2024
Automated Identification of Heart Failure With Reduced Ejection Fraction Using Deep Learning-Based Natural Language Processing
Nargesi A, Adejumo P, Dhingra L, Rosand B, Hengartner A, Coppi A, Benigeri S, Sen S, Ahmad T, Nadkarni G, Lin Z, Ahmad F, Krumholz H, Khera R. Automated Identification of Heart Failure With Reduced Ejection Fraction Using Deep Learning-Based Natural Language Processing. JACC Heart Failure 2024 PMID: 39453355, DOI: 10.1016/j.jchf.2024.08.012.Peer-Reviewed Original ResearchReduced ejection fractionEjection fractionHeart failureLeft ventricular ejection fractionVentricular ejection fractionYale-New Haven HospitalIdentification of patientsCommunity hospitalIdentification of heart failureLanguage modelNorthwestern MedicineMeasure care qualityQuality of careNew Haven HospitalDeep learning-based natural language processingHFrEFGuideline-directed careDeep learning language modelsMIMIC-IIIDetect HFrEFNatural language processingReclassification improvementHospital dischargePatientsCare quality
2023
Prognostic Impact of Repeated NT-proBNP Measurements in Patients With Heart Failure With Reduced Ejection Fraction
Fuery M, Leifer E, Samsky M, Sen S, O'Connor C, Fiuzat M, Ezekowitz J, Piña I, Whellan D, Mark D, Felker G, Desai N, Januzzi J, Ahmad T. Prognostic Impact of Repeated NT-proBNP Measurements in Patients With Heart Failure With Reduced Ejection Fraction. JACC Heart Failure 2023, 12: 479-487. PMID: 38127049, DOI: 10.1016/j.jchf.2023.11.007.Peer-Reviewed Original ResearchNT-proBNP measurementsPrimary trial endpointChronic heart failureNT-proBNP levelsReduced ejection fractionTrial endpointsHeart failureEjection fractionN-terminal pro-B-type natriuretic peptide (NT-proBNP) measurementBaseline NT-proBNP levelsChronic heart failure patientsNT-proBNP monitoringSecondary trial endpointsHeart failure hospitalizationNatriuretic peptide measurementHeart failure patientsCardiovascular deathFailure hospitalizationNT-proBNPFailure patientsPrognostic impactClinical outcomesPrognostic valueOutpatient sitesClinical studiesLeft Ventricular Ejection Fraction and the Future of Heart Failure Phenotyping
Dimond M, Ibrahim N, Fiuzat M, McMurray J, Lindenfeld J, Ahmad T, Bozkurt B, Bristow M, Butler J, Carson P, Felker G, Jessup M, Murillo J, Kondo T, Solomon S, Abraham W, O'Connor C, Psotka M. Left Ventricular Ejection Fraction and the Future of Heart Failure Phenotyping. JACC Heart Failure 2023, 12: 451-460. PMID: 38099892, DOI: 10.1016/j.jchf.2023.11.005.Peer-Reviewed Original ResearchRationale, Design, and Patient Characteristics of a Cluster-Randomized Pragmatic Trial to Improve Mineralocorticoid Antagonist Use
Clark K, Victoria-Castro A, Ghazi L, Yamamoto Y, Coronel-Moreno C, Kadhim B, Riello R, O'Connor K, Ahmad T, Wilson F, Desai N. Rationale, Design, and Patient Characteristics of a Cluster-Randomized Pragmatic Trial to Improve Mineralocorticoid Antagonist Use. JACC Heart Failure 2023, 12: 322-332. PMID: 37943221, DOI: 10.1016/j.jchf.2023.08.025.Peer-Reviewed Original ResearchBest practice alertMineralocorticoid receptor antagonistsNovel potassium bindersPotassium bindersEligible patientsUsual careEjection fractionSerum potassiumHistory of hyperkalemiaIncidence of hyperkalemiaStrong guideline recommendationsHeart failure hospitalizationReduced ejection fractionLaboratory test valuesPopulation health outcomesHyperkalemia treatmentMRA prescriptionAntagonist useFailure hospitalizationPatient characteristicsSecondary outcomesHeart failurePrimary outcomeGuideline recommendationsOutpatient visitsElectronic health record alerts for management of heart failure with reduced ejection fraction in hospitalized patients: the PROMPT-AHF trial
Ghazi L, Yamamoto Y, Fuery M, O'Connor K, Sen S, Samsky M, Riello R, Dhar R, Huang J, Olufade T, McDermott J, Inzucchi S, Velazquez E, Wilson F, Desai N, Ahmad T. Electronic health record alerts for management of heart failure with reduced ejection fraction in hospitalized patients: the PROMPT-AHF trial. European Heart Journal 2023, 44: 4233-4242. PMID: 37650264, DOI: 10.1093/eurheartj/ehad512.Peer-Reviewed Original ResearchGuideline-directed medical therapyAcute heart failureMineralocorticoid receptor antagonistsHeart failureElectronic health recordsGDMT prescriptionPrimary outcomeEnzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitorsSodium-glucose cotransporter 2 inhibitorsAngiotensin receptor neprilysin inhibitorElectronic health record alertsEvidence-based regimenProviders of patientsReduced ejection fractionCotransporter 2 inhibitorsRelevant patient characteristicsTime of dischargePre-specified criteriaAHF hospitalizationEligible patientsInpatient initiationPatient characteristicsEjection fractionHospitalized patientsMedian ageImpact Of Digital Health Interventions In The Quality Of Life Of Patients With Heart Failure: A Randomized Trial
Castro A, Martin M, Desai N, Ahmad T, Yamamoto Y, Melchinger H, Lee K, Gerber B, Nguyen A, Weinstein J, Subair L, Lee V, Williams A, Shaw M, Arora T, Wilson F. Impact Of Digital Health Interventions In The Quality Of Life Of Patients With Heart Failure: A Randomized Trial. Journal Of Cardiac Failure 2023, 29: 662. DOI: 10.1016/j.cardfail.2022.10.284.Peer-Reviewed Original ResearchQuality of lifeUsual careClinical summary scoreTotal symptom scoreHeart failureSymptom scoresSummary scoresKansas City Cardiomyopathy Questionnaire overall scoreYale New Haven Health SystemDigital health toolsHealth toolsReduced ejection fractionResults One hundred fiftyUsual care groupMethods One hundred eightyNon-Hispanic blacksDigital health interventionsHF clinicSecondary outcomesEjection fractionEmergency visitsMedian agePrimary outcomeClinical outcomesRandomization groupWHAT IS THE VALUE OF REPEATED NT-PROBNP MEASUREMENTS IN CHRONIC HEART FAILURE WITH REDUCED EJECTION FRACTION?
Fuery M, Leifer E, Samsky M, Sen S, O'Connor C, Fiuzat M, Ezekowitz J, Pina I, Whellan D, Mark D, Felker G, Desai N, Januzzi J, Ahmad T. WHAT IS THE VALUE OF REPEATED NT-PROBNP MEASUREMENTS IN CHRONIC HEART FAILURE WITH REDUCED EJECTION FRACTION? Journal Of The American College Of Cardiology 2023, 81: 624. DOI: 10.1016/s0735-1097(23)01068-9.Peer-Reviewed Original Research
2022
Pragmatic trial of messaging to providers about treatment of acute heart failure: The PROMPT-AHF trial
Ghazi L, O'Connor K, Yamamoto Y, Fuery M, Sen S, Samsky M, Riello R, Huang J, Olufade T, McDermott J, Inzucchi S, Velazquez E, Wilson F, Desai N, Ahmad T. Pragmatic trial of messaging to providers about treatment of acute heart failure: The PROMPT-AHF trial. American Heart Journal 2022, 257: 111-119. PMID: 36493842, DOI: 10.1016/j.ahj.2022.12.002.Peer-Reviewed Original ResearchConceptsGuideline-directed medical therapyAcute heart failureHeart failurePragmatic trialElectronic health recordsSubstantial health care costsBest practice advisoryReduced ejection fractionUsual care armHealth recordsTime of dischargeEvidence-based careHealth care costsClinical decision support systemAHF patientsCare armEligible patientsHF hospitalizationInpatient initiationCardiovascular deathMedication classesEjection fractionMedical therapyPrimary outcomePractice advisoryNetwork Meta-Analysis Comparing Angiotensin Receptor-Neprilysin Inhibitors, Angiotensin Receptor Blockers, and Angiotensin-Converting Enzyme Inhibitors in Heart Failure With Reduced Ejection Fraction
Park D, An S, Attanasio S, Jolly N, Malhotra S, Doukky R, Samsky M, Sen S, Ahmad T, Nanna M, Vij A. Network Meta-Analysis Comparing Angiotensin Receptor-Neprilysin Inhibitors, Angiotensin Receptor Blockers, and Angiotensin-Converting Enzyme Inhibitors in Heart Failure With Reduced Ejection Fraction. The American Journal Of Cardiology 2022, 187: 84-92. PMID: 36459752, PMCID: PMC10958453, DOI: 10.1016/j.amjcard.2022.10.026.Peer-Reviewed Original ResearchMeSH KeywordsAngiotensin Receptor AntagonistsAngiotensin-Converting Enzyme InhibitorsAntihypertensive AgentsBayes TheoremDeathHeart FailureHumansHypotensionNeprilysinNetwork Meta-AnalysisRandomized Controlled Trials as TopicReceptors, AngiotensinStroke VolumeTreatment OutcomeVentricular Dysfunction, LeftConceptsAngiotensin receptor neprilysin inhibitorAngiotensin receptor blockersReduced ejection fractionHeart failureEjection fractionHigh riskCause mortalityReceptor blockersCardiac deathLower riskEnzyme inhibitorsMajor adverse cardiac eventsAngiotensin converting enzyme (ACE) inhibitorsAdverse cardiac eventsEfficacy end pointNetwork meta-analysis approachImproved clinical outcomesRandomized clinical trialsP scoreCardiac eventsAngiotensin receptorsClinical outcomesNeprilysin inhibitorClinical benefitRecent trialsMachine learning to define phenotypes and outcomes of patients hospitalized for heart failure with preserved ejection fraction: Findings from ASCEND-HF
Murray EM, Greene SJ, Rao VN, Sun JL, Alhanti BA, Blumer V, Butler J, Ahmad T, Mentz RJ. Machine learning to define phenotypes and outcomes of patients hospitalized for heart failure with preserved ejection fraction: Findings from ASCEND-HF. American Heart Journal 2022, 254: 112-121. PMID: 36007566, DOI: 10.1016/j.ahj.2022.08.009.Peer-Reviewed Original ResearchConceptsASCEND-HF trialAtrial fibrillationBlood pressureEjection fractionHeart failureLatent class analysisOutcomes of patientsLong-term outcomesYoung menFour-hour urine outputDistinct phenotypesAcute HFRenal impairmentClinical profileUrine outputASCEND-HFClinical benefitHeterogenous diseaseClinical dataOlder womenHFpEFPatientsOlder individualsCluster 3Asian womenMedicare Coverage and Out-of-Pocket Costs of Quadruple Drug Therapy for Heart Failure
Faridi K, Dayoub E, Ross J, Dhruva S, Ahmad T, Desai N. Medicare Coverage and Out-of-Pocket Costs of Quadruple Drug Therapy for Heart Failure. Journal Of The American College Of Cardiology 2022, 79: 2516-2525. PMID: 35738713, DOI: 10.1016/j.jacc.2022.04.031.Peer-Reviewed Original ResearchConceptsSodium-glucose cotransporter 2 inhibitorsAngiotensin receptor neprilysin inhibitorQuadruple therapyOOP costsMedicare coveragePocket costsAngiotensin-converting enzyme inhibitorPrior authorizationAngiotensin receptor blockersQuadruple drug therapyCotransporter 2 inhibitorsMineralocorticoid receptor antagonistsReduced ejection fractionDrug plansReceptor blockersEjection fractionHeart failureDrug therapyReceptor antagonistPrescription drug plansMedicare patientsEnzyme inhibitorsTherapyRegimensMedication pricesElectronic Alerts to Improve Heart Failure Therapy in Outpatient Practice A Cluster Randomized Trial
Ghazi L, Yamamoto Y, Riello RJ, Coronel-Moreno C, Martin M, O'Connor KD, Simonov M, Huang J, Olufade T, McDermott J, Dhar R, Inzucchi SE, Velazquez EJ, Wilson FP, Desai NR, Ahmad T. Electronic Alerts to Improve Heart Failure Therapy in Outpatient Practice A Cluster Randomized Trial. Journal Of The American College Of Cardiology 2022, 79: 2203-2213. PMID: 35385798, DOI: 10.1016/j.jacc.2022.03.338.Peer-Reviewed Original ResearchConceptsGuideline-directed medical therapyUsual careEjection fractionHeart failureMedical therapyPrimary outcomeCluster-randomized comparative effectiveness trialSodium-glucose cotransporter 2 inhibitorsElectronic health record alertsAldosterone system inhibitorsReduced ejection fractionUsual care armCotransporter 2 inhibitorsMineralocorticoid receptor antagonistsVentricular ejection fractionComparative effectiveness trialNumber of patientsKnowledge of guidelinesLow-cost interventionCare armDays postrandomizationEligible patientsGDMT useFailure therapyPatient characteristicsUnsupervised Machine Learning To Define Acute Hfpef Phenotypes: Findings From Ascend-hf
Murray E, Greene S, Rao V, Sun J, Alhanti B, Blumer V, Butler J, Ahmad T, Hernandez A, Mentz R. Unsupervised Machine Learning To Define Acute Hfpef Phenotypes: Findings From Ascend-hf. Journal Of Cardiac Failure 2022, 28: s10-s11. DOI: 10.1016/j.cardfail.2022.03.029.Peer-Reviewed Original ResearchSystolic blood pressureHFpEF phenotypeGroup patientsBaseline characteristicsBlood pressureHeart rateHigher systolic blood pressureLower systolic blood pressureDistinct baseline characteristicsDistinct patient phenotypesClinical trial cohortNatriuretic peptide concentrationsASCEND-HF trialTime of admissionFuture clinical trialsDistinct clinical outcomesLower heart rateHigher heart rateDistinct phenotypesHigh rateMedical comorbiditiesTrial cohortClinical profileEjection fractionHeart failureTrends In US Heart Failure Hospitalizations: Increased Volume And Patient Diversity With Decreased Total Costs, 2008-2018
Reinhardt S, Clark K, Chouairi F, Miller E, Kay B, Fuery M, Guha A, Ahmad T, Desai N. Trends In US Heart Failure Hospitalizations: Increased Volume And Patient Diversity With Decreased Total Costs, 2008-2018. Journal Of Cardiac Failure 2022, 28: s109-s110. DOI: 10.1016/j.cardfail.2022.03.280.Peer-Reviewed Original ResearchOverall heart failureHeart failureInpatient mortalityDiagnosis codesHospital costsChronic obstructive pulmonary diseaseIntroduction Heart failureHeart failure hospitalizationPeripheral arterial diseaseObstructive pulmonary diseaseCoronary artery diseaseNational Inpatient SampleLength of stayUS healthcare costsComorbid diabetesHF hospitalizationHospitalization volumeFailure hospitalizationHF cohortArtery diseaseEjection fractionMedian agePulmonary diseaseArterial diseaseHispanic patientsAssessing race and ethnicity differences in outcomes based on GDMT and target NT-proBNP in patients with heart failure with reduced ejection fraction: An analysis of the GUIDE-IT study
Pahuja M, Leifer ES, Clarke JD, Ahmad T, Daubert MA, Mark DB, Cooper L, Desvigne-Nickens P, Fiuzat M, Adams K, Ezekowitz J, Whellan DJ, Januzzi JL, O'Connor CM, Felker GM, Piña IL. Assessing race and ethnicity differences in outcomes based on GDMT and target NT-proBNP in patients with heart failure with reduced ejection fraction: An analysis of the GUIDE-IT study. Progress In Cardiovascular Diseases 2022, 71: 79-85. PMID: 35490873, DOI: 10.1016/j.pcad.2022.04.010.Peer-Reviewed Original ResearchConceptsHeart failure hospitalizationNon-black patientsNT-proBNPBlack patientsFailure hospitalizationHigh riskKansas City Cardiomyopathy Questionnaire overall scorePre-specified subgroup analysisGUIDE-IT trialHigher NYHA classReduced ejection fractionNT-proBNP concentrationsHeart failure therapyNon-Hispanic patientsUsual clinical careImportant baseline covariatesQuality of lifeEthnicity-based differencesHF hospitalizationMore comorbiditiesNYHA classCause mortalityTriple therapyFailure therapyEjection fractionHeart Failure Spending Function: An Investment Framework for Sequencing and Intensification of Guideline-Directed Medical Therapies
Allen LA, Teerlink JR, Gottlieb SS, Ahmad T, Lam CSP, Psotka MA. Heart Failure Spending Function: An Investment Framework for Sequencing and Intensification of Guideline-Directed Medical Therapies. Circulation Heart Failure 2022, 15: e008594. PMID: 35000432, DOI: 10.1161/circheartfailure.121.008594.Peer-Reviewed Original ResearchConceptsGuideline-directed medical therapyMedical therapyReduced ejection fractionHealth care delivery researchAdverse eventsCardiac benefitsSerum creatinineBlood pressureEjection fractionHeart failureRoutine carePatient burdenHeart rateNew therapiesPatient harmHigh dosesPatientsPsychosocial domainsPocket costsTherapeutic opportunitiesClinical useTherapyNew drugsPhysiological domainsSpending function
2021
Rationale and design of a cluster-randomized pragmatic trial aimed at improving use of guideline directed medical therapy in outpatients with heart failure: PRagmatic trial of messaging to providers about treatment of heart failure (PROMPT-HF)
Ghazi L, Desai NR, Simonov M, Yamamoto Y, O'Connor KD, Riello RJ, Huang J, Olufade T, McDermott J, Inzucchi SE, Velazquez EJ, Wilson FP, Ahmad T. Rationale and design of a cluster-randomized pragmatic trial aimed at improving use of guideline directed medical therapy in outpatients with heart failure: PRagmatic trial of messaging to providers about treatment of heart failure (PROMPT-HF). American Heart Journal 2021, 244: 107-115. PMID: 34808104, DOI: 10.1016/j.ahj.2021.11.010.Peer-Reviewed Original ResearchConceptsGuideline-directed medical therapyBest practice alertLeft ventricular ejection fractionHeart failureUsual careMedical therapyPragmatic trialElectronic health recordsEjection fractionCluster-randomized pragmatic trialLarge integrated healthcare systemDays post randomizationAppropriate medical therapyHeart Failure TrialReduced ejection fractionUsual care groupCommon chronic illnessGlomerular filtration rateVentricular ejection fractionRecent blood pressureIntegrated healthcare systemUse of guidelinesLow-cost interventionCreatinine levelsReal-world practiceTrends in Heart Failure Hospitalizations in the US from 2008 to 2018
Clark KAA, Reinhardt SW, Chouairi F, Miller PE, Kay B, Fuery M, Guha A, Ahmad T, Desai NR. Trends in Heart Failure Hospitalizations in the US from 2008 to 2018. Journal Of Cardiac Failure 2021, 28: 171-180. PMID: 34534665, DOI: 10.1016/j.cardfail.2021.08.020.Peer-Reviewed Original ResearchConceptsOverall heart failureHeart failureEjection fractionStudy periodHeart failure hospitalizationInpatient mortality rateNational Inpatient SampleLength of stayHospital inpatient costsVolume of patientsHealth care costsHFpEF subgroupsComorbid diabetesFailure hospitalizationInpatient mortalityMedian ageBlack patientsHispanic patientsSleep apneaEntire cohortInpatient costsInpatient SampleHF typeHospital costsMortality rateThe Impact of Depression on Outcomes in Patients With Heart Failure and Reduced Ejection Fraction Treated in the GUIDE-IT Trial
Chouairi F, Fuery MA, Mullan CW, Caraballo C, Sen S, Maulion C, Wilkinson ST, Surti T, McCullough M, Miller PE, Pacor J, Leifer ES, Felker GM, Velazquez EJ, Fiuzat M, O'Connor CM, Januzzi JL, Desai NR, Ahmad T. The Impact of Depression on Outcomes in Patients With Heart Failure and Reduced Ejection Fraction Treated in the GUIDE-IT Trial. Journal Of Cardiac Failure 2021, 27: 1359-1366. PMID: 34166799, DOI: 10.1016/j.cardfail.2021.06.008.Peer-Reviewed Original ResearchConceptsGuideline-directed medical therapyReduced ejection fractionAmino-terminal pro-B-type natriuretic peptide levelsPro-B-type natriuretic peptide levelsGUIDE-IT trialNatriuretic peptide levelsHeart failureEjection fractionClinical outcomesPeptide levelsOptimal guideline-directed medical therapyCox proportional hazards regression modelingProportional hazards regression modelingImpact of depressionHistory of depressionCardiovascular deathCause hospitalizationCause mortalityOverall cohortMedical therapyAdverse outcomesTarget dosesPatientsMental healthTime pointsNational Trends in the Burden of Atrial Fibrillation During Hospital Admissions for Heart Failure
Reinhardt SW, Chouairi F, Miller PE, Clark KAA, Kay B, Fuery M, Guha A, Freeman JV, Ahmad T, Desai NR, Friedman DJ. National Trends in the Burden of Atrial Fibrillation During Hospital Admissions for Heart Failure. Journal Of The American Heart Association 2021, 10: e019412. PMID: 34013736, PMCID: PMC8483517, DOI: 10.1161/jaha.120.019412.Peer-Reviewed Original ResearchConceptsReduced ejection fractionComorbid atrial fibrillationHeart failureAtrial fibrillationEjection fractionHospital mortalityHF hospitalizationBackground Heart failureConclusion Atrial fibrillationWhite individualsNational Inpatient SampleMedian hospital chargesMore comorbiditiesComorbid hypertensionHF admissionsHF outcomesPatient demographicsDiabetes mellitusHospital admissionHospital chargesInpatient SampleVascular diseaseHospitalizationPatientsMortality