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https://www.readbyqxmd.com/read/29768317/heart-failure-episodes-of-missed-major-cardiac-events-when-applying-the-heart-pathway-to-an-observation-unit-population
#1
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
https://www.readbyqxmd.com/read/29725832/coronary-artery-calcium-assessed-with-calibrated-mass-scoring-in-asymptomatic-individuals-results-from-the-copenhagen-general-population-study
#2
Andreas D Knudsen, Andreas Fuchs, J Tobias Kühl, Ben A Arnold, Børge G Nordestgaard, Lars V Køber, Klaus F Kofoed
BACKGROUND: Coronary artery calcification (CAC) is commonly assessed with Agatston score (AS). A higher sensitivity and precision for the detection of CAC has been demonstrated with calibrated mass score (cMS). We hypothesized that cMS would detect low-level CAC not detectable with AS in a large asymptomatic background population. METHODS: Participants (N = 2985) from the Copenhagen General Population Study were evaluated for CAC using both conventional AS and cMS...
May 3, 2018: European Radiology
https://www.readbyqxmd.com/read/29622596/risk-stratifying-chest-pain-patients-in-the-emergency-department-using-heart-grace-and-timi-scores-with-a-single-contemporary-troponin-result-to-predict-major-adverse-cardiac-events
#3
Peter D W Reaney, Hamish I Elliott, Awsan Noman, Jamie G Cooper
BACKGROUND: The majority of patients presenting to the ED with cardiac sounding chest pain have a non-diagnostic ECG and the problem of differentiating those suffering an acute coronary syndrome from those without is familiar to all ED clinical staff. To stratify risk in these patients, specific scores have been developed. Recent work has focused on incorporating newer high-sensitivity cardiac troponin (hs-cTn) assays; however, issues regarding performance and availability of these assays remain...
April 5, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29614075/association-between-the-retinal-vascular-network-with-singapore-i-vessel-assessment-siva-software-cardiovascular-history-and-risk-factors-in-the-elderly-the-montrachet-study-population-based-study
#4
Louis Arnould, Christine Binquet, Charles Guenancia, Seydou Alassane, Ryo Kawasaki, Vincent Daien, Christophe Tzourio, Yumiko Kawasaki, Abderrahmane Bourredjem, Alain Bron, Catherine Creuzot-Garcher
PURPOSE: To identify patterns summarizing the retinal vascular network in the elderly and to investigate the relationship of these vascular patterns with cardiovascular history. METHODS: We conducted a population-based study, the Montrachet study (Maculopathy Optic Nerve nuTRition neurovAsCular and HEarT diseases), in participants older than 75 years. The history of cardiovascular disease and a score-based estimation of their 10-year risk of cardiovascular mortality (Heart SCORE) were collected...
2018: PloS One
https://www.readbyqxmd.com/read/29537350/association-of-obstructive-sleep-apnea-with-microvascular-endothelial-dysfunction-and-subclinical-coronary-artery-disease-in-a-community-based-population
#5
Daniel Shpilsky, Sebhat Erqou, Sanjay R Patel, Kevin E Kip, Oluremi Ajala, Aryan Aiyer, Patrick J Strollo, Steven E Reis, Oladipupo Olafiranye
Studies have reported an association between obstructive sleep apnea (OSA) and cardiovascular disease (CVD) morbidity and mortality. Proposed mechanisms include endothelial dysfunction and atherosclerosis. We aimed to investigate the associations of OSA with endothelial dysfunction and subclinical atherosclerotic coronary artery disease (CAD), and assess the impact of race on these associations. We used data from the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study, a community-based prospective cohort with approximately equal representation of black and white participants...
March 1, 2018: Vascular Medicine
https://www.readbyqxmd.com/read/29512019/an-external-validation-of-the-heart-pathway-among-emergency-department-patients-with-chest-pain
#6
Joshua James Oliver, Matthew Jay Streitz, Jessica Marie Hyams, Richard Michael Wood, Yevgeniy Mikhaylovich Maksimenko, Brit Long, Robert Michael Barnwell, Michael David April
The impact of an outpatient disposition strategy for patients with HEART score 0-3 (HEART pathway) on HEART score prognostic accuracy is unclear. Our objective is to perform an external validation the HEART score in the setting of recent implementation of the HEART pathway. We conducted an external validation study of the HEART pathway among patients presenting to our ED with chest pain 6 weeks after institutional implementation of a HEART pathway outpatient disposition pathway. We reviewed the charts of 625 consecutive patients with chest pain...
March 6, 2018: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/29500619/reliability-of-the-care-rule-and-the-heart-score-to-rule-out-an-acute-coronary-syndrome-in-non-traumatic-chest-pain-patients
#7
Thomas Moumneh, Vanessa Richard-Jourjon, Emilie Friou, Fabrice Prunier, Caroline Soulie-Chavignon, Jacques Choukroun, Betty Mazet-Guilaumé, Jérémie Riou, Andréa Penaloza, Pierre-Marie Roy
In patients consulting in the Emergency Department for chest pain, a HEART score ≤ 3 has been shown to rule out an acute coronary syndrome (ACS) with a low risk of major adverse cardiac event (MACE) occurrence. A negative CARE rule (≤ 1) that stands for the first four elements of the HEART score may have similar rule-out reliability without troponin assay requirement. We aim to prospectively assess the performance of the CARE rule and of the HEART score to predict MACE in a chest pain population. Prospective two-center non-interventional study...
March 2, 2018: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/29480016/a-direct-comparison-of-decision-rules-for-early-discharge-of-suspected-acute-coronary-syndromes-in-the-era-of-high-sensitivity-troponin
#8
Pei Gee Chew, Fredrick Frost, Liam Mullen, Michael Fisher, Heidar Zadeh, Ruth Grainger, Khaled Albouaini, James Dodd, Bilal Patel, Periaswamy Velavan, Babu Kunadian, Anju Rawat, Toba Obafemi, Sarah Tong, Julia Jones, Aleem Khand
BACKGROUND: We tested the hypothesis that a single high sensitivity troponin at limits of detection (LOD HSTnT) (<5 ng/l) combined with a presentation non-ischaemic electrocardiogram is superior to low-risk Global Registry of Acute Coronary Events (GRACE) (<75), Thrombolysis in Myocardial Infarction (TIMI) (≤1) and History, ECG, Age, Risk factors and Troponin (HEART) score (≤3) as an aid to early, safe discharge for suspected acute coronary syndrome. METHODS: In a prospective cohort study, risk scores were computed in consecutive patients with suspected acute coronary syndrome presenting to the Emergency Room of a large English hospital...
February 1, 2018: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29478861/impact-of-the-heart-pathway-on-admission-rates-for-emergency-department-patients-with-chest-pain-an-external-clinical-validation-study
#9
Jessica M Hyams, Matthew J Streitz, Joshua J Oliver, Richard M Wood, Yevgeniy M Maksimenko, Brit Long, Robert M Barnwell, Michael D April
BACKGROUND: Chest pain is a common emergency department (ED) chief complaint. Safe discharge mechanisms for low-risk chest pain patients would be useful. OBJECTIVE: To compare admission rates prior to and after implementation of an accelerated disposition pathway for ED patients with low-risk chest pain based upon the HEART (History, ECG, Age, Risk factors, Troponin) score (HEART pathway). METHODS: We conducted an impact analysis of the HEART pathway...
April 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29454508/the-has-choice-study-utilizing-the-heart-score-an-adp-and-shared-decision-making-to-decrease-admissions-in-chest-pain-patients
#10
Gregory Gafni-Pappas, Susanne D DeMeester, Michael A Boyd, Arun Ganti, Adam M Nicholson, Jeremy Albright, Juan Wu
OBJECTIVE: The HAS-Choice pathway utilizes the HEART Score, an accelerated diagnostic protocol (ADP), and shared decision-making using a visual aid in the evaluation of chest pain patients. We seek to determine if our intervention can improve resource utilization in a community emergency department (ED) setting while maintaining safe patient care. METHODS: This was a single-center prospective cohort study with historical that included ED patients ≥21years old presenting with a primary complaint of chest pain in two time periods...
February 8, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29428052/heart-score-and-stress-test-emergency-department-bayesian-decision-scheme-results-from-the-acute-care-diagnostic-collaboration
#11
Naureen Farook, L Cochon, A D Bode, B P Langer, A A Baez
BACKGROUND: Accurate identification of patients at risk of major adverse cardiac events (MACE) places a substantial burden on emergency physicians (EPs). Bayesian nomogram for risk stratification in low- to intermediate-risk cardiovascular patients has not been investigated previously. OBJECTIVE: The objective of this study was to develop a comparative diagnostic model using Bayesian statistics for exercise treadmill test (ETT) and stress echocardiogram (ECHO) to calculate post-test diagnostic risk of MACE using HEART (history, electrocardiogram, age, risk factors, and troponin) risk score as predictor of pretest probability...
February 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29420956/performance-of-coronary-risk-scores-among-patients-with-chest-pain-in-the-emergency-department
#12
Dustin G Mark, Jie Huang, Uli Chettipally, Mamata V Kene, Megan L Anderson, Erik P Hess, Dustin W Ballard, David R Vinson, Mary E Reed
BACKGROUND: Both the modified History, Electrocardiogram, Age, Risk factors and Troponin (HEART) score and the Emergency Department Assessment of Chest pain Score (EDACS) can identify patients with possible acute coronary syndrome (ACS) at low risk (<1%) for major adverse cardiac events (MACE). OBJECTIVES: The authors sought to assess the comparative accuracy of the EDACS (original and simplified) and modified HEART risk scores when using cardiac troponin I (cTnI) cutoffs below the 99th percentile, and obtain precise MACE risk estimates...
February 13, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29316995/prehospital-modified-heart-score-predictive-of-30-day-adverse-cardiac-events
#13
Jason P Stopyra, William S Harper, Tyson J Higgins, Julia V Prokesova, James E Winslow, Robert D Nelson, Roy L Alson, Christopher A Davis, Gregory B Russell, Chadwick D Miller, Simon A Mahler
Introduction The History, Electrocardiogram (ECG), Age, Risk Factors, and Troponin (HEART) score is a decision aid designed to risk stratify emergency department (ED) patients with acute chest pain. It has been validated for ED use, but it has yet to be evaluated in a prehospital setting. Hypothesis A prehospital modified HEART score can predict major adverse cardiac events (MACE) among undifferentiated chest pain patients transported to the ED. METHODS: A retrospective cohort study of patients with chest pain transported by two county-based Emergency Medical Service (EMS) agencies to a tertiary care center was conducted...
February 2018: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/29191490/prognosticating-clinical-prediction-scores-without-clinical-gestalt-for-patients-with-chest-pain-in-the-emergency-department
#14
Chin Pang Wong, Chun Tat Lui, Jonathan Gabriel Sung, Ho Lam, Hin Tat Fung, Ping Wa Yam
BACKGROUND: Assessment of patients with chest pain is a regular challenge in the emergency department (ED). Recent guidelines recommended quantitative assessment of ischemic risk by means of risk scores. OBJECTIVE: Our aim was to assess the performance of Thrombosis in Myocardial Infarction (TIMI); Global Registry of Acute Coronary Events (GRACE); history, electrocardiogram, age, risk factors, and troponin (HEART) scores; and the North America Chest Pain Rule (NACPR) without components of clinical gestalt in predicting 30-day major adverse cardiac events (MACE)...
February 2018: Journal of Emergency Medicine
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
#15
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
#16
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/29122104/the-diagnosis-of-chronic-coronary-heart-disease
#17
Christian Albus, Jörg Barkhausen, Eckart Fleck, Jörg Haasenritter, Oliver Lindner, Sigmund Silber
BACKGROUND: Chronic coronary heart disease (CHD) and acute myocardial infarction are endemic conditions. In Germany, an estimated 900 000 cardiac catheterizations were performed in the year 2014, and a percutaneous intervention was carried out in 40% of these procedures. It would be desirable to lessen the number of invasive diagnostic procedures while preserving the reliability of diagnosis. In this article, we present the updated recommendations of the German National Care Guideline for Chronic CHD with regard to diagnostic evaluation...
October 20, 2017: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/29114751/using-the-heart-score-in-patients-with-chest-pain-in-the-emergency-department
#18
COMMENT
Judith M Poldervaart, Johannes B Reitsma, Jacob Six, Rolf F Veldkamp, Arno W Hoes
No abstract text is available yet for this article.
November 7, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29114750/using-the-heart-score-in-patients-with-chest-pain-in-the-emergency-department
#19
COMMENT
Thomas Moumneh, Delphine Douillet, Pierre-Marie Roy
No abstract text is available yet for this article.
November 7, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29061617/secondary-analysis-of-frequency-circumstances-and-consequences-of-calculation-errors-of-the-heart-history-ecg-age-risk-factors-and-troponin-score-at-the-emergency-departments-of-nine-hospitals-in-the-netherlands
#20
Marten Ras, Johannes B Reitsma, Arno W Hoes, Alfred Jacob Six, Judith M Poldervaart
OBJECTIVE: The HEART score can accurately stratify the risk of major adverse cardiac events (MACE) in patients with chest pain. We investigated the frequency, circumstances and potential consequences of errors in its calculation. METHODS: We performed a secondary analysis of a stepped wedge trial of patients with chest pain presenting to nine Dutch emergency departments. We recalculated HEART scores for all patients by re-evaluating the elements age (A), risk factors (R) and troponin (T) and compared these new scores with those given by physicians in daily practice...
October 22, 2017: BMJ Open
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