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Myocardial infarction health utility

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https://www.readbyqxmd.com/read/28292489/the-3-year-cost-effectiveness-of-a-nurse-based-case-management-versus-usual-care-for-elderly-patients-with-myocardial-infarction-results-from-the-korinna-follow-up-study
#1
Hildegard Seidl, Matthias Hunger, Christa Meisinger, Inge Kirchberger, Bernhard Kuch, Reiner Leidl, Rolf Holle
OBJECTIVES: To assess the 3-year cost-effectiveness of a nurse-based case management intervention in elderly patients with myocardial infarction from a societal perspective. METHODS: The intervention consisted of one home visit and quarterly telephone calls in the first year, and semi-annual calls in the following 2 years. The primary effect measures were quality-adjusted life-years (QALYs), on the basis of the EuroQol five-dimensional questionnaire (EQ-5D-3L) and adjusted life-years from patients' self-rated health states according to the visual analogue scale (VAS-ALs)...
March 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28291598/identifying-radiology-s-place-in-the-expanding-landscape-of-episode-payment%C3%A2-models
#2
Andrew B Rosenkrantz, Joshua A Hirsch, Bibb Allen, H Benjamin Harvey, Gregory N Nicola
The current fee-for-service system for health care reimbursement in the United Stated is argued to encourage fragmented care delivery and a lack of accountability that predisposes to insufficient focus on quality as well as unnecessary or duplicative resource utilization. Episode payment models (EPMs) seek to improve coordination by linking payments for all services related to a patient's condition or procedure, thereby improving quality and efficiency of care. The CMS Innovation Center has implemented a broadening array of EPMs...
March 10, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28264868/global-longitudinal-strain-by-echocardiography-predicts-long-term-risk-of-cardiovascular-morbidity-and-mortality-in-a-low-risk-general-population-the-copenhagen-city-heart-study
#3
Tor Biering-Sørensen, Sofie Reumert Biering-Sørensen, Flemming Javier Olsen, Morten Sengeløv, Peter Godsk Jørgensen, Rasmus Mogelvang, Amil M Shah, Jan Skov Jensen
BACKGROUND: Global longitudinal strain (GLS) is prognostic of adverse cardiovascular outcomes in various patient populations, but the prognostic utility of GLS for long-term cardiovascular morbidity and mortality in the general population is unknown. METHODS AND RESULTS: A total of 1296 participants in a general population study underwent a health examination, including echocardiography measurement of GLS. The primary end point was the composite of incident heart failure, acute myocardial infarction, or cardiovascular death...
March 2017: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28214504/frequency-of-troponin-testing-in-inpatient-versus-outpatient-settings
#4
Adam J Farber, Keith Suarez, Kipp Slicker, Chhaya D Patel, Brandon Pope, Robert Kowal, Jeffrey B Michel
Troponin elevation is required to diagnose acute myocardial infarction (AMI), yet elevated values are often encountered in noncardiac disease states. We evaluated inpatient (IP) and outpatient (OP) encounters at 14 hospitals in calendar year 2014 and found that troponin assays were performed during 12% of all OP visits and 29% of all IP visits: 82,853 encounters in all. We employed an expert panel to estimate the likelihood of AMI based on primary International Statistical Classification of Diseases and Related Health Problems, 9th edition diagnoses...
January 25, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28178979/managed-care-and-inpatient-mortality-in-adults-effect-of-primary-payer
#5
Anika L Hines, Susan O Raetzman, Marguerite L Barrett, Ernest Moy, Roxanne M Andrews
BACKGROUND: Because managed care is increasingly prevalent in health care finance and delivery, it is important to ascertain its effects on health care quality relative to that of fee-for-service plans. Some stakeholders are concerned that basing gatekeeping, provider selection, and utilization management on cost may lower quality of care. To date, research on this topic has been inconclusive, largely because of variation in research methods and covariates. Patient age has been the only consistently evaluated outcome predictor...
February 8, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28150313/improved-outcomes-and-reduced-costs-associated-with-a-health-system-wide-patient-blood-management-program-a-retrospective-observational-study-in-four-major-adult-tertiary-care-hospitals
#6
Michael F Leahy, Axel Hofmann, Simon Towler, Kevin M Trentino, Sally A Burrows, Stuart G Swain, Jeffrey Hamdorf, Trudi Gallagher, Audrey Koay, Gary C Geelhoed, Shannon L Farmer
BACKGROUND: Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health-system-wide PBM program. This study assesses program outcomes. STUDY DESIGN AND METHODS: This was a retrospective study of 605,046 patients admitted to four major adult tertiary-care hospitals between July 2008 and June 2014. Outcome measures were red blood cell (RBC), fresh-frozen plasma (FFP), and platelet units transfused; single-unit RBC transfusions; pretransfusion hemoglobin levels; elective surgery patients anemic at admission; product and activity-based costs of transfusion; in-hospital mortality; length of stay; 28-day all-cause emergency readmissions; and hospital-acquired complications...
February 2, 2017: Transfusion
https://www.readbyqxmd.com/read/28119150/vascular-katp-channels-mitigate-severe-muscle-o2-delivery-utilization-mismatch-during-contractions-in-chronic-heart-failure-rats
#7
Clark T Holdsworth, Scott K Ferguson, Trenton D Colburn, Alexander J Fees, Jesse C Craig, Daniel M Hirai, David C Poole, Timothy I Musch
The vascular ATP-sensitive K(+) (KATP) channel is a mediator of skeletal muscle microvascular oxygenation (PO2mv) during contractions in health. We tested the hypothesis that KATP channel function is preserved in chronic heart failure (CHF) and therefore its inhibition would reduce PO2mv and exacerbate the time taken to reach the PO2mv steady-state during contractions of the spinotrapezius muscle. Moreover, we hypothesized that subsequent KATP channel activation would oppose the effects of this inhibition. Muscle PO2mv (phosphorescence quenching) was measured during 180s of 1-Hz twitch contractions (∼6V) under control, glibenclamide (GLI, KATP channel antagonist; 5mg/kg) and pinacidil (PIN, KATP channel agonist; 5mg/kg) conditions in 16 male Sprague-Dawley rats with CHF induced via myocardial infarction (coronary artery ligation, left ventricular end-diastolic pressure: 18±1mmHg)...
April 2017: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/28115328/myocardial-infarction-in-the-wisconsin-longitudinal-study-the-interaction-among-environmental-health-social-behavioural-and-genetic-factors
#8
Tina K Gonzales, James A Yonker, Vicky Chang, Carol L Roan, Pamela Herd, Craig S Atwood
OBJECTIVES: This study examined how environmental, health, social, behavioural and genetic factors interact to contribute to myocardial infarction (MI) risk. DESIGN: Survey data collected by Wisconsin Longitudinal Study (WLS), USA, from 1957 to 2011, including 235 environmental, health, social and behavioural factors, and 77 single- nucleotide polymorphisms were analysed for association with MI. To identify associations with MI we utilized recursive partitioning and random forest prior to logistic regression and chi-squared analyses...
January 23, 2017: BMJ Open
https://www.readbyqxmd.com/read/28100208/access-to-primary-health-care-for-acute-vascular-events-in-rural-low-income-settings-a-mixed-methods-study
#9
Shyfuddin Ahmed, Muhammad Ashique Haider Chowdhury, Md Alfazal Khan, Nafisa Lira Huq, Aliya Naheed
BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of global mortality. Among the CVDs, acute vascular events (AVE) mainly ischemic heart diseases and stroke are the largest contributors. To achieve 25% reduction in preventable deaths from CVDs by 2025, health systems need to be equipped with extended service coverage in order to provide person-centered care. The overall goal of this proposed study is to assess access to health care in-terms of service availability, care seeking patterns and barriers to access care after AVE in rural Bangladesh...
January 18, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28065635/meals-enhancing-nutrition-after-discharge-findings-from-a-pilot-randomized-controlled%C3%A2-trial
#10
David R Buys, Anthony D Campbell, Alice Godfryd, Kellie Flood, Elizabeth Kitchin, Meredith L Kilgore, Sally Allocca, Julie L Locher
BACKGROUND: After older adults experience episodes of poor health or are hospitalized, they may not return to premorbid or prehospitalization eating behaviors. Furthermore, poor nutrition increases hospital readmission risk, but evidence-based interventions addressing these risks are limited. OBJECTIVE: This pilot study's objective was to evaluate the feasibility of conducting a randomized controlled trial assessing a post-discharge home-delivered meal program's impact on older adults' nutritional intake and hospital readmissions and to assess patient acceptability and satisfaction with the program...
January 5, 2017: Journal of the Academy of Nutrition and Dietetics
https://www.readbyqxmd.com/read/28038444/an-association-between-autosomal-dominant-polycystic-kidney-disease-and-the-risk-of-acute-myocardial-infarction-in-asian-population-results-of-a-nationwide-study
#11
Pei-Hsun Sung, Hsin-Ju Chiang, Yao-Hsu Yang, Chi-Jen Chen, John Y Chiang, Hon-Kan Yip
Cardiovascular complications are the leading causes of death in patients with autosomal-dominant polycystic kidney disease (ADPKD) in the Western countries. However, theprevalence and risk of acute myocardial infarction (AMI) in patients with ADPKD remain unknown, especially in Asian population. We utilized the data from Taiwan National Health Insurance Research Database (NHIRD) to perform a population-based cohort study (1997-2008). A total of 2062 patients with ADPKD were selected from one million of general population after excluding those patients with age less than 18 years old, receiving renal replacement therapy, and concomitant diagnoses of AMI...
December 27, 2016: Oncotarget
https://www.readbyqxmd.com/read/28025925/contemporary-trends-in-oral-antiplatelet-agent-use-in-patients-treated-with-percutaneous-coronary-intervention-for-acute-coronary-syndrome
#12
Kibum Kim, Todd A Lee, Daniel R Touchette, Robert J DiDomenico, Amer K Ardati, Surrey M Walton
BACKGROUND: Recent trials demonstrated the efficacy of prasugrel and ticagrelor compared with clopidogrel in the reduction of cardiovascular complications in patients with acute coronary syndrome (ACS). However, it is unclear how use of the 3 antiplatelet medications has changed in commercially insured patients since the advent of the new agents. OBJECTIVES: To (a) describe the adoption of prasugrel and ticagrelor in patients who received percutaneous coronary intervention (PCI) for the onset of ACS and (b) explore patient factors associated with the selection of the drug to provide insight into utilization patterns of these antiplatelet agents...
January 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27997220/identifying-determinants-of-medication-adherence-following-myocardial-infarction-using-the-theoretical-domains-framework-and-the-health-action-process-approach
#13
Justin Presseau, J D Schwalm, Jeremy M Grimshaw, Holly O Witteman, Madhu K Natarajan, Stefanie Linklater, Katrina Sullivan, Noah M Ivers
BACKGROUND: Despite evidence-based recommendations, adherence with secondary prevention medications post-myocardial infarction (MI) remains low. Taking medication requires behaviour change, and using behavioural theories to identify what factors determine adherence could help to develop novel adherence interventions. OBJECTIVE: Compare the utility of different behaviour theory-based approaches for identifying modifiable determinants of medication adherence post-MI that could be targeted by interventions...
December 20, 2016: Psychology & Health
https://www.readbyqxmd.com/read/27973617/quantifying-geographic-variation-in-health-care-outcomes-in-the-united-states-before-and-after-risk-adjustment
#14
Barry L Rosenberg, Joshua A Kellar, Anna Labno, David H M Matheson, Michael Ringel, Paige VonAchen, Richard I Lesser, Yue Li, Justin B Dimick, Atul A Gawande, Stefan H Larsson, Hamilton Moses
BACKGROUND: Despite numerous studies of geographic variation in healthcare cost and utilization at the local, regional, and state levels across the U.S., a comprehensive characterization of geographic variation in outcomes has not been published. Our objective was to quantify variation in US health outcomes in an all-payer population before and after risk-adjustment. METHODS AND FINDINGS: We used information from 16 independent data sources, including 22 million all-payer inpatient admissions from the Healthcare Cost and Utilization Project (which covers regions where 50% of the U...
2016: PloS One
https://www.readbyqxmd.com/read/27865485/comparison-of-the-effectiveness-of-stress-echocardiography-versus-myocardial-perfusion-imaging-in-patients-presenting-to-the-emergency-department-with-low-risk-chest-pain
#15
Rhian Davies, Guodong Liu, Christopher Sciamanna, William R Davidson, Douglas L Leslie, Andrew J Foy
The aim of this study was to compare clinically relevant cardiovascular outcomes and downstream resource utilization associated with stress echocardiography (SE) and myocardial perfusion imaging (MPI) in emergency department patients with low-risk chest pain. This was a retrospective analysis of health insurance claims data for a national sample of privately insured patients over the period January 1 to December 31, 2011. Subjects were selected who presented to the emergency department with a primary or secondary diagnosis of chest pain and underwent either SE or MPI...
December 15, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27848189/the-impact-of-disability-and-social-determinants-of-health-on-condition-specific-readmissions-beyond-medicare-risk-adjustments-a-cohort-study
#16
Jennifer Meddings, Heidi Reichert, Shawna N Smith, Theodore J Iwashyna, Kenneth M Langa, Timothy P Hofer, Laurence F McMahon
BACKGROUND: Readmission rates after pneumonia, heart failure, and acute myocardial infarction hospitalizations are risk-adjusted for age, gender, and medical comorbidities and used to penalize hospitals. OBJECTIVE: To assess the impact of disability and social determinants of health on condition-specific readmissions beyond current risk adjustment. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of Medicare patients using 1) linked Health and Retirement Study-Medicare claims data (HRS-CMS) and 2) Healthcare Cost and Utilization Project State Inpatient Databases (Florida, Washington) linked with ZIP Code-level measures from the Census American Community Survey (ACS-HCUP)...
January 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/27811206/economic-considerations-of-early-rule-in-rule-out-algorithms-for-the-diagnosis-of-myocardial-infarction-in-the-emergency-department-using-cardiac-troponin-and-glycemic-biomarkers
#17
Colleen Shortt, Feng Xie, Richard Whitlock, Jinhui Ma, Natasha Clayton, Jonathan Sherbino, Stephen A Hill, Guillaume Pare, Matthew McQueen, Shamir R Mehta, P J Devereaux, Andrew Worster, Peter Kavsak
BACKGROUND: We have previously demonstrated the utility of a rule-in/rule-out strategy for myocardial infarction (MI) using glycemic biomarkers in combination with cardiac troponin in the emergency department (ED). Given that the cost of assessing patients with possible MI in the ED is increasing, we sought to compare the health services cost of our previously identified early rule-in/rule-out approaches for MI among patients who present to the ED with symptoms suggestive of acute coronary syndrome (ACS)...
November 3, 2016: Clinical Chemistry
https://www.readbyqxmd.com/read/27792657/predictors-of-cardiac-rehabilitation-utilization-in-england-results-from-the-national-audit
#18
Jennifer Sumner, Sherry L Grace, Patrick Doherty
BACKGROUND: Cardiac rehabilitation (CR) is grossly underused, with major inequities in access. However, use of CR and predictors of initiation in England where CR contracting is available is unknown. The aims were (1) to investigate CR utilization rates in England, and (2) to determine sociodemographic and clinical factors associated with CR initiation including social deprivation. METHODS AND RESULTS: Data from the National Audit of CR, between January 2012 and November 2015, were used...
October 21, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27778531/basic-mechanisms-of-platelet-receptor-shedding
#19
Robert K Andrews, Elizabeth E Gardiner
Proteolytic shedding of the extracellular ectodomain of platelet receptors provides a key mechanism for irreversible loss of ligand-binding capacity, and for regulating platelet function in health and disease. Platelets derived from megakaryocytes are small anucleate cells in peripheral blood, with the ability to rapidly adhere, become activated, and secrete an array of procoagulant and proinflammatory factors at sites of vascular injury or disease, and to form a platelet aggregate (thrombus) which is not only critical in normal hemostasis and wound healing, but in atherothrombotic diseases including myocardial infarction and ischemic stroke...
October 25, 2016: Platelets
https://www.readbyqxmd.com/read/27765481/cost-analysis-of-the-history-ecg-age-risk-factors-and-initial-troponin-heart-pathway-randomized-control-trial
#20
Robert F Riley, Chadwick D Miller, Gregory B Russell, Erin N Harper, Brian C Hiestand, James W Hoekstra, Cedric W Lefebvre, Bret A Nicks, David M Cline, Kim L Askew, Simon A Mahler
INTRODUCTION: The HEART Pathway is a diagnostic protocol designed to identify low-risk patients presenting to the emergency department with chest pain that are safe for early discharge. This protocol has been shown to significantly decrease health care resource utilization compared with usual care. However, the impact of the HEART Pathway on the cost of care has yet to be reported. METHODS AND RESULTS: We performed a cost analysis of patients enrolled in the HEART Pathway trial, which randomized participants to either usual care or the HEART Pathway protocol...
January 2017: American Journal of Emergency Medicine
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