A general factor model for the Beck Depression Inventory-II: validation in a sample of patients hospitalized with acute myocardial infarction.

Objective: Many studies have linked symptoms of depression after an acute myocardial infarction (AMI) to negative health outcomes, including mortality. It has been suggested, however, that this link may be due to biased measurement of depressive symptoms in post-AMI patients related to confounding with somatic symptoms related to AMI. The objective of this study was to validate a factor model for the Beck Depression Inventory-II (BDI-II) that would allow for modeling of depressive symptoms after explicitly removing bias related to somatic symptom overlap.

Comparing invasive and noninvasive management strategies for acute myocardial infarction using administrative databases.

Purpose: The aim of this study was to compare outcomes after acute myocardial infarction between regions with low and high catheterization access.

Methods: Observational study using administrative databases of patients with acute myocardial infarction in provinces with low (Ontario) and high (Quebec and British Colombia) access to invasive cardiac procedures (ICP, n = 141718). Using instrumental variables to control for confounding, effectiveness of treatment was measured on 1-year mortality among marginal patients (patients for whom treatment is discretionary and highly dependent on access to ICP).

Impact of on-site cardiac catheterization on resource utilization and fatal and non-fatal outcomes after acute myocardial infarction.

Background: Patterns of care for acute myocardial infarction (AMI) strongly depend on the availability of on-site cardiac catheterization facilities. Although the management found at hospitals without on-site catheterization does not lead to increased mortality, little it known about its impact on resource utilization and non-fatal outcomes.

Methods: We identified all patients (n = 35,289) admitted with a first AMI in the province of Quebec between January 1, 1996 and March 31, 1999 using population-based administrative databases.

Administrative Data Feedback for Effective Cardiac Treatment: AFFECT, a cluster randomized trial.

Context: Hospital report cards are increasingly being implemented for quality improvement despite lack of strong evidence to support their use.

Objective: To determine whether hospital report cards constructed using linked hospital and prescription administrative databases are effective for improving quality of care for acute myocardial infarction (AMI).

Design: The Administrative Data Feedback for Effective Cardiac Treatment (AFFECT) study, a cluster randomized trial.

Invasive versus noninvasive management of ST-elevation acute myocardial infarction: a review of clinical trials and observational studies.

Background: Despite decades of research, it is still unclear whether patients with uncomplicated ST-segment elevation acute myocardial infarction (AMI) should be managed with an invasive or a noninvasive approach after successful thrombolysis.

Methods: We reviewed randomized trials in which patients were randomized to a strategy of routine cardiac catheterization after thrombolysis (invasive) or a strategy whereby patients received cardiac catheterization only if they demonstrated reversible ischemia by noninvasive testing (noninvasive). We also reviewed observational studies that compared outcomes for patients who were admitted to hospitals with and without availability of cardiac catheterization facilities or in different geographic regions.

Secondary prevention after acute myocardial infarction in four Canadian provinces, 1997-2000.

Background: Publication of population-based analyses of medication use after acute myocardial infarction (AMI) could encourage the use of effective secondary prevention medications.

Objective: To describe outpatient use of beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, statins, calcium channel blockers and nitrates in elderly survivors of AMI over the fiscal years from 1997/98 to 1999/2000 in Nova Scotia, Quebec, Ontario and British Columbia.

Methods: Linked administrative databases were used to identify all AMI patients 65 years of age or older admitted in Quebec (n=14,880), Ontario (n=28,647) and British Columbia (n=7549) over the study period, and to measure 90-day postdischarge utilization rates of cardiac medications for these patients.

Does aggressive care following acute myocardial infarction reduce mortality? Analysis with instrumental variables to compare effectiveness in Canadian and United States patient populations.

Background: Previous U.S. studies suggest that the incremental ("marginal") use of the aggressive approach to care for acute myocardial infarction (AMI) in patients differing only in their distance to hospitals offering aggressive care may be associated with small mortality benefits.

Depression and prognosis following hospital admission because of acute myocardial infarction.

Background: Whether there is an association between depression at the time of acute myocardial infarction and subsequent risk of cardiac complications and death remains controversial. Most studies of this risk factor have been limited to patients of single institutions, and this might account for the varying results. We prospectively evaluated patients admitted to 5 tertiary care and 5 community hospitals and followed them for 1 year to measure the prevalence and prognostic impact of depressive symptoms after acute myocardial infarction.