Sandra Tsai

All Publications

• Electronic Health Record Alert to Promote Adoption of Limited Transthoracic Echocardiograms in Primary Care and Cardiology Clinics: A Mixed Methods Evaluation. Circulation. Cardiovascular quality and outcomes Kalwani, N. M., Kling, S. M., Vilendrer, S., Garvert, D. W., Veruttipong, D., Baratta, J., Saliba-Gustafsson, E. A., Levin, E., Gaspar, C., Brown-Johnson, C. G., Tsai, S. A., Winget, M. 2024; 17 (11): e010621

  Abstract

  A limited transthoracic echocardiogram (TTE) can be an appropriate, lower-cost substitute for a full TTE. We assessed the impact of an electronic health record alternative alert promoting the adoption of limited TTEs on the ordering practices of cardiology clinicians and primary care providers and captured their perspectives on the initiative.The alert was deployed in a cardiology clinic and 4 primary care clinics at an academic medical center. The alert provided clinical guidance on the appropriate use of limited TTEs when a clinician selected a full TTE order. We used logistic regression to estimate the change in the proportion of limited versus full TTEs ordered between the baseline and intervention periods in clinics with and without the alert. We also conducted interviews with 24 clinicians (5 cardiologists and 19 primary care providers) to identify implementation barriers and facilitators.Cardiology clinicians ordered 10 654 and 3761 TTEs during the baseline and intervention periods, respectively, for 9100 patients. Primary care providers ordered 723 and 617 TTEs during the baseline and intervention periods for 1273 patients. The model estimated that the percentage of limited TTEs ordered increased by 16.1±2.3 percentage points (P<0.0001) in the cardiology clinic with the alert and by 13.2±1.5 percentage points (P<0.0001) in the primary care clinics with the alert from baseline to post-intervention. Ordering practices did not change in the cardiology (0.7±0.6 percentage points; P=0.24) or primary care (0.7±1.0 percentage points; P=0.52) clinics without the alert. Clinicians viewed the alert as acceptable. Cardiologists appreciated that the alert was concise, whereas primary care providers wanted more information from the alert.An alternative alert providing clinical guidance on the use of limited TTEs at the point of care increased the selection of this lower-cost test in cardiology and primary care clinics. Perspectives on the alert differed between specialists and nonspecialists, highlighting the importance of tailoring intervention design to clinical expertise.

  View details for DOI 10.1161/CIRCOUTCOMES.123.010621

  View details for PubMedID 39561232

• Moving Diabetes Prevention Programs to the Workplace: A Qualitative Exploration of Barriers and Facilitators to Participant Engagement When Implemented by an Employer-Based Clinic. Preventing chronic disease Tsai, S. A., Blacker, A., Shaw, J. G., Brown-Johnson, C. 2024; 21: E83

  Abstract

  The Diabetes Prevention Program (DPP), an effective evidence-based strategy to reduce the incidence of type 2 diabetes, has been widely implemented in various locations, including workplaces. However, most people do not remain engaged in the program for the recommended full year. Limited qualitative research exists around participant engagement in the workplace DPP. Our study aimed to explore participant engagement in the DPP delivered through the employer-based clinic (EBC) at a large technology company.The DPP was implemented through the EBC at a large technology company in Southern California, beginning in September 2019 by using in-person and virtual synchronous group classes before and during the COVID-19 pandemic.Virtual focus groups with DPP participants from 2 inaugural cohorts were conducted via Zoom from October 2020 to February 2021. Data were analyzed by using inductive thematic analysis.Five focus groups with 2 to 3 participants in each (total n = 12) were conducted, 2 focus groups per cohort and 1 focus group with the group instructors. Barriers and facilitators to engagement in the DPP were grouped into thematic domains: Individual Drivers, Small Group Community, Workplace Setting, Integrated EBC, and the COVID-19 Pandemic. Results showed that prepandemic workplace demands (ie, meetings, travel) affected DPP participation, yet the group setting provided social support in the workplace to engage in and maintain healthy habits. With the move to a virtual synchronous offering during the pandemic, participants valued the group setting but expressed a preference for in-person meetings. Collectively, participant engagement was bolstered by shared buy-in and collaboration between the employer and the EBC.Our findings suggest that engagement in a workplace DPP can be supported by addressing workplace-specific barriers and gaining buy-in from employers. Delivering the DPP, in person and virtually, through an EBC has the potential to engage employees who have prediabetes.

  View details for DOI 10.5888/pcd21.240173

  View details for PubMedID 39447322

• Demographic, Clinical, Management, and Outcome Characteristics of 8,004 Young Children With Type 1 Diabetes. Diabetes care Sandy, J. L., Tittel, S. R., Rompicherla, S., Karges, B., James, S., Rioles, N., Zimmerman, A. G., Frohlich-Reiterer, E., Maahs, D. M., Lanzinger, S., Craig, M. E., Ebekozien, O., Australasian Diabetes Data Network (ADDN), T1D Exchanged Quality Improvement Collaborative (T1DX-QI), Prospective Diabetes Follow-Up Registry Initiative (DPV), Craig, M., Colman, P., Glastras, S., Jones, T., Johnson, S., Sinnott, R., Zimmerman, A., Anderson, K., Andrikopoulos, S., Ambler, G., Batch, J., Bergman, P., Brown, J., Cameron, F., Conwell, L., Cotterill, A., Couper, J., Davis, E., de Bock, M., Donaghue, K., Fairchild, J., Fegan, G., Fourlanos, S., Goss, P., Gray, L., Hamblin, S., Hofman, P., Holmes-Walker, D. J., Huynh, T., James, S., Jefferies, C., Kao, J., King, B. R., Lafferty, A., Martin, M., McCrossin, R., Neville, K., Pascoe, M., Paul, R., Pena, A., Phillips, L., Price, D., Rodda, C., Simmons, D., Smart, C., Stone, M., Stranks, S., Tham, E., Ward, G., Wheeler, B., Woodhead, H., Alonso, G. T., DeSalvo, D., Miyazaki, B., Choudhary, A., Clements, M., Majidi, S., Corathers, S., Mucci, A., Hsieh, S., Cossen, K., Gallagher, M. P., Hannon, T., Wolf, R., Bazan, G., Fogel, N., Wilkes, M., Kamboj, M., Sarhis, J., Mekhoubad, A., Accacha, S., Guttmann-Bauman, I., Demeterco-Berggren, C., Malik, F., Roberts, A., Eng, D., Prahalad, P., Izquierdo, R., Crossen, S., Schulmeister, C., Wong, J., Scott, M. L., Jacobsen, L., Sanchez, J., Lee, J., Guarneri, A., Raman, V., Mann, L., Antal, Z., Akturk, H., Steenkamp, D., Rao, P., Vouyiouklis, M., Agarwal, S., Davis, G., Mathioudakis, N., Levy, C., Aleppo, G., Golden, L., Ahmann, A., Lorincz, I., Basina, M., Weinstock, R., Surampudi, P., Kulasa, K., Masharani, U., Vendrame, F., Ng, J., Zupa, M., Herrick, C., Seyoum, B., Fantasia, K., DiGiovanna, M., Haw, S., Ziemer, D., Garg, R., Haft, H., Tsai, S., Gangupantula, G. 2024

  Abstract

  OBJECTIVE: To compare demographic, clinical, and therapeutic characteristics of children with type 1 diabetes age <6 years across three international registries: Diabetes Prospective Follow-Up Registry (DPV; Europe), T1D Exchange Quality Improvement Network (T1DX-QI; U.S.), and Australasian Diabetes Data Network (ADDN; Australasia).RESEARCH DESIGN AND METHODS: An analysis was conducted comparing 2019-2021 prospective registry data from 8,004 children.RESULTS: Mean ± SD ages at diabetes diagnosis were 3.2 ± 1.4 (DPV and ADDN) and 3.7 ± 1.8 years (T1DX-QI). Mean ± SD diabetes durations were 1.4 ± 1.3 (DPV), 1.4 ± 1.6 (T1DX-QI), and 1.5 ± 1.3 years (ADDN). BMI z scores were in the overweight range in 36.2% (DPV), 41.8% (T1DX-QI), and 50.0% (ADDN) of participants. Mean ± SD HbA1c varied among registries: DPV 7.3 ± 0.9% (56 ± 10 mmol/mol), T1DX-QI 8.0 ± 1.4% (64 ± 16 mmol/mol), and ADDN 7.7 ± 1.2% (61 ± 13 mmol/mol). Overall, 37.5% of children achieved the target HbA1c of <7.0% (53 mmol/mol): 43.6% in DPV, 25.5% in T1DX-QI, and 27.5% in ADDN. Use of diabetes technologies such as insulin pump (DPV 86.6%, T1DX 46.6%, and ADDN 39.2%) and continuous glucose monitoring (CGM; DPV 85.1%, T1DX-QI 57.6%, and ADDN 70.5%) varied among registries. Use of hybrid closed-loop (HCL) systems was uncommon (from 0.5% [ADDN] to 6.9% [DPV]).CONCLUSIONS: Across three major registries, more than half of children age <6 years did not achieve the target HbA1c of <7.0% (53 mmol/mol). CGM was used by most participants, whereas insulin pump use varied across registries, and HCL system use was rare. The differences seen in glycemia and use of diabetes technologies among registries require further investigation to determine potential contributing factors and areas to target to improve the care of this vulnerable group.

  View details for DOI 10.2337/dc23-1317

  View details for PubMedID 38305782

• Evaluation of video visit appropriateness for common symptoms seen in primary care: A retrospective cohort study. Journal of telemedicine and telecare Chen, D., Gonzales, E., Winget, M., Shaw, J., Artandi, M., Tsai, S. A., Nelligan, I. 2024: 1357633X231224094

  Abstract

  INTRODUCTION: Little is known about which conditions seen in primary care are appropriate for video visits. This study evaluated video visits compared to office visits for six conditions: abdominal pain, joint pain, back pain, headache, chest pain, and dizziness.METHODS: Six hundred charts of adult patients from our institution's same-day outpatient clinic were reviewed in this study. Charts for video visits evaluating the aforementioned chief complaints that occurred between August and October 2020 were reviewed and compared with charts for office visits that occurred from August to September 2019. Frequencies of 3-week follow-up visits, Emergency Room visits, imaging, and referrals for office and video visits were measured. Reasons for in-person evaluation for patients seen by video were determined by review of clinician notes.RESULTS: Three-week in-person follow-up was more frequent for patients presenting with chest pain (52% vs 18%, p=0.0007) and joint pain (24% vs 8%, p=0.05) after video evaluation, relative to an office evaluation. Three-week in-person follow-up was also more frequent for patients presenting with dizziness (38% vs 28%) and low back pain (24% vs 14%); however, this difference was not statistically significant. Patients presenting with headache and abdominal pain did not have a higher rate of follow-up.DISCUSSION: Based on the frequency of in-person follow-up, this study suggests that video visits are generally adequate for evaluating headache and abdominal pain. Patients with dizziness and chest pain have the highest frequency of in-person and Emergency Room follow-up within 3 weeks when first seen by video compared to other conditions evaluated and may be less suitable for an initial video visit. Institutions can consider these findings when scheduling and providing guidance to patients on what type of visit is most appropriate for their symptoms.

  View details for DOI 10.1177/1357633X231224094

  View details for PubMedID 38254267

• Increasing Awareness and Uptake of Connected Insulin Pens for Eligible Patients With Diabetes: A Quality Improvement Success Story. Clinical diabetes : a publication of the American Diabetes Association He, V. L., Shin, N., Shaghasi, H., Tsai, S. A. 2024; 42 (4): 479-483

  Abstract

  Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article is part of a special article collection from the T1D Exchange Quality Improvement Collaborative. It describes an initiative to increase the use of connected insulin pens in two primary care clinics and one endocrinology clinic serving diverse populations within the Stanford Health Care system in the San Francisco Bay area of California.

  View details for DOI 10.2337/cd24-0055

  View details for PubMedID 39429446

• An initiative to promote value-based stress test selection in primary care and cardiology clinics: A mixed methods evaluation. Journal of evaluation in clinical practice Kling, S. M., Kalwani, N. M., Winget, M., Gupta, K., Saliba-Gustafsson, E. A., Baratta, J., Garvert, D. W., Veruttipong, D., Brown-Johnson, C. G., Vilendrer, S., Gaspar, C., Levin, E., Tsai, S. 2023

  Abstract

  Exercise stress echocardiograms (stress echos) are overused, whereas exercise stress electrocardiograms (stress ECGs) can be an appropriate, lower-cost substitute. In this post hoc, mixed methods evaluation, we assessed an initiative promoting value-based, guideline-concordant ordering practices in primary care (PC) and cardiology clinics.Change in percent of stress ECGs ordered of all exercise stress tests (stress ECGs and echos) was calculated between three periods: baseline (January 2019-February 2020); Period 1 with reduced stress ECG report turnaround time + PC-targeted education (began June 2020); and Period 2 with the addition of electronic health record-based alternative alert (AA) providing point-of-care clinical decision support. The AA was deployed in two of five PC clinics in July 2020, two additional PC clinics in January 2021, and one of four cardiology clinics in February 2021. Nineteen primary care providers (PCPs) and five cardiologists were interviewed in Period 2.Clinicians reported reducing ECG report turnaround time was crucial for adoption. PCPs specifically reported that value-based education helped change their practice. In PC, the percent of stress ECGs ordered increased by 38% ± 6% (SE) (p < 0.0001) from baseline to Period 1. Most PCPs identified the AA as the most impactful initiative, yet stress ECG ordering did not change (6% ± 6%; p = 0.34) between Periods 1 and 2. In contrast, cardiologists reportedly relied on their expertise rather than AAs, yet their stress ECGs orders increased from Period 1 to 2 to a larger degree in the cardiology clinic with the AA (12% ± 5%; p = 0.01) than clinics without the AA (6% ± 2%; p = 0.01). The percent of stress ECGs ordered was higher in Period 2 than baseline for both specialties (both p < 0.0001).This initiative influenced ordering behaviour in PC and cardiology clinics. However, clinicians' perceptions of the initiative varied between specialties and did not always align with the observed behaviour change.

  View details for DOI 10.1111/jep.13896

  View details for PubMedID 37459156

• IMPLEMENTATION OF A TEAM-BASED HYPERTENSION CARE PROGRAM IN THE ERA OF TELEMEDICINE Phadke, A., Tsai, S. A., Sattler, A., Dang, J., Ramirez, M. SPRINGER. 2023: S635-S636

  View details for Web of Science ID 001043057202356

• Testing the Appropriateness of Diabetes Prevention and Care Information Given by the Online Conversational AI ChatGPT. Clinical diabetes : a publication of the American Diabetes Association Hong, J., Kikuta, N. T., Simos, A., Tsai, S., Lin, B., Rodriguez, F., Palaniappan, L. 2023; 41 (4): 549-552

  View details for DOI 10.2337/cd23-0026

  View details for PubMedID 37849522

  View details for PubMedCentralID PMC10577494

• Association of Neighborhood Income with Clinical Outcomes Among Pregnant Patients with Cardiac Disease Reproductive Sciences Carland, C., Panelli, D. M., Leonard, S. A., Bryant, E., Sherwin , E. B., Lee, C. J., Levin, E., Jimenez , S., Tremmel, J. A., Tsai , S., Heidenreich , P. A., Bianco , K., Khandelwal , A. 2022

  View details for DOI 10.1007/s43032-022-00978-z

• IT TAKES A VILLAGE: COMPARATIVE ANALYSIS OF STRATEGIES TO IMPROVE PROVIDER ENGAGEMENT FOR WEIGHT MANAGEMENT AT AN ACADEMIC MEDICAL CENTER Shah, S., Lu, C., Tsai, S. A., Reisenberg, A., Calugar, A., Filipowicz, H., Sharp, C., Phadke, A. SPRINGER. 2020: S667–S668

  View details for Web of Science ID 000567143602165

• Bicuspid Aortic Valve and Ascending Aortic Aneurysm in a Twin Pregnancy. JACC. Case reports Bryant, E., Tsai, S., Levin, E., Fleischman, D., Ansari, J., Fischbein, M., Bianco, K., Khandelwal, A. 2020; 2 (1): 96-100

  Abstract

  Bicuspid aortic valve with ascending aortic aneurysm is a common condition encountered in pregnancy. There are limited data on how to manage these patients. To our knowledge, we report the only case of a bicuspid aortic valve and aortic aneurysm with twin gestations. (Level of Difficulty: Intermediate.).

  View details for DOI 10.1016/j.jaccas.2019.12.012

  View details for PubMedID 34316973

• Psychological Distress Among Female Cardiac Patients Presenting to a Women's Heart Health Clinic AMERICAN JOURNAL OF CARDIOLOGY Edwards, K. S., Hekler, A. C., Baum, J., Nejedly, M., Tsai, S., Khandelwal, A., Naderi, S., Hoover, V., Tremmel, J. A. 2019; 123 (12): 2026–30

  View details for DOI 10.1016/j.amjcard.2019.03.029

  View details for Web of Science ID 000472238900022

• Association of triglyceride to HDL cholesterol ratio with cardiometabolic outcomes JOURNAL OF INVESTIGATIVE MEDICINE Yang, M., Rigdon, J., Tsai, S. A. 2019; 67 (3): 663–68

  View details for DOI 10.1136/jim-2018-000869

  View details for Web of Science ID 000471860800003

• Breastfeeding Duration and the Risk of Coronary Artery Disease JOURNAL OF WOMENS HEALTH Rajaei, S., Rigdon, J., Crowe, S., Tremmel, J., Tsai, S., Assimes, T. L. 2019; 28 (1): 30–36

  View details for DOI 10.1089/jwh.2018.6970

  View details for Web of Science ID 000452601000001

• Hypertensive Disorders of Pregnancy. Current atherosclerosis reports Naderi, S., Tsai, S. A., Khandelwal, A. 2017; 19 (3): 15-?

  Abstract

  Although pregnancy-related deaths are rare in the USA, they are on the rise and have more than doubled in the last 20 years. A substantial portion of these deaths are related to cardiovascular disease, specifically hypertensive disorders of pregnancy (HDP). In this review, we will discuss the definitions and proposed pathophysiology of HDP as well as its potential role in cardiovascular morbidity and mortality.Placental hypoperfusion may lead to an imbalance in proangiogenic and antiangiogenic factors, notably an increase in soluble fms-like tyrosine kinsase-1 (sFlt-1), thereby leading to endothelial dysfunction. Progress has been made in terms of determining the factors which lead to preeclampsia. Potential novel biomarkers for predicting preeclampsia risk have been identified through this research. Preeclampsia not only has important implications for the health during pregnancy but also for future cardiovascular risk. However, the exact mechanism by which it increases cardiovascular risk and the degree of risk it portends are yet to be elucidated.

  View details for DOI 10.1007/s11883-017-0648-z

  View details for PubMedID 28229431

• Association of the cardiometabolic staging system with individual engagement and quality of life in the US adult population. Obesity (Silver Spring, Md.) Tsai, S. A., Xiao, L. n., Lv, N. n., Liu, Y. n., Ma, J. n. 2017

  Abstract

  The aim of this study was to examine the relationships of Cardiometabolic Disease Staging (CMDS), a validated five-stage system for assessing risk for diabetes, cardiovascular mortality, and all-cause mortality, with measures of individual engagement and health-related quality of life (HRQOL) in the US adult population.Data from the 2011-2014 National Health and Nutrition Examination Survey were used to derive the CMDS stages, five participant engagement measures, and four HRQOL measures among adult participants ≥ 40 years of age. Analyses accounted for the complex sampling design and sample weights.Higher CMDS was associated with greater participant awareness of cardiometabolic risk, but after adjusting for covariates, only Stage 4 remained significant (odds ratio: 5.08; 95% CI: 3.25, 7.94). Higher CMDS was associated with receiving recommendations to engage in a healthy lifestyle, not meeting 2008 physical activity guidelines, and fewer leisure time moderate activities after controlling for covariates. For HRQOL measures, Stage 4 was associated with a higher likelihood of perceiving health as fair or poor (odds ratio: 4.85; 95% CI: 2.42, 9.73).Higher CMDS was associated with greater individual awareness of risk, less leisure time physical activity, and worse self-rated health. CMDS is a clinically practical method for identifying individuals for targeted preventive strategies.

  View details for PubMedID 28712159

• Impact of a Genetic Risk Score for Coronary Artery Disease on Reducing Cardiovascular Risk: A Pilot Randomized Controlled Study. Frontiers in cardiovascular medicine Knowles, J. W., Zarafshar, S. n., Pavlovic, A. n., Goldstein, B. A., Tsai, S. n., Li, J. n., McConnell, M. V., Absher, D. n., Ashley, E. A., Kiernan, M. n., Ioannidis, J. P., Assimes, T. L. 2017; 4: 53

  Abstract

  We tested whether providing a genetic risk score (GRS) for coronary artery disease (CAD) would serve as a motivator to improve adherence to risk-reducing strategies.We randomized 94 participants with at least moderate risk of CAD to receive standard-of-care with (N = 49) or without (N = 45) their GRS at a subsequent 3-month follow-up visit. Our primary outcome was change in low density lipoprotein cholesterol (LDL-C) between the 3- and 6-month follow-up visits (ΔLDL-C). Secondary outcomes included other CAD risk factors, weight loss, diet, physical activity, risk perceptions, and psychological outcomes. In pre-specified analyses, we examined whether there was a greater motivational effect in participants with a higher GRS.Sixty-five participants completed the protocol including 30 participants in the GRS arm. We found no change in the primary outcome between participants receiving their GRS and standard-of-care participants (ΔLDL-C: -13 vs. -9 mg/dl). Among participants with a higher GRS, we observed modest effects on weight loss and physical activity. All other secondary outcomes were not significantly different, including anxiety and worry.Adding GRS to standard-of-care did not change lipids, adherence, or psychological outcomes. Potential modest benefits in weight loss and physical activity for participants with high GRS need to be validated in larger trials.

  View details for PubMedID 28856136

• Gender Differences in Weight-Related Attitudes and Behaviors Among Overweight and Obese Adults in the United States. American journal of men's health Tsai, S. A., Lv, N., Xiao, L., Ma, J. 2016; 10 (5): 389-398

  Abstract

  Few studies have used nationally representative data to focus specifically on gender differences in weight-related outcomes. This article examines gender differences in weight-related outcomes across the body mass index (BMI) spectrum in overweight and obese adults. Data from the National Health and Nutrition Examination Survey 2009-2010 was analyzed. Weight-related outcomes were accurate weight perception, weight dissatisfaction, attempted weight loss, successful weight loss, and weight loss strategies. Compared with women, overweight and obese men were less likely to have accurate weight perception (odds ratio [OR] = 0.36; 95% confidence interval [CI] = 0.30-0.44), weight dissatisfaction (OR = 0.39; 95% CI = 0.32-0.47), and attempted weight loss (OR = 0.55; 95% CI = 0.48-0.63). The modifying effect of gender on these associations decreased as BMI increased. By BMI 35, the mean probability of women and men to have accurate weight perception and weight dissatisfaction was 90%; attempted weight loss was 60% (women) and 50% (men). At lower BMIs, men had up to 40% less probability than women for these weight loss outcomes. Men who attempted weight loss were more likely than women to lose and maintain ≥10 lb over 1 year (OR = 1.41; 95% CI = 1.20-1.65) and increase exercise and eat less fat as weight loss strategies; women were more likely to join weight loss programs, take prescription diet pills, and follow special diets. A need exists for male-specific interventions to improve overweight and obese men's likelihood for accurate weight perception, attempted weight loss, and ultimately, successful weight loss.

  View details for DOI 10.1177/1557988314567223

  View details for PubMedID 25595019

• Cardiovascular Disease Prevention in Prevention Practice in Primary Care Tsai, S. A., Ravenell, J., Fernandez, S., Schoenthaler, A., Kenny, K., Ogedegbe, G. edited by Gorin, S. S. Oxford University Press. 2014: 120–149
• Trends in menopausal hormone therapy use of US office-based physicians, 2000-2009 MENOPAUSE-THE JOURNAL OF THE NORTH AMERICAN MENOPAUSE SOCIETY Tsai, S. A., Stefanick, M. L., Stafford, R. S. 2011; 18 (4): 385-392

  Abstract

  The aim of this study was to evaluate recent trends and the adoption of practice recommendations for menopausal hormone therapy (MHT) use from 2001 to 2009 by formulation, dose, woman's age, and characteristics of physicians reporting MHT visits.The IMS Health (Plymouth Meeting PA) National Disease and Therapeutic Index physician survey data from 2001 to 2009 were analyzed for visits in which MHT use was reported by US office-based physicians. Estimated national volume of visits for which MHT use was reported.MHT use declined each year since 2002. Systemic MHT use fell from 16.3 million (M) visits in 2001 to 6.1 M visits in 2009. Declines were greatest for women 60 years or older (64%) but were also substantial for women younger than 50 years (59%) and women 50 to 59 years old (60%). Women 60 years or older accounted for 37% of MHT use. Lower dose product use increased modestly, from 0.7 M (2001) to 1.3 M (2009), as did vaginal MHT use, from 1.8 M (2001) to 2.4 M (2009). Declines in continuing systemic MHT use (65%) were greater than for newly initiated MHT use (51%). Compared with other physicians, obstetrician/gynecologists changed their practices less, thereby increasing their overall share of total MHT visits from 72% (2001) to 82% (2009).Total MHT use has steadily declined. Increased use of lower dose and vaginal products reflects clinical recommendations. Uptake of these products, however, has been modest, and substantial use of MHT continues in older women.

  View details for DOI 10.1097/gme.0b013e3181f43404

  View details for Web of Science ID 000288781800009

  View details for PubMedID 21127439

  View details for PubMedCentralID PMC3123410