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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  [370 journals]
  • Cardiovascular disease statistics from the European atlas: inequalities
           between high- and middle-income member countries of the ESC
    • Authors: Timmis A; Gale C, Flather M, et al.
      First page: 1
      Abstract: This editorial refers to ‘European Society of Cardiology: Cardiovascular Disease Statistics 2017’, by the Atlas Writing Group in Eur Heart J. 2017 Nov 27 [Epub ahead of print].
      PubDate: Tue, 21 Nov 2017 00:00:00 GMT
      DOI: 10.1093/ehjqcco/qcx045
  • Multimorbidity in heart failure patients
    • Authors: Woldman S.
      First page: 4
      Abstract: This editorial refers to ‘Recurrent events analysis for examination of hospitalizations in heart failure: insights from the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) Trial’, by J.R. Braga et al., on page 18.
      PubDate: Mon, 25 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ehjqcco/qcx035
  • Making it back to base: how recruitment to cohort studies affects outcomes
    • Authors: Junghans C; St John M.
      First page: 6
      Abstract: This editorial refers to ‘Why are outcomes different for registry patients enrolled prospectively and retrospectively' Insights from the global anticoagulant registry in the FIELD-Atrial Fibrillation (GARFIELD-AF)’, by K.A.A. Fox et al., on page 27.
      PubDate: Tue, 26 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ehjqcco/qcx036
  • Troponin measurement in patients with suspected acute coronary syndromes:
           walking beyond the wall
    • Authors: Collinson P.
      First page: 8
      Abstract: This editorial refers to ‘High-sensitivity cardiac troponin I and risk of heart failure in patients with suspected acute coronary syndrome: a cohort study’, by D. Stelzle et al., on page 36.
      PubDate: Fri, 22 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ehjqcco/qcx034
  • Long-term cardiovascular outcome, use of resources, and healthcare costs
           in patients with peripheral artery disease: results from a nationwide
           Swedish study
    • Authors: Hasvold P; Nordanstig J, Kragsterman B, et al.
      First page: 10
      Abstract: Aims:Data on long-term healthcare costs of patients with peripheral artery disease (PAD) is limited, and the aim of this study was to investigate healthcare costs for PAD patients at a nationwide level.Methods and results:A cohort study including all incident patients diagnosed with PAD in the Swedish National Patient Register between 2006-2014, and linked to cause of death- and prescribed drug registers. Mean per-patient annual healthcare costs (2015 Euros [€]) (hospitalisations and out-patient visits) were divided into cardiovascular (CV), lower limb and non-CV related cost. Results were stratified by high and low CV risk. The study included 66,189 patients, with 221,953 observation-years. Mean total healthcare costs were €6,577, of which 26% was CV-related (€1,710), during the year prior to the PAD diagnosis. First year after PAD diagnosis, healthcare costs were €12,549, of which €3,824 (30%) was CV-related and €3,201 (26%) lower limb related. High-risk CV patients had a higher annual total healthcare and CV related costs compared to low risk CV patients during follow-up (€7,439 and €1,442 versus €4,063 and €838). Annual lower limb procedure costs were €728 in the PAD population, with lower limb revascularisations as key cost driver (€474).Conclusion:Non-CV related hospitalizations and outpatient visits were the largest cost contributors for PAD patients. There is a substantial increase in healthcare costs in the first year after being diagnosed with PAD, driven by PAD follow-up and lower limb related procedures. Among the CV-related costs, hospitalisations and outpatient visits related to PAD represented the largest costs.
      PubDate: Wed, 16 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ehjqcco/qcx028
  • Recurrent events analysis for examination of hospitalizations in heart
           failure: insights from the Enhanced Feedback for Effective Cardiac
           Treatment (EFFECT) trial
    • Authors: Braga J; Tu J, Austin P, et al.
      First page: 18
      Abstract: AimsHospitalizations often occur multiple times during the disease course of a heart failure (HF) patient. However, repeated hospitalizations have not been explored in a fulsome way in this setting. We investigated the association between patient factors and the risk of hospitalization among patients with HF using an extension of the Cox model for the analysis of recurrent events.Methods and resultsWe examined hospitalizations and predictors of readmission among newly discharged patients with HF in the Enhanced Feedback For Effective Cardiac Treatment phase 1 (April 1999–March 2001) study with the Prentice–Williams–Peterson model with total time. Of 8948 individuals discharged alive from hospital, 7562 (84.5%) were hospitalized at least once during 15-year follow-up. More than 31 000 hospitalizations were observed. There was a progressive shortening of the interval length between hospitalization episodes. An increasing number of comorbidities (average 2.3 per patient) was associated to an increasing hazard of being readmitted to hospital. Most patient factors associated with the risk of hospitalization have been previously described in the literature. However, the estimates were smaller in comparison to a traditional analysis based on the Cox model.ConclusionThe importance of patient factors for the risk of being admitted to hospital was variable over the course of the disease. Conditions such as diabetes and chronic pulmonary obstructive disease had a sustained association with the rate of hospitalization across all episodes examined. The analysis of recurrent events can explore the longitudinal aspect of HF and the critical issue of hospitalizations in this population.
      PubDate: Mon, 12 Jun 2017 00:00:00 GMT
      DOI: 10.1093/ehjqcco/qcx015
  • Why are outcomes different for registry patients enrolled prospectively
           and retrospectively' Insights from the global anticoagulant registry
           in the FIELD-Atrial Fibrillation (GARFIELD-AF)
    • Authors: Fox K; Accetta G, Pieper K, et al.
      First page: 27
      Abstract: AimsRetrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result.Methods and resultsPatients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0 and 18 months (such that the total time of follow-up was 24 months; data collection December 2009 and October 2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between March 2010 and October 2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs. 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51–3.67] vs. 4.05 [95% CI 3.53–4.63]; P = 0.016).ConclusionInterpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment.Clinical trial registration Unique identifier for GARFIELD-AF (NCT01090362).
      PubDate: Wed, 16 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ehjqcco/qcx030
  • High-sensitivity cardiac troponin I and risk of heart failure in patients
           with suspected acute coronary syndrome: a cohort study
    • Authors: Stelzle D; Shah A, Anand A, et al.
      First page: 36
      Abstract: AimsHeart failure may occur following acute myocardial infarction, but with the use of high-sensitivity cardiac troponin assays we increasingly diagnose patients with minor myocardial injury. Whether troponin concentrations remain a useful predictor of heart failure in patients with acute coronary syndrome is uncertain.Methods and resultsWe identified all consecutive patients (n = 4748) with suspected acute coronary syndrome (61 ± 16 years, 57% male) presenting to three secondary and tertiary care hospitals. Cox-regression models were used to evaluate the association between high-sensitivity cardiac troponin I concentration and subsequent heart failure hospitalization. C-statistics were estimated to evaluate the predictive value of troponin for heart failure hospitalization. Over 2071 years of follow-up there were 83 heart failure hospitalizations. Patients with troponin concentrations above the upper reference limit (URL) were more likely to be hospitalized with heart failure than patients below the URL (118/1000 vs. 17/1000 person years, adjusted hazard ratio: 7.0). Among patients with troponin concentrations <URL the rate of heart failure hospitalization was 2.80-fold higher [95% confidence interval (95% CI 1.81–4.31)] per doubling of troponin concentration. On adding troponin to a model with demographic, cardiovascular risk factor, and clinical variables, the prediction of heart failure hospitalization improved considerably (C-statistic 0.80 vs. 0.86, P < 0.001).ConclusionCardiac troponin is an excellent predictor of heart failure hospitalization in patients with suspected acute coronary syndrome. The strongest associations were observed in patients with troponin concentrations in the normal reference range, in whom high-sensitivity cardiac troponin assays identify those at increased risk of heart failure who may benefit from further investigation and treatment.
      PubDate: Wed, 19 Jul 2017 00:00:00 GMT
      DOI: 10.1093/ehjqcco/qcx022
  • Association of acute kidney injury and chronic kidney disease with
           processes of care and long-term outcomes in patients with acute myocardial
    • Authors: Mody P; Wang T, McNamara R, et al.
      First page: 43
      Abstract: AimsTo examine the association of acute kidney injury (AKI) with long-term outcomes after myocardial infarction (MI), and evaluate whether effect modification is present according to baseline chronic kidney disease (CKD) status.Methods and resultsACTION Registry records from 2008 to 2012 were linked to Medicare claims data, creating a cohort of 76 500 acute MI patients aged ≥ 65 years who survived to hospital discharge. Mild, moderate, and severe AKI were defined as changes in creatinine from baseline to peak of 0.3 to < 0.5, 0.5 to < 1.0, and ≥ 1.0 mg/dL, respectively. Stage 3, Stage 4, and Stage 5 CKD were defined as estimated glomerular filtration rates of 30–59, 15–29, and <15 mL/min/m2, respectively. Cox proportional hazards modelling was used to examine associations of AKI with long-term outcomes. The prevalence of baseline CKD was: Stage 3 (41.2%), Stage 4 (6.7%), and Stage 5 (1.0%). The incidence of AKI was: mild (7.5%), moderate (6.0%), and severe (3.0%). A significant interaction of AKI with baseline CKD was observed for 1-year mortality (Pinteraction <0.001). Acute kidney injury was associated with worse multivariable-adjusted 1-year mortality among individuals without CKD: mild AKI [hazard ratio (HR): 1.33, 95% confidence interval (CI): 1.22–1.49], moderate AKI (HR:1.66, 95% CI: 1.46–1.89), and severe AKI (HR: 2.87, 95% CI: 2.41–3.43). An attenuation of this effect was noted with advancing stages of baseline CKD such that among patients with Stage 5 CKD, AKI was not associated with 1-year mortality.ConclusionAcute kidney injury is associated with worse long-term outcomes after MI. This effect is modified by baseline CKD status.
      PubDate: Tue, 27 Jun 2017 00:00:00 GMT
      DOI: 10.1093/ehjqcco/qcx020
  • New York Heart Association (NYHA) classification in adults with congenital
           heart disease: relation to objective measures of exercise and outcome
    • Authors: Bredy C; Ministeri M, Kempny A, et al.
      First page: 51
      Abstract: AimsThe New York Heart Association functional classification (NYHA class) is often used to describe the functional capacity of adults with congenital heart disease (ACHD), albeit with limited evidence on its validity in this heterogeneous population. We aimed to validate the NYHA functional classification in ACHD by examining its relation to objective measures of limitation using cardiopulmonary exercise testing (CPET) and mortality.Methods and resultsThis study included all ACHD patients who underwent a CPET between 2005 and 2015 at the Royal Brompton, in whom functional capacity was graded according to the NYHA classification. Congenital heart diagnoses were classified according to the Bethesda score. Time to all-cause mortality from CPET was recorded in all 2781 ACHD patients (mean age 33.8 ± 14.2 years) enrolled in the study. There was a strong relation between NYHA class and peak oxygen consumption (peak VO2), ventilation per unit in carbon dioxide production (VE/VCO2) slope and the Bethesda classification (P < 0.0001). Although a large number of ‘asymptomatic’ (NYHA class 1) patients did not achieve a ‘normal’ peak VO2, the NYHA class was a strong predictor of mortality, with an 8.7-fold increased mortality risk in class 3 compared with class 1 (hazard ratio 8.68, 95% confidence interval: 5.26–14.35, P < 0.0001).ConclusionDespite underestimating the degree of limitation in some ACHD patients, NYHA classification remains a valuable clinical tool. It correlates with objective measures of exercise and the severity of underlying cardiac disease, as well as mid- to long-term mortality and should, thus, be into incorporated the routine assessment and risk stratification of these patients.
      PubDate: Thu, 17 Aug 2017 00:00:00 GMT
      DOI: 10.1093/ehjqcco/qcx031
  • Impact of creatinine clearance on outcomes in patients with non-valvular
           atrial fibrillation: a subanalysis of the J-RHYTHM Registry
    • Authors: Kodani E; Atarashi H, Inoue H, et al.
      First page: 59
      Abstract: AimsTo clarify the influence of renal function on adverse outcomes in patients with non-valvular atrial fibrillation (NVAF), a post hoc analysis of the J-RHYTHM Registry was performed.Methods and resultsA consecutive series of outpatients with atrial fibrillation (AF) were enrolled from 158 institutions and followed for 2 years or until the occurrence of an event. Among 7406 patients with non-valvular AF, 6052 patients (69.8 ± 10.0 years, 71.2% men) with creatinine clearance (CrCl) value at baseline were divided into four groups according to CrCl level (<30, 30–49.9, 50–79.9, and ≥80 mL/min). Patients with CrCl <80 mL/min showed increased incidence of thromboembolism, major haemorrhage, all-cause and cardiovascular death, and composite events as compared with patients with CrCl ≥80 mL/min. After adjustment for multiple confounders, lower CrCl values emerged as independent predictors for thromboembolism [CrCl 30–49.9, hazard ratio (HR) 2.27, 95% confidence interval (CI) 1.09–4.72, P = 0.029; and CrCl 50–79.9, HR 1.99, 95% CI 1.07–3.72, P = 0.030] and all-cause death (CrCl <30, HR 6.44, 95% CI 3.03–13.7, P < 0.001; and CrCl 30–49.9, HR 3.14, 95% CI 1.54–6.41, P = 0.002), with CrCl ≥80 mL/min serving as a reference, whereas not for major haemorrhage. Warfarin treatment was associated with lower rates of composite events in patients with lower CrCl values of <80 mL/min.ConclusionRenal impairment was an independent predictor of adverse clinical outcomes except for major haemorrhage in Japanese patients with non-valvular AF. Warfarin was associated with lower rates of composite events in patients with lower CrCl values.Clinical Trial Registration: Unique identifier: UMIN000001569.
      PubDate: Fri, 01 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ehjqcco/qcx032
  • Cardiovascular disease burden in cancer patients from 2003 to 2014
    • Authors: Agarwal M; Aggarwal A, Rastogi S, et al.
      First page: 69
      Abstract: As per 2015 national report, cardiovascular disease (CVD) and cancer accounted for almost 63% of deaths. With dynamic progress in therapeutic strategies along with improving prognosis and cancer survivorship, CVD and related comorbidities is increasingly becoming a barrier to improvement in quality of life and outcomes of cancer patients. However, contemporary data describing CVD and its major risk factors in cancer are lacking. Hence, we studied the national inpatient sample databases (NIS) from 2003 to 2014 to describe the trends of 16 529 061 cancer hospitalizations.
      PubDate: Mon, 25 Sep 2017 00:00:00 GMT
      DOI: 10.1093/ehjqcco/qcx033
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