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2-year patient-related versus stent-related outcomes: the SORT OUT IV (Scandinavian Organization for Randomized Trials With Clinical Outcome IV) Trial.

https://arctichealth.org/en/permalink/ahliterature120892
Source
J Am Coll Cardiol. 2012 Sep 25;60(13):1140-7
Publication Type
Article
Date
Sep-25-2012
Author
Lisette Okkels Jensen
Per Thayssen
Evald Høj Christiansen
Hans Henrik Tilsted
Michael Maeng
Knud Nørregaard Hansen
Anne Kaltoft
Henrik Steen Hansen
Hans Erik Bøtker
Lars Romer Krusell
Jan Ravkilde
Morten Madsen
Leif Thuesen
Jens Flensted Lassen
Author Affiliation
Department of Cardiology, Odense University Hospital, Odense, Denmark. okkels@dadlnet.dk
Source
J Am Coll Cardiol. 2012 Sep 25;60(13):1140-7
Date
Sep-25-2012
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Balloon, Coronary
Coronary Artery Disease - mortality - therapy
Death
Denmark
Drug-Eluting Stents
Female
Follow-Up Studies
Humans
Immunosuppressive Agents - therapeutic use
Male
Middle Aged
Myocardial Infarction - etiology
Myocardial Revascularization - statistics & numerical data
Single-Blind Method
Sirolimus - adverse effects - analogs & derivatives - therapeutic use
Thrombosis - etiology
Treatment Outcome
Abstract
There are limited head-to-head randomized data on patient-related versus stent-related outcomes for everolimus-eluting stents (EES) and sirolimus-eluting stents (SES).
In the SORT OUT IV (Scandinavian Organization for Randomized Trials With Clinical Outcome IV) trial, comparing the EES with the SES in patients with coronary artery disease, the EES was noninferior to the SES at 9 months.
The primary endpoint was a composite: cardiac death, myocardial infarction (MI), definite stent thrombosis, or target vessel revascularization. Safety and efficacy outcomes at 2 years were further assessed with specific focus on patient-related composite (all death, all MI, or any revascularization) and stent-related composite outcomes (cardiac death, target vessel MI, or symptom-driven target lesion revascularization). A total of 1,390 patients were assigned to receive the EES, and 1,384 patients were assigned to receive the SES.
At 2 years, the composite primary endpoint occurred in 8.3% in the EES group and in 8.7% in the SES group (hazard ratio [HR]: 0.94, 95% confidence interval [CI]: 0.73 to 1.22). The patient-related outcome: 15.0% in the EES group versus 15.6% in the SES group, (HR: 0.95, 95% CI: 0.78 to 1.15), and the stent-related outcome: 5.2% in the EES group versus 5.3% in the SES group (HR: 0.97, 95% CI: 0.70 to 1.35) did not differ between groups. Rate of definite stent thrombosis was lower in the EES group (0.2% vs. 0.9%, (HR: 0.23, 95% CI: 0.07 to 0.80).
At 2-year follow-up, the EES was found to be noninferior to the SES with regard to both patient-related and stent-related clinical outcomes.
PubMed ID
22958957 View in PubMed
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18F-FDG PET imaging of myocardial viability in an experienced center with access to 18F-FDG and integration with clinical management teams: the Ottawa-FIVE substudy of the PARR 2 trial.

https://arctichealth.org/en/permalink/ahliterature144812
Source
J Nucl Med. 2010 Apr;51(4):567-74
Publication Type
Article
Date
Apr-2010
Author
Arun Abraham
Graham Nichol
Kathryn A Williams
Ann Guo
Robert A deKemp
Linda Garrard
Ross A Davies
Lloyd Duchesne
Haissam Haddad
Benjamin Chow
Jean DaSilva
Rob S B Beanlands
Author Affiliation
National Cardiac PET Centre and Division of Cardiology, Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Source
J Nucl Med. 2010 Apr;51(4):567-74
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Canada
Coronary Artery Disease - physiopathology - radionuclide imaging
Female
Fluorodeoxyglucose F18 - diagnostic use
Heart - physiopathology - radionuclide imaging
Heart Failure - physiopathology - radionuclide imaging
Humans
Male
Middle Aged
Myocardial Revascularization
Patient care team
Positron-Emission Tomography
Professional Competence
Radiopharmaceuticals - diagnostic use
Randomized Controlled Trials as Topic
Survival Analysis
Tissue Survival
Ventricular Dysfunction, Left - physiopathology - radionuclide imaging
Abstract
(18)F-FDG PET may assist decision making in ischemic cardiomyopathy. The PET and Recovery Following Revascularization (PARR 2) trial demonstrated a trend toward beneficial outcomes with PET-assisted management. The substudy of PARR 2 that we call Ottawa-FIVE, described here, was a post hoc analysis to determine the benefit of PET in a center with experience, ready access to (18)F-FDG, and integration with clinical teams.
Included were patients with left ventricular dysfunction and suspected coronary artery disease being considered for revascularization. The patients had been randomized in PARR 2 to PET-assisted management (group 1) or standard care (group 2) and had been enrolled in Ottawa after August 1, 2002 (the date that on-site (18)F-FDG was initiated) (n = 111). The primary outcome was the composite endpoint of cardiac death, myocardial infarction, or cardiac rehospitalization within 1 y. Data were compared with the rest of PARR 2 (PET-assisted management [group 3] or standard care [group 4]).
In the Ottawa-FIVE subgroup of PARR 2, the cumulative proportion of patients experiencing the composite event was 19% (group 1), versus 41% (group 2). Multivariable Cox proportional hazards regression showed a benefit for the PET-assisted strategy (hazard ratio, 0.34; 95% confidence interval, 0.16-0.72; P = 0.005). Compared with other patients in PARR 2, Ottawa-FIVE patients had a lower ejection fraction (25% +/- 7% vs. 27% +/- 8%, P = 0.04), were more often female (24% vs. 13%, P = 0.006), tended to be older (64 +/- 10 y vs. 62 +/- 10 y, P = 0.07), and had less previous coronary artery bypass grafting (13% vs. 21%, P = 0.07). For patients in the rest of PARR 2, there was no significant difference in events between groups 3 and 4. The observed effect of (18)F-FDG PET-assisted management in the 4 groups in the context of adjusted survival curves demonstrated a significant interaction (P = 0.016). Comparisons of the 2 arms in Ottawa-FIVE to the 2 arms in the rest of PARR 2 demonstrated a trend toward significance (standard care, P = 0.145; PET-assisted management, P = 0.057).
In this post hoc group analysis, a significant reduction in cardiac events was observed in patients with (18)F-FDG PET-assisted management, compared with patients who received standard care. The results suggest that outcome may be benefited using (18)F-FDG PET in an experienced center with ready access to (18)F-FDG and integration with imaging, heart failure, and revascularization teams.
Notes
Comment In: J Nucl Med. 2010 Apr;51(4):505-620237024
PubMed ID
20237039 View in PubMed
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[A 20-year follow-up of Danish coronary artery bypass patients].

https://arctichealth.org/en/permalink/ahliterature215805
Source
Ugeskr Laeger. 1995 Feb 13;157(7):889-92
Publication Type
Article
Date
Feb-13-1995
Author
C A Bertelsen
K. Høier-Madsen
K. Folke
P F Hansen
Author Affiliation
Thoraxkirurgisk afdeling R., Amtssygehuset i Gentofte.
Source
Ugeskr Laeger. 1995 Feb 13;157(7):889-92
Date
Feb-13-1995
Language
Danish
Publication Type
Article
Keywords
Adult
Coronary Artery Bypass - mortality
Denmark
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Revascularization
Prognosis
Quality of Life
Reoperation
Retrospective Studies
Time Factors
Abstract
This study describes the influence of complete revascularization on the long term survival of patients following coronary artery bypass surgery. The patient population consists of 100 consecutive patients discharged from our department after undergoing a coronary bypass operation between November 1973 and July 1978. Patients who survived less than 30 days postoperatively are excluded from the study. The patient population consists of 87 males and 13 females. Mean age was 52.2 years at time of surgery. The rate of revascularization was estimated by coronary angiography, performed between one and 34 months postoperatively, in contrast to other similar studies found in the literature, where such estimation was performed peroperatively. Twenty-five of 86 patients were completely revascularized at postoperative angiographic estimation. Long term survival for the patient population and for the group of completely revascularized patients were compared to the expected survival of the Danish background population (comparable age and sex). Long term survival for the patient population as a whole was similar to that found in similar studies. There was an expected increased mortality compared to the Danish background population.
PubMed ID
7701650 View in PubMed
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Absence of bias against smokers in access to coronary revascularization after cardiac catheterization.

https://arctichealth.org/en/permalink/ahliterature176495
Source
Int J Qual Health Care. 2005 Feb;17(1):37-42
Publication Type
Article
Date
Feb-2005
Author
Jacques Cornuz
Peter D Faris
P Diane Galbraith
Merril L Knudtson
William A Ghali
Author Affiliation
Department of Medicine, University of Lausanne, Lausanne, Switzerland.
Source
Int J Qual Health Care. 2005 Feb;17(1):37-42
Date
Feb-2005
Language
English
Publication Type
Article
Keywords
Alberta - epidemiology
Angioplasty, Balloon, Coronary - utilization
Attitude of Health Personnel
Cardiac Catheterization - utilization
Cohort Studies
Coronary Artery Bypass - utilization
Coronary Disease - diagnosis - therapy
Female
Humans
Male
Middle Aged
Myocardial Revascularization - utilization
Prejudice
Prospective Studies
Smoking - epidemiology
Abstract
Many consider smoking to be a personal choice for which individuals should be held accountable. We assessed whether there is any evidence of bias against smokers in cardiac care decision-making by determining whether smokers were as likely as non-smokers to undergo revascularization procedures after cardiac catheterization.
Prospective cohort study. Subjects and setting. All patients undergoing cardiac catheterization in Alberta, Canada.
Patients were categorized as current smokers, former smokers, or never smokers, and then compared for their risk-adjusted likelihood of undergoing revascularization procedures (percutaneous coronary intervention or coronary artery bypass grafting) after cardiac catheterization.
Among 20406 patients undergoing catheterization, 25.4% were current smokers at the time of catheterization, 36.6% were former smokers, and 38.0% had never smoked. When compared with never smokers (reference group), the hazard ratio for undergoing any revascularization procedure after catheterization was 0.98 (95% CI 0.93-1.03) for current smokers and 0.98 (0.94-1.03) for former smokers. The hazard ratio for undergoing coronary artery bypass grafting was 1.09 (1.00-1.19) for current smokers and 1.00 (0.93-1.08) for former smokers. For percutaneous coronary intervention, the hazard ratios were 0.93 (0.87-0.99) for current smokers and 1.00 (0.94-1.06) for former smokers.
Despite potential for discrimination on the basis of smoking status, current and former smokers undergoing cardiac catheterization in Alberta, Canada were as likely to undergo revascularization procedures as catheterization patients who had never smoked.
PubMed ID
15668309 View in PubMed
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Access to myocardial revascularization procedures: closing the gap with time?

https://arctichealth.org/en/permalink/ahliterature170348
Source
BMC Public Health. 2006;6:60
Publication Type
Article
Date
2006
Author
Alain Vanasse
Théophile Niyonsenga
Josiane Courteau
Abbas Hemiari
Author Affiliation
Family Medicine Department, Faculty of Medicine, Université de Sherbrooke, Sherbrooke (QC), J1H 5N4, Canada. alain.vanasse@usherbrooke.ca
Source
BMC Public Health. 2006;6:60
Date
2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Angioplasty, Balloon, Coronary - utilization
Cardiac Care Facilities - supply & distribution
Cohort Studies
Coronary Artery Bypass - utilization
Female
Geography
Health Services Accessibility - statistics & numerical data
Humans
Incidence
Male
Middle Aged
Myocardial Infarction - epidemiology - surgery
Myocardial Revascularization - utilization
Patient Discharge
Quebec - epidemiology
Registries
Time Factors
Abstract
Early access to revascularization procedures is known to be related to a more favorable outcome in myocardial infarction (MI) patients, but access to specialized care varies widely amongst the population. We aim to test if the early gap found in the revascularization rates, according to distance between patients' location and the closest specialized cardiology center (SCC), remains on a long term basis.
We conducted a population-based cohort study using data from the Quebec's hospital discharge register (MED-ECHO). The study population includes all patients 25 years and older living in the province of Quebec, who were hospitalized for a MI in 1999 with a follow up time of one year after the index hospitalization. The main variable is revascularization (percutaneous transluminal coronary angioplasty or a coronary artery bypass graft). The population is divided in four groups depending how close they are from a SCC ( or = 105 km). Revascularization rates are adjusted for age and sex.
The study population includes 11,802 individuals, 66% are men. The one-year incidence rate of MI is 244 individuals per 100,000 inhabitants. At index hospitalization, a significant gap is found between patients living close ( or = 32 km). During the first year, a gap reduction can be observed but only for patients living at an intermediate distance from the specialized center (64-105 km).
The gap observed in revascularization rates at the index hospitalization for MI is in favour of patients living closer (
Notes
Cites: Can J Cardiol. 1999 Nov;15(11):1277-8210579743
Cites: BMC Cardiovasc Disord. 2005;5(1):2116008836
Cites: Chronic Dis Can. 2000;21(3):104-1311082346
Cites: Med Care. 2001 May;39(5):446-5811317093
Cites: Eur Heart J. 2001 Sep;22(18):1702-1511511120
Cites: JAMA. 2002 Mar 13;287(10):1269-7611886318
Cites: Aust J Rural Health. 2000 Dec;8(6):310-711894790
Cites: Med Care. 2002 Jul;40(7):614-2612142777
Cites: J Gen Intern Med. 2002 Aug;17(8):604-1112213141
Cites: CMAJ. 2003 Feb 4;168(3):261-412566329
Cites: Ann Med. 2003;35(1):43-5012693612
Cites: Can J Cardiol. 2003 Jun;19(7):774-8112813610
Cites: Can J Cardiol. 2002 Oct;18(10):1067-7612420042
Cites: Can J Cardiol. 2003 Jun;19(7):782-912813611
Cites: Can J Cardiol. 2003 Jul;19(8):893-90112876609
Cites: Am Heart J. 2003 Aug;146(2):242-912891191
Cites: Can J Cardiol. 2003 Sep;19(10):1123-3114532937
Cites: Can J Cardiol. 2003 Oct;19(11):1241-814571309
Cites: Can J Cardiol. 2004 Jan;20(1):61-714968144
Cites: Can J Cardiol. 2004 Mar 1;20(3):282-9115054505
Cites: Can J Cardiol. 2004 Mar 15;20(4):391-715057314
Cites: Can J Cardiol. 2004 Apr;20(5):491-50015100750
Cites: Arch Intern Med. 1995 Feb 13;155(3):318-247832604
Cites: N Engl J Med. 1995 Aug 31;333(9):565-727623907
Cites: Med Care Res Rev. 1995 Nov;52(4):532-4210153313
Cites: Am J Cardiol. 1997 Sep 15;80(6):777-99315589
Cites: J Am Coll Cardiol. 1997 Nov 1;30(5):1187-929350913
Cites: Stroke. 1998 Nov;29(11):2304-109804638
Cites: Int J Cardiol. 1999 Jan;68(1):63-710077402
Cites: J Am Coll Cardiol. 1999 Sep;34(3):890-91110483976
Cites: J Gen Intern Med. 1999 Sep;14(9):555-810491245
Cites: Can J Cardiol. 2005 Mar;21(3):247-5515776114
Cites: J Epidemiol Community Health. 2000 Apr;54(4):293-810827912
PubMed ID
16524458 View in PubMed
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Achieving quality indicator benchmarks and potential impact on coronary heart disease mortality.

https://arctichealth.org/en/permalink/ahliterature131252
Source
Can J Cardiol. 2011 Nov-Dec;27(6):756-62
Publication Type
Article
Author
Harindra C Wijeysundera
Nicholas Mitsakakis
William Witteman
Mike Paulden
Gabrielle van der Velde
Jack V Tu
Douglas S Lee
Shaun G Goodman
Robert Petrella
Martin O'Flaherty
Simon Capewell
Murray Krahn
Author Affiliation
Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. wijeysundera@gmail.com
Source
Can J Cardiol. 2011 Nov-Dec;27(6):756-62
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Benchmarking - methods
Coronary Disease - mortality - therapy
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Revascularization - methods - standards
Ontario - epidemiology
Prognosis
Quality Indicators, Health Care - utilization
Retrospective Studies
Risk Assessment - methods
Risk factors
Abstract
Quality indicators in coronary heart disease (CHD) measure the practice gap between optimal care and current clinical practice. However, the potential impact of achieving quality indicator benchmarks remains unknown.
Using a validated, epidemiologic model of CHD in Ontario, Canada, we estimated the potential impact on mortality of improved utilization on CHD quality indicators from 2005 levels to recommend benchmark utilization of 90%. Eight CHD disease subgroups were evaluated, including inpatients with acute myocardial infarction (AMI), acute coronary syndromes, and heart failure, in addition to ambulatory patients who were post-acute myocardial infarction survivors, or had heart failure, chronic stable angina, hypertension, or hyperlipidemia. The primary outcome was the predicted mortality reduction associated with meeting quality indicator targets for each CHD subgroup-treatment combination.
In 2005, there were 10,060 CHD deaths in Ontario, representing an age-adjusted CHD mortality of 191 per 100,000 people. By meeting quality indicator utilization benchmarks, mortality could be potentially reduced by approximately 20% (95% confidence interval 17.8-21.1), representing approximately 1960 avoidable deaths. The bulk of this potential benefit was in ambulatory patients with chronic stable angina (36% of reduction) and heart failure (31% of reduction). The biggest drivers were optimizing angiotensin-converting enzyme inhibitor use in chronic stable angina patients (approximately 440 avoidable deaths) and ß-blocker use in heart failure (approximately 400 avoidable deaths).
These findings reinforce the importance of quality indicators and could aid policy makers in prioritizing strategies to meet the goals outlined in the Canadian Heart Health Strategy and Action Plan for reducing cardiovascular mortality.
PubMed ID
21920697 View in PubMed
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Acute heart failure with and without concomitant acute coronary syndromes: patient characteristics, management, and survival.

https://arctichealth.org/en/permalink/ahliterature263842
Source
J Card Fail. 2014 Oct;20(10):723-30
Publication Type
Article
Date
Oct-2014
Author
Tuukka Tarvasmäki
Veli-Pekka Harjola
Markku S Nieminen
Krista Siirilä-Waris
Jukka Tolonen
Heli Tolppanen
Johan Lassus
Source
J Card Fail. 2014 Oct;20(10):723-30
Date
Oct-2014
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - complications - mortality - physiopathology
Acute Disease
Aged
Cardiovascular Agents - therapeutic use
Disease Management
Female
Finland - epidemiology
Heart Failure - complications - mortality - physiopathology
Hospital Mortality
Hospitalization - statistics & numerical data
Humans
Male
Myocardial Revascularization - methods - statistics & numerical data
Prospective Studies
Pulmonary Edema - etiology
Shock, Cardiogenic - etiology
Survival Analysis
Abstract
Acute coronary syndromes (ACS) may precipitate up to a third of acute heart failure (AHF) cases. We assessed the characteristics, initial management, and survival of AHF patients with (ACS-AHF) and without (nACS-AHF) concomitant ACS.
Data from 620 AHF patients were analyzed in a prospective multicenter study. The ACS-AHF patients (32%) more often presented with de novo AHF (61% vs. 43%; P
PubMed ID
25079300 View in PubMed
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Acute versus chronic myocardial injury and long-term outcomes.

https://arctichealth.org/en/permalink/ahliterature309340
Source
Heart. 2019 12; 105(24):1905-1912
Publication Type
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Date
12-2019
Author
Erik Kadesjö
Andreas Roos
Anwar Siddiqui
Liyew Desta
Magnus Lundbäck
Martin J Holzmann
Author Affiliation
Functional Area of Emergency Medicine, Karolinska University Hospital, 14184, Stockholm.
Source
Heart. 2019 12; 105(24):1905-1912
Date
12-2019
Language
English
Publication Type
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Keywords
Acute Disease
Adult
Aged
Aged, 80 and over
Biomarkers - blood
Chronic Disease
Female
Follow-Up Studies
Heart Failure - etiology - mortality
Humans
Male
Middle Aged
Myocardial Infarction - complications - diagnosis - mortality - therapy
Myocardial Revascularization - methods
Prognosis
Sweden - epidemiology
Troponin T - blood
Abstract
There is a paucity of data regarding prognosis in patients with acute versus chronic myocardial injury for long-term outcomes. We hypothesised that patients with chronic myocardial injury have a similar long-term prognosis as patients with acute myocardial injury.
In an observational cohort study of 22?589 patients who had high-sensitivity cardiac troponin T (hs-cTnT) measured in the emergency department during 2011-2014, we identified all patients with level >14?ng/L and categorised them as acute myocardial injury, type 1 myocardial infarction (T1MI), type 2 myocardial infarction (T2MI) or chronic myocardial injury through adjudication. We estimated adjusted HRs with 95% CIs for the primary outcome all-cause mortality and secondary outcomes MI, and heart failure in patients with acute myocardial injury, T1MI and T2MI compared with chronic myocardial injury.
In total, 3853 patients were included. During 3.9 (±2) years of follow-up, 48%, 24%, 44% and 49% of patients with acute myocardial injury, T1MI, T2MI and chronic myocardial injury died, respectively. Patients with acute myocardial injury had higher adjusted risks of death (1.21, 95% CI 1.08 to 1.36) and heart failure (1.24, 95% CI 1.07 to 1.43), but a similar risk for myocardial infarction (MI) compared with the reference group. Patients with T1MI had a lower adjusted risk of death (0.86, 95% CI 0.74 to 1.00) and higher risk of MI (2.09, 95% CI 1.62 to 2.68), but a similar risk of heart failure. Patients with T2MI had a higher adjusted risk of death (1.46, 95% CI 1.18 to 1.80) and heart failure (1.30, 95% CI 1.00 to 1.69) compared with patients with chronic myocardial injury.
Absolute long-term risks for death are similar, and adjusted risks are slightly higher, among patients with acute myocardial injury and T2MI, respectively, compared with chronic myocardial injury. The lowest risk of long-term mortality was found in patients with T1MI. Both acute and chronic myocardial injury are associated with very high risks of adverse outcomes.
PubMed ID
31337668 View in PubMed
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Adapting to waiting lists for coronary revascularization. Do Canadian specialists agree on which patients come first?

https://arctichealth.org/en/permalink/ahliterature224256
Source
Chest. 1992 Mar;101(3):715-22
Publication Type
Article
Date
Mar-1992
Author
C D Naylor
C M Levinton
R S Baigrie
Author Affiliation
Clinical Epidemiology Unit, Sunnybrook Health Science Centre, Toronto, Ontario, Canada.
Source
Chest. 1992 Mar;101(3):715-22
Date
Mar-1992
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Cardiac Surgical Procedures
Cardiology
Coronary Disease - classification - surgery
Data Collection
Emergencies
Humans
Myocardial Revascularization
Ontario
Risk factors
Waiting Lists
Abstract
To assess specialists' adaptation to long waiting lists for coronary revascularization, and their acceptance of a formal queue-ordering schema proposed by an expert panel.
Mail survey of practitioners in referral centers using 49 hypothetical case scenarios. Scenarios were rated for maximum acceptable delay prior to coronary surgery, on a scale with seven interventional time frames graded from emergency to three to six months' permissible delay. The survey included the proposed schema and rating system; respondents were invited to differ as they saw fit. HYPOTHETICAL PATIENTS: Assumed uniformly to be middle aged with typical angina, but clinical factors varied, eg, severity and stability of angina, response to medical therapy, coronary anatomy, and noninvasive test results. PHYSICIAN SUBJECTS: There were 122 respondents, for a 60 percent response rate, including a majority of cardiac surgeons and invasive cardiologists on staff in Ontario teaching hospitals.
Fifty-seven percent rated some scenarios for acceptable waiting times of three to six months; another 39 percent rated their least urgent scenarios to wait six weeks to three months. Interpractitioner agreement was high: for 48/49 scenarios, at least 75 percent of urgency ratings fell within two contiguous points on the scale. Symptom status was the dominant determinant of waiting time, with mean maximum acceptable wait of 74 days for patients with mild-moderate stable angina but three days for those receiving parenteral nitroglycerin (p less than 0.00001). About half the ratings matched those predicted based on the original panel's consensus criteria; 90 percent were within one scale point.
Specialist practitioners in Ontario have adapted to waiting lists for coronary artery bypass surgery/percutaneous transluminal coronary angioplasty, and assess the priority of hypothetical patients in similar ways and in reasonable accord with formal queue-ordering criteria. This behavior may help mitigate the impact of resource constraints, allowing delay of services for those with less acute need--a potential contrast to delayed access in America based on low income or lack of insurance.
PubMed ID
1541137 View in PubMed
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[Adherence to guidelines on management of acute coronary syndrome in Russian hospitals and outcomes of hospitalization (data from the RECORD-2 Registry)].

https://arctichealth.org/en/permalink/ahliterature115057
Source
Kardiologiia. 2013;53(1):14-22
Publication Type
Article
Date
2013
Author
A D Érlikh
M S Kharchenko
O L Barbarash
V V Kashtalap
M V Zykov
T B Pecherina
I I Shevchenko
R R Islamov
E D Kosmacheva
L K Kruberg
O A Pozdniakova
N G Goroshko
V A Markov
A G Syrkina
N V Belokopytova
V V Gorbunov
A S Gagarkina
T V Kalinkina
O A Zaitseva
S A Luk'ianov
D P Tagirova
V M Provotorov
N A Gratsianskii
Source
Kardiologiia. 2013;53(1):14-22
Date
2013
Language
Russian
Publication Type
Article
Keywords
Acute Coronary Syndrome - diagnosis - mortality - therapy
Aged
Diagnostic Techniques, Cardiovascular
Disease Management
Female
Guideline Adherence - standards - statistics & numerical data
Hospital Mortality
Hospitalization - statistics & numerical data
Humans
Male
Myocardial Revascularization - methods
Outcome and Process Assessment (Health Care)
Practice Guidelines as Topic
Registries - statistics & numerical data
Retrospective Studies
Risk assessment
Risk factors
Russia - epidemiology
Severity of Illness Index
Abstract
Complete following existing guidelines for management of acute coronary syndrome (ACS) is known to be associated with better outcomes. Partly this is explained by lesser adherence to recommendations in high risk patients. Aim of our study was to assess relationship between degree of following current guidelines and in hospital outcomes independently from initial assessment of risk.
Each key recommendation from guidelines issued between 2008 and 2011 (13 for STE ACS, 12 for NSTE ACS) was given weight of 1. Sum of these units constituted index of guideline adherence (IGA). IGA was retrospectively calculated for 1656 patients included in Russian independent ACS registry RECORD-2 (7 hospitals, duration 04.2009 to 04.2011). The patients were divided into 2 groups according to quartiles of IGA distribution: 1) low adherence group (quartiles I-II); 2) high adherence group (quartiles III-IV).
In low adherence compared with high adherence group there were significantly more patients more or equal 65 years (=0.0007), with chronic heart failure [CHF] (
PubMed ID
23548345 View in PubMed
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221 records – page 1 of 23.