ACES (Accelerated Chest Pain Evaluation With Stress Imaging) Protocols Eliminate Testing Disparities in Patients With Chest Pain
Conclusions:
A care pathway with the expectation for stress imaging eliminates the racial disparity among AA and White participants with chest pain in the acquisition of index-visit cardiovascular testing. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - February 13, 2019 Category: Cardiology Tags: Original Articles Source Type: research
Implementation of an Emergency Department High-Sensitivity Troponin Chest Pain Pathway in the United States
No abstract available (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - February 13, 2019 Category: Cardiology Tags: Pathway Source Type: research
Acceptance of the Chest Pain Unit Certification Process: Current Status in Germany
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 prov...
Source: Critical Pathways in Cardiology - November 13, 2018 Category: Cardiology Tags: Review Article Source Type: research
Are Prior Aspirin Users With ST-Elevation Myocardial Infarction at Increased Risk of Adverse Events and Worse Angiographic Features?
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. Adjusted analysis showed that the prior aspirin users had a significan...
Source: Critical Pathways in Cardiology - November 13, 2018 Category: Cardiology Tags: Original Articles Source Type: research
Facilitators and Barriers to Reducing Emergency Department Admissions for Chest Pain: A Qualitative Study
Conclusions:
In conclusion, most participants have not adopted protocols focused on reducing variation in ED chest pain admissions. Robust systems to ensure follow-up care after ED visits may reduce admission rates by mitigating the perceived risk of discharging ED patients with chest pain. Greater use of observation protocols may promote adoption of clinical guidelines and reduce admission rates. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 13, 2018 Category: Cardiology Tags: Original Articles Source Type: research
Implementation of the HEART Pathway: Using the Consolidated Framework for Implementation Research
Conclusions:
Successful dissemination of the HEART Pathway will require addressing institution-specific barriers, which includes engaging clinical and financial stakeholders. New SMART-FHIR technologies, compatible with many electronic health record systems, can overcome barriers to health systems with limited information technology resources. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 13, 2018 Category: Cardiology Tags: Original Articles Source Type: research
Incorporation of the HEART Score Into a Low-risk Chest Pain Pathway to Safely Decrease Admissions
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-ris...
Source: Critical Pathways in Cardiology - November 13, 2018 Category: Cardiology Tags: Original Articles Source Type: research
Prognostic Utility of the HEART Score in the Observation Unit
In conclusion, our results suggest that patients with a HEART score ≤3 being evaluated for chest pain are at extremely low risk for major adverse cardiac events and may be safely discharged without provocative testing. Positive cardiac testing in this population is more likely to represent a false-positive finding, resulting in unnecessary testing. These findings should be prospectively validated. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 13, 2018 Category: Cardiology Tags: Original Articles Source Type: research
Implementation of High-Sensitivity Cardiac Troponin: Challenges From the International Experience
Conclusions:
Our survey of hs-cTn implementation at international institutions reveals satisfaction with new assays but reflects important variations in clinical practice. The use of sex-specific vs. combined cutoffs and timing of serial hs-cTn measurements varies across institutions and are subjects that United States centers must define without consensus from international practices. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 13, 2018 Category: Cardiology Tags: Original Articles Source Type: research
Unexpected Cardiac MRI Findings in Patients Presenting to the Emergency Department for Possible Acute Coronary Syndrome
Conclusions:
This experience suggests that stress CMR is useful in not only diagnosing symptomatic CAD but also potentially important non-CAD–related disease. These factors may impact their use in ED-based ACS workups. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 25, 2018 Category: Cardiology Tags: Original Articles Source Type: research
Serum Uric Acid and Atrial Fibrillation: Meta-analysis
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. A total of 24 studies with 30...
Source: Critical Pathways in Cardiology - July 25, 2018 Category: Cardiology Tags: Original Articles Source Type: research
The Impact of Formal Training and Certification on the Relationship Between Volume and Outcomes in Percutaneous Coronary Interventions
Conclusions:
Our study shows that the angiographic and procedural success rates of PCI, as well as the in-hospital mortality, do not seem to be dependent on the annual volume for formally trained and certified interventional cardiologists. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 25, 2018 Category: Cardiology Tags: Original Articles Source Type: research
A New Feasible Syncope Risk Score Appropriate for Emergency Department: A Prospective Cohort Study
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.
Results:
Overall, 356 patients (mean age: 44.5 years, 46.3% male) were followed for 3 months. Serious adverse events occurre...
Source: Critical Pathways in Cardiology - July 25, 2018 Category: Cardiology Tags: Original Articles Source Type: research
Importance of a Risk Stratification Strategy to Identify High-risk Patients Presenting With Cocaine-associated Acute Coronary Syndrome
Conclusions:
Cardiac catheterization in patients presenting with cocaine-associated ACS may be overutilized. A predictive model based on clinical risk factors may help individualize patient care and reduce unnecessary invasive diagnostic interventions. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 25, 2018 Category: Cardiology Tags: Original Articles Source Type: research
Role of Hypertension and Other Clinical Variables in Prognostication of Patients Presenting to the Emergency Department With Major Bleeding Events
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.
Results:
Enrolled patients were 2,792 (mean age, 65.6 ± 19.9 years) during 2-year su...
Source: Critical Pathways in Cardiology - July 25, 2018 Category: Cardiology Tags: Original Articles Source Type: research
