Abstract:
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.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
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.doi
10.1007/s11606-007-0498-4subject
Has Abstractpub_date
2008-03-01 00:00:00pages
310-6issue
3eissn
0884-8734issn
1525-1497journal_volume
23pub_type
杂志文章,多中心研究,随机对照试验abstract:OBJECTIVE:To determine whether depressive symptoms measured at baseline are associated with mortality and to describe the course of depressive symptoms and their relation to physical decline in patients over a 6-year period. DESIGN:Prospective cohort study conducted from 1990 through 1996. SETTING:Urban academic prim...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1998.00226.x
更新日期:1998-11-01 00:00:00
abstract:BACKGROUND:Racial and ethnic disparities in opioid prescribing in the emergency department (ED) are well described, yet the influence of socioeconomic status (SES) remains unclear. OBJECTIVES:(1) To examine the effect of neighborhood SES on the prescribing of opioids for moderate to severe pain; and (2) to determine i...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-013-2516-z
更新日期:2013-12-01 00:00:00
abstract:BACKGROUND:Entry into general internal medicine (GIM) has declined. The effect of the inpatient general medicine rotation on medical student career choices is uncertain. OBJECTIVE:To assess the effect of student satisfaction with the inpatient general medicine rotation on pursuit of a career in GIM. DESIGN:Multicente...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1525-1497.2006.00429.x
更新日期:2006-05-01 00:00:00
abstract::Multiple factors are driving residency programs to explicitly address practice-based learning and improvement (PBLI), yet few information systems exist to facilitate such training. We developed, implemented, and evaluated a Web-based tool that provides Internal Medicine residents at the University of Virginia Health S...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0467-y
更新日期:2008-04-01 00:00:00
abstract:OBJECTIVE:Overall suicide mortality rates are higher among American Indians than in the general population and are particularly high among Indians residing in the upper Midwest. The identification, during encounters with health care providers, of individuals at high risk of suicide is a potential intervention strategy....
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599598
更新日期:1996-09-01 00:00:00
abstract:PURPOSE:To compare the effects of three methods of values clarification (VCM): balance sheet; rating and ranking; and a discrete choice experiment (DCE) on decision-making about colorectal cancer (CRC) screening among adults in the US and Australia. METHODS:Using online panels managed by a survey research organization...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-013-2701-0
更新日期:2014-03-01 00:00:00
abstract::Anti-N-methyl-D-aspartate receptor (anti-NMDA-R) encephalitis is an immune-mediated syndrome that remains under-recognized despite a growing body of literature. This syndrome has been predominantly described in young females with a constellation of symptoms, including personality changes, autonomic dysfunction and neu...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-011-1641-9
更新日期:2011-07-01 00:00:00
abstract:BACKGROUND:Obesity and diabetes family history are the two strongest risk factors for type 2 diabetes (T2D). Prior work shows that an individual's obesity risk is associated with obesity in social contacts, but whether T2D risk follows similar patterns is unknown. OBJECTIVE:We aimed to estimate the relationship betwee...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-016-3723-1
更新日期:2016-10-01 00:00:00
abstract:OBJECTIVE:To develop a patient-based classification system to describe the clinical content of ambulatory medicine practices. DESIGN:A system of 100 diagnosis clusters was developed based on retrospective review of computerized problem lists of patients from a university practice, and then applied to the problem lists...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599394
更新日期:1991-01-01 00:00:00
abstract:BACKGROUND:Extension for Community Healthcare Outcomes (ECHO) and related models of medical tele-education are rapidly expanding; however, their effectiveness remains unclear. This systematic review examines the effectiveness of ECHO and ECHO-like medical tele-education models of healthcare delivery in terms of improve...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05291-1
更新日期:2019-12-01 00:00:00
abstract:OBJECTIVES:We examined the presence and correlates of Black/White racial disparities in adherence to guidelines for colorectal cancer screening (CRCS). METHODS:The sample included 328 Black and 1827 White patients age 50-75 from 24 VA medical facilities who responded to a mailed survey with phone follow-up (response r...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s11606-010-1575-7
更新日期:2011-03-01 00:00:00
abstract:BACKGROUND:Treatment guidelines recommend all HIV/HCV-co-infected persons be considered for hepatitis C virus (HCV) treatment, yet obstacles to testing and accessing treatment for HCV continue for women. OBJECTIVE:To assess awareness of HCV, and describe diagnostic referrals and HCV treatment among women in the Women'...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0395-x
更新日期:2007-12-01 00:00:00
abstract:BACKGROUND:Various stakeholders can have differing opinions regarding ethical review when introducing new procedures with patients. OBJECTIVE:This pilot study examines the way in which Research Ethics Boards (REBs; Institutional Review Boards) and clinical biochemists (CBs; laboratory medicine specialists) differ in t...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0410-2
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:Primary care physicians are spending fewer hours in direct patient care, yet it is not known whether reduced hours are associated with differences in patient outcomes. OBJECTIVE:To determine whether patient outcomes vary with physicians' clinic hours. DESIGN:Cross-sectional retrospective design assessing p...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2003.20401.x
更新日期:2003-09-01 00:00:00
abstract::Nicotine meets all critical criteria for an addictive drug. Furthermore, there is no evidence that there would be widespread compulsive use of tobacco without nicotine. These findings have led to consideration of the cigarette as a contaminated vehicle for an addictive drug (nicotine). Nevertheless, nicotine itself ma...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/BF02600847
更新日期:1990-09-01 00:00:00
abstract::While great strides have been made recently in improving end-of-life care in the United States, people with dementia often die with inadequate pain control, with feeding tubes in place, and without the benefits of hospice care. In this paper, we discuss the most important and persistent challenges to providing excelle...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1111/j.1525-1497.2004.30329.x
更新日期:2004-10-01 00:00:00
abstract:BACKGROUND:Rates of substance use in rural areas are close to those of urban areas. While recent efforts have emphasized integrated care as a promising model for addressing workforce shortages in providing behavioral health services to those living in medically underserved regions, little is known on how substance use ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-015-3488-y
更新日期:2016-02-01 00:00:00
abstract:OBJECTIVE:To identify gender differences in social and behavioral factors associated with antiretroviral adherence. DESIGN:Prospective cohort study. SETTING:Methadone maintenance program. PARTICIPANTS:One hundred thirteen HIV-seropositive current or former opioid users. MEASUREMENTS AND MAIN RESULTS:Participants we...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2004.30445.x
更新日期:2004-11-01 00:00:00
abstract:OBJECTIVE:To examine the relationship between resident physicians' perceptions of their preventive cardiology practices and a chart audit assessment of their documented services. DESIGN:A criterion standard comparison of two methods used to assess resident physicians' practices: self-report and chart audit. SETTING:P...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600254
更新日期:1995-04-01 00:00:00
abstract:OBJECTIVE:To compare the abilities of two methods for rapid detection of pyuria and three methods of urinalysis to predict significant bacteriuria in symptomatic ambulatory women. DESIGN:Prospective simultaneous comparison of the results of dipstick urinalysis, standard microscopic urinalysis, and hemocytometric cell ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02598002
更新日期:1992-03-01 00:00:00
abstract::The Accreditation Council of Graduate Medical Education (ACGME) and the Residency Review Committee require a competency-based, accessible evaluation system. The paper system at our institution did not meet these demands and suffered from low compliance. A diverse committee of internal medicine faculty, program directo...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2004.30065.x
更新日期:2004-05-01 00:00:00
abstract:BACKGROUND:Little is known about the quality of the patient-physician relationship for terminally ill African Americans. OBJECTIVE:To compare the quality of the patient-physician relationship between African-American and white patients and examine the extent to which relationship quality contributes to differences in ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0370-6
更新日期:2007-11-01 00:00:00
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
doi:10.1007/s11606-013-2665-0
更新日期:2014-02-01 00:00:00
abstract::This editorial, "Internal Medicine Point of Care Ultrasound: Indicators It's Here to Stay" (DOI: 10.1007/s11606-019-05268-0), was intended to accompany "Education Indicators for Internal Medicine Point-of-Care Ultrasound: a Consensus Report from the Canadian Internal Medicine Ultrasound (CIMUS) Group". ...
journal_title:Journal of general internal medicine
pub_type: 已发布勘误
doi:10.1007/s11606-020-05632-5
更新日期:2020-02-01 00:00:00
abstract:OBJECTIVE:To assess the risks and benefits of surgery for herniated lumbar discs (discectomy) and to evaluate the methodologic quality of the literature. DESIGN:Literature synthesis. STUDY SELECTION AND DATA ANALYSIS: A structured MEDLINE search identified studies of standard, microsurgical, or percutaneous discectomy...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,meta分析
doi:10.1007/BF02600110
更新日期:1993-09-01 00:00:00
abstract:BACKGROUND:Changes to national guidelines for breast and cervical cancer screening have created confusion and controversy for women and their primary care providers. OBJECTIVE:To characterize women's primary health care provider attitudes towards screening and changes in practice in response to recent revisions in gui...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-015-3449-5
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:African Americans suffer more than non-Hispanic whites from type 2 diabetes, but diabetes self-management education (DSME) has been less effective at improving glycemic control for African Americans. Our objective was to determine whether a novel, culturally tailored DSME intervention would result in sustain...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s11606-019-04894-y
更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:To address concerns that the Hospital Readmissions Reduction Program (HRRP) unfairly penalized safety net hospitals treating patients with high social and functional risks, Medicare recently modified HRRP to compare hospitals with similar proportions of high-risk, dual-eligible patients ("peer group hospital...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06222-1
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:Although patients are commonly using the Internet to find healthcare information, the amount of personal and professional physician information and patient-generated ratings freely accessible online is unknown. OBJECTIVE:To characterize the nature of online professional and personal information available to...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-010-1425-7
更新日期:2010-11-01 00:00:00
abstract:BACKGROUND:There is no available evidence from randomized trials that early detection of prostate cancer improves health outcomes, but the prostate-specific antigen (PSA) test is commonly used to screen men for prostate cancer. OBJECTIVE:The objective of the study is to see if screening with PSA decreases mortality fr...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0479-7
更新日期:2008-03-01 00:00:00