Abstract:
BACKGROUND:Prior studies of the impact of psychiatric comorbidity on outcomes after acute myocardial infarction (AMI) have frequently relied on inpatient secondary diagnosis codes. This study compared associations between psychiatric comorbidity and AMI outcomes that were derived using secondary diagnosis codes and codes captured from prior outpatient encounters. METHODS AND RESULTS:Retrospective cohort study analyzing 21 745 patients admitted in 2004 to 2006 to Veterans Health Administration hospitals with AMI using administrative data. Psychiatric comorbidity was identified using (1) secondary inpatient diagnosis codes from the index hospitalization and (2) diagnoses from prior outpatient encounters. Outcomes included 30- and 365-day mortality and the receipt of coronary revascularization within 30 days of admission. Generalized estimating equations and Cox proportional hazards were used to adjust mortality and receipt of revascularization for demographic and clinical variables. Psychiatric disorders were identified in 2285 (10%) patients from inpatient secondary diagnosis codes and 5225 (24%) patients from prior outpatient codes. Patients with psychiatric comorbidity had higher adjusted 30- and 365-day mortality, based on outpatient codes (odds ratios, 1.19 [95% CI, 1.09 to 1.30] and 1.12 [95% CI, 1.03 to 1.22], respectively), but similar mortality based on inpatient codes (odds ratios, 0.89 [95% CI, 0.69 to 1.01] and 0.93 [95% CI, 0.82 to 1.06], respectively). In contrast, patients with psychiatric comorbidity had lower receipt of coronary revascularization based on outpatient codes (hazard ratio, 0.92; [95% CI, 0.85 to 0.99], but similar receipt based on inpatient codes (hazard ratio, 1.00 [95% CI, 0.91 to 1.10]). CONCLUSIONS:Inpatient secondary diagnosis codes identified fewer patients with psychiatric comorbidity than prior outpatient codes. Moreover, associations with AMI outcomes differed for the 2 approaches. These findings raise potential concerns about the validity and reliability of psychiatric inpatient secondary diagnosis in estimating the impact of psychiatric comorbidities on AMI outcomes and in developing risk-adjustment models.
journal_name
Circ Cardiovasc Qual Outcomesjournal_title
Circulation. Cardiovascular quality and outcomesauthors
Abrams TE,Vaughan-Sarrazin M,Rosenthal GEdoi
10.1161/CIRCOUTCOMES.108.829143subject
Has Abstractpub_date
2009-05-01 00:00:00pages
213-20issue
3eissn
1941-7713issn
1941-7705pii
CIRCOUTCOMES.108.829143journal_volume
2pub_type
杂志文章abstract:BACKGROUND:Stress testing after percutaneous coronary intervention (PCI) in fee-for-service settings is common and rates vary by hospital. Rates of stress testing after PCI within integrated healthcare systems, such as the Veterans Affairs (VA) are unknown. METHODS AND RESULTS:We evaluated all VA patients who underwen...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCOUTCOMES.114.001561
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:Improving health-related quality of life (HRQoL) is an important treatment goal in the management of patients with atrial fibrillation (AF). Uncertainty exists as to whether patients' HRQoL differ when treated with medical rhythm control or rate control. We compared HRQoL between patients treated with rhythm...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1161/HCQ.0000000000000011
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:We sought to determine inter-rater reliability of the 2009 Appropriate Use Criteria for radionuclide imaging and whether physicians at various levels of training can effectively identify nuclear stress tests with inappropriate indications. METHODS AND RESULTS:Four hundred patients were randomly selected fro...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.114.001067
更新日期:2015-01-01 00:00:00
abstract:BACKGROUND:The number of women veterans is increasing, yet little is known about their cardiovascular risk factors, coronary anatomy, cardiac treatments, and outcomes after cardiac catheterization. Prior studies have shown that nonveteran women have more risk factors, receive less aggressive treatment, and have worse o...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.114.001613
更新日期:2015-03-01 00:00:00
abstract:BACKGROUND:Although home blood pressure (BP) monitoring interventions have shown potential in selected populations, it is unclear whether such strategies can be generalized. We sought to determine whether a multifaceted BP control program that uses a web-based health portal (Heart360), community health coaches, and phy...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCOUTCOMES.114.001039
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:Whether measuring and reporting of coronary artery calcium scores (CACS) might lead to changes in cardiovascular risk management is not established. In this observational study, we examined whether high baseline CACS were associated with the initiation as well continuation of new lipid-lowering medication (L...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.109.893396
更新日期:2010-05-01 00:00:00
abstract:BACKGROUND:Women have an increased risk of rehospitalization in the immediate postdischarge period; however, few studies have determined how readmission risk dynamically changes on a day-to-day basis over the full year after hospitalization by sex and how these differences compare with the risk for mortality. METHODS ...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCOUTCOMES.116.003271
更新日期:2017-05-01 00:00:00
abstract:BACKGROUND:The impact of polyvascular disease (peripheral arterial disease [PAD] and cerebrovascular disease [CVD]) on long-term cardiovascular outcomes among older patients with acute myocardial infarction has not been well studied. METHODS AND RESULTS:Patients with non-ST-segment-elevation myocardial infarction aged...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.111.964379
更新日期:2012-07-01 00:00:00
abstract::Despite decades of improvement in the quality and outcomes of cardiovascular care, significant gaps remain. Existing quality improvement strategies are often limited in scope to specific clinical conditions and episodic care. Health services and outcomes research is essential to inform gaps in care but rarely results ...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.120.006753
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:Patients with diabetes mellitus (DM) are at high risk for mortality after myocardial infarction (MI). Despite an overall trend of reduced mortality after MI, the mortality gap between MI patients with and without DM did not decrease over time in previous analyses. We assessed recent trends in hospital mortal...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.112.965491
更新日期:2012-11-01 00:00:00
abstract:BACKGROUND:High body mass index (BMI) increases the probability of indeterminate findings on diagnostic studies, length of stay, and cost of care for hospitalized patients. No study has examined the economic and operational impact of BMI in patients with chest complaints presenting to the emergency department (ED). The...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCOUTCOMES.113.000702
更新日期:2014-03-01 00:00:00
abstract:BACKGROUND:Balloon pulmonary angioplasty (BPA) is an alternative therapy for patients with chronic thromboembolic pulmonary hypertension who are ineligible for pulmonary endarterectomy-the standard therapy. Currently, most reported results of BPA are from relatively small cohorts treated at single centers. The present ...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCOUTCOMES.117.004029
更新日期:2017-11-01 00:00:00
abstract::Background Data about anticoagulation in pulmonary arterial hypertension (PAH) patients are inconsistent. The objective of this study was to examine the impact of adjunctive oral anticoagulants in patients with PAH through meta-analysis, and to further assess whether response differs by PAH subtype. Methods and Result...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,meta分析
doi:10.1161/CIRCOUTCOMES.118.004757
更新日期:2018-09-01 00:00:00
abstract:BACKGROUND:The burden of cardiovascular disease as a chronic illness increasingly requires patients to assume more responsibility for their self-management. Patient education is believed to be an essential component of cardiovascular care; however, there is limited evidence about specific therapeutic patient education ...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,评审
doi:10.1161/HCQ.0000000000000025
更新日期:2017-06-01 00:00:00
abstract:BACKGROUND:Recent studies have demonstrated an association between moderate kidney dysfunction and sudden cardiac death in people with cardiovascular disease. METHODS AND RESULTS:The study was a longitudinal analysis among 4465 participants from the Cardiovascular Health Study without prevalent cardiovascular disease ...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCOUTCOMES.109.875369
更新日期:2010-03-01 00:00:00
abstract:BACKGROUND:Bystander cardiopulmonary resuscitation (CPR) is an important determinant of survival from out-of-hospital cardiac arrest (OHCA), yet rates of bystander CPR are highly variable. In an effort to promote bystander CPR, the procedure has been streamlined, and ultrashort teaching modalities have been introduced....
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.117.004035
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:Clinical prediction models (CPMs) estimate the probability of clinical outcomes and hold the potential to improve decision making and individualize care. For patients with cardiovascular disease, there are numerous CPMs available although the extent of this literature is not well described. METHODS AND RESU...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,评审
doi:10.1161/CIRCOUTCOMES.115.001693
更新日期:2015-07-01 00:00:00
abstract:BACKGROUND:Temporal trends in stroke incidence are unclear. We aimed to examine age- and sex-specific temporal trends in incidence of fatal and nonfatal hospitalized stroke in Scotland from 1986 to 2005. METHODS AND RESULTS:Mean age at the time of first stroke was 70.8 (SD, 12.9) years in men and 76.4 (12.9) years in ...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.108.825968
更新日期:2009-09-01 00:00:00
abstract:BACKGROUND:Some patients with severe symptomatic aortic stenosis (AS) do not undergo aortic valve replacement (AVR) despite demonstrated symptomatic and survival advantages and despite unequivocal guideline recommendations for surgical evaluation. METHODS AND RESULTS:In 3 large tertiary care institutions (university, ...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCOUTCOMES.109.848259
更新日期:2009-11-01 00:00:00
abstract:BACKGROUND:Many hospitalized medically ill patients are at risk of venous thromboembolism (VTE). Risk factors include prior VTE, older age, immobility, obesity, cardiac or respiratory failure, and cancer (at-risk patients). Although guidelines recommend use of VTE prophylaxis for at-risk patients, many may not receive ...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCOUTCOMES.112.965939
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:In patients presenting with ST-segment-elevation myocardial infarction, percutaneous coronary intervention (PCI) reduces mortality when compared with fibrinolysis. In other forms of coronary artery disease (CAD), however, it has been controversial whether PCI reduces mortality. In this meta-analysis, we exam...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,meta分析
doi:10.1161/CIRCOUTCOMES.119.006363
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:Geriatric conditions may influence outcomes among patients receiving implantable cardioverter-defibrillators (ICDs). We sought to determine the prevalence of frailty and dementia among older adults receiving primary prevention ICDs and to determine the impact of multimorbidity on mortality within 1 year of I...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.115.002053
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:Long-term exposure to particulate matter <2.5 µm in diameter (PM2.5) and ozone has been associated with the development and progression of cardiovascular disease and, in the case of PM2.5, higher cardiovascular mortality. Whether exposure to PM2.5 and ozone is associated with patients' health status and qual...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCOUTCOMES.119.005598
更新日期:2019-04-01 00:00:00
abstract:BACKGROUND:Despite effective treatments to reduce cardiovascular disease risk, their translation into practice is limited. METHODS AND RESULTS:Using a parallel arm cluster-randomized controlled trial in 60 Australian primary healthcare centers, we tested whether a multifaceted quality improvement intervention comprisi...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1161/CIRCOUTCOMES.114.001235
更新日期:2015-01-01 00:00:00
abstract:BACKGROUND:Vitamin K antagonists (VKA) use is challenging because of frequent blood monitoring and complex dosing. Therefore, many patients and physicians are reluctant to start VKA. However, it is unclear whether VKA use actually lowers quality of life. We aimed to determine the impact of VKA initiation on quality of ...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.115.002612
更新日期:2016-07-01 00:00:00
abstract:BACKGROUND:Little is known regarding the adoption of direct thrombin inhibitors in clinical practice. We examine trends in oral anticoagulation for the prevention of thromboembolism in the United States. METHODS AND RESULTS:We used the IMS Health National Disease and Therapeutic Index, a nationally representative audi...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.112.967299
更新日期:2012-09-01 00:00:00
abstract:BACKGROUND:The necessity for rapid evaluation and treatment of acute ischemic stroke with intravenous tPA (tissue-type plasminogen activator) may increase the risk of administrating tPA to patients presenting with noncerebrovascular conditions that closely resemble stroke (stroke mimics). However, there are limited dat...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.119.005609
更新日期:2019-08-01 00:00:00
abstract::Background Since the direct oral anticoagulants (DOAC) were introduced, oral anticoagulant (OAC) prescription patterns have rapidly changed in patients with atrial fibrillation (AF). We aimed to evaluate the evolving trends of OAC use in a large nationwide cohort and specifically examine the changes in patient profile...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.119.005894
更新日期:2020-03-01 00:00:00
abstract:BACKGROUND:In 2009, the Centers for Medicare & Medicaid Services is publicly reporting hospital-level risk-standardized 30-day mortality and readmission rates after acute myocardial infarction (AMI) and heart failure (HF). We provide patterns of hospital performance, based on these measures. METHODS AND RESULTS:We cal...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.109.883256
更新日期:2009-09-01 00:00:00
abstract:BACKGROUND:Heart failure guidelines recommend routine monitoring of serum potassium, and renal function in patients treated with a mineralocorticoid receptor antagonist (MRA). How these recommendations are implemented in high-risk patients or according to setting of drug initiation is poorly characterized. METHODS AND...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.116.002946
更新日期:2017-01-01 00:00:00