[Show abstract][Hide abstract] ABSTRACT: To determine sex bias in the selection of strategies to evaluate patients with acute myocardial infarction (AMI), and determine if the choice of strategy influences survival.
Controversy exists regarding the role of female sex in the use of invasive evaluation for AMI and its possible effect on adverse outcomes.
Electronic health record data from the Geisinger Acute Myocardial Infarction Cohort (GAMIC) was analyzed which included 1,968 men and 1,047 women admitted to the Geisinger Medical Center between January 2001 and December 2006 with acute myocardial infarction (AMI).Multivariate logistic regression analyses were used to determine independent correlates of an invasive evaluation. Multivariate logistic regression modeling stratified on sex was used to determine when invasive evaluation was done and whether there was a correlation with mortality.
In unadjusted analyses, male sex was a significant predictor for the use of invasive evaluation (odds ratio = 1.71, 95% CI = [1.46, 2.00]). Adjusted for baseline differences (like age, renal function, co-morbid conditions) multivariate analyses found no significant relationship between male sex and invasive evaluation (OR = 1.02, 95% CI = [0.82, 1.23]). Females in the STEMI group were found to be less revascularized. No difference was observed in the one-year mortality between women and men regardless of invasive evaluation or revascularization.
Sex was not independently associated with the occurrence of an invasive evaluation of a MI. Females in the STEMI group were less revascularized. There was no strong gender effect on survival irrespective of the performance on an invasive evaluation or revascularization. (J Interven Cardiol 2013;26:14–21)
[Show abstract][Hide abstract] ABSTRACT: To determine the impact of percutaneous coronary interventions (PCI) performed during late-night hours on next day PCI performance by the same interventional cardiologist.
There is little data regarding the effects of sleep deprivation on interventional cardiologists performing PCIs.
All primary PCIs from January 1, 2005 to December 31, 2009 between 11 PM and 7 AM were identified. All PCIs performed during the subsequent work day by the same interventionists were included in the sleep-deprived group. All other PCIs were included in the non-sleep-deprived group. Data were entered prospectively into the American College of Cardiology National Cardiovascular Data Registry (NCDR). The two groups were compared with respect to efficacy and safety endpoints.
During the 5-year period, 3,944 PCIs were performed by four operators, including 3,644 non-sleep-deprived cases and 167 sleep-deprived cases. The two groups were similar with respect to demographics, comorbidities, and procedural characteristics. There were more intraprocedural deaths in the sleep-deprived group (1.2% vs. 0.2%, P = 0.04); however, the adjusted odds ratio (OR) was nonsignificant (OR = 6.83, 95% confidence interval [CI] = 0.66–39.63, P = 0.11). Excessive bleeding at the arterial access site in the non-sleep-deprived group was more frequent (2.7% vs. 0%, P = 0.02). There were no differences in the combined safety or efficacy endpoints between the two groups.
In this single-center study, we found no evidence that middle-of-the night procedures adversely affect safety or efficacy of procedures done the next day by the same operator.
[Show abstract][Hide abstract] ABSTRACT: We previously developed a new posttraumatic stress disorder (PTSD) screening instrument-the New York PTSD Risk Score (NYPRS). Since research suggests different PTSD risk factors and outcomes for men and women, in the current study we assessed the suitability of male and female versions of this screening instrument among 3298 adults exposed to traumatic events. Using diagnostic test methods, including receiver operating characteristic (ROC) curve and bootstrap techniques, we examined different prediction domains, including core PTSD symptoms, trauma exposures, sleep disturbances, depression symptoms, and other measures to assess PTSD prediction models for men and women. While the original NYPRS worked well in predicting PTSD, significant interaction was detected by gender, suggesting that separate models are warranted for men and women. Model comparisons suggested that while the overall results appeared robust, prediction results differed by gender. For example, for women, core PTSD symptoms contributed more to the prediction score than for men. For men, depression symptoms, sleep disturbance, and trauma exposure contributed more to the prediction score. Men also had higher cut-off scores for PTSD compared to women. There were other gender-specific differences as well. The NYPRS is a screener that appears to be effective in predicting PTSD status among at-risk populations. However, consistent with other medical research, this instrument appears to require male and female versions to be the most effective.
Psychiatry Research 05/2012; 200(2-3). DOI:10.1016/j.psychres.2012.04.022 · 2.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine the association of use of tumor necrosis factor-α (TNF-α) inhibitors with differences in lipid levels in patients with rheumatoid arthritis (RA).
We studied 807 patients with incident RA to compare differences in lipid levels in TNF-α inhibitor users versus nonusers, with adjustment for relevant covariables.
TNF-α inhibitor use was not associated with differences in levels of low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), triglycerides, LDL:HDL, or TC:HDL compared to nonusers.
Use of TNF-α inhibitor was not associated with differences in lipid levels in patients with RA.
The Journal of Rheumatology 04/2012; 39(5):946-8. DOI:10.3899/jrheum.111093 · 3.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: AIM: We previously developed a posttraumatic stress disorder (PTSD) screening instrument - the New York PTSD Risk Score - that was effective in predicting PTSD. In the present study, we assessed a 12-month prospective version of this risk score, which is important for patient management, follow-up, and for emergency medicine. METHODS: Using data collected in a study of New York City adults after the World Trade Center Disaster (WTCD), we developed a new PTSD prediction tool. Using diagnostic test methods, including receiver operating curve (ROC) and bootstrap procedures, we examined different prediction variables to assess PTSD status 12 months after initial assessment among 1,681 trauma-exposed adults. RESULTS: While our original PTSD screener worked well in the short term, it was not specifically developed to predict long-term PTSD. In the current study, we found that the Primary Care PTSD Screener (PCPS), when combined with psychosocial predictors from the original NY Risk Score, including depression, trauma exposure, sleep disturbance, and healthcare access, increased the area under the ROC curve (AUC) from 0.707 to 0.774, a significant improvement (p<0.0001). When additional risk-factor variables were added, including negative life events, handedness, self-esteem, and pain status, the AUC increased to 0.819, also a significant improvement (p=0.001). Adding Latino and foreign status to the model further increased the AUC to 0.839 (p=0.007). CONCLUSION: A prospective version of the New York PTSD Risk Score appears to be effective in predicting PTSD status 12 months after initial assessment among trauma-exposed adults. Further research is advised to further validate and expand these findings.
[Show abstract][Hide abstract] ABSTRACT: To examine the association of tumor necrosis factor α (TNFα) inhibitor use and the risk of developing diabetes mellitus in a rheumatoid arthritis (RA) inception cohort.
Adults diagnosed with RA between January 1, 2001, and December 31, 2009, were identified (n = 1,881). Prevalent cases of diabetes mellitus (n = 294) were excluded. Information on sociodemographic data, medical history, body mass index (BMI), laboratory measures, and medications was collected from the electronic health record. Incident diabetes mellitus was defined using the 2010 American Diabetes Association criteria or physician-established diagnosis. Time-varying Cox proportional hazards regression models were used to adjust for age, sex, race, BMI, rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (anti-CCP), erythrocyte sedimentation rate (ESR), and use of nonsteroidal antiinflammatory drugs (NSAIDs), glucocorticoids, hydroxychloroquine, and methotrexate.
A total of 1,587 incident RA patients without diabetes mellitus were included. The anti-TNFα users (n = 522) had a lower median age but greater baseline BMI; maximum ESR, RF, and anti-CCP positivity; and NSAID, glucocorticoid, or methotrexate use. The median followup time for the ever and never TNFα inhibitor users was 44.9 months (interquartile range [IQR] 23.7-73.0 months) and 37.1 months (IQR 16.3-65.1 months), respectively (P < 0.001). Of the 91 patients developing diabetes mellitus, 16 were ever and 75 were never TNFα inhibitor users, yielding incidence rates of 8.6 and 17.2 per 1,000 person-years (P = 0.048), respectively. Adjusting for covariates, the hazard ratio for incident diabetes mellitus in TNFα inhibitor users was 0.49 (95% confidence interval 0.24-0.99, P = 0.049) compared to the never users.
In this inception RA cohort, anti-TNFα use was associated with a 51% reduction in risk of developing diabetes mellitus.
[Show abstract][Hide abstract] ABSTRACT: Accelerated vascular calcification contributes to cardiovascular disease burden in patients with chronic kidney disease (CKD). We hypothesized that bisphosphonate therapy would reduce the risk of mortality and cardiovascular events in this population.
Retrospective cohort study.
Adult women with stage 3 or 4 CKD receiving primary care in a large rural integrated health care system in 2004-2010.
Time-dependent exposure status based on outpatient prescription for any medication within the bisphosphonate class, obtained from electronic health records.
Time to death and first cardiovascular event (composite of myocardial infarction, heart failure, or stroke).
Data from 9,604 eligible female patients with CKD were analyzed; 3,234 were treated with bisphosphonate therapy. During a median follow-up of 3.9 (25th-75th percentile, 2.3-5.4) years, there were 286 versus 881 deaths and 206 versus 571 cardiovascular events (treated vs not-treated groups, respectively). In a multivariate Cox proportional hazard model, the adjusted HR for death (treated vs not treated) was 0.78 (95% CI, 0.67-0.91; P = 0.003). In Cox modeling adjusted for similar baseline covariates, treatment with bisphosphonates was not associated with a lower risk of the composite cardiovascular outcome (adjusted HR, 1.14; 95% CI, 0.94-1.39; P = 0.2).
Residual confounding by unidentified factors, exclusion of male patients, and lack of information about longitudinal drug adherence.
For female patients with CKD, treatment with bisphosphonates is associated with a lower risk of death, but not cardiovascular events. Confirmatory studies and investigations of potential causal mechanisms are warranted.
American Journal of Kidney Diseases 01/2012; 59(5):636-44. DOI:10.1053/j.ajkd.2011.11.037 · 5.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Research suggests that posttraumatic stress disorder (PTSD) is associated with increased alcohol use, but the findings have not been consistent. We assessed alcohol use, binge drinking, and psychotropic medication use longitudinally in 1,681 New York City adults, representative of the 2000 census, 2 years after the World Trade Center attacks. We found that, with the exception of a modified CAGE Questionnaire index for alcohol, alcohol use showed a modest increase over time and was related to PTSD symptoms, with an increase of about 1 more drink per month for those with PTSD, even though overall levels appeared to be within the National Institute on Alcohol Abuse and Alcoholism's safe range. Psychotropic medication use followed a similar trend; those with PTSD used psychotropics about 20 more days over the past year than those without. Because the study analyses adjusted for key psychosocial variables and confounders, it is not clear if the increased alcohol use following trauma exposure is associated with self-medication of PTSD symptoms, whether increased alcohol use prior to exposure is a risk for delayed-onset PTSD, or whether a third unmeasured variable is involved. Further research is warranted.
[Show abstract][Hide abstract] ABSTRACT: The objective was to develop a brief posttraumatic stress disorder (PTSD) screening instrument that is useful in clinical practice, similar to the Framingham Risk Score used in cardiovascular medicine.
We used data collected in New York City after the World Trade Center disaster (WTCD) and other trauma data to develop a new PTSD prediction tool--the New York PTSD Risk Score. We used diagnostic test methods to examine different clinical domains, including PTSD symptoms, trauma exposures, sleep disturbances, suicidal thoughts, depression symptoms, demographic factors and other measures to assess different PTSD prediction models.
Using receiver operating curve (ROC) and bootstrap methods, five prediction domains, including core PTSD symptoms, sleep disturbance, access to care status, depression symptoms and trauma history, and five demographic variables, including gender, age, education, race and ethnicity, were identified. For the best prediction model, the area under the ROC curve (AUC) was 0.880 for the Primary Care PTSD Screen alone (specificity=82.2%, sensitivity=93.7%). Adding care status, sleep disturbance, depression and trauma exposure increased the AUC to 0.943 (specificity=85.7%, sensitivity=93.1%), a significant ROC improvement (P<.0001). Adding demographic variables increased the AUC to 0.945, which was not significant (P=.250). To externally validate these models, we applied the WTCD results to 705 pain patients treated at a multispecialty group practice and to 225 trauma patients treated at a Level I Trauma Center. These results validated those from the original WTCD development and validation samples.
The New York PTSD Risk Score is a multifactor prediction tool that includes the Primary Care PTSD Screen, depression symptoms, access to care, sleep disturbance, trauma history and demographic variables and appears to be effective in predicting PTSD among patients seen in healthcare settings. This prediction tool is simple to administer and appears to outperform other screening measures.
General hospital psychiatry 07/2011; 33(5):489-500. DOI:10.1016/j.genhosppsych.2011.06.001 · 2.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cardiovascular disease (CVD) is the leading cause of death in patients with rheumatoid arthritis (RA). Disease-modifying therapies that improve risk factors for CVD, such as dyslipidemia, are desired. This study used an electronic health record to determine if hydroxychloroquine (HCQ) use was associated with an improvement in lipid levels in an inception RA cohort.
All adult individuals with the initial diagnosis of RA between January 1, 2001, and March 31, 2008, were identified (n=1,539). Only patients with at least one lipid level post-RA diagnosis were included (n=706). Information on demographics, medical history, body mass index (BMI), laboratory measures, and medications were collected at office visits. Potential risk and protective factors for dyslipidemia were controlled for in linear mixed-effects regression models for low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol, triglycerides, LDL/HDL, and total cholesterol/HDL.
Patients were 69% women and 98% white, with a median age of 65 years and a median BMI of 29.8 kg/m2. In the adjusted regression models, HCQ use was associated with the following average differences in lipids: LDL decrease of 7.55 mg/dl (P<0.001), HDL increase of 1.02 mg/dl (P=0.20), total cholesterol decrease of 7.70 mg/dl (P=0.002), triglycerides decrease of 10.91 mg/dl (P=0.06), LDL/HDL decrease of 0.136 (P=0.008), and total cholesterol/HDL decrease of 0.191 (P=0.006), which were stable over time.
Use of HCQ in this RA cohort was independently associated with a significant decrease in LDL, total cholesterol, LDL/HDL, and total cholesterol/HDL. Considering these results, its safety profile, and low cost, HCQ remains a valuable initial or adjunct therapy in this patient population at high risk for CVD.
[Show abstract][Hide abstract] ABSTRACT: : To determine the relationship between overactive bladder (OAB), with or without urinary incontinence (UI), and hyperlipidemia.
: A random sample of 8077 primary care patients were recruited for the General Longitudinal Overactive Bladder Evaluation. This was a prospective population-based survey to determine severity and occurrence of urgency, frequency, nocturia, and UI. A composite score of 5+ (range, 0-12) was considered to be a case status for OAB, and 2+ (range, 0-6) for UI. Data on hyperlipidemia were pulled out from the electronic medical records of all corresponding patients. Baseline covariates included age, education, body mass index, marital status, and other comorbidities. Logistic regression models were fit predicting OAB status (with or without UI) with prevalent hyperlipidemia as the main predictor.
: A total of 3599 (45%) women older than 40 years completed the survey, with a mean (SD) age of 59 (13) years, median parity of 2 (range, 1-3), 66% being overweight or obese, 90% with at least high school education, and 66% married. The prevalence of OAB and UI was 33% and 35%, respectively. Prevalence of hyperlipidemia was 22%. The unadjusted odds ratio (OR) of OAB for those with versus without hyperlipidemia was significant: OR = 1.20 (95% confidence interval, 1.02-1.42; P = 0.029). After adjustment, this association was no longer significant: OR = 0.97 (95% confidence interval, 0.81-1.16; P = 0.726). Among women with OAB and UI, there was no association with hyperlipidemia before and after adjustment (P = 0.5).
: Although on the surface there seems to be an association between OAB and hyperlipidemia, this association is primarily accounted for by other confounders.
Journal of Pelvic Medicine and Surgery 03/2011; 17(2):76-9. DOI:10.1097/SPV.0b013e31820e9dde · 1.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To estimate the relationship between the history of childhood dysfunctional voiding and urinary incontinence (UI) in adult women with and without clinical UI and to estimate its relationship with stress, urge, and mixed UI.
Using a case-control study, we surveyed adult women with or without UI using a validated dysfunctional voiding questionnaire. Cases were clinically classified as stress, urge, or mixed UI. Patient characteristics were compared using Student's t-test, chi-square test, and Fisher's exact test. Confounders were controlled through logistic regression. We compared the history of childhood dysfunctional voiding status among the three UI subtypes using multinomial logistic regression.
We recruited 267 cases (120 stress, 37 urge, 98 mixed, and 12 other UI) and 107 controls. Mean age of cases and controls were 58 and 52 years and BMI 26 and 23 kg/m², respectively. Fifty-six percent of cases (48% stress, 65% urge, and 62% mixed UI) had a prevalence of childhood dysfunctional voiding compared to controls (40%) (P = 0.06). After adjusting for confounders, women with adult UI had a twofold increased odds (95% CI = 1.2-3.4, P = 0.006) of childhood dysfunctional voiding compared with controls. The highest prevalence of dysfunctional voiding was with urge UI (OR = 4.4, 95% CI = 1.8-10.7) followed by mixed UI (OR = 2.7, 95% CI = 1.5-5.2), and finally stress UI (OR = 1.4, 95% CI = 0.8-2.5).
Childhood dysfunctional voiding may predict adult bladder control problems. This association is strongest in women with urge UI followed by mixed UI, but not different between women with stress UI and controls.
World Journal of Urology 03/2011; 30(1):111-5. DOI:10.1007/s00345-011-0665-4 · 2.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Several studies have associated hydroxychloroquine use with decreased risk of diabetes mellitus (diabetes) or improved glycemic control in rheumatoid arthritis patients, but the studies were small or used data from self-report. The present study sought to replicate this protective relationship in a health system using electronic health records with laboratory data and physician diagnoses.
This study is a retrospective cohort of 1127 adults with newly diagnosed rheumatoid arthritis and no diabetes within the Geisinger Health System between January 1, 2003, and March 31, 2008. Patients were classified as ever users (n = 333) or never users (n = 794) of hydroxychloroquine. Incident diabetes cases were defined using 2010 American Diabetes Association criteria.
The median follow-up times for the ever and never hydroxychloroquine users were 26.0 and 23.0 months, respectively (P = 0.28). The median duration of hydroxychloroquine exposure was 14.0 months. Of the 48 cases developing diabetes during observation, 3 were exposed to hydroxychloroquine at time of development and 45 were nonexposed, yielding incidence rates of 6.2 and 22.0 per 1000 per year (P = 0.03), respectively. In time-varying Cox proportional hazards regression models adjusting for sex, age, body mass index, positive rheumatoid factor and anti-cyclic citrullinated peptide antibodies, erythrocyte sedimentation rate, and nonsteroidal anti-inflammatory drug, glucocorticoid, methotrexate, and tumor necrosis factor α inhibitor use, the hazard ratio for incident diabetes among hydroxychloroquine users was 0.29 (95% confidence interval, 0.09-0.95; P = 0.04) compared with nonusers.
Our findings support the potential benefit of hydroxychloroquine in attenuating the risk of diabetes in rheumatoid arthritis patients. Further work is needed to determine its potential preventive role in other groups at high risk for diabetes.
Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases 03/2011; 17(3):115-20. DOI:10.1097/RHU.0b013e318214b6b5 · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to demonstrate the feasibility of routine transfer of ST-segment elevation myocardial infarction (STEMI) patients to achieve percutaneous coronary intervention (PCI) in less than 90 min from presentation.
Many PCI hospitals have achieved routine door-to-balloon times under 90 min for patients with STEMI presenting directly to the hospital. However, few patients transferred from a non-PCI center undergo PCI within 90 min of presentation.
Our rural PCI hospital implemented a program in 2005 for rapid triage, transfer, and treatment of STEMI patients and made additional improvements in 2006 and 2007. Intervals between milestones in the STEMI triage/transfer/treatment process were assessed before and after implementation of the program.
During the 5-year study period, 676 patients with 687 STEMIs were transferred from 19 community hospitals and underwent PCI. Median door-to-balloon time decreased from 189 min to 88 min (p < 0.001). The time intervals reflecting efficiency of the referring hospitals, transfer services, and PCI hospital all significantly improved. In 2008, median door-to-balloon times were <90 min for 6 of the 7 most frequently referring hospitals. Delays during off-hours presentation in 2004 were abolished after the program was implemented in 2005. In-hospital mortality decreased from 6% before to 3% after implementation of the program. In multivariate modeling, presentation before initiation of the STEMI program predicted increased risk of in-hospital mortality (odds ratio: 3.74, 95% confidence interval: 1.22 to 11.51, p = 0.021).
A program of rapid triage, transfer, and treatment of STEMI patients presenting to non-PCI hospitals can reduce in-hospital mortality and produce progressive improvements in door-to-balloon time such that median door-to-balloon times under 90 min are feasible.
Journal of the American College of Cardiology 01/2011; 57(3):272-9. DOI:10.1016/j.jacc.2010.06.056 · 16.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Mortality in severe sepsis and septic shock (SS/SS) remains high. Surviving Sepsis Campaign (SSC) guidelines were published in 2004 with the goal of improving outcomes in SS/SS. We tested the hypothesis that adherence to SSC guidelines and management of patients with SS/SS were influenced by physician specialty.
A survey was mailed to 4998 randomly selected physicians, 1666 each for emergency medicine (EM), critical care medicine (CCM), and internal medicine (IM) from the American Medical Association database. Demographics, compliance with SSC guidelines, and approaches to management of patients with SS/SS were analyzed by specialty.
Four hundred ninety-nine respondents were included for final analysis. There were no differences between 3 specialties in obtaining blood cultures and in administering intravenous fluids, pressors, and antibiotics. The CCM physicians were more likely to measure serum lactate and central venous pressure, use corticosteroids and drotrecogin α, and aim for normoglycemia and plateau pressures less than 30 cm H(2)O in mechanically ventilated patients (all P < .001).
We observe that adherence with SSC guidelines continues to be a challenge for CCM, IM, and EM physicians. Significant differences in management of SS/SS exist for the 3 specialties. Because guideline implementation impacts patient outcomes, further evaluation of these differences is warranted.
Journal of critical care 12/2010; 25(4):658.e1-6. DOI:10.1016/j.jcrc.2010.04.005 · 2.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Evidence varies on the relation between parity and urgency or urge incontinence (UUI). We used data from the General Longitudinal Overactive Bladder Evaluation to determine whether differences in case definitions could account for variation in findings.
We simulated case criteria to correspond to studies of urgency, UUI, and parity using data from 1,880 patients. Logistic models were run for each case-control scenario corresponding to previously used case definitions.
Parity was significantly associated with urgency (odds ratios (OR) 1.70; CI: 1.30-2.22) and UUI (odds ratios (OR) 1.87; CI: 1.34-2.60) only when the case criteria included individuals with stress incontinence (SUI). Parity was not associated with UUI when individuals with SUI were excluded or with urgency when individuals with incontinence were excluded.
Neither urgency nor UUI symptoms appear to be associated with parity among women 40 years of age and older. Previous associations appear to be explained by inclusion of individuals with SUI.
International Urogynecology Journal 05/2010; 21(9):1095-102. DOI:10.1007/s00192-010-1164-7 · 1.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background/Aims: Study populations are commonly identified using a single data source. However, the inclusion criteria may result in an unacceptable level of false positives/negatives. The utilization of multiple sources may allow for more complex inclusion criteria, therefore improving the accuracy of identification of cases and controls for use in research. For this study, Geisinger's electronic health record (EHR) was combined with clinical databases to identify a population of patients with suspected Acute Myocardial Infarction (AMI). Methods: The Geisinger Acute Myocardial Infarction Cohort (GAMIC) database was created to conduct research on AMI. Geisinger databases were queried to identify all patients who had elevated cardiac enzymes during an inpatient hospital admission at Geisinger Medical Center from Jan. 1, 2001 to Dec. 31, 2006. Data from the resulting patients were gathered and extensively reviewed for validity and coherence. When possible, overlapping data were collected from different sources to check for internal consistency. Discrepancies between sources were reviewed and resolved. The medical charts of patients who did not go to catheterization were manually reviewed to determine the reason for not going. Similarly, charts of patients with elevated cardiac enzymes who also had invasive surgery on the same visit were reviewed to determine the timing of the enzyme elevation. After applying all criteria, a cohort of AMI cases was derived and retained in the final GAMIC database. Results: There were 3,625 patients who had elevated cardiac enzymes during an inpatient encounter; 58% went for catheterization. Of the 3,625 suspected AMI cases, the most common reasons for exclusion were elevated enzymes occurring post open-heart surgery (n=275) and admissions with elevated enzymes but with a recent catheterization (n=61). Only 3,265 (90%) fulfilled all criteria applied from the diverse set of data sources. Interestingly, of the 360 that were excluded and the 3,265 AMI cases, 40% and 90% had an AMI discharge diagnosis for the inpatient admission, respectively. Conclusions: A more careful approach to identifying a study population and validating the data for internal consistency results in greater accuracy. In addition, more resources utilized in the beginning of the study to better capture the population of interest can lead to a reduction in resources needed later in the study if issues or questions arise from a poorly identified cohort.
Clinical Medicine & Research 03/2010; 8(1):38. DOI:10.3121/cmr.8.1.38