Acute Reperfusion Therapy in ST-Elevation Myocardial Infarction from 1994-2003
Abstract Background Appropriate utilization of acute reperfusion therapy is not a national performance measure for ST-elevation myocardial infarction at this time, and the extent of its contemporary use among ideal patients is unknown. Methods From the National Registry of Myocardial Infarction, we...
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| creator | Nallamothu, Brahmajee K., MD, MPH Blaney, Martha E., PharmD Morris, Susan M., PhD Parsons, Lori, BS Miller, Dave P., MS Canto, John G., MD, MSPH Barron, Hal V., MD Krumholz, Harlan M., MD, SM |
| description | Abstract Background Appropriate utilization of acute reperfusion therapy is not a national performance measure for ST-elevation myocardial infarction at this time, and the extent of its contemporary use among ideal patients is unknown. Methods From the National Registry of Myocardial Infarction, we identified 238,291 patients enrolled from June 1994 to May 2003 who were ideally suited for acute reperfusion therapy with fibrinolytic therapy or primary percutaneous coronary intervention. We determined rates of not receiving therapy across 3 time periods (June 1994-May 1997, June 1997-May 2000, June 2000-May 2003) and evaluated factors associated with underutilization. Results The proportion of ideal patients not receiving acute reperfusion therapy decreased by one half throughout the past decade (time period 1: 20.6%; time period 2: 11.4%; time period 3: 11.6%; P |
| doi_str_mv | 10.1016/j.amjmed.2007.01.028 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_2020513</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0002934307002409</els_id><sourcerecordid>68124710</sourcerecordid><originalsourceid>FETCH-LOGICAL-c573t-25c247e338fd631c6ee88baf61ed71178ee5e71a3202fd87b4162946aecc4d823</originalsourceid><addsrcrecordid>eNqFUsFu1DAUtBCILoU_QChCgluCn-3E8QWpqgpUKiDR5Wx5nRfqkDiLnay0f4_DrrrQCyfbz_PGM29MyEugBVCo3nWFGboBm4JRKgsKBWX1I7KCsixzCRV7TFaUUpYrLvgZeRZjl45UldVTcgaykgpYvSJfLuw8YfYNtxjaObrRZ-s7DGa7z5zPbtf5VY87My31z_vRmtA402fXvjXB_qm2YRwyUErkSQd_Tp60po_44riek-8frtaXn_Kbrx-vLy9ucltKPuWstExI5Lxum4qDrRDremPaCrCRALJGLFGC4YyytqnlRiRDSlQGrRVNzfg5eX_g3c6bNAOLfgqm19vgBhP2ejRO_3vj3Z3-Me50IqQl8ETw9kgQxl8zxkkPLlrse-NxnKOuakgKgSbg6wfAbpyDT-Y044yDEnRhEweQDWOMAdt7JUD1kpbu9CEtvaSlKeiUVmp79beLU9MxngR4cwSYaE3fBuOtiyecAim4VKdxYJr5zmHQ0Tr0FhsX0E66Gd3_lDwksL3zLr35E_cY7y2DjkxTfbv8rOVjUZk2gir-G5Jbx_c</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>232319403</pqid></control><display><type>article</type><title>Acute Reperfusion Therapy in ST-Elevation Myocardial Infarction from 1994-2003</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Nallamothu, Brahmajee K., MD, MPH ; Blaney, Martha E., PharmD ; Morris, Susan M., PhD ; Parsons, Lori, BS ; Miller, Dave P., MS ; Canto, John G., MD, MSPH ; Barron, Hal V., MD ; Krumholz, Harlan M., MD, SM</creator><creatorcontrib>Nallamothu, Brahmajee K., MD, MPH ; Blaney, Martha E., PharmD ; Morris, Susan M., PhD ; Parsons, Lori, BS ; Miller, Dave P., MS ; Canto, John G., MD, MSPH ; Barron, Hal V., MD ; Krumholz, Harlan M., MD, SM ; National Registry of Myocardial Infarction Investigators</creatorcontrib><description>Abstract Background Appropriate utilization of acute reperfusion therapy is not a national performance measure for ST-elevation myocardial infarction at this time, and the extent of its contemporary use among ideal patients is unknown. Methods From the National Registry of Myocardial Infarction, we identified 238,291 patients enrolled from June 1994 to May 2003 who were ideally suited for acute reperfusion therapy with fibrinolytic therapy or primary percutaneous coronary intervention. We determined rates of not receiving therapy across 3 time periods (June 1994-May 1997, June 1997-May 2000, June 2000-May 2003) and evaluated factors associated with underutilization. Results The proportion of ideal patients not receiving acute reperfusion therapy decreased by one half throughout the past decade (time period 1: 20.6%; time period 2: 11.4%; time period 3: 11.6%; P <.001). Utilization remained significantly lower in key subgroups in the most recent time period: those without chest pain (odds ratio [OR] 0.29; 95% confidence interval [CI], 0.27-0.32); those presenting 6 to 12 hours after symptom onset (OR 0.57; 95% CI, 0.52-0.61); those 75 years or older (OR 0.63 compared with patients <55 years old; 95% CI, 0.58-0.68); women (OR 0.88; 95% CI, 0.84-0.93); and non-whites (OR 0.90; 95% CI, 0.83-0.97). Conclusions Utilization of acute reperfusion therapy in ideal patients has improved over the last decade, but more than 10% remain untreated. Measuring and improving its use in this cohort represents an important opportunity to improve care.</description><identifier>ISSN: 0002-9343</identifier><identifier>EISSN: 1555-7162</identifier><identifier>DOI: 10.1016/j.amjmed.2007.01.028</identifier><identifier>PMID: 17679128</identifier><identifier>CODEN: AJMEAZ</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Angioplasty ; Angioplasty, Balloon, Coronary - utilization ; Biological and medical sciences ; Cardiology. Vascular system ; Comorbidity ; Coronary heart disease ; Drug Utilization Review ; Female ; Fibrinolytic therapy ; General aspects ; Heart ; Heart attacks ; Humans ; Internal Medicine ; Male ; Medical sciences ; Middle Aged ; Myocardial Infarction - drug therapy ; Myocardial Infarction - epidemiology ; Myocardial Infarction - therapy ; Myocardial Reperfusion - utilization ; Odds Ratio ; Outcome Assessment (Health Care) ; Primary angioplasty ; Quality Indicators, Health Care ; Registries ; Reperfusion ; ST-elevation myocardial infarction ; Therapy ; Thrombolytic Therapy - utilization ; United States</subject><ispartof>The American journal of medicine, 2007-08, Vol.120 (8), p.693.e1-693.e8</ispartof><rights>Elsevier Inc.</rights><rights>2007 Elsevier Inc.</rights><rights>2007 INIST-CNRS</rights><rights>Copyright Elsevier Sequoia S.A. Aug 2007</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c573t-25c247e338fd631c6ee88baf61ed71178ee5e71a3202fd87b4162946aecc4d823</citedby><cites>FETCH-LOGICAL-c573t-25c247e338fd631c6ee88baf61ed71178ee5e71a3202fd87b4162946aecc4d823</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002934307002409$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19174379$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17679128$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nallamothu, Brahmajee K., MD, MPH</creatorcontrib><creatorcontrib>Blaney, Martha E., PharmD</creatorcontrib><creatorcontrib>Morris, Susan M., PhD</creatorcontrib><creatorcontrib>Parsons, Lori, BS</creatorcontrib><creatorcontrib>Miller, Dave P., MS</creatorcontrib><creatorcontrib>Canto, John G., MD, MSPH</creatorcontrib><creatorcontrib>Barron, Hal V., MD</creatorcontrib><creatorcontrib>Krumholz, Harlan M., MD, SM</creatorcontrib><creatorcontrib>National Registry of Myocardial Infarction Investigators</creatorcontrib><title>Acute Reperfusion Therapy in ST-Elevation Myocardial Infarction from 1994-2003</title><title>The American journal of medicine</title><addtitle>Am J Med</addtitle><description>Abstract Background Appropriate utilization of acute reperfusion therapy is not a national performance measure for ST-elevation myocardial infarction at this time, and the extent of its contemporary use among ideal patients is unknown. Methods From the National Registry of Myocardial Infarction, we identified 238,291 patients enrolled from June 1994 to May 2003 who were ideally suited for acute reperfusion therapy with fibrinolytic therapy or primary percutaneous coronary intervention. We determined rates of not receiving therapy across 3 time periods (June 1994-May 1997, June 1997-May 2000, June 2000-May 2003) and evaluated factors associated with underutilization. Results The proportion of ideal patients not receiving acute reperfusion therapy decreased by one half throughout the past decade (time period 1: 20.6%; time period 2: 11.4%; time period 3: 11.6%; P <.001). Utilization remained significantly lower in key subgroups in the most recent time period: those without chest pain (odds ratio [OR] 0.29; 95% confidence interval [CI], 0.27-0.32); those presenting 6 to 12 hours after symptom onset (OR 0.57; 95% CI, 0.52-0.61); those 75 years or older (OR 0.63 compared with patients <55 years old; 95% CI, 0.58-0.68); women (OR 0.88; 95% CI, 0.84-0.93); and non-whites (OR 0.90; 95% CI, 0.83-0.97). Conclusions Utilization of acute reperfusion therapy in ideal patients has improved over the last decade, but more than 10% remain untreated. Measuring and improving its use in this cohort represents an important opportunity to improve care.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angioplasty</subject><subject>Angioplasty, Balloon, Coronary - utilization</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Comorbidity</subject><subject>Coronary heart disease</subject><subject>Drug Utilization Review</subject><subject>Female</subject><subject>Fibrinolytic therapy</subject><subject>General aspects</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - drug therapy</subject><subject>Myocardial Infarction - epidemiology</subject><subject>Myocardial Infarction - therapy</subject><subject>Myocardial Reperfusion - utilization</subject><subject>Odds Ratio</subject><subject>Outcome Assessment (Health Care)</subject><subject>Primary angioplasty</subject><subject>Quality Indicators, Health Care</subject><subject>Registries</subject><subject>Reperfusion</subject><subject>ST-elevation myocardial infarction</subject><subject>Therapy</subject><subject>Thrombolytic Therapy - utilization</subject><subject>United States</subject><issn>0002-9343</issn><issn>1555-7162</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUsFu1DAUtBCILoU_QChCgluCn-3E8QWpqgpUKiDR5Wx5nRfqkDiLnay0f4_DrrrQCyfbz_PGM29MyEugBVCo3nWFGboBm4JRKgsKBWX1I7KCsixzCRV7TFaUUpYrLvgZeRZjl45UldVTcgaykgpYvSJfLuw8YfYNtxjaObrRZ-s7DGa7z5zPbtf5VY87My31z_vRmtA402fXvjXB_qm2YRwyUErkSQd_Tp60po_44riek-8frtaXn_Kbrx-vLy9ucltKPuWstExI5Lxum4qDrRDremPaCrCRALJGLFGC4YyytqnlRiRDSlQGrRVNzfg5eX_g3c6bNAOLfgqm19vgBhP2ejRO_3vj3Z3-Me50IqQl8ETw9kgQxl8zxkkPLlrse-NxnKOuakgKgSbg6wfAbpyDT-Y044yDEnRhEweQDWOMAdt7JUD1kpbu9CEtvaSlKeiUVmp79beLU9MxngR4cwSYaE3fBuOtiyecAim4VKdxYJr5zmHQ0Tr0FhsX0E66Gd3_lDwksL3zLr35E_cY7y2DjkxTfbv8rOVjUZk2gir-G5Jbx_c</recordid><startdate>20070801</startdate><enddate>20070801</enddate><creator>Nallamothu, Brahmajee K., MD, MPH</creator><creator>Blaney, Martha E., PharmD</creator><creator>Morris, Susan M., PhD</creator><creator>Parsons, Lori, BS</creator><creator>Miller, Dave P., MS</creator><creator>Canto, John G., MD, MSPH</creator><creator>Barron, Hal V., MD</creator><creator>Krumholz, Harlan M., MD, SM</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Sequoia S.A</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>7T5</scope><scope>7TK</scope><scope>7TO</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20070801</creationdate><title>Acute Reperfusion Therapy in ST-Elevation Myocardial Infarction from 1994-2003</title><author>Nallamothu, Brahmajee K., MD, MPH ; Blaney, Martha E., PharmD ; Morris, Susan M., PhD ; Parsons, Lori, BS ; Miller, Dave P., MS ; Canto, John G., MD, MSPH ; Barron, Hal V., MD ; Krumholz, Harlan M., MD, SM</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c573t-25c247e338fd631c6ee88baf61ed71178ee5e71a3202fd87b4162946aecc4d823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angioplasty</topic><topic>Angioplasty, Balloon, Coronary - utilization</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Comorbidity</topic><topic>Coronary heart disease</topic><topic>Drug Utilization Review</topic><topic>Female</topic><topic>Fibrinolytic therapy</topic><topic>General aspects</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - drug therapy</topic><topic>Myocardial Infarction - epidemiology</topic><topic>Myocardial Infarction - therapy</topic><topic>Myocardial Reperfusion - utilization</topic><topic>Odds Ratio</topic><topic>Outcome Assessment (Health Care)</topic><topic>Primary angioplasty</topic><topic>Quality Indicators, Health Care</topic><topic>Registries</topic><topic>Reperfusion</topic><topic>ST-elevation myocardial infarction</topic><topic>Therapy</topic><topic>Thrombolytic Therapy - utilization</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nallamothu, Brahmajee K., MD, MPH</creatorcontrib><creatorcontrib>Blaney, Martha E., PharmD</creatorcontrib><creatorcontrib>Morris, Susan M., PhD</creatorcontrib><creatorcontrib>Parsons, Lori, BS</creatorcontrib><creatorcontrib>Miller, Dave P., MS</creatorcontrib><creatorcontrib>Canto, John G., MD, MSPH</creatorcontrib><creatorcontrib>Barron, Hal V., MD</creatorcontrib><creatorcontrib>Krumholz, Harlan M., MD, SM</creatorcontrib><creatorcontrib>National Registry of Myocardial Infarction Investigators</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>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The American journal of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nallamothu, Brahmajee K., MD, MPH</au><au>Blaney, Martha E., PharmD</au><au>Morris, Susan M., PhD</au><au>Parsons, Lori, BS</au><au>Miller, Dave P., MS</au><au>Canto, John G., MD, MSPH</au><au>Barron, Hal V., MD</au><au>Krumholz, Harlan M., MD, SM</au><aucorp>National Registry of Myocardial Infarction Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Acute Reperfusion Therapy in ST-Elevation Myocardial Infarction from 1994-2003</atitle><jtitle>The American journal of medicine</jtitle><addtitle>Am J Med</addtitle><date>2007-08-01</date><risdate>2007</risdate><volume>120</volume><issue>8</issue><spage>693.e1</spage><epage>693.e8</epage><pages>693.e1-693.e8</pages><issn>0002-9343</issn><eissn>1555-7162</eissn><coden>AJMEAZ</coden><abstract>Abstract Background Appropriate utilization of acute reperfusion therapy is not a national performance measure for ST-elevation myocardial infarction at this time, and the extent of its contemporary use among ideal patients is unknown. Methods From the National Registry of Myocardial Infarction, we identified 238,291 patients enrolled from June 1994 to May 2003 who were ideally suited for acute reperfusion therapy with fibrinolytic therapy or primary percutaneous coronary intervention. We determined rates of not receiving therapy across 3 time periods (June 1994-May 1997, June 1997-May 2000, June 2000-May 2003) and evaluated factors associated with underutilization. Results The proportion of ideal patients not receiving acute reperfusion therapy decreased by one half throughout the past decade (time period 1: 20.6%; time period 2: 11.4%; time period 3: 11.6%; P <.001). Utilization remained significantly lower in key subgroups in the most recent time period: those without chest pain (odds ratio [OR] 0.29; 95% confidence interval [CI], 0.27-0.32); those presenting 6 to 12 hours after symptom onset (OR 0.57; 95% CI, 0.52-0.61); those 75 years or older (OR 0.63 compared with patients <55 years old; 95% CI, 0.58-0.68); women (OR 0.88; 95% CI, 0.84-0.93); and non-whites (OR 0.90; 95% CI, 0.83-0.97). Conclusions Utilization of acute reperfusion therapy in ideal patients has improved over the last decade, but more than 10% remain untreated. Measuring and improving its use in this cohort represents an important opportunity to improve care.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>17679128</pmid><doi>10.1016/j.amjmed.2007.01.028</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Angioplasty Angioplasty, Balloon, Coronary - utilization Biological and medical sciences Cardiology. Vascular system Comorbidity Coronary heart disease Drug Utilization Review Female Fibrinolytic therapy General aspects Heart Heart attacks Humans Internal Medicine Male Medical sciences Middle Aged Myocardial Infarction - drug therapy Myocardial Infarction - epidemiology Myocardial Infarction - therapy Myocardial Reperfusion - utilization Odds Ratio Outcome Assessment (Health Care) Primary angioplasty Quality Indicators, Health Care Registries Reperfusion ST-elevation myocardial infarction Therapy Thrombolytic Therapy - utilization United States |
| title | Acute Reperfusion Therapy in ST-Elevation Myocardial Infarction from 1994-2003 |
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