Acute coronary syndrome in young women under 55 years of age: clinical characteristics, treatment, and outcomes.

Background: Young women with acute coronary syndrome (ACS) may represent a high risk group, but little is known about specific age and sex differences in clinical characteristics, treatment, outcomes, and trends over time.

Methods: Data from 3237 men and women admitted with an ACS event from 1999 to 2006 were analyzed. Patients were grouped by sex and age less than 55 years.

Evaluation of a postdischarge coronary artery disease management program.

Objectives: We conducted a demonstration project to assess the value of a nurse practitioner (NP) based coronary artery disease management (CAD-DM) program for patients with an acute coronary syndrome (ACS) or percutaneous coronary intervention.

Methods: Patients were recruited to attend three 1-h monthly visits. The intervention included assessment of clinical symptoms and guideline-based treatments; education regarding CAD/ACS; review of nutrition, exercise, and appropriate referrals; and recognition of significant symptoms and emergency response.

Survival in systemic sclerosis with pulmonary arterial hypertension has not improved in the modern era.

Background: The impact of modern therapy on survival in pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SSc) is not clear. We sought to determine associations among commonly used clinical and hemodynamic variables, treatment, and long-term survival in PAH associated with SSc compared with PAH defined as idiopathic, familial, or associated with anorexigens.

Methods: The observation period (1996-2010) included the option for epoprostenol and the availability of oral agents in 2002 (modern era of endothelin antagonists and phosphodiesterase-5 inhibitors).

Quality of life and baseline characteristics associated with depressive symptoms among patients with heart disease.

We sought to examine factors associated with depressive symptoms among patients with heart disease. Data from 197 patients admitted for coronary artery disease were examined using multivariate predictive models. Women and unmarried patients were more likely to report depressive symptoms.

Physician variation in perceived barriers to personal health.

Objective: Physicians' personal health habits are associated with their counseling habits regarding physical activity. We sought to examine physicians' own barriers to a healthy lifestyle by level of training and gender.

Methods: Physicians at a major teaching hospital were surveyed regarding their lifestyle habits and barriers to healthy habits.

Lipoprotein (a): perspectives from a lipid-referral program.

Background: Lipoprotein (a) [Lp(a)] has a strong association with coronary disease (CHD). We evaluated the implications of implementing a niacin strategy in persons above low risk by the Framingham risk score (FRS).

Methods: Patients referred to a university lipid management program from January 2004 to June 2010 had an Lp(a) level measured at initial evaluation.

Effect of use of combination evidence-based medical therapy after acute coronary syndromes on long-term outcomes.

Several medications have individually been shown to reduce mortality in patients with acute coronary syndromes (ACS), but data on long-term outcomes related to the use of combinations of these medications are limited. For 2,684 consecutive patients admitted with ACS from January 1999 and January 2007, a composite score was calculated correlating with the use upon discharge of indicated evidence-based medications (EBMs): aspirin, β blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and lipid-lowering agents. Multivariate models were used to examine the impact of EBM score on 2-year events with adjustment for components of the Global Registry of Acute Coronary Events (GRACE) risk score, thienopyridine use, and year of discharge.

The metabolic fitness program: lifestyle modification for the metabolic syndrome using the resources of cardiac rehabilitation.

Purpose: To describe and assess the effectiveness of a lifestyle intervention program (Met Fit) designed to treat the metabolic syndrome (MetSyn) in a cardiac rehabilitation setting.

Methods: Met Fit is a physician referred and patient pay ($350) program consisting of 12 weekly sessions of 45 minutes of exercise and 45 minutes of education with target exercise recommendations of 150 to 200 minutes weekly and 5% loss in body weight using a Mediterranean-style diet. Primary outcomes are compliance with program recommendations and secondary outcomes effecting MetSyn components.

Does the outcome justify an oral-first treatment strategy for management of pulmonary arterial hypertension?

Background: Guidelines for the treatment of World Health Organization (WHO) functional class (FC) III pulmonary arterial hypertension (PAH) provide for oral (PO) therapy or parenteral prostacyclins at the discretion of expert physicians. The objective of this study was to assess the appropriateness of PO-first treatment in patients with WHO FC III PAH.

Methods: This study was a retrospective analysis of 79 treatment-naive adult patients with idiopathic, familial, or anorexigen-associated PAH, referred to a single pulmonary hypertension center.

Potential effects on clinical management of treatment algorithms on the basis of apolipoprotein-B/A-1 and total/high-density lipoprotein-cholesterol ratios.

Background: Apolipoprotein-B/A-1 (apoB/A-R) and total/high-density lipoprotein-cholesterol ratios (TC/HDL-R) outperform non-high-density lipoprotein-cholesterol (non-HDL-C) suggested by Adult Treatment Panel (ATP) III guidelines for predicting cardiovascular (CV) outcomes.

Objective: To evaluate the potential effects that implementing our proposed apoB/A-R and TC/HDL-R treatment algorithms would have on clinical management.

Methods: We performed a chart review of all patients referred to the University of Michigan Lipid Clinic from January 2004 to June 2010.

Perceived quality of care and lifestyle counseling among patients with heart disease.

Background: To examine patients' perceived quality of care and reported receipt of information on diet and exercise related to cardiovascular disease prevention.

Methods: Patients admitted with acute coronary syndromes or elective cardiac catheterization were eligible for enrollment. Baseline medical information was collected through medical-record review.

Psychological distress in cardiac rehabilitation participants.

Purpose: Limited data are available on the psychosocial characteristics of patients entering cardiac rehabilitation (CR). We characterized the psychological and clinical profiles of men and women entering CR to determine which, if any, characteristic identifies persons at high risk for psychological distress.

Methods: The records of 417 patients enrolled in phase II CR between January 2001 and December 2004 were analyzed.

Patient-related diet and exercise counseling: do providers' own lifestyle habits matter?

The goal of this research was to evaluate the personal health behaviors of physicians in training and attending physicians in association with patient-related lifestyle counseling. Physicians at a major teaching hospital were surveyed regarding their personal lifestyle behavior, perceived confidence, and frequency of counseling patients regarding lifestyle behaviors. One hundred eighty-three total responses were received.

Differences in mortality among Mexican-American, Puerto Rican, and Cuban-American dialysis patients in the United States.

Background: The Hispanic ethnic group is heterogeneous, with distinct genetic, cultural, and socioeconomic characteristics, but most prior studies of patients with end-stage renal disease focus on the overall Hispanic ethnic group without further granularity. We examined survival differences among Mexican-American, Puerto Rican, and Cuban-American dialysis patients in the United States.

Study Design: Prospective observational study.