Harmonized outcome measures for use in atrial fibrillation patient registries and clinical practice: Endorsed by the Heart Rhythm Society Board of Trustees.
Humans; Risk Factors; United States/epidemiology; Survival Rate/trends; Cardiology; Morbidity/trends; Risk Assessment/methods; Atrial fibrillation; Common data element; Data standard; Harmonization; Outcome measure; Patient outcome; Patient registry; Registries; Societies Medical; Atrial Fibrillation/complications/epidemiology; Outcome Assessment Health Care/methods; Stroke/epidemiology/etiology
BACKGROUND: Atrial fibrillation (AF) affects an estimated 33 million people worldwide, leading to increased mortality and an increased risk of heart failure and stroke. Many AF patient registries exist, but the ability to link and compare data across registries is hindered by differences in the outcome measures collected by each registry and a lack of harmonization. OBJECTIVES: The purpose of this project was to develop a minimum set of standardized outcome measures that could be collected in AF patient registries and clinical practice. METHODS: AF patient registries were identified through multiple sources and invited to join the workgroup and submit outcome measures. Additional measures were identified through literature searches and reviews of consensus statements. Outcome measures were categorized using the Agency for Healthcare Research and Quality's supported Outcome Measures Framework (OMF). A minimum set of broadly relevant measures was identified. Measure definitions were harmonized through in-person and virtual meetings. RESULTS: One hundred twelve outcome measures, including those from thirteen registries, were curated according to the OMF and then harmonized into a minimum set of measures in the OMF categories of survival (3 measures), clinical response (3 measures), events of interest (9 measures), patient-reported outcomes (2 measures), and resource utilization (3 measures). The harmonized definitions build on existing consensus statements. CONCLUSIONS: The harmonized measures represent a minimum set of outcomes that are relevant in AF research and clinical practice. Routine and consistent collection of these measures in registries and in other systems would support creation of a research infrastructure to efficiently address new questions and improve patient outcomes.
Calkins H; Gliklich RE; Leavy MB; Piccini JP; Hsu JC; Mohanty S; Lewis W; Nazarian S; Turakhia MP
Heart Rhythm
2019
2019-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.hrthm.2018.09.021" target="_blank" rel="noreferrer noopener">10.1016/j.hrthm.2018.09.021</a>
Effect of influenza on outcomes in patients with heart failure.
Female; Humans; Male; Aged; Retrospective Studies; Risk Factors; United States/epidemiology; Incidence; Follow-Up Studies; heart failure; hospitalization; Hospitalization/trends; vaccination; influenza; Survival Rate/trends; Risk Assessment/methods; Inpatients; Morbidity/trends; Hospital Mortality/trends; Propensity Score; Heart Failure/complications/epidemiology; Influenza Human/complications/epidemiology/prevention & control; Vaccination/methods
OBJECTIVES: This study sought to determine whether influenza infection increases morbidity and mortality in patients hospitalized with heart failure (HF). BACKGROUND: Patients with HF may be at increased risk of morbidity and mortality from influenza infection. However, there are limited data for the associated hazards of influenza infection in patients with HF. METHODS: We queried the 2013 to 2014 National Inpatient Sample database for all adult patients (18 years of age or older) admitted with HF with and without concomitant influenza infection. Propensity score matching was used to match patients across age, race, sex, and comorbidities. Outcomes included in-hospital mortality, in-hospital complications, length of stay, and average hospital costs. RESULTS: Of 8,189,119 all-cause hospitalizations in patients with HF, 54,590 (0.67%) had concomitant influenza infection. Patients with concomitant influenza had higher incidence of in-hospital mortality (6.2% vs. 5.4%, respectively; odds ratio [OR]: 1.15 [95% confidence interval [CI]: 1.03 to 1.30]; p = 0.02), acute respiratory failure (36.9% vs. 23.1%, respectively; OR: 1.95 [95% CI: 1.83 to 2.07]; p < 0.001), acute respiratory failure requiring mechanical ventilation (18.2% vs. 11.3%, respectively; OR: 1.75 [95% CI: 1.62 to 1.89]; p < 0.001), acute kidney injury (AKI) (30.3% vs. 28.7%, respectively; OR: 1.08 [95% CI: 1.02 to 1.15]; p = 0.01), and AKI requiring dialysis (2.4% vs. 1.8%, respectively; OR: 1.37 [95% CI: 1.14 to 1.65]; p = 0.001). Patients with influenza had longer mean lengths of stay (5.9 days vs. 5.2 days, respectively; p <0.001) but similar average hospital costs ($12,137 vs. $12,003, respectively; p = 0.40). CONCLUSIONS: Influenza infection is associated with increased in-hospital morbidity and mortality in patients with HF. Our results emphasize the need for efforts to mitigate the incidence of influenza, specifically in this high-risk patient cohort.
Panhwar MS; Kalra A; Gupta T; Kolte D; Khera S; Bhatt DL; Ginwalla M
Journal of the American College of Cardiology. Heart failure
2019
2019-02
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1016/j.jchf.2018.10.011" target="_blank" rel="noreferrer noopener">10.1016/j.jchf.2018.10.011</a>
PMID: 30611718
Cardiac computed tomographic angiography and the primary care physician.
Adult; Female; Humans; Male; Middle Aged; Aged; Risk Assessment/methods; Primary Health Care/*methods; Chest Pain/diagnosis/etiology; Coronary Artery Disease/*diagnosis/pathology; Coronary Vessels/*pathology; Stroke Volume; Tomography; *Physicians; Ventricular Function; Left; Primary Care; X-Ray Computed/*instrumentation
Through advancements in computer processing speed and storage capacity, new cardiac imaging modalities have become clinically feasible and useful. Cardiac computed tomographic angiography, a new diagnostic imaging modality, is capable of assessing coronary artery disease and left ventricular function on a par with invasive coronary arteriography in selected patients who meet appropriate use criteria. This imaging modality is of clinical value in the assessment of patients with chest pain who have an intermediate risk of coronary atherosclerosis. The purpose of the present report is to educate primary care physicians about the basic principles of advanced cardiac imaging techniques and to convey a useful strategy for their appropriate use in the current environment of medical economics.
Mikolich J Ronald
The Journal of the American Osteopathic Association
2012
2012-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Predictors of mortality for nursing home-acquired pneumonia: a systematic review.
80 and over; Aged; Bacterial/*diagnosis/*mortality/therapy; Biological Markers – Therapeutic Use; CINAHL Database; Cross Infection/*diagnosis/*mortality/therapy; Embase; Female; Homes for the Aged/statistics & numerical data; Human; Humans; Incidence; Male; Medline; Meta Analysis; Mortality – Risk Factors; Nursing Care/*statistics & numerical data; Nursing Home Patients; Nursing Homes/*statistics & numerical data; Pneumonia; Pneumonia – Risk Factors; Prognosis; Risk Assessment/methods; Severity of Illness Index; Survival Analysis; Systematic Review; Treatment Outcome
BACKGROUND: Current risk stratification tools, primarily used for CAP, are suboptimal in predicting nursing home acquired pneumonia (NHAP) outcome and mortality. We conducted a systematic review to evaluate current evidence on the usefulness of proposed predictors of NHAP mortality. METHODS: PubMed (MEDLINE), EMBASE, and CINAHL databases were searched for articles published in English between January 1978 and January 2014. The literature search elicited a total of 666 references; 580 were excluded and 20 articles met the inclusion criteria for the final analysis. RESULTS: More studies supported the Pneumonia Severity Index (PSI) as a superior predictor of NHAP severity. Fewer studies suggested CURB-65 and SOAR (especially for the need of ICU care) as useful predictors for NHAP mortality. There is weak evidence for biomarkers like C-reactive protein and copeptin as prognostic tools. CONCLUSION: The evidence supports the use of PSI as the best available indicator while CURB-65 may be an alternative prognostic indicator for NHAP mortality. Overall, due to the paucity of information, biomarkers may not be as effective in this role. Larger prospective studies are needed to establish the most effective predictor(s) or combination scheme to help clinicians in decision-making related to NHAP mortality.
Dhawan Naveen; Pandya Naushira; Khalili Michael; Bautista Manuel; Duggal Anurag; Bahl Jaya; Gupta Vineet
BioMed research international
2015
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1155/2015/285983" target="_blank" rel="noreferrer noopener">10.1155/2015/285983</a>