Trends In Patient Characteristics Research Articles

Trends in Patient Characteristics and Outcomes of Coronary Artery Bypass Grafting in the 2000 to 2012 Medicare Population

The purpose of this analysis was to examine the trends in patient characteristics and outcomes in patients who underwent coronary artery bypass grafting (CABG) over a 12-year period in the Medicare database. The study included 1,264,265 isolated CABG procedures in the Medicare population from January 2000 through November 2012. Comorbidities were determined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes. Trends in patient characteristics and hospital outcomes were assessed with Cochran-Armitage trend tests. Long-term survival was examined with Kaplan-Meier survival curves. The median age was 74 years. Comorbidity profiles increased significantly over time. The number of patients undergoing CABG decreased from 131,385 in 2000 to 71,086 in 2012. The majority of patients underwent multivessel revascularization (13.5% single-vessel CABG, 35.2% 2-vessel CABG, 32.1% 3-vessel CABG, and 15.7% ≥4-vessel CABG). The percentage of patients undergoing 1- and 2-vessel revascularization increased over time, whereas that of ≥3-vessel CABG decreased. Single internal mammary artery (IMA) use increased from 75.6% to 88.6%. Median length of stay (LOS) was 8 days. Thirty-day mortality decreased from 4.2% to 3.0%. Hospital mortality fell from 4.0% in 2000 to 2.7% in 2012 (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.69-0.77). Survival was 93% at 6 months, 91% at 1 year, 84% at 3 years, and 76% at 5 years. Five-year survival changed little over time (range, 75%-77%). Despite rising comorbidities in Medicare patients undergoing CABG, hospital mortality fell significantly from 2000 to 2012. When adjusted for comorbidities, this signified a 27% reduction in hospital mortality. IMA use increased during the study period, and there was a trend of decreased use of 3 or more grafts.

A Pilot Study Using a Web Survey to Identify Characteristics That Influence Hypogonadal Men to Initiate Testosterone Replacement Therapy.

Men with hypogonadism (HG) who choose testosterone replacement therapy (TRT) may have distinct characteristics that provide insight as to why they may/may not initiate therapy. The aim of the current study was to identify trends in patient characteristics and attitudes in men diagnosed with HG who initiated TRT (TRT+) compared with men who were diagnosed with HG but did not initiate TRT (TRT-). The market research-based online survey conducted between 2012 and 2013 included patients from a Federated Sample, a commercially available panel of patients with diverse medical conditions. The current analysis was composed of two groups: TRT+ ( n = 155) and TRT- ( n = 157). Patient demographics, clinical characteristics, and attitudes toward HG and TRT were examined as potential predictors of primary adherence in men with HG; cohorts were compared by using Fisher's exact test. Significant associations among sexual orientation, relationship status, educational level, presence of comorbid erectile dysfunction, area of residence, and TRT initiation were present ( p ≤ .05). College-educated, heterosexual, married men with comorbid erectile dysfunction living in suburban and urban areas were more likely to initiate treatment. The most bothersome symptoms reported were lack of energy (90% vs. 81%, p = .075), decreased strength and endurance (86% vs. 76%, p = .077), and deterioration in work performance (52% vs. 31%, p = .004); lack of energy prompted men to seek help. Patients (48%) in the TRT+ group were more knowledgeable regarding HG as compared with TRT- respondents (14%, p < .001), and most men obtained their information from a health care professional (89% vs. 82%, p = .074). The current analysis identified distinct demographic and clinical characteristics and attitudes among TRT users compared with men who were diagnosed with HG yet remained untreated.

TCT-165 Trends in Patient Characteristics and Outcomes of Percutaneous Coronary Intervention in the Elderly: Analysis of Medicare Beneficiaries from 2000-2012

TCT-165 Trends in Patient Characteristics and Outcomes of Percutaneous Coronary Intervention in the Elderly: Analysis of Medicare Beneficiaries from 2000-2012

How EVAR Changed the Game: Trends in Patient Characteristics, Surgical Techniques and Outcomes of Non–-ruptured AAA Repair in Germany from 1999 to 2010

2. The number of CEAs under loco-regional anesthesia increased significantly from 10.1% to 28.1% (p < 0.0001). Intraluminal shunting was performed less frequent (48.1% to 43.5%, p < 0.0001), whereas an intraoperative morphological control of the carotid artery was performed more often (44.5% to 68.3%, p < 0.0001). Any neuro-monitoring method was used increasingly (CEA: 49.8% to 61.4%, CAS: 33.7% to 35.8%; p < 0.0001). The portion of patients who were neurologically assessed before or after CEA increased from 61.7% to 69.0% and 36.5% to 57.2% respectively. In CAS 78% of the patients were assessed before and 70% after the procedure. The median time interval between the neurological index event and CEA was reduced from 25 in 2003 to 8 days in 2013 (CAS: 9 days in 2012 and 2013). 3. Combined peri-procedural stroke and death rates decreased significantly in asymptomatic patients after CEA (2.0% to 1.3%, p 1⁄4 <0.001) and remained stable for CAS (1.7%). In symptomatic patients with a 50e99% stenosis peri-operative complication rates decreased significantly (4.6% to 2.7%, p 1⁄4 0.001) whereas CAS was associated with a risk of 3.9% in 2012 and 4.2% in 2013. Conclusion: The analysis of the annual quality reports demonstrates that CEA and CAS were performed within acceptable stroke and death rates. While patient age is increasing the clinical outcomes after CEA have improved significantly over time. Most importantly the time interval between the neurological index event and CEA or CAS could be reduced to 8 to 9 days.

Temporal Trends in Patient Characteristics and Outcomes Among Children Enrolled in Mozambique's National Antiretroviral Therapy Program.

During 2004-2009, >12,000 children (<15 years old) initiated antiretroviral therapy (ART) in Mozambique. Nationally representative outcomes and temporal trends in outcomes were investigated. Rates of death, loss to follow-up (LTFU) and attrition (death or LTFU) were evaluated in a nationally representative sample of 1054 children, who initiated ART during 2004-2009 at 25 facilities randomly selected using probability-proportional-to-size sampling. At ART initiation during 2004-2009, 50% were male; median age was 3.3 years; median CD4% was 13%; median CD4 count was 375 cells/μL; median weight-for-age Z score was -2.1. During 2004-2009, median time from HIV diagnosis to care initiation declined from 33 to 0 days (P = 0.001); median time from care to ART declined from 93 to 62 days (P = 0.004); the percentage aged <2 at ART initiation increased from 16% to 48% (P = 0.021); the percentage of patients with prior tuberculosis declined from 50% to 10% (P = 0.009); and the percentage with prior lymphocytic interstitial pneumonia declined from 16% to 1% (P < 0.001). Over 2652 person-years of ART, 183 children became LTFU and 26 died. Twelve-month attrition was 11% overall but increased from 3% to 22% during 2004-2009, mainly because of increases in 12-month LTFU (from 3% to 18%). Declines in the prevalence of markers of advanced HIV disease at ART initiation probably reflect increasing ART access. However, 12-month LTFU increased during program expansion, and this negated any program improvements in outcomes that might have resulted from earlier ART initiation.

Invited Commentary

Yazdchi and colleagues [1Yazdchi F. Koch C.G. Mihaljevic T. et al.Increasing disadvantage of “watchful waiting” for repairing degenerative mitral valve disease.Ann Thorac Surg. 2015; 99: 1992-2000Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar] have contributed a 26-year experience describing trends in patient characteristics, surgical approaches, and outcomes in patients with degenerative mitral valve regurgitation. The news is encouraging. The authors document an important shift toward referral for mitral valve operation earlier in the disease process, before the adverse consequences of mitral regurgitation on the heart and pulmonary vasculature compromise long-term outcomes. Patients undergoing mitral valve operations for degenerative disease in this experience have progressively smaller ventricular and atrial dimensions, less manifest heart failure, a lower incidence of atrial fibrillation, and a higher likelihood of presenting without symptoms. The extremely low mortality and high rates of repair are a tribute to the entire perioperative care team, and these outcomes undoubtedly have shifted the equation toward earlier referral. The author’s institution is ahead of the national curve, where fewer than 10% (compared with 44% in this report) of referred patients are asymptomatic (The Society of Thoracic Surgeons Adult Cardiac Surgery Database, accessed October 2013). The repair rate of 93% exceeds the national average of 85% and is a reminder that highly reliable and durable mitral repair is probably best achieved by surgeons with a dedicated subspecialization in mitral valve repair. Key unanswered questions include the worth of “minimally invasive” mitral valve operations, which seem to be driving substantially increased cardiopulmonary and cross-clamp times. The next steps in the therapy of degenerative mitral valve disease include continued earlier referral for operation, truly less invasive (non-cardiopulmonary bypass and catheter-based) interventions, and simplification of repair strategies to increase mitral valve repair rates and enhance durability of repair. We are looking forward to the next era. Increasing Disadvantage of “Watchful Waiting” for Repairing Degenerative Mitral Valve DiseaseThe Annals of Thoracic SurgeryVol. 99Issue 6PreviewSuccessful durable repair of severe degenerative mitral regurgitation with low operative mortality encourages intervention in asymptomatic patients rather than “watchful waiting.” Our objectives were to assess trends in patient characteristics, timing of intervention, and evolving surgical techniques at a high-volume center, and determine effects of these changes on outcomes after mitral valve (MV) repair over a 25-year period. Full-Text PDF

Increasing Disadvantage of “Watchful Waiting” for Repairing Degenerative Mitral Valve Disease

Successful durable repair of severe degenerative mitral regurgitation with low operative mortality encourages intervention in asymptomatic patients rather than "watchful waiting." Our objectives were to assess trends in patient characteristics, timing of intervention, and evolving surgical techniques at a high-volume center, and determine effects of these changes on outcomes after mitral valve (MV) repair over a 25-year period. From January 1, 1985, to January 1, 2011, 5,902 patients underwent isolated repair (with or without tricuspid repair for functional regurgitation) for degenerative MV disease at Cleveland Clinic. For illustration, the experience is presented in 3 eras: 1985 to 1997 (era 1, n= 1,184), 1997 to 2005 (era 2, n= 2,400), and 2005 to 2011 (era 3, n= 2,318). In era 3, more patients were asymptomatic onpresentation (44% in New York Heart Association [NYHA] class I vs 25% in era 1), with less heart failure (11% vs 29%) and atrial fibrillation (9.9% vs 23%). Full sternotomy decreased from era 1 (n= 1,100/93%) to era 2 (n= 602/25%) (era 3, n= 717/31%), and robotic surgery emerged (n= 577/25%) in era 3. Median length of stay shortened (era 1= 7 days, era 2= 5.9 days, era 3= 5.2 days, p < 0.0001), and in-hospital mortality remained low (era 1= 5/0.42%, era 2= 5/0.21%, era 3= 1/0.043%); 0.73% overall required reoperation on the repaired valve before discharge, and 97% had 0 to 1+ regurgitation at discharge. Treatment trends over 25 years reveal that rather than watchful waiting, a more aggressive approach to degenerative MV disease, with earlier intervention for severe regurgitation in asymptomatic patients and less invasive operative techniques, is successful, safe, and effective.

Sex differences in characteristics, utilization, and outcomes of patient undergoing total elbow arthroplasty: a study of the US nationwide inpatient sample.

The aim of this study was to compare patient characteristics, utilization rates, and outcomes after total elbow arthroplasty (TEA) by sex. We used the nationwide inpatient sample from 1998 to 2011 to study sex-related time trends in patient characteristics, comorbidity, and outcomes after TEA. We used chi-squared test, analysis of variance, and the Cochran-Armitage test to assess differences in utilization rates and characteristics over time by sex and logistic regression to compare mortality, discharge disposition, and the length of hospital stay by sex. Overall TEA utilization 0.45 in 1998 to 0.96 per 100,000 in 2011 (p < 0.0001). The utilization rates were significantly higher in females compared to males throughout the study period: 0.62 vs. 0.29 in 1998 (p < 0.0001) and 1.31 vs. 0.70 in 2011 (p < 0.0001). Compared to males, females undergoing TEA were more likely to be white (79.7 vs. 71.4 %; p < 0.0001), have rheumatoid arthritis (16.7 vs. 8.1 %; p < 0.0001), and have Deyo-Charlson index of 2 or more (11.3 vs. 5.9 %; p < 0.0001) and were older (63.5 vs. 51.4 years; p < 0.0001). Compared to males undergoing TEA, females had significantly lower mortality, 0.1 vs. 0.4 % (p = 0.03); lower proportion were discharged to home, 81.9 vs. 89.6 % (p < 0.0001), and fewer had has index hospital stay above the median, 30.0 vs. 33.0 % (p = 0.01); most differences were significant after multivariable adjustment. TEA utilization in the USA more than doubled in the last 14 years, with rates higher in females than males. Females had better outcomes after TEA than men. Preoperative risk communication should be sex-specific based on these data.

Temporal trends in patient characteristics and outcomes among Medicare beneficiaries undergoing primary prevention implantable cardioverter-defibrillator placement in the United States, 2006-2010. Results from the National Cardiovascular Data Registry's Implantable Cardioverter-Defibrillator Registry.

Contemporary patterns of use and outcomes of implantable cardioverter-defibrillators (ICDs) in community practice settings are not well characterized. We assessed temporal trends in patient characteristics and outcomes among older patients undergoing primary prevention ICD therapy in US hospitals between 2006 and 2010. Using the National Cardiovascular Data Registry's ICD Registry, we identified Medicare fee-for-service beneficiaries aged ≥65 years and older with left ventricular ejection fraction ≤35% who underwent primary prevention ICD implantation, including those receiving concomitant cardiac resynchronization therapy between 2006 and 2010 and could be matched to Medicare claims. Outcomes were mortality and hospitalization (all-cause and heart failure) at 180 days, and device-related complications. We used multivariable hierarchical logistic regression to assess temporal trends in outcomes accounting for changes in patient, physician, and hospital characteristics. The cohort included 117 100 patients. Between 2006 and 2010, only modest changes in patient characteristics were noted. Fewer single lead devices and more cardiac resynchronization therapy devices were used over time. Between 2006 and 2010, there were significant improvements in all outcomes, including 6-month all cause mortality (7.1% in 2006, 6.5% 2010; adjusted odds ratio, 0.88; 95% confidence interval, 0.82-0.95), 6-month rehospitalization (36.3% in 2006, 33.7% in 2010; adjusted odds ratio, 0.87; 95% confidence interval, 0.83-0.91), and device-related complications (5.8% in 2006, 4.8% in 2010; adjusted odds ratio, 0.80; 95% confidence interval, 0.74-0.88). The clinical characteristics of this national population of Medicare patients undergoing primary prevention ICD implantation were stable between 2006 and 2010. Simultaneous improvements in outcomes suggest meaningful advances in the care for this patient population.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Time trends in the characteristics of patients undergoing primary total knee arthroplasty.

To study the time trends in sociodemographic and clinical characteristics of patients undergoing primary total knee arthroplasty (TKA). We used the Mayo Clinic Total Joint Registry to examine the time trends in patient demographics (body mass index [BMI] and age), underlying diagnosis, medical (Deyo-Charlson Index) and psychological comorbidity (anxiety and depression), and examination findings of primary TKA patients from 1993-2005. We used the chi-square test and analysis of variance. In total, 7,229 patients constituted the primary TKA cohort; 55% were women. The mean age decreased by 1.3 years (69.3 to 68.0 years), mean BMI increased by 1.7 kg/m(2) (30.1 to 31.8 kg/m(2) ), and mean Deyo-Charlson Index increased by 36% (1.1 to 1.5) over the 13-year study period (P ≤ 0.001 for all). Compared with 1993-1995, significantly more patients (by 2-3 times) in 2002-2005 had a BMI ≥40 kg/m(2) (4.8% versus 10.6%), age <50 years (2.9% versus 5.2%), Deyo-Charlson Index of ≥3 (12% versus 22.3%), depression (4.1% versus 14.8%), and anxiety (4.1% versus 8.9%), and significantly fewer patients had an underlying diagnosis of rheumatoid/inflammatory arthritis (6.4% versus 1.5%; P < 0.001 for all). Compared with 1993-1995, significant reductions were noted in 2002-2005 for the physical examination findings of anteroposterior knee instability, mediolateral knee instability, moderate to severe knee synovitis, severe limp, fair or poor muscle strength, and absent peripheral pulses (P ≤ 0.001 for all). In this large US total joint registry study, we found significant time trends in patient characteristics, diagnosis, comorbidity, and knee/extremity examination findings in primary TKA patients over 13 years. These secular trends should be taken into account when comparing outcomes over time and in policy-making decisions.

Temporal trends in treatment outcomes for HIV-1 and HIV-2-infected adults enrolled in Côte d'Ivoire's national antiretroviral therapy program.

BackgroundIn Côte d'Ivoire during 2004–2007, numbers of ART enrollees increased from <5,000 to 36,943. Trends in nationally representative ART program outcomes have not yet been reported.Methodology/Principal FindingsWe conducted a retrospective chart review to assess trends in patient characteristics and attrition [death or loss to follow-up (LTFU)] over time, among a nationally representative sample of 3,682 adults (≥15 years) initiating ART during 2004–2007 at 34 health facilities. Among ART enrollees during 2004–2007, median age was 36, the proportion female was 67%, the proportion HIV-2-infected or dually HIV-1&2 reactive was 5%, and median baseline CD4+ T-cell (CD4) count was 135 cells/µL. Comparing cohorts initiating ART in 2004 with cohorts initiating ART in 2007, median baseline weight declined from 55 kg to 52 kg (p = 0.008) and the proportion weighing <45 kg increased from 17% to 22% (p = 0.014). During 2004–2007, pharmacy-based estimates of the percentage of new ART enrollees ≥95% adherent to ART declined from 74% to 60% (p = 0.026), and twelve-month retention declined from 86% to 69%, due to increases in 12-month mortality from 2%–4% and LTFU from 12%–28%. In univariate analysis, year of ART initiation was associated with increasing rates of both LTFU and mortality. Controlling for baseline CD4, weight, adherence, and other risk factors, year of ART initiation was still strongly associated with LTFU but not mortality. In multivariate analysis, weight <45 kg and adherence <95% remained strong predictors of LTFU and mortality.ConclusionsDuring 2004–2007, increasing prevalence among ART enrollees of measured mortality risk factors, including weight <45 kg and ART adherence <95%, might explain increases in mortality over time. However, the association between later calendar year and increasing LTFU is not explained by risk factors evaluated in this analysis. Undocumented transfers, political instability, and patient dissatisfaction with crowded facilities might explain increasing LTFU.

30-Year Trends in Patient Characteristics, Treatment Practices, and Long-Term Outcomes of Adults Aged 35 to 54 Years Hospitalized With Acute Myocardial Infarction

Much of our knowledge about the characteristics, clinical management, and postdischarge outcomes of acute myocardial infarction (AMI) is derived from clinical studies in middle-aged and older subjects with little contemporary information available about the descriptive epidemiology of AMI in relatively young men and women. The objectives of our population-based study were to describe >3-decade-long trends in the clinical features, treatment practices, and long-term outcomes of young adults aged 35 to 54years discharged from the hospital after AMI. The study population consisted of 2,142 residents of the Worcester (Massachusetts) metropolitan area who were hospitalized with AMI at all central Massachusetts medical centers during 16 annual periods from 1975 to 2007. Our primarily male study population had an average age of 47years. Patients hospitalized during the most recent decade (1997 to 2007) under study were more likely to have a history of hypertension and heart failure than those hospitalized during earlier study years. Patients were less likely to have developed heart failure or stroke during their hospitalization in the most recent compared with the initial decade under study (heart failure 13.7% and stroke 0.7% vs 20.9% and 2.0%, respectively). One- and 2-year postdischarge death rates also decreased significantly between 1975 to 1986 (6.2% and 9.0%, respectively) and 1988 to 1995 (2.6% and 4.9%). These trends were concomitant with the increasing use of effective cardiac therapies and coronary interventions during hospitalization. The present results provide insights into the changing characteristics, management, and improving long-term outcomes of relatively young patients hospitalized with AMI.

Reviewing progress: 7 year trends in characteristics of adults and children enrolled at HIV care and treatment clinics in the United Republic of Tanzania

BackgroundTo evaluate the on-going scale-up of HIV programs, we assessed trends in patient characteristics at enrolment and ART initiation over 7 years of implementation.MethodsData were from Optimal Models, a prospective open cohort study of HIV-infected (HIV+) adults (≥15 years) and children (<15 years) enrolled from January 2005 to December 2011 at 44 HIV clinics in 3 regions of mainland Tanzania (Kagera, Kigoma, Pwani) and Zanzibar. Comparative statistics for trends in characteristics of patients enrolled in 2005–2007, 2008–2009 and 2010–2011 were examined.ResultsOverall 62,801 HIV + patients were enrolled: 58,102(92.5%) adults, (66.5% female); 4,699(7.5%) children.Among adults, pregnant women enrolment increased: 6.8%, 2005–2007; 12.1%, 2008–2009; 17.2%, 2010–2011; as did entry into care from prevention of mother-to-child HIV transmission (PMTCT) programs: 6.6%, 2005–2007; 9.5%, 2008–2009; 12.6%, 2010–2011. WHO stage IV at enrolment declined: 27.1%, 2005–2007; 20.2%, 2008–2009; 11.1% 2010–2011. Of the 42.5% and 29.5% with CD4+ data at enrolment and ART initiation respectively, median CD4+ count increased: 210 cells/μL, 2005–2007; 262 cells/μL, 2008–2009; 266 cells/μL 2010–2011; but median CD4+ at ART initiation did not change (148 cells/μL overall). Stavudine initiation declined: 84.9%, 2005–2007; 43.1%, 2008–2009; 19.7%, 2010–2011.Among children, median age (years) at enrolment decreased from 6.1(IQR:2.7-10.0) in 2005–2007 to 4.8(IQR:1.9-8.6) in 2008–2009, and 4.1(IQR:1.5-8.1) in 2010–2011 and children <24 months increased from 18.5% to 26.1% and 31.5% respectively. Entry from PMTCT was 7.0%, 2005–2007; 10.7%, 2008–2009; 15.0%, 2010–2011. WHO stage IV at enrolment declined from 22.9%, 2005–2007, to 18.3%, 2008–2009 to 13.9%, 2010–2011. Proportion initiating stavudine was 39.8% 2005–2007; 39.5%, 2008–2009; 26.1%, 2010–2011. Median age at ART initiation also declined significantly.ConclusionsOver time, the proportion of pregnant women and of adults and children enrolled from PMTCT programs increased. There was a decline in adults and children with advanced HIV disease at enrolment and initiation of stavudine. Pediatric age at enrolment and ART initiation declined. Results suggest HIV program maturation from an emergency response.

Temporal Trends in Patient Characteristics and Treatment With Intravenous Thrombolysis Among Acute Ischemic Stroke Patients at Get With the Guidelines-Stroke Hospitals

Substantial efforts over the past decade have increased rates of intravenous tissue plasminogen activator (tPA) use in the United States. We sought to determine changes in patient characteristics and rates of tPA use over time among hospitalized acute ischemic stroke (AIS) patients. We analyzed all AIS patients (n=1 093 895) and those arriving ≤ 2 hours and treated with tPA ≤ 3 hours after onset (n=50 798) from 2003 to 2011 in the American Heart Association's Get with the Guideline-Stroke (GWTG-Stroke). Categorical data were analyzed by Pearson χ(2) and continuous data by Wilcoxon test. Intravenous tPA use ≤ 3 hours after onset increased from 4.0% to 7.0% in all AIS admissions and 42.6% to 77.0% in AIS patients arriving ≤ 2 hours and fully eligible for tPA (P<0.001). In univariate analysis, tPA use increased over time, especially in those aged >85 years, nonwhite, and with milder strokes (National Institutes of Health Stroke Scale 0-4). Door-to-image time (median 24 versus 20 minutes) and door-to-tPA time (median 81 versus 72 minutes) also improved, with ≈65% of tPA-treated patients getting brain imaging ≤ 25 minutes after arrival. Multivariable analysis showed that with each additional calendar year, the odds that an eligible patient would receive tPA increased by 1.37-fold, adjusting for other covariates. The frequency of IV tPA use among all AIS patients, regardless of contraindications, nearly doubled from 2003 to 2011. Treatment with tPA has expanded to include more patients with mild deficits, nonwhite race/ethnicity, and oldest old age.

Temporal Trends in Patient Characteristics and Treatment With Intravenous Thrombolysis Among Acute Ischemic Stroke Patients at Get With the Guidelines–Stroke Hospitals

Background— Substantial efforts over the past decade have increased rates of intravenous tissue plasminogen activator (tPA) use in the United States. We sought to determine changes in patient characteristics and rates of tPA use over time among hospitalized acute ischemic stroke (AIS) patients. Methods and Results— We analyzed all AIS patients (n=1 093 895) and those arriving ≤2 hours and treated with tPA ≤3 hours after onset (n=50 798) from 2003 to 2011 in the American Heart Association’s Get with the Guideline–Stroke (GWTG–Stroke). Categorical data were analyzed by Pearson χ 2 and continuous data by Wilcoxon test. Intravenous tPA use ≤3 hours after onset increased from 4.0% to 7.0% in all AIS admissions and 42.6% to 77.0% in AIS patients arriving ≤2 hours and fully eligible for tPA ( P &lt;0.001). In univariate analysis, tPA use increased over time, especially in those aged &gt;85 years, nonwhite, and with milder strokes (National Institutes of Health Stroke Scale 0–4). Door-to-image time (median 24 versus 20 minutes) and door-to-tPA time (median 81 versus 72 minutes) also improved, with ≈65% of tPA-treated patients getting brain imaging ≤25 minutes after arrival. Multivariable analysis showed that with each additional calendar year, the odds that an eligible patient would receive tPA increased by 1.37-fold, adjusting for other covariates. Conclusions— The frequency of IV tPA use among all AIS patients, regardless of contraindications, nearly doubled from 2003 to 2011. Treatment with tPA has expanded to include more patients with mild deficits, nonwhite race/ethnicity, and oldest old age.

Temporal changes in patient characteristics and prophylactic pharmacotherapy among 156,496 patients referred for coronary angiography between 2000 and 2009 - a nationwide study

Background: Coronary angiography (CAG) holds a central role in the diagnosis of coronary heart disease. We studied the temporal trends in patient characteristics in a nationwide cohort of patients referred for CAG between 2000 and 2009. Methods: Patients undergoing their first CAG between 2000 and 2009 were identified in the nationwide Danish Heart Register. Trends in patient characteristics, pharmacological treatment and comorbidity prior to CAG were analyzed by logistic regression models. Results: A marked increase in the number of acute (5,943 to 10,707) as well as elective (17,294 to 25,550) procedures was observed between 2000-2001 and 2008-2009. Further, mean age increased from 61.8 to 63.9 years (p for difference <0.0001) and proportion of females increased from 33% to 37% (p for difference <0.0001). In 2008-2009 a lower proportion of patients with chronic heart failure (12.3% vs. 8.8%) and a higher proportion of diabetic patients (10.9% vs 12.7%) were referred for CAG compared to 2000-2001. Although the use of statins, antithrombotic therapy, ACE-inhibitors and, beta-blockers prior to angiography increased during the study period, prophylactic pharmacotherapy was still underutilized in 2008-2009 (Figure). Odds ratios for the use of statins, ACE-inhibitors and, antithrombotics in 2008-2009 were 3.42 [3.27; 3.57], 1.85 [1.77; 1.93] and, 1.43 [1.37; 1.49], respectively (2000-2001 used as reference). Elective patients received more prophylactic pharmacotherapy than acute patients (p<0.0001). ![Figure][1] Figure 1 Conclusion: During a 10 year period there was a substantial increase in CAG procedures, increased mean age and, increased proportion of females. Use of prophylactic drugs prior to angiography increased markedly, but treatment frequency may still be too low; however this remains to be further investigated. [1]: pending:yes

Long-Term Outcomes of Pediatric Living Donor Liver Transplantation in Japan: An Analysis of More Than 2200 Cases Listed in the Registry of the Japanese Liver Transplantation Society

The Japanese Liver Transplantation Society (JLTS) was established in 1980 in order to characterize and follow trends in patient characteristics and graft survival among all liver transplant patients in Japan. This study analyzed the comprehensive factors that may influence the outcomes of pediatric patients who undergo living donor liver transplantation (LDLT) by evaluating the largest cohort in the world. Between November 1989 and December 2010, 2224 pediatric patients underwent LDLT in Japan. There were 998 male (44.9%) and 1226 female donors (55.1%) without donor mortalities related to transplant surgery. There were 946 male (42.5%) and 1278 female (57.5%) recipients with a median age of 4.0 years (range: 13 days to 17.9 years). Cholestatic liver disease was the leading indication for LDLT (n = 1649; 76.2%), followed by metabolic disorders (n = 194; 8.7%), acute liver failure (n = 192; 8.6%) and neoplastic liver disease (n = 66; 3.0%). The 1-, 5-, 10- and 20-year patient survival rates were 88.3%, 85.4%, 82.8% and 79.6%, respectively. Blood-type incompatibility, recipient age, etiology of liver disease and transplant era were found to be significant predictors of overall survival. We are able to achieve satisfactory long-term pediatric patient survival outcomes in the JLTS series without compromising the living donors.

Circulation Editors’ Picks

<i>Circulation</i> Editors’ Picks

OP0297 Trends in Prescription of Biologics and Outcomes of Juvenile Idiopathic Arthritis; Results of the Dutch National Arthritis and Biologicals in Children Register

BackgroundTreatment of juvenile idiopathic arthritis (JIA) has changed dramatically since the introduction of biologics in 1999. Because of more insight in the immunological and biological pathways involved in the development...