Journal of the American College of Cardiology
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J. Am. Coll. Cardiol. · Apr 2014
Multicenter Study Comparative StudyTrends in the use and outcomes of ventricular assist devices among medicare beneficiaries, 2006 through 2011.
This study sought to examine trends in mortality, readmission, and costs among Medicare beneficiaries receiving ventricular assist devices (VADs) and associations between hospital-level procedure volume and outcomes. ⋯ Short- and long-term mortality after VAD implantation among Medicare beneficiaries improved, but readmission remained similar over time. A higher volume of VAD implants was associated with lower risk of mortality but not readmission. Costs to Medicare have not changed in recent years.
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J. Am. Coll. Cardiol. · Apr 2014
Polypills: essential medicines for cardiovascular disease secondary prevention?
In 1977, the World Health Organization (WHO) developed its first Model List of Essential Medicines to guide countries in the creation of national formularies and policies for access, quality, and use of essential medicines as part of achieving the right to health. In 2012, the WHO announced its goal of reducing the number of premature deaths (<70 years) due to noncommunicable chronic diseases by 25% by the year 2025, including the indicator that 50% of eligible people receive drugs to prevent myocardial infarction and stroke. Despite the large body of evidence supporting the use of pharmacological treatment for the secondary prevention of cardiovascular diseases (CVD), substantial gaps in coverage of secondary interventions for prevention of CVD are widespread globally. ⋯ In November 2012, along with 5 other scientists, we submitted an application to the Model List of Essential Medicines to include polypill therapy for secondary CVD prevention. In July 2013, the updated 18th Model List of Essential Medicines was released without inclusion of polypill therapy for secondary CVD prevention. In this article, we argue that polypill therapy meets the criteria for essential medicines and that inclusion in the Model List of Essential Medicines will facilitate its access and has the potential to avoid a few million premature deaths and related morbidity from CVD at low cost.
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J. Am. Coll. Cardiol. · Apr 2014
Multicenter Study Comparative Study Clinical TrialMulticenter core laboratory comparison of the instantaneous wave-free ratio and resting Pd/Pa with fractional flow reserve: the RESOLVE study.
This study sought to examine the diagnostic accuracy of the instantaneous wave-free ratio (iFR) and resting distal coronary artery pressure/aortic pressure (Pd/Pa) with respect to hyperemic fractional flow reserve (FFR) in a core laboratory-based multicenter collaborative study. ⋯ This comprehensive core laboratory analysis comparing iFR and Pd/Pa with FFR demonstrated an overall accuracy of ~80% for both nonhyperemic indices, which can be improved to ≥90% in a subset of lesions. Clinical outcome studies are required to determine whether the use of iFR or Pd/Pa might obviate the need for hyperemia in selected patients.