Quality of Care and Outcomes of Older Patients With Heart Failure Hospitalized in the United States and Canada

Ko, Dennis T.; Tu, Jack V.; Masoudi, Frederick A.; Wang, Yongfei; Havranek, Edward P.; Rathore, Saif S.; Newman, Alice; Donovan, Linda R.; Lee, Douglas S.; Foody, JoAnne M.; Krumholz, Harlan M.

doi:10.1001/archinte.165.21.2486

Cited by 66 publications

(34 citation statements)

References 42 publications

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“…17,18 Although Canadian data were used as opposed to data from the US, we have previously demonstrated similar patient demographics and co-morbidities among myocardial infarction and heart failure patients between these countries. [19][20][21] Furthermore, these data were unselected and population-based, which allowed an accurate estimation of gender-specific disease prevalence.…”

Section: Discussionmentioning

confidence: 99%

“…29,30 Other studies have also suggested hospitalized patients with myocardial infarction and heart failure have similar demographics, comorbidities, and outcomes in the US comparative studies. 19,20 Second, our results may be subject to publication bias because we only included trials published in the three most prominent medical journals. However, this search strategy has allowed us to draw conclusions from landmark cardiovascular clinical trials, which are the most likely to influence clinical practice.…”

Section: Discussionmentioning

confidence: 99%

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The Impact of Cardiovascular Disease Prevalence on Women's Enrollment in Landmark Randomized Cardiovascular Trials: A Systematic Review

et al. 2011

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Many studies have demonstrated that women are substantially underrepresented in cardiovascular trials, but few have considered that women develop cardiovascular disease at older ages than men. The extent to which observed gender enrollment inequalities persist after accounting for age-gender differences in disease prevalence is unknown. The purpose of the study was to compare observed rates of women participating in cardiovascular clinical trials with expected rates of female participation based on age-and gender-specific population disease prevalence. Publications between 1997 and 2009 in the three leading medical journals were included to calculate observed women's enrollment rates. Population-based data in Canada were used to determine the expected enrollment rates of women. Multicenter, randomized cardiovascular clinical trials that enrolled both men and women were analyzed. Two reviewers independently extracted data on women's enrollment and important clinical trial characteristics. The female enrollment rate was 30% in the included 325 trials, which ranged from 27% in trials of coronary artery disease, 27% in heart failure, 31% in arrhythmia, to 45% in primary prevention. Increased female enrollment correlated strongly with increasing age at recruitment in cardiovascular clinical trials (P< 0.001). After accounting for age-and gender-specific differences in disease prevalence, gaps in female enrollment were much lower than the expected enrollment rates estimated by 5% in coronary artery disease, 13% in heart failure, 9% in arrhythmia, and 3% in primary prevention. Only cardiovascular trials were evaluated in our study. Female underrepresentation in cardiovascular clinical trials is smaller than conventionally believed after accounting for age-and gender-specific population disease prevalence. Our findings suggest that greater representation of women in cardiovascular clinical trials can be achieved through the recruitment of older populations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Impact of Cardiovascular Disease Prevalence on Women's Enrollment in Landmark Randomized Cardiovascular Trials: A Systematic Review

et al. 2011

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“…21 Close to 20% of heart failure patients in our study had diabetes, compared with 32-34% of heart failure patients with diabetes reported in Canada and the United States. 17 Recent population-based studies have challenged the hypothesis that diabetes increases mortality from pneumonia. 11,16,22 We found that diabetes per se was associated with a slightly increased mortality but did not worsen outcomes among heart failure patients with pneumonia.…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of diabetes is very high among heart failure patients 17 , while hyperglycemia and diabetes have been associated with increased mortality from pneumonia. 18 We therefore conducted a separate interaction analysis by examining pneumonia mortality among patients with heart failure but not diabetes, patients with diabetes but not heart failure, and patients with joint exposure of heart failure and diabetes.…”

Section: Data On Potential Confounding Factorsmentioning

confidence: 99%

The Impact of Pre-existing Heart Failure on Pneumonia Prognosis: Population-based Cohort Study

et al. 2008

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“…Recurrence of heart failure is very frequent, estimated at 8.7% at 30 days, 14.1% at 90 days and up to 23.6% at one year (8). This readmission rate can be significantly reduced with appropriate follow-up, with the establishment of heart failure clinics proven to be effective in this setting.…”

Section: Burden On the Hospital Systemmentioning

confidence: 99%

Acute decompensated heart failure

Lepage

2008

Canadian Journal of Cardiology

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Quality of Care and Outcomes of Older Patients With Heart Failure Hospitalized in the United States and Canada

Abstract: Patients with heart failure who are hospitalized in the United States had lower short-term mortality at 30 days, but 1-year mortality rates were not significantly different between the United States and Canada.

Cited by 66 publications

References 42 publications

The Impact of Cardiovascular Disease Prevalence on Women's Enrollment in Landmark Randomized Cardiovascular Trials: A Systematic Review

The Impact of Cardiovascular Disease Prevalence on Women's Enrollment in Landmark Randomized Cardiovascular Trials: A Systematic Review

The Impact of Pre-existing Heart Failure on Pneumonia Prognosis: Population-based Cohort Study

Acute decompensated heart failure

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