2012 April 13 » Page 2

Novel oral anticoagulants versus warfarin in non-valvular atrial fibrillation: A meta-analysis of 50,578 patients.

Apr 132012

Novel oral anticoagulants versus warfarin in non-valvular atrial fibrillation: A meta-analysis of 50,578 patients.

Int J Cardiol. 2012 Apr 9;

Authors: Capodanno D, Capranzano P, Giacchi G, Calvi V, Tamburino C

Abstract
BACKGROUND: Warfarin, despite its known limitations, is the reference standard treatment for patients with AF and risk factors for stroke. We performed a meta-analysis of phase III trials that compare novel oral anticoagulants (NOACs) with warfarin to determine whether they improve clinical outcomes of patients with non-valvular atrial fibrillation (AF). METHODS: Three randomized trials that compared NOACs with warfarin in AF were selected. The primary efficacy endpoint was the incidence of stroke or systemic embolism. The primary safety endpoint was the incidence of major bleeding. RESULTS: A total of 50578 patients were included. NOACs significantly decreased stroke or systemic embolism (2.8% vs 3.5%, odds ratio [OR] 0.82, 95% confidence interval [CI] 0.74-0.91, P<0.001), death (6.0% vs 6.3%, OR 0.88, 95% CI 0.82-0.95, P=0.001) and stroke (2.4% vs 3.0%, OR 0.79, 95% CI 0.71-0.88, P<0.001). The reduction in stroke was mainly driven by fewer hemorrhagic strokes (0.3% vs 0.8%, OR 0.79, 95% CI 0.71-0.88, P<0.001). Major bleeding occurred in 5.0% and 5.6% of patients in the NOACs and warfarin groups (OR 0.85, 95% CI 0.69-1.05, P=0.14 in the random-effects model). NOACs were associated with lower rates of intracranial bleeding (0.6% vs 1.3%, P<0.001) and higher rates of gastrointestinal bleeding (2.3% vs 1.3%, P=0.036). CONCLUSIONS: In patients with non-valvular AF, NOACs decrease stroke or systemic embolism, hemorrhagic stroke and mortality, with similar risk of major bleeding compared to warfarin.

PMID: 22494863 [PubMed - as supplied by publisher]

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Impact of an Antimicrobial Stewardship Intervention on Shortening the Duration of Therapy for Community-Acquired Pneumonia.

Clin Infect Dis Start a Discussion »

Apr 132012

Impact of an Antimicrobial Stewardship Intervention on Shortening the Duration of Therapy for Community-Acquired Pneumonia.

Clin Infect Dis. 2012 Apr 10;

Authors: Avdic E, Cushinotto LA, Hughes AH, Hansen AR, Efird LE, Bartlett JG, Cosgrove SE

Abstract
Background.?Initial management of community-acquired pneumonia (CAP) has been a Centers for Medicare and Medicaid Services performance measure for a decade. We hypothesized that an intervention directed at management of CAP that assesses areas not covered by the performance measures-treatment duration and antimicrobial selection after additional microbiology data are available-would further improve CAP management.Methods.?We performed a single-center, prospective study to compare management of adult inpatients with presumed CAP before (from 1 January 2008 through 31 March 2008) and after (from 1 February 2010 through 10 May 2010) an intervention consisting of education and prospective feedback to teams regarding antibiotic choice and duration. The primary outcome measure was duration of antibiotic therapy in the 2 periods.Results.?There were 62 patients in the preintervention period and 65 patients in the intervention period. The duration of antibiotic therapy decreased from a median of 10 to 7 days (P < .001), with 148 fewer days of antibiotic therapy. The median lengths of stay were similar in the 2 groups (4 vs 5 days). A causative pathogen was identified less frequently during the intervention period (14% vs 34%); however, antibiotics were more frequently narrowed or modified on the basis of susceptibility results during the intervention period (67% vs 19%). Fewer patients received duplicate therapy within 24 hours in the intervention period (90% vs 55%).Conclusions.?The duration of therapy for CAP was excessive at our institution and was decreased with a stewardship intervention. Confirmatory studies at other institutions are needed; efforts to assess and reduce duration of therapy for CAP should be strongly considered.

PMID: 22495073 [PubMed - as supplied by publisher]

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Patient Satisfaction at America’s Lowest Performing Hospitals.

Circ Cardiovasc Qual Outcomes Start a Discussion »

Apr 132012

Patient Satisfaction at America's Lowest Performing Hospitals.

Circ Cardiovasc Qual Outcomes. 2012 Apr 10;

Authors: Girotra S, Cram P, Popescu I

Abstract
BACKGROUND: <0.01 for all). After adjusting for hospital characteristics, patients were less likely to recommend low-performing hospitals to family or friends, relative to intermediate and top-performing hospitals (AMI: 58.8% versus 63.9% versus 68.8%, HF: 61.3% versus 64.0% versus 66.8%; P<0.001 for all), or provide an overall rating of ?9 out of 10 (AMI: 56.7% versus 60.7% versus 64.9%, HF: 57.8% versus 61.1% versus 63.6%; P<0.01 for all). Despite the association between the hospital's performance on process measures and patient satisfaction, we noted discordance between these measures (kappa statistic <0.20).ConclusionsHospitals with consistently poor performance on cardiac process measures also have lower patient satisfaction on average, suggesting that these hospitals have overall poor quality of care. However, there is discordance between the 2 measures in profiling hospital quality.

PMID: 22496113 [PubMed - as supplied by publisher]

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The Chest Pain Choice Decision Aid: A Randomized Trial.

Circ Cardiovasc Qual Outcomes Start a Discussion »

Apr 132012

The Chest Pain Choice Decision Aid: A Randomized Trial.

Circ Cardiovasc Qual Outcomes. 2012 Apr 10;

Authors: Hess EP, Knoedler MA, Shah ND, Kline JA, Breslin M, Branda ME, Pencille LJ, Asplin BR, Nestler DM, Sadosty AT, Stiell IG, Ting HH, Montori VM

Abstract
BACKGROUND: . Unique identifier: NCT01077037.

PMID: 22496116 [PubMed - as supplied by publisher]

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The effects of incorporating a pneumonia severity index into the admission protocol for community-acquired pneumonia.

J Emerg Med Start a Discussion »

Apr 132012

The effects of incorporating a pneumonia severity index into the admission protocol for community-acquired pneumonia.

J Emerg Med. 2012 Feb;42(2):133-8

Authors: Jo S, Kim K, Jung K, Rhee JE, Cho IS, Lee CC, Singer AJ

Abstract
BACKGROUND: Community-acquired pneumonia (CAP) is a common reason for admissions in the emergency department (ED). However, patient disposition is not always standardized.
OBJECTIVE: To evaluate the effect of incorporating a pneumonia severity index (PSI) on admission rates and medical costs in CAP patients presenting to the ED.
METHODS: From April 2008 to March 2009, CAP patients presenting to the ED were prospectively screened and low-risk CAP patients (PSI I, II, or III) were enrolled (after group). Discharge and outpatient care were recommended for this group in the absence of other medical conditions requiring hospitalization. Data from low-risk CAP patients from May 2003 to October 2006 were also collected for comparative analysis (before group).
RESULTS: There were 365 and 174 patients in the before and after groups, respectively. The admission rate of the after group was significantly lower than that of the before group (30.4% vs. 68.2%, p < 0.01). The subsequent admission rates after ED discharge due to CAP were similar (3.2% vs. 7.7%, p = 0.10). The ultimate admission rate in the after group was significantly lower than that in the before group (32.5% vs. 70.7%, p < 0.01). Direct medical costs per patient for the before and after groups were $US 1532 and $US 1186, respectively (p = 0.03).
CONCLUSIONS: Incorporation of the PSI into the admission protocol for ED patients with CAP significantly reduced the admission rates and medical costs.

PMID: 20542398 [PubMed - indexed for MEDLINE]

Link to Article at PubMed