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Arrival Times & STEMI Outcomes

Arrival Times & STEMI Outcomes

For patients that are presenting with ST elevation myocardial infarction (STEMI), national guidelines recommend that the door-to-balloon time be less than 90 minutes. “The problem is that when patients present to the hospital with a STEMI in the middle of the night, there may be delays in care,” explains Jorge F. Saucedo, MD. Studies have suggested that STEMI patients who present during off-hours—weeknights, weekends, and holidays—have slower reperfusion times. “A greater emphasis has been placed on providing quality care 24/7 for STEMI,” says Dr. Saucedo. It remains unclear, however, if patients who present during off-hours receive similar quality care to those who present during on-hours. A Closer Look In a study published in Circulation: Cardiovascular Quality and Outcomes, Dr. Saucedo, Tarun W. Dasari, MD, and colleagues compared the care provided and survival outcomes for more than 27,000 STEMI patients arriving during off-hours with nearly 16,000 such patients who arrived during regular business hours at 447 hospitals in the United States. The analysis revealed that STEMI patients arriving during weeknights, weekends, and holidays had a 13% higher mortality risk when compared with those arriving during on-hours. “Overall, the in-hospital all-cause mortality was similar at slightly more than 4% for both groups, but the risk-adjusted all-cause mortality was higher for those who presented during off-hours,” Dr. Saucedo says. Importantly, time of day was not associated with delays in aspirin administration, electrocardiogram tests, or intravenous clot-busting medications. However, the average door-to-balloon time was 56 minutes for those receiving care during on-hours, compared with 72 minutes for off-hour STEMI patients. “About 88% of on-hour patients achieved door-to-balloon times of less than 90 minutes,...
CVD & Stroke: Examining Hospitalization & Mortality Trends

CVD & Stroke: Examining Hospitalization & Mortality Trends

Over the last decade, physicians and professional organizations have focused their efforts on improving the quality of care for cardiovascular disease (CVD) and stroke to ensure that proven interventions are appropriately administered. Groups such as the American College of Cardiology (ACC), American Heart Association (AHA), Society for Cardiovascular Angiography and Interventions (SCAI), and American Stroke Association (ASA) have supported efforts to measure performance and monitor care for CVD and stroke through registries and national quality improvement campaigns. In addition, CMS has initiated efforts to improve care and publicly report 30-day mortality and readmission rates for myocardial infarction (MI) and heart failure (HF). Several reports suggest that hospitalization rates and outcomes for CVD and stroke have improved recently, but many of these analyses have focused on specific communities, populations, or conditions and did not assess the conditions together or look at demographic or geographic differences. “We need to consistently look at temporal trends in CVD and stroke outcomes over the long term to see where our efforts are working and to identify areas for improvement,” says Chandan M. Devireddy, MD. New Long-Term Data In a study published in Circulation, researchers analyzed a national cohort of all Medicare fee-for-service beneficiaries from 1999 to 2011 to evaluate trends in various CVD and stroke outcomes. The analysis explored rates of hospitalization, mortality, and readmission as well as payments, length of stay, and discharge disposition for unstable angina, MI, HF, and ischemic stroke. The study also assessed rates of hospitalization for all other conditions as a comparison and examined variations in demographic and geographic subgroups over time.   “The strength of this research is...

New Missouri Law: Practicing Without Residency Training

Everyone knows there’s a shortage of primary care physicians, especially in rural areas. The state of Missouri has decided to alleviate this problem with a bill, signed into law by the governor this month, authorizing medical school graduates who have not done any residency training to act as “assistant physicians.” The assistant physicians will come from the pool of 7000 to 8000 graduates, mostly of offshore medical schools, who were unable to match to any residency. After spending 30 days with a “physician collaborator,” assistant physicians would be allowed to practice independently as long as they were within 50 miles of their collaborator. The physician collaborator is also required to review 10% of the assistant physician’s charts. Assistant physicians would be expected to treat simple problems and could prescribe Schedule III [including hydroxycodone or codeine when compounded with an NSAID as well as synthetic tetrahydrocannabinol], IV, and V drugs. Opponents of the bill included the American Medical Association, the Accreditation Council for Graduate Medical Education, and the American Academy of Physician Assistants. According to healthleadersmedia.com, the Missouri State Medical Association supported the bill. Its government relations director and general counsel, Jeffrey Howell, said the new rules would be no different than those for older doctors. “A lot of those guys didn’t have to go through a residency program. They just graduated from medical school and went back to the farming communities they grew up in, hung out their shingles, and treated people.” Perhaps Mr. Howell hasn’t heard that medicine is a bit more complex than it was 50 or 60 years ago. Proponents of the bill felt that rural...
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