Featured Publications
Individualising intensive systolic blood pressure reduction in hypertension using computational trial phenomaps and machine learning: a post-hoc analysis of randomised clinical trials
Oikonomou EK, Spatz ES, Suchard MA, Khera R. Individualising intensive systolic blood pressure reduction in hypertension using computational trial phenomaps and machine learning: a post-hoc analysis of randomised clinical trials. The Lancet Digital Health 2022, 4: e796-e805. PMID: 36307193, PMCID: PMC9768739, DOI: 10.1016/s2589-7500(22)00170-4.Peer-Reviewed Original ResearchConceptsSystolic blood pressure controlBlood pressure controlIntensive systolic blood pressure controlType 2 diabetesPressure controlCardiovascular benefitsClinical trialsMajor adverse cardiovascular eventsFirst major adverse cardiovascular eventLarge randomised clinical trialsACCORD-BP trialAdverse cardiovascular eventsRandomised clinical trialsSystolic blood pressureCox regression analysisTreatment effectsHazard ratio estimatesACCORD-BPBP trialCardiovascular eventsBlood pressurePrimary outcomeStandard treatmentBaseline variablesIndex patients
2023
Lifting the Veil on Advanced Heart Failure ∗
Sandhu A, Khera R. Lifting the Veil on Advanced Heart Failure ∗. JACC Heart Failure 2023, 11: 1607-1610. PMID: 37737760, PMCID: PMC11009373, DOI: 10.1016/j.jchf.2023.07.031.Peer-Reviewed Original ResearchHeart FailureHumansVariation in hospital use of cardiac resynchronization therapy-defibrillator among eligible patients and association with clinical outcomes
Chui P, Lan Z, Freeman J, Enriquez A, Khera R, Akar J, Masoudi F, Ong E, Curtis J. Variation in hospital use of cardiac resynchronization therapy-defibrillator among eligible patients and association with clinical outcomes. Heart Rhythm 2023, 20: 1000-1008. PMID: 36963741, DOI: 10.1016/j.hrthm.2023.03.022.Peer-Reviewed Original ResearchConceptsEligible patientsICD RegistryCardiac resynchronizationNational Cardiovascular Data Registry ICD RegistryCRT-D implantationCRT-D useHospital-level outcomesStrong guideline recommendationsHospital-level variationPatient-level outcomesIntraclass correlation coefficientQuality improvement effortsHospital mortalityGuideline indicationsReadmission ratesSelect patientsClinical outcomesGuideline recommendationsHospital variationHospital ratesUse of CRTHospital levelHospital usePatientsCase mix
2022
Performance of current risk stratification models for predicting mortality in patients with heart failure: a systematic review and meta-analysis
Siddiqi TJ, Ahmed A, Greene SJ, Shahid I, Usman MS, Oshunbade A, Alkhouli M, Hall ME, Murad MH, Khera R, Jain V, Van Spall HGC, Khan MS. Performance of current risk stratification models for predicting mortality in patients with heart failure: a systematic review and meta-analysis. European Journal Of Preventive Cardiology 2022, 29: 2027-2048. PMID: 35919956, DOI: 10.1093/eurjpc/zwac148.Peer-Reviewed Original ResearchConceptsChronic heart failureLong-term mortalityMid-term mortalityAcute HFHeart failureRisk scoreGeneric inverse variance random effects modelInverse variance random-effects modelCurrent risk stratification modelsExcellent discriminationAcute heart failureRisk stratification modelShort-term mortalityLack of headRandom-effects modelGood discriminationAHF mortalityCause mortalityC-statisticNineteen studiesPatientsMortality predictionSystematic reviewHead comparisonMortalitySubjective Financial Hardship due to Medical Bills Among Patients With Heart Failure in the United States: The 2014–2018 Medical Expenditure Panel Survey
Ali HR, Valero-Elizondo J, Wang SY, Cainzos-Achirica M, Bhimaraj A, Khan SU, Khan MS, Mossialos E, Khera R, Nasir K. Subjective Financial Hardship due to Medical Bills Among Patients With Heart Failure in the United States: The 2014–2018 Medical Expenditure Panel Survey. Journal Of Cardiac Failure 2022, 28: 1424-1433. PMID: 35839928, DOI: 10.1016/j.cardfail.2022.06.009.Peer-Reviewed Original ResearchRural-Urban Disparities in Heart Failure and Acute Myocardial Infarction Hospitalizations
Minhas AMK, Sheikh AB, Ijaz SH, Mostafa A, Nazir S, Khera R, Loccoh EC, Warraich HJ. Rural-Urban Disparities in Heart Failure and Acute Myocardial Infarction Hospitalizations. The American Journal Of Cardiology 2022, 175: 164-169. PMID: 35577603, DOI: 10.1016/j.amjcard.2022.04.014.Peer-Reviewed Original ResearchMeSH KeywordsAdultHeart FailureHospital MortalityHospitalizationHospitals, RuralHumansMyocardial InfarctionUnited StatesConceptsAcute myocardial infarctionHeart failureHospital mortalityUrban hospitalRural hospitalsInflation-adjusted costStudy periodAMI hospitalizationMortality gapNational Inpatient SampleLength of stayAcute myocardial infarction hospitalizationsShorter mean lengthMyocardial infarction hospitalizationsHF hospitalizationCardiovascular outcomesClinical outcomesConsistent decreaseMyocardial infarctionInpatient SampleRural-urban disparitiesCardiovascular careHospitalizationHospitalMean length
2021
Nonalcoholic Fatty Liver Disease and Risk of Heart Failure Among Medicare Beneficiaries
Fudim M, Zhong L, Patel KV, Khera R, Abdelmalek MF, Diehl AM, McGarrah RW, Molinger J, Moylan CA, Rao VN, Wegermann K, Neeland IJ, Halm EA, Das SR, Pandey A. Nonalcoholic Fatty Liver Disease and Risk of Heart Failure Among Medicare Beneficiaries. Journal Of The American Heart Association 2021, 10: e021654. PMID: 34755544, PMCID: PMC8751938, DOI: 10.1161/jaha.121.021654.Peer-Reviewed Original ResearchConceptsNonalcoholic fatty liver diseaseIncident heart failureReduced ejection fractionFatty liver diseaseHeart failureEjection fractionMedicare beneficiariesHF subtypesLiver diseaseHigh riskBackground Nonalcoholic fatty liver diseaseBaseline NAFLDAssociation of NAFLDNew-onset heart failureConclusions PatientsCohort studyPrior diagnosisBlack patientsNinth RevisionKidney diseaseOutpatient claimsRisk factorsIndependent associationHigh burdenMedicare patientsForgone Medical Care Associated With Increased Health Care Costs Among the U.S. Heart Failure Population
Thomas A, Valero-Elizondo J, Khera R, Warraich HJ, Reinhardt SW, Ali HJ, Nasir K, Desai NR. Forgone Medical Care Associated With Increased Health Care Costs Among the U.S. Heart Failure Population. JACC Heart Failure 2021, 9: 710-719. PMID: 34391737, DOI: 10.1016/j.jchf.2021.05.010.Peer-Reviewed Original ResearchMeSH KeywordsAgedEmergency Service, HospitalHealth Care CostsHealth ExpendituresHeart FailureHumansPrevalenceUnited StatesConceptsHeart failureHealth care utilizationHealth care costsHealth care expendituresCare utilizationCare costsMedical careMore emergency department visitsTotal health care costsCare expendituresAnnual health careAnnual inpatient costsPrevalence of patientsEmergency department visitsMedical Expenditure Panel SurveyOverall health care spendingHF patientsElderly patientsCare AssociatedDepartment visitsFailure populationInpatient costsHealth care spendingLeading causePatientsOut‐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
Temporal Trends in Heart Failure Incidence Among Medicare Beneficiaries Across Risk Factor Strata, 2011 to 2016
Khera R, Kondamudi N, Zhong L, Vaduganathan M, Parker J, Das SR, Grodin JL, Halm EA, Berry JD, Pandey A. Temporal Trends in Heart Failure Incidence Among Medicare Beneficiaries Across Risk Factor Strata, 2011 to 2016. JAMA Network Open 2020, 3: e2022190. PMID: 33095250, PMCID: PMC7584929, DOI: 10.1001/jamanetworkopen.2020.22190.Peer-Reviewed Original ResearchConceptsHeart failure incidenceHF risk factorsHF incidenceClinical Modification codesRisk factorsAcute MIMedicare beneficiariesFailure incidenceHF prevention strategiesRisk factor strataNational cohort studyService Medicare beneficiariesUnique Medicare beneficiariesInternational Statistical ClassificationRace/ethnicityPrior HFPrevalent hypertensionCohort studyIncident HFNinth RevisionPrevious diagnosisCardiovascular conditionsTenth RevisionMAIN OUTCOMEInternational ClassificationThe Upcoming Epidemic of Heart Failure in South Asia
Martinez-Amezcua P, Haque W, Khera R, Kanaya AM, Sattar N, Lam CSP, Harikrishnan S, Shah SJ, Kandula NR, Jose PO, Narayan KMV, Agyemang C, Misra A, Jenum AK, Bilal U, Nasir K, Cainzos-Achirica M. The Upcoming Epidemic of Heart Failure in South Asia. Circulation Heart Failure 2020, 13: e007218. PMID: 32962410, DOI: 10.1161/circheartfailure.120.007218.Peer-Reviewed Original ResearchConceptsType 2 diabetes mellitusHeart failureCoronary heart diseaseHeart diseaseHF epidemicDiabetes mellitusEarly type 2 diabetes mellitusLifestyle-related risk factorsPrognosis of HFPremature coronary heart diseasePremature heart failurePrevalent heart failureRheumatic heart diseaseSouth AsiansAbdominal obesityGeneral obesitySouth Asian populationRisk factorsDramatic healthGlobal burdenRecent studiesUrgent interventionUnderrecognized threatTobacco productsUpcoming epidemicDo or Do Not, There Is No Try
Khera R. Do or Do Not, There Is No Try. Circulation Cardiovascular Quality And Outcomes 2020, 13: e006693. PMID: 32393124, DOI: 10.1161/circoutcomes.120.006693.Commentaries, Editorials and LettersReadmission and Mortality After Hospitalization for Myocardial Infarction and Heart Failure
Ko DT, Khera R, Lau G, Qiu F, Wang Y, Austin PC, Koh M, Lin Z, Lee DS, Wijeysundera HC, Krumholz HM. Readmission and Mortality After Hospitalization for Myocardial Infarction and Heart Failure. Journal Of The American College Of Cardiology 2020, 75: 736-746. PMID: 32081282, DOI: 10.1016/j.jacc.2019.12.026.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionPost-discharge mortalityHospital mortalityReadmission ratesHospitalization ratesMyocardial infarctionMortality rateRisk-adjusted mortality ratesHospital Readmissions Reduction ProgramHF hospitalization ratesHeart failure hospitalizationPatients 65 yearsReadmissions Reduction ProgramFailure hospitalizationHF patientsSecondary outcomesHospital readmissionPrimary outcomeReadmissionMortalityAMI hospitalization ratesStudy periodPattern of outcomesHospitalizationOutcomesPost-discharge acute care and outcomes following readmission reduction initiatives: national retrospective cohort study of Medicare beneficiaries in the United States
Khera R, Wang Y, Bernheim SM, Lin Z, Krumholz HM. Post-discharge acute care and outcomes following readmission reduction initiatives: national retrospective cohort study of Medicare beneficiaries in the United States. The BMJ 2020, 368: l6831. PMID: 31941686, PMCID: PMC7190056, DOI: 10.1136/bmj.l6831.Peer-Reviewed Original ResearchConceptsAcute care utilizationAcute myocardial infarctionRetrospective cohort studyHeart failureCare utilizationPost-discharge periodEmergency departmentMyocardial infarctionDay mortalityCohort studyHospital admissionObservation unitAcute careNational retrospective cohort studyPost-acute care utilizationHospital Readmissions Reduction ProgramObservation unit carePost-discharge mortalityDay readmission rateRisk of deathReadmissions Reduction ProgramReadmission reduction initiativesReadmission ratesUnit careInpatient unit
2019
Machine Learning Prediction of Mortality and Hospitalization in Heart Failure With Preserved Ejection Fraction
Angraal S, Mortazavi BJ, Gupta A, Khera R, Ahmad T, Desai NR, Jacoby DL, Masoudi FA, Spertus JA, Krumholz HM. Machine Learning Prediction of Mortality and Hospitalization in Heart Failure With Preserved Ejection Fraction. JACC Heart Failure 2019, 8: 12-21. PMID: 31606361, DOI: 10.1016/j.jchf.2019.06.013.Peer-Reviewed Original ResearchConceptsHF hospitalizationRisk of mortalityEjection fractionBlood urea nitrogen levelsLogistic regressionPrevious HF hospitalizationHeart failure hospitalizationReduced ejection fractionReceiver-operating characteristic curveRisk of deathBody mass indexBlood urea nitrogenUrea nitrogen levelsHealth status dataMean c-statisticKCCQ scoresTOPCAT trialFailure hospitalizationHeart failureHemoglobin levelsMass indexC-statisticHospitalizationUrea nitrogenMortalityEvaluation of 30-Day Hospital Readmission and Mortality Rates Using Regression-Discontinuity Framework
Khera R, Wang Y, Nasir K, Lin Z, Krumholz HM. Evaluation of 30-Day Hospital Readmission and Mortality Rates Using Regression-Discontinuity Framework. Journal Of The American College Of Cardiology 2019, 74: 219-234. PMID: 31296295, PMCID: PMC8669780, DOI: 10.1016/j.jacc.2019.04.060.Peer-Reviewed Original ResearchMeSH KeywordsHeart FailureHumansMyocardial InfarctionPatient ReadmissionPneumoniaRegression AnalysisConceptsAcute myocardial infarctionHospital Readmissions Reduction ProgramHeart failureReadmission ratesElderly Medicare feeMedian readmission rateReadmissions Reduction ProgramPost-discharge daysInstitution of strategiesHospital readmissionReadmission riskMyocardial infarctionReadmission reductionCardiovascular conditionsEligible hospitalsMedicare feeReadmission penaltiesMortality rateDay 1Day 30ReadmissionDay 60HospitalU.S. hospitalsHospitalization
2018
Association of the Hospital Readmissions Reduction Program With Mortality During and After Hospitalization for Acute Myocardial Infarction, Heart Failure, and Pneumonia
Khera R, Dharmarajan K, Wang Y, Lin Z, Bernheim SM, Wang Y, Normand ST, Krumholz HM. Association of the Hospital Readmissions Reduction Program With Mortality During and After Hospitalization for Acute Myocardial Infarction, Heart Failure, and Pneumonia. JAMA Network Open 2018, 1: e182777. PMID: 30646181, PMCID: PMC6324473, DOI: 10.1001/jamanetworkopen.2018.2777.Peer-Reviewed Original ResearchConceptsHospital Readmissions Reduction ProgramAcute myocardial infarctionPostdischarge mortalityHeart failureHRRP announcementReadmissions Reduction ProgramMedicare beneficiariesRisk-adjusted ratesMyocardial infarctionService Medicare beneficiariesReduction programsInterrupted time series frameworkHospital mortalityReduced readmissionsCohort studyPneumonia hospitalizationsReadmission ratesMAIN OUTCOMEPneumoniaMedicare dataHospitalizationHospitalMortalityReadmissionConcomitant harmComparison of Outcomes of Transfemoral Versus Transapical Approach for Transcatheter Aortic Valve Implantation
Kumar N, Khera R, Fonarow GC, Bhatt DL. Comparison of Outcomes of Transfemoral Versus Transapical Approach for Transcatheter Aortic Valve Implantation. The American Journal Of Cardiology 2018, 122: 1520-1526. PMID: 30190074, DOI: 10.1016/j.amjcard.2018.07.025.Peer-Reviewed Original ResearchMeSH KeywordsAcute Kidney InjuryAge DistributionAged, 80 and overBlood TransfusionCohort StudiesDatabases, FactualFemaleHeart FailureHospital MortalityHumansLength of StayMalePacemaker, ArtificialPeripheral Vascular DiseasesPrevalencePropensity ScoreStrokeTranscatheter Aortic Valve ReplacementUnited StatesConceptsTranscatheter aortic valve implantationAcute kidney injuryTA-TAVI proceduresAortic valve implantationTF-TAVIHospital mortalityTA-TAVIPostoperative strokeTransapical approachValve implantationTAVI procedureTA TAVIReal-world patient populationTA-TAVI groupTF-TAVI groupPropensity-matched cohortPeripheral vascular diseasePropensity-matched pairsComparison of outcomesTF approachICD-9 procedureLower ratesTA approachKidney injuryBaseline characteristicsRising Mortality in Patients With Heart Failure in the United States Facts Versus Fiction
Khera R, Dharmarajan K, Krumholz HM. Rising Mortality in Patients With Heart Failure in the United States Facts Versus Fiction. JACC Heart Failure 2018, 6: 610-612. PMID: 29914774, DOI: 10.1016/j.jchf.2018.02.011.Peer-Reviewed Original ResearchRelative Impairments in Hemodynamic Exercise Reserve Parameters in Heart Failure With Preserved Ejection Fraction A Study-Level Pooled Analysis
Pandey A, Khera R, Park B, Haykowsky M, Borlaug BA, Lewis GD, Kitzman DW, Butler J, Berry JD. Relative Impairments in Hemodynamic Exercise Reserve Parameters in Heart Failure With Preserved Ejection Fraction A Study-Level Pooled Analysis. JACC Heart Failure 2018, 6: 117-126. PMID: 29413366, PMCID: PMC8135913, DOI: 10.1016/j.jchf.2017.10.014.Peer-Reviewed Original ResearchMeSH KeywordsExercise TestExercise ToleranceHeart FailureHeart RateHumansStroke VolumeVentricular Function, LeftConceptsPulmonary capillary wedge pressureCapillary wedge pressurePeak oxygen uptakePooled analysisWedge pressureEchocardiographic parametersHeart failureExercise intoleranceExaggerated increaseReserve parametersControl groupLower peak oxygen uptakeRelative impairmentStroke volume reserveOxygen uptakeChronic HFpEFHemodynamic reserveExercise toleranceExercise capacityEjection fractionChronotropic reserveControl subjectsCardinal manifestationsHFpEFSignificant abnormalities