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Critical Pathways in Cardiology

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https://www.readbyqxmd.com/read/29135626/community-outreach-in-terms-of-early-heart-attack-care-as-a-new-way-of-thinking-in-chest-pain-center-unit-care-giving-commentary-on-the-german-chest-pain-unit-network
#1
Raymond Bahr, Tienush Rassaf, Frank Breuckmann
No abstract text is available yet for this article.
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29135625/impact-of-sex-on-long-term-clinical-outcomes-after-percutaneous-coronary-intervention
#2
Seyed-Mohammad Ghoreyshi-Hefzabad, Seyed-Ebrahim Kassaian, Shahrbanoo Kheirkhah-Sabetghadam, Arash Jalali, Hamidreza Poorhosseini, Mohammad Reza Movahed, Ebrahim Nematipour, Mojtaba Salarifar, Mohammad Alidoosti, Seyedeharezoo Ghoreyshi-Hefzabad, Farshid Alaeddini, Saeed Sadeghian, Masoumeh Lotfi-Tokaldany
AIMS: To evaluate the impact of sex on long-term clinical outcomes after percutaneous coronary intervention (PCI). METHODS: In a large prospective cohort, 5664 patients (1716 women and 3948 men) who underwent PCI in a tertiary cardiac center between March 2007 and March 2010 were enrolled. Patients were followed up for median of 74.3 months. We compared the occurrence of long-term mortality, myocardial infarction (MI), and repeated revascularization between 2 sexes...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29135624/potassium-chloride-sustained-release-dosing-pathway-in-an-academic-medical-center
#3
Bryan M Cook, Danielle M Carter, Heather Dell'Orfano, Lina Matta
Potassium supplementation can be administered intravenously or orally with either immediate release or sustained release formulations. Sustained release potassium chloride allows for delayed absorption and peak effects. In the inpatient setting, it is important to monitor and prevent both hypokalemia and hyperkalemia. Our tertiary-care academic hospital created a clinical pathway for sustained release potassium chloride supplementation in the inpatient population. Our clinical pathway for sustained release potassium chloride creates dosing restrictions designed to prevent hyperkalemia, while allowing exceptions for patients with high requirements...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29135623/patient-ethnicity-predicts-poor-health-access-and-gaps-in-perception-of-personal-cardiovascular-risk-factors
#4
Yeunjung Kim, Kathryn Hogan, Gail D'Onofrio, Sharon Chekijian, Basmah Safdar
BACKGROUND: Focus of health literacy campaigns has centered around raising awareness. It is unknown whether awareness of coronary artery disease risk factors accurately reflects personalization of one's own cardiovascular risk. METHODS: A cross-sectional survey was performed in consecutive patients presenting with chest pain admitted to an observation unit of a tertiary care hospital. A 32-item questionnaire in English or Spanish examined knowledge of coronary artery disease risk factors...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29135622/troponin-limit-of-detection-plus-cardiac-risk-stratification-scores-to-rule-out-acute-myocardial-infarction-and-30-day-major-adverse-cardiac-events-in-ed-patients
#5
Mitchell D Datlow, Kelly M Gray, Adriel Watts, Deborah B Diercks, Bryn E Mumma
When screening for acute myocardial infarction (AMI), troponin levels below the 99th percentile, including those below the limit of detection (LOD), are considered normal. We hypothesized that a low-risk HEART score (0-3) or ACS Pretest Probability Assessment <2% plus a single troponin below the LOD would rule out both AMI and 30-day major adverse cardiac events (MACE). We studied all patients who presented to a single academic emergency department and received a troponin I (Siemens Ultra Troponin I) from September 1, 2013, to November 13, 2013 (n=888)...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29135621/efficacy-of-implementation-of-a-chest-pain-center-at-a-community-hospital
#6
Alexandra Davis, Jason Chiu, Stanley K Lau, Yih Jen Kok, Jonathan Y H Wu
INTRODUCTION: Chest pain is the second leading cause for emergency department (ED) visits in the United States; however, <20% of the patients have acute coronary syndrome that require immediate attention. The HEART score is designed for rapid risk stratification of ED chest pain patients using the following criteria: history, electrocardiogram, age, risk factors, and troponin. It has been shown to be superior in identifying patients with low (HEART score 0-3) and high (7-10) risk of major adverse cardiac events, who can then be rapidly discharged or admitted for intervention...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29135620/safety-of-a-1-hour-rule-out-high-sensitive-troponin-t-protocol-in-patients-with-chest-pain-at-the-emergency-department
#7
E Röttger, S de Vries-Spithoven, J B Reitsma, A Limburg, C E E van Ofwegen-Hanekamp, A W Hoes, J M Poldervaart
BACKGROUND: The 1-hour rule-out high-sensitive cardiac troponin T protocol (hs-cTnT), in which a serial troponin measurement is performed 1 hour after the first to assess the possibility of acute coronary syndrome (ACS), has been implemented in the European guidelines in 2015. Our aim was to assess the safety of this protocol in low-risk patients in the Emergency Department (ED) when implemented in daily practice. METHODS: Patients with acute chest pain presenting to the ED of our hospital and younger than 75 years were included (May 2013 to October 2014, The Netherlands)...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29135619/the-heart-pathway-and-hospital-cost-savings
#8
Amy A Yau, Long T Nguyendo, LaKeesha L Lockett, Edward Michaud
Chest pain is a common complaint in emergency departments. Several guidelines and tools exist to help the clinician determine need for hospitalization. For low-risk patients, clinical judgment can underestimate a patient's risk of major adverse cardiac event. Implementation of an advanced diagnostic protocol with the HEART Pathway can reduce hospital cost. For our academic institution, we saw an approximate $1 million in total savings during the initial implementation year along with increased outpatient visits...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29135618/pathway-for-the-management-of-hyperglycemia-in-the-cardiac-care-unit
#9
Seyed Hamed Hosseini Dehkordi, Jeanine Albu, Emad F Aziz, Eyal Herzog
Inpatient hyperglycemia has been associated with increased morbidity and mortality in critically ill patients. Optimal control of blood glucose (BG) levels using insulin infusion protocols has been shown to improve clinical outcomes. Protocols have been developed to prescribe a safe and effective rate of insulin infusion for optimal control of BG levels; however, a major obstacle in their implementation is their complexity. We have revised and updated our previously published pathway for the management of hyperglycemia, which introduces the "wheel" concept for insulin dosing...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28742648/vitamin-d-deficiency-supplementation-and-cardiovascular-health
#10
Naveen Trehan, Luis Afonso, Diane L Levine, Phillip D Levy
Vitamin D has been traditionally recognized as a vitamin quintessential for bone-mineral health. In the past 2 decades, numerous experimental and observational studies have highlighted the role of vitamin D in immunity, metabolic syndrome (obesity and diabetes), cancers, renal disease, memory, and neurological dysfunction. In this article, we review important studies that focused on the impact of vitamin D on blood pressure, myocardial infarction, peripheral arterial disease, heart failure, and statin intolerance...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28742647/the-dis-utility-of-a-change-in-troponin-i-for-diagnosis-of-non-st-segment-elevation-myocardial-infarction-in-an-observation-unit
#11
Iani Patsias, Benjamin Swanson, Michael Hudson, Sachin Parikh, Khaled Nour, Gordon Jacobsen, James McCord
BACKGROUND: Observation units (OUs) may be an efficient and effective setting to diagnose and risk stratify patients with coronary ischemia and myocardial infarction (MI). Given improved cardiac troponin I (cTnI) assays and expanded utilization of OUs, it is not uncommon for patients with mildly elevated cTnI to be evaluated in OUs. We investigated the serial cTnI results in OU patients to determine whether absolute or relative cTnI changes were useful for the diagnosis of MI. METHODS: This was a retrospective study of 260 patients placed in the OU from a single center in 2007, with an initial cTnI in the indeterminate range of 0...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28742646/comparison-of-3-symptom-classification-methods-to-standardize-the-history-component-of-the-heart-score
#12
Michael R Marchick, Michael L Setteducato, Jesse J Revenis, Matthew A Robinson, Emily C Weeks, Thomas F Payton, David E Winchester, Brandon R Allen
OBJECTIVES: The History, Electrocardiography, Age, Risk factors, Troponin (HEART) score enables rapid risk stratification of emergency department patients presenting with chest pain. However, the subjectivity in scoring introduced by the history component has been criticized by some clinicians. We examined the association of 3 objective scoring models with the results of noninvasive cardiac testing. METHODS: Medical records for all patients evaluated in the chest pain center of an academic medical center during a 1-year period were reviewed retrospectively...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28742645/quality-improvement-in-management-of-acute-coronary-syndrome-continuing-medical-education-and-peer-coaching-improve-antiplatelet-medication-adherence-and-reduce-hospital-readmissions
#13
Amy Larkin, Michael LaCouture, Kathleen Geissel, Peri Barr, Eric R Bates, Christopher P Cannon, Deepak L Bhatt
BACKGROUND: Reducing hospital readmissions and improving patient adherence to antiplatelet medications after an acute coronary syndrome (ACS) event are important goals for improving patient health and decreasing healthcare costs. Nearly half of patients will have a secondary event within 1 year of the initial ACS event. Quality improvement (QI) initiatives that include continuing medical education and peer coaching may improve physician practice patterns and, therefore, patient outcomes...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28742644/update-on-sglt2-inhibitors-new-data-released-at-the-american-diabetes-association
#14
Sara Lee
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are one of the newer classes of antiglycemic agents approved for the management of patients with type 2 diabetes mellitus. Due to their unique mechanism of action, SGLT2 inhibitors have shown to be beneficial beyond glucose control. The improvement in cardiovascular (CV) outcomes was first observed in the landmark EMPA-REG OUTCOMES study. Following these results, numerous CV outcome trials were designed to identify whether the beneficial CV and renal effects observed with empagliflozin are unique or a drug class effect...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28742643/sensitive-troponin-i-and-stress-testing-in-the-emergency-department-for-the-early-management-of-chest-pain-using-2-hour-protocol
#15
Shahriar Dadkhah, Zakaria Almuwaqqat, Samian Sulaiman, Husein Husein, Quang Nguyen, Saad Ali, Tuncay Taskesen
BACKGROUND: Despite improvements in identifying high-risk patients with non-ST segment ACS (acute coronary syndrome), low risk patients presenting with atypical chest pain and non-diagnostic Electrocardiogram (ECG) continued to undergo unnecessary admissions and testing. Since 1992, our chest pain protocol included using 4-hour serial biomarkers from ED admission in combination with stress testing to evaluate these patients. Our study aimed at determining whether a new accelerated diagnostic protocol using sensitive cardiac troponin I (cTnI) 2 hours after admission to the ED followed by stress testing is safe and effective in emergency settings, allowing for appropriate triage, earlier discharge and reducing costs...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28742642/pathway-for-the-management-of-sleep-apnea-in-the-cardiac-patient
#16
Emad F Aziz, Allison Selby, Edgar Argulian, Joshua Aziz, Eyal Herzog
Sleep-disordered breathing is a highly prevalent medical condition, which if undiagnosed leads to increased morbidity and mortality, particularly related to increased incidence of cardiovascular events. It is therefore imperative that we identify patient population at high risk for sleep apnea and refer them to the appropriate therapy as early as possible. Up-to-date there is no management guideline specifically geared towards cardiac patients. Thus, we propose a (SAP) Sleep Apnea Pathway to correctly identify and triage these patients to the appropriate therapy...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28509708/pvcs-pvc-induced-cardiomyopathy-and-the-role-of-catheter-ablation
#17
Esseim Sharma, Karuppiah Arunachalam, Mengyang Di, Antony Chu, Abhishek Maan
Premature ventricular contractions (PVCs) are common arrhythmias noticed in the clinical setting because of premature depolarization of the ventricular myocytes. Although often thought to be reflective of underlying disease rather than intrinsically harmful, PVCs have recently been linked with worse outcomes in patients without significant cardiac disease. Long-term exposure to a high PVC burden can lead to the development of PVC-induced cardiomyopathy. The pathogenesis of this condition is poorly understood at the current time...
June 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28509707/burden-of-psychosocial-and-cognitive-impairment-in-patients-with-atrial-fibrillation
#18
John A Bostrom, Jane S Saczynski, Alexandra Hajduk, Kevin Donahue, Lawrence S Rosenthal, Clifford Browning, Cynthia Ennis, Kevin C Floyd, Heather Richardson, Nada Esa, Jessica Ogarek, David D McManus
BACKGROUND: Impairments in psychosocial status and cognition relate to poor clinical outcomes in patients with atrial fibrillation (AF). However, how often these conditions co-occur and associations between burden of psychosocial and cognitive impairment and quality of life (QoL) have not been systematically examined in patients with AF. METHODS: A total of 218 patients with symptomatic AF were enrolled in a prospective study of AF and psychosocial factors between May 2013 and October 2014 at the University of Massachusetts Medical Center...
June 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28509706/length-of-stay-mortality-cost-and-perceptions-of-care-associated-with-transition-from-an-open-to-closed-staffing-model-in-the-cardiac-intensive-care-unit
#19
Jason N Katz, Anton Lishmanov, Sean van Diepen, Dongqing Yu, Haipeng Shen, Eric Pauley, Jatin Bhatia, Adam Buntaine, Arun Das, Cristie Dangerfield, Brooke McLaughlin, George A Stouffer, Prashant Kaul
BACKGROUND: Organizational models in the intensive care unit (ICU) have classically been described as either closed or open, depending on the presence or absence of a dedicated ICU team. Although a closed model has been shown to improve patient outcomes in medical and surgical ICUs, the merits of various care models have not been previously explored in the cardiac ICU (CICU) setting. METHODS: From November 2012 to March 2014, data were prospectively collected on all admissions before and after transition from an open to closed CICU at our institution...
June 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28509705/yield-of-cardiac-magnetic-resonance-imaging-in-patients-with-acute-coronary-syndrome-and-no-obstructive-coronary-artery-disease
#20
Mahraz Parvand, Andrew Starovoytov, Tara L Sedlak
PURPOSE: Ten percent to 25% of women and 6%-10% of men with acute coronary syndrome (ACS) are found to have no obstructive coronary artery disease (CAD) on coronary computed tomography angiogram or invasive coronary angiography. The etiology of presentation is often unclear. We examined the diagnostic yield of cardiac magnetic resonance imaging (CMR) in patients with signs and symptoms suggestive of an ACS and no obstructive CAD. METHODS: We retrospectively studied patients with signs and symptoms suggestive of an ACS and no obstructive CAD on coronary computed tomography angiogram or invasive coronary angiography who had CMR performed at St...
June 2017: Critical Pathways in Cardiology
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