The impact of pathways: a significant decrease in mortality

2009 ◽  
Vol 13 (2) ◽  
pp. 57-61 ◽  
Author(s):  
Massimiliano Panella
Keyword(s):  
Hospital Mortality ◽  
Usual Care ◽  
Heart Association ◽  
Cluster Randomized Trial ◽  
Primary Outcome Measure ◽  
Hospital Treatment ◽  
Hospital Death ◽  
Significance Level ◽  
Patient’S Satisfaction ◽  
The Impact

This study was undertaken to determine how care pathways (CPs) in the hospital treatment of heart failure (HF) affected in-hospital mortality, and outcomes at discharge. A two-arm, cluster randomized trial was conducted. Fourteen community hospitals were randomized either to arm 1 (CPs) or to arm 2 (no intervention, usual care). A sample size of 424 patients (212 in each group) was used in order to have 80% of power at the 5% significance level (two-sided). The primary outcome measure was in-hospital mortality. Secondary outcomes were also evaluated. In-hospital mortality was 5.6% in the experimental arm and 15.4% in the controls ( P = 0.001). In CP and usual care groups, the mean rates of unscheduled readmissions were 7.9% and 13.9%, respectively. Adjusting for age, smoking, New York Heart Association (NYHA) score, hypertension and source of referral, patients in the CP group, as compared with controls, had a significantly lower risk of in-hospital death (odds ratio [OR] = 0.18; 95% confidence interval [CI]: 0.07–0.46) and unscheduled readmissions (OR = 0.42; CI = 0.20–0.87). No differences were found between CP and control with respect to the appropriateness of the stay, costs and patient's satisfaction. This paper examines the evaluation of a complex intervention and adds evidence to previous knowledge, indicating that CP should be used to improve the quality of hospital treatment of HF.

scholarly journals Prognostic nomogram for the severity of acute organophosphate insecticide self-poisoning: a retrospective observational cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e042765
Author(s):  
Ning Dong ◽  
Shaokun Wang ◽  
Xingliang Li ◽  
Wei Li ◽  
Nan Gao ◽  
...  
Keyword(s):  
New York ◽  
Characteristic Curve ◽  
Oral Intake ◽  
Heart Association ◽  
Northern China ◽  
Primary Outcome Measure ◽  
Plasma Cholinesterase ◽  
Hospital Death ◽  
Calibration Plot ◽  
Organophosphate Insecticide

ObjectiveTo develop a convenient nomogram for the bedside evaluation of patients with acute organophosphorus poisoning (AOPP).DesignThis was a retrospective study.SettingTwo independent hospitals in northern China, the First Hospital of Jilin University and the Lequn Hospital of the First Hospital of Jilin University.ParticipantsA total of 1657 consecutive patients admitted for the deliberate oral intake of AOPP within 24 hours from exposure and aged >18 years were enrolled between 1 January 2013 and 31 December 2018. The exclusion criteria were: normal range of plasma cholinesterase, exposure to any other type of poisonous drug(s), severe chronic comorbidities including symptomatic heart failure (New York Heart Association III or IV) or any other kidney, liver and pulmonary diseases. Eight hundred and thirty-four patients were included.Primary outcome measureThe existence of severely poisoned cases, defined as patients with any of the following complications: cardiac arrest, respiratory failure requiring ventilator support, hypotension or in-hospital death.Results440 patients from one hospital were included in the study to develop a nomogram of severe AOPP, whereas 394 patients from the other hospital were used for the validation. Associated risk factors were identified by multivariate logistic regression. The nomogram was validated by the area under the receiver operating characteristic curve (AUC). A nomogram was developed with age, white cells, albumin, cholinesterase, blood pH and lactic acid levels. The AUC was 0.875 (95% CI 0.837 to 0.913) and 0.855 (95% CI 0.81 to 0.9) in the derivation and validation cohorts, respectively. The calibration plot for the probability of severe AOPP showed an optimal agreement between the prediction by nomogram and actual observation in both derivation and validation cohorts.ConclusionA convenient severity evaluation nomogram for patients with AOPP was developed, which could be used by physicians in making clinical decisions and predicting patients’ prognosis.

scholarly journals Impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular infarction

2006 ◽  
Vol 124 (4) ◽  
pp. 186-191 ◽  
Author(s):  
Afonso Celso Pereira ◽  
Roberto Alexandre Franken ◽  
Sandra Regina Schwarzwälder Sprovieri ◽  
Valdir Golin
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Hospital Death ◽  
Inferior Wall ◽  
Mortality And Morbidity ◽  
Killip Class ◽  
Increased Risk ◽  
The Impact

CONTEXT AND OBJECTIVE: There is uncertainty regarding the risk of major complications in patients with left ventricular (LV) infarction complicated by right ventricular (RV) involvement. The aim of this study was to evaluate the impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular myocardial infarction. DESIGN AND SETTING: Prospective cohort study, at Emergency Care Unit of Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo. METHODS: 183 patients with acute myocardial infarction participated in this study: 145 with LV infarction alone and 38 with both LV and RV infarction. The presence of complications and hospital death were compared between groups. RESULTS: 21% of the patients studied had LV + RV infarction. In this group, involvement of the dorsal and/or inferior wall was predominant on electrocardiogram (p < 0.0001). The frequencies of Killip class IV upon admission and 24 hours later were greater in the LV + RV group, along with electrical and hemodynamic complications, among others, and death. The probability of complications among the LV + RV patients was 9.7 times greater (odds ratio, OR = 9.7468; 95% confidence interval, CI: 2.8673 to 33.1325; p < 0.0001) and probability of death was 5.1 times greater (OR = 5.13; 95% CI: 2.2795 to 11.5510; p = 0.0001), in relation to patients with LV infarction alone. CONCLUSIONS: Patients with LV infarction with RV involvement present increased risk of early morbidity and mortality.

Active haematological manifestations of systemic lupus erythematosus lupus are associated with a high rate of in-hospital mortality

Lupus ◽  
2016 ◽  
Vol 26 (6) ◽  
pp. 640-645 ◽  
Author(s):  
D Miranda-Hernández ◽  
C Cruz-Reyes ◽  
C Monsebaiz-Mora ◽  
E Gómez-Bañuelos ◽  
U Ángeles ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Hospital Mortality ◽  
Lupus Erythematosus ◽  
Hospitalized Patients ◽  
High Rate ◽  
Hospital Death ◽  
Control Group ◽  
Systemic Lupus ◽  
Medical Referral ◽  
The Impact

The aim of this study was to estimate the impact of the haematological manifestations of systemic lupus erythematosus (SLE) on mortality in hospitalized patients. For that purpose a case–control study of hospitalized patients in a medical referral centre from January 2009 to December 2014 was performed. For analysis, patients hospitalized for any haematological activity of SLE ( n = 103) were compared with patients hospitalized for other manifestations of SLE activity or complications of treatment ( n = 206). Taking as a variable outcome hospital death, an analysis of potential associated factors was performed. The most common haematological manifestation was thrombocytopenia (63.1%), followed by haemolytic anaemia (30%) and neutropenia (25.2%). In the group of haematological manifestations, 17 (16.5%) deaths were observed compared to 10 (4.8%) deaths in the control group ( P < 0.001). The causes of death were similar in both groups. In the analysis of the variables, it was found that only haematological manifestations were associated with intra-hospital death (odds ratio 3.87, 95% confidence interval 1.8–88, P < 0.001). Our study suggests that apparently any manifestation of haematological activity of SLE is associated with poor prognosis and contributes to increased hospital mortality.

scholarly journals In-hospital Death Following Successful OHCA Resuscitation: Causes of early and late mortality and the impact of withdrawal of care

2020 ◽  
Author(s):  
Shu Li ◽  
Christos Lazaridis ◽  
Fernando D. Goldenberg ◽  
Atman P. Shah ◽  
Katie Tataris ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Human Study ◽  
Early Death ◽  
Organ Injury ◽  
Neurological Injury ◽  
Hospital Death ◽  
Categorization System ◽  
The Impact ◽  
Hospital Cardiac Arrest

AbstractObjectiveIn-hospital mortality in patients successfully resuscitated following out-of-hospital cardiac arrest (OHCA) is high. The factors and timings of these deaths is not well known. To better understand in hospital post-OHCA mortality we developed a novel categorization system of in hospital death and studied the factors and timings associated with these deaths.MethodsThis was a single-centered retrospective observational human study in adult non-traumatic OHCA patients in a university affiliated hospital. Through an expert consensus process, a novel classification system of hospital death was developed.ResultsTwo hundred and forty-one patients were enrolled in the study. Death was categorized as due to withdrawal of life sustaining treatment (WOLST) 159 (66.0%), recurrent in-hospital cardiac arrest 51 (21.1%), or due to neurological criteria 31 (12.9%). Subcategorization of factors associated with WOLST into 7 categories was done by defined criteria. Inter-reliability of this system was 0.858. 50% of WOLST decisions were due to neurological injury. Early death (≤ 3 days) was associated with recurrent in-hospital cardiac arrest and WOLST in the setting of refractory shock or multi-organ injury. Late in-hospital death (> 3 days) was primarily due to WOLST decisions in the setting of isolated neurological injury.ConclusionsOHCA in hospital mortality occurred in a bimodal pattern with early deaths due to recurrent arrest and multiorgan injury while late deaths were due to isolated neurological injury. The majority of deaths occurred in the setting of WOLST decisions. Further study of the influence of these factors on post OHCA survival are needed.

scholarly journals Impact of diabetes on COVID-19-related in-hospital mortality: a retrospective study from Northern Italy

2020 ◽  
Author(s):  
Stefano Ciardullo ◽  
Francesca Zerbini ◽  
Silvia Perra ◽  
Emanuele Muraca ◽  
Rosa Cannistraci ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Hospital Mortality ◽  
Northern Italy ◽  
Hospital Death ◽  
Chronic Obstructive ◽  
Malignant Neoplasms ◽  
Single Center ◽  
Comorbid Conditions ◽  
Diabetes Status ◽  
The Impact

Abstract Purpose. The purpose of this study was to evaluate the impact of pre-existing diabetes on in-hospital mortality in patients admitted for Coronavirus Disease 2019 (COVID-19).Methods. This is a single center, retrospective study conducted at Policlinico di Monza hospital, located in the Lombardy region, Northern Italy. We reviewed medical records of 373 consecutive adult patients who were hospitalized with COVID-19 between February 22 and May 15, 2020. Data were collected on diabetes status, comorbid conditions and laboratory findings. Multivariable logistic regression was performed to evaluate the effect of diabetes on in-hospital mortality after adjustment for potential confounding variables.Results. Mean age of the patients was 72 ± 14 years (range 17-98), 244 (65.4%) were male and 69 (18.5%) had diabetes. The most common comorbid conditions were hypertension (237 [64.8%]), cardiovascular disease (140 [37.7%]) and malignant neoplasms (50 [13.6%]). In-hospital death occurred in 142 (38.0%) patients. In the multivariable model older age (Odds Ratio [OR] 1.07 [1.04-1.10] per year), diabetes (OR 2.2 [1.10-4.73]), chronic obstructive pulmonary disease (OR 3.30 [1.22-8.90]), higher values of lactic dehydrogenase and C-reactive protein were independently associated with in-hospital mortality.Conclusion. In this retrospective single-center study, diabetes was independently associated with a higher in-hospital mortality. More intensive surveillance of patients with this condition is to be warranted.

scholarly journals The Impact of Age on the Delay in Diagnosis in Patients With Acute Pulmonary Embolism

2011 ◽  
Vol 17 (6) ◽  
pp. 605-610 ◽  
Author(s):  
T. M. Berghaus ◽  
C. Thilo ◽  
W. von Scheidt ◽  
M. Schwaiblmair
Keyword(s):  
Pulmonary Embolism ◽  
Hospital Mortality ◽  
Older Patients ◽  
Acute Pulmonary Embolism ◽  
Clinical Presentation ◽  
Late Diagnosis ◽  
Hospital Death ◽  
Delay In Diagnosis ◽  
The Impact ◽  
Acute Pe

It has been speculated that the atypical clinical presentation of acute pulmonary embolism (PE) in older patients leads to a late diagnosis and therefore contributes to a worse prognosis. Therefore, we prospectively evaluated the delay in diagnosis and its relation to the in-hospital mortality in 202 patients with acute PE. Patients >65 years presented more often with hypoxia ( P = .017) and with a history of syncope ( P = .046). Delay in diagnosis was not statistically different in both age groups. Older age was significantly associated with an increased risk for in-hospital mortality (OR 4.36, 95% CI 0.93-20.37, P = .043), whereas the delay in diagnosis was not associated with an increase of in-hospital mortality. We therefore conclude that the clinical presentation of acute PE in older patients cannot be considered as a risk factor for late diagnosis and is not responsible for their higher in-hospital death rate.

scholarly journals Impact of Admission Hyperglycemia on Short and Long-Term Prognosis in Acute Myocardial Infarction: MINOCA versus MIOCA

2021 ◽  
Author(s):  
Pasquale Paolisso ◽  
Alberto Foà ◽  
Luca Bergamaschi ◽  
Francesco Angeli ◽  
Michele Fabrizio ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Coronary Arteries ◽  
Hospital Death ◽  
Diabetic Patients ◽  
Long Term Outcomes ◽  
Short And Long Term ◽  
The Impact

Abstract BackgroundThe prognostic role of hyperglycemia in patients with myocardial infarction and obstructive coronary arteries (MIOCA) is acknowledged, while data on non-obstructive coronary arteries (MINOCA) are still lacking. Recently, we demonstrated that admission stress-hyperglycemia (aHGL) was associated with a larger infarct size and inflammatory response in MIOCA, while no differences were observed in MINOCA. We aim to investigate the impact of aHGL on short and long-term outcomes in MIOCA and MINOCA patients.MethodsMulticenter, population-based, cohort study of the prospective registry, designed to evaluate the prognostic information of patients admitted with acute myocardial infarction to S. Orsola-Malpighi and Maggiore Hospitals of Bologna metropolitan area. Among 2704 patients enrolled from 2016 to 2020, 2431 patients were classified according to the presence of aHGL (defined as admission glucose level ≥ 140mg/dL) and AMI phenotype (MIOCA/MINOCA): no-aHGL (n = 1321), aHGL (n = 877) in MIOCA and no-aHGL (n = 195), aHGL (n = 38) in MINOCA. Short-term outcomes included in-hospital death and arrhythmias. Long-term outcomes were all-cause and cardiovascular mortality.ResultsaHGL was associated with a higher in-hospital arrhythmic burden in MINOCA and MIOCA, with increased in-hospital mortality only in MIOCA. After adjusting for age, gender, hypertension, Killip class and AMI phenotypes, aHGL predicted higher in-hospital mortality in non-diabetic (HR = 4.2; 95% CI 1.9–9.5, p = 0.001) and diabetic patients (HR = 3.5, 95% CI 1.5–8.2, p = 0.003). During long-term follow-up, aHGL was associated with 2-fold increased mortality in MIOCA and a 4-fold increase in MINOCA (p = 0.032 and p = 0.016). Kaplan Meier 3-year survival of non-hyperglycemic patients was greater than in aHGL patients for both groups. No differences in survival were found between hyperglycemic MIOCA and MINOCA patients. After adjusting for age, gender, hypertension, smoking, LVEF, STEMI/NSTEMI and AMI phenotypes (MIOCA/MINOCA), aHGL predicted higher long-term mortality.ConclusionsaHGL was identified as a strong predictor of adverse short- and long-term outcomes in both MIOCA and MINOCA, regardless of diabetes. aHGL should be considered a high-risk prognostic marker in all AMI patients, independently of the underlying coronary anatomy.Trial Registrationdata were part of the ongoing observational study AMIPE: Acute Myocardial Infarction, Prognostic and Therapeutic Evaluation. ClinicalTrials.gov Identifier: NCT03883711.

scholarly journals Impact of admission hyperglycemia on short and long-term prognosis in acute myocardial infarction: MINOCA versus MIOCA

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Pasquale Paolisso ◽  
Alberto Foà ◽  
Luca Bergamaschi ◽  
Francesco Angeli ◽  
Michele Fabrizio ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Coronary Arteries ◽  
Hospital Death ◽  
Diabetic Patients ◽  
Long Term Outcomes ◽  
Short And Long Term ◽  
The Impact

Abstract Background The prognostic role of hyperglycemia in patients with myocardial infarction and obstructive coronary arteries (MIOCA) is acknowledged, while data on non-obstructive coronary arteries (MINOCA) are still lacking. Recently, we demonstrated that admission stress-hyperglycemia (aHGL) was associated with a larger infarct size and inflammatory response in MIOCA, while no differences were observed in MINOCA. We aim to investigate the impact of aHGL on short and long-term outcomes in MIOCA and MINOCA patients. Methods Multicenter, population-based, cohort study of the prospective registry, designed to evaluate the prognostic information of patients admitted with acute myocardial infarction to S. Orsola-Malpighi and Maggiore Hospitals of Bologna metropolitan area. Among 2704 patients enrolled from 2016 to 2020, 2431 patients were classified according to the presence of aHGL (defined as admission glucose level ≥ 140 mg/dL) and AMI phenotype (MIOCA/MINOCA): no-aHGL (n = 1321), aHGL (n = 877) in MIOCA and no-aHGL (n = 195), aHGL (n = 38) in MINOCA. Short-term outcomes included in-hospital death and arrhythmias. Long-term outcomes were all-cause and cardiovascular mortality. Results aHGL was associated with a higher in-hospital arrhythmic burden in MINOCA and MIOCA, with increased in-hospital mortality only in MIOCA. After adjusting for age, gender, hypertension, Killip class and AMI phenotypes, aHGL predicted higher in-hospital mortality in non-diabetic (HR = 4.2; 95% CI 1.9–9.5, p = 0.001) and diabetic patients (HR = 3.5, 95% CI 1.5–8.2, p = 0.003). During long-term follow-up, aHGL was associated with 2-fold increased mortality in MIOCA and a 4-fold increase in MINOCA (p = 0.032 and p = 0.016). Kaplan Meier 3-year survival of non-hyperglycemic patients was greater than in aHGL patients for both groups. No differences in survival were found between hyperglycemic MIOCA and MINOCA patients. After adjusting for age, gender, hypertension, smoking, LVEF, STEMI/NSTEMI and AMI phenotypes (MIOCA/MINOCA), aHGL predicted higher long-term mortality. Conclusions aHGL was identified as a strong predictor of adverse short- and long-term outcomes in both MIOCA and MINOCA, regardless of diabetes. aHGL should be considered a high-risk prognostic marker in all AMI patients, independently of the underlying coronary anatomy. Trial registration data were part of the ongoing observational study AMIPE: Acute Myocardial Infarction, Prognostic and Therapeutic Evaluation. ClinicalTrials.gov Identifier: NCT03883711.

scholarly journals Etiology, Incidence And Risk Factors For Meningitis After Craniotomy

2021 ◽  
Author(s):  
Gregory Lauar e Souza ◽  
Handerson Dias Duarte de Carvalho ◽  
Nicole Meireles Sacco ◽  
Lucca Gontijo Giarola ◽  
Estevão Urbano Silva ◽  
...  
Keyword(s):  
Risk Factor ◽  
Standard Deviation ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Length Of Hospital Stay ◽  
Hospital Death ◽  
Main Risk Factor ◽  
Significance Level ◽  
Etiologic Agents ◽  
The Impact

Background: Meningitis after craniotomy can cause devastating outcomes. Objectives: Estimate the risk of meningitis after craniotomy (MAC). Find the most prevalent pathogens. Assess the impact of meningitis over length of stay and mortality. Find the main risk factor for MAC. Design and setting: Multicentric, longitudinal and quantitative analysis of data collected between 2013-2017 from nine different hospitals from Minas Gerais, Brazil. Methods: Surveillance data was based on NHSN/CDC protocols. Observed outcomes were meningitis, hospital death and total length of stay. Twentythree variables were analyzed in Epi-Info in a two-tailed statistical test with a significance level of 5%. Results: 4,549 patients were analyzed. Risk of MAC was 1.9% (95%CI=1.6%; 2.4%). The mortality rate in patients without infection was 9%, increasing to 33% in infected patients (P<0.01). Length of hospital stay (HS) in uninfected patients (in days): mean=18, median=7, standard deviation=36. HS in infected patients: mean=56, median=37, standard deviation=63 P<0.001).The duration of the procedure ≤4 hours presented a 1.5% risk of MAC compared to 2.5% versus ≥4 hours (RR=1.7; P=0.041). From 88 MAC cases, pathogen was identified in 68 (77%): K.pneumoniae (20%), S.aureus (16%), A.baumannii (13%), P.aeruginosa (9%), Staphylococcus sp . (8%), Acinetobacter sp. (7%), S.epidermidis (5%) among others (20%).Conclusion: MAC risk was 1.9%. Mortality rate was high compared to literature. Meningitis caused threefold increase on HS. Procedure duration ≥4 hours was the main risk factor, presenting RR of 1.7. The most prevalent etiologic agents were K.pneumoniae and S.aureus. Considering the findings, infectious surveillance is paramount for patient safety.

scholarly journals Influence of comorbidity on hospital outcomes among patients with COVID-19 using electronic records from a nationwide Healthcare System in Peru

2021 ◽  
Author(s):  
Janeth Tenorio-Mucha ◽  
Percy Soto-Becerra ◽  
Roger V. Araujo-Castillo ◽  
YAMILEE HURTADO-ROCA
Keyword(s):  
Hospital Mortality ◽  
Cox Regression ◽  
Social Health Insurance ◽  
Rank Test ◽  
Hospital Death ◽  
Middle Income ◽  
Significance Level ◽  
Icu Admission ◽  
Log Rank Test ◽  
Context Specific

Abstract Background Large cases reported that older age and comorbidity are predictors for poor prognosis in COVID-19 patients. Nevertheless, context-specific evidence relevant in low-and middle-income countries is still pending. Methods Retrospective cohort study using electronic health records of confirmed cases admitted in hospitalization areas from the Peruvian Social Health Insurance. The main variable was the presence of comorbidities and the outcomes were in-hospital mortality or intensive care unit admission, and in/out hospital mortality. We used Kaplan-Meier survival curves with the Log-Rank test to compare time-to-event outcomes between comorbidities groups. Crude and adjusted Cox regression models were used to estimate hazard ratios (HR). Statistical analyses were conducted with a significance level of 5%. Results In patients with ICU admission or in-hospital death, 45.99% had one comorbidity and 50.26% had two or more comorbidities. Using in/out hospital deaths up to 60 days as the outcome, the overall survival of patients with two comorbidities is lower than patients with one comorbidity, and both are lowest than a patient without comorbidities (Log-rank test p = 0.001). After adjusting for sex, age, severity, and hospital care network patients with one comorbidity (HR: 1.16; IC 95 %: 1.04–1.31) and with two or more comorbidities (HR: 1.13; IC 95%: 1.01–1.26) are at higher risk to die compared with those without comorbidities. Conclusion The presence of comorbidities in hospitalized patients with COVID-19 are risk factors for ICU admission and mortality. Proper identification of these factors can help to identify patients at higher risk in hospital admission and provide specialized care to prevent deaths.

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