Prevalence and predictors of warfarin use in patients with atrial fibrillation at low or …

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The value of admission HbA(1c) level in diabetic patients with acute coronary syndrome.
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Top 5 common misconceptions about the medical inpatient: approaching cardiovascular prevention for the hospitalist.
Clin Cardiol. 2011 Apr;34(4):195
Authors: Levy DR

PMID: 21462212 [PubMed - in process]

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Use of guideline-recommended therapies for heart failure in the Medicare population.

Clin Cardiol. 2010 Jul;33(7):400-5

Authors: DiMartino LD, Shea AM, Hernandez AF, Curtis LH

BACKGROUND: Most information about the use of guideline-recommended therapies for heart failure reflects what occurred at discharge after an inpatient stay. HYPOTHESIS: Using a nationally representative, community-dwelling sample of elderly Medicare beneficiaries, we examined how the use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and beta-blockers has changed and factors associated with their use. METHODS: Using data from the Medicare Current Beneficiary Survey cost and use files matched with Medicare claims data, we identified beneficiaries for whom a diagnosis of heart failure was reported between January 1, 2000, and December 31, 2004. Data on medications prescribed during the year of cohort entry were based on patient self-report. We used multivariable logistic regression to explore relationships between the use of ACE inhibitors/ARBs and beta-blockers and patient demographic characteristics. RESULTS: From 2000 through 2004, the use of ARBs increased from 12% to 19%, and the use of beta-blockers increased from 30% to 41%. The use of ACE inhibitors remained constant at 45%. Beneficiaries who reported having prescription drug insurance coverage were 32% more likely than other beneficiaries to have filled a prescription for an ACE inhibitor or ARB and 26% more likely to have filled a prescription for a beta-blocker. CONCLUSIONS: Although the use of guideline-recommended therapies for heart failure has increased, it remains suboptimal.

PMID: 20641116 [PubMed - indexed for MEDLINE]

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Symptom presentation in patients hospitalized with acute heart failure.

Clin Cardiol. 2010 Jun;33(6):E73-80

Authors: Goldberg RJ, Spencer FA, Szklo-Coxe M, Tisminetzky M, Yarzebski J, Lessard D, Gore JM, Gaasch W

OBJECTIVES: The objectives of this study were to examine the type and frequency of symptoms in patients hospitalized with acute heart failure (HF) as well as the relationship between symptom patterns and patient characteristics, treatment practices, and hospital outcomes in patients hospitalized with decompensated HF. METHODS: The study sample consisted of 4537 residents of the Worcester, MA metropolitan area hospitalized for decompensated HF at 11 greater Worcester medical centers in 1995 and 2000. RESULTS: The average age of the study sample was 76 years; the majority (57%) were women, and three-quarters of our patient population had been previously diagnosed with HF. Dyspnea (93%) was the most frequent complaint reported by patients followed by the presence of peripheral edema (70%), cough (51%), orthopnea (37%), and chest pain/discomfort (30%). Patients reporting few cardiac symptoms were less likely to be treated with effective cardiac therapies during hospitalization than patients with multiple cardiac signs and symptoms and experienced higher hospital (9.7% vs. 7.7%) as well as 30-day (17.1% vs. 10.2%) death rates (P < 0.05). CONCLUSIONS: The results of this study in residents of a large New England community suggest that patients with fewer reported symptoms of decompensated HF were less likely to receive effective cardiac treatments and had worse short-term outcomes. Reasons for these differences in treatment practices and short-term outcomes need to be elucidated and attention directed to these high-risk patients.

PMID: 20552612 [PubMed - indexed for MEDLINE]

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Endocarditis complicating central venous catheter bloodstream infections: a unique form of health care associated endocarditis.

Clin Cardiol. 2009 Dec;32(12):E48-54

Authors: Chrissoheris MP, Libertin C, Ali RG, Ghantous A, Bekui A, Donohue T

BACKGROUND: Endocarditis complicating central venous catheter blood stream infection (CVC-BSI) is a serious complication and is being seen with increasing frequency. METHODS: All patients discharged from our institution with International Classification of Disease (ICD-9) codes of endocarditis and CVC-BSI were identified. The medical records of those meeting our inclusion criteria were reviewed. RESULTS: From October 1, 1998 until December 31, 2006, 24 patients were identified with inpatient mortality of 20.8%. Nine cases were nosocomial and 15 were non-nosocomial. The most common comorbidities were diabetes mellitus (45.8%), chronic kidney disease (58.4%), prior valvular abnormalities (37.5%), and multiple prior hospitalizations (65.2%). There were 13 external lines, 9 tunneled lines, and 2 implantable ports. Responsible microorganisms included Staphylococcus aureus in 54.6%, coagulase-negative staphylococci in 37.5%, Candida species (spp.) in 16.6%, and enterococci in 12.5%. Five cases were polymicrobial. The line tip was within the right atrium (RA) in 37.5%, the superior vena cava (SVC)-RA junction in 20.8%, the SVC in 33.3%, and the pulmonary artery in 4.2% of patients. Sites of endocardial involvement were the aortic valve in 6 patients, mitral valve in 7 patients, tricuspid valve in 6 patients, right atrial wall in 11 patients, and pacemaker wire in 2 patients. Isolated right-sided involvement occurred in 50% of cases, isolated left-sided in 33.4%, and bilateral involvement in 16.6%. Transesophageal echocardiography (TEE) was necessary for diagnosis in 10 cases (41.6%). CONCLUSIONS: Endocarditis complicating CVC-BSI more often involves right-sided structures, with catheter tips in or near the right atrium, frequently requires TEE for diagnosis, and has significant inpatient mortality.

PMID: 20014189 [PubMed - indexed for MEDLINE]

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