Comparison of Acute Ischemic Stroke Care and Outcomes Between Comprehensive Stroke Centers and Primary Stroke Centers in the United States [Original Articles]
Conclusions: CSCs and PSCs achieved similar overall care quality for patients with acute ischemic stroke. CSCs exceeded PSCs in timely acute reperfusion therapy for emergency department admissions, whereas PSCs had lower risk-adjusted in-hospital mortality. This information may be important for acute stroke triage and targeted quality improvement. (Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - May 23, 2018 Category: Cardiology Authors: Man, S., Zhao, X., Uchino, K., Hussain, M. S., Smith, E. E., Bhatt, D. L., Xian, Y., Schwamm, L. H., Shah, S., Khan, Y., Fonarow, G. C. Tags: Quality and Outcomes, Ischemic Stroke Original Articles Source Type: research

ISCHEMIA: Establishing the Primary End Point [Cardiovascular Perspectives]
(Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - May 11, 2018 Category: Cardiology Authors: Bangalore, S., Maron, D. J., Reynolds, H. R., Stone, G. W., OBrien, S. M., Alexander, K. P., Hochman, J. S. Tags: Catheter-Based Coronary and Valvular Interventions Cardiovascular Perspectives Source Type: research

Pregnancy After Fontan Palliation: Caution When Details Are Lost in Translation [Editorial]
(Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - May 11, 2018 Category: Cardiology Authors: Davis, M. B., Rogers, I. S. Tags: Quality and Outcomes Editorial Source Type: research

Pregnancy in Women With a Fontan Circulation: A Systematic Review of the Literature [Original Articles]
Conclusions: The most commonly reported cardiovascular complications in patients with Fontan physiology–associated pregnancy were arrhythmia and heart failure. Miscarriages were highly prevalent as was prematurity and intrauterine growth restriction. Postpartum hemorrhage seems to be the most common obstetric complication. Large-scale data sets are needed to confirm these early observations and address the late sequelae of pregnancy in women with a Fontan circulation. (Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - May 11, 2018 Category: Cardiology Authors: Garcia Ropero, A., Baskar, S., Roos Hesselink, J. W., Girnius, A., Zentner, D., Swan, L., Ladouceur, M., Brown, N., Veldtman, G. R. Tags: Pregnancy, Women, Congenital Heart Disease, Complications Original Articles Source Type: research

Predicting the Benefits of Percutaneous Coronary Intervention on 1-Year Angina and Quality of Life in Stable Ischemic Heart Disease: Risk Models From the COURAGE Trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) [Original Articles]
Conclusions: The health status outcomes of stable ischemic heart disease patients treated by OMT+PCI versus OMT alone can be predicted with modest accuracy. Angina and quality of life at 1 year is improved by PCI but is more strongly associated with other patient characteristics. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00007657. (Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - May 11, 2018 Category: Cardiology Authors: Zhang, Z., Jones, P., Weintraub, W. S., Mancini, G. B. J., Sedlis, S., Maron, D. J., Teo, K., Hartigan, P., Kostuk, W., Berman, D., Boden, W. E., Spertus, J. A. Tags: Quality and Outcomes Original Articles Source Type: research

Variation in Lipid-Lowering Therapy Use in Patients With Low-Density Lipoprotein Cholesterol >=190 mg/dL: Insights From the National Cardiovascular Data Registry-Practice Innovation and Clinical Excellence Registry [Original Articles]
Conclusions: Evidence-based LLT use remains low among patients with elevated LDL-C with significant variation in care. System-level interventions are needed to address these gaps and reduce variation in care of these high-risk patients. (Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - May 10, 2018 Category: Cardiology Authors: Virani, S. S., Kennedy, K. F., Akeroyd, J. M., Morris, P. B., Bittner, V. A., Masoudi, F. A., Stone, N. J., Petersen, L. A., Ballantyne, C. M. Tags: Lipids and Cholesterol, Cardiovascular Disease, Quality and Outcomes Original Articles Source Type: research

Of Signal and Noise: Overcoming Challenges in Blood Pressure Measurement to Optimize Hypertension Care [Cardiovascular Perspectives]
(Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - May 10, 2018 Category: Cardiology Authors: Muldoon, M. F., Kronish, I. M., Shimbo, D. Tags: Hypertension, Quality and Outcomes Cardiovascular Perspectives Source Type: research

Increasing Use of Anticoagulants in Germany and Its Impact on Hospitalization for Intracranial Bleeding [Data Report]
(Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - May 10, 2018 Category: Cardiology Authors: Gulker, J.-E., Kroger, K., Kowall, B., Dingelstadt, M., Stang, A. Tags: Atrial Fibrillation, Meta Analysis, Quality and Outcomes, Cerebrovascular Disease/Stroke, Intracranial Hemorrhage Data Report Source Type: research

Gastrointestinal Bleeding With Edoxaban Versus Warfarin: Results From the ENGAGE AF-TIMI 48 Trial (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis In Myocardial Infarction) [Original Articles]
Conclusions: MGIB occurred more frequently with HD-ER than warfarin. The rates of life-threatening or fatal GIB were low and similar with both HD-ER and warfarin. Clinical outcomes were generally favorable. The correlation between dose, trough edoxaban level, and the risk of GIB risk suggests GIB is exposure-related. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00781391. (Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - May 10, 2018 Category: Cardiology Authors: Aisenberg, J., Chatterjee-Murphy, P., Friedman Flack, K., Weitz, J. I., Ruff, C. T., Nordio, F., Mercuri, M. F., Choi, Y., Antman, E. M., Braunwald, E., Giugliano, R. P. Tags: Atrial Fibrillation, Risk Factors, Complications, Mortality/Survival Original Articles Source Type: research

Correction to: Association Between Early Outpatient Visits and Readmissions After Ischemic Stroke [Correction]
(Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - May 10, 2018 Category: Cardiology Tags: Correction Source Type: research

Transradial Percutaneous Coronary Intervention... Works Great! Less Billing! [Editorial]
(Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - May 9, 2018 Category: Cardiology Authors: Ardati, A. K., Cohen, D. J. Tags: Catheter-Based Coronary and Valvular Interventions Editorial Source Type: research

Health Economic Analysis of Access Site Practice in England During Changes in Practice: Insights From the British Cardiovascular Interventional Society [Original Articles]
Conclusions: The transition to TRA in England has been associated with significant cost savings across the national healthcare system, in addition to the well-established clinical benefits. (Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - May 9, 2018 Category: Cardiology Authors: Mamas, M. A., Tosh, J., Hulme, W., Hoskins, N., Bungey, G., Ludman, P., de Belder, M., Kwok, C. S., Verin, N., Kinnaird, T., Bennett, E., Curzen, N., Nolan, J., Kontopantelis, E. Tags: Catheter-Based Coronary and Valvular Interventions Original Articles Source Type: research

Stopping {beta}-Blockers After Myocardial Infarction: Not So Fast! [Editorial]
(Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - April 13, 2018 Category: Cardiology Authors: Ko, D. T., Jackevicius, C. A. Tags: Health Services Editorial Source Type: research

Overtreatment or Undertreatment of Carotid Disease: A Transatlantic Comparison of Carotid Endarterectomy Patient Cohorts [Research Letter]
(Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - April 13, 2018 Category: Cardiology Authors: Pothof, A. B., van Koeverden, I. D., Pasterkamp, G., Schermerhorn, M. L., de Borst, G. J. Tags: Revascularization, Treatment, Quality and Outcomes, Statements and Guidelines Research Letter Source Type: research

Value-Based ST-Segment-Elevation Myocardial Infarction Care Using Risk-Guided Triage and Early Discharge [Original Articles]
We describe the implementation of an STEMI risk score to decrease cost while maintaining optimal patient outcomes. Methods and Results: We determined the impact of risk-guided STEMI care on healthcare value through the retrospective application of the Zwolle Risk Score to 967 patients receiving primary percutaneous coronary intervention between 2009 and 2011. Of these patients, 540 (56%) were categorized as low risk, indicating they may be safely triaged directly to a telemetry unit rather than the intensive care unit and targeted for early discharge. We subsequently developed and implemented a modified Zwolle Risk Calcul...
Source: Circulation: Cardiovascular Quality and Outcomes - April 13, 2018 Category: Cardiology Authors: Ebinger, J. E., Strauss, C. E., Garberich, R. R., Bradley, S. M., Rush, P., Chavez, I. J., Poulose, A. K., Porten, B. R., Henry, T. D. Tags: Revascularization, Cost-Effectiveness, Health Services Original Articles Source Type: research

Clinical Events After Discontinuation of {beta}-Blockers in Patients Without Heart Failure Optimally Treated After Acute Myocardial Infarction: A Cohort Study on the French Healthcare Databases [Original Articles]
Background: β-blockers have been among the first medications shown to improve outcomes after acute myocardial infarction (AMI). With the advent of reperfusion therapy and other secondary-prevention medications, their role has become uncertain, and large-scale experience after AMI in the contemporary era is lacking. In particular, the effect of stopping β-blockers in patients initially treated after AMI is unknown. Methods and Results: Using the French healthcare databases, 73 450 patients (
Source: Circulation: Cardiovascular Quality and Outcomes - April 13, 2018 Category: Cardiology Authors: Neumann, A., Maura, G., Weill, A., Alla, F., Danchin, N. Tags: Cardiovascular Disease, Epidemiology, Secondary Prevention, Chronic Ischemic Heart Disease, Mortality/Survival Original Articles Source Type: research

Association Between Early Outpatient Visits and Readmissions After Ischemic Stroke [Original Articles]
Conclusions: Thirty-day outpatient follow-up was associated with a small reduction in hospital readmission among elderly patients with stroke discharged home. Further work should assess how outpatient care may be improved to further reduce readmissions. (Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - April 13, 2018 Category: Cardiology Authors: Terman, S. W., Reeves, M. J., Skolarus, L. E., Burke, J. F. Tags: Health Services, Quality and Outcomes, Ischemic Stroke Original Articles Source Type: research

Academic Cardiology and Social Media: Navigating the Wisdom and Madness of the Crowd [Editor's Perspective]
(Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - April 12, 2018 Category: Cardiology Authors: Yeh, R. W. Tags: Quality and Outcomes Editor ' s Perspective Source Type: research

Science in Social Media: Debating the Effects of Readmission Penalties [Cardiovascular Perspective]
(Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - April 12, 2018 Category: Cardiology Authors: Thompson, M. P. Tags: Quality and Outcomes Cardiovascular Perspective Source Type: research

Statins and the Classic Decision Analysis: Treat, Test, or Neither? [Editorial]
(Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - April 12, 2018 Category: Cardiology Authors: Pandya, A. Tags: Genetics, Treatment, Cost-Effectiveness Editorial Source Type: research

National Trends of Hospital Performance in Acute Myocardial Infarction Care: Department of Veterans Affairs, 2011-2014 [Data Report]
(Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - April 12, 2018 Category: Cardiology Authors: Hess, P. L., Gunzburger, E. C., Kini, V., Liu, C.-F., Jones, J., Matlock, D., Heidenreich, P. A., Levy, C. R., Maddox, T. M., Grunwald, G. K., Ho, P. M. Tags: Quality and Outcomes, Acute Coronary Syndromes Data Report Source Type: research

Cardiovascular Genetic Risk Testing for Targeting Statin Therapy in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Cost-Effectiveness Analysis [Original Articles]
Conclusions: Testing for a 27-single-nucleotide polymorphism cGRS is generally not a cost-effective approach for targeting statin therapy in the primary prevention of ASCVD for low- to intermediate-risk patients. (Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - April 12, 2018 Category: Cardiology Authors: Jarmul, J., Pletcher, M. J., Hassmiller Lich, K., Wheeler, S. B., Weinberger, M., Avery, C. L., Jonas, D. E., Earnshaw, S., Pignone, M. Tags: Cardiovascular Disease, Primary Prevention, Risk Factors, Genetics, Cost-Effectiveness Original Articles Source Type: research

Racial Heterogeneity in Treatment Effects in Peripheral Artery Disease: Insights From the CLEVER Trial (Claudication: Exercise Versus Endoluminal Revascularization) [Data Report]
(Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - April 11, 2018 Category: Cardiology Authors: Pokharel, Y., Jones, P. G., Graham, G., Collins, T., Regensteiner, J. G., Murphy, T. P., Cohen, D., Spertus, J. A., Smolderen, K. Tags: Health Services Data Report Source Type: research

Letter by Hochman and Maron Regarding Article, "'Faith Healing and 'Subtraction Anxiety in Unblinded Trials of Procedures: Lessons From DEFER and FAME-2 for End Points in the ISCHEMIA Trial." [Letter to the Editor]
(Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - April 10, 2018 Category: Cardiology Authors: Hochman, J. S., Maron, D. J. Tags: Percutaneous Coronary Intervention, Quality and Outcomes Letter to the Editor Source Type: research

Health Status Variation Across Practices in Outpatients With Heart Failure: Insights From the CHAMP-HF (Change the Management of Patients With Heart Failure) Registry [Original Articles]
Background: Although a key treatment goal for patients with heart failure with reduced ejection fraction is to optimize their health status (their symptoms, function, and quality of life), the variability across outpatient practices in achieving this goal is unknown. Methods and Results: In the CHAMP-HF (Change the Management of Patients With Heart Failure) registry, associations between baseline practice characteristics and Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary (OS) and Symptom Frequency (SF) scores were assessed in 3494 patients across 140 US practices using hierarchical regression after accoun...
Source: Circulation: Cardiovascular Quality and Outcomes - April 7, 2018 Category: Cardiology Authors: Khariton, Y., Hernandez, A. F., Fonarow, G. C., Sharma, P. P., Duffy, C. I., Thomas, L., Mi, X., Albert, N. M., Butler, J., McCague, K., Nassif, M. E., Williams, F. B., DeVore, A., Patterson, J. H., Spertus, J. A. Tags: Heart Failure, Health Services, Quality and Outcomes Original Articles Source Type: research

An Observational Study of the Association of Video- Versus Text-Based Informed Consent With Multicenter Trial Enrollment: Lessons From the PALM Study (Patient and Provider Assessment of Lipid Management) [Original Articles]
Background: Patient participation in clinical research is low, in part because of the length and complexity of the informed consent process. Video informed consent may enhance the appeal of research and help break down barriers to participation. Methods and Results: The PALM study (Patient and Provider Assessment of Lipid Management) enrolled 7904 patients at cardiology, endocrinology, and primary care clinics across the United States to evaluate cholesterol management practices. Of 153 participating clinics, 67 (43.8%) secured institutional review board approval to use a tablet-based video informed consent tool that pati...
Source: Circulation: Cardiovascular Quality and Outcomes - April 6, 2018 Category: Cardiology Authors: Fanaroff, A. C., Li, S., Webb, L. E., Miller, V., Navar, A. M., Peterson, E. D., Wang, T. Y. Tags: Clinical Studies, Health Services Original Articles Source Type: research

Abstract 282: The Effect of State Medicaid Expansions on Acute Myocardial Infarction Care Quality and Outcomes [Session Title: Poster Session PM]
Background: Despite considerable progress in the treatment of acute myocardial infarction (AMI), major disparities in care remain for the uninsured. Lack of insurance is associated with delays in seeking emergency care for AMI, and uninsured patients are less likely to receive guideline-directed medical therapy, invasive cardiac procedures, and have higher mortality rates than their insured counterparts. In 2014, Medicaid eligibility was expanded under the ACA, and millions of low-income adults gained insurance coverage in over 30 states. However, little is known about Medicaid expansions’ impact on the quality and o...
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Wadhera, R. K., Bhatt, D. L., Wang, T. Y., Lu, D., Lucas, J., Garratt, K. N., Yeh, R. W., Joynt Maddox, K. E. Tags: Session Title: Poster Session PM Source Type: research

Abstract 281: Contemporary Epidemiology of Atrial Fibrillation Among Medicare Beneficiaries, 2004-2013 [Session Title: Poster Session PM]
Background: Atrial fibrillation (AF) is the most common dysrhythmia in clinical practice, and is a significant contributor to morbidity and mortality. Prior reports have projected a large increase in AF burden over time. A contemporary assessment of epidemiology is needed to assess if an emphasis of prevention strategies over the last decade has been effective in alleviating this risk.Methods: We used a 5% national sample of all Medicare beneficiaries in the US from 2002 through 2013 to construct a longitudinal cohort of 2.3 million fee-for-service Medicare beneficiaries administratively followed for ≥2 years using clai...
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Parker, J., Khera, R., Pandey, A., Cheeran, D., Ayers, C., Das, S. R., Link, M. S., de Lemos, J. A., Berry, J. D. Tags: Session Title: Poster Session PM Source Type: research

Abstract 280: Strength of Clinical Trial Evidence for High-Risk Cardiovascular Devices Approved Through Food and Drug Administration (FDA) Priority Review [Session Title: Poster Session PM]
Conclusions and Relevance: Most priority review pathway high-risk cardiovascular devices are approved without a randomized or blinded trial. Noninferiority design and use of surrogate endpoints are common. These devices are frequently subject to recalls. (Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Jones, C., Dhruva, S. S., Redberg, R. F. Tags: Session Title: Poster Session PM Source Type: research

Abstract 279: Eligibility and Cost Estimates for Anti-inflammatory Therapy for Atherosclerotic Disease: Implications of the CANTOS Trial for the US Adult Population [Session Title: Poster Session PM]
Background: The CANTOS trial supports the use of canakinumab to target residual inflammatory risk for secondary cardiovascular prevention. To better understand the potential impact of these findings, we use nationally representative data to estimate the number of US adults who qualify for therapy with canakinumab and the projected cost burden on the US health system based on its current pricing.Methods: In National Health and Nutrition Examination Survey (NHANES) 2005-10, we identified all adults with a prior MI and elevated hsCRP ≥2 mg/L, and fulfilling all eligibility criteria for CANTOS. Further, we also assessed the...
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Khera, R., Saxena, A., Hong, J., Arrieta, A., Ross, J. S., Krumholz, H. M., Nasir, K. Tags: Session Title: Poster Session PM Source Type: research

Abstract 278: Trends in Prescribing Patterns for Patients Hospitalized With Heart Failure With Preserved Ejection Fraction Before and After Clinical Trial Presentation [Session Title: Poster Session PM]
Background: There are limited treatment options for patients with HFpEF, with guidelines focusing on diuresis and management of associated cardiovascular conditions. In the TOPCAT trial, treatment with spironolactone in patients with HFpEF compared to placebo did not significantly decrease the incidence of the composite primary outcome, but the incidence of heart failure (HF) hospitalization was significantly lower. The impact of the TOPCAT results on mineralocorticoid antagonists (MRA) prescribing rates is unknown. We analyzed discharge prescribing rates of MRAs in the Get With The Guidelines-Heart Failure (GWTG-HF) regis...
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Brophy, T. J., Wu, J., Kelly, J. P., DeVore, A. D., Hammill, B. G., Peterson, E. D., Pitt, B., Yancy, C. W., Fonarow, G. C., Hernandez, A. F. Tags: Session Title: Poster Session PM Source Type: research

Abstract 277: Comparison of All-Cause Hospitalization Rates and 30-Day Readmissions Among Patients With Non-Valvular Atrial Fibrillation, Newly Diagnosed and Newly Treated With Dabigatran, Rivaroxaban or Warfarin [Session Title: Poster Session PM]
Background: While dabigatran has been evaluated in real-world studies compared to warfarin, this is one of the first head-to-head studies that includes a new oral anticoagulant in the comparison of all-cause hospitalization and 30-day readmission.Methods: Adult non-valvular atrial fibrillation (NVAF) patients newly diagnosed and newly treated with dabigatran, rivaroxaban or warfarin were identified within MarketScan claims databases between 10/01/2010-12/31/2014. Patients were continuously enrolled for 12-months prior to index date (first oral anticoagulant claim) and followed for 12 months or until medication switch, disc...
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Gilligan, A., Franchino-Elder, J., Song, X., Wang, C., Henriques, C., Sainski-Nguyen, A., Wilson, K., Smith, D., Sander, S. Tags: Session Title: Poster Session PM Source Type: research

Abstract 276: Identification of Echocardiographic Imaging View Using Deep Learning [Session Title: Poster Session PM]
Conclusion: Vendor independent deep learning networks can rapidly and accurately identify features on standard echocardiogram images. DenseNet network architecture matched human level performance. Deep learning has the potential for rapid, automated image interpretation and can improve the accuracy and efficiency of echocardiogram interpretation. (Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Long, G., Wessler, B. S. Tags: Session Title: Poster Session PM Source Type: research

Abstract 275: Effects of Index Admission Length of Stay on Readmission Interval in Patients With Heart Failure [Session Title: Poster Session PM]
Conclusion: In our patients admitted with heart failure, 8 to 13-day index admission was associated with the longest readmission interval. It is possible that shorter index admission may not allow for sufficient medical optimization. This conclusion requires further study. While patients with prolonged index admission are more likely to have IDDM and CKD, these co-morbidities do not appear to result in shorter readmission intervals. There may be additional, currently not well investigated factors affecting readmission interval. Further research is needed to define optimal LOS and discharge criteria in patients admitted wit...
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Breen, T. J., Patel, H., Purga, S., Fein, S. A., Philbin, E. F., Torosoff, M. Tags: Session Title: Poster Session PM Source Type: research

Abstract 273: The Evolving Use of Cardiac CT to Inform Defining Quality in Imaging [Session Title: Poster Session PM]
Conclusion: Cardiac CT utilization is rising for inpatient chest pain and for TAVR planning. For 90% of the patients undergoing evaluation for chest pain, and 90% of patients with equivocal stress testing, cardiac CT potentially prevented need for further downstream invasive testing. This hypothesis-generating data has potential implications that may inform application of quality standards for TAVR and chest pain imaging. Further research is needed to disseminate the effect of cardiac CT on patient outcomes in this cohort. (Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Zhang, M., Earls, J., Choi, B. G., Zeman, R. K., Choi, A. D. Tags: Session Title: Poster Session PM Source Type: research

Abstract 272: Female Sex and Variations in Troponin Utilization [Session Title: Poster Session PM]
Conclusion: There is significant variation in the utilization of troponin testing across VA facilities. Our findings suggests that a patient’s sex may help explain the variation in troponin utilization. Further studies should explore whether sex differences in troponin testing account for discrepancies in outcomes and procedure utilization for patients with AMI. (Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Chui, P. W., Hauser, G. R. Tags: Session Title: Poster Session PM Source Type: research

Abstract 271: Variations in Troponin Utilization in the Veterans Affairs Health System [Session Title: Poster Session PM]
Conclusions: There is substantial variation across facilities in the variation of abnormal troponin results. We aim to utilize this data to study additional facility-level, clinician-level, and patient-level factors that may be contributing to this variation. Future findings may allow us to identify interventions that can improve quality of care in the workup of acute coronary syndrome across VA facilities. (Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Chui, P. W., Hauser, R. G. Tags: Session Title: Poster Session PM Source Type: research

Abstract 270: Prediction of Health-Related Quality of Life at 12 Months From Baseline Modifiable Factors in Patients With Heart Failure [Session Title: Poster Session PM]
Introduction: Patients with heart failure (HF) report that good health-related quality of life (HRQOL) is more valuable than longer survival, and improvement in HRQOL after discharge has been associated with lower rates of hospitalization. However, HRQOL in patients with HF is remarkably poorer than that in patients with other chronic diseases. To improve HRQOL effectively, it is critical to examine comprehensive modifiable predictors. However, to our knowledge, this has not been examined in patients with HF.Purpose: To examine baseline psychosocial, behavioral, and physical predictors of HRQOL at 12 months in patients wit...
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Heo, S., Kim, J., Moser, D. K., Lennie, T. A., Fischer, M., Ounpraseuth, S., Walsh, M. Tags: Session Title: Poster Session PM Source Type: research

Abstract 269: Do Transferred-In Patients Have Longer Lengths of Stay at a Stroke Center? [Session Title: Poster Session PM]
Background: Acute ischemic stroke (AIS) patients presenting to community hospitals may frequently be transferred to stroke centers if appropriate resources are not available at the referring facilities. Many patients may require discharge to acute rehabilitation (ARF) or skilled nursing (SNF) facilities prior to returning to home. We hypothesize that patients transferring to our comprehensive stroke center (CSC) who require discharge to either ARF or SNF may have longer lengths of stay (LOS) as compared to those who directly present to our CSC.Methods: From September 2015 to December 2016, LOS (days) of AIS patients admitt...
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Asaithambi, G., Castle, A. L., Kukielka, D., Ho, B. M., Marino, E. H., Hanson, S. K. Tags: Session Title: Poster Session PM Source Type: research

Abstract 268: Is There a Weekend Effect on Telestroke Code Time Metrics? [Session Title: Poster Session PM]
Conclusion: While there were no significant differences in outcomes, the "weekend effect" results in slower door to code activation and door to needle times. Efforts to improve methods in increasing efficiency of care on weekends should be considered. (Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Asaithambi, G., Castle, A. L., Marino, E. H., Ho, B. M., Hanson, S. K. Tags: Session Title: Poster Session PM Source Type: research

Abstract 267: A Single-page Best Practice Algorithm Reduces Stroke Risk and Improves Arrhythmia Management Decisions in Patients With Acute Atrial Fibrillation: A Quality Improvement Project [Session Title: Poster Session PM]
Conclusions: Using established quality improvement methodology and cost-neutral multi-disciplinary expertise, this novel management algorithm has significantly improved the quality and safety of care for patients with acute AF at NMUH. Prospective analysis of long-term adverse outcomes is now required to establish morbidity or mortality benefit. (Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Maclean, E., Patel, S., Joseph, O., de Block Golding, D., Maden, S., Boot, J., Denning, M., Rear, R. Tags: Session Title: Poster Session PM Source Type: research

Abstract 266: Preoperative Vancomycin and the Risk of Cardiovascular Implantable Electronic Device Infection: A Cohort Study in a Veteran Population [Session Title: Poster Session PM]
Background: The rate of cardiovascular implantable electronic device infection (CIEDI) has increased, despite the use of preoperative antibiotics at the time of device placement or revision. Cefazolin, a beta-lactam antibiotic, is used as standard preoperative prophylaxis in the bulk of patients. Vancomycin is used in the small minority of patients who have IgE-mediated allergies to beta-lactams or have a history of colonization/infection with MRSA. As compared to cefazolin, vancomycin is less effective against methicillin-susceptible Staphylococcus aureus, has no gram-negative coverage, and has nephrotoxicity risk.Methods...
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Alzahrani, T., Baddour, L. M., Karasik, P. E. Tags: Session Title: Poster Session PM Source Type: research

Abstract 265: Angiotensin-Converting-Enzyme Inhibition in Stable Coronary Artery Disease and Cardiomyopathy With Mid-range Ejection Fraction: Insights From the PEACE Trial [Session Title: Poster Session PM]
Background: There have been significant advances in the treatment of patients with cardiomyopathy with reduced ejection fraction (EF
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Alzahrani, T., Tiu, J., Solomon, A., Panjrath, G. Tags: Session Title: Poster Session PM Source Type: research

Abstract 264: Accuracy and Indication of Emergency Department Echocardiography, What Needs to Be Improved? A Single Center Experience [Session Title: Poster Session PM]
Conclusion: In general, FE is a valuable tool which provides accurate assessment of volume status (IVC dimension) and for the most part accurately assessed EF and the presence of a pericardial effusion. However, FE may significantly underestimate EF in 15% of patients. Both LV and RV function and size may be difficult to assess based on time constraints, inadequate echo windows or technical issues with imaging. FE was unable to assess the aortic root accurately in 25% of cases. Despite the limitations of FE (acuity of medical conditions, the relative brevity of the study and modest training in echocardiography undertaken b...
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Adeel, M., Mahmut, A., Shah, A., Borkovich, M., Lancaster, G., Zarich, S. Tags: Session Title: Poster Session PM Source Type: research

Abstract 263: Assessment of the Relationship Between Body Mass Index and Atherosclerotic Cardiovascular Disease Risk in a University Based Residency Training Program: A Quality Improvement Initiative [Session Title: Poster Session PM]
Conclusion: Obesity rates appear to be higher in our patient population in comparison to national estimates but our mathematical model cannot be used to explain any correlation between BMI and ASCVD risk scores. Obesity did not confer an increased ASCVD risk in comparison to being overweight (BMI 25-29.9). However, both overweight and obese patients had a higher likelihood of having a significantly elevated ASCVD risk score. Future aims include initiating a targeted educational intervention for residents in the continuity clinic to ultimately demonstrate that resident driven intervention is an effective way to address obes...
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Chang, E. Y., Farooq, A., Stevens, E. S., Bakinde, N. Tags: Session Title: Poster Session PM Source Type: research

Abstract 262: Preferences for Primary versus Specialty Palliative Care Among Patients With Heart Failure [Session Title: Poster Session PM]
Background: More than 5 million people in the USA suffer from heart failure (HF). Palliative care (PC) is both a clinical subspecialty and overall approach to care that focuses on promoting seriously ill patients and their family’s quality of life. PC takes several forms, including consultation by a PC specialist, or attention to palliative domains by a non-PC specialist (aka "primary" PC). Despite guidelines calling for the integration of PC in HF, specialty PC remains underutilized. Patient preferences regarding primary vs specialty PC are unknown.Objective: To identify patient knowledge and perceptions r...
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Ikejiani, D. Z., Hadler, R. A., Arnold, R. M., Bekelman, D., Moreines, L. T., Harinstein, M., Kavalieratos, D. Tags: Session Title: Poster Session PM Source Type: research

Abstract 261: Global Patterns of Comprehensive Cardiovascular Risk Factor Control in Patients With Type 2 Diabetes Mellitus: Insights From the Global DISCOVER Registry [Session Title: Poster Session PM]
Background: Guidelines recommend optimal control of cardiovascular risk factors such as blood pressure, lipids and smoking in addition to glycemic control to reduce the risk of micro and macro-vascular complications in patients with type 2 diabetes mellitus (T2D). However, the extent of comprehensive cardiovascular risk factor control in T2D internationally is not well-known.Methods: A total of 14,169 T2D patients initiating second-line therapy across 37 countries were enrolled in the DISCOVER registry. Optimal cardiovascular risk factor management at study baseline was defined as control of the following risk factors amon...
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Patel, K. K., Charbonnel, B., Chen, H., Cid-Rufaza, J., Fenici, P., Hammar, N., Ji, L., Kennedy, K. F., Khunti, K., Kosiborod, M., Pocock, S., Shestakova, M., Shimomura, I., Surmont, F., Watada, H., Gomes, M. B. Tags: Session Title: Poster Session PM Source Type: research

Abstract 260: Restructuring a Failed Cardiac Surgery Program in an Under Served Minority Population County [Session Title: Poster Session PM]
Objectives: Fifty years ago, Donabedian described the conceptual framework for quality in healthcare as the triad of process, structure and outcome. These principals were applied to a failed urban cardiac surgery program (volume, efficiency, and quality) in an underserved county of 900,000 people in which cardiovascular death rates are up to double the neighboring county and public health studies demonstrate high rates of cardio metabolic syndrome as well as poor access to health care. Using Cardiac Surgery as a highly measured clinical service model our hypothesis was that strict attention to all details related to Donabe...
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Brown, J., Dawood, M., Gammie, J. S., Odonkor, P., Siddiqi, I., Gillespie, M., Dominique, G., Bartlett, S. T. Tags: Session Title: Poster Session PM Source Type: research

Abstract 259: Pre-Procedure Checklist and Morning Huddle as Part of Patient Evaluation for Cardiac Catheterisation [Session Title: Poster Session PM]
Conclusions: Although the survey was overwhelmingly positive at baseline, room for improvement was noted. It is anticipated that the intervention will allow the staff an opportunity to speak up when a problem is perceived, and improve communication, by empowering the team during the ‘Morning Huddle’. Our overarching goal is to improve the safety climate in the catheterization laboratory. (Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Samani, S., Clegg, S., Sheldon, M., Garcia, M. Tags: Session Title: Poster Session PM Source Type: research

Abstract 258: Impact of Community Health Workers in Management of Heart Failure: A Pilot Study [Session Title: Poster Session PM]
Conclusions: This pilot study suggests that CHW may reduce healthcare utilization for patients with heart failure without negatively impacting mortality. Based on these findings, a larger study is warranted to assess the efficacy and cost-efficiency of CHWs in helping to manage patients with heart failure. (Source: Circulation: Cardiovascular Quality and Outcomes)
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Vohra, A. S., Chua, R., Alcain, C. F., Coplan, M. J., Spencer, K. T., Liao, J. K., Tabit, C. E. Tags: Session Title: Poster Session PM Source Type: research