Adrian F Hernandez

..We sought to characterize the performance of SVR nationally and describe the acute risks of mortality and major morbidity plus predictors of adverse outcomes...

..The purpose of this study was to evaluate mortality and readmission rates of heart failure (HF) patients after major noncardiac surgery...

..We examined a large national clinical database to assess trends in the incidence of post-cardiac surgery shock requiring VAD implantation, survival rates, and risk factors for mortality...

..Aldosterone antagonist therapy for heart failure and reduced ejection fraction has been highly efficacious in randomized trials. However, questions remain regarding the effectiveness and safety of the therapy in clinical practice...

..Previous studies have not confirmed associations between some current performance measures for inpatient heart failure processes of care and postdischarge outcomes. It is unknown if alternative measures are associated with outcomes...

..We sought to conduct an observational analysis to determine the influence of the opportunity-based and all-or-none composite performance measures on hospital rankings...

..7 or lower, there are few data on safety of intravenous tPA in warfarin-treated patients in clinical practice...

..Although pharmacologic prophylaxis regimens have reduced VTE risk in medically ill patients, associations with early postdischarge adverse clinical outcomes among patients with heart failure are unknown...

..Strategies are needed to ensure access among vulnerable populations to this supply-sensitive resource...

....

..Associations between BNP level and thromboembolic events in patients with HF without atrial fibrillation (AF) are not well studied...

..Limited clinical data exist to guide practice patterns and evidence-based use of inotropes and vasopressors following coronary artery bypass grafting (CABG)...

..In 2003, Medicare expanded coverage of ventricular assist devices as destination, or permanent, therapy for end-stage heart failure. Little is known about the long-term outcomes and costs associated with these devices...

..We sought to characterize patient factors and regional variations associated with vitamin K antagonist (VKA) use in patients with heart failure (HF) and atrial fibrillation (AF) in areas outside the United States and Europe...

..12, 95% confidence interval 1.04 to 1.20) but not readmission or total inpatient costs. In conclusion, worsening RF in patients hospitalized with HF was independently associated with long-term mortality...

..Whether these quality measures correlate with one another and the degree to which hospital provider rankings shift on the basis of the performance metric is uncertain...

..This study sought to examine quality of care and warfarin use at discharge in patients with atrial fibrillation (AF) and heart failure (HF)...

..Heart failure with preserved ejection fraction (EF) is a common syndrome, but trends in treatments and outcomes are lacking...

..Questions remain about its clinical effectiveness and safety for patients who are underrepresented in randomized trials and those at risk for hyperkalemia...

..In conclusion, a model based on variables from clinical registries can identify a group of patients with heart failure who on average will incur higher costs in the first year after hospitalization...

..The degree to which the overall use of ICD therapy and disparities in use have changed is unclear...

..The clinical effectiveness of implantable cardioverter-defibrillators (ICDs) in older patients with heart failure has not been established, and older patients have been underrepresented in previous studies...

..It is unknown if admission, discharge, or change from admission to discharge BNP measure is the most important predictor of long-term outcomes...

..To characterize geographic differences in clinical characteristics and care of patients hospitalized with heart failure and preserved ejection fraction (HF-PEF)...

..87 to 1.26). In conclusion, within the GWTG-CAD quality improvement initiative, patients with CAD treated at rural hospitals receive similar quality of care and have similar outcomes as those at urban centers...

..This study examined the degree to which hospital performance for acute myocardial infarction (AMI) and heart failure (HF) care processes are correlated...

..Most information about the use of guideline-recommended therapies for heart failure reflects what occurred at discharge after an inpatient stay...

....

..As clinical data become more readily available, the incremental value of adding clinical data to claims-based models of mortality and readmission is unclear...

..Get With The Guidelines (GWTG)-Stroke is a national stroke registry and quality improvement program. We examined the accuracy and reliability of data entered in GWTG-Stroke...

..However, there are limited data describing patterns of follow-up after heart failure hospitalization and its association with readmission rates...

..The purpose of this study was to compare baseline characteristics and outcomes after EC-AL versus DT-LVAD...

..Participation in clinical registries is nonrandom, so participants may differ in important ways from nonparticipants. The extent to which findings from clinical registries can be generalized to broader populations is unclear...

..To determine the adherence to national guidelines and in-hospital mortality of older patients with acute myocardial infarction (AMI) using a national database...

..Heart failure is a common cause of death among Medicare beneficiaries, but little is known about health care resource use at the end of life...

....

..Both heart failure (HF) and chronic kidney disease (CKD) are highly prevalent conditions that often coexist; however, the quality of care received by hospitalized patients with both is not known...

..The aim of this study was to describe hospital variation and factors associated with adherence to guidelines for implantable cardioverter-defibrillator (ICD) therapy...

..The frequency of AF increases with age, but representative national data about incidence and prevalence are limited. We examined the annual incidence, prevalence, and mortality associated with AF among older persons...

..This article summarizes the discussions held at this meeting...

..We hypothesized that other adverse outcomes, principally determined by recipient characteristics, occur at a higher rate in extended criteria recipients...

..Recently, the Food and Drug Administration approved implantable left ventricular assist devices (LVAD) as destination therapy (DT) for end-stage heart failure patients who are ineligible for cardiac transplantation...

..We present a method to link hospitalization records from registries with Medicare inpatient claims data, without using direct identifiers, to create a unique data source that pairs rich clinical data with long-term outcome data...

..Clinical registries are used increasingly to analyze quality and outcomes, but the generalizability of findings from registries is unclear...

..Yet, there have been insufficient data characterizing the clinical presentation, quality of care, and outcomes of patients hospitalized with HF as a function of race/ethnicity...

..The effect of hospital participation in a national performance improvement program on regional variation in quality of care and in-hospital outcomes for acute coronary syndromes (ACS) is unknown...

..However, DTB time is only one of several important AMI care processes. It is unclear whether quality efforts targeted to a single process will facilitate concomitant improvement in other quality measures and outcomes...

..We sought to examine associations between initiation of beta-blocker therapy and outcomes among elderly patients hospitalized for heart failure...

..We examined patient and implanting physician factors associated with outcomes of ICD therapy in Medicare beneficiaries from 2002 through 2005...

..The appropriate use of vasoactive cardiovascular drugs in high-risk coronary artery bypass grafting (CABG) patients has not been well characterized...

..It is unclear whether efforts undertaken to improve AMI care have mitigated these sex disparities in the current era...

..However, the effect of nesiritide on dyspnea at 6 or 24 hours is unknown, and no clinical outcome trials have been done to provide a reliable estimate of the effect of nesiritide on morbidity and mortality...

..The efficacy of eplerenone in patients with mild HF symptoms translates into a unique opportunity to reduce morbidity and mortality earlier in the course of the disease...

..Warfarin use and associated outcomes in patients with heart failure and atrial fibrillation and a cardiovascular implantable electronic device have not been described previously...

..He subsequently underwent uncomplicated heart transplantation. Nineteen months later, a routine surveillance endomyocardial biopsy specimen demonstrated recurrence of sarcoidosis in the transplanted heart...

..S. population...

..The treatment of chronic heart failure has improved during the past 2 decades, but little is known about whether the improvements are reflected in trends in early and long-term mortality and hospital readmission...

..We examined associations between WRF and 30-day readmission, mortality, and costs among Medicare beneficiaries hospitalized with heart failure...

..The authors evaluated short-term outcomes among patients with heart failure, coronary artery disease (CAD), or neither who underwent major noncardiac surgery...

..However, referral for LVAD therapy may be limited secondary to reports of poor outcomes when mechanical circulatory support is required before transplantation...

..Recent efforts to improve care for patients hospitalized with heart failure have focused on process-based performance measures. Data supporting the link between current process measures and patient outcomes are sparse...

..We studied the impact of chronic renal insufficiency on mortality and quality of inpatient care for AMI from the American Heart Association's Get With The Guidelines-Coronary Artery Disease Program...

..We sought to estimate the annual incidence and prevalence of heart failure and associated survival in elderly persons from January 1, 1994, through December 31, 2003...

..Guideline-recommended therapies and interventions are under-utilized in patients with NSTE ACS and HF, with and without preserved systolic function, compared with those without HF...

..While most comparisons of hospital outcomes adjust for patient characteristics, process performance comparisons typically do not...

..However, little is known regarding contemporary ischemic stroke mortality and rehospitalization rates for Medicare beneficiaries and how they vary by hospital...

..The influence of sex and race on ICD use among eligible patients is unknown...

....

....

..Whether a bundled payment approach can address the negative financial impact of DM programs is unknown...

..Although preferably D2B times should be <or=90 minutes, it is unclear how consistently this is achieved in community practice, particularly in women, elderly people, and minorities...

..This article summarizes the discussions that occurred at the meeting...

..A better understanding of the factors affecting pain during EMBx could improve the comfort level of this procedure...

..We were unable to demonstrate a statistically significant association between persistent ACEI/ARB use and survival...

..However, the pathophysiology of acute decompensated heart failure is complex and the impact of nesiritide on important clinical end points, beyond symptomatic and hemodynamic improvement, is unknown...

..Previous studies of sex differences in the use of implantable cardioverter-defibrillators (ICDs) predate recent expansions in Medicare coverage and did not provide patient follow-up over multiple years...

..We performed a quantitative meta-analysis of available randomized controlled trials to determine whether titration of therapy based on natriuretic peptide measurements improves mortality in chronic heart failure...

..We performed a phase 2 randomized trial to evaluate the safety and feasibility of M118 in the setting of elective percutaneous coronary intervention...

..The creation of an alternate list to match recipients with contraindications to traditional HT with sub-optimal donor organs has been implemented at some centers, but outcomes using this approach are uncertain...

..Loop diuretics are an essential component of therapy for patients with acute decompensated heart failure, but there are few prospective data to guide their use...

....

..This review will summarize preoperative assessment and perioperative management with an emphasis on heart failure...

..This article reviews the conceptual basis for driving evidence-based medicine by focusing on quality of care for heart failure patients...

..We provide considerations about prudent use of this therapy and review potential misconceptions about this long-used diuretic approach. Finally, we seek to highlight the need for pragmatic clinical trials for this commonly used therapy...

..41; P<.001). CONCLUSION: Left ventricular assessment was frequently not performed during the in-hospital stay of patients with acute MI, including those with clinical HF, and its use was associated with better quality of care...

..In conclusion, increasing BMI appears to be associated with better use of guideline-recommended medical treatment and invasive management of CAD, which may explain the observed lower rates of in-hospital mortality...

..However, there remain further opportunities to improve utilization of guideline-recommended therapies irrespective of discharge day...

..In conclusion, more widespread measurement of BNP levels for risk stratification of patients with NSTE ACS may be warranted...