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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2004.09.057 Byline: Dennis T. Ko (a)(b)(d), David A. Alter (a)(b)(d), Alice M. Newman (d), Linda R. Donovan (d), Jack V. Tu (c)(d) Abstract: Clinical guidelines recommend lipid testing in all hospitalized acute myocardial infarction (AMI) patients. Inhospital lipid testing has also been proposed as a quality indicator for AMI care, but little is known about its use or importance. We sought to examine rates of inhospital lipid testing and its association with statin therapy at hospital discharge. Author Affiliation: (a) Division of Cardiology, Schulich Heart Centre, Toronto, Ontario, Canada (b) Department of Medicine, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada (c) Division of General Internal Medicine and Clinical Epidemiology and Health Care Research Program, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada (d) Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada Article History: Received 26 July 2004; Accepted 24 September 2004 Article Note: (footnote) The results and conclusions of this study are those of the authors and should not be attributed to any of the sponsoring agencies.

Inhaled, long-acting anticholinergic medication (LAA), commonly used for moderate-to-severe chronic obstructive pulmonary disease (COPD), has been shown to decrease COPD hospitalizations, emergency department visits, and acute exacerbations but has also been associated with urinary tract infection (UTI) in a prior meta-analysis. The objective of this study was to verify if there was an association between LAA and UTI in older individuals with COPD. A population-based, real-world cohort study using health administrative data from Ontario, Canada was conducted. Incidence of UTI was compared between older people with physician-diagnosed COPD, who were new users of inhaled long-acting anticholinergics and new users of inhaled corticosteroids–a reference medication used in similar clinical settings that has no known association with UTI. Propensity score matching was used to minimize the effects of confounding. An overall association between LAA and various measures of UTI in older individuals was not found. However, ina prioridefined stratified analyses, men newly initiated on LAA were 75% more likely to develop a UTI than men newly started on an inhaled corticosteroid (hazard ratio 1.75; 95% confidence interval 1.05–2.92). No significant association was seen in women. In conclusion, older men with COPD newly started on LAA are at increased risk of UTI. Men considering an inhaled LAA should be informed of this risk and, if they decide to take it, be provided with appropriate monitoring. [ABSTRACT FROM PUBLISHER]

Background: Lengthy waiting lists for coronary angiography have been described in many health care systems worldwide. The extent to which formal queue management systems may improve the prioritization and survival of patients in the angiography queue is unknown., Objective: To prospectively evaluate the performance of a formal queue management system for patients awaiting coronary angiography in Ontario., Methods: The coronary angiography urgency scale, a formal queue management system developed in 1993 using a modified Delphi panel, allocates recommended maximum waiting times (RMWTs) in accordance with clinical necessity. By using a provincial clinical registry, 35,617 consecutive patients referred into the coronary angiography queue between April 1, 2001, and March 31, 2002, were prospectively tracked. Cox proportional hazards models were used to examined mortality risk across urgency after adjusting for additional clinical and comorbid factors., Results: Good agreement was determined in urgency ratings between scores from the coronary angiography urgency scale and implicit physician judgement, which was obtained independently at the time of the index referral (weighted kappa = 0.49). The overall mortality in the queue was 0.3% (0.47%, 0.26% and 0.13% for urgent, semiurgent and elective patients, respectively). Urgency, as specified by the coronary angiography urgency scale, was the strongest predictor of death in the queue (P<0.001). However, when patients were censored according to their RMWTs, mortality was similar across different levels of urgency. Consequently, up to 18.5 deaths per 10,000 patients could have potentially been averted had patients been triaged and undergone coronary angiography within the RMWT as specified by the coronary angiography urgency scale., Conclusions: The incorporation of the coronary angiography urgency scale as a formal queue management system may decrease mortality in the coronary angiography queue. The authors recommend its implementation in health care systems where patients experience excessive waiting time delays for coronary angiography.

Background: To date, although clinical databases have been used to report on single centre or regional valve surgery outcomes, neither clinical nor administrative data have been used to examine rates of valve surgery use across large geographical regions. The objective of the present study was to use administrative data to evaluate use of valve surgery over time and across Canada., Methods: All cases of aortic valve replacement (AVR), mitral valve replacement (MVR), mitral valve repair (MV repair), combined AVR and coronary artery bypass grafting (CABG), and combined MVR/MV repair and CABG between fiscal years 1994/95 and 1999/2000 were identified using hospital discharge abstract data obtained from the Canadian Institute of Health Information. Age- and sex-adjusted rates of valve surgery were then calculated by province and by procedure type., Results: Rates of valve surgery for all procedure types increased between fiscal years 1994/95 and 1999/2000 with the exception of MVR, which remained relatively constant. Significant variation in rates of valve surgery was found between male and female residents. Similar variation was also demonstrated across provinces by year and by procedure type., Conclusion: There was a trend toward increased use of valve surgery over time for most procedures. Variation in rates of valve surgery exists across provinces. These results provide a starting point from which to track future trends in use and outcomes for these major procedures.