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Lindman BR, Fonarow GC, Myers G, Alger HM, Rutan C, Troll K, Aringo A, Shahriary M, Jessup M, Arnold SV, Shah PB, Szeto WY, Yancy CW, Otto CM. Target Aortic Stenosis: A National Initiative to Improve Quality of Care and Outcomes for Patients With Aortic Stenosis. Circ Cardiovasc Qual Outcomes 2023; 16:e009712. [PMID: 37339188 DOI: 10.1161/circoutcomes.122.009712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Affiliation(s)
- Brian R Lindman
- Cardiovascular Division, Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.)
| | - Gregg C Fonarow
- Cardiovascular Division, UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Gary Myers
- American Heart Association (G.M., H.M.A., C.R., K.T., A.A., M.S., M.J.)
| | - Heather M Alger
- American Heart Association (G.M., H.M.A., C.R., K.T., A.A., M.S., M.J.)
| | - Christine Rutan
- American Heart Association (G.M., H.M.A., C.R., K.T., A.A., M.S., M.J.)
| | - Katie Troll
- American Heart Association (G.M., H.M.A., C.R., K.T., A.A., M.S., M.J.)
| | - Angeline Aringo
- American Heart Association (G.M., H.M.A., C.R., K.T., A.A., M.S., M.J.)
| | - Melanie Shahriary
- American Heart Association (G.M., H.M.A., C.R., K.T., A.A., M.S., M.J.)
| | - Mariell Jessup
- American Heart Association (G.M., H.M.A., C.R., K.T., A.A., M.S., M.J.)
| | - Suzanne V Arnold
- St. Luke's Mid America Heart Institute, University of Missouri-Kansas City (S.V.A.)
| | - Pinak B Shah
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.B.S.)
| | - Wilson Y Szeto
- Department of Cardiac Surgery, University of Pennsylvania, Philadelphia (W.Y.S.)
| | - Clyde W Yancy
- Cardiovascular Division, Northwestern Medical Center, Chicago, IL (C.W.Y.)
| | - Catherine M Otto
- Cardiovascular Division, University of Washington Medical Center, Seattle (C.M.O.)
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2
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Hall EJ, Ayers CR, Kolkailah AA, Rutan C, Walchok J, Williams JH, Wang TY, Rodriguez F, Bradley SM, Stevens L, Hall JL, Mallya P, Roth GA, Morrow DA, Elkind MSV, Das SR, de Lemos JA. Longitudinal Trends in Cardiovascular Risk Factor Profiles and Complications Among Patients Hospitalized for COVID-19 Infection: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry. Circ Cardiovasc Qual Outcomes 2023; 16:e009652. [PMID: 37017087 PMCID: PMC10178917 DOI: 10.1161/circoutcomes.122.009652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
BACKGROUND The COVID-19 pandemic has evolved through multiple phases characterized by new viral variants, vaccine development, and changes in therapies. It is unknown whether rates of cardiovascular disease (CVD) risk factor profiles and complications have changed over time. METHODS We analyzed the American Heart Association COVID-19 CVD registry, a national multicenter registry of hospitalized adults with active COVID-19 infection. The time period from April 2020 to December 2021 was divided into 3-month epochs, with March 2020 analyzed separately as a potential outlier. Participating centers varied over the study period. Trends in all-cause in-hospital mortality, CVD risk factors, and in-hospital CVD outcomes, including a composite primary outcome of cardiovascular death, cardiogenic shock, new heart failure, stroke, and myocardial infarction, were evaluated across time epochs. Risk-adjusted analyses were performed using generalized linear mixed-effects models. RESULTS A total of 46 007 patient admissions from 134 hospitals were included (mean patient age 61.8 years, 53% male, 22% Black race). Patients admitted later in the pandemic were younger, more likely obese, and less likely to have existing CVD (Ptrend ≤0.001 for each). The incidence of the primary outcome increased from 7.0% in March 2020 to 9.8% in October to December 2021 (risk-adjusted Ptrend=0.006). This was driven by an increase in the diagnosis of myocardial infarction and stroke (Ptrend<0.0001 for each). The overall rate of in-hospital mortality was 14.2%, which declined over time (20.8% in March 2020 versus 10.8% in the last epoch; adjusted Ptrend<0.0001). When the analysis was restricted to July 2020 to December 2021, no temporal change in all-cause mortality was seen (adjusted Ptrend=0.63). CONCLUSIONS Despite a shifting risk factor profile toward a younger population with lower rates of established CVD, the incidence of diagnosed cardiovascular complications of COVID increased from the onset of the pandemic through December 2021. All-cause mortality decreased during the initial months of the pandemic and thereafter remained consistently high through December 2021.
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Affiliation(s)
- Eric J Hall
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern, Dallas (E.J.H., C.R.A., A.A.K., S.R.D., J.A.d.L.)
| | - Colby R Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern, Dallas (E.J.H., C.R.A., A.A.K., S.R.D., J.A.d.L.)
| | - Ahmed A Kolkailah
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern, Dallas (E.J.H., C.R.A., A.A.K., S.R.D., J.A.d.L.)
| | - Christine Rutan
- Quality, Outcomes Research, and Analytics Department, American Heart Association, Dallas (C.R., J.W., J.H.W., L.S., J.L.H., P.M.)
| | - Jason Walchok
- Quality, Outcomes Research, and Analytics Department, American Heart Association, Dallas (C.R., J.W., J.H.W., L.S., J.L.H., P.M.)
| | - Joseph H Williams
- Quality, Outcomes Research, and Analytics Department, American Heart Association, Dallas (C.R., J.W., J.H.W., L.S., J.L.H., P.M.)
| | - Tracy Y Wang
- Duke Clinical Research Institute, Duke University, Durham, NC (T.Y.W.)
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of Medicine, Stanford University School of Medicine, CA (F.R.)
| | | | - Laura Stevens
- Quality, Outcomes Research, and Analytics Department, American Heart Association, Dallas (C.R., J.W., J.H.W., L.S., J.L.H., P.M.)
| | - Jennifer L Hall
- Quality, Outcomes Research, and Analytics Department, American Heart Association, Dallas (C.R., J.W., J.H.W., L.S., J.L.H., P.M.)
| | - Pratheek Mallya
- Quality, Outcomes Research, and Analytics Department, American Heart Association, Dallas (C.R., J.W., J.H.W., L.S., J.L.H., P.M.)
| | - Gregory A Roth
- Division of Cardiology, Department of Medicine, University of Washington, Seattle (G.A.R.)
| | - David A Morrow
- Levine Cardiac Intensive Care Unit, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.A.M.)
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.)
| | - Sandeep R Das
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern, Dallas (E.J.H., C.R.A., A.A.K., S.R.D., J.A.d.L.)
| | - James A de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern, Dallas (E.J.H., C.R.A., A.A.K., S.R.D., J.A.d.L.)
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3
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Oseran AS, Sun T, Wadhera RK, Dahabreh IJ, de Lemos JA, Das SR, Rutan C, Asnani AH, Yeh RW, Kazi DS. Enriching the American Heart Association COVID-19 Cardiovascular Disease Registry Through Linkage With External Data Sources: Rationale and Design. J Am Heart Assoc 2022; 11:e7743. [PMID: 36102226 PMCID: PMC9683646 DOI: 10.1161/jaha.122.027094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The AHA Registry (American Heart Association COVID-19 Cardiovascular Disease Registry) captures detailed information on hospitalized patients with COVID-19. The registry, however, does not capture information on social determinants of health or long-term outcomes. Here we describe the linkage of the AHA Registry with external data sources, including fee-for-service (FFS) Medicare claims, to fill these gaps and assess the representativeness of linked registry patients to the broader Medicare FFS population hospitalized with COVID-19. Methods and Results We linked AHA Registry records of adults ≥65 years from March 2020 to September 2021 with Medicare FFS claims using a deterministic linkage algorithm and with the American Hospital Association Annual Survey, Rural Urban Commuting Area codes, and the Social Vulnerability Index using hospital and geographic identifiers. We compared linked individuals with unlinked FFS beneficiaries hospitalized with COVID-19 to assess the representativeness of the AHA Registry. A total of 10 010 (47.0%) records in the AHA Registry were successfully linked to FFS Medicare claims. Linked and unlinked FFS beneficiaries were similar with respect to mean age (78.1 versus 77.9, absolute standardized difference [ASD] 0.03); female sex (48.3% versus 50.2%, ASD 0.04); Black race (15.1% versus 12.0%, ASD 0.09); dual-eligibility status (26.1% versus 23.2%, ASD 0.07); and comorbidity burden. Linked patients were more likely to live in the northeastern United States (35.7% versus 18.2%, ASD 0.40) and urban/metropolitan areas (83.9% versus 76.8%, ASD 0.18). There were also differences in hospital-level characteristics between cohorts. However, in-hospital outcomes were similar (mortality, 23.3% versus 20.1%, ASD 0.08; home discharge, 45.5% versus 50.7%, ASD 0.10; skilled nursing facility discharge, 24.4% versus 22.2%, ASD 0.05). Conclusions Linkage of the AHA Registry with external data sources such as Medicare FFS claims creates a unique and generalizable resource to evaluate long-term health outcomes after COVID-19 hospitalization.
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Affiliation(s)
- Andrew S. Oseran
- Richard A. and Susan F. Smith Center for Outcomes ResearchBeth Israel Deaconess Medical CenterBostonMA,Division of CardiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA
| | - Tianyu Sun
- Richard A. and Susan F. Smith Center for Outcomes ResearchBeth Israel Deaconess Medical CenterBostonMA
| | - Rishi K. Wadhera
- Richard A. and Susan F. Smith Center for Outcomes ResearchBeth Israel Deaconess Medical CenterBostonMA,Division of CardiologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMA
| | - Issa J. Dahabreh
- Richard A. and Susan F. Smith Center for Outcomes ResearchBeth Israel Deaconess Medical CenterBostonMA,CAUSALabHarvard T.H. Chan School of Public HealthBostonMA,Departments of Epidemiology and BiostatisticsHarvard T.H. Chan School of Public HealthBostonMA
| | - James A. de Lemos
- Division of CardiologyUniversity of Texas Southwestern Medical CenterDallasTX
| | - Sandeep R. Das
- Division of CardiologyUniversity of Texas Southwestern Medical CenterDallasTX
| | - Christine Rutan
- Quality, Outcomes Research and AnalyticsAmerican Heart AssociationDallasTX
| | - Aarti H. Asnani
- Division of CardiologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMA
| | - Robert W. Yeh
- Richard A. and Susan F. Smith Center for Outcomes ResearchBeth Israel Deaconess Medical CenterBostonMA,Division of CardiologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMA
| | - Dhruv S. Kazi
- Richard A. and Susan F. Smith Center for Outcomes ResearchBeth Israel Deaconess Medical CenterBostonMA,Division of CardiologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMA
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4
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Segar MW, Hall JL, Jhund PS, Powell-Wiley TM, Morris AA, Kao D, Fonarow GC, Hernandez R, Ibrahim NE, Rutan C, Navar AM, Stevens LM, Pandey A. Machine Learning-Based Models Incorporating Social Determinants of Health vs Traditional Models for Predicting In-Hospital Mortality in Patients With Heart Failure. JAMA Cardiol 2022; 7:844-854. [PMID: 35793094 PMCID: PMC9260645 DOI: 10.1001/jamacardio.2022.1900] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Importance Traditional models for predicting in-hospital mortality for patients with heart failure (HF) have used logistic regression and do not account for social determinants of health (SDOH). Objective To develop and validate novel machine learning (ML) models for HF mortality that incorporate SDOH. Design, Setting, and Participants This retrospective study used the data from the Get With The Guidelines-Heart Failure (GWTG-HF) registry to identify HF hospitalizations between January 1, 2010, and December 31, 2020. The study included patients with acute decompensated HF who were hospitalized at the GWTG-HF participating centers during the study period. Data analysis was performed January 6, 2021, to April 26, 2022. External validation was performed in the hospitalization cohort from the Atherosclerosis Risk in Communities (ARIC) study between 2005 and 2014. Main Outcomes and Measures Random forest-based ML approaches were used to develop race-specific and race-agnostic models for predicting in-hospital mortality. Performance was assessed using C index (discrimination), regression slopes for observed vs predicted mortality rates (calibration), and decision curves for prognostic utility. Results The training data set included 123 634 hospitalized patients with HF who were enrolled in the GWTG-HF registry (mean [SD] age, 71 [13] years; 58 356 [47.2%] female individuals; 65 278 [52.8%] male individuals. Patients were analyzed in 2 categories: Black (23 453 [19.0%]) and non-Black (2121 [2.1%] Asian; 91 154 [91.0%] White, and 6906 [6.9%] other race and ethnicity). The ML models demonstrated excellent performance in the internal testing subset (n = 82 420) (C statistic, 0.81 for Black patients and 0.82 for non-Black patients) and in the real-world-like cohort with less than 50% missingness on covariates (n = 553 506; C statistic, 0.74 for Black patients and 0.75 for non-Black patients). In the external validation cohort (ARIC registry; n = 1205 Black patients and 2264 non-Black patients), ML models demonstrated high discrimination and adequate calibration (C statistic, 0.79 and 0.80, respectively). Furthermore, the performance of the ML models was superior to the traditional GWTG-HF risk score model (C index, 0.69 for both race groups) and other rederived logistic regression models using race as a covariate. The performance of the ML models was identical using the race-specific and race-agnostic approaches in the GWTG-HF and external validation cohorts. In the GWTG-HF cohort, the addition of zip code-level SDOH parameters to the ML model with clinical covariates only was associated with better discrimination, prognostic utility (assessed using decision curves), and model reclassification metrics in Black patients (net reclassification improvement, 0.22 [95% CI, 0.14-0.30]; P < .001) but not in non-Black patients. Conclusions and Relevance ML models for HF mortality demonstrated superior performance to the traditional and rederived logistic regressions models using race as a covariate. The addition of SDOH parameters improved the prognostic utility of prediction models in Black patients but not non-Black patients in the GWTG-HF registry.
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Affiliation(s)
| | | | - Pardeep S. Jhund
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland,Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Alanna A. Morris
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - David Kao
- Divisions of Cardiology and Bioinformatics + Personalized Medicine, University of Colorado School of Medicine, Aurora
| | - Gregg C. Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, California,Associate Editor for Health Care Quality and Guidelines, JAMA Cardiology
| | - Rosalba Hernandez
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana
| | - Nasrien E. Ibrahim
- Heart Failure Clinical Research, Inova Heart and Vascular Institute, Washington, DC
| | - Christine Rutan
- Quality, Outcomes Research and Analytics, American Heart Association, Dallas, Texas
| | - Ann Marie Navar
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas,Deputy Editor, Diversity, Equity and Inclusion, JAMA Cardiology
| | - Laura M. Stevens
- Data Science, American Heart Association, Dallas, Texas,Divisions of Cardiology and Bioinformatics + Personalized Medicine, University of Colorado School of Medicine, Aurora
| | - Ambarish Pandey
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
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5
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Keshvani N, Mehta A, Alger HM, Rutan C, Williams J, Zhang S, Young R, Alhanti B, Chiswell K, Greene SJ, DeVore AD, Yancy CW, Fonarow GC, Pandey A. Heart Failure Quality of Care and In-Hospital Outcomes During the COVID-19 Pandemic Findings from the Get With The Guidelines-Heart Failure Registry. Eur J Heart Fail 2022; 24:1117-1128. [PMID: 35289038 PMCID: PMC9087396 DOI: 10.1002/ejhf.2484] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 11/08/2022] Open
Abstract
Aims To assess heart failure (HF) in‐hospital quality of care and outcomes before and during the COVID‐19 pandemic. Methods and results Patients hospitalized for HF with ejection fraction (EF) <40% in the American Heart Association Get With The Guidelines©‐HF (GWTG‐HF) registry during the COVID‐19 pandemic (3/1/2020–4/1/2021) and pre‐pandemic (2/1/2019–2/29/2020) periods were included. Adherence to HF process of care measures, in‐hospital mortality, and length of stay (LOS) were compared in pre‐pandemic vs. pandemic periods and in patients with vs. without COVID‐19. Overall, 42 004 pre‐pandemic and 37 027 pandemic period patients (median age 68, 33% women, 58% White) were included without observed differences across clinical characteristics, comorbidities, vital signs, or EF. Utilization of guideline‐directed medical therapy at discharge was comparable across both periods, with rates of implantable cardioverter defibrillator (ICD) placement or prescription lower during the pandemic (vs. pre‐pandemic period). In‐hospital mortality (3.0% vs. 2.5%, p <0.0001) and LOS (mean 5.7 vs. 5.4 days, p <0.0004) were higher during the pandemic vs. pre‐pandemic. The highest in‐hospital mortality during the pandemic was observed among patients hospitalized in the Northeast region (3.4%). Among patients concurrently diagnosed with COVID‐19 (n = 549; 1.5%), adherence to ICD placement or prescription, prescription of aldosterone antagonist or angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor–neprilysin inhibitor at discharge were lower, and in‐hospital mortality (8.2% vs. 3.0%, p <0.0001) and LOS (mean 7.7 vs. 5.7 days, p <0.0001) were higher than those without COVID‐19. Conclusion Among GWTG‐HF participating hospitals, patients hospitalized for HF with reduced EF during the pandemic received similar care quality but experienced higher in‐hospital mortality than the pre‐pandemic period.
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Affiliation(s)
- Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Anurag Mehta
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | | | | | | | | | | | | | | | - Stephen J Greene
- Duke Clinical Research Institute, Durham, NC.,Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Adam D DeVore
- Duke Clinical Research Institute, Durham, NC.,Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Clyde W Yancy
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, Los Angeles, CA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
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6
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Khera R, Liu Y, de Lemos JA, Das SR, Pandey A, Omar W, Kumbhani DJ, Girotra S, Yeh RW, Rutan C, Walchok J, Lin Z, Bradley SM, Velazquez EJ, Churchwell KB, Nallamothu BK, Krumholz HM, Curtis JP. Association of COVID-19 Hospitalization Volume and Case Growth at US Hospitals with Patient Outcomes. Am J Med 2021; 134:1380-1388.e3. [PMID: 34343515 PMCID: PMC8325555 DOI: 10.1016/j.amjmed.2021.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Whether the volume of coronavirus disease 2019 (COVID-19) hospitalizations is associated with outcomes has important implications for the organization of hospital care both during this pandemic and future novel and rapidly evolving high-volume conditions. METHODS We identified COVID-19 hospitalizations at US hospitals in the American Heart Association COVID-19 Cardiovascular Disease Registry with ≥10 cases between January and August 2020. We evaluated the association of COVID-19 hospitalization volume and weekly case growth indexed to hospital bed capacity, with hospital risk-standardized in-hospital case-fatality rate (rsCFR). RESULTS There were 85 hospitals with 15,329 COVID-19 hospitalizations, with a median hospital case volume was 118 (interquartile range, 57, 252) and median growth rate of 2 cases per 100 beds per week but varied widely (interquartile range: 0.9 to 4.5). There was no significant association between overall hospital COVID-19 case volume and rsCFR (rho, 0.18, P = .09). However, hospitals with more rapid COVID-19 case-growth had higher rsCFR (rho, 0.22, P = 0.047), increasing across case growth quartiles (P trend = .03). Although there were no differences in medical treatments or intensive care unit therapies (mechanical ventilation, vasopressors), the highest case growth quartile had 4-fold higher odds of above median rsCFR, compared with the lowest quartile (odds ratio, 4.00; 1.15 to 13.8, P = .03). CONCLUSIONS An accelerated case growth trajectory is a marker of hospitals at risk of poor COVID-19 outcomes, identifying sites that may be targets for influx of additional resources or triage strategies. Early identification of such hospital signatures is essential as our health system prepares for future health challenges.
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Affiliation(s)
- Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn.
| | - Yusi Liu
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
| | - James A de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Sandeep R Das
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Wally Omar
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Dharam J Kumbhani
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Saket Girotra
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa, Iowa City
| | - Robert W Yeh
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Mass; Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Mass
| | | | | | - Zhenqiu Lin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
| | - Steven M Bradley
- Healthcare Delivery Innovation Center, Minneapolis Heart Institute, Minn
| | - Eric J Velazquez
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Keith B Churchwell
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | | | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
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7
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Shakil SS, Emmons-Bell S, Rutan C, Walchok J, Navi B, Sharma R, Sheth K, Roth GA, Elkind MSV. Stroke Among Patients Hospitalized With COVID-19: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry. Stroke 2021; 53:800-807. [PMID: 34702063 PMCID: PMC8884133 DOI: 10.1161/strokeaha.121.035270] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Supplemental Digital Content is available in the text. Coronavirus disease 2019 (COVID-19) may be associated with increased risk for ischemic stroke. We present prevalence and characteristics of strokes in patients with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 infection enrolled in the American Heart Association COVID-19 Cardiovascular Disease Registry.
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Affiliation(s)
- Saate S Shakil
- Division of Cardiology, University of Washington, Seattle. (S.S.S., G.A.R.)
| | - Sophia Emmons-Bell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle. (S.E.-B., G.A.R.)
| | | | | | - Babak Navi
- Department of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York City, NY (B.N.)
| | - Richa Sharma
- Department of Neurology, Yale University, New Haven, CT. (R.S., K.S.)
| | - Kevin Sheth
- Department of Neurology, Yale University, New Haven, CT. (R.S., K.S.).,Department of Neurosurgery, Yale University, New Haven, CT. (K.S.)
| | - Gregory A Roth
- Division of Cardiology, University of Washington, Seattle. (S.S.S., G.A.R.).,Institute for Health Metrics and Evaluation, University of Washington, Seattle. (S.E.-B., G.A.R.)
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY. (M.S.V.E.).,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY. (M.S.V.E.)
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8
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Stevens LM, de Lemos JA, Das SR, Rutan C, Alger HM, Elkind MSV, Zhao J, Iyer K, Figueroa CA, Hall JL. American Heart Association Precision Medicine Platform Addresses Challenges in Data Sharing. Circ Cardiovasc Qual Outcomes 2021; 14:e007949. [PMID: 34517729 PMCID: PMC8452247 DOI: 10.1161/circoutcomes.121.007949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Laura M Stevens
- Department of Cardiology and Computational Bioscience Program, University of Colorado, Aurora (L.M.S.).,Quality, Outcomes Research and Analytics, American Heart Association, Dallas, TX (L.M.S., C.R., H.A., J.L.H.)
| | | | - Sandeep R Das
- UT Southwestern Medical Center, Dallas, TX (J.A.d.L., S.R.D.).,Center for Innovation and Value at Parkland, Dallas, TX (S.R.D.)
| | - Christine Rutan
- Quality, Outcomes Research and Analytics, American Heart Association, Dallas, TX (L.M.S., C.R., H.A., J.L.H.)
| | - Heather M Alger
- Quality, Outcomes Research and Analytics, American Heart Association, Dallas, TX (L.M.S., C.R., H.A., J.L.H.)
| | - Mitchell S V Elkind
- Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, NewYork-Presbyterian Hospital (M.S.V.E.)
| | - Juan Zhao
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN (J.Z.)
| | - Kritika Iyer
- Departments of Biomedical Engineering (K.I. and C.A.F.), University of Michigan, Ann Arbor
| | - C Alberto Figueroa
- Departments of Biomedical Engineering (K.I. and C.A.F.), University of Michigan, Ann Arbor.,Surgery (C.A.F.), University of Michigan, Ann Arbor
| | - Jennifer L Hall
- Quality, Outcomes Research and Analytics, American Heart Association, Dallas, TX (L.M.S., C.R., H.A., J.L.H.).,Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.)
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9
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Srivastava PK, Zhang S, Xian Y, Xu H, Rutan C, Alger HM, Walchok JG, Williams JH, de Lemos JA, Decker-Palmer MR, Alhanti B, Elkind MSV, Messé SR, Smith EE, Schwamm LH, Fonarow GC. Treatment and Outcomes of Patients With Ischemic Stroke During COVID-19: An Analysis From Get With The Guidelines-Stroke. Stroke 2021; 52:3225-3232. [PMID: 34192897 PMCID: PMC8478095 DOI: 10.1161/strokeaha.120.034414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Supplemental Digital Content is available in the text. The coronavirus disease 2019 (COVID-19) pandemic has created challenges in the delivery of acute stroke care. In this study, we analyze the characteristics, evaluation, treatment, and in-hospital outcomes of patients presenting with acute ischemic stroke (AIS) pre-COVID-19 and during COVID-19.
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Affiliation(s)
- Pratyaksh K Srivastava
- Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA. (P.K.S., G.C.F.)
| | - Shuaiqi Zhang
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. (S.Z., Y.X., B.A.)
| | - Ying Xian
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. (S.Z., Y.X., B.A.).,Department of Neurology, Duke University Medical Center, Durham, NC. (Y.X.)
| | - Hanzhang Xu
- Department of Family Medicine and Community Health (H.X.)
| | - Christine Rutan
- American Heart Association, Dallas, TX (C.R., H.M.A., J.G.W., J.H.W.)
| | - Heather M Alger
- American Heart Association, Dallas, TX (C.R., H.M.A., J.G.W., J.H.W.)
| | - Jason G Walchok
- American Heart Association, Dallas, TX (C.R., H.M.A., J.G.W., J.H.W.)
| | - Joseph H Williams
- American Heart Association, Dallas, TX (C.R., H.M.A., J.G.W., J.H.W.)
| | - James A de Lemos
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (J.A.d.L.)
| | | | - Brooke Alhanti
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. (S.Z., Y.X., B.A.)
| | - Mitchell S V Elkind
- Department of Neurology and Department of Epidemiology, Columbia University, NY (M.S.V.E.)
| | - Steve R Messé
- Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.)
| | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.)
| | - Lee H Schwamm
- Department of Neurology, Comprehensive Stroke Center, Massachusetts General Hospital, Boston (L.H.S.)
| | - Gregg C Fonarow
- Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA. (P.K.S., G.C.F.).,Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA. (G.C.F.)
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10
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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. J Am Heart Assoc 2021; 10:e020910. [PMID: 34107743 PMCID: PMC8477855 DOI: 10.1161/jaha.121.020910] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Emerging evidence links acute kidney injury (AKI) in patients with COVID‐19 with higher mortality and respiratory morbidity, but the relationship of AKI with cardiovascular disease outcomes has not been reported in this population. We sought to evaluate associations between chronic kidney disease (CKD), AKI, and mortality and cardiovascular outcomes in patients hospitalized with COVID‐19. Methods and Results In a large multicenter registry including 8574 patients with COVID‐19 from 88 US hospitals, data were collected on baseline characteristics and serial laboratory data during index hospitalization. Primary exposure variables were CKD (categorized as no CKD, CKD, and end‐stage kidney disease) and AKI (classified into no AKI or stages 1, 2, or 3 using a modification of the Kidney Disease Improving Global Outcomes guideline definition). The primary outcome was all‐cause mortality. The key secondary outcome was major adverse cardiac events, defined as cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, new‐onset nonfatal heart failure, and nonfatal cardiogenic shock. CKD and end‐stage kidney disease were not associated with mortality or major adverse cardiac events after multivariate adjustment. In contrast, AKI was significantly associated with mortality (stage 1 hazard ratio [HR], 1.72 [95% CI, 1.46–2.03]; stage 2 HR, 1.83 [95% CI, 1.52–2.20]; stage 3 HR, 1.69 [95% CI, 1.44–1.98]; versus no AKI) and major adverse cardiac events (stage 1 HR, 2.17 [95% CI, 1.74–2.71]; stage 2 HR, 2.70 [95% CI, 2.07–3.51]; stage 3 HR, 3.06 [95% CI, 2.52–3.72]; versus no AKI). Conclusions This large study demonstrates a significant association between AKI and all‐cause mortality and, for the first time, major adverse cardiovascular events in patients hospitalized with COVID‐19.
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Affiliation(s)
- Anjali Rao
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | - Sagar Ranka
- Department of Cardiovascular Medicine University of Kansas Kansas City KS
| | - Colby Ayers
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Nicholas Hendren
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | - Anna Rosenblatt
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | | | | | - Wally Omar
- Department of Internal Medicine Beth Israel Deaconess Medical Center Boston MA
| | - Rohan Khera
- Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Kamal Gupta
- Department of Cardiovascular Medicine University of Kansas Kansas City KS
| | - Purav Mody
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | | | - Sandeep R Das
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | - S Susan Hedayati
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - James A de Lemos
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
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11
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Roth GA, Emmons-Bell S, Alger HM, Bradley SM, Das SR, de Lemos JA, Gakidou E, Elkind MSV, Hay S, Hall JL, Johnson CO, Morrow DA, Rodriguez F, Rutan C, Shakil S, Sorensen R, Stevens L, Wang TY, Walchok J, Williams J, Murray C. Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e218828. [PMID: 33938933 PMCID: PMC8094014 DOI: 10.1001/jamanetworkopen.2021.8828] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE In-hospital mortality rates from COVID-19 are high but appear to be decreasing for selected locations in the United States. It is not known whether this is because of changes in the characteristics of patients being admitted. OBJECTIVE To describe changing in-hospital mortality rates over time after accounting for individual patient characteristics. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective cohort study of 20 736 adults with a diagnosis of COVID-19 who were included in the US American Heart Association COVID-19 Cardiovascular Disease Registry and admitted to 107 acute care hospitals in 31 states from March through November 2020. A multiple mixed-effects logistic regression was then used to estimate the odds of in-hospital death adjusted for patient age, sex, body mass index, and medical history as well as vital signs, use of supplemental oxygen, presence of pulmonary infiltrates at admission, and hospital site. MAIN OUTCOMES AND MEASURES In-hospital death adjusted for exposures for 4 periods in 2020. RESULTS The registry included 20 736 patients hospitalized with COVID-19 from March through November 2020 (9524 women [45.9%]; mean [SD] age, 61.2 [17.9] years); 3271 patients (15.8%) died in the hospital. Mortality rates were 19.1% in March and April, 11.9% in May and June, 11.0% in July and August, and 10.8% in September through November. Compared with March and April, the adjusted odds ratios for in-hospital death were significantly lower in May and June (odds ratio, 0.66; 95% CI, 0.58-0.76; P < .001), July and August (odds ratio, 0.58; 95% CI, 0.49-0.69; P < .001), and September through November (odds ratio, 0.59; 95% CI, 0.47-0.73). CONCLUSIONS AND RELEVANCE In this cohort study, high rates of in-hospital COVID-19 mortality among registry patients in March and April 2020 decreased by more than one-third by June and remained near that rate through November. This difference in mortality rates between the months of March and April and later months persisted even after adjusting for age, sex, medical history, and COVID-19 disease severity and did not appear to be associated with changes in the characteristics of patients being admitted.
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Affiliation(s)
- Gregory A. Roth
- Division of Cardiology, Department of Medicine, University of Washington, Seattle
| | - Sophia Emmons-Bell
- Division of Cardiology, Department of Medicine, University of Washington, Seattle
| | | | - Steven M. Bradley
- Minneapolis Heart Institute, Minneapolis, Minnesota
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
- Associate Editor, JAMA Network Open
| | - Sandeep R. Das
- Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
- Parkland Health and Hospital System, Dallas, Texas
| | - James A. de Lemos
- Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
- Parkland Health and Hospital System, Dallas, Texas
| | - Emmanuela Gakidou
- Division of Cardiology, Department of Medicine, University of Washington, Seattle
| | - Mitchell S. V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Simon Hay
- Division of Cardiology, Department of Medicine, University of Washington, Seattle
| | - Jennifer L. Hall
- American Heart Association, Dallas, Texas
- University of Minnesota, Minneapolis
| | - Catherine O. Johnson
- Division of Cardiology, Department of Medicine, University of Washington, Seattle
| | - David A. Morrow
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Fatima Rodriguez
- Cardiovascular Institute, Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | | | - Saate Shakil
- Division of Cardiology, Department of Medicine, University of Washington, Seattle
| | - Reed Sorensen
- Division of Cardiology, Department of Medicine, University of Washington, Seattle
| | - Laura Stevens
- American Heart Association, Dallas, Texas
- University of Colorado Anschutz Medical Campus, Aurora
| | - Tracy Y. Wang
- Duke Clinical Research Institute, Durham, North Carolina
| | | | | | - Christopher Murray
- Division of Cardiology, Department of Medicine, University of Washington, Seattle
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12
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Srivastava PK, Zhang S, Xian Y, Xu H, Rutan C, Alger HM, Walchok J, Williams J, de Lemos JA, Decker-Palmer MR, Alhanti B, Elkind MSV, Messé SR, Smith EE, Schwamm LH, Fonarow GC. Acute Ischemic Stroke in Patients With COVID-19: An Analysis From Get With The Guidelines-Stroke. Stroke 2021; 52:1826-1829. [PMID: 33728926 DOI: 10.1161/strokeaha.121.034301] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
[Figure: see text].
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Affiliation(s)
| | - Shuaiqi Zhang
- Duke Clinical Research Institute, Duke, Durham, NC (S.Z., Y.X., B.A.)
| | - Ying Xian
- Duke Clinical Research Institute, Duke, Durham, NC (S.Z., Y.X., B.A.).,Department of Neurology, Duke, Durham, NC (Y.X.)
| | - Hanzhang Xu
- Department of Family Medicine, Duke, NC (H.X.)
| | - Christine Rutan
- American Heart Association, Dallas, TX (C.R., H.M.A., J. Walchok, J. Williams)
| | - Heather M Alger
- American Heart Association, Dallas, TX (C.R., H.M.A., J. Walchok, J. Williams)
| | - Jason Walchok
- American Heart Association, Dallas, TX (C.R., H.M.A., J. Walchok, J. Williams)
| | - Joseph Williams
- American Heart Association, Dallas, TX (C.R., H.M.A., J. Walchok, J. Williams)
| | | | | | - Brooke Alhanti
- Duke Clinical Research Institute, Duke, Durham, NC (S.Z., Y.X., B.A.)
| | | | - Steve R Messé
- Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.)
| | - Eric E Smith
- Department of Clinical Neurosciences, University of Calgary, Canada (E.E.S.)
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.)
| | - Gregg C Fonarow
- Division of Cardiology (P.K.S., G.C.F.), UCLA, Los Angeles, CA.,Ahmanson-UCLA Cardiomyopathy Center (G.C.F.), UCLA, Los Angeles, CA
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13
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Alger HM, Rutan C, Williams JH, Walchok JG, Bolles M, Hall JL, Bradley SM, Elkind MSV, Rodriguez F, Wang TY, Morrow DA, Das SR, de Lemos JA. American Heart Association COVID-19 CVD Registry Powered by Get With The Guidelines. Circ Cardiovasc Qual Outcomes 2020; 13:e006967. [PMID: 32546000 DOI: 10.1161/circoutcomes.120.006967] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND In response to the public health emergency created by the coronavirus disease 2019 (COVID-19) pandemic, American Heart Association volunteers and staff aimed to rapidly develop and launch a resource for the medical and research community to expedite scientific advancement through shared learning, quality improvement, and research. In <4 weeks after it was first announced on April 3, 2020, AHA's COVID-19 CVD Registry powered by Get With The Guidelines received its first clinical records. METHODS AND RESULTS Participating hospitals are enrolling consecutive hospitalized patients with active COVID-19 disease, regardless of CVD status. This hospital quality improvement program will allow participating hospitals and health systems to evaluate patient-level data including mortality rates, intensive care unit bed days, and ventilator days from individual review of electronic medical records of sequential adult patients with active COVID-19 infection. Participating sites can leverage these data for onsite, rapid quality improvement, and benchmarking versus other institutions. After 9 weeks, >130 sites have enrolled in the program and >4000 records have been abstracted in the national dataset. Additionally, the aggregate dataset will be a valuable data resource for the medical research community. CONCLUSIONS The AHA COVID-19 CVD Registry will support greater understanding of the impact of COVID-19 on cardiovascular disease and will inform best practices for evaluation and management of patients with COVID-19.
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Affiliation(s)
- Heather M Alger
- Quality, Outcomes Research and Analytics Department, American Heart Association, Dallas, TX (H.M.A., C.R., J.H.W., J.G.W., M.B., J.L.H.)
| | - Christine Rutan
- Quality, Outcomes Research and Analytics Department, American Heart Association, Dallas, TX (H.M.A., C.R., J.H.W., J.G.W., M.B., J.L.H.)
| | - Joseph H Williams
- Quality, Outcomes Research and Analytics Department, American Heart Association, Dallas, TX (H.M.A., C.R., J.H.W., J.G.W., M.B., J.L.H.)
| | - Jason G Walchok
- Quality, Outcomes Research and Analytics Department, American Heart Association, Dallas, TX (H.M.A., C.R., J.H.W., J.G.W., M.B., J.L.H.)
| | - Michele Bolles
- Quality, Outcomes Research and Analytics Department, American Heart Association, Dallas, TX (H.M.A., C.R., J.H.W., J.G.W., M.B., J.L.H.)
| | - Jennifer L Hall
- Quality, Outcomes Research and Analytics Department, American Heart Association, Dallas, TX (H.M.A., C.R., J.H.W., J.G.W., M.B., J.L.H.).,University of Minnesota, Minneapolis, MN (J.L.H.)
| | - Steven M Bradley
- Healthcare Delivery Innovation Center; Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN (S.M.B.)
| | - Mitchell S V Elkind
- Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.).,New York-Presbyterian Hospital New York (M.S.V.E.)
| | | | - Tracy Y Wang
- Duke Clinical Research Institute, Duke University, Durham, NC (T.Y.W.)
| | - David A Morrow
- Levine Cardiac Intensive Care Unit, Harvard Medical School, Boston, MA (D.A.M.)
| | - Sandeep R Das
- UT Southwestern Medical Center, Dallas, TX (S.R.D., J.A.d.L.)
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14
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Affiliation(s)
- Heather M Alger
- American Heart Association, Dallas, TX (H.M.A., J.H.W., J.G.W., M.B., C.R.)
| | - Joseph H Williams
- American Heart Association, Dallas, TX (H.M.A., J.H.W., J.G.W., M.B., C.R.)
| | - Jason G Walchok
- American Heart Association, Dallas, TX (H.M.A., J.H.W., J.G.W., M.B., C.R.)
| | - Michele Bolles
- American Heart Association, Dallas, TX (H.M.A., J.H.W., J.G.W., M.B., C.R.)
| | - Gregg C Fonarow
- Division of Cardiology, University of California Los Angeles (G.C.F.)
| | - Christine Rutan
- American Heart Association, Dallas, TX (H.M.A., J.H.W., J.G.W., M.B., C.R.)
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15
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Rudd AG, Bladin C, Carli P, De Silva DA, Field TS, Jauch EC, Kudenchuk P, Kurz MW, Lærdal T, Ong M, Panagos P, Ranta A, Rutan C, Sayre MR, Schonau L, Shin SD, Waters D, Lippert F. Utstein recommendation for emergency stroke care. Int J Stroke 2020; 15:555-564. [PMID: 32223543 PMCID: PMC7672780 DOI: 10.1177/1747493020915135] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Recent advances in treatment for stroke give new possibilities for optimizing
outcomes. To deliver these prehospital care needs to become more
efficient. Aim To develop a framework to support improved delivery of prehospital care. The
recommendations are aimed at clinicians involved in prehospital and
emergency health systems who will often not be stroke specialists but need
clear guidance as to how to develop and deliver safe and effective care for
acute stroke patients. Methods Building on the successful implementation program from the Global
Resuscitation Alliance and the Resuscitation Academy, the Utstein
methodology was used to define a generic chain of survival for Emergency
Stroke Care by assembling international expertise in Stroke and Emergency
Medical Services (EMS). Ten programs were identified for Acute Stroke Care
to improve survival and outcomes, with recommendations for implementation of
best practice. Conclusions Efficient prehospital systems for acute stroke will be improved through
public awareness, optimized prehospital triage and timely diagnostics, and
quick and equitable access to acute treatments. Documentation, use of
metrics and transparency will help to build a culture of excellence and
accountability.
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Affiliation(s)
- A G Rudd
- NHS England and King's College, London, England
| | - C Bladin
- Eastern Health Monash University, Melbourne, Australia
| | - P Carli
- Emergency Medical Services, Paris, France
| | - D A De Silva
- National Neuroscience Institute, Singapore General Hospital, Singapore
| | - T S Field
- University of British Columbia, Vancouver, Canada
| | - E C Jauch
- Mission Health System, Asheville, USA
| | - P Kudenchuk
- University of Washington School of Medicine, Seattle, WA, USA
| | - M W Kurz
- Stavanger University Hospital, Stavanger, Norway
| | - T Lærdal
- The Laerdal Foundation, Stavanger, Norway
| | - Meh Ong
- Singapore General Hospital and Duke-NUS Medical School, Singapore, Singapore
| | - P Panagos
- Washington University School of Medicine, St. Louis, MO, USA
| | - A Ranta
- University of Otago, Dunedin, New Zealand
| | - C Rutan
- American Heart Association, Dallas, TX, USA
| | | | - L Schonau
- Danish Resuscitation Council, Copenhagen, Denmark
| | - S D Shin
- Seoul National University College of Medicine, Seoul, South Korea
| | - D Waters
- Ambulance New Zealand, Wellington, New Zealand
| | - F Lippert
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
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