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Critical Pathways in Cardiology

Shaban Mohammed, Ayman El-Menyar, Ihsan M Rafie, Hajar A AlBinAli, Rajvir Singh, Jassim Al Suwaidi
BACKGROUND: Gender discrepancy in the cardiovascular diseases has been evaluated in several studies. We studied the impact of gender disparity on the presentation and outcome of diabetic heart failure (DHF) patients. METHODS: A retrospective analysis was conducted including all DHF patients admitted to the Heart Hospital between 1991 and 2013. Patients' demographics, presentation, management, and hospital outcomes were analyzed and compared based on gender and age...
September 2016: Critical Pathways in Cardiology
Alessandro Iliceto, Sara Louise Berndt, Jaimi H Greenslade, William A Parsonage, Christopher Hammett, Martin Than, Tracey Hawkins, Kate Parker, Shannen O'Kane, Louise Cullen
OBJECTIVE: Obtaining an accurate medical history is essential in the assessment of patients, particularly in emergency department (ED) patients with acute chest pain, as there can be a time imperative for diagnosis and commencement of treatment. We aimed to evaluate reliability of patient-reported compared with physician-adjudicated medical history by assessing patient's recall and communication of personal events and its influence on the accuracy of the medical history. METHODS: A total of 776 patients presenting at ED with suspected cardiac chest pain were recruited...
September 2016: Critical Pathways in Cardiology
Wade Skoien
OBJECTIVE: Chest pain is one of the most frequent causes for presentation to emergency departments (EDs). The majority of patients will undergo diagnostic workup including stress testing to rule out an acute coronary syndrome, but very few patients will be diagnosed with a cardiac cause for their pain. Patients under 40 years represent a lower risk group in which routine stress testing may be of little benefit. This systematic review sought to determine the diagnostic yield of routine stress testing in low- and intermediate-risk chest pain patients under 40 years...
September 2016: Critical Pathways in Cardiology
Paul A Heidenreich, Parisa Gholami, Shoutzu Lin
BACKGROUND: The objective of this study was to determine how often providers did not obtain a recommended measure of left ventricular ejection fraction (LVEF) following a high B-type natriuretic peptide (BNP) value when the LVEF was not known to be low (<40%). Such patients may benefit from life-prolonging treatment. METHODS: We identified consecutive patients (inpatient or outpatient) with a BNP value of at least 200 pg/mL within a single VA health care system (3 inpatient facilities and 8 community clinics) during a 10-month period (September 2008-June 2009)...
September 2016: Critical Pathways in Cardiology
Benjamin I Shepple, William A Thistlethwaite, Christopher L Schumann, Kwame O Akosah, Robert C Schutt, Ellen C Keeley
As part of a quality improvement project, we performed a process analysis to evaluate how patients presenting with type 1 non-ST elevation myocardial infarction (STEMI) are diagnosed and managed early after the diagnosis has been made. We performed a retrospective chart review and collected detailed information regarding the timing of the first 12-lead electrocardiogram, troponin order entry and first positive troponin result, administration of anticoagulation and antiplatelet medications, and referral for coronary angiography to identify areas of treatment variability and delay...
September 2016: Critical Pathways in Cardiology
Ivan C Rokos, Karl Sporer, Paul B Savino, Mary P Mercer, Selinda S Shontz, Sarah Sabbagh, Renee Y Hsia
INTRODUCTION: California has been a global leader in regionalization efforts for time-critical medical conditions. A total of 33 local emergency medical service agencies (LEMSAs) exist, providing an organized EMS framework across the state for almost 40 years. We sought to develop a survey tool to quantify the degree and duration of ST-elevation myocardial infarction (STEMI) regionalization over the last decade in California. METHODS: The project started with the development of an 8-question survey tool via a multi-disciplinary expert consensus process...
September 2016: Critical Pathways in Cardiology
Jason P Stopyra, Cheryl Courage, Christopher A Davis, Brian C Hiestand, Robert D Nelson, James E Winslow
BACKGROUND: More than 300,000 persons in the United States experience an out-of-hospital cardiac arrest every year. The American Heart Association emphasizes on the rapid, effective delivery of cardiac arrest interventions by bystanders and emergency medical services (EMS) on scene. In July 2013, the EMS of Randolph County, a rural county in central North Carolina, implemented a team-focused cardiopulmonary resuscitation(CPR) protocol. The protocol emphasized early chest compressions and resuscitation on scene until the return of spontaneous circulation (ROSC) or until efforts were deemed futile...
September 2016: Critical Pathways in Cardiology
Tracy Ison, Linda Morris, Gloria Wilkerson, Carla Schmidt, David E Winchester
BACKGROUND: An efficient testing process is a key to a timely diagnosis of acute myocardial infarction in the emergency department (ED). This includes a rapid evaluation cardiac biomarkers. METHODS: We conducted a quality and process improvement project to reduce troponin-T turnaround time (TAT) in the central laboratory at our facility. An interdisciplinary team, including front-line staff members, reviewed each step of troponin-T processing in both the ED and the central laboratory...
September 2016: Critical Pathways in Cardiology
Seyed Ebrahim Kassaian, Yadollah Fathi, Masoumeh Lotfi-Tokaldany, Mojtaba Salarifar, Mohammad Alidoosti, Ali-Mohammad Haji-Zeinali, Hassan Aghajani, Alireza Amirzadegan, Younes Nozari, Seyedeh Hamideh Mortazavi, Arash Jalali, Sepideh Saroukhani
OBJECTIVE: The aim of this study is to compare intracoronary (IC) bolus only with IC bolus plus maintenance intravenous (IV) infusion of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors with respect to 1-year major adverse cardiac events including mortality, nonfatal myocardial infarction, revascularization, and bleeding events after primary percutaneous coronary intervention (PCI). METHODS: This is an observational study of 233 consecutive patients who presented with ST-elevation myocardial infarction and underwent primary PCI between April 2009 and December 2012...
September 2016: Critical Pathways in Cardiology
Megan E Barra, John Fanikos, Marie D Gerhard-Herman, Deepak L Bhatt
BACKGROUND: Patients who have undergone intracoronary stent implantation often require surgery within the first year after the procedure. Planned or emergent surgical intervention requires interruption of antiplatelet therapy and is associated with an increased risk of stent thrombosis. Eptifibatide, an intravenous glycoprotein IIb/IIIa inhibitor (GPIIb/IIIa), can be considered for antiplatelet bridging of high-risk patients in the periprocedural period. OBJECTIVES: The aim of this report is to describe the management of antiplatelet therapy and outcomes of patients who were bridged with eptifibatide perioperatively within 1 year of intracoronary stent implantation...
September 2016: Critical Pathways in Cardiology
Jessica Buchheit, Prabashni Reddy, Jean M Connors
Idarucizumab (Praxbind), a humanized monoclonal antibody fragment was granted accelerated approval from the Food and Drug Administration in October 2015 as the first agent to reverse the effects of a novel oral anticoagulant. The drug is indicated for dabigatran reversal in patients requiring emergency surgery/urgent procedures or with life-threatening or uncontrolled bleeding. In a randomized study with healthy volunteers, compared with placebo, idarucizumab reduced the clotting times for all tests assays (assessed pre-, end of-, and 24 hours after infusion), while the results for the placebo group remained unchanged...
September 2016: Critical Pathways in Cardiology
Tyler W Barrett, Keith D Wrenn, Corey M Slovis, Ian D Jones, Patty W Wright, Wesley H Self, Stephan Russ, Sean P Collins, Michael J Ward, Matthew Felbinger, Leanne Atchison, Joshua A Beckman
No abstract text is available yet for this article.
September 2016: Critical Pathways in Cardiology
Ali Bozorgi, Siavash Khaki, Seyedeh Hamideh Mortazavi, Saeed Sadeghian, Maryam Khoshnevis, Salar Tofighi, Arash Khaki
OBJECTIVE: Considering the limited studies specifically evaluating the role of Red blood cell distribution width (RDW) in primary percutaneous coronary intervention (PCI), we aimed to investigate the role of baseline RDW in short- and intermediate-term cardiovascular events in ST-elevation myocardial infarction patients under primary PCI. METHODS: This is a historical cohort registry analysis of 1161 patients with ST-elevation myocardial infarction under primary PCI...
June 2016: Critical Pathways in Cardiology
Benjamin C Sun, Amber Laurie, Rongwei Fu, Maros Ferencik, Michael Shapiro, Christopher J Lindsell, Deborah Diercks, James W Hoekstra, Judd E Hollander, J Douglas Kirk, W Frank Peacock, W Brian Gibler, Venkataraman Anantharaman, Charles V Pollack
BACKGROUND: Professional society guidelines suggest early stress testing (within 72 hours) after an emergency department (ED) evaluation for suspected acute coronary syndrome (ACS). However, there is increasing concern that current practice results in over-testing without evidence of benefit. We test the hypothesis that early stress testing improves outcomes. METHODS: We analyzed prospectively collected data from 9 EDs on patients with suspected ACS, 1999-2001. We excluded patients with an ED diagnosis of ACS...
June 2016: Critical Pathways in Cardiology
Robert F Hamburger, John A Spertus, David E Winchester
BACKGROUND: Because the Diamond-Forrester (DF) model is predictive of obstructive coronary artery disease (CAD), it is often used to risk stratify acute chest pain patients. We sought to further evaluate the clinical utility of the DF model within a chest pain evaluation center. METHODS: Consecutive patients with chest pain and no known CAD or evidence of active ischemia were asked to participate in a prospective registry. Patients were classified based on cardiovascular risk factors, age, and DF classification...
June 2016: Critical Pathways in Cardiology
Barbra E Backus, A Jacob Six, Pieter A Doevendans, Johannes C Kelder, Ewout W Steyerberg, Yvonne Vergouwe
OBJECTIVES: Risk stratification for chest pain patients at the emergency department is recommended in several guidelines. The history, ECG, age, risk factors, and troponin (HEART) score is based on medical literature and expert opinion to estimate the risk of a major adverse cardiac event. We aimed to assess the predictive effects of the 5 HEART components and to compare performances of the original HEART score and a model based on regression analysis. METHODS: We analyzed prospectively collected data from 2388 patients, of whom 407 (17%) had a major adverse cardiac event within 6 weeks (acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, significant stenosis with conservative treatment and death due to any cause)...
June 2016: Critical Pathways in Cardiology
Jason P Stopyra, Chadwick D Miller, Brian C Hiestand, Cedric W Lefebvre, Bret A Nicks, David M Cline, Kim L Askew, Robert F Riley, Gregory B Russell, Greg L Burke, David Herrington, James W Hoekstra, Simon A Mahler
BACKGROUND: The 2-hour accelerated diagnostic protocol (ADAPT) and the history electrocardiogram age risk factors troponin (HEART) Pathway are decision aids designed to identify Emergency Department (ED) patients with chest pain who are safe for early discharge. Both have demonstrated high sensitivity (>99%) for major adverse cardiac events (MACE) at 30 days and early discharge rates ≥20%. The objective of this study is to compare the sensitivity and early discharge rates of the ADAPT and HEART Pathway decision aids in a cohort of ED patients with acute chest pain...
June 2016: Critical Pathways in Cardiology
Tarun Jain, Richard Nowak, Michael Hudson, Tiberio Frisoli, Gordon Jacobsen, James McCord
INTRODUCTION: The HEART score is a risk-stratification tool that was developed and validated for patients evaluated for possible acute coronary syndrome (ACS) in the emergency department (ED). We sought to determine the short-term and long-term prognostic utility of the HEART score. METHODS: A retrospective single-center analysis of 947 patients evaluated for possible ACS in the ED in 1999 was conducted. Patients were followed for major adverse cardiac events (MACEs) at 30 days: death, acute myocardial infarction, or revascularization procedure...
June 2016: Critical Pathways in Cardiology
David E Winchester, Thomas A Burkart, Calvin Y Choi, Matthew S McKillop, Rebecca J Beyth, Phillipp Dahm
OBJECTIVE: Training in quality improvement (QI) is a pillar of the next accreditation system of the Accreditation Committee on Graduate Medical Education and a growing expectation of physicians for maintenance of certification. Despite this, many postgraduate medical trainees are not receiving training in QI methods. We created the Fellows Applied Quality Training (FAQT) curriculum for cardiology fellows using both didactic and applied components with the goal of increasing confidence to participate in future QI projects...
June 2016: Critical Pathways in Cardiology
David P Reardon, Kent Owusu
No abstract text is available yet for this article.
June 2016: Critical Pathways in Cardiology
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