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 outcomesTirzepatide and blood pressure reduction: stratified analyses of the SURMOUNT-1 randomised controlled trial
Krumholz H, de Lemos J, Sattar N, Linetzky B, Sharma P, Mast C, Ahmad N, Bunck M, Stefanski A. Tirzepatide and blood pressure reduction: stratified analyses of the SURMOUNT-1 randomised controlled trial. Heart 2024, 110: 1165-1171. PMID: 39084707, PMCID: PMC11420724, DOI: 10.1136/heartjnl-2024-324170.Peer-Reviewed Original ResearchBlood pressure reductionBlood pressure subgroupBlood pressurePost hoc analysisPressure reductionTirzepatide groupsAdverse eventsDiastolic blood pressure reductionHoc analysisAssociated with reduced blood pressureEffects of tirzepatideWeight-related complicationsOverall blood pressureLower blood pressure levelsWeight lossNormal blood pressureDiastolic blood pressureLower blood pressureBlood pressure levelsRandomised controlled trialsMediation analysisTirzepatideClinical subgroupsControlled hypertensionPlaceboLearning 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-upHypertension 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
Developing an Actionable Taxonomy of Persistent Hypertension Using Electronic Health Records
Lu Y, Du C, Khidir H, Caraballo C, Mahajan S, Spatz E, Curry L, Krumholz H. Developing an Actionable Taxonomy of Persistent Hypertension Using Electronic Health Records. Circulation Cardiovascular Quality And Outcomes 2023, 16: e009453. PMID: 36727515, DOI: 10.1161/circoutcomes.122.009453.Peer-Reviewed Original ResearchConceptsPersistent hypertensionElectronic health recordsBlood pressureHealth recordsPharmacologic agentsPrescribed treatmentYale New Haven Health SystemTreatment planAdditional pharmacologic agentsAntihypertensive treatment intensificationConsecutive outpatient visitsElevated blood pressurePersistence of hypertensionElectronic health record dataHealth record dataEligible patientsTreatment intensificationChart reviewHispanic patientsOutpatient visitsMean agePharmacological treatmentConventional content analysisHypertensionClinician notesPrimary 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
Gene Sequencing Identifies Perturbation in Nitric Oxide Signaling as a Nonlipid Molecular Subtype of Coronary Artery Disease
Khera AV, Wang M, Chaffin M, Emdin CA, Samani NJ, Schunkert H, Watkins H, McPherson R, Erdmann J, Elosua R, Boerwinkle E, Ardissino D, Butterworth A, Di Angelantonio E, Naheed A, Danesh J, Chowdhury R, Krumholz H, Sheu W, Rich S, Rotter J, Chen Y, Gabriel S, Lander E, Saleheen D, Kathiresan S. Gene Sequencing Identifies Perturbation in Nitric Oxide Signaling as a Nonlipid Molecular Subtype of Coronary Artery Disease. Circulation Genomic And Precision Medicine 2022, 15: e003598. PMID: 36215124, PMCID: PMC9771961, DOI: 10.1161/circgen.121.003598.Peer-Reviewed Original ResearchConceptsMolecular subtypesCAD riskHigher systolic blood pressureCoronary artery disease patientsEndothelial nitric oxide synthase geneDamaging missense variantsRisk of CADSystolic blood pressureCoronary artery diseaseRisk of hypertensionNitric oxide synthase geneMissense variantsNitric oxide synthesisRare variantsOxide synthase geneDiscrete molecular subtypesNitric Oxide SignalingLow density lipoprotein receptor geneArtery diseaseBlood pressureEndothelial functionVascular toneDisease patientsCAD casesCholesterol concentrationsHemodynamic differences between women and men with elevated blood pressure in China: A non-invasive assessment of 45,082 adults using impedance cardiography
Caraballo C, Mahajan S, Gu J, Lu Y, Spatz ES, Dreyer RP, Zhang M, Sun N, Ren Y, Zheng X, Zhao H, Lu H, J. Z, Krumholz HM. Hemodynamic differences between women and men with elevated blood pressure in China: A non-invasive assessment of 45,082 adults using impedance cardiography. PLOS ONE 2022, 17: e0269777. PMID: 35700163, PMCID: PMC9197037, DOI: 10.1371/journal.pone.0269777.Peer-Reviewed Original ResearchConceptsElevated blood pressureSystemic vascular resistance indexVascular resistance indexBlood pressureCardiac indexResistance indexHigh systemic vascular resistance indexLower systemic vascular resistance indexHigher mean systolic blood pressureMean diastolic blood pressureMean systolic blood pressureImpedance cardiographyLow cardiac indexHigher cardiac indexDiastolic blood pressureSystolic blood pressureBody mass indexYear old womanPersonalization of treatmentSame age groupNon-invasive assessmentSex differencesHemodynamic profileMass indexHemodynamic differencesEffectiveness of a clinical decision support system for hypertension management in primary care: study protocol for a pragmatic cluster-randomized controlled trial
Song J, Wang X, Wang B, Gao Y, Liu J, Zhang H, Li X, Li J, Wang JG, Cai J, Herrin J, Armitage J, Krumholz HM, Zheng X. Effectiveness of a clinical decision support system for hypertension management in primary care: study protocol for a pragmatic cluster-randomized controlled trial. Trials 2022, 23: 412. PMID: 35578345, PMCID: PMC9109449, DOI: 10.1186/s13063-022-06374-x.Peer-Reviewed Original ResearchConceptsHypertension managementPrimary carePrimary outcomeDual antihypertensive therapyHypertension Treatment TrialBlood pressure managementGuideline-based treatmentPrimary care sitesCluster-randomized trialUnit of randomizationGuideline-based decision support systemClinical decision support systemAntihypertensive regimensAntihypertensive treatmentUsual careGuideline adherenceBlood pressureMiddle-income countriesTreatment trialsManagement visitsStudy protocolCare sitesPatientsTrialsPressure managementProceedings From a National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention Workshop to Control Hypertension
Commodore-Mensah Y, Loustalot F, Himmelfarb CD, Desvigne-Nickens P, Sachdev V, Bibbins-Domingo K, Clauser SB, Cohen DJ, Egan BM, Fendrick AM, Ferdinand KC, Goodman C, Graham GN, Jaffe MG, Krumholz HM, Levy PD, Mays GP, McNellis R, Muntner P, Ogedegbe G, Milani RV, Polgreen LA, Reisman L, Sanchez EJ, Sperling LS, Wall HK, Whitten L, Wright JT, Wright JS, Fine LJ. Proceedings From a National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention Workshop to Control Hypertension. American Journal Of Hypertension 2022, 35: 232-243. PMID: 35259237, PMCID: PMC8903890, DOI: 10.1093/ajh/hpab182.Peer-Reviewed Original ResearchConceptsHypertension controlBlood pressureHypertension treatmentBlood InstituteNational HeartSelf-measured BP monitoringDisease controlCommunity-clinical linkagesModifiable risk factorsMore cardiovascular eventsAge-adjusted proportionSurgeon General's CallTeam-based careHigh-quality health carePublic health messagingCardiovascular eventsStroke preventionControl hypertensionBP monitoringHeart diseaseRisk factorsUS adultsClinical supportHealth messagingSocial determinants
2021
Temporal relationship of computed and structured diagnoses in electronic health record data
Schulz WL, Young HP, Coppi A, Mortazavi BJ, Lin Z, Jean RA, Krumholz HM. Temporal relationship of computed and structured diagnoses in electronic health record data. BMC Medical Informatics And Decision Making 2021, 21: 61. PMID: 33596898, PMCID: PMC7890604, DOI: 10.1186/s12911-021-01416-x.Peer-Reviewed Original ResearchConceptsElectronic health recordsStructured diagnosisOutpatient blood pressureElectronic health record dataAcademic health systemLow-density lipoproteinHealth record dataBlood pressureStructured data elementsAdministrative claimsHypertensionClinical informationHyperlipidemiaClinical phenotypeEquivalent diagnosisVital signsHealth systemDiagnosisProblem listAdditional studiesHealth recordsRecord dataTimely accessEHR dataPatients180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI study
Dodson JA, Hajduk AM, Murphy TE, Geda M, Krumholz HM, Tsang S, Nanna MG, Tinetti ME, Ouellet G, Sybrant D, Gill TM, Chaudhry SI. 180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI study. Open Heart 2021, 8: e001442. PMID: 33452007, PMCID: PMC7813425, DOI: 10.1136/openhrt-2020-001442.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionReadmission risk modelSelf-reported health statusMyocardial infarctionFunctional mobilityOlder adultsHealth statusDays of AMIFirst diastolic blood pressureChronic obstructive pulmonary diseaseIschemic ECG changesProspective cohort studyDiastolic blood pressureObstructive pulmonary diseaseLength of stayInitial heart rateFinal risk modelSILVER-AMI StudyRisk modelInitial hemoglobinCohort studyReadmission ratesBlood pressureEjection fractionHeart failure
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 adultsAdultsRelationship 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 cardiographyAgeSVRIWomenMenLeveraging the Electronic Health Records for Population Health: A Case Study of Patients With Markedly Elevated Blood Pressure
Lu Y, Huang C, Mahajan S, Schulz WL, Nasir K, Spatz ES, Krumholz HM. Leveraging the Electronic Health Records for Population Health: A Case Study of Patients With Markedly Elevated Blood Pressure. Journal Of The American Heart Association 2020, 9: e015033. PMID: 32200730, PMCID: PMC7428633, DOI: 10.1161/jaha.119.015033.Peer-Reviewed Original ResearchConceptsDiastolic blood pressureSystolic blood pressureElevated blood pressureBlood pressureElectronic health recordsPopulation health surveillanceHealth recordsYale New Haven Health SystemHealth surveillanceHealth systemPatterns of patientsLarge health systemUsual careOutpatient encountersControl ratePatientsCare patternsPopulation healthMonthsHgSurveillancePrevalenceRecordsVisitsCareHeterogeneity 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 education
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 hypertensionWorld Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions
Group T, Kaptoge S, Pennells L, De Bacquer D, Cooney M, Kavousi M, Stevens G, Riley L, Savin S, Khan T, Altay S, Amouyel P, Assmann G, Bell S, Ben-Shlomo Y, Berkman L, Beulens J, Björkelund C, Blaha M, Blazer D, Bolton T, Beaglehole R, Brenner H, Brunner E, Casiglia E, Chamnan P, Choi Y, Chowdry R, Coady S, Crespo C, Cushman M, Dagenais G, D'Agostino R, Daimon M, Davidson K, Engström G, Ford I, Gallacher J, Gansevoort R, Gaziano T, Giampaoli S, Grandits G, Grimsgaard S, Grobbee D, Gudnason V, Guo Q, Tolonen H, Humphries S, Iso H, Jukema J, Kauhanen J, Kengne A, Khalili D, Koenig W, Kromhout D, Krumholz H, Lam T, Laughlin G, Ibañez A, Meade T, Moons K, Nietert P, Ninomiya T, Nordestgaard B, O'Donnell C, Palmieri L, Patel A, Perel P, Price J, Providencia R, Ridker P, Rodriguez B, Rosengren A, Roussel R, Sakurai M, Salomaa V, Sato S, Schöttker B, Shara N, Shaw J, Shin H, Simons L, Sofianopoulou E, Sundström J, Völzke H, Wallace R, Wareham N, Willeit P, Wood D, Wood A, Zhao D, Woodward M, Danaei G, Roth G, Mendis S, Onuma O, Varghese C, Ezzati M, Graham I, Jackson R, Danesh J, Di Angelantonio E. World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. The Lancet Global Health 2019, 7: e1332-e1345. PMID: 31488387, PMCID: PMC7025029, DOI: 10.1016/s2214-109x(19)30318-3.Peer-Reviewed Original ResearchConceptsRisk prediction modelSystolic blood pressureCardiovascular disease riskBritish Heart FoundationIndividual participant dataCardiovascular diseaseBlood pressureTotal cholesterolC-indexFatal coronary heart diseaseNon-fatal cardiovascular diseaseDisease riskCardiovascular disease risk predictionParticipant dataIncident cardiovascular eventsHistory of diabetesRisk factor profileRisk prediction chartsWHO STEPwise approachSex-specific incidenceUK Medical Research CouncilCoronary heart diseaseFirst myocardial infarctionExternal validation cohortHarrell's C-indexEffects 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 adherence