Does Uric Acid Level Provide Additional Risk Stratification Information in Emergency Patients With Symptoms of Possible Acute Coronary Syndrome?
This study aimed to assess the clinical utility of serum uric acid levels to identify patients at high risk of acute coronary syndrome (ACS) in those who presented to the emergency department (ED) with chest pain.
Methods: This was a prospective observational study of 951 adult patients who were being evaluated for ACS in a single ED. Serum uric acid was taken on presentation. Patients were followed up 30 days and 1 year after initial presentation. The primary outcome was a diagnosis of ACS within 30 days of initial attendance. A logistic regression analysis was performed to identify whether elevated uric acid levels were...
Source: Critical Pathways in Cardiology - November 15, 2016 Category: Cardiology Tags: Original Articles Source Type: research
Association Between Hospital Practices and Door-in-door-out Time in ST-segment Elevation Myocardial Infarction
The objective of this study was to describe how frequently these critical practices are used and to determine whether their use was associated with shorter DIDO times.
Methods: We surveyed 18 STEMI referral hospitals for 4 STEMI-receiving centers regarding their use of these 18 practices. The median number used was 14 practices (interquartile range 12–15). We then evaluated their association with DIDO times in all patients (n = 93) transferred from these STEMI referral hospitals to the 4 STEMI-receiving centers for primary percutaneous coronary intervention.
Results: In univariate linear regression analyses, system-wid...
Source: Critical Pathways in Cardiology - November 15, 2016 Category: Cardiology Tags: Original Articles Source Type: research
A Novel Pretreatment Regimen for Breakthrough Radiocontrast Media Anaphylaxis in Cardiac Patients
Conclusion: This protocol is both safe and effective in mitigating anaphylaxis in cardiac patients. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 15, 2016 Category: Cardiology Tags: Original Articles Source Type: research
Carotid Intima-Media Thickness as a Cardiovascular Risk Factor and Imaging Pathway of Atherosclerosis
Assessment of carotid intima-media thickness (IMT) has emerged as a simple and noninvasive technique for measuring atherosclerotic burden. Although serum biomarkers have been linked to the risk of developing atherosclerosis, carotid IMT has the theoretical advantage of directly visualizing a final consequence of the disease itself, namely atherosclerosis in the vessel wall. The current widespread application of carotid IMT measurements has been based on the validity, standardization, and reproducibility of the measurement and the evidence that an increased carotid IMT can be regarded as an attractive biomarker of atheroscl...
Source: Critical Pathways in Cardiology - November 15, 2016 Category: Cardiology Tags: Original Articles Source Type: research
Chest Pain Risk Scores Can Reduce Emergent Cardiac Imaging Test Needs With Low Major Adverse Cardiac Events Occurrence in an Emergency Department Observation Unit
Objective: To compare and evaluate the performance of the HEART, Global Registry of Acute Coronary Events (GRACE), and Thrombolysis in Myocardial Infarction (TIMI) scores to predict major adverse cardiac event (MACE) rates after index placement in an emergency department observation unit (EDOU) and to determine the need for observation unit initiation of emergent cardiac imaging tests, that is, noninvasive cardiac stress tests and invasive coronary angiography.
Methods: A prospective observational single center study was conducted from January 2014 through June 2015. EDOU chest pain patients were included. HEART, GRACE, a...
Source: Critical Pathways in Cardiology - November 15, 2016 Category: Cardiology Tags: Original Articles Source Type: research
Novel Emergency Department Risk Score Discriminates Acute Coronary Syndrome Among Chest Pain Patients With Known Coronary Artery Disease
Conclusions: Application of these risk scores may reduce the number of potentially avoidable admissions and their associated hazards and costs. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 15, 2016 Category: Cardiology Tags: Original Articles Source Type: research
Implementation of a Risk Stratification and Management Pathway for Acute Chest Pain in the Emergency Department
Objectives: Chest pain is a common complaint in the emergency department, and a small but important minority represents an acute coronary syndrome (ACS). Variation in diagnostic workup, risk stratification, and management may result in underuse, misuse, and/or overuse of resources.
Methods: From July to October 2014, we conducted a prospective cohort study in an academic medical center by implementing a Standardized Clinical Assessment and Management Plan (SCAMP) for chest pain based on the HEART score. In addition to capturing adherence to the SCAMP algorithm and reasons for any deviations, we measured troponin sample ti...
Source: Critical Pathways in Cardiology - November 15, 2016 Category: Cardiology Tags: Original Articles Source Type: research
Gender Discrepancy in Diabetic Patients Hospitalized With Heart Failure: Does Age Matter?
Conclusions: In DHF, female gender is characterized by having a high prevalence of metabolic syndrome components. Also, females are more likely to have better Left ventricular ejection fraction but less likely to receive cardiovascular evidence based medications. There is no significant difference in the overall hospital mortality between both genders, however, in the younger age; males have a significantly higher mortality. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - August 2, 2016 Category: Cardiology Tags: Original Studies Source Type: research
Agreement Between Patient-reported and Cardiology-adjudicated Medical History in Patients With Possible Ischemic Chest Pain: An Observational Study
Conclusions: Accuracy of patient’s recall and communication of medical history and risk factors was substantial but not perfect in the assessment of patients with ACS in the ED context. Our study reinforces the importance in the utilization of medical records and collateral information to address possible discrepancies in the medical history and improve patient care. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - August 2, 2016 Category: Cardiology Tags: Original Studies Source Type: research
Diagnostic Yield of Routine Stress Testing in Low and Intermediate Risk Chest Pain Patients Under 40 Years: A Systematic Review
Conclusions: Diagnostic yield of routine stress testing in low- and intermediate-risk chest pain patients under 40 years is low. However, better quality studies are required to be able to draw definitive conclusions. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - August 2, 2016 Category: Cardiology Tags: Review Article Source Type: research
Lack of Left Ventricular Ejection Fraction Measurement Following a High B-type Natriuretic Peptide Value
Conclusion: Approximately half of patients with a high BNP and an LVEF not known to be low did not have a follow-up guideline recommended LVEF study and may have unrecognized heart failure. Our findings suggest that a trial is warranted of a clinical pathway where those patients with a high BNP and without appropriate follow-up are randomized to have their physician receive a notification of the high BNP value. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - August 2, 2016 Category: Cardiology Tags: Original Studies Source Type: research
Treatment of Non-ST Elevation Myocardial Infarction: A Process Analysis of Patient and Program Factors in a Teaching Hospital
As part of a quality improvement project, we performed a process analysis to evaluate how patients presenting with type 1 non-ST elevation myocardial infarction (STEMI) are diagnosed and managed early after the diagnosis has been made. We performed a retrospective chart review and collected detailed information regarding the timing of the first 12-lead electrocardiogram, troponin order entry and first positive troponin result, administration of anticoagulation and antiplatelet medications, and referral for coronary angiography to identify areas of treatment variability and delay. A total of 242 patients with type 1 non-STE...
Source: Critical Pathways in Cardiology - August 2, 2016 Category: Cardiology Tags: Original Studies Source Type: research
A Novel Survey Tool to Quantify the Degree and Duration of STEMI Regionalization Across California
Conclusion: This study evaluated the degree and duration of STEMI network regionalization from 2004 to 2014 in California, and ranked 33 LEMSAs into tertiles based upon their TRS and their Core Score. Successful application of the 8-item survey and ranking strategies across California suggests that this approach can be used to assess regionalization in other states or countries around the world. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - August 2, 2016 Category: Cardiology Tags: Original Studies Source Type: research
Impact of a “Team-focused CPR” Protocol on Out-of-hospital Cardiac Arrest Survival in a Rural EMS System
Background: More than 300,000 persons in the United States experience an out-of-hospital cardiac arrest every year. The American Heart Association emphasizes on the rapid, effective delivery of cardiac arrest interventions by bystanders and emergency medical services (EMS) on scene. In July 2013, the EMS of Randolph County, a rural county in central North Carolina, implemented a team-focused cardiopulmonary resuscitation(CPR) protocol. The protocol emphasized early chest compressions and resuscitation on scene until the return of spontaneous circulation (ROSC) or until efforts were deemed futile.
Methods: Data were collec...
Source: Critical Pathways in Cardiology - August 2, 2016 Category: Cardiology Tags: Original Studies Source Type: research
Process Improvements to Reduce Cardiac Troponin Turnaround Time in the Emergency Department
Conclusions: With an interdisciplinary team of health care professionals, we successfully reduced troponin-T TAT for possible acute coronary syndrome patients in our ED by 19%, consistently achieving laboratory results in less than 60 minutes. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - August 2, 2016 Category: Cardiology Tags: Pathway Source Type: research
