HARLAN MARC KRUMHOLZ

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..We characterized hospital patterns of ICU admission for patients with HF and determined their association with the use of ICU-level therapies and patient outcomes...

..The evaluation of hospital performance as measured by RSMRs and RSRRs has not been well characterized...

..CONCLUSION: The identification and examination of health care organizations that demonstrate positive deviance provides an opportunity to characterize and disseminate strategies for improving quality...

..This study presents data on (1) the prevalence of evidence-based strategies in U.S. hospitals that participated in the D2B Alliance and (2) identifies key hospital characteristics associated with their use...

..Genome-wide association studies (GWAS) have identified new candidate genes for the occurrence of acute coronary syndrome (ACS), but possible effects of such genes on survival following ACS have yet to be investigated...

..Many candidate genes have been reported to be risk factors for acute coronary syndrome (ACS), but their impact on clinical prognosis following ACS is unknown...

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..In addition to hospital risk-adjusted mortality standards, the Leapfrog Group recommends annual hospital procedure minimums of 450 for CABG and 400 for PCI to reduce procedure-associated mortality...

..We assessed the degree to which differences in guideline-based medical therapy for acute myocardial infarction (AMI) contribute to the higher mortality associated with kidney disease...

..One advantage of the MDR method is that it provides an internal prediction error for validation. We summarize our use of this internal prediction error for model validation...

..We sought to develop a hierarchical regression model using Medicare claims data that produces hospital risk-standardized 30-day mortality rates and to validate the hospital estimates against those derived from a medical record model...

..The working group concluded that a dedicated investment in CV outcomes research could directly improve the care delivered in the United States...

..These findings suggest that current cholesterol education efforts appear inadequate, particularly for women, nonwhites, and patients without any college education...

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..A model using administrative claims data that is suitable for profiling hospital performance for heart failure would be useful in quality assessment and improvement efforts...

..Recent developments in the methodology and standards for outcomes measurement have laid the groundwork for incorporating outcomes into performance monitoring efforts for these conditions...

..Moreover, we do not know whether improvements in door-to-balloon times were shared equally among patient and hospital groups...

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..We provide patterns of hospital performance, based on these measures...

..However, little has been reported about improvements in hospital short-term mortality rates or reductions in between-hospital variation in short-term mortality rates...

..We sought to describe national performance in DIDO time using a new measure developed by the Centers for Medicare & Medicaid Services...

..The prevalence and consequences of financial barriers to health care services and medications are not well documented for patients with an acute myocardial infarction (AMI)...

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..We sought to identify factors associated with length of stay among patients admitted for the treatment of heart failure resulting from systolic dysfunction...

..Despite the importance of beta-blockers for secondary prevention after acute myocardial infarction (AMI), several studies have suggested that they are substantially underutilized, particularly in older patients...

..We sought to describe the resuscitation preferences of patients hospitalized with an exacerbation of severe congestive heart failure, perceptions of those preferences by their physicians, and the stability of the preferences...

..Despite the evidence supporting the importance of early beta-blocker therapy, this intervention has received little attention as an indicator of quality of care...

..Identifying factors to predict risk of readmission in these patients could help clinicians focus resource-intensive disease management efforts on the high-risk patients...

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..To address this issue, we sought to determine whether emotional support is associated with fatal and nonfatal cardiovascular events in elderly patients hospitalized with heart failure...

..Although several demographic and clinical characteristics were significantly associated with cost, they accounted for only 7% of the variation. In-hospital procedures and adverse outcomes accounted for 53% of the variation...

..However, despite this interest, there is a paucity of information about the care of these patients in actual clinical practice across diverse sites...

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..Interest in the reporting of risk-adjusted outcomes for patients with acute myocardial infarction is growing. A useful risk-adjustment model must balance parsimony and ease of data collection with predictive ability...

..This type of study, using a positive deviance approach and mixed-methods design, can generate and test hypotheses about factors most strongly associated with exemplary performance based on practices currently in use...

..0% vs. 73.6%, P = 0.05). CONCLUSION: Elderly patients are less likely to receive guideline-indicated therapies when hospitalized with myocardial infarction. The effects of age were largest for acute reperfusion and smallest for aspirin...

..The results suggest that increasing use of beta-blockers in this group provides an opportunity to improve outcomes...

..49, 95% CI 0.35 to 0.67) than did patients in ASSENT-2. These findings support the use of smaller dose, weight-adjusted heparin in patients with ST-elevation myocardial infarction treated with tenecteplase...

..Although increased attention has been paid to sex and racial differences in the management of myocardial infarction, it is unknown whether these differences have narrowed over time...

..Future efforts to enhance enrollment of elderly women in cancer research should identify specific barriers related to SES that may be amenable to intervention...

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..A taxonomy of the characteristics of the physician quality leader from the perspective of physicians and nonphysicians was developed...

..Several hospital characteristics were associated with this improvement, but they are weak predictors of hospital-based improvement in the use of beta-blockers...

..Although previous studies have shown functional improvements in patients who undergo coronary artery bypass graft (CABG) surgery, data are conflicting on whether the gains achieved by women are similar to or less than those achieved by men...

..However, the small size of the volume-associated mortality difference and the heterogeneity in outcomes within all CABG volume groups suggest individual hospital CABG volume is not a reliable marker of hospital CABG quality...

..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...

..When marital status was examined as a main predictive variable, the analyses yielded similar results (unadjusted RR, 0.72; 95% CI, 0.58-0.86; RR adjusted for the same covariates, 0.80; 95% CI, 0.60-1.02)...

..This might, in part, reflect a poorer course of heart failure among African Americans...

..Future studies are needed to isolate hospital quality improvement efforts that are associated with superior performance...

..CONCLUSIONS: Alcohol-related diagnoses are not a barrier to receiving most quality of care measures in elderly patients hospitalized for acute myocardial infarction...

..CONCLUSIONS: There were small sex differences in the quality of care provided to fee-for-service Medicare patients hospitalized with heart failure, although women had higher rates of survival than men up to 1 year after hospitalization...

..Several patient characteristics, including age and sex, were associated with the use of specialty care, suggesting that factors other than clinical presentation may independently influence the use of specialty care...

..Multiple measures that reflect a variety of processes and also outcomes, such as risk-standardized mortality rates, are needed to more fully characterize hospital performance...

..Our objective was to evaluate the prognostic importance of transient, new, or persistent depression on outcomes at 6 months after MI...

..Long-term trends in the clinical characteristics, quality of care, and outcomes for AMI over time from the health system perspective in geographically diverse populations are not well known...

..We found no sex variations in procedure use among patients who had strong indications for cardiac catheterization...

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..Distinct morbidity and mortality burdens in black versus white patients underscore the importance of improving patient risk-stratification, defining optimal therapies, and exploring physiological underpinnings of racial differences...

..Digoxin therapy is associated with an increased risk of death from any cause among women, but not men, with heart failure and depressed left ventricular systolic function...

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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...

..We sought to determine whether access to cardiovascular resources at the admitting hospital influenced the prognosis of patients with acute myocardial infarction complicated by cardiogenic shock...

..This study was designed to examine whether female gender is associated with poorer recovery after coronary artery bypass graft (CABG) surgery...

..The proportion of trial participants who are black has declined in recent years...

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..This pattern is independent of patient or provider characteristics, suggesting other factors likely contribute to better short-term outcomes in New England...

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..A simple risk-stratification index for patients with ST-segment elevation myocardial infarction derived from an RCT population was recently proposed, but it has not been validated in a community-based cohort...

..Despite the many proposed methods for improving quality, little is known about which methods are being applied in practice across the United States or their perceived effectiveness...

..We sought to examine the use and impact of standard medical therapies in patients with end-stage renal disease (ESRD) faced with an acute myocardial infarction (AMI)...

..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...

..These findings support current efforts to incorporate quality of care in accreditation decisions...

..Further studies to establish the safety and effectiveness of this practice are needed to ensure optimal care of patients with diabetes and heart failure...

..Despite the importance of resident perspectives in designing effective responses to these pressures, understanding of residents' views is limited...

..Prior studies define worsening renal function using various creatinine elevations, but the relative value of definitions is unknown...

..Our objectives were to assess the correlates of ACE inhibitor use and the relationship between ACE inhibitor prescription and mortality in older patients with heart failure...

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..We studied the adoption of spironolactone therapy after publication of the Randomized Aldactone Evaluation Study (RALES) in national cohorts of older patients hospitalized for heart failure...

..Whether this results in adverse outcomes is unknown...

..Depression is an established independent prognostic factor for mortality, readmission, and cardiac events after CABG surgery. However, limited data exist on whether depression influences functional outcomes after CABG...

..Understanding the mechanisms and impact of the "obesity paradox" in patients with HF is necessary before recommendations are made concerning weight and weight control in this population...

..Comorbid conditions related to diabetes mellitus and ventricular function at the time of the index myocardial infarction are important contributors to poorer outcomes in patients with diabetes mellitus...

..Limitations in discrimination may undermine the value of health care quality ratings for patients or payers and may lead to misperceptions of hospitals' performance...

..CONCLUSION: This study provides no strong evidence to support the utility of this decision-support tool, but it demonstrates the value of rigorous evaluation of decision-support information technology...

..The risks of these adverse effects should be put in the context of the documented benefits of these medications...

..CONCLUSIONS: Elevated glucose is common, rarely treated, and associated with increased mortality risk in elderly acute myocardial infarction patients, particularly those without recognized diabetes...

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

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..We propose to conduct the largest, most comprehensive study of young women with heart attacks to identify the key determinants of their recovery and discover knowledge that will assist us in improving their care. ..

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..Data generated from these studies will guide efforts by clinicians, administrators, researchers, and policy makers to decrease time to reperfusion therapy for patients with STEMI. ..

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..We propose to conduct the largest, most comprehensive study of young women with heart attacks to identify the key determinants of their recovery and discover knowledge that will assist us in improving their care. ..