2024
Ischemic Stroke and Reduced Left Ventricular Ejection Fraction: A Multidisciplinary Approach to Optimize Brain and Cardiac Health
McNamara K, Merkler A, Freeman J, Krumholz H, Ahmad T, Sharma R. Ischemic Stroke and Reduced Left Ventricular Ejection Fraction: A Multidisciplinary Approach to Optimize Brain and Cardiac Health. Stroke 2024, 55: 1720-1727. PMID: 38660813, DOI: 10.1161/strokeaha.123.045623.Peer-Reviewed Original ResearchConceptsReduced left ventricular ejection fractionLeft ventricular ejection fractionIschemic strokeVentricular ejection fractionAdverse cardiac outcomesRecurrent acute ischemic strokeAcute ischemic stroke hospitalizationsIschemic stroke hospitalizationsAcute ischemic strokeCardiac healthEjection fractionCardiac outcomesStroke hospitalizationsRisk factorsCare paradigmOptimal brainMultidisciplinary approachHealthBrain
2022
Percutaneous Left Atrial Appendage Occlusion in Comparison to Non‐Vitamin K Antagonist Oral Anticoagulant Among Patients With Atrial Fibrillation
Noseworthy PA, Van Houten HK, Krumholz HM, Kent DM, Abraham NS, Graff‐Radford J, Alkhouli M, Henk HJ, Shah ND, Gersh BJ, Friedman PA, Holmes DR, Yao X. Percutaneous Left Atrial Appendage Occlusion in Comparison to Non‐Vitamin K Antagonist Oral Anticoagulant Among Patients With Atrial Fibrillation. Journal Of The American Heart Association 2022, 11: e027001. PMID: 36172961, PMCID: PMC9673739, DOI: 10.1161/jaha.121.027001.Peer-Reviewed Original ResearchConceptsComposite end pointAtrial appendage occlusionOral anticoagulantsAtrial fibrillationLower riskMajor bleedingSystemic embolismIntracranial bleedingAppendage occlusionNon-Vitamin K Antagonist Oral AnticoagulantsIschemic stroke/systemic embolismK Antagonist Oral AnticoagulantsPrimary composite end pointPropensity score overlap weightingStroke/systemic embolismEnd pointHigh bleeding riskSignificant differencesAntithrombotic regimensBleeding riskCause mortalityBaseline characteristicsComposite outcomeIschemic strokeSecondary outcomesEfficacy and Safety Considerations With Dose-Reduced Direct Oral Anticoagulants
Bikdeli B, Tajrishi F, Sadeghipour P, Talasaz AH, Fanikos J, Lippi G, Siegal DM, Eikelboom JW, Monreal M, Jimenez D, Connors JM, Ageno W, Barnes GD, Piazza G, Angiolillo DJ, Parikh SA, Kirtane AJ, Lopes RD, Bhatt DL, Weitz JI, Mehran R, Krumholz HM, Goldhaber SZ, Lip GYH. Efficacy and Safety Considerations With Dose-Reduced Direct Oral Anticoagulants. JAMA Cardiology 2022, 7: 747-759. PMID: 35648414, DOI: 10.1001/jamacardio.2022.1292.Peer-Reviewed Original ResearchConceptsDirect oral anticoagulantsRandomized clinical trialsAcute VTE treatmentDose adjustmentOral anticoagulantsLow-intensity treatmentPrimary preventionLarge registriesVTE treatmentHigh-risk medical patientsStable atherosclerotic vascular diseaseHigh-risk cancer patientsLarge randomized clinical trialsSecondary VTE preventionPeripheral artery diseaseAtherosclerotic vascular diseaseDaily clinical practiceRoutine practice patternEvidence of safetyRecent revascularizationStroke preventionVTE preventionArtery diseaseMedical patientsCancer patientsAssociation of Neighborhood-Level Material Deprivation With Atrial Fibrillation Care in a Single-Payer Health Care System: A Population-Based Cohort Study
Abdel-Qadir H, Akioyamen LE, Fang J, Pang A, Ha ACT, Jackevicius CA, Alter DA, Austin PC, Atzema CL, Bhatia RS, Booth GL, Johnston S, Dhalla I, Kapral MK, Krumholz HM, McNaughton CD, Roifman I, Tu K, Udell JA, Wijeysundera HC, Ko DT, Schull MJ, Lee DS. Association of Neighborhood-Level Material Deprivation With Atrial Fibrillation Care in a Single-Payer Health Care System: A Population-Based Cohort Study. Circulation 2022, 146: 159-171. PMID: 35678171, PMCID: PMC9287095, DOI: 10.1161/circulationaha.122.058949.Peer-Reviewed Original ResearchConceptsYears of ageCohort studyUniversal health careAF-related adverse eventsNeighbourhood-level material deprivationPopulation-based cohort studyPrimary care physician visitsCause-specific hazards regressionRhythm control interventionsHigh cardiovascular disease burdenCardiovascular disease burdenHealth careAtrial fibrillation careNeighborhood material deprivationSingle-payer health care systemMaterial deprivation quintileAtrial fibrillation diagnosisHealth care systemNoncardiovascular comorbiditiesAdverse eventsHeart failurePhysician visitsHazards regressionAdverse outcomesDeprivation quintileA Different Case of Penumbra—Reply
Kadakia KT, Ross JS, Krumholz HM. A Different Case of Penumbra—Reply. JAMA Internal Medicine 2022, 182: 570-571. PMID: 35285863, DOI: 10.1001/jamainternmed.2022.0105.Commentaries, Editorials and Letters
2020
Association Between Depressive Symptoms and Incident Cardiovascular Diseases
Harshfield EL, Pennells L, Schwartz JE, Willeit P, Kaptoge S, Bell S, Shaffer JA, Bolton T, Spackman S, Wassertheil-Smoller S, Kee F, Amouyel P, Shea SJ, Kuller LH, Kauhanen J, van Zutphen EM, Blazer DG, Krumholz H, Nietert PJ, Kromhout D, Laughlin G, Berkman L, Wallace RB, Simons LA, Dennison EM, Barr ELM, Meyer HE, Wood AM, Danesh J, Di Angelantonio E, Davidson KW. Association Between Depressive Symptoms and Incident Cardiovascular Diseases. JAMA 2020, 324: 2396-2405. PMID: 33320224, PMCID: PMC7739139, DOI: 10.1001/jama.2020.23068.Peer-Reviewed Original ResearchConceptsCoronary heart diseaseHazard ratioStroke eventsCardiovascular diseaseCorresponding incidence ratesDepressive symptomsHigher depression scoresCHD eventsCVD eventsCVD incidencePooled analysisIncidence rateDepression scoresNonfatal coronary heart diseasePatient Health Questionnaire-2Epidemiological Studies Depression ScaleIncident cardiovascular diseasePHQ-2 scoreAdditional risk factorsBaseline depressive symptomsSelf-reported depressive symptomsCES-D scoresEmerging Risk Factors CollaborationIndividual participant dataUK BiobankAssociation of Ticagrelor vs Clopidogrel With Net Adverse Clinical Events in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
You SC, Rho Y, Bikdeli B, Kim J, Siapos A, Weaver J, Londhe A, Cho J, Park J, Schuemie M, Suchard MA, Madigan D, Hripcsak G, Gupta A, Reich CG, Ryan PB, Park RW, Krumholz HM. Association of Ticagrelor vs Clopidogrel With Net Adverse Clinical Events in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. JAMA 2020, 324: 1640-1650. PMID: 33107944, PMCID: PMC7592033, DOI: 10.1001/jama.2020.16167.Peer-Reviewed Original ResearchMeSH KeywordsAcute Coronary SyndromeAdultAgedAged, 80 and overAlgorithmsAspirinCase-Control StudiesCause of DeathClopidogrelDatabases, FactualDyspneaFemaleHemorrhageHumansIschemiaMaleMiddle AgedMyocardial InfarctionNetwork Meta-AnalysisPercutaneous Coronary InterventionPropensity ScorePurinergic P2Y Receptor AntagonistsRecurrenceRepublic of KoreaRetrospective StudiesStrokeTicagrelorUnited StatesConceptsNet adverse clinical eventsAcute coronary syndromePercutaneous coronary interventionAdverse clinical eventsHemorrhagic eventsIschemic eventsHazard ratioCause mortalityCoronary syndromeCoronary interventionClinical eventsRisk of NACEClinical practiceLarge randomized clinical trialsPrimary end pointRetrospective cohort studyPropensity-matched pairsSummary hazard ratioRandomized clinical trialsRoutine clinical practiceSignificant differencesP2Y12 platelet inhibitorsTicagrelor groupCohort studySecondary outcomesAssociation Between Sociodemographic Determinants and Disparities in Stroke Symptom Awareness Among US Young Adults
Mszar R, Mahajan S, Valero-Elizondo J, Yahya T, Sharma R, Grandhi GR, Khera R, Virani SS, Lichtman J, Khan SU, Cainzos-Achirica M, Vahidy FS, Krumholz HM, Nasir K. Association Between Sociodemographic Determinants and Disparities in Stroke Symptom Awareness Among US Young Adults. Stroke 2020, 51: 3552-3561. PMID: 33100188, DOI: 10.1161/strokeaha.120.031137.Peer-Reviewed Original ResearchConceptsNational Health Interview SurveyCommon stroke symptomsStroke symptomsHealth Interview SurveyYoung adultsUS young adultsSymptom awarenessFocused public health interventionsInterview SurveyStroke symptom awarenessHigh-risk characteristicsPublic health interventionsArms/legsCertain sociodemographic subgroupsLow education levelStroke incidenceSevere headacheSingle symptomStudy populationTimely diagnosisHigher oddsStroke rateHispanic ethnicityGeneral populationSociodemographic determinantsStroke Code Presentations, Interventions, and Outcomes Before and During the COVID-19 Pandemic
Jasne AS, Chojecka P, Maran I, Mageid R, Eldokmak M, Zhang Q, Nystrom K, Vlieks K, Askenase M, Petersen N, Falcone GJ, Wira CR, Lleva P, Zeevi N, Narula R, Amin H, Navaratnam D, Loomis C, Hwang DY, Schindler J, Hebert R, Matouk C, Krumholz HM, Spudich S, Sheth KN, Sansing LH, Sharma R. Stroke Code Presentations, Interventions, and Outcomes Before and During the COVID-19 Pandemic. Stroke 2020, 51: 2664-2673. PMID: 32755347, PMCID: PMC7446978, DOI: 10.1161/str.0000000000000347.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBetacoronavirusBrain IschemiaCohort StudiesComorbidityConnecticutCoronary Artery DiseaseCoronavirus InfectionsCOVID-19DyslipidemiasEmergency Medical ServicesEthnicityFemaleHumansHypertensionIncomeInsurance, HealthIntracranial HemorrhagesMaleMedically UninsuredMiddle AgedOutcome and Process Assessment, Health CarePandemicsPneumonia, ViralRetrospective StudiesSARS-CoV-2Severity of Illness IndexStrokeSubstance-Related DisordersTelemedicineThrombectomyThrombolytic TherapyTime-to-TreatmentConceptsComprehensive stroke centerStroke codePatient characteristicsStroke severityStroke code patientsHistory of hypertensionStroke-like symptomsCoronary artery diseaseCoronavirus disease 2019 (COVID-19) pandemicPatient-level dataLower median household incomePublic health initiativesDisease 2019 pandemicCOVID-19 pandemicRace/ethnicityCode patientsHospital presentationPublic health insuranceRankin ScaleStroke centersArtery diseaseReperfusion timeStroke symptomsEarly outcomesConnecticut hospitals
2019
Comprehensive comparative effectiveness and safety of first-line antihypertensive drug classes: a systematic, multinational, large-scale analysis
Suchard MA, Schuemie MJ, Krumholz HM, You SC, Chen R, Pratt N, Reich CG, Duke J, Madigan D, Hripcsak G, Ryan PB. Comprehensive comparative effectiveness and safety of first-line antihypertensive drug classes: a systematic, multinational, large-scale analysis. The Lancet 2019, 394: 1816-1826. PMID: 31668726, PMCID: PMC6924620, DOI: 10.1016/s0140-6736(19)32317-7.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAngiotensin Receptor AntagonistsAngiotensin-Converting Enzyme InhibitorsAntihypertensive AgentsCalcium Channel BlockersChildCohort StudiesComparative Effectiveness ResearchDatabases, FactualDiureticsEvidence-Based MedicineFemaleHeart FailureHumansHypertensionMaleMiddle AgedMyocardial InfarctionStrokeYoung AdultConceptsNon-dihydropyridine calcium channel blockersCalcium channel blockersThiazide-like diureticsChannel blockersEnzyme inhibitorsDrug classesHazard ratioCurrent guidelinesFirst-line antihypertensive drug classesComparative effectivenessFirst-line drug classesNew-user cohort designDihydropyridine calcium channel blockerElectronic health record databaseFirst-line classesAngiotensin receptor blockersAntihypertensive drug classesAcute myocardial infarctionHealth record databaseReal-world evidenceMedical Research CouncilMillions of patientsAustralian National HealthOptimal monotherapyReceptor blockers
2017
Updated Cost-effectiveness Assessments of PCSK9 Inhibitors From the Perspectives of the Health System and Private Payers: Insights Derived From the FOURIER Trial
Arrieta A, Hong JC, Khera R, Virani SS, Krumholz HM, Nasir K. Updated Cost-effectiveness Assessments of PCSK9 Inhibitors From the Perspectives of the Health System and Private Payers: Insights Derived From the FOURIER Trial. JAMA Cardiology 2017, 2: 1369-1374. PMID: 29049467, PMCID: PMC5814995, DOI: 10.1001/jamacardio.2017.3655.Peer-Reviewed Original ResearchMeSH KeywordsAgedAnticholesteremic AgentsCardiovascular DiseasesCholesterol, LDLCost-Benefit AnalysisDecision Support TechniquesDrug Therapy, CombinationFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsHypercholesterolemiaInsuranceInsurance, HealthInsurance, Health, ReimbursementMaleMarkov ChainsMiddle AgedMyocardial InfarctionPCSK9 InhibitorsQuality-Adjusted Life YearsStrokeUnited StatesConceptsQuality-adjusted life yearsIncremental cost-effectiveness ratioCost-effectiveness ratioProprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitorsCurrent pricesLife yearsPrivate payersAdditional quality-adjusted life yearPreliminary cost-effectiveness analysisCost-effectiveness standardsProbabilistic sensitivity analysesCost-effectiveness analysisPrivate payer perspectiveCost-effectiveness assessmentNegative returnsHealth system perspectiveSignificant discountUS dollarsDrug pricesPatent protectionPricesStatin treatment strategiesHealth insuranceTime horizonSubtilisin/kexin type 9 inhibitorsBurden of Catastrophic Health Expenditures for Acute Myocardial Infarction and Stroke Among Uninsured in the United States
Khera R, Hong JC, Saxena A, Arrieta A, Virani SS, Blankstein R, de Lemos JA, Krumholz HM, Nasir K. Burden of Catastrophic Health Expenditures for Acute Myocardial Infarction and Stroke Among Uninsured in the United States. Circulation 2017, 137: 408-410. PMID: 29133601, PMCID: PMC5780190, DOI: 10.1161/circulationaha.117.030128.Commentaries, Editorials and LettersMeSH KeywordsAdolescentAdultFemaleHealth Care CostsHealth ExpendituresHealth Services AccessibilityHospital ChargesHospital CostsHumansIncomeMaleMedically UninsuredMiddle AgedMyocardial InfarctionPatient Protection and Affordable Care ActProcess Assessment, Health CareStrokeTime FactorsUnited StatesYoung AdultIncorporating Stroke Severity Into Hospital Measures of 30-Day Mortality After Ischemic Stroke Hospitalization
Schwartz J, Wang Y, Qin L, Schwamm LH, Fonarow GC, Cormier N, Dorsey K, McNamara RL, Suter LG, Krumholz HM, Bernheim SM. Incorporating Stroke Severity Into Hospital Measures of 30-Day Mortality After Ischemic Stroke Hospitalization. Stroke 2017, 48: 3101-3107. PMID: 28954922, DOI: 10.1161/strokeaha.117.017960.Peer-Reviewed Original ResearchConceptsRisk-standardized mortality ratesElectronic health record dataHealth record dataStroke severityClaims dataMortality rateAmerican Heart Association/American Stroke AssociationHealth Stroke Scale scoreRisk variablesMedicaid ServicesRisk adjustmentMedian risk-standardized mortality rateGuidelines-Stroke registryLow-mortality hospitalsStroke Scale scoreAcute ischemic strokeAmerican Stroke AssociationOdds of mortalityMortality measuresRecord dataIschemic stroke hospitalizationsHigh-mortality hospitalsService claims dataRisk-adjustment variablesHospital admission
2015
Stroke Issue 2015
Krumholz HM. Stroke Issue 2015. Circulation Cardiovascular Quality And Outcomes 2015, 8: s65. PMID: 26515210, PMCID: PMC6481163, DOI: 10.1161/circoutcomes.115.002345.Peer-Reviewed Original ResearchThe role of socioeconomic status in hospital outcomes measures.
Krumholz HM, Bernheim SM. The role of socioeconomic status in hospital outcomes measures. Annals Of Internal Medicine 2015, 162: 670. PMID: 25939004, DOI: 10.7326/l15-5087-2.Peer-Reviewed Original Research
2014
Considering the role of socioeconomic status in hospital outcomes measures.
Krumholz HM, Bernheim SM. Considering the role of socioeconomic status in hospital outcomes measures. Annals Of Internal Medicine 2014, 161: 833-4. PMID: 25437411, PMCID: PMC5459391, DOI: 10.7326/m14-2308.Peer-Reviewed Original ResearchTrends in Hospitalizations and Outcomes for Acute Cardiovascular Disease and Stroke, 1999–2011
Krumholz HM, Normand SL, Wang Y. Trends in Hospitalizations and Outcomes for Acute Cardiovascular Disease and Stroke, 1999–2011. Circulation 2014, 130: 966-975. PMID: 25135276, PMCID: PMC4171056, DOI: 10.1161/circulationaha.113.007787.Peer-Reviewed Original ResearchConceptsAcute cardiovascular diseaseCardiovascular diseaseIschemic strokeUnstable anginaHeart failureMyocardial infarctionNational Medicare dataYears of ageQuality of careDemographic subgroupsReadmission outcomesHospitalization ratesMortality overallService patientsCardiovascular conditionsAdjusted ratesHospitalizationMedicare dataMortality rateStrokeMortalityDiseaseAnginaReadmissionInfarctionNational trends in stroke after acute myocardial infarction among Medicare patients in the United States: 1999 to 2010
Wang Y, Lichtman JH, Dharmarajan K, Masoudi FA, Ross JS, Dodson JA, Chen J, Spertus JA, Chaudhry SI, Nallamothu BK, Krumholz HM. National trends in stroke after acute myocardial infarction among Medicare patients in the United States: 1999 to 2010. American Heart Journal 2014, 169: 78-85.e4. PMID: 25497251, PMCID: PMC4824179, DOI: 10.1016/j.ahj.2014.06.011.Peer-Reviewed Original ResearchRisk Adjustment of Ischemic Stroke Outcomes for Comparing Hospital Performance
Katzan IL, Spertus J, Bettger JP, Bravata DM, Reeves MJ, Smith EE, Bushnell C, Higashida RT, Hinchey JA, Holloway RG, Howard G, King RB, Krumholz HM, Lutz BJ, Yeh RW. Risk Adjustment of Ischemic Stroke Outcomes for Comparing Hospital Performance. Stroke 2014, 45: 918-944. PMID: 24457296, DOI: 10.1161/01.str.0000441948.35804.77.Peer-Reviewed Original ResearchMeSH KeywordsAmerican Heart AssociationBrain IschemiaHospitalsHumansModels, OrganizationalOutcome Assessment, Health CarePatient ReadmissionPredictive Value of TestsPrognosisQuality of Health CareRecovery of FunctionReproducibility of ResultsRisk AdjustmentSample SizeStrokeTreatment OutcomeUnited StatesConceptsIschemic stroke outcomeRisk-adjustment modelsStroke severityStroke outcomeStroke careOutcome measuresHospital levelRisk-adjusted outcome comparisonsRisk adjustmentHospital-level outcomesHospital performanceVascular risk factorsImportant prognostic factorIschemic stroke careIndividual patient levelStroke severity measuresRisk-adjusted modelsHospital-level performanceQuality of strokeComparison of qualityIschemic strokePrognostic factorsComorbid conditionsFunctional outcomeMajor disability
2011
Factors Associated With 30-Day Readmission Rates After Percutaneous Coronary Intervention
Khawaja FJ, Shah ND, Lennon RJ, Slusser JP, Alkatib AA, Rihal CS, Gersh BJ, Montori VM, Holmes DR, Bell MR, Curtis JP, Krumholz HM, Ting HH. Factors Associated With 30-Day Readmission Rates After Percutaneous Coronary Intervention. JAMA Internal Medicine 2011, 172: 112-117. PMID: 22123752, PMCID: PMC3688066, DOI: 10.1001/archinternmed.2011.569.Peer-Reviewed Original ResearchMeSH KeywordsAcute Coronary SyndromeAgedAngina, UnstableAngioplasty, Balloon, CoronaryCoronary Artery BypassEducational StatusFemaleFollow-Up StudiesHeart FailureHumansIschemic Attack, TransientKidney DiseasesLength of StayMaleMedicareMultivariate AnalysisMyocardial InfarctionNeoplasm MetastasisPatient ReadmissionPeptic UlcerProportional Hazards ModelsPulmonary Disease, Chronic ObstructiveRegistriesSex FactorsStrokeUnited StatesConceptsPercutaneous coronary interventionThirty-day readmissionReadmission ratesCoronary interventionHigh riskChronic obstructive pulmonary diseaseThirty-day readmission ratesCox proportional hazards modelMultivariate logistic regression modelTransient ischemic attackCongestive heart failureObstructive pulmonary diseasePeptic ulcer diseaseSevere renal diseaseAcute myocardial infarctionLength of stayMain outcome measuresProportional hazards modelSaint Mary's HospitalLogistic regression modelsIschemic attackTime-dependent covariatesUnstable anginaCerebrovascular accidentHeart failure