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Nakao K, Dafaalla M, Nakao YM, Wu J, Nadarajah R, Rashid M, Mohammad H, Sumita Y, Nakai M, Iwanaga Y, Miyamoto Y, Noguchi T, Yasuda S, Ogawa H, Mamas MA, Gale CP. Comparison of care and outcomes for myocardial infarction by heart failure status between United Kingdom and Japan. ESC Heart Fail 2023; 10:1372-1384. [PMID: 36737048 PMCID: PMC10053358 DOI: 10.1002/ehf2.14290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/23/2022] [Accepted: 12/15/2022] [Indexed: 02/05/2023] Open
Abstract
AIMS Prognosis for ST-segment elevation myocardial infarction (STEMI) is worse when heart failure is present on admission. Understanding clinical practice in different health systems can identify areas for quality improvement initiatives to improve outcomes. In the absence of international comparison studies, we aimed to compare treatments and in-hospital outcomes of patients admitted with ST elevation myocardial infarction (STEMI) by heart failure status in two healthcare-wide cohorts. METHODS AND RESULTS We used two nationwide databases to capture admissions with STEMI in the United Kingdom (Myocardial ischemia National Audit Project, MINAP) and Japan (Japanese Registry of All Cardiac and Vascular Diseases-Diagnostic Procedure Combination, JROAD-DPC) between 2012 and 2017. Participants were stratified using the HF Killip classification into three groups; Killip 1: no congestive heart failure, Killip 2-3: congestive heart failure, Killip 4: cardiogenic shock. We calculated crude rate and case mix standardized risk ratios (CSRR) for use of treatments and in-hospital death. Patients were younger in the United Kingdom (65.4 [13.6] vs. 69.1 [13.0] years) and more likely to have co-morbidities in the United Kingdom except for diabetes and hypertension. Japan had a higher percentage of heart failure and cardiogenic shock patients among STEMI during admission than that in the United Kingdom. Primary percutaneous coronary intervention (pPCI) rates were lower in the United Kingdom compared with Japan, especially for patients presenting with Killip 2-3 class heart failure (pPCI use in patients with Killip 1, 2-3, 4: Japan, 86.2%, 81.7%, 78.7%; United Kingdom, 79.6%, 58.2% and 79.9%). In contrast, beta-blocker use was consistently lower in Japan than in the United Kingdom (61.4% vs. 90.2%) across Killip classifications and length of hospital stay longer (17.0 [9.7] vs. 5.0 [7.4] days). The crude rate of in-hospital mortality increased with increasing Killip class group. Both the crude rate and CSRR was higher in the United Kingdom compared with Japan for Killip 2-3 (15.8% vs. 6.4%, CSRR 1.80 95% CI 1.73-1.87, P < 0.001), and similar for Killip 4 (36.9% vs. 36.3%, CSRR 1.11 95% CI 1.08-1.13, P < 0.001). CONCLUSIONS Important differences in the care and outcomes for STEMI with heart failure exist between the United Kingdom and Japan. Specifically, in the United Kingdom, there was a lower rate of pPCI, and in Japan, fewer patients were prescribed beta blockers and hospital length of stay was longer. This international comparison can inform targeted quality improvement programmes to narrow the outcome gap between health systems.
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Affiliation(s)
- Kazuhiro Nakao
- Leeds Institute for Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
- Leeds Institute of Data AnalyticsUniversity of LeedsLeedsUK
- National Cerebral and Cardiovascular CenterSuitaJapan
| | - Mohamed Dafaalla
- Keele Cardiovascular Research Group, Institute for Prognosis ResearchUniversity of KeeleNewcastle upon TyneUK
| | - Yoko M. Nakao
- Leeds Institute for Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
- Leeds Institute of Data AnalyticsUniversity of LeedsLeedsUK
- National Cerebral and Cardiovascular CenterSuitaJapan
| | - Jianhua Wu
- Leeds Institute for Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
- Leeds Institute of Data AnalyticsUniversity of LeedsLeedsUK
- School of DentistryUniversity of LeedsLeedsUK
| | - Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
- Leeds Institute of Data AnalyticsUniversity of LeedsLeedsUK
- Department of CardiologyLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Institute for Prognosis ResearchUniversity of KeeleNewcastle upon TyneUK
| | - Haris Mohammad
- Leeds Institute for Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
- Leeds Institute of Data AnalyticsUniversity of LeedsLeedsUK
- Department of CardiologyBlackpool Teaching Hospitals NHS TrustBlackpoolUK
| | - Yoko Sumita
- National Cerebral and Cardiovascular CenterSuitaJapan
| | | | | | | | - Teruo Noguchi
- National Cerebral and Cardiovascular CenterSuitaJapan
| | - Satoshi Yasuda
- National Cerebral and Cardiovascular CenterSuitaJapan
- Tohoku University Graduate School of MedicineSendaiJapan
| | | | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Institute for Prognosis ResearchUniversity of KeeleNewcastle upon TyneUK
| | - Chris P. Gale
- Leeds Institute for Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
- Leeds Institute of Data AnalyticsUniversity of LeedsLeedsUK
- Department of CardiologyLeeds Teaching Hospitals NHS TrustLeedsUK
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Kara P, Valentin JB, Mainz J, Johnsen SP. Composite measures of quality of health care: Evidence mapping of methodology and reporting. PLoS One 2022; 17:e0268320. [PMID: 35552561 PMCID: PMC9098058 DOI: 10.1371/journal.pone.0268320] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/27/2022] [Indexed: 11/19/2022] Open
Abstract
Background Quality indicators are used to quantify the quality of care. A large number of quality indicators makes assessment of overall quality difficult, time consuming and impractical. There is consequently an increasing interest for composite measures based on a combination of multiple indicators. Objective To examine the use of different approaches to construct composite measures of quality of care and to assess the use of methodological considerations and justifications. Methods We conducted a literature search on PubMed and EMBASE databases (latest update 1 December 2020). For each publication, we extracted information on the weighting and aggregation methodology that had been used to construct composite indicator(s). Results A total of 2711 publications were identified of which 145 were included after a screening process. Opportunity scoring with equal weights was the most used approach (86/145, 59%) followed by all-or-none scoring (48/145, 33%). Other approaches regarding aggregation or weighting of individual indicators were used in 32 publications (22%). The rationale for selecting a specific type of composite measure was reported in 36 publications (25%), whereas 22 papers (15%) addressed limitations regarding the composite measure. Conclusion Opportunity scoring and all-or-none scoring are the most frequently used approaches when constructing composite measures of quality of care. The attention towards the rationale and limitations of the composite measures appears low. Discussion Considering the widespread use and the potential implications for decision-making of composite measures, a high level of transparency regarding the construction process of the composite and the functionality of the measures is crucial.
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Affiliation(s)
- Pinar Kara
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- * E-mail:
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jan Mainz
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Department for Community Mental Health, University of Haifa, Haifa, Israel
- Department of Health Economics, University of Southern Denmark, Odense, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Yang N, Liu J, Liu J, Hao Y, Huo Y, Smith Jr SC, Ge J, Ma C, Han Y, Fonarow GC, Taubert KA, Morgan L, Zhou M, Xing Y, Zhao D. Performance on management strategies with Class I Recommendation and A Level of Evidence among hospitalized patients with non-ST-segment elevation acute coronary syndrome in China: Findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project. Am Heart J 2019; 212:80-90. [PMID: 30981036 DOI: 10.1016/j.ahj.2019.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/25/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to examine hospital performance on evidence-based management strategies for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and variations across hospitals. METHODS Improving Care for Cardiovascular Disease in China (CCC)-ACS project is an ongoing registry and quality improvement project, with 150 tertiary hospitals recruited across China. We examined hospital performance on nine management strategies (Class I Recommendations with A Level of Evidence) based on established guidelines. We also evaluated the proportion of patients receiving defect-free care, which was defined as the care that included all the required management strategies for which the patient was eligible. The hospital-level variations in the performance were examined. RESULTS From 2014 to 2018, 28,170 NSTE-ACS patients were included. Overall, 16% of patients received defect-free care. Higher-performing metrics were statin at discharge (93%), cardiac troponin measurement (92%), dual antiplatelet therapy (DAPT) within 24 hours (90%), and DAPT at discharge (85%). These were followed by metrics of β-blocker at discharge (69%), angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) at discharge (59%), and risk stratification (56%). Lower-performing metrics were smoking cessation counseling (35%) and percutaneous coronary intervention (PCI) within recommended times (33%). The proportion of patients receiving defect-free care substantially varied across hospitals, ranging from 0% to 58% (Median (interquartile range):12% (7%-21%)). There were large variations across hospitals in performance on risk stratification, smoking cessation counseling, PCI within recommended times, ACEI/ARB at discharge and β-blocker at discharge. CONCLUSIONS About one in six NSTE-ACS patients received defect-free care, and the performance varied across hospitals.
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Sauser Zachrison K, Levine DA, Fonarow GC, Bhatt DL, Cox M, Schulte P, Smith EE, Suter RE, Xian Y, Schwamm LH. Timely Reperfusion in Stroke and Myocardial Infarction Is Not Correlated: An Opportunity for Better Coordination of Acute Care. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003148. [PMID: 28283469 DOI: 10.1161/circoutcomes.116.003148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 02/01/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Timely reperfusion is critical in acute ischemic stroke (AIS) and ST-segment-elevation myocardial infarction (STEMI). The degree to which hospital performance is correlated on emergent STEMI and AIS care is unknown. Primary objective of this study was to determine whether there was a positive correlation between hospital performance on door-to-balloon (D2B) time for STEMI and door-to-needle (DTN) time for AIS, with and without controlling for patient and hospital differences. METHODS AND RESULTS Prospective study of all hospitals in both Get With The Guidelines-Stroke and Get With The Guidelines-Coronary Artery Disease from 2006 to 2009 and treating ≥10 patients. We compared hospital-level DTN time and D2B time using Spearman rank correlation coefficients and hierarchical linear regression modeling. There were 43 hospitals with 1976 AIS and 59 823 STEMI patients. Hospitals' DTN times for AIS did not correlate with D2B times for STEMI (ρ=-0.09; P=0.55). There was no correlation between hospitals' proportion of eligible patients treated within target time windows for AIS and STEMI (median DTN time <60 minutes: 21% [interquartile range, 11-30]; median D2B time <90 minutes: 68% [interquartile range, 62-79]; ρ=-0.14; P=0.36). The lack of correlation between hospitals' DTN and D2B times persisted after risk adjustment. We also correlated hospitals' DTN time and D2B time data from 2013 to 2014 using Get With The Guidelines (DTN time) and Hospital Compare (D2B time). From 2013 to 2014, hospitals' DTN time performance in Get With The Guidelines was not correlated with D2B time performance in Hospital Compare (n=546 hospitals). CONCLUSIONS We found no correlation between hospitals' observed or risk-adjusted DTN and D2B times. Opportunities exist to improve hospitals' performance of time-critical care processes for AIS and STEMI in a coordinated approach.
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Affiliation(s)
- Kori Sauser Zachrison
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.).
| | - Deborah A Levine
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.)
| | - Gregg C Fonarow
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.)
| | - Deepak L Bhatt
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.)
| | - Margueritte Cox
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.)
| | - Phillip Schulte
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.)
| | - Eric E Smith
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.)
| | - Robert E Suter
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.)
| | - Ying Xian
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.)
| | - Lee H Schwamm
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.)
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Maddox TM, Albert NM, Borden WB, Curtis LH, Ferguson TB, Kao DP, Marcus GM, Peterson ED, Redberg R, Rumsfeld JS, Shah ND, Tcheng JE. The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association. Circulation 2017; 135:e826-e857. [DOI: 10.1161/cir.0000000000000480] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The learning healthcare system uses health information technology and the health data infrastructure to apply scientific evidence at the point of clinical care while simultaneously collecting insights from that care to promote innovation in optimal healthcare delivery and to fuel new scientific discovery. To achieve these goals, the learning healthcare system requires systematic redesign of the current healthcare system, focusing on 4 major domains: science and informatics, patient-clinician partnerships, incentives, and development of a continuous learning culture. This scientific statement provides an overview of how these learning healthcare system domains can be realized in cardiovascular disease care. Current cardiovascular disease care innovations in informatics, data uses, patient engagement, continuous learning culture, and incentives are profiled. In addition, recommendations for next steps for the development of a learning healthcare system in cardiovascular care are presented.
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Iqbal J, Serruys PW. Optimal medical therapy is vital for patients with coronary artery disease and acute coronary syndromes regardless of revascularization strategy. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:140. [PMID: 28462220 DOI: 10.21037/atm.2017.02.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Javaid Iqbal
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Patrick W Serruys
- International Centre for Circulatory Health, Imperial College, London, UK
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Hira RS, Bhatt DL, Fonarow GC, Heidenreich PA, Ju C, Virani SS, Bozkurt B, Petersen LA, Hernandez AF, Schwamm LH, Eapen ZJ, Albert MA, Liang L, Matsouaka RA, Peterson ED, Jneid H. Temporal Trends in Care and Outcomes of Patients Receiving Fibrinolytic Therapy Compared to Primary Percutaneous Coronary Intervention: Insights From the Get With The Guidelines Coronary Artery Disease (GWTG-CAD) Registry. J Am Heart Assoc 2016; 5:JAHA.116.004113. [PMID: 27792640 PMCID: PMC5121508 DOI: 10.1161/jaha.116.004113] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Timely reperfusion after ST‐elevation myocardial infarction (STEMI) improves survival. Guidelines recommend primary percutaneous coronary intervention (PPCI) within 90 minutes of arrival at a PCI‐capable hospital. The alternative is fibrinolysis within 30 minutes for those in those for whom timely transfer to a PCI‐capable hospital is not feasible. Methods and Results We identified STEMI patients receiving reperfusion therapy at 229 hospitals participating in the Get With the Guidelines—Coronary Artery Disease (GWTG‐CAD) database (January 1, 2003 through December 31, 2008). Temporal trends in the use of fibrinolysis and PPCI, its timeliness, and in‐hospital mortality outcomes were assessed. We also assessed predictors of fibrinolysis versus PPCI and compliance with performance measures. Defect‐free care was defined as 100% compliance with all performance measures. We identified 29 190 STEMI patients, of whom 2441 (8.4%) received fibrinolysis; 38.2% of these patients achieved door‐to‐needle times ≤30 minutes. Median door‐to‐needle times increased from 36 to 60 minutes (P=0.005) over the study period. Among PPCI patients, median door‐to‐balloon times decreased from 94 to 64 minutes (P<0.0001) over the same period. In‐hospital mortality was higher with fibrinolysis than with PPCI (4.6% vs 3.3%, P=0.001) and did not change significantly over time. Patients receiving fibrinolysis were less likely to receive defect‐free care compared with their PPCI counterparts. Conclusions Use of fibrinolysis for STEMI has decreased over time with concomitant worsening of door‐to‐needle times. Over the same time period, use of PPCI increased with improvement in door‐to‐balloon times. In‐hospital mortality was higher with fibrinolysis than with PPCI. As reperfusion for STEMI continues to shift from fibrinolysis to PPCI, it will be critical to ensure that door‐to‐needle times and outcomes do not worsen.
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Affiliation(s)
- Ravi S Hira
- Division of Cardiology, University of Washington, Seattle, WA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA
| | | | - Paul A Heidenreich
- Veterans Administration Palo Alto Healthcare System, Palo Alto, CA Stanford University School of Medicine, Stanford, CA
| | - Christine Ju
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Salim S Virani
- Michael E. DeBakey VA Medical Center, Houston, TX Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Houston, TX
| | - Biykem Bozkurt
- Michael E. DeBakey VA Medical Center, Houston, TX Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Laura A Petersen
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Houston, TX
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Lee H Schwamm
- Department of Neurology, TeleStroke and Acute Stroke Services, Boston, MA Institute for Heart, Vascular, and Stroke Care, Massachusetts General Hospital, Boston, MA Department of Neurology, Harvard Medical School, Boston, MA
| | - Zubin J Eapen
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Michelle A Albert
- Division of Cardiology, University of California at San Francisco, San Francisco, CA
| | - Li Liang
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Roland A Matsouaka
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Hani Jneid
- Michael E. DeBakey VA Medical Center, Houston, TX Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
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Mathews R, Fonarow GC, Li S, Peterson ED, Rumsfeld JS, Heidenreich PA, Roe MT, Oetgen WJ, Jollis JG, Cannon CP, de Lemos JA, Wang TY. Comparison of performance on Hospital Compare process measures and patient outcomes between hospitals that do and do not participate in Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines. Am Heart J 2016; 175:1-8. [PMID: 27179718 DOI: 10.1016/j.ahj.2016.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 01/20/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines (ACTION Registry-GWTG) was designed to measure and improve the treatment and outcomes of patients with acute myocardial infarction (AMI), yet it is unknown whether performance of Medicare Hospital Compare metrics and outcomes differ between hospitals participating versus those not participating in the registry. METHODS Using 2007 to 2010 Hospital Compare data, we matched participating to nonparticipating hospitals based on teaching status, size, percutaneous coronary intervention capability, and baseline (2007) Hospital Compare AMI process measure performance. We used linear mixed modeling to compare 2010 Hospital Compare process measure adherence, 30-day risk-adjusted mortality, and readmission rates. We repeated these analyses after stratification according to baseline performance level. RESULTS Compared with nonparticipating hospitals, those participating were larger (median 288 vs 139 beds, P < .0001), more often teaching hospitals (18.8% vs 6.3%, P < .0001), and more likely had interventional catheterization lab capabilities (85.7% vs 34.0%, P < .0001). Among 502 matched pairs of participating and nonparticipating hospitals, we found high levels of process measure adherence in both 2007 and 2010, with minimal differences between them. Rates of 30-day mortality and readmission in 2010 were also similar between both groups. Results were consistent across strata of baseline performance level. CONCLUSIONS In this observational analysis, there were no significant differences in the performance of Hospital Compare process measures or outcomes between hospitals in Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines and other hospitals not in the registry. However, baseline performance on the Hospital Compare process measures was very high in both groups, suggesting the need for new quality improvement foci to further improve patient outcomes.
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Li S, Fonarow GC, Mukamal KJ, Liang L, Schulte PJ, Smith EE, DeVore A, Hernandez AF, Peterson ED, Bhatt DL. Sex and Race/Ethnicity–Related Disparities in Care and Outcomes After Hospitalization for Coronary Artery Disease Among Older Adults. Circ Cardiovasc Qual Outcomes 2016; 9:S36-44. [DOI: 10.1161/circoutcomes.115.002621] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Barth J, Jacob T, Daha I, Critchley JA. Psychosocial interventions for smoking cessation in patients with coronary heart disease. Cochrane Database Syst Rev 2015; 2015:CD006886. [PMID: 26148115 PMCID: PMC11064764 DOI: 10.1002/14651858.cd006886.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This is an update of a Cochrane review previously published in 2008. Smoking increases the risk of developing atherosclerosis but also acute thrombotic events. Quitting smoking is potentially the most effective secondary prevention measure and improves prognosis after a cardiac event, but more than half of the patients continue to smoke, and improved cessation aids are urgently required. OBJECTIVES This review aimed to examine the efficacy of psychosocial interventions for smoking cessation in patients with coronary heart disease in short-term (6 to 12 month follow-up) and long-term (more than 12 months). Moderators of treatment effects (i.e. intervention types, treatment dose, methodological criteria) were used for stratification. SEARCH METHODS The Cochrane Central Register of Controlled Trials (Issue 12, 2012), MEDLINE, EMBASE, PsycINFO and PSYNDEX were searched from the start of the database to January 2013. This is an update of the initial search in 2003. Results were supplemented by cross-checking references, and handsearches in selected journals and systematic reviews. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials (RCTs) in patients with CHD with a minimum follow-up of 6 months. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial eligibility and risk of bias. Abstinence rates were computed according to an intention to treat analysis if possible, or if not according to completer analysis results only. Subgroups of specific intervention strategies were analysed separately. The impact of study quality on efficacy was studied in a moderator analysis. Risk ratios (RR) were pooled using the Mantel-Haenszel and random-effects model with 95% confidence intervals (CI). MAIN RESULTS We found 40 RCTs meeting inclusion criteria in total (21 trials were new in this update, 5 new trials contributed to long-term results (more than 12 months)). Interventions consist of behavioural therapeutic approaches, telephone support and self-help material and were either focused on smoking cessation alone or addressed several risk factors (eg. obesity, inactivity and smoking). The trials mostly included older male patients with CHD, predominantly myocardial infarction (MI). After an initial selection of studies three trials with implausible large effects of RR > 5 which contributed to substantial heterogeneity were excluded. Overall there was a positive effect of interventions on abstinence after 6 to 12 months (risk ratio (RR) 1.22, 95% confidence interval (CI) 1.13 to 1.32, I² 54%; abstinence rate treatment group = 46%, abstinence rate control group 37.4%), but heterogeneity between trials was substantial. Studies with validated assessment of smoking status at follow-up had similar efficacy (RR 1.22, 95% CI 1.07 to 1.39) to non-validated trials (RR 1.23, 95% CI 1.12 to 1.35). Studies were stratified by intervention strategy and intensity of the intervention. Clustering reduced heterogeneity, although many trials used more than one type of intervention. The RRs for different strategies were similar (behavioural therapies RR 1.23, 95% CI 1.12 to 1.34, I² 40%; telephone support RR 1.21, 95% CI 1.12 to 1.30, I² 44%; self-help RR 1.22, 95% CI 1.12 to 1.33, I² 40%). More intense interventions (any initial contact plus follow-up over one month) showed increased quit rates (RR 1.28, 95% CI 1.17 to 1.40, I² 58%) whereas brief interventions (either one single initial contact lasting less than an hour with no follow-up, one or more contacts in total over an hour with no follow-up or any initial contact plus follow-up of less than one months) did not appear effective (RR 1.01, 95% CI 0.91 to 1.12, I² 0%). Seven trials had long-term follow-up (over 12 months), and did not show any benefits. Adverse side effects were not reported in any trial. These findings are based on studies with rather low risk of selection bias but high risk of detection bias (namely unblinded or non validated assessment of smoking status). AUTHORS' CONCLUSIONS Psychosocial smoking cessation interventions are effective in promoting abstinence up to 1 year, provided they are of sufficient duration. After one year, the studies showed favourable effects of smoking cessation intervention, but more studies including cost-effectiveness analyses are needed. Further studies should also analyse the additional benefit of a psychosocial intervention strategy to pharmacological therapy (e.g. nicotine replacement therapy) compared with pharmacological treatment alone and investigate economic outcomes.
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Affiliation(s)
- Jürgen Barth
- University of BernInstitute of Social and Preventive MedicineNiesenweg 6BernSwitzerlandCH‐3012
| | - Tiffany Jacob
- University of BernInstitute of Social and Preventive MedicineNiesenweg 6BernSwitzerlandCH‐3012
| | - Ioana Daha
- Carol Davila University of Medicine and Pharmacy, Colentina Clinical HospitalDepartment of Cardiology19‐21, Stefan cel MareBucharestRomania020142
| | - Julia A Critchley
- St George's, University of LondonPopulation Health Sciences InstituteCranmer TerraceLondonUKSW17 0RE
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Fang J, George MG, Gindi RM, Hong Y, Yang Q, Ayala C, Ward BW, Loustalot F. Use of low-dose aspirin as secondary prevention of atherosclerotic cardiovascular disease in US adults (from the National Health Interview Survey, 2012). Am J Cardiol 2015; 115:895-900. [PMID: 25670639 PMCID: PMC4365416 DOI: 10.1016/j.amjcard.2015.01.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/06/2015] [Accepted: 01/06/2015] [Indexed: 11/21/2022]
Abstract
Current guidelines recommend that adults with atherosclerotic cardiovascular disease take low-dose aspirin or other antiplatelet medications as secondary prevention of recurrent cardiovascular events. Yet, no national level assessment of low-dose aspirin use for secondary prevention of cardiovascular disease has been reported in a community-based population. Using data from the 2012 National Health Interview Survey, we assessed low-dose aspirin use in those with atherosclerotic cardiovascular disease. We estimated the prevalence ratios of low-dose aspirin use, adjusting for sociodemographic status, health insurance, and cardiovascular risk factors. In those with atherosclerotic cardiovascular disease (n = 3,068), 76% had been instructed to take aspirin and 88% of those were following this advice. Of those not advised, 11% took aspirin on their own. Overall, 70% were taking aspirin (including those who followed their health care provider's advice and those who were not advised but took aspirin on their own). Logistic regression models showed that women, non-Hispanic blacks and Hispanics, those aged 40 to 64 years, with a high school education or with some college, or with fewer cardiovascular disease risk factors were less likely to take aspirin than men, non-Hispanic whites, those aged ≥65 years, with a college education or higher, or with all 4 selected cardiovascular disease risk factors, respectively. Additional analyses conducted in those with coronary heart disease only (n = 2,007) showed similar patterns. In conclusion, use of low-dose aspirin for secondary prevention was 70%, with high reported adherence to health care providers' advice to take low-dose aspirin (88%) and significant variability within subgroups.
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Affiliation(s)
- Jing Fang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Mary G George
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Renee M Gindi
- Division for Health Interview Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Yuling Hong
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carma Ayala
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian W Ward
- Division for Health Interview Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Iqbal J, Zhang YJ, Holmes DR, Morice MC, Mack MJ, Kappetein AP, Feldman T, Stahle E, Escaned J, Banning AP, Gunn JP, Colombo A, Steyerberg EW, Mohr FW, Serruys PW. Optimal medical therapy improves clinical outcomes in patients undergoing revascularization with percutaneous coronary intervention or coronary artery bypass grafting: insights from the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial at the 5-year follow-up. Circulation 2015; 131:1269-77. [PMID: 25847979 DOI: 10.1161/circulationaha.114.013042] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 01/26/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND There is a paucity of data on the use of optimal medical therapy (OMT) in patients with complex coronary artery disease undergoing revascularization with percutaneous coronary intervention or coronary artery bypass grafting (CABG) and its long-term prognostic significance. METHODS AND RESULTS The Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial is a multicenter, randomized, clinical trial of patients (n=1800) with complex coronary disease randomized to revascularization with percutaneous coronary intervention or CABG. Detailed drug history was collected for all patients at discharge and at the 1-month, 6-month, 1-year, 3-year, and 5-year follow-ups. OMT was defined as the combination of at least 1 antiplatelet drug, statin, β-blocker, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. Five-year clinical outcomes were stratified by OMT and non-OMT. OMT was underused in patients treated with coronary revascularization, especially CABG. OMT was an independent predictor of survival. OMT was associated with a significant reduction in mortality (hazard ratio, 0.64; 95% confidence interval, 0.48-0.85; P=0.002) and composite end point of death/myocardial infarction/stroke (hazard ratio, 0.73; 95% confidence interval, 0.58-0.92; P=0.007) at the 5-year follow-up. The treatment effect with OMT (36% relative reduction in mortality over 5 years) was greater than the treatment effect of revascularization strategy (26% relative reduction in mortality with CABG versus percutaneous coronary intervention over 5 years). On stratified analysis, all the components of OMT were important for reducing adverse outcomes regardless of revascularization strategy. CONCLUSIONS The use of OMT remains low in patients with complex coronary disease requiring coronary intervention with percutaneous coronary intervention and even lower in patients treated with CABG. Lack of OMT is associated with adverse clinical outcomes. Targeted strategies to improve OMT use in postrevascularization patients are warranted. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00114972.
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Affiliation(s)
- Javaid Iqbal
- From the Thoraxcenter (J.I., Y.-J.Z., A.P.K., P.W.S.) and Department of Public Health (E.W.S.), Erasmus Medical Centre, Rotterdam, The Netherlands; University of Sheffield, UK (J.I., J.P.G.); Mayo Clinic, Rochester, MN (D.R.H.); ICPS, Hopital privé Jacques Cartier, Générale de Santé Massy, France (M.-C.M.); The Heart Hospital, Dallas, TX (M.J.M.); Evanston Hospital, IL (T.F.); University Hospital Uppsala, Sweden (E.S.); Hospital Clínico San Carlos, Madrid, Spain (J.E.); Oxford University Hospitals, UK (A.P.B.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Herzzentrum Universität Leipzig, Germany (F.W.M.); and International Centre for Circulatory Health, Imperial College London, UK (P.W.S.)
| | - Yao-Jun Zhang
- From the Thoraxcenter (J.I., Y.-J.Z., A.P.K., P.W.S.) and Department of Public Health (E.W.S.), Erasmus Medical Centre, Rotterdam, The Netherlands; University of Sheffield, UK (J.I., J.P.G.); Mayo Clinic, Rochester, MN (D.R.H.); ICPS, Hopital privé Jacques Cartier, Générale de Santé Massy, France (M.-C.M.); The Heart Hospital, Dallas, TX (M.J.M.); Evanston Hospital, IL (T.F.); University Hospital Uppsala, Sweden (E.S.); Hospital Clínico San Carlos, Madrid, Spain (J.E.); Oxford University Hospitals, UK (A.P.B.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Herzzentrum Universität Leipzig, Germany (F.W.M.); and International Centre for Circulatory Health, Imperial College London, UK (P.W.S.)
| | - David R Holmes
- From the Thoraxcenter (J.I., Y.-J.Z., A.P.K., P.W.S.) and Department of Public Health (E.W.S.), Erasmus Medical Centre, Rotterdam, The Netherlands; University of Sheffield, UK (J.I., J.P.G.); Mayo Clinic, Rochester, MN (D.R.H.); ICPS, Hopital privé Jacques Cartier, Générale de Santé Massy, France (M.-C.M.); The Heart Hospital, Dallas, TX (M.J.M.); Evanston Hospital, IL (T.F.); University Hospital Uppsala, Sweden (E.S.); Hospital Clínico San Carlos, Madrid, Spain (J.E.); Oxford University Hospitals, UK (A.P.B.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Herzzentrum Universität Leipzig, Germany (F.W.M.); and International Centre for Circulatory Health, Imperial College London, UK (P.W.S.)
| | - Marie-Claude Morice
- From the Thoraxcenter (J.I., Y.-J.Z., A.P.K., P.W.S.) and Department of Public Health (E.W.S.), Erasmus Medical Centre, Rotterdam, The Netherlands; University of Sheffield, UK (J.I., J.P.G.); Mayo Clinic, Rochester, MN (D.R.H.); ICPS, Hopital privé Jacques Cartier, Générale de Santé Massy, France (M.-C.M.); The Heart Hospital, Dallas, TX (M.J.M.); Evanston Hospital, IL (T.F.); University Hospital Uppsala, Sweden (E.S.); Hospital Clínico San Carlos, Madrid, Spain (J.E.); Oxford University Hospitals, UK (A.P.B.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Herzzentrum Universität Leipzig, Germany (F.W.M.); and International Centre for Circulatory Health, Imperial College London, UK (P.W.S.)
| | - Michael J Mack
- From the Thoraxcenter (J.I., Y.-J.Z., A.P.K., P.W.S.) and Department of Public Health (E.W.S.), Erasmus Medical Centre, Rotterdam, The Netherlands; University of Sheffield, UK (J.I., J.P.G.); Mayo Clinic, Rochester, MN (D.R.H.); ICPS, Hopital privé Jacques Cartier, Générale de Santé Massy, France (M.-C.M.); The Heart Hospital, Dallas, TX (M.J.M.); Evanston Hospital, IL (T.F.); University Hospital Uppsala, Sweden (E.S.); Hospital Clínico San Carlos, Madrid, Spain (J.E.); Oxford University Hospitals, UK (A.P.B.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Herzzentrum Universität Leipzig, Germany (F.W.M.); and International Centre for Circulatory Health, Imperial College London, UK (P.W.S.)
| | - Arie Pieter Kappetein
- From the Thoraxcenter (J.I., Y.-J.Z., A.P.K., P.W.S.) and Department of Public Health (E.W.S.), Erasmus Medical Centre, Rotterdam, The Netherlands; University of Sheffield, UK (J.I., J.P.G.); Mayo Clinic, Rochester, MN (D.R.H.); ICPS, Hopital privé Jacques Cartier, Générale de Santé Massy, France (M.-C.M.); The Heart Hospital, Dallas, TX (M.J.M.); Evanston Hospital, IL (T.F.); University Hospital Uppsala, Sweden (E.S.); Hospital Clínico San Carlos, Madrid, Spain (J.E.); Oxford University Hospitals, UK (A.P.B.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Herzzentrum Universität Leipzig, Germany (F.W.M.); and International Centre for Circulatory Health, Imperial College London, UK (P.W.S.)
| | - Ted Feldman
- From the Thoraxcenter (J.I., Y.-J.Z., A.P.K., P.W.S.) and Department of Public Health (E.W.S.), Erasmus Medical Centre, Rotterdam, The Netherlands; University of Sheffield, UK (J.I., J.P.G.); Mayo Clinic, Rochester, MN (D.R.H.); ICPS, Hopital privé Jacques Cartier, Générale de Santé Massy, France (M.-C.M.); The Heart Hospital, Dallas, TX (M.J.M.); Evanston Hospital, IL (T.F.); University Hospital Uppsala, Sweden (E.S.); Hospital Clínico San Carlos, Madrid, Spain (J.E.); Oxford University Hospitals, UK (A.P.B.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Herzzentrum Universität Leipzig, Germany (F.W.M.); and International Centre for Circulatory Health, Imperial College London, UK (P.W.S.)
| | - Elizabeth Stahle
- From the Thoraxcenter (J.I., Y.-J.Z., A.P.K., P.W.S.) and Department of Public Health (E.W.S.), Erasmus Medical Centre, Rotterdam, The Netherlands; University of Sheffield, UK (J.I., J.P.G.); Mayo Clinic, Rochester, MN (D.R.H.); ICPS, Hopital privé Jacques Cartier, Générale de Santé Massy, France (M.-C.M.); The Heart Hospital, Dallas, TX (M.J.M.); Evanston Hospital, IL (T.F.); University Hospital Uppsala, Sweden (E.S.); Hospital Clínico San Carlos, Madrid, Spain (J.E.); Oxford University Hospitals, UK (A.P.B.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Herzzentrum Universität Leipzig, Germany (F.W.M.); and International Centre for Circulatory Health, Imperial College London, UK (P.W.S.)
| | - Javier Escaned
- From the Thoraxcenter (J.I., Y.-J.Z., A.P.K., P.W.S.) and Department of Public Health (E.W.S.), Erasmus Medical Centre, Rotterdam, The Netherlands; University of Sheffield, UK (J.I., J.P.G.); Mayo Clinic, Rochester, MN (D.R.H.); ICPS, Hopital privé Jacques Cartier, Générale de Santé Massy, France (M.-C.M.); The Heart Hospital, Dallas, TX (M.J.M.); Evanston Hospital, IL (T.F.); University Hospital Uppsala, Sweden (E.S.); Hospital Clínico San Carlos, Madrid, Spain (J.E.); Oxford University Hospitals, UK (A.P.B.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Herzzentrum Universität Leipzig, Germany (F.W.M.); and International Centre for Circulatory Health, Imperial College London, UK (P.W.S.)
| | - Adrian P Banning
- From the Thoraxcenter (J.I., Y.-J.Z., A.P.K., P.W.S.) and Department of Public Health (E.W.S.), Erasmus Medical Centre, Rotterdam, The Netherlands; University of Sheffield, UK (J.I., J.P.G.); Mayo Clinic, Rochester, MN (D.R.H.); ICPS, Hopital privé Jacques Cartier, Générale de Santé Massy, France (M.-C.M.); The Heart Hospital, Dallas, TX (M.J.M.); Evanston Hospital, IL (T.F.); University Hospital Uppsala, Sweden (E.S.); Hospital Clínico San Carlos, Madrid, Spain (J.E.); Oxford University Hospitals, UK (A.P.B.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Herzzentrum Universität Leipzig, Germany (F.W.M.); and International Centre for Circulatory Health, Imperial College London, UK (P.W.S.)
| | - Julian P Gunn
- From the Thoraxcenter (J.I., Y.-J.Z., A.P.K., P.W.S.) and Department of Public Health (E.W.S.), Erasmus Medical Centre, Rotterdam, The Netherlands; University of Sheffield, UK (J.I., J.P.G.); Mayo Clinic, Rochester, MN (D.R.H.); ICPS, Hopital privé Jacques Cartier, Générale de Santé Massy, France (M.-C.M.); The Heart Hospital, Dallas, TX (M.J.M.); Evanston Hospital, IL (T.F.); University Hospital Uppsala, Sweden (E.S.); Hospital Clínico San Carlos, Madrid, Spain (J.E.); Oxford University Hospitals, UK (A.P.B.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Herzzentrum Universität Leipzig, Germany (F.W.M.); and International Centre for Circulatory Health, Imperial College London, UK (P.W.S.)
| | - Antonio Colombo
- From the Thoraxcenter (J.I., Y.-J.Z., A.P.K., P.W.S.) and Department of Public Health (E.W.S.), Erasmus Medical Centre, Rotterdam, The Netherlands; University of Sheffield, UK (J.I., J.P.G.); Mayo Clinic, Rochester, MN (D.R.H.); ICPS, Hopital privé Jacques Cartier, Générale de Santé Massy, France (M.-C.M.); The Heart Hospital, Dallas, TX (M.J.M.); Evanston Hospital, IL (T.F.); University Hospital Uppsala, Sweden (E.S.); Hospital Clínico San Carlos, Madrid, Spain (J.E.); Oxford University Hospitals, UK (A.P.B.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Herzzentrum Universität Leipzig, Germany (F.W.M.); and International Centre for Circulatory Health, Imperial College London, UK (P.W.S.)
| | - Ewout W Steyerberg
- From the Thoraxcenter (J.I., Y.-J.Z., A.P.K., P.W.S.) and Department of Public Health (E.W.S.), Erasmus Medical Centre, Rotterdam, The Netherlands; University of Sheffield, UK (J.I., J.P.G.); Mayo Clinic, Rochester, MN (D.R.H.); ICPS, Hopital privé Jacques Cartier, Générale de Santé Massy, France (M.-C.M.); The Heart Hospital, Dallas, TX (M.J.M.); Evanston Hospital, IL (T.F.); University Hospital Uppsala, Sweden (E.S.); Hospital Clínico San Carlos, Madrid, Spain (J.E.); Oxford University Hospitals, UK (A.P.B.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Herzzentrum Universität Leipzig, Germany (F.W.M.); and International Centre for Circulatory Health, Imperial College London, UK (P.W.S.)
| | - Friedrich W Mohr
- From the Thoraxcenter (J.I., Y.-J.Z., A.P.K., P.W.S.) and Department of Public Health (E.W.S.), Erasmus Medical Centre, Rotterdam, The Netherlands; University of Sheffield, UK (J.I., J.P.G.); Mayo Clinic, Rochester, MN (D.R.H.); ICPS, Hopital privé Jacques Cartier, Générale de Santé Massy, France (M.-C.M.); The Heart Hospital, Dallas, TX (M.J.M.); Evanston Hospital, IL (T.F.); University Hospital Uppsala, Sweden (E.S.); Hospital Clínico San Carlos, Madrid, Spain (J.E.); Oxford University Hospitals, UK (A.P.B.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Herzzentrum Universität Leipzig, Germany (F.W.M.); and International Centre for Circulatory Health, Imperial College London, UK (P.W.S.)
| | - Patrick W Serruys
- From the Thoraxcenter (J.I., Y.-J.Z., A.P.K., P.W.S.) and Department of Public Health (E.W.S.), Erasmus Medical Centre, Rotterdam, The Netherlands; University of Sheffield, UK (J.I., J.P.G.); Mayo Clinic, Rochester, MN (D.R.H.); ICPS, Hopital privé Jacques Cartier, Générale de Santé Massy, France (M.-C.M.); The Heart Hospital, Dallas, TX (M.J.M.); Evanston Hospital, IL (T.F.); University Hospital Uppsala, Sweden (E.S.); Hospital Clínico San Carlos, Madrid, Spain (J.E.); Oxford University Hospitals, UK (A.P.B.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Herzzentrum Universität Leipzig, Germany (F.W.M.); and International Centre for Circulatory Health, Imperial College London, UK (P.W.S.).
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Sardar P, Kundu A, Nairooz R, Chatterjee S, Ledley GS, Aronow WS. Health Resource Variability in the Achievement of Optimal Performance and Clinical Outcome in Ischemic Heart Disease. Curr Cardiol Rep 2015; 17:1. [PMID: 25612925 DOI: 10.1007/s11886-014-0551-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sharma S, Thapa R, Jeevanantham V, Myers T, Hu C, Brimacombe M, Vacek JL, Dawn B, Gupta K. Comparison of lipid management in patients with coronary versus peripheral arterial disease. Am J Cardiol 2014; 113:1320-5. [PMID: 24560066 DOI: 10.1016/j.amjcard.2014.01.405] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/08/2014] [Accepted: 01/08/2014] [Indexed: 11/18/2022]
Abstract
Peripheral arterial disease (PAD), similar to coronary artery disease (CAD), is a significant predictor of cardiovascular morbidity and mortality. Guidelines recommend a low-density lipoprotein (LDL) goal of <100 mg/dl for both groups. We assessed whether lipid control and statin use were as aggressively applied to PAD as to patients with CAD. This retrospective study of patients with the diagnosis of CAD, PAD, or both CAD and PAD compared lipid levels and statin use. For comparison of statins, we used a statin potency unit (1 potency unit=10 mg of simvastatin). Among 11,134 subjects (CAD 9,563, PAD 596, and both CAD and PAD 975), mean LDL in the PAD group was higher than the CAD (92 vs 83 mg/dl, respectively, p<0.001) and the combined CAD and PAD groups (92 vs 80 mg/dl, respectively, p<0.001). Fewer patients with PAD achieved a target LDL of <100 mg/dl compared with CAD (62% vs 78%, respectively, p<0.001) and the combined group (62% vs 79%, respectively, p<0.001). Similar differences were noted for a target LDL of <70 mg/dl. Compared with the CAD group, a lesser number of patients with PAD received statin therapy (76% vs 100%, respectively, p<0.001) with lower mean potency unit (5.3 vs 8.1, respectively, p<0.001). In conclusion, our study demonstrated lower use and less aggressive application of statins in patients with PAD compared with patients with CAD, ensuing lower mean LDL in the CAD and combined PAD and CAD groups. Our study suggests that physicians are more aggressive with lipid control in patients with CAD compared with patients with PAD alone.
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Affiliation(s)
- Suresh Sharma
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas
| | - Rashmi Thapa
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas
| | - Vinodh Jeevanantham
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas
| | - Taylor Myers
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas
| | - Casper Hu
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas
| | - Michael Brimacombe
- Department of Biostatistics, University of Kansas Medical Center and Hospital, Kansas City, Kansas
| | - James L Vacek
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas
| | - Buddhadeb Dawn
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas
| | - Kamal Gupta
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas.
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The impact of a measurement and feedback intervention on blood pressure control in ambulatory cardiology practice. Am Heart J 2014; 167:466-71. [PMID: 24655694 DOI: 10.1016/j.ahj.2013.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/18/2013] [Indexed: 01/13/2023]
Abstract
BACKGROUND Although hypertension is a modifiable cardiovascular risk factor, up to one-third of ambulatory patients have uncontrolled blood pressure (BP). We evaluated the impact of a targeted provider feedback intervention on rates of BP control. METHODS Clinic BP readings were aggregated among approximately 3,000 hypertensive patients followed up in 42 outpatient cardiology clinic practices at a large quaternary care academic medical center. Physician practices received quarterly reports on BP control rates. Provider-specific reports were benchmarked vs overall peer performance and distributed quarterly between September 2011 and September 2012. Rates of BP control were evaluated before and after the intervention. Medical record reviews were performed for a subset of patients with uncontrolled BP before (n = 300) and after (n = 300) the intervention to evaluate provider responses and interventions. RESULTS At baseline, 27.9% of clinic patients had uncontrolled BP. After one 1 of reports, the rate of uncontrolled BP remained unchanged (27.7%, P = .86). Analysis of provider performance revealed a subset of providers who consistently outperform their peers. In the sample of patients selected for medical record reviews, at baseline (n = 300) and follow-up (n = 300), cardiologists discussed BP in 80% of clinic notes for patients with uncontrolled BP. Cardiologists more frequently documented repeat measurements after the intervention (28.0% vs 35.7%, P = .04). No other changes were found in documentation of provider responses to BP. CONCLUSIONS Clinician-specific audit and feedback reports as a stand-alone intervention did not affect overall BP control rates in cardiology clinics. Future BP control interventions should consider real-time patient-specific reminders, provider incentive programs, and patient engagement interventions.
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Bainey KR, Armstrong PW, Fonarow GC, Cannon CP, Hernandez AF, Peterson ED, Peacock WF, Laskey WK, Zhao X, Schwamm LH, Bhatt DL. Use of Renin–Angiotensin System Blockers in Acute Coronary Syndromes. Circ Cardiovasc Qual Outcomes 2014; 7:227-35. [DOI: 10.1161/circoutcomes.113.000422] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Kevin R. Bainey
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - Paul W. Armstrong
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - Gregg C. Fonarow
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - Christopher P. Cannon
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - Adrian F. Hernandez
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - Eric D. Peterson
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - W. Frank Peacock
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - Warren K. Laskey
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - Xin Zhao
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - Lee H. Schwamm
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
| | - Deepak L. Bhatt
- From the Canadian VIGOUR Centre, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (K.R.B., P.W.A.); Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center (G.C.F.); Cardiovascular Division, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA (C.P.C.); Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H., E.D.P., X.Z.); Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W
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Bhuyan SS, Wang Y, Opoku S, Lin G. Rural-urban differences in acute myocardial infarction mortality: Evidence from Nebraska. J Cardiovasc Dis Res 2014; 4:209-13. [PMID: 24653583 DOI: 10.1016/j.jcdr.2014.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 01/22/2014] [Indexed: 12/25/2022] Open
Abstract
AIMS Acute myocardial infarction (AMI) remains a major cause of death and disability in the United States and worldwide. Despite the importance of surveillance and secondary prevention, the incidence of and mortality from AMI are not continuously monitored, and little is known about survival outcomes after 30 days of AMI hospitalization or associated risk factors, especially in the rural areas. The current study examines rural-urban differences in both in- and out-hospital survival outcomes for AMI patients. METHODS We performed a retrospective analysis using hospital discharge data in Nebraska for January 2005 to December 2009 and Nebraska death certificate records through October 2011. Multivariate logistic regression was used to estimate the rural-urban difference in 30-day mortality. A Cox proportional hazard model was used to predict out-of-hospital and overall survival rate. RESULTS In the 30-day mortality model, after controlling for age, comorbidities, and rehabilitation, patients in urban areas were less likely to die than patients in rural areas (odds ratio: 0.709, 95% confidence interval: 0.626-0.802). In the overall survival model, patients in urban areas had a lower hazard of AMI death (hazard ratio: 0.86, 95% confidence interval: 0.806-0.931) than patients in rural areas. Patients with a previous history of heart failure had a significantly higher likelihood of 30-day mortality, while atrial fibrillation, heart failure, and chronic kidney disease were associated with lower overall survival. Patients who attended at least 1 cardiac rehabilitation session had significantly lower 30-day and overall mortality (p < 0.0001). CONCLUSIONS This study confirms previous findings on rural-urban disparities in 30-day mortality following AMI hospitalization, and reports new findings on overall rural-urban mortality disparity. The study also found an association between cardiac rehabilitation and reduced mortality, a finding never before reported at the population level. Further efforts are needed to develop systems in rural hospitals and communities to ensure that AMI patients receive recommended care.
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Affiliation(s)
- Soumitra Sudip Bhuyan
- Dept. of Health Services Research & Administration, UNMC College of Public Health, 984350 Nebraska Medical Center, Omaha, NE 68198-4350, USA
| | - Yang Wang
- Dept. of Health Services Research & Administration, UNMC College of Public Health, 984350 Nebraska Medical Center, Omaha, NE 68198-4350, USA
| | - Samuel Opoku
- Dept. of Health Services Research & Administration, UNMC College of Public Health, 984350 Nebraska Medical Center, Omaha, NE 68198-4350, USA
| | - Ge Lin
- Dept. of Health Services Research & Administration, UNMC College of Public Health, 984350 Nebraska Medical Center, Omaha, NE 68198-4350, USA
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Kolte D, Khera S, Aronow WS, Mujib M, Palaniswamy C, Ahmed A, Frishman WH, Fonarow GC. Regional variation across the United States in management and outcomes of ST-elevation myocardial infarction: analysis of the 2003 to 2010 nationwide inpatient sample database. Clin Cardiol 2014; 37:204-12. [PMID: 24477863 DOI: 10.1002/clc.22250] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/21/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Regional differences in the treatment and outcomes of patients with ST-elevation myocardial infarction (STEMI) within the United States remain poorly understood. HYPOTHESIS Treatment choice and outcomes in patients with STEMI differ between regions within the United States. METHODS We used the 2003 to 2010 Nationwide Inpatient Sample databases to identify all patients age ≥ 40 years hospitalized with STEMI. Patients were divided into 4 groups according to region: Northeast, Midwest, South, and West. Multivariable logistic regression was used to identify differences in treatment choice and outcomes (in-hospital mortality, acute stroke, and cardiogenic shock) among the 4 regions. RESULTS Of 1,990,486 patients age ≥ 40 years with STEMI, 350,073 (17.6%) were hospitalized in the Northeast, 483,323 (24.3%) in the Midwest, 784,869 (39.4%) in the South, and 372,222 (18.7%) in the West. Compared with the Northeast, patients in the Midwest, South, and West were less likely to receive medical therapy alone and more likely to receive percutaneous coronary intervention and coronary artery bypass grafting. Risk-adjusted in-hospital mortality was higher in the Midwest (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 1.05-1.09, P <0.001), South (OR: 1.03, 95% CI: 1.01-1.05, P = 0.001), and West (OR: 1.06, 95% CI: 1.04-1.08, P <0.001), as compared with the Northeast. When adjusted further for regional variation in treatment selection, risk-adjusted in-hospital mortality was even higher in the Midwest, West, and South. CONCLUSIONS Despite higher reperfusion and revascularization rates, STEMI patients in the Midwest, West, and South have paradoxically higher risk-adjusted in-hospital mortality as compared with patients in the Northeast.
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Affiliation(s)
- Dhaval Kolte
- Department of Medicine, New York Medical College, Valhalla, New York
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Banka G, Heidenreich PA, Fonarow GC. Incremental cost-effectiveness of guideline-directed medical therapies for heart failure. J Am Coll Cardiol 2013; 61:1440-6. [PMID: 23433562 DOI: 10.1016/j.jacc.2012.12.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 12/12/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study sought to quantify the incremental cost-effectiveness ratios (ICER) of angiotensin-converting enzyme inhibitor (ACEI), beta-blocker (BB), and aldosterone antagonist (AldA) therapies for patients with heart failure with reduced ejection fraction (HFrEF). BACKGROUND There are evidence-based, guideline-directed medical therapies for patients with HFrEF, but the incremental cost-effectiveness of these therapies has not been well studied using contemporary data. METHODS A Markov model with lifetime horizon and two states, dead or alive, was created. We compared HFrEF patients treated with diuretic agents alone to three treatment arms: 1) ACEI therapy alone; 2) ACEI+BB; and 3) ACEI+BB+AldA. Sequential therapy was also analyzed. HF hospitalizations and mortality rates were based on representative studies. Costs of medications and inpatient and outpatient care were accounted for. RESULTS Treatment with ACEI and ACEI+BB strictly dominated treatment with diuretics only (cost-saving). The greatest gains in quality-adjusted life-years occurred when all 3 guideline-directed medications were provided. The incremental cost-effectiveness ratio (ICER) of ACEI+BB+AldA versus ACEI+BB and ACEI+BB versus ACEI was <$1,500 per quality-adjusted life-year. The cost-savings in the ACEI and ACEI+BB cohorts compared to that with diuretics alone were $444 and $33, respectively. Assuming lower treatment costs and lower hospitalization rates in the ACEI+BB+AldA arm resulted in greater cost-savings. Even in the most unfavorable situations, the ICER was <$10,000 per life-year gained. CONCLUSIONS Our analysis demonstrates that medical treatment of HFrEF is highly cost-effective and may even result in cost-savings. Greater efforts to ensure optimal adherence to guideline-directed medical therapy for HFrEF are warranted.
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Affiliation(s)
- Gaurav Banka
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA 90095, USA
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20
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Nieuwlaat R, Schwalm JD, Khatib R, Yusuf S. Why are we failing to implement effective therapies in cardiovascular disease? Eur Heart J 2013; 34:1262-9. [DOI: 10.1093/eurheartj/ehs481] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Huang PH, Kim CX, Lerman A, Cannon CP, Dai D, Laskey W, Peacock WF, Hernandez AF, Peterson ED, Smith EE, Fonarow GC, Schwamm LH, Bhatt DL. Trends in smoking cessation counseling: experience from American Heart Association-get with the guidelines. Clin Cardiol 2012; 35:396-403. [PMID: 22753250 DOI: 10.1002/clc.22023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Successful smoking cessation in stroke and coronary artery disease (CAD) patients is important, as smoking contributes to significant morbidity and mortality. The American Heart Association developed Get With The Guidelines (GWTG) to improve compliance with national guideline recommendations for cardiovascular care. Using data from GWTG, we examined trends associated with the smoking-cessation counseling (SCC) performance measure. HYPOTHESIS Implementation of a systematic quality improvement program will increase compliance with the SCC performance measure. METHODS We evaluated compliance with SCC in current or recent smokers identified from 224 671 CAD admissions between 2002 and 2008 in the GWTG-CAD database, and from 405 681 stroke admissions between 2002 and 2007 in the GWTG-Stroke database. Additionally, we examined adherence to other performance and quality measures related to CAD and stroke care. RESULTS Overall, 55 904 GWTG-CAD and 58 865 GWTG-Stroke admissions were used for the analysis. Rates of SCC improved in each successive year during the study, from 67.6% to 97.4% (P < 0.001) in GWTG-CAD and from 40.1% to 90.7% (P < 0.001) in GWTG-Stroke. Compliance with SCC was up to 34.7% lower (P < 0.0001) in GWTG-Stroke compared with GWTG-CAD, but this difference decreased to 6.7% (P < 0.0001) by the end of the study period. Compliance with many other performance and quality measures was significantly lower among patients not receiving SCC. CONCLUSIONS Get With The Guidelines has improved compliance with the SCC performance measure among patients with CAD and stroke. Although the initial disparity in rates of SCC between CAD and stroke patients gradually improved, the difference remained significant.
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Affiliation(s)
- Pei-Hsiu Huang
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Carlhed R, Bellman C, Bojestig M, Bojö L, Peterson A, Lindahl B. Quality improvement in coronary care: analysis of sustainability and impact on adjacent clinical measures after a Swedish controlled, multicenter quality improvement collaborative. J Am Heart Assoc 2012; 1:e000737. [PMID: 23130153 PMCID: PMC3487355 DOI: 10.1161/jaha.112.000737] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 06/01/2012] [Indexed: 11/16/2022]
Abstract
Background Quality Improvement in Coronary Care, a Swedish multicenter, controlled quality-improvement (QI) collaborative, has shown significant improvements in adherence to national guidelines for acute myocardial infarction, as well as improved clinical outcome. The objectives of this report were to describe the sustainability of the improvements after withdrawal of study support and a consolidation period of 3 months and to report whether improvements were disseminated to treatments and diagnostic procedures other than those primarily targeted. Methods and Results Multidisciplinary teams from 19 Swedish hospitals were educated in basic QI methodologies. Another 19 matched hospitals were included as blinded controls. All evaluations were made on the hospital level, and data were obtained from a national quality registry, Swedish Register of Information and Knowledge About Swedish Heart Intensive Care Admissions (RIKS-HIA). Sustainability indicators consisted of use of angiotensin-converting enzyme inhibitors, lipid-lowering therapy, clopidogrel, low-molecular weight heparin, and coronary angiography. Dissemination indicators were use of echocardiography, stress tests, and reperfusion therapy; time delays; and length of stay. At the reevaluation period of 6 months, the improvements at the QI intervention hospitals were sustained in all indicators but 1 (angiotensin-converting enzyme inhibitor). Between the 2 measurements, the control group improved significantly in all but 1 indicator (angiotensin-converting enzyme inhibitor). However, at the second measurement, the absolute adherence rates of the intervention hospitals were still numerically higher in all 5 indicators, and significantly so in 1 (clopidogrel). No significant changes were observed for the dissemination indicators. Conclusions The combination of a systematic QI collaborative with a national, interactive quality registry might lead to substantial and sustained improvements in the quality of acute myocardial infarction care. However, to achieve disseminated improvements in adjacent clinical measures, those adjacent measures probably should be made explicit before any QI intervention. (J Am Heart Assoc. 2012;1:e000737 doi: 10.1161/JAHA.112.000737.)
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Affiliation(s)
- Rickard Carlhed
- Department of Oncology, Central Hospital, Karlstad, Sweden (R.C.)
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Abstract
Adherence is critical to the overall management of individuals at risk for and with cardiovascular disease. It forms an interplay between the patient, provider, and health care system and includes barriers that have been encountered within all 3 domains. Improving adherence to exercise, diet, and medication as well as focusing on addictive disorders such as smoking cessation requires patient, provider, and health care system approaches. The use of the cognitive/behavioral elements of health behavior change and communication strategies such as motivational interviewing and coaching serve to enhance overall adherence. Continuous quality improvement initiatives at the system level of change also increase the likelihood that teams will succeed in helping individuals change their behavior. Cardiac rehabilitation programs offer a unique opportunity for health care professionals to play a key role in supporting individuals through the health behavior change process.
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Affiliation(s)
- Nancy Houston Miller
- Stanford Cardiac Rehabilitation Program, Stanford University School of Medicine, Palo Alto, California, USA.
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Bradley SM, Huszti E, Warren SA, Merchant RM, Sayre MR, Nichol G. Duration of hospital participation in Get With the Guidelines-Resuscitation and survival of in-hospital cardiac arrest. Resuscitation 2012; 83:1349-57. [PMID: 22429975 DOI: 10.1016/j.resuscitation.2012.03.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 03/01/2012] [Accepted: 03/12/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND Get With the Guidelines (GWTG-R) is a data registry and quality improvement program for in-hospital cardiac arrest (IHCA). It is unknown if duration of hospital participation in GWTG-R is associated with IHCA outcomes. METHODS We analyzed adults with IHCA from 362 hospitals participating in GWTG-R between 2000 and 2009. Using logistic regression with generalized estimating equations to account for clustering on hospital, we determined the association between duration of hospital participation in GWTG-R and patient outcomes after IHCA, adjusted for patient and arrest characteristics and secular trend. Using these methods, we also evaluated the association between duration of participation and factors previously correlated with survival after IHCA, including ECG monitored status, after-hours arrest, and time to defibrillation. RESULTS Of 104,732 patients with IHCA, 17,646 patients (16.9%) survived to discharge. Duration of hospital participation in GWTG-R was associated with IHCA event survival (per year of participation, odds ratio [OR] 1.02; 95% CI 1.00-1.04; p=0.046) but not survival to discharge (OR 1.02; 95% CI 0.99-1.04; p=0.18). Among factors previously correlated with IHCA survival, duration of participation was associated with time to defibrillation ≤2 min (per year of participation, OR 1.06; 95% CI 1.03-1.10; p<0.001), but not ECG monitored status (OR 1.00; 95% CI 0.93-1.06; p=0.90) or survival of after-hours arrest (OR 1.01; 95% CI 0.99-1.03; p=0.41). Among ventricular tachycardia or ventricular fibrillation (VT/VF) arrests, time to defibrillation attenuated the association between duration of hospital participation and outcomes. CONCLUSION Duration of hospital participation in GWTG-R was significantly associated with survival of the IHCA event, but not with survival to discharge. In VT/VF arrests, this association may have been mediated by improvements in time to defibrillation.
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Affiliation(s)
- Steven M Bradley
- VA Eastern Colorado Health Care System and University of Colorado-Denver, Denver, CO 80220-3808, USA.
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Wiltsey Stirman S, Kimberly J, Cook N, Calloway A, Castro F, Charns M. The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implement Sci 2012; 7:17. [PMID: 22417162 PMCID: PMC3317864 DOI: 10.1186/1748-5908-7-17] [Citation(s) in RCA: 723] [Impact Index Per Article: 60.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 03/14/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The introduction of evidence-based programs and practices into healthcare settings has been the subject of an increasing amount of research in recent years. While a number of studies have examined initial implementation efforts, less research has been conducted to determine what happens beyond that point. There is increasing recognition that the extent to which new programs are sustained is influenced by many different factors and that more needs to be known about just what these factors are and how they interact. To understand the current state of the research literature on sustainability, our team took stock of what is currently known in this area and identified areas in which further research would be particularly helpful. This paper reviews the methods that have been used, the types of outcomes that have been measured and reported, findings from studies that reported long-term implementation outcomes, and factors that have been identified as potential influences on the sustained use of new practices, programs, or interventions. We conclude with recommendations and considerations for future research. METHODS Two coders identified 125 studies on sustainability that met eligibility criteria. An initial coding scheme was developed based on constructs identified in previous literature on implementation. Additional codes were generated deductively. Related constructs among factors were identified by consensus and collapsed under the general categories. Studies that described the extent to which programs or innovations were sustained were also categorized and summarized. RESULTS Although "sustainability" was the term most commonly used in the literature to refer to what happened after initial implementation, not all the studies that were reviewed actually presented working definitions of the term. Most study designs were retrospective and naturalistic. Approximately half of the studies relied on self-reports to assess sustainability or elements that influence sustainability. Approximately half employed quantitative methodologies, and the remainder employed qualitative or mixed methodologies. Few studies that investigated sustainability outcomes employed rigorous methods of evaluation (e.g., objective evaluation, judgement of implementation quality or fidelity). Among those that did, a small number reported full sustainment or high fidelity. Very little research has examined the extent, nature, or impact of adaptations to the interventions or programs once implemented. Influences on sustainability included organizational context, capacity, processes, and factors related to the new program or practice themselves. CONCLUSIONS Clearer definitions and research that is guided by the conceptual literature on sustainability are critical to the development of the research in the area. Further efforts to characterize the phenomenon and the factors that influence it will enhance the quality of future research. Careful consideration must also be given to interactions among influences at multiple levels, as well as issues such as fidelity, modification, and changes in implementation over time. While prospective and experimental designs are needed, there is also an important role for qualitative research in efforts to understand the phenomenon, refine hypotheses, and develop strategies to promote sustainment.
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Affiliation(s)
- Shannon Wiltsey Stirman
- Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University, Boston, MA, USA
| | - John Kimberly
- Department of Healthcare Management, The Wharton School of the University of Pennsylvania, Philadelphia, PA, USA
| | - Natasha Cook
- Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Amber Calloway
- Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University, Boston, MA, USA
| | - Frank Castro
- Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University, Boston, MA, USA
| | - Martin Charns
- VA Boston Healthcare System, Boston, MA, USA
- VA Center for Organization, Leadership, and Management Research, Boston, MA, USA
- Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
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Qian F, Ling FS, Deedwania P, Hernandez AF, Fonarow GC, Cannon CP, Peterson ED, Peacock WF, Kaltenbach LA, Laskey WK, Schwamm LH, Bhatt DL. Care and outcomes of Asian-American acute myocardial infarction patients: findings from the American Heart Association Get With The Guidelines-Coronary Artery Disease program. Circ Cardiovasc Qual Outcomes 2012; 5:126-33. [PMID: 22235068 DOI: 10.1161/circoutcomes.111.961987] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Asian-Americans represent an important United States minority population, yet there are limited data regarding the clinical care and outcomes of Asian-Americans following acute myocardial infarction (AMI). Using data from the American Heart Association Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) program, we compared use of and trends in evidence-based care AMI processes and outcome in Asian-American versus white patients. METHODS AND RESULTS We analyzed 107,403 AMI patients (4412 Asian-Americans, 4.1%) from 382 United States centers participating in the Get With The Guidelines-Coronary Artery Disease program between 2003 and 2008. Use of 6 AMI performance measures, composite "defect-free" care (proportion receiving all eligible performance measures), door-to-balloon time, and in-hospital mortality were examined. Trends in care over this time period were explored. Compared with whites, Asian-American AMI patients were significantly older, more likely to be covered by Medicaid and recruited in the west region, and had a higher prevalence of diabetes, hypertension, heart failure, and smoking. In-hospital unadjusted mortality was higher among Asian-American patients. Overall, Asian-Americans were comparable with whites regarding the baseline quality of care, except that Asian-Americans were less likely to get smoking cessation counseling (65.6% versus 81.5%). Asian-American AMI patients experienced improvement in the 6 individual measures (P≤0.048), defect-free care (P<0.001), and door-to-balloon time (P<0.001). The improvement rates were similar for both Asian-Americans and whites. Compared with whites, the adjusted in-hospital mortality rate was higher for Asian-Americans (adjusted relative risk: 1.16; 95% confidence interval: 1.00-1.35; P=0.04). CONCLUSIONS Evidence-based care for AMI processes improved significantly over the period of 2003 to 2008 for Asian-American and white patients in the Get With The Guidelines-Coronary Artery Disease program. Differences in care between Asian-Americans and whites, when present, were reduced over time.
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Affiliation(s)
- Feng Qian
- University of Rochester, Rochester, NY 14642, USA.
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Changes in myocardial infarction guideline adherence as a function of patient risk: an end to paradoxical care? J Am Coll Cardiol 2011; 58:1760-5. [PMID: 21996387 DOI: 10.1016/j.jacc.2011.06.050] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 06/20/2011] [Accepted: 06/28/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The goals of this analysis were to determine: 1) whether guideline-based care during hospitalization for a myocardial infarction (MI) varied as a function of patients' baseline risk; and 2) whether temporal improvements in guideline adherence occurred in all risk groups. BACKGROUND Guideline-based care of patients with MI improves outcomes, especially among those at higher risk. Previous studies suggest that this group is paradoxically less likely to receive guideline-based care (risk-treatment mismatch). METHODS A total of 112,848 patients with MI were enrolled at 279 hospitals participating in Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) between August 2000 and December 2008. We developed and validated an in-hospital mortality model (C-statistic: 0.75) to stratify patients into risk tertiles: low (0% to 3%), intermediate (3% to 6.5%), and high (>6.5%). Use of guideline-based care and temporal trends were examined. RESULTS High-risk patients were significantly less likely to receive aspirin, beta-blockers, angiotensin-converting inhibitors/angiotensin receptor blockers, statins, diabetic treatment, smoking cessation advice, or cardiac rehabilitation referral at discharge compared with those at lower risk (all p < 0.0001). However, use of guideline-recommended therapies increased significantly in all risk groups per year (low-risk odds ratio: 1.33 [95% confidence interval (CI): 1.22 to 1.45]; intermediate-risk odds ratio: 1.30 [95% CI: 1.21 to 1.38]; and high-risk odds ratio: 1.30 [95% confidence interval: 1.23 to 1.37]). Also, there was a narrowing in the guideline adherence gap between low- and high-risk patients over time (p = 0.0002). CONCLUSIONS Although adherence to guideline-based care remains paradoxically lower in those MI patients at higher risk of mortality and most likely to benefit from treatment, care is improving for eligible patients within all risk categories, and the gaps between low- and high-risk groups seem to be narrowing.
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Giugliano RP, Braunwald E. The year in non-ST-segment elevation acute coronary syndrome. J Am Coll Cardiol 2011; 56:2126-38. [PMID: 21144974 DOI: 10.1016/j.jacc.2010.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Revised: 08/30/2010] [Accepted: 09/02/2010] [Indexed: 12/30/2022]
Affiliation(s)
- Robert P Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Lardizabal JA, Deedwania PC. Benefits of statin therapy and compliance in high risk cardiovascular patients. Vasc Health Risk Manag 2010; 6:843-53. [PMID: 20957130 PMCID: PMC2952453 DOI: 10.2147/vhrm.s9474] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Cardiovascular disease (CVD) remains the top cause of global mortality. There is considerable evidence that supports the mortality and morbidity benefit of statin therapy in coronary heart disease (CHD) and stroke, both in primary and secondary prevention settings. Data also exist pointing to the advantage of statin treatment in other high-risk CVD conditions, such as diabetes, CKD, CHF, and PVD. National and international clinical guidelines in the management of these CVD conditions all advocate for the utilization of statin therapy in appropriate patients. However, overall compliance to statin therapy remains suboptimal. Patient-, physician-, and economic-related factors all play a role. These factors need to be considered in devising approaches to enhance adherence to guideline-based therapies. To fully reap the benefits of statin therapy, interventions which improve long-term treatment compliance in real-world settings should be encouraged.
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Affiliation(s)
- Joel A Lardizabal
- Division of Cardiology, Department of Medicine, University of California in San Francisco (Fresno-MEP), Fresno, CA, USA
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