Utility of Framingham Risk Score in Urban Emergency Department Patients with Asymptomatic Hypertension
The objective of this study is to evaluate FRP scores in ED patients with asymptomatic HTN and subclinical hypertensive heart disease (SHHD). This is a substudy of a prospective randomized clinical trial designed to evaluate optimal blood pressure (BP) targets. Eligible patients were screened with echocardiography for the presence of SHHD and FRP scores were calculated. One hundred forty-nine patients enrolled in the study, 133 (89.2%) of whom had detectable SHHD. Mean [SD] calculated FRP scores were statistically similar for patients with SHHD versus those without (general CVD: 20.2 [8.5] vs. 15.6 [8.7]; P = 0.13 and HF c...
Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine - July 25, 2014 Category: Cardiology Tags: Original Articles Source Type: research
A Standardized Bleeding Risk Score Aligns Anticoagulation Choices with Current Evidence
Conclusions:Presentation of the HAS-BLED score led to an 18% improvement in appropriate OAC choices. Future study should evaluate incorporation of HAS-BLED use in real-time clinical situations. (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: Original Articles Source Type: research
False-Positive Rates of Provocative Cardiac Testing in Chest Pain Patients Admitted to an Emergency Department Observation Unit
Emergency department observation units (EDOUs) typically perform routine cardiac stress testing or coronary computed tomography (CCTA) to rule out ischemic cardiac chest pain. Some have questioned the utility of routine stress testing and advanced anatomic imaging in the low-risk chest pain patients. EDOU chest pain patients undergoing stress testing or CCTA prior to cardiac catheterization between June 1, 2009 and May 31, 2012 were studied in a prospective, observational manner. Baseline data, EDOU-related outcomes, and testing results were recorded. Stress tests were treadmill echocardiogram or myocardial perfusion stres...
Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine - July 25, 2014 Category: Cardiology Tags: Original Articles Source Type: research
Emergency Physicians’ Acute Coronary Syndrome Testing Threshold and Diagnostic Performance: Acute Coronary Syndrome Critical Pathway With Return Visit Feedback
Conclusions:Emergency physicians with lower threshold for ACS evaluation more frequently diagnose patients with ACS and less frequently miss the diagnosis of ACS. Feedback to emergency physicians of information on their patient’s return visits and their own diagnostic performance may improve outcome for patients with ACS. (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: Original Articles Source Type: research
Ranolazine Refractory Angina Registry: 1-Year Results
In conclusion, ranolazine is an effective antianginal therapy in patients with RA; still at 1 year only 57% of patients remained on ranolazine because of side effects, suboptimal effectiveness, cost, or progression of disease. (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: Original Articles Source Type: research
Noise Versus Signal: The Clinical Implications of an Increasingly Sensitive Troponin Assay for Patients With Suspected Acute Coronary Syndrome
Conclusions:Although non-ST segment elevation myocardial infarction diagnosis at admission and a positive troponin were more frequent postassay change, rates of anticoagulation and cardiac catheterization were lower and a non-ACS diagnosis at discharge was more common. These data suggest an evolving understanding and clinical impact of contemporary troponin assays when used in real-world settings. (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: Original Articles Source Type: research
STOP STEMI©-A Novel Medical Application to Improve the Coordination of STEMI Care: A Brief Report On Door-to-Balloon Times After Initiating the Application
Conclusions:In this cohort of patients, the utilization of STOP STEMI© decreased the average door-to-balloon times by 22% in the patients with acute STEMI arriving at our emergency department. This effect was maintained when looking at the subset of all STEMI cases reportable to CMS. We also observed modest improvements in meeting the less than 60-minute, less than 90-minute benchmarks, and improvements in the resource utilization. (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: Original Articles Source Type: research
Is Time to Cooling Target Temperature Important?
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 - May 15, 2014 Category: Cardiology Tags: Original Articles Source Type: research
Putting Class IIb Recommendations to the Test: The Influence of Unwitnessed and Non-VT/VF Arrests on Resource Consumption and Outcomes in Therapeutic Hypothermia and Targeted Temperature Management
Therapeutic hypothermia (TH) and targeted temperature management improve neurologic recovery, and survival for patients resuscitated from witnessed out-of-hospital ventricular tachycardia (VT) and ventricular fibrillation (VF) cardiac arrest. The American Heart Association recently gave a class IIb recommendation for the use of TH for non-VT/VF and unwitnessed arrests. We explored changes in baseline characteristics, resource use, and outcomes after expanding indications for TH at our institution based on these guidelines. Fifty-six consecutive patients treated with TH for out-of-hospital cardiac arrest were retrospectivel...
Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine - May 15, 2014 Category: Cardiology Tags: Original Articles Source Type: research
Emergency Department Use of Galectin-3
This article reviews the potential utility of galectin-3 measurement for use in emergency department decision making. (Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine)
Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine - May 15, 2014 Category: Cardiology Tags: Original Articles Source Type: research
Emergency Department Patients With Acute Severe Hypertension: A Comparison of Those Admitted Versus Discharged in Studying the Treatment of Acute Hypertension Registry
Objectives:To compare the characteristics, treatments, and outcomes for emergency department (ED) patients with severe hypertension by disposition (admitted versus discharged home).
Methods:Studying the Treatment of Acute hyperTension (STAT) is a multicenter registry of 1566 patients with blood pressure ≥180/110 mm Hg who were treated with intravenous antihypertensive medications in an ED or intensive care unit. Presenting and in-hospital variables, and postdischarge outcomes for the 1053 patients in the ED subset were compared by disposition.
Results:In the multivariable analysis, ED patients were less likely to be disc...
Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine - May 15, 2014 Category: Cardiology Tags: Original Articles Source Type: research
Adverse Outcomes in Hospitalized Patients Who Develop ST-elevation Myocardial Infarction
Conclusions:Optimized clinical pathways for prevention, early diagnosis, and expedited reperfusion of inpatients with STEMI are urgently needed. (Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine)
Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine - May 15, 2014 Category: Cardiology Tags: Original Articles Source Type: research
NT-proBNP in the Mitral Valve Surgery
Conclusions:NT-proBNP is a valuable biomarker of the clinical presentation and immediate postoperative outcome in patients undergoing mitral valve surgery. The preoperative measurement of NT-proBNP can be used to predict an optimal postoperative clinical outcome. (Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine)
Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine - May 15, 2014 Category: Cardiology Tags: Original Articles Source Type: research
Applying the Diamond Criteria Could Improve Utilization of Stress Echocardiography for Patients Who Present to the Emergency Department With Low-risk Chest Pain
We identified all patients with age 21 years and older, without a history of obstructive coronary artery disease, who presented to the emergency department with chest pain, and were admitted for cardiac observation followed by stress echocardiography during a 1-year period. The positive predictive value of stress echocardiography and cardiovascular outcomes were compared based on patients’ Diamond chest pain classification. In patients with typical chest pain, who accounted for 8.7% (44/503) of the total cohort, the positive predictive value of stress echocardiography was 75% compared with 0% for all other subgroups (P =...
Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine - May 15, 2014 Category: Cardiology Tags: Original Articles Source Type: research
Impact of an Emergency Department–Initiated Clinical Protocol for the Evaluation and Treatment of Atrial Fibrillation
Conclusions:We describe a novel approach to the care of patients with AF presenting to the ED. Usage of the ED-initiated AF clinical pathway with early follow-up in a protocol-driven AF clinic was associated with low readmission rates, no thromboembolic complications at 90 days, improved quality of life, and high patient satisfaction. (Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine)
Source: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine - May 15, 2014 Category: Cardiology Tags: Original Articles Source Type: research
