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Dayoub EJ, Nathan AS, Khatana SAM, Wadhera RK, Kolansky DM, Yeh RW, Giri J, Groeneveld PW. Trends in Coded Indications for Percutaneous Coronary Interventions in Medicare and the Veterans Affairs After Implementation of Hospital-Level Reporting of Appropriate Use Criteria. Circ Cardiovasc Qual Outcomes 2021; 14:e006887. [PMID: 33719490 DOI: 10.1161/circoutcomes.120.006887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In 2009, the American College of Cardiology and American Heart Association published Appropriate Use Criteria for Coronary Revascularization (AUC) to aid patient selection for percutaneous coronary intervention (PCI). The subsequent decline in inappropriate PCIs was interpreted as a success of AUC. However, there are concerns clinicians reclassify nonacute PCIs to acute indications to fulfill AUC. METHODS A longitudinal, observational difference-in-differences analysis was performed using administrative claims from US Department of Veterans Affairs (VA) beneficiaries coenrolled in Medicare and from a national random sample of Medicare beneficiaries, undergoing PCI from September 30, 2009, to December 31, 2013. Non-VA hospitals participating in the American College of Cardiology CathPCI registry began receiving AUC reports in 2011, while VA hospitals did not receive reports, serving as quasiexperimental and control cohorts, respectively. We measured the proportion of PCIs coded for acute myocardial infarction, unstable angina, and nonacute coronary syndrome indications by quarter. RESULTS There were 87 464 and 30 251 PCIs performed in the Medicare and VA cohorts, respectively. In Medicare, proportion of PCIs coded for acute myocardial infarction and unstable angina changed from 31.9% and 12.6% in quarter 4 2009 to 41.0% and 10.5% in quarter 4 2013, an associated 2.00% (95% CI, 1.56%-2.44%; P<0.001) increase per year in PCIs coded for acute coronary syndrome indications. In the VA, proportion of PCIs coded for acute myocardial infarction and unstable angina changed from 26.5% and 15.7% in quarter 4 2009 to 34.3% and 12.3% in quarter 4 2013, an associated 1.20% (95% CI, 0.56%-1.88%; P=0.001) increase per year in PCIs coded for acute coronary syndrome indications. Difference-in-differences modeling found no statistically significant change in PCI coded for acute indications between Medicare and VA, pre- and post-AUC reporting. CONCLUSIONS After introduction of AUC assessments and reporting, we observed comparable increases in coding for acute myocardial infarction and corresponding decreases in coding for unstable angina and nonacute coronary syndrome indications among national cohorts of Medicare and VA enrollees. The provision of appropriate use reporting did not appear to have a substantial impact on the proportion of PCIs coded for acute indications during this study period.
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Affiliation(s)
- Elias J Dayoub
- Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (E.J.D., J.G., P.W.G.).,Center for Cardiovascular Outcomes, Quality, and Evaluative Research (E.J.D., A.S.N., S.A.M.K., J.G., P.W.G.), University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics (E.J.D., A.S.N., S.A.M.K., J.G., P.W.G.), University of Pennsylvania, Philadelphia.,Division of Cardiovascular Medicine (E.J.D., A.S.N., S.A.M.K., D.M.K., J.G.), Hospital of the University of Pennsylvania, Philadelphia.,Department of Medicine (E.J.D., A.S.N., S.A.M.K., D.M.K., J.G., P.W.G.), Hospital of the University of Pennsylvania, Philadelphia
| | - Ashwin S Nathan
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research (E.J.D., A.S.N., S.A.M.K., J.G., P.W.G.), University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics (E.J.D., A.S.N., S.A.M.K., J.G., P.W.G.), University of Pennsylvania, Philadelphia.,Division of Cardiovascular Medicine (E.J.D., A.S.N., S.A.M.K., D.M.K., J.G.), Hospital of the University of Pennsylvania, Philadelphia.,Department of Medicine (E.J.D., A.S.N., S.A.M.K., D.M.K., J.G., P.W.G.), Hospital of the University of Pennsylvania, Philadelphia
| | - Sameed Ahmed M Khatana
- Center for Cardiovascular Outcomes, Quality, and Evaluative Research (E.J.D., A.S.N., S.A.M.K., J.G., P.W.G.), University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics (E.J.D., A.S.N., S.A.M.K., J.G., P.W.G.), University of Pennsylvania, Philadelphia.,Division of Cardiovascular Medicine (E.J.D., A.S.N., S.A.M.K., D.M.K., J.G.), Hospital of the University of Pennsylvania, Philadelphia.,Department of Medicine (E.J.D., A.S.N., S.A.M.K., D.M.K., J.G., P.W.G.), Hospital of the University of Pennsylvania, Philadelphia
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.K.W., R.W.Y.)
| | - Daniel M Kolansky
- Division of Cardiovascular Medicine (E.J.D., A.S.N., S.A.M.K., D.M.K., J.G.), Hospital of the University of Pennsylvania, Philadelphia.,Department of Medicine (E.J.D., A.S.N., S.A.M.K., D.M.K., J.G., P.W.G.), Hospital of the University of Pennsylvania, Philadelphia
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.K.W., R.W.Y.)
| | - Jay Giri
- Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (E.J.D., J.G., P.W.G.).,Center for Cardiovascular Outcomes, Quality, and Evaluative Research (E.J.D., A.S.N., S.A.M.K., J.G., P.W.G.), University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics (E.J.D., A.S.N., S.A.M.K., J.G., P.W.G.), University of Pennsylvania, Philadelphia.,Division of Cardiovascular Medicine (E.J.D., A.S.N., S.A.M.K., D.M.K., J.G.), Hospital of the University of Pennsylvania, Philadelphia.,Department of Medicine (E.J.D., A.S.N., S.A.M.K., D.M.K., J.G., P.W.G.), Hospital of the University of Pennsylvania, Philadelphia
| | - Peter W Groeneveld
- Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (E.J.D., J.G., P.W.G.).,Center for Cardiovascular Outcomes, Quality, and Evaluative Research (E.J.D., A.S.N., S.A.M.K., J.G., P.W.G.), University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics (E.J.D., A.S.N., S.A.M.K., J.G., P.W.G.), University of Pennsylvania, Philadelphia.,Department of Medicine (E.J.D., A.S.N., S.A.M.K., D.M.K., J.G., P.W.G.), Hospital of the University of Pennsylvania, Philadelphia
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Bengtsson B, Askling J, Ludvigsson JF, Hagström H. Validity of administrative codes associated with cirrhosis in Sweden. Scand J Gastroenterol 2020; 55:1205-1210. [PMID: 32960654 DOI: 10.1080/00365521.2020.1820566] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Although cirrhosisis a major cause of liver-related mortality globally, validation studies of the administrative coding for diagnoses associated with cirrhosis are scarce. We aimed to determine the validity of the International Classification of Diseases, 10th revision (ICD-10) codes corresponding to cirrhosis and its complications in the Swedish National Patient Register (NPR). METHODS We randomly selected 750 patients with ICD codes for either alcohol-related cirrhosis (K70.3), unspecified cirrhosis (K74.6) oesophageal varices (I85.0/I85.9), hepatocellular carcinoma (HCC, C22.0) or ascites (R18.9) registered in the NPR from 72 healthcare centres in 2000-2016. Hospitalisation events and outpatient visits in specialised care were included. Positive predictive values (PPVs) were calculated using the information in the patient charts as the gold standard. RESULTS Complete data were obtained for 630 (of 750) patients (84%). For alcohol-related cirrhosis, 126/136 cases were correctly coded, corresponding to a PPV of 93% (95% confidence interval, 95%CI: 87-96). The PPV for cirrhosis with unspecified aetiology was 91% (121/133, 95%CI: 85-95) and 96% for oesophageal varices (118/123, 95%CI: 91-99). The PPV was lower for HCC, 84% (91/109, 95%CI: 75-90). The PPV for liver-related ascites was low, 43% (56/129, 95%CI: 35-52), as this category often consisted of non-hepatic ascites. When combining the ascites code with a code for chronic liver disease, the PPV for liver-related ascites increased to 93% (50/54, 95%CI: 82-98). CONCLUSIONS The validity of ICD-10 codes for cirrhosis, oesophageal varices and HCC is high. However, coding for ascites should be combined with a code of chronic liver disease to have an acceptable validity.
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Affiliation(s)
- Bonnie Bengtsson
- Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden.,Unit of Gastroenterology and Rheumatology, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Johan Askling
- Rheumatology, Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden.,Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Hannes Hagström
- Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden.,Unit of Gastroenterology and Rheumatology, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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Guo S, Wu J, Zhou W, Liu X, Zhang J, Jia S, Meng Z, Liu S, Ni M, Liu Y. Investigating the multi-target pharmacological mechanism of danhong injection acting on unstable angina by combined network pharmacology and molecular docking. BMC Complement Med Ther 2020; 20:66. [PMID: 32122353 PMCID: PMC7076845 DOI: 10.1186/s12906-020-2853-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/11/2020] [Indexed: 02/06/2023] Open
Abstract
Background Danhong injection (DHI), which is one of the most well-known Traditional Chinese Medicine (TCM) injections, widely used to treat unstable angina (UA). However, its underlying pharmacological mechanisms need to be further clarified. Methods In the present study, network pharmacology was adopted. Firstly, the relative compounds were obtained by a wide-scaled literatures-mining and potential targets of these compounds by target fishing were collected. Then, we built the UA target database by DisGeNET, DigSee, TTD, OMIM. Based on data, protein-protein interaction (PPI) analysis, GO and KEGG pathway enrichment analysis were performed and screen the hub targets by topology. Furthermore, evaluation of the binding potential of key targets and compounds through molecular docking. Results The results showed that 12 ingredients of DHI and 27 putative known therapeutic targets were picked out. By systematic analysis, identified 4 hub targets (TNF, TLR4, NFKB1 and SERPINE1) mainly involved in the complex treating effects associated with coagulation and hemostasis, cell membrane region, platelet alpha granule, NF-kappa B signaling pathway and TNF signaling pathway. Conclusion The results of this study preliminarily explained the potential targets and signaling pathways of DHI in the treatment of UA, which may help to laid a good foundation for experimental research and further clinical application.
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Affiliation(s)
- Siyu Guo
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 of North Three-ring East Road, Chao Yang District, Beijing, China
| | - Jiarui Wu
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 of North Three-ring East Road, Chao Yang District, Beijing, China.
| | - Wei Zhou
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 of North Three-ring East Road, Chao Yang District, Beijing, China
| | - Xinkui Liu
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 of North Three-ring East Road, Chao Yang District, Beijing, China
| | - Jingyuan Zhang
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 of North Three-ring East Road, Chao Yang District, Beijing, China
| | - Shanshan Jia
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 of North Three-ring East Road, Chao Yang District, Beijing, China
| | - Ziqi Meng
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 of North Three-ring East Road, Chao Yang District, Beijing, China
| | - Shuyu Liu
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 of North Three-ring East Road, Chao Yang District, Beijing, China
| | - Mengwei Ni
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 of North Three-ring East Road, Chao Yang District, Beijing, China
| | - Yingying Liu
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 of North Three-ring East Road, Chao Yang District, Beijing, China
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The Feasibility and Safety of Same-Day Discharge for All Comers after Elective Percutaneous Coronary Interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:588-591. [PMID: 31767522 DOI: 10.1016/j.carrev.2019.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/28/2019] [Accepted: 09/30/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The safety of same day discharge (SDD) after percutaneous coronary interventions (PCI) has been demonstrated in several studies. However, SDD was only allowed in patients meeting strict criteria. We aimed to evaluate the feasibility and safety of SDD following elective-PCI in all comers. METHODS In 2012, we implemented a strategy of SDD for all elective PCI (no exclusion) but admissions were allowed at the discretion of the treating physician. We assessed the feasibility and safety of this approach in consecutive patients who underwent elective PCI at WVU. RESULTS Out of 3355 patients who underwent PCI between 2012 and 2016, 691 (21%) presented electively. Radial access was utilized in 480 (69.5%). Same day discharge was achieved in 539/691 (78%), and there was no difference between patients who had SDD and those who were admitted with regards to the 30-day major adverse cardiovascular and cerebrovascular events (3.2% vs. 3.5% respectively, P = 0.195). Predictors of SDD failure were procedural complications (OR 12.08, 95%CI 2.20-57.8. P = 0.002), use of Glycoprotein IIB-IIIA inhibitors (OR 3.45, 95%CI 1.067-11.41, P = 0.039), femoral access (OR 2.067, 95%CI 1.25-3.419, p = 0.005), anemia (OR 1.80, 95%CI 1.06-3.04, P = 0.029), home distance ≥60 miles (OR 1.68, 95%CI 1.03-2.72, P = 0.037). CONCLUSION SDD is feasible in the majority of all-comers after elective PCI, and is not associated with increase in adverse events at 30-days. Certain procedural and patient's characteristics predict SDD failure. If validated in prospective studies, these factors can possibly be integrated in a predictive tool to aid in triaging patients, post-elective PCI.
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Goyal N, Herrick JS, Son S, Metz TD, Shah RU. Maternal cardiovascular complications at the time of delivery and subsequent re-hospitalization in the USA, 2010-16. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 7:304-311. [PMID: 31626292 DOI: 10.1093/ehjqcco/qcz056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/24/2019] [Accepted: 10/09/2019] [Indexed: 11/13/2022]
Abstract
AIMS Cardiovascular (CV) complications are the leading cause of maternal morbidity and mortality. The objective was to estimate trends in the incidence of peripartum CV complications in the USA between 2010 and 2016. METHODS AND RESULTS This was a retrospective analyses using data from the Healthcare Cost and Utilization Project. We included women with delivery codes consistent with delivery, weighted to a national estimate. The primary outcome was the age-adjusted incidence of CV complications among all deliveries, including complications that occurred during re-hospitalizations. Complications were identified using International Classification of Diseases (ICD) codes. Joinpoint regression was used to evaluate time trends and complications were stratified by type. The secondary outcome was in-hospital maternal death among women with a CV complication. We identified a weighted estimate of 27 408 652 women hospitalized for delivery from 2010 to 2016. Including all years, the complication incidence was 7.36/1000 births [95% confidence interval (CI) 7.18-7.54], with an estimated annual percentage change of 5.8% (95% CI 3.7-7.8%). Cardiac dysrhythmia was the most common complication [3.98/1000 births (95% CI 3.88-4.08)] and acute myocardial infarction was the least common complication [0.11/1000 births (95% CI 0.10-0.11)]. The incidence of hypertension, acute myocardial infarction, and cardiac arrest increased over time, the incidence of congestive heart failure and acute cerebrovascular disease remained stable, the incidence of pulmonary heart disease increased from 2015 onward, and the incidence of cardiac dysrhythmia decreased in 2016. Complications during re-hospitalization accounted for 13.6% (95% CI 13.2-14.1%) of all complications and was highest for acute myocardial infarction [28.1% (95% CI 23.2-33.1)]. Among women with any complication, the mortality rate was 1.20 (95% CI 1.11-1.29) per 100 complications. CONCLUSION Our analyses suggest the rate of peripartum CV complications are increasing in the USA, which highlights the need for active efforts in research and prevention.
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Affiliation(s)
- Noopur Goyal
- Department of Internal Medicine, University of Utah School of Medicine, 30 N Medical Dr Rm 4c104, Salt Lake City, UT 84132, USA
| | - Jennifer S Herrick
- Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way Rm 1n400, Salt Lake City, UT 84108, USA
| | - Shannon Son
- Division of Maternal-Fetal Medicine, University of Utah Health, 30 N Medical Dr Rm 2b200, Salt Lake City, UT 84132, USA
| | - Torri D Metz
- Division of Maternal-Fetal Medicine, University of Utah Health, 30 N Medical Dr Rm 2b200, Salt Lake City, UT 84132, USA
| | - Rashmee U Shah
- Division of Cardiovascular Medicine, University of Utah School of Medicine, 30 N. 1900 E. Room 4A100, Salt Lake City, UT 84132, USA
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