Abstract:
BACKGROUND:Multidisciplinary disease management programs (MDMP) have demonstrated reduced hospitalizations in motivated pretransplant heart failure populations, but little is known about their effectiveness in largely indigent patients who are not transplant candidates. METHODS AND RESULTS:We studied 35 patients with heart failure with left ventricular ejection fraction (EF) =45% enrolled in an MDMP who were either indigent or funded by Medicaid/Medicare. This nonrandomized sample consisted of 14 patients identified because they had hospital readmission rates of >/=2 per year (group A) and 21 patients referred by their primary care physicians because they were difficult to manage (group B). Group A patients were New York Heart Association (NYHA) class III or IV, aged 25 to 87 years (mean 57 +/- 17 SD) and had an EF of 15% to 45% (29% +/- 11%). Group B patients were NYHA class II or III, aged 35 to 86 (57 +/- 16) years and had an EF of 20% to 45% (28% +/- 10%). Data were compared for the year before enrollment in the MDMP and the year afterward. In group A hospital admissions decreased from 33 to 3, a 91% reduction, and NYHA class improved to class II-III (P <.001). In group B hospital admissions decreased from 9 to 0, and NYHA class improved to class I-II (P <.001). When hospital and clinic charges were assessed for both groups, the net savings were $162,000 per year or $4600 per patient. CONCLUSIONS:A multidisciplinary heart failure program can improve functional status and reduce hospitalization and net costs compared with conventional care in indigent non-transplant candidate patients.
journal_name
Am Heart Jjournal_title
American heart journalauthors
O'Connell AM,Crawford MH,Abrams Jdoi
10.1067/mhj.2001.111956subject
Has Abstractpub_date
2001-02-01 00:00:00pages
254-8issue
2eissn
0002-8703issn
1097-6744pii
S0002-8703(01)20484-0journal_volume
141pub_type
杂志文章abstract:BACKGROUND:Circulating mediators, including thromboxane A2, the vasoconstrictor, platelet aggregant, and smooth muscle mitogen, may contribute to the progression of vascular narrowing in primary pulmonary hypertension (PPH). METHODS:To further understand the contribution of thromboxane and to provide novel therapy for...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1067/mhj.2002.121806
更新日期:2002-05-01 00:00:00
abstract::Electrolyte balance has been regarded as a factor important to cardiovascular stability, particularly in congestive heart failure. Among the common electrolytes, the significance of magnesium has been debated because of difficulty in accurate measurement and other associated factors, including other electrolyte abnorm...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/s0002-8703(96)90253-7
更新日期:1996-09-01 00:00:00
abstract:BACKGROUND:Peroxisome proliferator-activated receptors (PPARs) regulate transcription of genes involved in glucose uptake, lipid metabolism, and inflammation. Aleglitazar is a potent dual PPAR agonist with insulin-sensitizing and glucose-lowering actions and favorable effects on lipid profiles and biomarkers of cardiov...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2013.05.013
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Patients with heart failure (HF) frequently have comorbidities. Frequency, prognostic, and therapeutic implications of chronic obstructive pulmonary disease (COPD) in HF are largely unknown. We aimed to assess the prevalence and prognostic implications of COPD in a sample of stable patients with HF and to de...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2007.10.040
更新日期:2008-03-01 00:00:00
abstract::To determine whether mitral valve annulus displacement (MVAD) can be used to assess septal contractility in patients with paradoxical septal motion, we assessed four atrioventricular regions (septum, lateral wall, anterior wall, and inferior wall) by MVAD in 80 consecutive patients. The patients were divided into five...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(96)90062-9
更新日期:1996-01-01 00:00:00
abstract::Right- and left-sided endocarditis are two distinct entities, both clinically and experimentally. As such, they require different clinical approaches. The accurate diagnosis of right-sided endocarditis rests largely on a high index of suspicion which is often raised in the case of an intravenous drug abuser with fever...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(86)90564-8
更新日期:1986-01-01 00:00:00
abstract::We analyzed the long-term outcome of 198 patients after unsuccessful percutaneous transluminal coronary angioplasty. Forty-nine percent underwent emergency coronary artery bypass grafting surgery, 17% had elective bypass surgery, and 34% were treated medically. The in-hospital mortality rate was 4%, and myocardial inf...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(05)80313-8
更新日期:1990-04-01 00:00:00
abstract::A case with total intra-His bundle block and intermittent pre-excitation syndrome is presented. During A-V conduction there was a P-delta interval of 130 msec. with a P-A interval of 20 msec., an A-H interval of 60 msec. and an H-V interval of 50 msec. During rapid atrial pacing the P-delta interval increased primaril...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(77)80350-5
更新日期:1977-07-01 00:00:00
abstract::It is often difficult to make the clinical distinction between acute mitral regurgitation caused by papillary muscle dysfunction or rupture and ventricular septal defect complicating an acute myocardial infarction. A case of a patient with rapidly progressive congestive heart failure and a loud murmur is presented. Ec...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(79)90291-6
更新日期:1979-11-01 00:00:00
abstract::Intracoronary stents may potentially alleviate some of the problems associated with coronary angioplasty. Since the anatomy and physiology of swine coronary arteries closely resemble those of humans, the response to implantation of the Glanturco-Roubin, balloon-expandable, flexible stent was studied in this model. Add...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(91)90506-d
更新日期:1991-09-01 00:00:00
abstract:BACKGROUND:Carvedilol therapy during congestive heart failure demonstrated a good efficacy in mortality rate reduction and in improvement of left ventricular (LV) systolic performance. However, currently there is not any finding about the drug's effect on diastolic filling. The aim of this study was to evaluate the eff...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0002-8703(03)00525-8
更新日期:2004-01-01 00:00:00
abstract::A population of 2955 patients admitted to the hospital with acute myocardial infarction (AMI) was followed for 1 year after AMI or until death. Smokers as compared to nonsmokers were over 10 years younger (p less than 0.001) and had a lower prevalence of hypertension (p less than 0.01), congestive heart failure (p les...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(85)90071-7
更新日期:1985-09-01 00:00:00
abstract::Potential antiarrhythmic effects of calcium (slow-channel)-blocking drugs ca be indirect or direct. The indirect effect would affect ischemia-induced arrhythmias by improving myocardial perfusion or decreasing myocardial oxygen consumption. The direct effect would affect the electrical activity of the sinoatrial (SA) ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(82)90476-8
更新日期:1982-04-01 00:00:00
abstract::Current evidence suggests that the pathogenesis of atrial fibrillation (AF) is multifactorial. The observation that AF, once present, alters the electrophysiologic properties of the atrial myocardium causing self-perpetuation of the arrhythmia raised the importance of electrical remodeling in its pathogenesis. Althoug...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2008.10.009
更新日期:2009-02-01 00:00:00
abstract::We examined intraindividual variability in serum TC in 2912 men and women having TC measured at each of biennial examinations 2 through 7 of the FHS. RMSE described variability around the linear slope of an individual's TC during the baseline decade. Average biennial difference +/- SD was +3.7 +/- 6.7 mg/dl in men, +6...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90393-x
更新日期:1994-06-01 00:00:00
abstract::The incidence of cardiac events in Japanese men (mean age 54 +/- 10 years) with atypical or nonanginal chest pain was assessed prospectively. Three groups of patients, those with typical angina (TA; n = 134), those with atypical angina (AA; n = 192), and those with nonanginal chest pain (NA; n = 311) were studied with...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(92)90802-3
更新日期:1992-06-01 00:00:00
abstract::Atrial pacing-induced changes in the sum of R-wave amplitude were measured in leads V5, X, Y, and Z at rates of 100 bpm (phase I), 150 bpm (phase II), and immediately after pacing (phase III) in 33 patients undergoing cardiac catheterization for evaluation of chest pain. Seventeen (51%) patients showed evidence of isc...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90133-9
更新日期:1984-01-01 00:00:00
abstract:BACKGROUND:Percutaneous coronary intervention (PCI) of saphenous vein graft (SVG) is associated with frequent postprocedural enzyme elevation and late cardiac events. New strategies are proposed to minimize distal embolization and to improve the outcome of patients treated with stenting for SVG lesions. The objectives ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/S0002-8703(03)00309-0
更新日期:2003-09-01 00:00:00
abstract::The effects of lorcainide, a new antiarrhythmic drug, on serum electrolytes and osmolality are described in a series of 33 patients with organic heart disease and complex ventricular arrhythmias treated with lorcainide. In eight patients, a mean decrease in serum Na+ of 8.25 +/- 3.2 mEq/L was observed after a single 2...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90690-2
更新日期:1984-12-01 00:00:00
abstract::The hemodynamic effects of dopamine (DPM) and dobutamine (DBM) were compared in 13 patients with acute cardiogenic circulatory collapse. All patients presented with acute pump failure and inadequate systemic perfusion, and most were hypotensive. Nine patients had an acute myocardial infarction (AMI); the other four pa...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(82)90562-2
更新日期:1982-06-01 00:00:00
abstract::Release of thromboxane (TXA2) during acute myocardial infarction may be an important contributing factor in the genesis of ventricular fibrillation (VF). We assessed the effect of selective TXA2 inhibition on vulnerability to VF after total occlusion of the anterior descending coronary artery in chloralose-anesthetize...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(86)90099-2
更新日期:1986-04-01 00:00:00
abstract:BACKGROUND:The LaFarge equation is the most commonly used equation to estimate oxygen consumption (Vo(2)) in patients of all ages with congenital heart disease, although it was generated in patients older than 3 years. We sought to determine the validity of the LaFarge equation in estimating Vo(2) in children younger t...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2010.04.003
更新日期:2010-07-01 00:00:00
abstract::Percutaneous transluminal coronary angioplasty (PTCA) has, in general, been restricted to therapy for patients with angina pectoris. Thrombolytic therapy and guide wire recanalization have been used to recanalize coronary arteries in patients with evolving myocardial infarction. Recently we and others have examined th...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90352-1
更新日期:1984-04-01 00:00:00
abstract:BACKGROUND:Platelet inhibition is critical in reducing both short- and long-term atherothrombotic risks after acute myocardial infarction (MI), especially among patients managed with percutaneous coronary intervention (PCI). Currently available antiplatelet medications, including adenosine diphosphate (ADP) receptor in...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2011.08.021
更新日期:2011-11-01 00:00:00
abstract:BACKGROUND:Experimental studies suggest that metabolic myocardial support by intravenous (IV) glucose, insulin, and potassium (GIK) reduces ischemia-induced arrhythmias, cardiac arrest, mortality, progression from unstable angina pectoris to acute myocardial infarction (AMI), and myocardial infarction size. However, tr...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2012.02.002
更新日期:2012-03-01 00:00:00
abstract:BACKGROUND:This study was designed to investigate the efficacy of alteplase double-bolus dosing compared with the front-loaded 90-minute infusion regimen in patients with acute myocardial infarction. Recent pilot studies have suggested that bolus dosing may provide improved efficacy in establishing early, complete, and...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/s0002-8703(98)70024-9
更新日期:1998-10-01 00:00:00
abstract::Coronary angiography of both right and left coronary arteries, using the Sones technique, was performed during the attack of total spastic obstruction in 11 patients with clinically documented history of variant angina. None of the patients had more than 70% stenosis of organic atherosclerosis in any coronary artery a...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(85)90635-0
更新日期:1985-04-01 00:00:00
abstract:BACKGROUND:Although angiotensin-converting enzyme inhibitor attenuates ventricular enlargement, whether beta-blocker therapy induces regression of left ventricular remodeling is not known. The purpose of this study was to compare the effects of bisoprolol therapy with those of imidapril therapy on left ventricular remo...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1067/mhj.2000.110934
更新日期:2000-12-01 00:00:00
abstract::Recent developments have provided a unique opportunity for the organization of regional ST-elevation myocardial infarction (STEMI) receiving center (SRC) networks. Because cumulative evidence has demonstrated that rapid primary percutaneous coronary intervention (PCI) is the most effective reperfusion strategy for acu...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2006.06.001
更新日期:2006-10-01 00:00:00
abstract:BACKGROUND:The magnitude of benefit of cardiac resynchronization therapy (CRT) varies significantly among its recipients; approximately 30% of CRT patients do not report clinical improvement. Optimization of CRT pacing parameters can further improve cardiac function, both acutely and chronically. Echocardiographic opti...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2012.02.007
更新日期:2012-05-01 00:00:00