American heart journal
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American heart journal · Jul 2013
Randomized Controlled Trial Multicenter Study Comparative StudyCanada Acute Coronary Syndrome Risk Score: a new risk score for early prognostication in acute coronary syndromes.
Despite the availability of several acute coronary syndrome (ACS) prognostic risk scores, there is no appropriate score for early-risk stratification at the time of the first medical contact with patients with ACS. The primary objective of this study is to develop a simple risk score that can be used for early-risk stratification of patients with ACS. ⋯ The C-ACS risk score permits rapid stratification of patients with ACS. Because this risk score is simple and easy to memorize and calculate, it can be rapidly applied by health care professionals without advanced medical training.
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American heart journal · Jun 2013
Multicenter Study Comparative StudyAre we targeting the right metric for heart failure? Comparison of hospital 30-day readmission rates and total episode of care inpatient days.
Hospitals are challenged to reduce length of stay (LOS), yet simultaneously reduce readmissions for patients with heart failure (HF). This study investigates whether 30-day rehospitalization or an alternative measure of total inpatient days over an episode of care (EOC) is the best indicator of resource use, HF quality, and outcomes. ⋯ Although hospital 30-day readmission rate was poorly correlated with LOS, quality measures, and 30-day mortality, better performance on the EOC metric was associated with better 30-day survival. Total inpatient days during a 30-day EOC may more accurately reflect overall resource use and better serve as a target for quality improvement efforts.
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American heart journal · Jun 2013
Multicenter Study Comparative StudyTransitional adherence and persistence in the use of aldosterone antagonist therapy in patients with heart failure.
Aldosterone antagonist therapy is recommended for selected patients with heart failure and reduced ejection fraction. Adherence to therapy in the transition from hospital to home is not well understood. ⋯ Most eligible patients were not prescribed aldosterone antagonist therapy at discharge from a heart failure hospitalization. Eligible patients without a discharge prescription seldom initiated therapy as outpatients. Most patients who were prescribed an aldosterone antagonist at discharge filled the prescription within 90 days and remained on therapy.
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American heart journal · Jun 2013
Randomized Controlled Trial Multicenter StudyLiberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease.
Prior trials suggest it is safe to defer transfusion at hemoglobin levels above 7 to 8 g/dL in most patients. Patients with acute coronary syndrome may benefit from higher hemoglobin levels. ⋯ The liberal transfusion strategy was associated with a trend for fewer major cardiac events and deaths than a more restrictive strategy. These results support the feasibility of and the need for a definitive trial.
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American heart journal · Jun 2013
Multicenter Study Comparative StudyAtrial fibrillation among Medicare beneficiaries hospitalized with sepsis: incidence and risk factors.
Newly diagnosed atrial fibrillation (AF) during severe sepsis is associated with increased risks of in-hospital stroke and mortality. However, the prevalence, incidence, and risk factors associated with AF during the sepsis syndromes are unclear. ⋯ Atrial fibrillation is common among critically ill patients with sepsis. Acute factors, rather than preexisting cardiovascular comorbid conditions, are associated with increased risk for newly diagnosed AF during sepsis, suggesting that mechanisms of newly diagnosed AF during sepsis may differ from the general population of patients with AF.