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 groupsAutomated Identification of Heart Failure With Reduced Ejection Fraction Using Deep Learning-Based Natural Language Processing
Nargesi A, Adejumo P, Dhingra L, Rosand B, Hengartner A, Coppi A, Benigeri S, Sen S, Ahmad T, Nadkarni G, Lin Z, Ahmad F, Krumholz H, Khera R. Automated Identification of Heart Failure With Reduced Ejection Fraction Using Deep Learning-Based Natural Language Processing. JACC Heart Failure 2024 PMID: 39453355, DOI: 10.1016/j.jchf.2024.08.012.Peer-Reviewed Original ResearchReduced ejection fractionEjection fractionHeart failureLeft ventricular ejection fractionVentricular ejection fractionYale-New Haven HospitalIdentification of patientsCommunity hospitalIdentification of heart failureLanguage modelNorthwestern MedicineMeasure care qualityQuality of careNew Haven HospitalDeep learning-based natural language processingHFrEFGuideline-directed careDeep learning language modelsMIMIC-IIIDetect HFrEFNatural language processingReclassification improvementHospital dischargePatientsCare quality
2023
DEEP LEARNING-BASED IDENTIFICATION OF HEART FAILURE WITH REDUCED EJECTION FRACTION IN CLINICAL DOCUMENTATION TO AUTOMATE CARE QUALITY ASSESSMENT IN HEART FAILURE
Nargesi A, Rosand B, Hengartner A, Adejumo P, Khera R. DEEP LEARNING-BASED IDENTIFICATION OF HEART FAILURE WITH REDUCED EJECTION FRACTION IN CLINICAL DOCUMENTATION TO AUTOMATE CARE QUALITY ASSESSMENT IN HEART FAILURE. Journal Of The American College Of Cardiology 2023, 81: 2302. DOI: 10.1016/s0735-1097(23)02746-8.Peer-Reviewed Original Research
2022
Performance of current risk stratification models for predicting mortality in patients with heart failure: a systematic review and meta-analysis
Siddiqi TJ, Ahmed A, Greene SJ, Shahid I, Usman MS, Oshunbade A, Alkhouli M, Hall ME, Murad MH, Khera R, Jain V, Van Spall HGC, Khan MS. Performance of current risk stratification models for predicting mortality in patients with heart failure: a systematic review and meta-analysis. European Journal Of Preventive Cardiology 2022, 29: 2027-2048. PMID: 35919956, DOI: 10.1093/eurjpc/zwac148.Peer-Reviewed Original ResearchConceptsChronic heart failureLong-term mortalityMid-term mortalityAcute HFHeart failureRisk scoreGeneric inverse variance random effects modelInverse variance random-effects modelCurrent risk stratification modelsExcellent discriminationAcute heart failureRisk stratification modelShort-term mortalityLack of headRandom-effects modelGood discriminationAHF mortalityCause mortalityC-statisticNineteen studiesPatientsMortality predictionSystematic reviewHead comparisonMortalityRural-Urban Disparities in Heart Failure and Acute Myocardial Infarction Hospitalizations
Minhas AMK, Sheikh AB, Ijaz SH, Mostafa A, Nazir S, Khera R, Loccoh EC, Warraich HJ. Rural-Urban Disparities in Heart Failure and Acute Myocardial Infarction Hospitalizations. The American Journal Of Cardiology 2022, 175: 164-169. PMID: 35577603, DOI: 10.1016/j.amjcard.2022.04.014.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionHeart failureHospital mortalityUrban hospitalRural hospitalsInflation-adjusted costStudy periodAMI hospitalizationMortality gapNational Inpatient SampleLength of stayAcute myocardial infarction hospitalizationsShorter mean lengthMyocardial infarction hospitalizationsHF hospitalizationCardiovascular outcomesClinical outcomesConsistent decreaseMyocardial infarctionInpatient SampleRural-urban disparitiesCardiovascular careHospitalizationHospitalMean length
2021
Nonalcoholic Fatty Liver Disease and Risk of Heart Failure Among Medicare Beneficiaries
Fudim M, Zhong L, Patel KV, Khera R, Abdelmalek MF, Diehl AM, McGarrah RW, Molinger J, Moylan CA, Rao VN, Wegermann K, Neeland IJ, Halm EA, Das SR, Pandey A. Nonalcoholic Fatty Liver Disease and Risk of Heart Failure Among Medicare Beneficiaries. Journal Of The American Heart Association 2021, 10: e021654. PMID: 34755544, PMCID: PMC8751938, DOI: 10.1161/jaha.121.021654.Peer-Reviewed Original ResearchConceptsNonalcoholic fatty liver diseaseIncident heart failureReduced ejection fractionFatty liver diseaseHeart failureEjection fractionMedicare beneficiariesHF subtypesLiver diseaseHigh riskBackground Nonalcoholic fatty liver diseaseBaseline NAFLDAssociation of NAFLDNew-onset heart failureConclusions PatientsCohort studyPrior diagnosisBlack patientsNinth RevisionKidney diseaseOutpatient claimsRisk factorsIndependent associationHigh burdenMedicare patientsForgone Medical Care Associated With Increased Health Care Costs Among the U.S. Heart Failure Population
Thomas A, Valero-Elizondo J, Khera R, Warraich HJ, Reinhardt SW, Ali HJ, Nasir K, Desai NR. Forgone Medical Care Associated With Increased Health Care Costs Among the U.S. Heart Failure Population. JACC Heart Failure 2021, 9: 710-719. PMID: 34391737, DOI: 10.1016/j.jchf.2021.05.010.Peer-Reviewed Original ResearchConceptsHeart failureHealth care utilizationHealth care costsHealth care expendituresCare utilizationCare costsMedical careMore emergency department visitsTotal health care costsCare expendituresAnnual health careAnnual inpatient costsPrevalence of patientsEmergency department visitsMedical Expenditure Panel SurveyOverall health care spendingHF patientsElderly patientsCare AssociatedDepartment visitsFailure populationInpatient costsHealth care spendingLeading causePatientsOut‐of‐pocket Annual Health Expenditures and Financial Toxicity from Healthcare Costs in Patients with Heart Failure in the United States
Wang SY, Valero‐Elizondo J, Ali H, Pandey A, Cainzos‐Achirica M, Krumholz HM, Nasir K, Khera R. Out‐of‐pocket Annual Health Expenditures and Financial Toxicity from Healthcare Costs in Patients with Heart Failure in the United States. Journal Of The American Heart Association 2021, 10: e022164. PMID: 33998273, PMCID: PMC8483501, DOI: 10.1161/jaha.121.022164.Peer-Reviewed Original ResearchConceptsGreater risk-adjusted oddsRisk-adjusted oddsHeart failureMedical Expenditure Panel SurveyCatastrophic financial burdenPocket healthcare expensesHigh financial burdenFinancial toxicityHealthcare expensesFinancial burdenHealthcare costsCatastrophic burdenMajor public health burdenLow-income familiesBackground Heart failurePublic health burdenInsurance premiumsPanel SurveyPocket healthcare costsAnnual health expenditureWorld Health OrganizationConclusions PatientsHealth insurance premiumsPocket healthcare expenditureHealth burdenContemporary National Patterns of Eligibility and Utilization of Novel Cardioprotective Anti‐hyperglycemic agents in Type 2 Diabetes
Nargesi AA, Jeyashanmugaraja GP, Desai N, Lipska K, Krumholz H, Khera R. Contemporary National Patterns of Eligibility and Utilization of Novel Cardioprotective Anti‐hyperglycemic agents in Type 2 Diabetes. Journal Of The American Heart Association 2021, 10: e021084. PMID: 33998258, PMCID: PMC8403287, DOI: 10.1161/jaha.121.021084.Peer-Reviewed Original ResearchMeSH KeywordsAgedBiomarkersBlood GlucoseCardiovascular DiseasesDiabetes Mellitus, Type 2Drug UtilizationEligibility DeterminationFemaleGlucagon-Like Peptide-1 ReceptorGuideline AdherenceHeart Disease Risk FactorsHumansIncretinsMaleMiddle AgedNutrition SurveysPractice Guidelines as TopicPractice Patterns, Physicians'Risk AssessmentSodium-Glucose Transporter 2 InhibitorsTime FactorsTreatment OutcomeUnited StatesConceptsSGLT-2 inhibitorsType 2 diabetes mellitusAtherosclerotic cardiovascular diseaseChronic kidney diseaseLarge clinical trialsGLP-1RAsDiabetes mellitusCardiovascular diseaseHeart failureKidney diseaseClinical trialsHigh-risk atherosclerotic cardiovascular diseaseGLP-1RA useAmerican Diabetes AssociationNutrition Examination SurveyAnti-hyperglycemic agentsPublic health benefitsComplex survey designCardiovascular riskGuideline recommendationsDiabetes AssociationExamination SurveyProtective therapyNational HealthAmerican College
2020
The Upcoming Epidemic of Heart Failure in South Asia
Martinez-Amezcua P, Haque W, Khera R, Kanaya AM, Sattar N, Lam CSP, Harikrishnan S, Shah SJ, Kandula NR, Jose PO, Narayan KMV, Agyemang C, Misra A, Jenum AK, Bilal U, Nasir K, Cainzos-Achirica M. The Upcoming Epidemic of Heart Failure in South Asia. Circulation Heart Failure 2020, 13: e007218. PMID: 32962410, DOI: 10.1161/circheartfailure.120.007218.Peer-Reviewed Original ResearchConceptsType 2 diabetes mellitusHeart failureCoronary heart diseaseHeart diseaseHF epidemicDiabetes mellitusEarly type 2 diabetes mellitusLifestyle-related risk factorsPrognosis of HFPremature coronary heart diseasePremature heart failurePrevalent heart failureRheumatic heart diseaseSouth AsiansAbdominal obesityGeneral obesitySouth Asian populationRisk factorsDramatic healthGlobal burdenRecent studiesUrgent interventionUnderrecognized threatTobacco productsUpcoming epidemicPost-discharge acute care and outcomes following readmission reduction initiatives: national retrospective cohort study of Medicare beneficiaries in the United States
Khera R, Wang Y, Bernheim SM, Lin Z, Krumholz HM. Post-discharge acute care and outcomes following readmission reduction initiatives: national retrospective cohort study of Medicare beneficiaries in the United States. The BMJ 2020, 368: l6831. PMID: 31941686, PMCID: PMC7190056, DOI: 10.1136/bmj.l6831.Peer-Reviewed Original ResearchConceptsAcute care utilizationAcute myocardial infarctionRetrospective cohort studyHeart failureCare utilizationPost-discharge periodEmergency departmentMyocardial infarctionDay mortalityCohort studyHospital admissionObservation unitAcute careNational retrospective cohort studyPost-acute care utilizationHospital Readmissions Reduction ProgramObservation unit carePost-discharge mortalityDay readmission rateRisk of deathReadmissions Reduction ProgramReadmission reduction initiativesReadmission ratesUnit careInpatient unit
2019
Machine Learning Prediction of Mortality and Hospitalization in Heart Failure With Preserved Ejection Fraction
Angraal S, Mortazavi BJ, Gupta A, Khera R, Ahmad T, Desai NR, Jacoby DL, Masoudi FA, Spertus JA, Krumholz HM. Machine Learning Prediction of Mortality and Hospitalization in Heart Failure With Preserved Ejection Fraction. JACC Heart Failure 2019, 8: 12-21. PMID: 31606361, DOI: 10.1016/j.jchf.2019.06.013.Peer-Reviewed Original ResearchConceptsHF hospitalizationRisk of mortalityEjection fractionBlood urea nitrogen levelsLogistic regressionPrevious HF hospitalizationHeart failure hospitalizationReduced ejection fractionReceiver-operating characteristic curveRisk of deathBody mass indexBlood urea nitrogenUrea nitrogen levelsHealth status dataMean c-statisticKCCQ scoresTOPCAT trialFailure hospitalizationHeart failureHemoglobin levelsMass indexC-statisticHospitalizationUrea nitrogenMortalityNational Trends in Healthcare-Associated Infections for Five Common Cardiovascular Conditions
Miller PE, Guha A, Khera R, Chouairi F, Ahmad T, Nasir K, Addison D, Desai NR. National Trends in Healthcare-Associated Infections for Five Common Cardiovascular Conditions. The American Journal Of Cardiology 2019, 124: 1140-1148. PMID: 31371062, PMCID: PMC7883647, DOI: 10.1016/j.amjcard.2019.06.029.Peer-Reviewed Original ResearchConceptsLength of stayCommon cardiovascular conditionCentral line-associated bloodstream infectionsCatheter-associated urinary tract infectionsLine-associated bloodstream infectionsUrinary tract infectionVentilator-associated pneumoniaClostridium difficile infectionCardiovascular conditionsTract infectionsBloodstream infectionsDifficile infectionOutcome of HAICoronary artery bypassTotal hospital chargesAcute myocardial infarctionSkilled care facilityHealthcare-Associated InfectionsValue-based careHospital mortalityArtery bypassCardiogenic shockHeart failurePropensity matchingAtrial fibrillationEvaluation of 30-Day Hospital Readmission and Mortality Rates Using Regression-Discontinuity Framework
Khera R, Wang Y, Nasir K, Lin Z, Krumholz HM. Evaluation of 30-Day Hospital Readmission and Mortality Rates Using Regression-Discontinuity Framework. Journal Of The American College Of Cardiology 2019, 74: 219-234. PMID: 31296295, PMCID: PMC8669780, DOI: 10.1016/j.jacc.2019.04.060.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionHospital Readmissions Reduction ProgramHeart failureReadmission ratesElderly Medicare feeMedian readmission rateReadmissions Reduction ProgramPost-discharge daysInstitution of strategiesHospital readmissionReadmission riskMyocardial infarctionReadmission reductionCardiovascular conditionsEligible hospitalsMedicare feeReadmission penaltiesMortality rateDay 1Day 30ReadmissionDay 60HospitalU.S. hospitalsHospitalization
2018
Trends in 30-Day Readmission Rates for Medicare and Non-Medicare Patients in the Era of the Affordable Care Act
Angraal S, Khera R, Zhou S, Wang Y, Lin Z, Dharmarajan K, Desai NR, Bernheim SM, Drye EE, Nasir K, Horwitz LI, Krumholz HM. Trends in 30-Day Readmission Rates for Medicare and Non-Medicare Patients in the Era of the Affordable Care Act. The American Journal Of Medicine 2018, 131: 1324-1331.e14. PMID: 30016636, PMCID: PMC6380174, DOI: 10.1016/j.amjmed.2018.06.013.Peer-Reviewed Original ResearchConceptsHospital Readmissions Reduction ProgramReadmission ratesAcute myocardial infarctionHeart failurePatient groupMyocardial infarctionCause readmission rateNationwide Readmissions DatabaseReadmissions Reduction ProgramNon-Medicare patientsNon-target conditionsLower readmissionAffordable Care ActMedicare beneficiariesAge groupsPrivate insuranceCare ActPneumoniaInfarctionPatientsReduction programsMedicareGroupReadmissionFailureAssociation of the Hospital Readmissions Reduction Program With Mortality During and After Hospitalization for Acute Myocardial Infarction, Heart Failure, and Pneumonia
Khera R, Dharmarajan K, Wang Y, Lin Z, Bernheim SM, Wang Y, Normand ST, Krumholz HM. Association of the Hospital Readmissions Reduction Program With Mortality During and After Hospitalization for Acute Myocardial Infarction, Heart Failure, and Pneumonia. JAMA Network Open 2018, 1: e182777. PMID: 30646181, PMCID: PMC6324473, DOI: 10.1001/jamanetworkopen.2018.2777.Peer-Reviewed Original ResearchConceptsHospital Readmissions Reduction ProgramAcute myocardial infarctionPostdischarge mortalityHeart failureHRRP announcementReadmissions Reduction ProgramMedicare beneficiariesRisk-adjusted ratesMyocardial infarctionService Medicare beneficiariesReduction programsInterrupted time series frameworkHospital mortalityReduced readmissionsCohort studyPneumonia hospitalizationsReadmission ratesMAIN OUTCOMEPneumoniaMedicare dataHospitalizationHospitalMortalityReadmissionConcomitant harmRelative Impairments in Hemodynamic Exercise Reserve Parameters in Heart Failure With Preserved Ejection Fraction A Study-Level Pooled Analysis
Pandey A, Khera R, Park B, Haykowsky M, Borlaug BA, Lewis GD, Kitzman DW, Butler J, Berry JD. Relative Impairments in Hemodynamic Exercise Reserve Parameters in Heart Failure With Preserved Ejection Fraction A Study-Level Pooled Analysis. JACC Heart Failure 2018, 6: 117-126. PMID: 29413366, PMCID: PMC8135913, DOI: 10.1016/j.jchf.2017.10.014.Peer-Reviewed Original ResearchConceptsPulmonary capillary wedge pressureCapillary wedge pressurePeak oxygen uptakePooled analysisWedge pressureEchocardiographic parametersHeart failureExercise intoleranceExaggerated increaseReserve parametersControl groupLower peak oxygen uptakeRelative impairmentStroke volume reserveOxygen uptakeChronic HFpEFHemodynamic reserveExercise toleranceExercise capacityEjection fractionChronotropic reserveControl subjectsCardinal manifestationsHFpEFSignificant abnormalities
2017
Contemporary Epidemiology of Heart Failure in Fee-For-Service Medicare Beneficiaries Across Healthcare Settings
Khera R, Pandey A, Ayers CR, Agusala V, Pruitt SL, Halm EA, Drazner MH, Das SR, de Lemos JA, Berry JD. Contemporary Epidemiology of Heart Failure in Fee-For-Service Medicare Beneficiaries Across Healthcare Settings. Circulation Heart Failure 2017, 10: e004402. PMID: 29129828, PMCID: PMC6057614, DOI: 10.1161/circheartfailure.117.004402.Peer-Reviewed Original ResearchMeSH KeywordsAdministrative Claims, HealthcareAgedAged, 80 and overAmbulatory CareCardiology Service, HospitalDatabases, FactualFee-for-Service PlansFemaleHealth Services Needs and DemandHeart FailureHumansIncidenceInsurance BenefitsMaleMedicareNeeds AssessmentPrevalencePrognosisTime FactorsUnited StatesConceptsIncident HFService Medicare beneficiariesMedicare beneficiariesStudy periodEpidemiology of HFHeart failure epidemicOutpatient care settingsHealth policy interventionsHF mortalityPrevalent HFHeart failureMean ageOutpatient settingOverall burdenCare settingsContemporary epidemiologyNew diagnosisInpatientsHealthcare settingsCohortEpidemiologyPatientsMortalityFirst yearPronounced decrease
2016
Variation in Hospital Use and Outcomes Associated With Pulmonary Artery Catheterization in Heart Failure in the United States
Khera R, Pandey A, Kumar N, Singh R, Bano S, Golwala H, Kumbhani DJ, Girotra S, Fonarow GC. Variation in Hospital Use and Outcomes Associated With Pulmonary Artery Catheterization in Heart Failure in the United States. Circulation Heart Failure 2016, 9: e003226. PMID: 27780836, PMCID: PMC5123800, DOI: 10.1161/circheartfailure.116.003226.Peer-Reviewed Original ResearchMeSH KeywordsAgedArrhythmias, CardiacCase-Control StudiesCatheterization, Swan-GanzCerebrovascular DisordersCoronary Artery DiseaseDatabases, FactualDisease ManagementFemaleHeart ArrestHeart FailureHospital MortalityHospitalsHumansLength of StayLogistic ModelsMaleMiddle AgedMyocardial InfarctionOdds RatioPractice Patterns, Physicians'Propensity ScoreShock, CardiogenicUnited StatesConceptsPA catheterizationHeart failureCatheter useHospital useDiseases-Ninth Revision codesPropensity-matched analysisPulmonary artery catheterPulmonary artery catheterizationHospital-level variabilityHF hospitalizationHospital mortalityArtery catheterArtery catheterizationNumber of hospitalsPA catheterRevision codesPatient outcomesAcademic hospitalExcess mortalityOdds ratioOutcomes AssociatedCatheterizationInternational ClassificationHospitalMortality
2015
Use of Mechanical Circulatory Support in Percutaneous Coronary Intervention in the United States
Khera R, Cram P, Vaughan-Sarrazin M, Horwitz PA, Girotra S. Use of Mechanical Circulatory Support in Percutaneous Coronary Intervention in the United States. The American Journal Of Cardiology 2015, 117: 10-16. PMID: 26547292, PMCID: PMC4690753, DOI: 10.1016/j.amjcard.2015.10.005.Peer-Reviewed Original ResearchConceptsPercutaneous ventricular assist devicePercutaneous coronary interventionIntraaortic balloon pumpMechanical circulatory supportHigh-risk percutaneous coronary interventionHospital mortalityIABP recipientsCoronary interventionCirculatory supportPropensity-matched analysisChronic kidney diseaseNinth Edition codesNational Inpatient SampleAcute myocardial infarctionVentricular assist deviceCardiogenic shockUnadjusted mortalityBalloon pumpHeart failureRandomized trialsEdition codesMechanical ventilationKidney diseaseMyocardial infarctionInpatient Sample