Impact of Education-based HEART Score Pathway on Coronary Computed Tomography Angiography Utilization and Yield in the Emergency Department
Conclusions:
There was no significant change in the CCTA utilization or yield after the implementation of an education-based HEART pathway in a large academic center. Our findings suggest adopting a more comprehensive approach for deploying such evidence-based protocols to increase institutional compliance. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 19, 2020 Category: Cardiology Tags: Original Studies Source Type: research
Why Won't Emergency Physicians Discharge Patients With a Low HEART Score From an Observation Unit Without Further Evaluation?
Conclusions:
ED physicians in this urban ED felt that over half of patients with a low-risk HEART score were not good candidates for discharge from the EDOU without further evaluation due to poor follow-up, concerning risk factors or symptoms, or coexisting conditions. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 19, 2020 Category: Cardiology Tags: Original Studies Source Type: research
A Multidisciplinary Pathway for the Diagnosis and Treatment of Infectious Endocarditis
Clinical pathways can be useful when disparate clinical-pathologic groups converge on a common diagnostic and therapeutic trajectory. The progressive increase in the incidence of endocarditis in the US has included higher-risk subjects whose candidacy for aggressive cardiac surgical intervention may be highly resource-intensive, prohibitively high risk, or delayed and possibly deferred by comorbidities. We sought to define the sequence, application, and resolution of multidisciplinary endocarditis team decision-making in 4 distinct clinical groups. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 19, 2020 Category: Cardiology Tags: Pathway Source Type: research
Development of an Institutional Periprocedural Management Guideline for Oral Anticoagulants
Patients on oral anticoagulation commonly undergo surgery or other invasive procedures. Periprocedural management of oral anticoagulants involves a careful balance of the thromboembolic risk and bleeding risk. To standardize clinical practice at our institution, we developed a guideline for periprocedural management for patients taking oral anticoagulants that incorporates published data and expert opinion. In this article, we present our clinical practice guideline as a decision support tool to aid clinicians in developing a consistent strategy for managing periprocedural anticoagulation and for safely bridging anticoagul...
Source: Critical Pathways in Cardiology - November 19, 2020 Category: Cardiology Tags: Pathway Source Type: research
Improving Atraumatic Chest Pain Evaluation in an Urban, Safety-net Hospital Through Incorporation of a Modified HEART Score
In conclusion, the HEART score effectively stratified risk of MACE in a safety net population, improved evaluation consistency, and decreased ED length of stay. However, implementation was associated with an increase in hospitalizations and stress testing. Although the American Heart Association/American College of Cardiology guideline regarding atraumatic chest pain in the ED recommends universal noninvasive testing, the value of this approach, particularly in conjunction with the HEART score is uncertain in safety net hospitals. Further evaluation of the costs and clinical advantages of this approach are warranted. (Sour...
Source: Critical Pathways in Cardiology - November 19, 2020 Category: Cardiology Tags: Pathway Source Type: research
Oral Antiplatelet Therapy Administered Upstream to Patients With NSTEMI
Conclusions:
Upstream loading of P2Y12i was associated with very low rates of bleeding and short length of stay in a large cohort of non-ST elevation MI (NSTEMI) patients managed invasively. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 19, 2020 Category: Cardiology Tags: Original Study Source Type: research
A Smart Chest Pain Center to Improve Quality Control and Reduce Doctor’s Workload of Acute Myocardial Infarction
The establishment of a chest pain center (CPC) is an important strategy to improve the treatment of urgent cardiovascular disease, especially acute myocardial infarction. In order to monitor and continuously improve the quality of diagnosis and treatment of CPCs, accurate records of key time points must be made in the diagnosis and treatment of fatal chest pain, which consumes tremendous manpower and resources. Our research combined the application of the Internet of Things, big data, artificial intelligence, and other techniques, to establish a smart CPC that can automatically record key time points, which significantly r...
Source: Critical Pathways in Cardiology - November 19, 2020 Category: Cardiology Tags: Pathway Source Type: research
Effect of Vitamins and Dietary Supplements on Cardiovascular Health
Cardiovascular disease marks the leading cause of mortality and morbidity in the United States. Pharmacological therapies have been developed to reduce the burden of cardiovascular diseases in the setting of large-scale randomized controlled trials. In contrast, vitamins and minerals have not undergone an equal level of scrutiny, and the evidence of cardiovascular benefit remains elusive. Multivitamins are the most popular over-the-counter supplements in the United States, despite the lack of clear benefit as a means of primary or secondary cardiovascular prevention. Recent studies indicate a potential role of multivitamin...
Source: Critical Pathways in Cardiology - July 30, 2020 Category: Cardiology Tags: Review Article Source Type: research
Ventricular Arrhythmias in Patients with Spontaneous Coronary Artery Dissection: Findings from the Gulf Spontaneous Coronary Artery Dissection (Gulf SCAD) Registry
Conclusions:
In-hospital adverse cardiovascular events were significantly more frequent for patients with SCAD who presented with VA. However, follow-up events were not statistically significant between those with and without VA at presentation. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 30, 2020 Category: Cardiology Tags: Original Studies Source Type: research
Community Health Workers Reduce Rehospitalizations and Emergency Department Visits for Low-Socioeconomic Urban Patients With Heart Failure
Background:
Low-socioeconomic, urban, minority patients with heart failure (HF) often have unique barriers to care. Community health workers (CHWs) are specially trained laypeople who serve as liaisons between underserved communities and the health system. It is not known whether CHWs improve outcomes in low-socioeconomic, urban, minority patients with HF.
Hypothesis:
CHWs reduce rehospitalizations, emergency department (ED) visits, and healthcare costs for low-socioeconomic urban patients with HF.
Methods:
Patients admitted with acute decompensated HF were assigned to receive weekly visits by CHW after discharge. ...
Source: Critical Pathways in Cardiology - July 30, 2020 Category: Cardiology Tags: Original Studies Source Type: research
Bleeding Events in Patients 75 Years of Age and Older Under Long-term Anticoagulant Therapy: A Real-life Study
Objective:
To investigate the risk of bleeding events in older patients under oral anticoagulant with a 4-year survey of a catchment area with 197,722 inhabitants of whom 15,267 were on warfarin and 10,397 on direct oral anticoagulants (DOACs).
Methods:
Patients presented to the Emergency Department with major bleeding were enrolled and stratified according to age ≥75 years and ongoing warfarin or DOACs. Primary endpoint was 1-month death.
Results:
Out of 1919 major bleeding, those of patients ≥75 years of age were 1127 (59%) versus 792 (41%) (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 30, 2020 Category: Cardiology Tags: Original Studies Source Type: research
Continuous Monitoring of Coronary Care Mortality Using the Global Registry for Acute Coronary Events (GRACE) Score
Conclusions:
Continuous monitoring of coronary care mortality based on cumulative sum charts and the GRACE score demonstrated the occurrence of series of favorable and unfavorable outcomes on a real-time basis. Additionally, plotting the expected-to-observed probability of death for individual cases was useful to individualize unexpected deaths in low-risk patients. Although overall coronary care performance was adequate according to the GRACE score, we found that there is still some room for improvement, since over half of the deaths occurring in low-risk patients were potentially preventable. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 30, 2020 Category: Cardiology Tags: Original Studies Source Type: research
Systematic Review of Clinical Decision Support Systems for Prehospital Acute Coronary Syndrome Identification
Conclusions:
Although heterogeneity precluded meta-analysis, this review emphasizes the potential of ACS CDSS in prehospital environments that incorporate patient history in addition to integration of multiple components. The higher sensitivity of certain components, along with higher specificity of computer-aided decision-making, highlights the opportunity for developing an integrated algorithm with computer-aided decision support. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 30, 2020 Category: Cardiology Tags: Review Article Source Type: research
Predictors of Aspirin Nonadherence in Adults With Prior Myocardial Infarction
Conclusions:
In this observational contemporary study of adults with prior MI, predictors of aspirin nonadherence included female sex, Black race, Hispanic ethnicity, currently employed status, and absence of homeowner status. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 30, 2020 Category: Cardiology Tags: Original Study Source Type: research
Coronovirus Disease-2019 (COVID-19) Pandemic and Cardiac Electrophysiology: Guidance Protocol From a UK Tertiary Cardiac Center
Since December 2019, the coronovirus disease-2019 (COVID-19) pandemic has resulted in more than 2,160,000 positive cases and more than 145,000 deaths until April 18, 2020. The pressure to the health services worldwide has been unprecedented. The redeployment of staff and resources to treat more efficiently COVID-19 cases along with the need to reduce disease transmission has affected the field of electrophysiology among many others. Amendments to clinical pathways are obligatory in this perspective to continue to provide the necessary health services to the people who need them, although at the same time, infection control...
Source: Critical Pathways in Cardiology - July 30, 2020 Category: Cardiology Tags: Pathway Source Type: research
