2023
Sex Differences in Symptom Complexity and Door-to-Balloon Time in Patients With ST-Elevation Myocardial Infarction
Brush J, Chaudhry S, Dreyer R, D'Onofrio G, Greene E, Hajduk A, Lu Y, Krumholz H. Sex Differences in Symptom Complexity and Door-to-Balloon Time in Patients With ST-Elevation Myocardial Infarction. The American Journal Of Cardiology 2023, 197: 101-107. PMID: 37062667, PMCID: PMC10198892, DOI: 10.1016/j.amjcard.2023.03.009.Peer-Reviewed Original ResearchConceptsPercutaneous coronary interventionD2B timeSymptom complexityYoung womenChest painBalloon timeST-elevation myocardial infarctionSILVER-AMI StudySymptom phenotypeSex differencesPain symptomsCoronary interventionOlder patientsMyocardial infarctionOlder womenSTEMIOlder menSymptom patternsPresentation delayPatientsSymptom clustersLogistic regressionSymptomsWomenMean numberSex-Related Differences in Patient Characteristics, Risk Factors, and Symptomatology in Older Adults with Pulmonary Embolism: Findings from the SERIOUS-PE Study
Bikdeli B, Muriel A, Wang Y, Piazza G, Khairani C, Rosovsky R, Mehdipoor G, O'Donoghue M, Madridano O, Lopez-Saez J, Mellado M, Brasero A, Grandone E, Spagnolo P, Lu Y, Bertoletti L, López-Jiménez L, Núñez M, Blanco-Molina Á, Gerhard-Herman M, Goldhaber S, Bates S, Jimenez D, Krumholz H, Monreal M. Sex-Related Differences in Patient Characteristics, Risk Factors, and Symptomatology in Older Adults with Pulmonary Embolism: Findings from the SERIOUS-PE Study. Seminars In Thrombosis And Hemostasis 2023, 49: 725-735. PMID: 36868268, DOI: 10.1055/s-0043-1764231.Peer-Reviewed Original ResearchConceptsOlder adultsClinical characteristicsRisk factorsElderly womenPE risk stratificationTransient provoking factorsRelevant clinical characteristicsSex differencesWarrants further investigationSex-related differencesSex-specific factorsClot burdenPE presentationChest painHormonal therapyHormone therapyPatient characteristicsPulmonary embolismYounger patientsAtherosclerotic diseaseRisk stratificationLung diseaseMedicare databaseProvoking factorsCardiovascular disease
2020
Presentation, Treatment, and Outcomes of the Oldest-Old Patients with Acute Myocardial Infarction: The SILVER-AMI Study
Gupta A, Tsang S, Hajduk A, Krumholz HM, Nanna MG, Green P, Dodson JA, Chaudhry SI. Presentation, Treatment, and Outcomes of the Oldest-Old Patients with Acute Myocardial Infarction: The SILVER-AMI Study. The American Journal Of Medicine 2020, 134: 95-103. PMID: 32805225, PMCID: PMC7752813, DOI: 10.1016/j.amjmed.2020.07.020.Peer-Reviewed Original ResearchConceptsOldest-old patientsMyocardial infarctionFunctional impairmentOlder patientsMobility impairmentsCox proportional hazards regressionMiddle-old patientsProportional hazards regressionAcute myocardial infarctionCase fatality rateAcute myocardial infarction hospitalizationsSILVER-AMI StudyYears of ageMyocardial infarction hospitalizationsChest painCoronary revascularizationAtypical presentationHazards regressionClinical variablesRisk factorsAdvanced agePrimary symptomsPatientsFatality rateHealth status
2019
Variation and Disparities in Awareness of Myocardial Infarction Symptoms Among Adults in the United States
Mahajan S, Valero-Elizondo J, Khera R, Desai NR, Blankstein R, Blaha MJ, Virani SS, Kash BA, Zoghbi WA, Krumholz HM, Nasir K. Variation and Disparities in Awareness of Myocardial Infarction Symptoms Among Adults in the United States. JAMA Network Open 2019, 2: e1917885. PMID: 31851350, PMCID: PMC6991230, DOI: 10.1001/jamanetworkopen.2019.17885.Peer-Reviewed Original ResearchConceptsMyocardial infarction symptomsShortness of breathMyocardial infarctionInfarction symptomsLow education levelEmergency medical servicesChest painSociodemographic subgroupsNational Health Interview SurveyEmergency cardiac careCross-sectional studyMedical servicesHealth Interview SurveyPublic health initiativesEducation levelLow-income subgroupsPrompt recognitionBack painCommon symptomsMale sexCardiac careHigher oddsHispanic ethnicityMAIN OUTCOMEHigh riskSex-Based Differences in Presentation, Treatment, and Complications Among Older Adults Hospitalized for Acute Myocardial Infarction
Nanna MG, Hajduk AM, Krumholz HM, Murphy TE, Dreyer RP, Alexander KP, Geda M, Tsang S, Welty FK, Safdar B, Lakshminarayan DK, Chaudhry SI, Dodson JA. Sex-Based Differences in Presentation, Treatment, and Complications Among Older Adults Hospitalized for Acute Myocardial Infarction. Circulation Cardiovascular Quality And Outcomes 2019, 12: e005691. PMID: 31607145, PMCID: PMC6913190, DOI: 10.1161/circoutcomes.119.005691.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overComorbidityDisability EvaluationFemaleHealth Status DisparitiesHealthcare DisparitiesHumansLife StyleMaleMyocardial RevascularizationNon-ST Elevated Myocardial InfarctionPatient AdmissionPrevalenceProspective StudiesRisk AssessmentRisk FactorsSex FactorsSocial Determinants of HealthST Elevation Myocardial InfarctionTime FactorsTreatment OutcomeUnited StatesConceptsAcute myocardial infarctionSex-based differencesPercutaneous coronary interventionFunctional impairmentOlder adultsHospital complicationsCoronary interventionOlder patientsCoronary diseaseMyocardial infarctionAge-related functional impairmentsAge-associated functional impairmentsLower ratesPrior coronary diseaseObstructive coronary diseaseProspective observational studyNSTEMI subgroupSTEMI subgroupUnderwent revascularizationAcute myocardialChest painClinical presentationAMI subgroupRisk factorsHigh prevalence
2018
Emergency Department Volume and Outcomes for Patients After Chest Pain Assessment
Ko DT, Dattani ND, Austin PC, Schull MJ, Ross JS, Wijeysundera HC, Tu JV, Eberg M, Koh M, Krumholz HM. Emergency Department Volume and Outcomes for Patients After Chest Pain Assessment. Circulation Cardiovascular Quality And Outcomes 2018, 11: e004683. PMID: 30354285, DOI: 10.1161/circoutcomes.118.004683.Peer-Reviewed Original ResearchConceptsAcute coronary syndromeChest painHigh-volume EDsCoronary syndromeED volumeVolume thresholdCardiac medication useChest pain assessmentLower adverse outcomesEmergency department visitsAdjusted odds ratioPopulation-based dataProcess of carePotential confounding variablesHigher ED volumesHierarchical logistic regression modelsLogistic regression modelsEmergency department volumeCause deathCardiac testingComposite outcomeDepartment visitsDiabetes mellitusMedication usePrimary outcomeTime to hospital arrival among patients with acute myocardial infarction in China: a report from China PEACE prospective study
Guan W, Venkatesh AK, Bai X, Xuan S, Li J, Li X, Zhang H, Zheng X, Masoudi FA, Spertus JA, Krumholz HM, Jiang L. Time to hospital arrival among patients with acute myocardial infarction in China: a report from China PEACE prospective study. European Heart Journal - Quality Of Care And Clinical Outcomes 2018, 5: 63-71. PMID: 29878087, PMCID: PMC6307335, DOI: 10.1093/ehjqcco/qcy022.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionHospital arrivalSymptom onsetMyocardial infarctionMedical insuranceLower household incomeRural medical insuranceChest discomfortChest painIndex hospitalizationMedian timeMultivariable analysisAMI symptomsProspective studyAssociated FactorsPatients' perceptionsCare seekingAMI hospitalizationPatientsSymptomsHousehold incomeAMI studyHospitalizationInfarctionAverage timeSex Differences in the Presentation and Perception of Symptoms Among Young Patients With Myocardial Infarction
Lichtman JH, Leifheit EC, Safdar B, Bao H, Krumholz HM, Lorenze NP, Daneshvar M, Spertus JA, D'Onofrio G. Sex Differences in the Presentation and Perception of Symptoms Among Young Patients With Myocardial Infarction. Circulation 2018, 137: 781-790. PMID: 29459463, PMCID: PMC5822747, DOI: 10.1161/circulationaha.117.031650.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionPerception of symptomsChest painCare-seeking behaviorSymptom presentationYounger patientsMyocardial infarctionST-segment elevation acute myocardial infarctionMultivariable hierarchical logistic regressionIndex AMI hospitalizationMajority of womenHierarchical logistic regressionStress/anxietyVIRGO StudyMuscle painPatient characteristicsPredominant symptomAMI symptomsPerceive symptomsProdromal symptomsPatient interviewsHeart diseasePainAMI hospitalizationUS hospitals
2015
Variation in US Hospital Emergency Department Admission Rates by Clinical Condition
Venkatesh AK, Dai Y, Ross JS, Schuur JD, Capp R, Krumholz HM. Variation in US Hospital Emergency Department Admission Rates by Clinical Condition. Medical Care 2015, 53: 237-244. PMID: 25397965, PMCID: PMC4858175, DOI: 10.1097/mlr.0000000000000261.Peer-Reviewed Original ResearchConceptsEmergency Department Admission RatesED admission ratesAdmission ratesClinical conditionsMood disordersChronic obstructive pulmonary diseaseNational Emergency Department SampleAdult ED visitsNonspecific chest painObstructive pulmonary diseaseSoft tissue infectionsUrinary tract infectionEmergency Department SampleClinical Classification SoftwareCross-sectional analysisChest painED visitsTract infectionsPulmonary diseaseSpearman correlation coefficientTissue infectionsHospitalization ratesUS hospitalsCondition-specific variationsHospital correlation
2011
30-Day Readmission for Patients Undergoing Percutaneous Coronary Interventions in New York State
Hannan EL, Zhong Y, Krumholz H, Walford G, Holmes DR, Stamato NJ, Jacobs AK, Venditti FJ, Sharma S, King SB. 30-Day Readmission for Patients Undergoing Percutaneous Coronary Interventions in New York State. JACC Cardiovascular Interventions 2011, 4: 1335-1342. PMID: 22192374, DOI: 10.1016/j.jcin.2011.08.013.Peer-Reviewed Original ResearchConceptsPercutaneous coronary interventionReadmission ratesUnique risk factorsRisk factorsCoronary interventionAdministrative databasesComplications of PCIPre-procedural risk factorsRepeat percutaneous coronary interventionChronic ischemic heart diseaseOverall readmission rateHigher readmission ratesIschemic heart diseaseLength of stayNew York State patientsRecognition of patientsDiagnostic risk factorsCost-effectiveness standpointPCI patientsPCI registryChest painHeart failureHospital readmissionHeart diseasePrincipal diagnosisNational Trends in Use of Computed Tomography in the Emergency Department
Kocher KE, Meurer WJ, Fazel R, Scott PA, Krumholz HM, Nallamothu BK. National Trends in Use of Computed Tomography in the Emergency Department. Annals Of Emergency Medicine 2011, 58: 452-462.e3. PMID: 21835499, DOI: 10.1016/j.annemergmed.2011.05.020.Peer-Reviewed Original ResearchConceptsEmergency departmentCT useComputed tomographyED visitsRisk ratioNational Hospital Ambulatory Medical Care SurveyAmbulatory Medical Care SurveyShortness of breathLikelihood of admissionSpecific emergency departmentLarge nationwide surveyAbdominal painChest painFlank painAcute illnessED encountersRetrospective studyCare SurveyCommon complaintPatient visitsMultivariable modelingCT scanMAIN OUTCOMEED servicesPain
2007
Acute Reperfusion Therapy in ST-Elevation Myocardial Infarction from 1994-2003
Nallamothu BK, Blaney ME, Morris SM, Parsons L, Miller DP, Canto JG, Barron HV, Krumholz HM, Investigators R. Acute Reperfusion Therapy in ST-Elevation Myocardial Infarction from 1994-2003. The American Journal Of Medicine 2007, 120: 693.e1-693.e8. PMID: 17679128, PMCID: PMC2020513, DOI: 10.1016/j.amjmed.2007.01.028.Peer-Reviewed Original ResearchConceptsAcute reperfusion therapyST-elevation myocardial infarctionReperfusion therapyMyocardial infarctionIdeal patientPrimary percutaneous coronary interventionPercutaneous coronary interventionNational performance measuresChest painCoronary interventionFibrinolytic therapySymptom onsetNational registryPatientsTherapyInfarctionKey subgroupsAppropriate utilizationTime periodRecent time periodPainRegistryCohortContemporary useImportant opportunity
2005
Times to Treatment in Transfer Patients Undergoing Primary Percutaneous Coronary Intervention in the United States
Nallamothu BK, Bates ER, Herrin J, Wang Y, Bradley EH, Krumholz HM. Times to Treatment in Transfer Patients Undergoing Primary Percutaneous Coronary Intervention in the United States. Circulation 2005, 111: 761-767. PMID: 15699253, DOI: 10.1161/01.cir.0000155258.44268.f8.Peer-Reviewed Original ResearchConceptsPrimary PCIPrimary percutaneous coronary interventionST-segment elevation myocardial infarctionPercutaneous coronary interventionBalloon timeTransfer patientsCoronary interventionInterhospital transferMyocardial infarctionTotal doorRecent clinical trialsSpecific ECG findingsMultivariable hierarchical modelsChest painHospital presentationInitial hospitalFibrinolytic therapyPCI hospitalsPrimary outcomeSymptom onsetComorbid conditionsTreatment delayECG findingsHospital characteristicsNational registry
2002
Acute myocardial infarction in the elderly with diabetes
Chyun D, Vaccarino V, Murillo J, Young LH, Krumholz HM. Acute myocardial infarction in the elderly with diabetes. Heart & Lung 2002, 31: 327-339. PMID: 12487011, DOI: 10.1067/mhl.2002.126049.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionDiabetes mellitusMyocardial infarctionHeart failureComorbid conditionsMortality rateNon-Q-wave myocardial infarctionHistory of DMInsulin-treated diabetes mellitusRetrospective medical record reviewHigher body mass indexAcute MI settingPoor functional statusBlood pressure managementMedical record reviewSpecific comorbid conditionsSecondary preventive interventionsBody mass indexShort-term mortalityCooperative Cardiovascular ProjectEntire Medicare populationShort-term riskAggressive lipidDM statusChest pain
2001
Acute myocardial infarction in the elderly: differences by age
Mehta R, Rathore S, Radford M, Wang Y, Wang Y, Krumholz H. Acute myocardial infarction in the elderly: differences by age. Journal Of The American College Of Cardiology 2001, 38: 736-741. PMID: 11527626, DOI: 10.1016/s0735-1097(01)01432-2.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionAge-associated differencesElderly patientsClinical characteristicsAge groupsMyocardial infarctionThirty-day mortality rateMedicare beneficiaries ageOne-year mortalityPrior coronary diseaseProportion of patientsST-segment elevationOlder age groupsSignificant age-associated differencesChest painEffect of ageOlder patientsRenal insufficiencyCoronary diseaseHeart failureHospital admissionPatient characteristicsSuccessive age groupsSymptom onsetDiabetic patientsCan Practice Guidelines Be Transported Effectively to Different Settings? Results from a Multicenter Interventional Study
Lichtman J, Roumanis S, Radford M, Riedinger M, Weingarten S, Krumholz H. Can Practice Guidelines Be Transported Effectively to Different Settings? Results from a Multicenter Interventional Study. The Joint Commission Journal On Quality And Patient Safety 2001, 27: 42-53. PMID: 11147239, DOI: 10.1016/s1070-3241(01)27005-9.Peer-Reviewed Original ResearchMeSH KeywordsAgedChest PainConnecticutFollow-Up StudiesHealth Care SurveysHospitalizationHumansInterviews as TopicMaleMiddle AgedNebraskaNorth CarolinaOutcome Assessment, Health CarePatient DischargePatient SatisfactionPennsylvaniaPractice Guidelines as TopicProspective StudiesSouth CarolinaSurveys and QuestionnairesConceptsChest painClinical guidelinesIntervention periodGuideline adherenceGuideline implementationPatient outcomesLow-risk chest pain patientsLow-risk chest painStandardized protocolMulticenter interventional studyLow-risk patientsChest pain patientsInterventional trialsPain patientsSuccessful translationClinical outcomesGuideline periodInterventional studyPatient satisfactionPatient's physicianPractice guidelinesHospital settingBaseline valuesClinical practicePain
1999
Gender differences in symptom presentation associated with coronary heart disease
Milner K, Funk M, Richards S, Wilmes R, Vaccarino V, Krumholz H. Gender differences in symptom presentation associated with coronary heart disease. The American Journal Of Cardiology 1999, 84: 396-399. PMID: 10468075, DOI: 10.1016/s0002-9149(99)00322-7.Peer-Reviewed Original ResearchConceptsCoronary heart diseaseNon-chest pain symptomsChest painEmergency departmentPain symptomsUnadjusted analysesHeart diseaseSymptom presentationYale-New Haven HospitalSubgroup of patientsNurse data collectorsGender differencesMidback painProspective studyPainNauseaVomitingSymptomsPatientsWomenDyspneaSignificant gender differencesMenDiseaseIndigestion
1998
Trends in the Quality of Care for Medicare Beneficiaries Admitted to the Hospital With Unstable Angina
Krumholz H, Philbin D, Wang Y, Vaccarino V, Murillo J, Therrien M, Williams J, Radford M. Trends in the Quality of Care for Medicare Beneficiaries Admitted to the Hospital With Unstable Angina. Journal Of The American College Of Cardiology 1998, 31: 957-963. PMID: 9561993, DOI: 10.1016/s0735-1097(98)00106-5.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAngina, UnstableAnticoagulantsAspirinConnecticutFemaleGuideline AdherenceHeparinHospitalsHumansMaleMedicarePlatelet Aggregation InhibitorsPractice Guidelines as TopicQuality Indicators, Health CareQuality of Health CareRetrospective StudiesSurvival AnalysisUnited StatesConceptsUse of aspirinUnstable anginaElderly patientsConsecutive patientsHospital admissionRetrospective cohort studyPrincipal discharge diagnosisPatterns of treatmentCare of patientsGuideline-based useQuality of careHealth care policyAHCPR guidelinesChest painHospital dischargeCohort studyMedical chartsPatient factorsDischarge diagnosisPatient outcomesPractice patternsConnecticut hospitalsPractice guidelinesAnginaMedicare beneficiaries
1997
Validation 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 studyThrombolytic Therapy for Eligible Elderly Patients With Acute Myocardial Infarction
Krumholz HM, Murillo JE, Chen J, Vaccarino V, Radford MJ, Ellerbeck EF, Wang Y. Thrombolytic Therapy for Eligible Elderly Patients With Acute Myocardial Infarction. JAMA 1997, 277: 1683-1688. PMID: 9169894, DOI: 10.1001/jama.1997.03540450039032.Peer-Reviewed Original ResearchConceptsST-segment elevationAcute myocardial infarctionThrombolytic therapyBundle branch blockMyocardial infarctionChest painElderly patientsMental statusBranch blockTotal ST-segment elevationEligible elderly patientsThrombolytic therapy useRetrospective cohort studyHours of symptomsOnset of symptomsPopulation-based sampleLack of treatmentDirect angioplastyEligible patientsAbsolute contraindicationBypass surgeryCohort studyMedical chartsTherapy useContiguous leads