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Anne L Taylor - One of the best experts on this subject based on the ideXlab platform.
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effect of fixed dose combination of isosorbide dinitrate and hydralazine on all Hospitalizations and on 30 day readmission rates in patients with heart failure results from the african american heart failure trial
Circulation-heart Failure, 2014Co-Authors: Inder S Anand, Thomas S Rector, Jay N Cohn, Anne L TaylorAbstract:Background— Fixed-dose combination of isosorbide dinitrate and hydralazine (FDC-I/H) reduced mortality by 43% and death or first Hospitalization for heart failure (HF) by 37% in the African-American Heart Failure Trial (A-HeFT). Reduction in mortality makes it difficult to determine the effect on Hospitalizations unless the analysis adjusts for death as a competing risk. Methods and Results— In A-HeFT, 1050 self-identified black patients with moderate to severe HF were randomized to FDC-I/H or placebo. The effects of FDC-I/H on first and all Hospitalizations and 30-day readmission rates were analyzed. Deaths as competing risks were adjusted using Fine–Gray regression and joint models of Hospitalizations and mortality. There were 558 all-cause and 251 HF Hospitalizations in placebo compared with 435 and 173 Hospitalizations in the FDC-I/H group. Adjusting for deaths as a competing risk, the effect of FDC-I/H on the first Hospitalization for HF, expressed in hazard ratio (95% confidence interval), was 0.61 (0.47–0.80; P P =0.18) on the first all-cause Hospitalization. The effect of FDC-I/H on all recurrent Hospitalizations for HF was 0.66 (0.52–0.83; P =0.0005), similar to the effect on the first Hospitalizations for HF, whereas the effect on all Hospitalizations for any cause was 0.75 (0.63–0.91; P =0.003). The 30-day all-cause readmission rate after the first Hospitalization for HF was 23.6% (29 of 123) in placebo versus 14.8% (12 of 81) in the FDC-I/H group, but the effect (0.59; 0.30–1.16; P =0.12) in this small subgroup was not significant. Conclusions— Treatment with FDC-I/H was associated with a substantial reduction in the first and recurrent HF Hospitalizations, and in total all-cause Hospitalizations, reducing the total burden of costly and distressing Hospitalizations. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00047775.
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effect of fixed dose combination of isosorbide dinitrate and hydralazine on all Hospitalizations and on 30 day readmission rates in patients with heart failureclinical perspective
Circulation-heart Failure, 2014Co-Authors: Inder S Anand, Thomas S Rector, Jay N Cohn, Anne L TaylorAbstract:Background— Fixed-dose combination of isosorbide dinitrate and hydralazine (FDC-I/H) reduced mortality by 43% and death or first Hospitalization for heart failure (HF) by 37% in the African-American Heart Failure Trial (A-HeFT). Reduction in mortality makes it difficult to determine the effect on Hospitalizations unless the analysis adjusts for death as a competing risk. Methods and Results— In A-HeFT, 1050 self-identified black patients with moderate to severe HF were randomized to FDC-I/H or placebo. The effects of FDC-I/H on first and all Hospitalizations and 30-day readmission rates were analyzed. Deaths as competing risks were adjusted using Fine–Gray regression and joint models of Hospitalizations and mortality. There were 558 all-cause and 251 HF Hospitalizations in placebo compared with 435 and 173 Hospitalizations in the FDC-I/H group. Adjusting for deaths as a competing risk, the effect of FDC-I/H on the first Hospitalization for HF, expressed in hazard ratio (95% confidence interval), was 0.61 (0.47–0.80; P <0.001) and 0.88 (0.72–1.06; P =0.18) on the first all-cause Hospitalization. The effect of FDC-I/H on all recurrent Hospitalizations for HF was 0.66 (0.52–0.83; P =0.0005), similar to the effect on the first Hospitalizations for HF, whereas the effect on all Hospitalizations for any cause was 0.75 (0.63–0.91; P =0.003). The 30-day all-cause readmission rate after the first Hospitalization for HF was 23.6% (29 of 123) in placebo versus 14.8% (12 of 81) in the FDC-I/H group, but the effect (0.59; 0.30–1.16; P =0.12) in this small subgroup was not significant. Conclusions— Treatment with FDC-I/H was associated with a substantial reduction in the first and recurrent HF Hospitalizations, and in total all-cause Hospitalizations, reducing the total burden of costly and distressing Hospitalizations. Clinical Trial Registration— URL: . Unique identifier: [NCT00047775][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00047775&atom=%2Fcirchf%2F7%2F5%2F759.atom
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effect of fixed dose combination of isosorbide dinitrate and hydralazine on all Hospitalizations and on 30 day readmission rates in patients with heart failure results from the a heft trial
Circulation-heart Failure, 2014Co-Authors: Inder S Anand, Thomas S Rector, Jay N Cohn, Anne L TaylorAbstract:Background —Isosorbide-dinitrate and hydralazine (FDC-I/H) reduced mortality by 43% and death or first Hospitalization for heart failure (HF) by 37% in the African-American Heart Failure Trial (A-HeFT). Reduction in mortality makes it difficult to determine the effect on Hospitalizations unless the analysis adjusts for death as a competing risk. Methods and Results —In A-HeFT, 1050 self-identified black patients with moderate to severe HF were randomized to FDC-I/H or placebo. The effects of FDC-I/H on first and all-Hospitalizations, and 30-day readmission rates were analyzed. Deaths as competing risks were adjusted using Fine-Gray regression and joint-models of Hospitalizations and mortality. There were 558 all-cause and 251 HF-Hospitalizations in placebo compared to 435 and 173 Hospitalizations in the FDC-I/H group. Adjusting for deaths as a competing risk, the effect of FDC-I/H on the first Hospitalization for HF [HR (95% CI)] was 0.61 (0.47-0.80, p<0.001) and 0.88 (0.72-1.06, p=0.18) on the first all-cause Hospitalization. The effect of FDC-I/H on all-recurrent Hospitalizations for HF was 0.66 (0.52 to 0.83; p=0.0005), similar to the effect on the first-Hospitalizations for HF, whereas the effect on all-Hospitalizations for any-cause was 0.75 (0.63-0.91; p=0.003). The 30-day all-cause readmission rate after the first Hospitalization for HF was 23.6% (29/123) in placebo versus 14.8% (12/81) in FDC-I/H group, but the effect [0.59 (0.30 to 1.16; p = 0.12)] in this small subgroup was not significant. Conclusions —Treatment with FDC-I/H was associated with a substantial reduction in the first and recurrent heart failure Hospitalizations, and in total all-cause Hospitalizations, reducing the total-burden of costly and distressing Hospitalizations. Clinical Trial Registration —URL: http://www.clinicaltrials.gov. Unique identifier: [NCT00047775][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00047775&atom=%2Fcirchf%2Fearly%2F2014%2F06%2F26%2FCIRCHEARTFAILURE.114.001360.atom
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effect of fixed dose combination of isosorbide dinitrate and hydralazine on all Hospitalizations and on 30 day readmission rates in patients with heart failure
Circulation-heart Failure, 2014Co-Authors: Inder S Anand, Thomas S Rector, Jay N Cohn, Anne L TaylorAbstract:Background—Fixed-dose combination of isosorbide dinitrate and hydralazine (FDC-I/H) reduced mortality by 43% and death or first Hospitalization for heart failure (HF) by 37% in the African-American Heart Failure Trial (A-HeFT). Reduction in mortality makes it difficult to determine the effect on Hospitalizations unless the analysis adjusts for death as a competing risk. Methods and Results—In A-HeFT, 1050 self-identified black patients with moderate to severe HF were randomized to FDC-I/H or placebo. The effects of FDC-I/H on first and all Hospitalizations and 30-day readmission rates were analyzed. Deaths as competing risks were adjusted using Fine–Gray regression and joint models of Hospitalizations and mortality. There were 558 all-cause and 251 HF Hospitalizations in placebo compared with 435 and 173 Hospitalizations in the FDC-I/H group. Adjusting for deaths as a competing risk, the effect of FDC-I/H on the first Hospitalization for HF, expressed in hazard ratio (95% confidence interval), was 0.61 (0...
Inder S Anand - One of the best experts on this subject based on the ideXlab platform.
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the Hospitalization burden and post Hospitalization mortality risk in heart failure with preserved ejection fraction results from the i preserve trial irbesartan in heart failure and preserved ejection fraction
Jacc-Heart Failure, 2015Co-Authors: Peter E Carson, Inder S Anand, Thomas S Rector, Markus Haass, Jose Lopezsendon, Alan B Miller, John R Teerlink, Michel White, Robert S Mckelvie, Michel KomajdaAbstract:Abstract Objectives The aim of this study was to investigate prognosis in patients with heart failure (HF) with preserved ejection fraction and the causes of Hospitalization and post-Hospitalization mortality. Background Although Hospitalizations in patients with HF with preserved ejection fraction are common, there are limited data from clinical trials on the causes of admission and the influence of Hospitalizations on subsequent mortality risk. Methods Patients (n = 4,128) with New York Heart Association functional class II to IV HF and left ventricular ejection fractions >45% were enrolled in I-PRESERVE (Irbesartan in Heart Failure and Preserved Ejection Fraction). A blinded events committee adjudicated cardiovascular Hospitalizations and all deaths using predefined and standardized definitions. The risk for death after HF, any-cause, or non-HF Hospitalization was assessed using time-dependent Cox proportional hazard models. Results A total of 2,278 patients had 5,863 Hospitalizations during the 49 months of follow-up, of which 3,585 (61%) were recurrent Hospitalizations. For any-cause Hospitalizations, 26.5% of patients died during follow-up, with an incident mortality rate of 11.1 deaths per 100 patient-years (PYs) and an adjusted hazard ratio of 5.32 (95% confidence interval: 4.21 to 6.23). Overall, 53.6% of Hospitalizations were classified as cardiovascular and 43.7% as noncardiovascular, with 2.7% not classifiable. HF was the largest single cause of initial (17.6%) and overall (21.1%) Hospitalizations, although, after HF Hospitalization, a substantially higher proportion of readmissions were due to primary HF causes (40%). HF Hospitalization occurred in 685 patients, with 41% deaths during follow-up, an incident mortality rate of 19.3 deaths per 100 PYs. The adjusted hazard ratio was 2.93 (95% confidence interval: 2.40 to 3.57) relative to patients who were not hospitalized for HF and was greater in those with longer durations of Hospitalization. There were 1,593 patients with only non-HF Hospitalizations, 21% of whom died during follow-up, with an incident mortality rate of 8.7 deaths per 100 PYs and an adjusted hazard ratio of 4.25 (95% confidence interval: 3.27 to 5.32). The risk for death was highest in the first 30 days and declined over time for all Hospitalization categories. Patients not hospitalized for HF or for any cause had observed incident mortality rates of 3.8 and 1.3 deaths per 100 PYs, respectively. Conclusions In I-PRESERVE, HFpEF patients hospitalized for any reason, and especially for HF, were at high risk for subsequent death, particularly early. The findings support the need for careful attention in the post-discharge time period including attention to comorbid conditions. Among those hospitalized for HF, the high mortality rate and increased proportion of readmissions due to HF (highest during the first 30 days), suggest that this group would be an appropriate target for investigation of new interventions.
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effect of fixed dose combination of isosorbide dinitrate and hydralazine on all Hospitalizations and on 30 day readmission rates in patients with heart failure results from the african american heart failure trial
Circulation-heart Failure, 2014Co-Authors: Inder S Anand, Thomas S Rector, Jay N Cohn, Anne L TaylorAbstract:Background— Fixed-dose combination of isosorbide dinitrate and hydralazine (FDC-I/H) reduced mortality by 43% and death or first Hospitalization for heart failure (HF) by 37% in the African-American Heart Failure Trial (A-HeFT). Reduction in mortality makes it difficult to determine the effect on Hospitalizations unless the analysis adjusts for death as a competing risk. Methods and Results— In A-HeFT, 1050 self-identified black patients with moderate to severe HF were randomized to FDC-I/H or placebo. The effects of FDC-I/H on first and all Hospitalizations and 30-day readmission rates were analyzed. Deaths as competing risks were adjusted using Fine–Gray regression and joint models of Hospitalizations and mortality. There were 558 all-cause and 251 HF Hospitalizations in placebo compared with 435 and 173 Hospitalizations in the FDC-I/H group. Adjusting for deaths as a competing risk, the effect of FDC-I/H on the first Hospitalization for HF, expressed in hazard ratio (95% confidence interval), was 0.61 (0.47–0.80; P P =0.18) on the first all-cause Hospitalization. The effect of FDC-I/H on all recurrent Hospitalizations for HF was 0.66 (0.52–0.83; P =0.0005), similar to the effect on the first Hospitalizations for HF, whereas the effect on all Hospitalizations for any cause was 0.75 (0.63–0.91; P =0.003). The 30-day all-cause readmission rate after the first Hospitalization for HF was 23.6% (29 of 123) in placebo versus 14.8% (12 of 81) in the FDC-I/H group, but the effect (0.59; 0.30–1.16; P =0.12) in this small subgroup was not significant. Conclusions— Treatment with FDC-I/H was associated with a substantial reduction in the first and recurrent HF Hospitalizations, and in total all-cause Hospitalizations, reducing the total burden of costly and distressing Hospitalizations. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00047775.
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effect of fixed dose combination of isosorbide dinitrate and hydralazine on all Hospitalizations and on 30 day readmission rates in patients with heart failureclinical perspective
Circulation-heart Failure, 2014Co-Authors: Inder S Anand, Thomas S Rector, Jay N Cohn, Anne L TaylorAbstract:Background— Fixed-dose combination of isosorbide dinitrate and hydralazine (FDC-I/H) reduced mortality by 43% and death or first Hospitalization for heart failure (HF) by 37% in the African-American Heart Failure Trial (A-HeFT). Reduction in mortality makes it difficult to determine the effect on Hospitalizations unless the analysis adjusts for death as a competing risk. Methods and Results— In A-HeFT, 1050 self-identified black patients with moderate to severe HF were randomized to FDC-I/H or placebo. The effects of FDC-I/H on first and all Hospitalizations and 30-day readmission rates were analyzed. Deaths as competing risks were adjusted using Fine–Gray regression and joint models of Hospitalizations and mortality. There were 558 all-cause and 251 HF Hospitalizations in placebo compared with 435 and 173 Hospitalizations in the FDC-I/H group. Adjusting for deaths as a competing risk, the effect of FDC-I/H on the first Hospitalization for HF, expressed in hazard ratio (95% confidence interval), was 0.61 (0.47–0.80; P <0.001) and 0.88 (0.72–1.06; P =0.18) on the first all-cause Hospitalization. The effect of FDC-I/H on all recurrent Hospitalizations for HF was 0.66 (0.52–0.83; P =0.0005), similar to the effect on the first Hospitalizations for HF, whereas the effect on all Hospitalizations for any cause was 0.75 (0.63–0.91; P =0.003). The 30-day all-cause readmission rate after the first Hospitalization for HF was 23.6% (29 of 123) in placebo versus 14.8% (12 of 81) in the FDC-I/H group, but the effect (0.59; 0.30–1.16; P =0.12) in this small subgroup was not significant. Conclusions— Treatment with FDC-I/H was associated with a substantial reduction in the first and recurrent HF Hospitalizations, and in total all-cause Hospitalizations, reducing the total burden of costly and distressing Hospitalizations. Clinical Trial Registration— URL: . Unique identifier: [NCT00047775][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00047775&atom=%2Fcirchf%2F7%2F5%2F759.atom
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effect of fixed dose combination of isosorbide dinitrate and hydralazine on all Hospitalizations and on 30 day readmission rates in patients with heart failure results from the a heft trial
Circulation-heart Failure, 2014Co-Authors: Inder S Anand, Thomas S Rector, Jay N Cohn, Anne L TaylorAbstract:Background —Isosorbide-dinitrate and hydralazine (FDC-I/H) reduced mortality by 43% and death or first Hospitalization for heart failure (HF) by 37% in the African-American Heart Failure Trial (A-HeFT). Reduction in mortality makes it difficult to determine the effect on Hospitalizations unless the analysis adjusts for death as a competing risk. Methods and Results —In A-HeFT, 1050 self-identified black patients with moderate to severe HF were randomized to FDC-I/H or placebo. The effects of FDC-I/H on first and all-Hospitalizations, and 30-day readmission rates were analyzed. Deaths as competing risks were adjusted using Fine-Gray regression and joint-models of Hospitalizations and mortality. There were 558 all-cause and 251 HF-Hospitalizations in placebo compared to 435 and 173 Hospitalizations in the FDC-I/H group. Adjusting for deaths as a competing risk, the effect of FDC-I/H on the first Hospitalization for HF [HR (95% CI)] was 0.61 (0.47-0.80, p<0.001) and 0.88 (0.72-1.06, p=0.18) on the first all-cause Hospitalization. The effect of FDC-I/H on all-recurrent Hospitalizations for HF was 0.66 (0.52 to 0.83; p=0.0005), similar to the effect on the first-Hospitalizations for HF, whereas the effect on all-Hospitalizations for any-cause was 0.75 (0.63-0.91; p=0.003). The 30-day all-cause readmission rate after the first Hospitalization for HF was 23.6% (29/123) in placebo versus 14.8% (12/81) in FDC-I/H group, but the effect [0.59 (0.30 to 1.16; p = 0.12)] in this small subgroup was not significant. Conclusions —Treatment with FDC-I/H was associated with a substantial reduction in the first and recurrent heart failure Hospitalizations, and in total all-cause Hospitalizations, reducing the total-burden of costly and distressing Hospitalizations. Clinical Trial Registration —URL: http://www.clinicaltrials.gov. Unique identifier: [NCT00047775][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00047775&atom=%2Fcirchf%2Fearly%2F2014%2F06%2F26%2FCIRCHEARTFAILURE.114.001360.atom
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effect of fixed dose combination of isosorbide dinitrate and hydralazine on all Hospitalizations and on 30 day readmission rates in patients with heart failure
Circulation-heart Failure, 2014Co-Authors: Inder S Anand, Thomas S Rector, Jay N Cohn, Anne L TaylorAbstract:Background—Fixed-dose combination of isosorbide dinitrate and hydralazine (FDC-I/H) reduced mortality by 43% and death or first Hospitalization for heart failure (HF) by 37% in the African-American Heart Failure Trial (A-HeFT). Reduction in mortality makes it difficult to determine the effect on Hospitalizations unless the analysis adjusts for death as a competing risk. Methods and Results—In A-HeFT, 1050 self-identified black patients with moderate to severe HF were randomized to FDC-I/H or placebo. The effects of FDC-I/H on first and all Hospitalizations and 30-day readmission rates were analyzed. Deaths as competing risks were adjusted using Fine–Gray regression and joint models of Hospitalizations and mortality. There were 558 all-cause and 251 HF Hospitalizations in placebo compared with 435 and 173 Hospitalizations in the FDC-I/H group. Adjusting for deaths as a competing risk, the effect of FDC-I/H on the first Hospitalization for HF, expressed in hazard ratio (95% confidence interval), was 0.61 (0...
Denise J Jamieson - One of the best experts on this subject based on the ideXlab platform.
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Hospitalizations with amphetamine abuse among pregnant women
Obstetrics & Gynecology, 2008Co-Authors: Shanna Cox, Samuel F Posner, Athena P Kourtis, Denise J JamiesonAbstract:OBJECTIVE: To examine trends in pregnancy Hospitalizations with a diagnosis of amphetamine or cocaine abuse and the prevalence of associated medical complications. METHODS: Data were obtained from the Nationwide Inpatient Sample. Hospitalization ratios per 100 deliveries for amphetamine or cocaine abuse from 1998 to 2004 were tested for linear trends. Amphetamine-abuse Hospitalizations were compared with cocaine-abuse Hospitalizations and non-substance-abuse Hospitalizations. A chi2 analysis was used to compare Hospitalization characteristics. Conditional probabilities estimated by logistic regression were used to calculate adjusted prevalence ratios for each medical diagnosis of interest. RESULTS: From 1998 to 2004, the Hospitalization ratio for cocaine abuse decreased 44%, whereas the Hospitalization ratio for amphetamine abuse doubled. Pregnancy Hospitalizations with a diagnosis of amphetamine abuse were geographically concentrated in the West (82%), and were more likely to be among women younger than 24 years than the cocaine-abuse or non-substance-abuse Hospitalizations. Most medical conditions were more prevalent in the amphetamine-abuse group than the non-substance-abuse group. When the substance abuse groups were compared with each other, obstetric diagnoses associated with infant morbidity such as premature delivery and poor fetal growth were more common in the cocaine-abuse group, whereas vasoconstrictive effects such as cardiovascular disorders and hypertension complicating pregnancy were more common in the amphetamine-abuse group. CONCLUSION: As pregnancy Hospitalizations with a diagnosis of amphetamine abuse continue to increase, clinicians should familiarize themselves with the adverse consequences of amphetamine abuse during pregnancy and evidence-based guidelines to deal with this high-risk population. LEVEL OF EVIDENCE: III.
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Hospitalizations with amphetamine abuse among pregnant women.
Obstetrics and gynecology, 2008Co-Authors: Shanna Cox, Samuel F Posner, Athena P Kourtis, Denise J JamiesonAbstract:To examine trends in pregnancy Hospitalizations with a diagnosis of amphetamine or cocaine abuse and the prevalence of associated medical complications. Data were obtained from the Nationwide Inpatient Sample. Hospitalization ratios per 100 deliveries for amphetamine or cocaine abuse from 1998 to 2004 were tested for linear trends. Amphetamine-abuse Hospitalizations were compared with cocaine-abuse Hospitalizations and non-substance-abuse Hospitalizations. A chi2 analysis was used to compare Hospitalization characteristics. Conditional probabilities estimated by logistic regression were used to calculate adjusted prevalence ratios for each medical diagnosis of interest. From 1998 to 2004, the Hospitalization ratio for cocaine abuse decreased 44%, whereas the Hospitalization ratio for amphetamine abuse doubled. Pregnancy Hospitalizations with a diagnosis of amphetamine abuse were geographically concentrated in the West (82%), and were more likely to be among women younger than 24 years than the cocaine-abuse or non-substance-abuse Hospitalizations. Most medical conditions were more prevalent in the amphetamine-abuse group than the non-substance-abuse group. When the substance abuse groups were compared with each other, obstetric diagnoses associated with infant morbidity such as premature delivery and poor fetal growth were more common in the cocaine-abuse group, whereas vasoconstrictive effects such as cardiovascular disorders and hypertension complicating pregnancy were more common in the amphetamine-abuse group. As pregnancy Hospitalizations with a diagnosis of amphetamine abuse continue to increase, clinicians should familiarize themselves with the adverse consequences of amphetamine abuse during pregnancy and evidence-based guidelines to deal with this high-risk population. III.
Thomas S Rector - One of the best experts on this subject based on the ideXlab platform.
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the Hospitalization burden and post Hospitalization mortality risk in heart failure with preserved ejection fraction results from the i preserve trial irbesartan in heart failure and preserved ejection fraction
Jacc-Heart Failure, 2015Co-Authors: Peter E Carson, Inder S Anand, Thomas S Rector, Markus Haass, Jose Lopezsendon, Alan B Miller, John R Teerlink, Michel White, Robert S Mckelvie, Michel KomajdaAbstract:Abstract Objectives The aim of this study was to investigate prognosis in patients with heart failure (HF) with preserved ejection fraction and the causes of Hospitalization and post-Hospitalization mortality. Background Although Hospitalizations in patients with HF with preserved ejection fraction are common, there are limited data from clinical trials on the causes of admission and the influence of Hospitalizations on subsequent mortality risk. Methods Patients (n = 4,128) with New York Heart Association functional class II to IV HF and left ventricular ejection fractions >45% were enrolled in I-PRESERVE (Irbesartan in Heart Failure and Preserved Ejection Fraction). A blinded events committee adjudicated cardiovascular Hospitalizations and all deaths using predefined and standardized definitions. The risk for death after HF, any-cause, or non-HF Hospitalization was assessed using time-dependent Cox proportional hazard models. Results A total of 2,278 patients had 5,863 Hospitalizations during the 49 months of follow-up, of which 3,585 (61%) were recurrent Hospitalizations. For any-cause Hospitalizations, 26.5% of patients died during follow-up, with an incident mortality rate of 11.1 deaths per 100 patient-years (PYs) and an adjusted hazard ratio of 5.32 (95% confidence interval: 4.21 to 6.23). Overall, 53.6% of Hospitalizations were classified as cardiovascular and 43.7% as noncardiovascular, with 2.7% not classifiable. HF was the largest single cause of initial (17.6%) and overall (21.1%) Hospitalizations, although, after HF Hospitalization, a substantially higher proportion of readmissions were due to primary HF causes (40%). HF Hospitalization occurred in 685 patients, with 41% deaths during follow-up, an incident mortality rate of 19.3 deaths per 100 PYs. The adjusted hazard ratio was 2.93 (95% confidence interval: 2.40 to 3.57) relative to patients who were not hospitalized for HF and was greater in those with longer durations of Hospitalization. There were 1,593 patients with only non-HF Hospitalizations, 21% of whom died during follow-up, with an incident mortality rate of 8.7 deaths per 100 PYs and an adjusted hazard ratio of 4.25 (95% confidence interval: 3.27 to 5.32). The risk for death was highest in the first 30 days and declined over time for all Hospitalization categories. Patients not hospitalized for HF or for any cause had observed incident mortality rates of 3.8 and 1.3 deaths per 100 PYs, respectively. Conclusions In I-PRESERVE, HFpEF patients hospitalized for any reason, and especially for HF, were at high risk for subsequent death, particularly early. The findings support the need for careful attention in the post-discharge time period including attention to comorbid conditions. Among those hospitalized for HF, the high mortality rate and increased proportion of readmissions due to HF (highest during the first 30 days), suggest that this group would be an appropriate target for investigation of new interventions.
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effect of fixed dose combination of isosorbide dinitrate and hydralazine on all Hospitalizations and on 30 day readmission rates in patients with heart failure results from the african american heart failure trial
Circulation-heart Failure, 2014Co-Authors: Inder S Anand, Thomas S Rector, Jay N Cohn, Anne L TaylorAbstract:Background— Fixed-dose combination of isosorbide dinitrate and hydralazine (FDC-I/H) reduced mortality by 43% and death or first Hospitalization for heart failure (HF) by 37% in the African-American Heart Failure Trial (A-HeFT). Reduction in mortality makes it difficult to determine the effect on Hospitalizations unless the analysis adjusts for death as a competing risk. Methods and Results— In A-HeFT, 1050 self-identified black patients with moderate to severe HF were randomized to FDC-I/H or placebo. The effects of FDC-I/H on first and all Hospitalizations and 30-day readmission rates were analyzed. Deaths as competing risks were adjusted using Fine–Gray regression and joint models of Hospitalizations and mortality. There were 558 all-cause and 251 HF Hospitalizations in placebo compared with 435 and 173 Hospitalizations in the FDC-I/H group. Adjusting for deaths as a competing risk, the effect of FDC-I/H on the first Hospitalization for HF, expressed in hazard ratio (95% confidence interval), was 0.61 (0.47–0.80; P P =0.18) on the first all-cause Hospitalization. The effect of FDC-I/H on all recurrent Hospitalizations for HF was 0.66 (0.52–0.83; P =0.0005), similar to the effect on the first Hospitalizations for HF, whereas the effect on all Hospitalizations for any cause was 0.75 (0.63–0.91; P =0.003). The 30-day all-cause readmission rate after the first Hospitalization for HF was 23.6% (29 of 123) in placebo versus 14.8% (12 of 81) in the FDC-I/H group, but the effect (0.59; 0.30–1.16; P =0.12) in this small subgroup was not significant. Conclusions— Treatment with FDC-I/H was associated with a substantial reduction in the first and recurrent HF Hospitalizations, and in total all-cause Hospitalizations, reducing the total burden of costly and distressing Hospitalizations. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00047775.
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effect of fixed dose combination of isosorbide dinitrate and hydralazine on all Hospitalizations and on 30 day readmission rates in patients with heart failureclinical perspective
Circulation-heart Failure, 2014Co-Authors: Inder S Anand, Thomas S Rector, Jay N Cohn, Anne L TaylorAbstract:Background— Fixed-dose combination of isosorbide dinitrate and hydralazine (FDC-I/H) reduced mortality by 43% and death or first Hospitalization for heart failure (HF) by 37% in the African-American Heart Failure Trial (A-HeFT). Reduction in mortality makes it difficult to determine the effect on Hospitalizations unless the analysis adjusts for death as a competing risk. Methods and Results— In A-HeFT, 1050 self-identified black patients with moderate to severe HF were randomized to FDC-I/H or placebo. The effects of FDC-I/H on first and all Hospitalizations and 30-day readmission rates were analyzed. Deaths as competing risks were adjusted using Fine–Gray regression and joint models of Hospitalizations and mortality. There were 558 all-cause and 251 HF Hospitalizations in placebo compared with 435 and 173 Hospitalizations in the FDC-I/H group. Adjusting for deaths as a competing risk, the effect of FDC-I/H on the first Hospitalization for HF, expressed in hazard ratio (95% confidence interval), was 0.61 (0.47–0.80; P <0.001) and 0.88 (0.72–1.06; P =0.18) on the first all-cause Hospitalization. The effect of FDC-I/H on all recurrent Hospitalizations for HF was 0.66 (0.52–0.83; P =0.0005), similar to the effect on the first Hospitalizations for HF, whereas the effect on all Hospitalizations for any cause was 0.75 (0.63–0.91; P =0.003). The 30-day all-cause readmission rate after the first Hospitalization for HF was 23.6% (29 of 123) in placebo versus 14.8% (12 of 81) in the FDC-I/H group, but the effect (0.59; 0.30–1.16; P =0.12) in this small subgroup was not significant. Conclusions— Treatment with FDC-I/H was associated with a substantial reduction in the first and recurrent HF Hospitalizations, and in total all-cause Hospitalizations, reducing the total burden of costly and distressing Hospitalizations. Clinical Trial Registration— URL: . Unique identifier: [NCT00047775][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00047775&atom=%2Fcirchf%2F7%2F5%2F759.atom
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effect of fixed dose combination of isosorbide dinitrate and hydralazine on all Hospitalizations and on 30 day readmission rates in patients with heart failure results from the a heft trial
Circulation-heart Failure, 2014Co-Authors: Inder S Anand, Thomas S Rector, Jay N Cohn, Anne L TaylorAbstract:Background —Isosorbide-dinitrate and hydralazine (FDC-I/H) reduced mortality by 43% and death or first Hospitalization for heart failure (HF) by 37% in the African-American Heart Failure Trial (A-HeFT). Reduction in mortality makes it difficult to determine the effect on Hospitalizations unless the analysis adjusts for death as a competing risk. Methods and Results —In A-HeFT, 1050 self-identified black patients with moderate to severe HF were randomized to FDC-I/H or placebo. The effects of FDC-I/H on first and all-Hospitalizations, and 30-day readmission rates were analyzed. Deaths as competing risks were adjusted using Fine-Gray regression and joint-models of Hospitalizations and mortality. There were 558 all-cause and 251 HF-Hospitalizations in placebo compared to 435 and 173 Hospitalizations in the FDC-I/H group. Adjusting for deaths as a competing risk, the effect of FDC-I/H on the first Hospitalization for HF [HR (95% CI)] was 0.61 (0.47-0.80, p<0.001) and 0.88 (0.72-1.06, p=0.18) on the first all-cause Hospitalization. The effect of FDC-I/H on all-recurrent Hospitalizations for HF was 0.66 (0.52 to 0.83; p=0.0005), similar to the effect on the first-Hospitalizations for HF, whereas the effect on all-Hospitalizations for any-cause was 0.75 (0.63-0.91; p=0.003). The 30-day all-cause readmission rate after the first Hospitalization for HF was 23.6% (29/123) in placebo versus 14.8% (12/81) in FDC-I/H group, but the effect [0.59 (0.30 to 1.16; p = 0.12)] in this small subgroup was not significant. Conclusions —Treatment with FDC-I/H was associated with a substantial reduction in the first and recurrent heart failure Hospitalizations, and in total all-cause Hospitalizations, reducing the total-burden of costly and distressing Hospitalizations. Clinical Trial Registration —URL: http://www.clinicaltrials.gov. Unique identifier: [NCT00047775][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00047775&atom=%2Fcirchf%2Fearly%2F2014%2F06%2F26%2FCIRCHEARTFAILURE.114.001360.atom
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effect of fixed dose combination of isosorbide dinitrate and hydralazine on all Hospitalizations and on 30 day readmission rates in patients with heart failure
Circulation-heart Failure, 2014Co-Authors: Inder S Anand, Thomas S Rector, Jay N Cohn, Anne L TaylorAbstract:Background—Fixed-dose combination of isosorbide dinitrate and hydralazine (FDC-I/H) reduced mortality by 43% and death or first Hospitalization for heart failure (HF) by 37% in the African-American Heart Failure Trial (A-HeFT). Reduction in mortality makes it difficult to determine the effect on Hospitalizations unless the analysis adjusts for death as a competing risk. Methods and Results—In A-HeFT, 1050 self-identified black patients with moderate to severe HF were randomized to FDC-I/H or placebo. The effects of FDC-I/H on first and all Hospitalizations and 30-day readmission rates were analyzed. Deaths as competing risks were adjusted using Fine–Gray regression and joint models of Hospitalizations and mortality. There were 558 all-cause and 251 HF Hospitalizations in placebo compared with 435 and 173 Hospitalizations in the FDC-I/H group. Adjusting for deaths as a competing risk, the effect of FDC-I/H on the first Hospitalization for HF, expressed in hazard ratio (95% confidence interval), was 0.61 (0...
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the relationship between in home water service and the risk of respiratory tract skin and gastrointestinal tract infections among rural alaska natives
American Journal of Public Health, 2008Co-Authors: Thomas W Hennessy, Robert C. Holman, James E. Cheek, Troy Ritter, Dana Bruden, Krista L Yorita, Lisa R Bulkow, Rosalyn J Singleton, Jeff SmithAbstract:Objectives. We investigated the relationship between the presence of in-home piped water and wastewater services and Hospitalization rates for respiratory tract, skin, and gastrointestinal tract infections in rural Alaska. Methods. We determined in-home water service and Hospitalizations for selected infectious diseases among Alaska Natives by region during 2000 to 2004. Within 1 region, infant respiratory Hospitalizations and skin infections for all ages were compared by village-level water services. Results. Regions with a lower proportion of home water service had significantly higher Hospitalization rates for pneumonia and influenza (rate ratio [RR]=2.5), skin or soft tissue infection (RR=1.9), and respiratory syncytial virus (RR=3.4 among those younger than 5 years) than did higher-service regions. Within 1 region, infants from villages with less than 10% of homes served had higher Hospitalization rates for pneumonia (RR=1.3) and respiratory syncytial virus (RR=1.2) than did infants from villages with more than 80% served. Outpatient Staphylococcus aureus infections (RR=5.1, all ages) and skin infection Hospitalizations (RR=2.7, all ages) were higher in low-service than in high-service villages. Conclusions. Higher respiratory and skin infection rates were associated with a lack of in-home water service. This disparity should be addressed through sanitation infrastructure improvements.
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Hospitalizations associated with rotavirus gastroenteritis in the united states 1993 2002
Pediatric Infectious Disease Journal, 2006Co-Authors: Myrna Charles, Roger I Glass, Umesh D Parashar, Aaron T Curns, Robert C. Holman, Joseph S BreseeAbstract:Background : In the United States, rotavirus gastroenteritis remains a common disease of children that results in many Hospitalizations, clinic visits and medical costs. It is a common cause of morbidity and is associated with a high economic burden in developing countries. Prevention of Hospitalizations is the primary target of rotavirus vaccines. Methods: To update estimates of rotavirus Hospitalization rates in the United States, we conducted a retrospective analysis of 10 years of national Hospitalization data associated with gastroenteritis and used both direct and indirect methods to estimate the percentage of cases associated with rotavirus gastroenteritis. Results: During 1993-2002, an average of 18% of all Hospitalizations with gastroenteritis among children <5 years old were associated with rotavirus infection as determined by the rotavirus-specific International Classification of Diseases, 9th revision, Clinical Modification code. The annual proportion of rotavirus-associated Hospitalizations increased from 15% in 1993-1995 to 21% in 2000-2002. Hospitalizations associated with rotavirus and those associated with nonspecific gastroenteritis had a marked wintertime seasonality and similar age distribution, which peaked among children between 3 and 24 months old. Using indirect estimation methods, 58,000 to 70,000 rotavirus-associated Hospitalizations were estimated to occur each year in the United States. Conclusions: Rotavirus gastroenteritis remains an important cause of Hospitalizations in the United States, and the rate has not declined from 1993 through 2002.
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diarrhea and rotavirus associated Hospitalizations among children less than 5 years of age united states 1997 and 2000
Pediatrics, 2006Co-Authors: Mark A Malek, Roger I Glass, Aaron T Curns, Robert C. Holman, Joseph S Bresee, Claudia Steiner, Thea K Fischer, Umesh D ParasharAbstract:OBJECTIVE. A new rotavirus vaccine may be licensed in the United States in early 2006. Estimates of the burden of severe rotavirus disease, particularly Hospitalizations, will help evaluate the potential benefits of a national rotavirus immunization program. DESIGN. The Kids' Inpatient Database, a robust sample of 10% of the uncomplicated births and 80% of other pediatric discharges was used to estimate the number and rate of diarrhea- and rotavirus-associated Hospitalizations among US children <5 years of age in 1997 and 2000. RESULTS. In 1997 and 2000, diarrhea was coded in 13% of all childhood Hospitalizations, for an estimated cumulative incidence of 1 diarrhea Hospitalization per 23 to 27 children by age 5. Most diarrhea-associated Hospitalizations (62%) were coded as unspecified etiology, and 35% as viral. Rotavirus was the most common pathogen recorded for 18% and 19% of diarrhea-associated Hospitalizations in 1997 and 2000, respectively. Diarrhea-associated Hospitalizations coded as unspecified or viral exhibited a marked winter peak similar to that of Hospitalizations coded as rotavirus, suggesting that the rotavirus-specific code captures a fraction of all rotavirus Hospitalizations. Using indirect methods, we estimated that rotavirus was associated with 51 142-60 155 and 46 839-56 820 Hospitalizations in 1997 and 2000, respectively. By these estimates, rotavirus is associated with 4% to 5% of all childhood Hospitalizations, and 1 in 67 to 1 in 85 children will be hospitalized with rotavirus by 5 years of age. CONCLUSIONS. Diarrhea is an important cause of Hospitalization in US children, and rotavirus is the most important etiology. Disease burden estimates have remained stable during the past decade. An effective rotavirus vaccine will likely reduce substantially the burden of severe rotavirus disease, estimated to account for 4% to 5% of all Hospitalizations and ∼30% of Hospitalizations for watery diarrhea among children <5 years of age.
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epidemiology of cat scratch disease Hospitalizations among children in the united states
Pediatric Infectious Disease Journal, 2005Co-Authors: Mary G Reynolds, Aaron T Curns, Robert C. Holman, Michael Oreilly, Jennifer H Mcquiston, Claudia A SteinerAbstract:BACKGROUND Cat-scratch disease (CSD), caused by infection with Bartonella henselae, affects both children and adults but is principally a pediatric disease. Typical CSD is generally benign and self-limited and is characterized by regional lymphadenopathy with fever. Infections can, however, be accompanied by focal or diffuse inflammatory responses (atypical CSD) involving neurologic, organ (liver/spleen), lymphatic or skeletal systems. METHODS Pediatric Hospitalizations with CSD listed as a diagnosis were examined using the Kids' Inpatient Database for the year 2000. National estimates of CSD-associated Hospitalizations, Hospitalization rates and various Hospitalization statistics were examined for patients younger than 18 years of age. RESULTS During 2000, an estimated 437 (SE 43) pediatric Hospitalizations associated with CSD occurred among children younger than 18 years of age in the United States. The national CSD-associated Hospitalization rate was 0.60/100,000 children younger than 18 years of age (95% confidence interval, 0.49-0.72) and 0.86/100,000 children younger than 5 years of age (95% CI 0.64-1.07). Accompanying diagnoses included neurologic complications (12%), organ (liver/spleen) involvement (7%) and "other" (5%). Atypical CSD accounted for approximately 24% of the CSD-associated Hospitalizations. The median charge for a CSD-associated Hospitalization was 6140 dollars with total annual hospital charges of approximately 3.5 million dollars among children in the United States. CONCLUSIONS The CSD-associated Hospitalization rate among children during 2000 appeared similar to those estimated for the 1980s in the United States, despite significant increases in cat ownership in the intervening time. Early serologic and molecular testing for CSD in children is suggested to minimize unnecessary interventions and promote optimally effective care when supportive measures are required.
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Trends in infectious disease Hospitalizations among American Indians and Alaska Natives.
American journal of public health, 2001Co-Authors: Robert C. Holman, Aaron T Curns, Stephen F. Kaufman, James E. Cheek, Robert W. Pinner, Lawrence B. SchonbergerAbstract:OBJECTIVES: This study sought to describe trends in Hospitalizations associated with infectious diseases among American Indians and Alaska Natives. METHODS: Infectious disease Hospitalizations and rates among American Indians and Alaska Natives from 1980 through 1994 were examined via Indian Health Service hospital discharge data and compared with published trends for the general US population. RESULTS: Annual Hospitalization rates for infectious diseases among American Indians and Alaska Natives decreased by 31.0% between 1980 and 1994. Infectious disease Hospitalizations accounted for 16.3% of all Hospitalizations in 1980 and 21.2% in 1994, an increase of 30.1%. In 1994, the age-adjusted infectious disease Hospitalization rate for American Indians and Alaska Natives was 1863 per 100,000 population, approximately 21% greater than that for the general US population. CONCLUSIONS: Hospitalization trends for infectious diseases show that there has been improvement in the health status of American Indians and Alaska Natives but also indicate that this population has a higher infectious disease burden than the general US population.
