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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Describe the pathogenesis, classification, and risk factors of sternal wound infection. 2. Discuss options for sternal stabilization for the prevention of sternal wound infection, including wiring and plating techniques. 3. Discuss primary surgical reconstructive options for deep sternal wound infection and the use of adjunctive methods, such as negative-pressure wound therapy. SUMMARY Poststernotomy sternal wound infection remains a life-threatening complication of open cardiac surgery. Successful treatment relies on timely diagnosis and initiation of multidisciplinary, multimodal therapy.
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Guha A, Dey AK, Kalra A, Gumina R, Lustberg M, Lavie CJ, Sabik JF, Addison D. Coronary Artery Bypass Grafting in Cancer Patients: Prevalence and Outcomes in the United States. Mayo Clin Proc 2020; 95:1865-1876. [PMID: 32861331 PMCID: PMC7860624 DOI: 10.1016/j.mayocp.2020.05.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/04/2020] [Accepted: 05/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To characterize the contemporary efficacy and utilization patterns of coronary artery bypass grafting (CABG) in specific cancer types. METHODS We leveraged the data from the National Inpatient Sample and plotted trends of utilization and outcomes of isolated CABG (with no other additional surgeries during the same hospitalization) procedures from January 1, 2003, through September 1, 2015. Propensity score matching was used to assess for potential differences in outcomes by type of cancer status among contemporary (2012-2015) patients. RESULTS Overall, the utilization of CABG decreased over time (250,677 in 2003 vs 134,534 in 2015, P<.001). However, the proportion of those with comorbid cancer increased (7.0% vs 12.6%, P<.001). Over time, in-hospital mortality associated with CABG use in cancer remained unchanged (.9% vs 1.0%, P=.72); yet, cancer patients saw an increase in associated major bleeding (4.5% vs 15.3%, P<.001) and rate of stroke (.9% vs 1.5%, P<.001) over time. In-hospital cost-of-care associated with CABG-use in cancer also increased over time ($29,963 vs $33,636, P<.001). When stratified by cancer types, in-hospital mortality was not higher in breast, lung, prostate, colon cancer, or lymphoma versus non-cancer CABG patients (all P>.05). However, there was a significantly higher prevalence of major bleeding but not stroke in patients with breast and prostate cancer only compared with non-cancer CABG patients (P<.01). Discharge dispositions were not found to be different between cancer sub-groups and non-cancer patients (P>.05), except for breast cancer patients who had lower home care, but higher skilled care disposition (P<.001). CONCLUSION Among those undergoing CABG, the prevalence of comorbid cancer has steadily increased. Outside of major bleeding, these patients appear to share similar outcomes to those without cancer indicating that CABG utilization should be not be declined in cancer patients when otherwise indicated. Further research into the factors underlying the decision to pursue CABG in specific cancer sub-groups is needed.
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Affiliation(s)
- Avirup Guha
- Cardio-Oncology Program, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH; Division of Medical Oncology, James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH; Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH
| | - Amit K Dey
- Division of Cardiology, National Heart, Lung and Blood Institute, Bethesda, MD
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Richard Gumina
- Cardio-Oncology Program, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH
| | - Maryam Lustberg
- Cardio-Oncology Program, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH; Division of Medical Oncology, James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - Carl J Lavie
- Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA
| | - Joseph F Sabik
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH.
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Odoi EW, Nagle N, DuClos C, Kintziger KW. Disparities in Temporal and Geographic Patterns of Myocardial Infarction Hospitalization Risks in Florida. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4734. [PMID: 31783516 PMCID: PMC6926732 DOI: 10.3390/ijerph16234734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 11/23/2019] [Accepted: 11/24/2019] [Indexed: 12/12/2022]
Abstract
Knowledge of geographical disparities in myocardial infarction (MI) is critical for guiding health planning and resource allocation. The objectives of this study were to identify geographic disparities in MI hospitalization risks in Florida and assess temporal changes in these disparities between 2005 and 2014. This study used retrospective data on MI hospitalizations that occurred among Florida residents between 2005 and 2014. We identified spatial clusters of hospitalization risks using Kulldorff's circular and Tango's flexible spatial scan statistics. Counties with persistently high or low MI hospitalization risks were identified. There was a 20% decline in hospitalization risks during the study period. However, we found persistent clustering of high risks in the Big Bend region, South Central and southeast Florida, and persistent clustering of low risks primarily in the South. Risks decreased by 7%-21% in high-risk clusters and by 9%-28% in low-risk clusters. The risk decreased in the high-risk cluster in the southeast but increased in the Big Bend area during the last four years of the study. Overall, risks in low-risk clusters were ahead those for high-risk clusters by at least 10 years. Despite MI risk declining over the study period, disparities in MI risks persist. Eliminating/reducing those disparities will require prioritizing high-risk clusters for interventions.
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Affiliation(s)
- Evah W. Odoi
- Comparative and Experimental Medicine, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN 37996, USA;
| | - Nicholas Nagle
- Department of Geography, The University of Tennessee, Knoxville, TN 37996, USA;
| | - Chris DuClos
- Environmental Public Health Tracking, Division of Community Health Promotion, Florida Department of Health, Tallahassee, FL 32399, USA;
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Brindhaban A. RADIATION DOSE TO PATIENTS IN CORONARY INTERVENTIONAL PROCEDURES: A SURVEY. RADIATION PROTECTION DOSIMETRY 2019; 184:1-4. [PMID: 30289509 DOI: 10.1093/rpd/ncy179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/16/2018] [Accepted: 09/18/2018] [Indexed: 06/08/2023]
Abstract
The objective of this study was to evaluate dose-area product (DAP) and peak skin dose (PSD) for coronary angiography (CA) and percutaneous coronary intervention (PCI). The DAP and PSD of 300 randomly selected patients who were referred to CA and/or PCI, over a period of 3 months were recorded and analyzed. The mean DAP of 32 Gy cm2 and mean PSD of 412 mGy for CA were lower than 118 Gy cm2 and 857 mGy, respectively, for PCI. The DAP range of 2-84 Gy cm2 for CA and 12-378 mGy for PCI were also established. The maximum value of PSD for PCI procedures reached above the 2 Gy threshold for erythema. However, these values are similar to those available in literature. Periodic surveys may be required to monitor and/or reduce radiation doses in coronary interventional procedures.
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Affiliation(s)
- A Brindhaban
- Department of Radiologic Sciences, Kuwait University, Sulaibikhat, Kuwait
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Montone RA, Niccoli G. Percutaneous coronary intervention in patients refused from surgery: a different entity? Minerva Cardioangiol 2018. [DOI: 10.23736/s0026-4725.18.04656-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Moazzami K, Dolmatova E, Maher J, Gerula C, Sambol J, Klapholz M, Waller AH. In-Hospital Outcomes and Complications of Coronary Artery Bypass Grafting in the United States Between 2008 and 2012. J Cardiothorac Vasc Anesth 2016; 31:19-25. [PMID: 27887898 DOI: 10.1053/j.jvca.2016.08.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the frequency and predictors of in-hospital complications among patients undergoing coronary artery bypass grafting (CABG) in the United States. DESIGN Retrospective national database analysis SETTINGS: United States hospitals. PARTICIPANTS A weighted sample of 1,910,236 patients undergoing CABG surgery identified from the National (Nationwide) Inpatient Sample from 2008 to 2012. INTERVENTIONS CABG surgery MEASUREMENTS AND MAIN RESULTS: The number of CABG surgeries decreased from 436,275 in 2008 to 339,749 in 2012. The Deyo comorbidity index showed a steady increase from 2008 to 2012. The rate of in-hospital mortality decreased from 2.7% in 2008 to 2.2% in 2012 (p<0.001). The most common in-hospital complication was postoperative hemorrhage (30.4%), followed by cardiac (11.34%) and respiratory complications (2.3%). During the 5-year period, the rates of in-hospital cardiac, respiratory and infectious complications decreased (p<0.001), while the rate of postoperative hemorrhage showed a 35.8% relative increase in 2012 compared to 2008. CONCLUSION The annual number of CABG surgeries is declining in the United States. While the burden of comorbidities is increasing, the rates of mortality and most in-hospital complications are improving. The increasing rate of postoperative bleeding necessitates the need to develop strategies to improve the risk of bleeding in this patient population.
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Affiliation(s)
- Kasra Moazzami
- Department of Medicine, Rutgers New Jersey Medical School, The State University of New Jersey, Newark, NJ
| | - Elena Dolmatova
- Department of Medicine, Rutgers New Jersey Medical School, The State University of New Jersey, Newark, NJ
| | - James Maher
- Department of Medicine, Rutgers New Jersey Medical School, The State University of New Jersey, Newark, NJ; Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, The State University of New Jersey, Newark, NJ
| | - Christine Gerula
- Department of Medicine, Rutgers New Jersey Medical School, The State University of New Jersey, Newark, NJ; Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, The State University of New Jersey, Newark, NJ
| | - Justin Sambol
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers New Jersey Medical School, The State University of New Jersey, Newark, NJ
| | - Marc Klapholz
- Department of Medicine, Rutgers New Jersey Medical School, The State University of New Jersey, Newark, NJ; Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, The State University of New Jersey, Newark, NJ
| | - Alfonso H Waller
- Department of Medicine, Rutgers New Jersey Medical School, The State University of New Jersey, Newark, NJ; Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, The State University of New Jersey, Newark, NJ.
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2015; 133:e38-360. [PMID: 26673558 DOI: 10.1161/cir.0000000000000350] [Citation(s) in RCA: 3724] [Impact Index Per Article: 413.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Hagen TP, Häkkinen U, Belicza E, Fatore G, Goude F. Acute Myocardial Infarction, Use of Percutaneous Coronary Intervention, and Mortality: A Comparative Effectiveness Analysis Covering Seven European Countries. HEALTH ECONOMICS 2015; 24 Suppl 2:88-101. [PMID: 26633870 DOI: 10.1002/hec.3263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 05/04/2015] [Accepted: 08/09/2015] [Indexed: 06/05/2023]
Abstract
Percutaneous coronary interventions (PCI) on acute myocardial infarction (AMI) patients have increased substantially in the last 12-15 years because of its clinical effectiveness. The expansion of PCI treatment for AMI patients raises two questions: How did PCI utilization rates vary across European regions, and which healthcare system and regional characteristic variables correlated with the utilization rate? Were the differences in use of PCI associated with differences in outcome, operationalized as 30-day mortality? We obtained our results from a dataset based on the administrative information systems of the populations of seven European countries. PCI rates were highest in the Netherlands, followed by Sweden and Hungary. The probability of receiving PCI was highest in regions with their own PCI facilities and in healthcare systems with activity-based reimbursement systems. Thirty-day mortality rates differed considerably between the countries with the highest rates in Hungary, Scotland, and Finland. Mortality was lowest in Sweden and Norway. The associations between PCI and mortality were remarkable in all age groups and across most countries. Despite extensive risk adjustment, we interpret the associations both as effects of selection and treatments. We observed a lower effect of PCI in the higher age groups in Hungary.
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Affiliation(s)
- Terje P Hagen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Unto Häkkinen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
| | - Eva Belicza
- Health Services Management Training Center, Semmelweis University, Budapest, Hungary
| | - Giovanni Fatore
- Centre for Research on Health and Social Care Management, Bocconi University, Milano, Italy
| | - Fanny Goude
- Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
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Li S, Dor A. How Do Hospitals Respond to Market Entry? Evidence from a Deregulated Market for Cardiac Revascularization. HEALTH ECONOMICS 2015; 24:990-1008. [PMID: 24990327 DOI: 10.1002/hec.3079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 05/26/2014] [Accepted: 06/04/2014] [Indexed: 06/03/2023]
Abstract
Regulatory entry barriers to hospital service markets, namely Certificate of Need (CON) regulations, are enforced in many US states. Policy makers in other states are considering reinstating CON policies in tandem with service expansions mandated under the Affordable Care Act. Although previous studies examined the volume effects of CON, demand responses to actual entry into local hospital markets are not well understood. In this paper, we empirically examine the demand-augmenting, demand-redistribution, and risk-allocation effects of hospital entry by studying the cardiac revascularization markets in Pennsylvania, a state in which dynamic market entry occurred after repeal of CON in 1996. Results from interrupted time-series analyses indicate demand-augmenting effects for coronary artery bypass graft (CABG) and business-stealing effects for percutaneous coronary intervention (PCI) procedures: high entrant market share mitigated the declining incidence of CABG, but it had no significant effect on the rising trend in PCI use, among patients with coronary artery disease. We further find evidence that entry by new cardiac surgery centers tended to sort high-severity patients into the more invasive CABG procedure and low-severity patients into the less invasive PCI procedures. These findings underscore the importance of considering market-level strategic responses by hospitals when regulatory barriers are rescinded.
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Affiliation(s)
- Suhui Li
- Department of Health Policy, The George Washington University, Washington, DC, USA
| | - Avi Dor
- Department of Health Policy, The George Washington University, Washington, DC, USA
- National Bureau of Economic Research, Cambridge, MA, USA
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Choi YJ, Kim JB, Cho SJ, Cho J, Sohn J, Cho SK, Ha KH, Kim C. Changes in the Practice of Coronary Revascularization between 2006 and 2010 in the Republic of Korea. Yonsei Med J 2015; 56:895-903. [PMID: 26069109 PMCID: PMC4479855 DOI: 10.3349/ymj.2015.56.4.895] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Evidence suggests that technological innovations and reimbursement schemes of the National Health Insurance Service may have impacted the management of coronary artery disease. Thus, we investigated changes in the practice patterns of coronary revascularization. MATERIALS AND METHODS Revascularization and in-hospital mortality among Koreans ≥20 years old were identified from medical claims filed between 2006 and 2010. The age- and sex-standardized procedure rate per 100,000 person-years was calculated directly from the distribution of the 2008 Korean population. RESULTS The coronary revascularization rate increased from 116.1 (95% confidence interval, 114.9-117.2) in 2006 to 131.0 (129.9-132.1) in 2010. Compared to the rate ratios in 2006, the rate ratios for percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in 2010 were 1.16 (1.15-1.17) and 0.80 (0.76-0.84), respectively. Among patients who received PCI, the percentage with drug-eluting stents increased from 89.1% in 2006 to 93.0% in 2010. In-hospital mortality rates from PCI significantly increased during the study period (p=0.03), whereas those from CABG significantly decreased (p=0.01). The in-hospital mortality rates for PCI and CABG were higher in elderly and female patients and at the lowest-volume hospitals. CONCLUSION The annual volume of coronary revascularization continuously increased between 2006 and 2010 in Korea, although this trend differed according to procedure type. A high percentage of drug-eluting stent procedures and a high rate of in-hospital mortality at low-volume hospitals were noted.
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Affiliation(s)
- Yoon Jung Choi
- Health Technology Assessment Team, Health Insurance Review and Assessment Service, Seoul, Korea
| | - Jin-Bae Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Su-Jin Cho
- Health Technology Assessment Team, Health Insurance Review and Assessment Service, Seoul, Korea
| | - Jaelim Cho
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jungwoo Sohn
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | | | - Kyoung Hwa Ha
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Wang Y, Lichtman JH, Dharmarajan K, Masoudi FA, Ross JS, Dodson JA, Chen J, Spertus JA, Chaudhry SI, Nallamothu BK, Krumholz HM. National trends in stroke after acute myocardial infarction among Medicare patients in the United States: 1999 to 2010. Am Heart J 2015; 169:78-85.e4. [PMID: 25497251 DOI: 10.1016/j.ahj.2014.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/07/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Stroke is a common and important adverse event after acute myocardial infarction (AMI) in the elderly. It is unclear whether the risk of stroke after AMI has changed with improvements in treatments and outcomes for AMI in the last decade. METHODS To assess trends in risk of stroke after AMI, we used a national sample of Medicare data to identify Fee-for-Service patients (n = 2,305,441) aged ≥65 years who were discharged alive after hospitalization for AMI from 1999 to 2010. RESULTS We identified 57,848 subsequent hospitalizations for ischemic stroke and 4,412 hospitalizations for hemorrhagic stroke within 1 year after AMI. The 1-year rate of ischemic stroke decreased from 3.4% (95% CI 3.3%-3.4%) to 2.6% (2.5%-2.7%; P < .001). The risk-adjusted annual decline was 3% (hazard ratio, 0.97; [0.97-0.98]) and was similar across all age and sex-race groups. The rate of hemorrhagic stroke remained stable at 0.2% and did not differ by subgroups. The 30-day mortality for patients admitted with ischemic stroke after AMI decreased from 19.9% (18.8%-20.9%) to 18.3% (17.1%-19.6%) and from 48.3% (43.0%-53.6%) to 45.7% (40.3%-51.2%) for those admitted with hemorrhagic stroke. We observed a decrease in 1-year mortality from 37.8% (36.5%-39.1%) to 35.3% (33.8%-36.8%) for ischemic stroke and from 66.6% (61.4%-71.5%) to 60.6% (55.1%-65.9%) for hemorrhagic stroke. CONCLUSIONS From 1999 to 2010, the 1-year risk for ischemic stroke after AMI declined, whereas the risk of hemorrhagic stroke remained unchanged. However, 30-day and 1-year mortality continued to be high.
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation 2014; 131:e29-322. [PMID: 25520374 DOI: 10.1161/cir.0000000000000152] [Citation(s) in RCA: 4448] [Impact Index Per Article: 444.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ford ES, Roger VL, Dunlay SM, Go AS, Rosamond WD. Challenges of ascertaining national trends in the incidence of coronary heart disease in the United States. J Am Heart Assoc 2014; 3:e001097. [PMID: 25472744 PMCID: PMC4338697 DOI: 10.1161/jaha.114.001097] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Earl S. Ford
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (E.S.F.)
| | - Véronique L. Roger
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, RochesterMN (R., S.M.D.)
| | - Shannon M. Dunlay
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, RochesterMN (R., S.M.D.)
| | - Alan S. Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (A.S.G.)
- Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, CA (A.S.G.)
- Department of Health Research and Policy, Stanford University School of Medicine, Palo Alto, CA (A.S.G.)
| | - Wayne D. Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC (W.D.R.)
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Mortality Trends in Patients Hospitalized with the Initial Acute Myocardial Infarction in a Middle Eastern Country over 20 Years. Cardiol Res Pract 2014; 2014:464323. [PMID: 24868481 PMCID: PMC4020445 DOI: 10.1155/2014/464323] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 02/19/2014] [Accepted: 04/04/2014] [Indexed: 01/09/2023] Open
Abstract
We aimed to define the temporal trend in the initial Acute Myocardial Infarction (AMI) management and outcome during the last two decades in a Middle Eastern country. A total of 10,915 patients were admitted with initial AMI with mean age of 53 ± 11.8 years. Comparing the two decades (1991–2000) to (2001–2010), the use of antiplatelet drugs increased from 84% to 95%, β-blockers increased from 38% to 56%, and angiotensin converting enzyme inhibitors (ACEI) increased from 12% to 36% (P < 0.001 for all). The rates of PCI increased from 2.5% to 14.6% and thrombolytic therapy decreased from 71% to 65% (P < 0.001 for all). While the rate of hospitalization with Initial MI increased from 34% to 66%, and the average length of hospital stay decreased from 6.4 ± 3 to 4.6 ± 3, all hospital outcomes parameters improved significantly including a 39% reduction in in-hospital Mortality. Multivariate logistic regression analysis showed that higher utilization of antiplatelet drugs, β-blockers, and ACEI were the main contributors to better hospital outcomes. Over the study period, there was a significant increase in the hospitalization rate in patients presenting with initial AMI. Evidence-based medical therapies appear to be associated with a substantial improvement in outcome and in-hospital mortality.
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Tisminetzky M, McManus DD, Gore JM, Yarzebski J, Coles A, Lessard D, Goldberg RJ. 30-year trends in patient characteristics, treatment practices, and long-term outcomes of adults aged 35 to 54 years hospitalized with acute myocardial infarction. Am J Cardiol 2014; 113:1137-41. [PMID: 24507173 PMCID: PMC3959496 DOI: 10.1016/j.amjcard.2013.12.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 12/30/2022]
Abstract
Much of our knowledge about the characteristics, clinical management, and postdischarge outcomes of acute myocardial infarction (AMI) is derived from clinical studies in middle-aged and older subjects with little contemporary information available about the descriptive epidemiology of AMI in relatively young men and women. The objectives of our population-based study were to describe >3-decade-long trends in the clinical features, treatment practices, and long-term outcomes of young adults aged 35 to 54 years discharged from the hospital after AMI. The study population consisted of 2,142 residents of the Worcester (Massachusetts) metropolitan area who were hospitalized with AMI at all central Massachusetts medical centers during 16 annual periods from 1975 to 2007. Our primarily male study population had an average age of 47 years. Patients hospitalized during the most recent decade (1997 to 2007) under study were more likely to have a history of hypertension and heart failure than those hospitalized during earlier study years. Patients were less likely to have developed heart failure or stroke during their hospitalization in the most recent compared with the initial decade under study (heart failure 13.7% and stroke 0.7% vs 20.9% and 2.0%, respectively). One- and 2-year postdischarge death rates also decreased significantly between 1975 to 1986 (6.2% and 9.0%, respectively) and 1988 to 1995 (2.6% and 4.9%). These trends were concomitant with the increasing use of effective cardiac therapies and coronary interventions during hospitalization. The present results provide insights into the changing characteristics, management, and improving long-term outcomes of relatively young patients hospitalized with AMI.
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Affiliation(s)
- Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - David D McManus
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Joel M Gore
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Andrew Coles
- Department of Cell and Developmental Biology, Program in Gene Function and Expression, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
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Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation 2014; 129:e28-e292. [PMID: 24352519 PMCID: PMC5408159 DOI: 10.1161/01.cir.0000441139.02102.80] [Citation(s) in RCA: 3518] [Impact Index Per Article: 351.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Izadnegahdar M, Singer J, Lee MK, Gao M, Thompson CR, Kopec J, Humphries KH. Do younger women fare worse? Sex differences in acute myocardial infarction hospitalization and early mortality rates over ten years. J Womens Health (Larchmt) 2013; 23:10-7. [PMID: 24206026 DOI: 10.1089/jwh.2013.4507] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Recent research has identified younger women as an "at-risk" population with rising prevalence of cardiac risk factors and excess mortality risk following acute myocardial infarction (AMI). However, population-based data on trends in AMI hospitalization and early mortality post AMI among younger adults is scarce. We, therefore, aimed to provide a 10-year, descriptive analysis of these trends in a Canadian setting. METHODS AND RESULTS We assessed trends and sex differences in AMI hospitalization and 30-day mortality rates using negative binomial and logistic regression, respectively. From 2000 to 2009, there were 70,628 AMI hospitalizations in adults aged ≥20 years, in British Columbia, Canada, with 17.1% of cohort being younger adults ≤55 years. Overall, age-standardized AMI rates (per 100,000 population) declined similarly in men (295.8 to 247.7) and women (152.1 to 128.8) [sex-year interaction p=0.81]. However, these trends differed according to age (age-sex-year interaction p=0.02) with increased rates observed only in younger women (+1.7% per year; p=0.04). The 30-day mortality rates declined similarly for women (19.4% to 13.9%) and men (13.0% to 9.3%) (sex-year interaction p=0.33). Yet, younger women continued to have excess mortality risk, compared with younger men, even in the most recent period [odds ratio: (2008-09)=1.61 (95% onfidence interval: 1.25, 2.08)]. CONCLUSION While the overall AMI hospitalization and 30-day mortality rates significantly declined in women and men, hospitalization rates in women ≤55 years increased and their excess risk of 30-day mortality persisted. These findings highlight the need to intensify strategies to reduce the incidence of AMI and improve outcomes after AMI in younger women.
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Affiliation(s)
- Mona Izadnegahdar
- 1 School of Population and Public Health, University of British Columbia , Vancouver, British Columbia, Canada
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18
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Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation 2013; 127:e6-e245. [PMID: 23239837 PMCID: PMC5408511 DOI: 10.1161/cir.0b013e31828124ad] [Citation(s) in RCA: 3348] [Impact Index Per Article: 304.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Metcalfe A, Neudam A, Forde S, Liu M, Drosler S, Quan H, Jetté N. Case definitions for acute myocardial infarction in administrative databases and their impact on in-hospital mortality rates. Health Serv Res 2012; 48:290-318. [PMID: 22742621 DOI: 10.1111/j.1475-6773.2012.01440.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To identify validated ICD-9-CM/ICD-10 coded case definitions for acute myocardial infarction (AMI). DATA SOURCES Ovid Medline (1950-2010) was searched to identify studies that validated acute myocardial infarction (AMI) case definitions. Hospital discharge abstract data and chart data were linked to validate identified AMI definitions. STUDY DESIGN Systematic literature review, chart review, and administrative data analysis. DATA COLLECTION/EXTRACTION METHODS Data on sensitivity/specificity/positive and negative predictive values (PPV and NPV) were extracted from previous studies to identify validated case definitions for AMI. These case definitions were validated in administrative data through chart review and applied to hospital discharge data to assess in-hospital mortality. PRINCIPAL FINDINGS Of the eight ICD-9-CM definitions validated in the literature, use of ICD-9-CM code 410 to define AMI had the highest sensitivity (94 percent) and specificity (99 percent). In our data, ICD-9-CM/ICD-10 codes 410/I21-I22 in all available coding fields had high sensitivity (83.3 percent/82.8 percent) and PPV (82.8 percent/82.2 percent). The in-hospital mortality among AMI patients identified using this case definition was 7.6 percent in ICD-9-CM data and 6.6 percent in ICD-10 data. CONCLUSIONS We recommend that ICD-9-CM 410 or ICD-10 I21-I22 in the primary diagnosis coding field should be used to define AMI. The use of a consistent validated case definition would improve comparability across studies.
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Affiliation(s)
- Amy Metcalfe
- Departments of Community Health Sciences and Clinical Neurosciences, University of Calgary, TRW Building 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, Canada, T2N 4Z6.
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Bashore TM, Balter S, Barac A, Byrne JG, Cavendish JJ, Chambers CE, Hermiller JB, Kinlay S, Landzberg JS, Laskey WK, McKay CR, Miller JM, Moliterno DJ, Moore JWM, Oliver-McNeil SM, Popma JJ, Tommaso CL. 2012 American College of Cardiology Foundation/Society for Cardiovascular Angiography and Interventions expert consensus document on cardiac catheterization laboratory standards update: A report of the American College of Cardiology Foundation Task Force on Expert Consensus documents developed in collaboration with the Society of Thoracic Surgeons and Society for Vascular Medicine. J Am Coll Cardiol 2012; 59:2221-305. [PMID: 22575325 DOI: 10.1016/j.jacc.2012.02.010] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Sezai A, Hata M, Yoshitake I, Kimura H, Takahashi K, Hata H, Shiono M. Results of emergency coronary artery bypass grafting for acute myocardial infarction: importance of intraoperative and postoperative cardiac medical therapy. Ann Thorac Cardiovasc Surg 2012; 18:338-46. [PMID: 22572233 DOI: 10.5761/atcs.oa.11.01821] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The results of emergency coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) are less than satisfactory, and readmission for cardiac events is common. METHODS AND RESULTS 105 patients underwent emergency CABG for AMI. We examined the long-term results of emergency CABG for AMI from the viewpoints of preoperative, intraoperative, and postoperative factors. The operative mortality rate was 11.4%. Risk factors for early death were age ≥80 years, shock, veno-arterial bypass, creatine kinase isoenzyme Mb ≥100 U/L, non-use of a left internal thoracic artery graft and an extracorporeal circulation time ≥120 min. Risk factors for late cardiac events were ejection fraction <40%, non-use of human atrial natriuretic peptide (hANP) therapy, angiotensin II receptor blockers (ARB) and aldosterone blockers, and a 3-month postoperative brain natriuretic peptide level ≥200 pg/ml. CONCLUSIONS Early results of this study are similar to those seen in previous reports, whereas late phase results yield some new and interesting findings. We suggest that intraoperative hANP, and postoperative aldosterone blocker and ARB, following CABG for AMI, will, through control of the renin-angiotensin-aldsterone system, inhibit left ventricular remodelling, reduce the extent of infarction, and improve cardiac function, yielding a favourable long-term prognosis.
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Affiliation(s)
- Akira Sezai
- The Department of Cardiovascular Surgery, Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan.
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Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Soliman EZ, Sorlie PD, Sotoodehnia N, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation 2012; 125:e2-e220. [PMID: 22179539 PMCID: PMC4440543 DOI: 10.1161/cir.0b013e31823ac046] [Citation(s) in RCA: 3169] [Impact Index Per Article: 264.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Lai L, Morgan MK. The impact of changing intracranial aneurysm practice on the education of cerebrovascular neurosurgeons. J Clin Neurosci 2012; 19:81-4. [DOI: 10.1016/j.jocn.2011.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 07/23/2011] [Accepted: 07/24/2011] [Indexed: 10/15/2022]
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Towfighi A, Markovic D, Ovbiagele B. National gender-specific trends in myocardial infarction hospitalization rates among patients aged 35 to 64 years. Am J Cardiol 2011; 108:1102-7. [PMID: 21816380 DOI: 10.1016/j.amjcard.2011.05.046] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 05/26/2011] [Accepted: 05/29/2011] [Indexed: 01/13/2023]
Abstract
In recent years, the prevalence of myocardial infarction (MI) has increased among women and decreased among men aged 35 to 54 years. To determine the extent to which changes in incidence account for recent variations in prevalence, we assessed the temporal trends in gender-specific hospitalization rates for MI. Using the Nationwide Inpatient Sample, we identified patients aged 35 to 64 years admitted to United States hospitals with a primary discharge diagnosis of MI from 1997 to 2006 (n = 2,824,615). The age-standardized MI hospitalization rates per 100,000 subjects were assessed for men and women aged 35 to 44, 45 to 54, and 55 to 64 years. The MI hospitalization rates per 100,000 subjects decreased by 26% from 168 to 126 for men and by 18% from 56 to 46 for women (both p <0.001). The reductions in the MI hospitalization rates were greatest among men aged 45 to 54, men aged 55 to 64, and women aged 55 to 64 years (standardized rates of change -3%, -4%, and -3% annually, p <0.001). The MI hospitalization rates decreased slightly for women aged 45 to 54 years and men aged 35 to 44 years (standardized rate of change -2% annually, p <0.001) and increased for women aged 35 to 44 years (standardized rate of change 2% annually, p = 0.008). In conclusion, from 1997 to 2006, men and women aged 35 to 64 years experienced an overall decrease in MI hospitalization rates; the reductions were more pronounced in men than in women. The slight increase in MI hospitalizations among women aged 35 to 44 years might have played a small role in the previously noted increases in MI prevalence among middle-age women.
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Affiliation(s)
- Amytis Towfighi
- Stroke Center and Department of Neurology, University of Southern California, Los Angeles, USA.
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Race and timeliness of transfer for revascularization in patients with acute myocardial infarction. Med Care 2011; 49:662-7. [PMID: 21677592 DOI: 10.1097/mlr.0b013e31821d98b2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Patients with acute myocardial infarction (AMI) who are admitted to hospitals without coronary revascularization are frequently transferred to hospitals with this capability. We sought to determine whether the timeliness of hospital transfer and quality of destination hospitals differed between black and white patients. METHODS We evaluated all white and black Medicare beneficiaries admitted with AMI at nonrevascularization hospitals in 2006 who were transferred to a revascularization hospital. We compared hospital length of stay before transfer and the transfer destination's 30-day risk-standardized mortality rate for AMI between black and white patients. We used hierarchical regression to adjust for patient characteristics and examine within and across-hospital effects of race on 30-day mortality and length of stay before transfer. RESULTS A total of 25,947 (42%) white and 2345 (37%) black patients with AMI were transferred from 857 urban and 774 rural nonrevascularization hospitals to 928 revascularization hospitals. Median (interquartile range) length of stay before transfer was 1 day (1 to 3 d) for white patients and 2 days (1 to 4 d) for black patients (P<0.001). In adjusted models, black patients tended to be transferred more slowly than white patients, a finding because of both across and within-hospital effects. For example, within a given urban hospital, black patients were transferred an additional 0.24 days (95% confidence interval 0.03-0.44 d) later than white patients. In addition, the lengths of stay before transfer for all patients at urban hospitals increased by 0.37 days (95% confidence interval 0.28-0.47 d) for every 20% increase in the proportion of AMI patients who were black. These results were attenuated in rural hospitals. The risk-standardized mortality rate of the revascularization hospital to which patients were ultimately sent did not differ between black and white patients. CONCLUSIONS Black patients are transferred more slowly to revascularization hospitals after AMI than white patients, resulting from both less timely transfers within hospitals and admission to hospitals with greater delays in transfer; however, 30-day mortality of the revascularization hospital to which both groups were sent to appeared similar. Race-based delays in transfer may contribute to known racial disparities in outcomes of AMI.
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Takano T, Goto H, Hoshino K, Shimada H, Ichinose H, Shinozaki N. Coronary artery bypass grafting for acute myocardial infarction in stent ERA. Ann Thorac Cardiovasc Surg 2011; 17:267-72. [PMID: 21697788 DOI: 10.5761/atcs.oa.10.01590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 06/15/2010] [Indexed: 11/16/2022] Open
Abstract
PURPOSE We evaluated a treatment strategy for acute myocardial infarction (AMI) that percutaneous coronary intervention (PCI) is performed on a culprit lesion unless the culprit is an unprotected left main trunk. Emergent coronary artery bypass grafting (CABG) is done when the culprit is a left main trunk and a mechanical complication exists. METHODS From 1997 to 2008, 22 and 232 patients underwent CABG for AMI and non-AMI, respectively. Of the 22 patients of AMI, PCI was performed in 12 patients and not performed in 10 patients before surgery. We investigated complication, intubation period, in-hospital mortality and hospitalization period. RESULTS No in-hospital mortality was observed in all 22 AMI patients. There was no difference in in-hospital mortality and complication between the AMI and the non-AMI patients. No significant difference was found in hospital stay, complication, intubation period, in-hospital mortality and hospitalization period between patients who received preceding PCI and not. CONCLUSIONS These results suggest that our treatment strategy is reasonable. Further studies will be warranted to clarify the role of preceding PCI.
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Affiliation(s)
- Tamaki Takano
- Department of Cardiac Surgery and Cardiology, Cardiovascular Center, Shinonoi General Hospital, Nagano, Nagano, Japan.
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27
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Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, Carnethon MR, Dai S, de Simone G, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Greenlund KJ, Hailpern SM, Heit JA, Ho PM, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, McDermott MM, Meigs JB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Rosamond WD, Sorlie PD, Stafford RS, Turan TN, Turner MB, Wong ND, Wylie-Rosett J. Heart disease and stroke statistics--2011 update: a report from the American Heart Association. Circulation 2011; 123:e18-e209. [PMID: 21160056 PMCID: PMC4418670 DOI: 10.1161/cir.0b013e3182009701] [Citation(s) in RCA: 3666] [Impact Index Per Article: 282.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a valuable resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best national data available on disease morbidity and mortality and the risks, quality of care, medical procedures and operations, and costs associated with the management of these diseases in a single document. Indeed, since 1999, the Statistical Update has been cited more than 8700 times in the literature (including citations of all annual versions). In 2009 alone, the various Statistical Updates were cited ≈1600 times (data from ISI Web of Science). In recent years, the Statistical Update has undergone some major changes with the addition of new chapters and major updates across multiple areas. For this year’s edition, the Statistics Committee, which produces the document for the AHA, updated all of the current chapters with the most recent nationally representative data and inclusion of relevant articles from the literature over the past year and added a new chapter detailing how family history and genetics play a role in cardiovascular disease (CVD) risk. Also, the 2011 Statistical Update is a major source for monitoring both cardiovascular health and disease in the population, with a focus on progress toward achievement of the AHA’s 2020 Impact Goals. Below are a few highlights from this year’s Update.
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Hassan A, Newman A, Ko DT, Rinfret S, Hirsch G, Ghali WA, Tu JV. Increasing rates of angioplasty versus bypass surgery in Canada, 1994-2005. Am Heart J 2010; 160:958-65. [PMID: 21095286 DOI: 10.1016/j.ahj.2010.06.052] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 06/14/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is increasingly being offered to patients with coronary artery disease. The purpose of this study was to determine the impact of this change in coronary revascularization strategy on PCI and coronary artery bypass grafting (CABG) utilization across Canada. METHODS All cases of PCI and isolated CABG between years 1994 and 2005 were identified through the Canadian Institute for Health Information. Age- and sex-standardized rates of PCI and CABG per 100,000 population as well as PCI-to-CABG ratios were calculated by year and province and across age, sex, income, diabetes, and recent acute coronary syndrome subgroups. In addition, risk-adjusted rates of in-hospital mortality after PCI and CABG were reported by year. RESULTS Between 1994 and 2005, PCI rates increased from 85.6/100,000 to 186.7/100,000 (P < .001), whereas CABG rates remained stable (75.6/100,000-70.8/100,000; P = .43), resulting in an increase in PCI-to-CABG ratio (1.13-2.64; P < .001). Significant increases in PCI-to-CABG ratios were seen across all provinces (except Newfoundland and Alberta), as well as across all age, sex, income, diabetes, and recent acute coronary syndrome categories. Decline in risk-adjusted in-hospital mortality was seen after both CABG (3.9%-2.2%; P < .001) and PCI (1.6%-1.3%; P < .001) but appeared larger after CABG. CONCLUSIONS Since 1994, rates of PCI have increased significantly as compared to CABG. During the same period, greater declines in risk-adjusted rates of in-hospital mortality were seen among CABG versus PCI patients. Further study is needed to determine the appropriateness of PCI and CABG rates in terms of clinical outcomes and resource utilization.
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Affiliation(s)
- Ansar Hassan
- Department of Cardiac Surgery, New Brunswick Heart Center, Saint John, New Brunswick, Canada.
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Iwashyna TJ, Kahn JM, Hayward RA, Nallamothu BK. Interhospital transfers among Medicare beneficiaries admitted for acute myocardial infarction at nonrevascularization hospitals. Circ Cardiovasc Qual Outcomes 2010; 3:468-75. [PMID: 20682917 DOI: 10.1161/circoutcomes.110.957993] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with acute myocardial infarction (AMI) who are admitted to hospitals without coronary revascularization are frequently transferred to hospitals with this capability, yet we know little about the basis for how such revascularization hospitals are selected. METHODS AND RESULTS We examined interhospital transfer patterns in 71 336 AMI patients admitted to hospitals without revascularization capabilities in the 2006 Medicare claims using network analysis and regression models. A total of 31 607 (44.3%) AMI patients were transferred from 1684 nonrevascularization hospitals to 1104 revascularization hospitals. Median time to transfer was 2 days. Median transfer distance was 26.7 miles, with 96.1% within 100 miles. In 45.8% of cases, patients bypassed a closer hospital to go to a farther hospital that had a better 30-day risk standardized mortality rates. However, in 36.8% of cases, another revascularization hospital with lower 30-day risk-standardized mortality was actually closer to the original admitting nonrevascularization hospital than the observed transfer destination. Adjusted regression models demonstrated that shorter transfer distances were more common than transfers to the hospitals with lowest 30-day mortality rates. Simulations suggest that an optimized system that prioritized the transfer of AMI patients to a nearby hospital with the lowest 30-day mortality rate might produce clinically meaningful reductions in mortality. CONCLUSIONS More than 40% of AMI patients admitted to nonrevascularization hospitals are transferred to revascularization hospitals. Many patients are not directed to nearby hospitals with the lowest 30-day risk-standardized mortality, and this may represent an opportunity for improvement.
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Affiliation(s)
- Theodore J Iwashyna
- Department of Internal Medicine, University of Michigan Medical School, 300 North Ingalls, Ann Arbor, MI 48109-5419, USA.
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Chen J, Normand SLT, Wang Y, Drye EE, Schreiner GC, Krumholz HM. Recent Declines in Hospitalizations for Acute Myocardial Infarction for Medicare Fee-for-Service Beneficiaries. Circulation 2010; 121:1322-8. [DOI: 10.1161/circulationaha.109.862094] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Amid recent efforts to reduce cardiovascular risk, whether rates of acute myocardial infarction (AMI) in the United States have declined for elderly patients is unknown.
Methods and Results—
Medicare fee-for-service patients hospitalized in the United States with a principal discharge diagnosis of AMI were identified through the use of data from the Centers for Medicare and Medicaid Services from 2002 to 2007, a time period selected to reduce changes arising from the new definition of AMI. The Medicare beneficiary denominator file was used to determine the population at risk. AMI hospitalization rates were calculated annually per 100 000 beneficiary-years with Poisson regression analysis and stratified according to age, sex, and race. The annual AMI hospitalization rate in the fee-for-service Medicare population fell from 1131 per 100 000 beneficiary-years in 2002 to 866 in 2007, a relative 23.4% decline. After adjustment for age, sex, and race, the AMI hospitalization rate declined by 5.8%/y. From 2002 to 2007, white men experienced a 24.4% decrease in AMI hospitalizations, whereas black men experienced a smaller decline (18.0%;
P
<0.001 for interaction). Black women had a smaller decline in AMI hospitalization rate compared with white women (18.4% versus 23.3%, respectively;
P
<0.001 for interaction).
Conclusions—
AMI hospitalization rates fell markedly in the Medicare fee-for-service population between 2002 and 2007. However, black men and women appeared to have had a slower rate of decline compared with their white counterparts.
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Affiliation(s)
- Jersey Chen
- From the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Conn (J.C., H.M.K.); Department of Health Care Policy, Harvard Medical School, and Department of Biostatistics, Harvard School of Public Health, Boston, Mass (S.-L.T.N.); Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Conn (E.E.D., G.C.S., Y.W., H.M.K.); and Robert Wood Johnson Clinical Scholars Program, Department of Medicine, and the Section of
| | - Sharon-Lise T. Normand
- From the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Conn (J.C., H.M.K.); Department of Health Care Policy, Harvard Medical School, and Department of Biostatistics, Harvard School of Public Health, Boston, Mass (S.-L.T.N.); Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Conn (E.E.D., G.C.S., Y.W., H.M.K.); and Robert Wood Johnson Clinical Scholars Program, Department of Medicine, and the Section of
| | - Yun Wang
- From the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Conn (J.C., H.M.K.); Department of Health Care Policy, Harvard Medical School, and Department of Biostatistics, Harvard School of Public Health, Boston, Mass (S.-L.T.N.); Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Conn (E.E.D., G.C.S., Y.W., H.M.K.); and Robert Wood Johnson Clinical Scholars Program, Department of Medicine, and the Section of
| | - Elizabeth E. Drye
- From the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Conn (J.C., H.M.K.); Department of Health Care Policy, Harvard Medical School, and Department of Biostatistics, Harvard School of Public Health, Boston, Mass (S.-L.T.N.); Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Conn (E.E.D., G.C.S., Y.W., H.M.K.); and Robert Wood Johnson Clinical Scholars Program, Department of Medicine, and the Section of
| | - Geoffrey C. Schreiner
- From the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Conn (J.C., H.M.K.); Department of Health Care Policy, Harvard Medical School, and Department of Biostatistics, Harvard School of Public Health, Boston, Mass (S.-L.T.N.); Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Conn (E.E.D., G.C.S., Y.W., H.M.K.); and Robert Wood Johnson Clinical Scholars Program, Department of Medicine, and the Section of
| | - Harlan M. Krumholz
- From the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Conn (J.C., H.M.K.); Department of Health Care Policy, Harvard Medical School, and Department of Biostatistics, Harvard School of Public Health, Boston, Mass (S.-L.T.N.); Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Conn (E.E.D., G.C.S., Y.W., H.M.K.); and Robert Wood Johnson Clinical Scholars Program, Department of Medicine, and the Section of
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Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, Ferguson TB, Ford E, Furie K, Gillespie C, Go A, Greenlund K, Haase N, Hailpern S, Ho PM, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott MM, Meigs J, Mozaffarian D, Mussolino M, Nichol G, Roger VL, Rosamond W, Sacco R, Sorlie P, Roger VL, Thom T, Wasserthiel-Smoller S, Wong ND, Wylie-Rosett J. Heart Disease and Stroke Statistics—2010 Update. Circulation 2010; 121:e46-e215. [PMID: 20019324 DOI: 10.1161/circulationaha.109.192667] [Citation(s) in RCA: 2601] [Impact Index Per Article: 185.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Lee DW, Foster DA. The Association Between Hospital Outcomes and Diagnostic Imaging: Early Findings. J Am Coll Radiol 2009; 6:780-5. [DOI: 10.1016/j.jacr.2009.08.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 08/03/2009] [Indexed: 11/16/2022]
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Examining the challenges of recruiting women into a cardiac rehabilitation clinical trial. J Cardiopulm Rehabil Prev 2009; 29:13-21; quiz 22-3. [PMID: 19158582 DOI: 10.1097/hcr.0b013e31819276cb] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine the challenges of recruiting women for a 5-year cardiac rehabilitation randomized clinical trial; the aims of the study were to describe the range of recruitment sources, examine the myriad of factors contributing to ineligibility and nonparticipation of women during protocol screening, and discuss the challenges of enrolling women in the trial. METHODS The Women's-Only Phase II Cardiac Rehabilitation program used an experimental design with 2 treatment groups. Eligible participants included women who were (1) diagnosed with a myocardial infarction or stable angina or had undergone coronary revascularization within the last 12 months; (2) able to read, write, and speak English; and (3) older than 21 years. Responses to multiple recruitment strategies including automatic hospital referrals, physician office referrals, mass mailings, media advertisements, and community outreach are described. Reasons for ineligibility and nonparticipation in the trial are explored. RESULTS Automatic hospital order was the largest source of referral (n = 1,367, 81%) accounting for the highest enrollment rate of women (n = 184, 73%). The barriers to enrollment into the cardiac rehabilitation clinical trial included patient-oriented, provider-oriented, and programmatic factors. Of the referral sources, 52% were screened ineligible for provider-oriented reasons, 31% were ineligible due to patient-oriented factors, and 17.4% were linked to the study protocol. Study nonparticipation of those eligible (73.8%) was largely associated with patient-oriented factors (65.2%), with far less due to provider-related factors (4%) or study-related factors (3.4%). CONCLUSION Standing hospital orders facilitated enrollment to the cardiac rehabilitation clinical trial, yet women failed to participate predominantly due to significant patient-oriented biopsychosocial barriers.
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Abstract
The fastest-growing methodology for disease management outcomes measurement is valid, transparent, easy to apply, and freely available in the public domain and this article. It measures the actual goal of disease management, which is to reduce the rate of adverse events associated with the disease(s) being managed. Changes in this rate can be translated into a return on investment using some explicit assumptions about comorbidities and episode costs. Outcomes measured in this way show that in the health plan community as a whole, disease management in the broadest sense is working, as measured by the relative stability in the rate of adverse medical events closely associated with common chronic disease during this decade of increasing prevalence of most of the common chronic conditions.
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Affiliation(s)
- Al Lewis
- Disease Management Purchasing Consortium, Wellesley, Massachusetts 02481, USA.
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Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, Haase N, Hailpern S, Ho M, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott M, Meigs J, Mozaffarian D, Nichol G, O'Donnell C, Roger V, Rosamond W, Sacco R, Sorlie P, Stafford R, Steinberger J, Thom T, Wasserthiel-Smoller S, Wong N, Wylie-Rosett J, Hong Y. Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008; 119:e21-181. [PMID: 19075105 DOI: 10.1161/circulationaha.108.191261] [Citation(s) in RCA: 1356] [Impact Index Per Article: 84.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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The year in interventional cardiology. J Am Coll Cardiol 2008; 51:2355-69. [PMID: 18549922 DOI: 10.1016/j.jacc.2008.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 03/17/2008] [Accepted: 03/18/2008] [Indexed: 11/22/2022]
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Dinh DT, Lee GA, Billah B, Smith JA, Shardey GC, Reid CM. Trends in coronary artery bypass graft surgery in Victoria, 2001–2006: findings from the Australasian Society of Cardiac and Thoracic Surgeons database project. Med J Aust 2008; 188:214-7. [DOI: 10.5694/j.1326-5377.2008.tb01587.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Accepted: 11/19/2007] [Indexed: 11/17/2022]
Affiliation(s)
- Diem T Dinh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
| | - Geraldine A Lee
- Preventative Cardiology, Baker Heart Research Institute, Melbourne, VIC
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
| | - Julian A Smith
- Cardiothoracic Surgery Unit, Southern Health, Monash Medical Centre, Melbourne, VIC
- Department of Surgery, Monash University, Melbourne, VIC
| | - Gilbert C Shardey
- Cardiothoracic Surgery Unit, Southern Health, Monash Medical Centre, Melbourne, VIC
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
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