A community-wide quality improvement initiative to improve hypertension control and reduce disparities.

Initiatives to improve hypertension control within academic medical centers and closed health systems have been extensively studied, but large community-wide quality improvement (QI) initiatives have been both less common and less successful in the United States. The authors examined a community-wide QI initiative across 226 843 patients from 198 practices in nine counties across upstate New York to improve hypertension control and reduce disparities. The QI initiative focused on (a) providing population and practice-level comparative data, (b) community engagement, especially in underserved communities, and (c) practice-level quality improvement assistance, but was not designed to examine causality of specific components.

Patient Experience With Care and Its Association With Adherence to Hypertension Medications.

Background: Medication adherence is crucial to effective chronic disease management, yet little is known about the influence of the patient-provider interaction on medication adherence to hypertensive regimens. We aimed to examine the association between the patient's experience with care and medication adherence.

Methods: We collected 2,128 surveys over 4 years from a convenience sample of hypertensive patients seeking care at three urban safety-net practices in upstate New York.

Effectiveness of a multidisciplinary intervention to improve hypertension control in an urban underserved practice.

Patient-centered, multidisciplinary interventions offer one of the most promising strategies to improve blood pressure (BP) control, yet effectiveness trials in underserved real-world settings are limited. We used a multidisciplinary strategy to improve hypertension control in an underserved urban practice. We collected 1007 surveys to monitor medication adherence and used weighted generalized estimating equations to examine trends in BP control.

Clinical profile and underdiagnosis of pulmonary hypertension in US veteran patients.

Background: Pulmonary hypertension (PH) is a key contributor to cardiovascular morbidity and early mortality; however, reports are lacking on the epidemiology of PH in at-risk patient populations.

Methods And Results: The echocardiography registries from 2 major Veterans Affairs hospitals were accessed to identify patients with at least moderate PH, defined here as a pulmonary artery systolic pressure ≥60 mm Hg detected echocardiographically. From a total of 10 471 individual patient transthoracic echocardiograms, we identified moderate or severe PH in 340 patients (332 men; mean, 77 years; mean pulmonary artery systolic pressure, 69.

Endocarditis with aortic root pseudoaneurysm rupture.

We report a case of aortic valve endocarditis complicated by aortic root pseudoaneurysm and rupture. (Cardiol J 2007; 14: 202-204).

Comparison of management patterns and clinical outcomes in patients with atrial fibrillation in Canada and the United States (from the analysis of the Atrial Fibrillation Follow-up Investigation of Rhythm Management [AFFIRM] database).

Little is known about differences in practice patterns or outcomes in the management of patients who have atrial fibrillation in Canada compared with those in the United States (US). We evaluated the effect that the country of enrollment may have on the management patterns and clinical outcomes in patients who participated in the AFFIRM study. Three thousand four hundred patients came from the US and 660 from Canada.

Alternative endpoints for mortality in studies of patients with atrial fibrillation: the AFFIRM study experience.

Objectives: The purpose of this study was to examine possible alternatives for death, particularly hospitalization for cardiovascular reasons (CV hospitalization), as an endpoint in studies of atrial fibrillation (AF) using the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) database.

Background: AF is associated with increased mortality, but large numbers of patients are needed to demonstrate even a moderate effect of a therapy on mortality.

Methods: AFFIRM studied 4,060 patients with AF, randomized to either rate-control or rhythm-control strategy with death as the primary endpoint.

Quality of life in atrial fibrillation: the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study.

Objective: The objective of this prespecified substudy of the AFFIRM study, in which no differences in survival or event rates were found in patients with atrial fibrillation (AF) randomized to either rate control or rhythm control, was to test the null hypothesis that quality of life (QoL) is equal with rate- versus rhythm-control treatment strategies in AF.

Methods: Fifty-six (25%) of AFFIRM sites were randomly selected to recruit AFFIRM patients for the QoL substudy. Instruments used in the QoL assessment were (1) Perceived Health; (2) the Cantril Ladder of Life; (3) the Short Form 36 survey; (4) the QoL Index; and (5) the Symptom Checklist: Frequency and Severity.

Evaluation of a noninvasive system for determining left ventricular filling pressure.

Background: Measurement of left ventricular filling pressure (LVFP) provides an accurate assessment of left ventricular failure. Clinical and radiographic methods of estimating LVFP are unreliable. The noninvasive method of analyzing the decline in the arterial pressure during the strain phase of the Valsalva maneuver may be used to directly measure LVFP.