2024
Barriers to Optimal Clinician Guideline Adherence in Management of Markedly Elevated Blood Pressure
Lu Y, Arowojolu O, Qiu X, Liu Y, Curry L, Krumholz H. Barriers to Optimal Clinician Guideline Adherence in Management of Markedly Elevated Blood Pressure. JAMA Network Open 2024, 7: e2426135. PMID: 39106065, PMCID: PMC11304113, DOI: 10.1001/jamanetworkopen.2024.26135.Peer-Reviewed Original ResearchConceptsBarriers to guideline adherenceElectronic health recordsGuideline adherenceClinician adherenceEHR dataElevated blood pressureHypertension managementAnalysis of EHR dataYale New Haven Health SystemSevere hypertensionClinical practice guidelinesAdherence scenariosQualitative content analysisPublic health challengeThematic saturationHealth recordsHealth systemBlood pressureThematic analysisTargeted interventionsManagement of severe hypertensionQualitative studyHealth challengesPractice guidelinesPatient outcomesHypertension 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 patientsDigital Health Interventions for Hypertension Management in US Populations Experiencing Health Disparities
Katz M, Mszar R, Grimshaw A, Gunderson C, Onuma O, Lu Y, Spatz E. Digital Health Interventions for Hypertension Management in US Populations Experiencing Health Disparities. JAMA Network Open 2024, 7: e2356070. PMID: 38353950, PMCID: PMC10867699, DOI: 10.1001/jamanetworkopen.2023.56070.Peer-Reviewed Original ResearchConceptsDigital health interventionsHealth disparitiesHealth interventionsSystematic reviewSystolic BPSocial determinants of healthHypertension managementCommunity health workersFactors associated with cardiovascular diseaseDeterminants of healthLeveraging digital healthRemote BP monitoringDigital health technologiesStandard care groupMeta-analysisBlood pressureDiastolic BPPreferred Reporting ItemsControl groupSystolic BP changeBaseline to 6Random-effects modelSkilled nursingCultural tailoringSocial determinantsAssociation of marital/partner status with hospital readmission among young adults with acute myocardial infarction.
Zhu C, Dreyer R, Li F, Spatz E, Caraballo C, Mahajan S, Raparelli V, Leifheit E, Lu Y, Krumholz H, Spertus J, D'Onofrio G, Pilote L, Lichtman J. Association of marital/partner status with hospital readmission among young adults with acute myocardial infarction. PLOS ONE 2024, 19: e0287949. PMID: 38277368, PMCID: PMC10817183, DOI: 10.1371/journal.pone.0287949.Peer-Reviewed Original ResearchConceptsMarital/partner statusPsychosocial factorsAcute myocardial infarctionYoung adultsHospital dischargeYear of hospital dischargeYoung acute myocardial infarctionAssociated with 1.3-foldCohort of young adultsLong-term readmissionCox proportional hazards modelsStatus interactionSimilar-aged menMyocardial infarctionProportional hazards modelUnpartnered statusPatient interviewsPhysician panelCardiovascular healthHospital readmissionSocioeconomic factorsAMI survivorsSequential adjustmentCardiac readmissionMultiple imputation
2023
National Trends in Racial and Ethnic Disparities in Use of Recommended Therapies in Adults with Atherosclerotic Cardiovascular Disease, 1999-2020
Lu Y, Liu Y, Dhingra L, Caraballo C, Mahajan S, Massey D, Spatz E, Sharma R, Rodriguez F, Watson K, Masoudi F, Krumholz H. National Trends in Racial and Ethnic Disparities in Use of Recommended Therapies in Adults with Atherosclerotic Cardiovascular Disease, 1999-2020. JAMA Network Open 2023, 6: e2345964. PMID: 38039001, PMCID: PMC10692850, DOI: 10.1001/jamanetworkopen.2023.45964.Peer-Reviewed Original ResearchConceptsAtherosclerotic cardiovascular diseaseHistory of ASCVDCross-sectional studyLifestyle modificationPharmacological medicationsOptimal careCurrent careUS adultsEthnic differencesWhite individualsGuideline-recommended therapiesTotal cholesterol controlNon-Hispanic white individualsNutrition Examination SurveyLatino individualsQuality of careSelf-reported raceStatin useRecommended TherapiesSecondary preventionCholesterol controlOptimal regimensSmoking cessationEligible participantsExamination SurveyUncovering heterogeneous cardiometabolic risk profiles in US adults: the role of social and behavioral determinants of health
Ding Q, Lu Y, Herrin J, Zhang T, Marrero D. Uncovering heterogeneous cardiometabolic risk profiles in US adults: the role of social and behavioral determinants of health. BMJ Open Diabetes Research & Care 2023, 11: e003558. PMID: 37699720, PMCID: PMC10503393, DOI: 10.1136/bmjdrc-2023-003558.Peer-Reviewed Original ResearchConceptsCardiometabolic risk profileMetabolic risk factorsRace/ethnicityUndiagnosed diabetesUS adultsRisk factorsHealthcare accessNutrition Examination Survey 1999Risk profilePre-diabetes riskPrior diabetes diagnosisExamination Survey 1999Insurance coverageShort sleep durationLower diet qualityEffective prevention strategiesLimited healthcare accessBehavioral determinantsNon-white adultsMiddle-aged adultsHealth insurance coverageLow health insurance coverageCardiometabolic riskDiabetes statusDiabetes riskRacial/ethnic disparities in PM2.5-attributable cardiovascular mortality burden in the United States
Ma Y, Zang E, Opara I, Lu Y, Krumholz H, Chen K. Racial/ethnic disparities in PM2.5-attributable cardiovascular mortality burden in the United States. Nature Human Behaviour 2023, 7: 2074-2083. PMID: 37653149, PMCID: PMC10901568, DOI: 10.1038/s41562-023-01694-7.Peer-Reviewed Original ResearchConceptsNon-Hispanic White peopleCVD deathMortality burdenNon-Hispanic black peopleCardiovascular disease mortality ratesDisease mortality ratesNon-Hispanic blacksRace/ethnicityMortality rateLong-term exposureWhite peopleEthnic disparitiesHealth benefitsHispanic peopleSignificant differencesBurdenDeathUS countiesEthnic groupsAbsolute disparityAssociationExposureEthnic minoritiesDisparitiesAmbient fine particulate matter (PM2.5) concentrationsImpact of Marital Stress on 1‐Year Health Outcomes Among Young Adults With Acute Myocardial Infarction
Zhu C, Dreyer R, Li F, Spatz E, Caraballo‐Cordovez C, Mahajan S, Raparelli V, Leifheit E, Lu Y, Krumholz H, Spertus J, D'Onofrio G, Pilote L, Lichtman J. Impact of Marital Stress on 1‐Year Health Outcomes Among Young Adults With Acute Myocardial Infarction. Journal Of The American Heart Association 2023, 12: e030031. PMID: 37589125, PMCID: PMC10547344, DOI: 10.1161/jaha.123.030031.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionCardiac-specific qualityGeneric health statusMyocardial infarctionBaseline healthMarital stressHealth outcomesHealth statusWorse patient-reported outcomesMental healthYoung adultsObservational cohort studyPatient-reported outcomesSocioeconomic factorsWorse mental healthReadmission 1Cause readmissionCohort studyYounger patientsRoutine screeningDepressive symptomsGreater oddsAnginaMale participantsOutcomesExcess Mortality and Years of Potential Life Lost Among the Black Population in the US, 1999-2020
Caraballo C, Massey D, Ndumele C, Haywood T, Kaleem S, King T, Liu Y, Lu Y, Nunez-Smith M, Taylor H, Watson K, Herrin J, Yancy C, Faust J, Krumholz H. Excess Mortality and Years of Potential Life Lost Among the Black Population in the US, 1999-2020. JAMA 2023, 329: 1662-1670. PMID: 37191702, PMCID: PMC10189563, DOI: 10.1001/jama.2023.7022.Peer-Reviewed Original ResearchConceptsExcess mortality ratesExcess deathsMortality ratePotential lifeWhite populationExcess mortalitySerial cross-sectional studyHighest excess mortality ratesBlack populationCause-specific mortalityCross-sectional studyHigh mortality rateNon-Hispanic whitesYears of lifeUS national dataMiddle-aged adultsCause mortalityHeart diseaseDeath certificatesNon-Hispanic black populationMAIN OUTCOMEAge groupsDisease controlMortalityBlack malesSex 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. hospitalsWomenInfarctionOutcomesSex Differences in Symptom Complexity and Door-to-Balloon Time in Patients With ST-Elevation Myocardial Infarction
Brush J, Chaudhry S, Dreyer R, D'Onofrio G, Greene E, Hajduk A, Lu Y, Krumholz H. Sex Differences in Symptom Complexity and Door-to-Balloon Time in Patients With ST-Elevation Myocardial Infarction. The American Journal Of Cardiology 2023, 197: 101-107. PMID: 37062667, PMCID: PMC10198892, DOI: 10.1016/j.amjcard.2023.03.009.Peer-Reviewed Original ResearchConceptsPercutaneous coronary interventionD2B timeSymptom complexityYoung womenChest painBalloon timeST-elevation myocardial infarctionSILVER-AMI StudySymptom phenotypeSex differencesPain symptomsCoronary interventionOlder patientsMyocardial infarctionOlder womenSTEMIOlder menSymptom patternsPresentation delayPatientsSymptom clustersLogistic regressionSymptomsWomenMean numberDeveloping Validated Tools to Identify Pulmonary Embolism in Electronic Databases: Rationale and Design of the PE-EHR+ Study
Bikdeli B, Lo Y, Khairani C, Bejjani A, Jimenez D, Barco S, Mahajan S, Caraballo C, Secemsky E, Klok F, Hunsaker A, Aghayev A, Muriel A, Wang Y, Hussain M, Appah-Sampong A, Lu Y, Lin Z, Aneja S, Khera R, Goldhaber S, Zhou L, Monreal M, Krumholz H, Piazza G. Developing Validated Tools to Identify Pulmonary Embolism in Electronic Databases: Rationale and Design of the PE-EHR+ Study. Thrombosis And Haemostasis 2023, 123: 649-662. PMID: 36809777, PMCID: PMC11200175, DOI: 10.1055/a-2039-3222.Peer-Reviewed Original ResearchConceptsElectronic health recordsNLP algorithmNatural language processing toolsLanguage processing toolsPrincipal discharge diagnosisICD-10 codesDischarge diagnosisNLP toolsChart reviewHealth systemProcessing toolsYale New Haven Health SystemPatient identificationElectronic databasesHealth recordsData validationHigh-risk PEPulmonary Embolism ResearchSecondary discharge diagnosisIdentification of patientsManual chart reviewNegative predictive valueCodeRadiology reportsAlgorithmNonexercise machine learning models for maximal oxygen uptake prediction in national population surveys.
Liu Y, Herrin J, Huang C, Khera R, Dhingra L, Dong W, Mortazavi B, Krumholz H, Lu Y. Nonexercise machine learning models for maximal oxygen uptake prediction in national population surveys. Journal Of The American Medical Informatics Association 2023, 30: 943-952. PMID: 36905605, PMCID: PMC10114129, DOI: 10.1093/jamia/ocad035.Peer-Reviewed Original ResearchQuantifying Blood Pressure Visit-to-Visit Variability in the Real-World Setting: A Retrospective Cohort Study
Lu Y, Linderman G, Mahajan S, Liu Y, Huang C, Khera R, Mortazavi B, Spatz E, Krumholz H. Quantifying Blood Pressure Visit-to-Visit Variability in the Real-World Setting: A Retrospective Cohort Study. Circulation Cardiovascular Quality And Outcomes 2023, 16: e009258. PMID: 36883456, DOI: 10.1161/circoutcomes.122.009258.Peer-Reviewed Original ResearchConceptsRetrospective cohort studyBlood pressure valuesPatient characteristicsReal-world settingCohort studyPatient subgroupsYale New Haven Health SystemMean body mass indexSystolic blood pressure valuesBlood pressure visitHistory of hypertensionCoronary artery diseaseManagement of patientsMultivariable linear regression modelsBlood pressure readingsBody mass indexPatient-level measuresBlood pressure variationAbsolute standardized differencesNon-Hispanic whitesAntihypertensive medicationsReal-world practiceVisit variabilityArtery diseaseRegression modelsSex-Related Differences in Patient Characteristics, Risk Factors, and Symptomatology in Older Adults with Pulmonary Embolism: Findings from the SERIOUS-PE Study
Bikdeli B, Muriel A, Wang Y, Piazza G, Khairani C, Rosovsky R, Mehdipoor G, O'Donoghue M, Madridano O, Lopez-Saez J, Mellado M, Brasero A, Grandone E, Spagnolo P, Lu Y, Bertoletti L, López-Jiménez L, Núñez M, Blanco-Molina Á, Gerhard-Herman M, Goldhaber S, Bates S, Jimenez D, Krumholz H, Monreal M. Sex-Related Differences in Patient Characteristics, Risk Factors, and Symptomatology in Older Adults with Pulmonary Embolism: Findings from the SERIOUS-PE Study. Seminars In Thrombosis And Hemostasis 2023, 49: 725-735. PMID: 36868268, DOI: 10.1055/s-0043-1764231.Peer-Reviewed Original ResearchConceptsOlder adultsClinical characteristicsRisk factorsElderly womenPE risk stratificationTransient provoking factorsRelevant clinical characteristicsSex differencesWarrants further investigationSex-related differencesSex-specific factorsClot burdenPE presentationChest painHormonal therapyHormone therapyPatient characteristicsPulmonary embolismYounger patientsAtherosclerotic diseaseRisk stratificationLung diseaseMedicare databaseProvoking factorsCardiovascular diseaseDeveloping an Actionable Taxonomy of Persistent Hypertension Using Electronic Health Records
Lu Y, Du C, Khidir H, Caraballo C, Mahajan S, Spatz E, Curry L, Krumholz H. Developing an Actionable Taxonomy of Persistent Hypertension Using Electronic Health Records. Circulation Cardiovascular Quality And Outcomes 2023, 16: e009453. PMID: 36727515, DOI: 10.1161/circoutcomes.122.009453.Peer-Reviewed Original ResearchConceptsPersistent hypertensionElectronic health recordsBlood pressureHealth recordsPharmacologic agentsPrescribed treatmentYale New Haven Health SystemTreatment planAdditional pharmacologic agentsAntihypertensive treatment intensificationConsecutive outpatient visitsElevated blood pressurePersistence of hypertensionElectronic health record dataHealth record dataEligible patientsTreatment intensificationChart reviewHispanic patientsOutpatient visitsMean agePharmacological treatmentConventional content analysisHypertensionClinician notesTiming of Blood Draws Among Patients Hospitalized in a Large Academic Medical Center
Caraballo C, Mahajan S, Murugiah K, Mortazavi B, Lu Y, Khera R, Krumholz H. Timing of Blood Draws Among Patients Hospitalized in a Large Academic Medical Center. JAMA 2023, 329: 255-257. PMID: 36648476, PMCID: PMC9856620, DOI: 10.1001/jama.2022.21509.Peer-Reviewed Original ResearchPrimary care institutional characteristics associated with hypertension awareness, treatment, and control in the China PEACE-Million Persons Project and primary health-care survey: a cross-sectional study
Group C, Zhou T, Wang Y, Zhang H, Wu C, Tian N, Cui J, Bai X, Yang Y, Zhang X, Lu Y, Spatz E, Ross J, Krumholz H, Lu J, Li X, Hu S. Primary care institutional characteristics associated with hypertension awareness, treatment, and control in the China PEACE-Million Persons Project and primary health-care survey: a cross-sectional study. The Lancet Global Health 2023, 11: e83-e94. PMID: 36521957, DOI: 10.1016/s2214-109x(22)00428-4.Peer-Reviewed Original ResearchConceptsProportion of participantsPrimary care institutionsHypertension awarenessPrimary care systemBlood pressureCare institutionsCardiac Events Million Persons ProjectAverage diastolic blood pressureMedical Sciences (CAMS) Innovation FundAverage systolic blood pressureCare systemMillion Persons ProjectHistory of hypertensionDiastolic blood pressurePrimary care surveySystolic blood pressureCardiovascular disease riskBlood pressure measurementsCross-sectional studyParticipant-level dataProportion of physiciansRoutine service deliveryPrimary care roleHealth Care SurveyPublic health services
2022
Trends in Racial and Ethnic Disparities in Barriers to Timely Medical Care Among Adults in the US, 1999 to 2018
Caraballo C, Ndumele CD, Roy B, Lu Y, Riley C, Herrin J, Krumholz HM. Trends in Racial and Ethnic Disparities in Barriers to Timely Medical Care Among Adults in the US, 1999 to 2018. JAMA Health Forum 2022, 3: e223856. PMID: 36306118, PMCID: PMC9617175, DOI: 10.1001/jamahealthforum.2022.3856.Peer-Reviewed Original ResearchConceptsTimely medical careSerial cross-sectional studyNational Health Interview SurveyCross-sectional studyHealth Interview SurveyMedical careLack of transportationEthnic disparitiesHispanics/LatinosWhite individualsEthnicity groupsInterview SurveyCost of careSelf-reported raceStudy cohortClinic hoursMAIN OUTCOMEMedical officesCarePrevalenceLatino individualsBlack individualsSignificant differencesSignificant increasePopulation groupsHospital Variation of Spironolactone Use in Patients Hospitalized for Heart Failure in China—The China PEACE Retrospective Heart Failure Study
Yu Y, Guan W, Masoudi FA, Wang B, He G, Spertus JA, Lu Y, Krumholz HM, Li J. Hospital Variation of Spironolactone Use in Patients Hospitalized for Heart Failure in China—The China PEACE Retrospective Heart Failure Study. Journal Of The American Heart Association 2022, 11: e026300. PMID: 36172964, PMCID: PMC9673705, DOI: 10.1161/jaha.122.026300.Peer-Reviewed Original ResearchConceptsSpironolactone prescriptionSpironolactone useHeart failureMedian odds ratioIdeal patientAldosterone antagonistsHospital variationMedian rateReduced ejection fractionUse of spironolactoneMultivariable linear regression modelsHeart Failure StudyEjection fractionHospital characteristicsOdds ratioRepresentative cohortPatientsHospitalChinese hospitalsInappropriate usePrescriptionSpironolactoneSelect individualsAntagonistHigh rate