Inpatient and follow-up cardiology care and mortality for acute coronary syndrome patients in the Veterans Health Administration
Background The impact of inpatient and follow-up cardiology care on patient outcomes after acute coronary syndrome (ACS) hospital discharge is unknown. Methods This was a retrospective cohort study of all patients with ACS discharged from Veterans Health Administration facilities from 2003 to 2004....
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| Veröffentlicht in: | The American heart journal 2007-09, Vol.154 (3), p.489-494 |
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| creator | Ho, P. Michael, MD, PhD, FACC Luther, Stacie A., MD Masoudi, Frederick A., MD, MSPH, FACC Gupta, Indra, PhD Lowy, Elliott, PhD Maynard, Charles, PhD Sales, Anne E., MSN, PhD Peterson, Eric D., MD, MPH, FACC Fihn, Stephan D., MD, MPH Rumsfeld, John S., MD, PhD, FACC |
| description | Background The impact of inpatient and follow-up cardiology care on patient outcomes after acute coronary syndrome (ACS) hospital discharge is unknown. Methods This was a retrospective cohort study of all patients with ACS discharged from Veterans Health Administration facilities from 2003 to 2004. Patients were stratified into 2 categories of cardiology care: (1) inpatient and follow-up cardiology care within 60 days after discharge and (2) other levels of cardiology care (inpatient only, outpatient only, and neither inpatient nor outpatient). Multivariable regression assessed the association between inpatient and follow-up cardiology care with all-cause mortality, adjusting for demographics, comorbidities, hospital presentation and treatment variables, and clustering by site. Results Of 4933 patients with ACS, the majority (71.6%) had inpatient and follow-up cardiology care. Patients with inpatient and follow-up cardiology care were more likely to have prior coronary disease and diabetes and to present with myocardial infarction (vs unstable angina). All-cause mortality was lower for patients with inpatient and follow-up cardiology care (18.8% vs 22.1%, P = .009). In multivariable analysis, patients with inpatient and follow-up cardiology care remained at lower mortality risk (hazard ratio 0.73, 95% CI 0.62-0.87) compared with patients with other levels of cardiology care. The findings were consistent when cardiology follow-up was defined as 30 or 90 days after hospital discharge. Conclusions Patients with inpatient and follow-up cardiology care have lower mortality risk after ACS. Future studies should identify mediators of this potential benefit and determine if interventions enhancing continuity of care in general, and continuity of subspecialty care in particular, after ACS will improve patient outcomes. |
| doi_str_mv | 10.1016/j.ahj.2007.05.018 |
| format | Article |
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Michael, MD, PhD, FACC ; Luther, Stacie A., MD ; Masoudi, Frederick A., MD, MSPH, FACC ; Gupta, Indra, PhD ; Lowy, Elliott, PhD ; Maynard, Charles, PhD ; Sales, Anne E., MSN, PhD ; Peterson, Eric D., MD, MPH, FACC ; Fihn, Stephan D., MD, MPH ; Rumsfeld, John S., MD, PhD, FACC</creator><creatorcontrib>Ho, P. Michael, MD, PhD, FACC ; Luther, Stacie A., MD ; Masoudi, Frederick A., MD, MSPH, FACC ; Gupta, Indra, PhD ; Lowy, Elliott, PhD ; Maynard, Charles, PhD ; Sales, Anne E., MSN, PhD ; Peterson, Eric D., MD, MPH, FACC ; Fihn, Stephan D., MD, MPH ; Rumsfeld, John S., MD, PhD, FACC</creatorcontrib><description>Background The impact of inpatient and follow-up cardiology care on patient outcomes after acute coronary syndrome (ACS) hospital discharge is unknown. Methods This was a retrospective cohort study of all patients with ACS discharged from Veterans Health Administration facilities from 2003 to 2004. Patients were stratified into 2 categories of cardiology care: (1) inpatient and follow-up cardiology care within 60 days after discharge and (2) other levels of cardiology care (inpatient only, outpatient only, and neither inpatient nor outpatient). Multivariable regression assessed the association between inpatient and follow-up cardiology care with all-cause mortality, adjusting for demographics, comorbidities, hospital presentation and treatment variables, and clustering by site. Results Of 4933 patients with ACS, the majority (71.6%) had inpatient and follow-up cardiology care. Patients with inpatient and follow-up cardiology care were more likely to have prior coronary disease and diabetes and to present with myocardial infarction (vs unstable angina). All-cause mortality was lower for patients with inpatient and follow-up cardiology care (18.8% vs 22.1%, P = .009). In multivariable analysis, patients with inpatient and follow-up cardiology care remained at lower mortality risk (hazard ratio 0.73, 95% CI 0.62-0.87) compared with patients with other levels of cardiology care. The findings were consistent when cardiology follow-up was defined as 30 or 90 days after hospital discharge. Conclusions Patients with inpatient and follow-up cardiology care have lower mortality risk after ACS. Future studies should identify mediators of this potential benefit and determine if interventions enhancing continuity of care in general, and continuity of subspecialty care in particular, after ACS will improve patient outcomes.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2007.05.018</identifier><identifier>PMID: 17719295</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Acute coronary syndromes ; Acute Disease ; Aged ; Angina, Unstable - mortality ; Angina, Unstable - therapy ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiovascular ; Coronary heart disease ; Female ; Follow-Up Studies ; Heart ; Heart attacks ; Hospitalization ; Humans ; Male ; Medical sciences ; Mortality ; Myocardial Infarction - mortality ; Myocardial Infarction - therapy ; Patients ; Retrospective Studies ; Syndrome ; United States ; United States Department of Veterans Affairs</subject><ispartof>The American heart journal, 2007-09, Vol.154 (3), p.489-494</ispartof><rights>2007</rights><rights>2008 INIST-CNRS</rights><rights>Copyright Elsevier Limited Sep 2007</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c464t-5ece688e8c4244d448fb4f4146f4b0ebc290f8d5193dfff68de69363a91816363</citedby><cites>FETCH-LOGICAL-c464t-5ece688e8c4244d448fb4f4146f4b0ebc290f8d5193dfff68de69363a91816363</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1504616892?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,778,782,3539,27907,27908,45978,64366,64368,64370,72220</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19866835$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17719295$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ho, P. Michael, MD, PhD, FACC</creatorcontrib><creatorcontrib>Luther, Stacie A., MD</creatorcontrib><creatorcontrib>Masoudi, Frederick A., MD, MSPH, FACC</creatorcontrib><creatorcontrib>Gupta, Indra, PhD</creatorcontrib><creatorcontrib>Lowy, Elliott, PhD</creatorcontrib><creatorcontrib>Maynard, Charles, PhD</creatorcontrib><creatorcontrib>Sales, Anne E., MSN, PhD</creatorcontrib><creatorcontrib>Peterson, Eric D., MD, MPH, FACC</creatorcontrib><creatorcontrib>Fihn, Stephan D., MD, MPH</creatorcontrib><creatorcontrib>Rumsfeld, John S., MD, PhD, FACC</creatorcontrib><title>Inpatient and follow-up cardiology care and mortality for acute coronary syndrome patients in the Veterans Health Administration</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Background The impact of inpatient and follow-up cardiology care on patient outcomes after acute coronary syndrome (ACS) hospital discharge is unknown. Methods This was a retrospective cohort study of all patients with ACS discharged from Veterans Health Administration facilities from 2003 to 2004. Patients were stratified into 2 categories of cardiology care: (1) inpatient and follow-up cardiology care within 60 days after discharge and (2) other levels of cardiology care (inpatient only, outpatient only, and neither inpatient nor outpatient). Multivariable regression assessed the association between inpatient and follow-up cardiology care with all-cause mortality, adjusting for demographics, comorbidities, hospital presentation and treatment variables, and clustering by site. Results Of 4933 patients with ACS, the majority (71.6%) had inpatient and follow-up cardiology care. Patients with inpatient and follow-up cardiology care were more likely to have prior coronary disease and diabetes and to present with myocardial infarction (vs unstable angina). All-cause mortality was lower for patients with inpatient and follow-up cardiology care (18.8% vs 22.1%, P = .009). In multivariable analysis, patients with inpatient and follow-up cardiology care remained at lower mortality risk (hazard ratio 0.73, 95% CI 0.62-0.87) compared with patients with other levels of cardiology care. The findings were consistent when cardiology follow-up was defined as 30 or 90 days after hospital discharge. Conclusions Patients with inpatient and follow-up cardiology care have lower mortality risk after ACS. Future studies should identify mediators of this potential benefit and determine if interventions enhancing continuity of care in general, and continuity of subspecialty care in particular, after ACS will improve patient outcomes.</description><subject>Acute coronary syndromes</subject><subject>Acute Disease</subject><subject>Aged</subject><subject>Angina, Unstable - mortality</subject><subject>Angina, Unstable - therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Coronary heart disease</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mortality</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - therapy</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Syndrome</subject><subject>United States</subject><subject>United States Department of Veterans Affairs</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kl2L1DAUhoso7rj6A7yRgOhdx6RN0wRBWBZ1Fxa88OM2ZJITJ7VNxiRVeudPN3UGBvbCq5yQ53zkfU9VPSd4SzBhb4at2g_bBuN-i7stJvxBtSFY9DXrKX1YbTDGTc173F5UT1IaypU1nD2uLkjfE9GIblP9ufUHlR34jJQ3yIZxDL_r-YC0isaFMXxf1hD-vU4hZjW6vBQuIqXnDEiHGLyKC0qLNzFMgE71EnIe5T2gb5AhKp_QDagx79GVmZx3KcfCBf-0emTVmODZ6bysvn54_-X6pr779PH2-uqu1pTRXHeggXEOXNOGUkMptztqKaHM0h2GnW4Ettx0RLTGWsu4ASZa1ipBOGEluKxeH-seYvg5Q8pycknDOCoPYU6ScSIEZbiAL--BQ5ijL7NJ0mHKCOOiKRQ5UjqGlCJYeYhuKjpIguVqjhxkMUeu5kjcyWJOyXlxqjzvJjDnjJMbBXh1AlTSarRFNe3SmROcMd6u3NsjB0WwXw6iTLpIrsG4CDpLE9x_x3h3L1uPxZDS8AcskM6_lamRWH5et2hdItxjTDvWtX8Bo7HCwA</recordid><startdate>20070901</startdate><enddate>20070901</enddate><creator>Ho, P. Michael, MD, PhD, FACC</creator><creator>Luther, Stacie A., MD</creator><creator>Masoudi, Frederick A., MD, MSPH, FACC</creator><creator>Gupta, Indra, PhD</creator><creator>Lowy, Elliott, PhD</creator><creator>Maynard, Charles, PhD</creator><creator>Sales, Anne E., MSN, PhD</creator><creator>Peterson, Eric D., MD, MPH, FACC</creator><creator>Fihn, Stephan D., MD, MPH</creator><creator>Rumsfeld, John S., MD, PhD, FACC</creator><general>Mosby, Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20070901</creationdate><title>Inpatient and follow-up cardiology care and mortality for acute coronary syndrome patients in the Veterans Health Administration</title><author>Ho, P. Michael, MD, PhD, FACC ; Luther, Stacie A., MD ; Masoudi, Frederick A., MD, MSPH, FACC ; Gupta, Indra, PhD ; Lowy, Elliott, PhD ; Maynard, Charles, PhD ; Sales, Anne E., MSN, PhD ; Peterson, Eric D., MD, MPH, FACC ; Fihn, Stephan D., MD, MPH ; Rumsfeld, John S., MD, PhD, FACC</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c464t-5ece688e8c4244d448fb4f4146f4b0ebc290f8d5193dfff68de69363a91816363</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Acute coronary syndromes</topic><topic>Acute Disease</topic><topic>Aged</topic><topic>Angina, Unstable - mortality</topic><topic>Angina, Unstable - therapy</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Coronary heart disease</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mortality</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - therapy</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Syndrome</topic><topic>United States</topic><topic>United States Department of Veterans Affairs</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ho, P. Michael, MD, PhD, FACC</creatorcontrib><creatorcontrib>Luther, Stacie A., MD</creatorcontrib><creatorcontrib>Masoudi, Frederick A., MD, MSPH, FACC</creatorcontrib><creatorcontrib>Gupta, Indra, PhD</creatorcontrib><creatorcontrib>Lowy, Elliott, PhD</creatorcontrib><creatorcontrib>Maynard, Charles, PhD</creatorcontrib><creatorcontrib>Sales, Anne E., MSN, PhD</creatorcontrib><creatorcontrib>Peterson, Eric D., MD, MPH, FACC</creatorcontrib><creatorcontrib>Fihn, Stephan D., MD, MPH</creatorcontrib><creatorcontrib>Rumsfeld, John S., MD, PhD, FACC</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ho, P. Michael, MD, PhD, FACC</au><au>Luther, Stacie A., MD</au><au>Masoudi, Frederick A., MD, MSPH, FACC</au><au>Gupta, Indra, PhD</au><au>Lowy, Elliott, PhD</au><au>Maynard, Charles, PhD</au><au>Sales, Anne E., MSN, PhD</au><au>Peterson, Eric D., MD, MPH, FACC</au><au>Fihn, Stephan D., MD, MPH</au><au>Rumsfeld, John S., MD, PhD, FACC</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Inpatient and follow-up cardiology care and mortality for acute coronary syndrome patients in the Veterans Health Administration</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2007-09-01</date><risdate>2007</risdate><volume>154</volume><issue>3</issue><spage>489</spage><epage>494</epage><pages>489-494</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>Background The impact of inpatient and follow-up cardiology care on patient outcomes after acute coronary syndrome (ACS) hospital discharge is unknown. Methods This was a retrospective cohort study of all patients with ACS discharged from Veterans Health Administration facilities from 2003 to 2004. Patients were stratified into 2 categories of cardiology care: (1) inpatient and follow-up cardiology care within 60 days after discharge and (2) other levels of cardiology care (inpatient only, outpatient only, and neither inpatient nor outpatient). Multivariable regression assessed the association between inpatient and follow-up cardiology care with all-cause mortality, adjusting for demographics, comorbidities, hospital presentation and treatment variables, and clustering by site. Results Of 4933 patients with ACS, the majority (71.6%) had inpatient and follow-up cardiology care. Patients with inpatient and follow-up cardiology care were more likely to have prior coronary disease and diabetes and to present with myocardial infarction (vs unstable angina). All-cause mortality was lower for patients with inpatient and follow-up cardiology care (18.8% vs 22.1%, P = .009). In multivariable analysis, patients with inpatient and follow-up cardiology care remained at lower mortality risk (hazard ratio 0.73, 95% CI 0.62-0.87) compared with patients with other levels of cardiology care. The findings were consistent when cardiology follow-up was defined as 30 or 90 days after hospital discharge. Conclusions Patients with inpatient and follow-up cardiology care have lower mortality risk after ACS. Future studies should identify mediators of this potential benefit and determine if interventions enhancing continuity of care in general, and continuity of subspecialty care in particular, after ACS will improve patient outcomes.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>17719295</pmid><doi>10.1016/j.ahj.2007.05.018</doi><tpages>6</tpages></addata></record> |
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| ispartof | The American heart journal, 2007-09, Vol.154 (3), p.489-494 |
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| subjects | Acute coronary syndromes Acute Disease Aged Angina, Unstable - mortality Angina, Unstable - therapy Biological and medical sciences Cardiology. Vascular system Cardiovascular Coronary heart disease Female Follow-Up Studies Heart Heart attacks Hospitalization Humans Male Medical sciences Mortality Myocardial Infarction - mortality Myocardial Infarction - therapy Patients Retrospective Studies Syndrome United States United States Department of Veterans Affairs |
| title | Inpatient and follow-up cardiology care and mortality for acute coronary syndrome patients in the Veterans Health Administration |
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