bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validity of Performance and Outcome Measures for Heart Failure
Authors: Patel Jay , Sandhu Alex , Parizo Justin , Moayedi Yasbanoo , Fonarow Gregg C. , Heidenreich Paul A. 
Published: September 2018

Background
Numerous quality metrics for heart failure (HF) care now exist based on process and outcome. What remains unclear, however, is if the correct quality metrics are being emphasized. To determine the validity of certain measures, we compared correlations between measures and reliability over time. Measures assessed include guideline-recommended β-blocker (BB), any BB, angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker, mineralocorticoid receptor antagonist, and hydralazine/isosorbide dinitrate (in blacks) use among candidates, 30-day mortality, 1-year mortality, and 30-day readmission.

Methods and Results

This was an observational cohort analysis using chart review and electronic resources for 55 735 patients from 102 Veterans Affairs medical centers hospitalized with HF from 2008 to 2013. Assessments of convergent validity and reliability were performed. Significant correlations were found between in-hospital rates of ACE inhibitor use and the following measures: BB use, 30-day mortality, and 1-year mortality. Guideline-recommended BB use was also significantly correlated with mineralocorticoid receptor antagonists, 30-day mortality, and 1-year mortality. There was no correlation between 30-day readmission rates and any therapy or mortality. Measure reliability over time was seen for guideline-recommended BBs (
r
=0.57), mineralocorticoid receptor antagonists (
r
=0.50), 30-day mortality (
r
=0.29), and 1-year mortality (
r
=0.31). ACE inhibitor and readmission rates were not reliable measures over time.

Conclusions
BB use, ACE inhibitor use, mortality, and mineralocorticoid receptor antagonist use are valid measures of HF quality. Thirty-day readmission rate did not seem to be a valid measure of HF quality of care. If the goal is to identify high-quality HF care, the emphasis on decreasing readmission rates might be better directed towards improving usage of the recommended therapies.
Incident Atrial Fibrillation Is Associated With
MYH7
Sarcomeric Gene Variation in Hypertrophic Cardiomyopathy
Authors: Lee Seung-Pyo , Ashley Euan A. , Homburger Julian , Caleshu Colleen , Green Eric M. , Jacoby Daniel , Colan Steven D. , Arteaga-Fernández Edmundo , Day Sharlene M. , Girolami Francesca , Olivotto Iacopo , Michels Michelle , Ho Carolyn Y. , Perez Marco V. ,   on behalf of the SHaRe Investigators
Published: September 2018

Background
Although atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM) patients, the relationship between genetic variation and AF has been poorly defined. Characterizing genetic subtypes of HCM and their associations with AF may help to improve personalized medical care. We aimed to investigate the link between sarcomeric gene variation and incident AF in HCM patients.

Methods and Results

Patients from the multinational Sarcomeric Human Cardiomyopathy Registry were followed for incident AF. Those with likely pathogenic or pathogenic variants in sarcomeric genes were included. The AF incidence was ascertained by review of medical records and electrocardiograms at each investigative site. One thousand forty adult HCM patients, without baseline AF and with likely pathogenic or pathogenic variation in either
MYH7
(n=296),
MYBPC3
(n=659), or thin filament genes (n=85), were included. Compared with patients with variation in other sarcomeric genes, those with
MYH7
variants were younger on first clinical encounter at the Sarcomeric Human Cardiomyopathy Registry site and more likely to be probands than the
MYBPC3
variants. During an average follow-up of 7.2 years, 198 incident AF events occurred. Patients with likely pathogenic or pathogenic mutations in
MYH7
had the highest incidence of AF after adjusting for age, sex, proband status, left atrial size, maximal wall thickness, and peak pressure gradient (hazard ratio, 1.7; 95% CI, 1.1–2.6;
P
=0.009).

Conclusions

During a mean follow-up of 7.2 years, new-onset AF developed in 19% of HCM patients with sarcomeric mutations. Compared with other sarcomeric genes, patients with likely pathogenic or pathogenic variation in
MYH7
had a higher rate of incident AF independent of clinical and echocardiographic factors.
Association Between 30-Day Mortality After Percutaneous Coronary Intervention and Education and Certification Variables for New York State Interventional Cardiologists
Authors: Khatana Sameed Ahmed M. , Fiorilli Paul N. , Nathan Ashwin S. , Kolansky Daniel M. , Mitra Nandita , Groeneveld Peter W. , Giri Jay 
Published: September 2018

Background:
Patients and other providers have access to few publicly available physician attributes that identify interventional cardiologists with better postprocedural outcomes, particularly in states without public reporting of outcomes. Interventional cardiology board certification, maintenance of certification, graduation from a US medical school, medical school ranking, and length of practice represent such publicly available attributes. Previous studies on these measures have shown mixed results.

Methods and Results:

We included interventional cardiologists practicing in New York State in the years 2011 to 2013. The primary outcome was 30-day risk-standardized mortality rate (RSMR) after percutaneous coronary intervention. Hierarchical regression modeling was used to analyze the physician attributes and was adjusted for provider caseload. A total of 356 providers were studied. The average 30-day RSMR was 1.1 (SD=0.1) deaths per 100 cases for all percutaneous coronary interventions and 0.7 (SD=0.1) deaths per 100 cases for nonemergent procedures. The primary outcome was slightly lower among providers with interventional cardiology board certification compared with noncertified providers (1.06 [SD=0.14] versus 1.14 [SD=0.14] deaths per 100 cases;
P
<0.001). In multivariable hierarchical regression modeling, after adjusting for provider caseload, none of the physician attributes were associated with the primary outcome. Provider caseload was significantly associated with 30-day RSMR independent of the other attributes.

Conclusions:
Interventional cardiology board-certified providers had a modestly lower 30-day RSMR before accounting for caseload. However, after adjusting for provider caseload, none of the examined publicly available physician attributes, including interventional cardiology board certification, were independently associated with 30-day RSMR.
One-Year Survival After ST-Segment–Elevation Myocardial Infarction in Relation With Prehospital Administration of Dual Antiplatelet Therapy
Authors: Danchin Nicolas , Puymirat Etienne , Cayla Guillaume , Cottin Yves , Coste Pierre , Gilard Martine , Goldstein Patrick , Braun François , Belle Loic , Montalescot Gilles , Ferrières Jean , Schiele François , Simon Tabassome ,   for the FAST-MI Investigators
Published: September 2018

Background
The optimal timing of administration of dual antiplatelet therapy (DAPT) in acute ST-segment–elevation myocardial infarction patients is debated. Clinical trials have failed to demonstrate the superiority of pretreatment with P2Y12 inhibitors in ST-segment–elevation myocardial infarction, but they were not designed to assess hard clinical end points. We used data from the FAST-MI (French Registry on Acute ST-Segment–Elevation or Non-ST-Segment–Elevation Myocardial Infarction) cohorts to determine 1-year survival and in-hospital outcomes in patients receiving DAPT, comparing prehospital versus in-hospital administration.

Methods and Results

The FAST-MI program collects extensive data on patients admitted in France for acute myocardial infarction over a 1-month period every 5 years since 2005. For the present analysis, 3548 patients with ST-segment–elevation myocardial infarction ≤12 hours from symptom onset, transported by physician-staffed emergency medical system ambulances, not treated with intravenous fibrinolysis, and receiving DAPT were included, of whom 44% received DAPT in the ambulance. The primary end point was 1-year survival as assessed by multivariate Cox analysis and propensity score analysis. In-hospital bleeding and ischemic complications were also analyzed. Adjusted in-hospital mortality was numerically but not significantly lower in patients with prehospital DAPT. There were no differences in in-hospital bleeding complications. Fully-adjusted hazard ratio for 1-year death in patients with prehospital versus in-hospital DAPT was 0.69 (95% CI, 0.51–0.92;
P
=0.011), and propensity score–adjusted hazard ratio was 0.55 (95% CI, 0.41–0.73;
P
=0.001) in the whole population. In the propensity score–matched cohorts (360 patients each), 1-year survival was 93.9% in patients with prehospital versus 90.3% in those with in-hospital DAPT (hazard ratio, 0.62; 95% CI, 0.36–1.05;
P
=0.077). Results were consistent in subgroups, including by year of survey, age, presence of out-of-hospital cardiac arrest, morphine use, and type of P2Y12 inhibitor used.

Conclusions
In these cohorts of ST-segment–elevation myocardial infarction patients considered for primary percutaneous coronary intervention, prehospital administration of DAPT was associated with higher 1-year survival and no increase in in-hospital bleeding complications. The magnitude of the decrease in 1-year mortality, however, may suggest the persistence of some degree of residual confounding.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifiers: NCT00673036, NCT01237418, and NCT02566200.
COMPASS-CP: An Electronic Application to Capture Patient-Reported Outcomes to Develop Actionable Stroke and Transient Ischemic Attack Care Plans
Authors: Duncan Pamela W. , Abbott Rica M. , Rushing Scott , Johnson Anna M. , Condon Christina N. , Lycan Sarah L. , Lutz Barbara J. , Cummings Doyle M. , Pastva Amy M. , D’Agostino Ralph B. , Stafford Jeanette M. , Amoroso Robert M. , Jones Sara B. , Psioda Matthew A. , Gesell Sabina B. , Rosamond Wayne D. , Prvu-Bettger Janet , Sissine Mysha E. , Boynton Mark D. , Bushnell Cheryl D. ,   for the COMPASS Investigative Team
Published: September 2018

Background
Patient-reported outcomes (PROs) are clinical tools that measure patients’ goals of care and assess patient-reported physical, mental, and social well-being. Despite their value in advancing patient-centered care, routine use of PROs in stroke management has lagged. As part of the pragmatic COMPASS (Comprehensive Post-Acute Stroke Services) trial, we developed COMPASS-Care Plan (CP), a clinician-facing application that captures and analyzes PROs for stroke and transient ischemic attack patients discharged home and immediately generates individualized electronic CP. In this report, we (1) present our methods for developing and implementing COMPASS-CP PROs, (2) provide examples of CP generated from COMPASS-CP, (3) describe key functional, social, and behavioral determinants of health captured by COMPASS-CP, and (4) report on clinician experience with using COMPASS-CP in routine clinical practice for care planning and engagement of stroke and transient ischemic attack patients discharged home.

Methods and Results
We report on the first 871 patients enrolled in 20 North Carolina hospitals randomized to the intervention arm of COMPASS between July 2016 and February 2018; these patients completed a COMPASS follow-up visit within 14 days of hospital discharge. We also report user satisfaction results from 56 clinicians who used COMPASS-CP during these visits. COMPASS-CP identified more cognitive and depression deficits than physical deficits. Within 14-day posthospitalization, less than half of patients could list the major risk factors for stroke, 36% did not recognize blood pressure as a stroke risk factor, and 19% of patients were nonadherent with prescribed medications. Three-fourths of clinicians reported that COMPASS-CP identifies important factors impacting patients’ recovery that they otherwise may have missed, and two-thirds were highly satisfied with COMPASS-CP.

Conclusions
The COMPASS-CP application meets an immediate need to incorporate PROs into the clinical workflow to develop patient-centered CP for stroke patients and has high user satisfaction.

Clinical Trial Registration

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02588664.
Psychological Distress and Risk of Myocardial Infarction and Stroke in the 45 and Up Study
Authors: Jackson Caroline A. , Sudlow Cathie L.M. , Mishra Gita D. 
Published: September 2018

Background
The interplay between mental and physical health remains poorly understood. We investigated whether psychological distress is associated with risk of myocardial infarction (MI) and stroke in a population-based prospective study.

Methods and Results
We included participants without prior stroke/MI from the New South Wales 45 and Up Study. We categorized baseline psychological distress as low, medium, and high/very high on the 10-item Kessler Psychological Distress scale and identified stroke and MI through linkage to hospital admission and mortality records. We obtained sex and age-stratified adjusted and unadjusted hazard ratios for the association between psychological distress and MI and stroke. We investigated for interaction between psychological distress and each of age and sex. Among 221 677 participants, 16.2% and 7.3% had moderate and high/very high psychological distress at recruitment, respectively. During 4.7 (±0.98 SD) years of follow-up, 4573 MIs and 2421 strokes occurred. Absolute risk of MI and stroke increased with increasing psychological distress level. In men aged 45 to 79 years, high/very high versus low psychological distress was associated with a 30% increased risk of MI (fully adjusted hazard ratios, 1.30; 95% CI, 1.12–1.51), with weaker estimates in those aged ≥80 years. Among women, high/very high psychological distress was associated with an 18% increased risk of MI (adjusted hazard ratio, 1.18; 95% CI, 0.99–1.42) with similar findings across age groups. In the age group of participants aged 45 to 79 years, high/very high psychological distress and male sex had a supra-additive effect on MI risk. Similar estimates were observed for stroke, with high/very high psychological distress associated with a 24% and 44% increased stroke risk in men and women, respectively, with no evidence of interaction with age or sex.

Conclusions
Psychological distress has a strong, dose-dependent, positive association with MI and stroke in men and women, despite adjustment for a wide range of confounders.
Predicting Length of Stay and the Need for Postacute Care After Acute Myocardial Infarction to Improve Healthcare Efficiency
Authors: Wasfy Jason H. , Kennedy Kevin F. , Masoudi Frederick A. , Ferris Timothy G. , Arnold Suzanne V. , Kini Vinay , Peterson Pamela , Curtis Jeptha P. , Amin Amit P. , Bradley Steven M. , French William J. , Messenger John , Ho P. Michael , Spertus John A. 
Published: September 2018

Background
To improve value in the care of patients with acute myocardial infarction (MI), payment models increasingly hold providers accountable for costs. As such, providers need tools to predict length of stay (LOS) during hospitalization and the likelihood of needing postacute care facilities after discharge for acute MI patients. We developed models to estimate risk for prolonged LOS and postacute care for acute MI patients at time of hospital admission to facilitate coordinated care planning.

Methods and Results
We identified patients in the National Cardiovascular Data Registry ACTION registry (Acute Coronary Treatment and Intervention Outcomes Network) who were discharged alive after hospitalization for acute MI between July 1, 2008 and March 31, 2017. Within a 70% random sample (Training cohort) we developed hierarchical, proportional odds models to predict LOS and hierarchical logistic regression models to predict discharge to postacute care. Models were validated in the remaining 30%. Of 633 737 patients in the Training cohort, 16.8% had a prolonged LOS (≥7 days) and 7.8% were discharged to a postacute facility (extended care, a transitional care unit, or rehabilitation). Model discrimination was moderate in the validation dataset for predicting LOS (C statistic=0.640) and strong for predicting discharge to postacute care (C statistic=0.827). For both models, discrimination was similar in ST-segment–elevation MI and non–ST-segment–elevation MI subgroups and calibration was excellent.

Conclusions
These models developed in a national registry can be used at the time of initial hospitalization to predict LOS and discharge to postacute facilities. Prospective testing of these models is needed to establish how they can improve care coordination and lower costs.
First Medical Contact-to-Device Time and Heart Failure Outcomes Among Patients Undergoing Primary Percutaneous Coronary Intervention
Authors: Loh Joshua P. , Tan Li-Ling , Zheng Huili , Lau Yee-How , Chan Siew-Pang , Tan Kelvin-Bryan , Chua Terrance , Tan Huay-Cheem , Foo David , Lee Chee-Wan , Tong Khim-Leng , Foo Ling-Li , Hausenloy Derek , Sahlen Anders , Yeo Khung-Keong , Fox Keith A.A. , Wang Tracy Y. , Richards A. Mark , Chan Mark Y. 
Published: September 2018

Background
Expediting reperfusion during primary percutaneous coronary intervention is aimed at salvaging myocardium in ST-segment–elevation myocardial infarction. Few studies have examined the relation between reperfusion time and heart failure (HF) events.

Methods and Results:

We studied 7597 patients undergoing primary percutaneous coronary intervention from 2007 to 2013 in the Singapore Myocardial Infarct Registry, which captures HF at admission, postadmission in-hospital HF, and HF rehospitalization. We studied the relation of first medical contact to deployment of first device to achieve reperfusion (FTD) time with in-hospital HF events and HF rehospitalization, with mortality modeled as a competing risk. At the population level, median FTD time decreased from 91 minutes (interquartile range, 69–114) in 2007 to 58 minutes (45–75) in 2013 (
P
=0.001), whereas mortality remained unchanged (in-hospital: range 5.3%–7.3%;
P
=0.190 and 1-year: range 7.8%–10.9%;
P
=0.505). HF at admission increased from 12.2% in 2007 to 18.4% in 2013,
P
=0.020, whereas postadmission in-hospital HF decreased from 12.8% in 2007 to 7.1% in 2013,
P
=0.030. HF rehospitalization increased from 1.2% in 2007 to 2.6% in 2013 (
P
=0.003), for 30-day HF rehospitalization, and 3.8% in 2007 to 5.6% in 2013 (
P
=0.037), for 1-year HF rehospitalization. At the individual level, among patients with HF at admission (N=1191), longer FTD time was associated with more 30-day HF rehospitalization (compared with ≤60 minutes, adjusted hazard ratio, 1.68 [0.73–3.86] for 60–90 minutes, 2.88 [1.19–6.92], for 90–120 minutes, and 2.84 [1.08–7.44] for >120 minutes). Longer FTD time was associated with a greater risk of postadmission in-hospital HF (compared with ≤60 minutes, adjusted hazard ratio, 1.18 [0.96–1.44] for 60–90 minutes, 1.59 [1.25–2.03] for 90–120 minutes, and 1.67 [1.26–2.21] for >120 minutes).

Conclusions:
Temporal reductions in FTD time were associated with decrease in postadmission in-hospital HF. Among patients presenting with HF at admission, delays in FTD beyond 90 minutes were associated with more 30-day HF rehospitalization.
Gender Disparities Among Adult Recipients of Bystander Cardiopulmonary Resuscitation in the Public
Authors: Blewer Audrey L. , McGovern Shaun K. , Schmicker Robert H. , May Susanne , Morrison Laurie J. , Aufderheide Tom P. , Daya Mohamud , Idris Ahamed H. , Callaway Clifton W. , Kudenchuk Peter J. , Vilke Gary M. , Abella Benjamin S. ,   Resuscitation Outcomes Consortium (ROC) Investigators
Published: September 2018

Background:
Bystander cardiopulmonary resuscitation (BCPR) improves survival from out-of-hospital cardiac arrest (OHCA), yet BCPR rates remain low. It is unknown whether BCPR delivery disparities exist based on victim gender. We measured BCPR rates by gender in private and public environments, hypothesizing that females would be less likely than males to receive BCPR in public settings, with an associated difference in survival to hospital discharge.

Methods and Results:

We analyzed data from adult, nontraumatic OHCA events within the Resuscitation Outcomes Consortium registry (2011–2015). Using logistic regression, we modeled the likelihood of receiving BCPR by gender, including patient-level variables, stratified by location. A cohort of 19 331 OHCAs was assessed. Mean age was 64±17 years, and 63% (12 225/19 331) were male. Overall, 37% of OHCA victims received bystander CPR. In public locations, 39% (272/694) of females and 45% (1170/2600) of males received BCPR (
P
<0.01), whereas in private settings, 35% (2198/6328) of females and 36% (3364/9449) of males received BCPR (
P
=NS). Among public OHCAs, males had significantly increased odds of receiving BCPR compared with females (odds ratio, 1.27; 95% CI, 1.05–1.53;
P
=0.01); this was not the case in the private setting (odds ratio, 0.93; 95% CI, 0.87–1.01;
P
=NS). Controlling for site, age, and race, BCPR was significantly associated with survival to hospital discharge (odds ratio, 1.69; 95% CI, 1.54–1.85;
P
<0.01); in this model, males had 29% increased odds of survival compared with females (odds ratio, 1.29; 95% CI, 1.17–1.42;
P
<0.01).

Conclusions:
Males had an increased likelihood of receiving BCPR compared with females in public. BCPR improved survival to discharge, with greater survival among males compared with females.