaneous ventricular assist device. In addition to qualitative comparisons for each country, this study compared the date of the first regulatory review, time from submission to review completion, device approval date, agency approval requirements, number of review cycles, and necessity of postapproval studies as determined by the regulator, date of funding decision, final funding decision, and requirements for device reimbursement by relevant government payors.</p><p><strong>Results: </strong>Authorization data were easily accessible for the United States and Canada but extremely limited for the United Kingdom and the Netherlands. Chronologically, authorization occurred ≈10 years earlier in Europe (United Kingdom and the Netherlands) than in North America (United States and Canada) for both devices. The United States was the only country where the principal public payor (Medicare) explicitly reimbursed both procedures. The United States was similarly notable for more rapid adoption and higher utilization of both devices than the other countries, with the Watchman implanted at 3.4 devices per 100 000 adults annually and Impella used in 7 to 8 procedures per 100 000 people annually. In contrast, uptake was far lower in Canada and Europe.</p><p><strong>Conclusions: </strong>This research provides insights into how differences among countries in authorization and reimbursement mechanisms may impact the adoption and usage of medical devices, and may inform future policies on these processes.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011636"},"PeriodicalIF":6.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11999767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469803","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":"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":"10.1161/CIRCOUTCOMES.125.011887","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011887"},"PeriodicalIF":6.2,"publicationDate":"2025-04-01","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":"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":"10.1161/CIRCOUTCOMES.124.011532","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011532"},"PeriodicalIF":6.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11999778/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Relevance of the Kansas City Cardiomyopathy Questionnaire in Patients With Tricuspid Regurgitation: The Tri-QOL Qualitative Study.","authors":"Danielle M Olds, Jamie L Smith, John A Spertus, Shannon M Dunlay, Fraser D Bocell, Changfu Wu, David J Cohen, Suzanne V Arnold","doi":"10.1161/CIRCOUTCOMES.124.011245","DOIUrl":"10.1161/CIRCOUTCOMES.124.011245","url":null,"abstract":"<p><strong>Background: </strong>Validly measuring disease-specific health status is critical in patients with severe tricuspid regurgitation (TR) to quantify the benefit of different interventions. The Kansas City Cardiomyopathy Questionnaire (KCCQ) has been used to assess health status in patients with severe TR, but its content validity in this patient population is unknown, including whether additional questions are needed to supplement the KCCQ.</p><p><strong>Methods: </strong>Twenty participants with symptomatic severe TR from 2 midwestern clinical sites were interviewed in 2023 using a semistructured guide. The interview guide addressed symptoms, physical and social functioning, and quality of life concepts of the KCCQ, as well as other potential TR symptoms not represented in the KCCQ. Interview transcripts were analyzed using inductive and deductive coding and content analysis, with additional participants recruited until thematic saturation occurred.</p><p><strong>Results: </strong>Mean age of the participants was 80 (41-89), and 75% were female. Shortness of breath and fatigue were reported by virtually all participants (n=20 and n=19, respectively) and had a marked negative impact on their physical and social functioning and quality of life. Lower limb edema was also reported by 10 participants. Although these concepts are captured by the KCCQ, other symptoms were also reported, including appetite loss (n=8) and upper body edema (n=4), but did not seem to markedly affect participants' function or quality of life. In addition, all participants who experienced these other symptoms reported symptoms that were already captured by the KCCQ.</p><p><strong>Conclusions: </strong>All participants experienced symptoms captured by the KCCQ, and these symptoms had a substantial impact on their physical and social functioning and quality of life. Although some participants reported additional symptoms not assessed by the KCCQ, their incorporation would only marginally improve content validity. Thus, the current KCCQ appears to be appropriate for capturing the disease-specific health status of patients with severe TR.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011245"},"PeriodicalIF":6.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081810","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":"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":"2025-04-01","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":"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":"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":"2025-04-01","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}