Prevalence and Overlap of Noncardiac Conditions in the Evaluation of Low-risk Acute Chest Pain Patients
Conclusion: In our cohort of low-risk acute chest pain patients, depression, anxiety, and GERD were common, substantial overlap was observed. The severity of these noncardiac causes of chest pain causes correlated with the self-reported severity and frequency of angina, but weakly. These conditions should be part of a comprehensive plan of care for chest pain management. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 28, 2015 Category: Cardiology Tags: Original Articles Source Type: research
Acute Pulmonary Embolism Network and Multidisciplinary Response Team Approach to Treatment
Conclusions: Through the development of an Acute PE Network, with incorporation of a PERT and implementation of a critical care pathway, we report an innovative treatment approach to acute PE that includes utilization of USAT for submassive PE. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 28, 2015 Category: Cardiology Tags: Pathway Source Type: research
Utilization and Safety of a Pulmonary Embolism Treatment Protocol in an Emergency Department Observation Unit
Abstract: Pulmonary embolism (PE) is a common disease in emergency medicine and treatment approaches vary greatly. Emergency department observation units (EDOUs) have provided the opportunity to complete a PE workup, initiate treatment, and arrange appropriate follow-up for low-risk patients.
Objective: We sought to evaluate the utilization and safety of a treatment protocol for low-risk PE in an EDOU.
Methods: A prospective evaluation was performed in our EDOU for the treatment of low-risk PE between December 1, 2010 and May 31, 2012. The PE treatment protocol included telemetry monitoring, initiation of anticoagulation, ...
Source: Critical Pathways in Cardiology - July 28, 2015 Category: Cardiology Tags: Original Article Source Type: research
Obstructive Sleep Apnea and Atrial Fibrillation: Pathophysiology and Implications for Treatment
Obstructive sleep apnea (OSA) is increasingly recognized as an important risk factor for arrhythmogenesis. Epidemiological and clinical studies have suggested a strong association between OSA and atrial fibrillation (AF). With the increasing global epidemic of obesity, the incidence of OSA is also expected to rise. Various mechanisms mediated through adverse electrical and structural changes have been proposed to explain the increased risk of AF in patients with OSA. Multiple studies have also observed a greater risk of AF recurrence after cardioversion and catheter ablation (CA) in the patients with untreated OSA. The epi...
Source: Critical Pathways in Cardiology - May 18, 2015 Category: Cardiology Tags: Review Article Source Type: research
Agreement Between Cardiovascular Disease Risk Scores in Resource-Limited Settings: Evidence from 5 Peruvian Sites
In conclusion, poor concordance between current CVD risk scores demonstrates the uncertainty of choosing any of them for public health and clinical interventions in Latin American populations. There is a need to improve the evidence base of risk scores for CVD in low-income and middle-income countries. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - May 18, 2015 Category: Cardiology Tags: Original study Source Type: research
Chest Pain Centers: A Comparison of Accreditation Programs in Germany and the United States
Conclusion: Enhanced collaboration among international bodies interested in promoting high quality care might extend the opportunity for accreditation of facilities that treat cardiovascular patients, with national programs designed to meet local needs and local healthcare system requirements. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - May 18, 2015 Category: Cardiology Tags: Original Articles Source Type: research
Heparin Versus Bivalirudin in Contemporary Percutaneous Coronary Intervention: A Welcome Back to an Old Friend Unfractionated Heparin
The results of randomized trials and observational studies make a strong argument for the use of bivalirudin rather than heparin plus systematic glycoprotein (GP) IIb/IIIa inhibitors for the great majority of patients undergoing percutaneous coronary interventions (PCI). However, there is no doubt that the benefit observed with bivalirudin was achieved because of the major bleeding complications with heparin plus GP IIb/IIIa inhibitors. Therefore, if we diminish bleeding complications by eliminating the systematic utilization of GP IIb/IIIa inhibitors, there would be a lesser benefit with the use of bivalirudin. When this ...
Source: Critical Pathways in Cardiology - May 18, 2015 Category: Cardiology Tags: Original Articles Source Type: research
The Real-World Treatment of Hemorrhages Associated With Dabigatran and Rivaroxaban: A Multicenter Evaluation
Conclusion: The approach to the management of bleeding events borne from TSOACs has proven to be very heterogeneous. In the midst of this observation period, these facilities developed protocols, which created a stratification of bleeds and a more regimented approach to managing them. Although bleeding is less with new agents, the creation of pathways/algorithms for the management of TSOACs and education regarding clinical decision-making may be beneficial for the expeditious and appropriate management when these events arise. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - May 18, 2015 Category: Cardiology Tags: Original Articles Source Type: research
Knowledge of PCSK9 and Continued Educational Gaps: Evaluating the Impact of Continuing Medical Education
This study evaluated the impact of continuing medical education (CME) on increasing knowledge and awareness of the role of PCSK9 in lipid metabolism and analyzed persistent educational gaps to determine needs for future education. For cardiologists who participated in the CME activity, comparison of individually linked preassessment question responses to their respective postassessment question responses demonstrated improvement (n = 83; P < 0.05). Correct responses on postassessment questions ranged between 63% and 253% higher after CME, with an overall effect size of 0.72. Between 24% and 47% of learners showed improveme...
Source: Critical Pathways in Cardiology - February 17, 2015 Category: Cardiology Tags: Original Articles Source Type: research
Prevalence and Implications of Severe Anxiety in a Prospective Cohort of Acute Chest Pain Patients
Anxiety is a common condition which can manifest with symptoms of chest discomfort. Chest discomfort is one of the most common reasons to seek emergency medical care. We hypothesize that anxiety is highly prevalent, poorly diagnosed, and poorly treated in an acute care environment. We analyzed data from a prospective registry of chest pain patients with low to intermediate likelihood of acute coronary syndrome and coronary artery disease. Scores from the General Anxiety Disorder-7 questionnaire determined the prevalence of anxiety. Differences in presentation, evaluation, and 30-day outcomes were compared for subjects with...
Source: Critical Pathways in Cardiology - February 17, 2015 Category: Cardiology Tags: Original Articles Source Type: research
Impact of a Novel Interventional Platform and Hospital Design on the Door-to-balloon Time in Patients Presenting With ST-segment Elevation Myocardial Infarction
Conclusions: This study showed that the new hospital design had significant effects on immediate patient care by improving the DTB time at our institution. Further study regarding the long-term impact of hospital designs on patient care is needed. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - February 17, 2015 Category: Cardiology Tags: Original Articles Source Type: research
Assessment of Adherence to ACC/AHA Guidelines in Primary Management of Patients With NSTEMI in a Referral Cardiology Hospital
Acute coronary syndromes are considered as a global major health-care problem, and Iran as a developing country is of no exception. We aimed to investigate the degree of adherence to American College of Cardiology and American Heart Association (ACC/AHA) guideline for the management of non–ST-segment elevation myocardial infarction (NSTEMI) in patients who presented to the emergency department at Tehran Heart Center. Data of the patients who presented with acute chest pain to the emergency department of Tehran Heart Center within 1 year and were diagnosed as NSTEMI by the cardiologist in charge were included. The details...
Source: Critical Pathways in Cardiology - February 17, 2015 Category: Cardiology Tags: Original Articles Source Type: research
Effects of Critical Pathway on the Management of Patients With ST-elevation Acute Myocardial Infarction in an Emergency Department
Conclusion: Implementation of a CP resulted in greater use of recommended medications and reductions in the median door-to-balloon time. However, it did not reduce the symptom onset-to-door time, total ischemic time, or the 30-day and 1-year mortality rates. Therefore, additional strategies are needed to reduce mortality in patients with acute myocardial infarction undergoing primary PCI. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - February 17, 2015 Category: Cardiology Tags: Original Articles Source Type: research
Optimization of Door-to-electrocardiogram Time Within a Critical Pathway for the Management of Acute Coronary Syndromes at a Teaching Hospital in Colombia
Conclusions: The actions taken led to a lower median of D2E time and a higher percentage of patients with times below 10 minutes. However, further interventions are required to assure a higher number of patients with D2E times below 10 minutes. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - February 17, 2015 Category: Cardiology Tags: Pathway Source Type: research
Challenges in Acute Heart Failure Clinical Management: Optimizing Care Despite Incomplete Evidence and Imperfect Drugs
Acute heart failure is a common condition associated with considerable morbidity, mortality, and cost. However, evidence-based data on treating heart failure in the acute setting are limited, and current individual treatment options have variable efficacy. The healthcare team must often individualize patient care in ways that may extend beyond available clinical guidelines. In this review, we address the question, “How do you do the best you can clinically with incomplete evidence and imperfect drugs?” Expert opinion is provided to supplement guideline-based recommendations and help address the typical challenges that ...
Source: Critical Pathways in Cardiology - February 17, 2015 Category: Cardiology Tags: Review Article Source Type: research
