2024
Learning implementation of a guideline based decision support system to improve hypertension treatment in primary care in China: pragmatic cluster randomised controlled trial
Song J, Wang X, Wang B, Ge Y, Bi L, Jing F, Jin H, Li T, Gu B, Wang L, Hao J, Zhao Y, Liu J, Zhang H, Li X, Li J, Ma W, Wang J, Normand S, Herrin J, Armitage J, Krumholz H, Zheng X. Learning implementation of a guideline based decision support system to improve hypertension treatment in primary care in China: pragmatic cluster randomised controlled trial. The BMJ 2024, 386: e079143. PMID: 39043397, PMCID: PMC11265211, DOI: 10.1136/bmj-2023-079143.Peer-Reviewed Original ResearchConceptsClinical decision support systemsPrimary care practicesElectronic health recordsIntervention groupSystolic blood pressurePrimary careCare practicesBlood pressure <Health recordsPragmatic cluster randomised controlled trialCluster randomised controlled trialImproving hypertension treatmentPrimary care settingBlood pressure control ratesBlood pressureProportion of visitsProportion of participantsRandomised controlled trialsSystolic blood pressure <Control groupInjurious fallsRelated visitsCare settingsDiastolic blood pressure <Follow-up
2023
Primary care institutional characteristics associated with hypertension awareness, treatment, and control in the China PEACE-Million Persons Project and primary health-care survey: a cross-sectional study
Group C, Zhou T, Wang Y, Zhang H, Wu C, Tian N, Cui J, Bai X, Yang Y, Zhang X, Lu Y, Spatz E, Ross J, Krumholz H, Lu J, Li X, Hu S. Primary care institutional characteristics associated with hypertension awareness, treatment, and control in the China PEACE-Million Persons Project and primary health-care survey: a cross-sectional study. The Lancet Global Health 2023, 11: e83-e94. PMID: 36521957, DOI: 10.1016/s2214-109x(22)00428-4.Peer-Reviewed Original ResearchConceptsProportion of participantsPrimary care institutionsHypertension awarenessPrimary care systemBlood pressureCare institutionsCardiac Events Million Persons ProjectAverage diastolic blood pressureMedical Sciences (CAMS) Innovation FundAverage systolic blood pressureCare systemMillion Persons ProjectHistory of hypertensionDiastolic blood pressurePrimary care surveySystolic blood pressureCardiovascular disease riskBlood pressure measurementsCross-sectional studyParticipant-level dataProportion of physiciansRoutine service deliveryPrimary care roleHealth Care SurveyPublic health services
2022
Sex Differences in Characteristics, Treatments, and Outcomes Among Patients Hospitalized for Non–ST-Segment–Elevation Myocardial Infarction in China: 2006 to 2015
Guo W, Du X, Gao Y, Hu S, Lu Y, Dreyer RP, Li X, Spatz ES, Masoudi FA, Krumholz HM, Zheng X. Sex Differences in Characteristics, Treatments, and Outcomes Among Patients Hospitalized for Non–ST-Segment–Elevation Myocardial Infarction in China: 2006 to 2015. Circulation Cardiovascular Quality And Outcomes 2022, 15: e008535. PMID: 35607994, PMCID: PMC9208815, DOI: 10.1161/circoutcomes.121.008535.Peer-Reviewed Original ResearchConceptsSegment elevation myocardial infarctionInvasive strategyMyocardial infarctionHospital mortalityHospital outcomesMultivariable logistic regression modelCardiovascular risk factorsElevation myocardial infarctionSex-related disparitiesQuality of careProportion of womenLogistic regression modelsSex differencesClinical characteristicsClinical profileRisk factorsClinical covariatesSex-specific differencesPatientsInfarctionST segmentSex gapChinese hospitalsMortalityWomen
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 DBPChanges in ST segment elevation myocardial infarction hospitalisations in China from 2011 to 2015
Zhou T, Li X, Lu Y, Murugiah K, Bai X, Hu S, Gao Y, Masoudi FA, Krumholz HM, Li J, . Changes in ST segment elevation myocardial infarction hospitalisations in China from 2011 to 2015. Open Heart 2021, 8: e001666. PMID: 34599073, PMCID: PMC8488733, DOI: 10.1136/openhrt-2021-001666.Peer-Reviewed Original ResearchConceptsST-segment elevation myocardial infarctionPrehospital delayMyocardial infarctionSegment elevation myocardial infarctionProportion of patientsElevation myocardial infarctionAcute cardiovascular careAcute myocardial infarctionWeighted national estimateHealth service capacityRisk-adjusted ratesAcute reperfusionEligible patientsHospital deathReperfusion therapyMedical chartsPatient characteristicsHospital treatmentPatient outcomesRandom cohortCardiovascular diseaseCardiovascular carePatientsNational estimatesStandardised definitionsPrevalence of Dyslipidemia and Availability of Lipid-Lowering Medications Among Primary Health Care Settings in China
Lu Y, Zhang H, Lu J, Ding Q, Li X, Wang X, Sun D, Tan L, Mu L, Liu J, Feng F, Yang H, Zhao H, Schulz WL, Krumholz HM, Pan X, Li J, Huang C, Dong Z, Jiang B, Guo Z, Zhang Y, Sun J, Liu Y, Ren Z, Meng Y, Wang Z, Xi Y, Xing L, Tian Y, Liu J, Fu Y, Liu T, Sun W, Yan S, Jin L, Zheng Y, Wang J, Yan J, Xu X, Chen Y, Xing X, Zhang L, Zhong W, Fang X, Zhu L, Xu Y, Guo X, Xu C, Zhou G, Fan L, Qi M, Zhu S, Qi J, Li J, Yin L, Liu Q, Geng Q, Feng Y, Wang J, Wen H, Han X, Liu P, Ding X, Xu J, Deng Y, He J, Liu G, Jiang C, Zha S, Yang C, Bai G, Yu Y, Tashi Z, Qiu L, Hu Z, He H, Zhang J, Zhou M, Li X, Zhao J, Ma S, Ma Y, Huang Y, Zhang Y, Li F, Shen J. Prevalence of Dyslipidemia and Availability of Lipid-Lowering Medications Among Primary Health Care Settings in China. JAMA Network Open 2021, 4: e2127573. PMID: 34586366, PMCID: PMC8482054, DOI: 10.1001/jamanetworkopen.2021.27573.Peer-Reviewed Original ResearchConceptsAtherosclerotic cardiovascular diseaseLipid-lowering medicationsPrimary care institutionsPrevalence of dyslipidemiaControl of dyslipidemiaLipoprotein cholesterolCare institutionsControl rateFemale sexCardiovascular diseaseMAIN OUTCOMEHigh riskNonstatin lipid-lowering drugsHigh-density lipoprotein cholesterolLow-density lipoprotein cholesterolPrimary health care settingsMajor public health problemLipid lowering medicationsMillion Persons ProjectOverall control rateLDL-C levelsLipid-lowering drugsCross-sectional studyPublic health problemHealth care settingsObesity Prevalence and Risks Among Chinese Adults
Mu L, Liu J, Zhou G, Wu C, Chen B, Lu Y, Lu J, Yan X, Zhu Z, Nasir K, Spatz ES, Krumholz HM, Zheng X. Obesity Prevalence and Risks Among Chinese Adults. Circulation Cardiovascular Quality And Outcomes 2021, 14: e007292. PMID: 34107739, PMCID: PMC8204767, DOI: 10.1161/circoutcomes.120.007292.Peer-Reviewed Original ResearchConceptsAbdominal obesitySocio-demographic subgroupsSocio-demographic associationsOverall obesityHigh riskMillion Persons ProjectEpidemic of obesityAge-standardized ratesCommunity-dwelling adultsAssociation of ageMultivariable mixed modelsObesity prevalenceOlder womenLower riskObesityOlder menChinese adultsPrevalenceWomenRiskMenPersons ProjectSubgroupsAssociationAdults
2020
Assessment of Prevalence, Awareness, and Characteristics of Isolated Systolic Hypertension Among Younger and Middle-Aged Adults in China
Mahajan S, Feng F, Hu S, Lu Y, Gupta A, Murugiah K, Gao Y, Lu J, Liu J, Zheng X, Spatz ES, Zhang H, Krumholz HM, Li J. Assessment of Prevalence, Awareness, and Characteristics of Isolated Systolic Hypertension Among Younger and Middle-Aged Adults in China. JAMA Network Open 2020, 3: e209743. PMID: 33289843, PMCID: PMC7724558, DOI: 10.1001/jamanetworkopen.2020.9743.Peer-Reviewed Original ResearchConceptsMiddle-aged adultsSystolic hypertensionCardiac Events Million Persons ProjectOlder individualsIsolated systolic hypertensionManagement of ISHMillion Persons ProjectPrevalence of ISHPrevious cardiovascular eventsSystolic blood pressureTypes of hypertensionAssessment of prevalenceCross-sectional studyHypertension subtypesCardiovascular eventsBlood pressureChina PatientMean ageHypertensionMAIN OUTCOMEAwareness ratePrevalenceAged adultsYoung adultsAdultsGeographic Variation in Process and Outcomes of Care for Patients With Acute Myocardial Infarction in China From 2001 to 2015
Zhong Q, Gao Y, Zheng X, Chen J, Masoudi FA, Lu Y, Feng Y, Hu S, Zhang Q, Huang C, Wang Y, Krumholz HM, Li X, Zhou Y. Geographic Variation in Process and Outcomes of Care for Patients With Acute Myocardial Infarction in China From 2001 to 2015. JAMA Network Open 2020, 3: e2021182. PMID: 33095248, PMCID: PMC7584924, DOI: 10.1001/jamanetworkopen.2020.21182.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionProcess of careHospital mortalityMyocardial infarctionOdds ratioAngiotensin receptor blockersCross-sectional studyOutcomes of careReceptor blockersReperfusion therapyPatient characteristicsTherapy useCare measuresPatient hospitalizationIdeal patientOutcome measuresMAIN OUTCOMEΒ-blockersAMI managementPatientsEnzyme inhibitorsSignificant geographic variationMortalityCareHospitalizationQuality of primary health care in China: challenges and recommendations
Li X, Krumholz HM, Yip W, Cheng KK, De Maeseneer J, Meng Q, Mossialos E, Li C, Lu J, Su M, Zhang Q, Xu DR, Li L, Normand ST, Peto R, Li J, Wang Z, Yan H, Gao R, Chunharas S, Gao X, Guerra R, Ji H, Ke Y, Pan Z, Wu X, Xiao S, Xie X, Zhang Y, Zhu J, Zhu S, Hu S. Quality of primary health care in China: challenges and recommendations. The Lancet 2020, 395: 1802-1812. PMID: 32505251, PMCID: PMC7272159, DOI: 10.1016/s0140-6736(20)30122-7.Peer-Reviewed Original ResearchConceptsPrimary health care systemHealth care systemPrimary health carePublic health servicesClinical careHealth servicesPrimary health care physiciansPrimary health care practitionersPrimary health care institutionsBasic public health servicesHealth care physiciansHealth careCoronavirus disease 2019Entire health care systemHealth care practitionersHigh-value careLearning health systemChronic diseasesDisease 2019Health care institutionsInfectious diseasesHealth systemCare systemCareSuboptimal educationUse of intravenous magnesium sulfate among patients with acute myocardial infarction in China from 2001 to 2015: China PEACE—Retrospective AMI Study
Wang X, Du X, Yang H, Bucholz E, Downing N, Spertus JA, Masoudi FA, Li J, Guan W, Gao Y, Hu S, Bai X, Krumholz HM, Li X. Use of intravenous magnesium sulfate among patients with acute myocardial infarction in China from 2001 to 2015: China PEACE—Retrospective AMI Study. BMJ Open 2020, 10: e033269. PMID: 32220910, PMCID: PMC7170603, DOI: 10.1136/bmjopen-2019-033269.Peer-Reviewed Original ResearchConceptsIntravenous magnesium sulfateAcute myocardial infarctionMagnesium sulfate useMyocardial infarctionMagnesium sulfateChina PEACE-Retrospective AMI StudyHospital-level variationProportion of hospitalsHospital-specific characteristicsMedian ORsSignificant initial decreaseReperfusion therapyCardiac arrestAMI careIneffective therapyPatient outcomesRepresentative sampleObservational studyMAIN OUTCOMEChinese guidelinesPatientsChinese hospitalsRoutine useAMI studyInfarctionRelationship of Age With the Hemodynamic Parameters in Individuals With Elevated Blood Pressure
Mahajan S, Gu J, Caraballo C, Lu Y, Spatz ES, Zhao H, Zhang M, Sun N, Zheng X, Lu H, Yuan H, J. Z, Krumholz HM. Relationship of Age With the Hemodynamic Parameters in Individuals With Elevated Blood Pressure. Journal Of The American Geriatrics Society 2020, 68: 1520-1528. PMID: 32212398, DOI: 10.1111/jgs.16411.Peer-Reviewed Original ResearchConceptsElevated blood pressureBlood pressureCardiac indexHemodynamic profileHemodynamic parametersHealth checkup centerFinal study populationPathophysiology of hypertensionSelection of therapyCross-sectional studyMin/Relationship of ageDifferent age groupsHemodynamic assessmentMean ageStudy populationMAIN OUTCOMEAge strataAge groupsLarger studyImpedance cardiographyAgeSVRIWomenMenSex Differences in 1‐Year Health Status Following Percutaneous Coronary Intervention in Patients Without Acute Myocardial Infarction: Results From the China PEACE Prospective Study
Zheng X, Dreyer RP, Curtis JP, Liu S, Xu X, Bai X, Li X, Zhang H, Wang S, Masoudi FA, Spertus JA, Li J, Krumholz HM, Group F. Sex Differences in 1‐Year Health Status Following Percutaneous Coronary Intervention in Patients Without Acute Myocardial Infarction: Results From the China PEACE Prospective Study. Journal Of The American Heart Association 2020, 9: e014421. PMID: 32131687, PMCID: PMC7335522, DOI: 10.1161/jaha.119.014421.Peer-Reviewed Original ResearchConceptsPercutaneous coronary interventionAcute myocardial infarctionSAQ Summary ScoreCoronary interventionHealth status outcomesMyocardial infarctionHealth statusSummary scoresSAQ qualityAngina frequencyStatus outcomesPercutaneous coronary intervention studiesSAQ angina frequency scoreAngina frequency scoreCoronary Intervention StudyMarginal clinical significanceSAQ angina frequencyCardiac risk factorsChinese tertiary hospitalBackground Sex differencesSex differencesMultivariable adjustmentDiabetes mellitusTertiary hospitalLife scoresHeterogeneity in Trajectories of Systolic Blood Pressure among Young Adults in Qingdao Port Cardiovascular Health Study
Lin H, Cui M, Spatz ES, Wang Y, Lu J, Li J, Li S, Huang C, Liu X, Jiang L, Krumholz HM, Xu X. Heterogeneity in Trajectories of Systolic Blood Pressure among Young Adults in Qingdao Port Cardiovascular Health Study. Global Heart 2020, 15: 20. PMID: 32489793, PMCID: PMC7218791, DOI: 10.5334/gh.764.Peer-Reviewed Original ResearchConceptsSystolic blood pressureHigher systolic blood pressureCardiovascular Health StudyBlood pressureYoung adultsHealth StudyEffective blood pressure controlBaseline systolic blood pressureInitial systolic blood pressureGreater body mass indexBlood pressure controlBody mass indexGreater waist circumferenceBaseline health characteristicsSBP trendsWaist circumferenceMass indexSBP trajectoriesAdvanced ageOrdinal logistic regressionRisk factorsCardiovascular diseaseFamily historyHealth characteristicsHigh school educationSecondary prevention of cardiovascular disease in China
Lu J, Zhang L, Lu Y, Su M, Li X, Liu J, Zhang H, Nasir K, Masoudi F, Krumholz H, Li J, Zheng X. Secondary prevention of cardiovascular disease in China. Heart 2020, 106: 1349-1356. PMID: 31980439, DOI: 10.1136/heartjnl-2019-315884.Peer-Reviewed Original ResearchMeSH KeywordsAdultAge FactorsAgedAlcohol DrinkingCardiovascular DiseasesChinaFemaleHealthy LifestyleHeart Disease Risk FactorsHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedPlatelet Aggregation InhibitorsRisk AssessmentRisk Reduction BehaviorSecondary PreventionSex FactorsSmoking CessationTime FactorsTreatment OutcomeConceptsSecondary prevention drugsIschemic heart diseaseCardiovascular diseasePrevention drugsIschemic strokeSecondary preventionAntiplatelet drugsCardiac Events Million Persons ProjectHistory of IHDMillion Persons ProjectSecondary prevention therapiesPopulation subgroupsMultivariable mixed modelsPublic health programsCommunities of ChinaCurrent smokersCurrent useMedication usePrevention therapyMultivariable analysisChina PatientHeart diseaseCurrent drinkersHealth programsDrugsQuality of Care for Patients Hospitalized for Heart Failure in China
Gupta A, Yu Y, Tan Q, Liu S, Masoudi FA, Du X, Zhang J, Krumholz HM, Li J. Quality of Care for Patients Hospitalized for Heart Failure in China. JAMA Network Open 2020, 3: e1918619. PMID: 31913489, PMCID: PMC6991250, DOI: 10.1001/jamanetworkopen.2019.18619.Peer-Reviewed Original ResearchConceptsQuality of careHospital levelHF careEligible patientsComposite performance scoreEvidence-based β-blockersAngiotensin-converting enzyme inhibitorRetrospective cross-sectional studyVentricular ejection fraction assessmentMedian rateAngiotensin receptor blockersMedian patient ageHeart failure epidemicCross-sectional studyEjection fraction assessmentMedian odds ratioPerformance scoresHF hospitalizationReceptor blockersPatient ageHeart failureHospital admissionMedical recordsOdds ratioMAIN OUTCOME
2019
Prevalence, Awareness, and Treatment of Isolated Diastolic Hypertension: Insights From the China PEACE Million Persons Project
Mahajan S, Zhang D, He S, Lu Y, Gupta A, Spatz ES, Lu J, Huang C, Herrin J, Liu S, Yang J, Wu C, Cui J, Zhang Q, Li X, Nasir K, Zheng X, Krumholz HM, Li J, Dong Z, Jiang B, Zhang Y, Liu Y, Meng Y, Xi Y, Tian Y, Fu Y, Liu T, Yan S, Jin L, Wang J, Xu X, Xing X, Zhang L, Fang X, Xu Y, Xu C, Fan L, Qi M, Qi J, Li J, Liu Q, Feng Y, Wang J, Wen H, Xu J, He J, Jiang C, Yang C, Yu Y, Tashi Z, Hu Z, Zhang J, Li X, Ma S, Ma Y, Huang Y, Zhang Y, Shen J. Prevalence, Awareness, and Treatment of Isolated Diastolic Hypertension: Insights From the China PEACE Million Persons Project. Journal Of The American Heart Association 2019, 8: e012954. PMID: 31566101, PMCID: PMC6806046, DOI: 10.1161/jaha.119.012954.Peer-Reviewed Original ResearchConceptsMillion Persons ProjectPrior cardiovascular eventsBody mass indexAntihypertensive medicationsDiastolic hypertensionCardiovascular eventsDiabetes mellitusMass indexIsolated diastolic hypertensionDiastolic blood pressureSelf-reported diagnosisTreatment of peoplePersons ProjectBlood pressureTreatment patternsHypertensionLeast collegeHigher likelihoodMellitusMedicationsPrevalenceTreatmentDiagnosisSubstantial numberCurrent useHemodynamic Phenotypes of Hypertension Based on Cardiac Output and Systemic Vascular Resistance
Mahajan S, Gu J, Lu Y, Khera R, Spatz ES, Zhang M, Sun N, Zheng X, Zhao H, Lu H, Ma ZJ, Krumholz HM. Hemodynamic Phenotypes of Hypertension Based on Cardiac Output and Systemic Vascular Resistance. The American Journal Of Medicine 2019, 133: e127-e139. PMID: 31525336, DOI: 10.1016/j.amjmed.2019.08.042.Peer-Reviewed Original ResearchConceptsSystemic vascular resistance indexVascular resistance indexSystemic vascular resistanceCardiac indexBlood pressure categoriesResistance index ratioResistance indexVascular resistanceCardiac outputBlood pressureHemodynamic phenotypesPressure categoriesHigh systemic vascular resistance indexNormal systemic vascular resistance indexSystolic blood pressure 140Systolic blood pressure categoriesBlood pressure 140Health checkup centerNormal cardiac indexLow cardiac indexStroke volume indexHigher cardiac indexSystolic blood pressureBody mass indexSubtypes of hypertensionEffects of Mobile Text Messaging on Glycemic Control in Patients With Coronary Heart Disease and Diabetes Mellitus
Huo X, Krumholz HM, Bai X, Spatz ES, Ding Q, Horak P, Zhao W, Gong Q, Zhang H, Yan X, Sun Y, Liu J, Wu X, Guan W, Wang X, Li J, Li X, Spertus JA, Masoudi FA, Zheng X. Effects of Mobile Text Messaging on Glycemic Control in Patients With Coronary Heart Disease and Diabetes Mellitus. Circulation Cardiovascular Quality And Outcomes 2019, 12: e005805. PMID: 31474119, DOI: 10.1161/circoutcomes.119.005805.Peer-Reviewed Original ResearchMeSH KeywordsAgedAsian PeopleBiomarkersBlood GlucoseChinaCoronary DiseaseCulturally Competent CareDiabetes MellitusExerciseFemaleGlycated HemoglobinHealth CommunicationHealthy LifestyleHumansHypoglycemic AgentsMaleMedication AdherenceMiddle AgedMotivationPatient Education as TopicRisk Reduction BehaviorSelf CareSingle-Blind MethodTelemedicineText MessagingTime FactorsTreatment OutcomeConceptsCoronary heart diseaseHeart diseaseGlycemic controlIntervention groupUsual careDiabetes mellitusBlood glucosePhysical activityControl groupText message-based interventionBlood pressure controlProportion of patientsRisk factor managementGood glycemic controlSystolic blood pressureBody mass indexText messaging programsText message interventionMobile health interventionsSecondary outcomesBlood pressurePrimary outcomeLDL cholesterolMass indexMedication adherenceCharacteristics, Management, and Outcomes of Patients Hospitalized for Heart Failure in China: The China PEACE Retrospective Heart Failure Study
Yu Y, Gupta A, Wu C, Masoudi FA, Du X, Zhang J, Krumholz HM, Li J, Group T. Characteristics, Management, and Outcomes of Patients Hospitalized for Heart Failure in China: The China PEACE Retrospective Heart Failure Study. Journal Of The American Heart Association 2019, 8: e012884. PMID: 31431117, PMCID: PMC6755852, DOI: 10.1161/jaha.119.012884.Peer-Reviewed Original ResearchConceptsHeart failureHF careSignificant healthcare resource utilizationBackground Heart failureGuideline-recommended medicationsLower inpatient mortalityAcute heart failureOutcomes of patientsHealthcare resource utilizationLower prescription ratesMedical record abstractionHeart Failure StudyTraditional Chinese medicineHospital mortalityConclusions PatientsInpatient mortalityPatient characteristicsTreatment withdrawalEjection fractionMedian agePrescription ratesRecord abstractionMedian lengthBiomarker testingInpatient setting