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  • JAMA July 18, 2017

    Figure 1: Trends in Hospital 30-Day Risk-Adjusted Readmission Rates and Hospital 30-Day Risk-Adjusted Mortality Rates After Discharge for Heart Failure, Acute Myocardial Infarction, and Pneumonia, 2008 Through 2014

    Linear trends in mean monthly 30-day risk-adjusted readmission rates and 30-day risk-adjusted mortality rates after discharge from hospitalization for heart failure (A), acute myocardial infarction (B), and pneumonia (C) are shown for 3 periods: January 2008 through March 2010, April 2010 through September 2012, and October 2012 through December 2014. The vertical dotted lines denote April 1, 2010, and October 1, 2012, to be proximate to dates of passage of the Affordable Care Act and implementation of the Hospital Readmissions Reduction Program, respectively. Trend lines were fitted based on predictions of truncated time series models for the 3 periods above. Risk adjustment was made for patient age, sex, comorbidities, season, and hospital length of stay.
  • JAMA July 18, 2017

    Figure 2: Correlation of Paired Monthly Trends in Hospital 30-Day Risk-Adjusted Readmission Rates and Hospital 30-Day Risk-Adjusted Mortality Rates After Discharge for Heart Failure, Acute Myocardial Infarction, and Pneumonia, 2008 Through 2014

    Correlations of paired monthly trends in hospital 30-day risk-adjusted readmission rates and hospital 30-day risk-adjusted mortality rates after discharge from hospitalization for heart failure (4221 hospitals) (A), acute myocardial infarction (2469 hospitals) (B), and pneumonia (4483 hospitals) (C) from 2008 through 2014 are shown. Risk adjustment was made for patient age, sex, comorbidities, season, and hospital length of stay.
  • Association of Changing Hospital Readmission Rates With Mortality Rates After Hospital Discharge

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    JAMA. 2017; 318(3):270-278. doi: 10.1001/jama.2017.8444

    This cohort study examines whether reductions in hospital readmission rates following hospitalizations for heart failure, acute myocardial infarction, and pneumonia are associated with mortality rates after hospital discharge among Medicare fee-for-service beneficiaries.

  • JAMA September 27, 2016

    Figure 2: Association of Between-Group Difference in Achieved Low-Density Lipoprotein Cholesterol (LDL-C) Levels and Risk of Major Vascular Events

    The LDL-C differences are either mean or median depending on what was presented for each trial. Major vascular events include cardiovascular death, acute myocardial infarction or other acute coronary syndrome, coronary revascularization, and stroke (eTables 1-5 in the Supplement provide additional details). The size of the data marker is proportional to the weight in the meta-regression. The meta-regression slope (predicted relative risk for degree of LDL-C reduction) is represented by the solid line and the 95% CIs by the dashed lines. To convert LDL-C from mmol/L to mg/dL, divide by 0.0259.aThe square data markers indicate secondary prevention trials. There was 1 primary prevention trial and 1 secondary prevention trial for bile acid sequestrants.
  • Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial

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    JAMA. 2016; 315(24):2673-2682. doi: 10.1001/jama.2016.7050

    This randomized clinical trial evaluates the effects of intensive (<120 mm Hg) systolic blood pressure targets compared with standard (<140 mm Hg) systolic blood pressure targets in patients aged 75 years or older.

  • JAMA June 28, 2016

    Figure 2: Kaplan-Meier Curves for the Primary Cardiovascular Disease Outcome in Systolic Blood Pressure Intervention Trial (SPRINT) in Participants Aged 75 Years or Older by Baseline Frailty Status

    Tinted regions indicate 95% confidence intervals; FI, 37-item frailty index; HR, hazard ratio. The primary cardiovascular disease outcome was a composite of nonfatal myocardial infarction, acute coronary syndrome not resulting in a myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and death from cardiovascular causes.
  • Effect of Losmapimod on Cardiovascular Outcomes in Patients Hospitalized With Acute Myocardial Infarction: A Randomized Clinical Trial

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    JAMA. 2016; 315(15):1591-1599. doi: 10.1001/jama.2016.3609

    This randomized trial evaluates the efficacy and safety of losmapimod vs placebo on cardiovascular outcomes in patients hospitalized with an acute myocardial infarction (MI).

  • JAMA April 12, 2016

    Figure 3: Genome-Wide Transcriptional Analysis of Blood Leukocytes From Patients With Sepsis Who Did or Did Not Acquire an Infection While in the ICU

    A, Genome-wide blood gene expression profiles of 64 patients who developed an intensive care unit (ICU)–acquired infection and 398 patients who did not were each compared to 42 healthy controls. This analysis revealed 97% of the significantly altered gene transcripts in patients with and without acquired infection were common. Log2 fold changes relate to differences in gene expression between patients and healthy controls. Spearman correlation analysis of the resultant log2-transformed fold changes of standard biotin-fluorescence intensities per gene transcript between patients and healthy subjects (intensity genei,patients − intensity genei,health) showed a strongly correlating gene expression response. No differences in blood transcriptional profiles were uncovered when directly comparing patients with and without ICU-acquired infections with samples from patients with no ICU-acquired infection. ρ Indicates Spearman ρ. Each dot represents a specific gene transcript. B and C, Volcano plot representation (integrating log2 fold changes and −log10 Benjamin Hochberg [BH] P values) of genome-wide blood transcriptional profiles of paired ICU admission and event (follow-up) samples from 9 patients with no and 19 patients with ICU-acquired infections. Log2 fold changes relate to the difference in gene expression between (paired) admission and follow-up samples. Each dot represents a specific gene transcript. B, Gene expression profiles of patients without ICU-acquired infections sampled at ICU admission were compared with those sampled at the onset of a noninfectious ICU-acquired complication (2 acute lung injuries, 6 acute kidney injuries; 1 acute myocardial infarction). No differences were identified. C, Gene expression profiles of patients with ICU-acquired infections sampled at ICU admission were compared with samples taken at the onset of an ICU-acquired infectious complication. A total of 128 significantly different genes were identified in the paired samples of patients with ICU-acquired infections. Gray dots denote nonsignificant genes; red dots, significantly overexpressed genes (n=11); blue dots, significantly underexpressed genes (n=117). D, Heat map representation of samples from 19 patients with ICU-acquired infections collected at both ICU admission and at the onset of the infectious complication (paired analysis). Glycolysis-I gene expression values (log2-transformed intensities) were scaled and depicted in color code format, with red denoting overexpression and blue denoting underexpression. GPI indicates glucose-6-phosphate isomerase; TPI1, triosephosphate isomerase 1; GAPDH, glyceraldehyde-3-phosphate dehydrogenase; PGK1, phosphoglycerate kinase 1; PGAM1, phosphoglycerate mutase 1; and ENO1, enolase 1.
  • JAMA February 9, 2016

    Figure 1: Risk-Standardized Mortality Rates for Acute Myocardial Infarction, Heart Failure, or Pneumonia, 2010-2013

    Bin width is equal to 0.5%, and bars are centered over the midpoint of each bin.
  • JAMA February 9, 2016

    Figure 2: Risk-Standardized Readmission Rates for Acute Myocardial Infarction, Heart Failure, or Pneumonia, 2010-2013

    Bin width is equal to 0.5%, and bars are centered over the midpoint of each bin.
  • Association of Admission to Veterans Affairs Hospitals vs Non–Veterans Affairs Hospitals With Mortality and Readmission Rates Among Older Men Hospitalized With Acute Myocardial Infarction, Heart Failure, or Pneumonia

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    JAMA. 2016; 315(6):582-592. doi: 10.1001/jama.2016.0278

    This cross-sectional study compares mortality and readmission rates for acute myocardial infarction, heart failure, and pnemonia among older men treated at VA and non-VA hospitals in urban metropolitan statistical areas.

  • Does This Patient With Chest Pain Have Acute Coronary Syndrome? The Rational Clinical Examination Systematic Review

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    JAMA. 2015; 314(18):1955-1965. doi: 10.1001/jama.2015.12735

    This Rational Clinical Examination examines the accuracy of initial history, physical examination, electrocardiogram, and risk scores combined with the first cardiac-specific troponin for diagnosing acute coronary syndrome in the emergency department.

  • Acute Coronary Syndrome

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    JAMA. 2015; 314(18):1990-1990. doi: 10.1001/jama.2015.12743
  • JAMA July 28, 2015

    Figure 1: Publicly Reported Process-of-Care and Outcome Measures by Hospital Quality Summary Score

    A, Process-of-care measures were defined as follows: AMI-10: patient with acute myocardial infarction (AMI) prescribed statin at discharge; HF-1: patient with heart failure (HF) received discharge instructions; HF-3: patient with heart failure with left ventricular systolic dysfunction received an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; PN-6: patient with pneumonia given appropriate initial antibiotic; SCIP-CARD-2: preoperative β-blocker continued perioperatively; SCIP-INF-3: prophylactic antibiotics discontinued within 24 hours after surgery; and SCIP-INF-9: urinary catheter removed in surgical patients within 2 days postoperatively. B, Mortality measures included 30-day mortality from AMI, heart failure, and pneumonia. P < .001 for all examined measures using the Cuzick extension of Wilcoxon rank-sum test for trend across ordered hospital quality summary score categories with the following exceptions: HF-3 (P = .01) and SCIP-INF-3 (P = .36). Sensitivity analyses with 6 alternative hospital quality summary scores were also performed using the composites shown in eTable 4 in the Supplement. For all 10 measures examined, P < .05 using the Cuzick extension of Wilcoxon rank-sum test for trend with the following exceptions: SCIP-INF-9, composite score C = .06; and SCIP-INF-3, composite score B = .34; composite score C = .47; composite score D = .08; composite score E = .72; and composite score F = .06. Please see the Methods for details about the hospital quality summary score. Means and standard deviations for each measure for every hospital quality summary score category are in eTable 3 in the Supplement.
  • Implantable Cardioverter-Defibrillator Use Among Medicare Patients With Low Ejection Fraction After Acute Myocardial Infarction

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    JAMA. 2015; 313(24):2433-2440. doi: 10.1001/jama.2015.6409

    This cohort study uses registry and Medicare claims data to assess the frequency of ICD implantation within 1 year of myocardial infarction and to compare mortality in patients with vs without ICDs.

  • JAMA June 2, 2015

    Figure 1: Changes in Pioneer ACO Per-Beneficiary-Per-Month Total Spending by Geographic Area, 2012 and 2013

    Data markers represent the differential change in conditional means of total accountable care organization (ACO) per-beneficiary-per-month (PBPM) spending relative to comparison populations by geographic areas common to more than 1 ACO for 2012 and 2013. Negative values indicate differentially lower spending. Error bars indicate 95% confidence intervals, with those crossing $0 not statistically significant. ACOs. All results were regression-adjusted for age, sex, race, Medicaid dual eligibility status, end-stage renal disease, mortality, and indicator variables for acute myocardial infarction, hip fracture, colorectal cancer, lung cancer, and stroke and with Oaxaca-Blinder reweighting. ACOs arrayed by those with smallest increases in spending in 2012.
  • Bivalirudin vs Heparin With or Without Tirofiban During Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction: The BRIGHT Randomized Clinical Trial

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    JAMA. 2015; 313(13):1336-1346. doi: 10.1001/jama.2015.2323

    This randomized superiority trial in China found that among patients undergoing PCI, bivalirudin was associated with reduced adverse effects compared with heparin alone and heparin plus tirofiban.

  • JAMA April 7, 2015

    Figure 1: Diagram of Patient Flow in the BRIGHT Trial

    AMI indicates acute myocardial infarction; CABG, coronary artery bypass graft; NSTEMI, non–ST-segment elevation MI; PCI, percutaneous coronary intervention; STEMI, ST-segment elevation MI. The total number of patients with AMI who were screened but not enrolled and the reasons for their exclusion are not available.
  • JAMA December 3, 2014

    Figure: Example of Relationship of Risk Factors With Lifetime Benefit of Colorectal Cancer Screening With Colonoscopy

    CRC indicates colorectal cancer; RR, relative risk.aIndividuals are classified as having moderate comorbidity if diagnosed with an ulcer, rheumatologic disease, peripheral vascular disease, diabetes, paralysis, or cerebrovascular disease and in case of a history of acute myocardial infarction; as having severe comorbidity if diagnosed with chronic obstructive pulmonary disease, congestive heart failure, moderate or severe liver disease, chronic renal failure, dementia, cirrhosis and chronic hepatitis, or AIDS; and as having no comorbidity if none of these conditions is present.bThe range of the background risk for CRC is based on the National Cancer Institute’s Colorectal Cancer Risk Assessment Tool. In white women, the minimum background risk for CRC is 0.5, the maximum background risk in the absence of a family history of CRC is 1.8, and the maximum risk in the presence of a family history of CRC is 3.5.
  • JAMA November 19, 2014

    Figure 1: Extent, Distribution, and Location of Obstructive Non–Infarct-Related Artery Disease Among Patients With ST-Elevation Myocardial Infarction

    Obstructive coronary artery disease was defined as more than 50% stenosis in major epicardial coronary artery.aThe data are from the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) I trial, the GUSTO IIb trial, the GUSTO III trial, the Integrilin to Minimise Platelet Aggregation and Coronary Thrombus in Acute Myocardial Infarction (IMPACT-AMI) trial, the GUSTO V trial, the Integrilin and Tenecteplase in Acute Myocardial Infarction (INTEGRITI) trial, the Caldaret in ST Elevation Myocardial Infarction (CASTEMI) trial, and the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX AMI) trial.bPresence or absence of obstructive coronary artery disease on each vessel territory (LAD, LCX, RCA, or LMCA) was counted. The denominators include patients at risk for non-IRA disease in the specified artery who did not have missing data on angiogram-estimated stenosis necessary to determine non-IRA status.