2024
Automated 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
Prognostic Impact of Repeated NT-proBNP Measurements in Patients With Heart Failure With Reduced Ejection Fraction
Fuery M, Leifer E, Samsky M, Sen S, O'Connor C, Fiuzat M, Ezekowitz J, Piña I, Whellan D, Mark D, Felker G, Desai N, Januzzi J, Ahmad T. Prognostic Impact of Repeated NT-proBNP Measurements in Patients With Heart Failure With Reduced Ejection Fraction. JACC Heart Failure 2023, 12: 479-487. PMID: 38127049, DOI: 10.1016/j.jchf.2023.11.007.Peer-Reviewed Original ResearchNT-proBNP measurementsPrimary trial endpointChronic heart failureNT-proBNP levelsReduced ejection fractionTrial endpointsHeart failureEjection fractionN-terminal pro-B-type natriuretic peptide (NT-proBNP) measurementBaseline NT-proBNP levelsChronic heart failure patientsNT-proBNP monitoringSecondary trial endpointsHeart failure hospitalizationNatriuretic peptide measurementHeart failure patientsCardiovascular deathFailure hospitalizationNT-proBNPFailure patientsPrognostic impactClinical outcomesPrognostic valueOutpatient sitesClinical studiesRationale, Design, and Patient Characteristics of a Cluster-Randomized Pragmatic Trial to Improve Mineralocorticoid Antagonist Use
Clark K, Victoria-Castro A, Ghazi L, Yamamoto Y, Coronel-Moreno C, Kadhim B, Riello R, O'Connor K, Ahmad T, Wilson F, Desai N. Rationale, Design, and Patient Characteristics of a Cluster-Randomized Pragmatic Trial to Improve Mineralocorticoid Antagonist Use. JACC Heart Failure 2023, 12: 322-332. PMID: 37943221, DOI: 10.1016/j.jchf.2023.08.025.Peer-Reviewed Original ResearchBest practice alertMineralocorticoid receptor antagonistsNovel potassium bindersPotassium bindersEligible patientsUsual careEjection fractionSerum potassiumHistory of hyperkalemiaIncidence of hyperkalemiaStrong guideline recommendationsHeart failure hospitalizationReduced ejection fractionLaboratory test valuesPopulation health outcomesHyperkalemia treatmentMRA prescriptionAntagonist useFailure hospitalizationPatient characteristicsSecondary outcomesHeart failurePrimary outcomeGuideline recommendationsOutpatient visitsElectronic health record alerts for management of heart failure with reduced ejection fraction in hospitalized patients: the PROMPT-AHF trial
Ghazi L, Yamamoto Y, Fuery M, O'Connor K, Sen S, Samsky M, Riello R, Dhar R, Huang J, Olufade T, McDermott J, Inzucchi S, Velazquez E, Wilson F, Desai N, Ahmad T. Electronic health record alerts for management of heart failure with reduced ejection fraction in hospitalized patients: the PROMPT-AHF trial. European Heart Journal 2023, 44: 4233-4242. PMID: 37650264, DOI: 10.1093/eurheartj/ehad512.Peer-Reviewed Original ResearchGuideline-directed medical therapyAcute heart failureMineralocorticoid receptor antagonistsHeart failureElectronic health recordsGDMT prescriptionPrimary outcomeEnzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitorsSodium-glucose cotransporter 2 inhibitorsAngiotensin receptor neprilysin inhibitorElectronic health record alertsEvidence-based regimenProviders of patientsReduced ejection fractionCotransporter 2 inhibitorsRelevant patient characteristicsTime of dischargePre-specified criteriaAHF hospitalizationEligible patientsInpatient initiationPatient characteristicsEjection fractionHospitalized patientsMedian ageImpact Of Digital Health Interventions In The Quality Of Life Of Patients With Heart Failure: A Randomized Trial
Castro A, Martin M, Desai N, Ahmad T, Yamamoto Y, Melchinger H, Lee K, Gerber B, Nguyen A, Weinstein J, Subair L, Lee V, Williams A, Shaw M, Arora T, Wilson F. Impact Of Digital Health Interventions In The Quality Of Life Of Patients With Heart Failure: A Randomized Trial. Journal Of Cardiac Failure 2023, 29: 662. DOI: 10.1016/j.cardfail.2022.10.284.Peer-Reviewed Original ResearchQuality of lifeUsual careClinical summary scoreTotal symptom scoreHeart failureSymptom scoresSummary scoresKansas City Cardiomyopathy Questionnaire overall scoreYale New Haven Health SystemDigital health toolsHealth toolsReduced ejection fractionResults One hundred fiftyUsual care groupMethods One hundred eightyNon-Hispanic blacksDigital health interventionsHF clinicSecondary outcomesEjection fractionEmergency visitsMedian agePrimary outcomeClinical outcomesRandomization groupWHAT IS THE VALUE OF REPEATED NT-PROBNP MEASUREMENTS IN CHRONIC HEART FAILURE WITH REDUCED EJECTION FRACTION?
Fuery M, Leifer E, Samsky M, Sen S, O'Connor C, Fiuzat M, Ezekowitz J, Pina I, Whellan D, Mark D, Felker G, Desai N, Januzzi J, Ahmad T. WHAT IS THE VALUE OF REPEATED NT-PROBNP MEASUREMENTS IN CHRONIC HEART FAILURE WITH REDUCED EJECTION FRACTION? Journal Of The American College Of Cardiology 2023, 81: 624. DOI: 10.1016/s0735-1097(23)01068-9.Peer-Reviewed Original Research
2022
Pragmatic trial of messaging to providers about treatment of acute heart failure: The PROMPT-AHF trial
Ghazi L, O'Connor K, Yamamoto Y, Fuery M, Sen S, Samsky M, Riello R, Huang J, Olufade T, McDermott J, Inzucchi S, Velazquez E, Wilson F, Desai N, Ahmad T. Pragmatic trial of messaging to providers about treatment of acute heart failure: The PROMPT-AHF trial. American Heart Journal 2022, 257: 111-119. PMID: 36493842, DOI: 10.1016/j.ahj.2022.12.002.Peer-Reviewed Original ResearchConceptsGuideline-directed medical therapyAcute heart failureHeart failurePragmatic trialElectronic health recordsSubstantial health care costsBest practice advisoryReduced ejection fractionUsual care armHealth recordsTime of dischargeEvidence-based careHealth care costsClinical decision support systemAHF patientsCare armEligible patientsHF hospitalizationInpatient initiationCardiovascular deathMedication classesEjection fractionMedical therapyPrimary outcomePractice advisoryNetwork Meta-Analysis Comparing Angiotensin Receptor-Neprilysin Inhibitors, Angiotensin Receptor Blockers, and Angiotensin-Converting Enzyme Inhibitors in Heart Failure With Reduced Ejection Fraction
Park D, An S, Attanasio S, Jolly N, Malhotra S, Doukky R, Samsky M, Sen S, Ahmad T, Nanna M, Vij A. Network Meta-Analysis Comparing Angiotensin Receptor-Neprilysin Inhibitors, Angiotensin Receptor Blockers, and Angiotensin-Converting Enzyme Inhibitors in Heart Failure With Reduced Ejection Fraction. The American Journal Of Cardiology 2022, 187: 84-92. PMID: 36459752, PMCID: PMC10958453, DOI: 10.1016/j.amjcard.2022.10.026.Peer-Reviewed Original ResearchMeSH KeywordsAngiotensin Receptor AntagonistsAngiotensin-Converting Enzyme InhibitorsAntihypertensive AgentsBayes TheoremDeathHeart FailureHumansHypotensionNeprilysinNetwork Meta-AnalysisRandomized Controlled Trials as TopicReceptors, AngiotensinStroke VolumeTreatment OutcomeVentricular Dysfunction, LeftConceptsAngiotensin receptor neprilysin inhibitorAngiotensin receptor blockersReduced ejection fractionHeart failureEjection fractionHigh riskCause mortalityReceptor blockersCardiac deathLower riskEnzyme inhibitorsMajor adverse cardiac eventsAngiotensin converting enzyme (ACE) inhibitorsAdverse cardiac eventsEfficacy end pointNetwork meta-analysis approachImproved clinical outcomesRandomized clinical trialsP scoreCardiac eventsAngiotensin receptorsClinical outcomesNeprilysin inhibitorClinical benefitRecent trialsMedicare Coverage and Out-of-Pocket Costs of Quadruple Drug Therapy for Heart Failure
Faridi K, Dayoub E, Ross J, Dhruva S, Ahmad T, Desai N. Medicare Coverage and Out-of-Pocket Costs of Quadruple Drug Therapy for Heart Failure. Journal Of The American College Of Cardiology 2022, 79: 2516-2525. PMID: 35738713, DOI: 10.1016/j.jacc.2022.04.031.Peer-Reviewed Original ResearchConceptsSodium-glucose cotransporter 2 inhibitorsAngiotensin receptor neprilysin inhibitorQuadruple therapyOOP costsMedicare coveragePocket costsAngiotensin-converting enzyme inhibitorPrior authorizationAngiotensin receptor blockersQuadruple drug therapyCotransporter 2 inhibitorsMineralocorticoid receptor antagonistsReduced ejection fractionDrug plansReceptor blockersEjection fractionHeart failureDrug therapyReceptor antagonistPrescription drug plansMedicare patientsEnzyme inhibitorsTherapyRegimensMedication pricesElectronic Alerts to Improve Heart Failure Therapy in Outpatient Practice A Cluster Randomized Trial
Ghazi L, Yamamoto Y, Riello RJ, Coronel-Moreno C, Martin M, O'Connor KD, Simonov M, Huang J, Olufade T, McDermott J, Dhar R, Inzucchi SE, Velazquez EJ, Wilson FP, Desai NR, Ahmad T. Electronic Alerts to Improve Heart Failure Therapy in Outpatient Practice A Cluster Randomized Trial. Journal Of The American College Of Cardiology 2022, 79: 2203-2213. PMID: 35385798, DOI: 10.1016/j.jacc.2022.03.338.Peer-Reviewed Original ResearchConceptsGuideline-directed medical therapyUsual careEjection fractionHeart failureMedical therapyPrimary outcomeCluster-randomized comparative effectiveness trialSodium-glucose cotransporter 2 inhibitorsElectronic health record alertsAldosterone system inhibitorsReduced ejection fractionUsual care armCotransporter 2 inhibitorsMineralocorticoid receptor antagonistsVentricular ejection fractionComparative effectiveness trialNumber of patientsKnowledge of guidelinesLow-cost interventionCare armDays postrandomizationEligible patientsGDMT useFailure therapyPatient characteristicsAssessing race and ethnicity differences in outcomes based on GDMT and target NT-proBNP in patients with heart failure with reduced ejection fraction: An analysis of the GUIDE-IT study
Pahuja M, Leifer ES, Clarke JD, Ahmad T, Daubert MA, Mark DB, Cooper L, Desvigne-Nickens P, Fiuzat M, Adams K, Ezekowitz J, Whellan DJ, Januzzi JL, O'Connor CM, Felker GM, Piña IL. Assessing race and ethnicity differences in outcomes based on GDMT and target NT-proBNP in patients with heart failure with reduced ejection fraction: An analysis of the GUIDE-IT study. Progress In Cardiovascular Diseases 2022, 71: 79-85. PMID: 35490873, DOI: 10.1016/j.pcad.2022.04.010.Peer-Reviewed Original ResearchConceptsHeart failure hospitalizationNon-black patientsNT-proBNPBlack patientsFailure hospitalizationHigh riskKansas City Cardiomyopathy Questionnaire overall scorePre-specified subgroup analysisGUIDE-IT trialHigher NYHA classReduced ejection fractionNT-proBNP concentrationsHeart failure therapyNon-Hispanic patientsUsual clinical careImportant baseline covariatesQuality of lifeEthnicity-based differencesHF hospitalizationMore comorbiditiesNYHA classCause mortalityTriple therapyFailure therapyEjection fractionHeart Failure Spending Function: An Investment Framework for Sequencing and Intensification of Guideline-Directed Medical Therapies
Allen LA, Teerlink JR, Gottlieb SS, Ahmad T, Lam CSP, Psotka MA. Heart Failure Spending Function: An Investment Framework for Sequencing and Intensification of Guideline-Directed Medical Therapies. Circulation Heart Failure 2022, 15: e008594. PMID: 35000432, DOI: 10.1161/circheartfailure.121.008594.Peer-Reviewed Original ResearchConceptsGuideline-directed medical therapyMedical therapyReduced ejection fractionHealth care delivery researchAdverse eventsCardiac benefitsSerum creatinineBlood pressureEjection fractionHeart failureRoutine carePatient burdenHeart rateNew therapiesPatient harmHigh dosesPatientsPsychosocial domainsPocket costsTherapeutic opportunitiesClinical useTherapyNew drugsPhysiological domainsSpending function
2021
Rationale and design of a cluster-randomized pragmatic trial aimed at improving use of guideline directed medical therapy in outpatients with heart failure: PRagmatic trial of messaging to providers about treatment of heart failure (PROMPT-HF)
Ghazi L, Desai NR, Simonov M, Yamamoto Y, O'Connor KD, Riello RJ, Huang J, Olufade T, McDermott J, Inzucchi SE, Velazquez EJ, Wilson FP, Ahmad T. Rationale and design of a cluster-randomized pragmatic trial aimed at improving use of guideline directed medical therapy in outpatients with heart failure: PRagmatic trial of messaging to providers about treatment of heart failure (PROMPT-HF). American Heart Journal 2021, 244: 107-115. PMID: 34808104, DOI: 10.1016/j.ahj.2021.11.010.Peer-Reviewed Original ResearchConceptsGuideline-directed medical therapyBest practice alertLeft ventricular ejection fractionHeart failureUsual careMedical therapyPragmatic trialElectronic health recordsEjection fractionCluster-randomized pragmatic trialLarge integrated healthcare systemDays post randomizationAppropriate medical therapyHeart Failure TrialReduced ejection fractionUsual care groupCommon chronic illnessGlomerular filtration rateVentricular ejection fractionRecent blood pressureIntegrated healthcare systemUse of guidelinesLow-cost interventionCreatinine levelsReal-world practiceThe influence of comorbidities on achieving an N‐terminal pro‐b‐type natriuretic peptide target: a secondary analysis of the GUIDE‐IT trial
Ezekowitz JA, Alemayehu W, Rathwell S, Grant AD, Fiuzat M, Whellan DJ, Ahmad T, Adams K, Piña IL, Cooper LS, Januzzi JL, Leifer ES, Mark D, O'Connor CM, Felker GM. The influence of comorbidities on achieving an N‐terminal pro‐b‐type natriuretic peptide target: a secondary analysis of the GUIDE‐IT trial. ESC Heart Failure 2021, 9: 77-86. PMID: 34784657, PMCID: PMC8787989, DOI: 10.1002/ehf2.13692.Peer-Reviewed Original ResearchConceptsBody mass indexLower body mass indexNT-proBNPAtrial fibrillationN-terminal pro B-type natriuretic peptide valuesMedian body mass indexHigher body mass indexGUIDE-IT trialNT-proBNP targetWorse renal functionNT-proBNP levelsReduced ejection fractionCent of patientsNatriuretic peptide valuesGlomerular filtration rateHeart failure therapyInfluence of comorbiditiesSeverity of illnessEvidence-based therapiesPg/mLCare armLower eGFRRenal dysfunctionUsual careRenal functionThe Impact of Depression on Outcomes in Patients With Heart Failure and Reduced Ejection Fraction Treated in the GUIDE-IT Trial
Chouairi F, Fuery MA, Mullan CW, Caraballo C, Sen S, Maulion C, Wilkinson ST, Surti T, McCullough M, Miller PE, Pacor J, Leifer ES, Felker GM, Velazquez EJ, Fiuzat M, O'Connor CM, Januzzi JL, Desai NR, Ahmad T. The Impact of Depression on Outcomes in Patients With Heart Failure and Reduced Ejection Fraction Treated in the GUIDE-IT Trial. Journal Of Cardiac Failure 2021, 27: 1359-1366. PMID: 34166799, DOI: 10.1016/j.cardfail.2021.06.008.Peer-Reviewed Original ResearchConceptsGuideline-directed medical therapyReduced ejection fractionAmino-terminal pro-B-type natriuretic peptide levelsPro-B-type natriuretic peptide levelsGUIDE-IT trialNatriuretic peptide levelsHeart failureEjection fractionClinical outcomesPeptide levelsOptimal guideline-directed medical therapyCox proportional hazards regression modelingProportional hazards regression modelingImpact of depressionHistory of depressionCardiovascular deathCause hospitalizationCause mortalityOverall cohortMedical therapyAdverse outcomesTarget dosesPatientsMental healthTime pointsNational Trends in the Burden of Atrial Fibrillation During Hospital Admissions for Heart Failure
Reinhardt SW, Chouairi F, Miller PE, Clark KAA, Kay B, Fuery M, Guha A, Freeman JV, Ahmad T, Desai NR, Friedman DJ. National Trends in the Burden of Atrial Fibrillation During Hospital Admissions for Heart Failure. Journal Of The American Heart Association 2021, 10: e019412. PMID: 34013736, PMCID: PMC8483517, DOI: 10.1161/jaha.120.019412.Peer-Reviewed Original ResearchConceptsReduced ejection fractionComorbid atrial fibrillationHeart failureAtrial fibrillationEjection fractionHospital mortalityHF hospitalizationBackground Heart failureConclusion Atrial fibrillationWhite individualsNational Inpatient SampleMedian hospital chargesMore comorbiditiesComorbid hypertensionHF admissionsHF outcomesPatient demographicsDiabetes mellitusHospital admissionHospital chargesInpatient SampleVascular diseaseHospitalizationPatientsMortalityIntercountry Differences in Guideline-Directed Medical Therapy and Outcomes Among Patients With Heart Failure
Fuery MA, Chouairi F, Januzzi JL, Moe GW, Caraballo C, McCullough M, Miller PE, Reinhardt SW, Clark K, Oseran A, Milner A, Pacor J, Kahn PA, Singh A, Ravindra N, Guha A, Vadlamani L, Kulkarni NS, Fiuzat M, Felker GM, O'Connor CM, Ahmad T, Ezekowitz J, Desai NR. Intercountry Differences in Guideline-Directed Medical Therapy and Outcomes Among Patients With Heart Failure. JACC Heart Failure 2021, 9: 497-505. PMID: 33992564, DOI: 10.1016/j.jchf.2021.02.011.Peer-Reviewed Original ResearchConceptsGuideline-directed medical therapyGDMT useCountry of enrollmentHeart failureMedical therapyHigher body mass indexKaplan-Meier survival estimatesGUIDE-IT trialHeart failure hospitalizationReduced ejection fractionLog-rank testingMineralocorticoid receptor antagonistsPrimary study endpointBody mass indexPatterns of careCare delivery structuresGUIDE-ITHF hospitalizationFailure hospitalizationUsual careEjection fractionStudy endpointBlack patientsClinical outcomesMass indexDifferences in NT‐proBNP Response and Prognosis in Men and Women With Heart Failure With Reduced Ejection Fraction
Daubert MA, Yow E, Barnhart HX, Piña IL, Ahmad T, Leifer E, Cooper L, Desvigne‐Nickens P, Fiuzat M, Adams K, Ezekowitz J, Whellan DJ, Januzzi JL, O’Connor C, Felker GM. Differences in NT‐proBNP Response and Prognosis in Men and Women With Heart Failure With Reduced Ejection Fraction. Journal Of The American Heart Association 2021, 10: e019712. PMID: 33955231, PMCID: PMC8200692, DOI: 10.1161/jaha.120.019712.Peer-Reviewed Original ResearchMeSH KeywordsAdrenergic beta-AntagonistsAngiotensin Receptor AntagonistsAngiotensin-Converting Enzyme InhibitorsBiomarkersCanadaCause of DeathFemaleFollow-Up StudiesGuideline AdherenceHeart FailureHumansMaleMiddle AgedNatriuretic Peptide, BrainPeptide FragmentsPrognosisProtein PrecursorsRetrospective StudiesSex DistributionSex FactorsStroke VolumeUnited StatesConceptsReduced ejection fractionNT-proBNP responseGuideline-directed medical therapyGUIDE-IT trialHeart failureEjection fractionNT-proBNPPrognostic valuePg/mLHF hospitalizationMedical therapyEquivalent prognostic valueNT-proBNP reductionNT-proBNP valuesGreater prognostic valueNonischemic causesClinical characteristicsClinical outcomesImproved outcomesLandmark analysisPrognostic biomarkerTherapeutic goalsConclusions MenSecondary analysisWomenEffects of Atrial Fibrillation on Heart Failure Outcomes and NT-proBNP Levels in the GUIDE-IT Trial
Chouairi F, Pacor J, Miller PE, Fuery MA, Caraballo C, Sen S, Leifer ES, Felker GM, Fiuzat M, O’Connor C, Januzzi JL, Friedman DJ, Desai NR, Ahmad T, Freeman JV. Effects of Atrial Fibrillation on Heart Failure Outcomes and NT-proBNP Levels in the GUIDE-IT Trial. Mayo Clinic Proceedings Innovations Quality & Outcomes 2021, 5: 447-455. PMID: 33997640, PMCID: PMC8105522, DOI: 10.1016/j.mayocpiqo.2021.02.005.Peer-Reviewed Original ResearchNT-proBNP levelsReduced ejection fractionAtrial fibrillationHF hospitalizationHeart failureEjection fractionMedical therapyN-terminal pro-B-type natriuretic peptideOptimal guideline-directed medical therapyPro-B-type natriuretic peptideGuideline-directed medical therapyHigher NT-proBNP concentrationsHigher NT-proBNP levelsGUIDE-IT trialMedical therapy useHeart failure outcomesHeart Failure TrialPrevalent atrial fibrillationNT-proBNP concentrationsType natriuretic peptideEvidence-based therapiesCardiovascular deathAF patientsTherapy useFailure TrialEffect of Inotropes on Patient-Reported Health Status in End-Stage Heart Failure
Clarke JD, Riello R, Allen LA, Psotka MA, Teerlink JR, Lindenfeld J, Desai NR, Ahmad T. Effect of Inotropes on Patient-Reported Health Status in End-Stage Heart Failure. Circulation Heart Failure 2021, 14: e007759. PMID: 33530705, DOI: 10.1161/circheartfailure.120.007759.Peer-Reviewed Original ResearchConceptsEnd-stage heart failureReduced ejection fractionHealth-related qualityPatient-reported health statusEffect of inotropesHeart failureHealth status domainsEjection fractionHealth statusFunctional statusPositive inotropesStatus domainsAvailable clinical trial dataMorbidity/mortalityPopulation of patientsPatient-centered outcomesHealth status outcomesClinical trial dataFunctional capacity changesQuantity of lifeWeb of ScienceInotrope therapyInotrope useCalcium sensitizerSurvival benefit