D A Alter

..In conclusion, socioeconomically disadvantaged patients were sicker at baseline and less behaviorally responsive to embarking on healthy lifestyle changes after AMI than were those of higher socioeconomic status...

..Our objective was to evaluate the extent to which demand-side factors such as clinical urgency/need, and supply-side factors, as reflected by differences in physician and procedural supply account for these inequalities...

..This paper explores the relationship between depressive symptoms, health service cardiovascular consumption, and prognosis following acute myocardial infarction (AMI)...

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..To examine the extent to which inter-regional differences in fast-food concentrations account for variations in all-cause mortality and acute coronary syndromes throughout Ontario, Canada...

..The extent to which formal queue management systems may improve the prioritization and survival of patients in the angiography queue is unknown...

..The intermediary causes of such gradients remain poorly elucidated...

..The objective of this study was to examine the temporal trends in the utilization and costs of cardiovascular technologies for the evaluation and/or management of patients with ischemic heart disease in Canada...

..The magnitude and mechanisms of survival benefit associated with cardiac rehabilitation services among real-world populations within a universal health care system remain unclear...

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..The objective of the present study was to examine the relationship among cardiovascular evaluation and management intensity, physician supply and cardiovascular disease burden in the Canadian population...

..Universal access can only reduce these disparities. Our findings suggest the need to introduce large-scale preventive strategies early in patients' lives to help change unhealthy behavior...

..We compared the estimated effects of age and efficacy of treatment on survival among patients with acute coronary syndromes...

..The extent to which this theory is a valid representation of Canadian health care is unknown...

..It is unknown whether these differences can be attributed, in part, to variations in the prevalence of atherogenic risk factors preceding the index AMI event...

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..This study was designed to determine whether admission to a Canadian hospital with on-site revascularization (invasive hospital) affected revascularization choice, timing, and outcome compared with community (non-invasive) hospitals...

..Another objective was to evaluate the association of age, gender and treatment intensity with five-year survival after AMI...

..This study was conducted to determine whether the impact of socioeconomic status on angiography use would be lessened by considering variations in the supply of services...

..To compare the health service utilization and long-term outcomes of acute myocardial infarction (AMI) patients with and without diabetes in Ontario...

..Whether such differences are due to invasive procedure rates alone or to other patient, physician, and hospital characteristics is unknown...

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..Conventional logistic regression tended to increase the statistical significance for the effects of variables measured at the hospital-level compared to the level of significance indicated by the multilevel model...

..These findings are consistent with the view that these clinical decisions are more likely to be attributable to concerns about patient frailty or side effects than to a misunderstanding of treatment benefits...

..Wider implementation of data monitoring and explicit management systems may be required to ensure that appropriate utilisation of cardiac services is allocated to patients who are most in need...

..This study was to evaluate whether age-income stratification designs generate comparable income-mortality associations as those whose income rankings are based on absolute thresholds...

..The extent to which drug adherence may affect survival remains unclear, in part because mortality differences may be attributable to "healthy adherer" behavioral attributes more so than to pharmacological benefits...

..Although New York State (NYS) historically has had twice as many coronary revascularizations performed as Ontario, the relative evolution of coronary revascularization patterns in both jurisdictions over time is unknown...

..Understanding the reasons underlying this mismatch may facilitate improvements in care and outcomes for patients with heart failure...

..Since the benefits of a therapy are dependent on the baseline risk, the maximum benefits of statins may not be fully realized until implementation of therapy includes patients at highest risk...

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..To assess the completeness of cardiac risk factor documentation by cardiologists, and agreement with patient report...

..Although approximately one third of patients with heart failure (HF) visiting the emergency department (ED) are discharged home, little is known about their care and outcomes...

..We describe the impact of these restrictions on health care utilization and suggest lessons for future epidemics...

..Our objective was to identify the characteristics of patients, physicians, hospitals and communities associated with differences in the use of these medications after discharge...

..We sought to examine outcomes in recipients of implantable cardioverter-defibrillators (ICDs) and the effect of age, gender, and comorbidities on survival...

..We examined trends in the use of evidence-based drug therapies after discharge among elderly patients with myocardial infarction...

..Restrictions on non-urgent hospital care imposed to control the 2003 Toronto severe acute respiratory syndrome outbreak led to substantial disruptions in hospital clinical practice, admission, and transfer patterns...

..The type of outpatient physician care after an emergency department visit for heart failure may affect patients' outcomes. Methods and..

..However, the association between TZD use and cardiovascular events has not been adequately evaluated on a population level...

..We determined if a "dose-dependent" relationship exists between heart failure events and death, accounting for temporal changes in age, comorbidities, and disease severity...

..Publicly released report cards on hospital performance are increasingly common, but whether they are an effective method for improving quality of care remains uncertain...

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..Although substantial advances have been made in the prevention and treatment of coronary artery disease, their impact on the rates of ACS hospitalization is unclear...

..Randomized trials have shown that medical and interventional therapies improve outcomes for acute myocardial infarction (AMI) patients. The extent to which hospital quality improvement translates into better patient outcomes is unclear...

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..The objective of the current study was to determine whether the number of hospitals identified as mortality outliers depended upon the benchmark against which hospitals are compared...

..The role of scientific evidence in shaping recommendations on capacity targets and cardiovascular technology utilization is unclear...

..There is an increasing movement towards the release of hospital "report-cards. "However, there is a paucity of research into the abilities of the different methods to correctly classify hospitals as performance outliers...

..We sought to examine rates of inhospital lipid testing and its association with statin therapy at hospital discharge...

..Hospital report cards usually are based on administrative discharge abstracts. However, cardiac severity and comorbidities generally are under-reported in administrative data...

..CONCLUSION: Within Canada's universal health care system, those likely to be in lower socioeconomic groups are significantly less likely to visit a dermatologist for specialist consultation...

..Little information is available on recent population-based trends in the outcomes of patients who have had an acute myocardial infarction (AMI) in Canada...

..Investigators who want to determine how a distribution of delays in treatment or of waiting times changes with patient or system characteristics should consider complementing their analyses with the use of quantile regression...

..We explored the potential reduction in mortality at the population level that could result from improving statin prescribing among patients least likely to be prescribed a statin after acute myocardial infarction (AMI)...

..To examine the potential effectiveness and efficiency of different guidelines for statin treatment to reduce deaths from coronary heart disease in the Canadian population...

..However, previous studies have focused on predicting shorter-term mortality and limited data currently exist to predict expected survival among hospitalized patients with HF...

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..Comparisons of outcomes between patients treated and untreated in observational studies may be biased due to differences in patient prognosis between groups, often because of unobserved treatment selection biases...

..However, the nature and clinical significance of this association remain unclear, particularly as it relates to age of presentation...

..There are scarce population-based data on the use, complication rates, and outcomes of patients receiving implantable cardioverter defibrillators (ICDs)...

..Accordingly, future studies must better explore how costs accrue among obese populations, in order to best facilitate health and social policy interventions...

..To compare and contrast clinical epidemiology and population health perspectives on the role of health care in reducing socioeconomic disparities in health...

..Our results reinforce the concept that urgency-specific waiting list monitoring systems are required to best evaluate and appropriately respond to fluctuations in queue performance...

..This is due to both health system and patient-level factors; issues that have yet to be investigated concurrently. This study utilized a hierarchical design to examine physician and patient-level factors affecting verified CR enrollment...

..Given the cost of the device strategy, policies of targeted intervention based on the future risk of arrhythmia are warranted...

..CONCLUSIONS: The survival impact and cost-effectiveness of prophylactic ICDs in the population will depend upon the ability to risk-stratify and identify patients whose baseline risk for sudden cardiac death exceed 3% per year...

..Further studies must evaluate the role of echocardiography in the assessment and management of antimicrobial endocarditis prophylaxis to assist in the development of clear clinical guidelines...

..The aim of this study was to determine whether the incidence of type 2 diabetes differed among elderly users of four major antihypertensive drug classes...

..Troponin level elevations are common in patients with acute decompensated heart failure (ADHF), yet their prognostic value above and beyond traditional predictors of outcomes in heart failure is uncertain...

..Real-world examples are used to illustrate the infancy of funnel or demand-side reform initiatives targeting the queue, and the suggestion is made that policy needs to address the concept of 'waiting' much earlier in the treatment cycle...