2019
Home Health Care After Skilled Nursing Facility Discharge Following Heart Failure Hospitalization
Weerahandi H, Bao H, Herrin J, Dharmarajan K, Ross JS, Jones S, Horwitz LI. Home Health Care After Skilled Nursing Facility Discharge Following Heart Failure Hospitalization. Journal Of The American Geriatrics Society 2019, 68: 96-102. PMID: 31603248, PMCID: PMC6964248, DOI: 10.1111/jgs.16179.Peer-Reviewed Original ResearchConceptsSkilled nursing facilitiesHF hospitalizationReadmission ratesReadmission riskHeart failure readmission ratesDays of dischargeHeart failure hospitalizationRetrospective cohort studyHospital discharge practicesMore functional impairmentHome health careFailure hospitalizationHF patientsUnplanned readmissionCohort studyHospital dischargePrimary outcomeRestorative therapySNF stayFunctional impairmentHome healthcare servicesService Medicare dataAdjusted modelCox modelNursing facilitiesRisk of Readmission After Discharge From Skilled Nursing Facilities Following Heart Failure Hospitalization: A Retrospective Cohort Study
Weerahandi H, Li L, Bao H, Herrin J, Dharmarajan K, Ross JS, Kim KL, Jones S, Horwitz LI. Risk of Readmission After Discharge From Skilled Nursing Facilities Following Heart Failure Hospitalization: A Retrospective Cohort Study. Journal Of The American Medical Directors Association 2019, 20: 432-437. PMID: 30954133, PMCID: PMC6486375, DOI: 10.1016/j.jamda.2019.01.135.Peer-Reviewed Original ResearchConceptsSkilled nursing facilitiesSNF dischargeRetrospective cohort studySNF lengthHeart failureHF hospitalizationComposite outcomeCohort studyNursing facilitiesService beneficiaries 65Heart failure hospitalizationRisk of readmissionHazard rate ratiosFailure hospitalizationUnplanned readmissionHF diagnosisHospital dischargePostdischarge outcomesSNF stayMedicare patientsMedicare feeHome transitionPatientsReadmissionDay 3
2017
Age Differences in Hospital Mortality for Acute Myocardial Infarction: Implications for Hospital Profiling.
Dharmarajan K, McNamara RL, Wang Y, Masoudi FA, Ross JS, Spatz EE, Desai NR, de Lemos JA, Fonarow GC, Heidenreich PA, Bhatt DL, Bernheim SM, Slattery LE, Khan YM, Curtis JP. Age Differences in Hospital Mortality for Acute Myocardial Infarction: Implications for Hospital Profiling. Annals Of Internal Medicine 2017, 167: 555-564. PMID: 28973634, PMCID: PMC9359429, DOI: 10.7326/m16-2871.Peer-Reviewed Original ResearchConceptsRisk-standardized mortality ratesAcute myocardial infarctionOlder patientsYounger patientsMyocardial infarctionAge groupsHospital risk-standardized mortality ratesRetrospective cohort studyHospital mortality rankingsNational Quality ForumHospital mortalityMedian hospitalHospital outcomesCohort studyACTION RegistryAMI mortalityAmerican CollegeMedicare beneficiariesAMI hospitalizationPatientsMortality rateHospitalQuality ForumHospital ValueHospital profilingAssociation of Changing Hospital Readmission Rates With Mortality Rates After Hospital Discharge
Dharmarajan K, Wang Y, Lin Z, Normand ST, Ross JS, Horwitz LI, Desai NR, Suter LG, Drye EE, Bernheim SM, Krumholz HM. Association of Changing Hospital Readmission Rates With Mortality Rates After Hospital Discharge. JAMA 2017, 318: 270-278. PMID: 28719692, PMCID: PMC5817448, DOI: 10.1001/jama.2017.8444.Peer-Reviewed Original ResearchConceptsRisk-adjusted readmission ratesRisk-adjusted mortality ratesAcute myocardial infarctionHeart failureReadmission ratesMortality rateMyocardial infarctionMedicare feeService beneficiariesHospital readmission ratesMean hospitalHospital mortalityPostdischarge mortalityHospital dischargeHospital readmissionRetrospective studyAffordable Care ActReadmission reductionMAIN OUTCOMEPneumoniaHospitalSecondary analysisWeighted Pearson correlation coefficientMortalityCare ActQuality of Care in Chinese Hospitals: Processes and Outcomes After ST‐segment Elevation Myocardial Infarction
Downing NS, Wang Y, Dharmarajan K, Nuti SV, Murugiah K, Du X, Zheng X, Li X, Li J, Masoudi FA, Spertus JA, Jiang L, Krumholz HM. Quality of Care in Chinese Hospitals: Processes and Outcomes After ST‐segment Elevation Myocardial Infarction. Journal Of The American Heart Association 2017, 6: e005040. PMID: 28645937, PMCID: PMC5669155, DOI: 10.1161/jaha.116.005040.Peer-Reviewed Original ResearchConceptsST-elevation myocardial infarctionRisk-standardized mortality ratesQuality of careGuideline-recommended careGuideline-recommended treatmentMyocardial infarctionMortality rateST-segment elevation myocardial infarctionChina PEACE-Retrospective AMI StudyComposite rateMedian risk-standardized mortality rateProportion of patientsElevation myocardial infarctionQuality improvement initiativesProportion of opportunitiesDefect-free rateHospital levelInfarctionHospitalChinese hospitalsPatientsCareAMI studyImprovement initiativesHigh rateOutcomes after observation stays among older adult Medicare beneficiaries in the USA: retrospective cohort study
Dharmarajan K, Qin L, Bierlein M, Choi JES, Lin Z, Desai NR, Spatz ES, Krumholz HM, Venkatesh AK. Outcomes after observation stays among older adult Medicare beneficiaries in the USA: retrospective cohort study. The BMJ 2017, 357: j2616. PMID: 28634181, PMCID: PMC5476173, DOI: 10.1136/bmj.j2616.Peer-Reviewed Original ResearchSex Differences in Trajectories of Risk After Rehospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia
Dreyer RP, Dharmarajan K, Hsieh AF, Welsh J, Qin L, Krumholz HM. Sex Differences in Trajectories of Risk After Rehospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003271. PMID: 28506980, PMCID: PMC5650228, DOI: 10.1161/circoutcomes.116.003271.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionMyocardial infarctionHeart failureReadmission riskDaily riskImmediate postdischarge periodRisk of rehospitalizationSex differencesDeath 1 yearPrincipal discharge diagnosisHospitalization of patientsAssociation of sexRehospitalization riskPostdischarge periodDischarge diagnosisMedicare patientsHigh riskMortality riskMedicare feeTrajectories of riskRehospitalizationInfarctionService beneficiariesHospitalizationPneumoniaSeattle Heart Failure and Proportional Risk Models Predict Benefit From Implantable Cardioverter-Defibrillators
Bilchick KC, Wang Y, Cheng A, Curtis JP, Dharmarajan K, Stukenborg GJ, Shadman R, Anand I, Lund LH, Dahlström U, Sartipy U, Maggioni A, Swedberg K, O’Conner C, Levy WC. Seattle Heart Failure and Proportional Risk Models Predict Benefit From Implantable Cardioverter-Defibrillators. Journal Of The American College Of Cardiology 2017, 69: 2606-2618. PMID: 28545633, PMCID: PMC5502749, DOI: 10.1016/j.jacc.2017.03.568.Peer-Reviewed Original ResearchConceptsSeattle Heart Failure ModelSeattle Proportional Risk ModelNational Cardiovascular Data RegistryPrimary prevention ICDsHeart failureSudden deathCause mortalitySurvival benefitMultivariable Cox proportional hazards regressionCox proportional hazards regressionProportional riskProportional hazards regressionRecent clinical trialsHeart failure modelProportional risk modelControl patientsOverall survivalVentricular arrhythmiasHazards regressionICD benefitClinical trialsCardioverter defibrillatorLarge cohortHigh riskData registry
2016
Association Between Hospital Penalty Status Under the Hospital Readmission Reduction Program and Readmission Rates for Target and Nontarget Conditions
Desai NR, Ross JS, Kwon JY, Herrin J, Dharmarajan K, Bernheim SM, Krumholz HM, Horwitz LI. Association Between Hospital Penalty Status Under the Hospital Readmission Reduction Program and Readmission Rates for Target and Nontarget Conditions. JAMA 2016, 316: 2647-2656. PMID: 28027367, PMCID: PMC5599851, DOI: 10.1001/jama.2016.18533.Peer-Reviewed Original ResearchConceptsHospital Readmissions Reduction ProgramAcute myocardial infarctionReadmission ratesReadmissions Reduction ProgramHeart failurePenalty statusNontarget conditionsMedicare feeMean readmission rateThirty-day riskRetrospective cohort studyUnplanned readmission rateReduction programsHRRP announcementHRRP implementationPenalized hospitalsCohort studyService patientsMyocardial infarctionMAIN OUTCOMEExcess readmissionsMedicare beneficiariesService beneficiariesHospitalPatientsRelationship Between Age and Trajectories of Rehospitalization Risk in Older Adults
Dharmarajan K, Hsieh A, Dreyer RP, Welsh J, Qin L, Krumholz HM. Relationship Between Age and Trajectories of Rehospitalization Risk in Older Adults. Journal Of The American Geriatrics Society 2016, 65: 421-426. PMID: 27874977, PMCID: PMC5310961, DOI: 10.1111/jgs.14583.Peer-Reviewed Original ResearchTreatment for Multiple Acute Cardiopulmonary Conditions in Older Adults Hospitalized with Pneumonia, Chronic Obstructive Pulmonary Disease, or Heart Failure
Dharmarajan K, Strait KM, Tinetti ME, Lagu T, Lindenauer PK, Lynn J, Krukas MR, Ernst FR, Li SX, Krumholz HM. Treatment for Multiple Acute Cardiopulmonary Conditions in Older Adults Hospitalized with Pneumonia, Chronic Obstructive Pulmonary Disease, or Heart Failure. Journal Of The American Geriatrics Society 2016, 64: 1574-1582. PMID: 27448329, PMCID: PMC4988873, DOI: 10.1111/jgs.14303.Peer-Reviewed Original ResearchMeSH KeywordsAdrenal Cortex HormonesAgedAged, 80 and overAnti-Bacterial AgentsCardiotonic AgentsCohort StudiesComorbidityCross-Sectional StudiesDiureticsDrug Therapy, CombinationFemaleHeart FailureHospitalizationHumansMalePneumoniaPulmonary Disease, Chronic ObstructiveRetrospective StudiesUnited StatesVasodilator AgentsConceptsChronic obstructive pulmonary diseaseAcute cardiopulmonary conditionsObstructive pulmonary diseaseHeart failureCardiopulmonary conditionsOlder adultsPulmonary diseasePremier Research DatabaseEpisodes of pneumoniaRetrospective cohort studyReal-world treatmentHF hospitalizationCohort studyHospital daysPneumonia hospitalizationsCOPD hospitalizationsClinical syndromeAcute conditionsPneumoniaDiagnostic uncertaintyResearch DatabaseHospitalizationDiagnostic categoriesU.S. hospitalsAdultsDeclining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time
Dharmarajan K, Qin L, Lin Z, Horwitz LI, Ross JS, Drye EE, Keshawarz A, Altaf F, Normand SL, Krumholz HM, Bernheim SM. Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time. Health Affairs 2016, 35: 1294-1302. PMID: 27385247, DOI: 10.1377/hlthaff.2015.1614.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCenters for Medicare and Medicaid Services, U.S.Chronic DiseaseDatabases, FactualDisease ProgressionFemaleGeriatric AssessmentHospital MortalityHumansIncidenceLength of StayMaleOutcome Assessment, Health CarePatient AdmissionPatient ReadmissionRetrospective StudiesRisk AssessmentSeverity of Illness IndexTime FactorsUnited StatesCoronary Catheterization and Percutaneous Coronary Intervention in China: 10-Year Results From the China PEACE-Retrospective CathPCI Study
Zheng X, Curtis JP, Hu S, Wang Y, Yang Y, Masoudi FA, Spertus JA, Li X, Li J, Dharmarajan K, Downing NS, Krumholz HM, Jiang L. Coronary Catheterization and Percutaneous Coronary Intervention in China: 10-Year Results From the China PEACE-Retrospective CathPCI Study. JAMA Internal Medicine 2016, 176: 512. PMID: 26974883, PMCID: PMC5459379, DOI: 10.1001/jamainternmed.2016.0166.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAngina, UnstableCardiac CatheterizationChinaCoronary Artery DiseaseDrug-Eluting StentsFemaleHospital MortalityHospitals, UrbanHumansLength of StayMaleMedical RecordsMiddle AgedMyocardial InfarctionOdds RatioOutcome Assessment, Health CarePercutaneous Coronary InterventionPostoperative ComplicationsPostoperative HemorrhageQuality of Health CareRetrospective StudiesStentsTime-to-TreatmentConceptsPercutaneous coronary interventionDrug-eluting stentsQuality of careCoronary catheterizationCoronary interventionNonobstructive coronary artery diseasePrimary percutaneous coronary interventionFuture quality improvement initiativesEvidence-based medicationsOutcomes of patientsCoronary artery diseaseClinical observational studyUse of catheterizationQuality improvement initiativesCalendar year 2001Hospital mortalityArtery diseasePatient characteristicsStable patientsTreatment patternsMedian lengthMean agePCI proceduresMedical recordsObservational study
2015
Hospital variation in admission to intensive care units for patients with acute myocardial infarction
Chen R, Strait KM, Dharmarajan K, Li SX, Ranasinghe I, Martin J, Fazel R, Masoudi FA, Cooke CR, Nallamothu BK, Krumholz HM. Hospital variation in admission to intensive care units for patients with acute myocardial infarction. American Heart Journal 2015, 170: 1161-1169. PMID: 26678638, PMCID: PMC5459386, DOI: 10.1016/j.ahj.2015.09.003.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overAnterior Wall Myocardial InfarctionCoronary Care UnitsHealth Care RationingHospital MortalityHumansLength of StayMaleMiddle AgedOutcome and Process Assessment, Health CarePatient AdmissionQuality ImprovementRetrospective StudiesRisk AssessmentTriageUnited StatesConceptsAcute myocardial infarctionIntensive care unitCritical care therapiesRisk-standardized mortality ratesHospital risk-standardized mortality ratesICU admissionResource-intensive settingsCare therapyAMI patientsCare unitMyocardial infarctionMortality rateAdult hospitalizationsHospital variationNinth RevisionClinical ModificationICU triageInternational ClassificationBetter outcomesPatientsHospitalAdmissionPremier databaseTherapyAppropriate useSex Differences in the Rate, Timing, and Principal Diagnoses of 30-Day Readmissions in Younger Patients with Acute Myocardial Infarction
Dreyer RP, Ranasinghe I, Wang Y, Dharmarajan K, Murugiah K, Nuti SV, Hsieh AF, Spertus JA, Krumholz HM. Sex Differences in the Rate, Timing, and Principal Diagnoses of 30-Day Readmissions in Younger Patients with Acute Myocardial Infarction. Circulation 2015, 132: 158-166. PMID: 26085455, PMCID: PMC5322973, DOI: 10.1161/circulationaha.114.014776.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionMyocardial infarctionPrincipal diagnosisYounger patientsHigh riskUtilization Project State Inpatient DatabasesYoung womenCause readmission rateGreater mortality riskSex differencesNoncardiac diagnosesReadmission diagnosesReadmission timingReadmission ratesInpatient DatabaseReadmission riskFemale sexCondition categoriesReadmissionMortality riskHealthcare costsDay 2InfarctionPatientsDiagnosisHospital Variability in Use of Anticoagulant Strategies During Acute Myocardial Infarction Treated With an Early Invasive Strategy
Arnold SV, Li SX, Alexander KP, Spertus JA, Nallamothu BK, Curtis JP, Kosiborod M, Gupta A, Wang TY, Lin H, Dharmarajan K, Strait KM, Lowe TJ, Krumholz HM. Hospital Variability in Use of Anticoagulant Strategies During Acute Myocardial Infarction Treated With an Early Invasive Strategy. Journal Of The American Heart Association 2015, 4: e002009. PMID: 26077589, PMCID: PMC4599539, DOI: 10.1161/jaha.115.002009.Peer-Reviewed Original ResearchConceptsEarly invasive strategyAnticoagulant strategiesMyocardial infarctionBleeding rateInvasive strategyAcute myocardial infarction patientsOptimal anticoagulant strategyHalf of patientsPercutaneous coronary interventionAcute myocardial infarctionMyocardial infarction patientsHospital use patternsComparative effectiveness studiesRisk-standardized mortalityChoice of anticoagulantsMedian odds ratioCoronary interventionPatient factorsSystemic anticoagulationHospital variabilityInfarction patientsPrincipal diagnosisOdds ratioMultivariate regression modelPatterns of useTrajectories of risk after hospitalization for heart failure, acute myocardial infarction, or pneumonia: retrospective cohort study
Dharmarajan K, Hsieh AF, Kulkarni VT, Lin Z, Ross JS, Horwitz LI, Kim N, Suter LG, Lin H, Normand SL, Krumholz HM. Trajectories of risk after hospitalization for heart failure, acute myocardial infarction, or pneumonia: retrospective cohort study. The BMJ 2015, 350: h411. PMID: 25656852, PMCID: PMC4353309, DOI: 10.1136/bmj.h411.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionRetrospective cohort studyHeart failureRisk of deathMyocardial infarctionFirst readmissionAbsolute riskOlder patientsCohort studyRelative riskMedicare feeService beneficiariesRisk of readmissionGeneral elderly populationGeneral older populationRisk trajectoriesHigh-risk periodHospital dischargeHospital admissionDischarge diagnosisAdverse outcomesReadmissionHospitalizationTrajectories of riskElderly populationIntravenous Fluids in Acute Decompensated Heart Failure
Bikdeli B, Strait KM, Dharmarajan K, Li SX, Mody P, Partovian C, Coca SG, Kim N, Horwitz LI, Testani JM, Krumholz HM. Intravenous Fluids in Acute Decompensated Heart Failure. JACC Heart Failure 2015, 3: 127-133. PMID: 25660836, PMCID: PMC4438991, DOI: 10.1016/j.jchf.2014.09.007.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overCohort StudiesDatabases, FactualFemaleFluid TherapyHeart FailureHospital MortalityHospitalizationHumansInfusions, IntravenousIntensive Care UnitsIntubation, IntratrachealIsotonic SolutionsMaleMiddle AgedRenal Replacement TherapyRetrospective StudiesRinger's SolutionSaline Solution, HypertonicSodium Potassium Chloride Symporter InhibitorsUnited StatesYoung AdultConceptsAcute decompensated heart failureDecompensated heart failureHeart failureIntravenous fluidsRetrospective cohort studyCritical care admissionRenal replacement therapyDays of hospitalizationProportion of hospitalizationsHalf-normal salineWarrants further investigationOnly diureticsCare admissionHospital deathHospital outcomesCohort studyLoop diureticsPatient groupReplacement therapyWorse outcomesNormal salineInpatient careMedian volumePatientsHospitalization
2014
Readmissions after Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia among Young and Middle-Aged Adults: A Retrospective Observational Cohort Study
Ranasinghe I, Wang Y, Dharmarajan K, Hsieh AF, Bernheim SM, Krumholz HM. Readmissions after Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia among Young and Middle-Aged Adults: A Retrospective Observational Cohort Study. PLOS Medicine 2014, 11: e1001737. PMID: 25268126, PMCID: PMC4181962, DOI: 10.1371/journal.pmed.1001737.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionMiddle-aged adultsTiming of readmissionHeart failureReadmission ratesAMI cohortReadmission diagnosesHF cohortReadmission riskMyocardial infarctionAge groupsRetrospective observational cohort studyIndex admission diagnosisObservational cohort studySimilar risk patternNon-cardiac diagnosisPneumonia cohortAdmission diagnosisElderly patientsCohort studyPatient characteristicsPrimary outcomePayer statusReadmissionHospitalizationNational Trends in Recurrent AMI Hospitalizations 1 Year After Acute Myocardial Infarction in Medicare Beneficiaries: 1999–2010
Chaudhry SI, Khan RF, Chen J, Dharmarajan K, Dodson JA, Masoudi FA, Wang Y, Krumholz HM. National Trends in Recurrent AMI Hospitalizations 1 Year After Acute Myocardial Infarction in Medicare Beneficiaries: 1999–2010. Journal Of The American Heart Association 2014, 3: e001197. PMID: 25249298, PMCID: PMC4323804, DOI: 10.1161/jaha.114.001197.Peer-Reviewed Original Research