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Critical Pathways in Cardiology

Frank Breuckmann, Tienush Rassaf
The nationwide German certification process of specialized chest pain units is unique in Europe. By February 2018, 269 units had already been successfully certified. With that number, more than half of all catheter laboratories across the country offering service on a 24/7 basis for interventional treatment in myocardial infarction take part in that certified chest pain program - with still increasing tendency. Currently, those units provide a mean of one chest pain unit bed per 65,000 inhabitants. Thereby, a high percentage of recertification of about 95% reflects a high acceptance of the concept by the health care providers...
December 2018: Critical Pathways in Cardiology
Babak Geraiely, Hamidreza Poorhosseini, Saeed Sadeghian, Roya Sattarzadeh Badkoubeh, Seyedeh Hamideh Mortazavi
Despite its clinical benefits, aspirin has been considered one of the predictors of worse outcomes in patients with unstable angina/non-ST-segment-elevation myocardial infarction. Nevertheless, such association has not been demonstrated in patients with ST-elevation myocardial infarction (STEMI). Five hundred eighty-six STEMI patients undergoing primary percutaneous coronary intervention were evaluated including 116 prior aspirin users. Angiographic characteristics and 1-year major adverse cardiac events (MACE) were then compared between the 2 groups...
December 2018: Critical Pathways in Cardiology
Michelle P Lin, Shaw Natsui, Corine Sinnette, Alexis Ball, Joel S Weissman, Jeremiah D Schuur
BACKGROUND: Chest pain of possible cardiac etiology is a leading reason for emergency department (ED) visits and hospitalizations nationwide. Evidence suggests outpatient management is safe and effective for low-risk patients; however, ED admission rates for chest pain vary widely. To identify barriers and facilitators to outpatient management after ED visits, we performed a multicenter qualitative study of key stakeholders. METHODS AND RESULTS: We identified Massachusetts hospitals with below-average admission rates for adult ED chest pain visits from 2010 to 2011...
December 2018: Critical Pathways in Cardiology
Sabina B Gesell, Shannon L Golden, Alexander T Limkakeng, Christine M Carr, Andrew Matuskowitz, Lane M Smith, Simon A Mahler
OBJECTIVE: The HEART Pathway is an evidence-based decision tool for identifying emergency department (ED) patients with acute chest pain who are candidates for early discharge, to reduce unhelpful and potentially harmful hospitalizations. Guided by the Consolidated Framework for Implementation Research, we sought to identify important barriers and facilitators to implementation of the HEART Pathway. STUDY SETTING: Data were collected at 4 academic medical centers...
December 2018: Critical Pathways in Cardiology
Brandon R Allen, Grant G Simpson, Ideen Zeinali, Jared T Freitas, Jeffrey J Chapa, Liam J Rawson, Julie A Richter, Thomas F Payton, Joseph Adrian Tyndall
Chest pain can be a challenging complaint to manage in the emergency department. A missed diagnosis can result in significant morbidity or mortality, whereas avoidable testing and hospitalizations can lead to increased health care costs, contribute to hospital crowding, and increase risks to patients. The HEART score is a validated decision aid to identify patients at low risk for acute coronary syndrome who can be safely discharged without admission or objective cardiac testing. In the largest and one of the longest studies to date (N = 31,060; 30 months), we included the HEART score into a larger, newly developed low-risk chest pain decision pathway, using a retrospective observational pre/post study design with the objective of safely lowering admissions...
December 2018: Critical Pathways in Cardiology
Alexander Michaels, Joseph Gibbs, Sagger Mawri, George Dirani, Lindsey Aurora, Gordon Jacobsen, Richard Nowak, James McCord
The evaluation of individuals with possible acute myocardial infarction (AMI) is time consuming and costly. Risk stratification early during an acute care encounter presents an opportunity for increased delivery of high-value care. We sought to evaluate if the HEART score could be used in the triage of low-risk versus high-risk patients directly home without cardiac testing. Retrospective review of 838 patients placed in an observation unit for evaluation of AMI was done at a single-center, tertiary care teaching hospital...
December 2018: Critical Pathways in Cardiology
Stacey J Howell, Ezra A Amsterdam, Bryn E Mumma, Javier E López, Nam K Tran
OBJECTIVE: Implementation of the newly approved high-sensitivity cardiac troponin (hs-cTn) in the United States presents a challenge for clinical practice. Sex-specific cutoffs, clinical protocols, and workflows will likely require modifications before implementation. METHODS: We conducted a cross-sectional survey of international physicians and laboratorians already utilizing hs-cTn for the evaluation of acute myocardial infarction. RESULTS: Twenty-two of 54 (41%) eligible participants completed the survey, representing 9 countries and 18 hospitals...
December 2018: Critical Pathways in Cardiology
Cole E Ziegler, David M Painter, Joseph B Borawski, Raymond J Kim, Han W Kim, Alexander T Limkakeng
BACKGROUND: Stress cardiac magnetic resonance imaging (CMR) has become increasingly used in patients presenting to the emergency department (ED) with symptoms concerning for acute coronary syndrome (ACS). We hypothesized that CMR detects a number of alternative diagnoses (diagnoses other than ACS that could explain symptoms) and incidental findings in patients presenting to the ED for potential ACS. METHODS: We prospectively enrolled adult patients who presented to an academic ED from 2011 to 2015 for possible ACS and subsequently had an adenosine stress perfusion CMR as part of their diagnostic evaluation...
September 2018: Critical Pathways in Cardiology
Stella Pak, Yan Yatsynovich, Damian Valencia, Tian Chen
Hyperuricemia has been recently speculated to be associated with the development of atrial fibrillation (AF). A meta-analysis of observational studies was conducted to explore the relationship between serum uric acid (SUA) and AF. We searched the MEDLINE, EMBASE, and CINAHL databases and performed extensive bibliography search to identify studies with mean SUA level for patients with and without AF. Key search terms were "atrial fibrillation" and "uric acid." Under the random-effects model, the pooled standardized difference in means between patients with and without AF was calculated...
September 2018: Critical Pathways in Cardiology
Habib A Dakik, Wassef Karowni, Katia El-Sibai, Semaan Kobrossi, Karrar Abdul-Ameer, Hani Tamim
BACKGROUND: Little data are available on the impact of formal training and certification on the relationship between volumes and outcome in percutaneous coronary interventions (PCIs).The objective of this report is to study the relationship between PCI volume and outcome for a formally trained interventional cardiologist who is certified by the American Board on Internal Medicine - Interventional Cardiology subspecialty board. METHODS: The operator witnessed 3 different PCI volumes/yr over a 15-year practice period (2000-2014): <50 PCI/yr (years 2000-2006; n = 179), 50-100 PCI/yr (years 2007-2010; n = 256), and >100 PCI/yr (years 2011-2014; n = 427)...
September 2018: Critical Pathways in Cardiology
Ali Bozorgi, Kaveh Hosseini, Arash Jalali, Masih Tajdini
BACKGROUND: We aimed to compare current syncope risk stratification scores and propose a new more feasible and easy-to-use one. METHODS: In this prospective cohort study, we enrolled all patients (≥18 years) with chief complaint of syncope if they were not eligible for admission in terms of high-risk features. San Francisco Syncope Rule, Osservatorio Epidemiologico sulla Sincope nel Lazio, and risk stratification of syncope in the emergency department scores were compared in our population...
September 2018: Critical Pathways in Cardiology
Samineh Sehatbakhsh, Alexander Kushnir, Stefanie Furlan, Elie Donath, Waqas Ghumman, Robert Chait
OBJECTIVE: Current guidelines recommend treating patients with cocaine-associated chest pain, unstable angina, or myocardial infarction similarly to patients with traditional acute coronary syndrome (ACS). Risk stratifying these patients could potentially reduce unnecessary procedures and improve resource utilization. METHODS: This is a retrospective cross-sectional analysis of 258 patients presenting with cocaine-associated ACS who underwent cardiac catheterization in a community teaching hospital between 2006 and 2015...
September 2018: Critical Pathways in Cardiology
Alberto Conti, Daniele Molesti, Simone Bianchi, Stefania Catarzi, Mariuccia Mazzucchelli, Antonella Covelli, Andrea Tognarelli, Mafalda Ester Perrotta, Alessandro Pampana, Giovanni Orlandi, Iginio Dell'Amico, Alberto Baratta, Giuseppe Arena, Tito Torri
BACKGROUND: Clinical variables including hypertension could be linked with major bleeding events and death beyond vitamin K antagonist (warfarin) or direct oral anti-coagulants (DOACs) treatment strategy. METHODS: Subgroup analysis of major bleeding (primary endpoint) associated with clinical variables, site of bleeding, ongoing antithrombotics, reversal treatment or blood transfusion, outcomes (secondary endpoints) was performed in patients with bleeding events submitted to hard 5:1 propensity-score matching for hypertension...
September 2018: Critical Pathways in Cardiology
W Brian Gibler, Judy M Racadio, Amy L Hirsch, Todd W Roat
No abstract text is available yet for this article.
September 2018: Critical Pathways in Cardiology
Lynn Zaremski, Alon Mazori, Eric Shulman, Faraj Kargoli, Tina Shah, Jay Julius Chudow, Ephraim Leiderman, Luigi Di Biase, John Fisher, Kevin Ferrick, Andrew Krumerman
BACKGROUND: The weekend effect is a phenomenon in which worse outcomes have been found to occur over the weekend. This has been investigated in the context of stroke, ST-elevation myocardial infarction, and pulmonary embolism among others. Atrial fibrillation (AF) is the most common sustained arrhythmia, and admissions for AF have been increasing. However, few studies exist investigating the existence of a weekend effect regarding AF. Previous studies have been limited by a pragmatic but unrealistic definition of the weekend starting at midnight on Friday and ending midnight on Sunday...
September 2018: Critical Pathways in Cardiology
Simon A Mahler, Thomas C Register, Robert F Riley, Ralph B D'Agostino, Jason P Stopyra, Chadwick D Miller
BACKGROUND: Animal studies suggest that monocyte chemoattractant protein-1 (MCP-1) is a promising biomarker for coronary artery atherosclerosis (CAA), but human studies have been inconclusive. OBJECTIVE: To determine potential relationships between plasma MCP-1 and CAA in patients with acute chest pain. METHODS: A secondary analysis of 150 patients enrolled in emergency department chest pain risk stratification clinical investigations was conducted...
June 2018: Critical Pathways in Cardiology
Gerald Salame, Whitney E Juselius, Marisha Burden, Carlin S Long, Tiffany Bendelow, Brenda Beaty, Frederick A Masoudi, Mori J Krantz
Ultrasound contrast-enhanced stress echocardiography improves endocardial visualization, but diagnostic test rates versus stress myocardial perfusion imaging (MPI) have not been studied. A prospective randomized trial was performed between April 2012 and October 2014 at a single-center, safety net hospital. Hospitalized patients referred for noninvasive stress imaging were randomized 1:1 to stress echocardiography or stress MPI. The primary outcome was diagnostic test rate defined as interpretable images and achievement of >85% of age-predicted maximal heart rate (for dobutamine and exercise)...
June 2018: Critical Pathways in Cardiology
Babak Geraiely, Mojtaba Salarifar, Mohammad Alidoosti, Seyedeh Hamideh Mortazavi
Coronary ectasia accounts for 0.3%-4.9% of patients undergoing coronary angiography. We conducted the present study to evaluate the angiographic characteristics of ST-elevation myocardial infarction (STEMI) patients with infarct-related coronary artery ectasia (IRAE) undergoing primary percutaneous coronary intervention. We evaluated 667 STEMI patients who were divided into 2 groups of IRAE (n = 81) and non-IRAE (n = 568). Preprocedural thrombolysis in myocardial infarction (TIMI) flow grade, postprocedural TIMI flow grade, thrombus burden grade, and TIMI frame count were then evaluated...
June 2018: Critical Pathways in Cardiology
Alan Tesson, Rami Abdo, Aparna Kamath, Joanne Sutter, Rachel Cline, Sarah L Hale, Jonathan Bae, Lalit Verma
OBJECTIVE: The HEART Pathway risk prediction tool (HEART score plus serial troponin measures at 0 and 3 hours post-presentation) is used to identify low-risk patients with chest pain who may qualify for safe, early discharge. We calculated the percentage of patients in our observation unit that qualified as low risk using HEART Pathway, as well as their associated outcomes. METHODS: We retrospectively reviewed charts on 966 consecutive patients admitted to our observation unit for chest pain (January 2015 to February 2016); HEART Pathway scores were retrospectively calculated and serial cardiac troponin values logged...
June 2018: Critical Pathways in Cardiology
James W Schurr, Craig A Stevens, Anne Bane, Sarah E Culbreth, Amy Leigh Miller, Jean M Connors, Katelyn W Sylvester
BACKGROUND: Recently, our institution adopted a weight-based nurse-driven heparin titration protocol that relies on nurses ordering laboratories, adjusting doses, and initiating boluses. Numerous institutions have implemented similar protocols with reported success. METHODS: A single-center retrospective analysis was conducted at the Brigham and Women's Hospital in Boston, Massachusetts that included all patients who were initiated on the weight-based nurse-driven heparin nomogram during a 30-day period...
June 2018: Critical Pathways in Cardiology
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