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Rudolph TK, Messika-Zeitoun D, Frey N, Lutz M, Krapf L, Passefort S, Fryearson J, Simpson H, Mortensen K, Rehse S, Tiroke A, Dodos F, Mies F, Pohlmann C, Kurucova J, Thoenes M, Bramlage P, Steeds RP. Caseload management and outcome of patients with aortic stenosis in primary/secondary versus tertiary care settings-design of the IMPULSE enhanced registry. Open Heart 2019; 6:e001019. [PMID: 31413844 PMCID: PMC6667938 DOI: 10.1136/openhrt-2019-001019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/31/2019] [Accepted: 06/13/2019] [Indexed: 01/14/2023] Open
Abstract
Background Severe aortic stenosis (AS) is one of the most common and most serious valve diseases. Without timely intervention with surgical aortic valve replacement or transcatheter aortic valve replacement, patients have an estimated survival of 2–3 years. Guidelines for the treatment of AS have been developed, but studies suggest that as many as 42% of patients with AS are not treated according to these recommendations. The aims of this registry are to delineate the caseload of patients with AS, outline the management of these patients and determine appropriateness of treatments in participating centres with and without onsite access to surgery and percutaneous treatments. Methods/design The IMPULSE enhanced registry is an international, multicentre, prospective, observational cohort registry conducted at four central full access centres (tertiary care hospitals) and at least two satellite centres per hub (primary/secondary care hospitals). An estimated 800 patients will be enrolled in the registry and patient follow-up will last for 12 months. Discussion In addition to the primary aims determining the caseload management and outcome of patients with AS in primary, secondary and tertiary care settings, the registry will also determine a time course for the transition from asymptomatic to symptomatic status and the diagnostic steps, treatment decisions and the identification of decision-makers in tertiary versus primary/secondary care hospitals. The last patient will be enrolled in the registry in 2018 and results of the registry are anticipated in 2019. Registration number NCT03112629.
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Affiliation(s)
- Tanja K Rudolph
- Department of Cardiology, University of Cologne Heart Center, Cologne, Germany
| | - David Messika-Zeitoun
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Norbert Frey
- Department of Cardiology and Angiology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Matthias Lutz
- Department of Cardiology and Angiology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Laura Krapf
- Department of Cardiology, Hopital Max Fourestier, Nanterre, France
| | | | - John Fryearson
- Department of Cardiology, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Helen Simpson
- Department of Cardiology, Birmingham Heartlands Hospital, Birmingham, UK
| | | | - Sebastian Rehse
- Department of Internal Medicine, Hospital Preetz, Preetz, Germany
| | | | - Fotini Dodos
- Practice for Internal Medicine, Cardiology, Pneumology / Practice for Cardiology Hohenlind, Cologne, Germany
| | - Florian Mies
- Practice for Internal Medicine, Cardiology, Pneumology / Practice for Cardiology Hohenlind, Cologne, Germany
| | | | | | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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Pandey A, Golwala H, Hall HM, Wang TY, Lu D, Xian Y, Chiswell K, Joynt KE, Goyal A, Das SR, Kumbhani D, Julien H, Fonarow GC, de Lemos JA. Association of US Centers for Medicare and Medicaid Services Hospital 30-Day Risk-Standardized Readmission Metric With Care Quality and Outcomes After Acute Myocardial Infarction: Findings From the National Cardiovascular Data Registry/Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines. JAMA Cardiol 2019; 2:723-731. [PMID: 28445559 DOI: 10.1001/jamacardio.2017.1143] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance The US Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program penalizes hospitals with higher-than-expected risk-adjusted 30-day readmission rates (excess readmission ratio [ERR] > 1) after acute myocardial infarction (MI). However, the association of ERR with MI care processes and outcomes are not well established. Objective To evaluate the association between ERR for MI with in-hospital process of care measures and 1-year clinical outcomes. Design, Setting, and Participants Observational analysis of hospitalized patients with MI from National Cardiovascular Data Registry/Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines centers subject to the first cycle of the Hospital Readmissions Reduction Program between July 1, 2008, and June 30, 2011. Exposures The ERR for MI (MI-ERR) in 2011. Main Outcomes and Measures Adherence to process of care measures during index hospitalization in the overall study population and risk of the composite outcome of mortality or all-cause readmission within 1 year of discharge and its individual components among participants with available Centers for Medicare and Medicaid Services-linked data. Results The median ages of patients in the MI-ERR greater than 1 and tertiles 1, 2, and 3 of the MI-ERR greater than 1 groups were 64, 63, 64, and 63 years, respectively. Among 380 hospitals that treated a total of 176 644 patients with MI during the study period, 43% had MI-ERR greater than 1. The proportions of patients of black race, those with heart failure signs at admission, and bleeding complications increased with higher MI-ERR. There was no significant association between adherence to MI performance measures and MI-ERR (adjusted odds ratio, 0.94; 95% CI, 0.81-1.08, per 0.1-unit increase in MI-ERR for overall defect-free care). Among the 51 453 patients with 1-year outcomes data available, higher MI-ERR was associated with higher adjusted risk of the composite outcome and all-cause readmission within 1 year of discharge. This association was largely driven by readmissions early after discharge and was not significant in landmark analyses beginning 30 days after discharge. The MI-ERR was not associated with risk for mortality within 1 year of discharge in the overall and 30-day landmark analyses. Conclusions and Relevance During the first cycle of the Hospital Readmissions Reduction Program, participating hospitals' risk-adjusted 30-day readmission rates following MI were not associated with in-hospital quality of MI care or clinical outcomes occurring after the first 30 days after discharge.
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Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Harsh Golwala
- Brigham and Women's Hospital Heart and Vascular Center, Boston, Massachusetts
| | - Hurst M Hall
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Tracy Y Wang
- Duke Clinical Research Institute, Durham, North Carolina
| | - Di Lu
- Duke Clinical Research Institute, Durham, North Carolina
| | - Ying Xian
- Duke Clinical Research Institute, Durham, North Carolina4Department of Neurology, Duke University Medical Center, Durham, North Carolina
| | - Karen Chiswell
- Duke Clinical Research Institute, Durham, North Carolina
| | - Karen E Joynt
- Brigham and Women's Hospital Heart and Vascular Center, Boston, Massachusetts
| | - Abhinav Goyal
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Sandeep R Das
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Dharam Kumbhani
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Howard Julien
- Division of Cardiology, Columbia University School of Medicine, New York, New York
| | - Gregg C Fonarow
- Ronald Reagan-UCLA Medical Center, Los Angeles, California8Associate Editor for Health Care Quality and Guidelines, JAMA Cardiology
| | - James A de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
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Desai NR, Udell JA, Wang Y, Spatz ES, Dharmarajan K, Ahmad T, Julien HM, Annapureddy A, Goyal A, de Lemos JA, Masoudi FA, Bhatt DL, Minges KE, Krumholz HM, Curtis JP. Trends in Performance and Opportunities for Improvement on a Composite Measure of Acute Myocardial Infarction Care. Circ Cardiovasc Qual Outcomes 2019; 12:e004983. [DOI: 10.1161/circoutcomes.118.004983] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nihar R. Desai
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., T.A., A.A., K.E.M., H.M.K., J.P.C.)
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., A.A., K.E.M., H.M.K., J.P.C.)
| | - Jacob A. Udell
- Cardiovascular Division, Women’s College Hospital, Toronto General Hospital, University of Toronto, Ontario, Canada (J.A.U.)
| | - Yongfei Wang
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., T.A., A.A., K.E.M., H.M.K., J.P.C.)
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., A.A., K.E.M., H.M.K., J.P.C.)
| | - Erica S. Spatz
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., T.A., A.A., K.E.M., H.M.K., J.P.C.)
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., A.A., K.E.M., H.M.K., J.P.C.)
| | - Kumar Dharmarajan
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., T.A., A.A., K.E.M., H.M.K., J.P.C.)
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., A.A., K.E.M., H.M.K., J.P.C.)
| | - Tariq Ahmad
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., T.A., A.A., K.E.M., H.M.K., J.P.C.)
| | - Howard M. Julien
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA (H.M.J.)
| | - Amarnath Annapureddy
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., T.A., A.A., K.E.M., H.M.K., J.P.C.)
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., A.A., K.E.M., H.M.K., J.P.C.)
| | - Abhinav Goyal
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.)
| | - James A. de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX (J.D.L.)
| | - Frederick A. Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Colorado Cardiovascular Outcomes Research Consortium, Denver, CO (F.A.M.)
| | - Deepak L. Bhatt
- Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Karl E. Minges
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., T.A., A.A., K.E.M., H.M.K., J.P.C.)
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., A.A., K.E.M., H.M.K., J.P.C.)
| | - Harlan M. Krumholz
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., T.A., A.A., K.E.M., H.M.K., J.P.C.)
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., A.A., K.E.M., H.M.K., J.P.C.)
| | - Jeptha P. Curtis
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., T.A., A.A., K.E.M., H.M.K., J.P.C.)
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (N.R.D., Y.W., E.S.S., K.D., A.A., K.E.M., H.M.K., J.P.C.)
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Fanaroff AC, Steffel J, Alexander JH, Lip GYH, Califf RM, Lopes RD. Stroke prevention in atrial fibrillation: re-defining ‘real-world data’ within the broader data universe. Eur Heart J 2018; 39:2932-2941. [DOI: 10.1093/eurheartj/ehy236] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/06/2018] [Indexed: 02/07/2023] Open
Affiliation(s)
- Alexander C Fanaroff
- Division of Cardiology, Duke Clinical Research Institute, Duke University, 2400 Pratt Street, Durham, NC USA
| | - Jan Steffel
- Division of Cardiology, University Heart Center Zürich, Rämistrasse 100, Zürich, Switzerland
| | - John H Alexander
- Division of Cardiology, Duke Clinical Research Institute, Duke University, 2400 Pratt Street, Durham, NC USA
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, UK
- Division of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Søndre Skovvej 15, Forskningens Hus, Aalborg, Denmark
| | - Robert M Califf
- Division of Cardiology, Duke Clinical Research Institute, Duke University, 2400 Pratt Street, Durham, NC USA
- Verily Life Sciences, 269 E Grand Ave, South San Francisco, CA, USA
| | - Renato D Lopes
- Division of Cardiology, Duke Clinical Research Institute, Duke University, 2400 Pratt Street, Durham, NC USA
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