Development and validation of the ontario acute myocardial infarction mortality prediction rules

Tu, Jack V.; Austin, Peter C.; Walld, Randy; Roos, Leslie L.; Agras, Jean; McDonald, Kathryn M

doi:10.1016/s0735-1097(01)01109-3

Cited by 272 publications

(248 citation statements)

References 9 publications

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“…The derivation and validation of this model has been described elsewhere. 17 The regression models incorporated a variable denoting the number of years since 1992, which allowed us to determine changes in the use of each medical therapy over time. We modified each model by incorporating an interaction between time and each physician and hospital characteristic.…”

Section: Discussionmentioning

confidence: 99%

Use of evidence-based therapies after discharge among elderly patients with acute myocardial infarction

Austin¹,

Tu²,

Ko³

et al. 2008

Canadian Medical Association Journal

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Section: Discussionmentioning

confidence: 99%

Use of evidence-based therapies after discharge among elderly patients with acute myocardial infarction

Austin¹,

Tu²,

Ko³

et al. 2008

Canadian Medical Association Journal

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“…Socioeconomic status was derived using ecological income measures (i.e., median neighborhood household income) from 1991 official Canadian census data. Measures of illness severity incorporated variables included in the Ontario AMI mortality prediction rule for 30-day and 1-year mortality (11,13). In addition to diabetes (with and without complications), clinical variables included the following: shock, congestive heart failure, pulmonary edema, cardiac arrhythmia, stroke, malignancy, acute renal failure, and chronic renal failure.…”

Section: Sources Of Datamentioning

confidence: 99%

“…In addition to diabetes (with and without complications), clinical variables included the following: shock, congestive heart failure, pulmonary edema, cardiac arrhythmia, stroke, malignancy, acute renal failure, and chronic renal failure. The clinical prediction rule has been validated against several population-based AMI cohorts illustrating good predictive accuracy (areas under the receiver operating curve of 0.77 in validation datasets) (13).…”

Section: Sources Of Datamentioning

confidence: 99%

Processes and Outcomes of Care for Diabetic Acute Myocardial Infarction Patients in Ontario

et al. 2003

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OBJECTIVE -To compare the health service utilization and long-term outcomes of acute myocardial infarction (AMI) patients with and without diabetes in Ontario.RESEARCH DESIGN AND METHODS -We examined 25,697 patients from Ontario (6,052 and 19,645 patients with and without diabetes, respectively) who were hospitalized because of AMI between 1 April 1992 and 31 December 1993. Using linked administrative databases, we determined the use of invasive cardiac procedures at 1 year as well as the intensity of specialty follow-up care and use of evidence-based pharmacotherapies (among elderly individuals) within the first 90 days of hospital discharge. Outcomes examined included mortality and recurrent cardiac admissions at 30 days and 5 years post AMI. Multivariable analyses adjusted for sociodemographic and case-mix characteristics, attending physician specialty, and admitting hospital characteristics.RESULTS -Despite being at significantly higher risk for death at baseline, diabetic patients were less likely to be followed-up by a cardiologist (22.2 vs. 25.6%, P Ͻ 0.001), to receive myocardial revascularization (12.6 vs. 14.9%, P Ͻ 0.001), to receive ␤-blockers (34.2 vs. 44.0%, P Ͻ 0.001), and to receive aspirin therapy (59.7 vs. 63.5%, P Ͻ 0.001) after AMI than their nondiabetic counterparts. Diabetes was an important independent predictor of 5-year morbidity (adjusted hazard ratio 1.52, 95% CI 1.45-1.59) and 5-year mortality outcomes (1.57, 1.50 -1.63). Variations in processes of care were marginally associated with higher nonfatal complication rates for diabetic patients.CONCLUSIONS -When managing AMI patients with diabetes in Ontario, physician treatment aggressiveness does not correspond appropriately to the baseline risk of patients. Diabetes Care 26:1427-1434, 2003T here are ϳ2 million people (6% of the total population) who are affected by diabetes in Canada (1). The impact of diabetes on the mortality of a population is significant. Researchers have estimated that at least 5.2% of cardiovascular adult deaths and 3.6% of all adult deaths in the U.S. are attributable to diabetes (2). The deleterious pathophysiologic effects of diabetes seem to operate both before and after an index ischemic cardiovascular event (3-5). Among patients with acute coronary syndromes, the increase in mortality risk associated with diabetes is of similar magnitude to that of previous myocardial infarction (5,6).Notwithstanding the importance of biological and clinical factors, acute myocardial infarction (AMI) outcome studies have demonstrated that the use of evidence-based pharmacotherapies and the intensity of specialty cardiac care after discharge from the index AMI may positively impact long-term outcomes (7). One might hypothesize that if physicians appropriately attune themselves to the risk profiles of their patients, then cardiovascular management strategies should be more intensive among diabetic patients, given that baseline risks are what drive the treatment-outcome benefits within a population (8). However, available evid...

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“…This current algorithm was utilized to develop predictive models for mortality within the Ontario population and has been further validated with the new ICD-10 coding. 120,121 Accuracy of this diagnosis when compared to the hospital chart was approximately 94%. 122 Other studies validating CIHI diagnostic codes for MI demonstrated a sensitivity of 89% and positive predictive value of 89%.…”

Section: Myocardial Infarctionmentioning

confidence: 94%

1308 Partial Nephrectomy for the Treatment of Renal Cell Carcinoma and the Risk of End Stage Renal Disease

Yap¹,

Alibhai²,

Tomlinson³

et al. 2013

Journal of Urology

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The surgical management of renal masses involves either radical nephrectomy (RN) or partial nephrectomy (PN). PN has been associated with better long-term renal function, and has also been linked to improved cardiac morbidity and overall survival. However, the relationship between treatment choice and definitive outcomes of chronic kidney disease (CKD) are lacking. Our aim was to examine whether PN is associated with a lower risk of end-stage renal disease (ESRD) requiring renal replacement therapy.We performed a population-based, retrospective cohort study with data from linked administrative databases in the province of Ontario, Canada. We included individuals with pathologically confirmed renal cell carcinoma (RCC) diagnosed between 1995 and 2010. Cox proportional hazards (PH) models, propensity score models, and competing risks models were used to assess the impact of treatment choice. PN compared to RN reduces the risk of ESRD requiring renal replacement therapy in a modern cohort of patients (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). PN is associated with a lower risk of new-onset CKD, lower risk of cardiac morbidity, and improved overall survival. We provide further evidence for the benefit of PN compared to RN, particularly related to definitive outcomes of renal failure.iii ACKNOWLEDGEMENTS

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Development and validation of the ontario acute myocardial infarction mortality prediction rules

Cited by 272 publications

References 9 publications

Use of evidence-based therapies after discharge among elderly patients with acute myocardial infarction

Use of evidence-based therapies after discharge among elderly patients with acute myocardial infarction

Processes and Outcomes of Care for Diabetic Acute Myocardial Infarction Patients in Ontario

1308 Partial Nephrectomy for the Treatment of Renal Cell Carcinoma and the Risk of End Stage Renal Disease

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