Applicability and potential clinical effects of 2013 cholesterol guidelines on major cardiovascular events.

Background: The applicability to different race/ethnic groups and effects on cardiovascular disease (CVD) outcomes of the 2013 American College of Cardiology and American Heart Association (ACC/AHA) guidelines for cholesterol management remain to be determined. We estimated the proportion of Korean adults who would be affected by the 2013 cholesterol guidelines and to determine the related effects on cardiovascular events.

Methods: Using data from the Korean National Health and Nutrition Examination Survey of 2008 to 2012 (n = 18,573), we compared the estimated number of statin candidates under the 2013 ACC/AHA and the Third Adult Treatment Panel (ATP-III) guidelines and extrapolated the results to 19.

Using age- and sex-specific risk thresholds to guide statin therapy: one size may not fit all.

Background: New cholesterol guidelines emphasize 10-year risk of cardiovascular disease (CVD) to identify adults eligible for statin therapy as primary prevention. Whether these CVD risk thresholds should be individualized by age and sex has not been explored.

Objectives: This study evaluated the potential impact of incorporating age- and sex-specific CVD risk thresholds into current cholesterol guidelines.

Hyperlipidemia in early adulthood increases long-term risk of coronary heart disease.

Background: Many young adults with moderate hyperlipidemia do not meet statin treatment criteria under the new American Heart Association/American College of Cardiology cholesterol guidelines because they focus on 10-year cardiovascular risk. We evaluated the association between years of exposure to hypercholesterolemia in early adulthood and future coronary heart disease (CHD) risk.

Methods And Results: We examined Framingham Offspring Cohort data to identify adults without incident cardiovascular disease to 55 years of age (n=1478), and explored the association between duration of moderate hyperlipidemia (non-high-density lipoprotein cholesterol ≥ 160 mg/dL) in early adulthood and subsequent CHD.

Accuracy and validation of an automated electronic algorithm to identify patients with atrial fibrillation at risk for stroke.

Background: There is no universally accepted algorithm for identifying atrial fibrillation (AF) patients and stroke risk using electronic data for use in performance measures.

Methods: Patients with AF seen in clinic were identified based on International Classification of Diseases, Ninth Revision(ICD-9) codes. CHADS(2) and CHA(2)DS(s)-Vasc scores were derived from a broad, 10-year algorithm using IICD-9 codes dating back 10 years and a restrictive, 1-year algorithm that required a diagnosis within the past year.

Proportion of US adults potentially affected by the 2014 hypertension guideline.

Importance: The new 2014 blood pressure (BP) guideline released by the panel members appointed to the Eighth Joint National Committee (JNC 8; 2014 BP guideline) proposed less restrictive BP targets for adults aged 60 years or older and for those with diabetes and chronic kidney disease.

Objective: To estimate the proportion of US adults potentially affected by recent changes in recommendations for management of hypertension.

Design: Cross-sectional, nationally representative survey.

The impact of a measurement and feedback intervention on blood pressure control in ambulatory cardiology practice.

Background: Although hypertension is a modifiable cardiovascular risk factor, up to one-third of ambulatory patients have uncontrolled blood pressure (BP). We evaluated the impact of a targeted provider feedback intervention on rates of BP control.

Methods: Clinic BP readings were aggregated among approximately 3,000 hypertensive patients followed up in 42 outpatient cardiology clinic practices at a large quaternary care academic medical center.

Application of new cholesterol guidelines to a population-based sample.

Background: The 2013 guidelines of the American College of Cardiology and the American Heart Association (ACC-AHA) for the treatment of cholesterol expand the indications for statin therapy for the prevention of cardiovascular disease.

Methods: Using data from the National Health and Nutrition Examination Surveys of 2005 to 2010, we estimated the number, and summarized the risk-factor profile, of persons for whom statin therapy would be recommended (i.e.

The feasibility and accuracy of evaluating lipid management performance metrics using an electronic health record.

Background: Over the past decade, electronic health records (EHRs) have emerged as a potential tool to assess quality of care; however, the feasibility and accuracy of EHRs to assess adherence to lipid management performance measures have not been evaluated.

Methods: We created a retrospective cohort of 3779 patients with coronary artery disease who were followed up in a cardiology clinic at an academic medical center using an EHR database. Of these 3779 patients, 300 randomly-selected charts were reviewed to identify reasons for failure to adhere to lipid management performance measures.

Association of vaccine-related attitudes and beliefs between parents and health care providers.

Objectives: Health care providers influence parental vaccination decisions. Over 90% of parents report receiving vaccine information from their child's health care provider. The majority of parents of vaccinated children and children exempt from school immunization requirements report their child's primary provider is a good source for vaccine information.

Variability in performance measures for assessment of hypertension control.

Background: Definitions of multiple performance measures exist for the assessment of blood pressure control; however, limited data on how these technical variations may affect actual measured performance are available.

Methods: We evaluated patients with hypertension followed routinely by cardiologists at Duke University Health System from 2009 to 2010. Provider hypertension control was compared based on reading at the last clinic visit vs the average blood pressure across all visits.

Are Recent Medical Graduates More Skeptical of Vaccines?

Rates of delay and refusal of recommended childhood vaccines are increasing in many U.S. communities.

Pediatric-specific antimicrobial susceptibility data and empiric antibiotic selection.

Objective: Duke University Health System (DUHS) generates annual antibiograms combining adult and pediatric data. We hypothesized significant susceptibility differences exist for pediatric isolates and that distributing these results would alter antibiotic choices.

Methods: Susceptibility rates for Escherichia coli isolates from patients aged ≤12 years between July 2009 and September 2010 were compared with the 2009 DUHS antibiogram.

Hypertension control among patients followed by cardiologists.

Background: Hypertension control is an important and modifiable risk factor for cardiovascular disease. The overall rate of hypertension control among patients followed in cardiology clinics, as well as clinician variability in control rates, is unknown.

Methods And Results: We conducted a retrospective cohort study of patients with hypertension (n=5979) routinely followed in a cardiology clinic (n=47 physicians).

Congenital rubella syndrome and autism spectrum disorder prevented by rubella vaccination--United States, 2001-2010.

Background: Congenital rubella syndrome (CRS) is associated with several negative outcomes, including autism spectrum disorders (ASDs). The objective of this study was to estimate the numbers of CRS and ASD cases prevented by rubella vaccination in the United States from 2001 through 2010.

Methods: Prevention estimates were calculated through simple mathematical modeling, with values of model parameters determined from published literature.