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Journal Cover   European Heart Journal - Quality of Care and Clinical Outcomes
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   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 2058-5225 - ISSN (Online) 2058-1742
   Published by Oxford University Press Homepage  [368 journals]
  • Ischaemic heart disease in China: the time to address rising mortality
    • Authors: Downing NS; Li J.
      Abstract: This editorial refers to ‘Increasing mortality from ischemic heart disease in China from 2004-2010: disproportionate rise in rural areas and elderly subjects’, by X. Zhang et al., on page 47.
      PubDate: 2016-12-27
  • Timing of coronary angioplasty in patients with non-ST-segment elevation
           acute coronary syndromes
    • Authors: Joseph JP; Redwood SR.
      Abstract: This editorial refers to ‘Timing of percutaneous coronary intervention in patients with non-ST-elevation myocardial infarction: a SWEDEHEART study’, by Lindholm et al. doi:10.1093/ehjqcco/qcw044‘Never leave that till tomorrow which you can do today.’―Benjamin Franklin (1706–1790)More than three decades ago, while the first reports of using percutaneous coronary intervention (PCI) to treat evolving acute myocardial infarction (MI) were emerging, an invasive approach for patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) was only considered after a ‘cooling-off’ period.1 This delay of days to weeks following admission was adopted due to the higher procedural risks associated with PCI at the time and a paucity of effective anti-thrombotic therapies. During this prolonged ‘cooling-off’ period, patients were exposed to a risk of reinfarction or cardiac instability requiring emergent percutaneous or surgical revascularization.2
      PubDate: 2016-12-26
  • Why report outcomes when process measures will suffice'
    • Authors: Bebb O; Hall M, Gale CP.
      Abstract: This editorial refers to ‘The Contribution of the Composite of Clinical Process Indicators as a Measure of Hospital Performance in the Management of Acute Coronary Syndromes-insights from the CONCORDANCE Registry ’, by B. Aliprandi-Costa et al., on page 37.
      PubDate: 2016-10-15
  • Relationship of depression screening in cardiometabolic disease with
           vascular events and mortality: findings from a large primary care cohort
           with 4 years follow-up
    • Authors: Jani B; Boachie C, McCowan C, et al.
      Abstract: AimsBenefits of routine depression screening for cardiometabolic disease patients remain unclear. We examined the association between depression screening and all-cause mortality and vascular events in cardiometabolic disease patients.Methods and results125 143 patients with cardiometabolic diseases (coronary heart disease, diabetes or previous stroke) in the UK participated in primary care chronic disease management in 2008/09, which included depression screening using the Hospital Anxiety and Depression Score. 10 670 receiving depression treatment exempted, 35 537 screened, while 78 936 not screened. We studied all-cause mortality and vascular events at 4 years, by electronic data linkage of 124 414 patients (99.4%) on primary care registers to hospital discharge and mortality records and used Cox proportional hazards on matched data using propensity score. Mean age for the screened and not screened population was 69 years (standard deviation—SD 11.9) and 67 years (SD 14.3), respectively; 58% (20 658) of the screened population were men and 65.3% (22 726) were socioeconomically deprived, compared with 54.2% (42 727) and 67.4% (51 686), respectively, in the not screened population. The screened population had lower all-cause mortality (Hazard Ratio—HR 0.89) and vascular events (HR 0.85) in the matched data of N = 21 893 patients each in the screened and the unscreened groups.ConclusionDepression screening was associated with a reduction in all-cause mortality and vascular events in patients with cardiometabolic diseases. The uptake of screening was poor for unknown reasons. Reverse causality and confounding by disease severity and quality of care are important possible limitations. Further research to determine reproducibility and explore underlying mechanisms is merited.
      PubDate: 2016-10-06
  • Increasing mortality from ischaemic heart disease in China from 2004 to
           2010: disproportionate rise in rural areas and elderly subjects. 438
           million person-years follow-up
    • Authors: Zhang X; Khan AA, Haq E, et al.
      Abstract: AimsWe sought to ascertain the changes in mortality from ischaemic heart disease (IHD) from 2004 to 2010 in China as the sheer size of China's population makes disease patterns relevant globally.Methods and resultsData on IHD mortality were obtained from the Chinese Centre for Disease Control and Prevention National Disease Surveillance Point System, which includes 161 counties and a population of over 73 million—a representative sample of over 6% of the entire population of China. Both crude and World Health Organization (WHO)-standardized IHD mortality increased, in both men and women and in both urban and rural locations, during the study period, demonstrating the effect of urbanization, economic growth, and epidemiological transition on cardiovascular health. WHO-standardized IHD mortality increased for rural males by 9.2% per year (95% CI: 6.7–11.7%; P < 0.0001), and the trend was statistically significantly higher (P = 0.0001) than in urban males by 6.4% per year (95% CI: 3–10%; P = 0.02). WHO-standardized IHD mortality rate increased for rural females by 7.0% per year (95% CI: 4.6–9.4%; P < 0.0001); this was statistically significantly higher than urban females by 4.3% per year (95% CI: 1–8%; P = 0.02). The age group over 80 years showed the greatest increase in IHD mortality.ConclusionsMortality from IHD is increasing in China, in contrast to decreasing in other countries. This is largely driven by increasing IHD mortality in rural areas and subjects over 80 years old. This needs urgent attention by public health workers and policymakers.
      PubDate: 2016-10-05
  • Timing of percutaneous coronary intervention in patients with
           non-ST-elevation myocardial infarction: a SWEDEHEART study
    • Authors: Lindholm D; Alfredsson J, Angerås O, et al.
      Abstract: AimsAlthough routine invasive management is recommended in NSTEMI patients, the optimal timing of the procedure is not defined. The aim of this study was to assess outcomes in relation to timing of PCI in NSTEMI patients.Methods and resultsThis was an observational, prospective, multicentre cohort study from the SWEDEHEART registry including all Swedish PCI centres. We included 40 494 consecutive PCI-treated patients who were admitted to any coronary care unit from 2006 to 2013. The primary outcome was all-cause death, and secondary outcomes were recurrent myocardial infarction (MI), stent thrombosis, and severe in-hospital bleeding. Outcomes were assessed within 1 year from admission in relation to pre-specified cut-offs to define early PCI: within 1, 2, or 3 days. Patients who received delayed PCI, compared with those who did not, were older, and had a higher prevalence of comorbidities (hypertension, hyperlipidaemia, diabetes, and prior stroke) but showed similar angiographic findings. Cox mixed-effects models showed a lower risk of all-cause death with early PCI across all three cut-offs: HR (95% CI) of 0.88 (0.80–0.98), 0.78 (0.71–0.86), and 0.75 (0.68–0.84), for the 1-, 2-, and 3-day cut-offs, respectively. Early PCI was associated with lower risk of recurrent MI for the 2- and 3-day cut-offs, but not for the 1-day cut-off. The reported rates of severe in-hospital bleeding were low, but tended to be higher in patients receiving delayed PCI.ConclusionIn patients undergoing PCI for NSTEMI, early invasive treatment is associated with lower risk of ischaemic outcomes.
      PubDate: 2016-08-28
  • Alcohol, hypertension, and heart failure with preserved (or normal)
           ejection fraction
    • Authors: Sanderson JE.
      PubDate: 2016-08-18
  • Outcomes differ by first documented rhythm after witnessed out-of-hospital
           cardiac arrest in children: an observational study with prospective
           nationwide population-based cohort database in Japan
    • Authors: Hara M; Hayashi K, Kitamura T.
      Abstract: AimsTo evaluate and compare outcomes and impacts of delay of time to cardiopulmonary resuscitation (CPR) by type of first documented rhythm in paediatric patients with out-of-hospital cardiac arrest (OHCA).Methods and resultsWe enrolled 3968 paediatric (aged
      PubDate: 2016-08-11
  • Scientific, societal, and economic consequences of releasing interim data
           from clinical trials
    • Authors: Sharma A; Bigelow RH, Pencina MJ.
      PubDate: 2016-07-01
  • Measuring the quality of perioperative care in cardiac surgery
    • Authors: Coulson TG; Mullany DV, Reid CM, et al.
      Abstract: Quality of care is of increasing importance in health and surgical care. In order to maintain and improve quality, we must be able to measure it and identify variation. In this narrative review, we aim to identify measures used in the assessment of quality of care in cardiac surgery and to evaluate their utility. The electronic databases Pubmed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, and CINAHL were searched for original published studies using the terms ‘cardiac surgery’ and ‘quality or outcome or process or structure’ as either keywords in the title or text or MeSH terms. Secondary searches and identification of references from original articles were carried out. We found a total of 54 original articles evaluating measurements of quality. While structure, process, and outcome indicators remain the mainstay of quality measurement, new and innovative methods of risk assessment have improved reliability and discrimination. Continuous assessment provides a promising method of both maintaining and improving quality of care. Future studies should focus on long-term and patient-centred outcomes, such as quality-of-life measures.
      PubDate: 2016-05-19
  • Long-term clinical outcomes, health-related quality of life, and costs in
           different treatment modalities of stable coronary artery disease
    • Authors: Stenvall H; Tierala I, Räsänen P, et al.
      Abstract: AimsThis study is a prospective, observational 8-year follow-up of 300 stable unselected coronary artery disease patients entering elective coronary angiography in 2002–03. Recorded were clinical outcomes, health-related quality of life (HRQoL), and secondary care costs after coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI), or medical therapy (MT).Methods and resultsHRQoL was measured by the 15D instrument at baseline, 6 months, and 8 years. Regression techniques with an adjustment for relevant baseline characteristics were used to compare the 8-year survival and change in HRQoL between the groups. At baseline, all groups had statistically significantly impaired HRQoL compared with age- and gender-standardized general population. Six months after invasive interventions the mean HRQoL score had improved in a statistically significant and clinically important manner. This improvement was maintained at 8 years as the HRQoL no longer differed from that of the general population, whereas MT patients were still worse off. However, after adjustment for baseline characteristics, the groups no longer differed regarding 8-year survival or change in HRQoL among survivors. Mean 8-year secondary care costs were without (with) adjustment for baseline characteristics: €17 498 (16 730) for CABG, €7245 (6920) for PCI, and €4514 (4580) for MT, respectively.ConclusionWhen adjusted for baseline characteristics, no statistically significant differences were found between the patient groups in 8-year survival or change in HRQoL among survivors. The 8-year mean secondary care costs of CABG were over two-fold and almost four-fold, even after adjustment for baseline characteristics, compared with those of PCI and MT.
      PubDate: 2016-05-11
  • The contribution of the composite of clinical process indicators as a
           measure of hospital performance in the management of acute coronary
           syndromes—insights from the CONCORDANCE registry
    • Authors: Aliprandi-Costa B; Sockler J, Kritharides L, et al.
      Abstract: AimsAcute coronary syndrome (ACS) is a costly condition for health service provision yet variation in the delivery of care between hospitals persists. A composite measure of adherence with evidence-based clinical-process indicators (CPIs) could better inform hospital performance reporting and clinical outcomes in the management of ACS.MethodsData on 7444 ACS patients from 39 Australian hospitals were used to derive a hospital-specific composite quality score by calculating mean adherence to 14 evidence-based CPIs. Using the generalized estimating equation to account for clustering of patients within hospitals and the GRACE risk score to adjust for differences in presenting risk, we evaluated associations between the hospital-specific composite quality score, in-hospital major adverse events, in-hospital mortality and mortality and readmission for ACS at 6 months.ResultsHospitals had a mean adherence of 68.3% (SD 21.7) with the composite quality score. There was significant variation between hospital adherence tertile 1 (79%) and tertile 3 (56%), P < 0.0001. With risk adjustment, there was an association between hospitals with a higher composite quality score and reduced in-hospital adverse events (OR: 0.85, CI: 0.71–0.99) and survival at hospital discharge (OR: 0.47; 95% CI: 0.28–0.77). There was trending improvement in survival at 6 months (OR 0.48; CI: 0.20–1.16) and fewer readmissions to hospital for ACS at 6 months (OR 0.79; CI 0.60–1.05).ConclusionThe association between the quality composite score and reduced in-hospital events and survival at hospital discharge supports the utility of reporting CPIs in routine hospital performance reporting on the management of ACS.Australia and New Zealand Clinical Trial Registration (ANZCTR)CONCORDANCE Registry ACTRN12614000887673.
      PubDate: 2016-05-10
  • Impact of co-morbid burden on mortality in patients with coronary heart
           disease, heart failure, and cerebrovascular accident: a systematic review
           and meta-analysis
    • Authors: Rashid M; Kwok C, Gale CP, et al.
      Abstract: AimsWe sought to investigate the prognostic impact of co-morbid burden as defined by the Charlson Co-morbidity Index (CCI) in patients with a range of prevalent cardiovascular diseases.Methods and resultsWe searched MEDLINE and EMBASE to identify studies that evaluated the impact of CCI on mortality in patients with cardiovascular disease. A random-effects meta-analysis was undertaken to evaluate the impact of CCI on mortality in patients with coronary heart disease (CHD), heart failure (HF), and cerebrovascular accident (CVA). A total of 11 studies of acute coronary syndrome (ACS), 2 stable coronary disease, 5 percutaneous coronary intervention (PCI), 13 HF, and 4 CVA met the inclusion criteria. An increase in CCI score per point was significantly associated with a greater risk of mortality in patients with ACS [pooled relative risk ratio (RR) 1.33; 95% CI 1.15–1.54], PCI (RR 1.21; 95% CI 1.12–1.31), stable coronary artery disease (RR 1.38; 95% CI 1.29–1.48), and HF (RR 1.21; 95% CI 1.13–1.29), but not CVA. A CCI score of >2 significantly increased the risk of mortality in ACS (RR 2.52; 95% CI 1.58–4.04), PCI (RR 3.36; 95% CI 2.14–5.29), HF (RR 1.76; 95% CI 1.65–1.87), and CVA (RR 3.80; 95% CI 1.20–12.01).ConclusionIncreasing co-morbid burden as defined by CCI is associated with a significant increase in risk of mortality in patients with underlying CHD, HF, and CVA. CCI provides a simple way of predicting adverse outcomes in patients with cardiovascular disease and should be incorporated into decision-making processes when counselling patients.
      PubDate: 2016-05-10
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Heriot-Watt University
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