completeness of medical records to assess quality of hospital care: the case of acute myocardial infarction in a district-level general hospital in Iran

Quantifying the quality of care in high-cost and fatal conditions such as acute myocardial infarction [AMI] is a crucial step toward improving clinical outcomes in these patients. The main objective of this pilot study is to show whether abstraction of medical charts would be a useful method to systematically assess quality of care in patients hospitalized for AMI in a general hospital that has no interventional cardiac technology. A general physician and a cardiologist working with Shahid Gholipour Hospital in Bukan, Northwest Iran, retrospectively abstracted medical records of all patients with verified diagnoses of myocardial infarction who were hospitalized between April 1, 2010 and March 31, 2011. The targeted outcome variables were risk-adjusted mortality and risk-adjusted length of hospital stay. Process quality indicators were selected from those developed by the National Quality Forum [NQF] of the United States. We reported completeness of selected variables used to build and calculate quality indicators in this study. For most variables, missing values were negligible. However, missing data on fields related to contraindications for prescribed medications were common. Medical chart abstractions provide useful first steps in assessing differences in the quality of hospital care for patients with AMI. Extension of our pilot study is highly recommended and may help trigger policy decisions to promote hospital quality in Iran

[ quality of life after first acute myocardial infarction]

Improvement in the management of patients who are afflicted with acute myocardial infarction [AMI] has resulted in the increase of their survival after heart attacks. The purpose of this study was to determine the quality of life [QOL] after first AMI among patients who referred to teaching hospitals affiliated with Shahid Beheshti University of Medical Sciences. This cross-sectional study was performed with the participation of 300 patients. The inclusion criteria were age between 32 to 79, first AMI, 6 to 30 months after AMI and consent for participation. These patients had been admitted in Shahid Modares, Loghmane Hakeem, Taleghanee and Shahid Labafeenejad hospitals, affiliated to Shahid Beheshti University of Medical Sciences, for AMI and they had written medical records in these hospitals. The participants were enrolled in the study when they referred for routine follow-up visits at outpatient clinics. Data was collected by interviewing the patients. For measuring QOL, The Short Form Health Survey [SF-36] was used. The mean age of patients was 56.6 +/- 9.6 years from which 57.5% were men and 42.3% women. The mean scores of QOL in various aspects were 67.2 for physical function, 52.9 for role limitation due to physical health problems, 71.1 for bodily pain, 48 for general health, 52.6 for vitality, 71.3 for social function, 59.2 for role limitation due to emotional problems and 57.2 for mental health. In comparison with the general population, QOL in this study was reduced in all scales but the amount of reduction was not the same. With increasing age, QOL of patients decreased in all aspects. QOL in women after AMI, 9% to 23% more than men was reduced. The study showed that QOL of patients 6 to 30 months after the first AMI. The QOL decreased in physical scales more than mental and emotional scales. Decrease in QOL was related to increasing age and in women was more than men

[Response of the cardiovascular physiological and functional markers following the short term taurine supplementation and burce protocol in patients with cardiac heart failure]

Although a series of cardiovascular risk factors have been recently identified, taurine deficiency has been demonstrated as a risk factor for cardiovascular disease and has been poorly investigated in patients with Cardiac Heart Failure [CHF].The aim of present study was to investigate response of the cardiovascular physiological and functional markers following the short-term taurine supplementation and Burce protocol in patients with CHF. In a semi-experimental design, sixteen male CHF patients [classified in class II and III] aged between 50 to 65 yr. were randomly divided into taurine and placebo groups. The taurine group received 1.5 gr. of taurine [3 times daily 500 mg capsules], while at the same time, the placebo group consumed starch capsules for duration of 2 weeks. Systolic and diastolic blood pressure, heart rate, maximal activity time on treadmill by Bruce protocol, Vo2 peak and plasma taurine, cardiac troponin I and CPK-MB concentrations were measured before and after taurine supplementation by standard methods. Data was analyzed by using dependent and independent t- student tests at p

[Study of the relation between indices of ventricular function and pulmonary vascular resistance [PVR]]

Pulmonary vascular resistance [PVR] index is an important hemodynamic variable in determining the severity of cardiopulmonary diseases. This study was done to define the relationship of echocardiographic parameters of ventricular function with PVR. Mean PVR of 40 patients with cardiac disease was compared with the left ventricle diastolic function indices [LVEF] and the Systolic Pulmonary Arterial Pressure, [SPAP]. Results were analyzed by Linear Regression Test; also right ventricle TAPSE index was compared with mean PVR by Mann- Whitney Test, using SPSS Ver. 15. The comparison between PVR and TAPSE showed that the mean PVR reduces significantly with increase of TAPSE [cut off point 1.8; p= [0.0 26]. The study of the relation between SPAP and PVR made it clear that an increase in SPAP [mean PAP>25 mmHg] will cause the PVR to increase significantly [P<0.0001]. The study of LVEF and PVR showed that PVR decreases significantly parallel with an increase in EF [P= 0.004]. The study of mean PVR in LV Diastolic dysfunction groupings showed that the mean PVR difference in Restrictive Pattern was significantly higher than the Normal grouping [P<0.0001]. Measurement of right and left ventricles function indices by echocardiography is a reliable and accessible instrument for PVR estimation and monitoring. Noting the significance of PVR measurement in the process of treating cardiovascular diseases, we recommend use of echocardiography as a simple, accessible and noninvasive method for determining PVR, and an also as an index for estimating prognosis

[Research priority of cardiovascular research center of Shahid Beheshti university of medical sciences in 2009]

Allocation of limited resources to research proposals with high priority helps achievement of acceptable level of health. Therefore, priority setting in research centers is a necessary action. The objective of this study is to report the research priorities of the Cardiovascular Research Center of Shahid Beheshti University of Medical Sciences in 2009. This study involved 48 faculty members and other stakeholders in 2009. There were five basic principles including stakeholders' participation and consensus, situation analysis, need assessment, defining research priority topics, and scoring the criteria. This is a modified version of the proposed model of "The Council on Health Research for Development [COHRED]. Twenty diseases were determined as research priorities of the cardiovascular research center of Shahid Beheshti University of Medical Sciences. These priorities included myocardial infarction, hypertension, unstable angina, atherosclerosis, dyslipidemia, heart failure, stable angina, metabolic syndrome, coronary bypass complications, pulmonary embolism, heart valve diseases, prevention of deep vein thrombosis, rheumatic fever, cardiogenic shock, cardiac arrhythmia, cardiac arrest and sudden cardiac death, Peripheral vascular disease, syncope, angioplasty and valvuloplasty, cardiovascular diseases: epidemiology, etiology, risk factors, prevention, rehabilitation, socioeconomic factors, knowledge, attitude, and practice to risk factors and prevention. Providing researchers with a list of research priorities and commitment to it, conduct research topics toward priorities and consequently the most productivity is achieved from the limited resources

[Evaluation of anterior mitral leaflet concavity area by 2D echocardiography in ischemic induced mitral regurgitation]

Functional mitral regurgitation [FMR] results from left ventricular remodeling, anterior leaflet tethering or tenting. Coronary artery disease is one of the important causes of FMR due to tethering. Detection of FMR and its severity is one of important factors in patient prognosis. There are different methods for detection of FMR and its severity, including anterior mitral leaflet concavity area [AMLCA]. In this cross sectional study 32 patients were selected, 19 of them were male with three vessel disease [3VD] and were candidate for coronary bypass graft surgery [CABG] with or without mitral valve surgery. They had FMR in ventriculography. Anterior mitral leaflet concavity area [AMLCA] was determined by long axis view [LAX] of transthorasic echocardiography [TTE]. Relation between severity of MR and AMLCA determined with Spearman's correlation coefficient and according to Roc curve study cut-off point was 0.1 cm[2]. Statistical analysis was performed using SPSS Version 15. In studied patients, AMLCA were 0.1-0.43 cm[2] in transthorasic echocardiography [cutoff point was 0.1 cm[2]]. A strong correlation was seen between AMLCA and FMR severity with LAX view of TTE [r=0.89]. Relation between FMR and AMLCA was a simple linear relationship. The results showed that AMILCA in the parasternal LAX view provides rapid and reliable diagnosis of FMR due to coronary artery disease and is quantitatively related to the severity of MR. In this regard, further studies with more subjects are recommended

Measurement of NT- ProBNP in patients with heart failure

Heart failure is the final complication of many diseases and an important cause of morbidity and mortality. N- Terminal B- type Natriuretic Peptide [NT-Pro BNP] is a new diagnostic tool for evaluation of the severity of heart failure and for differentiation between systolic function of left and right heart. In addition, plasma level of NT-Pro BNP serves as a good guide in the management and follow-up of patients under treatment for heart failure. Patients with left side heart failure who referred to Taleghani hospital were consecutively recruited for this study. Diagnosis of heart failure was done through clinical evaluation and echocardiographic procedure. The severity of heart failure was determined according to New York heart association [NYHA] classification and clinical stage for each patient. Three ml citrated venous blood was obtained from the subjects and all samples were sent to the Endocrine and Metabolism research center laboratory of Shahid Beheshti Medical University for evaluation of plasma NT-ProBNP level by enzyme-linked immunoabsorbent assay [ELISA] technique. Patients with acute coronary syndrome, severe valvular stenosis, severe lung disease, liver cirrhosis, primary hyperaldesteronism, hyperthyroidism, acute respiratory distress syndrome [ARDS], and candidates for heart transplantation were excluded. Plasma level of NT- ProBNP for each classification of NYHA and clinical stages and left ventricular ejection fraction [LVEF] were evaluated. Seventy nine patients, with a mean age of 63.1% 14 years were included in the study. Fifty-five [69.6%] subjects were male. Forty-eight patients [60.8%] were hypertensive; twenty- two patients [27.8%] were diabetic and sixty- four patients [81.0%] suffered from ischemic heart disease [IHD]. The mean plasma level of NT- ProBNP in subjects aged 60 years or more was higher than younger subjects, [485. 8 +/- 418.6 versus 308.7 +/- 300.5], [p= 0.033]. The evaluation of NT-Pro BNP plasma levels showed correlation with decreased ejection fraction [p= 0.0 13], clinical stages [P< 0.001], and function class according to NYHA classification [P < 0.001]. Plasma levels of NT- Pro BNP were elevated proportional to decrease in ejection fraction and systolic function of left ventricle in patients with heart failure. Measurement of NT- Pro BNP is a good laboratory indicator for detection of left ventricular failure and its severity

Measurement of oxidized low-density lipoprotein and superoxide dismutase activity in patients with hypertension

Arterial hypertension is an important risk factor for coronary artery disease and cardiovascular-induced morbidity and mortality. It can cause end-organ damages such as cerebrovascular diseases, renal failure, and congestive heart failure. On the other hand, because of elevated blood pressure and rapid blood flow, there is an increase in oxidation and peroxidation reactions. The aim of this study was to evaluate the level of oxidized low-density lipoprotein and superoxide dismutase activity in sera of hypertensive patients. In this case-control study, 70 hypertensive patients without any other important diseases such as congestive heart failure, cardiomyopathy, liver disease, diabetes mellitus, renal disease, or thyroid disease were compared with 70 age-and gender-matched controls. The participants' age range was from 30 to 75 years. Measurement of oxidized low-density lipoprotein in serum was performed by enzyme-linked immunosorbent assay. The activity of superoxide dismutase in serum was measured by enzymatic colorimetry method. The patients' mean age +/- SD was 52.2 +/- 14 years. The controls' mean age +/- SD was 45 +/- 13 years. The level of superoxide dismutase activity in the patients' group was 100_27 U/mL, and in the controls_ group was 105 +/- 11 U/mL. The level of oxidized low-density lipoprotein in the patients' group was 14 +/- 4 mu/L, and in controls it was 7.7 +/- 3 mu/L. Data of this study demonstrated an elevation of oxidized low -density lipoprotein in hypertensive group that may be the result of oxidation processes. Superoxide dismutase activity was decreased in hypertensive patients, which can be the result of elevated oxidation reactions