Impact of Sex on Long-term Clinical Outcomes After Percutaneous Coronary Intervention
Conclusions: During>6 years of follow-up, no significant difference was observed in major clinical outcomes between 2 sexes. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 14, 2017 Category: Cardiology Tags: Original Article Source Type: research
Potassium Chloride Sustained Release Dosing Pathway in an Academic Medical Center
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 patient...
Source: Critical Pathways in Cardiology - November 14, 2017 Category: Cardiology Tags: Pathway Source Type: research
Patient Ethnicity Predicts Poor Health Access and Gaps in Perception of Personal Cardiovascular Risk Factors
Conclusions: There are major gaps between awareness and personalization of risk in major modifiable coronary artery disease risk factors in different ethnic groups. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 14, 2017 Category: Cardiology Tags: Original Articles Source Type: research
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
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 (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 14, 2017 Category: Cardiology Tags: Original Articles Source Type: research
Efficacy of Implementation of a Chest Pain Center at a Community Hospital
Introduction: Chest pain is the second leading cause for emergency department (ED) visits in the United States; however, (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 14, 2017 Category: Cardiology Tags: Original Articles Source Type: research
Safety of a 1-hour Rule-out High-sensitive Troponin T Protocol in Patients With Chest Pain at the Emergency Department
Conclusion: No AMIs or deaths occurred after introducing the 1-hour hs-cTnT protocol to rule-out ACS in chest pain patients, but other MACE such as unstable angina occurred. Our results suggest the protocol is safe to implement in the ED in The Netherlands. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 14, 2017 Category: Cardiology Tags: Original Articles Source Type: research
The HEART Pathway and Hospital Cost Savings
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. In addition, an increase in outpatient visits confirmed previous estimates that implementation of the HEART Pa...
Source: Critical Pathways in Cardiology - November 14, 2017 Category: Cardiology Tags: Pathways Source Type: research
Pathway for the Management of Hyperglycemia in the Cardiac Care Unit
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. The “wheel” serves as a treatment guide...
Source: Critical Pathways in Cardiology - November 14, 2017 Category: Cardiology Tags: Pathways Source Type: research
Vitamin D Deficiency, Supplementation, and Cardiovascular Health
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. Amidst the current pool of ambiguous evidence, we intend to discuss the role of vitamin D in “high-value c...
Source: Critical Pathways in Cardiology - July 27, 2017 Category: Cardiology Tags: Review Article Source Type: research
The (Dis) Utility of a Change in Troponin I for Diagnosis of Non–ST-Segment Elevation Myocardial Infarction in an Observation Unit
Conclusions: The diagnosis of MI in OU with low-level cTnI elevation is problematic. Furthermore, there is only marginal diagnostic utility of serial changes in cTnI in this patient population. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 27, 2017 Category: Cardiology Tags: Original Articles Source Type: research
Comparison of 3 Symptom Classification Methods to Standardize the History Component of the HEART Score
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. Each patient’s history component score was calculated using 3 models developed by the authors. Differences in the distribution of HEART scores for each model, as well as their degree of agreement with one another, as well as the results of cardiac testing were analyzed.
Results: Seven hundred forty nine patients were studied, 58 of which had an abnormal st...
Source: Critical Pathways in Cardiology - July 27, 2017 Category: Cardiology Tags: Original Articles Source Type: research
Quality Improvement in Management of Acute Coronary Syndrome: Continuing Medical Education and Peer Coaching Improve Antiplatelet Medication Adherence and Reduce Hospital Readmissions
This study evaluated the impact of a QI initiative on antiplatelet (P2Y12 inhibitor) medication adherence (measured via pharmacy fill rates postdischarge) and hospital readmissions.
Results: Notable physician performance and patient-level changes included significant increases in antiplatelet medication counseling at hospital discharge (30%–57%; P (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 27, 2017 Category: Cardiology Tags: Original Articles Source Type: research
Update on SGLT2 Inhibitors—New Data Released at the American Diabetes Association
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. The benefit of SGLT2 inhibition was confirmed by the...
Source: Critical Pathways in Cardiology - July 27, 2017 Category: Cardiology Tags: Review Article Source Type: research
Sensitive Troponin I and Stress Testing in the Emergency Department for the Early Management of Chest Pain Using 2-Hour Protocol
Conclusion: This study demonstrates that the 2 hours accelerated protocol using high sensitivity Troponin assay at 0 and 2 hours with comprehensive clinical evaluation and ECG followed by stress testing might be successful in identifying low-risk patient population who may benefit from early discharge from ED reducing associated costs and length of stay. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 27, 2017 Category: Cardiology Tags: Pathways Source Type: research
Pathway for the Management of Sleep Apnea in the Cardiac Patient
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. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 27, 2017 Category: Cardiology Tags: Pathways Source Type: research
