Optimal cardiovascular medical therapy: current guidelines and new developments.

Coronary artery disease is a leading cause of mortality worldwide, and patients with obstructive coronary artery disease require optimal cardiovascular medical therapy along with lifestyle modification for secondary prevention of future cardiac events. Optimal medical therapy includes antiplatelet agents, high-intensity statins, beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, aldosterone antagonists, and calcium channel blockers. There are differences in the medical therapy guidelines of the American Heart Association/American College of Cardiology and the European Society of Cardiology. In addition, there are emerging medical therapies that may be added to future guidelines with additional cardiovascular outcome benefits.

An analysis of physician reviews in relation to quality and social media presence.

Press Ganey patient engagement survey scores are used among health care facilities throughout the US to evaluate patients' perception of the quality of care provided. The relation of Press Ganey score to primary quality metrics has not been reported before; thus, we studied it in a cohort of Baylor Scott and White Health primary care physicians. Using simple linear regression, we evaluated Press Ganey scores and compared them with primary care quality metrics associated with improved patient outcomes, including cancer screening, depression screening, blood pressure, and glucose control, in addition to well-child visits. We found that overall quality had a very low linear correlation with Press Ganey survey items, and high-quality performance and increased number of practice years had an overall positive correlation with high survey ratings. We also found that social media presence or total website activity was not an important feature in predicting the top 25 quality performers within the health care system.

Cardiology co-management of rheumatoid arthritis patients with coronary artery disease as an intervention reduces hospitalization rates and adverse event occurrence.

INTRODUCTION: Rheumatoid arthritis (RA) is a systemic autoimmune disease with important cardiovascular (CV) implications. CV disease represents over half of RA patient deaths and causes significant morbidity. CV manifestations in RA can be complex, raising concerns for adequate patient management and provider-dependent roles. METHODS: This is a retrospective study of patients diagnosed with RA and coronary artery disease (CAD). Patients were identified and filtered via EPIC Database search engine. Parameters were set from January 1, 2014, to December 31, 2020. Inclusion criteria consisted of patients who met diagnostic criteria for both RA and CAD. A total of 399 patients met criteria. RESULTS: Of the 399 identified patients, 272 were female (68.2%) and 127 were male (31.8%) with a median age of 73 (range 26-98). The population was further divided into two groups: those with established cardiology care versus those without. Patients without cardiology follow-up experienced significantly more hospitalizations (RR 1.63 95% CI 1.12, 2.38), higher rates of adverse events including myocardial infarction (MI) (RR 4.82 95% CI 1.94, 11.98), heart failure (HF) (OR 15.81 95% CI 3.54, 70.52), and stroke (RR 2.55 95% CI 1.29, 5.03). Patients not followed by cardiology also had numerical increases in CV death (4 deaths compared to none in those with cardiology follow) and all-cause mortality (HR 1.03 95% CI 0.63, 1.67). CONCLUSION: Patients with regular cardiology follow-up demonstrated fewer cardiac-related adverse events. This suggests that co-management may have a role in adverse cardiac event risk reduction and should therefore be an early consideration. Key Points • Rheumatoid arthritis patients demonstrate higher rates of coronary disease compared to the general population. Traditional cardiac risk factors may not be entirely responsible for this phenomenon • Hospitalization rates and adverse event occurrence are significantly higher in patients with single-provider care (rheumatology only) compared to dual provider care (rheumatology and cardiology) • Cardiology co-management should be an early consideration in the management of RA patients • Early screening, risk stratification of coronary disease, and utilization of appropriate treatment algorithms are important to decrease morbidity and mortality.