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Importance Modern data regarding incidence and modes of death of patients with aortic stenosis (AS) are restricted to tertiary centers or studies of aortic valve replacement (AVR). Objective To provide new insights into the natural history of outpatients with native AS based on a large regionwide population study with inclusion by all cardiologists regardless of their mode of practice. Design, Setting, and Participants Between May 2016 and December 2017, consecutive outpatients with mild (peak aortic velocity, 2.5-2.9 m/s), moderate (peak aortic velocity, 3-3.9 m/s), and severe (peak aortic velocity, ≥4 m/s) native AS graded by echocardiography were included by 117 cardiologists from the Nord-Pas-de-Calais region in France. Analysis took place between August and November 2020. Main Outcomes and Measures Natural history, need for AVR, and survival of patients with AS were followed up. Indications for AVR were based on current guideline recommendations. Results Among 2703 patients (mean [SD] age, 76.0 [10.8] years; 1260 [46.6%] women), 233 (8.6%) were recruited in a university public hospital, 757 (28%) in nonuniversity public hospitals, and 1713 (63.4%) by cardiologists working in private practice. A total of 1154 patients (42.7%) had mild, 1122 (41.5%) had moderate, and 427 (15.8%) had severe AS. During a median (interquartile range) of 2.1 (1.4-2.7) years, 634 patients underwent AVR and 448 died prior to AVR. Most deaths were cardiovascular (200 [44.7%]), mainly associated with congestive heart failure (101 [22.6%]) or sudden death (60 [13.4%]). Deaths were noncardiovascular in 186 patients (41.5%) and from unknown causes in 62 patients (13.8%). Compared with patients with mild AS, there was increased cardiovascular mortality in those with moderate (hazard ratio, 1.47 [95% CI, 1.07-2.02]) and severe (hazard ratio, 3.66 [95% CI, 2.52-5.31]) AS. The differences remained significant when adjusted for baseline characteristics or in time-dependent analyses considering AS progression. In asymptomatic patients, moderate and mild AS were associated with similar cardiovascular mortality (hazard ratio, 0.99 [95% CI, 0.44-2.21]). Conclusions and Relevance While patients in this study with moderate AS had a slightly higher risk of cardiovascular death than patients with mild AS, this risk was much lower than that observed in patients with severe AS. Moreover, in asymptomatic patients, moderate and mild AS were associated with similar cardiovascular mortality.

Les donnees que vous utilisez dans le cadre de vos activites sont-elles suffisantes et representatives de ce que vous souhaitez observer ? Si ce n’est pas le cas, vous risquez de prendre de mauvaises decisions. Cette fiche decrit differents cas d’utilisation courants des statistiques, en vous indiquant comment vous assurer que les donnees sont suffisantes, et ainsi vous rassurer quant a la qualite de vos decisions !

Vous etes amene dans votre metier a interpreter des mesures ou des indicateurs, et a prendre des decisions sur la base de ces donnees chiffrees. Lorsqu’un indicateur se degrade, vous recherchez une explication ou une cause de cette degradation, pour vous-meme ou parce qu’on vous la demande, et vous mettez en place des plans d’action d’amelioration. Lorsqu’un indicateur s’ameliore, au contraire, on a tendance a considerer que les actions mises en place precedemment portent leurs fruits, et qu’il faut les maintenir. Les evolutions d’indicateurs ou de mesures sont generalement faites en comparant la periode observee (par exemple la semaine ou le mois ecoules) a la periode precedente (la semaine ou le mois precedents) ou a la meme periode de l’annee precedente. Mais ces methodes habituelles de surveillance des indicateurs ou mesures sont-elles toujours pertinentes ? Une degradation apparente necessite-t-elle toujours de remettre en cause les decisions prises precedemment ? Faut-il decider de nouvelles actions ? Faut-il rechercher un « fautif » ou demander a toutes les personnes impliquees de « faire des efforts » ? Cette fiche aborde un point essentiel de la philosophie de Deming : la theorie des variations.

Vous etes concerne par le management, et mettez en œuvre, ou souhaitez le faire, les principes d’une norme, techniques ou ecoles suivantes : Qualite totale, l’approche systeme, l’approche processus, le TPS, le Lean Management, le Six-Sigma, les entreprises liberees, ISO 9001… Cette fiche aborde deux points fondamentaux dans la philosophie de Deming, et donne quelques conseils pour les mettre en œuvre. L’approche systeme : meme si elle a ete adoptee par la norme ISO 9001 a partir de sa version 2000, il est bon de revenir aux fondamentaux de Deming si on veut en tirer tous les benefices. L’amelioration des processus : la aussi, revenir aux principes de Deming permet d’aboutir a des resultats bien plus solides que la pratique courante dans le cadre de la norme ISO 9001.

Background In patients with coronary artery disease (CAD), non-optimal use of evidence-based medications is associated with an increased risk of adverse outcome. Aims To assess the prevalence and correlates of non-optimal secondary medical prevention in patients with stable CAD. Methods We included 4184 consecutive outpatients with stable CAD. Treatment at inclusion was classified as optimal/non-optimal regarding the four major classes of secondary prevention drugs: antithrombotics; statins; angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs); and beta-blockers. For each treatment, the prescription was considered non-optimal if the drug was missing despite a class IA indication according to international guidelines. To assess the information globally, non-optimal secondary prevention was defined as at least one major treatment missing. Results The proportions of patients with non-optimal treatment were 0.7%, 7.8%, 12.9% and 10.3% for antithrombotics, statins, ACE inhibitors/ARBs and beta-blockers, respectively. Non-optimal secondary medical prevention was observed in 16.8% of cases. By multivariable analysis, the correlates of non-optimal secondary medical prevention were long time interval since last coronary event (P

Excerpt To the editor:Acute ergotism is a iatrogenic disease usually seen in young patients being treated with ergotamine tartrate. Concurrent treatment with troleandomycin, a macrolide antibiotic,...