Cardiology
for June 18, 2008 In-Hospital
Death After Coronary Artery Bypass Grafting: Preventable or
Not?
Summary
and Comment | Free
An
implicit chart review and analysis highlights the importance of asking
this question, even in institutions with low all-cause mortality
rates. By Howard
C. Herrmann, MD June 18, 2008
Covering:
Guru V et al. Circulation 2008 Jun 10; 117:2969
Krumholz HM. Circulation 2008 Jun 10;
117:2963
Rhythm
Control for Atrial Fibrillation Takes Another Hit
Summary
and Comment | Free
This
approach to treatment of patients with heart failure performed poorly in
two recent studies. By Mark S.
Link, MD June 18, 2008
Covering:
Roy D et al. for the Atrial Fibrillation and Congestive Heart Failure
Investigators. N Engl J Med 2008 Jun 19; 358:2667
Køber L et al. for the Dronedarone Study
Group. N Engl J Med 2008 Jun 19; 358:2678
Cain ME and Curtis AB. N Engl J Med 2008 Jun
19; 358:2725
Determinants
of Risk for Sudden Death in Myotonic Dystrophy
Summary
and Comment | Subscription Required
In a
multicenter case series, an abnormal ECG and atrial tachycardia were
independent predictors of sudden cardiac death. By Mark S.
Link, MD June 18, 2008
Covering:
Groh WJ et al. N Engl J Med 2008 Jun 19; 358:2688
ECGs
and Echocardiograms for Screening Athletes: A Black and White
Issue?
Summary
and Comment | Subscription Required
In two
studies, the prevalence of "abnormal" ECG and echocardiogram findings was
significantly higher in black athletes than in white athletes. By Mark S.
Link, MD June 18, 2008
Covering:
Magalski A et al. J Am Coll Cardiol 2008 Jun 10; 51:2250
Basavarajaiah S. J Am Coll Cardiol 2008 Jun
10; 51:2256
Pelliccia A. J Am Coll Cardiol 2008 Jun 10;
51:2263
Patients
with Heart Failure Overestimate Their Life Expectancies
Summary
and Comment | Subscription Required
Findings
from a small study suggest that patients’ expectations often are not
in line with their prognoses. By JoAnne M.
Foody, MD, FACC, FAHA June 18, 2008
Covering:
Allen LA et al. JAMA 2008 Jun 4; 299:2533
Editor's
Picks from across Journal Watch |
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Death
After Syncope: Can We Predict It?
Emergency
Medicine | Summary and Comment | Subscription Required
The San
Francisco Syncope Rule was a sensitive predictor of death at 1 year in
this single-center, prospective cohort study. By Richard
D. Zane, MD, FAAEM May 23, 2008
Covering:
Quinn J et al. Ann Emerg Med 2008 May 51:585
Is
Tight Glycemic Control Beneficial Perioperatively?
General
Medicine | Summary and Comment | Subscription Required
In a
meta-analysis, perioperative mortality was significantly lower with
insulin infusions than with control interventions, but the authors have
doubts about the data. By Allan
S. Brett, MD May 13, 2008
Covering:
Gandhi GY et al. Mayo Clin Proc 2008 Apr 83:418
Multislice
CT for Pulmonary Embolism Makes Leg Ultrasound Unnecessary
General
Medicine | Summary and Comment | Subscription Required
A
simplified diagnostic approach is efficient and less costly than the
standard protocol. By Bruce
Soloway, MD May 8, 2008
Covering:
Righini M et al. Lancet 2008 Apr 19; 371:1343
Alendronate
and Risk for Atrial Fibrillation
General
Medicine | Summary and Comment | Subscription Required
Because
of inconsistent results across several studies, it's still unclear
whether oral bisphosphonates increase risk for atrial fibrillation.
By Jamaluddin
Moloo, MD, MPH, and Paul
S. Mueller, MD, MPH, FACP May 6, 2008
Covering:
Heckbert SR et al. Arch Intern Med 2008 Apr 28; 168:826
Thiazolidinediones
and Risk for Fractures
General
Medicine | Summary and Comment | Subscription Required
In an
observational study, users of TZDs had higher risk for fractures than
those taking other antidiabetes medications. By Jamaluddin
Moloo, MD, MPH May 8, 2008
Covering:
Meier C et al. Arch Intern Med 2008 Apr 28; 168:820
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Full-Text Article
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Summary
and Comment
In-Hospital Death After Coronary Artery Bypass Grafting: Preventable or
Not?An implicit chart review and analysis highlights the importance
of asking this question, even in institutions with low all-cause mortality
rates. To improve quality of care, researchers in Ontario assessed the
relation between publicly reported in-hospital mortality after coronary
artery bypass grafting surgery and the proportion of such deaths deemed
preventable. Data were culled from medical records of 40 deaths that
occurred at each of eight hospitals (plus 27 deaths that occurred at a
cardiac surgery center) participating in a surgical registry from April
2000 through March 2002. Charts were abstracted by trained nurses and
reviewed by two experienced cardiac surgeons.
Among 347 deaths reviewed, 52 (15%) were judged preventable by both
reviewers, and an additional 59 (17%) were deemed preventable by one of the
two and by a third independent reviewer. Quality-of-care problems
identified included inappropriate timing of surgery, inappropriate decision
to operate, deviation from standard perioperative management, and missed
evidence of preventability. No correlation was found between the
institutions’ risk-adjusted all-cause mortality rates (range,
1.3%–3.1%) and their proportions of preventable deaths. Preventable
death was identified more frequently in patients with a lower predicted
operative risk than in those with a higher predicted risk.
Comment: Despite relatively low rates of all-cause mortality in
these high-volume centers, about one third of in-hospital deaths after CABG
were judged preventable by surgeon reviewers. Detailed adverse-event audits
may enable more targeted quality improvement than all-cause mortality
comparisons, which can ignore quality-of-care problems that exist across
all or most hospitals in a region. As noted in an accompanying editorial, a
systematic, comprehensive, adverse-event assessment via implicit review
should be part of every hospital’s quality improvement efforts.
— Howard
C. Herrmann, MD
Published in Journal Watch Cardiology June 18, 2008
Citation(s):
Guru V et
al. Relationship between preventability of death after coronary artery
bypass graft surgery and all-cause risk-adjusted mortality rates.
Circulation
2008 Jun 10; 117:2969. Original
article (Subscription may be required) Medline
abstract (Free)
Krumholz
HM. Seeking better outcomes in coronary artery bypass grafting: Lessons
from past experience.
Circulation
2008 Jun 10; 117:2963. Original
article (Subscription may be required) Medline
abstract (Free)
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