Featured Publications
Electronic 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 characteristicsEmpagliflozin in Heart Failure
Griffin M, Rao VS, Ivey-Miranda J, Fleming J, Mahoney D, Maulion C, Suda N, Siwakoti K, Ahmad T, Jacoby D, Riello R, Bellumkonda L, Cox Z, Collins S, Jeon S, Turner JM, Wilson FP, Butler J, Inzucchi SE, Testani JM. Empagliflozin in Heart Failure. Circulation 2020, 142: 1028-1039. PMID: 32410463, PMCID: PMC7521417, DOI: 10.1161/circulationaha.120.045691.Peer-Reviewed Original ResearchConceptsSodium-glucose cotransporter 2 inhibitorsCotransporter 2 inhibitorsNeurohormonal activationHeart failureRenal dysfunctionBlood volumeHeart failure-related outcomesPlacebo-controlled crossover studyType 2 diabetes mellitusProximal tubular siteHeart failure outcomesStable heart failureUrinary glucose excretionUric acid levelsElectrolyte wastingEmpagliflozin monotherapyOral empagliflozinPlacebo periodStudy drugGlucose excretionNatriuretic effectPotassium wastingTubular sitesDiabetes mellitusFractional excretionSodium glucose cotransporter 2 inhibitors as diuretic adjuvants in acute decompensated heart failure: a case series
Griffin M, Riello R, Rao VS, Ivey-Miranda J, Fleming J, Maulion C, McCallum W, Sarnak M, Collins S, Inzucchi SE, Testani JM. Sodium glucose cotransporter 2 inhibitors as diuretic adjuvants in acute decompensated heart failure: a case series. ESC Heart Failure 2020, 7: 1966-1971. PMID: 32476296, PMCID: PMC7373933, DOI: 10.1002/ehf2.12759.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureSodium-glucose cotransporter 2 inhibitorsGlucose cotransporter 2 inhibitorsDecompensated heart failureCotransporter 2 inhibitorsType 2 diabetesSGLT-2iBlood pressureHeart failureUrine outputYale-New Haven HospitalWeight lossIncidence of hypokalaemiaSGLT-2i initiationSGLT-2i therapyGlucose-lowering medicationsHeart failure outcomesCohort of patientsAverage weight lossDiuretic dosingDiuretic resistanceAdjunctive therapyWorsened survivalDiuretic efficiencyDiuretic monotherapyEffect of Inotropes on Patient-Reported Health Status in End-Stage Heart Failure
Clarke JD, Riello R, Allen LA, Psotka MA, Teerlink JR, Lindenfeld J, Desai NR, Ahmad T. Effect of Inotropes on Patient-Reported Health Status in End-Stage Heart Failure. Circulation Heart Failure 2021, 14: e007759. PMID: 33530705, DOI: 10.1161/circheartfailure.120.007759.Peer-Reviewed Original ResearchConceptsEnd-stage heart failureReduced ejection fractionHealth-related qualityPatient-reported health statusEffect of inotropesHeart failureHealth status domainsEjection fractionHealth statusFunctional statusPositive inotropesStatus domainsAvailable clinical trial dataMorbidity/mortalityPopulation of patientsPatient-centered outcomesHealth status outcomesClinical trial dataFunctional capacity changesQuantity of lifeWeb of ScienceInotrope therapyInotrope useCalcium sensitizerSurvival benefitNatriuretic Equation to Predict Loop Diuretic Response in Patients With Heart Failure
Rao VS, Ivey-Miranda JB, Cox ZL, Riello R, Griffin M, Fleming J, Soucier R, Sangkachand P, O'Brien M, LoRusso F, D'Ambrosi J, Churchwell K, Mahoney D, Bellumkonda L, Asher JL, Maulion C, Turner JM, Wilson FP, Collins SP, Testani JM. Natriuretic Equation to Predict Loop Diuretic Response in Patients With Heart Failure. Journal Of The American College Of Cardiology 2021, 77: 695-708. PMID: 33573739, PMCID: PMC8114781, DOI: 10.1016/j.jacc.2020.12.022.Peer-Reviewed Original ResearchConceptsLoop diuretic administrationDiuretic therapyNatriuretic responseDiuretic administrationSodium outputAcute decompensated heart failureDecompensated heart failureHeart failure admissionsDaily urine outputSpot urine samplesNet fluid outputNet fluid lossPathway cohortHeart failureLoop diureticsUrine outputDiuretic responseResidual congestionFluid outputTherapyCohortWeight lossAdditional studiesUrine samplesExcellent discriminationSequencing Quadruple Therapy for Heart Failure with Reduced Ejection Fraction: Does It Really Matter?
Hu J, Schwann A, Tan J, Nuqali A, Riello R, Beasley M. Sequencing Quadruple Therapy for Heart Failure with Reduced Ejection Fraction: Does It Really Matter? Cardiology Clinics 2023, 41: 511-524. PMID: 37743074, DOI: 10.1016/j.ccl.2023.06.007.Peer-Reviewed Original ResearchConceptsReduced ejection fractionEjection fractionHeart failureChronic kidney diseaseQuadruple therapyTarget dosingTherapy initiationAtrial fibrillationKidney diseaseSpecial populationsMedicationsConventional sequencesTolerabilityBradycardiaPatientsFailureFibrillationDosingTherapyInitiationDiseaseDosesGDMTPragmatic 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 advisoryRationale 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 interventionsOutpatientsRationale 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 practiceAdverse drug effects across patients with heart failure: a systematic review.
Butzner M, Riello RJ, Sarocco P, Desai N. Adverse drug effects across patients with heart failure: a systematic review. The American Journal Of Managed Care 2022, 28: e113-e120. PMID: 35404555, DOI: 10.37765/ajmc.2022.88844.Peer-Reviewed Original ResearchConceptsGuideline-directed medical therapyAdverse drug effectsAngiotensin receptor blockersMineralocorticoid receptor antagonistsDrug-related adverse effectsRenal impairmentHeart failureMedical therapyDrug effectsAngiotensin receptor neprilysin inhibitorAdverse effectsReduced ejection fractionAdditional real-world evidenceReal-world evidenceKey search termsSystematic literature reviewReceptor blockersAdult patientsEjection fractionACE inhibitorsReceptor antagonistClinical trialsOvid MEDLINEClinical KeyΒ-blockersAdoption of sacubitril-valsartan in the Medicare population
Kahn PA, Riello RJ, Ahmad T, Desai NR. Adoption of sacubitril-valsartan in the Medicare population. American Heart Journal 2020, 223: 81-83. PMID: 32179259, DOI: 10.1016/j.ahj.2020.02.009.Peer-Reviewed Original ResearchReal World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure A U.S. Center’s Experience
Griffin M, Soufer A, Goljo E, Colna M, Rao VS, Jeon S, Raghavendra P, D'Ambrosi J, Riello R, Coca SG, Mahoney D, Jacoby D, Ahmad T, Chen M, Tang WHW, Turner J, Mullens W, Wilson FP, Testani JM. Real World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure A U.S. Center’s Experience. JACC Heart Failure 2020, 8: 199-208. PMID: 32035891, PMCID: PMC7814403, DOI: 10.1016/j.jchf.2019.10.012.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureHypertonic saline administrationHypertonic saline therapyHypertonic salineSaline administrationSaline therapyDiuretic efficiencyUrine outputSerum sodiumWeight lossAcute decompensated heartDecompensated heart failureCohort of patientsTotal urine outputReal-world safetyU.S. academic medical centersAcademic medical centerLarge U.S. academic medical centerDiuretic doseCenter experienceHeart failureMetabolic derangementsPrimary analytic approachRespiratory statusClinical variablesWhy has positive inotropy failed in chronic heart failure? Lessons from prior inotrope trials
Ahmad T, Miller PE, McCullough M, Desai NR, Riello R, Psotka M, Böhm M, Allen LA, Teerlink JR, Rosano GMC, Lindenfeld J. Why has positive inotropy failed in chronic heart failure? Lessons from prior inotrope trials. European Journal Of Heart Failure 2019, 21: 1064-1078. PMID: 31407860, PMCID: PMC6774302, DOI: 10.1002/ejhf.1557.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsHeart failureClinical trialsPositive inotropic therapyChronic heart failureReduced ejection fractionAdvanced heart failureCurrent pharmacological therapiesPopulation of patientsDefinitive clinical trialsVentricular assist deviceQuality of lifePositive cardiac inotropeLong-term useInotropic therapyHeart transplantationSurvival benefitCardiac haemodynamicsEjection fractionPharmacological therapyCardiac outputFuture trialsNeurohormonal systemsFunctional statusPositive inotropesPositive inotropyA Blueprint for the Post Discharge Clinic Visit after an Admission for Heart Failure
Soufer A, Riello RJ, Desai NR, Testani JM, Ahmad T. A Blueprint for the Post Discharge Clinic Visit after an Admission for Heart Failure. Progress In Cardiovascular Diseases 2017, 60: 237-248. PMID: 28826671, DOI: 10.1016/j.pcad.2017.08.004.Commentaries, Editorials and LettersConceptsHeart failureClinic visitsPost-discharge servicesTransitions of carePatient-centered fashionHospital quality measuresHF patientsHF readmissionMulti-disciplinary servicesSymptom burdenDischarge servicesOutpatient settingCare deliveryHealthcare expendituresHospital systemPatientsVisitsCareReadmissionAdmissionFailureInpatientsCliniciansImportant role
2024
Medicare Coverage and Patient Out-of-Pocket Costs for Cardiovascular-Kidney-Metabolic Medications
Young G, Bansal K, Riello R, Clark K, Dhruva S, Faridi K, Desai N. Medicare Coverage and Patient Out-of-Pocket Costs for Cardiovascular-Kidney-Metabolic Medications. JAMA Network Open 2024, 7: e2412437. PMID: 38771578, PMCID: PMC11109768, DOI: 10.1001/jamanetworkopen.2024.12437.Peer-Reviewed Original Research
2022
Thirty-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 care
2018
Venous thromboembolism in acute medically ill patients: identifying unmet needs and weighing the value of prophylaxis.
Dobesh PP, Ahuja T, Davis GA, Fatodu H, Francis WH, Hull FP, Johnson GL, Lenchus JD, Lenoir JG, McPherson C, Nemeth J, Riello RJ. Venous thromboembolism in acute medically ill patients: identifying unmet needs and weighing the value of prophylaxis. The American Journal Of Managed Care 2018, 24: s468-s474. PMID: 30452198.Peer-Reviewed Original ResearchThe use of betrixaban for extended prophylaxis of venous thromboembolism events in hospitalized, high-risk patients.
Dobesh PP, Ahuja T, Davis GA, Fatodu H, Francis WH, Hull FP, Johnson GL, Lenchus JD, Lenoir JG, McPherson C, Nemeth J, Riello RJ. The use of betrixaban for extended prophylaxis of venous thromboembolism events in hospitalized, high-risk patients. The American Journal Of Managed Care 2018, 24: s475-s482. PMID: 30452199.Peer-Reviewed Original ResearchBest practices for implementing venous thromboembolism prophylaxis across the continuum of care.
Dobesh PP, Ahuja T, Davis GA, Fatodu H, Francis WH, Hull FP, Johnson GL, Lenchus JD, Lenoir JG, McPherson C, Nemeth J, Riello RJ. Best practices for implementing venous thromboembolism prophylaxis across the continuum of care. The American Journal Of Managed Care 2018, 24: s483-s488. PMID: 30452200.Peer-Reviewed Original ResearchEssential Elements of Early Post Discharge Care of Patients with Heart Failure
Soucier RJ, Miller PE, Ingrassia JJ, Riello R, Desai NR, Ahmad T. Essential Elements of Early Post Discharge Care of Patients with Heart Failure. Current Heart Failure Reports 2018, 15: 181-190. PMID: 29700697, DOI: 10.1007/s11897-018-0393-9.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsPost-discharge careDischarge careHeart failurePost-hospital dischargeHeart failure careHeart failure patientsSubset of patientsDevice-based therapiesAssessment of prognosisAmbulatory care settingsPost-hospitalization periodHealth care providersRecent FindingsRecent studiesWarrants further studyHealth care systemNeurohormonal therapyReviewHeart failureDiscussion of goalsFailure patientsHospital dischargeMost patientsPatient comorbiditiesMedical therapyMedication reconciliationPatient outcomes