Featured Publications
Individualising intensive systolic blood pressure reduction in hypertension using computational trial phenomaps and machine learning: a post-hoc analysis of randomised clinical trials
Oikonomou EK, Spatz ES, Suchard MA, Khera R. Individualising intensive systolic blood pressure reduction in hypertension using computational trial phenomaps and machine learning: a post-hoc analysis of randomised clinical trials. The Lancet Digital Health 2022, 4: e796-e805. PMID: 36307193, PMCID: PMC9768739, DOI: 10.1016/s2589-7500(22)00170-4.Peer-Reviewed Original ResearchConceptsSystolic blood pressure controlBlood pressure controlIntensive systolic blood pressure controlType 2 diabetesPressure controlCardiovascular benefitsClinical trialsMajor adverse cardiovascular eventsFirst major adverse cardiovascular eventLarge randomised clinical trialsACCORD-BP trialAdverse cardiovascular eventsRandomised clinical trialsSystolic blood pressureCox regression analysisTreatment effectsHazard ratio estimatesACCORD-BPBP trialCardiovascular eventsBlood pressurePrimary outcomeStandard treatmentBaseline variablesIndex patients
2024
Comparative Effectiveness of Second-Line Antihyperglycemic Agents for Cardiovascular Outcomes A Multinational, Federated Analysis of LEGEND-T2DM
Khera R, Aminorroaya A, Dhingra L, Thangaraj P, Pedroso Camargos A, Bu F, Ding X, Nishimura A, Anand T, Arshad F, Blacketer C, Chai Y, Chattopadhyay S, Cook M, Dorr D, Duarte-Salles T, DuVall S, Falconer T, French T, Hanchrow E, Kaur G, Lau W, Li J, Li K, Liu Y, Lu Y, Man K, Matheny M, Mathioudakis N, McLeggon J, McLemore M, Minty E, Morales D, Nagy P, Ostropolets A, Pistillo A, Phan T, Pratt N, Reyes C, Richter L, Ross J, Ruan E, Seager S, Simon K, Viernes B, Yang J, Yin C, You S, Zhou J, Ryan P, Schuemie M, Krumholz H, Hripcsak G, Suchard M. Comparative Effectiveness of Second-Line Antihyperglycemic Agents for Cardiovascular Outcomes A Multinational, Federated Analysis of LEGEND-T2DM. Journal Of The American College Of Cardiology 2024, 84: 904-917. PMID: 39197980, DOI: 10.1016/j.jacc.2024.05.069.Peer-Reviewed Original ResearchConceptsGLP-1 RAsSecond-line agentsGLP-1Antihyperglycemic agentsCardiovascular diseaseMACE riskGlucagon-like peptide-1 receptor agonistsSodium-glucose cotransporter 2 inhibitorsPeptide-1 receptor agonistsDipeptidyl peptidase-4 inhibitorsEffects of SGLT2isType 2 diabetes mellitusPeptidase-4 inhibitorsAdverse cardiovascular eventsCox proportional hazards modelsRandom-effects meta-analysisCardiovascular risk reductionTarget trial emulationProportional hazards modelPerformance of contemporary cardiovascular risk stratification scores in Brazil: an evaluation in the ELSA-Brasil study
Camargos A, Barreto S, Brant L, Ribeiro A, Dhingra L, Aminorroaya A, Bittencourt M, Figueiredo R, Khera R. Performance of contemporary cardiovascular risk stratification scores in Brazil: an evaluation in the ELSA-Brasil study. Open Heart 2024, 11: e002762. PMID: 38862252, PMCID: PMC11168182, DOI: 10.1136/openhrt-2024-002762.Peer-Reviewed Original ResearchConceptsPooled Cohort EquationsELSA-BrasilRisk scoreCardiovascular diseaseCVD eventsCommunity-based cohort studyArea under the receiver operating characteristic curveCVD risk scoreELSA-Brasil studyIncident CVD eventsMiddle-income countriesAdjudicated CVD eventsCardiovascular disease riskCVD scoreCohort EquationsNational guidelinesRisk stratification scoresWhite womenAge/sex groupsCohort studyProspective cohortLMICsSex/race groupsHigher incomeRisk discrimination
2023
Persistence on Novel Cardioprotective Antihyperglycemic Therapies in the United States
Nargesi A, Clark C, Aminorroaya A, Chen L, Liu M, Reddy A, Amodeo S, Oikonomou E, Suchard M, McGuire D, Lin Z, Inzucchi S, Khera R. Persistence on Novel Cardioprotective Antihyperglycemic Therapies in the United States. The American Journal Of Cardiology 2023, 196: 89-98. PMID: 37012183, PMCID: PMC11007258, DOI: 10.1016/j.amjcard.2023.03.002.Peer-Reviewed Original ResearchConceptsSGLT-2iGLP-1RAsGlucagon-like peptide-1 receptor agonistsUnited States administrative claims databasesSodium-glucose cotransporter 2 inhibitorsCommercial insurancePeptide-1 receptor agonistsType 2 diabetes mellitusSodium-glucose cotransporter-2 inhibitorsConsistent medication useHealth outcome benefitsCotransporter 2 inhibitorsElevated cardiovascular riskInitiation of therapyAdministrative claims databaseProportion of daysCotransporter-2 inhibitorsRate of prescriptionAntihyperglycemic therapyCardiovascular riskDiabetes mellitusMedication useCardioprotective effectsPrescription practicesClaims databaseVariation in hospital use of cardiac resynchronization therapy-defibrillator among eligible patients and association with clinical outcomes
Chui P, Lan Z, Freeman J, Enriquez A, Khera R, Akar J, Masoudi F, Ong E, Curtis J. Variation in hospital use of cardiac resynchronization therapy-defibrillator among eligible patients and association with clinical outcomes. Heart Rhythm 2023, 20: 1000-1008. PMID: 36963741, DOI: 10.1016/j.hrthm.2023.03.022.Peer-Reviewed Original ResearchConceptsEligible patientsICD RegistryCardiac resynchronizationNational Cardiovascular Data Registry ICD RegistryCRT-D implantationCRT-D useHospital-level outcomesStrong guideline recommendationsHospital-level variationPatient-level outcomesIntraclass correlation coefficientQuality improvement effortsHospital mortalityGuideline indicationsReadmission ratesSelect patientsClinical outcomesGuideline recommendationsHospital variationHospital ratesUse of CRTHospital levelHospital usePatientsCase mix
2022
Subjective Financial Hardship due to Medical Bills Among Patients With Heart Failure in the United States: The 2014–2018 Medical Expenditure Panel Survey
Ali HR, Valero-Elizondo J, Wang SY, Cainzos-Achirica M, Bhimaraj A, Khan SU, Khan MS, Mossialos E, Khera R, Nasir K. Subjective Financial Hardship due to Medical Bills Among Patients With Heart Failure in the United States: The 2014–2018 Medical Expenditure Panel Survey. Journal Of Cardiac Failure 2022, 28: 1424-1433. PMID: 35839928, DOI: 10.1016/j.cardfail.2022.06.009.Peer-Reviewed Original ResearchMeasures of Financial Hardship From Health Care Expenses Among Families With a Member With Atherosclerotic Cardiovascular Disease in the US
Wang SY, Valero-Elizondo J, Cainzos-Achirica M, Desai NR, Nasir K, Khera R. Measures of Financial Hardship From Health Care Expenses Among Families With a Member With Atherosclerotic Cardiovascular Disease in the US. JAMA Health Forum 2022, 3: e221962. PMID: 35977226, PMCID: PMC9308060, DOI: 10.1001/jamahealthforum.2022.1962.Peer-Reviewed Original ResearchConceptsFinancial hardshipFinancial burdenPocket medical expensesMedical Expenditure Panel SurveyHealth care expensesHigher incomePanel SurveyHealth careCare expensesFinancial consequencesHealth care costsForgone carePublic insuranceMedical billsSubstantial financial burdenMedical expensesIncomeDisparate measuresHardshipCare costsRepresentative surveySubjective measuresComprehensive frameworkExpenseInsuranceCost-Related Medication Nonadherence in Adults With Diabetes in the United States: The National Health Interview Survey 2013-2018.
Taha MB, Valero-Elizondo J, Yahya T, Caraballo C, Khera R, Patel KV, Ali HJR, Sharma G, Mossialos E, Cainzos-Achirica M, Nasir K. Cost-Related Medication Nonadherence in Adults With Diabetes in the United States: The National Health Interview Survey 2013-2018. Diabetes Care 2022, 45: 594-603. PMID: 35015860, DOI: 10.2337/dc21-1757.Peer-Reviewed Original ResearchConceptsCost-related medication nonadherenceNational Health Interview SurveyLack of insuranceMedication nonadherenceNational Health Interview Survey 2013Duration of diabetesHigher comorbidity burdenSelf-reported diabetesHealth Interview SurveyWorse health outcomesHealth-related expendituresComorbidity burdenInsulin useCurrent smokingLess medicationMedication adherenceFemale sexWeighted prevalenceHigher oddsAge subgroupsSkipping dosesDiabetesHealth outcomesElderly adultsNHIS participants
2021
Patterns of Prescribing Sodium-Glucose Cotransporter-2 Inhibitors for Medicare Beneficiaries in the United States
Sangha V, Lipska K, Lin Z, Inzucchi SE, McGuire DK, Krumholz HM, Khera R. Patterns of Prescribing Sodium-Glucose Cotransporter-2 Inhibitors for Medicare Beneficiaries in the United States. Circulation Cardiovascular Quality And Outcomes 2021, 14: e008381. PMID: 34779654, PMCID: PMC9022137, DOI: 10.1161/circoutcomes.121.008381.Peer-Reviewed Original ResearchConceptsType 2 diabetesMedicare beneficiariesSodium-glucose cotransporter 2 inhibitorsLarge randomized clinical trialsMedicare Part D prescriber dataChronic kidney diseaseCotransporter 2 inhibitorsAtherosclerotic cardiovascular diseasePercent of cliniciansRandomized clinical trialsUS Medicare beneficiariesAdvanced practice providersCross-sectional studyKidney outcomesSGLT2i useSulfonylurea prescriptionUnique cliniciansCardiovascular deathMedication classesKidney diseaseLabel indicationsClinical trialsSGLT2iCardiovascular diseasePractice providersNonalcoholic 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 ResearchConceptsNonalcoholic 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 patientsFinancial Hardship From Medical Bills Among Adults With Chronic Liver Diseases: National Estimates From the United States
Lago‐Hernandez C, Nguyen NH, Khera R, Loomba R, Asrani SK, Singh S. Financial Hardship From Medical Bills Among Adults With Chronic Liver Diseases: National Estimates From the United States. Hepatology 2021, 74: 1509-1522. PMID: 33772833, DOI: 10.1002/hep.31835.Peer-Reviewed Original ResearchConceptsChronic liver diseaseScope and Social Determinants of Food Insecurity Among Adults With Atherosclerotic Cardiovascular Disease in the United States
Mahajan S, Grandhi GR, Valero‐Elizondo J, Mszar R, Khera R, Acquah I, Yahya T, Virani SS, Blankstein R, Blaha MJ, Cainzos‐Achirica M, Nasir K. Scope and Social Determinants of Food Insecurity Among Adults With Atherosclerotic Cardiovascular Disease in the United States. Journal Of The American Heart Association 2021, 10: e020028. PMID: 34387089, PMCID: PMC8475063, DOI: 10.1161/jaha.120.020028.Peer-Reviewed Original ResearchConceptsHigh-risk characteristicsUS adultsNational Health Interview Survey dataHealth Interview Survey dataAtherosclerotic cardiovascular diseaseCoronary heart diseaseSelf-reported diagnosisNon-Hispanic blacksInterview Survey dataFood Security Survey ModuleCardiovascular disease resultsLow family incomeAdult Food Security Survey ModuleFood insecurityHeart diseaseASCVDCardiovascular diseasePocket healthcare expenditureHigher oddsSociodemographic determinantsDisease resultsStudy participantsSocial determinantsHealthcare expendituresSociodemographic subgroupsForgone Medical Care Associated With Increased Health Care Costs Among the U.S. Heart Failure Population
Thomas A, Valero-Elizondo J, Khera R, Warraich HJ, Reinhardt SW, Ali HJ, Nasir K, Desai NR. Forgone Medical Care Associated With Increased Health Care Costs Among the U.S. Heart Failure Population. JACC Heart Failure 2021, 9: 710-719. PMID: 34391737, DOI: 10.1016/j.jchf.2021.05.010.Peer-Reviewed Original ResearchConceptsHeart failureHealth care utilizationHealth care costsHealth care expendituresCare utilizationCare costsMedical careMore emergency department visitsTotal health care costsCare expendituresAnnual health careAnnual inpatient costsPrevalence of patientsEmergency department visitsMedical Expenditure Panel SurveyOverall health care spendingHF patientsElderly patientsCare AssociatedDepartment visitsFailure populationInpatient costsHealth care spendingLeading causePatientsComparative Outcomes of Percutaneous Coronary Intervention for ST-Segment–Elevation Myocardial Infarction Among Medicare Beneficiaries With Multivessel Coronary Artery Disease
Secemsky EA, Butala N, Raja A, Khera R, Wang Y, Curtis JP, Maddox TM, Virani SS, Armstrong EJ, Shunk KA, Brindis RG, Bhatt D, Yeh RW. Comparative Outcomes of Percutaneous Coronary Intervention for ST-Segment–Elevation Myocardial Infarction Among Medicare Beneficiaries With Multivessel Coronary Artery Disease. Circulation Cardiovascular Interventions 2021, 14: e010323. PMID: 34372676, PMCID: PMC8485756, DOI: 10.1161/circinterventions.120.010323.Peer-Reviewed Original ResearchRepeated cross-sectional analysis of hydroxychloroquine deimplementation in the AHA COVID-19 CVD Registry
Bradley SM, Emmons-Bell S, Mutharasan RK, Rodriguez F, Gupta D, Roth G, Gluckman TJ, Shah RU, Wang TY, Khera R, Peterson PN, Das S. Repeated cross-sectional analysis of hydroxychloroquine deimplementation in the AHA COVID-19 CVD Registry. Scientific Reports 2021, 11: 15097. PMID: 34302004, PMCID: PMC8302649, DOI: 10.1038/s41598-021-94203-7.Peer-Reviewed Original ResearchConceptsCOVID-19Use of hydroxychloroquineActive COVID-19Cross-sectional analysisRandomized trialsIneffective therapyNational registryMedian useClinical careClinical informationDeimplementationU.S. hospitalsOverall proportionLittle dataHydroxychloroquineFurther studiesPatientsRegistryTherapyHospitalTrialsCareCost-Related Nonadherence to Medications Among US Adults With Chronic Liver Diseases
Lago-Hernandez C, Nguyen NH, Khera R, Loomba R, Asrani SK, Singh S. Cost-Related Nonadherence to Medications Among US Adults With Chronic Liver Diseases. Mayo Clinic Proceedings 2021, 96: 2639-2650. PMID: 34120754, PMCID: PMC8492496, DOI: 10.1016/j.mayocp.2021.02.026.Peer-Reviewed Original ResearchAssociation of Kidney Disease With Outcomes in COVID‐19: Results From the American Heart Association COVID‐19 Cardiovascular Disease Registry
Rao A, Ranka S, Ayers C, Hendren N, Rosenblatt A, Alger HM, Rutan C, Omar W, Khera R, Gupta K, Mody P, DeFilippi C, Das SR, Hedayati SS, de Lemos JA. Association of Kidney Disease With Outcomes in COVID‐19: Results From the American Heart Association COVID‐19 Cardiovascular Disease Registry. Journal Of The American Heart Association 2021, 10: e020910. PMID: 34107743, PMCID: PMC8477855, DOI: 10.1161/jaha.121.020910.Peer-Reviewed Original ResearchConceptsAcute kidney injuryMajor adverse cardiac eventsAdverse cardiac eventsChronic kidney diseaseCardiac eventsKidney diseaseCause mortalityAmerican Heart Association COVID-19 Cardiovascular Disease RegistryCOVID-19Major adverse cardiovascular eventsEnd-stage kidney diseaseCardiovascular Disease RegistryLarge multicenter registryNonfatal heart failureSerial laboratory dataAdverse cardiovascular eventsNonfatal myocardial infarctionKey secondary outcomesCardiovascular disease outcomesPrimary exposure variableNonfatal strokeCardiogenic shockCardiovascular deathCardiovascular eventsCardiovascular outcomesUse of Machine Learning Models to Predict Death After Acute Myocardial Infarction
Khera R, Haimovich J, Hurley NC, McNamara R, Spertus JA, Desai N, Rumsfeld JS, Masoudi FA, Huang C, Normand SL, Mortazavi BJ, Krumholz HM. Use of Machine Learning Models to Predict Death After Acute Myocardial Infarction. JAMA Cardiology 2021, 6: 633-641. PMID: 33688915, PMCID: PMC7948114, DOI: 10.1001/jamacardio.2021.0122.Peer-Reviewed Original ResearchConceptsMachine learning modelsMeta-classifier modelLearning modelNeural networkGradient descent boostingAcute myocardial infarctionContemporary machineGradient descentXGBoost modelXGBoostHospital mortalityCohort studyLogistic regressionMyocardial infarctionNetworkChest Pain-MI RegistryPrecise classificationIndependent validation dataInitial laboratory valuesNovel methodLarge national registryHigh-risk individualsData analysisValidation dataResolution of riskOut‐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 burdenContemporary National Patterns of Eligibility and Utilization of Novel Cardioprotective Anti‐hyperglycemic agents in Type 2 Diabetes
Nargesi AA, Jeyashanmugaraja GP, Desai N, Lipska K, Krumholz H, Khera R. Contemporary National Patterns of Eligibility and Utilization of Novel Cardioprotective Anti‐hyperglycemic agents in Type 2 Diabetes. Journal Of The American Heart Association 2021, 10: e021084. PMID: 33998258, PMCID: PMC8403287, DOI: 10.1161/jaha.121.021084.Peer-Reviewed Original ResearchMeSH KeywordsAgedBiomarkersBlood GlucoseCardiovascular DiseasesDiabetes Mellitus, Type 2Drug UtilizationEligibility DeterminationFemaleGlucagon-Like Peptide-1 ReceptorGuideline AdherenceHeart Disease Risk FactorsHumansIncretinsMaleMiddle AgedNutrition SurveysPractice Guidelines as TopicPractice Patterns, Physicians'Risk AssessmentSodium-Glucose Transporter 2 InhibitorsTime FactorsTreatment OutcomeUnited StatesConceptsSGLT-2 inhibitorsType 2 diabetes mellitusAtherosclerotic cardiovascular diseaseChronic kidney diseaseLarge clinical trialsGLP-1RAsDiabetes mellitusCardiovascular diseaseHeart failureKidney diseaseClinical trialsHigh-risk atherosclerotic cardiovascular diseaseGLP-1RA useAmerican Diabetes AssociationNutrition Examination SurveyAnti-hyperglycemic agentsPublic health benefitsComplex survey designCardiovascular riskGuideline recommendationsDiabetes AssociationExamination SurveyProtective therapyNational HealthAmerican College