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 defibrillatorAssociation Between Insurance Status and Access to Hospital Care in Emergency Department Disposition
Venkatesh AK, Chou SC, Li SX, Choi J, Ross JS, D’Onofrio G, Krumholz HM, Dharmarajan K. Association Between Insurance Status and Access to Hospital Care in Emergency Department Disposition. JAMA Internal Medicine 2019, 179: 686-693. PMID: 30933243, PMCID: PMC6503571, DOI: 10.1001/jamainternmed.2019.0037.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAsthmaCritical CareCross-Sectional StudiesDatabases, FactualEmergency Service, HospitalFemaleHealth Services AccessibilityHospitalizationHumansInsurance CoverageInsurance, HealthLung DiseasesMaleMedicaidMedically UninsuredMiddle AgedPatient DischargePatient TransferPneumoniaPulmonary Disease, Chronic ObstructiveUnited StatesConceptsNational Emergency Department SampleEmergency Department SampleCommon medical conditionsUninsured patientsCritical care capabilitiesED dischargeED visitsED transfersPulmonary diseaseCare capabilitiesInsurance statusHigher oddsMedicaid beneficiariesMedical conditionsChronic obstructive pulmonary diseaseAcute pulmonary diseaseEmergency department transfersAdult ED visitsHospital admission ratesObstructive pulmonary diseaseEmergency department dispositionPatient insurance statusPatient case mixHospital ownership statusIntensive care capabilitiesThirty-Day Hospital Readmission After Acute Myocardial Infarction in China
Li J, Dharmarajan K, Bai X, Masoudi FA, Spertus JA, Li X, Zheng X, Zhang H, Yan X, Dreyer RP, Krumholz HM, Group F. Thirty-Day Hospital Readmission After Acute Myocardial Infarction in China. Circulation Cardiovascular Quality And Outcomes 2019, 12: e005628. PMID: 31092023, DOI: 10.1161/circoutcomes.119.005628.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionUnplanned cardiovascular readmissionsDays of dischargeMyocardial infarctionCardiovascular readmissionCause readmissionMost readmissionsLower riskFit Cox proportional hazards modelsST-segment elevation myocardial infarctionAcute Coronary Events (GRACE) scoreThirty-day hospital readmissionsDisease-specific health statusCox proportional hazards modelVentricular ejection fractionProportional hazards modelLow social supportBackground ReadmissionRecurrent anginaCardiovascular eventsHospital complicationsUnplanned readmissionIndex hospitalizationClinical factorsConsecutive patientsRisk 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 3Trends in Performance and Opportunities for Improvement on a Composite Measure of Acute Myocardial Infarction Care
Desai NR, Udell JA, Wang Y, Spatz ES, Dharmarajan K, Ahmad T, Julien HM, Annapureddy A, Goyal A, de Lemos JA, Masoudi FA, Bhatt DL, Minges KE, Krumholz HM, Curtis JP. Trends in Performance and Opportunities for Improvement on a Composite Measure of Acute Myocardial Infarction Care. Circulation Cardiovascular Quality And Outcomes 2019, 12: e004983. PMID: 30871375, DOI: 10.1161/circoutcomes.118.004983.Peer-Reviewed Original ResearchMeSH KeywordsAgedCardiology Service, HospitalFemaleGuideline AdherenceHealthcare DisparitiesHumansMaleMiddle AgedMyocardial InfarctionOutcome and Process Assessment, Health CarePractice Guidelines as TopicQuality ImprovementQuality Indicators, Health CareRacial GroupsRegistriesSex FactorsSocioeconomic FactorsTreatment OutcomeUnited StatesConceptsProportion of patientsAcute myocardial infarctionDefect-free careHispanic patientsAMI careOlder patientsCare measuresNational Cardiovascular Data Registry Acute Coronary TreatmentIntervention Outcomes Network RegistryAcute myocardial infarction careGuideline-recommended pharmacotherapyMedicaid insurance coverageSociodemographic groupsMyocardial infarction careSafety-net statusGreatest absolute improvementComposite measureQuality of careHospital-level performanceCessation counselingEvidence-based processReperfusion therapyCardiac rehabilitationCoronary TreatmentVentricular functionAssociation of Income Disparities with Patient-Reported Healthcare Experience
Okunrintemi V, Khera R, Spatz ES, Salami JA, Valero-Elizondo J, Warraich HJ, Virani SS, Blankstein R, Blaha MJ, Pawlik TM, Dharmarajan K, Krumholz HM, Nasir K. Association of Income Disparities with Patient-Reported Healthcare Experience. Journal Of General Internal Medicine 2019, 34: 884-892. PMID: 30783877, PMCID: PMC6544715, DOI: 10.1007/s11606-019-04848-4.Peer-Reviewed Original ResearchConceptsPatient healthcare experienceHealthcare experiencesHigher oddsMedical Expenditure Panel Survey cohortHealthcare providersRepresentative US adult populationUS adult populationTimes higher oddsQuality of careTimes greater oddsLow incomePoor healthcare experiencesRetrospective studyPatient incomePatient levelPatient reportsUS adultsProvider satisfactionGreater oddsPatientsHealth outcomesSurvey cohortAdult populationStudy participantsAspects of access
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 proportionAssociation 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 harmTrends 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 programsMedicareGroupReadmissionFailure
2017
Risk Trajectories of Readmission and Death in the First Year after Hospitalization for Chronic Obstructive Pulmonary Disease
Lindenauer PK, Dharmarajan K, Qin L, Lin Z, Gershon AS, Krumholz HM. Risk Trajectories of Readmission and Death in the First Year after Hospitalization for Chronic Obstructive Pulmonary Disease. American Journal Of Respiratory And Critical Care Medicine 2017, 197: 1009-1017. PMID: 29206052, PMCID: PMC5909167, DOI: 10.1164/rccm.201709-1852oc.Peer-Reviewed Original ResearchConceptsChronic obstructive pulmonary diseaseSame respective groupsObstructive pulmonary diseaseVentilator supportPulmonary diseaseRisk of readmissionRisk of hospitalizationGeneral elderly populationGeneral Medicare populationRisk of deathDaily riskRespective groupsReadmission ratesHospital readmissionAbsolute riskMedicare populationReadmissionElderly populationMedicare beneficiariesHospitalizationClinical servicesFirst monthProlonged riskDeathLongitudinal outcomesAge 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 profilingHospital-Readmission Risk — Isolating Hospital Effects from Patient Effects
Krumholz HM, Wang K, Lin Z, Dharmarajan K, Horwitz LI, Ross JS, Drye EE, Bernheim SM, Normand ST. Hospital-Readmission Risk — Isolating Hospital Effects from Patient Effects. New England Journal Of Medicine 2017, 377: 1055-1064. PMID: 28902587, PMCID: PMC5671772, DOI: 10.1056/nejmsa1702321.Peer-Reviewed Original ResearchConceptsRisk-standardized readmission ratesReadmission ratesObserved readmission ratesSimilar diagnosesHospital effectsDifferent hospitalsHospital readmission performanceRate of readmissionHospital readmission ratesLower readmission ratesStudy sampleYears of ageSignificant differencesMultiple admissionsReadmission outcomesOnly significant differencePatient effectsSame patientMedicare recipientsPatientsReadmission performanceRisk-standardized hospital readmission ratesHospitalHospital qualityQuartilePredicting death after acute myocardial infarction
Castro-Dominguez Y, Dharmarajan K, McNamara RL. Predicting death after acute myocardial infarction. Trends In Cardiovascular Medicine 2017, 28: 102-109. PMID: 28826668, DOI: 10.1016/j.tcm.2017.07.011.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionMyocardial infarctionRisk factorsClinical presentation characteristicsRisk stratification modelImportant risk factorPatients important informationPatient riskClinical informationStratification modelPresentation characteristicsMortalityInfarctionRiskHospitalizationPrognosisCliniciansRegional 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 systemHospitalisationReductions in Readmission Rates Are Associated With Modest Improvements in Patient-reported Health Gains Following Hip and Knee Replacement in England
Friebel R, Dharmarajan K, Krumholz HM, Steventon A. Reductions in Readmission Rates Are Associated With Modest Improvements in Patient-reported Health Gains Following Hip and Knee Replacement in England. Medical Care 2017, 55: 834-840. PMID: 28742545, PMCID: PMC5555974, DOI: 10.1097/mlr.0000000000000779.Peer-Reviewed Original ResearchConceptsRisk-adjusted readmission ratesReadmission ratesEQ-VASHealth gainsEQ-5DKnee replacementHip replacementOxford Hip ScoreOxford Knee ScorePatient-reported healthPatient-reported outcomesVisual analog scaleKnee replacement surgeryReadmission reduction initiativesHealth care systemAdditional health gainsHip scoreKnee scoreAnalog scalePresurgical assessmentReplacement surgeryPatients' senseHospital groupModest ImprovementPatient healthAssociation 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 structureSyndromeHospitalizationAdultsFailurePrognosisPathophysiologyDementiaFrailtyMortalityEpidemiologyPrevalenceIncidenceOutcomes after observation stays among older adult Medicare beneficiaries in the USA: retrospective cohort study
Dharmarajan K, Qin L, Bierlein M, Choi JES, Lin Z, Desai NR, Spatz ES, Krumholz HM, Venkatesh AK. Outcomes after observation stays among older adult Medicare beneficiaries in the USA: retrospective cohort study. The BMJ 2017, 357: j2616. PMID: 28634181, PMCID: PMC5476173, DOI: 10.1136/bmj.j2616.Peer-Reviewed Original ResearchSex 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 beneficiariesHospitalizationPneumoniaSeattle 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 registry