Circulation: Cardiovascular Quality and Outcomes

Treatment of dyslipidemia with moderate-dose statins leads to improved outcomes for patients with diabetes mellitus and high to moderate cardiovascular risk.Previous performance measures focused on attainment of low-density lipid levels rather than appropriate treatment with statins.Such performance measures could lead to overtreatment with high-dose statins.Use of a performance measure that credits appropriate clinical treatment rather than only low-density lipoprotein attainment shows that almost 85% of veterans 50 to 75 years of age are receiving appropriate dyslipidemia management.However, nearly 14% of patients with diabetes mellitus but without ischemic heart disease were potentially overtreated with high dose statins.Conclusions-Use of a performance measure that credits appropriate clinical action indicates that almost 85% of diabetic veterans 50 to 75 years of age are receiving appropriate dyslipidemia management.However, many patients are potentially overtreated with highdose statins. 1 A Pharmacist-Led, American Heart Association Heart360 Web-Enabled Home Blood Pressure Monitoring ProgramSummary-Previous studies involving pharmacist-or nurse-led home blood pressure (BP) monitoring programs have demonstrated improvements in BP control.However, the applicability of previous studies to routine practice may be limited by the exclusion of patients with diabetes mellitus or chronic kidney disease, complex monitoring protocols, or the use of expensive, proprietary software to support telemonitoring.This pragmatic, randomized, controlled trial found that a pharmacist-led, Heart360-supported, home BP monitoring intervention delivered by regular clinical staff to a broadly representative patient population led to greater BP reductions, superior BP control, and higher patient satisfaction than usual care.The impact of the intervention on BP control and degree of BP lowering was even greater among the subset of patients with diabetes mellitus or chronic kidney disease.The proportions of patients with a dose increase for an antihypertensive medication or the addition of at least 1 antihypertensive medication were greater for the home BP monitoring group than for the usual care group.Conclusions-A pharmacist-led, Heart360-supported, home BP monitoring intervention led to greater BP reductions, superior BP control, and higher patient satisfaction than UC. 2 Walking Impairment Questionnaire Improves Mortality Risk Prediction Models in a High-Risk Cohort Independent of Peripheral Arterial Disease StatusSummary-Subjective measures of walking capacity, such as the Walking Impairment Questionnaire, have previously been shown to be associated with cardiovascular events in patients with peripheral arterial disease.It is unclear whether this clinical tool can be applied to a broader patient population and whether it can provide information beyond established risk models.This study shows that the Walking Impairment Questionnaire is an independent predictor of all-cause and cardiovascular mortality among individuals undergoing coronary angiography, even in those without peripheral arterial disease.When added to established risk models, this questionnaire significantly improves mortality risk discrimination and reclassification.Taken together, these data suggest that simple and economical tools that correlate with exercise capacity may be able to enhance our ability to prognosticate risk.Conclusions-All 3 WIQ categories independently predicted future all-cause and cardiovascular mortality.Importantly, we found that this subjective measure of walking ability could be extended to patients without peripheral arterial disease.The addition of the WIQ scores to established cardiovascular risk models significantly improved risk discrimination and reclassification, suggesting broad clinical use for this simple, inexpensive test.3 Patterns of Emergency Medical Services Use and Its Association With Timely Stroke Treatment: Findings From Get With the Guidelines-StrokeSummary-There is increased public awareness that time is brain.Emergency medical services (EMSs) are recognized as an effective way to transport patients quickly to the hospital.Prior studies based on data collected more than a decade ago involving some particular regions of the United States and only modest numbers of patients indicated that only about half of acute stroke patients are transported