Cath Lab Digest - November 2007 - (Page 47)

47 practices from exemplary hospitals can result in improvement. If this focus were targeted to four key quality areas — heart failure, respiratory failure, sepsis, and pneumonia — the nation could achieve up to a 50percent reduction in potentially preventable deaths.” The study also found wide variation in risk-adjusted mortality at the state and regional levels: • Across all procedures and conditions, the average number of states performing statistically significantly better than predicted was 14, while an average of 19 states performed statistically significantly worse than predicted. • The region with the lowest overall risk-adjusted mortality was the East North Central Region (IL, IN, MI, OH and WI) while the East South Central region (AL, KY, MS and TN) had the highest mortality. • The region with the most overall improvement for all procedures and conditions was the West South Central region (AR, LA, OK and TX), where the risk-adjusted mortality dropped by 13.5 percent. The least improvement was seen in the Mountain region (AZ, CO, ID, MT, NE, NV, NM, UT, and WY), with a decline of 8.8 percent. • The East North Central region (IL, IN, MI, OH, and WI), had the highest percentage of best-performing hospitals — those hospitals that are among the best 15 percent for riskadjusted mortality overall — at 26 percent. • Less than seven percent of hospitals within the East South Central region (AL, KY, MS, and TN) and the New England region (CT, ME, MA, NH, RI, and VT) were top-performing hospitals. In the study’s analysis of mortality rates, the following 18 procedures and conditions were analyzed: atrial fibrillation, bowel obstruction, chronic obstructive pulmonary disease, coronary bypass surgery, coronary interventional procedures (angioplasty/stent), diabetic acidosis and coma, gastrointestinal bleed, gastrointestinal surgeries and procedures, heart attack, heart failure, pancreatitis, pneumonia, pulmonary embolism, resection/replacement of the abdominal aorta, respiratory failure, sepsis, stroke, and valve replacement surgery. The full study, along with its methodology and state-by-state hospital-quality statistics, can be found at www.healthgrades.com. ■ Mortality Rates cont. 2006, with the nation's top-rated hospitals improving at a faster rate (12.8 percent) than the lowest rated hospitals (11.4 percent). Of the 18 procedures and conditions studied, those that saw the most improvement in mortality rates were pancreatitis (19.2 percent), pulmonary embolism (17.4 percent) and diabetic acidosis and coma (16.6 percent). Those with the smallest improvement were resection/replacement of the abdominal aorta (0.4 percent), coronary interventional procedures such as angioplasties and stents (0.8 percent) and treatment of heart attack (8.9 percent). Full reports on mortality rate trends in each of the 50 states and the District of Columbia are available in the study. “While we are pleased to see that the hospital industry’s focus on improving care quality has continued to reduce mortality rates, a significant variation in quality among the nation’s best and poorest-performing hospitals persists,” said Samantha Collier, MD, HealthGrades’ chief medical officer and one of the authors of the study. “Concentrating on emulating Expecting an Afternoon Nap Can Reduce Blood Pressure W here does the benefit lie in an afternoon nap. Is it in the nap itself — or in the anticipation of taking a snooze? Researchers in the United Kingdom have found that the time just before you fall asleep is where beneficial cardiovascular changes take place. The finding is part of a study entitled Acute Changes in Cardiovascular Function During the Onset Period of Daytime Sleep: Comparison to Lying Awake and Standing, found in the online edition of the Journal of Applied Physiology, published by The American Physiological Society. The study was conducted by researchers at the Liverpool John Moores University in Liverpool, U.K. Afternoon naps, or siestas, are practiced in many Mediterranean and Latin American countries such as Spain and Argentina. They are typically short naps or rest periods of no more than an hour that are taken in the afternoon. While earlier studies on siestas have found that this practice may slightly increase the risk of heart attack, newer and more controlled studies have shown an inverse relationship between siesta taking and fatal heart attacks. In a recent epidemiological study of 23,000 people in Greece, those who regularly took siestas showed a 37% reduction in coronary mortality compared to those who never nap, while individuals who occasionally napped in the afternoon had a reduction of 12%. Why do afternoon naps affect cardiovascular function? One reason could be changes in blood pressure. At night, our blood pressure and heart rate decreases as we sleep. Some researchers hypothesize that the lower blood pressure reduces strain on the heart and decreases the risk of a fatal heart attack. Most studies have focused on cardiovascular behavior in nighttime sleeping. This study provides a detailed description of changes in cardiovascular function of daytime sleep in healthy individuals, comparing napping with other daytime activities such as standing and lying down without going to sleep. The researchers tested nine healthy volunteers (eight men, one woman) who did not routinely take afternoon naps. The volunteers attended the university laboratory on three separate afternoons after sleeping four hours the night before. The volunteers wore equipment that checked blood pressure, heart rate, and forearm cuta- neous vascular conductance (which determines dilation of blood vessels). During one afternoon session, the volunteer spent an hour resting, lying face-up in bed. During another session, the volunteer spent an hour relaxed, but standing. And in one session, the volunteer was allowed an hour to sleep, lying face-up. During the sleep stage, the researchers measured the volunteer’s different stages of sleep. The session in which the volunteer was allowed to fall asleep was delineated into three phases: • Phase 1: A five-minute period of relaxed wakefulness before lights were turned off (volunteers had been lying on the bed for a minimum of 15 minutes before this phase) • Phase 2: The period between “lights out” and the onset of Stage 1 sleep (loss of some conscious awareness of the external environment) • Phase 3: The period between the Stage 1 and the onset of Stage 2 sleep (conscious awareness of the external environment disappears) Researchers found a significant drop in blood pressure during the sleep trial, but not during the resting or standing trials. What’s more, this drop in blood pressure occurred mostly after lights out, just before the volunteer fell asleep. This reduction in blood pressure may be one explanation for the lower cardiovascular mortality that some studies have found among people who habitually take siestas. On the other hand, some studies of nocturnal sleep have shown that blood pressure rises when we awake and that more cardiac deaths occur in the mornings. The John Moores team plans to study blood pressure during the waking portion of the afternoon nap to see if this period may also pose an increased danger of coronary mortality. ■ Taking the Stress Out of Choosing the Right Stress Test S tress tests are good front-line indicators of heart disease, but just how good depends on ordering the right one, researchers say. Thirty percent of all women, for example, have a false positive exercise treadmill test, in which they walk for several minutes at a slightly increasing incline with an electrocardiogram measuring the electrical activity of the heart, they say. “So if you are female, I put you on a treadmill and the waves that measure the electrical activity of your heart drop. You say, ‘Am I going to die?’” says Dr. Vincent J.B. Robinson, nuclear cardiologist at the Medical College of Georgia and the Veterans Affairs Medical Center in Augusta. “That probably is not the case. But instead of then taking those 30 percent of women to the catheterization lab to look for blood vessel blockages, we put them back on the treadmill this time with a contrast medium so we can see the heart work and possibly with a Continued on next page http://www.healthgrades.com

Table of Contents Feed for the Digital Edition of Cath Lab Digest - November 2007

Henry Ford Heart and Vascular Institute Treating Patients with Complex Vascular Disease with a Multi-Disciplinary Approach Improving Patient Compliance with Antiplatelet Medications Clinical Editor’s Corner Cath Lab Nurse/Tech Vascular Access and Closure Using the StarClose® Device The Clinical and Economic Impact of Measuring Fractional Flow Reserve FFR and Choosing an Optimal Revascularization Strategy Finally! The New Registered Cardiac Electrophysiology Specialist (RCES) Credential Use of a Mobile Lab to ‘Test the Waters’ at a Rural Hospital Remembering a Cardiac Cath Lab History ACVP• Membership Page What Do You Think? The Ten-Minute Interview with… Ernie Livingston, RN, BSN SICP* Chapter Updates Who’s in Charge? Working to Eliminate Bottlenecks: Florida Hospital’s Cardiac Cath Lab Achieves Greater Efficiency and Higher Satisfaction Preserving Left Ventricular Function during Percutaneous Coronary Intervention Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Making the Most of Your First Impression: Interviewing Tips and Techniques CEU Education Center Clinical & Industry News Meetings Calendar

Cath Lab Digest - November 2007

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