19 results on '"McGuire, Darren K."'
Search Results
2. Residual Angina After Elective Percutaneous Coronary Intervention in Patients With Diabetes Mellitus.
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Grodzinsky, Anna, Kosiborod, Mikhail, Fengming Tang, Jones, Philip G., McGuire, Darren K., Spertus, John A., Beltrame, John F., Jae-Sik Jang, Goyal, Abhinav, Butala, Neel M., Yeh, Robert W., Arnold, Suzanne V., Tang, Fengming, and Jang, Jae-Sik
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CORONARY heart disease surgery ,TYPE 2 diabetes complications ,ANGINA pectoris ,CARDIOVASCULAR system ,COMPARATIVE studies ,TYPE 1 diabetes ,RESEARCH methodology ,MEDICAL care ,MEDICAL cooperation ,TYPE 2 diabetes ,POSTOPERATIVE period ,QUESTIONNAIRES ,RESEARCH ,RESEARCH funding ,ELECTIVE surgery ,EVALUATION research ,DISEASE incidence ,ACQUISITION of data ,RETROSPECTIVE studies ,PATIENT readmissions ,DISEASE complications - Abstract
Background: Previous studies suggest that among patients with stable coronary artery disease, patients with diabetes mellitus (DM) have less angina and more silent ischemia when compared with those without DM. However, the burden of angina in diabetic versus nondiabetic patients after elective percutaneous coronary intervention (PCI) has not been recently examined.Methods and Results: In a 10-site US PCI registry, we assessed angina before and at 1, 6, and 12 months after elective PCI with the Seattle Angina Questionnaire angina frequency score (range, 0-100, higher=better). We also examined the rates of antianginal medication prescriptions at discharge. A multivariable, repeated-measures Poisson model was used to examine the independent association of DM with angina over the year after treatment. Among 1080 elective PCI patients (mean age, 65 years; 74.7% men), 34.0% had DM. At baseline and at each follow-up, patients with DM had similar angina prevalence and severity as those without DM. Patients with DM were more commonly prescribed calcium channel blockers and long-acting nitrates at discharge (DM versus not: 27.9% versus 20.9% [P=0.01] and 32.8% versus 25.5% [P=0.01], respectively), whereas β-blockers and ranolazine were prescribed at similar rates. In the multivariable, repeated-measures model, the risk of angina was similar over the year after PCI in patients with versus without DM (relative risk, 1.04; range, 0.80-1.36).Conclusions: Patients with stable coronary artery disease and DM exhibit a burden of angina that is at least as high as those without DM despite more antianginal prescriptions at discharge. These findings contradict the conventional teachings that patients with DM experience less angina because of silent ischemia. [ABSTRACT FROM AUTHOR]- Published
- 2017
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3. Patterns of Prescribing Sodium-Glucose Cotransporter-2 Inhibitors for Medicare Beneficiaries in the United States.
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Sangha, Veer, Lipska, Kasia MHS, Lin, Zhenqiu, Inzucchi, Silvio E., McGuire, Darren K. MHSc, Krumholz, Harlan M. SM, Khera, Rohan MS, Lipska, Kasia, McGuire, Darren K, Krumholz, Harlan M, and Khera, Rohan
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CROSS-sectional method ,TYPE 2 diabetes ,DRUG prescribing ,RESEARCH funding ,PHYSICIAN practice patterns ,SODIUM-glucose cotransporter 2 inhibitors ,MEDICARE - Abstract
Background: Evidence from large randomized clinical trials supports the benefit of SGLT2i (sodium-glucose cotransporter-2 inhibitors) to improve cardiovascular and kidney outcomes in patients with type 2 diabetes with or at high risk for atherosclerotic cardiovascular disease or chronic kidney disease. Considering this evidence, which has been expanding since the product label indication for empagliflozin to reduce risk of cardiovascular death in 2016, clinician-level variation in the prescription of SGLT2i among US Medicare beneficiaries was evaluated.Methods: Antihyperglycemic medication prescribers were identified as those physicians and advanced practice providers prescribing metformin in Medicare part D prescriber data. In this cross-sectional study, the proportion prescribing SGLT2i was assessed overall and across specialties in 2018, with changes assessed from 2014 to 2018. SGLT2i use was compared with other second-line antihyperglycemic medication classes, sulfonylureas and DPP4is (dipeptidyl peptidase-4 inhibitors).Results: Among 232 523 unique clinicians who prescribed metformin for Medicare beneficiaries in 2018 (diabetes-treating clinicians), 45 255 (19.5%) prescribed SGLT2i. There was substantial variation across specialties-from 72% of endocrinologists to 14% of cardiologists who prescribed metformin also prescribed SGLT2i. Between 2014 and 2018, the number prescribing SGLT2i increased 5-fold from 9048 in 2014 to 45 255 in 2018. Among clinicians who prescribed both sulfonylureas and SGLT2i in 2018, SGLT2i was prescribed to a median 33 beneficiaries for every 100 prescribed sulfonylureas (interquartile range, 18-67). SGLT2i use relative to sulfonylureas increased from 19 (interquartile range, 11-34) per 100 in 2014 to 33 (interquartile range, 18-67) per 100 in 2018 (Ptrend<0.001).Conclusions: Eighty percent of clinicians prescribing metformin to Medicare beneficiaries did not prescribe SGLT2i in 2018. Moreover, sulfonylureas prescriptions were 3 times more frequent than those of SGLT2is, although a pattern of increasing uptake may portend future trends. These findings highlight a baseline opportunity to improve care and outcomes for patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]- Published
- 2021
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4. Predicting Adverse Outcomes After Myocardial Infarction Among Patients With Diabetes Mellitus.
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Arnold, Suzanne V., Spertus, John A., Jones, Philip G., McGuire, Darren K., Lipska, Kasia J., Yaping Xu, Stolker, Joshua M., Goyal, Abhinav, Kosiborod, Mikhail, and Xu, Yaping
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DIAGNOSIS of diabetes ,MYOCARDIAL infarction diagnosis ,MYOCARDIAL infarction-related mortality ,ANGINA pectoris ,COMPARATIVE studies ,DECISION making ,DIABETES ,RESEARCH methodology ,MEDICAL cooperation ,MYOCARDIAL infarction ,PROGNOSIS ,RESEARCH ,RESEARCH evaluation ,RESEARCH funding ,RISK assessment ,TIME ,EVALUATION research ,PREDICTIVE tests ,ACQUISITION of data ,PROPORTIONAL hazards models ,KAPLAN-Meier estimator - Abstract
Background: Although patients with diabetes mellitus experience high rates of adverse events after acute myocardial infarction (AMI), including death and recurrent ischemia, some diabetic patients are likely at low risk, whereas others are at high risk. We sought to develop prediction models to stratify risk after AMI in patients with diabetes mellitus.Methods and Results: We developed prediction models for long-term mortality and angina among 1613 patients with diabetes mellitus discharged alive after AMI from 24 US hospitals and then validated the models in a separate, multicenter registry of 786 patients with diabetes mellitus. Event rates in the derivation cohort were 27% for 5-year mortality and 27% for 1-year angina. Parsimonious prediction models demonstrated good discrimination (c-indices=0.78 and 0.69, respectively) and excellent calibration. Within the context of the predictors we estimated, the strongest predictors for mortality were higher creatinine, not working at the time of the AMI, older age, lower hemoglobin, left ventricular dysfunction, and chronic heart failure. The strongest predictors for angina were angina burden in the 4 weeks before the AMI, younger age, history of prior coronary bypass graft surgery, and non-white race. The lowest and highest deciles of predicted risk ranged from 4% to 80% for mortality and 12% to 59% for angina. The models also performed well in external validation (c-indices=0.78 and 0.73, respectively).Conclusions: We found a wide range of risk for adverse outcomes after AMI in diabetic patients. Predictive models can identify patients with diabetes mellitus for whom closer follow-up and aggressive secondary prevention strategies should be considered. [ABSTRACT FROM AUTHOR]- Published
- 2016
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5. Revascularization Trends in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease Presenting With Non-ST Elevation Myocardial Infarction: Insights From the National Cardiovascular Data Registry Acute Coronary Treatment and...
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Pandey, Ambarish, McGuire, Darren K., de Lemos, James A., Das, Sandeep R., Berry, Jarett D., Brilakis, Emmanouil S., Banerjee, Subhash, Marso, Steven P., Barsness, Gregory W., Simon, DaJuanicia N., Roe, Matthew, Goyal, Abhinav, Kosiborod, Mikhail, Amsterdam, Ezra A., and Kumbhani, Dharam J.
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CORONARY heart disease treatment ,DIAGNOSIS of diabetes ,MORTALITY ,CARDIOVASCULAR system ,CHI-squared test ,COMPARATIVE studies ,CORONARY artery bypass ,CORONARY disease ,DIABETES ,HOSPITAL admission & discharge ,RESEARCH methodology ,MEDICAL care ,MEDICAL cooperation ,MEDICAL protocols ,MULTIVARIATE analysis ,PATIENTS ,REGRESSION analysis ,RESEARCH ,RISK assessment ,TIME ,LOGISTIC regression analysis ,EVALUATION research ,TREATMENT effectiveness ,ACQUISITION of data ,RETROSPECTIVE studies - Abstract
Background: Current guidelines recommend surgical revascularization (coronary artery bypass graft [CABG]) over percutaneous coronary intervention (PCI) in patients with diabetes mellitus and multivessel coronary artery disease. Few data are available describing revascularization patterns among these patients in the setting of non-ST-segment-elevation myocardial infarction.Methods and Results: Using Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines (ACTION Registry-GWTG), we compared the in-hospital use of different revascularization strategies (PCI versus CABG versus no revascularization) in diabetes mellitus patients with non-ST-segment-elevation myocardial infarction who had angiography, demonstrating multivessel coronary artery disease between July 2008 and December 2014. Factors associated with use of CABG versus PCI were identified using logistic multivariable regression analyses. A total of 29 769 patients from 539 hospitals were included in the study, of which 10 852 (36.4%) were treated with CABG, 13 760 (46.2%) were treated with PCI, and 5157 (17.3%) were treated without revascularization. The overall use of revascularization increased over the study period with an increase in the proportion undergoing PCI (45% to 48.9%; Ptrend=0.0002) and no change in the proportion undergoing CABG (36.1% to 34.7%; ptrend=0.88). There was significant variability between participating hospitals in the use of PCI and CABG (range: 22%-100%; 0%-78%, respectively; P value <0.0001 for both). Patient-level, but not hospital-level, characteristics were statistically associated with the use of PCI versus CABG, including anatomic severity of the disease, early treatment of adenosine diphosphate receptor antagonists at presentation, older age, female sex, and history of heart failure.Conclusions: Among patients with diabetes mellitus and multivessel coronary artery disease presenting with non-ST-segment-elevation myocardial infarction, only one third undergo CABG during the index admission. Furthermore, the use of PCI, but not CABG, increased modestly over the past 6 years. [ABSTRACT FROM AUTHOR]- Published
- 2016
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6. Recognition of Incident Diabetes Mellitus During an Acute Myocardial Infarction.
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Arnold, Suzanne V., Stolker, Joshua M., Lipska, Kasia J., Jones, Philip G., Spertus, John A., McGuire, Darren K., Inzucchi, Silvio E., Goyal, Abhinav, Maddox, Thomas M., Lind, Marcus, Gumber, Divya, Shore, Supriya, and Kosiborod, Mikhail
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- 2015
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7. Contemporary Patterns of Discharge Aspirin Dosing After Acute Myocardial Infarction in the United States: Results From the National Cardiovascular Data Registry (NCDR)
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Hall, Hurst M, de Lemos, James A, Enriquez, Jonathan R, McGuire, Darren K, Peng, S Andrew, Alexander, Karen P, Roe, Matthew T, Desai, Nihar, Wiviott, Stephen D, and Das, Sandeep R
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- 2014
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8. Diabetes Mellitus and Trends in Hospital Survival After Myocardial Infarction, 1994 to 2006.
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Gore, M. Odette, Patel, Mahesh J., Kosiborod, Mikhail, Parsons, Lori S., Khera, Amit, de Lemos, James A., Rogers, William J., Peterson, Eric D., Canto, John C., and McGuire, Darren K.
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TRENDS ,HOSPITALS ,MORTALITY ,MYOCARDIAL infarction ,DIABETES ,PATIENTS - Abstract
The article presents a study on recent trends in hospital mortality for patients with myocardial infarction (MI) according to diabetes mellitus (DM) status from 1994-2006. It analyzed data from the U.S. National Registry of Myocardial Infarction, representing a fourth of all U.S. acute care hospitals. It finds that the hospital mortality gap between MI patients with and without DM narrowed significantly within the period, with the greatest improvement seen in women with DM.
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- 2012
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9. Low hemoglobin A1c and risk of all-cause mortality among US adults without diabetes.
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Carson, April P, Fox, Caroline S, McGuire, Darren K, Levitan, Emily B, Laclaustra, Martin, Mann, Devin M, and Muntner, Paul
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DIABETES complications ,GLYCOSYLATED hemoglobin ,LONGITUDINAL method ,PROGNOSIS ,RESEARCH funding ,SURVEYS ,RELATIVE medical risk ,PROPORTIONAL hazards models - Abstract
Background: Among individuals without diabetes, elevated hemoglobin A1c (HbA1c) has been associated with increased morbidity and mortality, but the literature is sparse regarding the prognostic importance of low HbA1c.Methods and Results: National Health and Nutrition Examination Survey III (NHANES III) participants, 20 years and older, were followed up to 12 years (median follow-up, 8.8 years) for all-cause mortality. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the association between HbA1c levels and all-cause mortality for 14 099 participants without diabetes. There were 1825 deaths during the follow-up period. Participants with a low HbA1c (<4.0%) had the highest levels of mean red blood cell volume, ferritin, and liver enzymes and the lowest levels of mean total cholesterol and diastolic blood pressure compared with their counterparts with HbA1c levels between 4.0% and 6.4%. An HbA1c <4.0% versus 5.0% to 5.4% was associated with an increased risk of all-cause mortality (HR, 3.73; 95% CI, 1.45 to 9.63) after adjustment for age, race-ethnicity, and sex. This association was attenuated but remained statistically significant after further multivariable adjustment for lifestyle, cardiovascular factors, metabolic factors, red blood cell indices, iron storage indices, and liver function indices (HR, 2.90; 95% CI, 1.25 to 6.76).Conclusions: In this nationally representative cohort, low HbA1c was associated with increased all-cause mortality among US adults without diabetes. Additional research is needed to confirm these results and identify potential mechanisms that may be underlying this association. [ABSTRACT FROM AUTHOR]- Published
- 2010
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10. Metabolic syndrome is not associated with increased mortality or cardiovascular risk in nondiabetic patients with a new diagnosis of coronary artery disease.
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Petersen, John L., Yow, Eric, AlJaroudi, Wael, Shaw, Linda K., Goyal, Abhinav, McGuire, Darren K., Peterson, Eric D., and Harrington, Robert A.
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METABOLIC syndrome ,CORONARY disease ,DIABETES ,MYOCARDIAL infarction ,MORTALITY ,DIABETES complications ,MYOCARDIAL infarction-related mortality ,METABOLIC syndrome diagnosis ,STROKE-related mortality ,BLOOD pressure ,BLOOD sugar ,CHI-squared test ,COMPARATIVE studies ,DATABASES ,LIPIDS ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH ,RISK assessment ,STROKE ,TIME ,EVALUATION research ,BODY mass index ,PREDICTIVE tests ,ACQUISITION of data ,PROPORTIONAL hazards models ,SEVERITY of illness index ,KAPLAN-Meier estimator ,CORONARY angiography ,DISEASE complications - Abstract
Background: Metabolic syndrome (MetSyn) is associated with increased cardiovascular risk in the general population. Its prognostic implications are less well defined in patients with coronary artery disease.Methods and Results: We analyzed patients in the Duke Database for Cardiovascular Disease with a diagnosis of incident obstructive coronary artery disease. Diabetes mellitus (DM) was classified as a clinical history of DM, use of hypoglycemic drugs, or fasting glucose of >or=126 mg/dL. MetSyn was defined as having 3 of 5 characteristics: fasting glucose >or=100 and <126 mg/dL, low high-density lipoprotein cholesterol (men, <40 mg/dL; women, <50 mg/dL), triglycerides >150 mg/dL, blood pressure >or=130/85 mm Hg, or use of antihypertensive therapy, or body mass index >or=27. Death, myocardial infarction, or stroke was assessed at 6 months, 1 year, then annually. Cox proportional hazards models were generated to compare mortality and cardiovascular events between groups. The primary cohort consisted of 5744 patients; 1831 (31.9%) had DM, 2491 (43.4%) had MetSyn, and 1422 (24.7%) had no DM/MetSyn. Median follow-up was 5 years. Compared with no DM/MetSyn patients, DM patients had a higher adjusted risk for mortality (hazard ratio, 1.47; 95% CI, 1.28 to 1.69) but MetSyn patients did not (hazard ratio, 0.94; 95% CI, 0.81 to 1.08). Similar results were found for the combined end points of death or myocardial infarction, and death, myocardial infarction, or stroke.Conclusions: In a population of consecutive patients with a new diagnosis of coronary artery disease by angiography, MetSyn without DM was not an independent predictor of mortality or cardiovascular events. [ABSTRACT FROM AUTHOR]- Published
- 2010
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11. Systems-Based Improvement in Door-to-Balloon Times at a Large Urban Teaching Hospital.
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Parikh, Shailja V., Treichle, D. Brent, DePaola, Sheila, Sharpe, Jennifer, Valdes, Marisa, Addo, Tayo, Das, Sandeep R., McGuire, Darren K., De Lemos, James A., Keeley, Ellen C., Warner, John J., and Holper, Elizabeth M.
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MYOCARDIAL infarction treatment ,CORONARY heart disease treatment ,CARDIAC surgery ,CARDIOLOGY ,OPERATIVE surgery - Abstract
The article discusses a study on a systems-based improvement in door-to-balloon times (DBT) at the urban teaching hospital, Parkland Health and Hospital System. In the study, four strategies or protocol to reduce were implemented. The study also examined each component time interval from the first 59 consecutive ST-Segment elevation myocardial infarction patients treated with the new protocol between March 2007 and June 2008.
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- 2009
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12. Abstract 4
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Arnold, Suzanne V, Stolker, Joshua M, Lipska, Kasia J, Li, Yan, Spertus, John A, McGuire, Darren K, Inzucchi, Silvio E, Goyal, Abhinav, Maddox, Thomas M, Lind, Marcus, Shore, Supriya, and Kosiborod, Mikhail
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Background:Diabetes mellitus (DM) is a common comorbidity in patients hospitalized with an acute myocardial infarction (AMI), and, in some cases, the AMI hospitalization represents the first opportunity to recognize and treat DM. We sought to understand both the prevalence of incident DM and its rate of recognition among AMI patients without DM diagnosis on admission.
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- 2014
13. Abstract 154
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Arnold, Suzanne V, McGuire, Darren K, Lipska, Kasia J, Tang, Fengming, Spertus, John A, Goyal, Abhinav, Gore, M O, Lanfear, David E, Maddox, Thomas M, and Kosiborod, Mikhail
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Background:Discharge beta blocker (BB) prescription after myocardial infarction (MI) is guideline recommended for all eligible patients and is a core quality measure. Numerous BB choices are presently available that vary with regard to their glycometabolic effects, a potentially important consideration in patients with diabetes mellitus (DM). We studied whether clinicians preferentially select BBs with favorable metabolic effects in patients with DM.
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- 2013
14. Abstract 142
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Abdallah, Mouin S, Kosiborod, Mikhail, Tang, Fengming, Karrowni, Wassef Y, Maddox, Thomas M, McGuire, Darren K, Spertus, John A, and Arnold, Suzanne V
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Background:Patients with diabetes mellitus (DM) and acute myocardial infarction (AMI) are at increased risk for death and recurrent AMIs. Intensive statin therapy, a key component of aggressive risk factor management, has been shown to improve AMI outcomes especially in such a high risk population. However the frequency and predictors of intensive statin therapy among patients with DM after an AMI has not yet been described.
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- 2013
15. Abstract 109
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Narang, Nikhil, Levine, Benjamin D, Gore, M. Odette, Ayers, Colby R, Lange, Richard A, Cigarroa, Joaquin E, Turer, Aslan T, Lemos, James A de, and McGuire, Darren K
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- 2012
16. Abstract 193
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Jarvie, Jennifer L, Ayers, Colby R, Snell, Peter G, Gore, Odette, Lakoski, Susan G, Berry, Jarett D, and McGuire, Darren K
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- 2012
17. Abstract 31
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Maddox, Thomas M, Gylys-Colwell, Ina, McDermott, Kelly, Ho, P. Michael, Tillquist, Maggie, Lowy, Elliott, McGuire, Darren K, Stolker, Joshua M, and Kosiborod, Mikhail
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- 2012
18. Abstract P161
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Stolker, Joshua M, Spertus, John A, McGuire, Darren K, Inzucchi, Silvio E, Rathore, Saif S, Maddox, Thomas M, Masoudi, Frederick A, Tang, Fengming, Jones, Philip G, and Kosiborod, Mikhail
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- 2011
19. Abstract P161
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Stolker, Joshua M, Spertus, John A, McGuire, Darren K, Inzucchi, Silvio E, Rathore, Saif S, Maddox, Thomas M, Masoudi, Frederick A, Tang, Fengming, Jones, Philip G, and Kosiborod, Mikhail
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BACKGROUNDHemoglobin A1c(A1C) assessment is recommended for hospitalized patients (pts) with diabetes (DM). Whether in-hospital A1C levels are associated with glucose therapy intensification (GTI) after MI is unknown.
- Published
- 2010
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