Abstract P70: Analysis of Downstream Encounter Data Drives Quality Interventions for Acute Coronary Syndrome

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
E B Jackson ◽  
Tiercy K Fortenberry ◽  
Melanie K Delvalle ◽  
Amy Frye-Anderson ◽  
Thomas E Ervin ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Emergency Room ◽  
Medical Center ◽  
Care Quality ◽  
Post Discharge ◽  
Data Set ◽  
Treatment Pathway ◽  
Coronary Syndrome ◽  
Vanderbilt University ◽  
Drive Time

Background: Understanding resource utilization is crucial to improving care quality in Acute Coronary Syndrome (ACS). We reviewed 6-month downstream encounters following an admission for ACS including hospitalization, emergency room visits, clinic visits and rehabilitation. Methods: Downstream encounter and cost data for 6 months following ACS admission to Vanderbilt University Medical Center (VUMC) were evaluated. The data set included 7,668 encounters from 2,196 unique patients for period 7/1/08-6/30/10. Analysis was stratified by patient drive time from home to VUMC, treatment pathway (surgery vs. percutaneous intervention) and encounter type. Unrelated encounters were excluded; analysis was limited to encounters at VUMC. Outcomes: We found 29% (1,522 of 5,318) of 6-month downstream encounters occurred within 4 weeks post-discharge, accounting for 35% of costs. Limiting data to readmissions only, 39% (255 of 661) of encounters, totaling 41% of costs, occurred during this 4-week period ( Figure ). Patients with shorter drive time had higher downstream utilization, with average 3.34 visits within 6 months for patients living ≤50 minutes from VUMC, versus 1.86 for patients living >50 minutes away. Emergency room encounters for patients ≤50 minutes away were also greater (average 0.51 versus 0.23 for patients >50 minutes). Conclusion: Analysis suggests that interventions targeting downstream encounters within the first 4 weeks of discharge for ACS will have greater effects on cost and quality, and those interventions should also be tailored based on patient drive time. Review of available encounter data can help direct resources to quality interventions.

CARDIOVASCULAR RISK IN PATIENTS WHO ARRIVE AT THE EMERGENCY ROOM WITH ACUTE CORONARY SYNDROME: PP.2.70

2010 ◽  
Vol 28 ◽  
pp. e68
Author(s):  
M Rizzi ◽  
S Herrera Mateo ◽  
A Coloma Conde ◽  
M Mateo ◽  
D Filella Agulló ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiovascular Risk ◽  
Emergency Room ◽  
Coronary Syndrome

Impact of anxiety on the post-discharge outcomes of patients discharged from the hospital after an acute coronary syndrome

2019 ◽  
Vol 278 ◽  
pp. 28-33 ◽  
Author(s):  
Hoang Tran ◽  
Nancy Byatt ◽  
Nathaniel Erskine ◽  
Darleen Lessard ◽  
Randolph S. Devereaux ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Discharge Outcomes

High-Density Lipoprotein Cholesterol (HDL-C) Levels Independently Correlates With Cardiac Arrhythmias and Atrial Fibrillation

2018 ◽  
Vol 35 (5) ◽  
pp. 438-444 ◽  
Author(s):  
Farzin Brian Boudi ◽  
Nicholas Kalayeh ◽  
Mohammad Reza Movahed
Keyword(s):  
Acute Coronary Syndrome ◽  
High Density Lipoprotein ◽  
Medical Center ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
High Density ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Cholesterol Levels ◽  
Low Hdl

Objective: Acute coronary syndrome is frequently complicated by rhythm disturbances, yet any association between high-density lipoprotein (HDL) cholesterol levels and arrhythmias in the setting of non-ST-segment elevation myocardial infarction (non-STEMI) is uncertain. The goal of this study was to evaluate any association between HDL-cholesterol levels and arrhythmias in the setting of non-STEMI. Methods: Retrospective data from Phoenix Veterans Affair Medical Center records were utilized for our study. A total of 6881 patients were found who presented during 2000 to 2003 with non-STEMI with available fasting lipid panels collected within the first 24 hours of admission. Patients were followed for the development of rhythm disturbances up to 6 years after initial presentation, with a mean follow up of 1269 days. Results: We found that high triglycerides/HDL and low-density lipid/HDL ratios were predictive of arrhythmias. However, low HDL levels had strongest association with highest odds ratio (OR) for development of arrhythmias (for HDL <31 mg/dL, OR = 3.72, 95% confidence interval [CI] = 2.55-5.44, P < .05) in patients with diabetes and (for HDL < 31 mg/dL, OR = 3.69, 95% CI = 2.85-4.71, P < .05) in patients without diabetes. Using multivariate analysis adjusting for comorbidities, low HDL level remained independently associated with arrhythmias. Conclusions: Patients with low HDL levels during hospitalization with non-STEMI have a greater risk of developing cardiac rhythm disturbances independent of other risk factors. These data suggest a possible protective role of HDL in preventing arrhythmias in the setting of acute coronary syndrome.

Abstract 165: In-hospital Serum HbA1c and Glucose Levels and 30-Day Hospital Readmissions Among Adults Hospitalized with an Acute Coronary Syndrome: TRACE-CORE

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Nathaniel A Erskine ◽  
Molly E Waring ◽  
Joel M Gore ◽  
Jerry H Gurwitz ◽  
Darleen M Lessard ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Significant Proportion ◽  
Serum Glucose ◽  
Day Hospital ◽  
Glucose Levels ◽  
Coronary Syndrome ◽  
Study Results ◽  
Hba1c Levels

Objective: Abnormalities in glucose metabolism may worsen the prognosis of patients hospitalized with an acute coronary syndrome (ACS). We examined the association of in-hospital serum glucose and glycated hemoglobin (HbA1c) levels with the occurrence of 30-day hospital readmissions among adults discharged from the hospital after an ACS. Methods: Using data from the Transitions, Risks, and Action in Coronary Events - Center for Outcomes Research and Education (TRACE-CORE) study, we reviewed the medical records of 2,187 patients discharged from 6 hospitals in MA and GA after an ACS between 2011 and 2013. We stratified patients according to diabetes mellitus (DM) status at baseline, as defined by medical history of DM, admission medications, or a serum HbA1c > 6.5%. Using logistic regression models, we calculated crude and adjusted odds ratios to estimate the association between serum HbA1c and glucose levels during hospitalization with 30-day all-cause readmissions. We controlled for prior and inpatient insulin use, age, body mass index, ACS classification, length of stay, and hospital site. Results: Data on serum HbA1c and glucose levels were available for 1,102 (50%) participants. This study sample had a mean age of 60 (SD: 11) years, 68% were male, 77% were non-Hispanic white, and 52% had DM. The mean in-hospital serum HbA1c and maximum and minimum serum glucose levels were 8.2%, 277 mg/dL, and 101 mg/dL, respectively, for those with known DM (n = 526) and 5.7%, 155 mg/dL, and 92 mg/dL for those without known DM (n = 576). A higher, but non-significant, proportion of patients with DM (14%) were readmitted to an area medical center within 30 days of discharge compared to those without DM (11%, p = 0.27). Neither serum HbA1c levels, nor minimum or maximum glucose values during hospitalization were associated with all-cause 30-day readmissions among those with and without DM (Table). Conclusions: In this prospective study of adults with an ACS, we found no significant association between serum HbA1c or glucose levels with the occurrence of 30-day hospital readmissions. The low proportion of subjects with serum HbA1c testing may have biased the study results. Further investigation should examine the in-hospital management of ACS patients with varying serum glucose and HBA1C levels and their post-discharge outcomes.

Abstract 320: Healthcare Resource Utilization Among Patients with Acute Coronary Syndrome Managed with Percutaneous Coronary Intervention and Using Prasugrel or Ticagrelor: A Retrospective Database Analysis

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Cliff Molife ◽  
Mark B Effron ◽  
Mitch DeKoven ◽  
Swapna Karkare ◽  
Feride Frech-Tamas ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Resource Utilization ◽  
Healthcare Resource ◽  
Coronary Intervention ◽  
Healthcare Resource Utilization ◽  
P Value ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Objective: To show that prasugrel (pras) was non-inferior to ticagrelor (ticag) in terms of healthcare resource utilization (HCRU) based upon 30- and 90-day all-cause rehospitalization rates among patients (pts) with acute coronary syndrome (ACS) managed with percutaneous coronary intervention (PCI). Methods: This retrospective study used anonymized hospital data from the IMS Patient-Centric Data Warehouse to identify ACS-PCI pts aged ≥18 years with ≥1 in-hospital claim for pras or ticag between 8/1/11-4/30/13. Three cohorts were predefined and analyzed: ACS-PCI (primary cohort), ACS-PCI without prior TIA or stroke (label cohort), and ACS-PCI pts without prior TIA or stroke and if age ≥75 years required evidence of diabetes or prior MI (core cohort). The McNemar’s test was used to evaluate adjusted outcome differences between propensity matched (PM) groups. P-value for non-inferiority (p-NI) test was obtained through a one-sided Z test by comparing log (RR) with log(1.2), a predefined margin. Results: Among 16,098 eligible pts, 13,134 (82%) received pras and 2,964 (18%) received ticag. Compared to ticag pts, pras pts were younger, more likely men, and less likely to have cardiovascular or bleeding risk factors (P<0.05). Of the total population, 1,375 (8.54%) and 2,374 (14.75%) were rehospitalized for any reason within 30 and 90 days post discharge, respectively. After PM adjustment, pras was non-inferior to ticag for 30- and 90-day all-cause rehospitalization rates in all 3 cohorts (p-NI < 0.01). Data are summarized in Table 1. All-cause rehospitalization for the label and core cohorts showed non-inferiority and a significantly lower 90-day rehospitalization rate with pras compared with ticag (Table). Conclusions: All-cause rehospitalizations at 30-and 90-days post discharge in ACS-PCI pts were non-inferior with pras vs. ticag in all 3 cohorts. Pras was associated with significantly lower risk for 90-day all-cause rehospitalizations compared with ticag in the label and core cohorts, which are the majority of pts receiving pras. Although there appears to be inherent bias and unmeasured confounders related to use of pras vs. ticag, these data show reductions in HCRU with pras compared with ticag in the real-world setting at 30- and 90-days post-discharge.

461Modulation of ischemic and bleeding risk by peripheral artery disease after an acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Cespon Fernandez ◽  
S Raposeiras Roubin ◽  
E Abu-Assi ◽  
S Manzano-Fernandez ◽  
F Dascenzo ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Peripheral Artery Disease ◽  
Cumulative Incidence ◽  
Bleeding Risk ◽  
Peripheral Artery ◽  
Data Set ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
The Impact

Abstract Introduction Peripheral artery disease (PAD) is associated with heightened ischemic and bleeding risk in patients with acute coronary syndrome (ACS). With this study from real-life patients, we try to analyze the balance between ischemic and bleeding risk during treatment with dual antiplatelet therapy (DAPT) after an ACS according to the presence or not of PAD. Methods The data analyzed in this study were obtained from the fusion of 3 clinical registries of ACS patients: BleeMACS (2004–2013), CardioCHUVI/ARRITXACA (2010–2016) and RENAMI (2013–2016). All 3 registries include consecutive patients discharged after an ACS with DAPT and undergoing PCI. The merged data set contain 26,076 patients. A propensity-matched analysis was performed to match the baseline characteristics of patients with and without PAD. The impact of prior PAD in the ischemic and bleeding risk was assessed by a competitive risk analysis, using a Fine and Gray regression model, with death being the competitive event. For ischemic risk we have considered a new acute myocardial infarction (AMI), whereas for bleeding risk we have considered major bleeding (MB) defined as bleeding requiring hospital admission. Follow-up time was censored by DAPT suspension/withdrawal. Results From the 26,076 ACS patients, 1,600 have PAD (6.1%). Patients with PAD were older, and with more cardiovascular risk factors. DAPT with prasugrel/ticagrelor was less frequently prescribed in patients with PAD in comparison with the rest of the population (8.2% vs 22.8%, p<0.001). During a mean follow-up of 12.2±4.8 months, 964 patients died (3.7%), and 640 AMI (2.5%) and 685 MB (2.6%) were reported. After propensity-score matching, we obtained two matched groups of 1,591 patients. Patients with PAD showed a significant higher risk of both AMI (sHR 2.17, 95% CI 1.51–3.10, p<0.001) and MB (sHR 1.51, 95% CI 1.07–2.12, p=0.018), in comparison with those without PAD. The cumulative incidence of AMI was 63.9 and 29.8 per 1,000 patients/year in patients with and without PAD, respectively. The cumulative incidence of MB was 55.9 and 37.6 per 1,000 patients/year in patients with and without PAD, respectively. The rate difference per 1,000 patient-years for AMI between patients with and without PAD was +34.1 (95% CI 30.1–38.1), and for MB +18.3 (16.1–20.4). The net balance between ischemic and bleeding events comparing patients with and without PAD was positive (+15.8 per 1,000 patients/year, 95% CI 9.7–22.0). Conclusions PAD was associated with higher ischemic and bleeding risk after hospital discharge for ACS treated with DAPT. However, the balance between ischemic and bleeding risk was positive for patients with PAD in comparison with patients without PAD. As summary, ACS patients with PAD had an ischemic risk greater than the bleeding risk.

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