Circ Cardiovasc Qual
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Circ Cardiovasc Qual · Sep 2012
Multicenter Study Comparative StudyLeft ventricular ejection fraction assessment among patients with acute myocardial infarction and its association with hospital quality of care and evidence-based therapy use.
The left ventricular ejection fraction (LVEF) has prognostic and therapeutic utility after acute myocardial infarction (AMI). Although LVEF assessment is a key performance measure among AMI patients, contemporary rates of in-hospital assessment and its association with therapy use have not been well characterized. ⋯ The assessment of LVEF among patients with AMI has improved significantly over time, yet significant interhospital variability exists. Patients who did not have in-hospital LVEF assessment were less likely to receive evidence-based medications at discharge. These patients represent targets for future quality improvement efforts.
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Circ Cardiovasc Qual · Sep 2012
Multicenter StudyDemographics, trends, and outcomes in pediatric acute myocarditis in the United States, 2006 to 2011.
There is a lack of clear diagnostic and management guidelines for acute myocarditis in the pediatric population. We used a multi-institutional database to characterize demographics, practice variability, and outcomes in this population. ⋯ There is significant temporal and regional variation in the diagnostic modalities and management used for pediatric myocarditis, which continues to have high morbidity and mortality. Extracorporeal membrane oxygenation, ventricular assist device, and vasoactive medications are independently associated with increased mortality/transplantation.
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Circ Cardiovasc Qual · Sep 2012
Multicenter StudyImpact of door-to-activation time on door-to-balloon time in primary percutaneous coronary intervention for ST-segment elevation myocardial infarctions: a report from the Activate-SF registry.
Little is known about the components of door-to-balloon time among patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. We assessed the role of time from hospital arrival to ST-segment elevation myocardial infarction diagnosis (door-to-activation time) on door-to-balloon time in contemporary practice and evaluated factors that influence door-to-activation times. ⋯ The interval from hospital arrival to ST-segment elevation myocardial infarction diagnosis and catheterization laboratory activation (door-to-activation time) is a strong driver of overall door-to-balloon times. Achieving a door-to-activation time ≤20 minutes was key to achieving a door-to-balloon time ≤90 minutes. Delays in door-to-activation time are not associated with delays in other aspects of the primary percutaneous coronary intervention process.
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Circ Cardiovasc Qual · Sep 2012
Comparative StudyComparison of outcomes after use of biphasic or monophasic defibrillators among out-of-hospital cardiac arrest patients: a nationwide population-based observational study.
The use and popularity of the biphasic waveform defibrillator as a replacement for the monophasic waveform defibrillator are increasing, but it is unclear whether this can improve the rate of survival among out-of-hospital cardiac arrest patients. This study aimed to verify the hypothesis that the outcome of out-of-hospital cardiac arrest patients who received defibrillation shock with the biphasic waveform defibrillator was better than that of patients who received defibrillation shock with the monophasic defibrillator. ⋯ Although monophasic defibrillators are being replaced by biphasic defibrillators, our nationwide population-based observational study failed to demonstrate a statistically significant association between defibrillation waveform and 1-month survival rate with minimal neurological impairment.
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Circ Cardiovasc Qual · Sep 2012
Development of 2 registry-based risk models suitable for characterizing hospital performance on 30-day all-cause mortality rates among patients undergoing percutaneous coronary intervention.
Variation in outcomes after percutaneous coronary interventions (PCI) may reflect differences in quality of care. To date, however, we lack a methodology to monitor and improve national hospital 30-day mortality rates among patients undergoing PCI. ⋯ These National Quality Forum endorsed registry-based models produce estimates of hospital risk-standardized mortality rates for patients undergoing PCI.