2024
Natural Language Processing of Clinical Documentation to Assess Functional Status in Patients With Heart Failure
Adejumo P, Thangaraj P, Dhingra L, Aminorroaya A, Zhou X, Brandt C, Xu H, Krumholz H, Khera R. Natural Language Processing of Clinical Documentation to Assess Functional Status in Patients With Heart Failure. JAMA Network Open 2024, 7: e2443925. PMID: 39509128, PMCID: PMC11544492, DOI: 10.1001/jamanetworkopen.2024.43925.Peer-Reviewed Original ResearchConceptsFunctional status assessmentArea under the receiver operating characteristic curveClinical documentationElectronic health record dataHF symptomsOptimal care deliveryHealth record dataAssess functional statusStatus assessmentClinical trial participationProcessing of clinical documentsFunctional status groupCare deliveryOutpatient careMain OutcomesMedical notesTrial participantsNew York Heart AssociationFunctional statusQuality improvementRecord dataHeart failureClinical notesDiagnostic studiesStatus groups
2021
SARS-CoV-2 Infection Hospitalization Rate and Infection Fatality Rate Among the Non-Congregate Population in Connecticut
Mahajan S, Caraballo C, Li SX, Dong Y, Chen L, Huston SK, Srinivasan R, Redlich CA, Ko AI, Faust JS, Forman HP, Krumholz HM. SARS-CoV-2 Infection Hospitalization Rate and Infection Fatality Rate Among the Non-Congregate Population in Connecticut. The American Journal Of Medicine 2021, 134: 812-816.e2. PMID: 33617808, PMCID: PMC7895685, DOI: 10.1016/j.amjmed.2021.01.020.Peer-Reviewed Original ResearchConceptsInfection hospitalization rateInfection fatality rateHospitalization ratesFatality rateSeroprevalence estimatesSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodiesSARS-CoV-2 antibodiesConnecticut Hospital AssociationNon-Hispanic black peopleProportion of deathsCoronavirus disease 2019Total infected individualsTotal hospitalizationsAdverse outcomesNon-congregate settingsHigh burdenDisease 2019Prevalence studyMost subgroupsInfected individualsHospitalizationOlder peopleHospital AssociationConnecticut DepartmentDeath
2020
Seroprevalence of SARS-CoV-2-Specific IgG Antibodies Among Adults Living in Connecticut: Post-Infection Prevalence (PIP) Study
Mahajan S, Srinivasan R, Redlich CA, Huston SK, Anastasio KM, Cashman L, Massey DS, Dugan A, Witters D, Marlar J, Li SX, Lin Z, Hodge D, Chattopadhyay M, Adams MD, Lee C, Rao LV, Stewart C, Kuppusamy K, Ko AI, Krumholz HM. Seroprevalence of SARS-CoV-2-Specific IgG Antibodies Among Adults Living in Connecticut: Post-Infection Prevalence (PIP) Study. The American Journal Of Medicine 2020, 134: 526-534.e11. PMID: 33130124, PMCID: PMC7598362, DOI: 10.1016/j.amjmed.2020.09.024.Peer-Reviewed Original ResearchConceptsSARS-CoV-2-specific IgG antibodiesWeighted seroprevalenceIgG antibodiesSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodiesSARS-CoV-2-specific antibodiesConnecticut residentsSelf-reported adherenceImmunoglobulin G antibodiesSARS-CoV-2Symptomatic illnessSerology testingSeroprevalence studyG antibodiesPrevalence studyGeneral populationPercentage of peopleSeroprevalenceLack antibodiesMajority of respondentsAntibodiesHispanic subpopulationsConvenience sampleHispanic populationCOVID-19Risk mitigation behaviorsStroke Code Presentations, Interventions, and Outcomes Before and During the COVID-19 Pandemic
Jasne AS, Chojecka P, Maran I, Mageid R, Eldokmak M, Zhang Q, Nystrom K, Vlieks K, Askenase M, Petersen N, Falcone GJ, Wira CR, Lleva P, Zeevi N, Narula R, Amin H, Navaratnam D, Loomis C, Hwang DY, Schindler J, Hebert R, Matouk C, Krumholz HM, Spudich S, Sheth KN, Sansing LH, Sharma R. Stroke Code Presentations, Interventions, and Outcomes Before and During the COVID-19 Pandemic. Stroke 2020, 51: 2664-2673. PMID: 32755347, PMCID: PMC7446978, DOI: 10.1161/str.0000000000000347.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBetacoronavirusBrain IschemiaCohort StudiesComorbidityConnecticutCoronary Artery DiseaseCoronavirus InfectionsCOVID-19DyslipidemiasEmergency Medical ServicesEthnicityFemaleHumansHypertensionIncomeInsurance, HealthIntracranial HemorrhagesMaleMedically UninsuredMiddle AgedOutcome and Process Assessment, Health CarePandemicsPneumonia, ViralRetrospective StudiesSARS-CoV-2Severity of Illness IndexStrokeSubstance-Related DisordersTelemedicineThrombectomyThrombolytic TherapyTime-to-TreatmentConceptsComprehensive stroke centerStroke codePatient characteristicsStroke severityStroke code patientsHistory of hypertensionStroke-like symptomsCoronary artery diseaseCoronavirus disease 2019 (COVID-19) pandemicPatient-level dataLower median household incomePublic health initiativesDisease 2019 pandemicCOVID-19 pandemicRace/ethnicityCode patientsHospital presentationPublic health insuranceRankin ScaleStroke centersArtery diseaseReperfusion timeStroke symptomsEarly outcomesConnecticut hospitalsLeveraging the Electronic Health Records for Population Health: A Case Study of Patients With Markedly Elevated Blood Pressure
Lu Y, Huang C, Mahajan S, Schulz WL, Nasir K, Spatz ES, Krumholz HM. Leveraging the Electronic Health Records for Population Health: A Case Study of Patients With Markedly Elevated Blood Pressure. Journal Of The American Heart Association 2020, 9: e015033. PMID: 32200730, PMCID: PMC7428633, DOI: 10.1161/jaha.119.015033.Peer-Reviewed Original ResearchConceptsDiastolic blood pressureSystolic blood pressureElevated blood pressureBlood pressureElectronic health recordsPopulation health surveillanceHealth recordsYale New Haven Health SystemHealth surveillanceHealth systemPatterns of patientsLarge health systemUsual careOutpatient encountersControl ratePatientsCare patternsPopulation healthMonthsHgSurveillancePrevalenceRecordsVisitsCare
2010
Patterns of moderate and vigorous physical activity in obese and overweight compared with non‐overweight children
DORSEY KB, HERRIN J, KRUMHOLZ HM. Patterns of moderate and vigorous physical activity in obese and overweight compared with non‐overweight children. Pediatric Obesity 2010, 6: e547-e555. PMID: 20883127, PMCID: PMC3815589, DOI: 10.3109/17477166.2010.490586.Peer-Reviewed Original ResearchConceptsVigorous physical activityOW/OBNon-overweight childrenMVPA boutsPhysical activityGreater body mass index z-scoreVPA boutsOW/OB groupBody mass index z-scoreMean daily MVPANon-overweight groupLess physical activityIndex z-scoreMinutes of MVPANon-overweight peersObese childrenObese participantsOverweight childrenOB groupDaily MVPASustained MVPADistinct patternsOB participantsMVPAConsecutive bouts
2008
Influence of Patients’ Socioeconomic Status on Clinical Management Decisions: A Qualitative Study
Bernheim SM, Ross JS, Krumholz HM, Bradley EH. Influence of Patients’ Socioeconomic Status on Clinical Management Decisions: A Qualitative Study. The Annals Of Family Medicine 2008, 6: 53-59. PMID: 18195315, PMCID: PMC2203396, DOI: 10.1370/afm.749.Peer-Reviewed Original ResearchConceptsClinical management decisionsPatients' socioeconomic statusClinical managementSocioeconomic statusPatient sPatient outcomesPrimary care physiciansStandard of careInfluence of patientLow socioeconomic statusVaried practice settingsHealth care qualitySES influencesCare physiciansHispanic ethnicityPhysician perspectivesPractice settingsCare qualityPatientsPhysiciansPatient interestMinority racial backgroundsInterview guideFinancial strainOutcomes
2006
Health related quality of life after mitral valve repairs and replacements
Sedrakyan A, Vaccarino V, Elefteriades JA, Mattera JA, Lin Z, Roumanis SA, Krumholz HM. Health related quality of life after mitral valve repairs and replacements. Quality Of Life Research 2006, 15: 1153-1160. PMID: 17004004, DOI: 10.1007/s11136-006-0055-3.Peer-Reviewed Original ResearchConceptsValve repair groupQuality of lifeValve repairRepair groupValve replacementReplacement groupMitral valveSimultaneous coronary artery bypass graft surgeryMedical Outcomes Trust Short FormCoronary artery bypass graft surgeryArtery bypass graft surgeryBypass graft surgeryMitral valve replacementMitral valve surgeryValve replacement groupMean HRQoL scoresHealth survey questionnaireMitral valve repairHealth status perspectiveGraft surgeryValve surgeryHRQoL scoresMultivariable analysisHigher social functioningPhysical functioningDelay in the Diagnosis of Acute Myocardial Infarction: Effect on Quality of Care and Its Assessment
Graff LG, Wang Y, Borkowski B, Tuozzo K, Foody JM, Krumholz HM, Radford MJ. Delay in the Diagnosis of Acute Myocardial Infarction: Effect on Quality of Care and Its Assessment. Academic Emergency Medicine 2006, 13: 931-938. PMID: 16894002, DOI: 10.1197/j.aem.2006.04.016.Peer-Reviewed Original ResearchMeSH KeywordsAdrenergic beta-AntagonistsAge DistributionAgedAged, 80 and overAngina, UnstableAspirinCohort StudiesConnecticutEvidence-Based MedicineFemaleFibrinolytic AgentsHumansMaleMyocardial InfarctionPatient AdmissionQuality Assurance, Health CareQuality of Health CareRetrospective StudiesTime FactorsConceptsAcute myocardial infarctionAdmission diagnosisBeta blockersQuality of careMyocardial infarctionDiagnosis of AMICharacteristics of patientsPercutaneous coronary interventionPrincipal discharge diagnosisEvidence-based therapiesRate of administrationCoronary interventionCardiac catheterizationDischarge diagnosisPrincipal diagnosisFrequency of delaysDischarge statusPatient careAdmissionAMI diagnosisPatientsDiagnosisMedicare casesCareInfarctionComparison of Functional Status After Coronary Artery Bypass Grafting in Patients With and Without Diabetes Mellitus
Sahakyan K, Abramson JL, Krumholz HM, Vaccarino V. Comparison of Functional Status After Coronary Artery Bypass Grafting in Patients With and Without Diabetes Mellitus. The American Journal Of Cardiology 2006, 98: 619-623. PMID: 16923448, DOI: 10.1016/j.amjcard.2006.03.038.Peer-Reviewed Original ResearchConceptsPhysical Component Scale scoresCoronary artery bypassDiabetes mellitusPhysical functionMental healthArtery bypassScale scoreRisk of morbidityMental component scaleShort formHealth Survey dataDM statusFirst CABGCABG surgeryBaseline characteristicsConsecutive patientsFunctional recoveryFunctional statusPhysical functioningHealth SurveyCABGPatientsScore changeMellitusComponent scalePhysician Board Certification and the Care and Outcomes of Elderly Patients with Acute Myocardial Infarction
Chen J, Rathore SS, Wang Y, Radford MJ, Krumholz HM. Physician Board Certification and the Care and Outcomes of Elderly Patients with Acute Myocardial Infarction. Journal Of General Internal Medicine 2006, 21: 238-244. PMID: 16637823, PMCID: PMC1828098, DOI: 10.1111/j.1525-1497.2006.00326.x.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionBoard-certified physiciansPhysician board certificationMyocardial infarctionFamily practitionersInternal medicineBoard certificationHigher useUse of aspirinQuality of careMultivariate regression analysisBoard-certified internistsElderly patientsHospitalized patientsClinical guidelinesMedicare patientsAspirinPatientsMortalityPhysiciansFamily practiceCareInfarctionRegression analysisCardiologists
2004
Sources of ethical conflict in medical housestaff training: a qualitative study
Rosenbaum JR, Bradley EH, Holmboe ES, Farrell MH, Krumholz HM. Sources of ethical conflict in medical housestaff training: a qualitative study. The American Journal Of Medicine 2004, 116: 402-407. PMID: 15006589, DOI: 10.1016/j.amjmed.2003.09.044.Peer-Reviewed Original ResearchSocial Support as a Predictor of Participation in Cardiac Rehabilitation After Coronary Artery Bypass Graft Surgery
Husak L, Krumholz HM, Lin ZQ, Kasl SV, Mattera JA, Roumanis SA, Vaccarino V. Social Support as a Predictor of Participation in Cardiac Rehabilitation After Coronary Artery Bypass Graft Surgery. Journal Of Cardiopulmonary Rehabilitation And Prevention 2004, 24: 19-26. PMID: 14758099, DOI: 10.1097/00008483-200401000-00005.Peer-Reviewed Original ResearchMeSH KeywordsAgedConnecticutCoronary Artery BypassCoronary DiseaseFemaleFollow-Up StudiesHumansMaleMarital StatusMiddle AgedMultivariate AnalysisPredictive Value of TestsPrevalenceQuality of LifeReferral and ConsultationRisk FactorsSickness Impact ProfileSocial SupportStroke VolumeSurvival AnalysisTreatment OutcomeConceptsCoronary artery bypass graftCardiovascular disease risk factorsDisease risk factorsCardiac rehabilitationRisk factorsCoronary artery bypass graft surgeryArtery bypass graft surgerySocial supportBypass graft surgeryArtery bypass graftBetter physical functionCardiac rehabilitation participationQuality of lifeLow social supportMain predictive variableComorbidity burdenHospital complicationsGraft surgerySocial Support InventoryIndependent predictorsBypass graftPhysical functionPredictors of participationUnadjusted analysesMedical history
2003
Sex Differences in Health Status After Coronary Artery Bypass Surgery
Vaccarino V, Lin ZQ, Kasl SV, Mattera JA, Roumanis SA, Abramson JL, Krumholz HM. Sex Differences in Health Status After Coronary Artery Bypass Surgery. Circulation 2003, 108: 2642-2647. PMID: 14597590, DOI: 10.1161/01.cir.0000097117.28614.d8.Peer-Reviewed Original ResearchConceptsPhysical functionMental healthReadmission ratesFunctional gainsCoronary artery bypass graft surgeryArtery bypass graft surgeryCoronary artery bypass surgeryLower functional gainsBypass graft surgeryArtery bypass surgeryHigher readmission ratesMan 6 monthsMean score improvementFirst CABGCABG surgeryGraft surgeryBaseline characteristicsBypass surgeryHospital readmissionMultivariable analysisAdverse outcomesFunctional statusFunctional improvementHealth SurveyHealth statusAge does not limit quality of life improvement in cardiac valve surgery
Sedrakyan A, Vaccarino V, Paltiel AD, Elefteriades JA, Mattera JA, Roumanis SA, Lin Z, Krumholz HM. Age does not limit quality of life improvement in cardiac valve surgery. Journal Of The American College Of Cardiology 2003, 42: 1208-1214. PMID: 14522482, DOI: 10.1016/s0735-1097(03)00949-5.Peer-Reviewed Original ResearchConceptsMental component summaryQuality of lifeCardiac valve surgeryPhysical component summaryValve surgeryAssociation of ageValve proceduresComponent summarySF-36PCS scoresMedical Outcomes Trust Short FormPatients' QOLMitral valve proceduresAortic valve proceduresOlder patientsAortic patientsMCS scoresMitral patientsQOL benefitsHealth SurveyPatientsSurgeryStatistical significanceAgeMultiple regression analysisWorsening renal function: What is a clinically meaningful change in creatinine during hospitalization with heart failure?
Smith GL, Vaccarino V, Kosiborod M, Lichtman JH, Cheng S, Watnick SG, Krumholz HM. Worsening renal function: What is a clinically meaningful change in creatinine during hospitalization with heart failure? Journal Of Cardiac Failure 2003, 9: 13-25. PMID: 12612868, DOI: 10.1054/jcaf.2003.3.Peer-Reviewed Original ResearchMeSH KeywordsAgedBiomarkersCohort StudiesConnecticutCreatinineFemaleFollow-Up StudiesHeart FailureHospitalizationHumansKidney DiseasesKidney Function TestsMaleMiddle AgedMultivariate AnalysisPredictive Value of TestsProspective StudiesRisk FactorsSensitivity and SpecificityStatistics as TopicStroke VolumeSurvival AnalysisConceptsCreatinine elevationRenal functionHeart failureAdverse outcomesRisk of deathNumber of patientsMagnitude of riskBaseline creatinineProspective cohortRisk factorsFunctional declineHigh riskPatientsCreatinineMortalityHospitalizationDeathDlImportant predictorRiskElevationMeaningful changeMaximum specificityOutcomesBetter definitionA Critical Evaluation of Critical Pathways in Head and Neck Cancer
Yueh B, Weaver EM, Bradley EH, Krumholz HM, Heagerty P, Conley A, Sasaki CT. A Critical Evaluation of Critical Pathways in Head and Neck Cancer. JAMA Otolaryngology - Head & Neck Surgery 2003, 129: 89-95. PMID: 12525201, DOI: 10.1001/archotol.129.1.89.Peer-Reviewed Original ResearchMeSH KeywordsAgedConnecticutCritical PathwaysFemaleHead and Neck NeoplasmsHumansLength of StayMaleMiddle AgedConceptsNeck cancerCritical pathwaysLaryngectomy patientsManagement of headLow-volume proceduresLinear spline regression modelsPathway adoptionObservational cohortPathway patientsContemporary cohortHistorical cohortPathway implementationMedical CenterSpline regression modelsConfounding variablesLaryngectomyPatientsUtilization trendsCohortPrior reportsIndependent impactLOSSignificant differencesCancer
2002
Cardiac outcomes after myocardial infarction in elderly patients with diabetes mellitus.
Chyun D, Vaccarino V, Murillo J, Young LH, Krumholz HM. Cardiac outcomes after myocardial infarction in elderly patients with diabetes mellitus. American Journal Of Critical Care 2002, 11: 504-19. PMID: 12425401, DOI: 10.4037/ajcc2002.11.6.504.Peer-Reviewed Original ResearchConceptsRecurrent myocardial infarctionInsulin-treated diabetes mellitusDiabetes mellitusMyocardial infarctionElderly patientsHeart failureVentricular functionComorbid conditionsClinical findingsIndex myocardial infarctionPoor ventricular functionInsulin-treated diabetesAcute myocardial infarctionCardiac outcomesPoor outcomeMedical recordsMellitusInfarctionMedicare beneficiariesPatientsGreater riskInsulinMortalityRiskOutcomesThrombolysis for Acute Stroke in Routine Clinical Practice
Bravata DM, Kim N, Concato J, Krumholz HM, Brass LM. Thrombolysis for Acute Stroke in Routine Clinical Practice. JAMA Internal Medicine 2002, 162: 1994-2001. PMID: 12230423, DOI: 10.1001/archinte.162.17.1994.Peer-Reviewed Original ResearchConceptsMajor protocol deviationsRoutine clinical practiceConnecticut cohortProtocol deviationsHospital mortalityAcute strokeThrombolytic therapyClinical practiceExtracranial hemorrhageCommunity-based patientsMinor protocol deviationsHigh rateIntravenous thrombolysisAdverse eventsRetrospective cohortHemorrhage ratePatient outcomesConnecticut hospitalsPatientsThrombolysisNeurological disordersCohortExperienced cliniciansStudy settingTherapyRandomized trial of an education and support intervention to preventreadmission of patients with heart failure
Krumholz HM, Amatruda J, Smith GL, Mattera JA, Roumanis SA, Radford MJ, Crombie P, Vaccarino V. Randomized trial of an education and support intervention to preventreadmission of patients with heart failure. Journal Of The American College Of Cardiology 2002, 39: 83-89. PMID: 11755291, DOI: 10.1016/s0735-1097(01)01699-0.Peer-Reviewed Original ResearchConceptsHeart failureSupport interventionsIntervention groupControl groupHospital readmission costsOne-year readmissionRate of readmissionAdverse clinical outcomesCost of careDisease management programsReadmission costsClinical outcomesHospital costsReadmissionLower riskPatientsOne-yearDemographic characteristicsInterventionTrialsGroupFormal educationTotal numberMedical componentsFailure