2022
Alerting Clinicians to 1-Year Mortality Risk in Patients Hospitalized With Heart Failure
Ahmad T, Desai NR, Yamamoto Y, Biswas A, Ghazi L, Martin M, Simonov M, Dhar R, Hsiao A, Kashyap N, Allen L, Velazquez EJ, Wilson FP. Alerting Clinicians to 1-Year Mortality Risk in Patients Hospitalized With Heart Failure. JAMA Cardiology 2022, 7: 905-912. PMID: 35947362, PMCID: PMC9366654, DOI: 10.1001/jamacardio.2022.2496.Peer-Reviewed Original ResearchConceptsUsual care groupElectronic health recordsHeart failureAlert groupMedian agePrimary outcomeFemale patientsTerminal pro-brain natriuretic peptide levelsYale New Haven Health SystemPro-brain natriuretic peptide levelsMedian NT-proBNP levelLeft ventricular ejection fractionLarge tertiary care centerHeart failure hospitalizationHeart failure medicationsNatriuretic peptide levelsNT-proBNP levelsHealth recordsHours of admissionTertiary care centerVentricular ejection fractionRate of hospitalizationIntensive care unitEthnicity groupsSmall community hospitalRationale and design of a pragmatic trial aimed at improving treatment of hyperlipidemia in outpatients with very high risk atherosclerotic cardiovascular disease: A pragmatic trial of messaging to providers about treatment of hyperlipidemia (PROMPT-LIPID)
Shah NN, Ghazi L, Yamamoto Y, Martin M, Simonov M, Riello RJ, Faridi KF, Ahmad T, Wilson FP, Desai NR. Rationale and design of a pragmatic trial aimed at improving treatment of hyperlipidemia in outpatients with very high risk atherosclerotic cardiovascular disease: A pragmatic trial of messaging to providers about treatment of hyperlipidemia (PROMPT-LIPID). American Heart Journal 2022, 253: 76-85. PMID: 35841944, PMCID: PMC9936562, DOI: 10.1016/j.ahj.2022.07.002.Peer-Reviewed Original ResearchConceptsLipid-lowering therapyAtherosclerotic cardiovascular diseaseTreatment of hyperlipidemiaProportion of patientsElectronic health recordsPragmatic trialHigh riskCardiovascular diseaseProprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitorsHigh-risk atherosclerotic cardiovascular diseaseSubtilisin/kexin type 9 inhibitorsLow-density lipoprotein cholesterol reductionImportant public health implicationsEnrollment of patientsPublic health implicationsUsual careSecondary outcomesPrimary outcomeGuideline recommendationsCholesterol reductionPatientsLDLHyperlipidemiaScalable interventionsOutpatientsThirty-Day and 90-Day Episode of Care Spending Following Heart Failure Hospitalization Among Medicare Beneficiaries
Reinhardt SW, Clark KAA, Xin X, Parzynski CS, Riello R, Sarocco P, Ahmad T, Desai NR. Thirty-Day and 90-Day Episode of Care Spending Following Heart Failure Hospitalization Among Medicare Beneficiaries. Circulation Cardiovascular Quality And Outcomes 2022, 15: e008069. PMID: 35861780, DOI: 10.1161/circoutcomes.121.008069.Peer-Reviewed Original ResearchConceptsHypertensive heart diseaseIndex hospitalizationMedicare beneficiariesPost-acute care spendingService administrative claims dataMedicare Bundled PaymentsHeart failure admissionsHeart failure hospitalizationPrimary discharge diagnosisChronic kidney diseaseAdministrative claims dataCare spendingPostacute care spendingSkilled nursing facilitiesCare Improvement ProgramDrivers of costDiastolic HFHF careHF hospitalizationSystolic HFFailure hospitalizationDischarge diagnosisKidney diseaseObservation staysPostacute careMedicare 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 characteristics
2021
Brief report: Cannabis and opioid use disorder among heart failure admissions, 2008–2018
Chouairi F, Mullan CW, Ravindra N, Clark KAA, Jaffe EM, Bhinder J, Fuery M, Guha A, Ahmad T, Desai NR. Brief report: Cannabis and opioid use disorder among heart failure admissions, 2008–2018. PLOS ONE 2021, 16: e0255514. PMID: 34591847, PMCID: PMC8483306, DOI: 10.1371/journal.pone.0255514.Peer-Reviewed Original ResearchCannabis use disorder among atrial fibrillation admissions, 2008–2018
Chouairi F, Miller PE, Guha A, Clarke J, Reinhardt SW, Ahmad T, Freeman JV, Desai NR, Friedman DJ. Cannabis use disorder among atrial fibrillation admissions, 2008–2018. Pacing And Clinical Electrophysiology 2021, 44: 1934-1938. PMID: 34506639, DOI: 10.1111/pace.14356.Peer-Reviewed Original ResearchConceptsAtrial fibrillation hospitalizationsAF hospitalizationsImpact of CUDNational Inpatient SampleProportion of admissionsDiseases diagnosis codesPrevalence of cannabisHistory of CUDHospital dischargeYounger patientsHigher proportionUnderserved patientsBlack raceDiagnosis codesInpatient SampleInternational ClassificationHospitalizationLegality of cannabisCannabis usePatientsAdmissionCodiagnosisLittle dataCUDCannabisComparison of Transcatheter and Open Mitral Valve Repair Among Patients With Mitral Regurgitation
Kay B, Chouairi F, Clark KAA, Reinhardt SW, Fuery M, Guha A, Ahmad T, Kaple RK, Desai NR. Comparison of Transcatheter and Open Mitral Valve Repair Among Patients With Mitral Regurgitation. Mayo Clinic Proceedings 2021, 96: 1522-1529. PMID: 34088415, DOI: 10.1016/j.mayocp.2021.01.029.Peer-Reviewed Original ResearchConceptsMitral valve repairMitral regurgitationValve repairInternational ClassificationPatient underwent mitral valve repairOpen mitral valve repairUnderwent mitral valve repairTranscatheter mitral valve repairStudy periodComparison of transcatheterProhibitive surgical riskTenth Revision codesTotal hospital chargesDegenerative mitral regurgitationNational Inpatient SampleLength of stayTranscatheter mitral valve repair deviceDischarge homeHospital mortalityDischarge dispositionPatient comorbiditiesSurgical riskHospital chargesMedian lengthNinth RevisionNational 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 diseaseHospitalizationPatientsMortalityElectronic health record risk score provides earlier prognostication of clinical outcomes in patients admitted to the cardiac intensive care unit
Kunitomo Y, Thomas A, Chouairi F, Canavan ME, Kochar A, Khera R, Katz JN, Murphy C, Jentzer J, Ahmad T, Desai NR, Brennan J, Miller PE. Electronic health record risk score provides earlier prognostication of clinical outcomes in patients admitted to the cardiac intensive care unit. American Heart Journal 2021, 238: 85-88. PMID: 33891906, DOI: 10.1016/j.ahj.2021.04.004.Peer-Reviewed Original ResearchConceptsCardiac intensive care unitIntensive care unitRothman IndexCare unitRisk scoreModern cardiac intensive care unitSequential Organ Failure Assessment scoreOrgan Failure Assessment scoreElectronic health recordsCICU mortalityCICU patientsSOFA scoreCICU admissionClinical outcomesEarly prognosticationObservational studyPrognostic abilityAssessment scoresOutcome predictionHealth recordsGood calibrationSuperior discriminationPatientsAdmissionScoresTrends in 30- and 90-Day Readmission Rates for Heart Failure
Khan MS, Sreenivasan J, Lateef N, Abougergi MS, Greene SJ, Ahmad T, Anker SD, Fonarow GC, Butler J. Trends in 30- and 90-Day Readmission Rates for Heart Failure. Circulation Heart Failure 2021, 14: e008335. PMID: 33866827, DOI: 10.1161/circheartfailure.121.008335.Peer-Reviewed Original ResearchConceptsHospital Readmissions Reduction ProgramHF readmission ratesIndex HF hospitalizationLow-volume hospitalsReadmission ratesHF hospitalizationPayer sourceHeart failure outcomesNational Readmission DatabaseReadmissions Reduction ProgramNon-Medicare insuranceCause 30Cause readmissionEjection fractionHeart failureSubgroup analysisReadmissionLinear regression analysisPrimary analysisSecondary analysisHospitalizationFailure outcomesHF volumeLimited dataRegression analysisRelation of Cardiovascular Risk Factors to Mortality and Cardiovascular Events in Hospitalized Patients With Coronavirus Disease 2019 (from the Yale COVID-19 Cardiovascular Registry)
Pareek M, Singh A, Vadlamani L, Eder M, Pacor J, Park J, Ghazizadeh Z, Heard A, Cruz-Solbes AS, Nikooie R, Gier C, Ahmed ZV, Freeman JV, Meadows J, Smolderen KGE, Lampert R, Velazquez EJ, Ahmad T, Desai NR. Relation of Cardiovascular Risk Factors to Mortality and Cardiovascular Events in Hospitalized Patients With Coronavirus Disease 2019 (from the Yale COVID-19 Cardiovascular Registry). The American Journal Of Cardiology 2021, 146: 99-106. PMID: 33539857, PMCID: PMC7849530, DOI: 10.1016/j.amjcard.2021.01.029.Peer-Reviewed Original ResearchConceptsCardiovascular risk factorsCoronavirus disease 2019Risk factorsHigher troponin TCardiovascular diseaseCardiovascular eventsHospitalized patientsLaboratory findingsMental statusDisease 2019Multivariable binary logistic regression analysisTroponin TMajor adverse cardiovascular eventsPre-existing cardiovascular diseaseHigher C-reactive proteinCOVID-19 positive patientsPredictors of MACEPrevious ventricular arrhythmiaUse of P2YAdverse cardiovascular eventsProspective cohort studyTertiary care centerC-reactive proteinBinary logistic regression analysisPoor prognostic markerTransition From an Open to Closed Staffing Model in the Cardiac Intensive Care Unit Improves Clinical Outcomes
Miller PE, Chouairi F, Thomas A, Kunitomo Y, Aslam F, Canavan ME, Murphy C, Daggula K, Metkus T, Vallabhajosyula S, Carnicelli A, Katz JN, Desai NR, Ahmad T, Velazquez EJ, Brennan J. Transition From an Open to Closed Staffing Model in the Cardiac Intensive Care Unit Improves Clinical Outcomes. Journal Of The American Heart Association 2021, 10: e018182. PMID: 33412899, PMCID: PMC7955420, DOI: 10.1161/jaha.120.018182.Peer-Reviewed Original ResearchConceptsCardiac intensive care unitIntensive care unitHospital mortalityCare unitCICU mortalityClinical outcomesModern cardiac intensive care unitSurgical intensive care unitTotal hospital chargesSeverity of illnessMultivariable logistic regressionCICU lengthMultivariable adjustmentRespiratory insufficiencyPrimary outcomeUnique admissionsHospital chargesCardiac arrestSubgroup analysisImproved outcomesMortalityLogistic regressionAdmissionClosed unitStaffing models
2020
Clinical implications of differences between real world and clinical trial usage of left ventricular assist devices for end stage heart failure
Mezzacappa C, Ravindra NG, Caraballo C, Chouairi F, Miller PE, Clarke JD, Gruen J, Mori M, McCullough M, Mullan C, Geirsson A, Rogers JG, Anwer M, Desai N, Ahmad T. Clinical implications of differences between real world and clinical trial usage of left ventricular assist devices for end stage heart failure. PLOS ONE 2020, 15: e0242928. PMID: 33270648, PMCID: PMC7714148, DOI: 10.1371/journal.pone.0242928.Peer-Reviewed Original ResearchConceptsClinical trialsVentricular assist deviceExclusion criteriaLVAD recipientsAssist deviceReal-world settingClinical implicationsClinical trial exclusion criteriaHeart failure clinical trialsEnd-stage renal diseaseEnd-stage heart failureReal-world registryRetrospective cohort studyLandmark clinical trialsStage renal diseaseTrial exclusion criteriaRisk of deathStage heart failureRespiratory failureCohort studyPatient characteristicsHeart failurePatient factorsRenal diseaseClinical outcomesImpact of Preoperative Lymphopenia on Survival Following Left Ventricular Assist Device Placement
Stawiarski K, Agboola O, Park J, Geirsson A, Jacoby D, Bellumkonda L, Ahmad T, Chou J, Lee F, Mangi A, Bonde P. Impact of Preoperative Lymphopenia on Survival Following Left Ventricular Assist Device Placement. ASAIO Journal 2020, 67: 650-657. PMID: 33074860, DOI: 10.1097/mat.0000000000001289.Peer-Reviewed Original ResearchConceptsAbsolute lymphocyte countCause mortalityLymphopenia groupLeft ventricular assist device patientsVentricular assist device patientsVentricular assist device placementCox proportional hazards modelImpact of lymphopeniaHeart failure populationKaplan-Meier plotsFurther clinical investigationProportional hazards modelLog-rank statisticsDurable LVADPreoperative lymphopeniaLVAD placementLymphocyte countLymphopenic patientsDevice patientsSingle centerPoor outcomePrognostic implicationsALC levelsFailure populationStudy populationCOVID-19 infections and outcomes in a live registry of heart failure patients across an integrated health care system
Caraballo C, McCullough M, Fuery MA, Chouairi F, Keating C, Ravindra NG, Miller PE, Malinis M, Kashyap N, Hsiao A, Wilson FP, Curtis JP, Grant M, Velazquez EJ, Desai NR, Ahmad T. COVID-19 infections and outcomes in a live registry of heart failure patients across an integrated health care system. PLOS ONE 2020, 15: e0238829. PMID: 32997657, PMCID: PMC7526909, DOI: 10.1371/journal.pone.0238829.Peer-Reviewed Original ResearchConceptsHeart failure patientsIntegrated health care systemHeart Failure RegistryHealth care systemFailure patientsCOVID-19 infectionCare systemCOVID-19SARS-CoV-2 infectionReal-time registryRenin-angiotensin blockersRetrospective chart reviewCoronary artery diseaseRisk of deathCOVID-19 testingAngiotensin blockersMultiple comorbiditiesRespiratory failureChart reviewSymptomatic patientsArtery diseaseHeart failureComorbid conditionsPatient mortalityClinical managementComparison of Mortality and Readmission in Non-Ischemic Versus Ischemic Cardiomyopathy After Implantable Cardioverter-Defibrillator Implantation
Higgins AY, Bjerre J, Parzynski CS, Minges KE, Ahmad T, Desai NR, Enriquez A, Spatz ES, Friedman DJ, Curtis JP, Hlatky MA, Freeman JV. Comparison of Mortality and Readmission in Non-Ischemic Versus Ischemic Cardiomyopathy After Implantable Cardioverter-Defibrillator Implantation. The American Journal Of Cardiology 2020, 133: 116-125. PMID: 32862971, DOI: 10.1016/j.amjcard.2020.07.035.Peer-Reviewed Original ResearchConceptsNon-ischemic cardiomyopathyImplantable cardioverter defibrillator implantationCardioverter-defibrillator implantationICM patientsIschemic cardiomyopathyNational Cardiovascular Data Registry ICD RegistryCox proportional hazards regression modelPrimary prevention ICD implantationLeft ventricular ejection fractionProportional hazards regression modelsPrimary prevention ICDsRetrospective cohort studyVentricular ejection fractionKaplan-Meier curvesHazards regression modelsRisk of mortalityComparison of mortalityMedian followCohort studyICD implantationEjection fractionHeart failureHospital readmissionICD RegistryPatient subgroups
2015
Cardiac dysfunction associated with a nucleotide polymerase inhibitor for treatment of hepatitis C
Ahmad T, Yin P, Saffitz J, Pockros PJ, Lalezari J, Shiffman M, Freilich B, Zamparo J, Brown K, Dimitrova D, Kumar M, Manion D, Heath-Chiozzi M, Wolf R, Hughes E, Muir AJ, Hernandez AF. Cardiac dysfunction associated with a nucleotide polymerase inhibitor for treatment of hepatitis C. Hepatology 2015, 62: 409-416. PMID: 25251156, DOI: 10.1002/hep.27488.Peer-Reviewed Original ResearchConceptsNucleotide polymerase inhibitorLVEF dysfunctionPolymerase inhibitorsB-type natriuretic peptide levelsChronic hepatitis C virus (HCV) infectionHepatitis C virus infectionActing antiviral (DAA) agentsSevere myocyte damageC virus infectionNatriuretic peptide levelsPhase II studyVentricular ejection fractionT-wave inversionOff-target toxicityHCV treatmentHepatitis CII studySystolic functionTransthoracic echocardiogramEjection fractionNew DAAsCardiac dysfunctionElectrocardiogram changesPathological findingsCardiac toxicity