Questions and Answers (1) View all
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Answer added in Cardiovascular System16 Is it necessary to give acid acetyl salycilic to patients who are type 2 diabetics?Dear Hadj: You have raised an interesting and very common question. We have known since the early 1980's that ASA is a useful drug for secondary preve... [more]
Publications (3) View all
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Article: National priorities partnership focus on eliminating overuse: applications to cardiac revascularization.
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ABSTRACT: As one of several initiatives to transform health care delivery across the United States, the National Priorities Partnership has identified "eliminating overuse while ensuring the delivery of appropriate care" as a top priority. Cardiac revascularization procedures, including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), constitute one area of focus for reduction of overuse. Despite the multiyear development of clinical guidelines to define appropriate use of cardiac revascularization, substantial variability in the application of these procedures is observed. Concurrent data collection tools to support real-time clinical decision making regarding appropriateness are needed and can be used, along with financial incentives such as pay-for-performance programs and public reporting of performance information, to support more appropriate use of cardiac revascularization. Efforts to achieve more rational use of CABG and PCI should be made carefully and with the goal that patients receive the most appropriate and effective care.American Journal of Medical Quality 07/2011; 26(6):485-90. · 1.64 Impact Factor -
Article: Impact of a standardized heart failure order set on mortality, readmission, and quality and costs of care.
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ABSTRACT: To determine the impact of a standardized heart failure order set on mortality, readmission, and quality and costs of care. Observational study. Eight acute care hospitals and two specialty heart hospitals. All adults (>18 years) discharged from one of the included hospitals between December 2007 and March 2009 with a diagnosis of heart failure, who had not undergone heart transplant, did not have a left ventricular assistive device, and with a length of stay of 120 or less days. A standardized heart failure order set was developed internally, with content driven by the prevailing American College of Cardiology/American Heart Association clinical practice guidelines, and deployed systemwide via an intranet physician portal. Publicly reported process of care measures, in-patient mortality, 30-day mortality, 30-day readmission, length of stay, and direct cost of care were compared for heart failure patients treated with and without the order set. Order set used reached 73.1% in March 2009. After propensity score adjustment, order set use was associated with significantly increased core measures compliance [odds ratio (95% confidence interval) = 1.51(1.08; 2.12)] and reduced in-patient mortality [odds ratio (95% confidence interval) = 0.49(0.28; 0.88)]. Reductions in 30-day mortality and readmission approached significance. Direct cost for initial admissions alone and in combination with readmissions were significantly lower with order set use. Implementing an evidence-based standardized order set may help improve outcomes, reduce costs of care and increase adherence to evidence-based processes of care.International Journal for Quality in Health Care 10/2010; 22(6):437-44. · 1.96 Impact Factor -
Article: Clinical and angiographic results of balloon-expandable intracoronary stents in right coronary artery stenoses
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ABSTRACT: Balloon-expandable stents were placed successfully in 35 (95%) of 37 patients whose right coronary artery lesion was believed to have a poor short- or long-term prognosis with conventional balloon angioplasty because of prior restenosis or adverse lesion morphology. Quantitative angiography showed a reduction in stenosis diameter from 83 ± 14% to 42 ± 14% after conventional balloon dilation, with a further reduction to − 3 ± 12% after stent placement (p < 0.001). There were no acute stent thromboses, but one patient (with two stents and unstented distal disease) developed subacute thrombosis on day 8 after self-discontinuation of warfarin and was treated with thrombolytic therapy and reflation.Follow-up angiography was performed at 4 to 6 months in 25 patients, demonstrating restenosis (83 ± 13%) in 4 (57%) of 7 patients with multiple stents, but only 3 (17%) of 18 patients with a single stent (p < 0.05). Six of the seven in-stent restenotic lesions were subtotal (80 ± 12%) and were subjected to repeat conventional balloon angioplasty (postdilation stenosis 13 ± 21%). The 18 patients without restenosis had a maximal in-stent diameter stenosis of 29 ± 15%, corresponding to a maximal focal neointimal thickness of 0.68 ± 0.26 mm within the stented segment. These preliminary results suggest that the Schatz-Palmaz stent may be a useful adjunctive device in the performance of coronary angioplasty.Journal of the American College of Cardiology 09/1990; · 14.16 Impact Factor
