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Articles by F. A Masoudi
Total Records ( 5 ) for F. A Masoudi
  P. N Peterson , J. S Rumsfeld , L Liang , N. M Albert , A. F Hernandez , E. D Peterson , G. C Fonarow , F. A Masoudi and on behalf of the American Heart Association Get With the Guidelines Heart Failure Program
 

Background— Effective risk stratification can inform clinical decision-making. Our objective was to derive and validate a risk score for in-hospital mortality in patients hospitalized with heart failure using American Heart Association Get With the Guidelines–Heart Failure (GWTG-HF) program data.

Methods and Results— A cohort of 39 783 patients admitted January 1, 2005, to June 26, 2007, to 198 hospitals participating in GWTG-HF was divided into derivation (70%, n=27 850) and validation (30%, n=11 933) samples. Multivariable logistic regression identified predictors of in-hospital mortality in the derivation sample from candidate demographic, medical history, and laboratory variables collected at admission. In-hospital mortality rate was 2.86% (n=1139). Age, systolic blood pressure, blood urea nitrogen, heart rate, sodium, chronic obstructive pulmonary disease, and nonblack race were predictive of in-hospital mortality. The model had good discrimination in the derivation and validation datasets (c-index, 0.75 in each). Effect estimates from the entire sample were used to generate a mortality risk score. The predicted probability of in-hospital mortality varied more than 24-fold across deciles (range, 0.4% to 9.7%) and corresponded with observed mortality rates. The model had the same operating characteristics among those with preserved and impaired left ventricular systolic function. The morality risk score can be calculated on the Web-based calculator available with the GWTG-HF data entry tool.

Conclusions— The GWTG-HF risk score uses commonly available clinical variables to predict in-hospital mortality and provides clinicians with a validated tool for risk stratification that is applicable to a broad spectrum of patients with heart failure, including those with preserved left ventricular systolic function.

  P. J Hauptman , J. P Swindle , F. A Masoudi and T. E. Burroughs
 

Background— Current guidelines emphasize the need for optimal medical therapy before implantation of cardiac devices (implantable cardioverter-defibrillator, cardiac resynchronization therapy). Our objective was to evaluate use of β-blockers (BB) among patients with heart failure undergoing a cardiac device procedure.

Methods and Results— We used a large, multistate, managed-care database (January 2003 to December 2006) to identify adults admitted with an International Classification of Diseases, Ninth Revision (ICD-9) procedure code for cardiac device, continuous enrollment for 180 days before and 180 days after device procedure, and a primary or secondary ICD-9 diagnosis code for heart failure during that period. Our primary measures were use of BB before device procedure and changes after discharge. A total of 2766 beneficiaries (78.8% men; median age, 61 years) underwent a device procedure for primary prevention. The median number of days on BB therapy in the 90 days before device procedure was 46. Beneficiaries who did not have a pharmacy fill for BB during that time (n=925, 33.4%) were more elderly and had fewer antecedent outpatient visits with a cardiologist. There was a shift toward greater use of BB after device procedure; 83.4% had at least 1 pharmacy fill for a BB during follow-up.

Conclusions— BB are underused before and after cardiac device procedures. There is a modest increase in use after the procedure. Strategies are required to ensure that patients are on optimal medical therapy before device therapy is selected.

  K. J Lipska , Y Wang , M Kosiborod , F. A Masoudi , E. P Havranek , H. M Krumholz and S. E. Inzucchi
 

Background— Patients with diabetes are frequently admitted for acute myocardial infarction (AMI) on antihyperglycemic agents but may be discharged without glucose-lowering therapy. We examined the frequency of this practice and evaluated the associated outcomes of readmission and mortality.

Methods and Results— We conducted a retrospective study of 24 953 Medicare beneficiaries with diabetes discharged after hospitalization for AMI. We examined the frequency of discontinuation of antihyperglycemic agents on discharge among those patients admitted on a diabetic regimen. The independent association between discharge on versus off antihyperglycemic therapy and outcomes at 1 year was assessed in multivariable Cox proportional hazards models, adjusting for patient, physician, and hospital variables. The primary outcome was time to death within 1 year of discharge; secondary outcomes were time to first rehospitalization within 1 year for AMI, heart failure, and all causes. There were 8751 patients admitted on at least 1 antihyperglycemic agent who met our inclusion/exclusion criteria. Of these, 7581 (86.6%) were discharged on antihyperglycemic therapy and 1170 (13.4%) were discharged off antihyperglycemic therapy. After multivariable analysis, as compared with those whose diabetes therapy was continued at discharge, patients who were not prescribed a glucose-lowering agent had higher 1-year mortality rate (hazard ratio, 1.29; 95% confidence interval, 1.15 to 1.45). Readmission rates did not differ significantly between the 2 groups (hazard ratio, 0.95; 95% confidence interval, 0.87 to 1.03).

Conclusions— In older patients with diabetes after AMI, discontinuation of antihyperglycemic therapy is common and associated with higher mortality rates. The reasons behind this practice as well as the specific effects of hyperglycemia after AMI merit further study.

  P. N Peterson , J. S Rumsfeld , L Liang , A. F Hernandez , E. D Peterson , G. C Fonarow , F. A Masoudi and on behalf of the American Heart Association Get With The Guidelines Heart Failure Program
 

Background— Although the absolute benefits of an intervention are proportional to patients’ underlying risk, studies in heart failure have noted a paradoxical inverse relationship between treatment and risk. The extent to which this reflects higher rates of contraindications in patients with higher risk or larger gaps in care quality has not been explored.

Methods and Results— We studied 18 307 patients with left ventricular systolic dysfunction surviving hospitalization between January 2005 and June 2007 from 194 hospitals participating in Get With The Guidelines (GWTG)–Heart Failure. Patients were categorized according to their estimated risk for in-hospital mortality using a validated risk score. The proportions of patients with documented contraindications to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and β-blockers as well as the use of these medications among patients without contraindications at hospital discharge was determined across levels of risk. For each therapy, the proportion of patients with contraindications was significantly higher with increasing patient risk (P<0.001 for each). Even after excluding those with contraindications, the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and β-blockers was significantly lower with increasing risk (P<0.001 for each).

Conclusions— The use of evidence-based therapies is lower in patients with heart failure at higher risk of mortality both because of higher rates of contraindications to therapy and lower rates of use among eligible patients. Optimizing heart failure outcomes will require both the expansion of the evidence base for treating the highest-risk patients as well as the development of effective strategies to assure that eligible high-risk patients receive all appropriate therapies.

  A. C Salisbury , K. P Alexander , K. J Reid , F. A Masoudi , S. S Rathore , T. Y Wang , R. G Bach , S. P Marso , J. A Spertus and M. Kosiborod
  Background—

Anemia is common among patients hospitalized with acute myocardial infarction and is associated with poor outcomes. Less is known about the incidence, correlates, and prognostic implications of acute, hospital-acquired anemia (HAA).

Methods and Results—

We identified 2909 patients with acute myocardial infarction who had normal hemoglobin (Hgb) on admission in the multicenter TRIUMPH registry and defined HAA by criteria proposed by Beutler and Waalen. We used hierarchical Poisson regression to identify independent correlates of HAA and multivariable proportional hazards regression to identify the association of HAA with mortality and health status. At discharge, 1321 (45.4%) patients had HAA, of whom 348 (26.3%) developed moderate-severe HAA (Hgb <11 g/dL). The incidence of HAA varied significantly across hospitals (range, 33% to 69%; median rate ratio for HAA, 1.13; 95% confidence interval, 1.07 to 1.23, adjusting for patient characteristics). Although documented bleeding was more frequent with more severe HAA, fewer than half of the patients with moderate-severe HAA had any documented bleeding. Independent correlates of HAA included age, female sex, white race, chronic kidney disease, ST-segment elevation myocardial infarction, acute renal failure, use of glycoprotein IIb/IIIa inhibitors, in-hospital complications (cardiogenic shock, bleeding and bleeding severity), and length of stay. After adjustment for GRACE score and bleeding, patients with moderate-severe HAA had higher mortality rates (hazard ratio, 1.82; 95% confidence interval, 1.11 to 2.98 versus no HAA) and poorer health status at 1 year.

Conclusions—

HAA develops in nearly half of acute myocardial infarction hospitalizations among patients treated medically or with percutaneous coronary intervention, commonly in the absence of documented bleeding, and is associated with worse mortality and health status. Better understanding of how HAA can be prevented and whether its prevention can improve patient outcomes is needed.

 
 
 
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