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Mortality post-transplantation historically was largely attributed to coronary artery disease (CAD). Current guidelines recommend screening with non-invasive modalities in patients with risk factors. An analysis of 1221 patients at Indiana University (IU) found a reduction in the incidence of

Background: Adults with congenital heart disease (ACHD) often require repeat cardiothoracic surgery, which can result in significant morbidity and mortality. Currently there are few preoperative risk assessment tools available. In the general adult population, preoperative cardiopulmonary exercise

Objective. The aim of this study was to examine the effects of provider profiling on bypass surgery access and outcomes in elderly patients in New York.Background. Since 1989, New York (NY) has compiled provider-specific bypass surgery mortality reports. While some have proposed that “provider profiling” has led to lower surgical mortality rates, critics have suggested that such programs lower in-state procedural access (increasing out-of-state transfers) without improving patient outcomes.Methods. Using national Medicare data, we examined trends in the percentages of NY residents aged 65 years or older receiving out-of-state bypass surgery between 1987 and 1992 (before and after program initiation). We also examined in-state procedure use among elderly myocardial infarction patients during this period. Finally, we compared trends in surgical outcomes in NY Medicare patients with those for the rest of the nation.Results. Between 1987 and 1992, the percentage of NY residents receiving bypass out-of-state actually declined (from 12.5% to 11.3%, p < 0.01 for trend). An elderly patient’s likelihood for bypass following myocardial infarction in NY increased significantly since the program’s initiation. Between 1987 and 1992, unadjusted 30-day mortality rates following bypass declined by 33% in NY Medicare patients compared with a 19% decline nationwide (p < 0.001). As a result of this improvement, NY had the lowest risk-adjusted bypass mortality rate of any state in 1992.Conclusions. We found no evidence that NY’s provider profiling limited procedure access in NY’s elderly or increased out-of-state transfers. Despite an increasing preoperative risk profile, procedural outcomes in NY improved significantly faster than the national average.

Women and men come to coronary artery bypass grafting (CABG) with different comorbidity profiles and clinical presentation. We sought to identify sex-related differences in preoperative risk factors and revascularization strategies, and examine the influence of these strategies on outcomes. From 1/

The Society of Thoracic Surgeons (STS) score is the preferred method to estimate preoperative risk in patients undergoing cardiothoracic surgery. Calculating this score is time-consuming and requires the use of a computer-based calculator. We aimed to compare the accuracy of R2-CHADS2 score and

For investigators interested in cardiovascular disease, these are exciting times. It is rare that a new technology with the potential to revolutionize the understanding and management of a major disease process is introduced. For coronary artery disease (CAD), it might be that time, because