2024
Barriers to Optimal Clinician Guideline Adherence in Management of Markedly Elevated Blood Pressure
Lu Y, Arowojolu O, Qiu X, Liu Y, Curry L, Krumholz H. Barriers to Optimal Clinician Guideline Adherence in Management of Markedly Elevated Blood Pressure. JAMA Network Open 2024, 7: e2426135. PMID: 39106065, PMCID: PMC11304113, DOI: 10.1001/jamanetworkopen.2024.26135.Peer-Reviewed Original ResearchConceptsBarriers to guideline adherenceElectronic health recordsGuideline adherenceClinician adherenceEHR dataElevated blood pressureHypertension managementAnalysis of EHR dataYale New Haven Health SystemSevere hypertensionClinical practice guidelinesAdherence scenariosQualitative content analysisPublic health challengeThematic saturationHealth recordsHealth systemBlood pressureThematic analysisTargeted interventionsManagement of severe hypertensionQualitative studyHealth challengesPractice guidelinesPatient outcomesHypertension Trends and Disparities Over 12 Years in a Large Health System: Leveraging the Electronic Health Records
Brush J, Lu Y, Liu Y, Asher J, Li S, Sawano M, Young P, Schulz W, Anderson M, Burrows J, Krumholz H. Hypertension Trends and Disparities Over 12 Years in a Large Health System: Leveraging the Electronic Health Records. Journal Of The American Heart Association 2024, 13: e033253. PMID: 38686864, PMCID: PMC11179912, DOI: 10.1161/jaha.123.033253.Peer-Reviewed Original ResearchConceptsElectronic health recordsRegional health systemImprove hypertension careHealth systemHealth recordsHypertension careDiastolic blood pressureAge-adjusted prevalence ratesNon-Hispanic Black patientsPrevalence ratesLarger health systemCross-sectional analysisTransformation of medical dataLeveraging real-world dataHigh prevalence rateHypertension trendsHypertension prevalenceBlood pressureBlood pressure measurementsHypertension diagnosisPrimary outcomeNational trendsProportion of patientsAntihypertensive medicationsBlack patientsDigital Health Interventions for Hypertension Management in US Populations Experiencing Health Disparities
Katz M, Mszar R, Grimshaw A, Gunderson C, Onuma O, Lu Y, Spatz E. Digital Health Interventions for Hypertension Management in US Populations Experiencing Health Disparities. JAMA Network Open 2024, 7: e2356070. PMID: 38353950, PMCID: PMC10867699, DOI: 10.1001/jamanetworkopen.2023.56070.Peer-Reviewed Original ResearchConceptsDigital health interventionsHealth disparitiesHealth interventionsSystematic reviewSystolic BPSocial determinants of healthHypertension managementCommunity health workersFactors associated with cardiovascular diseaseDeterminants of healthLeveraging digital healthRemote BP monitoringDigital health technologiesStandard care groupMeta-analysisBlood pressureDiastolic BPPreferred Reporting ItemsControl groupSystolic BP changeBaseline to 6Random-effects modelSkilled nursingCultural tailoringSocial determinants
2023
National Trends in Racial and Ethnic Disparities in Use of Recommended Therapies in Adults with Atherosclerotic Cardiovascular Disease, 1999-2020
Lu Y, Liu Y, Dhingra L, Caraballo C, Mahajan S, Massey D, Spatz E, Sharma R, Rodriguez F, Watson K, Masoudi F, Krumholz H. National Trends in Racial and Ethnic Disparities in Use of Recommended Therapies in Adults with Atherosclerotic Cardiovascular Disease, 1999-2020. JAMA Network Open 2023, 6: e2345964. PMID: 38039001, PMCID: PMC10692850, DOI: 10.1001/jamanetworkopen.2023.45964.Peer-Reviewed Original ResearchConceptsAtherosclerotic cardiovascular diseaseHistory of ASCVDCross-sectional studyLifestyle modificationPharmacological medicationsOptimal careCurrent careUS adultsEthnic differencesWhite individualsGuideline-recommended therapiesTotal cholesterol controlNon-Hispanic white individualsNutrition Examination SurveyLatino individualsQuality of careSelf-reported raceStatin useRecommended TherapiesSecondary preventionCholesterol controlOptimal regimensSmoking cessationEligible participantsExamination SurveyUncovering heterogeneous cardiometabolic risk profiles in US adults: the role of social and behavioral determinants of health
Ding Q, Lu Y, Herrin J, Zhang T, Marrero D. Uncovering heterogeneous cardiometabolic risk profiles in US adults: the role of social and behavioral determinants of health. BMJ Open Diabetes Research & Care 2023, 11: e003558. PMID: 37699720, PMCID: PMC10503393, DOI: 10.1136/bmjdrc-2023-003558.Peer-Reviewed Original ResearchConceptsCardiometabolic risk profileMetabolic risk factorsRace/ethnicityUndiagnosed diabetesUS adultsRisk factorsHealthcare accessNutrition Examination Survey 1999Risk profilePre-diabetes riskPrior diabetes diagnosisExamination Survey 1999Insurance coverageShort sleep durationLower diet qualityEffective prevention strategiesLimited healthcare accessBehavioral determinantsNon-white adultsMiddle-aged adultsHealth insurance coverageLow health insurance coverageCardiometabolic riskDiabetes statusDiabetes riskExcess Mortality and Years of Potential Life Lost Among the Black Population in the US, 1999-2020
Caraballo C, Massey D, Ndumele C, Haywood T, Kaleem S, King T, Liu Y, Lu Y, Nunez-Smith M, Taylor H, Watson K, Herrin J, Yancy C, Faust J, Krumholz H. Excess Mortality and Years of Potential Life Lost Among the Black Population in the US, 1999-2020. JAMA 2023, 329: 1662-1670. PMID: 37191702, PMCID: PMC10189563, DOI: 10.1001/jama.2023.7022.Peer-Reviewed Original ResearchConceptsExcess mortality ratesExcess deathsMortality ratePotential lifeWhite populationExcess mortalitySerial cross-sectional studyHighest excess mortality ratesBlack populationCause-specific mortalityCross-sectional studyHigh mortality rateNon-Hispanic whitesYears of lifeUS national dataMiddle-aged adultsCause mortalityHeart diseaseDeath certificatesNon-Hispanic black populationMAIN OUTCOMEAge groupsDisease controlMortalityBlack malesNonexercise machine learning models for maximal oxygen uptake prediction in national population surveys.
Liu Y, Herrin J, Huang C, Khera R, Dhingra L, Dong W, Mortazavi B, Krumholz H, Lu Y. Nonexercise machine learning models for maximal oxygen uptake prediction in national population surveys. Journal Of The American Medical Informatics Association 2023, 30: 943-952. PMID: 36905605, PMCID: PMC10114129, DOI: 10.1093/jamia/ocad035.Peer-Reviewed Original ResearchQuantifying 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
Trends in Racial and Ethnic Disparities in Barriers to Timely Medical Care Among Adults in the US, 1999 to 2018
Caraballo C, Ndumele CD, Roy B, Lu Y, Riley C, Herrin J, Krumholz HM. Trends in Racial and Ethnic Disparities in Barriers to Timely Medical Care Among Adults in the US, 1999 to 2018. JAMA Health Forum 2022, 3: e223856. PMID: 36306118, PMCID: PMC9617175, DOI: 10.1001/jamahealthforum.2022.3856.Peer-Reviewed Original ResearchConceptsTimely medical careSerial cross-sectional studyNational Health Interview SurveyCross-sectional studyHealth Interview SurveyMedical careLack of transportationEthnic disparitiesHispanics/LatinosWhite individualsEthnicity groupsInterview SurveyCost of careSelf-reported raceStudy cohortClinic hoursMAIN OUTCOMEMedical officesCarePrevalenceLatino individualsBlack individualsSignificant differencesSignificant increasePopulation groupsRacial and Ethnic Disparities in Financial Barriers Among Overweight and Obese Adults Eligible for Semaglutide in the United States
Lu Y, Liu Y, Krumholz HM. Racial and Ethnic Disparities in Financial Barriers Among Overweight and Obese Adults Eligible for Semaglutide in the United States. Journal Of The American Heart Association 2022, 11: e025545. PMID: 36172953, PMCID: PMC9673703, DOI: 10.1161/jaha.121.025545.Peer-Reviewed Original ResearchConceptsLow family incomeEligible populationUsual sourceHispanic adultsFinancial barriersEthnic disparitiesNutrition Examination Survey 2015Drug Administration labelingCross-sectional analysisFamily incomePercentage of adultsObese adultsNational HealthUS adultsSemaglutideEligibility criteriaSocial determinantsBlack adultsLarge proportionFinal analysisWeight lossHispanic individualsWhite individualsAdultsRisk reductionLarge-scale evidence generation and evaluation across a network of databases for type 2 diabetes mellitus (LEGEND-T2DM): a protocol for a series of multinational, real-world comparative cardiovascular effectiveness and safety studies
Khera R, Schuemie MJ, Lu Y, Ostropolets A, Chen R, Hripcsak G, Ryan PB, Krumholz HM, Suchard MA. Large-scale evidence generation and evaluation across a network of databases for type 2 diabetes mellitus (LEGEND-T2DM): a protocol for a series of multinational, real-world comparative cardiovascular effectiveness and safety studies. BMJ Open 2022, 12: e057977. PMID: 35680274, PMCID: PMC9185490, DOI: 10.1136/bmjopen-2021-057977.Peer-Reviewed Original ResearchConceptsLarge-scale Evidence GenerationType 2 diabetes mellitusCardiovascular effectivenessDiabetes mellitusSafety outcomesGlucagon-like peptide-1 receptor agonistsSodium-glucose co-transporter-2 inhibitorsMajor adverse cardiovascular eventsNew-user cohort designPeptide-1 receptor agonistsDipeptidyl peptidase-4 inhibitorsSafety studiesAdverse cardiovascular eventsPrimary cardiovascular outcomePeptidase-4 inhibitorsAnti-hyperglycaemic agentsElectronic health record data sourcesEvidence generationCardiovascular eventsCardiovascular outcomesCardiovascular riskActive comparatorTherapeutic optionsReceptor agonistDrug comparisonsTemporal Trends in Racial and Ethnic Disparities in Multimorbidity Prevalence in the United States, 1999-2018
Caraballo C, Herrin J, Mahajan S, Massey D, Lu Y, Ndumele CD, Drye EE, Krumholz HM. Temporal Trends in Racial and Ethnic Disparities in Multimorbidity Prevalence in the United States, 1999-2018. The American Journal Of Medicine 2022, 135: 1083-1092.e14. PMID: 35472394, DOI: 10.1016/j.amjmed.2022.04.010.Peer-Reviewed Original ResearchConceptsMultimorbidity prevalenceRace/ethnicityWhite individualsChronic conditionsBlack individualsSerial cross-sectional analysisCommon chronic conditionsRisk of morbidityPrevalence of multimorbidityPublic health interventionsCross-sectional analysisSelf-reported presenceSelf-reported raceLatino/HispanicMAIN OUTCOMEHealth interventionsEthnic disparitiesPrevalenceHealth inequalitiesStudy periodEarly lifeHispanic individualsTemporal trendsStudy sampleAsian individualsEvaluation of Temporal Trends in Racial and Ethnic Disparities in Sleep Duration Among US Adults, 2004-2018
Caraballo C, Mahajan S, Valero-Elizondo J, Massey D, Lu Y, Roy B, Riley C, Annapureddy AR, Murugiah K, Elumn J, Nasir K, Nunez-Smith M, Forman HP, Jackson CL, Herrin J, Krumholz HM. Evaluation of Temporal Trends in Racial and Ethnic Disparities in Sleep Duration Among US Adults, 2004-2018. JAMA Network Open 2022, 5: e226385. PMID: 35389500, PMCID: PMC8990329, DOI: 10.1001/jamanetworkopen.2022.6385.Peer-Reviewed Original ResearchConceptsCross-sectional studyLong sleep durationSleep durationWhite individualsBlack individualsLatino individualsEthnic differencesSerial cross-sectional studyNational Health Interview Survey dataHealth Interview Survey dataSelf-reported sleep durationShort sleep durationInterview Survey dataMiddle-aged adultsSelf-reported raceEstimated prevalenceMAIN OUTCOMELong sleepSleep deficiencyHigher household incomeEthnic disparitiesAge groupsHealth disparitiesPrevalenceSleep disparitiesAnalysis of Dual Combination Therapies Used in Treatment of Hypertension in a Multinational Cohort
Lu Y, Van Zandt M, Liu Y, Li J, Wang X, Chen Y, Chen Z, Cho J, Dorajoo SR, Feng M, Hsu MH, Hsu JC, Iqbal U, Jonnagaddala J, Li YC, Liaw ST, Lim HS, Ngiam KY, Nguyen PA, Park RW, Pratt N, Reich C, Rhee SY, Sathappan SMK, Shin SJ, Tan HX, You SC, Zhang X, Krumholz HM, Suchard MA, Xu H. Analysis of Dual Combination Therapies Used in Treatment of Hypertension in a Multinational Cohort. JAMA Network Open 2022, 5: e223877. PMID: 35323951, PMCID: PMC8948532, DOI: 10.1001/jamanetworkopen.2022.3877.Peer-Reviewed Original ResearchConceptsDual combination therapyUse of ACEIAntihypertensive drug classesProportion of patientsKhoo Teck Puat HospitalCombination therapyUniversity Hospital databaseHospital databaseDrug classesDual combinationSouth Western Sydney Local Health DistrictWestern Sydney Local Health DistrictPatients age 65 yearsSydney Local Health DistrictElectronic health record databasePatients age 18Local Health DistrictAge 65 yearsTreatment of hypertensionHealth record databaseARB monotherapyTreatment escalationAdult patientsCohort studyCombination regimen
2021
Effectiveness of an impedance cardiography guided treatment strategy to improve blood pressure control in a real-world setting: results from a pragmatic clinical trial
Wang L, Lu Y, Wang H, Gu J, J Z, Lian Z, Zhang Z, Krumholz H, Sun N. Effectiveness of an impedance cardiography guided treatment strategy to improve blood pressure control in a real-world setting: results from a pragmatic clinical trial. Open Heart 2021, 8: e001719. PMID: 34580169, PMCID: PMC8477318, DOI: 10.1136/openhrt-2021-001719.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overAntihypertensive AgentsBlood PressureCardiography, ImpedanceChinaClinical Decision-MakingFemaleFollow-Up StudiesHumansHypertensionIncidenceMaleMiddle AgedPractice Guidelines as TopicRetrospective StudiesTherapy, Computer-AssistedTime FactorsTreatment OutcomeYoung AdultConceptsBody mass indexPeking University People's HospitalStandard care groupBlood pressure controlSystolic BPHaemodynamic groupsTreatment strategiesImpedance cardiographyBaseline BPBP goalHypertension clinicHaemodynamic profileBP levelsCare groupPeople's HospitalMean baseline systolic BPPressure controlReal-world clinical practiceBaseline systolic BPMean systolic BPDiastolic BP levelsProportion of patientsPragmatic clinical trialsReal-world populationBaseline DBP
2017
Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project)
Lu J, Lu Y, Wang X, Li X, Linderman GC, Wu C, Cheng X, Mu L, Zhang H, Liu J, Su M, Zhao H, Spatz ES, Spertus JA, Masoudi FA, Krumholz HM, Jiang L. Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project). The Lancet 2017, 390: 2549-2558. PMID: 29102084, DOI: 10.1016/s0140-6736(17)32478-9.Peer-Reviewed Original ResearchConceptsControl of hypertensionBlood pressureAntihypertensive medicationsCardiac Events Million Persons ProjectSelf-reported antihypertensive medication usePopulation-based screening studyPopulation-based screening projectMillion Persons ProjectPrescribed antihypertensive medicationsPrevious cardiovascular eventsAntihypertensive medication useDiastolic blood pressureSystolic blood pressureManagement of hypertensionCalcium channel blockersProportion of participantsSelf-reported diagnosisCommunity-dwelling adultsSex-standardised ratesCardiovascular eventsHypertensive adultsMedication classesHypertension awarenessHypertension prevalenceClinical factorsWorldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults
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Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. The Lancet 2017, 390: 2627-2642. PMID: 29029897, PMCID: PMC5735219, DOI: 10.1016/s0140-6736(17)32129-3.Peer-Reviewed Original ResearchConceptsMean body mass indexBody mass indexPrevalence of obesitySevere underweightAge-standardised mean body mass indexPrevalence of BMIGlobal age-standardised prevalenceCentral Latin AmericaAge-standardised prevalencePopulation-based studyAdolescent body mass indexAdverse health consequencesNon-significant increaseAndean Latin AmericaBMI categoriesWHO growth referencesMeasurements of heightPooled analysisHigh-income countriesObesityUnderweightHealth programsPrevalenceHealth consequencesGrowth referencesTrends in obesity and diabetes across Africa from 1980 to 2014: an analysis of pooled population-based studies
Kengne A, Bentham J, Zhou B, Peer N, Matsha T, Bixby H, Di Cesare M, Hajifathalian K, Lu Y, Taddei C, Bovet P, Kyobutungi C, Agyemang C, Aounallah-Skhiri H, Assah F, Barkat A, Romdhane H, Chan Q, Chaturvedi N, Damasceno A, Delisle H, Delpeuch F, Doua K, Egbagbe E, Ati J, Elliott P, Engle-Stone R, Erasmus R, Fouad H, Gareta D, Gureje O, Hendriks M, Houti L, Ibrahim M, Kemper H, Killewo J, Kowlessur S, Kruger H, Laamiri F, Laid Y, Levitt N, Lunet N, Magliano D, Maire B, Martin-Prevel Y, Mediene-Benchekor S, Mohamed M, Mondo C, Monyeki K, Mostafa A, Nankap M, Owusu-Dabo E, de Wit T, Saidi O, Schultsz C, Schutte A, Senbanjo I, Shaw J, Smeeth L, Sobngwi E, Jérome C, Stronks K, Tanser F, Tchibindat F, Traissac P, Tshepo L, Tullu F, Ukoli F, Viswanathan B, Wade A, Danaei G, Stevens G, Riley L, Ezzati M, Mbanya J. Trends in obesity and diabetes across Africa from 1980 to 2014: an analysis of pooled population-based studies. International Journal Of Epidemiology 2017, 46: 1421-1432. PMID: 28582528, PMCID: PMC5837192, DOI: 10.1093/ije/dyx078.Peer-Reviewed Original ResearchConceptsMean body mass indexBody mass indexAge-standardized mean body mass indexPopulation-based studyNon-communicable diseasesWorldwide population-based studyAge-standardized prevalenceBurden of diabetesDiabetes prevalence estimatesPopulation-based surveyDiabetes statusDiabetes prevalenceMass indexControl diabetesDiabetes estimatesDiabetesPrevalence estimatesPrevalenceObesityPositive associationWomenSaharan AfricaSexMenHigher numberSex Differences in Inflammatory Markers and Health Status Among Young Adults With Acute Myocardial Infarction
Lu Y, Zhou S, Dreyer RP, Spatz ES, Geda M, Lorenze NP, D'Onofrio G, Lichtman JH, Spertus JA, Ridker PM, Krumholz HM. Sex Differences in Inflammatory Markers and Health Status Among Young Adults With Acute Myocardial Infarction. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003470. PMID: 28228461, PMCID: PMC5459381, DOI: 10.1161/circoutcomes.116.003470.Peer-Reviewed Original ResearchMeSH Keywords1-Alkyl-2-acetylglycerophosphocholine EsteraseAdolescentAdultAge of OnsetBiomarkersChi-Square DistributionComorbidityC-Reactive ProteinFemaleHealth Status DisparitiesHumansInflammation MediatorsLinear ModelsMaleMiddle AgedMultivariate AnalysisMyocardial InfarctionProspective StudiesRisk AssessmentRisk FactorsSex FactorsSocioeconomic FactorsUnited StatesUp-RegulationYoung AdultConceptsHigh-sensitivity C-reactive proteinAcute myocardial infarctionHigher inflammatory levelsInflammatory markersPoor health statusHealth statusYoung womenMyocardial infarctionInflammatory levelsTargeted anti-inflammatory treatmentsElevated inflammatory markersResidual cholesterol riskResidual inflammatory riskSex differencesAnti-inflammatory treatmentAnti-inflammatory therapyC-reactive proteinHigher mortality riskYoung menPhospholipase A2Years of ageCardiovascular outcomesMultivariable adjustmentPatient characteristicsSecondary prevention
2016
Sex differences in lipid profiles and treatment utilization among young adults with acute myocardial infarction: Results from the VIRGO study
Lu Y, Zhou S, Dreyer RP, Caulfield M, Spatz ES, Geda M, Lorenze NP, Herbert P, D'Onofrio G, Jackson EA, Lichtman JH, Bueno H, Spertus JA, Krumholz HM. Sex differences in lipid profiles and treatment utilization among young adults with acute myocardial infarction: Results from the VIRGO study. American Heart Journal 2016, 183: 74-84. PMID: 27979045, PMCID: PMC5459396, DOI: 10.1016/j.ahj.2016.09.012.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionLipid profileYoung womenLipoprotein cholesterolLipoprotein profileMyocardial infarctionTreatment utilizationLow-density lipoprotein cholesterolHigh-density lipoprotein cholesterolLow HDL cholesterol levelsYoung adultsHigh-intensity doseMajor lipid abnormalitiesSex differencesAdverse lipid profileFavorable lipoprotein profileHDL cholesterol ratioLower total cholesterolHDL cholesterol levelsHigher HDL cholesterolImportant risk factorHigher mortality riskMultivariate regression analysisVIRGO StudyCardiovascular outcomes