Publications by authors named "Boback Ziaeian"
Article Synopsis
- The study analyzed data from 2016 to 2021 to examine trends in cardiovascular (CV) hospitalizations, associated healthcare costs, and procedural utilization in the U.S., finding 4.7 million CV-related hospitalizations in 2021 at a hefty cost of $108 billion.
- Heart failure was the most expensive condition, costing $18.5 billion, with other significant expenses tied to non-ST-elevation myocardial infarction and stroke.
- Although total costs rose by over $10 billion (10%) during the observation period, fluctuations were noted year to year, and costs are projected to hit $131.3 billion by 2030.
Importance: Guideline-directed medical therapy (GDMT) remains underutilized on a global level, with significant disparities in access to treatment worldwide. The potential global benefits of quadruple therapy on patients with heart failure with reduced ejection fraction (HFrEF) have not yet been estimated.
Objective: To assess the projected population-level benefit of optimal GDMT use globally among patients with HFrEF.
Article Synopsis
- Since January 2020, COVID-19 impacted over 100 million people in the U.S., and there is a need for better understanding of racial and ethnic disparities in hospitalization data related to the virus.
- A study analyzed data from the National Inpatient Sample to quantify these disparities, revealing significant differences in hospitalization rates and outcomes among different racial and ethnic groups.
- The findings showed that Black, Hispanic, and Native American patients experienced hospitalization rates over twice that of White patients, with higher mortality rates linked to factors like age, sex, and certain health conditions.
This document describes performance measures for heart failure that are appropriate for public reporting or pay-for-performance programs and is meant to serve as a focused update of the "2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures." The new performance measures are taken from the "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines" and are selected from the strongest recommendations (Class 1 or Class 3). In contrast, quality measures may not have as much evidence base and generally comprise metrics that might be useful for clinicians and health care organizations for quality improvement but are not yet appropriate for public reporting or pay-for-performance programs.
View Article and Find Full Text PDFArticle Synopsis
- - This document updates performance measures for heart failure, suitable for public reporting and pay-for-performance systems, based on the "2022 AHA/ACC/HFSA Guideline for Management of Heart Failure" and focusing on strong recommendations.
- - New performance measures include managing blood pressure in patients with preserved ejection fraction, using specific medications for those with reduced ejection fraction, and ensuring proper medical therapy for hospitalized patients.
- - The quality measures cover broader aspects, such as medication use, patient counseling on health risks related to heart failure, and the importance of screenings for related conditions, but aren't yet ready for public reporting.
Sex, Race, and Rural-Urban Disparities in Ventricular Tachycardia Ablations.
JACC Clin Electrophysiol
October 2024
Background: Ventricular ablation may be clinically indicated for patients with recurrent ventricular tachycardia (VT) and has been shown to decrease risk of recurrence and overall morbidity. However, the existence of disparities among patients receiving ventricular ablation has not been well characterized.
Objectives: In this study, the authors examined patients hospitalized with VT to determine whether disparities exist among those receiving ablations.
Background: How housing insecurity might affect patients with heart failure (HF) is not well characterized. Housing insecurity increases risks related to both communicable and noncommunicable diseases. For patients with HF, housing insecurity is likely to increase the risk for worse outcomes and rehospitalizations.
View Article and Find Full Text PDFBackground: The optimal timing of noncardiac surgery (NCS) following transcatheter aortic valve replacement (TAVR) for aortic stenosis has not been elucidated by current national guidelines.
Objectives: The aim of this study was to evaluate the effect of the time interval between TAVR and NCS (Δt) on the perioperative risk of major adverse events (MAEs).
Methods: All adult admissions for isolated TAVR for aortic stenosis were identified in the 2016 to 2020 Nationwide Readmissions Database.
Background: Three medications are now guideline-recommended treatments for heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), however, the cost-effectiveness of these agents in combination has yet to be established.
Objectives: The purpose of this study was to determine the cost-effectiveness of mineralocorticoid receptor antagonists (MRA), angiotensin receptor-neprilysin inhibitors (ARNIs), and sodium glucose co-transporter 2 inhibitors (SGLT2is) in individuals with HFmrEF/HFpEF.
Methods: Using a 3-state Markov model, we performed a cost-effectiveness study using simulated cohorts of 1,000 patients with HFmrEF and HFpEF.
Trends in Income Inequities in Cardiovascular Health Among US Adults, 1988-2018.
Circ Cardiovasc Qual Outcomes
May 2024
Article Synopsis
- Mean cardiovascular health in the U.S. has improved from 1988 to 2018, with the average risk of major cardiovascular events decreasing from 7.8% to 6.4% for the general population.
- However, this improvement mainly benefits individuals in higher income categories, while those in the lowest income category (PIR <1) experienced little to no change in their cardiovascular risk.
- The study highlights a growing inequity in cardiovascular health, as the risk for the lowest income group worsened relative to higher income groups, indicating that poorer populations continue to experience a greater share of adverse health outcomes.
Heart failure (HF) is a common disease with increasing prevalence around the world. There is high morbidity and mortality associated with poorly controlled HF along with increasing costs and strain on healthcare systems due to a high rate of rehospitalization and resource utilization. Despite the establishment of clear evidence-based guideline directed medical therapies (GDMT) proven to improve HF morbidity and mortality, there remains significant clinical inertia to optimizing HF patients on GDMT.
View Article and Find Full Text PDFBackground: The STRONG-HF trial (Safety, Tolerability and Efficacy of Up-Titration of Guideline-Directed Medical Therapies for Acute Heart Failure) demonstrated substantial reductions in the composite of mortality and morbidity over 6 months among hospitalized patients with heart failure (HF) who were randomized to intensive guideline-directed medical therapy (GDMT) optimization compared with usual care. Whether an intensive GDMT optimization program would be cost-effective for patients with HF with reduced ejection fraction is unknown.
Methods: Using a 2-state Markov model, we evaluated the effect of an intensive GDMT optimization program on hospitalized patients with HF with reduced ejection fraction.
Background: In 2020, the Veterans Affairs (VA) health care system deployed a heart failure (HF) dashboard for use nationally. The initial version was notably imprecise and unreliable for the identification of HF subtypes. We describe the development and subsequent optimization of the VA national HF dashboard.
View Article and Find Full Text PDFObjective: To evaluate the impact of age and COVID-19 variant time period on morbidity and mortality among those hospitalized with COVID-19.
Patients And Methods: Patients from the American Heart Association's Get With The Guidelines COVID-19 cardiovascular disease registry (January 20, 2020-February 14, 2022) were divided into groups based on whether they presented during periods of wild type/alpha, delta, or omicron predominance. They were further subdivided by age (young: 18-40 years; older: more than 40 years), and characteristics and outcomes were compared.
Asian American/Pacific Islanders (AAPIs) and Hispanics are growing minority United States populations, but are poorly represented in the cardiovascular literature. This study examines guideline adherence and outcomes in AAPIs and Hispanics compared with non-Hispanic Whites (NHWs) in a quaternary care center after inpatient percutaneous coronary intervention (PCI). The primary end points were inpatient post-PCI bleed, heart failure, cardiogenic shock, and all-cause mortality, whereas the secondary end point was the prescription rate of post-PCI guideline-directed medical therapy including aspirin, statins, P2Y receptor blockers, and cardiopulmonary rehabilitation.
View Article and Find Full Text PDFBackground: The burden of heart failure is growing. Guideline-directed medical therapies (GDMT) reduce adverse outcomes in heart failure with reduced ejection fraction (HFrEF). Whether there is geographic variation in HFrEF quality of care is not well described.
View Article and Find Full Text PDFBackground: Heart failure is a prevailing diagnosis of hospitalization and readmission within 6 months, and nearly a quarter of these patients die within a year. Guideline-directed medication therapies reduce risk of mortality by 73% over 2 years; however, the implementation of these therapies to their target dose in clinical practice continues to be challenging. In 2020, the Veterans Affairs (VA) Health Care System developed a HF dashboard to monitor and improve outpatient HF management.
View Article and Find Full Text PDFObjective: To evaluate the adoption and discontinuation of four broadly used non-pharmaceutical interventions on shifts in the covid-19 burden among US states.
Design: Retrospective, observational cohort study.
Setting: US state data on covid-19 between 19 January 2020 and 7 March 2021.
Background: Heart failure with reduced ejection fraction (HFrEF) is one of the most costly and deadly chronic disease states. The cost effectiveness of a comprehensive quadruple therapy regimen for HFrEF has not been studied.
Objectives: The authors sought to determine the cost-effectiveness of quadruple therapy comprised of beta-blockers, mineralocorticoid receptor antagonists, angiotensin receptor-neprilysin inhibitors, and sodium glucose cotransporter-2 inhibitors vs regimens composed of only beta-blockers, angiotensin-converting enzyme inhibitors, and mineralocorticoid receptor antagonists (triple therapy), and angiotensin-converting enzyme inhibitors and beta-blockers (double therapy).