2023
Developing Validated Tools to Identify Pulmonary Embolism in Electronic Databases: Rationale and Design of the PE-EHR+ Study
Bikdeli B, Lo Y, Khairani C, Bejjani A, Jimenez D, Barco S, Mahajan S, Caraballo C, Secemsky E, Klok F, Hunsaker A, Aghayev A, Muriel A, Wang Y, Hussain M, Appah-Sampong A, Lu Y, Lin Z, Aneja S, Khera R, Goldhaber S, Zhou L, Monreal M, Krumholz H, Piazza G. Developing Validated Tools to Identify Pulmonary Embolism in Electronic Databases: Rationale and Design of the PE-EHR+ Study. Thrombosis And Haemostasis 2023, 123: 649-662. PMID: 36809777, PMCID: PMC11200175, DOI: 10.1055/a-2039-3222.Peer-Reviewed Original ResearchConceptsElectronic health recordsNLP algorithmNatural language processing toolsLanguage processing toolsPrincipal discharge diagnosisICD-10 codesDischarge diagnosisNLP toolsChart reviewHealth systemProcessing toolsYale New Haven Health SystemPatient identificationElectronic databasesHealth recordsData validationHigh-risk PEPulmonary Embolism ResearchSecondary discharge diagnosisIdentification of patientsManual chart reviewNegative predictive valueCodeRadiology reportsAlgorithmDeveloping an Actionable Taxonomy of Persistent Hypertension Using Electronic Health Records
Lu Y, Du C, Khidir H, Caraballo C, Mahajan S, Spatz E, Curry L, Krumholz H. Developing an Actionable Taxonomy of Persistent Hypertension Using Electronic Health Records. Circulation Cardiovascular Quality And Outcomes 2023, 16: e009453. PMID: 36727515, DOI: 10.1161/circoutcomes.122.009453.Peer-Reviewed Original ResearchConceptsPersistent hypertensionElectronic health recordsBlood pressureHealth recordsPharmacologic agentsPrescribed treatmentYale New Haven Health SystemTreatment planAdditional pharmacologic agentsAntihypertensive treatment intensificationConsecutive outpatient visitsElevated blood pressurePersistence of hypertensionElectronic health record dataHealth record dataEligible patientsTreatment intensificationChart reviewHispanic patientsOutpatient visitsMean agePharmacological treatmentConventional content analysisHypertensionClinician notes
2019
Predicting 6-Month Mortality for Older Adults Hospitalized With Acute Myocardial Infarction: A Cohort Study.
Dodson JA, Hajduk AM, Geda M, Krumholz HM, Murphy TE, Tsang S, Tinetti ME, Nanna MG, McNamara R, Gill TM, Chaudhry SI. Predicting 6-Month Mortality for Older Adults Hospitalized With Acute Myocardial Infarction: A Cohort Study. Annals Of Internal Medicine 2019, 172: 12-21. PMID: 31816630, PMCID: PMC7695040, DOI: 10.7326/m19-0974.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionPost-AMI mortalityFunctional impairmentOlder adultsCohort studyMean ageMyocardial infarctionPatient-reported health statusNet reclassification improvement indexProspective cohort studyParticipants' mean ageFinal risk modelMobility impairmentsGood discriminatory abilityRisk modelChart reviewHospital dischargePrognostic utilityBlood InstituteClinical variablesNational HeartHigh prevalenceHealth statusMortalityYounger counterpartsApplication of the VIRGO taxonomy to differentiate acute myocardial infarction in young women
Sciria CT, Dreyer RP, D'Onofrio G, Safdar B, Krumholz HM, Spatz ES. Application of the VIRGO taxonomy to differentiate acute myocardial infarction in young women. International Journal Of Cardiology 2019, 288: 5-11. PMID: 31031078, DOI: 10.1016/j.ijcard.2019.03.054.Peer-Reviewed Original ResearchConceptsCoronary artery diseaseCardiac catheterizationYoung womenNon-obstructive coronary artery diseaseSingle-center retrospective chart reviewYoung AMI Patients (VIRGO) studyObstructive coronary artery diseaseRetrospective chart reviewAcute myocardial infarctionProportion of womenUniversal definitionIndex admissionChart reviewArtery diseaseConsecutive womenMyocardial infarctionTreatment strategiesCatheterizationMore young womenType 2Type 1Class IType 4BWomenPatient studies
2018
Traditional Chinese Medicine for Acute Myocardial Infarction in Western Medicine Hospitals in China
Spatz ES, Wang Y, Beckman AL, Wu X, Lu Y, Du X, Li J, Xu X, Davidson PM, Masoudi FA, Spertus JA, Krumholz HM, Jiang L. Traditional Chinese Medicine for Acute Myocardial Infarction in Western Medicine Hospitals in China. Circulation Cardiovascular Quality And Outcomes 2018, 11: e004190. PMID: 29848478, PMCID: PMC5882246, DOI: 10.1161/circoutcomes.117.004190.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionTraditional Chinese medicineTCM useWestern Medicine HospitalMyocardial infarctionHospital bleedingMedicine HospitalChinese medicineCardiovascular risk factorsHospital-level factorsHours of hospitalizationMultivariable hierarchical modelsQuality of careLack of evidenceChart reviewChina PatientRetrospective studySecondary hospitalsEarly managementRisk factorsIntravenous useCardiovascular diseasePatientsSignificant associationHospital
2015
Development and Validation of an Algorithm to Identify Planned Readmissions From Claims Data
Horwitz LI, Grady JN, Cohen DB, Lin Z, Volpe M, Ngo CK, Masica AL, Long T, Wang J, Keenan M, Montague J, Suter LG, Ross JS, Drye EE, Krumholz HM, Bernheim SM. Development and Validation of an Algorithm to Identify Planned Readmissions From Claims Data. Journal Of Hospital Medicine 2015, 10: 670-677. PMID: 26149225, PMCID: PMC5459369, DOI: 10.1002/jhm.2416.Peer-Reviewed Original ResearchConceptsSame-hospital readmissionsNegative predictive valuePositive predictive valuePredictive valueReadmission measuresHospital-wide readmission measureGold standard chart reviewAdministrative claims-based algorithmDiagnostic cardiac catheterizationClaims-based algorithmLarge teaching centersAcute care hospitalsSmall community hospitalUnplanned readmissionChart reviewCardiac catheterizationScheduled careSpecificity 96.5Community hospitalReadmissionClaims dataCardiac devicesHealth systemTeaching centerPublic reporting
2012
Discontinuation of Antihyperglycemic Therapy After Acute Myocardial Infarction: Medical Necessity or Medical Error?
Lovig KO, Horwitz L, Lipska K, Kosiborod M, Krumholz HM, Inzucchi SE. Discontinuation of Antihyperglycemic Therapy After Acute Myocardial Infarction: Medical Necessity or Medical Error? The Joint Commission Journal On Quality And Patient Safety 2012, 38: 403-407. PMID: 23002492, PMCID: PMC3534988, DOI: 10.1016/s1553-7250(12)38051-3.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionLeft ventricular ejection fractionAntihyperglycemic therapyDiabetic patientsMyocardial infarctionMedical necessityOne-year mortalityDetailed chart reviewVentricular ejection fractionIschemic heart diseaseNational Medicare databaseMedical errorsAcademic medical centerQuality improvement opportunitiesChart reviewClinical characteristicsOlder patientsRecurrent hypoglycemiaEjection fractionMedicare databaseBlood glucoseHeart diseasePrincipal diagnosisCommunity hospitalMedical Center
2007
Failure to Rescue
Horwitz LI, Cuny JF, Cerese J, Krumholz HM. Failure to Rescue. Medical Care 2007, 45: 283-287. PMID: 17496710, DOI: 10.1097/01.mlr.0000250226.33094.d4.Peer-Reviewed Original ResearchConceptsChart reviewQuality Patient Safety IndicatorsRetrospective chart reviewPatient safety indicatorsRate of deathAdministrative dataHospital complicationsComplication typePatient agePatient characteristicsPrimary outcomeNonsurgical casesInsurance statusComplicationsHealthcare ResearchPatientsMortalityConsortium institutionsAgeSafety indicatorsFailureReviewHospitalizationAdmissionCases
2004
Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure
Forman DE, Butler J, Wang Y, Abraham WT, O'Connor CM, Gottlieb SS, Loh E, Massie BM, Rich MW, Stevenson LW, Young JB, Krumholz HM. Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. Journal Of The American College Of Cardiology 2004, 43: 61-67. PMID: 14715185, DOI: 10.1016/j.jacc.2003.07.031.Peer-Reviewed Original ResearchConceptsRenal functionHF patientsHospitalized heart failure patientsHistory of HFChronic HF patientsDay of admissionHeart failure patientsLength of hospitalizationSystolic blood pressureRelative risk ratiosAssociation of developmentMajority of casesRegression model analysisAdmission creatinineHospital deathHospital outcomesChart reviewClinical characteristicsFailure patientsSerum creatinineBlood pressureClinical predictorsConsecutive patientsDiabetes mellitusHeart failure
1999
Early beta-blocker therapy for acute myocardial infarction in elderly patients.
Krumholz H, Radford M, Wang Y, Chen J, Marciniak T. Early beta-blocker therapy for acute myocardial infarction in elderly patients. Annals Of Internal Medicine 1999, 131: 648-54. PMID: 10577326, DOI: 10.7326/0003-4819-131-9-199911020-00003.Peer-Reviewed Original ResearchConceptsEarly beta-blocker therapyBeta-blocker therapyAcute myocardial infarctionMyocardial infarctionElderly patientsEarly useHospital mortality ratePatients 65 yearsMedical chart reviewAcute care hospitalsYears of ageHospital mortalityHospital deathChart reviewPatient demographicsCare hospitalClinical factorsTreatment characteristicsEarly treatmentBaseline differencesObservational studyHigh riskMedicare beneficiariesMortality ratePatientsComparing AMI Mortality Among Hospitals in Patients 65 Years of Age and Older
Krumholz H, Chen J, Wang Y, Radford M, Chen Y, Marciniak T. Comparing AMI Mortality Among Hospitals in Patients 65 Years of Age and Older. Circulation 1999, 99: 2986-2992. PMID: 10368115, DOI: 10.1161/01.cir.99.23.2986.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionMyocardial infarctionWhite blood cell countPatients 65 yearsSystolic blood pressureCongestive heart failureMedical chart reviewReceiver-operating characteristic curveBlood cell countRisk-adjusted outcomesYears of ageAdministrative billing codesRisk-adjustment modelsHospital outcomesSerum creatinineChart reviewDerivation cohortHeart failurePatient characteristicsBlood pressureCardiac arrestValidation cohortCandidate predictor variablesAMI mortalityBilling codesQuality of care for patients hospitalized with heart failure at academic medical centers
Nohria A, Chen Y, Morton D, Walsh R, Vlasses P, Krumholz H. Quality of care for patients hospitalized with heart failure at academic medical centers. American Heart Journal 1999, 137: 1028-1034. PMID: 10347327, DOI: 10.1016/s0002-8703(99)70358-3.Peer-Reviewed Original ResearchConceptsLeft ventricular ejection fractionCongestive heart failureAcademic medical centerTime of dischargeStandard of careMedical CenterHeart failureACE inhibitorsAssessment of LVEFDiagnosis of CHFDaily weightEnzyme inhibitor therapyRetrospective chart reviewVentricular ejection fractionLarge clinical trialsPatient education guidelinesQuality of careHealth care policyChart reviewDietary counselingHospital dischargeEjection fractionInhibitor therapyTreatment guidelinesMedication complianceRisk factors for heart failure in the elderly: a prospective community-based study
Chen Y, Vaccarino V, Williams C, Butler J, Berkman L, Krumholz H. Risk factors for heart failure in the elderly: a prospective community-based study. The American Journal Of Medicine 1999, 106: 605-612. PMID: 10378616, DOI: 10.1016/s0002-9343(99)00126-6.Peer-Reviewed Original ResearchConceptsTraditional cardiovascular risk factorsCardiovascular risk factorsHeart failureRisk factorsMyocardial infarctionRisk ratioCommunity-based elderly populationProportional hazards regression modelsProspective community-based studyIncident heart failureBody mass indexHazards regression modelsConfidence intervalsCommunity-based studyManagement of diabetesYears of ageConnecticut cohortChart reviewBlood pressureIndependent predictorsMass indexMale sexElderly ProgramPulse pressurePreventive strategies
1998
Trends in costs of percutaneous transluminal coronary angioplasty.
Heiat A, Mattera JA, Henry GA, Chen YT, Krumholz HM. Trends in costs of percutaneous transluminal coronary angioplasty. The American Journal Of Managed Care 1998, 4: 1667-74. PMID: 10339099.Peer-Reviewed Original ResearchConceptsPercutaneous transluminal coronary angioplastyTransluminal coronary angioplastyCoronary angioplastyClinical outcomesElective percutaneous transluminal coronary angioplastyYale-New Haven HospitalCatheterization laboratory costsMedical chart reviewGroup of patientsTotal hospital costsLength of stayHospital cost accounting systemChart reviewClinical characteristicsConsecutive patientsAngiographic featuresHospital recordsContrast volumeRetrospective studyPatient populationHospital costsLesion characteristicsStent useCatheterization laboratoryPatient profilesDepression and Risk of Coronary Heart Disease in Elderly Men and Women: New Haven EPESE, 1982-1991
Mendes de Leon CF, Krumholz HM, Seeman TS, Vaccarino V, Williams CS, Kasl SV, Berkman LF. Depression and Risk of Coronary Heart Disease in Elderly Men and Women: New Haven EPESE, 1982-1991. JAMA Internal Medicine 1998, 158: 2341-2348. PMID: 9827785, DOI: 10.1001/archinte.158.21.2341.Peer-Reviewed Original ResearchMeSH KeywordsActivities of Daily LivingAge FactorsAgedCause of DeathCohort StudiesConnecticutCoronary DiseaseDeath CertificatesDepressionFemaleForecastingHospitalizationHumansIncidenceInterviews as TopicMaleMedical AuditMyocardial InfarctionOutcome Assessment, Health CarePatient AdmissionReproducibility of ResultsRisk FactorsSex FactorsSurvival RateConceptsCoronary heart diseaseCHD risk factorsDepressive symptomsRisk factorsCHD outcomesHeart diseaseAge-adjusted relative riskImpaired physical functionIncident coronary diseasePhysical function impairmentIncident CHD eventsNonfatal myocardial infarctionIndependent risk factorMedical chart reviewHealthy older womenCause of deathCHD deathCHD eventsCHD mortalityChart reviewCHD incidenceCoronary diseaseFunction impairmentPhysical functionElderly menWarfarin Use Following Ischemic Stroke Among Medicare Patients With Atrial Fibrillation
Brass LM, Krumholz HM, Scinto JD, Mathur D, Radford M. Warfarin Use Following Ischemic Stroke Among Medicare Patients With Atrial Fibrillation. JAMA Internal Medicine 1998, 158: 2093-2100. PMID: 9801175, DOI: 10.1001/archinte.158.19.2093.Peer-Reviewed Original ResearchConceptsUse of warfarinAtrial fibrillationIschemic strokeRecurrent strokeWarfarin useElderly patientsPrincipal diagnosisMedicare patientsLower riskConnecticut Peer Review OrganizationRegimen of warfarinElderly stroke patientsRisk of strokeAcute myocardial infarctionHigh-risk populationHigh rateChart reviewPeer review organizationsStroke patientsMyocardial infarctionWarfarin sodiumPatientsWarfarinFibrillationAnticoagulation
1997
Warfarin use among patients with atrial fibrillation.
Brass L, Krumholz H, Scinto J, Radford M. Warfarin use among patients with atrial fibrillation. Stroke 1997, 28: 2382-9. PMID: 9412618, DOI: 10.1161/01.str.28.12.2382.Peer-Reviewed Original ResearchConceptsAtrial fibrillationAdditional vascular risk factorsConnecticut Peer Review OrganizationRate of strokeVascular risk factorsStroke preventionWarfarin anticoagulationChart reviewElderly patientsRelative contraindicationPeer review organizationsRisk factorsMedicare patientsAnticoagulationHigh riskPatientsWarfarinFibrillationStrokeContraindicationsAspirinReview organizationsPopulation sampleHospitalizationMonthsQuality of Care for Elderly Patients Hospitalized With Heart Failure
Krumholz HM, Wang Y, Parent EM, Mockalis J, Petrillo M, Radford MJ. Quality of Care for Elderly Patients Hospitalized With Heart Failure. JAMA Internal Medicine 1997, 157: 2242-2247. PMID: 9343001, DOI: 10.1001/archinte.1997.00440400092011.Peer-Reviewed Original ResearchConceptsHeart failureQuality of careEnzyme inhibitorsElderly patientsClinical practiceResearch Clinical Practice GuidelinesLeft ventricular ejection fractionLeft ventricular systolic functionRetrospective medical record reviewAngiotensin-converting enzyme inhibitorSevere aortic stenosisPercentage of patientsVentricular systolic functionMedical record reviewVentricular ejection fractionClinical practice guidelinesPrincipal discharge diagnosisAcute care hospitalsActual clinical practiceHealth care policyChart reviewSystolic functionAortic stenosisAppropriate patientsCare hospitalValidation of a clinical prediction rule for left ventricular ejection fraction after myocardial infarction in patients ≥ 65 years old
Krumholz H, Howes C, Murillo J, Vaccarino L, Radford M, Ellerbeck E. Validation of a clinical prediction rule for left ventricular ejection fraction after myocardial infarction in patients ≥ 65 years old. The American Journal Of Cardiology 1997, 80: 11-15. PMID: 9205012, DOI: 10.1016/s0002-9149(97)00299-3.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCohort StudiesConnecticutEchocardiographyElectrocardiographyFemaleHumansMaleMedicareMultivariate AnalysisMyocardial InfarctionPilot ProjectsPredictive Value of TestsRetrospective StudiesRisk FactorsStroke VolumeTreatment OutcomeUnited StatesVentricular Function, LeftConceptsLeft ventricular ejection fractionAcute myocardial infarctionClinical prediction ruleVentricular ejection fractionPositive predictive valuePrediction ruleElderly patientsEjection fractionMyocardial infarctionExclusion criteriaPredictive valueEligible elderly patientsRetrospective chart reviewConnecticut cohortChest painBypass surgeryChart reviewDiabetes mellitusMedicare patientsPatientsPilot studyMultivariate modelInfarctionElectrocardiogram interpretationOriginal study
1994
Clinical utility of transthoracic two-dimensional and Doppler echocardiography
Krumholz H, Douglas P, Goldman L, Waksmonski C. Clinical utility of transthoracic two-dimensional and Doppler echocardiography. Journal Of The American College Of Cardiology 1994, 24: 125-131. PMID: 8006255, DOI: 10.1016/0735-1097(94)90552-5.Peer-Reviewed Original ResearchConceptsNew diagnosisChart reviewEchocardiographic examinationMitral regurgitationClinical utilityLeft ventricular wall motion abnormalitiesTertiary care teaching hospitalVentricular wall motion abnormalitiesGreater mitral regurgitationProspective observational studyUse of echocardiographyWall motion abnormalitiesPharmacologic treatmentTransthoracic twoDoppler echocardiographyMotion abnormalitiesPhysician interviewsTeaching hospitalObservational studyEchocardiographyClinical practiceOutpatientsInpatientsPatient diagnosisContemporary echocardiography