1,721,050 research outputs found
Critical appraisal of multivariable prognostic scores in heart failure: Development, validation and clinical utility
No full textOptimal management of heart failure requires accurate risk assessment. Many prognostic risk models have been proposed for patient with chronic and acute heart failure. Methodological critical issues are the data source, the outcome of interest, the choice of variables entering the model, the validation of the model in external population. Up to now, the proposed risk models can be a useful tool to help physician in the clinical decision-making. The availability of big data and of new methods of analysis may lead to developing new models in the future
Transient myocardial ischemia in patients with chronic angina: relation to heart rate changes and variability in exercise threshold. BAY r 1999 in Chronic Angina Study Group.
No full textEarly mortality following percutaneous coronary intervention and cardiac surgery: Correlations within providers and operators
No full textMeasures of hospital competition and their impact on early mortality for congestive heart failure, acute myocardial infarction and cardiac surgery
No full textObjective: To measure competition amongst providers and to examine whether a correlation exists with hospitals mortality for congestive heart failure (CHF), acute myocardial infarction (AMI), isolated-coronary artery bypass graft (CABG) or valve surgery. Design: Cross-sectional study based on publically available data from the National Outcome Evaluation Program (Edition 2016) of the Italian Agency for Regional Health Services. Setting and participants: Patients discharged during 2015 for CHF or AMI, and between 2014 and 2015 for cardiac surgery (respectively, from 662, 395 and 91 hospitals). Main outcome measures: Risk-adjusted mortality rates at 30 days and measures of hospital competition for areas centred on hospital' location (fixed-radius 50-150 km, variable-radius to capture 10-30 hospitals and 6-10% of national volume). Competition was estimated as number of providers and Herfindahl-Hirschman Index (HHI). Results: Indicators of competitions varied by condition and were sensitive to method used for the area definition. Hospital mortality after AMI and valve surgery increased with competition in areas identified by the variable-radius method (higher rates for a greater number of hospitals or lower HHIs). In area with fixed radius of 100-150 km, competition reduced mortality after CABG procedures (lower rates for a greater number of hospitals or smaller HHIs). Neither the number of hospitals nor HHI correlated with outcomes in CHF. Conclusions: The measures of hospital competition changed according to definition of local market and results in mortality correlations varied among conditions. Understanding the relationship between hospital competition and outcomes is important to identify strategies to improve quality of care
Intra-hospital correlations among 30-day mortality rates in 18 different clinical and surgical settings
No full textOBJECTIVE:
To examine whether a correlation exists in hospitals among 30-day mortality rates for different types of hospitalizations.
DESIGN:
Cross-sectional study of hospital care based on publically available Italian data from the National Outcome Evaluation Program Edition 2015 of the Italian Agency for Regional Health Services.
SETTING AND PARTICIPANTS:
Patients hospitalized with a diagnosis of congestive heart failure, acute myocardial infarction, chronic renal failure, chronic obstructive pulmonary disease exacerbation, femoral neck fracture, ischemic stroke and non-variceal upper gastrointestinal bleeding, or those who underwent isolated cardiac valve procedure, isolated coronary artery bypass graft surgery, non-ruptured abdominal aortic aneurysm repair and interventions for the following tumors: colon, kidney, brain, lung, stomach, rectal, liver or pancreatic cancer.
MAIN OUTCOME MEASURES:
Condition-specific 30-day crude and risk-adjusted mortality rates.
RESULTS:
A total of 808 280 admissions were reported from 844 institutions (median of 4 conditions evaluated per hospital; interquartile range 2-8). Volumes and outcome varied by clinical and surgical conditions across hospitals. Out of 153 pairs of different conditions, 41 were statistically significant in terms of concordance with crude mortality rates and 44 for their adjusted values. The hospital mean percentile rank for 30-day mortality, a composite measure that summarized the multiple indicators, increased significantly alongside number of conditions per hospital with a significant reduction of mortality when most of the studied conditions were treated in the same hospital.
CONCLUSIONS:
The variability in 30-day mortality rates at hospital level and the correlation between risk mortality rates suggest that there may be common hospital-wide factors influencing short-term mortality
Physical activity for coronary heart disease: cardioprotective mechanisms and effects on prognosis
No full textAbstract: A sedentary lifestyle is one of the five major risk factors for coronary heart disease (CHD) along with hypertension, abnormal values of blood lipids, smoking and obesity. After an acute myocardial infarction, risk factors continue to contribute synergically to the clinical progression and prognosis of CHD. Regular physical exercise has been shown to improve exercise capacity and quality of life, to reduce symptoms and to decrease the risk of new coronary events in patients with CHD. Regular physical activity with its favourable effects on coronary risk factors, endothelial dysfunction, inflammation, tendency to thrombosis, on autonomic tone and myocardial ischemia, may play a role in reducing the risk of new coronary events and death. In view of the clinical benefits yielded and its well-documented cardioprotective mechanisms, regular physical activity should be regarded, by general practitioners and cardiologists, as a true and effective form of therapy for patients with CHD
Predicting mortality in patients with acute heart failure: Role of risk scores
No full textAcute heart failure is a leading cause of hospitalization and death, and it is an increasing burden on health care systems. The correct risk stratification of patients could improve clinical outcome and resources allocation, avoiding the overtreatment of low-risk subjects or the early, inappropriate discharge of high-risk patients. Many clinical scores have been derived and validated for in-hospital and post-discharge survival; predictive models include demographic, clinical, hemodynamic and laboratory variables. Data sets are derived from public registries, clinical trials, and retrospective data. Most models show a good capacity to discriminate patients who reach major clinical end-points, with C-indices generally higher than 0.70, but their applicability in real-world populations has been seldom evaluated. No study has evaluated if the use of risk score-based stratification might improve patient outcome. Some variables (age, blood pressure, sodium concentration, renal function) recur in most scores and should always be considered when evaluating the risk of an individual patient hospitalized for acute heart failure. Future studies will evaluate the emerging role of plasma biomarkers
[Acute effects of propionyl-L-carnitine on anomalies of parietal kinetics of the left ventricle induced by atrial pacing in patients with ischemic heart disease. A bidimensional echocardiographic study]
No full textCombined use of high sensitivity C-reactive protein and N-terminal pro-B-type natriuretic peptide for risk stratification of vascular surgery patients.
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