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CLINICAL
NEWS JACC in a FLASH
adjusted 30-day HF readmission rates
and received a readmission penalty in
2013. Researchers noted no differences
between the two groups in median
adherence rates to all performance
measures or median percentage of
defect-free care. Additionally, the
composite one-year outcome of death
or all-cause readmission rates did
not differ between the two groups.
Of note, however, hospitals with low
risk-adjusted 30-day HF readmission
rates had significantly lower one-year
all-cause readmission rates (median
54.7% vs. 59.1%; p = 0.01), but a
trend toward paradoxically higher
1-year morality rates (median 31.7%
vs. 28.2%; p = 0.07).
“These findings suggest that the
30-day readmission metric currently
used by CMS to determine readmission
penalties are not associated with quality
of care or overall clinical outcomes as
indexed by the composite rates of oneyear mortality or all-cause readmission
among GWTG-HF participating centers,” the researchers conclude. Moving
forward, they recommend future prospective studies to determine the impact
of readmission penalties on quality of
care and patient outcomes over time.
In an accompanying editorial
comment, Marvin A. Konstam, MD,
writes: “The 30-day readmission
metric, with its many flaws, and clear
direction to reduce utilization and cost,
but without focus on patient wellbeing, should serve as an alarm that we
are heading in the wrong direction of
allowing government policy-makers,
rather than patients to drive the design
“These results
should be viewed
as preliminary
given the small
sample size.”
—Kim Eagle, MD
10
CardioSource WorldNews
of clinical care metrics. Alternatively,
the government can and should play
an important role in facilitating an
environment of integrated health care
systems and market-based competition,
within which consumers can drive the
advancement of their own health.”
Pandey A, Golwala H, Xu H, et al. J Am Coll
Cardiol HF. DOI: 10.1016/j.jchf.2016.07.003
Genetic Etiology
in Cases of LifeThreatening
Arrhythmia
Genetic testing may be able to identify
apparent idiopathic bundle branch reentrant ventricular tachycardia (BBRVT),
according to the results of research
presented during the young clinical investigator award session at AHA 2016,
and simultaneously published in JACC:
Clinical Electrophysiology.
Jason D. Roberts, MD, MAS, et al.,
evaluated six patients with BBRVT with
normal biventricular size and function
to investigate any underlying genetic
etiology associated with the BBRVT.
Researchers screened genes associated
with cardiac conduction system disease
for mutations, and the pathogenicity of
the identified mutations were evaluated using in silico phylogenetic and
physicochemical analyses and in vitro
biophysical studies.
The results of the study found
that 3 of the 6 cases had putative
culprit mutations: two in SCN5A
and c.4719C>T, and one in LMNA.
According to the authors, “the SCN5A
c.4719C>T splice site mutation has
previously been reported as disease
causing in 3 cases of Brugada syndrome, while the novel LMNA Leu327Val mutation was associated with
a classic laminopathy phenotype.”
Further, researchers discovered
that BBRVT was non-inducible in all
cases following catheter ablation and
patients did not experience a clinical
recurrence during follow-up.
“These results should be viewed
as preliminary given the small sample
size,” commented Kim A. Eagle, MD,
editor-in-chief of ACC.org. ■
Roberts JD, Gollob MH, Young C, et al. JACEP. 2016;doi:10.1016/j.jacep.2016.09.019
December 2016