2024
Hypertension 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
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 ResearchMeSH KeywordsAspirinChinaFemaleHealthcare DisparitiesHumansMaleNon-ST Elevated Myocardial InfarctionRetrospective StudiesSex CharacteristicsTime FactorsTreatment OutcomeConceptsSegment 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 hospitalsMortalityWomenRacism as a leading cause of death in the United States
Krumholz HM, Massey DS, Dorsey KB. Racism as a leading cause of death in the United States. The BMJ 2022, 376: o213. PMID: 35078777, DOI: 10.1136/bmj.o213.Peer-Reviewed Original Research
2021
National Trends in Racial and Ethnic Disparities in Antihypertensive Medication Use and Blood Pressure Control Among Adults With Hypertension, 2011–2018
Lu Y, Liu Y, Dhingra LS, Massey D, Caraballo C, Mahajan S, Spatz ES, Onuma O, Herrin J, Krumholz HM. National Trends in Racial and Ethnic Disparities in Antihypertensive Medication Use and Blood Pressure Control Among Adults With Hypertension, 2011–2018. Hypertension 2021, 79: 207-217. PMID: 34775785, DOI: 10.1161/hypertensionaha.121.18381.Peer-Reviewed Original ResearchConceptsAntihypertensive medication usePoor hypertension controlOverall treatment rateLow control rateHypertension controlHypertension awarenessMedication useControl rateHispanic individualsEthnic differencesTreatment ratesBlack individualsGuideline-recommended medicationsBlood pressure controlWhite individualsNutrition Examination SurveyLow awareness rateAntihypertensive medicationsHypertensive peopleExamination SurveyIntensive medicationNational HealthAwareness rateEthnic disparitiesPressure controlNational Trends and Disparities in Hospitalization for Acute Hypertension Among Medicare Beneficiaries (1999–2019)
Lu Y, Wang Y, Spatz ES, Onuma O, Nasir K, Rodriguez F, Watson KE, Krumholz HM. National Trends and Disparities in Hospitalization for Acute Hypertension Among Medicare Beneficiaries (1999–2019). Circulation 2021, 144: 1683-1693. PMID: 34743531, DOI: 10.1161/circulationaha.121.057056.Peer-Reviewed Original ResearchConceptsHigher hospitalization ratesAcute hypertensionHospitalization ratesMedicare feeService beneficiariesBlack adultsSerial cross-sectional analysisCause readmission rateNational hospitalization ratesPrimary discharge diagnosisAnnual hospitalization rateCause mortality ratesPoisson link functionDual-eligible statusMedicare/MedicaidCross-sectional analysisHypertension controlReadmission ratesDischarge diagnosisDiseases codesMedicare denominatorInpatient filesHypertensionInternational ClassificationMedicare beneficiariesTrends in Differences in Health Status and Health Care Access and Affordability by Race and Ethnicity in the United States, 1999-2018
Mahajan S, Caraballo C, Lu Y, Valero-Elizondo J, Massey D, Annapureddy AR, Roy B, Riley C, Murugiah K, Onuma O, Nunez-Smith M, Forman HP, Nasir K, Herrin J, Krumholz HM. Trends in Differences in Health Status and Health Care Access and Affordability by Race and Ethnicity in the United States, 1999-2018. JAMA 2021, 326: 637-648. PMID: 34402830, PMCID: PMC8371573, DOI: 10.1001/jama.2021.9907.Peer-Reviewed Original ResearchConceptsHealth care accessFair health statusSelf-reported health statusCare accessHealth statusWhite individualsEthnic differencesLatino/HispanicNational Health Interview Survey dataSerial cross-sectional studySelf-reported functional limitationsBlack individualsHealth Interview Survey dataLow incomeCross-sectional studyCross-sectional survey studyInterview Survey dataSelf-reported raceSelf-report measuresMAIN OUTCOMEUS adultsFunctional limitationsPercentage of peopleSignificant decreaseAdults
2020
Inflection Point
Krumholz HM. Inflection Point. Circulation Cardiovascular Quality And Outcomes 2020, 13: e007615-e007615. PMID: 33200951, PMCID: PMC7742208, DOI: 10.1161/circoutcomes.120.007615.Peer-Reviewed Original ResearchEvaluation of STEMI Regionalization on Access, Treatment, and Outcomes Among Adults Living in Nonminority and Minority Communities
Hsia RY, Krumholz H, Shen YC. Evaluation of STEMI Regionalization on Access, Treatment, and Outcomes Among Adults Living in Nonminority and Minority Communities. JAMA Network Open 2020, 3: e2025874. PMID: 33196809, PMCID: PMC7670311, DOI: 10.1001/jamanetworkopen.2020.25874.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overBlack or African AmericanCaliforniaCause of DeathCohort StudiesFemaleHealth Services AccessibilityHealthcare DisparitiesHispanic or LatinoHospitalizationHumansMaleMiddle AgedMinority GroupsMortalityNon-Randomized Controlled Trials as TopicPercutaneous Coronary InterventionRegional Medical ProgramsResidence CharacteristicsST Elevation Myocardial InfarctionTime-to-TreatmentWhite PeopleConceptsST-segment elevation myocardial infarctionElevation myocardial infarctionPercutaneous coronary interventionPCI-capable hospitalsZip codesNon-Hispanic whitesPatient's countyCause mortalityCohort studyCoronary interventionPCI hospitalsPCI treatmentWhite patientsCapable hospitalsMyocardial infarctionTop tertileInpatient dataMAIN OUTCOMEPatientsSTEMI regionalizationSmall improvementHospitalPotential mechanismsSame dayHispanic population
2019
Variation and Disparities in Awareness of Myocardial Infarction Symptoms Among Adults in the United States
Mahajan S, Valero-Elizondo J, Khera R, Desai NR, Blankstein R, Blaha MJ, Virani SS, Kash BA, Zoghbi WA, Krumholz HM, Nasir K. Variation and Disparities in Awareness of Myocardial Infarction Symptoms Among Adults in the United States. JAMA Network Open 2019, 2: e1917885. PMID: 31851350, PMCID: PMC6991230, DOI: 10.1001/jamanetworkopen.2019.17885.Peer-Reviewed Original ResearchConceptsMyocardial infarction symptomsShortness of breathMyocardial infarctionInfarction symptomsLow education levelEmergency medical servicesChest painSociodemographic subgroupsNational Health Interview SurveyEmergency cardiac careCross-sectional studyMedical servicesHealth Interview SurveyPublic health initiativesEducation levelLow-income subgroupsPrompt recognitionBack painCommon symptomsMale sexCardiac careHigher oddsHispanic ethnicityMAIN OUTCOMEHigh riskSex-Based Differences in Presentation, Treatment, and Complications Among Older Adults Hospitalized for Acute Myocardial Infarction
Nanna MG, Hajduk AM, Krumholz HM, Murphy TE, Dreyer RP, Alexander KP, Geda M, Tsang S, Welty FK, Safdar B, Lakshminarayan DK, Chaudhry SI, Dodson JA. Sex-Based Differences in Presentation, Treatment, and Complications Among Older Adults Hospitalized for Acute Myocardial Infarction. Circulation Cardiovascular Quality And Outcomes 2019, 12: e005691. PMID: 31607145, PMCID: PMC6913190, DOI: 10.1161/circoutcomes.119.005691.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overComorbidityDisability EvaluationFemaleHealth Status DisparitiesHealthcare DisparitiesHumansLife StyleMaleMyocardial RevascularizationNon-ST Elevated Myocardial InfarctionPatient AdmissionPrevalenceProspective StudiesRisk AssessmentRisk FactorsSex FactorsSocial Determinants of HealthST Elevation Myocardial InfarctionTime FactorsTreatment OutcomeUnited StatesConceptsAcute myocardial infarctionSex-based differencesPercutaneous coronary interventionFunctional impairmentOlder adultsHospital complicationsCoronary interventionOlder patientsCoronary diseaseMyocardial infarctionAge-related functional impairmentsAge-associated functional impairmentsLower ratesPrior coronary diseaseObstructive coronary diseaseProspective observational studyNSTEMI subgroupSTEMI subgroupUnderwent revascularizationAcute myocardialChest painClinical presentationAMI subgroupRisk factorsHigh prevalenceTrends in Performance and Opportunities for Improvement on a Composite Measure of Acute Myocardial Infarction Care
Desai NR, Udell JA, Wang Y, Spatz ES, Dharmarajan K, Ahmad T, Julien HM, Annapureddy A, Goyal A, de Lemos JA, Masoudi FA, Bhatt DL, Minges KE, Krumholz HM, Curtis JP. Trends in Performance and Opportunities for Improvement on a Composite Measure of Acute Myocardial Infarction Care. Circulation Cardiovascular Quality And Outcomes 2019, 12: e004983. PMID: 30871375, DOI: 10.1161/circoutcomes.118.004983.Peer-Reviewed Original ResearchMeSH KeywordsAgedCardiology Service, HospitalFemaleGuideline AdherenceHealthcare DisparitiesHumansMaleMiddle AgedMyocardial InfarctionOutcome and Process Assessment, Health CarePractice Guidelines as TopicQuality ImprovementQuality Indicators, Health CareRacial GroupsRegistriesSex FactorsSocioeconomic FactorsTreatment OutcomeUnited StatesConceptsProportion of patientsAcute myocardial infarctionDefect-free careHispanic patientsAMI careOlder patientsCare measuresNational Cardiovascular Data Registry Acute Coronary TreatmentIntervention Outcomes Network RegistryAcute myocardial infarction careGuideline-recommended pharmacotherapyMedicaid insurance coverageSociodemographic groupsMyocardial infarction careSafety-net statusGreatest absolute improvementComposite measureQuality of careHospital-level performanceCessation counselingEvidence-based processReperfusion therapyCardiac rehabilitationCoronary TreatmentVentricular functionAssociation of Income Disparities with Patient-Reported Healthcare Experience
Okunrintemi V, Khera R, Spatz ES, Salami JA, Valero-Elizondo J, Warraich HJ, Virani SS, Blankstein R, Blaha MJ, Pawlik TM, Dharmarajan K, Krumholz HM, Nasir K. Association of Income Disparities with Patient-Reported Healthcare Experience. Journal Of General Internal Medicine 2019, 34: 884-892. PMID: 30783877, PMCID: PMC6544715, DOI: 10.1007/s11606-019-04848-4.Peer-Reviewed Original ResearchConceptsPatient healthcare experienceHealthcare experiencesHigher oddsMedical Expenditure Panel Survey cohortHealthcare providersRepresentative US adult populationUS adult populationTimes higher oddsQuality of careTimes greater oddsLow incomePoor healthcare experiencesRetrospective studyPatient incomePatient levelPatient reportsUS adultsProvider satisfactionGreater oddsPatientsHealth outcomesSurvey cohortAdult populationStudy participantsAspects of access
2018
Sex and Race Differences in the Utilization and Outcomes of Coronary Artery Bypass Grafting Among Medicare Beneficiaries, 1999–2014
Angraal S, Khera R, Wang Y, Lu Y, Jean R, Dreyer RP, Geirsson A, Desai NR, Krumholz HM. Sex and Race Differences in the Utilization and Outcomes of Coronary Artery Bypass Grafting Among Medicare Beneficiaries, 1999–2014. Journal Of The American Heart Association 2018, 7: e009014. PMID: 30005557, PMCID: PMC6064835, DOI: 10.1161/jaha.118.009014.Peer-Reviewed Original ResearchConceptsCoronary artery bypassCABG utilizationArtery bypassUse of CABGService Medicare beneficiariesCalendar year trendsCABG mortalityUnderwent CABGReadmission ratesCABG proceduresWhite patientsBlack patientsPatient groupMedicare beneficiariesMedicare feeMortality rateCABGAnnual declineWomenRacial subgroupsRacial differencesGreater declineOutcomesPatientsSexNational and Regional Trends in Deep Vein Thrombosis Hospitalization Rates, Discharge Disposition, and Outcomes for Medicare Beneficiaries
Minges KE, Bikdeli B, Wang Y, Attaran RR, Krumholz HM. National and Regional Trends in Deep Vein Thrombosis Hospitalization Rates, Discharge Disposition, and Outcomes for Medicare Beneficiaries. The American Journal Of Medicine 2018, 131: 1200-1208. PMID: 29753792, PMCID: PMC7040884, DOI: 10.1016/j.amjmed.2018.04.033.Peer-Reviewed Original ResearchConceptsDeep vein thrombosisHospitalization ratesVein thrombosisBlack patientsMedicare Standard Analytic FilesProportion of patientsPrincipal discharge diagnosisStandard Analytic FilesSecondary prevention effortsDischarge dispositionHospital lengthInpatient managementReadmission ratesDischarge diagnosisService patientsAdjusted outcomesOutpatient careAnalytic FilesMedicare feeMedicare beneficiariesMortality rateClinical practiceHospitalizationPatientsThrombosisSex Differences in Timeliness of Reperfusion in Young Patients With ST‐Segment–Elevation Myocardial Infarction by Initial Electrocardiographic Characteristics
Gupta A, Barrabes JA, Strait K, Bueno H, Porta‐Sánchez A, Acosta‐Vélez J, Lidón R, Spatz E, Geda M, Dreyer RP, Lorenze N, Lichtman J, D'Onofrio G, Krumholz HM. Sex Differences in Timeliness of Reperfusion in Young Patients With ST‐Segment–Elevation Myocardial Infarction by Initial Electrocardiographic Characteristics. Journal Of The American Heart Association 2018, 7: e007021. PMID: 29514807, PMCID: PMC5907538, DOI: 10.1161/jaha.117.007021.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAge of OnsetElectrocardiographyFemaleHealthcare DisparitiesHumansMaleMiddle AgedMyocardial ReperfusionPredictive Value of TestsProspective StudiesRisk AssessmentRisk FactorsSex FactorsSpainST Elevation Myocardial InfarctionTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesYoung AdultConceptsST-segment elevation myocardial infarctionElectrocardiographic characteristicsMyocardial infarctionReperfusion delayYounger patientsVentricular hypertrophyST elevationPrehospital ECGLateral leadsMultivariable logistic regression modelTimeliness of reperfusionVoltage criteriaElevation myocardial infarctionLeft ventricular hypertrophyAcute myocardial infarctionYears of ageLogistic regression modelsSex differencesClinical characteristicsCohort studyElectrocardiographic correlatesMultivariable analysisFemale sexSpanish hospitalsReperfusion guidelinesNational Trends in Nonstatin Use and Expenditures Among the US Adult Population From 2002 to 2013: Insights From Medical Expenditure Panel Survey
Salami JA, Warraich HJ, Valero‐Elizondo J, Spatz ES, Desai NR, Rana JS, Virani SS, Blankstein R, Khera A, Blaha MJ, Blumenthal RS, Katzen BT, Lloyd‐Jones D, Krumholz HM, Nasir K. National Trends in Nonstatin Use and Expenditures Among the US Adult Population From 2002 to 2013: Insights From Medical Expenditure Panel Survey. Journal Of The American Heart Association 2018, 7: e007132. PMID: 29358195, PMCID: PMC5850149, DOI: 10.1161/jaha.117.007132.Peer-Reviewed Original ResearchAdultAgedAtherosclerosisDatabases, FactualDrug CostsDrug PrescriptionsDyslipidemiasFemaleHealth Care SurveysHealth ExpendituresHealthcare DisparitiesHumansHydroxymethylglutaryl-CoA Reductase InhibitorsHypolipidemic AgentsLongitudinal StudiesMaleMedically UninsuredMiddle AgedPractice Patterns, Physicians'Racial GroupsRetrospective StudiesRisk FactorsSex FactorsSocioeconomic FactorsTime FactorsTreatment OutcomeUnited StatesGeographical Health Priority Areas For Older Americans
Krumholz HM, Normand ST, Wang Y. Geographical Health Priority Areas For Older Americans. Health Affairs 2018, 37: 104-110. PMID: 29309217, DOI: 10.1377/hlthaff.2017.0744.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overGeography, MedicalHealth PrioritiesHealth Services AccessibilityHealthcare DisparitiesHumansMedicareMortalityUnited StatesConceptsHealth priority areasMortality rateHigher adjusted mortality ratesRisk-standardized mortality ratesAdjusted mortality rateHealth careUnique Medicare beneficiariesMedicare beneficiariesUS populationHealth disparitiesOlder adultsStudy periodGeographic disparitiesOlder AmericansCarePercentDisparitiesPriority areasWide disparity
2017
Urban–Rural Comparisons in Hospital Admission, Treatments, and Outcomes for ST-Segment–Elevation Myocardial Infarction in China From 2001 to 2011
Li X, Murugiah K, Li J, Masoudi FA, Chan PS, Hu S, Spertus JA, Wang Y, Downing NS, Krumholz HM, Jiang L. Urban–Rural Comparisons in Hospital Admission, Treatments, and Outcomes for ST-Segment–Elevation Myocardial Infarction in China From 2001 to 2011. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003905. PMID: 29158421, PMCID: PMC6312853, DOI: 10.1161/circoutcomes.117.003905.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overChinaDisease ManagementFemaleHealthcare DisparitiesHospital MortalityHospitalizationHospitals, RuralHospitals, UrbanHumansMaleMiddle AgedOdds RatioQuality ImprovementRetrospective StudiesRural PopulationST Elevation Myocardial InfarctionSurvival RateTime FactorsUrban PopulationConceptsEvidence-based treatmentsMyocardial infarctionEnzyme inhibitors/angiotensin receptor blockersRural hospitalsST-segment elevation myocardial infarctionUrban-rural disparitiesAngiotensin receptor blockersElevation myocardial infarctionAdjusted odds ratioResource-intensive careRisk-adjusted ratesHospital deathReperfusion therapyReceptor blockersHospital admissionCardiac facilitiesPatient outcomesOdds ratioCare persistUrban hospitalΒ-blockersBetter outcomesRural careHealthcare resourcesST segmentQuality 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 rateComparing Outcomes of Coronary Artery Bypass Grafting Among Large Teaching and Urban Hospitals in China and the United States
Zheng Z, Zhang H, Yuan X, Rao C, Zhao Y, Wang Y, Normand SL, Krumholz HM, Hu S. Comparing Outcomes of Coronary Artery Bypass Grafting Among Large Teaching and Urban Hospitals in China and the United States. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003327. PMID: 28611187, PMCID: PMC5482563, DOI: 10.1161/circoutcomes.116.003327.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedChinaCoronary Artery BypassCoronary Artery DiseaseFemaleHealthcare DisparitiesHospital Bed CapacityHospital MortalityHospitals, High-VolumeHospitals, TeachingHospitals, UrbanHumansLength of StayMaleMiddle AgedOdds RatioPrevalenceProcess Assessment, Health CarePropensity ScoreQuality Indicators, Health CareRegistriesRisk AssessmentRisk FactorsTime FactorsTreatment OutcomeUnited StatesYoung AdultConceptsIsolated CABG surgeryCoronary artery bypassUrban hospitalHospital mortalityArtery bypassCABG surgeryChinese Cardiac Surgery RegistryTotal hospital stayCardiac Surgery RegistryCoronary artery diseaseNational Inpatient SampleLarge teachingLength of staySignificant mortality differenceHospital staySecondary outcomesArtery diseasePrimary outcomeMedian lengthComparing outcomesInpatient SampleMortality differencesHigher ageHigh mortalityHospital