Abstract:
BACKGROUND:Data collected as part of routine clinical practice could be used to detect cardiovascular outcomes in pragmatic clinical trials or clinical registry studies. The reliability of claims data for documenting outcomes is unknown. METHODS AND RESULTS:We linked records of Women's Health Initiative (WHI) participants aged ≥65 years to Medicare claims data and compared hospitalizations that had diagnosis codes for acute myocardial infarction or coronary revascularization with WHI outcomes adjudicated by study physicians. We then compared the hazard ratios for active versus placebo hormone therapy based solely on WHI-adjudicated events with corresponding hazard ratios based solely on claims data for the same hormone trial participants. Agreement between WHI-adjudicated outcomes and Medicare claims was good for the diagnosis of myocardial infarction (κ, 0.71-0.74) and excellent for coronary revascularization (κ, 0.88-0.91). The hormone:placebo hazard ratio for clinical myocardial infarction was 1.31 (95% confidence interval, 1.03-1.67) based on WHI outcomes and 1.29 (95% confidence interval, 1.00-1.68) based on Medicare data. The hazard ratio for coronary revascularization was 1.09 (95% confidence interval, 0.88-1.35) based on WHI outcomes and 1.10 (95% confidence interval, 0.89-1.35) based on Medicare data. The differences between hazard ratios derived from WHI and Medicare data were not significant in 1000 bootstrap replications. CONCLUSIONS:Medicare claims may provide useful data on coronary heart disease outcomes among patients aged ≥65 years in clinical research studies. CLINICAL TRIALS REGISTRATION INFORMATION:URL: www.clinicaltrials.gov. Unique identifier: NCT00000611.
journal_name
Circ Cardiovasc Qual Outcomesjournal_title
Circulation. Cardiovascular quality and outcomesauthors
Hlatky MA,Ray RM,Burwen DR,Margolis KL,Johnson KC,Kucharska-Newton A,Manson JE,Robinson JG,Safford MM,Allison M,Assimes TL,Bavry AA,Berger J,Cooper-DeHoff RM,Heckbert SR,Li W,Liu S,Martin LW,Perez MV,Tindle HA,Windoi
10.1161/CIRCOUTCOMES.113.000373subject
Has Abstractpub_date
2014-01-01 00:00:00pages
157-62issue
1eissn
1941-7713issn
1941-7705pii
CIRCOUTCOMES.113.000373journal_volume
7pub_type
杂志文章abstract:BACKGROUND:Hemoglobin A1C (HbA1C) is associated with increased risk of cardiovascular events, but its use for prediction of cardiovascular disease (CVD) events in combination with conventional risk factors has not been well defined. METHODS AND RESULTS:To understand the effect of HbA1C on CVD risk in the context of ot...
journal_title:Circulation. Cardiovascular quality and outcomes
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doi:10.1161/CIRCOUTCOMES.115.001639
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abstract:BACKGROUND:Many hospitalized medically ill patients are at risk of venous thromboembolism (VTE). Risk factors include prior VTE, older age, immobility, obesity, cardiac or respiratory failure, and cancer (at-risk patients). Although guidelines recommend use of VTE prophylaxis for at-risk patients, many may not receive ...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究
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更新日期:2013-01-01 00:00:00
abstract::Despite decades of improvement in the quality and outcomes of cardiovascular care, significant gaps remain. Existing quality improvement strategies are often limited in scope to specific clinical conditions and episodic care. Health services and outcomes research is essential to inform gaps in care but rarely results ...
journal_title:Circulation. Cardiovascular quality and outcomes
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doi:10.1161/CIRCOUTCOMES.120.006753
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:Little is known regarding the adoption of direct thrombin inhibitors in clinical practice. We examine trends in oral anticoagulation for the prevention of thromboembolism in the United States. METHODS AND RESULTS:We used the IMS Health National Disease and Therapeutic Index, a nationally representative audi...
journal_title:Circulation. Cardiovascular quality and outcomes
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doi:10.1161/CIRCOUTCOMES.112.967299
更新日期:2012-09-01 00:00:00
abstract:BACKGROUND:Risk models in the private insurance setting may systematically underpredict in the socially disadvantaged. In this study, we sought to determine whether US minority Medicare beneficiaries had disproportionately low costs compared with their clinical outcomes and whether adding social determinants of health ...
journal_title:Circulation. Cardiovascular quality and outcomes
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journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:Mobile health technologies are low cost, scalable interventions with the potential to promote patient engagement and behavior change. We aimed to test whether a culturally sensitive text messaging intervention supporting secondary prevention improves the control of risk factors in patients with coronary hear...
journal_title:Circulation. Cardiovascular quality and outcomes
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更新日期:2019-04-01 00:00:00
abstract:BACKGROUND:Long-term exposure to particulate matter <2.5 µm in diameter (PM2.5) and ozone has been associated with the development and progression of cardiovascular disease and, in the case of PM2.5, higher cardiovascular mortality. Whether exposure to PM2.5 and ozone is associated with patients' health status and qual...
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abstract:BACKGROUND:Early readmissions among older adults hospitalized for acute myocardial infarction (AMI) are costly and difficult to predict. Aging-related functional impairments may inform risk prediction but are unavailable in most studies. Our objective was to, therefore, develop and validate an AMI readmission risk mode...
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更新日期:2019-05-01 00:00:00
abstract:BACKGROUND:Despite effective treatments to reduce cardiovascular disease risk, their translation into practice is limited. METHODS AND RESULTS:Using a parallel arm cluster-randomized controlled trial in 60 Australian primary healthcare centers, we tested whether a multifaceted quality improvement intervention comprisi...
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更新日期:2015-01-01 00:00:00
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doi:10.1161/CIRCOUTCOMES.118.005010
更新日期:2019-03-01 00:00:00
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journal_title:Circulation. Cardiovascular quality and outcomes
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doi:10.1161/CIRCOUTCOMES.108.829523
更新日期:2009-07-01 00:00:00
abstract:BACKGROUND:As new techniques emerge to quantify patients' health status, new opportunities are created to validate patient-reported outcome questionnaires. The Seattle Angina Questionnaire (SAQ), a widely used coronary artery disease-specific health status tool, has not been validated against daily records of angina fr...
journal_title:Circulation. Cardiovascular quality and outcomes
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更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:Clinical prediction models (CPMs) estimate the probability of clinical outcomes and hold the potential to improve decision making and individualize care. For patients with cardiovascular disease, there are numerous CPMs available although the extent of this literature is not well described. METHODS AND RESU...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,评审
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更新日期:2015-07-01 00:00:00
abstract:BACKGROUND:Geriatric conditions may influence outcomes among patients receiving implantable cardioverter-defibrillators (ICDs). We sought to determine the prevalence of frailty and dementia among older adults receiving primary prevention ICDs and to determine the impact of multimorbidity on mortality within 1 year of I...
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pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.115.002053
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:Patients on dialysis who have an acute myocardial infarction (AMI) have an exceedingly poor prognosis, but it is unknown to what extent guideline-recommended interventions and treatments are used and to which benefit. We aimed to assess temporal changes in the use of treatments and survival rates in dialysis...
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doi:10.1161/CIRCOUTCOMES.119.005879
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:Exposure to tobacco smoke is associated with markers of preclinical atherosclerosis in adults, but its effect on arterial structure in adolescents is unknown. METHODS AND RESULTS:Healthy 13-year-old adolescents from the atherosclerosis prevention trial STRIP were studied. Maximum carotid and aortic intima-m...
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更新日期:2016-05-01 00:00:00
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abstract:BACKGROUND:High body mass index (BMI) increases the probability of indeterminate findings on diagnostic studies, length of stay, and cost of care for hospitalized patients. No study has examined the economic and operational impact of BMI in patients with chest complaints presenting to the emergency department (ED). The...
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doi:10.1161/CIRCOUTCOMES.113.000702
更新日期:2014-03-01 00:00:00
abstract:BACKGROUND:Using electronic health records data to predict events and onset of diseases is increasingly common. Relatively little is known, although, about the tradeoffs between data requirements and model utility. METHODS AND RESULTS:We examined the performance of machine learning models trained to detect prediagnost...
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abstract:BACKGROUND:In 2009, the Centers for Medicare & Medicaid Services is publicly reporting hospital-level risk-standardized 30-day mortality and readmission rates after acute myocardial infarction (AMI) and heart failure (HF). We provide patterns of hospital performance, based on these measures. METHODS AND RESULTS:We cal...
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abstract:BACKGROUND:Instruments to assess symptom burden and quality of life among patients with atrial fibrillation (AF) have not been well evaluated in community practice or associated with patient outcomes. METHODS AND RESULTS:Using data from 10 087 AF patients in the Outcomes Registry for Better Informed Treatment of AF (O...
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更新日期:2015-07-01 00:00:00
abstract:BACKGROUND:Improving health-related quality of life (HRQoL) is an important treatment goal in the management of patients with atrial fibrillation (AF). Uncertainty exists as to whether patients' HRQoL differ when treated with medical rhythm control or rate control. We compared HRQoL between patients treated with rhythm...
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abstract:BACKGROUND:Patients with diabetes are frequently admitted for acute myocardial infarction (AMI) on antihyperglycemic agents but may be discharged without glucose-lowering therapy. We examined the frequency of this practice and evaluated the associated outcomes of readmission and mortality. METHODS AND RESULTS:We condu...
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更新日期:2010-05-01 00:00:00
abstract:BACKGROUND:Identifying patients at increased risk of contrast-associated acute kidney injury (CA-AKI) can help target risk mitigation strategies toward these individuals during percutaneous coronary intervention. Illuminating which risk models best stratify risk is an important foundation for such quality improvement e...
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更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:Despite the widespread availability of effective and affordable therapies, hypertension remains this country's most significant modifiable cardiovascular risk factor. Approximately 30% to 50% of individuals with hypertension currently fail to reach guideline-recommended target blood pressure (BP) goals. Alth...
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pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.113.000148
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:Nearly half of Americans with diagnosed hypertension have uncontrolled blood pressure (BP) while some integrated healthcare systems, such as Kaiser Permanente Northern California, have achieved control rates upwards 90%. METHODS AND RESULTS:We adapted Kaiser Permanente's evidence-based treatment protocols i...
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更新日期:2018-07-01 00:00:00
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更新日期:2020-03-01 00:00:00