2024
Hypertension 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 patients
2023
Race and Ethnicity and Emergency Department Discharge Against Medical Advice
Tsai J, Janke A, Krumholz H, Khidir H, Venkatesh A. Race and Ethnicity and Emergency Department Discharge Against Medical Advice. JAMA Network Open 2023, 6: e2345437. PMID: 38015503, PMCID: PMC10685883, DOI: 10.1001/jamanetworkopen.2023.45437.Peer-Reviewed Original ResearchConceptsWhite patientsHispanic patientsEmergency departmentCross-sectional studyED visitsBlack patientsDAMA rateMedical adviceMAIN OUTCOMEEthnic disparitiesNationwide Emergency Department SampleNational cross-sectional studyHospital ED visitsEmergency department dischargeHospital-level variationEmergency Department SampleMetropolitan teaching hospitalHealth care resourcesMedian ageGreater morbidityHospital variationUnadjusted analysesTeaching hospitalAdditional adjustmentLower odds
2018
Racial Disparities in Patient Characteristics and Survival After Acute Myocardial Infarction
Graham GN, Jones PG, Chan PS, Arnold SV, Krumholz HM, Spertus JA. Racial Disparities in Patient Characteristics and Survival After Acute Myocardial Infarction. JAMA Network Open 2018, 1: e184240. PMID: 30646346, PMCID: PMC6324589, DOI: 10.1001/jamanetworkopen.2018.4240.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionWhite patientsBlack patientsMortality rate differencesMortality ratePatient characteristicsMyocardial infarctionPropensity scoreAcute Myocardial Infarction Patients' Health Status (TRIUMPH) registrySelf-identified black patientsObserved survival differencesNational Death IndexTime of admissionLower propensity scoreProspective registryClinical characteristicsCohort studyDeath IndexHighest quintileBlack raceC-statisticSurvival differencesWorse outcomesMAIN OUTCOMEPatientsAssociation of Racial and Socioeconomic Disparities With Outcomes Among Patients Hospitalized With Acute Myocardial Infarction, Heart Failure, and Pneumonia
Downing NS, Wang C, Gupta A, Wang Y, Nuti SV, Ross JS, Bernheim SM, Lin Z, Normand ST, Krumholz HM. Association of Racial and Socioeconomic Disparities With Outcomes Among Patients Hospitalized With Acute Myocardial Infarction, Heart Failure, and Pneumonia. JAMA Network Open 2018, 1: e182044. PMID: 30646146, PMCID: PMC6324513, DOI: 10.1001/jamanetworkopen.2018.2044.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBlack PeopleCohort StudiesFee-for-Service PlansFemaleHealth Status DisparitiesHeart FailureHospitalizationHospitalsHumansMaleMedicareMiddle AgedMyocardial InfarctionOutcome Assessment, Health CarePneumoniaRacial GroupsRetrospective StudiesSocial ClassUnited StatesWhite PeopleConceptsAcute myocardial infarctionRisk-standardized mortality ratesRisk-standardized readmission ratesReadmission ratesHeart failureMyocardial infarctionMortality rateIntraclass correlation coefficientAnalysis cohortBlack patientsHospital proportionSocioeconomic disparitiesHospital analysisRisk-standardized outcomesRisk-standardized ratesRetrospective cohort studySocioeconomic statusNeighborhood income levelHospital performanceHospital outcomesCohort studyNumber of hospitalsBroader systemic effectsPatient raceMAIN OUTCOMESex and Race Differences in the Utilization and Outcomes of Coronary Artery Bypass Grafting Among Medicare Beneficiaries, 1999–2014
Angraal S, Khera R, Wang Y, Lu Y, Jean R, Dreyer RP, Geirsson A, Desai NR, Krumholz HM. Sex and Race Differences in the Utilization and Outcomes of Coronary Artery Bypass Grafting Among Medicare Beneficiaries, 1999–2014. Journal Of The American Heart Association 2018, 7: e009014. PMID: 30005557, PMCID: PMC6064835, DOI: 10.1161/jaha.118.009014.Peer-Reviewed Original ResearchConceptsCoronary artery bypassCABG utilizationArtery bypassUse of CABGService Medicare beneficiariesCalendar year trendsCABG mortalityUnderwent CABGReadmission ratesCABG proceduresWhite patientsBlack patientsPatient groupMedicare beneficiariesMedicare feeMortality rateCABGAnnual declineWomenRacial subgroupsRacial differencesGreater declineOutcomesPatientsSexNational and Regional Trends in Deep Vein Thrombosis Hospitalization Rates, Discharge Disposition, and Outcomes for Medicare Beneficiaries
Minges KE, Bikdeli B, Wang Y, Attaran RR, Krumholz HM. National and Regional Trends in Deep Vein Thrombosis Hospitalization Rates, Discharge Disposition, and Outcomes for Medicare Beneficiaries. The American Journal Of Medicine 2018, 131: 1200-1208. PMID: 29753792, PMCID: PMC7040884, DOI: 10.1016/j.amjmed.2018.04.033.Peer-Reviewed Original ResearchConceptsDeep vein thrombosisHospitalization ratesVein thrombosisBlack patientsMedicare Standard Analytic FilesProportion of patientsPrincipal discharge diagnosisStandard Analytic FilesSecondary prevention effortsDischarge dispositionHospital lengthInpatient managementReadmission ratesDischarge diagnosisService patientsAdjusted outcomesOutpatient careAnalytic FilesMedicare feeMedicare beneficiariesMortality rateClinical practiceHospitalizationPatientsThrombosis
2016
Participation of the elderly, women, and minorities in pivotal trials supporting 2011–2013 U.S. Food and Drug Administration approvals
Downing NS, Shah ND, Neiman JH, Aminawung JA, Krumholz HM, Ross JS. Participation of the elderly, women, and minorities in pivotal trials supporting 2011–2013 U.S. Food and Drug Administration approvals. Trials 2016, 17: 199. PMID: 27079511, PMCID: PMC4832528, DOI: 10.1186/s13063-016-1322-4.Peer-Reviewed Original ResearchMeSH KeywordsAdultAge FactorsAgedClinical Trials as TopicCross-Sectional StudiesDatabases, FactualDrug ApprovalEthnicityFemaleHealth Status DisparitiesHealthcare DisparitiesHumansMaleMiddle AgedMinority GroupsPatient SelectionSex FactorsTime FactorsUnited StatesUnited States Food and Drug AdministrationConceptsSubgroup efficacy analysesPivotal trialsEfficacy analysisNovel therapeuticsSubgroup analysisTrial participantsU.S. FoodMean proportionAvailable FDA documentsCross-sectional studyDrug Administration approvalBasis of approvalYears of ageTrial patientsElderly patientsMedian ageBlack patientsAsian patientsAdministration approvalClinical studiesFDA reviewersPatientsHispanic participantsTrialsDemographic characteristics
2015
National Trends in Pulmonary Embolism Hospitalization Rates and Outcomes for Adults Aged ≥65 Years in the United States (1999 to 2010)
Minges KE, Bikdeli B, Wang Y, Kim N, Curtis JP, Desai MM, Krumholz HM. National Trends in Pulmonary Embolism Hospitalization Rates and Outcomes for Adults Aged ≥65 Years in the United States (1999 to 2010). The American Journal Of Cardiology 2015, 116: 1436-1442. PMID: 26409636, PMCID: PMC4841688, DOI: 10.1016/j.amjcard.2015.07.068.Peer-Reviewed Original ResearchConceptsHospitalization ratesMortality rateReadmission ratesBlack patientsPrincipal discharge diagnosis codeOlder adultsCause readmission rateHospital mortality rateProportion of patientsRetrospective cohort studyDischarge diagnosis codesSkilled nursing facilitiesNational trendsSignificant racial differencesHigh rateHome health careHospital stayAdults AgedCohort studyMore patientsTherapeutic advancesDiagnosis codesMedicare feeNursing facilitiesSignificant burdenLife Expectancy and Years of Potential Life Lost After Acute Myocardial Infarction by Sex and Race A Cohort-Based Study of Medicare Beneficiaries
Bucholz EM, Normand SL, Wang Y, Ma S, Lin H, Krumholz HM. Life Expectancy and Years of Potential Life Lost After Acute Myocardial Infarction by Sex and Race A Cohort-Based Study of Medicare Beneficiaries. Journal Of The American College Of Cardiology 2015, 66: 645-655. PMID: 26248991, PMCID: PMC5459400, DOI: 10.1016/j.jacc.2015.06.022.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionWhite patientsBlack patientsLife expectancyMyocardial infarctionMedicare beneficiariesCox proportional hazards regressionPotential lifeProspective cohort studyCohort-based studyProportional hazards regressionCooperative Cardiovascular ProjectBurden of diseaseLong-term survivalCohort studyClinical presentationHazards regressionBlack raceSurvival advantageGeneral populationPatientsAverage ageRace differencesLife expectancy estimatesYPLLRacial Differences in Heart Failure Outcomes Evidence From the Tele-HF Trial (Telemonitoring to Improve Heart Failure Outcomes)
Qian F, Parzynski CS, Chaudhry SI, Hannan EL, Shaw BA, Spertus JA, Krumholz HM. Racial Differences in Heart Failure Outcomes Evidence From the Tele-HF Trial (Telemonitoring to Improve Heart Failure Outcomes). JACC Heart Failure 2015, 3: 531-538. PMID: 26160368, PMCID: PMC8635169, DOI: 10.1016/j.jchf.2015.03.005.Peer-Reviewed Original ResearchConceptsPatient-reported health statusKansas City Cardiomyopathy QuestionnaireHeart failureBlack patientsHealth statusHF hospitalizationRacial differencesBaseline KCCQ scoresClinical laboratory valuesPatient-reported outcomesSignificant racial differencesKCCQ scoresHF admissionsPatient demographicsWhite patientsLaboratory valuesPropensity score methodsPatientsHospitalizationOutcome evidenceMonthsLinear mixed modelsBaselineTrialsStatus
2014
Trends in Hospitalizations Among Medicare Survivors of Aortic Valve Replacement in the United States From 1999 to 2010
Murugiah K, Wang Y, Dodson JA, Nuti SV, Dharmarajan K, Ranasinghe I, Cooper Z, Krumholz HM. Trends in Hospitalizations Among Medicare Survivors of Aortic Valve Replacement in the United States From 1999 to 2010. The Annals Of Thoracic Surgery 2014, 99: 509-517. PMID: 25527425, PMCID: PMC4454375, DOI: 10.1016/j.athoracsur.2014.08.045.Peer-Reviewed Original ResearchConceptsAortic valve replacementValve replacementHospitalization ratesAnnual Medicare paymentsPrincipal diagnosisOne-year hospitalization rateCommon principal diagnosisRisk of hospitalizationMean lengthGeneral Medicare populationMedicare paymentsPostoperative complicationsHeart failureBlack patientsMedicare patientsHospitalizationMedicare populationMedicare beneficiariesMortality ratePatientsStayCumulative daysCumulative lengthCertain subgroupsSurvivorsVariation in Hospital-Level Risk-Standardized Complication Rates Following Elective Primary Total Hip and Knee Arthroplasty
Bozic KJ, Grosso LM, Lin Z, Parzynski CS, Suter LG, Krumholz HM, Lieberman JR, Berry DJ, Bucholz R, Han L, Rapp MT, Bernheim S, Drye EE. Variation in Hospital-Level Risk-Standardized Complication Rates Following Elective Primary Total Hip and Knee Arthroplasty. Journal Of Bone And Joint Surgery 2014, 96: 640-647. PMID: 24740660, DOI: 10.2106/jbjs.l.01639.Peer-Reviewed Original ResearchConceptsElective total hip arthroplastyTotal hip arthroplastyComplication rateBlack patientsStudy cohortTKA proceduresMedicaid patientsU.S. hospitalsMedicare feeElective primary total hip arthroplastyPrimary total hip arthroplastyElective primary total hipTotal knee arthroplasty proceduresPrimary total hipPeriprosthetic joint infectionKnee arthroplasty proceduresNational Medicare feeHigher proportionHospital-level riskNational Quality ForumCross-sectional analysisHierarchical logistic regressionTKA patientsCommon complicationPatient comorbidities
2013
Trends in Aortic Valve Replacement for Elderly Patients in the United States, 1999-2011
Barreto-Filho JA, Wang Y, Dodson JA, Desai MM, Sugeng L, Geirsson A, Krumholz HM. Trends in Aortic Valve Replacement for Elderly Patients in the United States, 1999-2011. JAMA 2013, 310: 2078-2084. PMID: 24240935, PMCID: PMC4089974, DOI: 10.1001/jama.2013.282437.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overAortic ValveBicuspid Aortic Valve DiseaseBlack PeopleCohort StudiesCoronary Artery BypassCross-Sectional StudiesFee-for-Service PlansFemaleHeart Defects, CongenitalHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansLength of StayMaleMedicarePatient ReadmissionTreatment OutcomeUnited StatesConceptsSurgical aortic valve replacementAortic valve replacementValve replacementProcedure ratesElderly patientsCoronary artery bypass graft surgeryArtery bypass graft surgeryCross-sectional cohort studyPatients 85 yearsBypass graft surgeryHigh mortality rateCause readmissionCABG surgeryGraft surgeryOlder patientsCohort studyReadmission ratesTranscatheter optionsBlack patientsTranscatheter treatmentMechanical prosthesesThirty-dayContemporary outcomesMAIN OUTCOMEMedicare feeLong-Term Outcomes in Elderly Survivors of In-Hospital Cardiac Arrest
Chan PS, Nallamothu BK, Krumholz HM, Spertus JA, Li Y, Hammill BG, Curtis LH. Long-Term Outcomes in Elderly Survivors of In-Hospital Cardiac Arrest. New England Journal Of Medicine 2013, 368: 1019-1026. PMID: 23484828, PMCID: PMC3652256, DOI: 10.1056/nejmoa1200657.Peer-Reviewed Original ResearchConceptsHospital cardiac arrestCardiac arrestNeurologic disabilityReadmission ratesElderly survivorsRisk-adjusted ratesNeurologic statusHeart failureIn-Hospital Cardiac ArrestInpatient cardiac arrestsSevere neurologic disabilityDemographic characteristicsLong-term outcomesLong-term survivalYears of ageRate of survivalHospital dischargeOlder patientsYounger patientsWhite patientsBlack patientsTerm outcomesNational registryMedicare filesPatients
2011
Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH)
Arnold SV, Chan PS, Jones PG, Decker C, Buchanan DM, Krumholz HM, Ho PM, Spertus JA. Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH). Circulation Cardiovascular Quality And Outcomes 2011, 4: 467-476. PMID: 21772003, PMCID: PMC3376532, DOI: 10.1161/circoutcomes.110.960468.Peer-Reviewed Original ResearchConceptsHealth status studiesMyocardial infarctionHealth statusPostdischarge careAcute Myocardial Infarction Patients' Health StatusSubset of patientsTranslational researchPost-MI outcomesRacial differencesHigh mortality ratePatients' health statusMI registryChart abstractionHospital dischargeWhite patientsBlack patientsVital statusMedical historyWorse outcomesTreatment characteristicsInpatient careBaseline interviewUS CentersBlood samplesPatients
2009
Racial Differences in Survival After In-Hospital Cardiac Arrest
Chan PS, Nichol G, Krumholz HM, Spertus JA, Jones PG, Peterson ED, Rathore SS, Nallamothu BK, Investigators F. Racial Differences in Survival After In-Hospital Cardiac Arrest. JAMA 2009, 302: 1195-1201. PMID: 19755698, PMCID: PMC2795316, DOI: 10.1001/jama.2009.1340.Peer-Reviewed Original ResearchConceptsHospital cardiac arrestCardiac arrestBlack patientsWhite patientsSuccessful resuscitationPostresuscitation survivalRacial differencesHospital sitesIn-Hospital Cardiac ArrestLower ratesPulseless ventricular tachycardiaRate of survivalCohort studyHospital dischargePatient characteristicsClinical factorsImmediate resuscitationPostresuscitation periodNational registryVentricular tachycardiaHospital CenterVentricular fibrillationCardiopulmonary resuscitationAdditional adjustmentPatientsFactors associated with racial differences in myocardial infarction outcomes.
Spertus JA, Jones PG, Masoudi FA, Rumsfeld JS, Krumholz HM. Factors associated with racial differences in myocardial infarction outcomes. Annals Of Internal Medicine 2009, 150: 314-24. PMID: 19258559, PMCID: PMC3387537, DOI: 10.7326/0003-4819-150-5-200903030-00007.Peer-Reviewed Original ResearchConceptsQuality of lifeMyocardial infarction outcomesSite of careBlack patientsMyocardial infarctionRacial differencesPost-myocardial infarction outcomesBaseline cardiac riskHigher unadjusted mortalityProspective cohort studySeattle Angina QuestionnaireAngina QuestionnaireCardiovascular outcomesCause mortalityRehospitalization ratesUnadjusted mortalityCohort studyHospital factorsPatient characteristicsWhite patientsCardiac dysfunctionCardiac riskPatient factorsPatient's symptomsNational Heart
2005
Racial differences in reperfusion therapy use in patients hospitalized with myocardial infarction: A regional phenomenon
Rathore SS, Frederick PD, Every NR, Barron HV, Krumholz HM. Racial differences in reperfusion therapy use in patients hospitalized with myocardial infarction: A regional phenomenon. American Heart Journal 2005, 149: 1074-1081. PMID: 15976791, PMCID: PMC2790272, DOI: 10.1016/j.ahj.2004.08.018.Peer-Reviewed Original ResearchConceptsTherapy useMyocardial infarctionBlack patientsReperfusion therapyWhite patientsRacial differencesLower crude ratesMyocardial Infarction 2Reperfusion therapy ratesCohort of patientsTherapy ratesMultivariable adjustmentClinical contraindicationsNational registryPractice patternsCrude ratePatientsInfarctionGeographic regionsTherapyLower ratesTreatmentNational patternsContraindicationsDifferencesRace and Renal Impairment in Heart Failure
Smith GL, Shlipak MG, Havranek EP, Masoudi FA, McClellan WM, Foody JM, Rathore SS, Krumholz HM. Race and Renal Impairment in Heart Failure. Circulation 2005, 111: 1270-1277. PMID: 15769768, DOI: 10.1161/01.cir.0000158131.78881.d5.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBiomarkersBlack or African AmericanCohort StudiesComorbidityCreatinineDiabetes MellitusFemaleGlomerular Filtration RateHeart FailureHumansHypertensionInpatientsKidney DiseasesMaleMedicareMortalityMyocardial InfarctionPrognosisRetrospective StudiesRisk FactorsTreatment OutcomeWhite PeopleConceptsRenal impairmentHF patientsWhite patientsMortality riskRacial differencesElderly HF patientsSimilar racial differencesGlomerular filtration rateHeart failure patientsStriking racial disparitiesMagnitude of riskDistinct morbidityElevated creatinineFailure patientsRenal functionHeart failureHigher creatinineRenal diseaseBlack patientsOptimal therapyPrognostic indicatorFiltration rateMedicare patientsMortality burdenRepresentative cohortThe impact of socioeconomic status and race on trial participation for older women with breast cancer
Gross CP, Filardo G, Mayne ST, Krumholz HM. The impact of socioeconomic status and race on trial participation for older women with breast cancer. Cancer 2005, 103: 483-491. PMID: 15597407, DOI: 10.1002/cncr.20792.Peer-Reviewed Original ResearchMeSH KeywordsAgedAsianBlack or African AmericanBreast NeoplasmsCase-Control StudiesClinical Trials as TopicFemaleHispanic or LatinoHumansLogistic ModelsMedicaidMultivariate AnalysisNational Institutes of Health (U.S.)Odds RatioPatient SelectionPovertySEER ProgramUnemploymentUnited StatesWhite PeopleConceptsBreast cancer trialsTrial participationOlder womenBreast cancerSocioeconomic statusMedicaid insuranceTrial enrollmentCancer patientsCancer trialsMultivariable logistic regression modelBreast cancer patientsMedicaid insurance coverageAssociation of SESHigh-poverty zip codesCase-control studyPopulation-based sampleLow socioeconomic statusLogistic regression modelsImpact of SESWhite patientsBlack patientsSEER areasBlack raceElderly womenTrial participants