BackgroundElderly patients undergoing transcatheter aortic valve replacement (TAVR) are at risk of hospital readmission postprocedure. It is not known whether the index hospital length of stay and, specifically, early discharge post‐TAVR is associated with an increased risk of readmission. We hypothesized a nonlinear relationship whereby both short and long lengths of stay were associated with increased readmission risk.Methods and ResultsWe performed a retrospective multicenter cohort analysis of patients undergoing elective transfemoral TAVR and surviving to discharge between January 2007 and March 2014. The exposure variable was hospital length of stay measured from the procedure date to the date of discharge and modeled as a continuous variable in a multivariable cause‐specific Cox regression. Main outcome measures were 30‐day and 1‐year all‐cause readmissions. The study population consisted of 709 patients with a median length of stay of 6 days (interquartile range, 4–8). At 30‐days and 1‐year, 13.5% and 44.0% of patients were readmitted, respectively. Although post‐TAVR length of stay was not associated with 30‐day all‐cause readmissions (P=0.925), there existed a significant association with 1‐year readmission (P=0.010) after adjustment for baseline clinical variables. The association between post‐TAVR length of stay and 1‐year readmission was linear (P=0.549 for nonlinearity) with no evidence supporting an increased readmission risk for shorter length of stays.ConclusionsAmong elderly survivors of elective transfemoral TAVR, a short postprocedural length of stay was not associated with an increased risk readmission within 30 days or 1 year. However, the risk of 1‐year readmission increased with longer post‐TAVR lengths of stay.
Background-Little is known about variations in the quality of ambulatory care between urban and rural communities for patients with stable ischemic heart disease. The objectives of this study were to understand the effect of rurality on variations of ambulatory processes of care and outcomes for patients with stable ischemic heart disease. Methods and Results-A population-based cohort study was conducted, which included all Ontario patients with stable ischemic heart disease confirmed on cardiac catheterization between October 1, 2008, and September 30, 2011. Patients were categorized as rural or urban based on the Rurality Index for Ontario score. Ambulatory processes of care of interest were diagnostic testing, medication usage, and access to general/speciality physicians over a 1-year time-horizon. Primary outcome was 1-year mortality. Conclusions-Despite variation in ambulatory processes of care between urban and rural patients with stable ischemic heart disease, there were no outcome differences. (Circ Cardiovasc Qual Outcomes. 2014;7:835-843.)Key Words: ambulatory care ◼ coronary artery disease ◼ health services research ◼ quality improvement ◼ rural
Six New Andrographolide Metabolites in Rats. -Among the six metabolites the three sulfate esters (I) and (II) are new compounds. -(HE, X.; LI, J.; GAO, H.; QUI, F.; CUI, X.; YAO*, X.; Chem.
BackgroundThere is a paucity of data on the need for optimal medical therapy (OMT) in nonobstructive coronary artery disease . We sought to understand if there was variation in the use of OMT between hospitals for patients with nonobstructive coronary artery disease, the factors associated with such variation, and its clinical consequences.Methods and ResultsUsing a population‐level clinical registry in Ontario, Canada, we identified all patients >66 years undergoing coronary angiography for the indication of stable angina, who had nonobstructive coronary artery disease between November 1, 2010, and October 31, 2013. Hierarchical multivariable logistic models were developed to identify the factors associated with OMT use, with median odds ratio used to quantify the degree of variation between hospitals not explained by the modeled risk factors. Clinical outcomes of interest were all‐cause mortality and rehospitalization, with follow‐up until March 31, 2015. Our cohort consisted of 5413 patients, of whom 2554 (47.2%) were receiving OMT within 1 year. There was a 2‐fold variation in OMT across hospitals (30.4%–61.8%). The variation between hospitals was fully explained by preangiography medication use (median odds ratio of 1.21 in the null model and 1.03 in the full model). There was no difference in risk‐adjusted mortality (hazard ratio, 0.94; 95% confidence interval, 0.76–1.16); however, patients receiving OMT had a lower risk of all‐cause hospital readmission (hazard ratio, 0.89; 95% confidence interval, 0.84–0.95).ConclusionsThere is wide variation in the use of OMT in patients with nonobstructive coronary artery disease, the major driver of which is differences in baseline medication use.
CSBC is positioned to help medical professionals and participating hospitals implement effective and continuous quality improvement processes. This report provides a contemporary snapshot of invasive cardiovascular procedures as performed in BC including their current baseline characteristics and outcomes. METHODS: This report includes 59,823 patients undergoing only diagnostic cardiac catheterization (DxCath), 36,746 undergoing percutaneous coronary intervention (PCI), and 9,466 undergoing Isolated CABG (CABG) for indications of ACS/Stable Angina in the year 2009 -2013. RESULTS: Figure 1 shows the trends for all invasive cardiovascular procedures performed in BC in last 19 years. 75.3% of the patients undergoing DxCath were diagnosed as obstructive coronary artery disease. 56.2% of them received PCI within 90 days, 17.0% received CABG within 6 months. Ad hoc PCI was performed during the same laboratory session as the DxCath in 90.9% of the PCI records. Multi-vessel coronary disease was more likely to receive CABG than PCI (26.2% vs. 45.1%) when compared to single-vessel coronary disease (3.4% vs. 72.5%).81.6% of those undergoing CABG were male, whereas 74.7% of PCI, 64.4% of diagnostic study were male. Median age and the age distribution were similar for the DxCath and PCI groups, with approximately 40% of the patients being 65 years of age or older and approximately 14% of the patients being 80 years of age or older. More than half of those undergoing CABG were older than 65 years of age, with 8.5% being octogenarian or older. Almost 69% of DxCath, 71% of PCI, and 74% of CABG patients were overweight (BMI 25); 60% of DxCath and PCI, 86% of CABG patients had dyslipidemia; and 14% of DxCath, 20% of PCI, and 16% of CABG patients were current or recent smokers. Approximately two-thirds of DxCaths or PCIs, 85% of CABGs were hypertension patients. Among patients undergoing CABG, the percentage of diabetes, peripheral vascular disease, and cerebrovascular disease were higher when compared to the DxCath and PCI groups. 30day unadjusted mortality in DxCath, PCI, and CABG patients was 1.7%, 2.1%, and 1.5%, respectively, in this sample. CONCLUSION: Data from the CSBC Registry provides a contemporary view of the current practice of invasive cardiovascular procedures in BC. BACKGROUND: Previous research on variations of cardiovascular care between urban and rural communities has mainly focused on in-hospital care. Little is known about variations in ambulatory care between urban and rural communities for patients with known coronary artery disease (CAD). The objectives of this study were to understand the impact of rurality on variations of ambulatory processes of care for patients with CAD, and if those variations impact cardiovascular outcomes and the utilization of health services. METHODS: We conducted a retrospective cohort study that incorporated multiple linked health care administrative databases. We evaluated a cohort of Ontario patients who were identified with CAD by cardiac catheterization between Oct. 1, 2008 a...
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