-
1دورية أكاديمية
المؤلفون: Canto, John G., Every, Nathan R., Magid, David J., Rogers, William J., Malmgren, Judith A., Frederick, Paul D., French, William J., Tiefenbrunn, Alan J., Misra, Vijay K., Kiefe, Catarina I., Barron, Hal V.
المساهمون: Department of Quantitative Health Sciences
المصدر: The New England journal of medicine ; 342 ; 21 ; 1573-80
مصطلحات موضوعية: Angioplasty, Transluminal, Percutaneous Coronary, numerical data, Hospital Mortality, Humans, Logistic Models, Myocardial Infarction, Registries, Risk, Thrombolytic Therapy, Time Factors, United States, Bioinformatics, Biostatistics, Epidemiology, Health Services Research
الوصف: BACKGROUND: There is an inverse relation between mortality from cardiovascular causes and the number of elective cardiac procedures (coronary angioplasty, stenting, or coronary bypass surgery) performed by individual practitioners or hospitals. However, it is not known whether patients with acute myocardial infarction fare better at centers where more patients undergo primary angioplasty or thrombolytic therapy than at centers with lower volumes. METHODS: We analyzed data from the National Registry of Myocardial Infarction to determine the relation between the number of patients receiving reperfusion therapy (primary angioplasty or thrombolytic therapy) and subsequent in-hospital mortality. A total of 450 hospitals were divided into quartiles according to the volume of primary angioplasty. Multiple logistic-regression models were used to determine whether the volume of primary angioplasty procedures was an independent predictor of in-hospital mortality among patients undergoing this procedure. Similar analyses were performed for patients receiving thrombolytic therapy at 516 hospitals. RESULTS: In-hospital mortality was 28 percent lower among patients who underwent primary angioplasty at hospitals with the highest volume than among those who underwent angioplasty at hospitals with the lowest volume (adjusted relative risk, 0.72; 95 percent confidence interval, 0.60 to 0.87; P<0.001). This lower rate, which represented 2.0 fewer deaths per 100 patients treated, was independent of the total volume of patients with myocardial infarction at each hospital, year of admission, and use or nonuse of adjunctive pharmacologic therapies. There was no significant relation between the volume of thrombolytic interventions and in-hospital mortality among patients who received thrombolytic therapy (7.0 percent for patients in the highest-volume hospitals vs. 6.9 percent for those in the lowest-volume hospitals, P=0.36). CONCLUSIONS: Among hospitals in the United States that have full interventional capabilities, a higher ...
العلاقة: Link to Article in PubMed; http://content.nejm.org/cgi/content/abstract/342/21/1573Test; N Engl J Med. 2000 May 25;342(21):1573-80.; 0028-4793 (Linking); http://hdl.handle.net/20.500.14038/46759Test; https://escholarship.umassmed.edu/qhs_pp/122Test; 1287867; qhs_pp/122
-
2دورية أكاديمية
المؤلفون: Canto, John G., Kiefe, Catarina I., Rogers, William J., Peterson, Eric D., Frederick, Paul D., French, William J., Gibson, C. Michael, Pollack, Charles V. Jr., Ornato, Joseph P., Zalenski, Robert J., Penney, Jan, Tiefenbrunn, Alan J., Greenland, Philip, NRMI Investigators
المساهمون: Department of Quantitative Health Sciences
المصدر: The American journal of cardiology ; 110 ; 9 ; 1256-61
مصطلحات موضوعية: Myocardial Infarction, Atherosclerosis, Risk Factors, Hospital Mortality, UMCCTS funding, Cardiology, Cardiovascular Diseases, Epidemiology, Health Services Research
الوصف: Few studies have examined associations between atherosclerotic risk factors and short-term mortality after first myocardial infarction (MI). Histories of 5 traditional atherosclerotic risk factors at presentation (diabetes, hypertension, smoking, dyslipidemia, and family history of premature heart disease) and hospital mortality were examined among 542,008 patients with first MIs in the National Registry of Myocardial Infarction (1994 to 2006). On initial MI presentation, history of hypertension (52.3%) was most common, followed by smoking (31.3%). The least common risk factor was diabetes (22.4%). Crude mortality was highest in patients with MI with diabetes (11.9%) and hypertension (9.8%) and lowest in those with smoking histories (5.4%) and dyslipidemia (4.6%). The inclusion of 5 atherosclerotic risk factors in a stepwise multivariate model contributed little toward predicting hospital mortality over age alone (C-statistic = 0.73 and 0.71, respectively). After extensive multivariate adjustments for clinical and sociodemographic factors, patients with MI with diabetes had higher odds of dying (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.20 to 1.26) than those without diabetes and similarly for hypertension (OR 1.08, 95% CI 1.06 to 1.11). Conversely, family history (OR 0.71, 95% CI 0.69 to 0.73), dyslipidemia (OR 0.62, 95% CI 0.60 to 0.64), and smoking (OR 0.85, 95% CI 0.83 to 0.88) were associated with decreased mortality (C-statistic = 0.82 for the full model). In conclusion, in the setting of acute MI, histories of diabetes and hypertension are associated with higher hospital mortality, but the inclusion of atherosclerotic risk factors in models of hospital mortality does not improve predictive ability beyond other major clinical and sociodemographic characteristics.
العلاقة: Link to Article in PubMed; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4494670Test/; Am J Cardiol. 2012 Nov 1;110(9):1256-61. doi:10.1016/j.amjcard.2012.06.025. Link to article on publisher's site; 0002-9149 (Linking); http://hdl.handle.net/20.500.14038/46545Test; https://escholarship.umassmed.edu/qhs_pp/1011Test; 3393443; qhs_pp/1011
الإتاحة: https://doi.org/10.1016Test/j.amjcard.2012.06.025
https://doi.org/20.500.14038/46545Test
https://hdl.handle.net/20.500.14038/46545Test
https://escholarship.umassmed.edu/qhs_pp/1011Test -
3دورية أكاديمية
المؤلفون: Gurwitz, Jerry H., Goldberg, Robert J., Malmgren, Judith A., Barron, Hal V., Tiefenbrunn, Alan J., Frederick, Paul D. F., Gore, Joel M.
المساهمون: Department of Medicine, Division of Cardiovascular Medicine, Department of Medicine, Division of Geriatric Medicine, Meyers Primary Care Institute
المصدر: The American journal of medicine ; 112 ; 7
مصطلحات موضوعية: Age Factors, Aged, Health Services Accessibility, Humans, Insurance, Health, Logistic Models, Middle Aged, Multivariate Analysis, Myocardial Infarction, Odds Ratio, Patient Transfer, Prospective Studies, Sex Factors, Socioeconomic Factors, United States, Health Services Research, Medicine and Health Sciences
الوصف: BACKGROUND: Many factors precipitate the transfer of patients hospitalized for acute myocardial infarction, including clinical status and the need for diagnostic testing and therapeutic interventions not available at the admitting hospital. The objectives of this study were to assess the frequency of transfer to another hospital and to determine whether nonmedical factors, such as age, sex, race, and insurance status, are associated with transfer. METHODS: We conducted a prospective study of patients with acute myocardial infarction who were enrolled in the National Registry of Myocardial Infarction 2 from June 1994 through March 1998. The Registry involves 1674 hospitals in the United States. All patients survived to the time of hospital discharge or until transfer. Multivariable logistic regression models, with transfer as the outcome variable, were developed for the entire sample, as well as for subgroups determined by the interventional capabilities of the admitting hospital. RESULTS: Of 537,283 patients with acute myocardial infarction, 152,310 (28%) were transferred to another hospital after admission. After adjustment for differences in clinical and hospital characteristics, factors that were most associated with a reduced odds of transfer included older age (odds ratio [OR] = 0.43; 95% confidence interval [CI]: 0.42 to 0.44 for those aged >75 vs. <65>years), African-American race (OR = 0.69; 95% CI: 0.67 to 0.71 for African Americans vs. whites), and Medicaid/self-pay insurance status (OR = 0.68; 95% CI: 0.66 to 0.70 for Medicaid/self-pay vs. commercial insurance). These effects were most apparent for patients admitted to hospitals without full invasive diagnostic and therapeutic capabilities, but persisted to some extent among those admitted to hospitals with full invasive services. CONCLUSION: Our findings suggest that nonmedical factors, including age, race, and insurance type, affect decisions regarding the transfer of patients hospitalized with acute myocardial infarction. As only a ...
العلاقة: Link to article in PubMed; http://dx.doi.org/10.1016/S0002-9343Test(02)01072-0; Am J Med. 2002 May;112(7):528-34.; http://hdl.handle.net/20.500.14038/37320Test; https://escholarship.umassmed.edu/meyers_pp/77Test; 1018934; meyers_pp/77
-
4دورية أكاديمية
المساهمون: Department of Medicine, Division of Geriatric Medicine, Meyers Primary Care Institute
المصدر: Cardiology in review ; 7 ; 3 ; 156-60
مصطلحات موضوعية: Adult, Aged, Clinical Trials as Topic, Female, Health Services Accessibility, Hospital Mortality, Humans, Male, Middle Aged, Myocardial Infarction, Myocardial Reperfusion, Patient Selection, Physician's Practice Patterns, Practice Guidelines as Topic, Registries, Risk Factors, Survival Rate, United States, Health Services Research, Primary Care
الوصف: The National Registry of Myocardial Infarction 2 (NRMI-2) provides a unique opportunity to evaluate the practice patterns among participating cardiology and emergency medicine departments involved in the care of patients with acute myocardial infarction. The data from NRMI-2 suggest that almost 1/3 of all non-transfer-in and non-transfer-out patients are eligible for reperfusion therapy. Furthermore, of those patients who are clearly eligible for reperfusion therapy, 24% are not given this proven therapy. Specifically, women, the elderly, patients without chest pain on presentation, and those patients at highest risk for in-hospital mortality were least likely to be treated with reperfusion therapy. The reason for underuse of reperfusion therapy may in part reflect a concern for adverse bleeding events associated with the use of thrombolytic therapy. The data from NRMI-2 also suggest that patients with contraindications to thrombolysis may be very appropriate for primary angioplasty. Realizing the full potential benefits of reperfusion therapy in terms of reduced cardiovascular morbidity and mortality will require that clinical practice patterns be aligned more closely with the recommended national guidelines, which are based on extensive clinical trial data that show the benefit of reperfusion therapy in a wide range of patients with acute myocardial infarction. By using observational databases, such as the NRMI-2, which describe how clinical care is administered in nonclinical trial settings, we can continually monitor our progress and initiate changes to ensure that patients are given access to the many therapies that have been shown to improve their quality of life and survival.
العلاقة: Link to Article in PubMed; Cardiol Rev. 1999 May-Jun;7(3):156-60. Link to article on publisher's website; 1061-5377 (Linking); http://hdl.handle.net/20.500.14038/36872Test; https://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1551&context=meyers_pp&unstamped=1Test; https://escholarship.umassmed.edu/meyers_pp/253Test; 2307214; meyers_pp/253
-
5دورية أكاديمية
المؤلفون: John G., Canto, Canto, John G., Kiefe, Catarina I., Rogers, William J., Peterson, Eric D., Frederick, Paul D., French, William J., Gibson, C. Michael, Pollack, Charles V., Ornato, Joseph P., Zalenski, Robert J., Penney, Jan, Tiefenbrunn, Alan J., Greenland, Philip
الوصف: openAccessArticle: False ; Page Range: 1256-1256 ; doi:10.1016/j.amjcard.2012.06.025 ; Harvest Date: 2016-01-12 15:13:50 ; issueName: ; cover date: 2012-11-01 ; pubType: Coronary artery disease
وصف الملف: [Elsevier APIv3;S0002914912016190]
العلاقة: The American Journal of Cardiology; S0002-9149(12)01619-0; 29149; http://ufdc.ufl.edu/LS00002486/00017Test
-
6دورية أكاديمية
المؤلفون: Canto, John G., Kiefe, Catarina I., Rogers, William J., Peterson, Eric D., Frederick, Paul D., French, William J., Michael Gibson, C., Pollack, Charles V., Ornato, Joseph P., Lambrew, Costas G., Zalenski, Robert J., Penney, Jan, Tiefenbrunn, Alan J., Greenland, Philip
المصدر: Journal of the American College of Cardiology ; volume 57, issue 14, page E1037 ; ISSN 0735-1097
مصطلحات موضوعية: Cardiology and Cardiovascular Medicine
الإتاحة: https://doi.org/10.1016/s0735-1097Test(11)61037-1
https://api.elsevier.com/content/article/PII:S0735109711610371?httpAccept=text/xmlTest
https://api.elsevier.com/content/article/PII:S0735109711610371?httpAccept=text/plainTest -
7دورية أكاديمية
المؤلفون: Canto, John G., Kiefe, Catarina I., Rogers, William J., Peterson, Eric D., Frederick, Paul D., French, William J., Gibson, C. Michael, Pollack, Charles V., Ornato, Joseph P., Zalenski, Robert J., Penney, Jan, Tiefenbrunn, Alan J., Greenland, Philip, NRMI Investigators, for the
المصدر: JAMA ; volume 306, issue 19 ; ISSN 0098-7484
الإتاحة: https://doi.org/10.1001/jama.2011.1654Test
http://jamanetwork.com/journals/jama/fullarticle/1104631Test -
8دورية أكاديمية
المؤلفون: Rogers, William J., Canto, John G., Lambrew, Costas T., Tiefenbrunn, Alan J., Kinkaid, Becky, Shoultz, David A., Frederick, Paul D., Every, Nathan
المصدر: Journal of the American College of Cardiology ; volume 36, issue 7, page 2056-2063 ; ISSN 0735-1097
مصطلحات موضوعية: Cardiology and Cardiovascular Medicine
الإتاحة: https://doi.org/10.1016/s0735-1097Test(00)00996-7
https://api.elsevier.com/content/article/PII:S0735109700009967?httpAccept=text/xmlTest
https://api.elsevier.com/content/article/PII:S0735109700009967?httpAccept=text/plainTest -
9دورية أكاديمية
المؤلفون: Barron, Hal V., Bowlby, Laura J., Breen, Tim, Rogers, William J., Canto, John G., Zhang, Yuan, Tiefenbrunn, Alan J., Weaver, W. Douglas
المصدر: Circulation ; volume 97, issue 12, page 1150-1156 ; ISSN 0009-7322 1524-4539
الوصف: Background —There is clear evidence that reperfusion therapy improves survival in selected patients with an acute myocardial infarction. However, several studies have suggested that many patients with an acute myocardial infarction do not receive this therapy. Whether this underutilization occurs in patients appropriate for such therapy remains unclear. Methods and Results —We examined the use of reperfusion therapy in patients with an acute myocardial infarction hospitalized at 1470 hospitals participating in the National Registry of Myocardial Infarction 2. We identified 84 663 patients who were eligible for reperfusion therapy as defined by diagnostic changes on the initial 12-lead ECG, presentation to the hospital within 6 hours from symptom onset, and no contraindications to thrombolytic therapy. Twenty-four percent of these eligible patients did not receive any form of reperfusion therapy (7.5% of all patients). When multivariate analyses were used, left bundle-branch block (odds ratio [OR]=0.22; 95% CI=0.20 to 0.24), lack of chest pain at presentation (OR=0.22; 95% CI=0.21 to 0.24), age >75 years (OR=0.40, 95% CI=0.36 to 0.43), female sex (OR=0.88, 95% CI=0.83 to 0.92), and various preexisting cardiovascular conditions were independent predictors that the patient would not receive reperfusion therapy. Conclusions —Reperfusion therapy may be underutilized in the United States. Increased use of reperfusion therapy could potentially reduce the unnecessarily high mortality rates observed in women, the elderly, and other patient groups with the highest risk of death from an acute myocardial infarction.
-
10دورية أكاديمية
المصدر: Journal of the American College of Cardiology ; volume 31, issue 6, page 1240-1245 ; ISSN 0735-1097
مصطلحات موضوعية: Cardiology and Cardiovascular Medicine
الإتاحة: https://doi.org/10.1016/s0735-1097Test(98)00094-1
https://api.elsevier.com/content/article/PII:S0735109798000941?httpAccept=text/xmlTest
https://api.elsevier.com/content/article/PII:S0735109798000941?httpAccept=text/plainTest
