scholarly journals Facility-Level Variation in Cardiac Stress Test Use Among Patients With Diabetes: Findings From the Veterans Affairs National Database

Diabetes Care ◽  
2020 ◽  
Vol 43 (5) ◽  
pp. e58-e60
Author(s):  
Dhruv Mahtta ◽  
Sarah T. Ahmed ◽  
Nishant R. Shah ◽  
David J. Ramsey ◽  
Julia M. Akeroyd ◽  
...  
Keyword(s):  
Stress Test ◽  
Veterans Affairs ◽  
National Database ◽  
Level Variation ◽  
Cardiac Stress ◽  
Patients With Diabetes ◽  
Facility Level ◽  
Test Use ◽  
Cardiac Stress Test

scholarly journals Statin Use and Its Facility-Level Variation in Patients With Diabetes: Insight From the Veterans Affairs National Database

2016 ◽  
Vol 39 (4) ◽  
pp. 185-191 ◽  
Author(s):  
Yashashwi Pokharel ◽  
Julia M. Akeroyd ◽  
David J. Ramsey ◽  
Ravi S. Hira ◽  
Vijay Nambi ◽  
...  
Keyword(s):  
Veterans Affairs ◽  
National Database ◽  
Level Variation ◽  
Patients With Diabetes ◽  
Facility Level ◽  
Statin Use

scholarly journals Facility-level variation in diabetes and blood pressure control in patients with diabetes: Findings from the Veterans Affairs national database

2017 ◽  
Vol 40 (11) ◽  
pp. 1055-1060 ◽  
Author(s):  
Hasan Rehman ◽  
Julia M. Akeroyd ◽  
David Ramsey ◽  
Sarah T. Ahmed ◽  
Anwar T. Merchant ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Veterans Affairs ◽  
National Database ◽  
Level Variation ◽  
Patients With Diabetes ◽  
Facility Level

scholarly journals Comparison of Preoperative Assessment of Patient’s Metabolic Equivalents (METs) Estimated from History versus Measured by Exercise Cardiac Stress Testing

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Adam S. Weinstein ◽  
Martin I. Sigurdsson ◽  
Angela M. Bader
Keyword(s):  
Cardiac Failure ◽  
Stress Testing ◽  
Stress Test ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Exercise Stress ◽  
Cardiac Stress ◽  
Metabolic Equivalents ◽  
Cardiac Stress Testing ◽  
Cardiac Stress Test

Background. Preoperative anesthetic evaluations of patients before surgery traditionally involves assessment of a patient’s functional capacity to estimate perioperative risk of cardiovascular complications and need for further workup. This is typically done by inquiring about the patient’s physical activity, with the goal of providing an estimate of the metabolic equivalents (METs) that the patient can perform without signs of myocardial ischemia or cardiac failure. We sought to compare estimates of patients’ METs between preoperative assessment by medical history with quantified assessment of METs via the exercise cardiac stress test. Methods. A single-center retrospective chart review from 12/1/2005 to 5/31/2015 was performed on 492 patients who had preoperative evaluations with a cardiac stress test ordered by a perioperative anesthesiologist. Of those, a total of 170 charts were identified as having a preoperative evaluation note and an exercise cardiac stress test. The METs of the patient estimated by history and the METs quantified by the exercise cardiac stress test were compared using a Bland–Altman plot and Cohen’s kappa. Results. Exercise cardiac stress test quantified METs were on average 3.3 METS higher than the METs estimated by the preoperative evaluation history. Only 9% of patients had lower METs quantified by the cardiac stress test than by history. Conclusions. The METs of a patient estimated by preoperative history often underestimates the METs measured by exercise stress testing. This demonstrates that the preoperative assessments of patients’ METs are often conservative which errs on the side of patient safety as it lowers the threshold for deciding to order further cardiac stress testing for screening for ischemia or cardiac failure.

scholarly journals Facility-Level Variations in Kidney Disease Care among Veterans with Diabetes and CKD

2018 ◽  
Vol 13 (12) ◽  
pp. 1842-1850 ◽  
Author(s):  
Sankar D. Navaneethan ◽  
Julia M. Akeroyd ◽  
David Ramsey ◽  
Sarah T. Ahmed ◽  
Shiva Raj Mishra ◽  
...  
Keyword(s):  
Veterans Affairs ◽  
Creatinine Ratio ◽  
Angiotensin Receptor ◽  
Urine Protein ◽  
Urine Albumin ◽  
Patients With Diabetes ◽  
Facility Level ◽  
Rate Ratios ◽  
Core Measures ◽  
Median Rate

Background and objectivesFacility-level variation has been reported among veterans receiving care for various diseases. We studied the frequency and facility-level variations of guideline-recommended practices in patients with diabetes and CKD.Design, setting, participants, & measurementsPatients with diabetes and concomitant CKD (eGFR 15–59 ml/min per 1.73 m2, measured twice, 90 days apart) receiving care in 130 facilities across the Veterans Affairs Health Care System were included (n=281,223). We studied the proportions of patients (facility-level) receiving recommended core measures and facility-level variations of these study outcomes using median rate ratios, adjusting for various patient and provider-level factors. Median rate ratio quantifies the degree to which care may vary for similar patients receiving care at two randomly chosen facilities, with <1 being no variation and >1.2 as substantial variation between the facilities. Study outcomes included measurement of urine albumin-to-creatinine ratio/urine protein-to-creatinine ratio and blood hemoglobin concentration, prescription of statins and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, BP<140/90 mm Hg, and referral to a Veterans Affairs nephrologist (only for those with eGFR<30 ml/min per 1.73 m2).ResultsAmong those with eGFR 30–59 ml/min per 1.73 m2, proportion of patients receiving recommended core measures (median and interquartile range across facilities) were 37% (22%–47%) for urine albumin-to-creatinine ratio/urine protein-to-creatinine ratio, 74% (72%–79%) for hemoglobin measurement, 66% (62%–69%) for angiotensin-converting enzyme inhibitor/angiotensin receptor blocker prescription, 85% (74%–87%) for statin prescription, 47% (42%–53%) for achieving BP<140/90 mm Hg, and 13% (7%–16%) for meeting all outcome measures. Adjusted median rate ratios (95% confidence intervals) were 5.2 (4.1 to 6.4), 2.4 (2.1 to 2.6), 1.3 (1.2 to 1.3), 1.2 (1.2 to 1.3), 1.4 (1.3 to 1.4), and 4.1 (3.3 to 5.0), respectively. Median rate ratios were qualitatively similar in an analysis restricted to those with eGFR 15–29 ml/min per 1.73 m2.ConclusionsAmong patients with diabetes and CKD, at facility-level, ordering of laboratory tests, and scheduling of nephrology referrals in eligible patients remains suboptimal, with substantial variations across facilities.

scholarly journals Low Cost Magnetic Resonance Imaging-Compatible Stepper Exercise Device for Use in Cardiac Stress Tests

2014 ◽  
Vol 8 (4) ◽  
Author(s):  
Omid Forouzan ◽  
Evan Flink ◽  
Jared Warczytowa ◽  
Nick Thate ◽  
Andrew Hanske ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Low Cost ◽  
Stress Test ◽  
Exercise Stress ◽  
Resonance Imaging ◽  
Pharmacological Stress ◽  
Cardiac Stress ◽  
Adjustable Weight ◽  
Cardiac Stress Test

Cardiovascular disease is the leading cause of death worldwide. Many cardiovascular diseases are better diagnosed during a cardiac stress test. Current approaches include either exercise or pharmacological stress echocardiography and pharmacological stress magnetic resonance imaging (MRI). MRI is the most accurate noninvasive method of assessing cardiac function. Currently there are very few exercise devices that allow collection of cardiovascular MRI data during exercise. We developed a low-cost exercise device that utilizes adjustable weight resistance and is compatible with magnetic resonance (MR) imaging. It is equipped with electronics that measure power output. Our device allows subjects to exercise with a leg-stepping motion while their torso is in the MR imager. The device is easy to mount on the MRI table and can be adjusted for different body sizes. Pilot tests were conducted with 5 healthy subjects (3 male and 2 female, 29.2 ± 3.9 yr old) showing significant exercise-induced changes in heart rate (+42%), cardiac output (+40%) and mean pulmonary artery (PA) flow (+%49) post exercise. These data demonstrate that our MR compatible stepper exercise device successfully generated a hemodynamically stressed state while allowing for high quality imaging. The adjustable weight resistance allows exercise stress testing of subjects with variable exercise capacities. This low-cost device has the potential to be used in a variety of pathologies that require a cardiac stress test for diagnosis and assessment of disease progression.

Lack of the QTc physiologic decrease during cardiac stress test in patients with type 2 diabetes treated with secretagogues

2012 ◽  
Vol 51 (1) ◽  
pp. 31-33 ◽  
Author(s):  
Mario Curione ◽  
Simonetta Di Bona ◽  
Silvia Amato ◽  
Irene Turinese ◽  
Giovanna Tarquini ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Stress Test ◽  
Cardiac Stress ◽  
Cardiac Stress Test

DOES MUSIC IMPACT EXERCISE CAPACITY DURING CARDIAC STRESS TEST? A SINGLE BLINDED PILOT RANDOMIZED CONTROLLED STUDY

2018 ◽  
Vol 71 (11) ◽  
pp. A400
Author(s):  
Karan Sarode ◽  
Waseem Shami ◽  
Sucheta Gosavi ◽  
Indika Mallawaarachchi ◽  
Alok Kumar Dwivedi ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Stress Test ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Cardiac Stress ◽  
Randomized Controlled ◽  
Impact Exercise ◽  
Cardiac Stress Test
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