Diagnosis of left ventricular noncompaction by computed tomography.

Left ventricular noncompaction (LVNC) is a rare disorder in which the left ventricular endocardial surface is not appropriately flattened and is heavily trabeculated. Patients with this condition can be affected by stroke from emboli that originate from these recesses. We present a patient with LVNC who was originally misdiagnosed as having an idiopathic dilated cardiomyopathy. Ultimately, diagnosis of LVNC was confirmed through the use of 64-slice multidetector cardiac computed tomography (CT). There are few reports of using multidetector CT for diagnosis of LVNC, but this appears to be a viable option in confirming the diagnosis and at the same time assessing the coronary arteries. The recognition of this cardiomyopathy and its differentiation from other nonischemic cardiomyopathies have important implications for the patient and for family members, given its potential familial inheritance patterns and poor long-term prognosis.

Impact of a standardized heart failure order set on mortality, readmission, and quality and costs of care.

OBJECTIVE: To determine the impact of a standardized heart failure order set on mortality, readmission, and quality and costs of care. DESIGN: Observational study. SETTING: Eight acute care hospitals and two specialty heart hospitals. PARTICIPANTS: All adults (>18 years) discharged from one of the included hospitals between December 2007 and March 2009 with a diagnosis of heart failure, who had not undergone heart transplant, did not have a left ventricular assistive device, and with a length of stay of 120 or less days. INTERVENTIONS: A standardized heart failure order set was developed internally, with content driven by the prevailing American College of Cardiology/American Heart Association clinical practice guidelines, and deployed systemwide via an intranet physician portal. MAIN OUTCOME MEASURES: Publicly reported process of care measures, in-patient mortality, 30-day mortality, 30-day readmission, length of stay, and direct cost of care were compared for heart failure patients treated with and without the order set. RESULTS: Order set used reached 73.1% in March 2009. After propensity score adjustment, order set use was associated with significantly increased core measures compliance [odds ratio (95% confidence interval) = 1.51(1.08; 2.12)] and reduced in-patient mortality [odds ratio (95% confidence interval) = 0.49(0.28; 0.88)]. Reductions in 30-day mortality and readmission approached significance. Direct cost for initial admissions alone and in combination with readmissions were significantly lower with order set use. CONCLUSIONS: Implementing an evidence-based standardized order set may help improve outcomes, reduce costs of care and increase adherence to evidence-based processes of care.