19 results on '"DeLong JF"'
Search Results
2. Impact of atrial fibrillation on mortality and readmission in older adults hospitalized with heart failure.
- Author
-
Ahmed A, Thornton P, Perry GJ, Allman RM, and DeLong JF
- Subjects
- Aged, Aged, 80 and over, Alabama epidemiology, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Patient Discharge, Reproducibility of Results, Risk Factors, Statistics as Topic, Survival Analysis, Time Factors, Ventricular Dysfunction, Left mortality, Ventricular Dysfunction, Left therapy, Atrial Fibrillation mortality, Atrial Fibrillation therapy, Heart Failure mortality, Heart Failure therapy, Patient Readmission
- Abstract
Background: Atrial fibrillation is common in older adults with heart failure. It is known to adversely affect outcomes., Aim: To examine the associations of atrial fibrillation with 4-year mortality and 30-day readmission in older adults hospitalized with heart failure., Methods: Patients were Medicare beneficiaries 65 years of age and older discharged with a primary diagnosis of heart failure. Baseline data were obtained by retrospective chart reviews and data on mortality and readmission were obtained from Medicare administrative files. Presence of atrial fibrillation was confirmed using electrocardiogram during hospital admission. Using Cox proportional hazards models we estimated bivariate and multivariable (adjusted for various patient and care covariates) hazards ratios (HR) and 95% confidence intervals (CI) for 4-year mortality and 30-day readmission of patients with atrial fibrillation compared with those without., Results: Patients (n=944) had a mean age (+/-S.D.) of 79 (+/-7) years, 61% were women, 18% African-Americans, 25% had atrial fibrillation by admission electrocardiogram, 64% died within 4 years, and 8% were readmitted. Patients with atrial fibrillation had a 52% increased risk of 4-year mortality (adjusted HR=1.52; 95%CI=1.11-2.07). Atrial fibrillation was also associated with higher risk of readmission (unadjusted HR=1.64; 95%CI=1.01-2.68). However, the association lost its statistical significance after adjustment for various patient and care variables (adjusted HR=2.09; 95%CI=0.94-4.65)., Conclusion: Presence of atrial fibrillation was associated with significant increased risk of long-term mortality in older adults hospitalized with heart failure and was associated with a non-significant higher risk of hospital readmission.
- Published
- 2004
- Full Text
- View/download PDF
3. Diagnosis of heart failure in older adults: predictive value of dyspnea at rest.
- Author
-
Ahmed A, Allman RM, Aronow WS, and DeLong JF
- Subjects
- Aged, Aged, 80 and over, Empirical Research, Female, Heart Failure complications, Humans, Likelihood Functions, Male, Predictive Value of Tests, Rest, Retrospective Studies, Dyspnea etiology, Heart Failure diagnosis
- Abstract
The objective of this study was to describe the predictive value of dyspnea at rest in the diagnosis of heart failure in older adults. We have conducted a retrospective chart review of older adults hospitalized with heart failure in 11 hospitals in Alabama, US. We defined dyspnea at rest as dyspnea not accompanied by activities, sleep, or lying down. We confirmed diagnosis of heart failure using modified Framingham criteria (based on available variables). We estimated values for sensitivity, specificity, predictive value positive and likelihood ratio positive of dyspnea at rest along with their 95% confidence intervals (95% CI). Patients had a mean (+/-S.D.) age 79 (+/-7.5) years, were 60% female and 18% African-American. The prevalence (pre-test probability) of heart failure was 77%. Dyspnea at rest was reported by 975 (89%) patients. Dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea were, respectively, reported by 279 (26%), 356 (33%) and 230 (21%) patients. The sensitivity, specificity and positive predictive value (post-test probability) of dyspnea at rest were, respectively, 92% (95% CI = 90 - 94%), 19% (95% CI = 14 - 24%) and 79% (95% CI = 77 - 82%). Patients with dyspnea at rest were 13% (likelihood = 1.13; 95% CI = 1.06 - 1.20) more likely to have heart failure than those without. Presence of any three of the symptoms of dyspnea at rest, dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, fatigue and lower extremity edema increased the positive predictive value to 90% (95% CI = 87 - 93%). Dyspnea at rest was the commonest symptom among elderly hospitalized HF patients and had high sensitivity, but low specificity and positive predictive value, which increased in the presence of other symptoms.
- Published
- 2004
- Full Text
- View/download PDF
4. Alabama coronary artery bypass grafting project: results from phase II of a statewide quality improvement initiative.
- Author
-
Holman WL, Sansom M, Kiefe CI, Peterson ED, Hubbard SG, Delong JF, and Allman RM
- Subjects
- Adrenergic beta-Antagonists therapeutic use, Aged, Alabama epidemiology, Aspirin therapeutic use, Benchmarking, Coronary Artery Bypass adverse effects, Coronary Artery Bypass methods, Coronary Artery Disease surgery, Female, Graft Rejection, Graft Survival, Health Services Research, Hospital Mortality, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Postoperative Care methods, Postoperative Care standards, Program Evaluation, Severity of Illness Index, Survival Analysis, Cardiology Service, Hospital standards, Coronary Artery Bypass mortality, Coronary Artery Bypass standards, Coronary Artery Disease drug therapy, Coronary Artery Disease mortality, Quality Assurance, Health Care, Surgery Department, Hospital standards, Total Quality Management methods
- Abstract
Objective/background: This report describes the first round of results for Phase II of the Alabama CABG Project, a regional quality improvement initiative., Methods: Charts submitted by all hospitals in Alabama performing CABG (ICD-9 codes 36.10-36.20) were reviewed by a Clinical Data Abstraction Center (CDAC) (preintervention 1999-2000; postintervention 2000-2001). Variables that described quality in Phase I were abstracted for Phase II and data describing the new variables of beta-blocker use and lipid management were collected. Data samples collected onsite by participating hospitals were used for rapid cycle improvement in Phase II., Results: CDAC data (n = 1927 cases in 1999; n = 2001 cases in 2000) showed that improvements from Phase I in aspirin prescription, internal mammary artery use, and duration of intubation persisted in Phase II. During Phase II, use of beta-blockers before, during, or after CABG increased from 65% to 76% of patients (P < 0.05). Appropriate lipid management, an aggregate variable, occurred in 91% of patients before and 91% after the educational intervention. However, there were improvements in 3 of 5 subcategories for lipid management (documenting a lipid disorder [52%-57%], initiating drug therapy [45%-53%], and dietary counseling [74%-91%]; P < 0.05)., Conclusions: In Phase II, this statewide process-oriented quality improvement program added two new measures of quality. Achievements of quality improvement from Phase I persisted in Phase II, and improvements were seen in the new variables of lipid management and perioperative use of beta-blockers.
- Published
- 2004
- Full Text
- View/download PDF
5. Association of consultation between generalists and cardiologists with quality and outcomes of heart failure care.
- Author
-
Ahmed A, Allman RM, Kiefe CI, Person SD, Shaneyfelt TM, Sims RV, Howard G, and DeLong JF
- Subjects
- Age Distribution, Aged, Aged, 80 and over, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Female, Heart Failure mortality, Heart Failure physiopathology, Hospital Mortality, Hospitalization, Humans, Male, Odds Ratio, Practice Patterns, Physicians', Retrospective Studies, Cardiology statistics & numerical data, Family Practice statistics & numerical data, Heart Failure therapy, Outcome and Process Assessment, Health Care, Referral and Consultation statistics & numerical data, Ventricular Function, Left
- Abstract
Background: The appropriate roles for generalists and cardiologists in the care of patients with heart failure (HF) are unknown. The objective of this retrospective cohort study was to determine whether consultation between generalists and cardiologists was associated with better quality and outcomes of HF care., Methods: We studied left ventricular function evaluation (LVFE) and angiotensin-converting enzyme inhibitor (ACEI) use and 90-day readmission and 90-day mortality rates in patients with HF who were hospitalized. Patient care was categorized into cardiologist (solo), generalist (solo), or consultative cares. The processes and outcomes of care were compared by care category using logistic regression analyses fit with generalized linear mixed models to adjust for hospital-related clustering., Results: Of the 1075 patients studied, 13% received cardiologist care, 55% received generalist care, and 32% received consultative care. More patients who received consultative care (75%) received LVFE than patients who received generalist care (36%) and cardiologist care (53%; P <.001). Fewer patients who received solo care (54% each) received ACEI compared with 71% of patients who received consultative care (P <.001). After multivariable adjustment, consultative care was associated with higher odds of LVFE than generalist care (adjusted odds ratio [OR], 6.06; 95% CI, 3.97-9.26) or cardiologist care (adjusted OR, 2.96; 95% CI, 1.70-5.13) care. Consultation was also associated with higher odds of ACEI use compared with generalist (adjusted OR, 2.42; 95% CI, 1.42-4.12) or cardiologist (adjusted OR, 2.32; 95% CI, 1.14-4.72) care. Compared with patients who received generalist care, patients who received consultative care had lower odds of 90-day readmission (adjusted OR, 0.54; 95% CI, 0.34-0.86)., Conclusion: Collaboration between generalists and cardiologists, rather than solo care by either, was associated with better HF processes and outcomes of care.
- Published
- 2003
- Full Text
- View/download PDF
6. Clinical correlates of isolated left ventricular diastolic dysfunction among hospitalized older heart failure patients.
- Author
-
Ahmed A, Nanda NC, Weaver MT, Allman RM, and DeLong JF
- Subjects
- Aged, Aged, 80 and over, Blood Pressure physiology, Diastole physiology, Echocardiography, Female, Heart Failure diagnosis, Heart Failure therapy, Heart Rate physiology, Humans, Male, Multivariate Analysis, Sex Characteristics, Statistics as Topic, Stroke Volume physiology, Systole physiology, Ventricular Dysfunction, Left diagnosis, Ventricular Dysfunction, Left therapy, Heart Failure physiopathology, Patient Admission, Ventricular Dysfunction, Left physiopathology
- Abstract
Heart failure due to isolated left ventricular diastolic dysfunction (LVDD) is common among older adults. The purpose of this study was to develop a model based on admission clinical features to predict isolated LVDD in older adults hospitalized with heart failure. The authors studied 394 Alabama Medicare beneficiaries discharged with a primary discharge diagnosis of heart failure. All patients had data on LV function determined by echocardiography performed during the index hospitalization. Isolated LVDD was defined by LV ejection fraction >/=45% or LV function described as normal. The authors used all subsets multiple logistic regression analyses to examine various models predicting isolated LVDD. Patients had a mean (+/-SD) age of 78 (+/-7) years and 58% were women. One hundred thirty nine (35%) patients had isolated LVDD. More women (47%) than men (21%) had isolated LVDD (p<0.001). Variables independently associated with isolated LVDD in the selected 12-predictor model were female sex (odds ratio [OR]=3.10; 95% confidence interval [CI]=1.86-5.15), pulse 100 beats/min or greater (OR=0.43; 95% CI=0.25-0.72), systolic blood pressure (OR=1.01; 95% CI=1.00-1.02), diastolic blood pressure (OR=0.98; 95% CI=0.96-0.99), pulmonary vascular congestion by chest x-ray (OR=0.51; 95% CI=0.30-0.88), coronary artery disease (OR=0.54; 95% CI=0.32-0.92), cardiomyopathy (OR=0.21; 95% CI=0.10-0.47), and admission to a teaching hospital (OR=0.36; 95% CI=0.15-0.88). The authors concluded that the proportion of patients with isolated LVDD among this cohort of elderly hospitalized heart failure patients was low and was associated with few clinical characteristics. Except for female sex and systolic blood pressure, all model variables were negatively associated with isolated LVDD., (Copyright 2003 Le Jacq Communications, Inc.)
- Published
- 2003
- Full Text
- View/download PDF
7. Heart failure mortality among older Medicare beneficiaries: association with left ventricular function evaluation and angiotensin-converting enzyme inhibitor use.
- Author
-
Ahmed A, Maisiak R, Allman RM, DeLong JF, and Farmer R
- Subjects
- Age Factors, Aged, Aged, 80 and over, Female, Follow-Up Studies, Heart Failure complications, Hospitalization statistics & numerical data, Humans, Male, Patient Discharge statistics & numerical data, Proportional Hazards Models, Retrospective Studies, Survival Rate, Ventricular Dysfunction, Left complications, Angiotensin-Converting Enzyme Inhibitors adverse effects, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Heart Failure drug therapy, Heart Failure mortality, Medicare statistics & numerical data, Quality of Health Care statistics & numerical data, Ventricular Dysfunction, Left drug therapy, Ventricular Dysfunction, Left mortality
- Abstract
Background: Left ventricular function evaluation and angiotensin-converting enzyme (ACE) inhibitor use are the two basic indicators of heart failure quality of care. In this retrospective follow-up study, we analyzed the association between these two quality indicators and mortality in elderly hospitalized heart failure patients., Methods: The patients in our study were older Alabama Medicare beneficiaries discharged with a diagnosis of heart failure in 1994. Cox regression analyses, adjusted for various patient and care characteristics, were performed to estimate the overall mortality rate., Results: The mean age of the 1,090 patients in our study was 79+/-7.5 years. Both left ventricular function evaluation (hazard ratio, 0.83; 95% confidence interval, 0.705-0.976) and ACE inhibitor use (hazard ratio, 0.77; 95% confidence interval, 0.655-0.905) were associated with a lower 3-year mortality rate. Adjustment for various patient and care characteristics did not alter these associations., Conclusion: Left ventricular function evaluation and ACE inhibitor use were each associated with increased survival time in older Medicare beneficiaries with heart failure.
- Published
- 2003
- Full Text
- View/download PDF
8. Racial variations in cardiology care among hospitalized older heart failure patients.
- Author
-
Ahmed A, Sims RV, Allman RM, DeLong JF, and Aronow WS
- Subjects
- Aged, Female, Follow-Up Studies, Hospitalization, Humans, Male, Medicare, Retrospective Studies, United States, Delivery of Health Care statistics & numerical data, Ethnicity, Health Services Accessibility statistics & numerical data, Heart Failure ethnology, Heart Failure therapy
- Abstract
In this retrospective follow-up study, the authors examined the association between race and the receipt of cardiology care in 1062 Medicare beneficiaries 65 years of age and older who were hospitalized with heart failure. The primary outcome measure was receipt of care from a cardiologist (via admission or consultation). Using logistic regression analyses, crude and adjusted odds ratios (OR) and 95% confidence intervals (95%CI) of receipt of cardiology care were estimated for nonwhite versus white patients. Two hundred (19%) patients were nonwhites and 483 (46%) patients received care from cardiologists. Proportion of patients receiving cardiology care was lower among nonwhite patients (35% versus 48% among whites; P = 0.001), and nonwhite race was associated with a lower odds of receiving cardiology care (crude OR = 0.57; 95%CI = 0.42-0.79). After adjustment for various patient characteristics and process-of-care variables, the magnitude and precision of the association between nonwhite race and a lower odds of receiving care from a cardiologist remained unchanged (adjusted OR = 0.43; 95% CI = 0.30-0.62). These findings suggest that nonwhite elderly hospitalized heart failure patients are less likely to be cared for by cardiologists.
- Published
- 2003
- Full Text
- View/download PDF
9. Quality of care of nursing home residents hospitalized with heart failure.
- Author
-
Ahmed A, Weaver MT, Allman RM, DeLong JF, and Aronow WS
- Subjects
- Age Factors, Aged, Aged, 80 and over, Female, Heart Failure diagnosis, Heart Failure physiopathology, Humans, Length of Stay statistics & numerical data, Male, Retrospective Studies, Stroke Volume physiology, Heart Failure therapy, Hospitalization statistics & numerical data, Nursing Homes statistics & numerical data, Patient Discharge statistics & numerical data, Quality of Health Care statistics & numerical data
- Abstract
Objectives: To determine whether the quality of heart failure (HF) care of hospitalized nursing home (NH) residents is different from that of patients admitted from other locations., Design: Retrospective chart review., Setting: Nursing home residents discharged from hospitals., Participants: Medicare beneficiaries aged 65 and older., Measurements: Subjects were discharged with a primary discharge diagnosis of HF in Alabama in 1994. They were categorized as having been admitted from a NH or other locations. Bivariate logistic regression analysis was used to estimate crude odds ratios (ORs) and 95% confidence intervals (CIs) for left ventricular function (LVF) evaluation and angiotensin-converting enzyme (ACE) inhibitor use for NH residents relative to nonresidents. Multivariate generalized linear models were developed to determine independence of associations., Results: Subjects (N = 1,067 years) had a mean age +/- standard deviation of 79 +/- 7.4, 60% were female, and 18% were African Americans. Fewer NH residents (n = 95) received LVF evaluation (39% vs 60%, P <.001) and ACE inhibitors (50% vs 72%, P =.111). NH residents had lower odds for LVF evaluation (OR = 0.42, 95% CI = 0.27-0.64). The odds for ACE inhibitor use, although of similar magnitude, did not reach statistical significance (OR = 0.40, 95% CI = 0.12-1.28). After adjustment of patient and care characteristics, admission from a NH was significantly associated with lower LVF evaluation (adjusted OR = 0.64, 95% CI = 0.49-0.82) but not with ACE inhibitor use (adjusted OR = 0.59, 95% CI = 0.16-2.14)., Conclusions: Quality of HF care received by hospitalized NH residents was lower than that received by others. Further studies are needed to determine reasons for the lack of appropriate evaluation and treatment of NH patients with HF who are admitted to hospitals.
- Published
- 2002
- Full Text
- View/download PDF
10. Survival benefits of angiotensin-converting enzyme inhibitors in older heart failure patients with perceived contraindications.
- Author
-
Ahmed A, Kiefe CI, Allman RM, Sims RV, and DeLong JF
- Subjects
- Aged, Aged, 80 and over, Contraindications, Female, Follow-Up Studies, Heart Failure mortality, Hospitalization, Humans, Male, Patient Discharge statistics & numerical data, Proportional Hazards Models, Retrospective Studies, Survival Analysis, Survival Rate, Treatment Outcome, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Heart Failure drug therapy
- Abstract
Objectives: To determine the association between angiotensin-converting enzyme (ACE) inhibitor therapy and survival of older heart failure patients with conditions perceived by physicians as contraindications to ACE inhibitors., Setting: Hospital., Design: Retrospective follow-up study., Participants: Hospitalized older heart failure patients with systolic blood pressure of 90 mmHg or less, serum creatinine of 2.5 mg/dL or more, serum potassium of 5.5 mmol/L or more, or severe aortic stenosis., Measurements: One-year postdischarge mortality (with and without adjustment for various patient and care characteristics). Logistic regression analyses were used to estimate the effect of the perceived contraindications on subsequent use of ACE inhibitors. Using Cox proportional hazards models, crude and adjusted hazard ratios (HRs) of 1-year mortality with 95% confidence intervals (CIs) were estimated for patients discharged on ACE inhibitors and compared with those without. HRs were estimated for all patients and were repeated after stratifying patients based on the presence of perceived contraindications to ACE inhibitor use., Results: Of the 295 subjects, 52 (18%) had conditions perceived as contraindications, 186 (63%) received ACE inhibitors, and 107 (40%) died within 1 year of discharge. Presence of a perceived contraindication was independently associated with underutilization of ACE inhibitors on discharge (adjusted OR = 0.35, 95% CI = 0.17-0.71). ACE inhibitor prescription at discharge was associated with lower 1-year mortality overall (HR = 0.58, 95% CI = 0.40-0.85) and for the groups of patients with (HR = 0.34, 95% CI = 0.14-0.81) and without (HR = 0.66, 95% CI = 0.42-1.02) perceived contraindications., Conclusions: ACE inhibitor use was associated with a significant survival benefit in this cohort of hospitalized older heart failure patients with perceived contraindications.
- Published
- 2002
- Full Text
- View/download PDF
11. Correlates and outcomes of preserved left ventricular systolic function among older adults hospitalized with heart failure.
- Author
-
Ahmed A, Roseman JM, Duxbury AS, Allman RM, and DeLong JF
- Subjects
- Aged, Aged, 80 and over, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Black People, Comorbidity, Female, Heart Failure drug therapy, Hospitalization statistics & numerical data, Humans, Male, Medicare statistics & numerical data, Prevalence, Proportional Hazards Models, Sex Distribution, Survival Rate, Treatment Outcome, United States epidemiology, Black or African American, Heart Failure epidemiology, Ventricular Dysfunction, Left epidemiology
- Abstract
Background: Heart failure (HF) in older adults is often associated with preserved left ventricular systolic function (LVSF). The objective of this retrospective follow-up study was to determine the correlates and outcomes of preserved LVSF among older adults hospitalized with HF., Methods: We studied older Medicare beneficiaries hospitalized with HF (n = 1091) who had documented LVSF evaluation (n = 438). LVSF was defined as preserved if left ventricular ejection fraction was > or =40%. The Fisher exact test and the Student t test were used to compare baseline characteristics between patients with preserved versus those with impaired LVSF. Multivariate logistic regression analysis was used to determine the correlates of preserved LVSF. Cox proportional hazards analyses were used to determine the associations between LVSF and both 4-year mortality rates and 6-month readmission rates and the associations between angiotensin-converting enzyme (ACE) inhibitor use and 4-year mortality rates, separately, in patients with preserved and impaired LVSF., Results: Of the 438 patients, 200 (46%) had preserved LVSF. Women were more likely to have preserved LVSF (odds ratio [OR] = 2.44, 95% CI 1.57-3.81) than men. Preserved LVSF was associated with lower 4-year mortality rates (adjusted hazards ratio [HR] = 0.67, 95% CI 0.52-0.86) but not with 6-month readmission rates (adjusted HR = 0.66, 95% CI 0.41-1.09). The use of ACE inhibitors was associated with lower 4-year mortality rates in patients with impaired LVSF (adjusted HR = 0.61, 95% CI 0.43-0.86) but not in those with preserved LVSF (HR = 0.96, 95% CI 0.65-1.42)., Conclusions: Among older adults hospitalized with HF, preserved LVSF was common among women and was associated with significantly higher morbidity and mortality rates, which were unaffected by treatment with ACE inhibitors.
- Published
- 2002
- Full Text
- View/download PDF
12. Age-related underutilization of angiotensin-converting enzyme inhibitors in older hospitalized heart failure patients.
- Author
-
Ahmed A, Allman RM, DeLong JF, Bodner EV, and Howard G
- Subjects
- Age Factors, Aged, Aged, 80 and over, Alabama, Angiotensin-Converting Enzyme Inhibitors administration & dosage, Captopril administration & dosage, Captopril therapeutic use, Cardiac Output, Low complications, Cardiology, Drug Utilization, Enalapril administration & dosage, Enalapril therapeutic use, Female, Hospitalization, Humans, Logistic Models, Male, Odds Ratio, Referral and Consultation, Retrospective Studies, Ventricular Dysfunction, Left complications, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Cardiac Output, Low drug therapy, Ventricular Dysfunction, Left drug therapy
- Abstract
Background: The extent to which age plays a role in the underutilization of angiotensin-converting enzyme (ACE) inhibitors in heart failure patients has not been well studied., Methods: We studied age-related variation in the use of ACE inhibitors in older Medicare beneficiaries discharged alive in Alabama with a diagnosis of heart failure with left ventricular systolic dysfunction., Results: A total of 285 patients had a mean age +/- SD of 78 +/- 6.9 years; 59% were female and 21% were African American. Of the 285 patients, 181 (63%) were prescribed ACE inhibitors at discharge. Therapy with ACE inhibitors was initiated in 47% of the patients. Compared with patients 65 to 74 years, those 85 years and older had lower odds of receiving ACE inhibitors at discharge. Among patients not admitted on an ACE inhibitor, those 85 years and older also had lower odds of ACE inhibitor therapy being initiated., Conclusion: The overall rate of ACE inhibitor use was low, and age of 85 years and older was independently associated with lower use and initiation of ACE inhibitors. Opportunities remain to increase the use of ACE inhibitors in older patients with heart failure.
- Published
- 2002
13. Age-related underutilization of left ventricular function evaluation in older heart failure patients.
- Author
-
Ahmed A, Allman RM, DeLong JF, Bodner EV, and Howard G
- Subjects
- Age Factors, Aged, Aged, 80 and over, Alabama, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Cardiac Output, Low complications, Cardiac Output, Low drug therapy, Cardiology, Female, Hospitalization, Humans, Logistic Models, Male, Odds Ratio, Referral and Consultation, Retrospective Studies, Ventricular Dysfunction, Left complications, Cardiac Output, Low diagnosis, Heart Function Tests statistics & numerical data, Ventricular Dysfunction, Left diagnosis
- Abstract
Background: Underutilization of left ventricular function (LVF) evaluation in older patients with heart failure has been well documented, but age-related variation in the use of LVF evaluation has not been., Methods: We studied age-related variation of LVF evaluation in older Medicare-beneficiaries discharged with a diagnosis of heart failure in 1994 in Alabama., Results: A total of 1,090 patients had a mean +/- SD age of 79 +/- 7.5 years; 60% were female and 18% were African American. Of these, 636 (58%) had LVF evaluation. Compared with patients aged 65 to 74 years, those 75 to 84 years of age and those aged 85 and older were less likely to receive LVF evaluation. Age of 85 years and older was also independently associated with lower odds of LTF evaluation., Conclusion: The overall rate of LVF evaluation was low, and performance of evaluation decreased with patient age. Left ventricular function evaluation should be performed in all patients with heart failure. Considerable opportunities exist for improving care among hospitalized Medicare beneficiaries diagnosed with heart failure.
- Published
- 2002
14. Inappropriate use of digoxin in older hospitalized heart failure patients.
- Author
-
Ahmed A, Allman RM, and DeLong JF
- Subjects
- Aged, Drug Utilization, Female, Humans, Male, Cardiotonic Agents therapeutic use, Digoxin therapeutic use, Heart Failure drug therapy, Hospitalization
- Abstract
Background: Older adults are more likely to suffer from the adverse effects of digoxin. Studies have described the inappropriate use of digoxin in various populations. The objective of this study was to determine the correlates of inappropriate digoxin use in older heart failure patients., Methods: We studied older hospitalized heart failure patients with documented left ventricular (LV) function evaluation and electrocardiography. Digoxin use was considered inappropriate if patients had preserved LV systolic function (ejection fraction greater > or =40%) or if they had no atrial fibrillation (AF). We compared baseline patient characteristics by indication for digoxin and tested statistical significance using Pearson's chi-square analysis and Student's t tests. Using logistic regression, we determined the correlates of inappropriate use and initiation of digoxin., Results: Subjects (N = 603) had a mean age of 79 (+/-7) years; 59% were women, and 18% were African American. A total of 376 patients (62%) were discharged on digoxin, and 223 (37%) had no indication for its use. Half of the patients without an indication for digoxin received the drug. Of 132 patients without an indication and not already on digoxin, 38 (29%) were initiated on it. After adjustment for various patient and care characteristics, prior digoxin use (adjusted odds ratio [OR] 11.47, 95% confidence interval [CI] 5.72-23.02) and pulse > or =100/min (adjusted OR 2.33, 95% CI 1.10-4.94) were associated with inappropriate digoxin use. Pulse > or =100/min was also associated with inappropriate initiation of the drug (adjusted OR 2.95, 95% CI 1.28-6.78)., Conclusions: Inappropriate use of digoxin was common and was associated with prior use. Tachycardia was associated with inappropriate use and initiation. Electrocardiography and echocardiography should be performed in all older heart failure patients. Digoxin therapy should not be initiated or continued in patients without any evidence of LV systolic dysfunction or chronic AF.
- Published
- 2002
- Full Text
- View/download PDF
15. A congestive heart failure project with measured improvements in care.
- Author
-
DeLong JF, Allman RM, Sherrill RG, and Schiesz N
- Subjects
- Alabama, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Clinical Protocols, Data Collection, Humans, Medicare standards, Professional Review Organizations, Quality Indicators, Health Care, United States, Ventricular Dysfunction, Left diagnosis, Heart Failure therapy, Outcome and Process Assessment, Health Care, Quality Assurance, Health Care
- Abstract
This project was designed to improve the in-hospital management of Medicare beneficiaries with congestive heart failure (CHF). Eleven hospitals were studied using two indicators: (a) assessment of left ventricular (LV) function, and (b) use of angiotensin converting enzyme (ACE) inhibitors in patients with systolic dysfunction. Baseline performance rates were obtained for 990 cases with the Diagnosis Related Group (DRG) 127 for CHF discharged January 1994 to December 1994. Baseline data feedback presentations in 1995 spurred quality improvement plans with interventions such as physician education, critical care maps, and standing orders. Follow-up abstractions were performed on 612 discharges October 1995 through April 1997. The study demonstrated 12% improvement (53% to 65%, p < .01) in assessing LV function and 20% improvement (54% to 74%, p < .01) in appropriate ACE inhibitor use. Projects emphasizing Health Care Quality Improvement Program (HCQIP) principles can successfully affect health care management for the Medicare population.
- Published
- 1998
- Full Text
- View/download PDF
16. Primary causes of medical instability of Medicare patients at discharge 1990-1991.
- Author
-
Sherrill RG Jr, Hood HM, Everett WD, Schiesz N, Lowe JS, and DeLong JF
- Subjects
- Alabama, Humans, Intensive Care Units organization & administration, Intensive Care Units standards, Length of Stay, United States, Delivery of Health Care standards, Hospital-Patient Relations, Medicare Part A, Patient Discharge standards, Professional Review Organizations standards, Quality of Health Care
- Abstract
Background: HCFA-sponsored Peer Review Organizations nationwide have been criticized by organized medicine, Medicare beneficiaries and interested Congressional parties for being punitive without exploiting educational opportunities garnered through their massive data collection capabilities. Until now this data has been poorly analyzed and has not been adequately utilized as a positive motivational tool., Methods: HCFA has developed, with the cooperation of the medical community, six generic screens for Peer Review Organizations to utilize when evaluating quality care provided Medicare beneficiaries in an acute care setting. Through the sheer volume of cases seen, significant inpatient information can be obtained that cannot be duplicated in any other epidemiological endeavor. Line item discrepancies can be further studied through small-area-analysis to determine "who" as well as "what" may be the problem., Results: By compiling and reviewing data in a systematic manner over two years (1990-1991), the Alabama Quality Assurance Foundation (AQAF) has singled out problems with patient medical stability at discharge as the predominant concern for care providers and reviewers alike., Conclusions: Having determined the primary problem in rendering quality care in a Prospective Payment System to Medicare beneficiaries lies in premature discharges, subsequent small-area-analysis further narrows the focus of concerned individuals. Hopefully, practitioners and providers alike will act on their own initiative in correcting this problem. Follow-up review will be utilized to assure this self-corrective action.
- Published
- 1992
17. Subdural empyema associated with an apparent regional hyperperfusion (luxury perfusion).
- Author
-
DeLong JF
- Subjects
- Adult, Female, Humans, Radionuclide Imaging, Technetium, Brain diagnostic imaging, Brain Abscess diagnostic imaging
- Abstract
A patient with a subdural empyema demonstrated a late arterial "blush" during a 99mTc-pertechnetate cerebral dynamic flow study which "washed out" in the delayed images. Cerebral arteriography and subsequent autopsy documented inflammatory tissue surrounding the empyema, resulting in this scintigraphic pattern.
- Published
- 1978
- Full Text
- View/download PDF
18. A retronephric extramedullary plasmacytoma demonstrating avid uptake of Ga-67.
- Author
-
Collins MC, Demmi EL, and DeLong JF
- Subjects
- Aged, Female, Humans, Liver Neoplasms diagnostic imaging, Mediastinal Neoplasms diagnostic imaging, Radionuclide Imaging, Sulfur, Technetium, Technetium Tc 99m Sulfur Colloid, Gallium Radioisotopes, Plasmacytoma diagnostic imaging
- Published
- 1983
- Full Text
- View/download PDF
19. Lung scan utilization in the diagnosis of pulmonary disease.
- Author
-
Krumholz RA, Burnham GM, and DeLong JF
- Subjects
- Asthma diagnosis, Bronchiectasis diagnosis, Bronchitis diagnosis, Humans, Pulmonary Emphysema diagnosis, Respiratory Function Tests, Ventilation-Perfusion Ratio, Iodine Radioisotopes, Lung Diseases, Obstructive diagnosis, Pulmonary Embolism diagnosis, Radionuclide Imaging
- Published
- 1972
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.