2024
Artificial intelligence applied to electrocardiographic images for the risk stratification of cancer therapeutics-related cardiac dysfunction
Oikonomou E, Sangha V, Dhingra L, Aminorroaya A, Coppi A, Krumholz H, Baldassarre L, Khera R. Artificial intelligence applied to electrocardiographic images for the risk stratification of cancer therapeutics-related cardiac dysfunction. European Heart Journal 2024, 45: ehae666.3190. DOI: 10.1093/eurheartj/ehae666.3190.Peer-Reviewed Original ResearchCancer therapeutics-related cardiac dysfunctionImmune checkpoint inhibitorsGlobal longitudinal strainLeft ventricular systolic dysfunctionNon-Hodgkin's lymphomaCardiac dysfunctionAI-ECGNegative control analysesAssociated with higher incidenceVentricular systolic dysfunctionCohort of patientsRisk stratification strategiesCheckpoint inhibitorsTrastuzumab exposureSystolic dysfunctionRisk stratificationBreast cancerRisk biomarkersSecondary outcomesLongitudinal strainStratification strategiesTrastuzumabPatientsHigher incidenceAnthracyclinesArtificial intelligence applied to electrocardiographic images for scalable screening of cardiac amyloidosis
Sangha V, Oikonomou E, Krumholz H, Miller E, Khera R. Artificial intelligence applied to electrocardiographic images for scalable screening of cardiac amyloidosis. European Heart Journal 2024, 45: ehae666.3436. DOI: 10.1093/eurheartj/ehae666.3436.Peer-Reviewed Original ResearchATTR-CMBone scintigraphy scansTransthyretin amyloid cardiomyopathyPositive predictive valueAI-ECG algorithmCardiac amyloidosisScintigraphy scanAmyloid cardiomyopathyAI-ECGSex-matchedDevelopment cohortMyocardial remodelingUnder-diagnosedUnder-treatedMatched controlsPredictive valueUnder-recognizedTransthyretin stabilizersConvolutional neural networkPatientsECGArtificial intelligenceHospitalPrevalenceTransthyretinAutomated 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 qualityMultimodal fusion learning for long QT syndrome pathogenic genotypes in a racially diverse population
Jiang J, Thi Vy H, Charney A, Kovatch P, Reddy V, Jayaraman P, Do R, Khera R, Chugh S, Bhatt D, Vaid A, Lampert J, Nadkarni G. Multimodal fusion learning for long QT syndrome pathogenic genotypes in a racially diverse population. Npj Digital Medicine 2024, 7: 226. PMID: 39181999, PMCID: PMC11344778, DOI: 10.1038/s41746-024-01218-1.Peer-Reviewed Original ResearchLong QT syndromeUnited Kingdom BiobankHigh-risk genotypesElectronic health record dataHealth record dataPathogenic variantsRacially/ethnically diverse cohortCongenital long QT syndromeLQTS-susceptibility genesRacially diverse populationMount Sinai BioMe BiobankPathogenic genetic mutationsQT corrected intervalArea under the receiver operating curveBioMe BiobankPatient prioritizationReceiver operating curveQT syndromeRecord dataDiverse cohortGenetic testingDiverse populationsPathogen genotypesGenetic mutationsPatients
2023
Clinical Risk Prediction Models with Meta-Learning Prototypes of Patient Heterogeneity
Zhang L, Khera R, Mortazavi B. Clinical Risk Prediction Models with Meta-Learning Prototypes of Patient Heterogeneity. Annual International Conference Of The IEEE Engineering In Medicine And Biology Society (EMBC) 2023, 00: 1-4. PMID: 38083199, PMCID: PMC11007255, DOI: 10.1109/embc40787.2023.10340765.Peer-Reviewed Original ResearchSex 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. hospitalsWomenInfarctionOutcomesVariation 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 mixTiming 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 Research
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 comparisonMortalityHealth status outcomes after spontaneous coronary artery dissection and comparison with other acute myocardial infarction: The VIRGO experience
Murugiah K, Chen L, Dreyer RP, Bouras G, Safdar B, Khera R, Lu Y, Spatz ES, Ng VG, Gupta A, Bueno H, Tweet MS, Spertus JA, Hayes SN, Lansky A, Krumholz HM. Health status outcomes after spontaneous coronary artery dissection and comparison with other acute myocardial infarction: The VIRGO experience. PLOS ONE 2022, 17: e0265624. PMID: 35320296, PMCID: PMC8942215, DOI: 10.1371/journal.pone.0265624.Peer-Reviewed Original ResearchConceptsSpontaneous coronary artery dissectionAcute myocardial infarctionAMI patientsCoronary artery dissectionYoung AMI patientsHealth status outcomesHealth status instrumentsSCAD patientsArtery dissectionMyocardial infarctionStatus outcomesPatientsOutcomesHousehold incomeCollege educationInfarctionPhenomapping-Derived Tool to Individualize the Effect of Canagliflozin on Cardiovascular Risk in Type 2 Diabetes.
Oikonomou EK, Suchard MA, McGuire DK, Khera R. Phenomapping-Derived Tool to Individualize the Effect of Canagliflozin on Cardiovascular Risk in Type 2 Diabetes. Diabetes Care 2022, 45: 965-974. PMID: 35120199, PMCID: PMC9016734, DOI: 10.2337/dc21-1765.Peer-Reviewed Original ResearchConceptsCanagliflozin Cardiovascular Assessment StudyMajor adverse cardiovascular eventsType 2 diabetesHazard ratioSodium-glucose cotransporter 2 inhibitorsCardiovascular disease benefitAdverse cardiovascular eventsCotransporter 2 inhibitorsEffects of canagliflozinCanagliflozin dosesCanagliflozin's effectsCardiovascular eventsCardiovascular riskPatients 5Cardioprotective effectsSGLT2 inhibitorsDisease benefitBaseline variablesOriginal trialCanagliflozinType 2DiabetesPatientsRisk estimatesEffect estimates
2021
Forgone 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 ResearchConceptsHeart 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 causePatientsSparse Gated Mixture-of-Experts to Separate and Interpret Patient Heterogeneity in EHR data
Huo Z, Zhang L, Khera R, Huang S, Qian X, Wang Z, Mortazavi B. Sparse Gated Mixture-of-Experts to Separate and Interpret Patient Heterogeneity in EHR data. 2021, 00: 1-4. DOI: 10.1109/bhi50953.2021.9508549.Peer-Reviewed Original ResearchRepeated cross-sectional analysis of hydroxychloroquine deimplementation in the AHA COVID-19 CVD Registry
Bradley SM, Emmons-Bell S, Mutharasan RK, Rodriguez F, Gupta D, Roth G, Gluckman TJ, Shah RU, Wang TY, Khera R, Peterson PN, Das S. Repeated cross-sectional analysis of hydroxychloroquine deimplementation in the AHA COVID-19 CVD Registry. Scientific Reports 2021, 11: 15097. PMID: 34302004, PMCID: PMC8302649, DOI: 10.1038/s41598-021-94203-7.Peer-Reviewed Original ResearchConceptsCOVID-19Use of hydroxychloroquineActive COVID-19Cross-sectional analysisRandomized trialsIneffective therapyNational registryMedian useClinical careClinical informationDeimplementationU.S. hospitalsOverall proportionLittle dataHydroxychloroquineFurther studiesPatientsRegistryTherapyHospitalTrialsCareAtherosclerotic Cardiovascular Disease, Cancer, and Financial Toxicity Among Adults in the United States
Valero-Elizondo J, Chouairi F, Khera R, Grandhi GR, Saxena A, Warraich HJ, Virani SS, Desai NR, Sasangohar F, Krumholz HM, Esnaola NF, Nasir K. Atherosclerotic Cardiovascular Disease, Cancer, and Financial Toxicity Among Adults in the United States. JACC CardioOncology 2021, 3: 236-246. PMID: 34396329, PMCID: PMC8352280, DOI: 10.1016/j.jaccao.2021.02.006.Peer-Reviewed Original ResearchCost-related medication nonadherenceFinancial toxicityMedication nonadherenceNational Health Interview SurveyAtherosclerotic cardiovascular diseaseMedical billsHealth Interview SurveyCancer careASCVDCardiovascular diseaseHigh burdenHigher oddsElderly populationCancerInterview SurveyFood insecurityCareNonadherenceSignificant proportionAdultsToxicityHigh financial distressPatientsPrevalenceDiseaseFinancial burden, distress, and toxicity in cardiovascular disease
Slavin SD, Khera R, Zafar SY, Nasir K, Warraich HJ. Financial burden, distress, and toxicity in cardiovascular disease. American Heart Journal 2021, 238: 75-84. PMID: 33961830, DOI: 10.1016/j.ahj.2021.04.011.Peer-Reviewed Original ResearchConceptsCardiovascular diseaseFinancial burdenCommunity Health Worker IntegrationHigh-risk individualsComparative effectiveness studiesNon-medical needsHigh-cost interventionsHigh-cost treatmentsCVD managementEffectiveness studiesHealth systemPsychological distressInsurance coverageHealthcare policyBurdenDistressDiseaseSystem navigationInterventionCommunity-based initiativesPatientsPhysiciansElectronic 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 discriminationPatientsAdmissionScoresPrevalence of Missing Data in the National Cancer Database and Association With Overall Survival
Yang DX, Khera R, Miccio JA, Jairam V, Chang E, Yu JB, Park HS, Krumholz HM, Aneja S. Prevalence of Missing Data in the National Cancer Database and Association With Overall Survival. JAMA Network Open 2021, 4: e211793. PMID: 33755165, PMCID: PMC7988369, DOI: 10.1001/jamanetworkopen.2021.1793.Peer-Reviewed Original ResearchConceptsNational Cancer DatabaseNon-small cell lung cancerOverall survivalCell lung cancerCancer DatabaseMedical recordsLung cancerProstate cancerBreast cancerPatient recordsComplete dataRetrospective cohort studyCohort studyCancer RegistryCommon cancerVariables of interestHigh prevalenceMAIN OUTCOMEPatientsClinical advancementReal-world data sourcesCancerPrevalenceSurvivalHeterogeneous differences
2020
Trends in Reoperative Coronary Artery Bypass Graft Surgery for Older Adults in the United States, 1998 to 2017
Mori M, Wang Y, Murugiah K, Khera R, Gupta A, Vallabhajosyula P, Masoudi FA, Geirsson A, Krumholz HM. Trends in Reoperative Coronary Artery Bypass Graft Surgery for Older Adults in the United States, 1998 to 2017. Journal Of The American Heart Association 2020, 9: e016980. PMID: 33045889, PMCID: PMC7763387, DOI: 10.1161/jaha.120.016980.Peer-Reviewed Original ResearchConceptsCoronary artery bypass graft surgeryFirst-time coronary artery bypass graft surgeryArtery bypass graft surgeryBypass graft surgeryGraft surgeryMedicare feeOlder adultsPatient baseline characteristicsData of adultsYear of dischargeProportion of womenService inpatientsIndex surgeryBaseline characteristicsHospital dischargeOlder patientsMedian agePrimary outcomeCox regressionService patientsUnique patientsPatientsSurgeryAnnual declineDemographic subgroupsRates and Predictors of Patient Underreporting of Hospitalizations During Follow-Up After Acute Myocardial Infarction
Caraballo C, Khera R, Jones PG, Decker C, Schulz W, Spertus JA, Krumholz HM. Rates and Predictors of Patient Underreporting of Hospitalizations During Follow-Up After Acute Myocardial Infarction. Circulation Cardiovascular Quality And Outcomes 2020, 13: e006231. PMID: 32552061, PMCID: PMC9465954, DOI: 10.1161/circoutcomes.119.006231.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionMyocardial infarctionHospitalization eventsMedical recordsLongitudinal multicenter cohort studyMulticenter cohort studyMedical record abstractionDifferent patient characteristicsHealth care eventsPatients' underreportingTRIUMPH registryAccuracy of reportingCohort studyPatient characteristicsRecord abstractionProspective studyClinical studiesClinical investigationHospitalizationPatientsCare eventsInfarctionEvent ratesParticipantsPredictors