2024
Real-world evaluation of an algorithmic machine-learning-guided testing approach in stable chest pain: a multinational, multicohort study
Oikonomou E, Aminorroaya A, Dhingra L, Partridge C, Velazquez E, Desai N, Krumholz H, Miller E, Khera R. Real-world evaluation of an algorithmic machine-learning-guided testing approach in stable chest pain: a multinational, multicohort study. European Heart Journal - Digital Health 2024, 5: 303-313. PMID: 38774380, PMCID: PMC11104476, DOI: 10.1093/ehjdh/ztae023.Peer-Reviewed Original ResearchRisk of acute myocardial infarctionAssociated with lower oddsHospital health systemCoronary artery diseaseCardiac testingRisk of adverse outcomesUK BiobankHealth systemProvider-drivenLower oddsAssociated with better outcomesAcute myocardial infarctionBlack raceStable chest painFemale sexReal world evaluationDiabetes historyMulticohort studyFunction testsSuspected coronary artery diseaseYounger ageRisk profileAdverse outcomesMultinational cohortPost hoc analysis
2023
Sex Difference in Outcomes of Acute Myocardial Infarction in Young Patients
Sawano M, Lu Y, Caraballo C, Mahajan S, Dreyer R, Lichtman J, D'Onofrio G, Spatz E, Khera R, Onuma O, Murugiah K, Spertus J, Krumholz H. Sex Difference in Outcomes of Acute Myocardial Infarction in Young Patients. Journal Of The American College Of Cardiology 2023, 81: 1797-1806. PMID: 37137590, DOI: 10.1016/j.jacc.2023.03.383.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionNoncardiac hospitalizationsSubdistribution HRYounger patientsMyocardial infarctionSex differencesYoung womenCause-specific hospitalizationsCause of hospitalizationWorse health statusSignificant sex disparityNoncardiovascular hospitalizationsVIRGO StudyIndex episodeAdverse outcomesIncidence rateHospitalizationHigh riskSex disparitiesHealth statusPatientsU.S. hospitalsWomenInfarctionOutcomesASSOCIATION OF NEIGHBORHOOD-LEVEL MATERIAL DEPRIVATION WITH ADVERSE OUTCOMES AND PROCESSES OF CARE AMONG PATIENTS WITH HEART FAILURE IN A SINGLE-PAYER HEALTHCARE SYSTEM: A POPULATION-BASED COHORT STUDY
Dorovenis A, Bobrowski D, Abdel-Qadir H, McNaughton C, Alonzo R, Fang J, Austin P, Udell J, Jackevicius C, Alter D, Bhatia R, Atzema C, Ha A, Johnston S, Dhalla I, Kapral M, Krumholz H, Wijeysundera H, Ko D, Tu K, Ross H, Schull M, Lee D. ASSOCIATION OF NEIGHBORHOOD-LEVEL MATERIAL DEPRIVATION WITH ADVERSE OUTCOMES AND PROCESSES OF CARE AMONG PATIENTS WITH HEART FAILURE IN A SINGLE-PAYER HEALTHCARE SYSTEM: A POPULATION-BASED COHORT STUDY. Journal Of The American College Of Cardiology 2023, 81: 361. DOI: 10.1016/s0735-1097(23)00805-7.Peer-Reviewed Original Research
2022
Association of Neighborhood-Level Material Deprivation With Atrial Fibrillation Care in a Single-Payer Health Care System: A Population-Based Cohort Study
Abdel-Qadir H, Akioyamen LE, Fang J, Pang A, Ha ACT, Jackevicius CA, Alter DA, Austin PC, Atzema CL, Bhatia RS, Booth GL, Johnston S, Dhalla I, Kapral MK, Krumholz HM, McNaughton CD, Roifman I, Tu K, Udell JA, Wijeysundera HC, Ko DT, Schull MJ, Lee DS. Association of Neighborhood-Level Material Deprivation With Atrial Fibrillation Care in a Single-Payer Health Care System: A Population-Based Cohort Study. Circulation 2022, 146: 159-171. PMID: 35678171, PMCID: PMC9287095, DOI: 10.1161/circulationaha.122.058949.Peer-Reviewed Original ResearchConceptsYears of ageCohort studyUniversal health careAF-related adverse eventsNeighbourhood-level material deprivationPopulation-based cohort studyPrimary care physician visitsCause-specific hazards regressionRhythm control interventionsHigh cardiovascular disease burdenCardiovascular disease burdenHealth careAtrial fibrillation careNeighborhood material deprivationSingle-payer health care systemMaterial deprivation quintileAtrial fibrillation diagnosisHealth care systemNoncardiovascular comorbiditiesAdverse eventsHeart failurePhysician visitsHazards regressionAdverse outcomesDeprivation quintile
2021
SARS-CoV-2 Infection Hospitalization Rate and Infection Fatality Rate Among the Non-Congregate Population in Connecticut
Mahajan S, Caraballo C, Li SX, Dong Y, Chen L, Huston SK, Srinivasan R, Redlich CA, Ko AI, Faust JS, Forman HP, Krumholz HM. SARS-CoV-2 Infection Hospitalization Rate and Infection Fatality Rate Among the Non-Congregate Population in Connecticut. The American Journal Of Medicine 2021, 134: 812-816.e2. PMID: 33617808, PMCID: PMC7895685, DOI: 10.1016/j.amjmed.2021.01.020.Peer-Reviewed Original ResearchConceptsInfection hospitalization rateInfection fatality rateHospitalization ratesFatality rateSeroprevalence estimatesSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodiesSARS-CoV-2 antibodiesConnecticut Hospital AssociationNon-Hispanic black peopleProportion of deathsCoronavirus disease 2019Total infected individualsTotal hospitalizationsAdverse outcomesNon-congregate settingsHigh burdenDisease 2019Prevalence studyMost subgroupsInfected individualsHospitalizationOlder peopleHospital AssociationConnecticut DepartmentDeath
2019
Patient-Reported Quality of Hospital Discharge Transitions: Results from the SILVER-AMI Study
Richards BG, Hajduk AM, Perry J, Krumholz HM, Khan AM, Chaudhry SI. Patient-Reported Quality of Hospital Discharge Transitions: Results from the SILVER-AMI Study. Journal Of General Internal Medicine 2019, 35: 808-814. PMID: 31654359, PMCID: PMC7080904, DOI: 10.1007/s11606-019-05414-8.Peer-Reviewed Original ResearchConceptsDays of dischargeEmergency department utilizationAcute myocardial infarctionPatient-reported qualityHospital discharge processOlder patientsAcute Myocardial Infarction StudyMyocardial Infarction StudyProspective cohort studyMedical record reviewEmergency room utilizationAdults age 75Key ResultsA totalHospital Consumer AssessmentSILVER-AMI StudyHospital discharge transitionsHigh-risk periodDesignMulti-centerCohort studyHospital dischargeMedian ageClinical outcomesRecord reviewAdverse outcomesResultsA totalDigoxin Use and Associated Adverse Events Among Older Adults
Angraal S, Nuti SV, Masoudi FA, Freeman JV, Murugiah K, Shah ND, Desai NR, Ranasinghe I, Wang Y, Krumholz HM. Digoxin Use and Associated Adverse Events Among Older Adults. The American Journal Of Medicine 2019, 132: 1191-1198. PMID: 31077654, DOI: 10.1016/j.amjmed.2019.04.022.Peer-Reviewed Original ResearchConceptsRate of hospitalizationDigoxin useDigoxin toxicityNational Prescription AuditMedicare feeService beneficiariesDigoxin prescriptionAssociated adverse eventsAdverse eventsCohort studyAdverse outcomesSecondary diagnosisNational cohortPrescription auditPrescription trendsClinical guidelinesHospitalizationMortality rateClinical practiceOlder adultsSubsequent outcomesOutcomesToxicityPrescriptionNational-level trends
2018
Is Posthospital Syndrome a Result of Hospitalization-Induced Allostatic Overload?
Goldwater DS, Dharmarajan K, McEwan BS, Krumholz HM. Is Posthospital Syndrome a Result of Hospitalization-Induced Allostatic Overload? Journal Of Hospital Medicine 2018, 13 PMID: 29813141, DOI: 10.12788/jhm.2986.Peer-Reviewed Original ResearchConceptsPosthospital syndromeAllostatic overloadAutonomic nervous systemMultiple organ systemsHospital dischargeInflammatory markersAdverse eventsHospital readmissionAdrenal axisAdverse outcomesPlausible etiologyPathophysiologic consequencesElevated riskNervous systemNarrative reviewOrgan systemsEnhanced vulnerabilityElevated levelsHospital environmentTraditional hospital environmentSyndromeMaladaptive statesOverloadOutcomesPossible mechanism
2015
Trajectories 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 populationHospital Variation in Quality of Discharge Summaries for Patients Hospitalized With Heart Failure Exacerbation
Al-Damluji MS, Dzara K, Hodshon B, Punnanithinont N, Krumholz HM, Chaudhry SI, Horwitz LI. Hospital Variation in Quality of Discharge Summaries for Patients Hospitalized With Heart Failure Exacerbation. Circulation Cardiovascular Quality And Outcomes 2015, 8: 77-86. PMID: 25587091, PMCID: PMC4303507, DOI: 10.1161/circoutcomes.114.001227.Peer-Reviewed Original ResearchConceptsDays of dischargeDischarge summary qualityDischarge summariesHeart failureHeart Failure Outcome StudyHeart failure exacerbationHospital-level variationHospital-level performanceSingle-site studyMedian hospitalHospital courseDischarge weightHospital variationVolume statusAdverse outcomesOutcome studiesConsensus conferencePatientsHospitalCare toolsPhysiciansInadequate qualityDaysExacerbationSummary
2014
Design and rationale of the comprehensive evaluation of risk factors in older patients with AMI (SILVER-AMI) study
Dodson JA, Geda M, Krumholz HM, Lorenze N, Murphy TE, Allore HG, Charpentier P, Tsang SW, Acampora D, Tinetti ME, Gill TM, Chaudhry SI. Design and rationale of the comprehensive evaluation of risk factors in older patients with AMI (SILVER-AMI) study. BMC Health Services Research 2014, 14: 506. PMID: 25370536, PMCID: PMC4239317, DOI: 10.1186/s12913-014-0506-4.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionHealth status declineOlder patientsRisk factorsGeriatric impairmentsHospital readmissionOlder adultsDetailed medical record abstractionStatus declineDiagnostic study resultsPost-AMI outcomesProportion of patientsProspective cohort studyMedical record abstractionAMI studyHealth status measuresClinical characteristicsCohort studyRecord abstractionAdverse outcomesMyocardial infarctionAcademic hospitalHospital assessmentMultivariable regressionStatus measures
2010
Delay From Symptom Onset to Hospital Presentation for Patients With Non–ST-Segment Elevation Myocardial Infarction
Ting HH, Chen AY, Roe MT, Chan PS, Spertus JA, Nallamothu BK, Sullivan MD, DeLong ER, Bradley EH, Krumholz HM, Peterson ED. Delay From Symptom Onset to Hospital Presentation for Patients With Non–ST-Segment Elevation Myocardial Infarction. JAMA Internal Medicine 2010, 170: 1834-1841. PMID: 21059977, DOI: 10.1001/archinternmed.2010.385.Peer-Reviewed Original ResearchConceptsST-segment elevation myocardial infarctionElevation myocardial infarctionHospital presentationSymptom onsetHospital mortalityMultivariable adjustmentMyocardial infarctionUnstable Angina Patients Suppress Adverse OutcomesCan Rapid Risk StratificationSegment elevation myocardial infarctionNational quality improvement initiativeRapid Risk StratificationQuality improvement initiativesMedian delay timeSecular trendsNon–STCurrent smokingRisk stratificationNonwhite raceAdverse outcomesFemale sexOdds ratioEarly presentationAmerican CollegePatients
2009
Elevated Admission Glucose and Mortality in Elderly Patients Hospitalized With Heart Failure
Kosiborod M, Inzucchi SE, Spertus JA, Wang Y, Masoudi FA, Havranek EP, Krumholz HM. Elevated Admission Glucose and Mortality in Elderly Patients Hospitalized With Heart Failure. Circulation 2009, 119: 1899-1907. PMID: 19332465, DOI: 10.1161/circulationaha.108.821843.Peer-Reviewed Original ResearchConceptsHeart failureAdmission glucoseElderly patientsDiabetes mellitusAdverse outcomesMultivariable Cox regression modelsAdmission glucose levelsElevated admission glucoseAcute myocardial infarctionCox regression modelCause mortalityMultivariable adjustmentEntire cohortGlucose controlMyocardial infarctionCardiovascular conditionsGlucose levelsLarge cohortElevated glucoseRepresentative cohortPatientsSignificant associationMortalityCohortMellitus
2006
Depressive Symptoms After Acute Myocardial Infarction: Evidence for Highest Rates in Younger Women
Mallik S, Spertus JA, Reid KJ, Krumholz HM, Rumsfeld JS, Weintraub WS, Agarwal P, Santra M, Bidyasar S, Lichtman JH, Wenger NK, Vaccarino V. Depressive Symptoms After Acute Myocardial Infarction: Evidence for Highest Rates in Younger Women. JAMA Internal Medicine 2006, 166: 876-883. PMID: 16636213, DOI: 10.1001/archinte.166.8.876.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionMean PHQ scoreWomen 60 yearsPrevalence of depressionPHQ scoresMyocardial infarctionYoung womenCoronary heart disease risk factorsProspective Registry Evaluating OutcomesHeart disease risk factorsPatient Health Questionnaire scoresPost-AMI depressionPrimary Care EvaluationDisease risk factorsTime of hospitalizationHigh-risk groupOdds of depressionAggressive screeningOlder patientsYounger patientsAMI patientsAdverse outcomesMen 60Medical historyRisk factors
2005
Anemia and Outcomes in Patients With Heart Failure: A Study From the National Heart Care Project
Kosiborod M, Curtis JP, Wang Y, Smith GL, Masoudi FA, Foody JM, Havranek EP, Krumholz HM. Anemia and Outcomes in Patients With Heart Failure: A Study From the National Heart Care Project. JAMA Internal Medicine 2005, 165: 2237-2244. PMID: 16246989, DOI: 10.1001/archinte.165.19.2237.Peer-Reviewed Original ResearchConceptsHeart failureLower hematocrit levelsIndependent predictorsHematocrit levelsComorbid illnessesHigh riskCare ProjectMultivariable logistic regression analysisPatients 65 yearsPrincipal discharge diagnosisAcute care hospitalsLogistic regression analysisLow hematocrit valuesCause mortalityHF patientsMultiple comorbiditiesMultivariable adjustmentOlder patientsCare hospitalClinical factorsHospital readmissionComorbid conditionsDischarge diagnosisSevere anemiaAdverse outcomesThiazolidinediones, Metformin, and Outcomes in Older Patients With Diabetes and Heart Failure
Masoudi FA, Inzucchi SE, Wang Y, Havranek EP, Foody JM, Krumholz HM. Thiazolidinediones, Metformin, and Outcomes in Older Patients With Diabetes and Heart Failure. Circulation 2005, 111: 583-590. PMID: 15699279, DOI: 10.1161/01.cir.0000154542.13412.b1.Peer-Reviewed Original ResearchConceptsHeart failureInsulin-sensitizing drugsOlder patientsLower riskCox proportional hazards modelAntidiabetic drug prescriptionRetrospective cohort studyPrincipal discharge diagnosisClustering of patientsProportional hazards modelCohort studySecondary outcomesPrimary outcomeMetformin treatmentRandomized trialsThiazolidinedione treatmentDischarge diagnosisInsulin sensitizersAdverse outcomesDrug prescriptionsMultivariable modelObservational studyHospital variablesThiazolidinedione classHigh riskThe Obesity Paradox: Body Mass Index and Outcomes in Patients With Heart Failure
Curtis JP, Selter JG, Wang Y, Rathore SS, Jovin IS, Jadbabaie F, Kosiborod M, Portnay EL, Sokol SI, Bader F, Krumholz HM. The Obesity Paradox: Body Mass Index and Outcomes in Patients With Heart Failure. JAMA Internal Medicine 2005, 165: 55-61. PMID: 15642875, DOI: 10.1001/archinte.165.1.55.Peer-Reviewed Original ResearchConceptsBody mass indexHeart failureDigitalis Investigation Group trialBaseline body mass indexStable heart failureStudy of patientsLean patientsObese patientsMass indexHealthy weightAdverse outcomesChronic diseasesGroup trialsGeneral populationStable outpatientsBetter outcomesPatientsOutcomesOverweightObesityOutpatientsDiseaseTrials
2003
Sex Differences in Health Status After Coronary Artery Bypass Surgery
Vaccarino V, Lin ZQ, Kasl SV, Mattera JA, Roumanis SA, Abramson JL, Krumholz HM. Sex Differences in Health Status After Coronary Artery Bypass Surgery. Circulation 2003, 108: 2642-2647. PMID: 14597590, DOI: 10.1161/01.cir.0000097117.28614.d8.Peer-Reviewed Original ResearchConceptsPhysical functionMental healthReadmission ratesFunctional gainsCoronary artery bypass graft surgeryArtery bypass graft surgeryCoronary artery bypass surgeryLower functional gainsBypass graft surgeryArtery bypass surgeryHigher readmission ratesMan 6 monthsMean score improvementFirst CABGCABG surgeryGraft surgeryBaseline characteristicsBypass surgeryHospital readmissionMultivariable analysisAdverse outcomesFunctional statusFunctional improvementHealth SurveyHealth statusWorsening renal function: What is a clinically meaningful change in creatinine during hospitalization with heart failure?
Smith GL, Vaccarino V, Kosiborod M, Lichtman JH, Cheng S, Watnick SG, Krumholz HM. Worsening renal function: What is a clinically meaningful change in creatinine during hospitalization with heart failure? Journal Of Cardiac Failure 2003, 9: 13-25. PMID: 12612868, DOI: 10.1054/jcaf.2003.3.Peer-Reviewed Original ResearchMeSH KeywordsAgedBiomarkersCohort StudiesConnecticutCreatinineFemaleFollow-Up StudiesHeart FailureHospitalizationHumansKidney DiseasesKidney Function TestsMaleMiddle AgedMultivariate AnalysisPredictive Value of TestsProspective StudiesRisk FactorsSensitivity and SpecificityStatistics as TopicStroke VolumeSurvival AnalysisConceptsCreatinine elevationRenal functionHeart failureAdverse outcomesRisk of deathNumber of patientsMagnitude of riskBaseline creatinineProspective cohortRisk factorsFunctional declineHigh riskPatientsCreatinineMortalityHospitalizationDeathDlImportant predictorRiskElevationMeaningful changeMaximum specificityOutcomesBetter definition
1998
Clinical correlates of in-hospital costs for acute myocardial infarction in patients 65 years of age and older
Krumholz H, Chen J, Murillo J, Cohen D, Radford M. Clinical correlates of in-hospital costs for acute myocardial infarction in patients 65 years of age and older. American Heart Journal 1998, 135: 523-531. PMID: 9506340, DOI: 10.1016/s0002-8703(98)70331-x.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionPatients 65 yearsHospital costsMyocardial infarctionAcute myocardial infarction hospitalizationsActual clinical practiceMyocardial infarction hospitalizationsClinical characteristicsAdverse outcomesClinical correlatesMedical recordsClinical practiceHospital proceduresRoom costsInfarctionStudy sampleTotal meanRelative paucityAgeLarge proportionCorrelatesHospitalizationPatientsHospitalYears