Key Points
Question
What is the real-world effectiveness of a 12-month community-based physical activity (PA) coaching intervention on reducing all-cause acute care use and death in patients with a history of a chronic obstructive pulmonary disease (COPD) exacerbation?
Findings
In this multisite, randomized clinical trial that included a population-based sample of 2707 patients with COPD, 321 of 1358 patients participated in the PA coaching intervention and increased PA significantly, but there were no significant differences in the all-cause primary outcome (compostite measure of all-cause hospitalizations, observation stays, emergency department visits, and death) at 12 months.
Meaning
Most patients with a COPD exacerbation did not engage in PA, and the limited PA did not lead to significant benefit in 12-month health care use.
Objective: We sought to identify subgroups of "low-risk" HEART score patients (history, ECG, age, risk factors, and troponin) at elevated risk of acute myocardial infarction or death within 30 days. Methods: We performed a secondary analysis of prospective emergency department (ED) encounters for suspected acute coronary syndrome in a large health system with low-risk HEART scores (0-5 points). Logistic regression using the 5 components of the HEART score analyzed the increase risk attributable to points from each of the 5 score components. Results: Of 30,971 encounters among 28,992 unique patients, 135 (0.44%, 95% confidence interval [CI] = 0.37-0.51) experienced acute myocardial infarction or death.
Background
The objective of this study was to evaluate the effect of changing the laboratory‐reported D‐dimer reference intervals to age‐adjusted reference intervals on the use of advanced chest imaging and 30‐day adverse events among emergency department (ED) encounters.
Methods
A retrospective interrupted time‐series analysis of ED encounters for patients > 50 years evaluated for suspected pulmonary embolism (PE) from April 2014 to April 2016. The primary outcome was use of advanced diagnostic imaging, and the secondary outcome was 30‐day mortality or PE diagnosis. Secondary analyses also quantified delayed PE diagnoses pre‐ and postintervention. A generalized estimating equation segmented logistic regression model, adjusting for patient and facility characteristics, was used to determine changes in odds of diagnostic imaging and 30‐day mortality or PE diagnoses.
Results
A total of 10,534 (5,153 pre‐ and 5,381 postimplementation) ED encounters were included. Advanced imaging was obtained in 35.9% of pre‐ versus 33% of postimplementation encounters. Age‐adjusted D‐dimer (AADD) showed a small and nonsignificant decrease in month‐to‐month trends of advanced chest imaging postimplementation (odds ratio [OR] = 0.98, 95% confidence interval [CI] = 0.96 to 1.00). Use of advanced imaging in patients with D‐dimer values lower than 500 ng/mL fibrinogen‐equivalent units (FEU) was similar in the preintervention (5.8%) and postintervention (6.8%) periods. However, imaging was obtained in 30% of patients postintervention with a D‐dimer result less than AADD reference interval , but more than the historical 500 ng/mL FEU reference interval. Implementing an AADD threshold demonstrated no change in the rate of 30‐day adverse events (missed PE or mortality).
Conclusion
Changing the laboratory‐reported D‐dimer reference intervals for evaluation of PE was not associated with reduction in advanced chest imaging and did not increase 30‐day adverse events. However, there was substantial noncompliance with the age‐adjusted reference intervals in the postintervention period likely blunting the impact of this intervention.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.