Impact of left ventricular assist devices and heart transplants on acute myocardial infarction and heart failure mortality and readmission measures.

BackgroundConcern has been raised about consequences of including patients with left ventricular assist device (LVAD) or heart transplantation in readmission and mortality measures.MethodsWe calculated unadjusted and hospital-specific 30-day risk-standardized mortality (RSMR) and readmission (RSRR) rates for all Medicare fee-for-service beneficiaries with a primary diagnosis of AMI or HF discharged between July 2010 and June 2013. Hospitals were compared before and after excluding LVAD and heart transplantation patients. LVAD indication was measured.ResultsIn the AMI mortality (n = 506,543) and readmission (n = 526,309) cohorts, 1,166 and 1,016 patients received an LVAD while 3 and 2 had a heart transplantation, respectively. In the HF mortality (n = 1,015,335) and readmission (n = 1,254,124) cohorts, 789 and 931 received an LVAD, while 212 and 202 received a heart transplantation, respectively. Less than 2% of hospitals had either ≥6 patients who received an LVAD or, independently, had ≥1 heart transplantation. The AMI mortality and readmission cohorts used 1.8% and 2.8% of LVADs for semi-permanent/permanent indications, versus 73.8% and 78.0% for HF patients, respectively. The rest were for temporary/external indications. In the AMI cohort, RSMR for hospitals without LVAD patients versus hospitals with ≥6 LVADs was 14.8% and 14.3%, and RSRR was 17.8% and 18.3%, respectively; the HF cohort RSMR was 11.9% and 9.7% and RSRR was 22.6% and 23.4%, respectively. In the AMI cohort, RSMR for hospitals without versus with heart transplantation patients was 14.7% and 13.9% and RSRR was 17.8% and 17.7%, respectively; in the HF cohort, RSMR was 11.9% and 11.0%, and RSRR was 22.6% and 22.6%, respectively. Estimations changed ≤0.1% after excluding LVAD or heart transplantation patients.ConclusionHospitals caring for ≥6 patients with LVAD or ≥1 heart transplantation typically had a trend toward lower RSMRs but higher RSRRs. Rates were insignificantly changed when these patients were excluded. LVADs were primarily for acute-care in the AMI cohort and chronic support in the HF cohort. LVAD and heart transplantation patients are a distinct group with differential care requirements and outcomes, thus should be considered separately from the rest of the HF cohort

Who is missing from the measures? Trends in the proportion and treatment of patients potentially excluded from publicly reported quality measures

Cilj diplomskog rada je ispitati valjanost, odnosno primjenjivost gravitacijskog modela trgovine na primjeru Hrvatske i odabranih zemalja regije – Bosne i Hercegovine, Slovenije, Srbije, Kosova, Crne Gore i Sjeverne Makedonije. Gravitacijski model počiva na jednadžbi u kojoj je vanjska trgovina kao funkcija objašnjena s dvije varijable: BDP-om i udaljenosti. Sukladno postavkama gravitacijskog modela trgovine, povećanje BDP-a bi trebalo pozitivno utjecati na trgovinsku razmjenu dok povećanje udaljenosti ima negativan utjecaj na trgovinsku razmjenu. Gravitacijski model trgovine nastao je iz Newtonovog zakona gravitacije. Ovaj model prihvaćen je od strane ekonomista zbog svoje jednostavnosti i lake primjenjivosti. Za potrebe modela potrebni su podaci o vanjskoj trgovini (bilo izvozu, uvozu ili ukupnoj trgovini), bruto društvenom proizvodu te podaci o geografskoj udaljenosti (u ovome konkretnome radu izraženi u kilometrima). Dakle, rad polazi od pretpostavke da veća i bliža gospodarstva više međusobno trguju. U radu su korišteni sekundarni podaci iz domaće i strane literature te raznih baza podataka. Od metoda, korištene su metode analize, sinteze, komparacije te deskripcije. U svrhu empirijske analize provedena je cross – section analiza metodom višestruke linearne regresije za izvoz i uvoz Hrvatske i svih odabranih zemalja. Prema dobivenim rezultatima gravitacijskim modelom trgovine moguće je objasniti izvoz i uvoz Hrvatske te preostalih odabranih zemalja uz iznimke izvoza Kosova te Sjeverne Makedonije

The adjusted risk of readmission by age group for HF, AMI, and pneumonia cohorts, respectively.

<p>The referent group is patients age ≥65 years within each cohort.</p

Baseline characteristics of patients with an index hospitalization for acute myocardial infarction.

<p>Baseline characteristics of patients with an index hospitalization for acute myocardial infarction.</p

Baseline characteristics of patients with an index hospitalization for heart failure.

<p>Baseline characteristics of patients with an index hospitalization for heart failure.</p