Circ Cardiovasc Qual
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Circ Cardiovasc Qual · Nov 2009
Randomized Controlled Trial Multicenter StudyA randomized clinical trial to reduce patient prehospital delay to treatment in acute coronary syndrome.
Delay from onset of acute coronary syndrome (ACS) symptoms to hospital admission continues to be prolonged. To date, community education campaigns on the topic have had disappointing results. Therefore, we conducted a clinical randomized trial to test whether an intervention tailored specifically for patients with ACS and delivered one-on-one would reduce prehospital delay time. ⋯ clinicaltrials.gov. Identifier NCT00734760.
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Circ Cardiovasc Qual · Nov 2009
Mortality and readmission for patients with heart failure among U.S. News & World Report's top heart hospitals.
The rankings of "America's Best Hospitals" by U.S. News & World Report are influential, but the performance of ranked hospitals in caring for patients with routine cardiac conditions such as heart failure is not known. ⋯ Hospitals ranked by U.S. News & World Report as "America's Best Hospitals" in "Heart & Heart Surgery" are more likely than nonranked hospitals to have a significantly lower than expected 30-day mortality rate, but there was much overlap in performance. For readmission, the rates were similar in ranked and nonranked hospitals.
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Circ Cardiovasc Qual · Nov 2009
Outcomes among patients with ST-segment-elevation myocardial infarction presenting to interventional hospitals with and without on-site cardiac surgery.
Primary percutaneous coronary intervention (pPCI) is the preferred reperfusion strategy for patients with ST-segment-elevation myocardial infarction (STEMI). The quality of care and safety and efficacy of pPCI at hospitals without on-site open heart surgery (No-OHS hospitals) remains an area of active investigation. ⋯ STEMI patients presenting to No-OHS hospitals have substantially higher mortality, are less likely to receive guideline recommended medications within 24 hours, and are less likely to undergo acute reperfusion therapy, although this difference was of borderline significance after adjusting for hospital and treatment variables. There was no difference in mortality among patients undergoing pPCI.
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Circ Cardiovasc Qual · Nov 2009
Randomized Controlled TrialNumber needed to treat with rosuvastatin to prevent first cardiovascular events and death among men and women with low low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein: justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin (JUPITER).
As recently demonstrated, random allocation to rosuvastatin results in large relative risk reductions for first cardiovascular events among apparently healthy men and women with low levels of low-density lipoprotein cholesterol but elevated levels of high-sensitivity C-reactive protein. However, whether the absolute risk reduction among such individuals justifies wide application of statin therapy in primary prevention is a controversial issue with broad policy and public health implications. ⋯ clinicaltrials.gov. Identifier NCT00239681.
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Circ Cardiovasc Qual · Nov 2009
ST-elevation myocardial infarction: which patients do quality assurance programs include?
In the United States, efforts are underway to improve timely access to percutaneous coronary intervention in ST-elevation myocardial infarction (STEMI). The Joint Commission (TJC) and the American College of Cardiology National Cardiovascular Data Registry (NCDR) have developed standardized definitions and clinical performance measures for STEMI. The purpose of this study was to determine differences in 3 quality-assurance registries for STEMI patients. ⋯ Current inclusion criteria for enrollment in STEMI registries are not uniform. This may lead to variable quality assurance outcomes for the same patient cohort and has important implications for standardized quality measurement.