Journal of the American Heart Association
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The Joint Commission began certifying primary stroke centers (PSCs) in December 2003 and provides a standardized definition of stroke center care. It is unknown if PSCs outperform noncertified hospitals. We hypothesized that PSCs would use more recombinant tissue plasminogen activator (rt-PA) for ischemic stroke than would non-PSCs. ⋯ Subjects evaluated at PSCs were more likely to receive rt-PA than those evaluated at non-PSCs. This association was significant after adjustment for patient and hospital-level variables. Systems of care are necessary to ensure stroke patients have rapid access to PSCs throughout the United States.
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Depression has been related to mortality in coronary heart disease (CHD) patients, but few studies have evaluated the role of anxiety or the role of the co-occurrence of depression and anxiety. We examined whether anxiety is associated with increased risk of mortality after accounting for depression in individuals with established CHD. ⋯ Anxiety is associated with increased risk of mortality in CHD patients, particularly when comorbid with depression. Future studies should focus on the co-occurrence of these psychosocial factors as markers of increased mortality risk.