Impact of Age in Acute Myocardial Infarction Cardiogenic Shock: Insights From the National Cardiogenic Shock Initiative
Background:
Acute myocardial infarction complicated by cardiogenic shock (AMICS) is associated with high mortality. Patients ≥75 years old represent an increasing proportion of those who present with AMICS and are at high risk for adverse outcomes.
Methods:
The National Cardiogenic Shock Initiative includes patients with AMICS treated using a standard shock protocol with early invasive hemodynamic monitoring, mechanical circulatory support (MCS), and percutaneous coronary intervention (PCI). We evaluated the outcomes of patients based on their age group, dividing them into (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - August 28, 2021 Category: Cardiology Tags: Original Study Source Type: research
Misdiagnosis of Acute Myocardial Infarction: A Systematic Review of the Literature
Conclusions:
Misdiagnosed AMI is an unfortunate part of everyday clinical practice and better training in electrocardiogram interpretation, and education about atypical presentations of AMI may reduce the number of misdiagnosed AMIs. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - August 28, 2021 Category: Cardiology Tags: Review Article Source Type: research
Safety and Efficacy of Pharmaco-invasive Approach Using Streptokinase Compared With Primary Percutaneous Coronary Angiography
Conclusion:
Utilizing streptokinase in early re-perfused patients by PI approach (≤3 hrs) seems safe and efficient when PPCI delay (>120 min from symptom onset) is the other option. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - August 28, 2021 Category: Cardiology Tags: Original Study Source Type: research
Patient, Clinician, and Healthcare Perspectives in Evaluating Care Pathways for Stable Chest Pain
This report describes the concept of clinical pathways and their importance. It iterates different perspectives of the investigation of chest pain and the barriers to understanding the clinical sequence of events. By considering the patient, clinician, and healthcare service perspective, it is possible to critically evaluate the current stable chest pain pathway. This exercise gives consideration into the way in which patient care could be improved. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - August 28, 2021 Category: Cardiology Tags: Review Article Source Type: research
A Point-of-Care Algorithm to Guide Proper Device Selection for Ambulatory Electrocardiography
In the outpatient setting, ambulatory electrocardiography is the most frequently used diagnostic modality for the evaluation of patients in whom cardiac arrhythmias or conduction abnormalities are suspected. Proper selection of the device type and monitoring duration is critical for optimizing diagnostic yield and cost-effective resource utilization. However, despite guidance from major professional societies, the lack of systematic guidance for proper test selection in many institutions results in the need for repeat testing, which leads to not only increased resource utilization and cost of care, but also suboptimal pati...
Source: Critical Pathways in Cardiology - August 28, 2021 Category: Cardiology Tags: Pathway Source Type: research
Prognostic Utility of a Modified HEART Score When Different Troponin Cut Points Are Used
Conclusions:
Using the recommended 99th percentile cut point for hs-cTnT, the combination of a HS ≤ 3 with nonelevated hs-cTnT values over 2 hours identifies a low-risk cohort who can be considered for discharge from the emergency department without further testing. The prognostic utility of this strategy is greatly lessened as higher hs-cTnT cut points are used. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - August 28, 2021 Category: Cardiology Tags: Original Study Source Type: research
Heart Valve Critical Pathway and Heart Valve Clinic: Novel Benchmarks for Modern Management of Valvular Heart Disease
The growing burden of valvular heart disease in Western countries represents a challenge for the daily clinical practice, especially in the light of the ever-increasing number of therapeutic options. The Euro Heart Survey showed that, among elderly subjects with severe, symptomatic valve dysfunction, surgery is denied for 33% of patients with aortic stenosis and for 50% of patients with mitral regurgitation. Current management (from diagnosis to follow-up) is often fragmented in multiple—sometimes unnecessary—steps. Such a “patchy” approach may translate into a suboptimal management, especially in the geriatric pop...
Source: Critical Pathways in Cardiology - August 28, 2021 Category: Cardiology Tags: Pathway Source Type: research
The Changing Role of Chest Pain in the Emergency Department Observation Unit
Conclusions:
Utilization of the EDOU for chest pain decreased over time, with corresponding increases in other conditions. This decline preceded the introduction of the HEART score. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - August 28, 2021 Category: Cardiology Tags: Original Study Source Type: research
Promoting Cardiac Rehabilitation in Acute Coronary Syndrome Patients: Quality Initiative Based on Education, Automated Referral, and Multidisciplinary Rounds
Cardiac rehabilitation is a class 1 recommendation for acute coronary syndrome (ACS) patients according to the American College of Cardiology/American Heart Association. However, only 1 in 5 ACS patients are referred for cardiac rehabilitation nationally, and even fewer at our institution. We sought to improve the number of referrals to cardiac rehabilitation for post-ACS patients admitted to our inpatient cardiology service, and ultimately their participation in the program. We designed a quality improvement initiative that included education of patients and house staff, automated referral order, and participation of card...
Source: Critical Pathways in Cardiology - August 28, 2021 Category: Cardiology Tags: Original Study Source Type: research
Prevalence, Clinical Factors, and Outcomes Associated With Myocardial Infarction With Nonobstructive Coronary Artery
Background:
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is an underrecognized clinical problem in patients presenting with acute coronary syndrome. Various clinical disorders lead to MINOCA thus making treatment and diagnosis a challenge. We aimed to compare the clinical factors and outcomes of patients with MINOCA versus obstructive disease [myocardial infarction due to coronary artery disease (MI-CAD)] in a largely rural health system.
Methods:
Between May 1, 2009 and June 24, 2019, all consecutive ST-segment elevation myocardial infarction patients at Essentia Health were prospectivel...
Source: Critical Pathways in Cardiology - May 27, 2021 Category: Cardiology Tags: Original Studies Source Type: research
Atrial Fibrillation Patients on Warfarin and Their Transition to Direct Oral Anticoagulants
Conclusions:
Every institution or provider network that manages AF patients on warfarin should assess their population on a regular basis to identify candidates for DOAC therapy. Our initiative outlines a process for identifying and transitioning DOAC-eligible AF patients established on warfarin therapy and describes the most commonly encountered barriers to DOAC therapy. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - May 27, 2021 Category: Cardiology Tags: Original Studies Source Type: research
Angiotensin II Administration in Patients With COVID-19 Shock
Conclusions:
On average, the hemodynamic response to angiotensin II in COVID-19 related shock was favorable. Two patients had a marked rapid improvement. Given the relationship of SARS-CoV-2 with the renin-angiotensin-aldosterone system, further evaluation of angiotensin II for the treatment of COVID-19 related shock is warranted. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - May 27, 2021 Category: Cardiology Tags: Original Studies Source Type: research
The Care of Patients With Atrial Fibrillation and Heart Failure
Atrial fibrillation (AF) and heart failure (HF) are the 2 emerging epidemics in global cardiovascular disease. AF remains the most common cardiac arrhythmia, affecting over 33 million adults worldwide, and continues to increase in prevalence as the populations of many nations age. The prevalence of HF also surges, now afflicting 37 million adults globally. Interestingly, these 2 disease processes share many of the same risk factors and stem from many of the same pathophysiologic derangements, with AF occurring in over half of all patients with HF and HF occurring in over one third of all patients with AF. Furthermore, exac...
Source: Critical Pathways in Cardiology - May 27, 2021 Category: Cardiology Tags: Review Article Source Type: research
Chest Pain Severity Rating Is a Poor Predictive Tool in the Diagnosis of ST-Segment Elevation Myocardial Infarction
Current ST-segment elevation myocardial infarction (STEMI) guidelines require persistent electrocardiogram ST-segment elevation, cardiac enzyme changes, and symptoms of myocardial ischemia. Chest pain is the determinant symptom, often measured using an 11-point scale (0–10). Greater severity of chest pain is presumed to be associated with a stronger likelihood of a true positive STEMI diagnosis. This retrospective observational cohort study considered consecutive STEMI patients from May 02, 2009 to December 31, 2018. Analysis of standard STEMI metrics included positive electrocardiogram-to-device and first medical contac...
Source: Critical Pathways in Cardiology - May 27, 2021 Category: Cardiology Tags: Original Studies Source Type: research
24/7 Primary Percutaneous Coronary Intervention as a National Program
Due to the importance of early treatment in the final prognosis of ST-elevation myocardial infarction (STEMI) patients, full-time provision of revascularization services should be available 24 hours a day, 7 days a week (24/7) in conjunction with a fully-coordinated pre-hospital emergency system and equipped centers with experienced medical teams. We reviewed the 24/7 primary percutaneous coronary intervention (PCI) management registry and evaluated the quality of care and patient management as well as the temporal trend of provided health care services. In the present cross-sectional study, we retrieved the data on 11,563...
Source: Critical Pathways in Cardiology - May 27, 2021 Category: Cardiology Tags: Original Studies Source Type: research
