RESEARCH

The overall objective of this study is to provide real world evidence on the incidence of adverse effects of antihypertensive medications.

The overall objective of this study is to determine whether having an ambulatory blood pressure that is substantially lower than clinic blood pressure as well has having large fluctuations or labile out-of-clinic blood pressure over 24-hours and with meals is associated with an increased risk of falls among older adults with hypertension and taking antihypertensive medication.

The main goal of this study is to use state of the art approaches to identify relevant genes based on a very large sample of patients with Obstructive Sleep Apnea (OSA), a common disorder with multiple adverse consequences. It is known that OSA has a genetic basis, but to date no convincing gene variants have been identified. This study uses OSA obtained from multiple institutions in the United States. It is the largest study ever proposed for identifying genes for this common sleep disorder.

The aim of this cohort is to assess the risk of cardiovascular disease associated with endocrine treatments for breast cancer.

KPSC is one of nine sites throughout the country funded by an Innovation Award from the Centers of Medicare and Medicaid to implement a coordinated care model for depressed patients with cardiovascular disease. We have the following goals for this project: 1. To implement in three stages a multiple condition collaborative care management model in primary care clinics of care systems in states. 2. To demonstrate that this model improves care quality, patient experience and health, provider satisfaction, and total healthcare costs for the Medicare and Medicaid patients with the targeted conditions. 3. To develop role descriptions and training for the two new types of workers required for this model – care managers and care consultants. 4. To identify the costs and payment models needed by care systems to sustain and spread this care model.

Despite advances in heart failure (HF) care, there is a poor prognosis for adults with HF. Reduced ejection fraction (EF) is a central factor in HF; however, there are no safe medical therapies to directly improve cardiac function in these patients. Compared to the general population, HF patients have more hospitalizations and emergency department visits. Additionally, adherence to standard of care cardiovascular therapies among patients having HF with reduced EF (HFrEF) is poor. The GALACTIC-HF (Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure) clinical trial is testing the hypotheses that omecamtiv mecarbil can safely improve symptoms, prevent clinical HF events, and delay cardiovascular death in patients with HF. The goal of this retrospective study is to describe a contemporary population of patients with HFrEF similar to that included in the GALACTIC-HF trial using real-world data.

The primary goal of this study is to assess the impact of specific glucose-lowering strategies on cardiovascular events and on mortality in order to identify whether some glucose-lowering strategies confer more cardiovascular benefit than others.

The overall goal of this study is to provide real-world estimates of the incidence of angioedema among both HF patients initiating sacubitril/valsartan and HF patients initiating an ACEI, with a primary focus on Black patients.

The goals of this pilot project are to develop a chronic kidney disease (CKD) discordance index defined by the presence of chronic conditions and treatments that oppose, contradict, or complicate CKD treatment or worsen kidney function in a subsample of CKD patients from KPSC

High blood pressure can be missed in patients who do not have regular visits with their primary care provider. The goal of the present project is to estimate the efficacy of blood pressure assessments in specialty clinics. We will compare recognition, follow-up, and time-to-treatment between patients first recognized in specialty care to those in primary care.

To evaluate a remote blood pressure monitoring (RBPM) program to identify facilitators and barriers to RBPM and ultimately identify opportunities to improve the effectiveness, acceptability, appropriateness, and scalability of the program to lead to better hypertension management in the Kaiser Permanente Southern California hypertension population.

The overall goal of this study is to identify optimal treatment strategies to reduce the impact of cardiovascular disease complications in HIV-infected patients, focusing on the understudied diagnosis of heart failure

The purpose of this program is to establish a collaborative CVRN among 15 member plans of the HMO Research Network to create a unique national resource that leverages the network’s CV expertise, diverse community-based study populations, and rich electronic data systems.

Healthcare providers must balance the cardiovascular benefits of blood pressure lowering medication with the potential risk for falls among older adults with hypertension. Blood pressure has traditionally been measured in the clinic setting; however, for many people, blood pressure differs when measured inside versus outside of the clinic setting. The proposed study will determine whether self-measured blood pressure by a person in their home, a procedure called home blood pressure monitoring, is useful for identifying older adults taking antihypertensive medication who are at increased risk for falls.

The overall goal of this study is to identify the associations of the in-utero cardio-metabolic milieu with young adult cardiovascular health and subclinical cardiovascular disease in offspring, and to investigate whether DNA methylation mediates these associations.

About 20% of US young adults have high blood pressure (BP), however, the optimal BP screening and treatment strategies in young adults are unknown. Many young adults are not aware of their high BP, and are not recommended for BP lowering medication, partly due to the lack of evidence. The overall goal of this study is to determine the optimal BP screening intervals and identify subgroups of young adults with high cardiovascular risk who may benefit most from BP lowering medications.

The goal of this study is to compare three evidence-based approaches for blood pressure measurement: office blood pressure measurement, 24-hour ambulatory blood pressure monitoring and home blood pressure monitoring to determine the best approach for blood pressure measurement for both the diagnosis and management of hypertension.

Given the high risk of ASCVD among patients with LDL-C = 190 mg/dL, it is important to improve the rate of prescribing statins to such patients, improving medication adherence to statins, and ultimately lowering cholesterol and subsequently ASCVD risk in these patients. This study aims to quantify the prevalence of primary non-adherence to statins among patients with very high LDL-C, and to identify facilitators and barriers to statin initiation and follow-up labs to identify opportunities for care improvement. We also aim to identify whether the SureNet program is effective and equitable and whether there are opportunities for improvement.

The overall goal of this study is to characterize the clinical utility of ZIO® Patch monitoring vs. other monitoring strategies by linking ZIO® Patch data on arrhythmia burden and timing to detailed clinical information.

The overall goal of this study is to examine longitudinal LLT utilization patterns, including evaluating trajectories of LLT adherence, LLT switching, titration, and discontinuation in high risk patients who can benefit from primary or secondary prevention with LLT.

The overall objective of this project is to identify the direct oral anticoagulant care model(s) that maximize(s) (1) safety (major bleeding), (2) effectiveness (stroke), and (3) cost.

Evaluating the effect of treating mild-to-moderate hypertension in pregnancy, compare the risks of clinically important outcomes with different medications, and determine whether the benefits and risks vary by maternal race/ethnicity or obesity status.

Heart failure (HF) is the most common reason for hospitalization in older adults. Over 85% of all patients hospitalized with HF are 65 years of age or older. Multimorbidity, usually defined as the presence of two or more chronic conditions, greatly increases the risk of hospitalization and mortality among older HF patients. In addition, the presence of multiple chronic conditions can greatly complicate the management of HF, especially with regard to pharmacotherapeutic decision-making. The overall goal of this study is to evaluate the effectiveness and safety of common treatments for patients with HF and multimorbidity—individuals who have been traditionally excluded from clinical trials.

The current US atherosclerotic cardiovascular disease (ASCVD) risk prediction tools are limited by failing to include data on social determinants of health (SDOH) and important US ethnic groups. The overall goal of this project is to improve ASCVD risk assessment for both primary and secondary prevention by drawing from more contemporary data sources. Results of this study will improve lipid-lowering therapy use and may reduce health inequities.

Atrial fibrillation affects ~25% of patients with kidney disease and is associated with poor clinical outcomes. It remains unknown whether standard therapies for atrial fibrillation are effective and safe in patients with chronic kidney disease. The overall goal of this proposal to study the receipt, safety and efficacy of medications and procedures used in the treatment of atrial fibrillation in patients with kidney disease.

The major goals of this project was to develop a collaboration of population-based researchers as well as a research platform using a contemporary cohort of about 40,000 adults with atrial fibrillation to improve comparative effectiveness studies, risk stratification of outcomes and the planning and conduct of future observational studies and randomized trials for atrial fibrillation.

The aims of this study are (1) to ascertain prevalent diabetes cases in calendar year 2017 among youth age <20 years at diagnosis, using cost-efficient approaches that maximize use of information in the electronic health records (EHRs) and administrative databases, (2) to continue to ascertain newly diagnosed (incident 2015-2020) diabetes cases in youth age <20 years, using cost-efficient approaches that maximize use of EHRs and administrative databases, (3) to determine agreement between the etiological classification of diabetes type using biochemical markers and provider assessment; to describe selected clinical characteristics at diagnosis, and to establish an infrastructure that facilitates the development of more detailed ancillary studies by storing biological samples and preserving contact with potential study participants, and (4) To optimize efficiency of SEARCH surveillance activities through targeted Development and Validation (D&V) Projects designed to utilize electronic health data to operationalize each of the three tiers of surveillance to the extent possible. (1U18 DP006133)

The objective of the trial is to evaluate the effectiveness of systematic testing and treatment of reduced iron stores vs. usual care on the risk of hospitalization in older patients with heart failure and previously unexplained anemia. The goal of the pilot study is to determine the feasibility of conducting the full trial.

The aim of this cohort study is to examine how combined breast cancer adjuvant therapies affect the risk of developing early and late cardiovascular disease. Results will be used to develop risk prediction models to inform clinical decision-making to optimize cancer control while mitigating cardiovascular disease risk.

The goal of this study is to examine the long-term development of complications over the course of type 2 diabetes and estimate the incidence of complications including cardiovascular disease, chronic kidney disease, end-stage renal disease, neuropathy, diabetic retinopathy to inform strategies to reduce the burden of type 2 diabetes complications.

The major goal of this project is to assemble and characterize an analytic cohort of Kaiser Permanente Southern California members with incident critical limb ischemia (CLI) and to determine the rate of statin utilization and statin intensity among patients with CLI over time.

The overall objective of this study is to understand the relationship between statin use, changes in BMI and lifestyle behaviors that impact cardiovascular health.

The overall goal of this study is to determine the association of elections with the incidence of cardiovascular events and deaths from acute cardiovascular causes.

The overall goal of this project is to provide information on the benefits and harms comparing different treatment options for the extended treatment of VTE, information that can be used by clinicians and patients in deciding on the optimal treatment strategy.
COVID-19-Related Project Enhancement
Recent studies have reported that COVID-19 is associated with abnormal coagulation profiles and may predispose patients to VTE and other types of thrombotic events. The goals of this study are to determine the risk of VTE following COVID-19 hospitalization and whether the risk of post-hospitalization VTE varies by age, prior history of VTE or severity of COVID-19.

The overall goal of this non-interventional study is to analyze the economic impact of triglyceride lowering and to determine whether this differs among patients who did and did not receive therapy to intentionally lower triglycerides.

The overall goals of this project are to describe the demographic and clinical characteristics of patients with moderately elevated triglycerides and to calculate the burden of disease in this cohort.

The major goal of this project is to examine recent trends in incidence of hospitalized myocardial infarction among members in the Kaiser Permanente Southern California region aged 35 years and older.
COVID-19-Related Project Enhancement
National surveillance data from the U.S. Centers for Disease Control and Prevention suggest a decline in emergency department visits during the Covid-19 pandemic. The goal of this study is to understand the impact of the stay-at-home orders on health care utilization and delays in care for acute myocardial infarction during the Covid-19 pandemic.

The overall objective of this study is to examine trends and patterns of lipid screening and statin utilization from 2009 to 2015.