Timing of Percutaneous Coronary Intervention in Troponin-negative Patients With Acute Coronary Syndrome Without Persistent ST-segment Elevation: Preliminary Results and Status Quo in German Chest Pain Units
Objective: Management of acute coronary syndromes without persistent ST-segment elevation (NSTE-ACS) and unstable angina pectoris (UAP) remains challenging. The study aimed to analyze the current management of UAP patients in German chest pain units focussing on the different time lines of invasive strategy.
Methods: A total of 1400 UAP patients admitted to a certified chest pain unit were enrolled. Analyses of high-risk criteria with indication for invasive management and of 3-month clinical outcomes were performed by subgrouping UAP patients to immediate and early invasive ( (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - February 17, 2015 Category: Cardiology Tags: Original Articles Source Type: research
The Stroke 8: A Daily Checklist for Inpatient Stroke Management
We describe the Stroke 8 checklist, designed to be part of the daily assessment of patients hospitalized with acute stroke. It consists of 8 items classified into 3 categories as follows: (1) stroke prevention: antithrombotic use, statin use, glucose control, blood pressure control; (2) prevention of complications: deep venous thrombosis prophylaxis, temperature control; and (3) recovery and disposition: fluids and nutrition, mobility and therapy. The Stroke 8 checklist has been implemented in 3 formats over an 8-year period: laminated cards, an electronic documentation template, and an electronic template supplemented wit...
Source: Critical Pathways in Cardiology - February 17, 2015 Category: Cardiology Tags: Original Articles Source Type: research
Pharmacodynamic and Clinical Implications of Switching Between P2Y12 Receptor Antagonists: Considerations for Practice
Dual antiplatelet therapy with aspirin and a P2Y12 receptor antagonist, either clopidogrel or the newer more potent agents prasugrel or ticagrelor, is standard therapy in patients receiving a coronary stent and those with a recent acute coronary syndrome. Switching antiplatelet drug regimen may be required in some patients for efficacy, safety, adherence, and cost considerations. However, there are potential concerns when switching from one agent to another that gaps in effective antiplatelet inhibition could lead to thrombotic events, and overlap of agents might cause excessive platelet inhibition thereby increasing the r...
Source: Critical Pathways in Cardiology - December 1, 2014 Category: Cardiology Tags: Pathway Source Type: research
Hypertension and Atrial Fibrillation: Prognostic Aspects of Troponin Elevations in Clinical Practice
Conclusions: In patients with hypertension, AFib, and e-TnI, tailored-care inclusive of echocardiography and stress testing succeeded in recognizing and treating CAD avoiding adverse events without increase in admissions. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - December 1, 2014 Category: Cardiology Tags: Original Articles Source Type: research
“No Culprit” ST-Elevation Myocardial Infarction: Role of Cardiac Magnetic Resonance Imaging
We examined the value of cardiac magnetic resonance (CMR) for diagnosis in patients with “no culprit” STEMI. Data from a comprehensive prospective registry of STEMI patients were reviewed from March 2003 to December 2009. “No culprit” patients were followed for diagnosis and clinical outcome. CMR was performed at the discretion of the attending cardiologist. Of 2728 consecutive presumed STEMI patients, 412 (15%) had no clear culprit artery. Of these, 202 (49%) had abnormal cardiac biomarkers with a definitive diagnosis in 157 (78%). Diagnoses in this group included myocardial infarction without a culprit lesion (24...
Source: Critical Pathways in Cardiology - December 1, 2014 Category: Cardiology Tags: Original Articles Source Type: research
Recommendations for the Evaluation and Management of Observation Services: A Consensus White Paper: The Society of Cardiovascular Patient Care
Observation Services (OS) was founded by emergency physicians in an attempt to manage “boarding” issues faced by emergency departments throughout the United States. As a result, OS have proven to be an effective strategy in reducing costs and decreasing lengths of stay while improving patient outcomes. When OS are appropriately leveraged for maximum efficiency, patients presenting to emergency departments with common disease processes can be effectively treated in a timely manner. A well-structured observation program will help hospitals reduce the number of inappropriate, costly inpatient admissions while avoiding the...
Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine - November 14, 2014 Category: Cardiology Tags: Recommendation Source Type: research
Creating A Virtual Coronary Care Unit in the Community in 2014 Dr. Raymond D. Bahr Founder, Society of Cardiovascular Patient Care and Early Heart Attack Care
No abstract available (Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine)
Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine - November 14, 2014 Category: Cardiology Tags: Commentary Source Type: research
Pharmacodynamic and Clinical Implications of Switching Between P2Y12 Receptor Antagonists: Considerations for Practice
Dual antiplatelet therapy with aspirin and a P2Y12 receptor antagonist, either clopidogrel or the newer more potent agents prasugrel or ticagrelor, is standard therapy in patients receiving a coronary stent and those with a recent acute coronary syndrome. Switching antiplatelet drug regimen may be required in some patients for efficacy, safety, adherence, and cost considerations. However, there are potential concerns when switching from one agent to another that gaps in effective antiplatelet inhibition could lead to thrombotic events, and overlap of agents might cause excessive platelet inhibition thereby increasing the r...
Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine - November 14, 2014 Category: Cardiology Tags: Pathway Source Type: research
Gender Disparities in Stress Test Utilization in Chest Pain Unit Patients Based Upon the Ordering Physician's Gender
Conclusions:Male physicians appear less likely to utilize stress testing in female patients even after controlling for objective clinical variables, including TIMI score. Although adverse outcomes are uncommon in this patient cohort, further investigation into provider-specific practice patterns based on patient gender is necessary. (Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine)
Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine - November 14, 2014 Category: Cardiology Tags: Original Articles Source Type: research
Impact of Troponin Testing in Noncardiac Admissions
Conclusions:TNI testing in patients admitted to the gastroenterology service was associated with increased length of stay and echocardiography, without any change in management. This study supports adherence to national guidelines for the use of TNI, to reduce TNI testing and length of hospital stay. (Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine)
Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine - November 14, 2014 Category: Cardiology Tags: Original Articles Source Type: research
Hypertension and Atrial Fibrillation: Prognostic Aspects of Troponin Elevations in Clinical Practice
Conclusions:In patients with hypertension, AFib, and e-TnI, tailored-care inclusive of echocardiography and stress testing succeeded in recognizing and treating CAD avoiding adverse events without increase in admissions. (Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine)
Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine - November 14, 2014 Category: Cardiology Tags: Original Articles Source Type: research
“No Culprit” ST-Elevation Myocardial Infarction: Role of Cardiac Magnetic Resonance Imaging
We examined the value of cardiac magnetic resonance (CMR) for diagnosis in patients with “no culprit” STEMI. Data from a comprehensive prospective registry of STEMI patients were reviewed from March 2003 to December 2009. “No culprit” patients were followed for diagnosis and clinical outcome. CMR was performed at the discretion of the attending cardiologist. Of 2728 consecutive presumed STEMI patients, 412 (15%) had no clear culprit artery. Of these, 202 (49%) had abnormal cardiac biomarkers with a definitive diagnosis in 157 (78%). Diagnoses in this group included myocardial infarction without a culprit lesion (24...
Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine - November 14, 2014 Category: Cardiology Tags: Original Articles Source Type: research
Successful Collaborative Model for STEMI Care Between a STEMI-Referral and a STEMI Receiving Center
We describe the experience and benefits of such a relationship.
Methods:A partnership between our 2 institutions was established in April 2011. Saint Anthony Hospital (SAH) of Chicago is an inner city hospital with interventional cardiologists on staff, but no catheterization laboratory. Before the partnership, STEMI patients were transferred 8 miles to a percutaneous coronary intervention (PCI) hospital on the city’s north side. Rush University Medical Center (RUMC) is an academic medical center with 24/7/365 PCI capability. SAH decided that a transfer relationship with a closer SRC would benefit patient care. The follo...
Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine - November 14, 2014 Category: Cardiology Tags: Original Articles Source Type: research
Abstracts of the Seventeenth Congress of the Cardiovascular Patient Care Center
No abstract available (Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine)
Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine - July 25, 2014 Category: Cardiology Tags: Abstracts Source Type: research
2014 Oman Heart Association Protocol for the Management of Acute Atrial Fibrillation
Although atrial fibrillation (AF) is the most common cardiac arrhythmia, there is variation in practice with regard to the management of acute AF among the hospitals and even within the same hospital in Oman. This variation likely reflects a lack of high-quality evidence. Standard guidelines and textbooks do not offer clear evidence-based direction for physicians to guide the management of acute AF. Particularly controversial is the issue of using rhythm control or rate control. This stimulated Oman Heart Association (OHA) to issue a simplified protocol for the management of acute AF to be applied by the entire cardiac car...
Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine - July 25, 2014 Category: Cardiology Tags: Pathway Source Type: research
