2021
Out‐of‐pocket Annual Health Expenditures and Financial Toxicity from Healthcare Costs in Patients with Heart Failure in the United States
Wang SY, Valero‐Elizondo J, Ali H, Pandey A, Cainzos‐Achirica M, Krumholz HM, Nasir K, Khera R. Out‐of‐pocket Annual Health Expenditures and Financial Toxicity from Healthcare Costs in Patients with Heart Failure in the United States. Journal Of The American Heart Association 2021, 10: e022164. PMID: 33998273, PMCID: PMC8483501, DOI: 10.1161/jaha.121.022164.Peer-Reviewed Original ResearchConceptsGreater risk-adjusted oddsRisk-adjusted oddsHeart failureMedical Expenditure Panel SurveyCatastrophic financial burdenPocket healthcare expensesHigh financial burdenFinancial toxicityHealthcare expensesFinancial burdenHealthcare costsCatastrophic burdenMajor public health burdenLow-income familiesBackground Heart failurePublic health burdenInsurance premiumsPanel SurveyPocket healthcare costsAnnual health expenditureWorld Health OrganizationConclusions PatientsHealth insurance premiumsPocket healthcare expenditureHealth burden
2020
Association Between Sociodemographic Determinants and Disparities in Stroke Symptom Awareness Among US Young Adults
Mszar R, Mahajan S, Valero-Elizondo J, Yahya T, Sharma R, Grandhi GR, Khera R, Virani SS, Lichtman J, Khan SU, Cainzos-Achirica M, Vahidy FS, Krumholz HM, Nasir K. Association Between Sociodemographic Determinants and Disparities in Stroke Symptom Awareness Among US Young Adults. Stroke 2020, 51: 3552-3561. PMID: 33100188, DOI: 10.1161/strokeaha.120.031137.Peer-Reviewed Original ResearchConceptsNational Health Interview SurveyCommon stroke symptomsStroke symptomsHealth Interview SurveyYoung adultsUS young adultsSymptom awarenessFocused public health interventionsInterview SurveyStroke symptom awarenessHigh-risk characteristicsPublic health interventionsArms/legsCertain sociodemographic subgroupsLow education levelStroke incidenceSevere headacheSingle symptomStudy populationTimely diagnosisHigher oddsStroke rateHispanic ethnicityGeneral populationSociodemographic determinantsStroke Code Presentations, Interventions, and Outcomes Before and During the COVID-19 Pandemic
Jasne AS, Chojecka P, Maran I, Mageid R, Eldokmak M, Zhang Q, Nystrom K, Vlieks K, Askenase M, Petersen N, Falcone GJ, Wira CR, Lleva P, Zeevi N, Narula R, Amin H, Navaratnam D, Loomis C, Hwang DY, Schindler J, Hebert R, Matouk C, Krumholz HM, Spudich S, Sheth KN, Sansing LH, Sharma R. Stroke Code Presentations, Interventions, and Outcomes Before and During the COVID-19 Pandemic. Stroke 2020, 51: 2664-2673. PMID: 32755347, PMCID: PMC7446978, DOI: 10.1161/str.0000000000000347.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBetacoronavirusBrain IschemiaCohort StudiesComorbidityConnecticutCoronary Artery DiseaseCoronavirus InfectionsCOVID-19DyslipidemiasEmergency Medical ServicesEthnicityFemaleHumansHypertensionIncomeInsurance, HealthIntracranial HemorrhagesMaleMedically UninsuredMiddle AgedOutcome and Process Assessment, Health CarePandemicsPneumonia, ViralRetrospective StudiesSARS-CoV-2Severity of Illness IndexStrokeSubstance-Related DisordersTelemedicineThrombectomyThrombolytic TherapyTime-to-TreatmentConceptsComprehensive stroke centerStroke codePatient characteristicsStroke severityStroke code patientsHistory of hypertensionStroke-like symptomsCoronary artery diseaseCoronavirus disease 2019 (COVID-19) pandemicPatient-level dataLower median household incomePublic health initiativesDisease 2019 pandemicCOVID-19 pandemicRace/ethnicityCode patientsHospital presentationPublic health insuranceRankin ScaleStroke centersArtery diseaseReperfusion timeStroke symptomsEarly outcomesConnecticut hospitals
2019
Association Between Insurance Status and Access to Hospital Care in Emergency Department Disposition
Venkatesh AK, Chou SC, Li SX, Choi J, Ross JS, D’Onofrio G, Krumholz HM, Dharmarajan K. Association Between Insurance Status and Access to Hospital Care in Emergency Department Disposition. JAMA Internal Medicine 2019, 179: 686-693. PMID: 30933243, PMCID: PMC6503571, DOI: 10.1001/jamainternmed.2019.0037.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAsthmaCritical CareCross-Sectional StudiesDatabases, FactualEmergency Service, HospitalFemaleHealth Services AccessibilityHospitalizationHumansInsurance CoverageInsurance, HealthLung DiseasesMaleMedicaidMedically UninsuredMiddle AgedPatient DischargePatient TransferPneumoniaPulmonary Disease, Chronic ObstructiveUnited StatesConceptsNational Emergency Department SampleEmergency Department SampleCommon medical conditionsUninsured patientsCritical care capabilitiesED dischargeED visitsED transfersPulmonary diseaseCare capabilitiesInsurance statusHigher oddsMedicaid beneficiariesMedical conditionsChronic obstructive pulmonary diseaseAcute pulmonary diseaseEmergency department transfersAdult ED visitsHospital admission ratesObstructive pulmonary diseaseEmergency department dispositionPatient insurance statusPatient case mixHospital ownership statusIntensive care capabilities
2018
Association of Out-of-Pocket Annual Health Expenditures With Financial Hardship in Low-Income Adults With Atherosclerotic Cardiovascular Disease in the United States
Khera R, Valero-Elizondo J, Okunrintemi V, Saxena A, Das SR, de Lemos JA, Krumholz HM, Nasir K. Association of Out-of-Pocket Annual Health Expenditures With Financial Hardship in Low-Income Adults With Atherosclerotic Cardiovascular Disease in the United States. JAMA Cardiology 2018, 3: 729-738. PMID: 29971325, PMCID: PMC6143078, DOI: 10.1001/jamacardio.2018.1813.Peer-Reviewed Original ResearchConceptsCatastrophic financial burdenLow-income familiesPocket health care expensesHigh financial burdenMedical Expenditure Panel SurveyHealth care expensesFamily incomeFinancial burdenPanel SurveyHealth expensesMean annual family incomePocket expensesCare expensesFinancial hardshipAtherosclerotic cardiovascular diseaseLow incomePocket health expensesAssociation of OutAnnual family incomeFederal poverty limitHigh-income familiesAnnual health expenditureLow-income adultsInsurance premiumsHealth expenditureTime to hospital arrival among patients with acute myocardial infarction in China: a report from China PEACE prospective study
Guan W, Venkatesh AK, Bai X, Xuan S, Li J, Li X, Zhang H, Zheng X, Masoudi FA, Spertus JA, Krumholz HM, Jiang L. Time to hospital arrival among patients with acute myocardial infarction in China: a report from China PEACE prospective study. European Heart Journal - Quality Of Care And Clinical Outcomes 2018, 5: 63-71. PMID: 29878087, PMCID: PMC6307335, DOI: 10.1093/ehjqcco/qcy022.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionHospital arrivalSymptom onsetMyocardial infarctionMedical insuranceLower household incomeRural medical insuranceChest discomfortChest painIndex hospitalizationMedian timeMultivariable analysisAMI symptomsProspective studyAssociated FactorsPatients' perceptionsCare seekingAMI hospitalizationPatientsSymptomsHousehold incomeAMI studyHospitalizationInfarctionAverage time
2017
The primary health-care system in China
Li X, Lu J, Hu S, Cheng K, De Maeseneer J, Meng Q, Mossialos E, Xu DR, Yip W, Zhang H, Krumholz HM, Jiang L, Hu S. The primary health-care system in China. The Lancet 2017, 390: 2584-2594. PMID: 29231837, DOI: 10.1016/s0140-6736(17)33109-4.Peer-Reviewed Original ResearchMeSH KeywordsChinaHealthcare FinancingHumansInsurance, HealthMedical InformaticsPrimary Health CareQuality of Health CareWorkforceConceptsPrimary health care systemHealth care systemChronic non-communicable diseasesEvidence-based performance indicatorsNon-communicable diseasesEveryday clinical practiceQuality of careHealth information technology systemsRisk factorsClinical practiceCare deliveryVillage doctorsHealth care reformInadequate educationCost savingsWorld populationPopulationPrevalenceDiseaseUpdated Cost-effectiveness Assessments of PCSK9 Inhibitors From the Perspectives of the Health System and Private Payers: Insights Derived From the FOURIER Trial
Arrieta A, Hong JC, Khera R, Virani SS, Krumholz HM, Nasir K. Updated Cost-effectiveness Assessments of PCSK9 Inhibitors From the Perspectives of the Health System and Private Payers: Insights Derived From the FOURIER Trial. JAMA Cardiology 2017, 2: 1369-1374. PMID: 29049467, PMCID: PMC5814995, DOI: 10.1001/jamacardio.2017.3655.Peer-Reviewed Original ResearchMeSH KeywordsAgedAnticholesteremic AgentsCardiovascular DiseasesCholesterol, LDLCost-Benefit AnalysisDecision Support TechniquesDrug Therapy, CombinationFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsHypercholesterolemiaInsuranceInsurance, HealthInsurance, Health, ReimbursementMaleMarkov ChainsMiddle AgedMyocardial InfarctionPCSK9 InhibitorsQuality-Adjusted Life YearsStrokeUnited StatesConceptsQuality-adjusted life yearsIncremental cost-effectiveness ratioCost-effectiveness ratioProprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitorsCurrent pricesLife yearsPrivate payersAdditional quality-adjusted life yearPreliminary cost-effectiveness analysisCost-effectiveness standardsProbabilistic sensitivity analysesCost-effectiveness analysisPrivate payer perspectiveCost-effectiveness assessmentNegative returnsHealth system perspectiveSignificant discountUS dollarsDrug pricesPatent protectionPricesStatin treatment strategiesHealth insuranceTime horizonSubtilisin/kexin type 9 inhibitorsHospital Readmissions among Commercially Insured and Medicare Advantage Beneficiaries with Diabetes and the Impact of Severe Hypoglycemic and Hyperglycemic Events
McCoy RG, Lipska KJ, Herrin J, Jeffery MM, Krumholz HM, Shah ND. Hospital Readmissions among Commercially Insured and Medicare Advantage Beneficiaries with Diabetes and the Impact of Severe Hypoglycemic and Hyperglycemic Events. Journal Of General Internal Medicine 2017, 32: 1097-1105. PMID: 28685482, PMCID: PMC5602759, DOI: 10.1007/s11606-017-4095-x.Peer-Reviewed Original ResearchConceptsDiabetes Complications Severity IndexSevere dysglycemiaIndex hospitalizationMedicare Advantage beneficiariesRisk factorsBetter care transitionsComplications Severity IndexPost-discharge managementIndependent risk factorYounger patient ageOptumLabs Data WarehouseStrong risk factorYears of ageBackgroundHospital readmissionsDesignRetrospective analysisCause readmissionUnplanned readmissionPatient agePrior hospitalizationReadmission ratesYounger patientsHeart failureHospital readmissionSevere hypoglycemiaDiabetes complications
2015
Insurance and Prehospital Delay in Patients ≤55 Years With Acute Myocardial Infarction
Chen SI, Wang Y, Dreyer R, Strait KM, Spatz ES, Xu X, Smolderen KG, Desai NR, Lorenze NP, Lichtman JH, Spertus JA, D'Onofrio G, Bueno H, Masoudi FA, Krumholz HM. Insurance and Prehospital Delay in Patients ≤55 Years With Acute Myocardial Infarction. The American Journal Of Cardiology 2015, 116: 1827-1832. PMID: 26541907, PMCID: PMC5323057, DOI: 10.1016/j.amjcard.2015.09.018.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionPrehospital delayInsurance statusMyocardial infarctionSpanish patientsGender differencesHealth care systemUS patientsProspective studyUS cohortUS womenPatientsUniversal insuranceCare systemWomenSignificant gender differencesInfarctionMenInsurance groupsHoursStatusAssociationLarge proportionDifferencesCohort
2013
National Trends in Heart Failure Hospital Stay Rates, 2001 to 2009
Chen J, Dharmarajan K, Wang Y, Krumholz HM. National Trends in Heart Failure Hospital Stay Rates, 2001 to 2009. Journal Of The American College Of Cardiology 2013, 61: 1078-1088. PMID: 23473413, PMCID: PMC3939721, DOI: 10.1016/j.jacc.2012.11.057.Peer-Reviewed Original ResearchConceptsHospital stay ratesLength of stayHF hospital stayHospital mortalityYears of ageHospital stayPatients 18Stay ratesNational Inpatient Sample dataU.S. hospital dischargesPatients 65 yearsPrimary discharge diagnosisSignificant declineOlder Medicare beneficiariesNational Inpatient SampleBlack menLarge national datasetHospital dischargeOlder patientsPatients 55Younger patientsDischarge diagnosisInpatient SampleMedicare beneficiariesAge 65
2011
Do Imaging Studies Performed in Physician Offices Increase Downstream Utilization? An Empiric Analysis of Cardiac Stress Testing With Imaging
Chen J, Fazel R, Ross JS, McNamara RL, Einstein AJ, Al-Mallah M, Krumholz HM, Nallamothu BK. Do Imaging Studies Performed in Physician Offices Increase Downstream Utilization? An Empiric Analysis of Cardiac Stress Testing With Imaging. JACC Cardiovascular Imaging 2011, 4: 630-637. PMID: 21679898, PMCID: PMC3319749, DOI: 10.1016/j.jcmg.2011.04.003.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overCardiac CatheterizationChi-Square DistributionEchocardiography, StressEmpirical ResearchFemaleHealthcare DisparitiesHumansInsurance, HealthLogistic ModelsMaleMiddle AgedMyocardial Perfusion ImagingMyocardial RevascularizationOffice VisitsOutpatient Clinics, HospitalPractice Patterns, Physicians'Predictive Value of TestsResidence CharacteristicsTime FactorsUnited StatesYoung AdultConceptsMyocardial perfusion imagingSubsequent myocardial perfusion imagingProportion of patientsStress echocardiographyCardiac catheterizationHospital outpatient settingPhysician's officeOutpatient settingStress testingSubsequent cardiac testingCardiac stress testingDownstream resource utilizationHospital outpatient facilitiesCardiac testingPrivate health insuranceDownstream testingOffice imagingPerfusion imagingCatheterizationImaging studiesOutpatient imagingPatientsHealth insuranceLower ratesHigh rate
2010
Health Care Insurance, Financial Concerns in Accessing Care, and Delays to Hospital Presentation in Acute Myocardial Infarction
Smolderen KG, Spertus JA, Nallamothu BK, Krumholz HM, Tang F, Ross JS, Ting HH, Alexander KP, Rathore SS, Chan PS. Health Care Insurance, Financial Concerns in Accessing Care, and Delays to Hospital Presentation in Acute Myocardial Infarction. JAMA 2010, 303: 1392-1400. PMID: 20388895, PMCID: PMC3020978, DOI: 10.1001/jama.2010.409.Peer-Reviewed Original Research
2007
Financial Barriers to Health Care and Outcomes After Acute Myocardial Infarction
Rahimi AR, Spertus JA, Reid KJ, Bernheim SM, Krumholz HM. Financial Barriers to Health Care and Outcomes After Acute Myocardial Infarction. JAMA 2007, 297: 1063-1072. PMID: 17356027, DOI: 10.1001/jama.297.10.1063.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionHealth care servicesCare servicesMyocardial infarctionCardiac rehospitalizationSAQ qualityCause rehospitalizationLife scoresFinancial barriersMulticenter US studyHealth care outcomesProspective registryBaseline prevalenceRehospitalizationHigh riskMedicationsCare outcomesWorse recoveryInfarctionPrevalenceHealth careUS studiesPatientsPoor qualityOutcomes