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Articles by N. M Albert
Total Records ( 2 ) for N. M Albert
  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.

  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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