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Articles by C. W Yancy
Total Records ( 3 ) for C. W Yancy
  G. C Fonarow , T Gregory , M Driskill , M. D Stewart , C Beam , J Butler , A. K Jacobs , N. M Meltzer , E. D Peterson , L. H Schwamm , J. A Spertus , C. W Yancy , G. F Tomaselli and R. L. Sacco
 

Cardiovascular disease and stroke remain leading causes of mortality, disability, and rising healthcare expenditures in the United States. Although a number of organizations provide hospital accreditation, recognition, and certification programs, existing programs do not address cardiovascular disease and stroke care in a comprehensive way. Current evidence suggests mixed findings for correlation between accreditation, recognition, and certification programs and hospitals' actual quality of care and outcomes. This advisory discusses potential opportunities to develop and enhance hospital certification programs for cardiovascular disease and stroke. The American Heart Association/American Stroke Association is uniquely positioned as a patient-centered, respected, transparent healthcare organization to help drive improvements in care and outcomes for patients hospitalized with cardiovascular disease and stroke. As a part of its commitment to promoting high-quality, evidence-based care for cardiovascular and stroke patients, it is recommended that the American Heart Association/American Stroke Association explore hospital certification programs to develop truly meaningful programs to facilitate improvements in and recognition for cardiovascular disease and stroke quality of care and outcomes. Future strategies should standardize objective, unbiased assessments of hospital structural, process, and outcome performance while allowing flexibility as technology and methodology advances occur.

  A. F Hernandez , G. C Fonarow , B. G Hammill , S. M Al Khatib , C. W Yancy , C. M O'Connor , K. A Schulman , E. D Peterson and L. H. Curtis
 

Background— The clinical effectiveness of implantable cardioverter-defibrillators (ICDs) in older patients with heart failure has not been established, and older patients have been underrepresented in previous studies.

Methods and Results— We identified patients with heart failure who were aged 65 years or older and were eligible for an ICD, had left ventricular ejection fraction of 35% or less, and were discharged alive from hospitals participating in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure and the Get With the Guidelines–Heart Failure quality-improvement programs during the period January 1, 2003, through December 31, 2006. We matched the patients to Medicare claims to examine long-term outcomes. The main outcome measure was all-cause mortality over 3 years. The study population included 4685 patients who were discharged alive and were eligible for an ICD. Mean age was 75.2 years, 60% of the patients were women, mean ejection fraction was 25%, and 376 (8.0%) patients received an ICD before discharge. Mortality was significantly lower among patients who received an ICD compared with those who did not (19.8% versus 27.6% at 1 year, 30.9% versus 41.9% at 2 years, and 38.1% versus 52.3% at 3 years; P<0.001 for all comparisons). The inverse probability-weighted adjusted hazard of mortality at 3 years for patients receiving an ICD was 0.71 (95% CI, 0.56 to 0.91).

Conclusions— Medicare beneficiaries hospitalized with heart failure and left ventricular ejection fraction of 35% or less who were selected for ICD therapy had lower risk-adjusted long-term mortality compared with those who did not receive an ICD.

Clinical Trial Registration— clinicaltrials.gov. Identifier: NCT00344513.

  J. T Heywood , G. C Fonarow , C. W Yancy , N. M Albert , A. B Curtis , M Gheorghiade , P. J Inge , M. L McBride , M. R Mehra , C. M O'Connor , D Reynolds and M. N. Walsh
  Background—

Few data exist to characterize the delivery of evidence-based medical therapy for outpatients with heart failure who have received implantable cardioverter-defibrillators or cardiac resynchronization therapy (CRT) for systolic dysfunction.

Methods and Results—

IMPROVE HF is a prospective study characterizing the management of 15 381 outpatients with systolic heart failure (left ventricular ejection fraction ≤35%) enrolled from 167 US cardiology practices. Data were abstracted for dose, type, and daily frequency for angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and aldosterone antagonists. Target doses for each medication class were based on current guidelines. Patients with devices (implantable cardioverter-defibrillators, CRT with defibrillators, or CRT with pacemakers) more frequently received evidence-based medical therapy than did those without such devices, although treatment at or above target doses was low for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (implantable cardioverter-defibrillators 32.6%, CRT with pacemaker 30.7%, CRT with defibrillator 32.0%, no device 34.6%) and β-blockers (20.2%, 17.4%, 20.4%, and 15.3%, respectively). Fewer patients received aldosterone antagonists, although when used, doses were more frequently within the target dosing range (70.1%, 72.1%, 72.7%, and 76.5%, respectively). Multivariable models showed that use of CRT with defibrillators and CRT with pacemakers was significantly associated with delivery of β-blockers at or above target doses, but no device therapies were associated with angiotensin-converting enzyme inhibitor/angiotensin receptor blocker or aldosterone antagonist dosing.

Conclusions—

Patients treated with heart failure devices received evidence-based medical therapy at similar or greater frequency than did those without such devices. Patients with CRT with defibrillator or CRT with pacemaker devices were more likely to be treated with target doses of β-blockers than were patients not treated with device therapy. Doses of evidenced-based therapies remain significantly lower in clinical practice than in clinical trials.

Clinical Trial Registration—

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00303979.

 
 
 
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