Yongfei Wang

• MS
• Yale University

BACKGROUND In-hospital mortality risk prediction is an important tool for benchmarking quality and patient prognostication. Given changes in patient characteristics and treatments over time, a contemporary risk model for patients with acute myocardial infarction (MI) is needed. METHODS Data from 313 825 acute MI hospitalizations between January 20...

Background: Administrative claims data are increasingly used for post-marketing surveillance of drugs and medical devices, though data reliability remains uncertain. Given their associated morbidity and mortality, stroke events are particularly important to monitor for cardiovascular therapies such as transcatheter left atrial appendage occlusion (...

Objective To determine the feasibility of integrating Medicare Advantage (MA) admissions into the Centers for Medicare & Medicaid Services (CMS) hospital outcome measures through combining Medicare Advantage Organization (MAO) encounter‐ and hospital‐submitted inpatient claims. Data Sources and Study Setting Beneficiary enrollment data and inpatie...

Importance Medicare Advantage (MA) enrollment is rapidly expanding, yet Centers for Medicare & Medicaid Services (CMS) claims-based hospital outcome measures, including readmission rates, have historically included only fee-for-service (FFS) beneficiaries. Objective To assess the outcomes of incorporating MA data into the CMS claims-based FFS Hosp...

Objectives The extent to which care quality influenced outcomes for patients hospitalised with COVID-19 is unknown. Our objective was to determine if prepandemic hospital quality is associated with mortality among Medicare patients hospitalised with COVID-19. Design This is a retrospective observational study. We calculated hospital-level risk-sta...

Introduction: While the ACC NCDR CathPCI registry has long provided risk-adjusted benchmarking of in-hospital mortality after percutaneous coronary intervention (PCI), extending follow-up to 30 days in those who are discharged can provide a more comprehensive assessment of post-PCI outcomes. Aims: We sought to develop a new model for predicting in-...

Background: We assess the rates of device use and outcomes by race among patients undergoing lower extremity peripheral arterial intervention using the American College of Cardiology National Cardiovascular Data Registry-Peripheral Vascular Intervention (PVI) registry. Methods: Patients who underwent PVI between April 2014 and March 2019 were in...

Background: The impact of preprocedure imaging on the safety and effectiveness of left atrial appendage occlusion (LAAO) remains unclear. Objectives: This study sought to determine the rates of use of preprocedure computed tomography (CT)/cardiac magnetic resonance (CMR) and its association with safety and effectiveness of LAAO procedures. Meth...

Background Chronic total occlusion (CTO) percutaneous coronary interventions (PCIs) represent 4% of all PCIs for stable angina in the United States and have been associated with lower success and higher in-hospital event rates compared with non-CTO PCIs. We aimed to examine long-term outcomes of CTO PCI compared with non-CTO PCI, including prespeci...

Introduction: Pre-procedure cardiac computed tomography (CT) or magnetic resonance imaging (MRI) prior to percutaneous left atrial appendage occlusion (LAAO) has many theoretical benefits but data on its association with periprocedural safety and effectiveness is limited. Hypothesis: Pre-procedure imaging has the potential to improve the safety and...

Objective Older, relatively small studies identified female sex as a risk factor for adverse events after catheter ablation for atrial fibrillation (AF). We aimed to assess contemporary sex-based differences in baseline and procedural characteristics, adverse events, and quality of life among adults undergoing catheter ablation for AF. Methods In...

BACKGROUND The Food and Drug Administration approved left atrial appendage occlusion with the Watchman device for patients who are at increased stroke risk and are suitable for oral anticoagulation but who have an appropriate reason to seek a nondrug alternative. These broad criteria raise the question of their interpretation in clinical practice....

Background Clinical events committee(CEC) evaluation is the standard approach for endpoint adjudication in clinical trials. Due to resource constraints, large registries typically rely on site-reported endpoints without further confirmation, which may preclude use for regulatory oversight. Methods We developed a novel automated adjudication algori...

Background As patients derive variable benefit from generator changes (GCs) of implantable cardioverter‐defibrillators (ICDs) with an original primary prevention (PP) indication, better predictors of outcomes are needed. Methods and Results In the National Cardiovascular Data Registry ICD Registry, patients undergoing GCs of initial non‐cardiac re...

Background We aimed to characterize the occurrence of major adverse cardiovascular and limb events (MACE and MALE) among patients with peripheral artery disease (PAD) undergoing peripheral vascular intervention (PVI), as well as associated factors in patients with chronic limb threatening ischemia (CLTI). Methods and Results Patients undergoing PV...

Objectives The aim of this study was to compare outcomes among patients from the PROTECT-AF (WATCHMAN Left Atrial Appendage System for Embolic PROTECTion in Patients With Atrial Fibrillation) and PREVAIL (Evaluation of the WATCHMAN Left Atrial Appendage [LAA] Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy) lef...

Background Pivotal trials of percutaneous left atrial appendage occlusion (LAAO) used specific postprocedure treatment protocols. Objectives This study sought to evaluate patterns of postprocedure care after LAAO with the Watchman device in clinical practice and compare the risk of adverse events for different discharge antithrombotic strategies....

Importance: Limited data exist regarding the characteristics of hospitals that do and do not participate in voluntary public reporting programs. Objective: To describe hospital characteristics and trends associated with early participation in the American College of Cardiology (ACC) voluntary reporting program for cardiac catheterization-percuta...

Background Implantable cardioverter-defibrillators (ICDs) are recommended for patients with cardiac sarcoidosis (CS) with an indication for pacing, prior ventricular arrhythmias, cardiac arrest, or LVEF <35%, but data on outcomes are limited. Methods Using data from the NCDR ICD Registry between April 1, 2010 and December 31, 2015, we evaluated a...

Background : The Medtronic Sprint Fidelis® and Abbott Riata®/Riata ST® leads are at risk of failure and are subject to FDA recall. Comparative risks of various lead management strategies during elective generator change in a multi-center population are unknown. We aim to describe patients with functional, recalled ICD leads undergoing elective gene...

Background Prior studies on the use of multivessel percutaneous coronary intervention (MV PCI) for patients with ST-segment–elevation myocardial infarction (STEMI) and multivessel coronary artery disease have yielded heterogeneous results. The recent COMPLETE trial (Complete Versus Culprit-Only Revascularization Strategies to Treat Multivessel Dise...

Background Standardization of risk is critical in benchmarking and quality improvement efforts for percutaneous coronary interventions (PCI). In 2018, the CathPCI Registry was updated to include additional variables to better classify higher-risk patients. Objectives We sought to develop a model for predicting in-hospital mortality risk following...

Objectives To develop a model of in-hospital mortality using medical record front page (MRFP) data and assess its validity in case-mix standardisation by comparison with a model developed using the complete medical record data. Design A nationally representative retrospective study. Setting Representative hospitals in China, covering 161 hospital...

Objectives This study analyzed the predictors of defibrillation safety margin (DSM) testing at the time of implantable cardioverter-defibrillator (ICD) insertion and factors associated with inadequate DSM in patients with congenital heart disease (CHD). Background There are few data about the prevalence and safety of DSM testing in those with CHD....

Background Coronary artery bypass graft (CABG) surgery is a focus of bundled and alternate payment models that capture outcomes up to 90 days postsurgery. While clinical registry risk models perform well, measures encompassing mortality beyond 30 days do not currently exist. We aimed to develop a risk-adjusted hospital-level 90-day all-cause mortal...

Background : The connection between paclitaxel-coated devices (PCD) use during peripheral vascular interventions (PVI) and mortality is debated. We aimed to analyze patterns of PCD use and the safety and effectiveness of PCD use in the superficial femoral and/or popliteal arteries. Methods : Patients undergoing PVI of femoropopliteal lesions with...

Introduction: Left atrial appendage occlusion (LAAO) has emerged as an alternative to anticoagulation in select patients with atrial fibrillation (AF), however women are underrepresented in trial data and sex-specific sub analyses are limited. Hypothesis: Women will be more likely than men to experience adverse events following left atrial appenda...

Introduction: Whether to reuse, abandon, or extract functioning, recalled ICD leads at the time of generator replacement is an area of uncertainty as lead failure is more common following generator replacement, and long term failure rates of recalled ICD leads are unknown. We sought to evaluate outcomes following various lead management strategies...

Introduction: Left atrial appendage occlusion (LAAO) has emerged as an alternative to anticoagulation in select patients with atrial fibrillation (AF), however women are underrepresented in trial data and sex-specific sub analyses are limited. Hypothesis: Women will be more likely than men to experience adverse events following left atrial appendag...

Importance: After disparate results from observational and small randomized studies, the COMPLETE trial demonstrated superiority of multivessel (MV) percutaneous coronary intervention (PCI) over culprit-only PCI for ST-elevation myocardial infarction (STEMI). Objective: To describe temporal trends and institutional variation of MV PCI use for ST...

Importance: Little is known about the association between industry payments and medical device selection. Objective: To examine the association between payments from device manufacturers to physicians and device selection for patients undergoing first-time implantation of a cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-de...

Background Outcomes data in patients with cardiac amyloidosis after implantable cardioverter‐defibrillator (ICD) implantation are limited. We compared outcomes of patients with ICDs implanted for cardiac amyloidosis versus nonischemic cardiomyopathies (NICMs) and evaluated factors associated with mortality among patients with cardiac amyloidosis....

Importance Cardiogenic shock after acute myocardial infarction (AMI) is associated with high mortality, particularly among patients with multivessel coronary artery disease. Recent evidence suggests that use of multivessel percutaneous coronary intervention (PCI) may be associated with harm. However, little is known about recent patterns of care an...

Background: To estimate, prior to finalization of claims, the national monthly numbers of admissions and rates of 30-day readmissions and post-discharge observation-stays for Medicare fee-for-service beneficiaries hospitalized with acute myocardial infarction (AMI), heart failure (HF), or pneumonia. Methods: The centers for Medicare & Medicaid S...

To the Editor The recently published Original Investigation by Wadhera and colleagues¹ uses a flag for homelessness in State Inpatient Databases of New York, Florida, and Massachusetts from 2010 through 2015 to study quality of care and outcomes of homeless adults with acute cardiovascular conditions. Cardiovascular conditions among homeless person...

Background: Although increased age is associated with higher systolic blood pressure (SBP) in general, there may be variation across individuals in how SBP changes over time. The goal of this paper is to identify heterogeneity in SBP trajectories among young adults with similar initial values and identify personal characteristics associated with d...

Background Cardiac resynchronization therapy with defibrillator (CRT-D) implantation involves left ventricular (LV) lead placement for biventricular pacing and is more complex than implantable cardioverter-defibrillator (ICD)-only implantation. Differences in the prescription of CRT-D versus ICD may result from clinician biases based on patient bod...

Background: Readmission rates after acute myocardial infarction (AMI) and heart failure (HF) hospitalizations have decreased in the United States since the implementation of the Hospital Readmissions Reduction Program. Objectives: This study was designed to examine the temporal trends of readmission and mortality after AMI and HF in Ontario, Can...

Background: There are little data about the prevalence and safety of DFT testing in pediatric populations. We analyzed the predictors and outcomes of defibrillation threshold (DFT) testing at the time of implantable cardioverter-defibrillator (ICD) implant and factors associated with inadequate defibrillation safety margin (DSM) in pediatric patie...

Objectives To determine whether patients discharged after hospital admissions for conditions covered by national readmission programs who received care in emergency departments or observation units but were not readmitted within 30 days had an increased risk of death and to evaluate temporal trends in post-discharge acute care utilization in inpati...

Background: Patients with heart failure having a low expected probability of arrhythmic death may not benefit from implantable cardioverter defibrillators (ICDs). Objective: The objective was to validate models to identify cardiac resynchronization therapy (CRT) candidates who may not require CRT devices with ICD functionality. Methods: Heart...

Importance Some uncertainty exists about whether hospital variations in cost are largely associated with differences in case mix. Objective To establish whether the same patients admitted with the same diagnosis (heart failure or pneumonia) at 2 different hospitals incur different costs associated with the hospital’s Medicare payment profile. Des...

Background: There is conflicting evidence about whether the Hospital Readmission Reduction Program (HRRP) is associated with an increase in mortality. Methods: In a cohort of Medicare beneficiaries hospitalized with heart failure (HF), we compared two published approaches to evaluating the association of HRRP and risk-adjusted 30-day mortality, inc...

Background: The evaluation of trends in patient outcomes requires adjustment for the changes in case-mix over time and, thus, could be influenced by the expansion of code slots on inpatient claims that occurred in January 2011. We tested the hypothesis that the changes in code slots caused an artifactual increase in the case mix over time compared...

Importance Defibrillation testing (DFT) is performed during implantable cardioverter-defibrillator (ICD) implantation to assess the capacity of the device to detect and terminate ventricular arrhythmias. However, DFT can result in complications and omission of its use has been shown to be safe. Objective To describe temporal trends and variation i...

Background: With incentives to reduce readmission rates, there are concerns that patients who need hospitalization after a recent hospital discharge may be denied access, which would increase their risk of mortality. Objective: We determined whether patients with hospitalizations for conditions covered by national readmission programs who received...

Background: The Hospital Readmissions Reduction Program (HRRP) has been associated with reduced 30-day readmissions for acute myocardial infarction (AMI) and heart failure (HF). Objectives: The purpose of this study was to test whether this 30-day readmission reduction is a manifestation of practices that defer or avoid hospitalizations beyond t...

Aims: The prognosis of patients with MINOCA (myocardial infarction with non-obstructive coronary arteries) is poorly understood. We examined major adverse cardiac events (MACE) defined as all-cause mortality, re-hospitalization for acute myocardial infarction (AMI), heart failure (HF), or stroke 12-months post-AMI in patients with MINOCA versus AM...

Background Patients undergoing implantable cardioverter-defibrillator (ICD) implantations have high rates of long-term device-related complications and reoperations. Whether physician specialty training is associated with differences in long-term outcomes following ICD implantation is unclear. Methods and Results We linked data from the National C...

Background Despite improvements on individual process of care measures for acute myocardial infarction (AMI), little is known about performance on a composite measure of AMI care that assesses the delivery of many components of high-quality AMI care. We sought to examine trends in patient- and hospital-level performance on a composite defect-free c...

Objective To propose and evaluate a metric for quantifying hospital‐specific disparities in health outcomes that can be used by patients and hospitals. Data Sources/Study Setting Inpatient admissions for Medicare patients with acute myocardial infarction, heart failure, or pneumonia to all non‐federal, short‐term, acute care hospitals during 2012‐...

Importance Despite a rapid increase in percutaneous coronary intervention (PCI) procedures in China, little is known about patient-reported health status before and after PCI in patients without acute myocardial infarction (AMI). Objective To describe self-perceived angina-specific health status prior to PCI and 1 year after the procedure in patie...

Background The current acute kidney injury (AKI) risk prediction model for patients undergoing percutaneous coronary intervention (PCI) from the American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) employed regression techniques. This study aimed to evaluate whether models using machine learning techniques could signifi...

Set A variables (N = 20) and feature engineering in strategy A during preprocessing. (DOCX)

Variable-selection results from set B variables (N = 32) from 100 experiments. (DOCX)

Prediction accuracy of the baseline model (Model 1) and XGBoost model (Model 8) for low- and high-risk subgroups of patients. XGBoost, extreme gradient boost. (DOCX)

Patient characteristics for the development cohort and the contemporary cohort. (DOCX)

Summary of data used for building model or recalibration and performance of updated model from Model 1 (baseline model) and the Model 8 (XGBoost model) for 4 different strategies. XGBoost, extreme gradient boost. (DOCX)

Analysis flow for evaluating previously developed prediction models on a more contemporary cohort. (DOCX)

Performance comparison with 95% CIs of the updated models via 4 strategies in the AUC, reliability, resolution, and Brier score from Model 1 (baseline model) and Model 8 (XGBoost model). AUC, area under the receiver operating characteristics curve; CI, confidence interval; XGBoost, extreme gradient boost. (DOCX)

Candidate variables (N = 50). Models were developed both without and with race and ethnicity variables. (DOCX)

Set B variables (N = 32) and feature engineering in strategy B during preprocessing. (DOCX)

Patient characteristics for the cohort used in developing the models. (DOCX)

Variable-selection results from set A variables (N = 20) from 100 experiments. (DOCX)

Flowchart of study participants for (A) the development cohort for the main analysis and (B) the contemporary cohort for temporal validation. PCI, percutaneous coronary intervention. (DOCX)

Illustration of reliability and resolution metrics. The x-axes of the points are the deciles of predicted risks, and the y-axes of the points are the observed event rate of the patients in each decile. (DOCX)

TRIPOD Checklist. TRIPOD, transparent reporting of a multivariable prediction model for individual prognosis or diagnosis. (DOCX)

Background: Some patients with heart failure (HF) experience recovery of left ventricular (LV) systolic function by the end of their implantable cardioverter-defibrillator (ICD) generator battery life. Outcomes following generator replacement in this setting are poorly understood. Objective: We sought to describe outcomes following ICD generator...

Importance The US Hospital Readmissions Reduction Program (HRRP) was associated with reduced readmissions among Medicare beneficiaries hospitalized for acute myocardial infarction (AMI), heart failure (HF), and pneumonia. It is important to assess whether there has been a signal for concomitant harm with an increase in mortality. Objective To eval...

Importance Although studies have described differences in hospital outcomes by patient race and socioeconomic status, it is not clear whether such disparities are driven by hospitals themselves or by broader systemic effects. Objective To determine patterns of racial and socioeconomic disparities in outcomes within and between hospitals for patien...

Background: Temporal changes in the readmission rates for patient groups and conditions that were not directly under the purview of the Hospital Readmissions Reduction Program (HRRP) can help assess whether efforts to lower readmissions extended beyond targeted patients and conditions. Methods: Using the Nationwide Readmissions Database (2010-20...

Background: Hospital readmission rates are publicly reported by the Centers for Medicare & Medicaid Services (CMS); however, the implications of emergency department (ED) visits following hospital discharge on readmissions are uncertain. We describe the frequency, diagnoses, and hospital-level variation in ED visitation following hospital discharg...

Background Amid national efforts to improve the quality of care for people with cardiovascular disease in China, the use of traditional Chinese medicine (TCM) is increasing, yet little is known about its use in the early management of acute myocardial infarction (AMI). Methods and Results We aimed to examine intravenous use of TCM within the first...

Background: Whether types of hospitals with high readmission rates also have high overall postdischarge acute care utilization (including emergency department and observation care) is unknown. Design: Cross-sectional analysis. Subjects: Nonfederal United States acute care hospitals. Measures: Using methodology established by the Centers for...

Objectives: This study was designed to examine the association between adopting the transradial approach for percutaneous coronary intervention (PCI) and rates of vascular complications following transfemoral PCI. Background: Recent studies raised concerns that operators adopting the transradial approach may lose their transfemoral access skills...

Background: In response to urban-rural disparities in healthcare resources, China recently launched a healthcare reform with a focus on improving rural care during the past decade. However, nationally representative studies comparing medical care and patient outcomes between urban and rural areas in China during this period are not available. Met...

Background and purpose: The Centers for Medicare & Medicaid Services publicly reports a hospital-level stroke mortality measure that lacks stroke severity risk adjustment. Our objective was to describe novel measures of stroke mortality suitable for public reporting that incorporate stroke severity into risk adjustment. Methods: We linked data f...

Background: Publicly reported hospital risk-standardized mortality rates (RSMRs) for acute myocardial infarction (AMI) are calculated for Medicare beneficiaries. Outcomes for older patients with AMI may not reflect general outcomes. Objective: To examine the relationship between hospital 30-day RSMRs for older patients (aged ≥65 years) and those...

Patients with childhood heart disease are living longer, entering adulthood, and may undergo implantable cardioverter -defibrillator (ICD) implantation to reduce the risk of sudden death. We evaluated the characteristics of adult patients with congenital heart disease (CHD) or left ventricular non-compaction cardiomyopathy (LVNC) in the National Ca...

Aims: ST-segment elevation myocardial infarctions (STEMI) in China and other low- and middle-income countries outnumber non-ST-segment elevation myocardial infarctions (NSTEMI). We hypothesized that the STEMI predominance was associated with lower biomarker use and would vary with hospital characteristics. Methods and results: We hypothesized th...

Importance The Affordable Care Act has led to US national reductions in hospital 30-day readmission rates for heart failure (HF), acute myocardial infarction (AMI), and pneumonia. Whether readmission reductions have had the unintended consequence of increasing mortality after hospitalization is unknown. Objective To examine the correlation of pair...

Appendix S1. China PEACE‐Retrospective AMI Study Site Investigators by Hospital. Data S1. Definition of ideal patients used to compute process measures. Data S2. For the international comparison, we first determined whether there were publicly available quality measures for hospitals in the United States that corresponded to the 6 process measure...

Background China has gaps in the quality of care provided to patients with ST‐elevation myocardial infarction, but little is known about how quality varies between hospitals. Methods and Results Using nationally representative data from the China PEACE‐Retrospective AMI Study, we characterized the quality of care for ST‐elevation myocardial infarc...

Background: Recent clinical trials highlight the need for better models to identify patients at higher risk of sudden death. Objectives: The authors hypothesized that the Seattle Heart Failure Model (SHFM) for overall survival and the Seattle Proportional Risk Model (SPRM) for proportional risk of sudden death, including death from ventricular a...

Background: It is unknown if financial pressures to reduce hospital readmission rates following passage of the Affordable Care Act (ACA) have had the unintended effect of increasing mortality rates after hospitalization. We therefore examined correlations between paired changes in hospital 30-day readmission rates and 30-day mortality rates among M...

Introduction: Despite a dramatic increase in the incidence of acute myocardial infarction (AMI) in China, little is known about patient’s health status in the year following discharge. We studied the change in angina frequency and angina-related quality of life at 1 year after AMI among Chinese patients. Methods: Among 3,336 patients admitted for A...