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Ciccarone Articles

Ciccarone Center Research

Topic

Quality of Care

Landmark Articles

A community-engaged cardiovascular health disparities research training curriculum: Implementation and preliminary outcomes.
By: Golden SH, Purnell T, Halbert J, Matens R, Miller ER, Levine D, Nguyen TH, Gudzune KA, Crews DC, Mahlangu-Ngcobo M, Cooper LA.
This manuscript summarizes the key elements, implementation, and preliminary outcomes of the CVD Disparities Fellowship and Summer Internship Programs at the Johns Hopkins University Schools of Medicine, Nursing, and Bloomberg School of Public Health.
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A clinician’s guide to the updated ABCs of cardiovascular disease prevention.
By: Kohli P, Whelton SP, Hsu S, Yancy CW, Stone NJ, Chrispin J, Gilotra NA, Houston B, Ashen MD, Martin SS, Joshi PH, McEvoy JW, Gluckman TJ, Michos ED, Blaha MJ, Blumenthal RS.

To facilitate the guideline-based implementation of treatment recommendations in the ambulatory setting and to encourage participation in the multiple preventive health efforts that exist, we have organized several recent guideline updates into a simple ABCDEF approach. We would remind clinicians that evidence-based medicine is meant to inform recommendations but that synthesis of patient-specific data and use of appropriate clinical judgment in each individual situation is ultimately preferred.

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Troponin elevations only detected with a high-sensitivity assay: Clinical correlations and prognostic significance.
By: Korley FK, Schulman SP, Sokoll LJ, DeFilippis AP, Stolbach AI, Bayram JD, Saheed MO, Omron R, Fernandez C, Lwin A, Cai SS, Post WS, Jaffe AS.

With clinical use of high-sensitivity troponin I (hsTnI), more frequent troponin elevations will occur. However, the burden and implications of these elevations are not well understood. The authors quantified the prevalence of elevated hsTnI in patients presenting with possible acute coronary syndrome (ACS) who do not have elevated troponin with a current generation assay (cardiac troponin I [cTnI]) and determined the association of these newly detected elevations with a composite of all-cause mortality and subsequent cardiac hospitalization. On the initial sample, 9% to 11% of subjects without cTnI elevation had hsTnI elevation. Although the majority of the patients with these newly detected hsTnI elevations did not have ACS, they had a higher risk for all-cause mortality and subsequent cardiac hospitalization.

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The turing test and a call to action to improve electronic health record documentation.
By: McEvoy JW.

Clinical informatics represents arguably the most significant advance in medicine since the deciphering of the human genome. In particular, as the “front end” of the clinical informatics revolution, the electronic health record has immense potential to transform modern healthcare. Demonstrated benefits of the electronic health record include decision support, adverse event tracking, and quality control.1 An additional strength of the electronic health record is an inherent capacity to augment research, including embedded, randomized, controlled clinical trials.

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Impact of a pharmacy-based glucose management program on glycemic control in an inpatient general medicine population.
By: Efird LE, Golden SH, Visram K, Shermock K.
This study found no global benefit of the pharmacy-based glucose management program for improving blood glucose values compared with usual care.
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Polypill therapy, subclinical atherosclerosis, and cardiovascular events — implications for the use of preventive pharmacotherapy: MESA (Multi-Ethnic Study of Atherosclerosis).
By: Bittencourt MS, Blaha MJ, Blankstein R, Budoff M, Vargas JD, Blumenthal RS, Agatston AS, Nasir K.
The authors conclude that avoidance of polypill therapy in individuals with subclinical atherosclerosis could allow for a more selective use of the treatment and, as a result, avoidance of treatment in those who are unlikely to benefit.
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A systematic review of internet-based worksite wellness approaches for cardiovascular disease risk management: outcomes, challenges and opportunities.
By: Aneni EC, Roberson LL, Maziak W, Agatston AS, Feldman T, Rouseff M, Tran TH, Blumenthal RS, Blaha MJ, Blankstein R, Al-Mallah MH, Budoff MJ, Nasir K.
Internet-based programs hold promise for improving the cardiovascular wellness among employees. However, much work is required to fully understand its utility and long-term impact, especially in special/at-risk populations.
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Development of a center for prevention of cardiovascular disease.
By: Ashen MD, Nell-Dybdahl CL, Sperling L, Blumenthal RS.
We discuss the key components of various types of preventive cardiology centers that can be put together in academic and private practice settings.
Pathways to quality inpatient management of hyperglycemia and diabetes: A call to action.
By: Draznin B, Gilden J, Golden SH, Inzucchi SE; PRIDE investigators.
This paper outlines eight aspects of inpatient glucose management (four as system-based issues and four as patient-based issues) in which randomized clinical trials are needed, and urges further progress in the science of inpatient diabetes management.
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A clinician’s guide to the ABCs of cardiovascular disease prevention: The Johns Hopkins Ciccarone Center for the prevention of Heart Disease and American College of Cardiology Cardiosource approach to the Million Hearts Initiative.
By: Hsu S, Ton VK, Ashen MD, Martin SS, Gluckman TJ, Kohli P, Sisson SD, Blumenthal RS, Blaha MJ.
As part of an initiative that aims to prevent 1 million myocardial infarctions and strokes over the next 5 years, we present the simply organized “ABCDE” approach for guiding a consistent comprehensive approach to managing cardiovascular risk in daily clinical practice. We summarize recommendations related to each topic and reference landmark trials and data that support our approach.
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