2023
Quantifying Blood Pressure Visit-to-Visit Variability in the Real-World Setting: A Retrospective Cohort Study
Lu Y, Linderman G, Mahajan S, Liu Y, Huang C, Khera R, Mortazavi B, Spatz E, Krumholz H. Quantifying Blood Pressure Visit-to-Visit Variability in the Real-World Setting: A Retrospective Cohort Study. Circulation Cardiovascular Quality And Outcomes 2023, 16: e009258. PMID: 36883456, DOI: 10.1161/circoutcomes.122.009258.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultBlood PressureBlood Pressure DeterminationFemaleHumansHypertensionMaleMiddle AgedRetrospective StudiesRisk FactorsConceptsRetrospective cohort studyBlood pressure valuesPatient characteristicsReal-world settingCohort studyPatient subgroupsYale New Haven Health SystemMean body mass indexSystolic blood pressure valuesBlood pressure visitHistory of hypertensionCoronary artery diseaseManagement of patientsMultivariable linear regression modelsBlood pressure readingsBody mass indexPatient-level measuresBlood pressure variationAbsolute standardized differencesNon-Hispanic whitesAntihypertensive medicationsReal-world practiceVisit variabilityArtery diseaseRegression models
2022
Time in therapeutic range for targeted temperature management and outcomes following out-of-hospital cardiac arrest
Wheelock K, Chan P, Chen L, de Lemos J, Miller P, Nallamothu B, Girotra S, Khera R. Time in therapeutic range for targeted temperature management and outcomes following out-of-hospital cardiac arrest. Resuscitation 2022, 182: 109650. PMID: 36442596, PMCID: PMC9885789, DOI: 10.1016/j.resuscitation.2022.11.016.Peer-Reviewed Original ResearchConceptsFavorable neurologic outcomeHospital cardiac arrestTherapeutic rangeNeurologic outcomeOverall survivalTemperature managementCardiac arrestFavorable neurologic survivalFavorable neurological outcomeRetrospective cohort studyTargeted temperature managementHigh therapeutic rangeRisk-adjusted analysisComatose survivorsNeurologic survivalNeurological outcomeCohort studyHospital dischargeMedian durationMedian timeCurrent guidelinesCompression trialTreatment targetsSignificant associationGoal temperature
2021
Clinician Trends in Prescribing Direct Oral Anticoagulants for US Medicare Beneficiaries
Wheelock KM, Ross JS, Murugiah K, Lin Z, Krumholz HM, Khera R. Clinician Trends in Prescribing Direct Oral Anticoagulants for US Medicare Beneficiaries. JAMA Network Open 2021, 4: e2137288. PMID: 34870678, PMCID: PMC8649845, DOI: 10.1001/jamanetworkopen.2021.37288.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, OralAtrial FibrillationFactor Xa InhibitorsHumansMedicarePractice Patterns, Physicians'Retrospective StudiesTime FactorsUnited StatesWarfarinConceptsDOAC useAnticoagulant prescriptionOral anticoagulantsUS cliniciansMedicare beneficiariesNational clinical practice guidelinesElevated bleeding riskOral anticoagulant prescriptionsRetrospective cohort studyDirect oral anticoagulantsClinical practice guidelinesUS Medicare beneficiariesInternal medicine physiciansNumber of cliniciansAnticoagulant prescribingDOAC prescriptionsUnique cliniciansBleeding riskCohort studyAnticoagulant strategiesPrescription claimsPractice guidelinesMAIN OUTCOMEMost indicationsMedicare populationNonalcoholic Fatty Liver Disease and Risk of Heart Failure Among Medicare Beneficiaries
Fudim M, Zhong L, Patel KV, Khera R, Abdelmalek MF, Diehl AM, McGarrah RW, Molinger J, Moylan CA, Rao VN, Wegermann K, Neeland IJ, Halm EA, Das SR, Pandey A. Nonalcoholic Fatty Liver Disease and Risk of Heart Failure Among Medicare Beneficiaries. Journal Of The American Heart Association 2021, 10: e021654. PMID: 34755544, PMCID: PMC8751938, DOI: 10.1161/jaha.121.021654.Peer-Reviewed Original ResearchMeSH KeywordsAgedFemaleHeart FailureHumansMedicareNon-alcoholic Fatty Liver DiseaseRetrospective StudiesRisk FactorsStroke VolumeUnited StatesConceptsNonalcoholic fatty liver diseaseIncident heart failureReduced ejection fractionFatty liver diseaseHeart failureEjection fractionMedicare beneficiariesHF subtypesLiver diseaseHigh riskBackground Nonalcoholic fatty liver diseaseBaseline NAFLDAssociation of NAFLDNew-onset heart failureConclusions PatientsCohort studyPrior diagnosisBlack patientsNinth RevisionKidney diseaseOutpatient claimsRisk factorsIndependent associationHigh burdenMedicare patientsOut‐of‐pocket Annual Health Expenditures and Financial Toxicity from Healthcare Costs in Patients with Heart Failure in the United States
Wang SY, Valero‐Elizondo J, Ali H, Pandey A, Cainzos‐Achirica M, Krumholz HM, Nasir K, Khera R. Out‐of‐pocket Annual Health Expenditures and Financial Toxicity from Healthcare Costs in Patients with Heart Failure in the United States. Journal Of The American Heart Association 2021, 10: e022164. PMID: 33998273, PMCID: PMC8483501, DOI: 10.1161/jaha.121.022164.Peer-Reviewed Original ResearchConceptsGreater risk-adjusted oddsRisk-adjusted oddsHeart failureMedical Expenditure Panel SurveyCatastrophic financial burdenPocket healthcare expensesHigh financial burdenFinancial toxicityHealthcare expensesFinancial burdenHealthcare costsCatastrophic burdenMajor public health burdenLow-income familiesBackground Heart failurePublic health burdenInsurance premiumsPanel SurveyPocket healthcare costsAnnual health expenditureWorld Health OrganizationConclusions PatientsHealth insurance premiumsPocket healthcare expenditureHealth burdenElectronic health record risk score provides earlier prognostication of clinical outcomes in patients admitted to the cardiac intensive care unit
Kunitomo Y, Thomas A, Chouairi F, Canavan ME, Kochar A, Khera R, Katz JN, Murphy C, Jentzer J, Ahmad T, Desai NR, Brennan J, Miller PE. Electronic health record risk score provides earlier prognostication of clinical outcomes in patients admitted to the cardiac intensive care unit. American Heart Journal 2021, 238: 85-88. PMID: 33891906, DOI: 10.1016/j.ahj.2021.04.004.Peer-Reviewed Original ResearchConceptsCardiac intensive care unitIntensive care unitRothman IndexCare unitRisk scoreModern cardiac intensive care unitSequential Organ Failure Assessment scoreOrgan Failure Assessment scoreElectronic health recordsCICU mortalityCICU patientsSOFA scoreCICU admissionClinical outcomesEarly prognosticationObservational studyPrognostic abilityAssessment scoresOutcome predictionHealth recordsGood calibrationSuperior discriminationPatientsAdmissionScoresPrevalence of Missing Data in the National Cancer Database and Association With Overall Survival
Yang DX, Khera R, Miccio JA, Jairam V, Chang E, Yu JB, Park HS, Krumholz HM, Aneja S. Prevalence of Missing Data in the National Cancer Database and Association With Overall Survival. JAMA Network Open 2021, 4: e211793. PMID: 33755165, PMCID: PMC7988369, DOI: 10.1001/jamanetworkopen.2021.1793.Peer-Reviewed Original ResearchMeSH KeywordsAgedData ManagementDatabases, FactualFemaleFollow-Up StudiesHumansMaleMiddle AgedNeoplasmsPrevalenceRegistriesRetrospective StudiesSurvival RateUnited StatesConceptsNational Cancer DatabaseNon-small cell lung cancerOverall survivalCell lung cancerCancer DatabaseMedical recordsLung cancerProstate cancerBreast cancerPatient recordsComplete dataRetrospective cohort studyCohort studyCancer RegistryCommon cancerVariables of interestHigh prevalenceMAIN OUTCOMEPatientsClinical advancementReal-world data sourcesCancerPrevalenceSurvivalHeterogeneous differences
2020
Financial Hardship After Traumatic Injury: Risk Factors and Drivers of Out-of-Pocket Health Expenses
O'Neill KM, Jean RA, Gross CP, Becher RD, Khera R, Elizondo JV, Nasir K. Financial Hardship After Traumatic Injury: Risk Factors and Drivers of Out-of-Pocket Health Expenses. Journal Of Surgical Research 2020, 256: 1-12. PMID: 32663705, DOI: 10.1016/j.jss.2020.05.095.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedChildChild, PreschoolCost of IllnessCross-Sectional StudiesFamilyFemaleFinancial StressHealth ExpendituresHospitalizationHumansInfantInfant, NewbornInsurance, HealthMaleMiddle AgedPrescription DrugsRetrospective StudiesRisk FactorsSocioeconomic FactorsUnited StatesWounds and InjuriesYoung AdultConceptsTraumatic injuryOOP expensesPocket health expensesExcess financial burdenHealth expensesInpatient costsCatastrophic medical expensesFinancial burdenMultivariable logistic regression analysisMedical expensesHealth care factorsCostly medical conditionsCross-sectional studyMedical Expenditure Panel SurveyLogistic regression analysisPrescription drug costsFinancial hardshipHealth care systemFamily membersTrauma-related disordersPrimary outcomeCare factorsEmergency roomRisk factorsDrug costsReadmission and Mortality After Hospitalization for Myocardial Infarction and Heart Failure
Ko DT, Khera R, Lau G, Qiu F, Wang Y, Austin PC, Koh M, Lin Z, Lee DS, Wijeysundera HC, Krumholz HM. Readmission and Mortality After Hospitalization for Myocardial Infarction and Heart Failure. Journal Of The American College Of Cardiology 2020, 75: 736-746. PMID: 32081282, DOI: 10.1016/j.jacc.2019.12.026.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overFemaleHeart FailureHumansMaleMyocardial InfarctionOntarioPatient ReadmissionRetrospective StudiesConceptsAcute myocardial infarctionPost-discharge mortalityHospital mortalityReadmission ratesHospitalization ratesMyocardial infarctionMortality rateRisk-adjusted mortality ratesHospital Readmissions Reduction ProgramHF hospitalization ratesHeart failure hospitalizationPatients 65 yearsReadmissions Reduction ProgramFailure hospitalizationHF patientsSecondary outcomesHospital readmissionPrimary outcomeReadmissionMortalityAMI hospitalization ratesStudy periodPattern of outcomesHospitalizationOutcomesPost-discharge acute care and outcomes following readmission reduction initiatives: national retrospective cohort study of Medicare beneficiaries in the United States
Khera R, Wang Y, Bernheim SM, Lin Z, Krumholz HM. Post-discharge acute care and outcomes following readmission reduction initiatives: national retrospective cohort study of Medicare beneficiaries in the United States. The BMJ 2020, 368: l6831. PMID: 31941686, PMCID: PMC7190056, DOI: 10.1136/bmj.l6831.Peer-Reviewed Original ResearchConceptsAcute care utilizationAcute myocardial infarctionRetrospective cohort studyHeart failureCare utilizationPost-discharge periodEmergency departmentMyocardial infarctionDay mortalityCohort studyHospital admissionObservation unitAcute careNational retrospective cohort studyPost-acute care utilizationHospital Readmissions Reduction ProgramObservation unit carePost-discharge mortalityDay readmission rateRisk of deathReadmissions Reduction ProgramReadmission reduction initiativesReadmission ratesUnit careInpatient unit
2019
Diagnostic and prognostic utility of cardiac troponin in post-cardiac arrest care
Agusala V, Khera R, Cheeran D, Mody P, Reddy PP, Link MS. Diagnostic and prognostic utility of cardiac troponin in post-cardiac arrest care. Resuscitation 2019, 141: 69-72. PMID: 31201884, DOI: 10.1016/j.resuscitation.2019.06.004.Peer-Reviewed Original ResearchMeSH KeywordsAgedFemaleHeart ArrestHumansMaleMiddle AgedPredictive Value of TestsPrognosisRetrospective StudiesSurvival RateTroponin TConceptsLeft ventricular systolic dysfunctionIschemic etiologyInitial cTnTPeak cTnTCardiac troponinPost-cardiac arrest settingRetrospective single-center registryPost-cardiac arrest careVentricular systolic dysfunctionSingle-center registryTroponin T testingSystolic dysfunctionCenter registryConsecutive patientsSpontaneous circulationArrest carePrognostic utilityCardiac arrestMean agePatient outcomesExpert adjudicationEtiologyCTnTDiagnostic testsT-testingCost-minimization study of the percutaneous approach to endovascular aortic aneurysm repair
Hong JC, Yang GK, Delarmente BA, Khera R, Price J, Faulds J, Chen JC. Cost-minimization study of the percutaneous approach to endovascular aortic aneurysm repair. Journal Of Vascular Surgery 2019, 71: 444-449. PMID: 31176637, DOI: 10.1016/j.jvs.2019.03.040.Peer-Reviewed Original ResearchMeSH KeywordsAortic AneurysmCost SavingsDecision TreesEndovascular ProceduresHumansRetrospective StudiesVascular Closure DevicesConceptsEndovascular aortic aneurysm repairVascular closure deviceAortic aneurysm repairLength of hospitalizationP-EVARCost savingsProbabilistic sensitivity analysesAneurysm repairSensitivity analysisTwo-way sensitivity analysesCost-minimization studyCost saving strategyEconomic effectsCost parametersMean cost savingsCost differencesPayer perspectiveSurgical site infectionNational Inpatient SampleThoracic EVARResource allocationSaving strategiesBase caseSavingsSummary measuresAssociation of access to exercise opportunities and cardiovascular mortality
Angraal S, Gupta A, Khera R, Nasir K, Desai NR. Association of access to exercise opportunities and cardiovascular mortality. American Heart Journal 2019, 212: 152-156. PMID: 31051426, DOI: 10.1016/j.ahj.2019.02.010.Peer-Reviewed Original ResearchConceptsCVD mortalityLower CVD mortalityCardiovascular disease mortalityLeisure physical activityExercise opportunitiesAssociation of accessCardiovascular mortalityDisease mortalityHigh prevalencePhysical activityExercise facilitiesMortalityHigh accessHigh percentageLow accessObesityDiabetesPrevalence
2018
Increasing Sepsis Rates in the United States: Results From National Inpatient Sample, 2005 to 2014
Rubens M, Saxena A, Ramamoorthy V, Das S, Khera R, Hong J, Armaignac D, Veledar E, Nasir K, Gidel L. Increasing Sepsis Rates in the United States: Results From National Inpatient Sample, 2005 to 2014. Journal Of Intensive Care Medicine 2018, 35: 858-868. PMID: 30175649, DOI: 10.1177/0885066618794136.Peer-Reviewed Original ResearchAnnual Burden and Costs of Hospitalization for High-Need, High-Cost Patients With Chronic Gastrointestinal and Liver Diseases
Nguyen NH, Khera R, Ohno-Machado L, Sandborn WJ, Singh S. Annual Burden and Costs of Hospitalization for High-Need, High-Cost Patients With Chronic Gastrointestinal and Liver Diseases. Clinical Gastroenterology And Hepatology 2018, 16: 1284-1292.e30. PMID: 29474966, PMCID: PMC6056327, DOI: 10.1016/j.cgh.2018.02.015.Peer-Reviewed Original ResearchConceptsFunctional gastrointestinal disordersChronic liver diseaseInflammatory bowel diseaseHigh-cost patientsCost of hospitalizationGastrointestinal hemorrhageLiver diseasePancreatic diseaseChronic gastrointestinalHospitalization costsAnnual burdenNationwide Readmissions Database 2013Medicare/Medicaid insuranceHigher comorbidity burdenInfection-related hospitalizationNationwide database analysisMultivariate logistic regressionDays/monthLarge rural hospitalPopulation health managementLow-income statusCardiopulmonary causesComorbidity burdenIndex hospitalizationHigh-value care
2017
Comparison of Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Chronic Kidney Disease
Kumar N, Khera R, Garg N, Echouffo-Tcheugui JB, Venkatraman A, Pandey A, Bhatt DL. Comparison of Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Chronic Kidney Disease. The American Journal Of Cardiology 2017, 121: 343-348. PMID: 29268936, DOI: 10.1016/j.amjcard.2017.10.029.Peer-Reviewed Original ResearchConceptsSurgical aortic valve replacementTranscatheter aortic valve implantationDialysis-requiring acute kidney injuryAcute kidney injuryChronic kidney diseaseAortic valve replacementPostoperative strokeSAVR proceduresKidney diseaseHospital mortalityValve replacementTranscatheter Versus Surgical Aortic Valve ReplacementRate of AKIRetrospective cohort studySevere aortic stenosisCo-primary outcomesPropensity-matched pairsAortic valve implantationComparison of outcomesKidney injuryCohort studyValve implantationAortic stenosisMultivariate analysisPatientsPredictors of Death in Adults With Duchenne Muscular Dystrophy–Associated Cardiomyopathy
Cheeran D, Khan S, Khera R, Bhatt A, Garg S, Grodin JL, Morlend R, Araj FG, Amin AA, Thibodeau JT, Das S, Drazner MH, Mammen PPA. Predictors of Death in Adults With Duchenne Muscular Dystrophy–Associated Cardiomyopathy. Journal Of The American Heart Association 2017, 6: e006340. PMID: 29042427, PMCID: PMC5721845, DOI: 10.1161/jaha.117.006340.Peer-Reviewed Original ResearchConceptsDuchenne muscular dystrophyDMD patientsPrognostic factorsDMD populationCardiac biomarkersHigh-risk cardiovascular populationLower body mass indexAdult DMD patientsHeart failure medicationsPredictors of deathAlanine aminotransferase levelsElevated cardiac biomarkersPoor prognostic factorMaximum inspiratory pressureBody mass indexElectronic medical recordsCardiomyopathy clinicMedian followAminotransferase levelsBaseline characteristicsCardiovascular populationRetrospective cohortConsecutive patientsMass indexWorse prognosisComparison of Readmission Rates After Acute Myocardial Infarction in 3 Patient Age Groups (18 to 44, 45 to 64, and ≥65 Years) in the United States
Khera R, Jain S, Pandey A, Agusala V, Kumbhani DJ, Das SR, Berry JD, de Lemos JA, Girotra S. Comparison of Readmission Rates After Acute Myocardial Infarction in 3 Patient Age Groups (18 to 44, 45 to 64, and ≥65 Years) in the United States. The American Journal Of Cardiology 2017, 120: 1761-1767. PMID: 28865892, PMCID: PMC5825232, DOI: 10.1016/j.amjcard.2017.07.081.Peer-Reviewed Original ResearchConceptsYounger age groupsLow-income patientsReadmission ratesAge groupsHigh hospitalization burdenIndex AMI hospitalizationNationwide Readmissions DatabaseRisk of readmissionPatient age groupsAcute myocardial infarctionVulnerable patient groupSignificant resource utilizationMultivariable hierarchical modelsYears of ageHealth care resourcesHealth care systemReadmission periodHospitalization burdenPayer databaseAMI survivorsPost-AMIPatient groupInpatient hospitalizationMyocardial infarctionReadmission
2016
Atrial fibrillation associated hospitalizations in patients with end-stage renal disease in the United States, 2003–2012
Kumar N, Khera R, Garg N. Atrial fibrillation associated hospitalizations in patients with end-stage renal disease in the United States, 2003–2012. Heart Rhythm 2016, 13: 2027-2033. PMID: 27374238, DOI: 10.1016/j.hrthm.2016.06.031.Peer-Reviewed Original ResearchConceptsEnd-stage renal diseaseLength of stayCase fatality ratioUS ESRD populationAF hospitalizationsAtrial fibrillationHospitalization ratesESRD patientsESRD populationRenal diseaseHospital case-fatality ratioNational Inpatient Sample databasePrimary outcomeMean ageMarker of qualityHospitalizationFatality ratioEconomic burdenPatientsSample databaseSignificant decreaseSignificant increaseFibrillationAnnual numberOutcomesRacial Differences in Outcomes after Acute Ischemic Stroke Hospitalization in the United States
Kumar N, Khera R, Pandey A, Garg N. Racial Differences in Outcomes after Acute Ischemic Stroke Hospitalization in the United States. Journal Of Stroke And Cerebrovascular Diseases 2016, 25: 1970-1977. PMID: 27212273, DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.049.Peer-Reviewed Original ResearchConceptsEndovascular mechanical thrombectomyLength of stayAcute ischemic stroke hospitalizationsIschemic stroke hospitalizationsInflation-adjusted chargesHospital mortalityIschemic strokeStroke hospitalizationsRacial differencesAverage LOSUtilization of thrombolysisAcute ischemic strokeNational Inpatient SampleHealth policy implicationsReperfusion therapyMechanical thrombectomySecondary outcomesStroke outcomePrimary outcomeClinical outcomesMean ageInpatient SamplePrimary diagnosisHospitalizationStroke