Circ Cardiovasc Qual
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Circ Cardiovasc Qual · Sep 2012
Review Meta AnalysisSystematic review and adjusted indirect comparison meta-analysis of oral anticoagulants in atrial fibrillation.
Oral anticoagulants such as apixaban, dabigatran, and rivaroxaban are alternatives to warfarin for preventing events in patients with atrial fibrillation. Direct comparative studies between agents are unavailable. Our objective was to conduct an adjusted indirect comparison meta-analysis between new oral agents in atrial fibrillation. ⋯ Significant differences in efficacy and safety parameters may exist between oral anticoagulant agents in patients with atrial fibrillation. Apixaban lowers the risk of major and gastrointestinal bleeding versus dabigatran and rivaroxaban. Dabigatran lowers the composite of stroke or systemic emboli, and ischemic stroke versus rivaroxaban. Head-to-head clinical trials are required to confirm these findings.
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Circ Cardiovasc Qual · Sep 2012
Review Meta AnalysisAssociation of obstructive sleep apnea with risk of serious cardiovascular events: a systematic review and meta-analysis.
The relationship between obstructive sleep apnea (OSA) and cardiovascular events remains unclear. We conducted a systematic review to determine the incident risk of cardiovascular events among patients with OSA. ⋯ OSA appears to be associated with stroke, but the relationship with ischemic heart disease and cardiovascular mortality needs further research.
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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 Study Comparative StudyGuideline adherence after ST-segment elevation versus non-ST segment elevation myocardial infarction.
Clinical guidelines recommend similar medical therapy for patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation MI (NSTEMI). ⋯ Among hospitals participating in GWTG-CAD, adherence with guideline-based medical therapy was high for patients with both STEMI and NSTEMI. Yet, there is still room for further improvement, particularly in the care of NSTEMI patients.
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Circ Cardiovasc Qual · Sep 2012
Multicenter StudyVariability in surgeons' perioperative practices may influence the incidence of low-output failure after coronary artery bypass grafting surgery.
Postoperative low-output failure (LOF) is an important contributor to morbidity and mortality after coronary artery bypass grafting surgery. We sought to understand which pre- and intra-operative factors contribute to postoperative LOF and to what degree the surgeon may influence rates of LOF. ⋯ Rates of LOF significantly varied across surgeons and could not be explained solely by patient case mix, suggesting that variability in perioperative practices influences risk of LOF.