Abstract:
:Little is known about the impact of accountable care organizations (ACO) on hospitalized heart failure (HF) patients, a high-cost and high-risk population. OBJECTIVE:We linked Medicare fee-for-service claims from 2013 to 2015 with data from American Heart Association Get With The Guidelines-HF registry to compare HF care, post-discharge outcomes, and total annual Medicare spending by ACO status at discharge. METHODS:Using adjusted Cox models and accounting for competing risks of death, we compared all-cause mortality and readmission at 1 year by ACO status with reporting of hazard ratios (HR) and 99% confidence intervals (CI). RESULTS:The study included 45,259 HF patients from 300 hospitals, with 21.1% assigned to an ACO. Patient characteristics were similar between the two groups with a few exceptions. The ACO patients lived in geographic areas with higher median income ($54400 [IQR $48600-65900] vs $52300 [$45900-61200], P < .0001). Compliance with four HF-specific quality measures was modestly higher in the ACO group (80% vs 76%, P < .0001). In adjusted analysis, ACO status was associated with similar all-cause readmission (HR: 1.03; 99% CI: 0.99, 1.07) but lower risk of 1-year mortality (HR: 0.85; 99% CI: 0.85, 0.90) compared with non-ACO status. Median Medicare spending in the calendar year of hospitalization was similar (ACO $42,737 [IQR $23,011-72,667] vs non-ACO $42,586 [$22,896-72,518], P = 0.06). CONCLUSIONS:Among Medicare patients hospitalized for HF, participation in an ACO was associated with similar rates of all-cause readmission and no associated cost reductions compared with non-ACO status. There was a lower risk of 1-year mortality associated with ACO participation, which warrants further evaluation.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Luo N,Hammill BG,DeVore AD,Xu H,Fonarow GC,Albert NM,Matsouaka RA,Hernandez AF,Yancy C,Mentz RJdoi
10.1016/j.ahj.2020.04.028subject
Has Abstractpub_date
2020-08-01 00:00:00pages
13-23eissn
0002-8703issn
1097-6744pii
S0002-8703(20)30136-8journal_volume
226pub_type
杂志文章abstract:BACKGROUND:The recent North American and European practice guidelines in patients with non-ST-segment elevation acute coronary syndrome (nSTE ACS) recommend glycoprotein IIb/IIIa (GpIIb-IIIa) inhibition in patients undergoing an early invasive treatment strategy. However, the guidelines are not explicit regarding the t...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2005.03.029
更新日期:2005-06-01 00:00:00
abstract:BACKGROUND:Exercise training is now an accepted component of the therapeutic regimen in patients with heart failure and underlying ischemia, but few data are available on the effects of training in patients with nonischemic dilated cardiomyopathy. METHODS:Twenty-four patients (mean age 55 +/- 9 years, mean ejection fr...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1067/mhj.2002.124401
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abstract:INTRODUCTION:It has been demonstrated that skin tissue cholesterol (SkinTc) is associated with angiographic disease. Now, we further delineate the relative risk of multivessel disease (>50% stenosis in at least two vessels) in the conjoint presence of high SkinTc and high traditional risk burden. METHODS:Patients sche...
journal_title:American heart journal
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doi:10.1016/j.ahj.2006.04.027
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abstract::The efficacy of aspirin to prevent ischemic cardiovascular disease has received considerable attention recently. To determine the prevalence of aspirin use for cardiovascular disease prevention, the Minnesota Heart Survey examined population-based samples of Twin Cities' adults in 1981 to 82 and 1985 to 86. Over the 4...
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doi:10.1016/0002-8703(88)90344-4
更新日期:1988-09-01 00:00:00
abstract:BACKGROUND:Although there is evidence linking smoking and heart failure (HF), the association between lifetime smoking exposure and HF in older adults and the strength of this association among current and past smokers is not well known. METHODS:We examined the association between smoking status, pack-years of exposur...
journal_title:American heart journal
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doi:10.1016/j.ahj.2012.05.013
更新日期:2012-08-01 00:00:00
abstract::Eighty-seven patients with isolated ventricular septal defect (VSD) operated on in the first 5 years of life, that had a mean interval of 10 months between diagnostic catheterization and surgery, were studied retrospectively. The size of the VSD was correlated with diagnostic catheterization data and comparative analy...
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doi:10.1016/s0002-8703(77)80170-1
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abstract:BACKGROUND:All patients who present to an emergency department (ED) are triaged. The ED triage score may determine when patients are seen by a physician. Half of patients with acute myocardial infarction (AMI) were given a low priority score in Ontario in 2000/2001. We assessed the appropriateness of ED triage and its ...
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.2011.05.015
更新日期:2011-09-01 00:00:00
abstract:BACKGROUND:Coronary heart disease (CHD) in women is strongly associated with estrogen deprivation. For example, risk for CHD increases dramatically after menopause. However, the role of hormone replacement therapy (HRT) in CHD prevention currently is unresolved. To better understand CHD in women, the precise mechanisms...
journal_title:American heart journal
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doi:10.1067/mhj.2002.121262
更新日期:2002-04-01 00:00:00
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journal_title:American heart journal
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doi:10.1016/s0002-8703(96)90425-1
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journal_title:American heart journal
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更新日期:1993-08-01 00:00:00
abstract::A dilated cardiomyopathy picture has been produced by rapid atrial and ventricular rates sustained for a long period of time in some patients. The ventricular tachycardias have in some instances been associated with ventricular tumors as the cause of the tachycardia. Once the tumor is removed, the tachycardia stops an...
journal_title:American heart journal
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doi:10.1016/0002-8703(88)90811-3
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journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1067/mhj.2001.113217
更新日期:2001-03-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2017.10.006
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:Optimal antithrombotic treatment after transcatheter aortic valve replacement (TAVR) is unknown and determined empirically. The direct factor Xa inhibitor rivaroxaban may potentially reduce TAVR-related thrombotic complications and premature valve failure. DESIGN:GALILEO is an international, randomized, ope...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2017-02-01 00:00:00
abstract:BACKGROUND:Despite a survival benefit and guideline recommendation for beta-blockers in left ventricular systolic dysfunction, beta-blockers are underused in clinical practice. METHODS:Medical practices with > or = 15 patients with heart failure (HF) in the Duke Databank for Cardiovascular Disease (DDCD) were identifi...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2005.06.038
更新日期:2006-05-01 00:00:00
abstract::To assess relative capabilities of magnetic resonance (MR) imaging and two-dimensional echocardiography (2DE) for evaluating regional contractile dysfunction in the left ventricle after a myocardial infarction, results from 22 concurrent MR (orthogonal-transaxial, ECG-gated, multiphasic, single-spin echo) and 2DE exam...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(88)90533-9
更新日期:1988-01-01 00:00:00
abstract:BACKGROUND:It has been reported that mineralocorticoid receptor antagonist improves the prognosis of chronic heart failure (CHF). Recently, hemoglobin A₁(c) (HbA₁(c)) levels have been reported to be an independent risk factor for mortality in CHF, suggesting the important role of insulin resistance in CHF. We compared ...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2010.04.024
更新日期:2010-11-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90517-7
更新日期:1994-01-01 00:00:00
abstract::A new mechanically rotated 20 MHz intravascular ultrasound guide wire (0.032 inch) with a transducer core was placed through the central lumen of a peripheral arterial balloon-expandable stent. Using an anesthetized canine model, 11 stents were then deployed into the iliac or femoral arteries. Eight stents were succes...
journal_title:American heart journal
pub_type: 杂志文章
doi:
更新日期:1993-05-01 00:00:00
abstract::In a double blind, placebo-controlled study, the efficacy of propafenone, a new antiarrhythmic drug was compared to that of disopyramide. Sixteen patients with frequent and complex premature ventricular contractions (PVCs) were studied by serial 24-hour ambulatory monitoring, while they were receiving propafenone, 300...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1985-04-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
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更新日期:1980-08-01 00:00:00
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journal_title:American heart journal
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更新日期:1990-06-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2004.08.014
更新日期:2005-02-01 00:00:00
abstract:BACKGROUND:Diabetes mellitus is a major public health problem in the United States. We assess the prevalence of diabetes in Dallas County, quantify the association between diabetes and subclinical cardiovascular disease, and assess the use of evidence-based cardiovascular disease risk-modifying therapies. METHODS:This...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2005.10.016
更新日期:2006-05-01 00:00:00
abstract:BACKGROUND:Diabetes mellitus is an increasingly prevalent condition among heart failure (HF) patients. The long-term morbidity and mortality among patients with and without diabetes with HF with reduced (HFrEF), borderline (HFbEF), and preserved ejection fraction (HFpEF) are not well described. METHODS:Using the Get W...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2019.01.006
更新日期:2019-05-01 00:00:00
abstract:BACKGROUND:Coronary artery disease (CAD) and, increasingly, diabetes are recognized as having an inflammatory basis. Membrane toll-like receptors (TLRs) activate signaling pathways that up-regulate inflammation. We evaluated whether the Asp299Gly polymorphism in the TLR4 gene, which impairs inflammatory responses, is a...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2004.05.049
更新日期:2004-12-01 00:00:00
abstract::The actions of the beta-adrenergic receptor antagonist, d,l-nadolol, were examined in anesthetized dogs subjected to circumflex coronary artery ligation in the presence of previous anterior myocardial infarction. With circumflex ligation, control dogs (N = 18) developed premature ventricular beats and ventricular tach...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(88)90444-9
更新日期:1988-11-01 00:00:00
abstract::Antiplatelet therapy has been shown to significantly reduce the risk of serious vascular events in high-risk patients, including those with a prior acute ischemic event. The long-term use of antiplatelet agents is a key component of secondary prevention measures following acute coronary syndromes, including ST-segment...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2010.10.014
更新日期:2010-12-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2007.03.009
更新日期:2007-06-01 00:00:00
abstract:BACKGROUND:As stenting practice has evolved to include greater numbers of stents and adjunctive balloon catheters per case, concern has focused on the increasing costs of equipment for the delivery of stents. METHODS AND RESULTS:To evaluate temporal changes in costs of intracoronary stenting, we examined total costs, ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(98)70193-0
更新日期:1998-07-01 00:00:00