2019
Modeling defibrillation benefit for survival among cardiac resynchronization therapy defibrillator recipients
Bilchick KC, Wang Y, Curtis JP, Cheng A, Dharmarajan K, Shadman R, Dardas TF, Anand I, Lund LH, Dahlström U, Sartipy U, Maggioni A, O'Connor C, Levy WC. Modeling defibrillation benefit for survival among cardiac resynchronization therapy defibrillator recipients. American Heart Journal 2019, 222: 93-104. PMID: 32032927, PMCID: PMC7814502, DOI: 10.1016/j.ahj.2019.12.017.Peer-Reviewed Original ResearchConceptsCRT-D patientsImplantable cardioverter defibrillatorSurvival benefitCRT-DsCardiac resynchronization therapy defibrillator recipientsCardiac resynchronization therapy candidatesSeattle Heart Failure ModelSeattle Proportional Risk ModelCox proportional hazards regressionNational Cardiovascular Data RegistryHeart Failure TrialHeart failure patientsProportional hazards regressionHeart failure modelProportional risk modelFailure patientsCRT candidatesHeart failureCRT pacemakerFailure TrialArrhythmic deathHazards regressionDefibrillator recipientsCRT deviceCardioverter defibrillatorRisk of Readmission After Discharge From Skilled Nursing Facilities Following Heart Failure Hospitalization: A Retrospective Cohort Study
Weerahandi H, Li L, Bao H, Herrin J, Dharmarajan K, Ross JS, Kim KL, Jones S, Horwitz LI. Risk of Readmission After Discharge From Skilled Nursing Facilities Following Heart Failure Hospitalization: A Retrospective Cohort Study. Journal Of The American Medical Directors Association 2019, 20: 432-437. PMID: 30954133, PMCID: PMC6486375, DOI: 10.1016/j.jamda.2019.01.135.Peer-Reviewed Original ResearchConceptsSkilled nursing facilitiesSNF dischargeRetrospective cohort studySNF lengthHeart failureHF hospitalizationComposite outcomeCohort studyNursing facilitiesService beneficiaries 65Heart failure hospitalizationRisk of readmissionHazard rate ratiosFailure hospitalizationUnplanned readmissionHF diagnosisHospital dischargePostdischarge outcomesSNF stayMedicare patientsMedicare feeHome transitionPatientsReadmissionDay 3Relationship Between Patient-Reported Hospital Experience and 30-Day Mortality and Readmission Rates for Acute Myocardial Infarction, Heart Failure, and Pneumonia
Dong N, Eisenberg JD, Dharmarajan K, Spatz ES, Desai NR. Relationship Between Patient-Reported Hospital Experience and 30-Day Mortality and Readmission Rates for Acute Myocardial Infarction, Heart Failure, and Pneumonia. Journal Of General Internal Medicine 2019, 34: 526-528. PMID: 30746641, PMCID: PMC6446004, DOI: 10.1007/s11606-018-4746-6.Peer-Reviewed Original Research
2018
Admission diagnoses among patients with heart failure: Variation by ACO performance on a measure of risk-standardized acute admission rates
Benchetrit L, Zimmerman C, Bao H, Dharmarajan K, Altaf F, Herrin J, Lin Z, Krumholz HM, Drye EE, Lipska KJ, Spatz ES. Admission diagnoses among patients with heart failure: Variation by ACO performance on a measure of risk-standardized acute admission rates. American Heart Journal 2018, 207: 19-26. PMID: 30404047, DOI: 10.1016/j.ahj.2018.09.006.Peer-Reviewed Original ResearchMeSH KeywordsAccountable Care OrganizationsAgedAlgorithmsAnalysis of VarianceCardiovascular DiseasesComorbidityFemaleHeart FailureHospitalizationHumansInternational Classification of DiseasesMaleMedicare Part AMedicare Part BPatient AdmissionPatient DischargePatient-Centered CareSex DistributionTime FactorsUnited StatesConceptsHeart failureAccountable care organizationsMean admission rateAdmission ratesAdmission typeAcute admission ratesNoncardiovascular conditionsAdmission diagnosisCause admission ratesMedicare Shared Savings Program Accountable Care OrganizationsRate of hospitalizationPrincipal discharge diagnosisProportion of admissionsType of admissionNoncardiovascular causesHF admissionsHF patientsPerson yearsDischarge diagnosisPatient populationPatientsAdmissionKey quality metricDiagnosisSubstantial proportionTrends in 30-Day Readmission Rates for Medicare and Non-Medicare Patients in the Era of the Affordable Care Act
Angraal S, Khera R, Zhou S, Wang Y, Lin Z, Dharmarajan K, Desai NR, Bernheim SM, Drye EE, Nasir K, Horwitz LI, Krumholz HM. Trends in 30-Day Readmission Rates for Medicare and Non-Medicare Patients in the Era of the Affordable Care Act. The American Journal Of Medicine 2018, 131: 1324-1331.e14. PMID: 30016636, PMCID: PMC6380174, DOI: 10.1016/j.amjmed.2018.06.013.Peer-Reviewed Original ResearchConceptsHospital Readmissions Reduction ProgramReadmission ratesAcute myocardial infarctionHeart failurePatient groupMyocardial infarctionCause readmission rateNationwide Readmissions DatabaseReadmissions Reduction ProgramNon-Medicare patientsNon-target conditionsLower readmissionAffordable Care ActMedicare beneficiariesAge groupsPrivate insuranceCare ActPneumoniaInfarctionPatientsReduction programsMedicareGroupReadmissionFailureAssociation of the Hospital Readmissions Reduction Program With Mortality During and After Hospitalization for Acute Myocardial Infarction, Heart Failure, and Pneumonia
Khera R, Dharmarajan K, Wang Y, Lin Z, Bernheim SM, Wang Y, Normand ST, Krumholz HM. Association of the Hospital Readmissions Reduction Program With Mortality During and After Hospitalization for Acute Myocardial Infarction, Heart Failure, and Pneumonia. JAMA Network Open 2018, 1: e182777. PMID: 30646181, PMCID: PMC6324473, DOI: 10.1001/jamanetworkopen.2018.2777.Peer-Reviewed Original ResearchConceptsHospital Readmissions Reduction ProgramAcute myocardial infarctionPostdischarge mortalityHeart failureHRRP announcementReadmissions Reduction ProgramMedicare beneficiariesRisk-adjusted ratesMyocardial infarctionService Medicare beneficiariesReduction programsInterrupted time series frameworkHospital mortalityReduced readmissionsCohort studyPneumonia hospitalizationsReadmission ratesMAIN OUTCOMEPneumoniaMedicare dataHospitalizationHospitalMortalityReadmissionConcomitant harm
2017
Regional variation in hospitalisation and mortality in heart failure: comparison of England and Lombardy using multistate modelling
Bottle A, Ventura CM, Dharmarajan K, Aylin P, Ieva F, Paganoni AM. Regional variation in hospitalisation and mortality in heart failure: comparison of England and Lombardy using multistate modelling. Health Care Management Science 2017, 21: 292-304. PMID: 28755175, DOI: 10.1007/s10729-017-9410-x.Peer-Reviewed Original ResearchConceptsHeart failureClinical practice differencesMedium-term mortalityHospital administrative databaseSerious chronic conditionsNon-hospital settingsSet of patientsHF admissionsCommon comorbiditiesFirst admissionLondon patientsDeath RegisterHigh morbidityChronic conditionsAdministrative databasesDisease progressionPatientsLower mortalityMortalityAdmissionPractice differencesShort stayLong stayHealthcare systemHospitalisationAssociation of Changing Hospital Readmission Rates With Mortality Rates After Hospital Discharge
Dharmarajan K, Wang Y, Lin Z, Normand ST, Ross JS, Horwitz LI, Desai NR, Suter LG, Drye EE, Bernheim SM, Krumholz HM. Association of Changing Hospital Readmission Rates With Mortality Rates After Hospital Discharge. JAMA 2017, 318: 270-278. PMID: 28719692, PMCID: PMC5817448, DOI: 10.1001/jama.2017.8444.Peer-Reviewed Original ResearchConceptsRisk-adjusted readmission ratesRisk-adjusted mortality ratesAcute myocardial infarctionHeart failureReadmission ratesMortality rateMyocardial infarctionMedicare feeService beneficiariesHospital readmission ratesMean hospitalHospital mortalityPostdischarge mortalityHospital dischargeHospital readmissionRetrospective studyAffordable Care ActReadmission reductionMAIN OUTCOMEPneumoniaHospitalSecondary analysisWeighted Pearson correlation coefficientMortalityCare ActEpidemiology, Pathophysiology, and Prognosis of Heart Failure in Older Adults
Dharmarajan K, Rich MW. Epidemiology, Pathophysiology, and Prognosis of Heart Failure in Older Adults. Heart Failure Clinics 2017, 13: 417-426. PMID: 28602363, DOI: 10.1016/j.hfc.2017.02.001.Peer-Reviewed Original ResearchConceptsHeart failureOlder adultsGeriatric syndromesHeart failure increasesCommon cardiovascular conditionAge-associated changesRehospitalization ratesCardiovascular conditionsCardiovascular syndromeCommon reasonCardiovascular structureSyndromeHospitalizationAdultsFailurePrognosisPathophysiologyDementiaFrailtyMortalityEpidemiologyPrevalenceIncidenceSeattle Heart Failure and Proportional Risk Models Predict Benefit From Implantable Cardioverter-Defibrillators
Bilchick KC, Wang Y, Cheng A, Curtis JP, Dharmarajan K, Stukenborg GJ, Shadman R, Anand I, Lund LH, Dahlström U, Sartipy U, Maggioni A, Swedberg K, O’Conner C, Levy WC. Seattle Heart Failure and Proportional Risk Models Predict Benefit From Implantable Cardioverter-Defibrillators. Journal Of The American College Of Cardiology 2017, 69: 2606-2618. PMID: 28545633, PMCID: PMC5502749, DOI: 10.1016/j.jacc.2017.03.568.Peer-Reviewed Original ResearchConceptsSeattle Heart Failure ModelSeattle Proportional Risk ModelNational Cardiovascular Data RegistryPrimary prevention ICDsHeart failureSudden deathCause mortalitySurvival benefitMultivariable Cox proportional hazards regressionCox proportional hazards regressionProportional riskProportional hazards regressionRecent clinical trialsHeart failure modelProportional risk modelControl patientsOverall survivalVentricular arrhythmiasHazards regressionICD benefitClinical trialsCardioverter defibrillatorLarge cohortHigh riskData registrySex Differences in Trajectories of Risk After Rehospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia
Dreyer RP, Dharmarajan K, Hsieh AF, Welsh J, Qin L, Krumholz HM. Sex Differences in Trajectories of Risk After Rehospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003271. PMID: 28506980, PMCID: PMC5650228, DOI: 10.1161/circoutcomes.116.003271.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionMyocardial infarctionHeart failureReadmission riskDaily riskImmediate postdischarge periodRisk of rehospitalizationSex differencesDeath 1 yearPrincipal discharge diagnosisHospitalization of patientsAssociation of sexRehospitalization riskPostdischarge periodDischarge diagnosisMedicare patientsHigh riskMortality riskMedicare feeTrajectories of riskRehospitalizationInfarctionService beneficiariesHospitalizationPneumonia
2016
Association Between Hospital Penalty Status Under the Hospital Readmission Reduction Program and Readmission Rates for Target and Nontarget Conditions
Desai NR, Ross JS, Kwon JY, Herrin J, Dharmarajan K, Bernheim SM, Krumholz HM, Horwitz LI. Association Between Hospital Penalty Status Under the Hospital Readmission Reduction Program and Readmission Rates for Target and Nontarget Conditions. JAMA 2016, 316: 2647-2656. PMID: 28027367, PMCID: PMC5599851, DOI: 10.1001/jama.2016.18533.Peer-Reviewed Original ResearchConceptsHospital Readmissions Reduction ProgramAcute myocardial infarctionReadmission ratesReadmissions Reduction ProgramHeart failurePenalty statusNontarget conditionsMedicare feeMean readmission rateThirty-day riskRetrospective cohort studyUnplanned readmission rateReduction programsHRRP announcementHRRP implementationPenalized hospitalsCohort studyService patientsMyocardial infarctionMAIN OUTCOMEExcess readmissionsMedicare beneficiariesService beneficiariesHospitalPatientsRelationship Between Age and Trajectories of Rehospitalization Risk in Older Adults
Dharmarajan K, Hsieh A, Dreyer RP, Welsh J, Qin L, Krumholz HM. Relationship Between Age and Trajectories of Rehospitalization Risk in Older Adults. Journal Of The American Geriatrics Society 2016, 65: 421-426. PMID: 27874977, PMCID: PMC5310961, DOI: 10.1111/jgs.14583.Peer-Reviewed Original ResearchAnalysis of Machine Learning Techniques for Heart Failure Readmissions
Mortazavi BJ, Downing NS, Bucholz EM, Dharmarajan K, Manhapra A, Li SX, Negahban SN, Krumholz HM. Analysis of Machine Learning Techniques for Heart Failure Readmissions. Circulation Cardiovascular Quality And Outcomes 2016, 9: 629-640. PMID: 28263938, PMCID: PMC5459389, DOI: 10.1161/circoutcomes.116.003039.Peer-Reviewed Original ResearchTrajectories of Risk for Specific Readmission Diagnoses after Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia
Krumholz HM, Hsieh A, Dreyer RP, Welsh J, Desai NR, Dharmarajan K. Trajectories of Risk for Specific Readmission Diagnoses after Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia. PLOS ONE 2016, 11: e0160492. PMID: 27716841, PMCID: PMC5055318, DOI: 10.1371/journal.pone.0160492.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionRisk of readmissionHeart failureReadmission diagnosesHospital dischargeReadmission riskTiming of riskMyocardial infarctionImmediate post-discharge periodDiagnostic categoriesPhysiologic systemsRisk of rehospitalizationGeneral elderly populationRisk of deathPost-discharge periodPost-discharge interventionsTrauma/injuryHospitalization riskHospitalizationTrajectories of riskElderly populationMedicare feePneumoniaRehospitalizationService beneficiariesImpact of Exercise Programs on Hospital Readmission Following Hospitalization for Heart Failure: A Systematic Review
Goyal P, Delgado D, Hummel SL, Dharmarajan K. Impact of Exercise Programs on Hospital Readmission Following Hospitalization for Heart Failure: A Systematic Review. Current Cardiovascular Risk Reports 2016, 10: 33. PMID: 28713480, PMCID: PMC5507625, DOI: 10.1007/s12170-016-0514-5.Peer-Reviewed Original ResearchHeart failureExercise programReadmission ratesSystematic reviewAmbulatory heart failure patientsReadmission Following HospitalizationHeart failure hospitalizationHeart failure patientsWiley Cochrane LibraryPre-defined criteriaFailure hospitalizationExercise interventionFailure patientsHospital readmissionHospitalization ratesCochrane LibraryPrincipal diagnosisOvid MEDLINEInclusion criteriaOutpatient facilitiesHigh riskMetropolitan hospitalExercise frequencyPatientsDetection biasTreatment for Multiple Acute Cardiopulmonary Conditions in Older Adults Hospitalized with Pneumonia, Chronic Obstructive Pulmonary Disease, or Heart Failure
Dharmarajan K, Strait KM, Tinetti ME, Lagu T, Lindenauer PK, Lynn J, Krukas MR, Ernst FR, Li SX, Krumholz HM. Treatment for Multiple Acute Cardiopulmonary Conditions in Older Adults Hospitalized with Pneumonia, Chronic Obstructive Pulmonary Disease, or Heart Failure. Journal Of The American Geriatrics Society 2016, 64: 1574-1582. PMID: 27448329, PMCID: PMC4988873, DOI: 10.1111/jgs.14303.Peer-Reviewed Original ResearchMeSH KeywordsAdrenal Cortex HormonesAgedAged, 80 and overAnti-Bacterial AgentsCardiotonic AgentsCohort StudiesComorbidityCross-Sectional StudiesDiureticsDrug Therapy, CombinationFemaleHeart FailureHospitalizationHumansMalePneumoniaPulmonary Disease, Chronic ObstructiveRetrospective StudiesUnited StatesVasodilator AgentsConceptsChronic obstructive pulmonary diseaseAcute cardiopulmonary conditionsObstructive pulmonary diseaseHeart failureCardiopulmonary conditionsOlder adultsPulmonary diseasePremier Research DatabaseEpisodes of pneumoniaRetrospective cohort studyReal-world treatmentHF hospitalizationCohort studyHospital daysPneumonia hospitalizationsCOPD hospitalizationsClinical syndromeAcute conditionsPneumoniaDiagnostic uncertaintyResearch DatabaseHospitalizationDiagnostic categoriesU.S. hospitalsAdultsMultimorbidity in Older Adults with Heart Failure
Dharmarajan K, Dunlay SM. Multimorbidity in Older Adults with Heart Failure. Clinics In Geriatric Medicine 2016, 32: 277-289. PMID: 27113146, DOI: 10.1016/j.cger.2016.01.002.Peer-Reviewed Original Research
2015
Trajectories of risk after hospitalization for heart failure, acute myocardial infarction, or pneumonia: retrospective cohort study
Dharmarajan K, Hsieh AF, Kulkarni VT, Lin Z, Ross JS, Horwitz LI, Kim N, Suter LG, Lin H, Normand SL, Krumholz HM. Trajectories of risk after hospitalization for heart failure, acute myocardial infarction, or pneumonia: retrospective cohort study. The BMJ 2015, 350: h411. PMID: 25656852, PMCID: PMC4353309, DOI: 10.1136/bmj.h411.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionRetrospective cohort studyHeart failureRisk of deathMyocardial infarctionFirst readmissionAbsolute riskOlder patientsCohort studyRelative riskMedicare feeService beneficiariesRisk of readmissionGeneral elderly populationGeneral older populationRisk trajectoriesHigh-risk periodHospital dischargeHospital admissionDischarge diagnosisAdverse outcomesReadmissionHospitalizationTrajectories of riskElderly populationIntravenous Fluids in Acute Decompensated Heart Failure
Bikdeli B, Strait KM, Dharmarajan K, Li SX, Mody P, Partovian C, Coca SG, Kim N, Horwitz LI, Testani JM, Krumholz HM. Intravenous Fluids in Acute Decompensated Heart Failure. JACC Heart Failure 2015, 3: 127-133. PMID: 25660836, PMCID: PMC4438991, DOI: 10.1016/j.jchf.2014.09.007.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overCohort StudiesDatabases, FactualFemaleFluid TherapyHeart FailureHospital MortalityHospitalizationHumansInfusions, IntravenousIntensive Care UnitsIntubation, IntratrachealIsotonic SolutionsMaleMiddle AgedRenal Replacement TherapyRetrospective StudiesRinger's SolutionSaline Solution, HypertonicSodium Potassium Chloride Symporter InhibitorsUnited StatesYoung AdultConceptsAcute decompensated heart failureDecompensated heart failureHeart failureIntravenous fluidsRetrospective cohort studyCritical care admissionRenal replacement therapyDays of hospitalizationProportion of hospitalizationsHalf-normal salineWarrants further investigationOnly diureticsCare admissionHospital deathHospital outcomesCohort studyLoop diureticsPatient groupReplacement therapyWorse outcomesNormal salineInpatient careMedian volumePatientsHospitalization