Use of Continuous Quality Improvement to Increase Use of Process Measures in Patients Undergoing Coronary Artery Bypass Graft Surgery

Ferguson, T. Bruce; Peterson, Eric D.; Coombs, Laura P.; Eiken, M; Carey, Meghan L.; Grover, Frederick L.; DeLong, Elizabeth R.

doi:10.1001/jama.290.1.49

Cited by 171 publications

(21 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Systems will then be needed to capture relevant outcomes from EMRs and other clinical systems and settings, and to analyze and interpret the findings. Funding for these efforts will of course be needed, but to the degree that studies can be embedded in ongoing clinical care, costs of evidence generation may be significantly reduced [49–51]. …”

Section: Opportunities For International Collaborationmentioning

confidence: 99%

Global implementation of genomic medicine: We are not alone

et al. 2015

View full text Add to dashboard Cite

Advances in high-throughput genomic technologies coupled with a growing number of genomic results potentially useful in clinical care have led to ground-breaking genomic medicine implementation programs in various nations. Many of these innovative programs capitalize on unique local capabilities arising from the structure of their health care systems or their cultural or political milieu, as well as from unusual burdens of disease or risk alleles. Many such programs are being conducted in relative isolation and might benefit from sharing of approaches and lessons learned in other nations. The National Human Genome Research Institute recently brought together 25 of these groups from around the world to describe and compare projects, examine the current state of implementation and desired near-term capabilities, and identify opportunities for collaboration to promote the responsible implementation of genomic medicine. The wide variety of nascent programs in diverse settings demonstrates that implementation of genomic medicine is expanding globally in varied and highly innovative ways. Opportunities for collaboration abound in the areas of evidence generation, health information technology, education, workforce development, pharmacogenomics, and policy and regulatory issues. Several international organizations that are already facilitating effective research collaborations should engage to ensure implementation proceeds collaboratively without potentially wasteful duplication. Efforts to coalesce these groups around concrete but compelling signature projects, such as global eradication of genetically-mediated drug reactions or developing a truly global genomic variant data resource across a wide number of ethnicities, would accelerate appropriate implementation of genomics to improve clinical care world-wide.

show abstract

Section: Opportunities For International Collaborationmentioning

confidence: 99%

Global implementation of genomic medicine: We are not alone

et al. 2015

View full text Add to dashboard Cite

show abstract

“…1 However, despite major advances in surgical techniques, intraoperative adjuncts, and perioperative care, vein grafts continue to have high failure rates. 2,3 In fact, per-graft occlusion rates are estimated to be up to 25% during the first 12 to 18 months after surgery. 4–6 Although prior studies have identified patient- and graft-specific variables that are associated with graft patency, 4–7 little is known about the relationship between vein graft failure and subsequent clinical outcomes.…”

mentioning

confidence: 99%

Relationship Between Vein Graft Failure and Subsequent Clinical Outcomes After Coronary Artery Bypass Surgery

et al. 2012

Self Cite

View full text Add to dashboard Cite

Background Vein graft failure (VGF) is common after coronary artery bypass graft surgery, but its relationship with long-term clinical outcomes is unknown. In this retrospective analysis, we examined the relationship between VGF, assessed by coronary angiography 12 to 18 months after coronary artery bypass graft surgery, and subsequent clinical outcomes. Methods and Results Using the Project of Ex Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) trial database, we studied data from 1829 patients who underwent coronary artery bypass graft surgery and had an angiogram performed up to 18 months after surgery. The main outcome measure was death, myocardial infarction, and repeat revascularization through 4 years after angiography. VGF occurred in 787 of 1829 patients (43%). Clinical follow-up was completed in 97% of patients with angiographic follow-up. The composite of death, myocardial infarction, or revascularization occurred more frequently among patients who had any VGF compared with those who had none (adjusted hazard ratio, 1.58; 95% confidence interval, 1.21–2.06; P=0.008). This was due mainly to more frequent revascularization with no differences in death (adjusted hazard ratio, 1.04; 95% confidence interval, 0.71–1.52; P=0.85) or death or myocardial infarction (adjusted hazard ratio, 1.08; 95% confidence interval, 0.77–1.53; P=0.65). Conclusions VGF is common after coronary artery bypass graft surgery and is associated with repeat revascularization but not with death and/or myocardial infarction. Further investigations are needed to evaluate therapies and strategies for decreasing VGF to improve outcomes in patients undergoing coronary artery bypass graft surgery.

show abstract

“…LDL levels <100mg/dl). Thus, further research is needed into how to improve the medical management of patients following CABG surgery [25, 26]. …”

Section: Discussionmentioning

confidence: 99%

Edifoligide and long-term outcomes after coronary artery bypass grafting: PRoject of Ex-vivo Vein graft ENgineering via Transfection IV (PREVENT IV) 5-year results

Lópes

Williams

Mehta

et al. 2012

American Heart Journal

Self Cite

View full text Add to dashboard Cite

Background Edifoligide, an E2F transcription factor decoy, does not prevent vein graft failure or adverse clinical outcomes at 1-year in patients undergoing coronary artery bypass grafting (CABG). We compared the 5-year clinical outcomes of patients in PREVENT IV treated with edifoligide and placebo and to identify predictors of long-term clinical outcomes. Methods A total of 3014 patients undergoing CABG with at least 2 planned vein grafts were enrolled. Kaplan-Meier curves were generated to compare the long-term effects of edifoligide and placebo. A Cox proportional hazards model was constructed to identify factors associated with 5-year post-CABG outcomes. The main outcome measure was death, myocardial infarction (MI), repeat revascularization, and rehospitalization through 5 years. Results Five-year follow-up was complete in 2865 (95.1%) patients. At 5 years, patients randomized to edifoligide and placebo had similar rates of death (11.7% and 10.7%), MI (2.3% and 3.2%), revascularization (14.1% and 13.9%), and rehospitalization (61.6% and 62.5%). The 5-year composite outcome of death, MI, or revascularization occurred at similar frequency in patients assigned to edifoligide and placebo (26.3% and 25.5%; hazard ratio 1.03 [95% confidence interval 0.89–1.18]; P=0.721). Factors associated with death, MI, or revascularization at 5 years included diabetes, sex, worst graft quality, peri-index CABG MI, and ejection fraction. Conclusions Up to a quarter of patients undergoing CABG will have a major cardiac event or repeat revascularization procedure within 5 years of surgery. Edifoligide does not affect outcomes following CABG; however, common identifiable baseline and procedural risk factors are associated with long-term outcomes following CABG.

show abstract

Use of Continuous Quality Improvement to Increase Use of Process Measures in Patients Undergoing Coronary Artery Bypass Graft Surgery

Cited by 171 publications

References 56 publications

Global implementation of genomic medicine: We are not alone

Global implementation of genomic medicine: We are not alone

Relationship Between Vein Graft Failure and Subsequent Clinical Outcomes After Coronary Artery Bypass Surgery

Edifoligide and long-term outcomes after coronary artery bypass grafting: PRoject of Ex-vivo Vein graft ENgineering via Transfection IV (PREVENT IV) 5-year results

Contact Info

Product

Resources

About