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105. Standards for Statistical Models Used for Public Reporting of Health Outcomes

Author

Krumholz, Harlan M., primary, Brindis, Ralph G., additional, Brush, John E., additional, Cohen, David J., additional, Epstein, Andrew J., additional, Furie, Karen, additional, Howard, George, additional, Peterson, Eric D., additional, Rathore, Saif S., additional, Smith, Sidney C., additional, Spertus, John A., additional, Wang, Yun, additional, and Normand, Sharon-Lise T., additional

Published
2006
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112. Race and Renal Impairment in Heart Failure

Author

Smith, Grace L., primary, Shlipak, Michael G., additional, Havranek, Edward P., additional, Masoudi, Frederick A., additional, McClellan, William M., additional, Foody, JoAnne M., additional, Rathore, Saif S., additional, and Krumholz, Harlan M., additional

Published
2005
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113. The Obesity Paradox

Author

Curtis, Jeptha P., primary, Selter, Jared G., additional, Wang, Yongfei, additional, Rathore, Saif S., additional, Jovin, Ion S., additional, Jadbabaie, Farid, additional, Kosiborod, Mikhail, additional, Portnay, Edward L., additional, Sokol, Seth I., additional, Bader, Feras, additional, and Krumholz, Harlan M., additional

Published
2005
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146. Delay in reperfusion with transradial percutaneous coronary intervention for ST-elevation myocardial infarction: Might some delays be acceptable?

Author

Wimmer, Neil J., Cohen, David J., Wasfy, Jason H., Rathore, Saif S., Mauri, Laura, and Yeh, Robert W.

Abstract

Background: Randomized clinical trials (RCTs) suggest benefits for the transradial approach to percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). However, transradial PCI may delay reperfusion, leading to its avoidance. We sought to quantify the delay in reperfusion from transradial PCI (“transradial delay”) that would need to be introduced to offset the potential mortality benefit of transradial PCI, compared with transfemoral, observed in RCTs. Methods: We developed a decision-analytic model to compare transfemoral and transradial PCI in STEMI. Thirty-day mortality rates were estimated by pooling STEMI patients from 2 RCTs comparing transfemoral and transradial PCI. We projected the impact of transradial delay using estimates of the increase in mortality associated with door-to-balloon time delays. Sensitivity analyses were performed to understand the impact of uncertainty in assumptions. Results: In the base case, a transradial delay of 83.0 minutes was needed to offset the mortality benefit of transradial PCI. When the mortality benefit of transradial PCI was one-quarter that observed in RCTs, the delay associated with equivalent mortality was 20.9 minutes. In probabilistic sensitivity analyses, transradial PCI was preferred over transfemoral PCI in 97.5% of simulations when transradial delay was 30 minutes and in 79.0% of simulations when delay was 60 minutes. Conclusions: A substantial transradial delay is required to eliminate even a fraction of the mortality benefit observed with transradial PCI in RCTs. Results were robust to changing multiple assumptions and have implications for operators reluctant to transition to transradial PCI in STEMI because of concern for delaying reperfusion. [Copyright &y& Elsevier]

Published
2014
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148. Body Mass Index and Mortality in Acute Myocardial Infarction Patients

Author

Bucholz, Emily M., Rathore, Saif S., Reid, Kimberly J., Jones, Philip G., Chan, Paul S., Rich, Michael W., Spertus, John A., and Krumholz, Harlan M.

Subjects
*BODY mass index, *MYOCARDIAL infarction, *OBESITY, *HEART failure, *HOSPITAL patients, *PATIENTS, MYOCARDIAL infarction-related mortality
Abstract

Abstract: Background: Previous studies have described an “obesity paradox” with heart failure, whereby higher body mass index (BMI) is associated with lower mortality. However, little is known about the impact of obesity on survival after acute myocardial infarction. Methods: Data from 2 registries of patients hospitalized in the US with acute myocardial infarction between 2003-2004 (PREMIER) and 2005-2008 (TRIUMPH) were used to examine the association of BMI with mortality. Patients (n=6359) were categorized into BMI groups (kg/m2) using baseline measurements. Two sets of analyses were performed using Cox proportional hazards regression with fractional polynomials to model BMI as categorical and continuous variables. To assess the independent association of BMI with mortality, analyses were repeated, adjusting for 7 domains of patient and clinical characteristics. Results: Median BMI was 28.6. BMI was inversely associated with crude 1-year mortality (normal, 9.2%; overweight, 6.1%; obese, 4.7%; morbidly obese; 4.6%; P <.001), which persisted after multivariable adjustment. When BMI was examined as a continuous variable, the hazards curve declined with increasing BMI and then increased above a BMI of 40. Compared with patients with a BMI of 18.5, patients with higher BMIs had a 20% to 68% lower mortality at 1 year. No interactions between age (P =.37), sex (P =.87), or diabetes mellitus (P =.55) were observed. Conclusions: There appears to be an “obesity paradox” among patients after acute myocardial infarction such that higher BMI is associated with lower mortality, an effect that was not modified by patient characteristics and was comparable across age, sex, and diabetes subgroups. [Copyright &y& Elsevier]

Published
2012
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150. Effect of Living Alone on Patient Outcomes After Hospitalization for Acute Myocardial Infarction

Author

Bucholz, Emily M., Rathore, Saif S., Gosch, Kensey, Schoenfeld, Amy, Jones, Philip G., Buchanan, Donna M., Spertus, John A., and Krumholz, Harlan M.

Subjects
*MYOCARDIAL infarction, *HEALTH outcome assessment, *HOSPITAL care, *LIVING alone, *SOCIAL support, *MORTALITY, *QUALITY of life, *PATIENTS
Abstract

Considerable attention has been devoted to the effect of social support on patient outcomes after acute myocardial infarction (AMI). However, little is known about the relation between patient living arrangements and outcomes. Thus, we used data from PREMIER, a registry of patients hospitalized with AMI at 19 United States centers from 2003 through 2004, to assess the association of living alone with outcomes after AMI. Outcome measurements included 4-year mortality, 1-year readmission, and 1-year health status using the Seattle Angina Questionnaire (SAQ) and the Short Form-12 Physical Health Component scales. Patients who lived alone had higher crude 4-year mortality (21.8% vs 14.5%, p <0.001) but comparable rates of 1-year readmission (41.6% vs 38.3%, p = 0.79). Living alone was associated with lower unadjusted quality of life (mean SAQ −2.40, 95% confidence interval [CI] −4.44 to −0.35, p = 0.02) but had no impact on Short Form-12 Physical Health Component (−0.45, 95% CI −1.65 to 0.76, p = 0.47) compared to patients who did not live alone. After multivariable adjustment, patients who lived alone had a comparable risk of mortality (hazard ratio 1.35, 95% CI 0.94 to 1.93) and readmission (hazard ratio 0.99, 95% CI 0.76 to 1.28) as patients who lived with others. Mean quality-of-life scores remained lower in patients who lived alone (SAQ −2.91, 95% CI −5.56 to −0.26, p = 0.03). In conclusion, living alone may be associated with poorer angina-related quality of life 1 year after MI but is not associated with mortality, readmission, or other health status measurements after adjusting for other patient and treatment characteristics. [Copyright &y& Elsevier]

Published
2011
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