In this large single-institution study, rapid response team implementation was not associated with reductions in hospital-wide code rates or mortality.

Background Smoking cessation after acute myocardial infarction (AMI) decreases the risk of recurrent AMI and mortality by 30–40%, but many patients continue to smoke. The association of smoking with angina and health-related quality of life (HRQOL) after AMI is unclear. Methods and Results Patients in 2 U.S. multicenter AMI registries (n=4003) were assessed for smoking and HRQOL at admission and 1, 6 and 12 months after AMI. Angina and HRQOL were measured with the Seattle Angina Questionnaire (SAQ) and Short Form-12 (SF-12) physical and mental component scales (PCS and MCS). At admission, 29% never had smoked, 34% were former smokers (quit before AMI) and 37% were active smokers, of whom 46% quit by 1 year (recent quitters). In hierarchical, multivariable, regression models that adjusted for sociodemographic, clinical and treatment factors, never and former smokers had similar and the best HRQOL in all domains. Recent quitters had intermediate HRQOL levels, with angina and SF-12 MCS scores similar to never smokers. Persistent smokers had worse HRQOL in all domains compared to never smokers and worse SF-12 MCS scores than recent quitters. Conclusion Smoking after AMI is associated with more angina and worse HRQOL in all domains, while smokers who quit after AMI have similar angina levels and mental health as never smokers. These observations may help encourage patients to stop smoking after AMI.

Background— Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are alternative strategies for stroke prevention in patients with atherosclerotic carotid disease. Although randomized clinical trials are the gold standard for assessing the relative benefits of different treatments, observational research is necessary for determining “real-world” effectiveness. Current recommendations limit the application of CAS to high-risk patients, undermining the ability to “balance” the characteristics of patients treated with either approach. We compared the clinical profiles of patients referred for CAS versus CEA in a large national database. Methods and Results— Clinical characteristics of 12 701 patients referred for CAS or CEA in the National Cardiovascular Data Registry–Carotid Artery Revascularization and Endarterectomy were compared for 44 clinical and demographic variables. To investigate the comparability of CAS and CEA patients, we stratified the cohort into quintiles of the propensity score for referral for CAS. Among 8069 patients referred for CAS and 4632 referred for CEA, the CAS patients had significantly more comorbidities. Whereas the propensity model balanced most covariates, the pooled standardized differences (≥10%) suggested persistent imbalance for ischemic heart disease, recent myocardial infarction, and restenosis of prior CAS/CEA, all of which were more common in the CAS group. After stratification of propensity scores by quintile, CEA patients comprised only 14% of the upper 2 quintiles. Conclusions— Characteristics of patients referred for CAS differ markedly from those referred for CEA. Because of extreme clinical disparities between these patients, generalizable comparative effectiveness analyses of observational data will be difficult.