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William Tierney

Publications and source records attributed to William Tierney.

13 recordsLinked to original sources
PubMed2006

Enteral stents.

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Current Procedural Terminology↗
PubMed2005

Decreased survival in diabetic patients with heart failure due to systolic dysfunction.

BACKGROUND: Prognosis of patients with heart failure (HF) has improved in recent years due to advances in therapy. Whether this is also true for diabetic subjects with HF in clinical practice has not been studied in a prospective manner. METHODS: All patients with HF and left ventricular systolic dysfunction attending the outpatient clinic at our Veteran's Hospital between October 1999 and November 2000 were enrolled in our study and followed prospectively. Electronic medical records were accessed for data on comorbid conditions, medications, echocardiogram results and mortality information. Mean follow-up was 2.7 years. RESULTS: Of 495 patients with HF due to systolic dysfunction enrolled in the study, 293 (59%) had diabetes. Prevalence of hypertension, diuretic use and angiotensin converting enzyme inhibitor use was higher among diabetics. Beta-blocker usage was equal and high in both groups (60%). On follow-up, 109/273 (37%) patients in the diabetic group died, compared with 49/202 (24%) in the non-diabetic group. Independent predictors of death were diabetes (p<0.005, OR=1.73), age at enrollment (p<0.0001, OR=1.06), serum creatinine (p<0.01, OR=1.44) and diuretic use (p=0.038, OR=1.85). Beta-blocker use was associated with a decreased risk of death on univariate analysis only. CONCLUSIONS: Our results show that diabetic patients with HF continue to have higher mortality than non-diabetic patients with HF despite advances in therapy.

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PubMed2005

Secular trends in prevalence of diabetes among younger patients admitted with acute myocardial infarction.

BACKGROUND: Diabetes prevalence is increasing in the population, both in the young and the elderly. We assessed the impact of increasing prevalence of diabetes on admissions for acute myocardial infarctions (MI) from 1990 through 1997. METHODS AND RESULTS: We retrospectively identified all patients discharged with the primary diagnosis of MI from any Veteran's Affairs Medical Center (VAMC) in the country between October 1990 and September 1997. Patients were classified as having diabetes from the ICD-9-CM codes and stratified by age. Demographic data were extracted from the patient treatment files. Prevalence of diabetes among MI patients for the years 1990 through 1997 was compared to that in the general population obtained from the Center for Disease Control. We identified 67,889 patients with MI of whom 17,756 (26%) had diabetes. In the age group < or =44 years, the prevalence of diabetes remained at approximately 11.5% from 1991 to 1998. In the age group 45-64 years, the increase was from 23% to 28%--a 23% increase (p<0.001), while in the older age group over 65 years, it increased from 25% to 33.5%--a 34% increase (p<0.001). In the general population, prevalence of diabetes increased by 50%, 63% and 44% in the three age groups. CONCLUSIONS: Despite substantial increase in prevalence of diabetes among the younger population, it does not appear to be predisposing them to increased risk for MI. The prevalence of diabetes among older patients with MI paralleled the increase seen in the general population with the steepest increase seen in the group > or =65 years. These data are important in focusing our resources for preventive measures.

Adult↗
PubMed2005

Similar decline in post-myocardial infarction mortality among subjects with and without diabetes.

BACKGROUND: Data from the 1970s and 1980s suggest that the rate of mortality from coronary disease for patients with diabetes has changed less than that for patients without diabetes. We evaluated trends in post-myocardial infarction mortality and morbidity in patients with and without diabetes over a 7-year period from 1990 through 1997, when substantial changes occurred in the management of coronary disease. METHODS: All patients discharged with the primary diagnosis of acute myocardial infarction (MI) from any Veterans Affairs Medical Center in the country between October 1990 and September 1997 were identified. Demographic, comorbid conditions, inpatient, outpatient, mortality, and readmission data were extracted. Mortality, trends in mortality over time, revascularization, readmissions, and length of hospital stay for MI were compared for the group with diabetes and the group without diabetes. Independent predictors of survival using a Cox regression model were examined. RESULTS: We identified 67,889 patients with MI, of whom 17,756 (26%) had diabetes. At 60 days post-MI, there was a 29% higher mortality rate in the group with diabetes (5.2% versus 4.0%, P < 0.001), which increased to 35% at 1 year (16.1% versus 11.9%, P < 0.001). Diabetes was independently associated with increased overall mortality. Age-adjusted 1-year post-MI mortality from 1991 to 1998 had a significant downward trend (4.9% decrease in odds of mortality per year, P < 0.001) regardless of diabetes status. CONCLUSIONS: Patients with diabetes showed a trend toward declining 1-year post-MI mortality rate that was not significantly different from that seen in patients without diabetes. Further work needs to be done to narrow the gap between the two groups.

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PubMed2003

Comparison of tailored interventions to increase mammography screening in nonadherent older women.

BACKGROUND: Recent increases in mammography use have led to a decrease in mortality from breast cancer. METHODS: Building on the Health Belief Model, the Transtheoretical Model, and past effectiveness of tailored interventions, we conducted a prospective randomized trial (n = 773) to test the efficacy on mammography adherence of tailored interventions delivered by five different methods, i.e., telephone counseling, in-person counseling, physician letter, and combinations of telephone with letter and in-person with letter. RESULTS: All five interventions increased mammography adherence significantly relative to usual care (odds ratios, 1.93 to 3.55) at 6 months post intervention. The combination of in-person with physician letter was significantly more effective than telephone alone or letter alone. Women thinking about getting a mammogram at baseline were more likely to be adherent by 6 months; even those in usual care achieved 48% adherence compared with 50-70% in the intervention groups. In contrast, women not thinking about getting a mammogram needed the interventions to increase their adherence from 13% to over 30%. CONCLUSIONS: All five interventions were effective at increasing mammography adherence. Women not thinking about getting a mammogram were most likely to benefit from these tailored interventions while other women might need less intensive interventions.

Breast Neoplasms↗
PubMed2002

Geographic variation in health care utilization and outcomes in veterans with acute myocardial infarction.

OBJECTIVES: To examine regional variation in health care utilization and outcomes during acute and chronic care of veterans following acute myocardial infarction (AMI), identifying potentially modifiable variables and processes of care that influence patient outcomes. METHODS: Using national VA databases, we identified all veterans hospitalized at any VA Medical Center (VAMC) for AMI between October 1990 and September 1997. Demographic, inpatient, outpatient, mortality, and readmission data were extracted for 4 regions: Northeast, South, Midwest and West. Multivariable Cox proportional hazards regression models, controlled for comorbidity, were used to assess predictors of time to death and readmission. RESULTS: We identified 67,889 patients with AMI. Patient demographic characteristics by region were similar. Patients in the Northeast had more comorbid conditions and longer lengths of stay during the index AMI hospitalization. Region of the country independently predicted time to death, with lower risk of death in the Northeast (hazard ratio [HR] = 0.875; 95% confidence interval [95% CI], 0.834 to 0.918; P < .0001) and West (HR = 0.856; 95%CI, 0.818 to 0.895; P = .0001) than in the South. Patients in the Northeast and West also had more cardiology or primary care follow-up within 60 days and at 1 year post-discharge than patients in the South and Midwest. Outpatient follow-up accounted for a significant portion of the variation in all-cause mortality. CONCLUSION: Substantial geographic variation exists in subsequent clinical care and outcomes among veterans hospitalized in VAMCs for AMIs. Outpatient follow-up was highly variable and associated with decreased mortality. Further studies are needed to explore the causes of regional variation in processes of care and to determine the most effective strategies for improving outcomes after AMI.

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