{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T21:55:06Z","timestamp":1775771706910,"version":"3.50.1"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2016,5,6]]},"abstract":"\n Background<\/jats:title>\n \n Premature clopidogrel discontinuation after drug\u2010eluting stent placement is associated with adverse outcomes. Little is known about patient and hospital factors associated with premature discontinuation or whether less variation in premature discontinuation exists in integrated health care systems such as the\n Veterans Affairs<\/jats:styled-content>\n (VA).\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We evaluated the frequency of premature clopidogrel discontinuation, defined as a gap between clopidogrel refills of \u226590\u00a0days during the first 6\u00a0months of treatment, among 12\u00a0707 patients who received drug\u2010eluting stents in\n VA<\/jats:styled-content>\n hospitals between 2008 and 2010. We evaluated the association between premature discontinuation and all\u2010cause mortality and\/or acute myocardial infarction, variation in the proportion of premature discontinuation among hospitals, the patient and hospital characteristics associated with premature discontinuation, and the extent to which unexplained hospital characteristics contribute to premature discontinuation. Of the patients, 963 (7.6%) discontinued clopidogrel prematurely. Premature discontinuation was associated with acute myocardial infarction and all\u2010cause mortality (hazard ratio 1.65, 95% CI 1.37\u20131.99,\n P<\/jats:italic>\n <0.001). The proportion of patients with premature discontinuation varied across hospitals from 0% to 16.5% (\n P<\/jats:italic>\n <0.001). We found a median of 24% greater odds of patients with identical covariates with premature discontinuation at one randomly selected hospital compared with another (median odds ratio 1.24, 95% CI 1.17\u20131.44). Patient factors associated with premature discontinuation included lack of cardiology follow\u2010up within 30\u00a0days of discharge and smaller initial clopidogrel fill.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n One in 13 patients prematurely discontinued clopidogrel, and variation in discontinuation across hospitals was\u00a0observed. Patient factors were associated with premature discontinuation that may represent targets for quality improvement.<\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.114.001376","type":"journal-article","created":{"date-parts":[[2016,5,6]],"date-time":"2016-05-06T04:49:26Z","timestamp":1462510166000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Hospital Variation in Premature Clopidogrel Discontinuation After Drug\u2010Eluting Stent Placement in the Veterans Affairs (VA) Healthcare System"],"prefix":"10.1161","volume":"5","author":[{"given":"Rebecca","family":"Vigen","sequence":"first","affiliation":[{"name":"The University of Texas at Southwestern Medical Center, Dallas, TX"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas M.","family":"Maddox","sequence":"additional","affiliation":[{"name":"VA Eastern Colorado Health Care System, Denver, CO"},{"name":"University of Colorado Denver, Aurora, CO"},{"name":"Colorado Cardiovascular Outcomes Research (CCOR) Consortium, Denver, CO"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colin I.","family":"O'Donnell","sequence":"additional","affiliation":[{"name":"VA Eastern Colorado Health Care System, Denver, CO"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary K.","family":"Grunwald","sequence":"additional","affiliation":[{"name":"VA Eastern Colorado Health Care System, Denver, CO"},{"name":"University of Colorado Denver, Aurora, CO"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepak L.","family":"Bhatt","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas T.","family":"Tsai","sequence":"additional","affiliation":[{"name":"VA Eastern Colorado Health Care System, Denver, CO"},{"name":"University of Colorado Denver, Aurora, CO"},{"name":"Colorado Cardiovascular Outcomes Research (CCOR) Consortium, Denver, CO"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John S.","family":"Rumsfeld","sequence":"additional","affiliation":[{"name":"VA Eastern Colorado Health Care System, Denver, CO"},{"name":"University of Colorado Denver, Aurora, CO"},{"name":"Colorado Cardiovascular Outcomes Research (CCOR) Consortium, Denver, CO"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. Michael","family":"Ho","sequence":"additional","affiliation":[{"name":"VA Eastern Colorado Health Care System, Denver, CO"},{"name":"University of Colorado Denver, Aurora, CO"},{"name":"Colorado Cardiovascular Outcomes Research (CCOR) Consortium, Denver, CO"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.02.011"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.180944"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2010.08.067"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.17.2126"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.618066"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1104816"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.110.958264"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2012.394"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.112.965285"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-009-1130-6"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1047-2797(01)00285-X"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/1478-7954-4-2"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.02.005"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.09.045"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.114.001376","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T10:20:50Z","timestamp":1715595650000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.114.001376"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,5,6]]},"references-count":14,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2016,5,6]]}},"alternative-id":["10.1161\/JAHA.114.001376"],"URL":"https:\/\/doi.org\/10.1161\/jaha.114.001376","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,5,6]]},"assertion":[{"value":"2014-08-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-03-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-05-05","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e001376"}}