2017
Age Differences in Hospital Mortality for Acute Myocardial Infarction: Implications for Hospital Profiling.
Dharmarajan K, McNamara RL, Wang Y, Masoudi FA, Ross JS, Spatz EE, Desai NR, de Lemos JA, Fonarow GC, Heidenreich PA, Bhatt DL, Bernheim SM, Slattery LE, Khan YM, Curtis JP. Age Differences in Hospital Mortality for Acute Myocardial Infarction: Implications for Hospital Profiling. Annals Of Internal Medicine 2017, 167: 555-564. PMID: 28973634, PMCID: PMC9359429, DOI: 10.7326/m16-2871.Peer-Reviewed Original ResearchConceptsRisk-standardized mortality ratesAcute myocardial infarctionOlder patientsYounger patientsMyocardial infarctionAge groupsHospital risk-standardized mortality ratesRetrospective cohort studyHospital mortality rankingsNational Quality ForumHospital mortalityMedian hospitalHospital outcomesCohort studyACTION RegistryAMI mortalityAmerican CollegeMedicare beneficiariesAMI hospitalizationPatientsMortality rateHospitalQuality ForumHospital ValueHospital profiling
2016
Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time
Dharmarajan K, Qin L, Lin Z, Horwitz LI, Ross JS, Drye EE, Keshawarz A, Altaf F, Normand SL, Krumholz HM, Bernheim SM. Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time. Health Affairs 2016, 35: 1294-1302. PMID: 27385247, DOI: 10.1377/hlthaff.2015.1614.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCenters for Medicare and Medicaid Services, U.S.Chronic DiseaseDatabases, FactualDisease ProgressionFemaleGeriatric AssessmentHospital MortalityHumansIncidenceLength of StayMaleOutcome Assessment, Health CarePatient AdmissionPatient ReadmissionRetrospective StudiesRisk AssessmentSeverity of Illness IndexTime FactorsUnited StatesOutcomes 1 Year After Implantable Cardioverter–Defibrillator Lead Abandonment Versus Explantation for Unused or Malfunctioning Leads
Zeitler EP, Wang Y, Dharmarajan K, Anstrom KJ, Peterson ED, Daubert JP, Curtis JP, Al-Khatib SM. Outcomes 1 Year After Implantable Cardioverter–Defibrillator Lead Abandonment Versus Explantation for Unused or Malfunctioning Leads. Circulation Arrhythmia And Electrophysiology 2016, 9: e003953. PMID: 27406605, PMCID: PMC4973616, DOI: 10.1161/circep.116.003953.Peer-Reviewed Original ResearchConceptsNational Cardiovascular Data Registry ICD RegistryLead explantationUpper extremity thrombosisProcedure-related complicationsImplantable cardioverter-defibrillator leadsOutcomes 1 yearLong-term safetyCardioverter-defibrillator leadsHospital complicationsHospital deathUrgent surgeryPulmonary embolismICD RegistryHospital eventsPostprocedure complicationsMortality riskPatientsICD leadPropensity scoreComplicationsExplantationLead abandonmentMalfunctioning leadsHigh rateComparative acuteCoronary Catheterization and Percutaneous Coronary Intervention in China: 10-Year Results From the China PEACE-Retrospective CathPCI Study
Zheng X, Curtis JP, Hu S, Wang Y, Yang Y, Masoudi FA, Spertus JA, Li X, Li J, Dharmarajan K, Downing NS, Krumholz HM, Jiang L. Coronary Catheterization and Percutaneous Coronary Intervention in China: 10-Year Results From the China PEACE-Retrospective CathPCI Study. JAMA Internal Medicine 2016, 176: 512. PMID: 26974883, PMCID: PMC5459379, DOI: 10.1001/jamainternmed.2016.0166.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAngina, UnstableCardiac CatheterizationChinaCoronary Artery DiseaseDrug-Eluting StentsFemaleHospital MortalityHospitals, UrbanHumansLength of StayMaleMedical RecordsMiddle AgedMyocardial InfarctionOdds RatioOutcome Assessment, Health CarePercutaneous Coronary InterventionPostoperative ComplicationsPostoperative HemorrhageQuality of Health CareRetrospective StudiesStentsTime-to-TreatmentConceptsPercutaneous coronary interventionDrug-eluting stentsQuality of careCoronary catheterizationCoronary interventionNonobstructive coronary artery diseasePrimary percutaneous coronary interventionFuture quality improvement initiativesEvidence-based medicationsOutcomes of patientsCoronary artery diseaseClinical observational studyUse of catheterizationQuality improvement initiativesCalendar year 2001Hospital mortalityArtery diseasePatient characteristicsStable patientsTreatment patternsMedian lengthMean agePCI proceduresMedical recordsObservational study
2015
Hospital variation in admission to intensive care units for patients with acute myocardial infarction
Chen R, Strait KM, Dharmarajan K, Li SX, Ranasinghe I, Martin J, Fazel R, Masoudi FA, Cooke CR, Nallamothu BK, Krumholz HM. Hospital variation in admission to intensive care units for patients with acute myocardial infarction. American Heart Journal 2015, 170: 1161-1169. PMID: 26678638, PMCID: PMC5459386, DOI: 10.1016/j.ahj.2015.09.003.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overAnterior Wall Myocardial InfarctionCoronary Care UnitsHealth Care RationingHospital MortalityHumansLength of StayMaleMiddle AgedOutcome and Process Assessment, Health CarePatient AdmissionQuality ImprovementRetrospective StudiesRisk AssessmentTriageUnited StatesConceptsAcute myocardial infarctionIntensive care unitCritical care therapiesRisk-standardized mortality ratesHospital risk-standardized mortality ratesICU admissionResource-intensive settingsCare therapyAMI patientsCare unitMyocardial infarctionMortality rateAdult hospitalizationsHospital variationNinth RevisionClinical ModificationICU triageInternational ClassificationBetter outcomesPatientsHospitalAdmissionPremier databaseTherapyAppropriate useTrajectories 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 volumePatientsHospitalizationRisk after hospitalization: We have a lot to learn
Dharmarajan K, Krumholz HM. Risk after hospitalization: We have a lot to learn. Journal Of Hospital Medicine 2015, 10: 135-136. PMID: 25627350, PMCID: PMC4337805, DOI: 10.1002/jhm.2309.Peer-Reviewed Original Research
2014
National Trends in Recurrent AMI Hospitalizations 1 Year After Acute Myocardial Infarction in Medicare Beneficiaries: 1999–2010
Chaudhry SI, Khan RF, Chen J, Dharmarajan K, Dodson JA, Masoudi FA, Wang Y, Krumholz HM. National Trends in Recurrent AMI Hospitalizations 1 Year After Acute Myocardial Infarction in Medicare Beneficiaries: 1999–2010. Journal Of The American Heart Association 2014, 3: e001197. PMID: 25249298, PMCID: PMC4323804, DOI: 10.1161/jaha.114.001197.Peer-Reviewed Original ResearchHospital Variation in Noninvasive Positive Pressure Ventilation for Acute Decompensated Heart Failure
Kulkarni VT, Kim N, Dai Y, Dharmarajan K, Safavi KC, Bikdeli B, Lindenauer PK, Testani J, Dries DL, Krumholz HM. Hospital Variation in Noninvasive Positive Pressure Ventilation for Acute Decompensated Heart Failure. Circulation Heart Failure 2014, 7: 427-433. PMID: 24633829, PMCID: PMC4386575, DOI: 10.1161/circheartfailure.113.000698.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureNoninvasive positive pressure ventilationDecompensated heart failureRisk-standardized mortality ratesPositive pressure ventilationHeart failureIntubation rateMortality ratePressure ventilationUse of NPPVHospital risk-standardized mortality ratesHigher intubation rateHospital practice patternsHospital-level outcomesCross-sectional studyHierarchical logistic regression modelsLogistic regression modelsNIPPV useHospital variationSuch hospitalizationsPractice patternsHospitalizationHospitalQuartileBottom quartile
2013
Acute Decompensated Heart Failure Is Routinely Treated as a Cardiopulmonary Syndrome
Dharmarajan K, Strait KM, Lagu T, Lindenauer PK, Tinetti ME, Lynn J, Li SX, Krumholz HM. Acute Decompensated Heart Failure Is Routinely Treated as a Cardiopulmonary Syndrome. PLOS ONE 2013, 8: e78222. PMID: 24250751, PMCID: PMC3824040, DOI: 10.1371/journal.pone.0078222.Peer-Reviewed Original ResearchConceptsDecompensated heart failureHeart failureRespiratory therapyHospital daysCardiopulmonary syndromeAcute decompensated heart failureAcute heart failure treatmentChronic obstructive pulmonary diseaseReceipt of medicationHeart failure hospitalizationHigh-dose corticosteroidsHospital day 2Hospital day 3Half of patientsChronic lung diseaseDays of hospitalizationHeart failure treatmentObstructive pulmonary diseaseShortness of breathIntensive care unitPrincipal discharge diagnosisLate intubationAcute asthmaFailure hospitalizationHospital deathNational Trends in Heart Failure Hospital Stay Rates, 2001 to 2009
Chen J, Dharmarajan K, Wang Y, Krumholz HM. National Trends in Heart Failure Hospital Stay Rates, 2001 to 2009. Journal Of The American College Of Cardiology 2013, 61: 1078-1088. PMID: 23473413, PMCID: PMC3939721, DOI: 10.1016/j.jacc.2012.11.057.Peer-Reviewed Original ResearchConceptsHospital stay ratesLength of stayHF hospital stayHospital mortalityYears of ageHospital stayPatients 18Stay ratesNational Inpatient Sample dataU.S. hospital dischargesPatients 65 yearsPrimary discharge diagnosisSignificant declineOlder Medicare beneficiariesNational Inpatient SampleBlack menLarge national datasetHospital dischargeOlder patientsPatients 55Younger patientsDischarge diagnosisInpatient SampleMedicare beneficiariesAge 65Variation Exists in Rates of Admission to Intensive Care Units for Heart Failure Patients Across Hospitals in the United States
Safavi KC, Dharmarajan K, Kim N, Strait KM, Li SX, Chen SI, Lagu T, Krumholz HM. Variation Exists in Rates of Admission to Intensive Care Units for Heart Failure Patients Across Hospitals in the United States. Circulation 2013, 127: 923-929. PMID: 23355624, PMCID: PMC3688061, DOI: 10.1161/circulationaha.112.001088.Peer-Reviewed Original ResearchConceptsIntensive care unitHeart failureRisk-standardized mortalityICU admissionICU useCare unitPatient outcomesCoronary intensive care unitMedical intensive care unitNoninvasive positive pressure ventilationSurgical intensive care unitTop quartileGreater ICU useOverall heart failureTop quartile hospitalsICU admission ratePercent of patientsPremier Perspective databaseHeart failure patientsPositive pressure ventilationRate of admissionHigh-cost settingsQuality of careHF admissionsICU days
2012
Procedure Intensity and the Cost of Care
Chen SI, Dharmarajan K, Kim N, Strait KM, Li SX, Safavi KC, Lindenauer PK, Krumholz HM, Lagu T. Procedure Intensity and the Cost of Care. Circulation Cardiovascular Quality And Outcomes 2012, 5: 308-313. PMID: 22576844, PMCID: PMC3415230, DOI: 10.1161/circoutcomes.112.966069.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overCosts and Cost AnalysisCross-Sectional StudiesFemaleHeart FailureHospital Bed CapacityHospital CostsHospital MortalityHospitalizationHospitals, RuralHospitals, TeachingHospitals, UrbanHumansLength of StayLinear ModelsMaleMiddle AgedModels, EconomicOutcome and Process Assessment, Health CareResidence CharacteristicsRisk AssessmentRisk FactorsTime FactorsTreatment OutcomeUnited StatesYoung AdultConceptsHF hospitalizationHeart failureInvasive proceduresHospital groupRisk-standardized mortality ratesProportion of patientsLength of stayCost of careWilcoxon rank sum testHigher procedure ratesRank sum testPatient demographicsPerspective databaseMedian lengthSurgical proceduresProcedure ratesHospitalizationOutcome differencesMortality rateHospitalPatientsPractice styleProcedure useSum testOverall use