Bueno and colleagues analyzed Medicare data from 1993 through 2006 to assess temporal trends in length of stay, discharge status, and short-term outcomes among patients hospitalized with heart failure. Among the authors' findings were that hospital length of stay decreased by approximately 2 days from 1993 to 2006, while discharge to skilled nursing facilities and 30-day hospital readmission rates increased. The authors also found that rates of in-hospital mortality and 30-day mortality decreased during the 14-year study.
Two articles in this issue report data relevant to the management of patients with coronary artery disease. In an analysis of data from 80 hospitals in Quebec, Canada, Lambert and colleagues Article examined the association between the timeliness of reperfusion therapy—defined as maximum delays of 90 minutes for primary percutaneous coronary intervention (PCI) and 30 minutes for fibrinolysis—and clinical outcomes among patients with ST-elevation myocardial infarction. The authors report that reperfusion therapy delivered outside these guideline-recommended delays was associated with an increased risk of mortality at 1 year. In an analysis of data from the National Cardiovascular Data Registry, Marso and colleagues Article examined the association between the use of vascular closure devices or bivalirudin and the risk of periprocedural bleeding and found that compared with manual compression, these 2 bleeding avoidance strategies were associated with significantly lower bleeding rates, particularly among patients at greatest risk. In an editorial, Bhatt Article discusses the use of registry data to advance clinical decision making in cardiovascular medicine.
In a prospective multicenter cohort study involving patients admitted to the intensive care unit (ICU) following resuscitation from cardiac arrest, Kilgannon and colleagues Article assessed the association of postresuscitation hyperoxia—a PaO2 of 300 mm Hg or greater in the first 24 hours following ICU admission—with in-hospital mortality. In analyses that controlled for potential confounding factors, the authors found that compared with either hypoxia or normoxia, postresuscitation arterial hyperoxia was independently associated with an increased risk of in-hospital mortality. In an editorial, Kochanek and Bayir Article discuss the need to better define the use of oxygen during and after cardiopulmonary resuscitation.
Mrs F, a physically active 83-year-old woman, has experienced occasional urinary incontinence and urgency since 1996, particularly during long walks or hiking or if she coughs. She experienced little improvement with behavioral interventions, intravaginal estrogen cream, or sublingual hyoscyamine. Goode and colleagues Article review the evaluation and evidence-based treatment of incontinence in older women—including special considerations for women with dementia. Readers may submit comments for online posting at http://www.jama.com. A commentary by Wagner and Subak Article discusses the importance of asking patients about incontinence and considers strategies for prevention and management.
“Amidst the constant shuffling of nurses and residents and attendings, amidst the passage of months and seasons and holidays, my coat was the odd constant and the constant witness.” From “Worn.”
Surgeon General Regina Benjamin, MD, MBA, wants to change the nation's conversation on health care by making prevention and wellness a priority.
Using science to improve the nation's health system
Patient-centered medical homes in Ontario
Join David B. Carr, MD, Wednesday, June 16, from 2 to 3 PM eastern time to discuss dealing with older adult drivers with cognitive impairment. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
For your patients: Information about incontinence in older women.
This Week in JAMA . JAMA. 2010;303(21):2109. doi:10.1001/jama.2010.745