Prediction of one-year survival in high-risk patients with acute coronary syndromes: results from the SYNERGY trial.


BACKGROUND:Despite advances in pharmacologic therapy and invasive management strategies for patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS), these patients still suffer substantial morbidity and mortality. OBJECTIVE:The objective of this study was to analyze independent predictors of 1-year mortality in patients with high-risk NSTE ACS. DESIGN AND PARTICIPANTS:A total of 9,978 patients were assigned to receive enoxaparin or unfractionated heparin (UFH) in this prospective, randomized, open-label, international trial. MEASUREMENTS:Vital status at 1 year was collected. Univariable and multivariable predictors of 1-year mortality were identified. Three different multivariable regression models were constructed to identify: (1) predictors of 30-day mortality; (2) predictors of 1-year mortality; (3) predictors of 1-year mortality in 30-day survivors. The last model is the focus of this paper. RESULTS:Overall, 9,922 (99.4%) of patients had 1-year follow-up. Of the 56 patients (37 UFH-assigned and 19 enoxaparin-assigned) without 1-year data, 11 patients were excluded because of withdrawal of consent, and 45 could not be located. One-year mortality was 7.5% (7.7% enoxaparin-assigned patients; 7.3% UFH-assigned patients; P = 0.4). In patients surviving 30 days after enrollment, independent predictors of 1-year mortality included factors known at baseline such as increased age, male sex, decreased weight, having ever smoked, decreased creatinine clearance, ST-segment depression, history of diabetes, history of angina, congestive heart failure, coronary artery bypass grafting, increased heart rate, rales, increased hematocrit, lowered hemoglobin, and higher platelet count. Factors predictive of mortality during the hospitalization and 30-day follow-up period were decreased weight at 30 days from baseline, atrial fibrillation, decreased nadir platelet, no use of beta-blockers and statins up to 30 days, and not receiving an intervention (c-index = 0.82). CONCLUSIONS:Easily determined baseline clinical characteristics can be used to predict 1-year mortality with reasonable discriminative power. These models corroborate prior work in a contemporary aggressively managed population. A model to predict 1-year mortality in patients surviving at least 30 days may be quite helpful to healthcare providers in setting expectations and goals with patients after ACS.


J Gen Intern Med


Mahaffey KW,Yang Q,Pieper KS,Antman EM,White HD,Goodman SG,Cohen M,Kleiman NS,Langer A,Aylward PE,Col JJ,Reist C,Ferguson JJ,Califf RM,SYNERGY Trial Investigators.




Has Abstract


2008-03-01 00:00:00












  • Symptom burden, depression, and spiritual well-being: a comparison of heart failure and advanced cancer patients.

    abstract:BACKGROUND:A lower proportion of patients with chronic heart failure receive palliative care compared to patients with advanced cancer. OBJECTIVE:We examined the relative need for palliative care in the two conditions by comparing symptom burden, psychological well-being, and spiritual well-being in heart failure and ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究


    authors: Bekelman DB,Rumsfeld JS,Havranek EP,Yamashita TE,Hutt E,Gottlieb SH,Dy SM,Kutner JS

    更新日期:2009-05-01 00:00:00

  • Perceptions of financial payment for research participation among African-American drug users in HIV studies.

    abstract:BACKGROUND:Financial compensation for participating in research is controversial, especially when participants are recruited from economically disadvantaged and/or marginalized populations such as drug users. Little is known about these participants' own views regarding payment for research participation. OBJECTIVE:Th...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Slomka J,McCurdy S,Ratliff EA,Timpson S,Williams ML

    更新日期:2007-10-01 00:00:00

  • Foramen magnum meningioma: Dysphagia of atypical etiology.

    abstract:INTRODUCTION:We present a case of a foramen magnum meningioma that highlights the importance of the neurologic exam when evaluating a patient with dysphagia. A 58-year-old woman presented with an 18-month history of progressive dysphagia, chronic cough and 30-pound weight loss. Prior gastroenterologic and laryngologic ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Tsao GJ,Tsang MW,Mobley BC,Cheng WW

    更新日期:2008-02-01 00:00:00

  • Reimbursement for preventive services: can we construct an equitable system?

    abstract::This report examines alternative methods of paying for clinical preventive care services. First, the extent of coverage of preventive health care services in public and private health insurance plans is reviewed. Included in this review are Medicare, Medicaid, health maintenance organizations, and private health insur...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Davis K,Bialek R,Parkinson M,Smith J,Vellozzi C

    更新日期:1990-09-01 00:00:00

  • Specialists' and primary care physicians' participation in medicaid managed care.

    abstract:OBJECTIVE:To compare specialist and primary care physician participation in California's Medicaid fee-for-service and managed care programs. DESIGN:Cross-sectional survey. PARTICIPANTS:A probability sample stratified by county and by race of 962 specialist physicians and 713 primary care physicians practicing in the ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Backus L,Osmond D,Grumbach K,Vranizan K,Phuong L,Bindman AB

    更新日期:2001-12-01 00:00:00

  • Relationship of electronic medical knowledge resource use and practice characteristics with Internal Medicine Maintenance of Certification Examination scores.

    abstract:BACKGROUND:Maintenance of certification examination performance is associated with quality of care. We aimed to examine relationships between electronic medical knowledge resource use, practice characteristics and examination scores among physicians recertifying in internal medicine. METHODS:We conducted a cross-secti...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,随机对照试验


    authors: Reed DA,West CP,Holmboe ES,Halvorsen AJ,Lipner RS,Jacobs C,McDonald FS

    更新日期:2012-08-01 00:00:00

  • Primary Care Prognostic (PCP) Index of 11-Year Mortality Risk: Development and Validation of a Brief Prognostic Tool.

    abstract:BACKGROUND:Healthcare providers use a life expectancy of at least 5 to 10 years in shared clinical decision-making with older adults about cancer screening, major surgeries, and disease prevention interventions. At present, few prognostic indexes predict long-term mortality beyond 10 years or are suited for use in prim...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Chiang GSH,Nyunt MSZ,Gao Q,Wee SL,Yap KB,Tan BY,Ng TP

    更新日期:2020-08-20 00:00:00

  • Psychosocial risk factors for adverse outcomes in patients with nonvalvular atrial fibrillation receiving warfarin.

    abstract:OBJECTIVE:Our goal was to establish whether psychosocial risk factors for nonadherence, previously identified as negative predictors of warfarin prescribing, are predictors of adverse events for patients with nonvalvular atrial fibrillation receiving warfarin. DESIGN:Retrospective cohort analysis. SETTING:Ohio Medica...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Schauer DP,Moomaw CJ,Wess M,Webb T,Eckman MH

    更新日期:2005-12-01 00:00:00

  • Cigarette Smoking and Quitting-Related Factors Among US Adult Health Center Patients with Serious Mental Illness.

    abstract:INTRODUCTION:US adults with serious mental illness (SMI), compared to those without SMI, have a higher prevalence of smoking, which contributes to a shorter life expectancy. This study compared current smoking and quitting-related characteristics of low-income US adults with and without SMI who received healthcare at f...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Kalkhoran S,Thorndike AN,Rigotti NA,Fung V,Baggett TP

    更新日期:2019-06-01 00:00:00

  • Simulating Strategies for Improving Control of Hypertension Among Patients with Usual Source of Care in the United States: The Blood Pressure Control Model.

    abstract:BACKGROUND:Only half of hypertensive adults achieve blood pressure (BP) control in the United States, and it is unclear how BP control rates may be improved most effectively and efficiently at the population level. OBJECTIVE:We sought to compare the potential effects of system-wide isolated improvements in medication ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Fontil V,Bibbins-Domingo K,Kazi DS,Sidney S,Coxson PG,Khanna R,Victor RG,Pletcher MJ

    更新日期:2015-08-01 00:00:00

  • Which advance directive do patients prefer?

    abstract::This study examined patient acceptance of two different advance directives. Outpatients completed the two directives and a 12-item acceptability questionnaire for each, and then stated their directive preferences. Of 128 patients enrolled, 97 (76%) responded. Overall, 47% of the respondents were satisfied with the Let...

    journal_title:Journal of general internal medicine

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Reinders M,Singer PA

    更新日期:1994-01-01 00:00:00

  • Exercise as a vital sign: a quasi-experimental analysis of a health system intervention to collect patient-reported exercise levels.

    abstract:BACKGROUND:Lack of regular physical activity is highly prevalent in U.S. adults and significantly increases mortality risk. OBJECTIVE:To examine the clinical impact of a newly implemented program ("Exercise as a Vital Sign" [EVS]) designed to systematically ascertain patient-reported exercise levels at the beginning o...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究


    authors: Grant RW,Schmittdiel JA,Neugebauer RS,Uratsu CS,Sternfeld B

    更新日期:2014-02-01 00:00:00

  • Sexual minority status and violence among HIV infected and at-risk women.

    abstract:IMPORTANCE:Sexual minority women with and at-risk for human immunodeficiency virus (HIV) may face increased risks of violence. OBJECTIVE:To understand the relationship between sexual minority status and violence; and how high-risk sex and substance use mediate that relationship among women with and at-risk for HIV. D...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究


    authors: Pyra M,Weber K,Wilson TE,Cohen J,Murchison L,Goparaju L,Cohen MH

    更新日期:2014-08-01 00:00:00

  • Peer Support for Self-Management of Chronic Pain: the Evaluation of a Peer Coach-Led Intervention to Improve Pain Symptoms (ECLIPSE) Trial.

    abstract:BACKGROUND:Pain self-management is an effective, evidence-based treatment for chronic pain. Peer support, in which patients serve as coaches for other patients, has been effective in other chronic conditions and is a potentially promising approach to implementing pain self-management programs using fewer clinical resou...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Matthias MS,Bair MJ,Ofner S,Heisler M,Kukla M,McGuire AB,Adams J,Kempf C,Pierce E,Menen T,McCalley S,Johnson NL,Daggy J

    更新日期:2020-12-01 00:00:00

  • Impact of echocardiography on the management of patients with mitral valve prolapse.

    abstract:OBJECTIVE:To determine whether echocardiography affects the decisions to use beta blockers or to recommend bacterial endocarditis prophylaxis in patients suspected of having mitral valve prolapse (MVP). DESIGN:Retrospective review of echocardiograms and clinical records. SETTING:Military tertiary care hospital. PATI...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Olive KE,Grassman ED

    更新日期:1990-11-01 00:00:00

  • Moral distress in medical education and training.

    abstract::Moral distress is the experience of cognitive-emotional dissonance that arises when one feels compelled to act contrary to one's moral requirements. Moral distress is common, but under-recognized in medical education and training, and this relative inattention may undermine educators' efforts to promote empathy, ethic...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审


    authors: Berger JT

    更新日期:2014-02-01 00:00:00

  • General internal medicine and technologically less developed countries.

    abstract:OBJECTIVE:To assess the international health activities of departments of medicine, divisions of general medicine, and general medicine faculty and the interest among departments of medicine in joint international health ventures. DESIGN:15-item, mailed questionnaire. PARTICIPANTS:100 chiefs of divisions of general m...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Einterz RM,Dittus RS,Mamlin JJ

    更新日期:1990-09-01 00:00:00

  • Factors influencing disease self-management among veterans with diabetes and poor glycemic control.

    abstract:SPECIFIC AIM:Although the Department of Veterans Affairs (VA) has made significant organizational changes to improve diabetes care, diabetes self-management has received limited attention. The purpose of this study is to assess factors influencing diabetes self-management among veterans with poorly controlled diabetes....

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Nelson KM,McFarland L,Reiber G

    更新日期:2007-04-01 00:00:00

  • Impact of the Young Adult Dependent Coverage Expansion on Opioid Overdoses and Deaths: a Quasi-Experimental Study.

    abstract:BACKGROUND:Several policymakers have suggested that the Affordable Care Act (ACA) has fueled the opioid epidemic by subsidizing opioid pain medications. These claims have supported numerous efforts to repeal the ACA. OBJECTIVE:To determine the effect of the ACA's young adult dependent coverage insurance expansion on e...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Coupet E Jr,Werner RM,Polsky D,Karp D,Delgado MK

    更新日期:2020-06-01 00:00:00

  • Determining whether a patient is feeling better: pitfalls from the science of human perception.

    abstract::Human perception is fallible and may lead patients to be inaccurate when judging whether their symptoms are improving with treatment. This article provides a narrative review of studies in psychology that describe misconceptions related to a patient's comprehension, recall, evaluation and expression. The specific misc...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审


    authors: Redelmeier DA,Dickinson VM

    更新日期:2011-08-01 00:00:00

  • Comparing a self-administered measure of empathy with observed behavior among medical students.

    abstract:PURPOSE:Studies show that measures of physician and medical students' empathy decline with clinical training. Presently, there are limited data relating self-reported measures to observed behavior. This study explores a self-reported measure and observed empathy in medical students. METHOD:Students in the Class of 200...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Chen DC,Pahilan ME,Orlander JD

    更新日期:2010-03-01 00:00:00

  • Treatment intensification and blood glucose control among hospitalized diabetic patients.

    abstract:BACKGROUND:Hyperglycemia is common among diabetic inpatients, and has been linked to adverse outcomes. However, antihyperglycemic treatment is seldom intensified in noncritical care patients, and the relationship between intensification frequency and glucose control is poorly understood. We evaluated the relationship b...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Matheny ME,Shubina M,Kimmel ZM,Pendergrass ML,Turchin A

    更新日期:2008-02-01 00:00:00

  • The Importance of Addressing Depression and Diabetes Distress in Adults with Type 2 Diabetes.

    abstract::People with type 2 diabetes often experience two common mental health conditions: depression and diabetes distress. Both increase a patient's risk for mortality, poor disease management, diabetes-related complications, and poor quality of life. The American Diabetes Association and the U.S. Preventive Services Task Fo...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审


    authors: Owens-Gary MD,Zhang X,Jawanda S,Bullard KM,Allweiss P,Smith BD

    更新日期:2019-02-01 00:00:00

  • Medical students' use of the stages of change model in tobacco cessation counseling.

    abstract:BACKGROUND:Many medical schools have incorporated the Stages of Change Model into their curricula with specific application to tobacco cessation. OBJECTIVE:This study examined the extent to which medical students were prepared to provide stage-based interventions to treat nicotine dependence. DESIGN:Using a quasi-exp...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Prochaska JJ,Teherani A,Hauer KE

    更新日期:2007-02-01 00:00:00

  • "Mini-Residency" in Musculoskeletal Care: a National Continuing Professional Development Program for Primary Care Providers.

    abstract:INTRODUCTION:A cost-effective professional development program enhancing musculoskeletal (MSK) skills of physicians and allied health providers working in primary care settings has been reported at a single site. This article describes the first 2 years of the national expansion and implementation of a 3-day "MSK Mini-...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Battistone MJ,Barker AM,Grotzke MP,Beck JP,Lawrence P,Cannon GW

    更新日期:2016-11-01 00:00:00

  • Chapter 12: systematic review of prognostic tests.

    abstract::A number of new biological markers are being studied as predictors of disease or adverse medical events among those who already have a disease. Systematic reviews of this growing literature can help determine whether the available evidence supports use of a new biomarker as a prognostic test that can more accurately p...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审


    authors: Rector TS,Taylor BC,Wilt TJ

    更新日期:2012-06-01 00:00:00

  • Food insecurity is associated with diabetes mellitus: results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999-2002.

    abstract:BACKGROUND:Food insecurity refers to limited or uncertain access to food resulting from inadequate financial resources. There is a clear association between food insecurity and obesity among women, but little is known about the relationship between food insecurity and type 2 diabetes. OBJECTIVE:To evaluate whether the...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Seligman HK,Bindman AB,Vittinghoff E,Kanaya AM,Kushel MB

    更新日期:2007-07-01 00:00:00

  • Patterns and determinants of inappropriate antibiotic use in injection drug users.

    abstract:BACKGROUND:Inappropriate antibiotic use contributes to the emergence and spread of drug resistant infections. Though injection drug users are at increased risk for drug resistant infections, few studies have examined antibiotic use in this population. OBJECTIVE:To understand patterns and determinants of antibiotic use...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Starrels JL,Barg FK,Metlay JP

    更新日期:2009-02-01 00:00:00

  • The accuracy of clinician perceptions of "usual" blood pressure control.

    abstract:BACKGROUND:The term "clinical inertia" is used to describe the failure to manage a chronic condition aggressively enough to bring it under control. The underlying mechanisms for clinical inertia remain poorly understood. OBJECTIVE:To describe one potential mechanism for clinical inertia, seen through the lens of clini...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究


    authors: Rose AJ,Shimada SL,Rothendler JA,Reisman JI,Glassman PA,Berlowitz DR,Kressin NR

    更新日期:2008-02-01 00:00:00

  • A Qualitative Study of Primary Care Providers' Experiences with the Veterans Choice Program.

    abstract:BACKGROUND:The Veterans Access, Choice and Accountability Act (hereafter, Choice Program) seeks to improve access to care by enabling eligible Veterans to receive care from community providers. Veterans Affairs (VA) primary care providers (PCPs) play a key role in making referrals to community specialists, but their fr...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章


    authors: Nevedal AL,Wagner TH,Ellerbe LS,Asch SM,Koenig CJ

    更新日期:2019-04-01 00:00:00