E D Peterson

..Public reporting efforts currently profile hospitals based on overall stroke mortality rates, yet the "mix" of hemorrhagic and ischemic stroke cases may impact this rate...

..Selected care processes are increasingly being used to measure hospital quality; however, data regarding the association between hospital process performance and outcomes are limited...

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..We also identified important risk factors for TMR and compared outcomes of TMR combined with coronary artery bypass graft surgery (TMR + CABG) versus bypass alone in patients receiving incomplete revascularization...

..We sought to identify patient and hospital features associated with early glycoprotein (GP) IIb/IIIa inhibitor therapy for non-ST-elevation (NSTE) myocardial infarction (MI) and to relate this treatment to in-hospital outcomes...

..Guideline recommendations for CVD risk factor modification are also reviewed with emphasis on issues pertaining to the older adult population...

..This article outlines the objectives, operational structure, patient population, data elements, data collection methodology, and reporting components of this landmark registry...

..Participating centers were intended to carry out state-of-the-art outcomes research in cardiovascular disease and stroke, to train the next generation of investigators, and to support the formation of a collaborative research network...

..We also sought to determine the relationship between hospitals' risk-adjusted PLOS and mortality outcomes...

..In conclusion, patient willingness to consider RCT participation does not explain underenrollment of elderly and minority patients. Women, however, were more reluctant to consider RCTs, an area requiring further study...

..Furthermore, it is unknown whether gender-, race-, and age-based care disparities have narrowed over time...

..We pooled the largest PCI and CABG clinical registries in the United States to better understand revascularization procedure use, risks and outcomes in patients aged > or =75 years...

..In addition, the use of the "pay for performance" method, which can be advantageous for patients, physicians, and hospitals, may potentially improve the care of post-MI patients with LVD...

..While many clinicians would generally agree with the concept that providing better medical care should be rewarded, putting the idea into practice poses a challenge...

..Ongoing quality improvement efforts will be needed to further improve evidence-based and personalized care of patients with ACS...

..The effectiveness of treatment, revascularization and medical therapies, on reducing angina symptoms is also reviewed...

..Our findings support the use of broad, guideline-based performance metrics as a means of assessing and helping improve hospital quality...

..We sought to create contemporary models for predicting mortality risk following percutaneous coronary intervention (PCI)...

..Data are available for research by application to: http://www.ncdr.com...

..We conclude that in contemporary practice, a patient's body size rather than gender, conveys independent risk for mortality after PCI...

..We compared the acute and one year medical costs and outcomes of coronary stenting with those for balloon angioplasty (percutaneous transluminal coronary angioplasty) in contemporary clinical practice...

..Elderly persons and women were underrepresented in randomized controlled trials (RCTs) prior to 1990. Since then, efforts have been made to correct these biases, but their effect is unclear...

..Although multiple new coronary interventional devices have been approved for marketing in the United States, use of these technologies in general clinical practice and their associated outcomes have not been reported...

..The aim of this study was to examine the effects of provider profiling on bypass surgery access and outcomes in elderly patients in New York...

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..This study examined the impact of early hospital discharge on short-term clinical outcomes of elderly patients treated with coronary artery bypass graft surgery (CABG) in the United States in 1992...

..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...

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

..The aim of this study was to examine timing of in-hospital coronary artery bypass graft surgery (CABG) for non-ST-segment elevation myocardial infarction (NSTEMI) patients...

..We studied the relationship between diabetes and survival after revascularization in a large prospective cohort of patients with multivessel coronary artery disease...

..Patient medical records are important means of communication among health care providers. Limited evaluation has been performed of the quality of the medical records or its association with health care processes or outcomes...

..Lessons learned from previous and ongoing quality improvement initiatives will provide the tools needed to ensure that widespread adoption of guideline-based therapy is complete...

..Alternative methods that weight process measures according to how hospitals organize care and the range for possible improvement may be more closely related to patient outcomes...

..However, its usefulness for providing diagnostic estimates has yet to be determined...

..The purpose of this study to determine whether use of cardiac medications reflects evidence-based recommendations for patients with non-ST elevation acute coronary syndromes...

..The objective of this study was to identify preprocedure patient factors associated with percutaneous intervention costs and to examine the impact of these patient factors on economic profiles of interventional cardiologists...

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..Expanding upon existing valve models, the new STS models include several nonfatal complications in addition to mortality...

..We sought to determine the impact of acute beta-blocker therapy on outcomes in patients with NSTEMI...

..Reducing the length of hospitalizations can reduce short-term costs, but there are few data on the long-term clinical and economic consequences of early discharge...

..Data regarding the management of non-ST-segment elevation acute coronary syndromes (NSTE ACS) in Hispanic patients, the largest and fastest-growing minority in the United States, are scarce...

..We investigated whether greater use of secondary prevention medications after coronary artery bypass graft surgery is associated with improved clinical outcomes...

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..Previous studies have shown that women younger than 55 years have higher hospital mortality rates after acute myocardial infarction (MI) than age-matched men. We examined whether such mortality differences have decreased in recent years...

..Innovative strategies to facilitate CR enrollment and tailoring programs to better address the needs of all patient subgroups would extend these benefits to more eligible patients...

..Our purpose was to compare formulae for estimating glomerular filtration rate (GFR) in non-ST-segment elevation acute coronary syndromes (NSTE ACS) patients...

..In 2003, the Centers for Medicare & Medicaid Services (CMS) launched the largest pay-for-performance pilot project to date in the United States, including indicators for acute myocardial infarction...

..The purpose of this study was to evaluate characteristics and outcomes of patients age > or =80 undergoing cardiac surgery...

..Early outpatient follow-up after acute myocardial infarction (AMI) is recommended in guidelines, but its relationship with the use of evidence-based therapies is unknown...

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..These results underscore the importance of treatments aimed at maintaining functional status in older persons with heart failure, including those with significant baseline functional limitations...

..Multiple sensitivity analyses were also performed to determine the variables that most profoundly affect outcome...

..We sought to determine the ability of a treadmill score to provide accurate diagnostic and prognostic risk estimates in women...

..To evaluate the relationship between how much a new cardiovascular therapy improves clinical outcomes over current therapies and how much more it can cost while still remaining 'economically attractive'...

..In particular, concern has been raised that the elderly, who are at high risk for recurrent ischemia and short-term death, are not referred as often as younger patients for post-MI testing...

..This paper discusses these issues and suggests strategies to deal with them. A proposed methodology is developed, applied and evaluated on a large observational database that has long-term follow-up on nearly 10 000 patients...

..Provisional stenting may potentially reduce costs and rates of in-stent restenosis without compromising the quality of health care delivery...

..The purpose of this study was to determine whether pay-for-performance (PFP) increases existing racial care disparities...

..This review discusses, in the light of clinical trials recently presented, what we know, what we are learning, and what we still need to learn...

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..87, respectively; p for trend <0.001). In conclusion, timely administration of fibrinolytic therapy continues to significantly impact on mortality in the modern era, particularly in patients presenting early after symptom onset...

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..The objective of this study was to determine whether patient satisfaction is associated with adherence to practice guidelines and outcomes for acute myocardial infarction and to identify the key drivers of patient satisfaction...

..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...

..CONCLUSIONS: Among the myocardial infarction patients with cardiogenic shock who underwent IABP placement, mortality rate was significantly lower at high-IABP volume hospitals compared with low-IABP volume hospitals...

..22 [2.47, 4.46], P < 0.0001). CONCLUSIONS: Laparoscopic appendectomy has significant advantages over open appendectomy with respect to length of hospital stay, rate of routine discharge, and postoperative in-hospital morbidity...

..We describe center variation in delayed sternal closure after stage 1 palliation and associated outcomes...

..These ACC/AHA guidelines are intended to help physicians make appropriate decisions when diagnosing and treating patients with NSTE ACS...

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..5x ULN) remains uncertain. Using the CRUSADE database, we explored relationships between sex and treatment and outcomes among patients with troponin 1 to 1.5x ULN...

..Further research is needed into the prevention and treatment of perioperative MI in patients undergoing CABG...

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..Physicians need to be aware of patient factors which influence adherence to facilitate higher use of evidence-based medications...

..These results highlight the need for a large randomized, controlled trial to compare these 2 techniques...

..However, in the range of survival benefit observed in MADIT-II, ICD therapy for these patients is economically attractive by conventional standards...

..We sought to identify hospital characteristics associated with high levels of adherence in order to gain insight into successful processes of care...

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..An example that examines the effect of early extubation after bypass surgery is also presented...

..These results are important because of the prevalence of this condition in African American patients and their potential heterogeneous response to many heart failure therapies...

..Efforts to shorten door-to-balloon time should apply to all patients...

..Patients using the VA regional medical system initially are admitted to a hospital with or without the on-site availability of technology-intensive cardiac services...

..In pediatric cardiac surgery, infection is a leading cause of morbidity and mortality. We created a model to predict risk of major infection in this population...

..Given the wide variation in transfusion practice, further efforts to understand patient and process factors that result in bleeding and need for transfusion in NSTE ACS are needed...

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..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, innovative recommendation and referral strategies are needed because few elderly patients actually enroll...

..0001). The greatest effects appeared to be concentrated in those patients with less education (p = .04), and the program appeared to increase anxiety in nonwhite patients compared with white patients (p = 0.07)...

..This study explored the association between the initiation of hormone replacement therapy (HRT) and early cardiac events (<1 year) in women with a recent myocardial infarction (MI)...

..This report describes the first round of results for Phase II of the Alabama CABG Project, a regional quality improvement initiative...

..The goal of this study was to determine if cardiology subspecialty involvement improves the attainment of recommended low-density lipoprotein (LDL) cholesterol and blood pressure (BP) targets in coronary artery disease (CAD) patients...

..4%, adjusted P=0.02). We sought to determine whether Canadian-US differences in practice patterns in GUSTO-I had an impact on 5-year mortality...

..quot; The influence of the BARI findings and of the Clinical Alert on practice patterns is unknown...

..This study identified the preoperative risk factors associated with several complications and a composite outcome (the presence of any major morbidity or 30-day operative mortality or both)...

..Several of the modified and new recommendations again potentially affect ED management. These are presented and discussed here...

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..It is the intent of CRUSADE to improve patient care in the ED by tracking and encouraging compliance with evidence-based guidelines for the evaluation and management of NSTE ACS...

..The goal of this work was to explore the treatment and outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) age > or =90 years...

..This study examined the use, complication risks, and operative (30-day) mortality associated with internal thoracic artery grafting in patients 75 years of age and older...

..Finally, we will use established relations with professional societies and the VHA to widely disseminate our study's major findings. ..

..4. Widely disseminate those interventions found to be effective. 5. Train the next generation of CV outcomes researchers. ..