Background Prior studies have reported race and sex differences in cardiac catheterization use after acute myocardial infarction (AMI). It is unclear whether race or sex differences in procedure refusal may contribute...
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Background Prior studies have reported race and sex differences in cardiac catheterization use after acute myocardial infarction (AMI). It is unclear whether race or sex differences in procedure refusal may contribute to this difference. We sought to determine whether cardiac catheterization refusal rates differ by patient race or sex. Methods We evaluated medical records of 74,745 Medicare beneficiaries hospitalized for AMI between January 1994 and February 1996 to ascertain refusal of cardiac catheterization during hospitalization. Patient race and sex were evaluated for their association with cardiac catheterization refusal adjusting for patient, physician, and hospital characteristics. Results The cardiac catheterization refusal rate in the overall cohort was 2.92% (95% CI 2.80%-3.04%). Race and sex differences in cardiac catheterization were observed after multivariate adjustment, with white women (odds ratio [OR] 1.28), black men (OR 1.34), and black women (OR 1.37) more likely to refuse cardiac catheterization than white men (OR 1.00). Relative differences in refusal were associated with only modest absolute differences in risk-standardized rates of cardiac catheterization refusal;rates were lowest for white men (2.55%), and higher for white women (3.21%), black men (3.36%), and black women (3.38%, P <.001 for global comparison). Conclusions Patient race and sex were associated with cardiac catheterization refusal among elderly patients hospitalized with AMI. However, absolute race and sex differences in rates of procedure refusal were small, suggesting that race and sex differences in cardiac catheterization refusal provide only a partial explanation of observed differences in cardiac procedure use.
The consequences of failing to comply to doctor's instructions can be damaging and devastating for the individual patient and their family. Noncompliance also lends to waste, as it reduces the potential benefits o...
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The consequences of failing to comply to doctor's instructions can be damaging and devastating for the individual patient and their family. Noncompliance also lends to waste, as it reduces the potential benefits of therapy and to the extra cost of treating avoidable consequent morbidity. Life-long immunosuppression is a prerequisite for good graft function, and noncompliance is often associated with late acute rejection episodes, graft loss, and death. If might be assumed that transplant patients constitute a highly motivated group, and that compliance would be high. Unfortunately, this is not the case: overall noncompliance rates vary from 20 to 50%. This overview includes literature on heart, liver, and kidney transplants in adult and pediatric transplant patients. Compliance behavior after transplantation, noncompliance and its relationship to organ loss and death, retransplantation outcome after graft loss due to noncompliance, and reasons far postoperative noncompliance will be addressed. (C) 2000 Elsevier Science Inc.
Different methods for estimating the effect of treatment actually received in a longitudinal placebo-controlled trial with non-compliance are discussed. Total mortality from the ATBC Study is used as an illustrative e...
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Different methods for estimating the effect of treatment actually received in a longitudinal placebo-controlled trial with non-compliance are discussed. Total mortality from the ATBC Study is used as an illustrative example. In the ATBC Study some 25 per cent of the participants dropped out from active follow-up prior to the scheduled end of the study. The 'intention-to-treat' analysis showed an increased death risk in the beta-carotene arm when compared with the no beta-carotene arm. Owing to considerable non-compliance it is also of interest to estimate the effect of beta-carotene actually received. We use a simple model for the treatment action and discuss three methods for estimation of the treatment effect under the model - the 'intention-to-treat' approach, the 'as-treated' approach and the g-estimation approach. These approaches are compared in a simulation study under different settings for non-compliance. Finally the data from the ATBC Study are analysed using the proposed methods, Copyright (C) 1999 John Wiley & Sons, Ltd.
OBJECTIVES This study was designed to compare different proposed methods of assessing adherence with angiotensin-converting enzyme (ACE) inhibitor (ACEI) therapy in chronic heart failure. BACKGROUND The use of ACEIs i...
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OBJECTIVES This study was designed to compare different proposed methods of assessing adherence with angiotensin-converting enzyme (ACE) inhibitor (ACEI) therapy in chronic heart failure. BACKGROUND The use of ACEIs in chronic heart failure gives us a unique opportunity to assess a patient's adherence by measuring whether the expected biochemical effect of an ACEI is present in the patient's bloodstream. In fact, there are several different ways of assessing ACE in vivo: these are serum ACE activity itself, plasma N-acetyl-seryl-aspartyl lysyl-proline (AcSDKP), urine AcSDKP, plasma angiotensin I (AI), plasma angiotensin II (AII), or the AII/AI ratio. METHODS Patients with chronic heart failure (n = 39) were randomized to regimens of ACEI nonadherence for one week, ACEI adherence for one week or two versions of partial adherence for one week, after which the above six tests were performed. RESULTS All six tests significantly distinguished between full nonadherence for one week and full or partial adherence. Only plasma AcSDKP produced a significantly different result between partial adherence and either full adherence or full nonadherence for one week. In terms of their ability to distinguish full nonadherence from full adherence, plasma AcSDKP was 89% sensitive and 100% specific with an area under its ROC of 0.95. Corresponding figures for urine AcSDKP were 92%, 97% and 0.95 and for serum ACE they were 86%, 95% and 0.90. CONCLUSIONS All six tests distinguished full nonadherence from all other forms of adherence. The rank order of performance was plasma AcSDKP, urine AcSDKP, serum ACE, AII/AI ratio and plasma AII followed by plasma AI. (C) 1999 by the American College of Cardiology.
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