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 qualityIschemic 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 diagnosis
2019
Thirty-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 patients
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
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 inhibitorsDifficulty 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
2005
Patients With Depressive Symptoms Have Lower Health Status Benefits After Coronary Artery Bypass Surgery
Mallik S, Krumholz HM, Lin ZQ, Kasl SV, Mattera JA, Roumains SA, Vaccarino V. Patients With Depressive Symptoms Have Lower Health Status Benefits After Coronary Artery Bypass Surgery. Circulation 2005, 111: 271-277. PMID: 15655132, DOI: 10.1161/01.cir.0000152102.29293.d7.Peer-Reviewed Original ResearchConceptsPhysical component scalePhysical functionGeriatric Depression ScaleGDS scoresDepressive symptomsPCS scoresRisk factorsFunctional improvementShort-Form 36 physical component scaleCoronary artery bypass surgeryHealth status benefitsInverse risk factorTime of CABGPatients' physical functionArtery bypass surgeryHistory of diabetesVentricular ejection fractionWorse physical functionCoronary artery diseaseIndependent prognostic factorPrevious myocardial infarctionStrong risk factorBaseline PCS scoresHigher GDS scoresSignificant independent predictors
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 ratePatientsMortalityDeathOutpatientsRace, Quality of Care, and Outcomes of Elderly Patients Hospitalized With Heart Failure
Rathore SS, Foody JM, Wang Y, Smith GL, Herrin J, Masoudi FA, Wolfe P, Havranek EP, Ordin DL, Krumholz HM. Race, Quality of Care, and Outcomes of Elderly Patients Hospitalized With Heart Failure. JAMA 2003, 289: 2517-2524. PMID: 12759323, DOI: 10.1001/jama.289.19.2517.Peer-Reviewed Original ResearchMeSH KeywordsAgedAngiotensin-Converting Enzyme InhibitorsBlack or African AmericanFee-for-Service PlansFemaleHeart FailureHospitalsHumansMaleMedicareMultivariate AnalysisOutcome Assessment, Health CarePatient ReadmissionQuality of Health CareRetrospective StudiesSurvival AnalysisUnited StatesVentricular Function, LeftWhite PeopleConceptsLeft ventricular ejection fractionQuality of careACE inhibitor useWhite patientsBlack patientsHeart failureYear of dischargeACE inhibitorsMultivariable adjustmentInhibitor useLVEF assessmentCrude rateMedicare beneficiariesMortality rateAngiotensin receptor blocker useNational Heart Failure ProjectBlack Medicare patientsHeart Failure ProjectPrescription of angiotensinReceptor blocker useHigh rateVentricular ejection fractionYear of admissionHigher crude ratesService Medicare beneficiariesThe association of left ventricular ejection fraction, mortality, and cause of death in stable patients with heart failure
Curtis J, Sokol S, Wang Y, Rathore S, Ko D, Jadbabaie F, Portnay E, Marshalko S, Radford M, Krumholz H. The association of left ventricular ejection fraction, mortality, and cause of death in stable patients with heart failure. Journal Of The American College Of Cardiology 2003, 41: 219-220. DOI: 10.1016/s0735-1097(03)81606-6.Peer-Reviewed Original ResearchLeft ventricular ejection fractionVentricular ejection fractionCause of deathStable patientsEjection fractionHeart failurePatientsMortalityAssociation of Serum Digoxin Concentration and Outcomes in Patients With Heart Failure
Rathore SS, Curtis JP, Wang Y, Bristow MR, Krumholz HM. Association of Serum Digoxin Concentration and Outcomes in Patients With Heart Failure. JAMA 2003, 289: 871-878. PMID: 12588271, DOI: 10.1001/jama.289.7.871.Peer-Reviewed Original ResearchConceptsSerum digoxin concentrationHigh serum digoxin concentrationsLeft ventricular ejection fractionVentricular ejection fractionHeart failureMortality rateDIG trialDigoxin therapyEjection fractionDigoxin concentrationsDepressed left ventricular systolic functionDigitalis Investigation Group trialHigher absolute mortality rateLeft ventricular systolic functionOverall mortality benefitVentricular systolic functionCause mortality ratesAbsolute mortality ratesLower mortality rateCause mortalityMultivariable adjustmentMortality benefitSystolic functionClinical outcomesSerum concentrationsThe prognostic importance of anemia in patients with heart failure
Kosiborod M, Smith GL, Radford MJ, Foody JM, Krumholz HM. The prognostic importance of anemia in patients with heart failure. The American Journal Of Medicine 2003, 114: 112-119. PMID: 12586230, DOI: 10.1016/s0002-9343(02)01498-5.Peer-Reviewed Original ResearchConceptsHeart failureLow hematocritHospital readmissionPrognostic importanceHematocrit levelsMultivariate Cox proportional hazards regressionLeft ventricular ejection fractionCox proportional hazards regressionTraditional risk factorsVentricular ejection fractionPrincipal discharge diagnosisProportional hazards regressionRisk of deathElderly patientsOlder patientsClinical factorsEjection fractionIndependent predictorsDischarge diagnosisHazards regressionMedian hematocritPrognostic valueMean ageTreatable conditionRisk factors
2002
Differences between African Americans and whites in the outcome of heart failure: Evidence for a greater functional decline in African Americans
Vaccarino V, Gahbauer E, Kasl SV, Charpentier PA, Acampora D, Krumholz HM. Differences between African Americans and whites in the outcome of heart failure: Evidence for a greater functional decline in African Americans. American Heart Journal 2002, 143: 1058-1067. PMID: 12075264, DOI: 10.1067/mhj.2002.122123.Peer-Reviewed Original ResearchMeSH KeywordsActivities of Daily LivingAgedAnalysis of VarianceBlack PeopleCohort StudiesFemaleHealth Services AccessibilityHeart FailureHospitalizationHumansIncomeMaleMiddle AgedOutcome Assessment, Health CareProportional Hazards ModelsProspective StudiesQuality of Health CareSocioeconomic FactorsWhite PeopleConceptsGreater functional declineHeart failureCare indicatorsFunctional declineAfrican AmericansSelf-reported health statusSigns of decompensationDecompensated heart failureHistory of hypertensionProspective cohort studyVentricular ejection fractionDaily living functionAfrican American patientsDaily living functioningRenal insufficiencyBaseline characteristicsCohort studyConsecutive patientsEjection fractionHospital admissionFunctional statusAmerican patientsPoor courseLiving functioningHigh riskSpectrum of heart failure in older patients: Results from the national heart failure project
Havranek EP, Masoudi FA, Westfall KA, Wolfe P, Ordin DL, Krumholz HM. Spectrum of heart failure in older patients: Results from the national heart failure project. American Heart Journal 2002, 143: 412-417. PMID: 11868045, DOI: 10.1067/mhj.2002.120773.Peer-Reviewed Original ResearchConceptsLong-term care facilitiesHeart failureCare facilitiesElderly patientsClinical trialsNational Heart Failure ProjectLeft ventricular ejection fractionLeft ventricular systolic functionChronic obstructive pulmonary diseaseAssociated laboratory abnormalitiesHeart Failure ProjectHistory of hypertensionPoor renal functionThird of patientsVentricular systolic functionMajority of patientsMultiple comorbid conditionsObstructive pulmonary diseaseVentricular ejection fractionExclusion of patientsLong-term hemodialysisCoronary heart diseasePopulation-based studyAcute care facilitiesEvidence-based guidance
1999
Quality of care for patients hospitalized with heart failure at academic medical centers
Nohria A, Chen Y, Morton D, Walsh R, Vlasses P, Krumholz H. Quality of care for patients hospitalized with heart failure at academic medical centers. American Heart Journal 1999, 137: 1028-1034. PMID: 10347327, DOI: 10.1016/s0002-8703(99)70358-3.Peer-Reviewed Original ResearchConceptsLeft ventricular ejection fractionCongestive heart failureAcademic medical centerTime of dischargeStandard of careMedical CenterHeart failureACE inhibitorsAssessment of LVEFDiagnosis of CHFDaily weightEnzyme inhibitor therapyRetrospective chart reviewVentricular ejection fractionLarge clinical trialsPatient education guidelinesQuality of careHealth care policyChart reviewDietary counselingHospital dischargeEjection fractionInhibitor therapyTreatment guidelinesMedication compliance
1998
National Use and Effectiveness of β-Blockers for the Treatment of Elderly Patients After Acute Myocardial Infarction: National Cooperative Cardiovascular Project
Krumholz HM, Radford MJ, Wang Y, Chen J, Heiat A, Marciniak TA. National Use and Effectiveness of β-Blockers for the Treatment of Elderly Patients After Acute Myocardial Infarction: National Cooperative Cardiovascular Project. JAMA 1998, 280: 623-629. PMID: 9718054, DOI: 10.1001/jama.280.7.623.Peer-Reviewed Original ResearchConceptsBeta-blocker therapyAcute myocardial infarctionDischarge medicationsElderly patientsMyocardial infarctionPrescribed useNational Cooperative Cardiovascular ProjectBeta-blocker prescriptionRetrospective cohort studyVentricular ejection fractionLow-risk populationCalcium channel blockersCooperative Cardiovascular ProjectFamily practice physiciansBetter survival rateEligible patientsCohort studyHospital dischargeOlder patientsSecondary preventionEjection fractionMedical chartsTreatment patternsClinical variablesPotential confounders
1997
Quality of Care for Elderly Patients Hospitalized With Heart Failure
Krumholz HM, Wang Y, Parent EM, Mockalis J, Petrillo M, Radford MJ. Quality of Care for Elderly Patients Hospitalized With Heart Failure. JAMA Internal Medicine 1997, 157: 2242-2247. PMID: 9343001, DOI: 10.1001/archinte.1997.00440400092011.Peer-Reviewed Original ResearchConceptsHeart failureQuality of careEnzyme inhibitorsElderly patientsClinical practiceResearch Clinical Practice GuidelinesLeft ventricular ejection fractionLeft ventricular systolic functionRetrospective medical record reviewAngiotensin-converting enzyme inhibitorSevere aortic stenosisPercentage of patientsVentricular systolic functionMedical record reviewVentricular ejection fractionClinical practice guidelinesPrincipal discharge diagnosisAcute care hospitalsActual clinical practiceHealth care policyChart reviewSystolic functionAortic stenosisAppropriate patientsCare hospitalValidation of a clinical prediction rule for left ventricular ejection fraction after myocardial infarction in patients ≥ 65 years old
Krumholz H, Howes C, Murillo J, Vaccarino L, Radford M, Ellerbeck E. Validation of a clinical prediction rule for left ventricular ejection fraction after myocardial infarction in patients ≥ 65 years old. The American Journal Of Cardiology 1997, 80: 11-15. PMID: 9205012, DOI: 10.1016/s0002-9149(97)00299-3.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCohort StudiesConnecticutEchocardiographyElectrocardiographyFemaleHumansMaleMedicareMultivariate AnalysisMyocardial InfarctionPilot ProjectsPredictive Value of TestsRetrospective StudiesRisk FactorsStroke VolumeTreatment OutcomeUnited StatesVentricular Function, LeftConceptsLeft ventricular ejection fractionAcute myocardial infarctionClinical prediction ruleVentricular ejection fractionPositive predictive valuePrediction ruleElderly patientsEjection fractionMyocardial infarctionExclusion criteriaPredictive valueEligible elderly patientsRetrospective chart reviewConnecticut cohortChest painBypass surgeryChart reviewDiabetes mellitusMedicare patientsPatientsPilot studyMultivariate modelInfarctionElectrocardiogram interpretationOriginal study