Circ Cardiovasc Qual
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Circ Cardiovasc Qual · May 2013
Comparative Study Observational StudyDiabetes mellitus and cardiovascular events in older patients with myocardial infarction prescribed intensive-dose and moderate-dose statins.
Practice guidelines recommend intensive-dose statins for patients with acute coronary syndrome, but recent data about the risk of new-onset diabetes mellitus have raised concerns about its use. Our main objective was to evaluate the association between intensive statin therapy and new-onset diabetes mellitus in patients with myocardial infarction and to evaluate the association of intensive statin therapy with long-term adverse clinical outcomes. ⋯ In older patients with myocardial infarction, we found intensive-dose statin therapy to be effective in reducing repeat hospitalization for acute coronary syndrome. The rate of new-onset diabetes mellitus at long term was not significantly different between intensive-dose and moderate-dose statins.
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Circ Cardiovasc Qual · May 2013
Comparative StudyLong-term outcomes after invasive management for older patients with non-ST-segment elevation myocardial infarction.
Early invasive management is recommended for patients with non-ST-segment elevation myocardial infarction (MI), but the incidence of long-term outcomes after early catheterization among older patients and the relationship of revascularization procedures with outcomes in this population have not been described. ⋯ Older patients with non-ST-segment elevation MI with significant coronary disease face high long-term risks for mortality and nonfatal cardiovascular outcomes after early catheterization that differ by type of revascularization procedure performed. These findings can help guide the design of studies evaluating long-term therapies among elderly post-MI patients.
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Circ Cardiovasc Qual · May 2013
Primary prevention of acute rheumatic fever and rheumatic heart disease with penicillin in South African children with pharyngitis: a cost-effectiveness analysis.
Acute rheumatic fever and subsequent rheumatic heart disease remain significant in developing countries. We describe a cost-effective analysis of 7 strategies for the primary prevention of acute rheumatic fever and rheumatic heart disease in children presenting with pharyngitis in urban primary care clinics in South Africa. ⋯ Treating all children presenting with pharyngitis in urban primary care clinics in South Africa with intramuscular penicillin is the least costly. A strategy of using a clinical decision rule without culturing is overall the preferred strategy. A strategy of culturing all children may be prohibitively expensive.
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Circ Cardiovasc Qual · May 2013
Comparative StudyRacial and ethnic differences in outcomes in older patients with acute ischemic stroke.
Little is known as to whether long-term outcomes of acute ischemic stroke (AIS) vary by race/ethnicity. Using the American Heart Association Get With The Guidelines-Stroke registry linked with Medicare claims data set, we examined whether 30-day and 1-year outcomes differed by race/ethnicity among older patients with AIS. ⋯ Among older Medicare beneficiaries with AIS, there were significant differences in long-term outcomes by race/ethnicity, even after adjustment for stroke severity, other prognostic variables, and hospital characteristics.
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Circ Cardiovasc Qual · Mar 2013
Review Meta AnalysisQuantifying the effect of cardiopulmonary resuscitation quality on cardiac arrest outcome: a systematic review and meta-analysis.
Background- Evidence has accrued that cardiopulmonary resuscitation quality affects cardiac arrest outcome. However, the relative contributions of chest compression components (such as rate and depth) to successful resuscitation remain unclear. Methods and Results- We sought to measure the effect of cardiopulmonary resuscitation quality on cardiac arrest outcome through systematic review and meta-analysis. ⋯ Likewise, survivors were significantly more likely to have received chest compression rates closer to 85 to 100 compressions per minute (cpm) than nonsurvivors (absolute mean difference from 85 cpm, -4.81 cpm; 95% confidence interval, -8.19 to -1.43 [P=0.005]; from 100 cpm, -5.04 cpm; 95% confidence interval, -8.44 to -1.65 [P=0.004]; n=6 studies; I(2)<49%; P for heterogeneity >0.2). No significant difference in no-flow fraction (n=7 studies) or ventilation rate (n=4 studies) was detected between survivors and nonsurvivors. Conclusions- Deeper chest compressions and rates closer to 85 to 100 cpm are significantly associated with improved survival from cardiac arrest.