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Frailty is a common reason that patients with atrial fibrillation (AF) are not treated with an oral anticoagulant (OAC) for stroke prevention. Included patients from the Premier Health Database were age ≥ 40 years, admitted January 2011 to June 2015 with a primary or secondary AF diagnosis

Renal function has been associated with outcomes of patients anticoagulated for atrial fibrillation (AF). We hypothesize that oral anticoagulant (OAC) prescribing patterns and clinical outcomes change based on chronic kidney disease (CKD) status. Included patients from the Premier Health Database

ObjectivesWe examined the association between glycemic control determined by preprocedural hemoglobin A1c (A1c) and the incidence of target vessel revascularization (TVR) in diabetic patients undergoing elective percutaneous coronary intervention (PCI).BackgroundPatients with diabetes mellitus (DM) have increased rates of restenosis and a worse clinical outcome after PCI than patients without DM.MethodsA total of 239 patients (60 without DM and 179 with DM) were enrolled in this study. Optimal glycemic control was defined as A1c ≤7%, and suboptimal control was defined as A1c >7%. Follow-up was performed at six and 12 months after the index intervention.ResultsDiabetic patients with optimal glycemic control had a rate of 12-month TVR similar to that of nondiabetic patients (15% vs. 18%, p = NS). Diabetic patients with A1c >7% had a significantly higher rate of TVR than those with A1c 7% was a significant independent predictor of TVR (odds ratio 2.87, 95% confidence interval 1.13 to 7.24; p = 0.03). Optimal glycemic control was associated with a lower rate of cardiac rehospitalization (15% vs. 31%, p = 0.03) and recurrent angina (13% vs. 37%, p = 0.002) at 12-month follow-up.ConclusionsIn diabetic patients undergoing elective PCI, optimal glycemic control (A1c ≤7%) is associated with a lower rate of TVR, cardiac rehospitalization, and recurrent angina. These data suggest that aggressive treatment of DM to achieve A1c ≤7% is beneficial in improving the clinical outcome after PCI.

Objectives The purpose of this study was to describe the health status (symptoms, function, and quality of life) changes of elderly patients undergoing coronary artery bypass grafting (CABG) and compare these to younger patients. Background Despite increasing use of CABG in the elderly, few data exist about elderly patients' health status benefits from CABG. Methods A total of 690 consecutive patients (n = 156, >75 years of age; n = 534, ≤75 years of age) from a single center were administered the Seattle Angina Questionnaire (SAQ) at baseline and at one year. The first 224 patients were also given monthly questionnaires for six months after CABG. Results Although peri-operative mortality was similar (2.6% vs. 2.2%, p = NS), one-year mortality was greater in older patients (11.5% vs. 5.4%, p = 0.008). Among survivors, similar health status benefits were observed one year after surgery (SAQ change scores for Physical Function 21.5 ± 27.0 vs. 19.7 ± 27.0, p = 0.67; Angina Frequency 30.1 ± 25.7 vs. 24.6 ± 25.6, p = 0.07; and Quality of Life 37.7 ± 21.8 vs. 33.6 ± 25.2, p = 0.16). In 224 patients assessed monthly, elderly patients' physical function scores were significantly lower than the younger group until one year. The age-time interaction term was significant (p = 0.003), confirming a slower recovery of physical function. In contrast, angina relief and quality of life improvement did not differ by age. Conclusions Despite a slower rate of physical recovery, older patients derived similar health status benefits from CABG compared with younger patients. These data should assist physicians in counseling elderly patients and suggest that age alone should not be a deterrent for recommending bypass surgery.

Background: Oral anticoagulant (OAC) under-treatment for stroke prevention in atrial fibrillation (AF) has been demonstrated. Limited data are available on treatment trends treatment over time, as non-vitamin K antagonists (NOACs) were introduced. Methods: Included patients from the Premier Health

Methods: We developed a decision-analytic model of costs and bleeding events of transradial vs. transfemoral PCI using inputs from 4 hospitals, and direct PCI costs from each hospital’s respective cost accounting system. Independent costs of radial PCI, urgent vs. elective PCI indication and bleeding complications were identiied by a linear regression model and used as model inputs. The eficacy measure was major bleeding as deined by the NCDR.

Results: There were 1.5 million PCI procedures evaluated. Major bleeding occurred in 30,429 (2%) patients. The Figure presents observed bleeding events and number needed to treat to prevent 1 bleeding event by use of bivalirudin, vascular closure devices, both, or neither for the total group and stratiied by subgroup of bleeding risk. The combination of bivalirudin and closure devices was associated with the lowest rate of bleeding in each group. High risk patients were more likely to receive no therapy than low risk patients (40% vs 31%, P

While transradial PCI (TRI) reduces access–site complications and bleeding over transfemoral (TFI), less is known about its economic impact on hospitals. Hospital costs in 7,121 consecutive PCI procedures from January 1, 2010 to March 31, 2011 were analyzed using data from cost accounting systems

Health status is associated with improved short to intermediate-term survival in patients with peripheral arterial disease (PAD) who undergo peripheral endovascular revascularization (PER). It is unknown whether these improvements are associated with improved long-term survival. From February 2001