Relationship of a quality measure composite to clinical outcomes for patients with heart failure.

BACKGROUND: To determine whether compliance with heart failure performance measures (HFPMs) is associated with short-term outcome benefit. METHODS: In a cohort study, 194 patients satisfying all the HFPMs for which they were eligible were compared with 206 controls. Over 6 months, time to death and first all-cause readmission data were collected. Data were adjusted for differences in comorbidities, medications, and demographics in a multivariate model. RESULTS: There was no difference in 6-month mortality between the 2 groups. Adjusted time to death or all-cause hospitalization (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.58-0.97; P = .03) and all-cause hospitalization (HR, 0.74; 95% CI, 0.57-0.97; P = .03) were shorter for the study group compared with control, whereas there was no difference in time to death (HR, 0.86; 95% CI, 0.66-1.11; P = .24). CONCLUSIONS: Adherence to a composite of HFPM appears to be related to a reduction in all-cause readmissions for patients with HF but not short-term mortality.

Early revascularization and ACC/AHA guideline-compliant medical management improve left ventricular function and short-term prognosis in patients presenting with acute myocardial infarction and severe left ventricular dysfunction.

BACKGROUND: Myocardial infarction (MI) complicated by severe left ventricular (LV) dysfunction is associated with significant morbidity and mortality. The natural history of this population with contemporary revascularization and guideline-based medical therapies is poorly defined. We sought to determine the impact of contemporary treatment strategies on LV function and prognosis in patients with MI and severe LV dysfunction. METHODS: Consecutive MI patients were prospectively followed as part of an ongoing internal database. The current report comprises 75 patients with first MI and severe LV systolic dysfunction (EF less than or equal to 3%). Initial demographic and clinical data were collected during hospitalization and at 1-, 3- and 6-month follow up. RESULTS: Patients were 71% male, 36% diabetic and 51% had prior coronary disease with a mean (+/- SD) age of 65 +/- 14 years. The average hospital stay was 5.7 days for ST-elevation (CPK range 424 to 5,250) and 2.4 days for non-ST-elevation MI (CPK range 175 to 705). Revascularization in-hospital was performed in 87% of patients (62 percutaneous, 3 surgical). At hospital discharge, treatment included beta-blockers (84%), ACE-inhibitors (73%), statins (81%), aspirin (88%) and clopidogrel (84%). Mean (+/- SD) LVEF was 25.7 +/- 5.9% in hospital, 36.6 +/- 11.8% by 1 to 3 months (p < 0.01), and 37.6 +/- 9.3% at 6 months (p < 0.01). By 1 to 3 months, 63% had improved LVEF, 24% were unchanged and 14% were worse. One patient died in the hospital and 3 died by 6-month follow up (mortality 5.3%). CONCLUSION: A strategy of early revascularization combined with guideline-based medical management favorably impacts LV function and short-term prognosis in MI patients with severe LV systolic dysfunction. With contemporary treatment strategies, the majority (> 60%) of patients demonstrate improvement in LVEF and mortality is low (5.3%).

Returning coronary heart disease patients to work: a modified perspective.

A very large number of Americans die from Coronary heart disease (CHD); a large number survive. It is the goal of cardiac rehabilitation to restore the physical and economic status of individuals suffering from CHD. This paper reviews current CHD statistics, summarizes the factors that are known to cause CHD, traces the evolution of cardiac rehabilitation programs, and, finally, provides a new perspective for rehabilitating CHD patients based on job simulation.