American heart journal
-
American heart journal · Jan 2008
Multicenter StudyRole of magnetic resonance imaging in arrhythmogenic right ventricular dysplasia: insights from the North American arrhythmogenic right ventricular dysplasia (ARVD/C) study.
Prior reports describing magnetic resonance (MR) imaging abnormalities in arrhythmogenic right ventricular dysplasia (ARVD/C) were limited by nonuniform inclusion criteria. The aim of our study was to define the prevalence, sensitivity, and specificity of quantitative MR imaging findings in the probands of multidisciplinary study of right ventricular dysplasia. ⋯ Fat infiltration is seldom the only MR imaging abnormality and is less sensitive for ARVD/C diagnosis compared with RV regional dysfunction. Qualitative estimates of RV function may underestimate the prevalence of RV dysfunction in ARVD/C. Quantitative evaluation of RV by MR imaging may have a high sensitivity and specificity for ARVD/C diagnosis.
-
American heart journal · Dec 2007
Multicenter StudyOptimal medical therapy at discharge in patients with acute coronary syndromes: temporal changes, characteristics, and 1-year outcome.
There are limited data on the recent trend in the use of optimal evidence-based medical therapies after acute coronary syndromes (ACSs). We sought to evaluate (1) the temporal changes in medical management of patients discharged after an ACS; (2) patient and practice characteristics associated with optimal medical therapy at discharge; and (3) the association between discharge medication use and 1-year outcome. ⋯ Despite the temporal increases in the combined use of evidence-based pharmacologic therapies, which is associated with improved outcome, medical management of ACS remains suboptimal. Quality improvement strategies are needed to enhance the appropriate use of effective therapies, targeting specifically the high-risk but undertreated patients who may derive the greatest therapeutic benefit.
-
American heart journal · Dec 2007
A framework for quality improvement: an analysis of factors responsible for improvement at hospitals participating in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) quality improvement initiative.
Hospitals are under increasing pressure to improve their quality of care. However, a key question remains: how can hospitals best design and implement successful quality improvement (QI) programs? Hospitals currently employ a variety of QI initiatives but have little empirical evidence on which to base their quality efforts. ⋯ We identified several institutional factors associated with improved quality of care in the treatment of high-risk NSTE ACS. We hope that this evidence-based framework will help guide the development and implementation of future QI programs in order to improve the institutional quality of care for NSTE ACS.
-
American heart journal · Dec 2007
The effect of leisure-time physical activity on the presence of metabolic syndrome in patients with manifest arterial disease. The SMART study.
Physical activity can influence insulin sensitivity and metabolic syndrome (MetS) independent of weight loss. Therefore, we investigated the independent effect of leisure-time physical activity on the prevalence of MetS and insulin resistance in patients with manifest arterial disease and the role of body fat and fat distribution on this relationship. ⋯ Patients with manifest arterial disease who are physically active are less likely to have MetS and insulin resistance than physically inactive patients, although body weight is comparable between the groups.