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 it. METHODS AND RESULTS:Using a database linking admission records from >150 US hospitals to health insurance claims, we identified people ≥40 years of age, hospitalized from 2003 to 2008. We excluded patients who: (1) were treated for VTE or hospitalized in the previous 30 days; (2) were admitted for traumatic injury or surgery; (3) had hypercoagulability at admission; or (4) received therapeutic dosages of low-molecular weight heparin, unfractionated heparin, or fondaparinux at admission. We examined the use of VTE prophylaxis (both pharmacological and nonpharmacological) on day 1 or 2 in hospital among at-risk patients; predictors of receipt of prophylaxis were examined using multivariate logistic regression. The study population consisted of 49 948 patients, of whom 34 374 (69%) were at risk. Only 18% of at-risk patients received VTE prophylaxis on day 1 or 2 in hospital, typically with low-molecular weight heparin (56% of patients receiving prophylaxis), intermittent pneumatic compression (25%), warfarin (16%), or graduated compression stockings (11%). Use of prophylaxis exceeded 25% only in patients admitted from nursing homes and those with prior VTE. Although there were several significant predictors of receipt of VTE prophylaxis, model discrimination was relatively poor (C-statistic=0.61). CONCLUSION:The majority of at-risk hospitalized medically ill patients do not receive VTE prophylaxis.
journal_name
Circ Cardiovasc Qual Outcomesjournal_title
Circulation. Cardiovascular quality and outcomesauthors
Pendergraft T,Liu X,Edelsberg J,Phatak H,Vera-Llonch M,Liu LZ,Oster Gdoi
10.1161/CIRCOUTCOMES.112.965939subject
Has Abstractpub_date
2013-01-01 00:00:00pages
75-82issue
1eissn
1941-7713issn
1941-7705pii
CIRCOUTCOMES.112.965939journal_volume
6pub_type
杂志文章,多中心研究abstract:BACKGROUND:Patients on dialysis who have an acute myocardial infarction (AMI) have an exceedingly poor prognosis, but it is unknown to what extent guideline-recommended interventions and treatments are used and to which benefit. We aimed to assess temporal changes in the use of treatments and survival rates in dialysis...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.119.005879
更新日期:2019-09-01 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:Radial artery access for coronary angiography and interventions has been promoted for reducing hemostasis time and vascular complications compared with femoral access, yet it can take longer to perform and is not always successful, leading to concerns about its cost. We report a cost-benefit analysis of radi...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,meta分析,评审
doi:10.1161/CIRCOUTCOMES.112.965269
更新日期:2012-07-01 00:00:00
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: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:Nearly half of Americans with diagnosed hypertension have uncontrolled blood pressure (BP) while some integrated healthcare systems, such as Kaiser Permanente Northern California, have achieved control rates upwards 90%. METHODS AND RESULTS:We adapted Kaiser Permanente's evidence-based treatment protocols i...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCOUTCOMES.117.004386
更新日期:2018-07-01 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:Angina in patients with coronary artery disease is associated with worse quality of life; however, the relationship between angina frequency and resource utilization is unknown. METHODS AND RESULTS:Using data from the MERLIN-TIMI 36 trial, we assessed the association between the extent of angina after an ac...
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.108.829523
更新日期:2009-07-01 00:00:00
abstract::Infants with complex congenital heart disease are at high risk for poor neurodevelopmental outcomes. However, implementation of dedicated congenital heart disease follow-up programs presents important infrastructure, personnel, and resource challenges. We present the development, implementation, and retrospective revi...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.116.002614
更新日期:2016-07-01 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:Propensity-score matching is frequently used in the cardiology literature. Recent systematic reviews have found that this method is, in general, poorly implemented in the medical literature. The study objective was to examine the quality of the implementation of propensity-score matching in the general cardi...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,评审
doi:10.1161/CIRCOUTCOMES.108.790634
更新日期:2008-09-01 00:00:00
abstract:BACKGROUND:Translation of evidence-based heart failure (HF) therapies to clinical practice is incomplete and may vary internationally. We examined common measures of quality of care in patients enrolled in the international Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure trial. METHO...
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.113.000119
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Percent time in therapeutic range (TTR) and international normalized ratio (INR) variability both measure warfarin control and are associated with outcomes independently. Here, we examine the advantages of a warfarin composite measure (WCM), which summarizes the 2 when measuring patient outcomes. We also exa...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.115.001789
更新日期:2015-11-01 00:00:00
abstract:BACKGROUND:Most studies evaluating neurocognitive outcomes in children with congenital heart defects (CHD) have focused on high-risk patients or used specialized, resource-intensive testing. To determine the association of CHD with academic outcomes and compare outcomes according to the severity of CHD, we linked state...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.116.003074
更新日期:2017-02-01 00:00:00
abstract::BACKGROUND- Although older patients frequently undergo percutaneous coronary interventions (PCI), frailty, comorbidity, and quality of life are seldom part of risk prediction approaches. We assessed their incremental prognostic value over and above the risk factors in the Mayo Clinic risk score. METHODS AND RESULTS- P...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.111.961375
更新日期:2011-09-01 00:00:00
abstract:BACKGROUND:Early readmissions among older adults hospitalized for acute myocardial infarction (AMI) are costly and difficult to predict. Aging-related functional impairments may inform risk prediction but are unavailable in most studies. Our objective was to, therefore, develop and validate an AMI readmission risk mode...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCOUTCOMES.118.005320
更新日期:2019-05-01 00:00:00
abstract:BACKGROUND:Data collected as part of routine clinical practice could be used to detect cardiovascular outcomes in pragmatic clinical trials or clinical registry studies. The reliability of claims data for documenting outcomes is unknown. METHODS AND RESULTS:We linked records of Women's Health Initiative (WHI) particip...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.113.000373
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:As part of state-mandated public reporting of outcomes after percutaneous coronary interventions (PCIs) in Massachusetts, procedural and clinical data were prospectively collected. Variables associated with higher mortality were audited to ensure accuracy of coding. We examined the impact of adjudication on ...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.110.957597
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:Cardiac rehabilitation (CR) is recommended in clinical practice guidelines, but dose prescribed varies highly by country. This study characterized the dose offered in supervised CR programs and alternative models worldwide and their potential correlates. METHODS AND RESULTS:In this cross-sectional study, an...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.119.005453
更新日期:2020-01-01 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:Despite improvements in prognosis following myocardial infarction (MI), racial disparities persist. The objective of this study was to examine disparities between Black and White adults in cardiovascular disease (CVD), coronary heart disease, stroke, heart failure (HF), and mortality after MI and characteris...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.120.006683
更新日期:2020-12-01 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 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:Cardiovascular prevention guidelines use estimated 10-year atherosclerotic cardiovascular disease (CVD) risk based on the pooled cohort equations to guide treatment decisions and engage patients in shared decision-making. We sought to determine patient perceived versus actual risk of atherosclerotic CVD and ...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.120.006548
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:The absolute risk reduction (ARR) in cardiovascular events from therapy is generally assumed to be proportional to baseline risk-such that high-risk patients benefit most. Yet newer analyses have proposed using randomized trial data to develop models that estimate individual treatment effects. We tested 2 hy...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.118.005010
更新日期:2019-03-01 00:00:00
abstract:BACKGROUND:Cardiac perforation is a feared complication of implantable cardioverter-defibrillator (ICD) lead implantation because of the potential for significant morbidity and mortality. Predictors of perforation and the severity of associated adverse events have not been well studied. We sought to identify predictors...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.113.000299
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Left ventricular assist device (LVAD) therapy is an increasingly viable alternative for patients who are not candidates for heart transplantation or who are waiting for a suitable donor. We aimed to determine whether there is an association between sex, race/ethnicity, insurance coverage, and neighborhood in...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.119.006284
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:The association of psychological variables with cardiovascular health might depend on socioeconomic status. We examined the moderating effect of occupational grade on the association between depression and incident cardiac events among middle-aged workers from the GAZEL cohort. METHODS AND RESULTS:A total o...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.116.002767
更新日期:2017-02-01 00:00:00
abstract:BACKGROUND:Nonelective procedure status is the greatest risk factor for postoperative morbidity and mortality in patients undergoing thoracic aortic operations. We hypothesized that uninsured patients were more likely to require nonelective thoracic aortic operation due to decreased access to preventative care and elec...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.113.000593
更新日期:2014-05-01 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