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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2007.06.031 Byline: Vivian Ho (a)(b), Joseph S. Ross (c)(d), Brahmajee K. Nallamothu (e), Harlan M. Krumholz (f)(g)(h) Abstract: Many states enforce Certificate of Need (CON) regulations for cardiac procedures, but little is known about how CON affects utilization. We assessed the association between cardiac CON regulations, availability of revascularization facilities, and revascularization rates. Author Affiliation: (a) Baker Institute for Public Policy, Rice University, Houston, TX (b) Department of Medicine, Baylor College of Medicine (c) Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY (d) Geriatrics Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY (e) Health Services Research and Development Center of Excellence, Ann Arbor VA Medical Center, Ann Arbor, MI (f) Department of Medicine, Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, New Haven, CT (g) Department of Epidemiology and Public Health, Section of Health Policy and Administration, Yale University School of Medicine, New Haven, CT (h) Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT Article History: Received 29 January 2007; Accepted 19 June 2007 Article Note: (footnote) Dr Ross was a scholar in the Robert Wood Johnson Clinical Scholars Program at Yale University sponsored by the Robert Wood Johnson Foundation at times during his involvement in the project., Support was given from a grant awarded to Dr Ho by the National Heart, Lung, and Blood Institute (R01 HL073825-01A1).

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2005.05.010 Byline: Artyom Sedrakyan (a)(b), Heping Zhang (c), Tom Treasure (d), Harlan M. Krumholz (c)(e) Abstract: Knowledge of the risk of atrial fibrillation (AF) for patients undergoing coronary artery bypass graft surgery (CABG) can guide decisions about prophylactic therapy. Accordingly, we sought to use tree-based methods to stratify patients into groups that will have similar risk of AF after CABG and informed decision making regarding aggressive prophylaxis of AF. Author Affiliation: (a) Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (b) Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom (c) Yale University School of Medicine, New Haven, CT (d) Cardiothoracic Unit, Guy's Hospital, London, United Kingdom (e) Center for Outcomes Research and Evaluation, Yale-New Haven Health, New Haven, CT Article History: Received 8 October 2004; Accepted 9 May 2005

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2005.03.069 Byline: Saif S. Rathore (a), Kevin P. Weinfurt (c), JoAnne M. Foody (a), Harlan M. Krumholz (a)(b)(d)(e)(f) Abstract: The TIMI ST-elevation myocardial infarction (STEMI) score was developed and validated in a randomized controlled trial population. We sought to assess its accuracy in a community-based cohort of elderly patients hospitalized with STEMI. Author Affiliation: (a) Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn (b) Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn (c) Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (d) Qualidigm, Middletown, Conn (e) Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Conn (f) The Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Conn Article History: Received 18 November 2003; Accepted 29 March 2005 Article Note: (footnote) Saif Rathore was supported by NIH/National Institute of General Medical Sciences Medical Scientist Training Grant GM07205.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2004.08.018 Byline: Saif S. Rathore (a)(b), Paul D. Frederick (e), Nathan R. Every (e), Hal V. Barron (f), Harlan M. Krumholz (a)(c)(d) Abstract: Racial differences in reperfusion therapy use among patients hospitalized with myocardial infarction (MI) have been previously reported as national phenomenon. However, it is unclear whether racial differences in treatment vary by region. Author Affiliation: (a) Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn (b) MD/PhD Program, Yale University School of Medicine, New Haven, Conn (c) Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn (d) Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Conn (e) Ovation Research Group, Chicago, Ill (f) Genentech, Incorporated, South San Francisco, Calif Article History: Received 13 January 2004; Accepted 17 August 2004 Article Note: (miscellaneous) The National Registry of Myocardial Infarction-2 and -3 is supported by Genentech, Inc, South San Francisco, Calif. Mr Rathore is supported by National Institutes of Health National Institute of General Medical Sciences Medical Scientist Training Grant GM07205.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0002-8703(00)90311-9 Byline: Harlan M. Krumholz, Ya-Ting Chen, Yun Wang, Viola Vaccarino, Martha J. Radford, Ralph I. Horwitz Abstract: Background Readmission rates for patients discharged with heart failure approach 50% within 6 months. Identifying factors to predict risk of readmission in these patients could help clinicians focus resource-intensive disease management efforts on the high-risk patients. Methods The study sample included patients 65 years of age or older with a principal discharge diagnosis of heart failure who were admitted to 18 Connecticut hospitals in 1994 and 1995. We obtained patient and clinical data from medical record review. We determined outcomes within 6 months after discharge, including all-cause readmission, heart failure-related readmission, and death, from the Medicare administrative database. We evaluated 2176 patients, including 1129 in the derivation cohort and 1047 in the validation cohort. Results Of 32 patient and clinical factors examined, 4 were found to be significantly associated with readmission in a multivariate model. They were prior admission within 1 year, prior heart failure, diabetes, and creatinine level >2.5 mg/dL at discharge. The event rates according to number of risk predictors were similar in the derivation and the validation sets for all outcomes. In the validation cohort, rates for all-cause readmission and combined readmission or death were 26% and 31% in patients with no risk predictors, 48% and 54% in patients with 1 or 2 risk predictors, and 59% and 65% in patients with 3 or all risk predictors. Conclusions Few patient and clinical factors predict readmission within 6 months after discharge in elderly patients with heart failure. Although we were unable to identify a group of patients at very low risk, a group of high-risk patients were identified for whom resource-intensive interventions designed to improve outcomes may be justified. (Am Heart J 2000;139:72-7.) Author Affiliation: New Haven and Middletown, Conn From the.sup.aSection of Cardiovascular Medicine, Department of Medicine, the.sup.bSection of Chronic Disease Epidemiology, School of Epidemiology and Public Health, and the.sup.cDepartment of Medicine, Yale University School of Medicine, New Haven..sup.dYale-New Haven Hospital Center for Outcomes Research and Evaluation; and.sup.eQualidigm, Middletown Article History: Received 11 January 1999; Accepted 12 May 1999 Article Note: (footnote) [star] The analyses on which this publication is based were performed under contract number 500-96-P549, titled 'Utilization and Quality Control Peer Review Organization for the State of Connecticut,' sponsored by the Health Care Financing Administration, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The author assumes full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Health Care Financing Administration, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this Contractor. Ideas and contributions to the author concerning experience in engaging with issues presented are welcomed., [star][star] Reprint requests: Harlan M. Krumholz, MD, Yale University School of Medicine, 333 Cedar St, Box 208025, New Haven, CT 06520-8025. E-mail: harlan.krumholz@yale.edu , a 0002-8703/2000/$12.00 + 0 4/1/100183