Circ Cardiovasc Qual
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Circ Cardiovasc Qual · Jan 2012
Bivalirudin therapy is associated with improved clinical and economic outcomes in ST-elevation myocardial infarction patients undergoing percutaneous coronary intervention: results from an observational database.
Randomized trials show improved outcomes among acute coronary syndrome patients treated with bivalirudin. The objective of this analysis was to compare clinical and economic outcomes in ST-elevation myocardial infarction (STEMI) patients encountered in routine clinical practice undergoing primary percutaneous coronary intervention (PPCI), treated with bivalirudin or heparin+GP IIb/IIIa receptor inhibitor (heparin+GPI). ⋯ This large "real-world" retrospective analysis demonstrates that bivalirudin therapy compared with heparin+GPI is associated with a lower rate of inpatient death, inpatient bleeding, and decreased overall in-hospital cost in STEMI patients undergoing PPCI.
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Circ Cardiovasc Qual · Jan 2012
Retrospective description and analysis of consecutive catheterization laboratory ST-segment elevation myocardial infarction activations with proposal, rationale, and use of a new classification scheme.
Rapid activation of a cardiac catheterization laboratory (CCL) has reduced door-to-balloon times in ST-segment elevation myocardial infarction (STEMI), leading to lower mortality. This process is accelerated with prehospital electrocardiography and notification. False activations of the CCL occur at an unknown rate and have been poorly described. ⋯ If all CCL activations are considered, the occurrence of false activations is surprisingly high. Although still the gold standard for diagnosis, these data reveal the inherent limitations of clinical evaluation and the ECG in identifying patients with STEMI. Within our retrospective review, we used a 2-tiered classification for STEMI activations based on ECG appropriateness and final clinical diagnosis to give a complete picture of false activations and assist in quality improvement.
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Circ Cardiovasc Qual · Jan 2012
Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993-2007.
Atrial fibrillation (AF) is a common and costly problem among older persons. The frequency of AF increases with age, but representative national data about incidence and prevalence are limited. We examined the annual incidence, prevalence, and mortality associated with AF among older persons. ⋯ Among older Medicare beneficiaries, incident AF is common and has remained relatively stable for more than a decade. Incident AF is associated with significant comorbidity and mortality; death occurs in one-quarter of beneficiaries within 1 year.
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Circ Cardiovasc Qual · Jan 2012
Public reporting on risk-adjusted mortality after percutaneous coronary interventions in New York State: forecasting ability and impact on market share and physicians' decisions to discontinue practice.
Since the advent of public reporting on risk-adjusted mortality for coronary artery bypass graft surgery, public reporting on outcomes has expanded to include a variety of dissimilar conditions and procedures. We have little evidence to support such broad-based efforts. ⋯ Public reporting on nonemergent percutaneous coronary interventions in New York State identifies very high and low performers but provides insufficient information to differentiate between most hospitals. It appears to have had no effect on market share or physicians' decisions to leave practice. The utility of public reporting on RAMRs may differ for different conditions and procedures.