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https://www.readbyqxmd.com/read/29343987/performance-of-the-lace-index-to-predict-30-day-hospital-readmissions-in-patients-with-chronic-obstructive-pulmonary-disease
#1
Maryam A Hakim, Frances L Garden, Matthew D Jennings, Claudia C Dobler
Background and objective: Patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (COPD) have a high 30-day hospital readmission rate, which has a large impact on the health care system and patients' quality of life. The use of a prediction model to quantify a patient's risk of readmission may assist in directing interventions to patients who will benefit most. The objective of this study was to calculate the rate of 30-day readmissions and evaluate the accuracy of the LACE index (length of stay, acuity of admission, co-morbidities, and emergency department visits within the last 6 months) for 30-day readmissions in a general hospital population of COPD patients...
2018: Clinical Epidemiology
https://www.readbyqxmd.com/read/29331103/comparison-of-coronary-risk-factors-and-angiographic-findings-in-younger-and-older-patients-with-significant-coronary-artery-disease
#2
Mohammad Parsa Mahjoob, Soheila Sadeghi, Hamide Falahaty Khanaman, Mohammadreza Naderian, Isa Khaheshi
BACKGROUND: Coronary artery disease (CAD) is uncommon among young adults and may have certain characteristics that are different from those in older patients. The aim of the current study was to determine the risk factors of CAD, important laboratory data and angiographic findings in young patients with CAD and to compare them with the old patients. METHODS: Patients with typical chest pain whose CAD was confirmed by coronary angiography were included in the study...
December 20, 2017: Romanian Journal of Internal Medicine, Revue Roumaine de Médecine Interne
https://www.readbyqxmd.com/read/29326821/age-sex-and-gene-expression-score-identifies-a-symptomatic-nondiabetic-male-patient-as-being-at-high-risk-of-obstructive-coronary-artery-disease
#3
Ronald J Polinsky
In October 2015, a 74-year-old Caucasian male patient (past medical history of hyperlipidemia, paroxysmal atrial fibrillation, hypertension, and hypothyroidism) presented to the cardiologist for follow-up outpatient evaluation of exertional chest pain. The patient had recently been seen at the Emergency Department for the same complaint. At that time, the patient's cardiac markers, EKG, and pharmacological nuclear stress testing were all reported as normal. At presentation to the cardiologist, the patient's physical examination findings were unremarkable...
2018: SAGE Open Medical Case Reports
https://www.readbyqxmd.com/read/29322167/use-of-high-risk-coronary-atherosclerotic-plaque-detection-for-risk-stratification-of-patients-with-stable-chest-pain-a-secondary-analysis-of-the-promise-randomized-clinical-trial
#4
Maros Ferencik, Thomas Mayrhofer, Daniel O Bittner, Hamed Emami, Stefan B Puchner, Michael T Lu, Nandini M Meyersohn, Alexander V Ivanov, Elizabeth C Adami, Manesh R Patel, Daniel B Mark, James E Udelson, Kerry L Lee, Pamela S Douglas, Udo Hoffmann
Importance: Coronary computed tomographic angiography (coronary CTA) can characterize coronary artery disease, including high-risk plaque. A noninvasive method of identifying high-risk plaque before major adverse cardiovascular events (MACE) could provide practice-changing optimizations in coronary artery disease care. Objective: To determine whether high-risk plaque detected by coronary CTA was associated with incident MACE independently of significant stenosis (SS) and cardiovascular risk factors...
January 10, 2018: JAMA Cardiology
https://www.readbyqxmd.com/read/29316995/prehospital-modified-heart-score-predictive-of-30-day-adverse-cardiac-events
#5
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...
January 10, 2018: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/29303766/no-additional-value-of-conventional-and-high-sensitivity-cardiac-troponin-over-clinical-scoring-systems-in-the-differential-diagnosis-of-type-1-versus-type-2-myocardial-infarction
#6
Luciano Consuegra-Sánchez, Juan José Martínez-Díaz, Luis García de Guadiana-Romualdo, Samantha Wasniewski, Patricia Esteban-Torrella, Francisco Guillermo Clavel-Ruipérez, Alfredo Bardají, Juan Antonio Castillo-Moreno, Juan Carlos Kaski
BACKGROUND: The distinction of type 1 and type 2 myocardial infarction (MI) is of major clinical importance. Our aim was to evaluate the diagnostic ability of absolute and relative conventional cardiac troponin I (cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) in the distinction between type 1 and type 2 MI in patients presenting at the emergency department with non-ST-segment elevation acute chest pain within the first 12 h. METHODS: We measured cTnI (Dimension Vista) and hs-cTnT (Cobas e601) concentrations at presentation and after 4 h in 200 patients presenting with suspected acute MI...
January 5, 2018: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/29274930/immediate-stress-echocardiography-for-low-risk-chest-pain-patients-in-the-emergency-department-a-prospective-observational-cohort-study
#7
Gregory Jasani, Mia Papas, Avkash J Patel, Neil Jasani, Brian Levine, Yuanyuan Zhang, Erik S Marshall
BACKGROUND: Evaluation and disposition of low-risk chest pain (CP) patients in the emergency department (ED) is time consuming and expensive. Low-risk CP often results in hospital admission to rule out myocardial infarction, which leads to additional costs and delays. OBJECTIVE: Our aim was to assess whether an immediate exercise stress echocardiogram (IESE) in the ED will allow safe, efficient, and cost-effective evaluation and discharge of patients with low-risk CP...
December 20, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29249436/identification-of-patients-with-stable-chest-pain-deriving-minimal-value-from-coronary-computed-tomography-angiography-an-external-validation-of-the-promise-minimal-risk-tool
#8
Philip D Adamson, Christopher B Fordyce, David A McAllister, James E Udelson, Pamela S Douglas, David E Newby
BACKGROUND: The PROspective Multicenter Imaging Study for Evaluation of chest pain (PROMISE) minimal-risk tool was recently developed to identify patients with suspected stable angina at very low risk of coronary artery disease (CAD) and clinical events. We assessed the external validity of this tool within the context of the Scottish Computed Tomography of the HEART (SCOT-HEART) multicenter randomised controlled trial of patients with suspected stable angina due to coronary disease. METHODS: The minimal-risk tool was applied to 1764 patients with complete imaging and follow-up data...
February 1, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29248334/diagnostic-accuracy-of-a-new-high-sensitivity-troponin-i-assay-and-five-accelerated-diagnostic-pathways-for-ruling-out-acute-myocardial-infarction-and-acute-coronary-syndrome
#9
Jaimi H Greenslade, Edward W Carlton, Christopher Van Hise, Elizabeth Cho, Tracey Hawkins, William A Parsonage, Jillian Tate, Jacobus Ungerer, Louise Cullen
STUDY OBJECTIVE: This diagnostic accuracy study describes the performance of 5 accelerated chest pain pathways, calculated with the new Beckman's Access high-sensitivity troponin I assay. METHODS: High-sensitivity troponin I was measured with presentation and 2-hour blood samples in 1,811 patients who presented to an emergency department (ED) in Australia. Patients were classified as being at low risk according to 5 rules: modified accelerated diagnostic protocol to assess patients with chest pain symptoms using troponin as the only biomarker (m-ADAPT), the Emergency Department Assessment of Chest Pain Score (EDACS) pathway, the History, ECG, Age, Risk Factors, and Troponin (HEART) pathway, the No Objective Testing Rule, and the new Vancouver Chest Pain Rule...
December 13, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29232768/modification-of-the-thrombolysis-in-myocardial-infarction-risk-score-for-patients-presenting-with-chest-pain-to-the-emergency-department
#10
Jaimi H Greenslade, Kimberly Chung, William A Parsonage, Tracey Hawkins, Martin Than, John W Pickering, Louise Cullen
OBJECTIVE: To develop a modified Thrombolysis in Myocardial Infarction (TIMI) score to effectively risk stratify patients presenting to the ED with chest pain. METHODS: A prospective observational study was conducted at two metropolitan EDs. Data were obtained during patient interview. The primary outcome was major adverse cardiovascular events (MACE) within 30 days of presentation. Two separate modifications of the TIMI score were developed. These scores were compared to the original TIMI in terms of the area under the receiver operating characteristic curve and diagnostic accuracy statistics (sensitivity, specificity, positive and negative predictive values)...
December 12, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29227870/impact-of-alcohol-drinking-on-acetylcholine-induced-coronary-artery-spasm-in-korean-populations
#11
Sung Min Sohn, Byoung Geol Choi, Se Yeon Choi, Jae Kyeong Byun, Ahmed Mashaly, Yoonjee Park, Won Young Jang, Woohyeun Kim, Jah Yeon Choi, Eun Jin Park, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh, Seung-Woon Rha
BACKGROUND AND AIMS: Generally, immoderate alcohol consumption is associated with variant angina and accepted as one of the risk factors for coronary artery spasm (CAS), but evidence is lacking in this regard. The aim of this study is to evaluate the impact of alcohol consumption and drinking pattern on CAS by acetylcholine (ACH) provocation test and long-term clinical outcomes. METHODS: A total of 5491 patients with typical or atypical chest pain, without significant coronary artery disease, who underwent intracoronary ACH provocation test, were enrolled prospectively, and retrospectively analyzed in this study...
December 8, 2017: Atherosclerosis
https://www.readbyqxmd.com/read/29191490/prognosticating-clinical-prediction-scores-without-clinical-gestalt-for-patients-with-chest-pain-in-the-emergency-department
#12
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)...
November 27, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29135621/efficacy-of-implementation-of-a-chest-pain-center-at-a-community-hospital
#13
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/29131477/a-risk-assessment-score-and-initial-high-sensitivity-troponin-combine-to-identify-low-risk-of-acute-myocardial-infarction-in-the-emergency-department
#14
John W Pickering, Dylan Flaws, Stephen W Smith, Jaimi Greenslade, Louise Cullen, William Parsonage, Edward Carlton, A Mark Richards, Richard Troughton, Christopher Pemberton, Peter M George, Martin P Than
OBJECTIVES: Early discharge of patients with presentations triggering assessment for possible acute coronary syndrome is safe when clinical assessment indicates low-risk, biomarkers are negative, and electrocardiograms (ECGs) are non-ischemic. We hypothesized that the Emergency Department Assessment of Chest Pain Score (EDACS) combined with a single measurement of high-sensitivity cardiac troponin (hs-cTn) could allow early discharge of a clinically meaningful proportion of patients. METHODS: We pooled data from 4 patient cohorts from New Zealand and Australia presenting to an ED with symptoms suggestive of ACS...
November 13, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29127877/breast-arterial-calcification-on-screening-mammography-can-predict-significant-coronary-artery-disease-in-women
#15
Brendan S Kelly, Emer ScanlON, Helen Heneghan, Ciaran E Redmond, Gerard M Healy, Enda Mc Dermott, Eric J Heffernan, Ruth Prichard, Sorcha Mc Nally
INTRODUCTION: Breast Arterial Calcification (BAC) on digital mammography has been associated with an increased risk of Coronary Artery Disease (CAD). We aimed to investigate the association of BAC with findings on Coronary Computed Tomography Angiography (CCTA) within a cohort of women from the national breast screening program. METHODS: Symptomatic women (chest pain) aged between 50 and 65 who underwent a CCTA and who also had a screening mammography between 2014 and 2015 were recorded...
November 3, 2017: Clinical Imaging
https://www.readbyqxmd.com/read/29122104/the-diagnosis-of-chronic-coronary-heart-disease
#16
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/29121752/identification-of-coronary-artery-calcification-can-optimize-risk-stratification-in-patients-with-acute-chest-pain
#17
Daniel O Bittner, Richard A P Takx, Pedro V Staziaki, Sumbal Janjua, Tomas G Neilan, Nandini M Meyersohn, Michael T Lu, Anand M Prabhakar, John T Nagurney, Udo Hoffmann, Brian B Ghoshhajra
BACKGROUND: The number of patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS) is substantial. We tested whether identification of coronary artery calcium (CAC) can improve the negative predictive value (NPV) of clinical risk assessment for ACS in patients with acute chest pain. METHODS AND RESULTS: We included 826 consecutive patients (mean age: 53±11years; 42% female) without known coronary artery disease (CAD) or initially elevated serum biomarkers, whom underwent non-contrast CT, to assess the CAC score, and CT angiography (CTA), to detect coronary stenosis...
December 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/29117666/prognostic-significance-of-non-chest-pain-symptoms-in-patients-with-non-st-segment-elevation-myocardial-infarction
#18
Inna Kim, Min Chul Kim, Keun Ho Park, Doo Sun Sim, Young Joon Hong, Ju Han Kim, Myung Ho Jeong, Jeong Gwan Cho, Jong Chun Park, Myeong Chan Cho, Jong Jin Kim, Young Jo Kim, Youngkeun Ahn
Background/Aims: Chest pain is an essential symptom in the diagnosis of acute coronary syndrome (ACS). One-third of patients with ACS present atypically, which can influence their receiving timely lifesaving therapy. Methods: A total of 617 NSTEMI patients from the Korea Acute MI Registry (KAMIR) and the Korea Working Group on MI (KorMI) databases were analyzed. The study population was divided into two groups by symptoms at presentation (typical symptoms group, 128; atypical symptoms groups, 128)...
November 10, 2017: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/29089344/impact-of-diabetes-mellitus-on-the-evaluation-of-stable-chest-pain-patients-insights-from-the-promise-prospective-multicenter-imaging-study-for-evaluation-of-chest-pain-trial
#19
Abhinav Sharma, Nishant K Sekaran, Adrian Coles, Neha J Pagidipati, Udo Hoffmann, Daniel B Mark, Kerry L Lee, Hussein R Al-Khalidi, Michael T Lu, Patricia A Pellikka, Quynh A Trong, Pamela S Douglas
BACKGROUND: The impact of diabetes mellitus on the clinical presentation and noninvasive test (NIT) results among stable outpatients presenting with symptoms suggestive of coronary artery disease (CAD) has not been well described. METHODS AND RESULTS: The PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial enrolled 10 003 patients with known diabetic status, of whom 8966 were tested as randomized and had interpretable NIT results (1908 with diabetes mellitus, 21%)...
October 31, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29066939/prevalence-of-neuro-musculoskeletal-pain-and-dysfunction-in-open-heart-surgical-patients-preoperatively-and-at-6-and-12-weeks-postoperatively-a-prospective-longitudinal-observation-study
#20
R Nicole Bellet, Rhonda L Lamb, Tonya D Gould, Harold J Bartlett
Chronic neuro-musculoskeletal pain is an important complication of open-heart surgery (OHS). To better understand the development and natural course of neuro-musculoskeletal pain in the immediate post-OHS period, this prospective longitudinal study assessed the prevalence and degree of pain and shoulder disability, and areas of pain pre- and post-OHS. Usual medical, nursing, and physiotherapy care was provided including early extubation, education, walking, sitting out of bed, and upper, lower limb, and trunk exercises from day 1 post-operation...
2017: Pragmatic and Observational Research
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