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  • 1
    Online Resource
    Online Resource
    Causes of Short-Term Readmission After Percutaneous Coronary Intervention
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation: Cardiovascular Interventions Vol. 7, No. 1 ( 2014-02), p. 97-103
    Details
    In: Circulation: Cardiovascular Interventions, Ovid Technologies (Wolters Kluwer Health), Vol. 7, No. 1 ( 2014-02), p. 97-103
    Abstract: Rehospitalization within 30 days after an admission for percutaneous coronary intervention (PCI) is common, costly, and a future target for Medicare penalties. Causes of readmission after PCI are largely unknown. Methods and Results— To illuminate the causes of PCI readmissions, patients with PCI readmitted within 30 days of discharge between 2007 and 2011 at 2 hospitals were identified, and their medical records were reviewed. Of 9288 PCIs, 9081 (97.8%) were alive at the end of the index hospitalization. Of these, 893 patients (9.8%) were readmitted within 30 days of discharge and included in the analysis. Among readmitted patients, 341 patients (38.1%) were readmitted for evaluation of recurrent chest pain or other symptoms concerning for angina, whereas 59 patients (6.6%) were readmitted for staged PCI without new symptoms. Complications of PCI accounted for 60 readmissions (6.7%). For cases in which chest pain or other symptoms concerning for angina prompted the readmission, 21 patients (6.2%) met criteria for myocardial infarction, and repeat PCI was performed in 54 patients (15.8%). The majority of chest pain patients (288; 84.4%) underwent ≥1 diagnostic imaging test, most commonly coronary angiography, and only 9 (2.6%) underwent target lesion revascularization. Conclusions— After PCI, readmissions within 30 days were seldom related to PCI complications but often for recurrent chest pain. Readmissions with recurrent chest pain infrequently met criteria for myocardial infarction but were associated with high rates of diagnostic testing.
    Type of Medium: Online Resource
    ISSN: 1941-7640 , 1941-7632
    URL: Article
    DOI: 10.1161/CIRCINTERVENTIONS.113.000988
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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    detail.hit.zdb_id: 2450797-0
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  • 2
    Online Resource
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    Abstract 147: Do Billing Data Accurately Describe Causes Of Readmission After PCI? An Analysis Of A Large PCI Readmission Database.
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 7, No. suppl_1 ( 2014-07)
    Details
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 7, No. suppl_1 ( 2014-07)
    Abstract: Introduction: Early readmission after PCI can be a useful performance measure, particularly if the reasons for readmission are related to patient management (e.g. angina, stent thrombosis or bleeding). Prior studies on readmission have used principal billing discharge diagnosis, but the validity of billing codes for this purpose is unclear. Methods: PCI patients readmitted within 30 days of discharge at the Massachusetts General Hospital (January 2007-December 2011) and Brigham and Women’s Hospital (June 2009-December 2011), were identified, and their medical records reviewed by a cardiologist. For each readmission, the principal billing discharge diagnosis of the readmission was compared to the primary diagnosis of the readmission as determined by the chart review. The accuracy of billing discharge diagnoses for readmissions due to chest pain or other symptoms concerning for angina and vascular access complications was assessed. Results: Of 9081 patients undergoing PCI and surviving to hospital discharge, 1011 (11.1%) were readmitted to the index hospital within 30 days. After excluding repeat readmissions, 894 readmissions were reviewed and of those, 754 (84.3%) could be matched to billing diagnoses. For each reason for readmission, corresponding billing diagnoses were diverse (Table 1). The sensitivity and specificity of billing code 414.01 for a readmission for chest pain or other symptoms concerning for angina were 0.36 and 0.85, respectively. The sensitivity and specificity of billing code 997.2 (Peripheral vascular complications, not elsewhere classified) for a bleeding or vascular complication of PCI were 0.28 and 0.997, respectively. Conclusions: The diversity of ICD-9 codes does not allow straightforward categorization of principal diagnoses of readmission from billing data. More complex algorithms need to be developed and validated to reliably derive reasons for readmission after PCI from billing data.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    URL: Article
    DOI: 10.1161/circoutcomes.7.suppl_1.147
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 2453882-6
    detail.hit.zdb_id: 2483197-9
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  • 3
    Online Resource
    Online Resource
    Association Between Operator Procedure Volume and Patient Outcomes in Percutaneous Coronary Intervention : A Systematic Review and Meta-Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 7, No. 4 ( 2014-07), p. 560-566
    Details
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 7, No. 4 ( 2014-07), p. 560-566
    Abstract: The growth of centers capable of performing percutaneous coronary intervention (PCI) has outpaced population growth despite declining incidence of myocardial infarction and prevalence of coronary artery disease, potentially increasing the proportion of operators falling below minimal yearly volume standards set by professional societies. Methods and Results— Electronic literature search of MEDLINE and the Cochrane Library for English-language articles published between 1977 and November 2012 was performed. Title and abstract review followed by full-text and references review were performed by 2 authors independently to identify studies examining the association between operator volume and outcomes in PCI. Using a standardized form, 2 authors abstracted information on study design, methods, outcomes, statistical methods, and conclusions. Studies were categorized according to methodological quality and outcomes. Meta-analyses were performed by outcome using a random-effects model. Of the 23 studies included in the analysis, 14 (61%) evaluated mortality, 7 (30%) evaluated major adverse cardiac events, and 2 (9%) evaluated angiographic success. In total, the studies evaluated 15 907 operators performing 205 214 PCIs on 1 109 103 patients at 2456 centers with a mean follow-up of 2.8 years. Eleven (48%) were considered higher quality. Studies with higher methodological quality and large sample sizes more often showed a relationship between operator volume and outcomes in PCI. Higher volume was associated with improved major adverse cardiac events at every threshold, regardless of the threshold evaluated. Conclusions— Mortality and major adverse cardiac events increase as operator volumes decrease in PCI. Among studies showing a relationship, high-volume operators were defined variably, with annual PCIs ranging from 〉 11 to 〉 270, with no clear evidence of a threshold effect within the ranges studied.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    URL: Article
    DOI: 10.1161/CIRCOUTCOMES.114.000884
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 2453882-6
    detail.hit.zdb_id: 2483197-9
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  • 4
    Online Resource
    Online Resource
    Clinical Preventability of 30‐Day Readmission After Percutaneous Coronary Intervention
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Journal of the American Heart Association Vol. 3, No. 5 ( 2014-09-16)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 3, No. 5 ( 2014-09-16)
    Abstract: Early readmission after PCI is an important contributor to healthcare expenditures and a target for performance measurement. The extent to which 30‐day readmissions after PCI are preventable is unknown yet essential to minimizing their occurrence. Methods and Results PCI patients readmitted to hospital at which PCI was performed within 30 days of discharge at the Massachusetts General Hospital and Brigham and Women's Hospital were identified, and their medical records were independently reviewed by 2 physicians. Each reviewer used an ordinal scale (0, not; 1, possibly; 2, probably; and 3, definitely preventable) to rate clinical preventability, and a total sum score ≥2 was considered preventable. Characteristics of preventable and unpreventable readmissions were compared, and predictors of clinical preventability were assessed by using multivariate logistic regression. Of 9288 PCI s performed, 9081 (97.8%) patients survived to initial hospital discharge and 1007 (11.1%) were readmitted to the index hospital within 30 days. After excluding repeat readmissions, 893 readmissions were reviewed. Fair agreement between physician reviewers was observed (weighted κ statistic 0.44 [95% CI 0.39 to 0.49]). After aggregation of scores, 380 (42.6%) readmissions were deemed preventable and 513 (57.4%) were deemed not preventable. Common causes of preventable readmissions included staged PCI without new symptoms (14.7%), vascular/bleeding complications of PCI (10.0%), and congestive heart failure (9.7%). Conclusions Nearly half of 30‐day readmissions after PCI may have been prevented by changes in clinical decision‐making. Focusing on these readmissions may reduce readmission rates.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.114.001290
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 2653953-6
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  • 5
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    Abstract 71: Causes of 30-day Readmission Rates after Percutaneous Coronary Intervention - Lessons from Direct Chart Review
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 6, No. suppl_1 ( 2013-05)
    Details
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 6, No. suppl_1 ( 2013-05)
    Abstract: Background: Policymakers have designated 30-day readmission after percutaneous coronary intervention (PCI) as an important quality metric. Nevertheless, detailed descriptions of the causes and preventability of readmissions after PCI are lacking, leading some to question the usefulness of readmission as a quality metric. Determination of the causes of 30-day readmissions can help clarify the clinical validity of this measure and enable hospitals to develop strategies to reduce readmission rates. Methods: We identified all readmissions after PCI at the Massachusetts General Hospital occurring within 30 days of discharge from 2007 - 2011. For patients with multiple readmissions, only the first readmission was included. Detailed patient medical record reviews were conducted to ascertain documented reasons for readmission. Results: Among 5573 patients receiving PCI, we identified 651 readmissions within 30 days for medical record review representing 625 unique readmitted patients (11.2%). Of these, 241 readmissions (37.0%) were for the evaluation of chest pain, pressure, or other symptoms concerning for angina without an immediately obvious stent thrombosis. Of those, 21 required repeat PCI (8.7%) and 3 (1.2%) required CABG. Forty patients (6.1%) were readmitted for planned, staged procedures in the absence of new symptoms (“staged PCI”); 18 patients (2.8%) were readmitted non-urgently for peripheral vascular procedures or surgery unrelated to the PCI procedure; 24 patients (3.7%) were admitted for vascular or bleeding complications of the PCI procedure. Conclusions: In this single center study, the largest proportion of readmissions after PCI is due to symptoms that prompt concern for angina, the overwhelming majority of which (90.0%) do not require repeat revascularization. Hospitals may be able to minimize 30-day readmission rates after PCI substantially by postponing non-urgent, non-coronary procedures after PCI. Transferring the evaluation of low-risk chest pain to the outpatient setting or to emergency department observation units could dramatically reduce 30 day readmission rates after PCI. Table 1: Main reason for readmission (N = 651) Chest pain or other symptoms concerning for angina - 238 (36.6%) ** Subset of those patients who received repeat PCI - 21 (3.2%) Staged PCI - 40 (6.1%) Stent thrombosis - 19 (2.9%) Sudden cardiac death - 4 (0.6%) Elective peripheral procedure or surgery not related to PCI - 18 (2.8%) Elective CABG - 14 (2.2%) ** Subset of those patients with failed PCI - 10 (1.5%) ** Subset of those patients with staged CABG after PCI - 4 (0.6%) Vascular/bleeding complication of PCI - 24 (3.7%) Atrial fibrillation - 11 (1.7%) Congestive heart failure - 39 (6.0%) Cholecystitis or cholangitis - 7 (1.1%) Gastrointestinal hemorrhage - 25 (3.8%) Venous thromboembolism - 6 (0.9%) Pneumonia - 10 (1.5%) Urinary tract infection - 9 (1.4%)
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    URL: Article
    DOI: 10.1161/circoutcomes.6.suppl_1.A71
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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    detail.hit.zdb_id: 2483197-9
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  • 6
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    Abstract 345: High Risk Characteristics of Patients Returning Within 30 Days After PCI with Chest Discomfort
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 7, No. suppl_1 ( 2014-07)
    Details
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 7, No. suppl_1 ( 2014-07)
    Abstract: Background: To improve care coordination, Medicare is reporting 30-day readmissions after percutaneous coronary interventions (PCI) as a quality metric. Chest pain or other symptoms concerning for angina is the most common reason for early hospital readmission after PCI. To reduce hospital readmission in ways that improve value and ensure patient safety, clinicians need to understand which patients returning with symptoms are at high risk and merit admission. Methods: The Partners PCI Readmission Database is a database of 893 patients readmitted within 30 days of PCI that includes detailed information from chart review. Among patients readmitted for chest pain, or other symptoms concerning for angina, we evaluated patient characteristics associated with either myocardial infarction or repeat PCI during the readmission. Continuous variables were evaluated with t-tests and categorical variables with chi-squared tests. Variables with p 〈 0.3 on initial screen were included to create a logistic regression model, and a C-statistic was calculated. Results: Of these patients, 341 (38.1%) were readmitted for evaluation of chest pain or other symptoms concerning for angina, of which 65 (19.1%) required PCI or met criteria for myocardial infarction during the readmission (PCI/MI patients). Age, Caucasian race, hypertension, prior PCI (before the PCI during the index admission), diabetes, multivessel disease found on index catheterization, and drug-eluting stent found on index catheterization all were found to have p 〈 0.3 in bivariate comparisons and included in the model (Figure 1). The C-statistic of the model was 0.71. Conclusions: Among patients returning with chest pain or other anginal symptoms within 30 days after PCI, this model can be used to predict likelihood of having a myocardial infarction or requiring repeat PCI. The association of race with PCI/MI merits further investigation. This model may help physicians risk-stratify patients for readmission versus outpatient evaluation.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    URL: Article
    DOI: 10.1161/circoutcomes.7.suppl_1.345
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 2453882-6
    detail.hit.zdb_id: 2483197-9
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  • 7
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    Online Resource
    A meta-analysis identifies new loci associated with body mass index in individuals of African ancestry
    Springer Science and Business Media LLC ; 2013
    In:  Nature Genetics Vol. 45, No. 6 ( 2013-6), p. 690-696
    Details
    In: Nature Genetics, Springer Science and Business Media LLC, Vol. 45, No. 6 ( 2013-6), p. 690-696
    Type of Medium: Online Resource
    ISSN: 1061-4036 , 1546-1718
    URL: Article
    DOI: 10.1038/ng.2608
    RVK:
    XA 10000
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2013
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    detail.hit.zdb_id: 1108734-1
    SSG: 12
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  • 8
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    Interactions Between Commensal Fungi and the C-Type Lectin Receptor Dectin-1 Influence Colitis
    American Association for the Advancement of Science (AAAS) ; 2012
    In:  Science Vol. 336, No. 6086 ( 2012-06-08), p. 1314-1317
    Details
    In: Science, American Association for the Advancement of Science (AAAS), Vol. 336, No. 6086 ( 2012-06-08), p. 1314-1317
    Abstract: The intestinal microflora, typically equated with bacteria, influences diseases such as obesity and inflammatory bowel disease. Here, we show that the mammalian gut contains a rich fungal community that interacts with the immune system through the innate immune receptor Dectin-1. Mice lacking Dectin-1 exhibited increased susceptibility to chemically induced colitis, which was the result of altered responses to indigenous fungi. In humans, we identified a polymorphism in the gene for Dectin-1 ( CLEC7A ) that is strongly linked to a severe form of ulcerative colitis. Together, our findings reveal a eukaryotic fungal community in the gut (the “mycobiome”) that coexists with bacteria and substantially expands the repertoire of organisms interacting with the intestinal immune system to influence health and disease.
    Type of Medium: Online Resource
    ISSN: 0036-8075 , 1095-9203
    URL: Article
    DOI: 10.1126/science.1221789
    RVK:
    TA 1000
    RVK:
    WA 15000
    Language: English
    Publisher: American Association for the Advancement of Science (AAAS)
    Publication Date: 2012
    detail.hit.zdb_id: 128410-1
    detail.hit.zdb_id: 2066996-3
    SSG: 11
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