Category Archives: Am J Med

Turning Points in the Conception and Regulation of Physician-Assisted Dying in the Netherlands.

Turning Points in the Conception and Regulation of Physician-Assisted Dying in the Netherlands.
Am J Med. 2016 Mar 15;
Authors: Koopman JJ, Boer TA
PMID: 26992560 [PubMed – as supplied by publisher]

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Hemoconcentration-Guided Diuresis in Heart Failure.

Hemoconcentration-Guided Diuresis in Heart Failure.
Am J Med. 2014 Jun 14;
Authors: Vaduganathan M, Greene SJ, Fonarow GC, Voors AA, Butler J, Gheorghiade M
Abstract
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Digoxin use and lower 30-day all-cause readmission for Medicare beneficiaries hospitalized for heart failure.

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Digoxin use and lower 30-day all-cause readmission for Medicare beneficiaries hospitalized for heart failure.

Am J Med. 2014 Jan;127(1):61-70

Authors: Ahmed A, Bourge RC, Fonarow GC, Patel K, Morgan CJ, Fleg JL, Aban IB, Love TE, Yancy CW, Deedwania P, van Veldhuisen DJ, Filippatos GS, Anker SD, Allman RM

Abstract
BACKGROUND: Heart failure is the leading cause for hospital readmission, the reduction of which is a priority under the Affordable Care Act. Digoxin reduces 30-day all-cause hospital admission in chronic systolic heart failure. Whether digoxin is effective in reducing readmission after hospitalization for acute decompensation remains unknown.
METHODS: Of the 5153 Medicare beneficiaries hospitalized for acute heart failure and not receiving digoxin, 1054 (20%) received new discharge prescriptions for digoxin. Propensity scores for digoxin use, estimated for each of the 5153 patients, were used to assemble a matched cohort of 1842 (921 pairs) patients (mean age, 76 years; 56% women; 25% African American) receiving and not receiving digoxin, who were balanced on 55 baseline characteristics.
RESULTS: Thirty-day all-cause readmission occurred in 17% and 22% of matched patients receiving and not receiving digoxin, respectively (hazard ratio [HR] for digoxin, 0.77; 95% confidence interval [CI], 0.63-0.95). This beneficial association was observed only in those with ejection fraction <45% (HR 0.63; 95% CI, 0.47-0.83), but not in those with ejection fraction ≥ 45% (HR 0.91; 95% CI, 0.60-1.37; P for interaction, .145), a difference that persisted throughout the first 12 months postdischarge (P for interaction, .019). HRs (95% CIs) for 12-month heart failure readmission and all-cause mortality were 0.72 (0.61-0.86) and 0.83 (0.70-0.98), respectively.
CONCLUSIONS: In Medicare beneficiaries with systolic heart failure, a discharge prescription of digoxin was associated with lower 30-day all-cause hospital readmission, which was maintained at 12 months, and was not at the expense of higher mortality. Future randomized controlled trials are needed to confirm these findings.

PMID: 24257326 [PubMed – indexed for MEDLINE]

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The cardiovascular risk profile of atherosclerotic gastrointestinal ischemia is different from other vascular beds.

The cardiovascular risk profile of atherosclerotic gastrointestinal ischemia is different from other vascular beds.
Am J Med. 2012 Apr;125(4):394-8
Authors: Veenstra RP, ter Steege RW, Geelkerken RH, Huisman AB, Kolkman JJ
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