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https://www.readbyqxmd.com/read/29691206/designing-for-clinical-change-creating-an-intervention-to-implement-new-statin-guidelines-in-a-primary-care-clinic
#1
Melissa DeJonckheere, Claire H Robinson, Lindsey Evans, Julie Lowery, Bradley Youles, Adam Tremblay, Caitlin Kelley, Jeremy B Sussman
BACKGROUND: Recent clinical practice guidelines from major national organizations, including a joint United States Department of Veterans Affairs (VA) and Department of Defense (DoD) committee, have substantially changed recommendations for the use of the cholesterol-lowering statin medications after years of relative stability. Because statin medications are among the most commonly prescribed treatments in the United States, any change in their use may have significant implications for patients and providers alike...
April 24, 2018: JMIR Human Factors
https://www.readbyqxmd.com/read/29680824/dash-score-and-subsequent-risk-of-coronary-artery-disease-the-findings-from-million-veteran-program
#2
Luc Djoussé, Yuk-Lam Ho, Xuan-Mai T Nguyen, David R Gagnon, Peter W F Wilson, Kelly Cho, J Michael Gaziano
BACKGROUND: While adherence to healthful dietary patterns has been associated with a lower risk of coronary artery disease (CAD) in the general population, limited data are available among US veterans. We tested the hypothesis that adherence to Dietary Approach to Stop Hypertension (DASH) food pattern is associated with a lower risk of developing CAD among veterans. METHODS AND RESULTS: We analyzed data on 153 802 participants of the Million Veteran Program enrolled between 2011 and 2016...
April 21, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29600737/statin-prescription-rates-and-their-facility-level-variation-in-patients-with-peripheral-artery-disease-and-ischemic-cerebrovascular-disease-insights-from-the-department-of-veterans-affairs
#3
Cameron L McBride, Julia M Akeroyd, David J Ramsey, Vijay Nambi, Khurram Nasir, Erin D Michos, Ruth L Bush, Hani Jneid, Pamela B Morris, Vera A Bittner, Christie M Ballantyne, Laura A Petersen, Salim S Virani
The 2013 American College of Cardiology/American Heart Association cholesterol guideline recommends moderate to high-intensity statin therapy in patients with peripheral artery disease (PAD) and ischemic cerebrovascular disease (ICVD). We examined frequency and facility-level variation in any statin prescription and in guideline-concordant statin prescriptions in patients with PAD and ICVD receiving primary care in 130 facilities across the Veterans Affairs (VA) health care system between October 2013 and September 2014...
March 1, 2018: Vascular Medicine
https://www.readbyqxmd.com/read/29588132/epidemiology-of-lower-extremity-peripheral-artery-disease-in-veterans
#4
James Willey, Amgad Mentias, Mary Vaughan-Sarrazin, Kimberly McCoy, Gary Rosenthal, Saket Girotra
OBJECTIVE: The objective of this study was to describe the epidemiology, clinical features, outcomes, and predictors of mortality in veterans with peripheral artery disease (PAD). METHODS: We used national data from the Veterans Health Administration from fiscal years 2009 to 2011 to identify patients with a new diagnosis of PAD. Within this cohort, we describe characteristics of the patients, use of recommended medications, and clinical outcomes during a 3-year follow-up (fiscal year 2014)...
March 24, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29503265/temporal-trends-of-high-intensity-statin-therapy-among-veterans-treated-with-percutaneous-coronary-intervention
#5
Aref A Bin Abdulhak, Mary Vaughan-Sarrzin, Peter Kaboli, Phillip A Horwitz, Hilary Mosher, Gardar Sigurdsson, Nicholas E Walker, Robert Wallace, Jennifer G Robinson
BACKGROUND: The 2013 American College of Cardiology/American Heart Association blood cholesterol guideline recommends high-intensity statin therapy among certain groups of patients, but full implementation of the guideline has not yet been satisfactory. We aimed to investigate the temporal trends and predictors of high-intensity statin therapy among veterans who had been treated with percutaneous coronary intervention (PCI) and followed up by cardiologists within the Veterans Health Administrative system...
March 4, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29447742/a-comparative-analysis-of-current-lipid-treatment-guidelines-nothing-stands-still
#6
REVIEW
Anjan Tibrewala, Arif Jivan, William J Oetgen, Neil J Stone
Lipid treatment guidelines have continued to evolve as new evidence emerges. We sought to review similarities and differences of 5 lipid treatment guidelines from the American College of Cardiology/American Heart Association, Canadian Cardiovascular Society, European Society for Cardiology/European Atherosclerosis Society, U.S. Preventive Services Task Force, and U.S. Veterans Affairs/Department of Defense. All guidelines utilize rigorous evidentiary review, highlight statin therapy for primary and secondary prevention of atherosclerotic cardiovascular disease, and emphasize a clinician-patient risk discussion...
February 20, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29404578/quality-of-care-for-veterans-with-transient-ischemic-attack-and-minor-stroke
#7
Dawn M Bravata, Laura J Myers, Greg Arling, Edward J Miech, Teresa Damush, Jason J Sico, Michael S Phipps, Alan J Zillich, Zhangsheng Yu, Mathew Reeves, Linda S Williams, Jason Johanning, Seemant Chaturvedi, Fitsum Baye, Susan Ofner, Curt Austin, Jared Ferguson, Glenn D Graham, Rachel Rhude, Chad S Kessler, Donald S Higgins, Eric Cheng
Importance: The timely delivery of guideline-concordant care may reduce the risk of recurrent vascular events for patients with transient ischemic attack (TIA) and minor stroke. Although many health care organizations measure stroke care quality, few evaluate performance for patients with TIA or minor stroke, and most include only a limited subset of guideline-recommended processes. Objective: To assess the quality of guideline-recommended TIA and minor stroke care across the Veterans Health Administration (VHA) system nationwide...
April 1, 2018: JAMA Neurology
https://www.readbyqxmd.com/read/29381696/association-between-triglyceride-levels-and-cardiovascular-disease-in-patients-with-acute-pancreatitis
#8
Laurel A Copeland, C Scott Swendsen, Dawn M Sears, Andrea A MacCarthy, Catherine J McNeal
Conventional wisdom supports prescribing "fibrates before statins", that is, prioritizing treatment of hypertriglyceridemia (hTG) to prevent pancreatitis ahead of low-density lipoprotein cholesterol to prevent coronary heart disease. The relationship between hTG and acute pancreatitis, however, may not support this approach to clinical management. This study analyzed administrative data from the Veterans Health Administration for evidence of (1) temporal association between assessed triglycerides level and days to acute pancreatitis admission; (2) association between hTG and outcomes in the year after hospitalization for acute pancreatitis; (3) relative rates of prescription of fibrates vs statins in patients with acute pancreatitis; (4) association of prescription of fibrates alone versus fibrates with statins or statins alone with rates of adverse outcomes after hospitalization for acute pancreatitis...
2018: PloS One
https://www.readbyqxmd.com/read/29341172/statin-use-and-the-risk-of-cardiovascular-implantable-electronic-device-infection-a-cohort-study-in-a-veteran-population
#9
Talal Alzahrani, Angelike P Liappis, Larry M Baddour, Pamela E Karasik
BACKGROUND: The rate of cardiovascular implantable electronic device infection (CIEDI) has increased, despite the use of perioperative antibiotics at the time of device placement or revision. This is due, in part, to the presence of multiple comorbid conditions in an elderly population, in general, who require CIED. Statins may have an antibacterial effect, although there is currently no evidence that the likelihood of CIEDI has been impacted by statin use. METHODS: A retrospective cohort study was performed to assess whether statins are associated with a reduced risk of CIEDI...
January 17, 2018: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/29330214/association-of-statin-dose-with-amputation-and-survival-in-patients-with-peripheral-artery-disease
#10
Shipra Arya, Anjali Khakharia, Zachary O Binney, Randall R DeMartino, Luke P Brewster, Philip P Goodney, Peter W F Wilson
BACKGROUND: Statin dose guidelines for patients with peripheral artery disease (PAD) are largely based on coronary artery disease and stroke data. The aim of this study is to determine the effect of statin intensity on PAD outcomes of amputation and mortality. METHODS: Using an observational cohort study design and a validated algorithm, we identified patients with incident PAD (2003-2014) in the national Veterans Affairs data. Highest statin intensity exposure (high-intensity versus low-to-moderate-intensity versus antiplatelet therapy but no statin use) was determined within 1 year of diagnosis of PAD...
April 3, 2018: Circulation
https://www.readbyqxmd.com/read/29172840/the-influence-of-oral-statin-medications-on-progression-of-glaucomatous-visual-field-loss-a-propensity-score-analysis
#11
Ben Whigham, Eugene Z Oddone, Sandra Woolson, Cynthia Coffman, R Rand Allingham, Christine Shieh, Kelly W Muir
PURPOSE: The purpose of this study was to examine the association between oral statin use and the progression of open angle glaucoma. METHODS: Medical records of 847 Veterans were reviewed to collect statin use history, record demographic and comorbid medical conditions, and review visual fields. Visual field progression was judged by an ophthalmologist masked to statin use history. Progression rates in a propensity score matched cohort were compared between statin users and nonusers using McNemar's test with the propensity model derived using associated medical and demographic factors...
November 27, 2017: Ophthalmic Epidemiology
https://www.readbyqxmd.com/read/29130272/effects-of-guideline-and-formulary-changes-on-statin-prescribing-in-the-veterans-affairs
#12
Adam A Markovitz, Rob G Holleman, Timothy P Hofer, Eve A Kerr, Mandi L Klamerus, Jeremy B Sussman
OBJECTIVE: To compare the effects of two sequential policy changes-the addition of a high-potency statin to the Department of Veterans Affairs (VA) formulary and the release of the American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines-on VA provider prescribing. DATA SOURCES/STUDY SETTING: Retrospective analysis of 1,100,682 VA patients, 2011-2016. STUDY DESIGN: Interrupted time-series analysis of changes in prescribing of moderate-to-high-intensity statins among high-risk patients and across high-risk subgroups...
December 2017: Health Services Research
https://www.readbyqxmd.com/read/29107453/longitudinal-trends-and-predictors-of-statin-use-among-patients-with-diabetes
#13
Meghan B Brennan, Elbert S Huang, Jennifer M Lobo, Hyojung Kang, Marylou Guihan, Anirban Basu, Min-Woong Sohn
AIM: Statins reduce morbidity and mortality among patients with diabetes, but their use remains suboptimal. Understanding trends in statin use may inform strategies for improvement. METHODS: We enrolled a national, retrospective cohort of 899,664 veterans aged≥40years with diabetes in 2003. We followed them through 2011, dividing the nine-year follow-up into 90-day periods. For each period, we determined statin use, defined as possession of ≥30-day supply. We examine factors associated with statin uptake among baseline non-users with a multivariate model...
January 2018: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/29091289/a-risk-score-to-predict-the-development-of-hepatic-encephalopathy-in-a-population-based-cohort-of-patients-with-cirrhosis
#14
Elliot B Tapper, Neehar Parikh, Neil Sengupta, Jessica Mellinger, David Ratz, Anna S Lok, Grace L Su
Over 40% of patients with cirrhosis will develop hepatic encephalopathy (HE). HE is associated with decreased survival, falls, motor vehicle accidents, and frequent hospitalization. Accordingly, we aimed to develop a tool to risk-stratify patients for HE development. We studied a population-based cohort of all patients with cirrhosis without baseline HE (N=1,979) from the Veterans Administration from Michigan, Indiana, and Ohio (1/1/2005-12/31/10) using demographic, clinical, laboratory, and pharmacy data. The primary outcome was the development of HE...
November 1, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/29020184/risk-of-acute-liver-injury-after-statin-initiation-by-human-immunodeficiency-virus-and-chronic-hepatitis-c-virus-infection-status
#15
Dana D Byrne, Janet P Tate, Kimberly A Forde, Joseph K Lim, Matthew Bidwell Goetz, David Rimland, Maria C Rodriguez-Barradas, Adeel A Butt, Cynthia L Gibert, Sheldon T Brown, Roger Bedimo, Matthew S Freiberg, Amy C Justice, Jay R Kostman, Jason A Roy, Vincent Lo Re
Background: Patients with human immunodeficiency virus (HIV) and/or chronic hepatitis C virus (HCV) infection may be prescribed statins as treatment for metabolic/cardiovascular disease, but it remains unclear if the risk of acute liver injury (ALI) is increased for statin initiators compared to nonusers in groups classified by HIV/HCV status. Methods: We conducted a cohort study to compare rates of ALI in statin initiators vs nonusers among 7686 HIV/HCV-coinfected, 8155 HCV-monoinfected, 17739 HIV-monoinfected, and 36604 uninfected persons in the Veterans Aging Cohort Study (2000-2012)...
October 16, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28912200/development-and-validation-of-electronic-quality-measures-to-assess-care-for-patients-with-transient-ischemic-attack-and-minor-ischemic-stroke
#16
Dawn M Bravata, Laura J Myers, Eric Cheng, Mathew Reeves, Fitsum Baye, Zhangsheng Yu, Teresa Damush, Edward J Miech, Jason Sico, Michael Phipps, Alan Zillich, Jason Johanning, Seemant Chaturvedi, Curt Austin, Jared Ferguson, Bailey Maryfield, Kathy Snow, Susan Ofner, Glenn Graham, Rachel Rhude, Linda S Williams, Greg Arling
BACKGROUND: Despite interest in using electronic health record (EHR) data to assess quality of care, the accuracy of such data is largely unknown. We sought to develop and validate transient ischemic attack and minor ischemic stroke electronic quality measures (eQMs) using EHR data. METHODS AND RESULTS: A random sample of patients with transient ischemic attack or minor ischemic stroke, cared for in Veterans Health Administration facilities (fiscal year 2011), was identified...
September 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28746145/treatment-and-outcomes-of-type-2-myocardial-infarction-and-myocardial-injury-compared-with-type-1-myocardial-infarction
#17
Nathaniel R Smilowitz, Pritha Subramanyam, Eugenia Gianos, Harmony R Reynolds, Binita Shah, Steven P Sedlis
BACKGROUND: Type 2 myocardial infarction (MI) is defined by a rise and fall of cardiac biomarkers and evidence of ischemia without unstable coronary artery disease (CAD) because of a mismatch in myocardial oxygen supply and demand. Myocardial injury is similar but does not fulfill the clinical criteria for MI. There is uncertainty in terms of the clinical characteristics, management, and outcomes of type 2 MI and myocardial injury in comparison with type 1 MI. PATIENTS AND METHODS: Patients admitted to a Veterans Affairs tertiary care hospital with a rise and fall in cardiac troponin were identified...
January 2018: Coronary Artery Disease
https://www.readbyqxmd.com/read/28641862/perioperative-beta-blockers-and-statins-for-noncardiac-surgery-patients-with-coronary-stents
#18
Joshua S Richman, Laura A Graham, Aerin DeRussy, Thomas M Maddox, Kamal M F Itani, Mary T Hawn
IMPORTANCE: Recent publications report that perioperative initiation of statin therapy is associated with improved outcomes particularly among patients with increased cardiac risk. However, findings on associations with beta blocker (BB) initiation are mixed. OBJECTIVE: This study examines associations between perioperative statin and BB use in a national sample of patients with cardiac stents. DESIGN: Retrospective cohort study. SETTING: VA Medical Centers nationwide...
August 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28552431/cardiorespiratory-fitness-and-incidence-of-type-2-diabetes-in-united-states-veterans-on-statin-therapy
#19
Peter Kokkinos, Charles Faselis, Puneet Narayan, Jonathan Myers, Eric Nylen, Xuemei Sui, Jiajia Zhang, Carl J Lavie
BACKGROUND: Impact of cardiorespiratory fitness on statin-related incidence of type 2 diabetes has not been assessed. We assessed the cardiorespiratory fitness and diabetes incidence association in dyslipidemic patients on statins. METHODS: We identified dyslipidemic patients with a normal exercise test performed during 1986 and 2014 at the Veterans Affairs Medical Centers in Washington, DC or Palo Alto, Calif. The statin-treated patients (n = 4092; age = 58.8 ± 10...
October 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28549471/the-shared-health-appointments-and-reciprocal-enhanced-support-shares-study-study-protocol-for-a-randomized-trial
#20
RANDOMIZED CONTROLLED TRIAL
Michele Heisler, Jennifer Burgess, Jeffrey Cass, John F Chardos, Alexander B Guirguis, Sean M Jeffery, Lorrie A Strohecker, Adam S Tremblay, Wen-Chih Wu, Donna M Zulman
BACKGROUND: Diabetes shared medical appointments (SMAs) and reciprocal peer support programs have been found in efficacy trials to help adults with diabetes improve their self-management and achieve short-term gains in clinical and patient-centered outcomes. In order to translate this evidence to system-level interventions, there is a need for large-scale, pragmatic trials that examine the effectiveness, implementation, and costs of SMAs and reciprocal peer support across diverse settings...
May 26, 2017: Trials
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