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Eric D Peterson - One of the best experts on this subject based on the ideXlab platform.
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temporal trends for Secondary Prevention measures among patients hospitalized with coronary artery disease
The American Journal of Medicine, 2015Co-Authors: Dharam J Kumbhani, Gregg C Fonarow, Eric D Peterson, Adrian F Hernandez, Christopher P Cannon, Frank W Peacock, Warren K Laskey, Prakash Deedwania, Maria V Grausepulveda, Lee H SchwammAbstract:Abstract Background Prior studies have noted that in-hospital adherence to Secondary Prevention measures varied among patients undergoing coronary artery bypass graft surgery, percutaneous coronary revascularization, or no intervention. We sought to study contemporary temporal trends in the in-hospital management of patients with coronary artery disease. Methods By using data from the Get With The Guidelines-Coronary Artery Disease registry, we compared adherence to 6 performance measures (aspirin within 24 hours, discharge on aspirin, discharge on beta-blockers, patients with low ejection fraction discharged on angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, smoking cessation counseling, and use of lipid-lowering medications) in eligible patients with coronary artery disease who underwent coronary artery bypass graft surgery, percutaneous coronary intervention, or no intervention between 2003 and 2008. Results A total of 113,971 patients with coronary artery disease were treated at 193 hospitals. Overall adherence to all 6 quality of care measures improved over time in all 3 treatment groups, but was highest at all time periods in the percutaneous coronary intervention group compared with the coronary artery bypass graft surgery group, whereas the no intervention group had the lowest use of Prevention measures at all time points ( P P Conclusions Over the last decade, overall adherence with Secondary Prevention measures improved significantly in patients hospitalized with coronary artery disease regardless of revascularization strategy. However, there still exist select opportunities for improving adherence, particularly among patients undergoing coronary artery bypass graft surgery or no intervention.
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persistence of Secondary Prevention medications after acute ischemic stroke or transient ischemic attack in chinese population data from china national stroke registry
Neurological Research, 2013Co-Authors: Gaifen Liu, Eric D Peterson, Haipeng Shen, Yilong Wang, Yongjun WangAbstract:AbstractObjective: Although proven stroke Secondary Prevention medications are available, persistent use is required to be effective. The present study aimed to investigate the degree of Secondary Prevention medications persistence after acute ischemic stroke (AIS) or transient ischemic attack (TIA), factors influencing persistence and its association with stroke outcomes.Methods: We examined patients with AIS or TIA enrolled in China National Stroke Registry (CNSR) between 2007 and 2008. Three-month persistence was defined as medication continuation between hospital discharge and 3-month postdischarge. Recurrent stroke and modified Rankin scale (mRS)≤2 at 3-month postdischarge were used as stroke outcomes. Logistic regression was used to adjust for confounders.Results: Totally, 9998 patients were analyzed. At 3 months, 63·6% of patients continued taking all Secondary Prevention medications prescribed at hospital discharge. Younger age (P = 0·05), male gender (P = 0·03), present history of hypertension (P...
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Secondary Prevention after coronary artery bypass graft surgery findings of a national randomized controlled trial and sustained society led incorporation into practice
Circulation, 2011Co-Authors: Judson B Williams, Eric D Peterson, Elizabeth R Delong, Rachel S Dokholyan, Fangshu Ou, Bruce T FergusonAbstract:Background—Despite evidence supporting the use of aspirin, β-blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering therapies in eligible patients, adoption of these Secondary Prevention measures after coronary artery bypass grafting has been inconsistent. We sought to rigorously test on a national scale whether low-intensity continuous quality improvement interventions can be used to speed Secondary Prevention adherence after coronary artery bypass grafting. Methods and Results—A total of 458 hospitals participating in the Society of Thoracic Surgeons National Cardiac Database and treating 361 328 patients undergoing isolated coronary artery bypass grafting were randomized to either a control or an intervention group. The intervention group received continuous quality improvement materials designed to influence the prescription of the Secondary Prevention medications at discharge. The primary outcome measure was discharge prescription rates of the targeted Secondary Prevention medications at intervention versus control sites, assessed by measuring preintervention and postintervention site differences. Prerandomization treatment patterns and baseline data were similar in the control (n=234) and treatment (n=224) groups. Individual medication use and composite adherence increased over 24 months in both groups, with a markedly more rapid rate of adherence uptake among the intervention hospitals and a statistically significant therapy hazard ratio in the intervention versus control group for all 4 Secondary Prevention medications. Conclusions—Provider—led, low-intensity continuous quality improvement efforts can improve the adoption of care processes into national practice within the context of a medical specialty society infrastructure. The findings of the present trial have led to the incorporation of study outcome metrics into a medical society rating system for ongoing quality improvement.
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atherosclerosis Secondary Prevention performance measures after coronary bypass graft surgery compared with percutaneous catheter intervention and nonintervention patients in the get with the guidelines database
Circulation, 2007Co-Authors: Loren F Hiratzka, Kim A Eagle, Li Liang, Gregg C Fonarow, Kenneth A Labresh, Eric D PetersonAbstract:Background— The American Heart Association Get With the Guidelines-Coronary Artery Disease program facilitates patient and physician compliance with proven atherosclerosis risk reduction strategies with collaborative learning sessions, teaching materials, predischarge online check lists, and web-based performance measure feedback for continuous quality improvement. Patients having coronary artery bypass graft surgery (CABG) may be subject to different care processes, nursing unit pathways, and personnel than patients having percutaneous catheter intervention or neither intervention, which may affect compliance. Methods and Results— The Get With the Guidelines-Coronary Artery Disease database was queried to determine whether compliance with Secondary Prevention performance measures for CABG patients was different from that for nonsurgical patients. A total of 119 106 patients were treated with CABG (14 118), percutaneous catheter intervention (58 702), or neither intervention (46 286). Compliance with medication prescriptions, including aspirin, β-blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering drugs, and smoking cessation counseling for eligible patients was analyzed. Medically appropriate exclusions and contraindications were included in the analysis. After adjusting for 14 clinical variables, CABG patients were less likely to receive most Secondary Prevention measures relative to percutaneous catheter intervention patients. In contrast, CABG patients were more likely to receive aspirin, β-blocker, and smoking cessation counseling than neither intervention patients. Composite adherence and defect-free rates were highest for percutaneous catheter intervention patients and lowest for neither intervention patients after adjustment. Conclusions— There are significant differences in compliance at hospital discharge with Secondary Prevention performance measures for CABG patients compared with nonsurgical patients. Process of care differences may explain these differences and should be examined further because significant opportunities for improved compliance are evident. CABG patients in particular represent a group for whom Secondary Prevention has proven benefits, and they may benefit from future quality improvement interventions.
Lee H Schwamm - One of the best experts on this subject based on the ideXlab platform.
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temporal trends for Secondary Prevention measures among patients hospitalized with coronary artery disease
The American Journal of Medicine, 2015Co-Authors: Dharam J Kumbhani, Gregg C Fonarow, Eric D Peterson, Adrian F Hernandez, Christopher P Cannon, Frank W Peacock, Warren K Laskey, Prakash Deedwania, Maria V Grausepulveda, Lee H SchwammAbstract:Abstract Background Prior studies have noted that in-hospital adherence to Secondary Prevention measures varied among patients undergoing coronary artery bypass graft surgery, percutaneous coronary revascularization, or no intervention. We sought to study contemporary temporal trends in the in-hospital management of patients with coronary artery disease. Methods By using data from the Get With The Guidelines-Coronary Artery Disease registry, we compared adherence to 6 performance measures (aspirin within 24 hours, discharge on aspirin, discharge on beta-blockers, patients with low ejection fraction discharged on angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, smoking cessation counseling, and use of lipid-lowering medications) in eligible patients with coronary artery disease who underwent coronary artery bypass graft surgery, percutaneous coronary intervention, or no intervention between 2003 and 2008. Results A total of 113,971 patients with coronary artery disease were treated at 193 hospitals. Overall adherence to all 6 quality of care measures improved over time in all 3 treatment groups, but was highest at all time periods in the percutaneous coronary intervention group compared with the coronary artery bypass graft surgery group, whereas the no intervention group had the lowest use of Prevention measures at all time points ( P P Conclusions Over the last decade, overall adherence with Secondary Prevention measures improved significantly in patients hospitalized with coronary artery disease regardless of revascularization strategy. However, there still exist select opportunities for improving adherence, particularly among patients undergoing coronary artery bypass graft surgery or no intervention.
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Secondary Prevention after ischemic stroke or transient ischemic attack
The American Journal of Medicine, 2014Co-Authors: Sripal Bangalore, Li Liang, Gregg C Fonarow, Lee H Schwamm, Eric E Smith, Inder M Singh, Deepak L BhattAbstract:Abstract Background Patients with stroke or transient ischemic attack are at increased risk of recurrent stroke. Transient ischemic attack is a harbinger for stroke merely hours to days after the initial transient ischemic attack. There is thus a narrow window of opportunity to initiate evidence-based therapies for Secondary Prevention of stroke. Our objective was to assess hospital adherence at discharge to Secondary Prevention measures after transient ischemic attack or ischemic stroke. Methods Observational study of patients in the Get With The Guidelines-Stroke registry from 2007 to 2011. Patients were divided into 2 cohorts based on presentation: transient ischemic attack versus ischemic stroke. Adherence to evidence-based Secondary Prevention and other quality measures were assessed. Results Among the 858,835 patients with transient ischemic attack or ischemic stroke, 259,319 (30%) patients presented with a transient ischemic attack and 599,516 (70%) patients presented with an ischemic stroke. After adjusting for patient and hospital characteristics, adherence to Secondary Prevention measures was consistently lower for the transient ischemic attack cohort (vs ischemic stroke cohort), who had lower odds of being discharged on antithrombotics (odds ratio [OR] 0.63; 95% confidence interval [CI], 0.59-0.66; P P 100 mg/dL (OR 0.52; 95% CI, 0.50-0.54; P P P P P P P Conclusions In patients surviving an ischemic stroke or transient ischemic attack, adherence to evidence-based Secondary Prevention discharge measures were consistently less for patients with transient ischemic attack, thus representing a missed opportunity at instituting preventive measures to reduce the risk of recurrent stroke.
Gregg C Fonarow - One of the best experts on this subject based on the ideXlab platform.
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temporal trends for Secondary Prevention measures among patients hospitalized with coronary artery disease
The American Journal of Medicine, 2015Co-Authors: Dharam J Kumbhani, Gregg C Fonarow, Eric D Peterson, Adrian F Hernandez, Christopher P Cannon, Frank W Peacock, Warren K Laskey, Prakash Deedwania, Maria V Grausepulveda, Lee H SchwammAbstract:Abstract Background Prior studies have noted that in-hospital adherence to Secondary Prevention measures varied among patients undergoing coronary artery bypass graft surgery, percutaneous coronary revascularization, or no intervention. We sought to study contemporary temporal trends in the in-hospital management of patients with coronary artery disease. Methods By using data from the Get With The Guidelines-Coronary Artery Disease registry, we compared adherence to 6 performance measures (aspirin within 24 hours, discharge on aspirin, discharge on beta-blockers, patients with low ejection fraction discharged on angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, smoking cessation counseling, and use of lipid-lowering medications) in eligible patients with coronary artery disease who underwent coronary artery bypass graft surgery, percutaneous coronary intervention, or no intervention between 2003 and 2008. Results A total of 113,971 patients with coronary artery disease were treated at 193 hospitals. Overall adherence to all 6 quality of care measures improved over time in all 3 treatment groups, but was highest at all time periods in the percutaneous coronary intervention group compared with the coronary artery bypass graft surgery group, whereas the no intervention group had the lowest use of Prevention measures at all time points ( P P Conclusions Over the last decade, overall adherence with Secondary Prevention measures improved significantly in patients hospitalized with coronary artery disease regardless of revascularization strategy. However, there still exist select opportunities for improving adherence, particularly among patients undergoing coronary artery bypass graft surgery or no intervention.
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Secondary Prevention after ischemic stroke or transient ischemic attack
The American Journal of Medicine, 2014Co-Authors: Sripal Bangalore, Li Liang, Gregg C Fonarow, Lee H Schwamm, Eric E Smith, Inder M Singh, Deepak L BhattAbstract:Abstract Background Patients with stroke or transient ischemic attack are at increased risk of recurrent stroke. Transient ischemic attack is a harbinger for stroke merely hours to days after the initial transient ischemic attack. There is thus a narrow window of opportunity to initiate evidence-based therapies for Secondary Prevention of stroke. Our objective was to assess hospital adherence at discharge to Secondary Prevention measures after transient ischemic attack or ischemic stroke. Methods Observational study of patients in the Get With The Guidelines-Stroke registry from 2007 to 2011. Patients were divided into 2 cohorts based on presentation: transient ischemic attack versus ischemic stroke. Adherence to evidence-based Secondary Prevention and other quality measures were assessed. Results Among the 858,835 patients with transient ischemic attack or ischemic stroke, 259,319 (30%) patients presented with a transient ischemic attack and 599,516 (70%) patients presented with an ischemic stroke. After adjusting for patient and hospital characteristics, adherence to Secondary Prevention measures was consistently lower for the transient ischemic attack cohort (vs ischemic stroke cohort), who had lower odds of being discharged on antithrombotics (odds ratio [OR] 0.63; 95% confidence interval [CI], 0.59-0.66; P P 100 mg/dL (OR 0.52; 95% CI, 0.50-0.54; P P P P P P P Conclusions In patients surviving an ischemic stroke or transient ischemic attack, adherence to evidence-based Secondary Prevention discharge measures were consistently less for patients with transient ischemic attack, thus representing a missed opportunity at instituting preventive measures to reduce the risk of recurrent stroke.
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atherosclerosis Secondary Prevention performance measures after coronary bypass graft surgery compared with percutaneous catheter intervention and nonintervention patients in the get with the guidelines database
Circulation, 2007Co-Authors: Loren F Hiratzka, Kim A Eagle, Li Liang, Gregg C Fonarow, Kenneth A Labresh, Eric D PetersonAbstract:Background— The American Heart Association Get With the Guidelines-Coronary Artery Disease program facilitates patient and physician compliance with proven atherosclerosis risk reduction strategies with collaborative learning sessions, teaching materials, predischarge online check lists, and web-based performance measure feedback for continuous quality improvement. Patients having coronary artery bypass graft surgery (CABG) may be subject to different care processes, nursing unit pathways, and personnel than patients having percutaneous catheter intervention or neither intervention, which may affect compliance. Methods and Results— The Get With the Guidelines-Coronary Artery Disease database was queried to determine whether compliance with Secondary Prevention performance measures for CABG patients was different from that for nonsurgical patients. A total of 119 106 patients were treated with CABG (14 118), percutaneous catheter intervention (58 702), or neither intervention (46 286). Compliance with medication prescriptions, including aspirin, β-blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering drugs, and smoking cessation counseling for eligible patients was analyzed. Medically appropriate exclusions and contraindications were included in the analysis. After adjusting for 14 clinical variables, CABG patients were less likely to receive most Secondary Prevention measures relative to percutaneous catheter intervention patients. In contrast, CABG patients were more likely to receive aspirin, β-blocker, and smoking cessation counseling than neither intervention patients. Composite adherence and defect-free rates were highest for percutaneous catheter intervention patients and lowest for neither intervention patients after adjustment. Conclusions— There are significant differences in compliance at hospital discharge with Secondary Prevention performance measures for CABG patients compared with nonsurgical patients. Process of care differences may explain these differences and should be examined further because significant opportunities for improved compliance are evident. CABG patients in particular represent a group for whom Secondary Prevention has proven benefits, and they may benefit from future quality improvement interventions.
Bruce T Ferguson - One of the best experts on this subject based on the ideXlab platform.
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Secondary Prevention after coronary artery bypass graft surgery a scientific statement from the american heart association
Circulation, 2015Co-Authors: Alexander Kulik, Marc Ruel, Hani Jneid, Bruce T Ferguson, Loren F Hiratzka, John S Ikonomidis, Francisco Lopezjimenez, Sheila M Mcnallan, Mahesh J Patel, Veronique L RogerAbstract:Background—Despite evidence supporting the use of aspirin, β-blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering therapies in eligible patients, adoption of these Secondary Prevention measures after coronary artery bypass grafting has been inconsistent. We sought to rigorously test on a national scale whether low-intensity continuous quality improvement interventions can be used to speed Secondary Prevention adherence after coronary artery bypass grafting. Methods and Results—A total of 458 hospitals participating in the Society of Thoracic Surgeons National Cardiac Database and treating 361 328 patients undergoing isolated coronary artery bypass grafting were randomized to either a control or an intervention group. The intervention group received continuous quality improvement materials designed to influence the prescription of the Secondary Prevention medications at discharge. The primary outcome measure was discharge prescription rates of the targeted Secondary Prevention medications...
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Secondary Prevention after coronary artery bypass graft surgery findings of a national randomized controlled trial and sustained society led incorporation into practice
Circulation, 2011Co-Authors: Judson B Williams, Eric D Peterson, Elizabeth R Delong, Rachel S Dokholyan, Fangshu Ou, Bruce T FergusonAbstract:Background—Despite evidence supporting the use of aspirin, β-blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering therapies in eligible patients, adoption of these Secondary Prevention measures after coronary artery bypass grafting has been inconsistent. We sought to rigorously test on a national scale whether low-intensity continuous quality improvement interventions can be used to speed Secondary Prevention adherence after coronary artery bypass grafting. Methods and Results—A total of 458 hospitals participating in the Society of Thoracic Surgeons National Cardiac Database and treating 361 328 patients undergoing isolated coronary artery bypass grafting were randomized to either a control or an intervention group. The intervention group received continuous quality improvement materials designed to influence the prescription of the Secondary Prevention medications at discharge. The primary outcome measure was discharge prescription rates of the targeted Secondary Prevention medications at intervention versus control sites, assessed by measuring preintervention and postintervention site differences. Prerandomization treatment patterns and baseline data were similar in the control (n=234) and treatment (n=224) groups. Individual medication use and composite adherence increased over 24 months in both groups, with a markedly more rapid rate of adherence uptake among the intervention hospitals and a statistically significant therapy hazard ratio in the intervention versus control group for all 4 Secondary Prevention medications. Conclusions—Provider—led, low-intensity continuous quality improvement efforts can improve the adoption of care processes into national practice within the context of a medical specialty society infrastructure. The findings of the present trial have led to the incorporation of study outcome metrics into a medical society rating system for ongoing quality improvement.
Veronique L Roger - One of the best experts on this subject based on the ideXlab platform.
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Secondary Prevention after coronary artery bypass graft surgery a scientific statement from the american heart association
Circulation, 2015Co-Authors: Alexander Kulik, Marc Ruel, Hani Jneid, Bruce T Ferguson, Loren F Hiratzka, John S Ikonomidis, Francisco Lopezjimenez, Sheila M Mcnallan, Mahesh J Patel, Veronique L RogerAbstract:Background—Despite evidence supporting the use of aspirin, β-blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering therapies in eligible patients, adoption of these Secondary Prevention measures after coronary artery bypass grafting has been inconsistent. We sought to rigorously test on a national scale whether low-intensity continuous quality improvement interventions can be used to speed Secondary Prevention adherence after coronary artery bypass grafting. Methods and Results—A total of 458 hospitals participating in the Society of Thoracic Surgeons National Cardiac Database and treating 361 328 patients undergoing isolated coronary artery bypass grafting were randomized to either a control or an intervention group. The intervention group received continuous quality improvement materials designed to influence the prescription of the Secondary Prevention medications at discharge. The primary outcome measure was discharge prescription rates of the targeted Secondary Prevention medications...
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abstract 18387 compliance with chronic coronary artery disease Secondary Prevention guidelines in the usa
Circulation, 2013Co-Authors: Francisco Lopezjimenez, Veronique L Roger, Victoria Zysek, Virend K Somers, Juliette Liesinger, Henry Ting, Randal J Thomas, Ondrej SochorAbstract:Objectives: To assess compliance with chronic coronary artery disease (CAD) Secondary Prevention guidelines in the USA, to determine time trends, and to identify potential sociodemographic predictors of low compliance. Design, Setting and Participants: We analyzed the National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2010, representative of non-institutionalized civilian population in the USA. We included people with self-reported previous diagnosis of CAD, angina or myocardial infarction (MI). Primary Outcome: Adherence to Secondary Prevention guidelines including blood pressure control, lipid control, not smoking, normal body mass index, physical activity at goal, and meeting all 5 outcomes (“all-or-none”). Use of antiplatelet therapy was reported and analyzed from 1999-2004. Secondary Outcome: Use of beta-blocker therapy in people with history of MI; in diabetes (DM), use of ACE-inhibitors or angiotensin receptor blocker, and HgbA1C <7%. Age, gender, race, income, education an...
