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Emergency cardiovascular care

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https://www.readbyqxmd.com/read/28087180/a-comparison-of-hfref-vs-hfpef-s-clinical-workload-and-cost-in-the-first-year-following-hospitalization-and-enrollment-in-a-disease-management-program
#1
T M Murphy, D F Waterhouse, S James, C Casey, E Fitzgerald, E O'Connell, C Watson, J Gallagher, M Ledwidge, K McDonald
BACKGROUND: Admission with heart failure (HF) is a milestone in the progression of the disease, often resulting in higher intensity medical care and ensuing readmissions. Whilst there is evidence supporting enrolling patients in a heart failure disease management program (HF-DMP), not all reported HF-DMPs have systematically enrolled patients with HF with preserved ejection fraction (HFpEF) and there is a scarcity of literature differentiating costs based on HF-phenotype. METHODS: 1292 consenting, consecutive patients admitted with a primary diagnosis of HF were enrolled in a hospital based HF-DMP and categorized as HFpEF (EF≥45%) or HFrEF (EF<45%)...
December 23, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/28078862/a-placebo-controlled-trial-of-a-proprietary-lipid-lowering-nutraceutical-supplement-in-the-management-of-dyslipidemia
#2
M Houston, R Rountree, J Lamb, S Phipps, S Meng, B Zhang
There is an ever growing emergence in the popularity of patient-driven care. As this health and wellness model grows, inquiries into diet, lifestyle, and supplemental approaches will continue to become a focal point for the healthcare consumer. Because of this, the aim of this study is to determine the tolerability, and overall effectiveness of a proprietary multi-ingredient lipid-lowering supplement in subjects with dyslipidemia. Forty participants were recruited for a single-center, double-blind randomized, placebocontrolled trial...
October 2016: Journal of Biological Regulators and Homeostatic Agents
https://www.readbyqxmd.com/read/28077385/impact-of-sex-and-contact-to-device-time-on-clinical-outcomes-in-acute-st-segment-elevation-myocardial-infarction-findings-from-the-national-cardiovascular-data-registry
#3
Robert O Roswell, Jordan Kunkes, Anita Y Chen, Karen Chiswell, Sohah Iqbal, Matthew T Roe, Sripal Bangalore
BACKGROUND: Emergent myocardial reperfusion via primary percutaneous coronary intervention is optimal care for patients presenting with ST-segment elevation myocardial infarction (STEMI). Delays in such interventions are associated with increases in mortality. With the shift in focus to contact-to-device (C2D) time as a new perfusion metric, this study was designed to examine how sex affects C2D time and mortality in STEMI patients. METHODS AND RESULTS: Clinical data on male and female STEMI patients were extracted and analyzed from the National Cardiovascular Data Registry from July 1, 2008 to December 31, 2014...
January 11, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28077150/the-equity-of-china-s-emergency-medical-services-from-2010-2014
#4
Ke Yan, Yi Jiang, Jingfu Qiu, Xiaoni Zhong, Yang Wang, Jing Deng, Jingxi Lian, Tingting Wang, Cheng Cao
BACKGROUND: With the depth development of health care system reform in China, emergency medical services (EMS) is confronted with challenges as well as opportunities. This study aimed to analyze the equity of China's EMS needs, utilization, and resources distribution, and put forward proposal to improve the equity. METHOD: Three emergency needs indicators (mortality rate of cardiovascular and cerebrovascular diseases, harm, and digestive system disease), two utilization indicators (emergency outpatient visits and rate of utilization) and one resource allocation indicator (number of EMS facilities) were collected after the review of the China Statistical Yearbook and the National Disease Surveillance System...
January 11, 2017: International Journal for Equity in Health
https://www.readbyqxmd.com/read/28068521/hiv-and-its-relationship-to-insulin-resistance-and-lipid-abnormalities
#5
REVIEW
Lemuel R Non, Gerome V Escota, William G Powderly
Antiretroviral therapy has revolutionized the care of people with human immunodeficiency virus (HIV) by reducing morbidity and mortality from acquired immunodeficiency syndrome-related conditions. Despite longer life expectancy, however, HIV-infected individuals continue to have a higher risk of death compared with the general population. This has been attributed to the increasing incidence of noncommunicable diseases, in particular, atherosclerotic cardiovascular diseases. This is driven, in part, by the emergence of metabolic disorders, particularly dyslipidemia, insulin resistance, and lipodystrophy, in those on antiretroviral therapy...
December 23, 2016: Translational Research: the Journal of Laboratory and Clinical Medicine
https://www.readbyqxmd.com/read/28067862/impact-of-indoxyl-sulfate-on-progenitor-cell-related-neovascularization-of-peripheral-arterial-disease-and-post-angioplasty-thrombosis-of-dialysis-vascular-access
#6
REVIEW
Chih-Cheng Wu, Szu-Chun Hung, Ko-Lin Kuo, Der-Cherng Tarng
Patients with chronic kidney disease (CKD) have an increased risk of vascular disease, which is associated with considerable health care costs. Vascular disease in CKD differs clinically and pathobiologically from that in patients with normal renal function. Besides the traditional risk factors, retention of uremic toxins contributes to the pathogenesis of vascular disease in patients with CKD. Indoxyl sulfate is a protein-bound uremic toxin and is inefficiently removed by conventional dialysis. Accumulating evidence suggests that indoxyl sulfate is a vascular toxin involved in atherosclerosis, arteriosclerosis, vascular calcification and vascular repair...
January 7, 2017: Toxins
https://www.readbyqxmd.com/read/28064444/phosphate-binders-and-targets-over-decades-do-we-have-it-right-now
#7
Morgan Marcuccilli, Michel Chonchol, Anna Jovanovich
In advanced renal disease, the kidney is unable to maintain phosphate balance due to decreased urinary excretion as well as the imbalance of the bone metabolic axis. It is well established that hyperphosphatemia is associated with increased cardiovascular events and mortality in patients with chronic kidney disease (CKD). However, there are no randomized controlled trials that demonstrate a clear benefit on hard outcomes in lowering serum phosphate levels to recommended targets in the CKD or dialysis population...
January 8, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28062631/rule-in-and-rule-out-of-myocardial-infarction-using-cardiac-troponin-and-glycemic-biomarkers-in-patients-with-symptoms-suggestive-of-acute-coronary-syndrome
#8
Colleen Shortt, Jinhui Ma, Natasha Clayton, Jonathan Sherbino, Richard Whitlock, Guillaume Pare, Stephen A Hill, Matthew McQueen, Shamir R Mehta, P J Devereaux, Andrew Worster, Peter A Kavsak
BACKGROUND: Early rule-in/rule-out of myocardial infarction (MI) in patients presenting to the emergency department (ED) is important for patient care and resource allocation. Given that dysglycemia is a strong risk factor for MI, we sought to explore and compare different combinations of cardiac troponin (cTn) cutoffs with glycemic markers for the early rule-in/rule-out of MI. METHODS: We included ED patients (n = 1137) with symptoms suggestive of acute coronary syndrome (ACS) who had cTnI, high-sensitivity cTnI (hs-cTnI), hs-cTnT, glucose, and hemoglobin A1c (Hb A1c) measurements...
January 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28060868/non-communicable-disease-preventive-screening-by-hiv-care-model
#9
Corinne M Rhodes, Yuchiao Chang, Susan Regan, Virginia A Triant
IMPORTANCE: The Human Immunodeficiency Virus (HIV) epidemic has evolved, with an increasing non-communicable disease (NCD) burden emerging and need for long-term management, yet there are limited data to help delineate the optimal care model to screen for NCDs for this patient population. OBJECTIVE: The primary aim was to compare rates of NCD preventive screening in persons living with HIV/AIDS (PLWHA) by type of HIV care model, focusing on metabolic/cardiovascular disease (CVD) and cancer screening...
2017: PloS One
https://www.readbyqxmd.com/read/28057368/genomic-translational-research-paving-the-way-to-individualized-cardiac-functional-analyses-and-personalized-cardiology
#10
REVIEW
Ares Pasipoularides
For most of Medicine's past, the best that physicians could do to cope with disease prevention and treatment was based on the expected response of an average patient. Currently, however, a more personalized/precise approach to cardiology and medicine in general is becoming possible, as the cost of sequencing a human genome has declined substantially. As a result, we are witnessing an era of precipitous advances in biomedicine and bourgeoning understanding of the genetic basis of cardiovascular and other diseases, reminiscent of the resurgence of innovations in physico-mathematical sciences and biology-anatomy-cardiology in the Renaissance, a parallel time of radical change and reformation of medical knowledge, education and practice...
December 21, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/28057245/alcohol-abuse-and-cardiac-disease
#11
Isaac R Whitman, Vratika Agarwal, Gregory Nah, Jonathan W Dukes, Eric Vittinghoff, Thomas A Dewland, Gregory M Marcus
BACKGROUND: Understanding the relationship between alcohol abuse, a common and theoretically modifiable condition, and the most common cause of death in the world, cardiovascular disease, may inform potential prevention strategies. OBJECTIVES: The study sought to investigate the associations among alcohol abuse and atrial fibrillation (AF), myocardial infarction (MI), and congestive heart failure (CHF). METHODS: Using the Healthcare Cost and Utilization Project database, we performed a longitudinal analysis of California residents ≥21 years of age who received ambulatory surgery, emergency, or inpatient medical care in California between 2005 and 2009...
January 3, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28055998/-hypertensive-crisis-urgency-and-hypertensive-emergency
#12
Javier Sobrino Martínez, Mónica Doménech Feria-Carot, Alberto Morales Salinas, Antonia Coca Payeras
Hypertensive crises lumped several clinical situations with different seriousness and prognosis. The differences between hypertensive urgency and hypertensive emergency depends on if this situation involves a vital risk for the patient. This risk is defined more by the severity of the organ damage than for the higher values of blood pressure. The hypertensive urgency not involves an immediately risk for the patient, for these reason, the treatment can be completed after discharged. Otherwise, the hypertensive emergency is a critical clinical condition that requires hospital assistance...
November 18, 2016: Medwave
https://www.readbyqxmd.com/read/28045952/predictive-factors-of-one-year-mortality-in-a-cohort-of-patients-undergoing-urgent-start-hemodialysis
#13
Luciene P Magalhães, Luciene M Dos Reis, Fabiana G Graciolli, Benedito J Pereira, Rodrigo B de Oliveira, Altay A L de Souza, Rosa M Moyses, Rosilene M Elias, Vanda Jorgetti
BACKGROUND: Chronic kidney disease (CKD) affects 10-15% of adult population worldwide. Incident patients on hemodialysis, mainly those on urgent-start dialysis at the emergency room, have a high mortality risk, which may reflect the absence of nephrology care. A lack of data exists regarding the influence of baseline factors on the mortality of these patients. The aim of this study was to evaluate the clinical and laboratory characteristics of this population and identify risk factors that contribute to their mortality...
2017: PloS One
https://www.readbyqxmd.com/read/28042233/gastrointestinal-endoscopy-in-patients-on-anticoagulant-therapy-and-antiplatelet-agents
#14
REVIEW
Angelo Zullo, Cesare Hassan, Franco Radaelli
Periprocedural management of antithrombotics for gastrointestinal endoscopy is a common clinical issue, given the widespread use of these drugs for primary and secondary cardiovascular prevention. For diagnostic procedures, with or without biopsy, no adjustments in antithrombotics are usually needed. For operative procedures, balancing the risk of periprocedural hemorrhage with the continuation of antithrombotics against the chance of recurrent thromboembolic events with their discontinuation may be challenging...
2017: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
https://www.readbyqxmd.com/read/28040411/emergency-department-critical-care-unit-for-critically-ill-cardiovascular-patients-an-observation-study
#15
Ken-Hui Fu, Yin-Ru Chen, Ju-Shin Fan, Yen-Chia Chen, Hsien-Hao Huang, Chorng-Kuang How, David Hung-Tsang Yen, Si-An Chen, Mu-Shun Huang
BACKGROUND: We investigated an intensive care model for acute critically cardiovascular emergency patients in the emergency department (ED) as compared with those in the coronary care unit (CCU) after ED visits. METHODS: We performed a retrospective cohort analysis of patients with acute cardiovascular emergency admitted to the intensive care unit in the ED (EICU) or CCU from January 1, 2010 to March 31, 2011 in an university-affiliated medical center. All clinical characteristics or predictors possibly related to in-hospital mortality were documented, completed, and measured via electronic medical records review...
December 28, 2016: Journal of the Chinese Medical Association: JCMA
https://www.readbyqxmd.com/read/28033165/developing-an-adapted-cardiac-rehabilitation-training-for-home-care-clinicians-patient-perspectives-clinician-knowledge-and-curriculum-overview
#16
Jodi L Feinberg, David Russell, Ana Mola, Kathryn H Bowles, Terri H Lipman
PURPOSE: There is limited evidence that home care clinicians receive education on the core competencies of cardiac rehabilitation (CR). This article describes the development and implementation of a CR training program adapted for home care clinicians, which incorporated the viewpoints of homebound patients with cardiovascular disease. METHODS: Literature and guideline reviews were performed to glean curriculum content, supplemented with themes identified among patients and clinicians...
December 28, 2016: Journal of Cardiopulmonary Rehabilitation and Prevention
https://www.readbyqxmd.com/read/28032312/molecular-approaches-in-hfpef-micrornas-and-ipsc-derived-cardiomyocytes
#17
REVIEW
Alison J Kriegel, Melanie Gartz, Muhammad Z Afzal, Willem J de Lange, J Carter Ralphe, Jennifer L Strande
Heart failure with preserved left ventricular ejection fraction (HFpEF) has emerged as one of the largest unmet needs in cardiovascular medicine. HFpEF is increasing in prevalence and causes significant morbidity, mortality, and health care resource utilization. Patients have multiple co-morbidities which contribute to the disease complexity. To date, no effective treatment for HFpEF has been identified. The paucity of cardiac biopsies from this patient population and the absence of well-accepted animal models limit our understanding of the underlying molecular mechanisms of HFpEF...
December 28, 2016: Journal of Cardiovascular Translational Research
https://www.readbyqxmd.com/read/28030458/interorganizational-collaboration-in-emergency-cardiovascular-care
#18
James R Langabeer, Tiffany Champagne-Langabeer, Jeffrey R Helton, Wendy Segrest, Bita Kash, Jami DelliFraine, Raymond Fowler
BACKGROUND: Interorganizational collaboration management theory contends that cooperation between distinct but related organizations can yield innovation and competitive advantage to the participating organization. Yet, it is unclear if a multi-institutional collaborative can improve quality outcomes across communities. METHODS: We developed a large regional collaborative network of 15 hospitals and 24 emergency medical service agencies surrounding Dallas, Texas, and collected patient-level data on treatment times for acute myocardial infarctions...
January 2017: Quality Management in Health Care
https://www.readbyqxmd.com/read/28028134/fibroblast-growth-factor-23-levels-associate-with-aki-and-death-in-critical-illness
#19
David E Leaf, Kirolos A Jacob, Anand Srivastava, Margaret E Chen, Marta Christov, Harald Jüppner, Venkata S Sabbisetti, Aline Martin, Myles Wolf, Sushrut S Waikar
Elevated plasma levels of the osteocyte-derived hormone fibroblast growth factor 23 (FGF23) have emerged as a powerful biomarker of cardiovascular disease and death in patients with CKD. Whether elevated urinary or plasma FGF23 levels are prospectively associated with AKI and death in critically ill patients is unknown. We therefore conducted a prospective cohort study of 350 critically ill patients admitted to intensive care units at an academic medical center to investigate whether higher urinary FGF23 levels associate with the composite end point of AKI or in-hospital mortality (AKI/death)...
December 27, 2016: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/28024550/simulation-as-a-tool-to-ensure-competency-and-quality-of-care-in-the-cardiac-critical-care-unit
#20
REVIEW
Véronique Brunette, Nicolas Thibodeau-Jarry
Cardiac critical care units are high-risk clinical environments. Medical emergencies are frequent and require the intervention of a cohesive, efficient, and well trained interprofessional team. In modern clinical practice there is increased emphasis on safety but also increased lack of acceptance of medical errors and as a consequence, increased litigation. In the past decade, simulation-based learning has arisen as an effective and safe means to learn and practice acute care setting skills. It has been used and studied in different contexts including procedural skills training, crisis resource management and team training, patient and family member communication skills, and health care system quality improvement...
January 2017: Canadian Journal of Cardiology
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