2023
Impact of Sex‐ and Gender‐Related Factors on Length of Stay Following Non–ST‐Segment–Elevation Myocardial Infarction: A Multicountry Analysis
Bender U, Norris C, Dreyer R, Krumholz H, Raparelli V, Pilote L. Impact of Sex‐ and Gender‐Related Factors on Length of Stay Following Non–ST‐Segment–Elevation Myocardial Infarction: A Multicountry Analysis. Journal Of The American Heart Association 2023, 12: e028553. PMID: 37489737, PMCID: PMC10492965, DOI: 10.1161/jaha.122.028553.Peer-Reviewed Original ResearchConceptsSegment elevation myocardial infarctionMyocardial infarctionGender-related factorsLonger LOSSegment elevation myocardial infarction diagnosisConclusions Older ageObservational cohort studyAdverse clinical outcomesAdjusted multivariable modelAcute myocardial infarctionLength of stayImpact of sexHealth care expendituresGENESIS-PRAXYHospital lengthNon–STCause mortalityCohort studyIndependent predictorsMyocardial infarction diagnosisClinical outcomesShorter LOSMedical historyMultivariable modelUnivariate associationsSex Difference in Outcomes of Acute Myocardial Infarction in Young Patients
Sawano M, Lu Y, Caraballo C, Mahajan S, Dreyer R, Lichtman J, D'Onofrio G, Spatz E, Khera R, Onuma O, Murugiah K, Spertus J, Krumholz H. Sex Difference in Outcomes of Acute Myocardial Infarction in Young Patients. Journal Of The American College Of Cardiology 2023, 81: 1797-1806. PMID: 37137590, DOI: 10.1016/j.jacc.2023.03.383.Peer-Reviewed Original ResearchMeSH KeywordsFemaleHealth StatusHospitalizationHumansMaleMyocardial InfarctionRisk FactorsSex CharacteristicsSex FactorsConceptsAcute myocardial infarctionNoncardiac hospitalizationsSubdistribution HRYounger patientsMyocardial infarctionSex differencesYoung womenCause-specific hospitalizationsCause of hospitalizationWorse health statusSignificant sex disparityNoncardiovascular hospitalizationsVIRGO StudyIndex episodeAdverse outcomesIncidence rateHospitalizationHigh riskSex disparitiesHealth statusPatientsU.S. hospitalsWomenInfarctionOutcomes
2021
Sex Differences in Symptom Phenotypes Among Older Patients with Acute Myocardial Infarction
Brush JE, Hajduk AM, Greene EJ, Dreyer RP, Krumholz HM, Chaudhry SI. Sex Differences in Symptom Phenotypes Among Older Patients with Acute Myocardial Infarction. The American Journal Of Medicine 2021, 135: 342-349. PMID: 34715061, PMCID: PMC8901454, DOI: 10.1016/j.amjmed.2021.09.022.Peer-Reviewed Original ResearchMeSH KeywordsFemaleHospitalizationHumansMaleMyocardial InfarctionPhenotypeRisk FactorsSex CharacteristicsSex FactorsConceptsAcute myocardial infarctionMyocardial infarctionSymptom combinationsOlder patientsAcute myocardial infarction subgroupsAcute myocardial infarction admissionsMyocardial infarction subgroupsPatients 75 yearsMyocardial infarction admissionsSILVER-AMI StudySymptom phenotypeClinical studiesIndividual patientsMore symptomsPatientsInfarctionDiagnostic possibilitiesSymptomsWomenPerson interviewsMenCommon phenotypeSex differencesCliniciansPhenotypeVariations in Quality of Care by Sex and Social Determinants of Health Among Younger Adults With Acute Myocardial Infarction in the US and Canada
Raparelli V, Pilote L, Dang B, Behlouli H, Dziura JD, Bueno H, D’Onofrio G, Krumholz HM, Dreyer RP. Variations in Quality of Care by Sex and Social Determinants of Health Among Younger Adults With Acute Myocardial Infarction in the US and Canada. JAMA Network Open 2021, 4: e2128182. PMID: 34668947, PMCID: PMC8529414, DOI: 10.1001/jamanetworkopen.2021.28182.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionQuality of careHealth care systemYoung adultsFemale sexMyocardial infarctionCare systemHospital careSocial determinantsRetrospective cohort analysisLow qualityAdverse SDOHLowest tertileReadmission ratesMore patientsPostacute careAMI careOutpatient careCare scoresHigh prevalenceCohort analysisLarge cohortMAIN OUTCOMESDOHHospital
2020
Sex Differences in 1‐Year Health Status Following Percutaneous Coronary Intervention in Patients Without Acute Myocardial Infarction: Results From the China PEACE Prospective Study
Zheng X, Dreyer RP, Curtis JP, Liu S, Xu X, Bai X, Li X, Zhang H, Wang S, Masoudi FA, Spertus JA, Li J, Krumholz HM, Group F. Sex Differences in 1‐Year Health Status Following Percutaneous Coronary Intervention in Patients Without Acute Myocardial Infarction: Results From the China PEACE Prospective Study. Journal Of The American Heart Association 2020, 9: e014421. PMID: 32131687, PMCID: PMC7335522, DOI: 10.1161/jaha.119.014421.Peer-Reviewed Original ResearchConceptsPercutaneous coronary interventionAcute myocardial infarctionSAQ Summary ScoreCoronary interventionHealth status outcomesMyocardial infarctionHealth statusSummary scoresSAQ qualityAngina frequencyStatus outcomesPercutaneous coronary intervention studiesSAQ angina frequency scoreAngina frequency scoreCoronary Intervention StudyMarginal clinical significanceSAQ angina frequencyCardiac risk factorsChinese tertiary hospitalBackground Sex differencesSex differencesMultivariable adjustmentDiabetes mellitusTertiary hospitalLife scoresSex Differences in Symptom Phenotypes Among Patients With Acute Myocardial Infarction
Brush JE, Krumholz HM, Greene EJ, Dreyer RP. Sex Differences in Symptom Phenotypes Among Patients With Acute Myocardial Infarction. Circulation Cardiovascular Quality And Outcomes 2020, 13: e005948. PMID: 32063049, PMCID: PMC7041412, DOI: 10.1161/circoutcomes.119.005948.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultBiological Variation, IndividualFemaleHealth Status DisparitiesHumansInterviews as TopicMaleMiddle AgedMyocardial InfarctionPatient AdmissionPhenotypePredictive Value of TestsProspective StudiesRisk AssessmentRisk FactorsSex FactorsSpainSymptom AssessmentUnited StatesYoung AdultConceptsAcute myocardial infarctionMyocardial infarctionMedical recordsYoung womenDiagnosis of AMIObservational cohort studyMedical record abstractionSymptom phenotypeDiagnostic processAnalysis of symptomsVIRGO StudyCohort studyRecord abstractionIndividual patientsClinician's abilityDiagnosis rateStandardized interviewPhenotype subgroupsSymptomsSimilar findingsYoung adultsWomenMenInfarctionPatientsSecondary prevention of cardiovascular disease in China
Lu J, Zhang L, Lu Y, Su M, Li X, Liu J, Zhang H, Nasir K, Masoudi F, Krumholz H, Li J, Zheng X. Secondary prevention of cardiovascular disease in China. Heart 2020, 106: 1349-1356. PMID: 31980439, DOI: 10.1136/heartjnl-2019-315884.Peer-Reviewed Original ResearchMeSH KeywordsAdultAge FactorsAgedAlcohol DrinkingCardiovascular DiseasesChinaFemaleHealthy LifestyleHeart Disease Risk FactorsHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedPlatelet Aggregation InhibitorsRisk AssessmentRisk Reduction BehaviorSecondary PreventionSex FactorsSmoking CessationTime FactorsTreatment OutcomeConceptsSecondary prevention drugsIschemic heart diseaseCardiovascular diseasePrevention drugsIschemic strokeSecondary preventionAntiplatelet drugsCardiac Events Million Persons ProjectHistory of IHDMillion Persons ProjectSecondary prevention therapiesPopulation subgroupsMultivariable mixed modelsPublic health programsCommunities of ChinaCurrent smokersCurrent useMedication usePrevention therapyMultivariable analysisChina PatientHeart diseaseCurrent drinkersHealth programsDrugs
2019
Sex-Based Differences in Presentation, Treatment, and Complications Among Older Adults Hospitalized for Acute Myocardial Infarction
Nanna MG, Hajduk AM, Krumholz HM, Murphy TE, Dreyer RP, Alexander KP, Geda M, Tsang S, Welty FK, Safdar B, Lakshminarayan DK, Chaudhry SI, Dodson JA. Sex-Based Differences in Presentation, Treatment, and Complications Among Older Adults Hospitalized for Acute Myocardial Infarction. Circulation Cardiovascular Quality And Outcomes 2019, 12: e005691. PMID: 31607145, PMCID: PMC6913190, DOI: 10.1161/circoutcomes.119.005691.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overComorbidityDisability EvaluationFemaleHealth Status DisparitiesHealthcare DisparitiesHumansLife StyleMaleMyocardial RevascularizationNon-ST Elevated Myocardial InfarctionPatient AdmissionPrevalenceProspective StudiesRisk AssessmentRisk FactorsSex FactorsSocial Determinants of HealthST Elevation Myocardial InfarctionTime FactorsTreatment OutcomeUnited StatesConceptsAcute myocardial infarctionSex-based differencesPercutaneous coronary interventionFunctional impairmentOlder adultsHospital complicationsCoronary interventionOlder patientsCoronary diseaseMyocardial infarctionAge-related functional impairmentsAge-associated functional impairmentsLower ratesPrior coronary diseaseObstructive coronary diseaseProspective observational studyNSTEMI subgroupSTEMI subgroupUnderwent revascularizationAcute myocardialChest painClinical presentationAMI subgroupRisk factorsHigh prevalenceAssociation of Diabetes Mellitus With Health Status Outcomes in Young Women and Men After Acute Myocardial Infarction: Results From the VIRGO Study
Ding Q, Funk M, Spatz ES, Whittemore R, Lin H, Lipska KJ, Dreyer RP, Spertus JA, Krumholz HM. Association of Diabetes Mellitus With Health Status Outcomes in Young Women and Men After Acute Myocardial Infarction: Results From the VIRGO Study. Journal Of The American Heart Association 2019, 8: e010988. PMID: 31441351, PMCID: PMC6755841, DOI: 10.1161/jaha.118.010988.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAge FactorsDiabetes MellitusFemaleHealth StatusHealth Status IndicatorsHumansMaleMental HealthMiddle AgedMyocardial InfarctionPatient Reported Outcome MeasuresPredictive Value of TestsPrevalencePrognosisQuality of LifeRecovery of FunctionRisk AssessmentRisk FactorsSex FactorsSpainTime FactorsUnited StatesYoung AdultConceptsAcute myocardial infarctionEuroQol visual analogue scaleSeattle Angina QuestionnaireDiabetes mellitusForm Health SurveyHealth status outcomesHealth statusVIRGO StudyAnalog scaleMyocardial infarctionHealth SurveyStatus outcomesYoung adultsSAQ angina frequencyCardiovascular risk factorsHealth status scoresRisk of mortalityWorse health statusPoor health statusQuality of lifeWorse anginaAngina QuestionnaireClinical characteristicsHealthcare useStatus scoreApplication of the VIRGO taxonomy to differentiate acute myocardial infarction in young women
Sciria CT, Dreyer RP, D'Onofrio G, Safdar B, Krumholz HM, Spatz ES. Application of the VIRGO taxonomy to differentiate acute myocardial infarction in young women. International Journal Of Cardiology 2019, 288: 5-11. PMID: 31031078, DOI: 10.1016/j.ijcard.2019.03.054.Peer-Reviewed Original ResearchConceptsCoronary artery diseaseCardiac catheterizationYoung womenNon-obstructive coronary artery diseaseSingle-center retrospective chart reviewYoung AMI Patients (VIRGO) studyObstructive coronary artery diseaseRetrospective chart reviewAcute myocardial infarctionProportion of womenUniversal definitionIndex admissionChart reviewArtery diseaseConsecutive womenMyocardial infarctionTreatment strategiesCatheterizationMore young womenType 2Type 1Class IType 4BWomenPatient studiesTrends 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 function
2018
Sex differences in health outcomes at one year following acute myocardial infarction: A report from the China Patient-Centered Evaluative Assessment of Cardiac Events prospective acute myocardial infarction study
Dreyer RP, Zheng X, Xu X, Liu S, Li J, Ding Q, Du X, Li X, Zhang H, Masoudi FA, Spertus JA, Krumholz HM, Jiang L. Sex differences in health outcomes at one year following acute myocardial infarction: A report from the China Patient-Centered Evaluative Assessment of Cardiac Events prospective acute myocardial infarction study. European Heart Journal Acute Cardiovascular Care 2018, 8: 273-282. PMID: 30270637, DOI: 10.1177/2048872618803726.Peer-Reviewed Original ResearchConceptsMajor adverse cardiac eventsDisease-specific health statusAdverse cardiac eventsAcute myocardial infarctionGeneric health statusMyocardial infarctionCardiac eventsFemale sexHealth statusWeekly anginaChina PatientHealth outcomesAcute Myocardial Infarction StudyPost-acute myocardial infarctionAcute myocardial infarction patientsLong-term health outcomesCardiac Events (PEACE) studyMyocardial Infarction StudyMyocardial infarction patientsSpecific health statusHigher crude ratesSex differencesCardiovascular deathMultivariable analysisInfarction patientsSex and Race Differences in the Utilization and Outcomes of Coronary Artery Bypass Grafting Among Medicare Beneficiaries, 1999–2014
Angraal S, Khera R, Wang Y, Lu Y, Jean R, Dreyer RP, Geirsson A, Desai NR, Krumholz HM. Sex and Race Differences in the Utilization and Outcomes of Coronary Artery Bypass Grafting Among Medicare Beneficiaries, 1999–2014. Journal Of The American Heart Association 2018, 7: e009014. PMID: 30005557, PMCID: PMC6064835, DOI: 10.1161/jaha.118.009014.Peer-Reviewed Original ResearchConceptsCoronary artery bypassCABG utilizationArtery bypassUse of CABGService Medicare beneficiariesCalendar year trendsCABG mortalityUnderwent CABGReadmission ratesCABG proceduresWhite patientsBlack patientsPatient groupMedicare beneficiariesMedicare feeMortality rateCABGAnnual declineWomenRacial subgroupsRacial differencesGreater declineOutcomesPatientsSexPresentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study
Safdar B, Spatz ES, Dreyer RP, Beltrame JF, Lichtman JH, Spertus JA, Reynolds HR, Geda M, Bueno H, Dziura JD, Krumholz HM, D'Onofrio G. Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study. Journal Of The American Heart Association 2018, 7: e009174. PMID: 29954744, PMCID: PMC6064896, DOI: 10.1161/jaha.118.009174.Peer-Reviewed Original ResearchConceptsMI-CAD patientsNonobstructive coronary arteriesMI-CADYounger patientsClinical profileCoronary arteryMyocardial infarctionTraditional cardiac risk factorsAcute myocardial infarction patientsCardiac risk factorsGestational diabetes mellitusMyocardial infarction patientsTimes higher oddsMINOCA patientsSAQ qualityVIRGO StudyClinical characteristicsHypercoaguable stateDiabetes mellitusObstructive diseaseClinical outcomesInfarction patientsRisk factorsMINOCAPsychosocial statusSex Differences in Omega‐3 and ‐6 Fatty Acids and Health Status Among Young Adults With Acute Myocardial Infarction: Results From the VIRGO Study
Lu Y, Ding Q, Xu X, Spatz ES, Dreyer RP, D'Onofrio G, Caulfield M, Nasir K, Spertus JA, Krumholz HM. Sex Differences in Omega‐3 and ‐6 Fatty Acids and Health Status Among Young Adults With Acute Myocardial Infarction: Results From the VIRGO Study. Journal Of The American Heart Association 2018, 7: e008189. PMID: 29848494, PMCID: PMC6015388, DOI: 10.1161/jaha.117.008189.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionHealth status scoresArachidonic acidVIRGO StudyStatus scoreMyocardial infarctionHealth statusPoorer health status outcomesYoung menPatient-reported health statusYoung womenOmega-3 fatty acidsSex differencesPatient-reported outcomesFatty acidsHealth status outcomesCardiovascular outcomesClinical characteristicsAdjusted analysisAMI patientsRisk factorsUS adultsStatus outcomesOmega-3Women 1Sex Differences in Timeliness of Reperfusion in Young Patients With ST‐Segment–Elevation Myocardial Infarction by Initial Electrocardiographic Characteristics
Gupta A, Barrabes JA, Strait K, Bueno H, Porta‐Sánchez A, Acosta‐Vélez J, Lidón R, Spatz E, Geda M, Dreyer RP, Lorenze N, Lichtman J, D'Onofrio G, Krumholz HM. Sex Differences in Timeliness of Reperfusion in Young Patients With ST‐Segment–Elevation Myocardial Infarction by Initial Electrocardiographic Characteristics. Journal Of The American Heart Association 2018, 7: e007021. PMID: 29514807, PMCID: PMC5907538, DOI: 10.1161/jaha.117.007021.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAge of OnsetElectrocardiographyFemaleHealthcare DisparitiesHumansMaleMiddle AgedMyocardial ReperfusionPredictive Value of TestsProspective StudiesRisk AssessmentRisk FactorsSex FactorsSpainST Elevation Myocardial InfarctionTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesYoung AdultConceptsST-segment elevation myocardial infarctionElectrocardiographic characteristicsMyocardial infarctionReperfusion delayYounger patientsVentricular hypertrophyST elevationPrehospital ECGLateral leadsMultivariable logistic regression modelTimeliness of reperfusionVoltage criteriaElevation myocardial infarctionLeft ventricular hypertrophyAcute myocardial infarctionYears of ageLogistic regression modelsSex differencesClinical characteristicsCohort studyElectrocardiographic correlatesMultivariable analysisFemale sexSpanish hospitalsReperfusion guidelinesNational Trends in Nonstatin Use and Expenditures Among the US Adult Population From 2002 to 2013: Insights From Medical Expenditure Panel Survey
Salami JA, Warraich HJ, Valero‐Elizondo J, Spatz ES, Desai NR, Rana JS, Virani SS, Blankstein R, Khera A, Blaha MJ, Blumenthal RS, Katzen BT, Lloyd‐Jones D, Krumholz HM, Nasir K. National Trends in Nonstatin Use and Expenditures Among the US Adult Population From 2002 to 2013: Insights From Medical Expenditure Panel Survey. Journal Of The American Heart Association 2018, 7: e007132. PMID: 29358195, PMCID: PMC5850149, DOI: 10.1161/jaha.117.007132.Peer-Reviewed Original ResearchAdultAgedAtherosclerosisDatabases, FactualDrug CostsDrug PrescriptionsDyslipidemiasFemaleHealth Care SurveysHealth ExpendituresHealthcare DisparitiesHumansHydroxymethylglutaryl-CoA Reductase InhibitorsHypolipidemic AgentsLongitudinal StudiesMaleMedically UninsuredMiddle AgedPractice Patterns, Physicians'Racial GroupsRetrospective StudiesRisk FactorsSex FactorsSocioeconomic FactorsTime FactorsTreatment OutcomeUnited States
2017
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)
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 factorsComparison of Electrocardiographic Characteristics in Men Versus Women ≤ 55 Years With Acute Myocardial Infarction (a Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients Substudy)
Barrabés JA, Gupta A, Porta-Sánchez A, Strait KM, Acosta-Vélez JG, D'Onofrio G, Lidón RM, Geda M, Dreyer RP, Lorenze NP, Lichtman JH, Spertus JA, Bueno H, Krumholz HM. Comparison of Electrocardiographic Characteristics in Men Versus Women ≤ 55 Years With Acute Myocardial Infarction (a Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients Substudy). The American Journal Of Cardiology 2017, 120: 1727-1733. PMID: 28865896, DOI: 10.1016/j.amjcard.2017.07.106.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionST-segment depressionElectrocardiographic presentationMyocardial infarctionQ wavesAnterior ST segment depressionST-segment elevation myocardial infarction diagnosisOutcome of AMIYoung AMI patientsMen Versus WomenST-segment elevationLonger QTc intervalsIntraventricular conduction disturbancesCentral core labNegative T wavesAbnormal Q wavesGender-related differencesBaseline characteristicsContemporary registryAnterior leadsMyocardial infarction diagnosisYounger patientsQTc intervalAMI patientsWorse prognosisDepression Treatment and Health Status Outcomes in Young Patients With Acute Myocardial Infarction
Smolderen KG, Spertus JA, Gosch K, Dreyer RP, D'Onofrio G, Lichtman JH, Geda M, Beltrame J, Safdar B, Bueno H, Krumholz HM. Depression Treatment and Health Status Outcomes in Young Patients With Acute Myocardial Infarction. Circulation 2017, 135: 1762-1764. PMID: 28461419, PMCID: PMC5755692, DOI: 10.1161/circulationaha.116.027042.Peer-Reviewed Original Research