Racial Differences in Device-Detected Incident Atrial Fibrillation.

Background: Prior research suggests Black individuals have a lower risk of atrial fibrillation (AF) than White individuals, but this may be related to the underdetection of AF. Whether this trend persists using highly sensitive methods of AF diagnosis has not been well-studied.

Objectives: The objective of this study was to use cardiac implantable electronic devices (CIEDs) capable of AF diagnosis to compare AF incidence between Black and White individuals.

Using Atrial Fibrillation Burden Trends and Machine Learning to Predict Near-Term Risk of Cardiovascular Hospitalization.

Background: Atrial fibrillation is associated with an increased risk of cardiovascular hospitalization (CVH), which may be triggered by changes in daily burden. Machine learning of dynamic trends in atrial fibrillation burden, as measured by insertable cardiac monitors (ICMs), may be useful in predicting near-term CVH.

Methods: Using Optum's deidentified Clinformatics Data Mart Database (2007-2019), linked with the Medtronic CareLink ICM database, we identified patients with >1 days of ICM-detected atrial fibrillation.

Performance of Atrial Fibrillation Burden Trends for Stroke Risk Stratification.

Background: Atrial fibrillation (AF) is associated with an increased risk of stroke, yet the limitations of conventional monitoring have restricted our understanding of AF burden risk thresholds. Predictive algorithms incorporating continuous AF burden measures may be useful for predicting stroke. This study evaluated the performance of temporal AF burden trends as predictors of stroke from a large cohort with insertable cardiac monitors.

Association of Atrial Fibrillation Burden and Mortality Among Patients With Cardiac Implantable Electronic Devices.

Background: Current estimates of atrial fibrillation (AF)-associated mortality rely on claims- or clinical-derived diagnoses of AF, limit AF to a binary entity, or are confounded by comorbidities. The objective of the present study is to assess the association between device-recognized AF and mortality among patients with cardiac implantable electronic devices capable of sensitive and continuous atrial arrhythmia detection. Secondary outcomes include relative mortality among cohorts with no AF, paroxysmal AF, persistent AF, and permanent AF.

Mortality Benefit Among Primary Prevention Implantable Cardioverter-Defibrillator Recipients on Contemporary Heart Failure Treatment.

Background: Past clinical trials have shown the benefit of implantable cardioverter-defibrillators (ICDs) for reducing sudden cardiac death in at-risk patients. However, heart failure management and ICD technology have changed since these trials were first published. An updated assessment of ICD mortality benefit is needed.

Impact of Atrial Fibrillation Burden on Health Care Costs and Utilization.

Background: Integrating patient-specific cardiac implantable electronic device (CIED)-detected atrial fibrillation (AF) burden with measures of health care cost and utilization allows for an accurate assessment of the AF-related impact on health care use.

Objectives: The goal of this study was to assess the incremental cost of device-recognized AF vs no AF; compare relative costs of paroxysmal atrial fibrillation (pAF), persistent atrial fibrillation (PeAF), and permanent atrial fibrillation (PermAF) AF; and evaluate rates and sources of health care utilization between cohorts.

Methods: Using the de-identified Optum Clinformatics U.

Impact of atrial fibrillation ablation on activity minutes in patients with cardiac implantable electronic devices.

Background: Impaired quality of life due to atrial fibrillation (AF), which often includes decreased activity level, is an indication for ablation. However, the impact of ablation for AF on activity is poorly understood.

Objective: The purpose of this study was to assess the impact of ablation on activity minutes per day using continuous accelerometer data from cardiac implantable electronic devices (CIEDs).

Guideline-directed device therapies in heart failure: A clinical practice-based analysis using electronic health record data.

Background: Guideline-directed device therapies (GDDT) improve outcomes for eligible patients with heart failure (HF) with reduced ejection fraction (HFrEF). Utilization rates of device therapies in HFrEF after the 2012 ACCF/AHA/HRS Focused Update for Device-based Therapies of Cardiac Rhythm Abnormalities have not been well studied.

Objective: Characterize the use of GDDT in newly indicated HFrEF patients from 2012 to 2019 using aggregated electronic health record (EHR) data.

Guideline-concordant-phenotyping: Identifying patient indications for implantable cardioverter defibrillators from electronic health records.

Background: Implantable cardioverter-defibrillators (ICDs) have been shown to reduce sudden cardiac death in appropriately selected patients, but they remain underutilized among indicated patients.

Objective: To develop a new approach to identifying guideline indications among patients implanted with ICDs by creating algorithms that extract data from electronic health records (EHR).

Methods: Published guidelines providing recommendations for ICD use were distilled into categories of diagnoses, measures, procedures, and terminologies.

Integrated, Accountable Care For Medicaid Expansion Enrollees: A Comparative Evaluation of Hennepin Health.

Hennepin Health, a Medicaid accountable care organization, began serving early expansion enrollees (very low-income childless adults) in 2012. It uses an integrated care model to address social and behavioral needs. We compared health care utilization in Hennepin Health with other Medicaid managed care in the same area from 2012 to 2014, controlling for demographics, chronic conditions, and enrollment patterns.

Identifying Homeless Medicaid Enrollees Using Enrollment Addresses.

Objective: To design and test the validity of a method to identify homelessness among Medicaid enrollees using mailing address data.

Data Sources/study Setting: Enrollment and claims data on Medicaid expansion enrollees in Hennepin and Ramsey counties who also provided self-reported information on their current housing situation in a psychosocial needs assessment.

Study Design: Construction of address-based indicators and comparison with self-report data.

Medicaid expansion and mental health: A Minnesota case study.

Introduction: The health status and psychosocial needs of the Medicaid expansion population have been estimated but not measured. This population includes childless adults predicted to have high rates of mental illness, especially among the homeless. Given limitations in access to mental health services, it is unclear how prepared the U.

Hennepin Health: a safety-net accountable care organization for the expanded Medicaid population.

Health care payment and delivery models that challenge providers to be accountable for outcomes have fueled interest in community-level partnerships that address the behavioral, social, and economic determinants of health. We describe how Hennepin Health--a county-based safety-net accountable care organization in Minnesota--has forged such a partnership to redesign the health care workforce and improve the coordination of the physical, behavioral, social, and economic dimensions of care for an expanded community of Medicaid beneficiaries. Early outcomes suggest that the program has had an impact in shifting care from hospitals to outpatient settings.

Outbreaks of enteric infections caused by multiple pathogens associated with calves at a farm day camp.

Background: Transmission of enteric pathogens at venues where the public contacts farm animals is a growing problem, particularly among children. In 2000 and again in 2001, enteric illness outbreaks caused by multiple pathogens occurred at a farm day camp for children in Minnesota.

Methods: Camp attendees were interviewed about illness history and potential exposures each year.

Trends in population-based active surveillance for shigellosis and demographic variability in FoodNet sites, 1996-1999.

Shigella is a common cause of diarrhea in the United States, and accurate surveillance is needed to determine the burden of illness that they cause. Active surveillance for culture-confirmed Shigella infection was done as part of the Foodborne Diseases Active Surveillance Network (FoodNet). A total of 4317 cases of shigellosis were reported during 1996-1999 in the original FoodNet surveillance areas.