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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]
  • Environmental factors and out-of-hospital cardiac arrest
    • Authors: Tian L; Qiu H.
      First page: 97
      Abstract: This editorial refers to ‘Out-of-hospital cardiac arrest attributable to sunshine: a nationwide, retrospective, observational study’, by D. Onozuka and A. Hagihara, on page 107.
      PubDate: 2017-01-23
      DOI: 10.1093/ehjqcco/qcw061
  • Quality of data in observational studies: separating the wheat from the
    • Authors: Schiele F.
      First page: 99
      Abstract: Observational studies are a major and indispensable source of medical and scientific knowledge, but their results are not viewed with the same level of scientific value as those of randomized clinical trials, for example. The degree of reliability of observational studies may vary widely, in particular depending on such factors as the design of the registry, the methods used for analysis, and the quality of the data recorded. A report from the GARFIELD registry details their innovations in auditing strategies and data verification, and these procedures allowed them to achieve an error rate of less than 5%, closely approaching the quality level of randomized trials. They used a multi-faceted approach, combining partial source data verification (SDV), both distant and onsite, regularly and repeatedly, initiated from the very outset of the registry. Detailed description of the quality control methods should be integrated among the requirements for the publication of results from observational registry studies. The monitoring strategy used in the GARFIELD registry could serve as a standard in this regard.
      PubDate: 2017-02-21
      DOI: 10.1093/ehjqcco/qcx003
  • C-reactive protein level on admission and time to and cause of death in
           patients hospitalized for acute heart failure
    • Authors: Minami Y; Kajimoto K, Sato N, et al.
      First page: 148
      Abstract: AimsWe analysed the association between C-reactive protein (CRP) levels measured on admission and timing and cause of death among patients hospitalized for acute heart failure (AHF).Methods and ResultsThe ATTEND study prospectively registered 4777 hospitalized AHF patients with data on CRP levels on admission. Mortality risks were assessed by univariable and multivariable Cox proportional and non-proportional hazards models. The overall median CRP level was 5.8 mg/L (intertertile range: 2.9–11.8 mg/L). There were significant increases in all-cause, cardiac, and non-cardiac mortalities from the lowest to highest CRP tertiles throughout the follow-up periods. Within 120 days after admission, CRP levels in the highest tertile (>11.8 mg/L) were independently associated with higher all-cause (hazard ratio [HR], 2.21; 95% confidence interval [CI], 1.69–2.88; P 
      PubDate: 2017-01-09
      DOI: 10.1093/ehjqcco/qcw054
  • Health status outcomes of percutaneous coronary intervention in bypass
           grafts vs. native coronary arteries
    • Authors: Qintar M; Omer M, Tang F, et al.
      First page: 160
      Abstract: Percutaneous coronary intervention (PCI) of bypass grafts is associated with lower technical success and more complications than PCI of native coronary arteries.1,2 However, despite these challenges, no studies have compared patients’ health status (e.g. symptoms, functional status, quality of life) after bypass graft vs. native coronary PCI. Since the primary goal of PCI for stable coronary disease is health status improvement, these data are needed to better understand the whether the benefits of bypass graft intervention are comparable to PCI of native coronary arteries.
      PubDate: 2017-01-08
      DOI: 10.1093/ehjqcco/qcw053
  • Erratum
    • First page: 162
      Abstract: Erratum to: Atypical chest pain in diabetic patients with suspected stable angina: impact on diagnosis and coronary outcomes
      PubDate: 2017-02-27
      DOI: 10.1093/ehjqcco/qcx001
  • What happens to work capacity after coronary revascularization'
    • Authors: Kivimäki M; Ferrie JE, Hemingway H.
      First page: 95
      Abstract: This editorial refers to ‘Permanent work disability in patients ≤50 years old after percutaneous coronary intervention and coronary artery bypass grafting (the CRAGS study)’, by A. Lautamäki et al., on page 101.
      PubDate: 2016-12-21
      DOI: 10.1093/ehjqcco/qcw052
  • Permanent work disability in patients ≤50 years old after percutaneous
           coronary intervention and coronary artery bypass grafting (the CRAGS
    • Authors: Lautamäki A; Gunn JM, Airaksinen K, et al.
      First page: 101
      Abstract: BackgroundThe aim of this study was to investigate the incidence of permanent working disability (PWD) in young patients after percutaneous or surgical coronary revascularization.Methods and ResultsThe study included 1035 consecutive patients ≤50 years old who underwent coronary revascularization [910 and 125 patients in percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) groups, respectively] between 2002 and 2012 at 4 Finnish hospitals. The median follow-up time was 41 months. The overall incidence of PWD was higher after CABG compared to PCI (at 5 years, 34.8 vs. 14.7%, P < 0.001). Freedom from PWD in the general population aged 45 was 97.2% at 4 years follow-up. Median time to grant disability pension was 11.6 months after CABG and 24.4 months after PCI (P = 0.018). Reasons for PWD were classified as cardiac (35.3 vs. 36.9%), psychiatric (14.7 vs. 14.6%), and musculoskeletal (14.7 vs. 15.5%) in patients undergoing CABG vs. PCI. Overall freedom from PWD was higher in patients without major adverse cardiac and cerebrovascular event (MACCE) (at 5 years, 85.6 vs. 71.9%, P < 0.001). Nevertheless, rate of PWD was high also in patients without MACCE and patients with preserved ejection fraction during follow-up.ConclusionsAlthough coronary revascularization confers good overall survival in young patients, PWD is common especially after CABG and mostly for cardiac reasons even without occurrence of MACCE. Supportive measures to preserve occupational health are warranted concomitantly with coronary revascularization at all levels of health care.
      PubDate: 2016-08-24
      DOI: 10.1093/ehjqcco/qcw043
  • Out-of-hospital cardiac arrest attributable to sunshine: a nationwide,
           retrospective, observational study
    • Authors: Onozuka D; Hagihara A.
      First page: 107
      Abstract: AimsTo investigate the population attributable risk of out-of-hospital cardiac arrest (OHCA) from non-optimal sunshine duration and the relative contribution of daily sunshine hours.Methods and ResultsNational registry data of all cases of OHCA occurred between 2005 and 2014 in the 47 Japanese prefectures were obtained. We examined the relationship between daily duration of sunshine and OHCA risk for each prefecture in Japan using a Poisson regression model combined with a distributed lag non-linear model, adjusting for confounding factors. The estimated associations for each prefecture were pooled at the nationwide level using a multivariate random-effects meta-analysis. A total of 658 742 cases of OHCA of presumed cardiac origin met our inclusion criteria. The minimum morbidity sunshine duration varied from the 21st percentile in Okayama to the 99th percentile in Hokkaido, Gifu, and Hyogo. Overall, 5.78% [95% empirical confidence interval (eCI): 3.57–7.16] of the OHCA cases were attributable to daily sunshine duration. The attributable fraction for short sunshine duration (below the minimum morbidity sunshine duration) was 4.18% (95% eCI: 2.64–5.38), whereas that for long sunshine duration (above the minimum morbidity sunshine duration) was 1.59% (95% eCI: 0.81–2.21).ConclusionsDaily sunshine duration was responsible for OHCA burden, and a greater number of OHCA cases occurred in patients who were only exposed to sunshine for short periods of time each day. Our findings suggest that public health efforts to reduce OHCA burden should take sunshine level into account.
      PubDate: 2016-11-10
      DOI: 10.1093/ehjqcco/qcw056
  • Evolving quality standards for large-scale registries: the GARFIELD-AF
    • Authors: Fox KA; Gersh BJ, Traore S, et al.
      First page: 114
      Abstract: AimsRegistries have the potential to capture treatment practices and outcomes in populations beyond the constraints of clinical trial settings. The value of data obtained depend critically upon robust quality standards (including source data verification [SDV] and training); features that are commonly absent from registries. This article outlines the quality standards developed for Global Anticoagulant Registry in the FIELD–Atrial Fibrillation (GARFIELD-AF).Methods and ResultsGARFIELD-AF comprises ∼57 000 patients prospectively recruited over 6.5 years in 35 countries in five successive cohorts. The registry employs a combination of remote and onsite monitoring to ascertain completeness and accuracy of records and by design, SDV is performed on 20% of cases (i.e. ∼11 400 patients). Four performance measures for ranking sites according to data quality and other performance indicators were evaluated (including data quality for 13 quantifiable variables, late data locking, number of missing critical variables, and history of poor data quality from the previous monitoring phase). These criteria facilitated the identification of sites with potentially suboptimal data quality for onsite monitoring. During early phases of the registry, critical variables for data checking were also identified. SDV using these variables (partial SDV in 902 patients) showed similar concordance to SDV of all fields (110 patients): 94.4% vs. 93.1%, respectively. This standard formed the baseline against which ongoing quality improvements were assessed, facilitating corrective action on data quality issues. In consequence, concordance was improved in the next monitoring phase (95.6%; n = 1172).ConclusionThe quality standards in GARFIELD-AF have the potential to inform a future ‘reference’ for registries.
      PubDate: 2016-11-15
      DOI: 10.1093/ehjqcco/qcw058
  • The relationship between preoperative frailty and outcomes following
           transcatheter aortic valve implantation: a systematic review and
    • Authors: Anand A; Harley C, Visvanathan A, et al.
      First page: 123
      Abstract: AimsTranscatheter aortic valve implantation (TAVI) is an increasingly common intervention for patients with aortic stenosis deemed high risk for major cardiac surgery, but identifying those who will benefit can be challenging. Frailty reflects physiological reserve and may be a useful prognostic marker in this population. We performed a systematic review and meta-analysis of the association between frailty and outcomes after TAVI.Methods and ResultsFive databases were searched between January 2000 and May 2015. From 2623 articles screened, 54 were assessed for eligibility. Ten cohort studies (n = 4592) met the inclusion criteria of reporting a measure of frailty with early (≤30 days) or late (>30 days) mortality and procedural complications following TAVI as defined by the Valve Academic Research Consortium (VARC). Frailty was associated with increased early mortality in four studies (n = 1900) (HR 2.35, 95% CI 1.78–3.09, P < 0.001) and increased late mortality in seven studies (n = 3159) (HR 1.63, 95% CI 1.34–1.97, P < 0.001). Objective frailty tools identified an even higher risk group for late mortality (HR 2.63, 95% CI 1.87–3.70, P < 0.001). Frail individuals undergoing TAVI have a mortality rate of 34 deaths per 100 patient years, compared with 19 deaths per 100 patient years in non-frail patients. There was limited reporting of VARC procedural outcomes in relation to frailty, preventing meta-analysis.ConclusionFrailty assessment in an already vulnerable TAVI population identifies individuals at even greater risk of poor outcomes. Use of objective frailty tools may inform patient selection, but this requires further assessment in large prospective registries.
      PubDate: 2016-06-08
      DOI: 10.1093/ehjqcco/qcw030
  • Has invasive management for acute coronary syndromes become more
           ‘risk-appropriate’: pooled results of five Australian registries
    • Authors: Halabi A; Chew DP, Horsfall M, et al.
      First page: 133
      Abstract: BackgroundDespite being recommended in acute coronary syndrome (ACS) guidelines, the use of invasive management within specific risk groups continues to be debated. This study examines the change in the use of invasive management in ACS by patient risk and the associated change in mortality within Australia over the last 17 years.MethodsPooled cohorts derived from five ACS registries (ACACIA, CONCORDANCE, GRACE, Snapshot-ACS, and Predict) spanned from 1999 to 2015. After excluding patients without a final diagnosis of ACS (n = 4460), enrolled outside Australia (n = 1477) and without an enrolling year (n = 4), 15 912 patients were analysed. Data was stratified across three time periods (1999–2004, 2005–2009, and 2010–2015) using clinical risk characteristics (age, ACS diagnosis, biomarker elevation, and GRACE score) to monitor change in practice.ResultsOver the 17-year period, the use of invasive management increased (4073/6863 (59.3%) cases [1999–2009] vs. 6670/8706 (76.6%) cases [2010–2015]). Invasive management accounted for improvements in mortality in intermediate- and high-risk groups (intermediate risk: 14% (95% CI 1–66%) [1999–2009] vs. 49% (95% CI 2–59%) [2010–2015]; high risk: 24% (95% CI 6–42%) [1999–2009] vs. 48% (95% CI 19–76%) [2010–2015]). Patients receiving no angiography compared with interventional management had worse outcomes (1999–2004 1.55 HR [95% CI 1.36–1.80], P < 0.0001 vs. 2010–2015 1.90 HR [95% CI 1.45–2.51], P < 0.0001).ConclusionsClinical practice in ACS has changed over the last 17 years with positive outcomes seen with invasive management among high-risk patients. Unfortunately, a considerable burden of mortality remains in patients managed medically, highlighting a need for more focused strategies that improve care and outcomes in this group.
      PubDate: 2016-08-02
      DOI: 10.1093/ehjqcco/qcw038
  • Increased incidence of infective endocarditis after the 2009 European
           Society of Cardiology guideline update: a nationwide study in the
    • Authors: van den Brink FS; Swaans MJ, Hoogendijk MG, et al.
      First page: 141
      Abstract: AimsAfter the introduction of the European Society of Cardiology (ESC) guidelines on prevention, diagnosis, and treatment of infective endocarditis (IE) in 2009, prophylaxis for patients at risk became less strict. We hypothesize that there will be a rise in IE after the introduction of the guideline update.Methods and ResultsWe performed a nationwide retrospective trend study using segmented regression analysis of the interrupted time series. The patient data were obtained via the national healthcare insurance database, which collects all the diagnoses nationwide. We compared the data before and after the introduction of the 2009 ESC guideline. Between 2005 and 2011, a total of 5213 patients were hospitalized with IE in the Netherlands. During this period, there was a significant increase in IE from 30.2 new cases per 1 000 000 in 2005 to 62.9 cases per 1 000 000 in 2011 (P < 0.001). In 2009, the incidence of IE increased significantly above the projected historical trend (rate ratio: 1.327, 95% CI: 1.205–1.462; P < 0.001). This coincides with the introduction of the 2009 ESC guideline. After the introduction of the ESC guideline, the streptococci-positive cultures increased significantly in the following years 2010–11 from 31.1 to 53.2% (P = 0.0031).ConclusionThis observational study shows that there has been a steady increase in the IE incidence between 2005 and 2011. After the introduction of the 2009 ESC guidelines, the incidence increased more than expected from previous historical trends. Furthermore, there was a significant increase in streptococci-related IE cases.
      PubDate: 2016-08-01
      DOI: 10.1093/ehjqcco/qcw039
  • External validation of the multivariable ‘In-hospital Mortality for
           PulmonAry embolism using Claims daTa’ prediction rule in the Premier
           Hospital Database
    • Authors: Nguyen E; Peacock W, Fermann GJ, et al.
      First page: 157
      Abstract: A tool that allows researchers, payers, and hospital administrators to retrospectively estimate the early mortality risk in patients diagnosed with pulmonary embolism (PE) may enable epidemiologic research and influence hospital resource utilization. The multivariable In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) prediction rule was recently derived for this purpose.1 While clinical data-based rules for the risk stratification of patients with PE are available, their implementation requires access to vital sign and laboratory data not commonly found or easily accessible in claims databases. Here we sought to externally validate IMPACT using administrative claims data at the time of PE patient admission from the Premier Hospital Database.
      PubDate: 2016-09-08
      DOI: 10.1093/ehjqcco/qcw046
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