2024
Learning implementation of a guideline based decision support system to improve hypertension treatment in primary care in China: pragmatic cluster randomised controlled trial
Song J, Wang X, Wang B, Ge Y, Bi L, Jing F, Jin H, Li T, Gu B, Wang L, Hao J, Zhao Y, Liu J, Zhang H, Li X, Li J, Ma W, Wang J, Normand S, Herrin J, Armitage J, Krumholz H, Zheng X. Learning implementation of a guideline based decision support system to improve hypertension treatment in primary care in China: pragmatic cluster randomised controlled trial. The BMJ 2024, 386: e079143. PMID: 39043397, PMCID: PMC11265211, DOI: 10.1136/bmj-2023-079143.Peer-Reviewed Original ResearchConceptsClinical decision support systemsPrimary care practicesElectronic health recordsIntervention groupSystolic blood pressurePrimary careCare practicesBlood pressure <Health recordsPragmatic cluster randomised controlled trialCluster randomised controlled trialImproving hypertension treatmentPrimary care settingBlood pressure control ratesBlood pressureProportion of visitsProportion of participantsRandomised controlled trialsSystolic blood pressure <Control groupInjurious fallsRelated visitsCare settingsDiastolic blood pressure <Follow-up
2023
Primary care institutional characteristics associated with hypertension awareness, treatment, and control in the China PEACE-Million Persons Project and primary health-care survey: a cross-sectional study
Group C, Zhou T, Wang Y, Zhang H, Wu C, Tian N, Cui J, Bai X, Yang Y, Zhang X, Lu Y, Spatz E, Ross J, Krumholz H, Lu J, Li X, Hu S. Primary care institutional characteristics associated with hypertension awareness, treatment, and control in the China PEACE-Million Persons Project and primary health-care survey: a cross-sectional study. The Lancet Global Health 2023, 11: e83-e94. PMID: 36521957, DOI: 10.1016/s2214-109x(22)00428-4.Peer-Reviewed Original ResearchConceptsProportion of participantsPrimary care institutionsHypertension awarenessPrimary care systemBlood pressureCare institutionsCardiac Events Million Persons ProjectAverage diastolic blood pressureMedical Sciences (CAMS) Innovation FundAverage systolic blood pressureCare systemMillion Persons ProjectHistory of hypertensionDiastolic blood pressurePrimary care surveySystolic blood pressureCardiovascular disease riskBlood pressure measurementsCross-sectional studyParticipant-level dataProportion of physiciansRoutine service deliveryPrimary care roleHealth Care SurveyPublic health services
2022
Gene Sequencing Identifies Perturbation in Nitric Oxide Signaling as a Nonlipid Molecular Subtype of Coronary Artery Disease
Khera AV, Wang M, Chaffin M, Emdin CA, Samani NJ, Schunkert H, Watkins H, McPherson R, Erdmann J, Elosua R, Boerwinkle E, Ardissino D, Butterworth A, Di Angelantonio E, Naheed A, Danesh J, Chowdhury R, Krumholz H, Sheu W, Rich S, Rotter J, Chen Y, Gabriel S, Lander E, Saleheen D, Kathiresan S. Gene Sequencing Identifies Perturbation in Nitric Oxide Signaling as a Nonlipid Molecular Subtype of Coronary Artery Disease. Circulation Genomic And Precision Medicine 2022, 15: e003598. PMID: 36215124, PMCID: PMC9771961, DOI: 10.1161/circgen.121.003598.Peer-Reviewed Original ResearchConceptsMolecular subtypesCAD riskHigher systolic blood pressureCoronary artery disease patientsEndothelial nitric oxide synthase geneDamaging missense variantsRisk of CADSystolic blood pressureCoronary artery diseaseRisk of hypertensionNitric oxide synthase geneMissense variantsNitric oxide synthesisRare variantsOxide synthase geneDiscrete molecular subtypesNitric Oxide SignalingLow density lipoprotein receptor geneArtery diseaseBlood pressureEndothelial functionVascular toneDisease patientsCAD casesCholesterol concentrationsHemodynamic differences between women and men with elevated blood pressure in China: A non-invasive assessment of 45,082 adults using impedance cardiography
Caraballo C, Mahajan S, Gu J, Lu Y, Spatz ES, Dreyer RP, Zhang M, Sun N, Ren Y, Zheng X, Zhao H, Lu H, J. Z, Krumholz HM. Hemodynamic differences between women and men with elevated blood pressure in China: A non-invasive assessment of 45,082 adults using impedance cardiography. PLOS ONE 2022, 17: e0269777. PMID: 35700163, PMCID: PMC9197037, DOI: 10.1371/journal.pone.0269777.Peer-Reviewed Original ResearchConceptsElevated blood pressureSystemic vascular resistance indexVascular resistance indexBlood pressureCardiac indexResistance indexHigh systemic vascular resistance indexLower systemic vascular resistance indexHigher mean systolic blood pressureMean diastolic blood pressureMean systolic blood pressureImpedance cardiographyLow cardiac indexHigher cardiac indexDiastolic blood pressureSystolic blood pressureBody mass indexYear old womanPersonalization of treatmentSame age groupNon-invasive assessmentSex differencesHemodynamic profileMass indexHemodynamic differences
2020
Assessment of Prevalence, Awareness, and Characteristics of Isolated Systolic Hypertension Among Younger and Middle-Aged Adults in China
Mahajan S, Feng F, Hu S, Lu Y, Gupta A, Murugiah K, Gao Y, Lu J, Liu J, Zheng X, Spatz ES, Zhang H, Krumholz HM, Li J. Assessment of Prevalence, Awareness, and Characteristics of Isolated Systolic Hypertension Among Younger and Middle-Aged Adults in China. JAMA Network Open 2020, 3: e209743. PMID: 33289843, PMCID: PMC7724558, DOI: 10.1001/jamanetworkopen.2020.9743.Peer-Reviewed Original ResearchConceptsMiddle-aged adultsSystolic hypertensionCardiac Events Million Persons ProjectOlder individualsIsolated systolic hypertensionManagement of ISHMillion Persons ProjectPrevalence of ISHPrevious cardiovascular eventsSystolic blood pressureTypes of hypertensionAssessment of prevalenceCross-sectional studyHypertension subtypesCardiovascular eventsBlood pressureChina PatientMean ageHypertensionMAIN OUTCOMEAwareness ratePrevalenceAged adultsYoung adultsAdultsLeveraging the Electronic Health Records for Population Health: A Case Study of Patients With Markedly Elevated Blood Pressure
Lu Y, Huang C, Mahajan S, Schulz WL, Nasir K, Spatz ES, Krumholz HM. Leveraging the Electronic Health Records for Population Health: A Case Study of Patients With Markedly Elevated Blood Pressure. Journal Of The American Heart Association 2020, 9: e015033. PMID: 32200730, PMCID: PMC7428633, DOI: 10.1161/jaha.119.015033.Peer-Reviewed Original ResearchConceptsDiastolic blood pressureSystolic blood pressureElevated blood pressureBlood pressureElectronic health recordsPopulation health surveillanceHealth recordsYale New Haven Health SystemHealth surveillanceHealth systemPatterns of patientsLarge health systemUsual careOutpatient encountersControl ratePatientsCare patternsPopulation healthMonthsHgSurveillancePrevalenceRecordsVisitsCareHeterogeneity in Trajectories of Systolic Blood Pressure among Young Adults in Qingdao Port Cardiovascular Health Study
Lin H, Cui M, Spatz ES, Wang Y, Lu J, Li J, Li S, Huang C, Liu X, Jiang L, Krumholz HM, Xu X. Heterogeneity in Trajectories of Systolic Blood Pressure among Young Adults in Qingdao Port Cardiovascular Health Study. Global Heart 2020, 15: 20. PMID: 32489793, PMCID: PMC7218791, DOI: 10.5334/gh.764.Peer-Reviewed Original ResearchConceptsSystolic blood pressureHigher systolic blood pressureCardiovascular Health StudyBlood pressureYoung adultsHealth StudyEffective blood pressure controlBaseline systolic blood pressureInitial systolic blood pressureGreater body mass indexBlood pressure controlBody mass indexGreater waist circumferenceBaseline health characteristicsSBP trendsWaist circumferenceMass indexSBP trajectoriesAdvanced ageOrdinal logistic regressionRisk factorsCardiovascular diseaseFamily historyHealth characteristicsHigh school education
2019
Hemodynamic Phenotypes of Hypertension Based on Cardiac Output and Systemic Vascular Resistance
Mahajan S, Gu J, Lu Y, Khera R, Spatz ES, Zhang M, Sun N, Zheng X, Zhao H, Lu H, Ma ZJ, Krumholz HM. Hemodynamic Phenotypes of Hypertension Based on Cardiac Output and Systemic Vascular Resistance. The American Journal Of Medicine 2019, 133: e127-e139. PMID: 31525336, DOI: 10.1016/j.amjmed.2019.08.042.Peer-Reviewed Original ResearchConceptsSystemic vascular resistance indexVascular resistance indexSystemic vascular resistanceCardiac indexBlood pressure categoriesResistance index ratioResistance indexVascular resistanceCardiac outputBlood pressureHemodynamic phenotypesPressure categoriesHigh systemic vascular resistance indexNormal systemic vascular resistance indexSystolic blood pressure 140Systolic blood pressure categoriesBlood pressure 140Health checkup centerNormal cardiac indexLow cardiac indexStroke volume indexHigher cardiac indexSystolic blood pressureBody mass indexSubtypes of hypertensionWorld Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions
Group T, Kaptoge S, Pennells L, De Bacquer D, Cooney M, Kavousi M, Stevens G, Riley L, Savin S, Khan T, Altay S, Amouyel P, Assmann G, Bell S, Ben-Shlomo Y, Berkman L, Beulens J, Björkelund C, Blaha M, Blazer D, Bolton T, Beaglehole R, Brenner H, Brunner E, Casiglia E, Chamnan P, Choi Y, Chowdry R, Coady S, Crespo C, Cushman M, Dagenais G, D'Agostino R, Daimon M, Davidson K, Engström G, Ford I, Gallacher J, Gansevoort R, Gaziano T, Giampaoli S, Grandits G, Grimsgaard S, Grobbee D, Gudnason V, Guo Q, Tolonen H, Humphries S, Iso H, Jukema J, Kauhanen J, Kengne A, Khalili D, Koenig W, Kromhout D, Krumholz H, Lam T, Laughlin G, Ibañez A, Meade T, Moons K, Nietert P, Ninomiya T, Nordestgaard B, O'Donnell C, Palmieri L, Patel A, Perel P, Price J, Providencia R, Ridker P, Rodriguez B, Rosengren A, Roussel R, Sakurai M, Salomaa V, Sato S, Schöttker B, Shara N, Shaw J, Shin H, Simons L, Sofianopoulou E, Sundström J, Völzke H, Wallace R, Wareham N, Willeit P, Wood D, Wood A, Zhao D, Woodward M, Danaei G, Roth G, Mendis S, Onuma O, Varghese C, Ezzati M, Graham I, Jackson R, Danesh J, Di Angelantonio E. World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. The Lancet Global Health 2019, 7: e1332-e1345. PMID: 31488387, PMCID: PMC7025029, DOI: 10.1016/s2214-109x(19)30318-3.Peer-Reviewed Original ResearchConceptsRisk prediction modelSystolic blood pressureCardiovascular disease riskBritish Heart FoundationIndividual participant dataCardiovascular diseaseBlood pressureTotal cholesterolC-indexFatal coronary heart diseaseNon-fatal cardiovascular diseaseDisease riskCardiovascular disease risk predictionParticipant dataIncident cardiovascular eventsHistory of diabetesRisk factor profileRisk prediction chartsWHO STEPwise approachSex-specific incidenceUK Medical Research CouncilCoronary heart diseaseFirst myocardial infarctionExternal validation cohortHarrell's C-indexEffects of Mobile Text Messaging on Glycemic Control in Patients With Coronary Heart Disease and Diabetes Mellitus
Huo X, Krumholz HM, Bai X, Spatz ES, Ding Q, Horak P, Zhao W, Gong Q, Zhang H, Yan X, Sun Y, Liu J, Wu X, Guan W, Wang X, Li J, Li X, Spertus JA, Masoudi FA, Zheng X. Effects of Mobile Text Messaging on Glycemic Control in Patients With Coronary Heart Disease and Diabetes Mellitus. Circulation Cardiovascular Quality And Outcomes 2019, 12: e005805. PMID: 31474119, DOI: 10.1161/circoutcomes.119.005805.Peer-Reviewed Original ResearchMeSH KeywordsAgedAsian PeopleBiomarkersBlood GlucoseChinaCoronary DiseaseCulturally Competent CareDiabetes MellitusExerciseFemaleGlycated HemoglobinHealth CommunicationHealthy LifestyleHumansHypoglycemic AgentsMaleMedication AdherenceMiddle AgedMotivationPatient Education as TopicRisk Reduction BehaviorSelf CareSingle-Blind MethodTelemedicineText MessagingTime FactorsTreatment OutcomeConceptsCoronary heart diseaseHeart diseaseGlycemic controlIntervention groupUsual careDiabetes mellitusBlood glucosePhysical activityControl groupText message-based interventionBlood pressure controlProportion of patientsRisk factor managementGood glycemic controlSystolic blood pressureBody mass indexText messaging programsText message interventionMobile health interventionsSecondary outcomesBlood pressurePrimary outcomeLDL cholesterolMass indexMedication adherenceEffect of Text Messaging on Risk Factor Management in Patients With Coronary Heart Disease
Zheng X, Spatz ES, Bai X, Huo X, Ding Q, Horak P, Wu X, Guan W, Chow CK, Yan X, Sun Y, Wang X, Zhang H, Liu J, Li J, Li X, Spertus JA, Masoudi FA, Krumholz HM. Effect of Text Messaging on Risk Factor Management in Patients With Coronary Heart Disease. Circulation Cardiovascular Quality And Outcomes 2019, 12: e005616. PMID: 30998400, DOI: 10.1161/circoutcomes.119.005616.Peer-Reviewed Original ResearchMeSH KeywordsAgedAsian PeopleBlood PressureChinaCoronary DiseaseCulturally Competent CareFemaleHealth Knowledge, Attitudes, PracticeHumansMaleMiddle AgedPatient Education as TopicRisk AssessmentRisk FactorsSecondary PreventionSingle-Blind MethodTelemedicineText MessagingTime FactorsTreatment OutcomeConceptsCoronary heart diseaseSystolic blood pressureBody mass indexBlood pressureHeart diseaseSecondary preventionIntervention groupPhysical activityEnd pointSmoking statusMass indexControl groupPrimary end pointRisk factor controlSecondary end pointsRisk factor managementLDL-C levelsDisease-specific knowledgeMobile phone textMobile health technologyUsual careDiabetes mellitusMedication adherenceRisk factorsFactor management
2018
Association of Body Mass Index With Blood Pressure Among 1.7 Million Chinese Adults
Linderman GC, Lu J, Lu Y, Sun X, Xu W, Nasir K, Schulz W, Jiang L, Krumholz HM. Association of Body Mass Index With Blood Pressure Among 1.7 Million Chinese Adults. JAMA Network Open 2018, 1: e181271-e181271. PMID: 30646115, PMCID: PMC6324286, DOI: 10.1001/jamanetworkopen.2018.1271.Peer-Reviewed Original ResearchConceptsBody mass indexSystolic blood pressureBlood pressureAntihypertensive medicationsMass indexMean (SD) BMIMean (SD) systolic BPIncrease of BPUnit body mass indexPrimary health care sitesComprehensive subgroup analysisMillion Persons ProjectDiastolic blood pressureSubgroup of patientsCross-sectional studyElectronic BP monitorsHealth care sitesSubgroup of individualsUntreated subgroupSubgroup analysisCare sitesBP monitorMAIN OUTCOMEChinese adultsChinese population
2017
Design and rationale of the Cardiovascular Health and Text Messaging (CHAT) Study and the CHAT-Diabetes Mellitus (CHAT-DM) Study: two randomised controlled trials of text messaging to improve secondary prevention for coronary heart disease and diabetes
Huo X, Spatz ES, Ding Q, Horak P, Zheng X, Masters C, Zhang H, Irwin ML, Yan X, Guan W, Li J, Li X, Spertus JA, Masoudi FA, Krumholz HM, Jiang L. Design and rationale of the Cardiovascular Health and Text Messaging (CHAT) Study and the CHAT-Diabetes Mellitus (CHAT-DM) Study: two randomised controlled trials of text messaging to improve secondary prevention for coronary heart disease and diabetes. BMJ Open 2017, 7: e018302. PMID: 29273661, PMCID: PMC5778311, DOI: 10.1136/bmjopen-2017-018302.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overBlood PressureChinaCoronary DiseaseDiabetes Mellitus, Type 1Diabetes Mellitus, Type 2ExerciseFemaleGlycated HemoglobinHumansLife StyleMaleMedication AdherenceMiddle AgedMotivationResearch DesignRisk FactorsSecondary PreventionSelf CareSingle-Blind MethodTelemedicineText MessagingYoung AdultConceptsSystolic blood pressureBody mass indexTrials of textProportion of patientsMedication adherencePhysical activitySecondary outcomesPrimary outcomeSmoking cessationCardiovascular healthMellitus StudySecondary coronary heart disease preventionCoronary heart disease preventionLow-density lipoprotein cholesterolUsual scientific forumsBlood pressure controlRisk factor managementHeart disease preventionCoronary heart diseaseMobile health interventionsInstitutional review boardUniversity Institutional Review BoardBehavioral skills modelText messagingBehavioral change techniquesPrevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project)
Lu J, Lu Y, Wang X, Li X, Linderman GC, Wu C, Cheng X, Mu L, Zhang H, Liu J, Su M, Zhao H, Spatz ES, Spertus JA, Masoudi FA, Krumholz HM, Jiang L. Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project). The Lancet 2017, 390: 2549-2558. PMID: 29102084, DOI: 10.1016/s0140-6736(17)32478-9.Peer-Reviewed Original ResearchConceptsControl of hypertensionBlood pressureAntihypertensive medicationsCardiac Events Million Persons ProjectSelf-reported antihypertensive medication usePopulation-based screening studyPopulation-based screening projectMillion Persons ProjectPrescribed antihypertensive medicationsPrevious cardiovascular eventsAntihypertensive medication useDiastolic blood pressureSystolic blood pressureManagement of hypertensionCalcium channel blockersProportion of participantsSelf-reported diagnosisCommunity-dwelling adultsSex-standardised ratesCardiovascular eventsHypertensive adultsMedication classesHypertension awarenessHypertension prevalenceClinical factors
2016
China PEACE risk estimation tool for in-hospital death from acute myocardial infarction: an early risk classification tree for decisions about fibrinolytic therapy
Li X, Li J, Masoudi FA, Spertus JA, Lin Z, Krumholz HM, Jiang L. China PEACE risk estimation tool for in-hospital death from acute myocardial infarction: an early risk classification tree for decisions about fibrinolytic therapy. BMJ Open 2016, 6: e013355. PMID: 27798032, PMCID: PMC5093680, DOI: 10.1136/bmjopen-2016-013355.Peer-Reviewed Original ResearchConceptsST-segment elevation myocardial infarctionAcute myocardial infarctionFibrinolytic therapyLow-risk groupMyocardial infarctionHospital deathHospital mortalitySegment elevation myocardial infarctionCardiac Events (PEACE) studyHospital death riskComposite of deathElevation myocardial infarctionSystolic blood pressureTime of presentationRelative risk reductionCross-sectional studyBaseline mortality riskAcute reperfusionMajor bleedingReperfusion therapyBlood pressureDerivation cohortStudy cohortChina PatientValidation cohort
2015
Development of a Hospital Outcome Measure Intended for Use With Electronic Health Records
McNamara RL, Wang Y, Partovian C, Montague J, Mody P, Eddy E, Krumholz HM, Bernheim SM. Development of a Hospital Outcome Measure Intended for Use With Electronic Health Records. Medical Care 2015, 53: 818-826. PMID: 26225445, DOI: 10.1097/mlr.0000000000000402.Peer-Reviewed Original ResearchConceptsElectronic health recordsOutcome measuresClinical dataMortality rateClinical practiceFuture quality improvement measuresRisk-standardized mortality ratesHospital risk-standardized mortality ratesLow-mortality hospitalsHealth recordsSystolic blood pressureOdds of mortalityClinical registry dataAcute myocardial infarctionHigh-mortality hospitalsHospital outcome measuresEHR dataFinal risk modelCurrent clinical practiceStandard clinical practiceFirst outcome measureNational Quality ForumCurrent electronic health recordsQuality improvement measuresChart abstractionNational assessment of early β-blocker therapy in patients with acute myocardial infarction in China, 2001-2011: The China Patient-centered Evaluative Assessment of Cardiac Events (PEACE)–Retrospective AMI Study
Zhang H, Masoudi FA, Li J, Wang Q, Li X, Spertus JA, Ross JS, Desai NR, Krumholz HM, Jiang L, Group C. National assessment of early β-blocker therapy in patients with acute myocardial infarction in China, 2001-2011: The China Patient-centered Evaluative Assessment of Cardiac Events (PEACE)–Retrospective AMI Study. American Heart Journal 2015, 170: 506-515.e1. PMID: 26385034, PMCID: PMC5459420, DOI: 10.1016/j.ahj.2015.05.012.Peer-Reviewed Original ResearchConceptsΒ-blocker therapyAcute myocardial infarctionΒ-blocker useCardiogenic shockRisk factorsAbsolute contraindicationMyocardial infarctionEarly β-blocker useLower systolic blood pressureHours of admissionMedical record reviewSystolic blood pressureClinical practice guidelinesLower heart rateQuality of careChest discomfortCardiac eventsBlood pressureRecord reviewChina PatientIdeal patientPractice guidelinesHeart rateHigh riskPatterns of use
2010
The relationship between systolic blood pressure on admission and mortality in older patients with heart failure
Vidán MT, Bueno H, Wang Y, Schreiner G, Ross JS, Chen J, Krumholz HM. The relationship between systolic blood pressure on admission and mortality in older patients with heart failure. European Journal Of Heart Failure 2010, 12: 148-155. PMID: 20083624, PMCID: PMC2807767, DOI: 10.1093/eurjhf/hfp195.Peer-Reviewed Original ResearchConceptsAdmission systolic blood pressureSystolic blood pressureHeart failureBlood pressureOlder patientsNational Heart Failure ProjectHigher systolic blood pressureInitial systolic blood pressureHeart Failure ProjectMultivariable logistic regressionPrevious hypertensionSBP 90Ventricular dysfunctionClinical factorsIndependent associationOdds ratioMedicare patientsMortality ratePatientsMmHgLogistic regressionMortalityAdmissionSubgroupsInverse relationship
2004
Systolic Hypertension in Older Persons
Chaudhry SI, Krumholz HM, Foody JM. Systolic Hypertension in Older Persons. JAMA 2004, 292: 1074-1080. PMID: 15339901, DOI: 10.1001/jama.292.9.1074.BooksConceptsSystolic blood pressureSystolic hypertensionBlood pressureOlder personsOlder patientsClinical trialsBaseline systolic blood pressureTolerance of therapyJoint National CommitteeFirst-line therapyDiastolic blood pressureHigh blood pressureCalcium channel blockersRandomized clinical trialsTreatment of patientsEnglish-language literatureLarge-scale trialsSearch terms hypertensionAntihypertensive therapyCardiovascular riskThiazide diureticsDATA EXTRACTIONPatient preferencesSeventh ReportTerm hypertensionIncidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure
Forman DE, Butler J, Wang Y, Abraham WT, O'Connor CM, Gottlieb SS, Loh E, Massie BM, Rich MW, Stevenson LW, Young JB, Krumholz HM. Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. Journal Of The American College Of Cardiology 2004, 43: 61-67. PMID: 14715185, DOI: 10.1016/j.jacc.2003.07.031.Peer-Reviewed Original ResearchConceptsRenal functionHF patientsHospitalized heart failure patientsHistory of HFChronic HF patientsDay of admissionHeart failure patientsLength of hospitalizationSystolic blood pressureRelative risk ratiosAssociation of developmentMajority of casesRegression model analysisAdmission creatinineHospital deathHospital outcomesChart reviewClinical characteristicsFailure patientsSerum creatinineBlood pressureClinical predictorsConsecutive patientsDiabetes mellitusHeart failure