2024
Automated Identification of Heart Failure With Reduced Ejection Fraction Using Deep Learning-Based Natural Language Processing
Nargesi A, Adejumo P, Dhingra L, Rosand B, Hengartner A, Coppi A, Benigeri S, Sen S, Ahmad T, Nadkarni G, Lin Z, Ahmad F, Krumholz H, Khera R. Automated Identification of Heart Failure With Reduced Ejection Fraction Using Deep Learning-Based Natural Language Processing. JACC Heart Failure 2024 PMID: 39453355, DOI: 10.1016/j.jchf.2024.08.012.Peer-Reviewed Original ResearchReduced ejection fractionEjection fractionHeart failureLeft ventricular ejection fractionVentricular ejection fractionYale-New Haven HospitalIdentification of patientsCommunity hospitalIdentification of heart failureLanguage modelNorthwestern MedicineMeasure care qualityQuality of careNew Haven HospitalDeep learning-based natural language processingHFrEFGuideline-directed careDeep learning language modelsMIMIC-IIIDetect HFrEFNatural language processingReclassification improvementHospital dischargePatientsCare qualityA Multimodal Video-Based AI Biomarker for Aortic Stenosis Development and Progression
Oikonomou E, Holste G, Yuan N, Coppi A, McNamara R, Haynes N, Vora A, Velazquez E, Li F, Menon V, Kapadia S, Gill T, Nadkarni G, Krumholz H, Wang Z, Ouyang D, Khera R. A Multimodal Video-Based AI Biomarker for Aortic Stenosis Development and Progression. JAMA Cardiology 2024, 9: 534-544. PMID: 38581644, PMCID: PMC10999005, DOI: 10.1001/jamacardio.2024.0595.Peer-Reviewed Original ResearchCardiac magnetic resonanceAortic valve replacementCardiac magnetic resonance imagingAV VmaxSevere ASAortic stenosisCohort studyPeak aortic valve velocityCohort study of patientsAortic valve velocityCohort of patientsTraditional cardiovascular risk factorsAssociated with faster progressionStudy of patientsCedars-Sinai Medical CenterAssociated with AS developmentCardiovascular risk factorsCardiovascular imaging modalitiesIndependent of ageModerate ASEjection fractionEchocardiographic studiesValve replacementRisk stratificationCardiac structureIschemic 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
2023
Predicting aortic stenosis progression using a video-based deep learning model of aortic stenosis built for single-view two-dimensional echocardiography
Oikonomou E, Holste G, Mcnamara R, Velazquez E, Nadkarni G, Ouyang D, Krumholz H, Wang Z, Khera R. Predicting aortic stenosis progression using a video-based deep learning model of aortic stenosis built for single-view two-dimensional echocardiography. European Heart Journal 2023, 44: ehad655.040. DOI: 10.1093/eurheartj/ehad655.040.Peer-Reviewed Original ResearchLeft ventricular ejection fractionSevere aortic stenosisAortic stenosisAS progressionAV VmaxTransthoracic echocardiographyYale New Haven Health SystemBaseline left ventricular ejection fractionAortic stenosis progressionModerate aortic stenosisRetrospective cohort studyVentricular ejection fractionTwo-dimensional echocardiographyMean rateModerate ASAS severityCohort studyEjection fractionPatient sexStenosis progressionTTE studiesEligible participantsSerial monitoringSpecialized centersTimely diagnosisDetection of Left Ventricular Systolic Dysfunction From Electrocardiographic Images
Sangha V, Nargesi A, Dhingra L, Khunte A, Mortazavi B, Ribeiro A, Banina E, Adeola O, Garg N, Brandt C, Miller E, Ribeiro A, Velazquez E, Giatti L, Barreto S, Foppa M, Yuan N, Ouyang D, Krumholz H, Khera R. Detection of Left Ventricular Systolic Dysfunction From Electrocardiographic Images. Circulation 2023, 148: 765-777. PMID: 37489538, PMCID: PMC10982757, DOI: 10.1161/circulationaha.122.062646.Peer-Reviewed Original ResearchConceptsLV systolic dysfunctionYale-New Haven HospitalVentricular systolic dysfunctionSystolic dysfunctionLV ejection fractionBrazilian Longitudinal StudyNew Haven HospitalEjection fractionCardiology clinicRegional hospitalLeft ventricular systolic dysfunctionCedars-Sinai Medical CenterAdult Health (ELSA-Brasil) cohortOpportunities and Achievement of Medication Initiation Among Inpatients With Heart Failure With Reduced Ejection Fraction
Swat S, Xu H, Allen L, Greene S, DeVore A, Matsouaka R, Goyal P, Peterson P, Hernandez A, Krumholz H, Yancy C, Fonarow G, Hess P, Program A. Opportunities and Achievement of Medication Initiation Among Inpatients With Heart Failure With Reduced Ejection Fraction. JACC Heart Failure 2023, 11: 918-929. PMID: 37318420, DOI: 10.1016/j.jchf.2023.04.015.Peer-Reviewed Original ResearchConceptsEvidence-based medicationsMedication initiationReduced ejection fractionNumber of medicationsMultivariable logistic regressionNumber of patientsPre-existing conditionsReduced ejectionEjection fractionHeart failureMultivariable analysisFemale sexLower oddsMedicationsMean net gainPatientsRural hospitalsAdmissionOlder ageLogistic regressionStudy periodMean numberOddsInitiationRural locations
2022
Hospital Variation of Spironolactone Use in Patients Hospitalized for Heart Failure in China—The China PEACE Retrospective Heart Failure Study
Yu Y, Guan W, Masoudi FA, Wang B, He G, Spertus JA, Lu Y, Krumholz HM, Li J. Hospital Variation of Spironolactone Use in Patients Hospitalized for Heart Failure in China—The China PEACE Retrospective Heart Failure Study. Journal Of The American Heart Association 2022, 11: e026300. PMID: 36172964, PMCID: PMC9673705, DOI: 10.1161/jaha.122.026300.Peer-Reviewed Original ResearchConceptsSpironolactone prescriptionSpironolactone useHeart failureMedian odds ratioIdeal patientAldosterone antagonistsHospital variationMedian rateReduced ejection fractionUse of spironolactoneMultivariable linear regression modelsHeart Failure StudyEjection fractionHospital characteristicsOdds ratioRepresentative cohortPatientsHospitalChinese hospitalsInappropriate usePrescriptionSpironolactoneSelect individualsAntagonistHigh rate
2021
Prior Authorization, Copayments, and Utilization of Sacubitril/Valsartan in Medicare and Commercial Plans in Patients With Heart Failure With Reduced Ejection Fraction
Ozaki AF, Krumholz HM, Mody FV, Tran TT, Le QT, Yokota M, Jackevicius CA. Prior Authorization, Copayments, and Utilization of Sacubitril/Valsartan in Medicare and Commercial Plans in Patients With Heart Failure With Reduced Ejection Fraction. Circulation Cardiovascular Quality And Outcomes 2021, 14: e007665. PMID: 34465124, DOI: 10.1161/circoutcomes.120.007665.Peer-Reviewed Original ResearchConceptsSacubitril/valsartanSacubitril/valsartan useInsurance plan typeReduced ejection fractionHeart failureEjection fractionValsartan useCommercial plansNew York Heart Association classPA criteriaReduced ejection fraction patientsReduced ejection fraction populationPlan typeEjection fraction patientsMedicare plansEjection fraction populationCross-sectional studyProportion of plansPrescription copaymentsAssociation classCopayment amountPrimary outcomeClinical outcomesPlan populationMore prescriptionsNational Trends in the Use of Sacubitril/Valsartan
Ozaki AF, Krumholz HM, Mody FV, Jackevicius CA. National Trends in the Use of Sacubitril/Valsartan. Journal Of Cardiac Failure 2021, 27: 839-847. PMID: 34364661, DOI: 10.1016/j.cardfail.2021.05.015.Peer-Reviewed Original ResearchConceptsSacubitril/valsartanSacubitril/valsartan useReduced ejection fractionValsartan useEjection fractionHeart failurePopulation-level cohort studyNational Prescription AuditEligible patientsCohort studyPrescription patternsYounger patientsPrescription auditDosage patternClinical implicationsFurther evaluationValsartanPatientsSubstantial proportionNational trendsPrescriptionGreater increaseRecent useGreater proportionUnited States180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI study
Dodson JA, Hajduk AM, Murphy TE, Geda M, Krumholz HM, Tsang S, Nanna MG, Tinetti ME, Ouellet G, Sybrant D, Gill TM, Chaudhry SI. 180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI study. Open Heart 2021, 8: e001442. PMID: 33452007, PMCID: PMC7813425, DOI: 10.1136/openhrt-2020-001442.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionReadmission risk modelSelf-reported health statusMyocardial infarctionFunctional mobilityOlder adultsHealth statusDays of AMIFirst diastolic blood pressureChronic obstructive pulmonary diseaseIschemic ECG changesProspective cohort studyDiastolic blood pressureObstructive pulmonary diseaseLength of stayInitial heart rateFinal risk modelSILVER-AMI StudyRisk modelInitial hemoglobinCohort studyReadmission ratesBlood pressureEjection fractionHeart failure
2019
Machine Learning Prediction of Mortality and Hospitalization in Heart Failure With Preserved Ejection Fraction
Angraal S, Mortazavi BJ, Gupta A, Khera R, Ahmad T, Desai NR, Jacoby DL, Masoudi FA, Spertus JA, Krumholz HM. Machine Learning Prediction of Mortality and Hospitalization in Heart Failure With Preserved Ejection Fraction. JACC Heart Failure 2019, 8: 12-21. PMID: 31606361, DOI: 10.1016/j.jchf.2019.06.013.Peer-Reviewed Original ResearchConceptsHF hospitalizationRisk of mortalityEjection fractionBlood urea nitrogen levelsLogistic regressionPrevious HF hospitalizationHeart failure hospitalizationReduced ejection fractionReceiver-operating characteristic curveRisk of deathBody mass indexBlood urea nitrogenUrea nitrogen levelsHealth status dataMean c-statisticKCCQ scoresTOPCAT trialFailure hospitalizationHeart failureHemoglobin levelsMass indexC-statisticHospitalizationUrea nitrogenMortalityCharacteristics, Management, and Outcomes of Patients Hospitalized for Heart Failure in China: The China PEACE Retrospective Heart Failure Study
Yu Y, Gupta A, Wu C, Masoudi FA, Du X, Zhang J, Krumholz HM, Li J, Group T. Characteristics, Management, and Outcomes of Patients Hospitalized for Heart Failure in China: The China PEACE Retrospective Heart Failure Study. Journal Of The American Heart Association 2019, 8: e012884. PMID: 31431117, PMCID: PMC6755852, DOI: 10.1161/jaha.119.012884.Peer-Reviewed Original ResearchConceptsHeart failureHF careSignificant healthcare resource utilizationBackground Heart failureGuideline-recommended medicationsLower inpatient mortalityAcute heart failureOutcomes of patientsHealthcare resource utilizationLower prescription ratesMedical record abstractionHeart Failure StudyTraditional Chinese medicineHospital mortalityConclusions PatientsInpatient mortalityPatient characteristicsTreatment withdrawalEjection fractionMedian agePrescription ratesRecord abstractionMedian lengthBiomarker testingInpatient setting
2013
Risk Factors for Hospital Admission Among Older Persons With Newly Diagnosed Heart Failure Findings From the Cardiovascular Health Study
Chaudhry SI, McAvay G, Chen S, Whitson H, Newman AB, Krumholz HM, Gill TM. Risk Factors for Hospital Admission Among Older Persons With Newly Diagnosed Heart Failure Findings From the Cardiovascular Health Study. Journal Of The American College Of Cardiology 2013, 61: 635-642. PMID: 23391194, PMCID: PMC3576871, DOI: 10.1016/j.jacc.2012.11.027.Peer-Reviewed Original ResearchConceptsHeart failure diagnosisIndependent risk factorHospital admissionCardiovascular Health StudyHeart failureGeriatric conditionsRisk factorsMuscle weaknessSlow gaitOlder personsHealth StudyNew diagnosisNew York Heart Association functional class IIICommunity-living older personsDepressed ejection fractionHeart Failure FindingsFunctional class IIIChronic kidney diseaseCause hospital admissionsMedical record reviewRelevant clinical dataLong-term riskDiabetes mellitusEjection fractionKidney disease
2012
Discontinuation of Antihyperglycemic Therapy After Acute Myocardial Infarction: Medical Necessity or Medical Error?
Lovig KO, Horwitz L, Lipska K, Kosiborod M, Krumholz HM, Inzucchi SE. Discontinuation of Antihyperglycemic Therapy After Acute Myocardial Infarction: Medical Necessity or Medical Error? The Joint Commission Journal On Quality And Patient Safety 2012, 38: 403-407. PMID: 23002492, PMCID: PMC3534988, DOI: 10.1016/s1553-7250(12)38051-3.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionLeft ventricular ejection fractionAntihyperglycemic therapyDiabetic patientsMyocardial infarctionMedical necessityOne-year mortalityDetailed chart reviewVentricular ejection fractionIschemic heart diseaseNational Medicare databaseMedical errorsAcademic medical centerQuality improvement opportunitiesChart reviewClinical characteristicsOlder patientsRecurrent hypoglycemiaEjection fractionMedicare databaseBlood glucoseHeart diseasePrincipal diagnosisCommunity hospitalMedical Center
2008
Systolic Function as a Predictor of Mortality and Quality of Life in Long‐term Survivors with Heart Failure
McNamara R, Austin B, Wang Y, Smith G, Vaccarine V, Krumholz H. Systolic Function as a Predictor of Mortality and Quality of Life in Long‐term Survivors with Heart Failure. Clinical Cardiology 2008, 31: 119-124. PMID: 18383045, PMCID: PMC6653267, DOI: 10.1002/clc.20118.Peer-Reviewed Original ResearchConceptsQuality of lifeEjection fractionHeart failureLong-term survivorsFunctional declineSystolic functionKansas City Cardiomyopathy Questionnaire scoreModest survival advantageReduced ejection fractionDaily living scoreDisease-related qualityPredictors of mortalityHeart failure patientsClinical summary scoreLong-term survivalHigh mortality rateKCCQ scoresRenal insufficiencyFailure patientsLiving scoreDiabetes mellitusOverall mortalityPrimary outcomeLimitation scoresQOL scores
2006
Gender Differences in Treatment of Heart Failure and Acute Myocardial Infarction
Gold LD, Krumholz HM. Gender Differences in Treatment of Heart Failure and Acute Myocardial Infarction. Cardiology In Review 2006, 14: 180-186. PMID: 16788330, DOI: 10.1097/01.crd.0000194093.53005.f0.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionHeart failureMyocardial infarctionCoronary artery bypass graft surgeryNational Heart Failure ProjectArtery bypass graft surgeryLeft ventricular ejection fractionShort-term mortality rateEnzyme inhibitor prescriptionHeart Failure ProjectBypass graft surgeryPercutaneous coronary interventionVentricular ejection fractionCooperative Cardiovascular ProjectRisk of mortalityQuality of carePoor quality careGraft surgeryInhibitor prescriptionCoronary interventionFibrinolytic therapyReadmission ratesCardiac catheterizationEjection fractionACE inhibitorsPrediction of medical morbidity and mortality after acute myocardial infarction in patients at increased psychosocial risk in the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) study
Jaffe AS, Krumholz HM, Catellier DJ, Freedland KE, Bittner V, Blumenthal JA, Calvin JE, Norman J, Sequeira R, O'Connor C, Rich MW, Sheps D, Wu C, Investigators F. Prediction of medical morbidity and mortality after acute myocardial infarction in patients at increased psychosocial risk in the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) study. American Heart Journal 2006, 152: 126-135. PMID: 16824842, DOI: 10.1016/j.ahj.2005.10.004.Peer-Reviewed Original ResearchConceptsPost-MI patientsAcute myocardial infarctionMyocardial infarctionLow social supportCardiovascular mortalityEnd pointNonfatal myocardial infarctionPrimary end pointSecondary end pointsLong-term mortalityPrior myocardial infarctionSignificant multivariable predictorsProportional hazards modelSocial supportKillip classCause mortalityElevated creatinineRecurrent infarctionAdverse eventsBaseline characteristicsBypass surgeryEjection fractionHeart failureMedical morbidityMedical predictorsDifficulty Taking Medications, Depression, and Health Status in Heart Failure Patients
Morgan AL, Masoudi FA, Havranek EP, Jones PG, Peterson PN, Krumholz HM, Spertus JA, Rumsfeld JS, Consortium F. Difficulty Taking Medications, Depression, and Health Status in Heart Failure Patients. Journal Of Cardiac Failure 2006, 12: 54-60. PMID: 16500581, DOI: 10.1016/j.cardfail.2005.08.004.Peer-Reviewed Original ResearchConceptsKansas City Cardiomyopathy QuestionnaireHeart failure outpatientsWorse health statusHealth statusDepressive symptomsMedication nonadherenceLeft ventricular ejection fractionPatient-reported difficultyHeart failure populationHeart failure patientsVentricular ejection fractionCross-sectional associationsMore depressive symptomsCoexistent depressionTaking MedicationsFailure patientsClinical factorsEjection fractionMedication adherenceDepression treatmentFailure populationMedical historyClinical evaluationMultivariable regressionMedications
2004
Provider and Hospital Characteristics Associated With Geographic Variation in the Evaluation and Management of Elderly Patients With Heart Failure
Havranek EP, Wolfe P, Masoudi FA, Rathore SS, Krumholz HM, Ordin DL. Provider and Hospital Characteristics Associated With Geographic Variation in the Evaluation and Management of Elderly Patients With Heart Failure. JAMA Internal Medicine 2004, 164: 1186-1191. PMID: 15197043, DOI: 10.1001/archinte.164.11.1186.Peer-Reviewed Original ResearchConceptsGuideline-based careElderly patientsHeart failureHospital characteristicsPatient factorsEnzyme inhibitorsSmall-area geographic variationLeft ventricular ejection fractionEnzyme inhibitor prescriptionHeart failure variesHeart failure careVentricular ejection fractionHospital referral regionsHigh-quality health careMedical school affiliationInhibitor prescriptionEjection fractionPatient characteristicsSmall area variationUnadjusted ratesMedicare patientsReferral regionsAppropriate prescriptionPatientsCharacteristics of providers
2003
The association of left ventricular ejection fraction, mortality, and cause of death in stable outpatients with heart failure
Curtis JP, Sokol SI, Wang Y, Rathore SS, Ko DT, Jadbabaie F, Portnay EL, Marshalko SJ, Radford MJ, Krumholz HM. The association of left ventricular ejection fraction, mortality, and cause of death in stable outpatients with heart failure. Journal Of The American College Of Cardiology 2003, 42: 736-742. PMID: 12932612, DOI: 10.1016/s0735-1097(03)00789-7.Peer-Reviewed Original ResearchConceptsLeft ventricular ejection fractionVentricular ejection fractionHeart failureCause of deathLVEF groupHF patientsMultivariable adjustmentEjection fractionStable outpatientsAssociation of LVEFHigher left ventricular ejection fractionLow left ventricular ejection fractionDigitalis Investigation Group trialHigh LVEF groupStable HF patientsPrognostic importanceAbsolute riskPrognostic indicatorSinus rhythmGroup trialsMortality ratePatientsMortalityDeathOutpatients