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Ofman P, Hoffmeister P, Kaloupek DG, Gagnon DR, Peralta A, Djousse L, Gaziano JM, Rahilly-Tierney CR. Posttraumatic stress disorder and mortality in VA patients with implantable cardioverter-defibrillators. Clin Cardiol 2018. [PMID: 29532498 DOI: 10.1002/clc.22945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The association between posttraumatic stress disorder (PTSD) and mortality in patients undergoing implantable cardioverter-defibrillator (ICD) placement has not been evaluated in US veterans. HYPOTHESIS PTSD in veterans with ICD is associated with increased mortality. METHODS We studied a retrospective cohort of 25 678 veterans who underwent ICD implantation between September 30, 2002, and December 31, 2011. Of these subjects, 3280 carried the diagnosis of PTSD prior to ICD implantation. Primary outcome was all-cause mortality between date of ICD implantation and end of follow-up (September 30, 2013). We used Cox proportional hazard models to compute multivariable adjusted hazard ratios with corresponding 95% confidence intervals for the relation between PTSD diagnosis and death following ICD placement. RESULTS During a mean follow-up of 4.21 ± 2.62 years, 11 015 deaths were reported. The crude incidence rate of death was 87.8 and 103.9/1000 person-years for people with and without PTSD, respectively. We did not find an association between presence of PTSD before or after ICD implantation and incident death when adjusted for multiple risk factors (hazard ratio: 1.003, 95% confidence interval: 0.948-1.061). In secondary analysis, no statistically significant association was found. CONCLUSIONS In this retrospective cohort study among more than 25 000 veterans undergoing ICD implantation, almost 13% had a diagnosis of PTSD. Subjects with PTSD were significantly younger, yet they had a higher incidence of coronary heart disease, major cardiac comorbidities, cancer, and mental health conditions. We found no association between presence of PTSD before or after ICD implantation and incident death when adjusting for all covariates.
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Affiliation(s)
- Peter Ofman
- Division of Cardiology, VA Boston Healthcare System and Harvard Medical School, Boston, Massachusetts.,Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Peter Hoffmeister
- Division of Cardiology, VA Boston Healthcare System and Harvard Medical School, Boston, Massachusetts
| | - Danny G Kaloupek
- National Center for Posttraumatic Stress Disorders, VA Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts
| | - David R Gagnon
- Division of Psychology, VA Boston Healthcare System and Harvard Medical School, Boston, Massachusetts.,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Adelqui Peralta
- Division of Cardiology, VA Boston Healthcare System and Harvard Medical School, Boston, Massachusetts
| | - Luc Djousse
- Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts.,Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts
| | - J Michael Gaziano
- Division of Cardiology, VA Boston Healthcare System and Harvard Medical School, Boston, Massachusetts.,Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts.,Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Catherine R Rahilly-Tierney
- Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts
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Ofman P, Petrone AB, Peralta A, Hoffmeister P, Albert CM, Djousse L, Gaziano JM, Rahilly-Tierney CR. Aspirin use and risk of atrial fibrillation in the Physicians' Health Study. J Am Heart Assoc 2014; 3:jah3584. [PMID: 24980132 PMCID: PMC4310361 DOI: 10.1161/jaha.113.000763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Inflammatory processes have been associated with an increased risk of atrial fibrillation (AF), potentially allowing for preventive therapy by anti‐inflammatory agents such as aspirin. However, the effect of chronic aspirin on the incidence of AF has not been evaluated in a prospective cohort followed for an extended period. Methods and Results This study was comprised of a prospective cohort of 23 480 male participants of the Physicians' Health Study. Aspirin intake and covariates were estimated using self‐reported questionnaires. Incident AF was ascertained through yearly follow‐up questionnaires. Cox's regression, with adjustment for multiple covariates, was used to estimate relative risk of AF. Average age at baseline was 65.1±8.9 years. During a mean follow‐up of 10.0 years, 2820 cases of AF were reported. Age‐standardized incidence rates were 12.6, 11.1, 12.7, 11.3, 15.8, and 13.8/1000 person‐years for people reporting baseline aspirin intake of 0, <14 days per year, 14 to 30 days per year, 30 to 120 days per year, 121 to 180 days per year, and >180 days per year, respectively. Multivariable adjusted hazard ratios (95% confidence interval) for incident AF were 1.00 (reference), 0.88 (0.76 to 1.02), 0.93 (0.76 to 1.14), 0.96 (0.80 to 1.14), 1.07 (0.80 to 1.14), and 1.04 (0.94 to 1.15) across consecutive categories of aspirin intake. Analysis of the data using time‐varying Cox's regression model to update aspirin intake over time showed similar results. Conclusions In a large cohort of males followed for a long period, we did not find any association between aspirin use and incident AF.
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Affiliation(s)
- Peter Ofman
- Division of Cardiology, VA Boston Healthcare System and Harvard Medical School, Boston, MA (P.O., A.P., P.H., M.G.) Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (P.O., A.B.P., L.D., M.G., C.R.R.T.) Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Boston Veterans Affairs Healthcare System, Boston, MA (P.O., L.D., M.G., C.R.R.T.) Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (P.O., M.G.)
| | - Andrew B Petrone
- Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (P.O., A.B.P., L.D., M.G., C.R.R.T.)
| | - Adelqui Peralta
- Division of Cardiology, VA Boston Healthcare System and Harvard Medical School, Boston, MA (P.O., A.P., P.H., M.G.)
| | - Peter Hoffmeister
- Division of Cardiology, VA Boston Healthcare System and Harvard Medical School, Boston, MA (P.O., A.P., P.H., M.G.)
| | - Christine M Albert
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.M.A., M.G.)
| | - Luc Djousse
- Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (P.O., A.B.P., L.D., M.G., C.R.R.T.) Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Boston Veterans Affairs Healthcare System, Boston, MA (P.O., L.D., M.G., C.R.R.T.) Geriatric Research Education, and Clinical Center (GRECC), Boston Veterans Affairs Healthcare System, Boston, MA (L.D., M.G.)
| | - J Michael Gaziano
- Division of Cardiology, VA Boston Healthcare System and Harvard Medical School, Boston, MA (P.O., A.P., P.H., M.G.) Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (P.O., A.B.P., L.D., M.G., C.R.R.T.) Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Boston Veterans Affairs Healthcare System, Boston, MA (P.O., L.D., M.G., C.R.R.T.) Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (P.O., M.G.) Geriatric Research Education, and Clinical Center (GRECC), Boston Veterans Affairs Healthcare System, Boston, MA (L.D., M.G.) Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.M.A., M.G.)
| | - Catherine R Rahilly-Tierney
- Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (P.O., A.B.P., L.D., M.G., C.R.R.T.) Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Boston Veterans Affairs Healthcare System, Boston, MA (P.O., L.D., M.G., C.R.R.T.)
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Ofman P, Khawaja O, Rahilly-Tierney CR, Peralta A, Hoffmeister P, Reynolds MR, Gaziano JM, Djousse L. Regular Physical Activity and Risk of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2013; 6:252-6. [DOI: 10.1161/circep.113.000147] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter Ofman
- From the Division of Cardiology, VA Boston Healthcare System, Harvard Medical School, Boston, MA (P.O., A.P., P.H., M.R.R., J.M.G.); Division of Aging, Department of Medicine (P.O., C.R.R.-T., J.M.G., L.D.); Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (C.R.R.-T., J.M.G.); Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC) (P.O., C.R.R.-T., J.M.G., L.D.) and Geriatric Research, Education, and Clinical Center (GRECC), VA
| | - Owais Khawaja
- From the Division of Cardiology, VA Boston Healthcare System, Harvard Medical School, Boston, MA (P.O., A.P., P.H., M.R.R., J.M.G.); Division of Aging, Department of Medicine (P.O., C.R.R.-T., J.M.G., L.D.); Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (C.R.R.-T., J.M.G.); Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC) (P.O., C.R.R.-T., J.M.G., L.D.) and Geriatric Research, Education, and Clinical Center (GRECC), VA
| | - Catherine R. Rahilly-Tierney
- From the Division of Cardiology, VA Boston Healthcare System, Harvard Medical School, Boston, MA (P.O., A.P., P.H., M.R.R., J.M.G.); Division of Aging, Department of Medicine (P.O., C.R.R.-T., J.M.G., L.D.); Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (C.R.R.-T., J.M.G.); Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC) (P.O., C.R.R.-T., J.M.G., L.D.) and Geriatric Research, Education, and Clinical Center (GRECC), VA
| | - Adelqui Peralta
- From the Division of Cardiology, VA Boston Healthcare System, Harvard Medical School, Boston, MA (P.O., A.P., P.H., M.R.R., J.M.G.); Division of Aging, Department of Medicine (P.O., C.R.R.-T., J.M.G., L.D.); Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (C.R.R.-T., J.M.G.); Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC) (P.O., C.R.R.-T., J.M.G., L.D.) and Geriatric Research, Education, and Clinical Center (GRECC), VA
| | - Peter Hoffmeister
- From the Division of Cardiology, VA Boston Healthcare System, Harvard Medical School, Boston, MA (P.O., A.P., P.H., M.R.R., J.M.G.); Division of Aging, Department of Medicine (P.O., C.R.R.-T., J.M.G., L.D.); Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (C.R.R.-T., J.M.G.); Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC) (P.O., C.R.R.-T., J.M.G., L.D.) and Geriatric Research, Education, and Clinical Center (GRECC), VA
| | - Mathew R. Reynolds
- From the Division of Cardiology, VA Boston Healthcare System, Harvard Medical School, Boston, MA (P.O., A.P., P.H., M.R.R., J.M.G.); Division of Aging, Department of Medicine (P.O., C.R.R.-T., J.M.G., L.D.); Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (C.R.R.-T., J.M.G.); Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC) (P.O., C.R.R.-T., J.M.G., L.D.) and Geriatric Research, Education, and Clinical Center (GRECC), VA
| | - J. Michael Gaziano
- From the Division of Cardiology, VA Boston Healthcare System, Harvard Medical School, Boston, MA (P.O., A.P., P.H., M.R.R., J.M.G.); Division of Aging, Department of Medicine (P.O., C.R.R.-T., J.M.G., L.D.); Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (C.R.R.-T., J.M.G.); Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC) (P.O., C.R.R.-T., J.M.G., L.D.) and Geriatric Research, Education, and Clinical Center (GRECC), VA
| | - Luc Djousse
- From the Division of Cardiology, VA Boston Healthcare System, Harvard Medical School, Boston, MA (P.O., A.P., P.H., M.R.R., J.M.G.); Division of Aging, Department of Medicine (P.O., C.R.R.-T., J.M.G., L.D.); Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (C.R.R.-T., J.M.G.); Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC) (P.O., C.R.R.-T., J.M.G., L.D.) and Geriatric Research, Education, and Clinical Center (GRECC), VA
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Rahilly-Tierney CR, Arnett DK, North KE, Pankow JS, Hunt SC, Ellison RC, Gaziano JM, Djoussé L. Apolipoprotein ε4 polymorphism does not modify the association between body mass index and high-density lipoprotein cholesterol: a cross-sectional cohort study. Lipids Health Dis 2011; 10:167. [PMID: 21939561 PMCID: PMC3187732 DOI: 10.1186/1476-511x-10-167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 09/23/2011] [Indexed: 11/10/2022] Open
Abstract
Background We sought to examine whether ε4 carrier status modifies the relation between body mass index (BMI) and HDL. The National Heart, Lung, and Blood Institute Family Heart Study included 657 families with high family risk scores for coronary heart disease and 588 randomly selected families of probands in the Framingham, Atherosclerosis Risk in Communities, and Utah Family Health Tree studies. We selected 1402 subjects who had ε4 carrier status available. We used generalized estimating equations to examine the interaction between BMI and ε4 allele carrier status on HDL after adjusting for age, gender, smoking, alcohol intake, mono- and poly-unsaturated fat intake, exercise, comorbidities, LDL, and family cluster. Results The mean (standard deviation) age of included subjects was 56.4(11.0) years and 47% were male. Adjusted means of HDL for normal, overweight, and obese BMI categories were 51.2(± 0.97), 45.0(± 0.75), and 41.6(± 0.93), respectively, among 397 ε4 carriers (p for trend < 0.0001) and 53.6(± 0.62), 51.3(± 0.49), and 45.0(± 0.62), respectively, among 1005 non-carriers of the ε4 allele (p-value for trend < 0.0001). There was no evidence for an interaction between BMI and ε4 status on HDL(p-value 0.39). Conclusion Our findings do not support an interaction between ε4 allele status and BMI on HDL.
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Affiliation(s)
- Catherine R Rahilly-Tierney
- Massachusetts Veterans Epidemiology and Information Research Center (MAVERIC), Boston VA Healthcare, Boston, Massachusetts, USA.
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Rahilly-Tierney CR, Spiro A, Vokonas P, Gaziano JM. Relation between high-density lipoprotein cholesterol and survival to age 85 years in men (from the VA normative aging study). Am J Cardiol 2011; 107:1173-7. [PMID: 21296318 DOI: 10.1016/j.amjcard.2010.12.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Revised: 12/03/2010] [Accepted: 12/03/2010] [Indexed: 11/15/2022]
Abstract
No previous researchers have sought to determine whether high-density lipoprotein (HDL) cholesterol levels are associated with survival to 85 years of age in a prospective cohort of aging men. We selected 652 men (mean age 65 years) enrolled in the VA Normative Aging Study who had ≥ 1 HDL cholesterol level documented during the study and who were old enough on the date of HDL cholesterol measurement to reach 85 years of age by the end of follow-up (July 1, 2008). We categorized initial HDL cholesterol into < 40 mg/dl (reference group), 40 to 49 mg/dl, or ≥ 50 mg/dl. Information on co-morbidities, lifestyle factors, measured lipid parameters, and medications were collected during triennial visits. We used proportional hazards to determine hazard ratios (HRs) for mortality before age 85 years for each category of initial HDL cholesterol compared to the reference adjusting for co-morbidities, calculated low-density lipoprotein cholesterol, medications, smoking, body mass index, and alcohol consumption. Treating HDL cholesterol as a continuous predictor, we also determined the HR for each 10-mg/dl increment in HDL cholesterol. Fully adjusted HR (95% confidence interval) for survival to 85 years of age for participants with an initial HDL cholesterol level ≥ 50 mg/dl compared to the reference was 0.72 (0.53 to 0.98). Each 10-mg/dl increment in HDL cholesterol was associated with a 14% (HR 0.86, 0.78 to 0.96) decrease in risk of mortality before 85 years of age. In conclusion, after adjusting for other factors associated with longevity, higher HDL cholesterol levels were significantly associated with survival to 85 years of age.
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Affiliation(s)
- Catherine R Rahilly-Tierney
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Boston VA Healthcare System, Boston, Massachusetts, USA.
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Rahilly-Tierney CR, Lawler EV, Scranton RE, Gaziano JM. Cardiovascular benefit of magnitude of low-density lipoprotein cholesterol reduction: a comparison of subgroups by age. Circulation 2009; 120:1491-7. [PMID: 19786636 DOI: 10.1161/circulationaha.108.846931] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We examined the effect of the magnitude of low-density lipoprotein cholesterol (LDL-C) reduction across subjects of various ages in a retrospective cohort study. METHODS AND RESULTS We selected 20,132 male veterans at high risk for an acute cardiovascular event and who had 2 or more LDL-C measurements before their first documented acute myocardial infarction, revascularization, death, or censoring date. LDL-C reduction was categorized as no reduction (<10 mg/dL; reference), small reduction (between 10 and 40 mg/dL), moderate reduction (between 40 and 70 mg/dL), or large reduction (> or =70 mg/dL). The primary outcome was combined acute myocardial infarction or revascularization. The first and last LDL-C levels in the databases were used to calculate the LDL-C reduction in patients who experienced no outcome or who died. Within each age quartile and in a subgroup of patients > or =80 years of age, a Cox proportional hazards model was used to determine hazard ratios for each category of LDL-C reduction compared with the reference category, with adjustment for age, body mass index, current smoking status, medications, and comorbidities. In all age groups, the magnitude of LDL-C reduction was proportional to the magnitude of cardiovascular risk reduction. Risk reduction for the combined outcome in patients who achieved a large LDL-C reduction was similar in all age quartiles, with multivariate-adjusted hazard ratios of approximately 0.30. CONCLUSIONS In a cohort of veterans at high risk for cardiovascular events, patients of all ages, including those 80 years or older, benefitted the most from large reductions in LDL-C.
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Rahilly-Tierney CR, Lawler EV, Scranton RE, Michael Gaziano J. Low-density lipoprotein reduction and magnitude of cardiovascular risk reduction. ACTA ACUST UNITED AC 2009; 12:80-7. [PMID: 19476581 DOI: 10.1111/j.1751-7141.2008.00018.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The authors examined the relationship between the magnitude of low-density lipoprotein cholesterol (LDL-C) reduction and the magnitude of cardiovascular risk reduction. From the Veterans Integrated Service Network 1 databases, the authors selected 54,611 patients with prevalent ischemic heart disease, peripheral vascular disease or diabetes mellitus, and >or=2 documented LDL-C levels who were followed between 1997 and 2006. The outcome was defined as acute myocardial infarction or revascularization. Preoutcome LDL-C reduction was categorized as follows: <10 mg/dL, reference; >or=10 but <40 mg/dL, small reduction; >or=40 but <70 mg/dL, moderate reduction; >or=70 mg/dL, large reduction. Proportional hazards were used to determine the hazard ratio for the outcome for each LDL-C reduction category compared with the reference. Results revealed a graded relationship between the magnitude of reduction in LDL-C and cardiovascular risk reduction. Stratified analyses demonstrated these findings to be robust regardless of initial LDL-C levels or whether patients achieved "target" final LDL-C values of <100 mg/dL.
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Affiliation(s)
- Catherine R Rahilly-Tierney
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Boston VA Healthcare System, Boston, MA 02130, USA.
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Rahilly-Tierney CR, Nash IS. Decision-making in percutaneous coronary intervention: a survey. BMC Med Inform Decis Mak 2008; 8:28. [PMID: 18578880 PMCID: PMC2443120 DOI: 10.1186/1472-6947-8-28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 06/25/2008] [Indexed: 11/24/2022] Open
Abstract
Background Few researchers have examined the perceptions of physicians referring cases for angiography regarding the degree to which collaboration occurs during percutaneous coronary intervention (PCI) decision-making. We sought to determine perceptions of physicians concerning their involvement in PCI decisions in cases they had referred to the cardiac catheterization laboratory at a major academic medical center. Methods An anonymous survey was mailed to internal medicine faculty members at a major academic medical center. The survey elicited whether responders perceived that they were included in decision-making regarding PCI, and whether they considered such collaboration to be the best process of decision-making. Results Of the 378 surveys mailed, 35% (133) were returned. Among responding non-cardiologists, 89% indicated that in most cases, PCI decisions were made solely by the interventionalist at the time of the angiogram. Among cardiologists, 92% indicated that they discussed the findings with the interventionalist prior to any PCI decisions. When asked what they considered the best process by which PCI decisions are made, 66% of non-cardiologists answered that they would prefer collaboration between either themselves or a non-interventional cardiologist and the interventionalist. Among cardiologists, 95% agreed that a collaborative approach is best. Conclusion Both non-cardiologists and cardiologists felt that involving another decision-maker, either the referring physician or a non-interventional cardiologist, would be the best way to make PCI decisions. Among cardiologists, there was more concordance between what they believed was the best process for making decisions regarding PCI and what they perceived to be the actual process.
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Affiliation(s)
- Catherine R Rahilly-Tierney
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Boston VA Healthcare System, Boston, Massachusetts, USA.
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