2024
Performance of contemporary cardiovascular risk stratification scores in Brazil: an evaluation in the ELSA-Brasil study
Camargos A, Barreto S, Brant L, Ribeiro A, Dhingra L, Aminorroaya A, Bittencourt M, Figueiredo R, Khera R. Performance of contemporary cardiovascular risk stratification scores in Brazil: an evaluation in the ELSA-Brasil study. Open Heart 2024, 11: e002762. PMID: 38862252, PMCID: PMC11168182, DOI: 10.1136/openhrt-2024-002762.Peer-Reviewed Original ResearchConceptsPooled Cohort EquationsELSA-BrasilRisk scoreCardiovascular diseaseCVD eventsCommunity-based cohort studyArea under the receiver operating characteristic curveCVD risk scoreELSA-Brasil studyIncident CVD eventsMiddle-income countriesAdjudicated CVD eventsCardiovascular disease riskCVD scoreCohort EquationsNational guidelinesRisk stratification scoresWhite womenAge/sex groupsCohort studyProspective cohortLMICsSex/race groupsHigher incomeRisk discriminationA Multimodal Video-Based AI Biomarker for Aortic Stenosis Development and Progression
Oikonomou E, Holste G, Yuan N, Coppi A, McNamara R, Haynes N, Vora A, Velazquez E, Li F, Menon V, Kapadia S, Gill T, Nadkarni G, Krumholz H, Wang Z, Ouyang D, Khera R. A Multimodal Video-Based AI Biomarker for Aortic Stenosis Development and Progression. JAMA Cardiology 2024, 9: 534-544. PMID: 38581644, PMCID: PMC10999005, DOI: 10.1001/jamacardio.2024.0595.Peer-Reviewed Original ResearchCardiac magnetic resonanceAortic valve replacementCardiac magnetic resonance imagingAV VmaxSevere ASAortic stenosisCohort studyPeak aortic valve velocityCohort study of patientsAortic valve velocityCohort of patientsTraditional cardiovascular risk factorsAssociated with faster progressionStudy of patientsCedars-Sinai Medical CenterAssociated with AS developmentCardiovascular risk factorsCardiovascular imaging modalitiesIndependent of ageModerate ASEjection fractionEchocardiographic studiesValve replacementRisk stratificationCardiac structureDevelopment and multinational validation of an algorithmic strategy for high Lp(a) screening
Aminorroaya A, Dhingra L, Oikonomou E, Saadatagah S, Thangaraj P, Vasisht Shankar S, Spatz E, Khera R. Development and multinational validation of an algorithmic strategy for high Lp(a) screening. Nature Cardiovascular Research 2024, 3: 558-566. PMID: 39195936, DOI: 10.1038/s44161-024-00469-1.Peer-Reviewed Original ResearchElectronic health recordsAssociated with premature atherosclerotic cardiovascular diseaseElevated Lp(aHealth recordsUK BiobankPremature atherosclerotic cardiovascular diseaseMachine learning modelsAtherosclerotic cardiovascular diseaseCohort studyReal-world settingsTargeted screeningCardiovascular diseaseLearning modelsNovel targeted therapeuticsAlgorithmic strategiesCohortProbability thresholdScreeningClinical featuresValidation cohortElevated lipoproteinRisk inspectionARICLp(a
2023
Predicting aortic stenosis progression using a video-based deep learning model of aortic stenosis built for single-view two-dimensional echocardiography
Oikonomou E, Holste G, Mcnamara R, Velazquez E, Nadkarni G, Ouyang D, Krumholz H, Wang Z, Khera R. Predicting aortic stenosis progression using a video-based deep learning model of aortic stenosis built for single-view two-dimensional echocardiography. European Heart Journal 2023, 44: ehad655.040. DOI: 10.1093/eurheartj/ehad655.040.Peer-Reviewed Original ResearchLeft ventricular ejection fractionSevere aortic stenosisAortic stenosisAS progressionAV VmaxTransthoracic echocardiographyYale New Haven Health SystemBaseline left ventricular ejection fractionAortic stenosis progressionModerate aortic stenosisRetrospective cohort studyVentricular ejection fractionTwo-dimensional echocardiographyMean rateModerate ASAS severityCohort studyEjection fractionPatient sexStenosis progressionTTE studiesEligible participantsSerial monitoringSpecialized centersTimely diagnosisLifetime healthcare expenses across demographic and cardiovascular risk groups: The application of a novel modeling strategy in a large multiethnic cohort study
Khera R, Kondamudi N, Liu M, Ayers C, Spatz E, Rao S, Essien U, Powell-Wiley T, Nasir K, Das S, Capers Q, Pandey A. Lifetime healthcare expenses across demographic and cardiovascular risk groups: The application of a novel modeling strategy in a large multiethnic cohort study. American Journal Of Preventive Cardiology 2023, 14: 100493. PMID: 37397263, PMCID: PMC10314135, DOI: 10.1016/j.ajpc.2023.100493.Peer-Reviewed Original ResearchOverweight/obesityRisk factorsRace/ethnicityHealthcare expensesCardiovascular risk factorsCardiovascular risk groupsNon-black individualsMultiethnic Cohort StudySignificant independent associationYears of ageBlack individualsDallas Heart StudyCohort studyCohort enrollmentOutpatient claimsIndependent associationRisk groupsHigh prevalenceHeart StudyOlder ageHealthcare spendingHypertensionObesitySmokingDiabetesQuantifying Blood Pressure Visit-to-Visit Variability in the Real-World Setting: A Retrospective Cohort Study
Lu Y, Linderman G, Mahajan S, Liu Y, Huang C, Khera R, Mortazavi B, Spatz E, Krumholz H. Quantifying Blood Pressure Visit-to-Visit Variability in the Real-World Setting: A Retrospective Cohort Study. Circulation Cardiovascular Quality And Outcomes 2023, 16: e009258. PMID: 36883456, DOI: 10.1161/circoutcomes.122.009258.Peer-Reviewed Original ResearchConceptsRetrospective cohort studyBlood pressure valuesPatient characteristicsReal-world settingCohort studyPatient subgroupsYale New Haven Health SystemMean body mass indexSystolic blood pressure valuesBlood pressure visitHistory of hypertensionCoronary artery diseaseManagement of patientsMultivariable linear regression modelsBlood pressure readingsBody mass indexPatient-level measuresBlood pressure variationAbsolute standardized differencesNon-Hispanic whitesAntihypertensive medicationsReal-world practiceVisit variabilityArtery diseaseRegression models
2022
Time in therapeutic range for targeted temperature management and outcomes following out-of-hospital cardiac arrest
Wheelock K, Chan P, Chen L, de Lemos J, Miller P, Nallamothu B, Girotra S, Khera R. Time in therapeutic range for targeted temperature management and outcomes following out-of-hospital cardiac arrest. Resuscitation 2022, 182: 109650. PMID: 36442596, PMCID: PMC9885789, DOI: 10.1016/j.resuscitation.2022.11.016.Peer-Reviewed Original ResearchConceptsFavorable neurologic outcomeHospital cardiac arrestTherapeutic rangeNeurologic outcomeOverall survivalTemperature managementCardiac arrestFavorable neurologic survivalFavorable neurological outcomeRetrospective cohort studyTargeted temperature managementHigh therapeutic rangeRisk-adjusted analysisComatose survivorsNeurologic survivalNeurological outcomeCohort studyHospital dischargeMedian durationMedian timeCurrent guidelinesCompression trialTreatment targetsSignificant associationGoal temperature
2021
Clinician Trends in Prescribing Direct Oral Anticoagulants for US Medicare Beneficiaries
Wheelock KM, Ross JS, Murugiah K, Lin Z, Krumholz HM, Khera R. Clinician Trends in Prescribing Direct Oral Anticoagulants for US Medicare Beneficiaries. JAMA Network Open 2021, 4: e2137288. PMID: 34870678, PMCID: PMC8649845, DOI: 10.1001/jamanetworkopen.2021.37288.Peer-Reviewed Original ResearchConceptsDOAC useAnticoagulant prescriptionOral anticoagulantsUS cliniciansMedicare beneficiariesNational clinical practice guidelinesElevated bleeding riskOral anticoagulant prescriptionsRetrospective cohort studyDirect oral anticoagulantsClinical practice guidelinesUS Medicare beneficiariesInternal medicine physiciansNumber of cliniciansAnticoagulant prescribingDOAC prescriptionsUnique cliniciansBleeding riskCohort studyAnticoagulant strategiesPrescription claimsPractice guidelinesMAIN OUTCOMEMost indicationsMedicare populationNonalcoholic 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 patientsUse of Machine Learning Models to Predict Death After Acute Myocardial Infarction
Khera R, Haimovich J, Hurley NC, McNamara R, Spertus JA, Desai N, Rumsfeld JS, Masoudi FA, Huang C, Normand SL, Mortazavi BJ, Krumholz HM. Use of Machine Learning Models to Predict Death After Acute Myocardial Infarction. JAMA Cardiology 2021, 6: 633-641. PMID: 33688915, PMCID: PMC7948114, DOI: 10.1001/jamacardio.2021.0122.Peer-Reviewed Original ResearchConceptsMachine learning modelsMeta-classifier modelLearning modelNeural networkGradient descent boostingAcute myocardial infarctionContemporary machineGradient descentXGBoost modelXGBoostHospital mortalityCohort studyLogistic regressionMyocardial infarctionNetworkChest Pain-MI RegistryPrecise classificationIndependent validation dataInitial laboratory valuesNovel methodLarge national registryHigh-risk individualsData analysisValidation dataResolution of riskPrevalence of Missing Data in the National Cancer Database and Association With Overall Survival
Yang DX, Khera R, Miccio JA, Jairam V, Chang E, Yu JB, Park HS, Krumholz HM, Aneja S. Prevalence of Missing Data in the National Cancer Database and Association With Overall Survival. JAMA Network Open 2021, 4: e211793. PMID: 33755165, PMCID: PMC7988369, DOI: 10.1001/jamanetworkopen.2021.1793.Peer-Reviewed Original ResearchConceptsNational Cancer DatabaseNon-small cell lung cancerOverall survivalCell lung cancerCancer DatabaseMedical recordsLung cancerProstate cancerBreast cancerPatient recordsComplete dataRetrospective cohort studyCohort studyCancer RegistryCommon cancerVariables of interestHigh prevalenceMAIN OUTCOMEPatientsClinical advancementReal-world data sourcesCancerPrevalenceSurvivalHeterogeneous differences
2020
Revascularization Practices and Outcomes in Patients With Multivessel Coronary Artery Disease Who Presented With Acute Myocardial Infarction and Cardiogenic Shock in the US, 2009-2018
Khera R, Secemsky EA, Wang Y, Desai NR, Krumholz HM, Maddox TM, Shunk KA, Virani SS, Bhatt DL, Curtis J, Yeh RW. Revascularization Practices and Outcomes in Patients With Multivessel Coronary Artery Disease Who Presented With Acute Myocardial Infarction and Cardiogenic Shock in the US, 2009-2018. JAMA Internal Medicine 2020, 180: 1317-1327. PMID: 32833024, PMCID: PMC9377424, DOI: 10.1001/jamainternmed.2020.3276.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedCohort StudiesCoronary VesselsFemaleFollow-Up StudiesHospital MortalityHumansMaleMiddle AgedMyocardial InfarctionPatient DischargePercutaneous Coronary InterventionRisk AssessmentRisk FactorsShock, CardiogenicST Elevation Myocardial InfarctionTime FactorsTreatment OutcomeUnited StatesConceptsST-segment elevation myocardial infarctionMultivessel percutaneous coronary interventionMultivessel coronary artery diseasePercutaneous coronary interventionAcute myocardial infarctionCoronary artery diseaseCulprit vessel percutaneous coronary interventionCardiogenic shockHospital mortalityArtery diseaseMyocardial infarctionCohort studyPrimary outcomeHospital variationPCI strategyMedicare beneficiariesUnderwent multivessel PCISignificant hospital variationElevation myocardial infarctionSubset of patientsHigh-risk populationRecent evidenceHospital complicationsPCI useRevascularization practiceTemporal Trends in Heart Failure Incidence Among Medicare Beneficiaries Across Risk Factor Strata, 2011 to 2016
Khera R, Kondamudi N, Zhong L, Vaduganathan M, Parker J, Das SR, Grodin JL, Halm EA, Berry JD, Pandey A. Temporal Trends in Heart Failure Incidence Among Medicare Beneficiaries Across Risk Factor Strata, 2011 to 2016. JAMA Network Open 2020, 3: e2022190. PMID: 33095250, PMCID: PMC7584929, DOI: 10.1001/jamanetworkopen.2020.22190.Peer-Reviewed Original ResearchConceptsHeart failure incidenceHF risk factorsHF incidenceClinical Modification codesRisk factorsAcute MIMedicare beneficiariesFailure incidenceHF prevention strategiesRisk factor strataNational cohort studyService Medicare beneficiariesUnique Medicare beneficiariesInternational Statistical ClassificationRace/ethnicityPrior HFPrevalent hypertensionCohort studyIncident HFNinth RevisionPrevious diagnosisCardiovascular conditionsTenth RevisionMAIN OUTCOMEInternational ClassificationPerformance of the Pooled Cohort Equations to Estimate Atherosclerotic Cardiovascular Disease Risk by Body Mass Index
Khera R, Pandey A, Ayers CR, Carnethon MR, Greenland P, Ndumele CE, Nambi V, Seliger SL, Chaves PHM, Safford MM, Cushman M, Xanthakis V, Ramachandran V, Mentz RJ, Correa A, Lloyd-Jones DM, Berry JD, de Lemos JA, Neeland IJ. Performance of the Pooled Cohort Equations to Estimate Atherosclerotic Cardiovascular Disease Risk by Body Mass Index. JAMA Network Open 2020, 3: e2023242. PMID: 33119108, PMCID: PMC7596579, DOI: 10.1001/jamanetworkopen.2020.23242.Peer-Reviewed Original ResearchConceptsHigh-sensitivity C-reactive proteinPooled Cohort EquationsASCVD riskAtherosclerotic cardiovascular diseaseBody mass indexBMI categoriesCohort EquationsObesity categoriesCohort studySevere obesityWaist circumferenceBMI groupsMass indexUnderweight categoryAtherosclerotic cardiovascular disease riskMean baseline BMIRisk of ASCVDUsual clinical measuresCardiovascular disease riskC-reactive proteinPooled individual-level dataSevere obesity groupLongitudinal cohort studyNormal weight categoryAdults ages 40Rates and Predictors of Patient Underreporting of Hospitalizations During Follow-Up After Acute Myocardial Infarction
Caraballo C, Khera R, Jones PG, Decker C, Schulz W, Spertus JA, Krumholz HM. Rates and Predictors of Patient Underreporting of Hospitalizations During Follow-Up After Acute Myocardial Infarction. Circulation Cardiovascular Quality And Outcomes 2020, 13: e006231. PMID: 32552061, PMCID: PMC9465954, DOI: 10.1161/circoutcomes.119.006231.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionMyocardial infarctionHospitalization eventsMedical recordsLongitudinal multicenter cohort studyMulticenter cohort studyMedical record abstractionDifferent patient characteristicsHealth care eventsPatients' underreportingTRIUMPH registryAccuracy of reportingCohort studyPatient characteristicsRecord abstractionProspective studyClinical studiesClinical investigationHospitalizationPatientsCare eventsInfarctionEvent ratesParticipantsPredictorsPost-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
2018
Association 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 harm
2017
Comparison of Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Chronic Kidney Disease
Kumar N, Khera R, Garg N, Echouffo-Tcheugui JB, Venkatraman A, Pandey A, Bhatt DL. Comparison of Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Chronic Kidney Disease. The American Journal Of Cardiology 2017, 121: 343-348. PMID: 29268936, DOI: 10.1016/j.amjcard.2017.10.029.Peer-Reviewed Original ResearchConceptsSurgical aortic valve replacementTranscatheter aortic valve implantationDialysis-requiring acute kidney injuryAcute kidney injuryChronic kidney diseaseAortic valve replacementPostoperative strokeSAVR proceduresKidney diseaseHospital mortalityValve replacementTranscatheter Versus Surgical Aortic Valve ReplacementRate of AKIRetrospective cohort studySevere aortic stenosisCo-primary outcomesPropensity-matched pairsAortic valve implantationComparison of outcomesKidney injuryCohort studyValve implantationAortic stenosisMultivariate analysisPatients