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Critical Pathways in Cardiology

Sergey V Brodsky, Ramesh Ganju, Sanjay Mishra, Iouri Ivanov, Paolo Fadda, Huabao Wang, Rolf F Barth
BACKGROUND: Atherosclerosis of the aorta and coronary arteries is still one of the major causes of death. We recently reported obesity paradox between body mass index and atherosclerosis of the aortas (AA) in morbidly obese decedent patients. The cause of this obesity paradox is unknown. The aim of the present study was to carry out genomic microarray analysis to determine gene expression profiles in the aortas of morbidly obese decedents with either mild or severe atherosclerosis of the aorta...
March 2019: Critical Pathways in Cardiology
Noreen Kamal, Thomas Jeerakathil, Kelly Mrklas, Eric E Smith, Balraj Mann, Shelley Valaire, Michael D Hill
BACKGROUND: Alteplase is a proven medical treatment for acute ischemic stroke; however, the effectiveness of this treatment is highly time dependent. Therefore, it is imperative that hospitals treat acute ischemic stroke patients as quickly as possible. The measure, door-to-needle time, is the time from hospital arrival to when alteplase administration begins. OBJECTIVE: The goal in the Canadian province of Alberta was to reduce the door-to-needle time to a median of 30 minutes and to increase the percent of patients treated within 60 minutes to 90%...
March 2019: Critical Pathways in Cardiology
Ersilia M DeFilippis, Kyan Safavi, Jahir Reyes, Lara Coakley, Maryclare Hickey, Michael M Givertz
We evaluated the feasibility of a mobile phone-based geolocation technology in patients with ventricular assist devices (VAD). We prospectively enrolled VAD patients with a smartphone for 6 months. A proprietary mobile technology platform (Position Health, Reading, MA) was downloaded onto Apple or Android smartphones. When a patient entered an emergency department, the app was activated and a "ping" with patient location and contact information was sent to our VAD team pager. Fifty-four patients were approached, and 21 were enrolled...
March 2019: Critical Pathways in Cardiology
Harel Gilutz, Sevatlana Shindel, Ilana Shoham-Vardi
BACKGROUND: Adherence to guidelines for the initial treatment of ST-Segment Elevation Myocardial Infarction has been thoroughly studied, whereas the study of emergency department (ED) adherence to guidelines for Non-ST-Segment Elevation Myocardial Infarction-Acute Coronary Syndrome (NSTEMI-ACS) has been much scarcer. The recommended guidelines for the initial prompt workup and treatment of NSTEMI-ACS remains a challenge. AIM: We studied adherence to guidelines for NSTEMI in the ED...
March 2019: Critical Pathways in Cardiology
Philip Lavenburg, Gregg Cantor, Olufunmilayo Agunloye, Aditi Bhagat, Erin Taub, Getu Teressa
BACKGROUND: The aim of this study was to evaluate whether pretest probability (PTP) assessment using the Diamond-Forrester Model (DFM) combined with coronary calcium scoring (CCS) can safely rule out obstructive coronary artery disease (CAD) and 30-day major adverse cardiovascular events (MACE) in acute chest pain patients. METHODS: We retrospectively evaluated consecutive patients, age ≥18 years, with no known CAD, negative initial electrocardiogram, and troponin level...
March 2019: Critical Pathways in Cardiology
Mehdi Mousavi, Hamidreza Poorhosseini, Ebrahim Nematipour, Seyed Ebrahim Kassaian, Mojtaba Salarifar, Mohammad Alidoosti, Alimohammad Hajizeinali, Younes Nozari, Alireza Amirzadegan, Seyed Kianoosh Hosseini, Mahamood Sheikh Fathollahi, Mohammad Reza Movahed
BACKGROUND: Increasing age appears to be a risk factor for adverse outcome in patients undergoing percutaneous coronary intervention (PCI). The goal of this study was to compare procedural success, complications, and 12 months major adverse cardiac events (MACE) based on age using a large angioplasty registry. METHODS: This registry included 10,412 patients with at least 12-month follow-up from April 1993 to April 2011. Patients were divided into 3 age groups: group 1 age < 60 (n = 6195), group 2 age 60-75 (n = 3724) and group 3 elderly age ≥ 75 (n = 493)...
March 2019: Critical Pathways in Cardiology
Troy Madsen, Rachelle Perkins, Brennen Holt, Margaret Carlson, Jacob Steenblik, Philip Bossart, Stephen Hartsell
BACKGROUND: Although some emergency department observation units (EDOUs) may exclude patients over 65 years old, our EDOU accepts patients up to 79 years old. We assessed the utilization of our EDOU by older patients (those 65-79 years old). METHODS: We prospectively enrolled emergency department (ED) patients with chest pain. We gathered baseline data at the time of ED presentation and tracked outcomes related to the ED stay, EDOU, and/or inpatient admission. Our primary outcome included EDOU placement among older patients...
March 2019: Critical Pathways in Cardiology
Asad Shabbir, Lampson Fan, Gregory Fraser, Mark Philip Cassar, Jon Swinburn
The latest European Society of Cardiology guideline on the management of acute coronary syndromes without persistent ST-elevation stipulates several acceptable pathways through which patients presenting with chest pain can be assessed for unstable coronary disease. This article reviews the data behind the "rule-in and rule-out algorithm," which can exclude acute myocardial infarction within 1 hour of presentation through the use of fifth generation high-sensitivity troponin assays.
March 2019: Critical Pathways in Cardiology
James McCord, Lindsey Aurora, Bertil Lindahl, Evangelos Giannitsis, Carlos Calle-Muller, Richard Nowak, Richard Body, Michael Christ, Christopher R deFilippi, Robert H Christenson, Gordon Jacobsen, Aitor Alquezar, Mauro Panteghini, Dina Melki, Mario Plebani, Franck Verschuren, John French, Garnet Bendig, Silvia Weiser, Christian Mueller
The TRAPID-AMI (High Sensitivity Cardiac Troponin T assay for rapid Rule-out of Acute Myocardial Infarction) study evaluated a rapid "rule-out" acute myocardial infarction (AMI). We evaluated what symptoms were associated with AMI as part of a substudy of TRAPID-AMI. There were 1282 patients evaluated from 12 centers in Europe, the United States of America, and Australia from 2011 to 2013. Multiple symptom variables were prospectively obtained and evaluated for association with the final diagnosis of AMI...
March 2019: Critical Pathways in Cardiology
Chadwick D Miller, Jason P Stopyra, Simon A Mahler, L Doug Case, Sujethra Vasu, Ronny A Bell, W Gregory Hundley
BACKGROUND: Patients from racial and ethnic minority groups presenting to the Emergency Department (ED) with chest pain experience lower odds of receiving stress testing compared with nonminorities. Studies have demonstrated that care pathways administered within the ED can reduce health disparities, but this has yet to be studied as a strategy to increase stress testing equity. METHODS: A secondary analysis from 3 randomized clinical trials involving ED patients with acute chest pain was performed to determine whether a care pathway, ACES (Accelerated Chest pain Evaluation with Stress imaging), reduces the racial disparity in index visit cardiac testing between African American (AA) and White patients...
March 2019: Critical Pathways in Cardiology
Christopher W Baugh, Benjamin M Scirica, James L Januzzi, David A Morrow, Kent B Lewandrowski, Petr Jarolim, Benjamin A White, Mark S Weinfeld, Udo Hoffmann, John T Nagurney
No abstract text is available yet for this article.
March 2019: Critical Pathways in Cardiology
Frank Breuckmann, Tienush Rassaf
The nationwide German certification process of specialized chest pain units is unique in Europe. By February 2018, 269 units had already been successfully certified. With that number, more than half of all catheter laboratories across the country offering service on a 24/7 basis for interventional treatment in myocardial infarction take part in that certified chest pain program - with still increasing tendency. Currently, those units provide a mean of one chest pain unit bed per 65,000 inhabitants. Thereby, a high percentage of recertification of about 95% reflects a high acceptance of the concept by the health care providers...
December 2018: Critical Pathways in Cardiology
Babak Geraiely, Hamidreza Poorhosseini, Saeed Sadeghian, Roya Sattarzadeh Badkoubeh, Seyedeh Hamideh Mortazavi
Despite its clinical benefits, aspirin has been considered one of the predictors of worse outcomes in patients with unstable angina/non-ST-segment-elevation myocardial infarction. Nevertheless, such association has not been demonstrated in patients with ST-elevation myocardial infarction (STEMI). Five hundred eighty-six STEMI patients undergoing primary percutaneous coronary intervention were evaluated including 116 prior aspirin users. Angiographic characteristics and 1-year major adverse cardiac events (MACE) were then compared between the 2 groups...
December 2018: Critical Pathways in Cardiology
Michelle P Lin, Shaw Natsui, Corine Sinnette, Alexis Ball, Joel S Weissman, Jeremiah D Schuur
BACKGROUND: Chest pain of possible cardiac etiology is a leading reason for emergency department (ED) visits and hospitalizations nationwide. Evidence suggests outpatient management is safe and effective for low-risk patients; however, ED admission rates for chest pain vary widely. To identify barriers and facilitators to outpatient management after ED visits, we performed a multicenter qualitative study of key stakeholders. METHODS AND RESULTS: We identified Massachusetts hospitals with below-average admission rates for adult ED chest pain visits from 2010 to 2011...
December 2018: Critical Pathways in Cardiology
Sabina B Gesell, Shannon L Golden, Alexander T Limkakeng, Christine M Carr, Andrew Matuskowitz, Lane M Smith, Simon A Mahler
OBJECTIVE: The HEART Pathway is an evidence-based decision tool for identifying emergency department (ED) patients with acute chest pain who are candidates for early discharge, to reduce unhelpful and potentially harmful hospitalizations. Guided by the Consolidated Framework for Implementation Research, we sought to identify important barriers and facilitators to implementation of the HEART Pathway. STUDY SETTING: Data were collected at 4 academic medical centers...
December 2018: Critical Pathways in Cardiology
Brandon R Allen, Grant G Simpson, Ideen Zeinali, Jared T Freitas, Jeffrey J Chapa, Liam J Rawson, Julie A Richter, Thomas F Payton, Joseph Adrian Tyndall
Chest pain can be a challenging complaint to manage in the emergency department. A missed diagnosis can result in significant morbidity or mortality, whereas avoidable testing and hospitalizations can lead to increased health care costs, contribute to hospital crowding, and increase risks to patients. The HEART score is a validated decision aid to identify patients at low risk for acute coronary syndrome who can be safely discharged without admission or objective cardiac testing. In the largest and one of the longest studies to date (N = 31,060; 30 months), we included the HEART score into a larger, newly developed low-risk chest pain decision pathway, using a retrospective observational pre/post study design with the objective of safely lowering admissions...
December 2018: Critical Pathways in Cardiology
Alexander Michaels, Joseph Gibbs, Sagger Mawri, George Dirani, Lindsey Aurora, Gordon Jacobsen, Richard Nowak, James McCord
The evaluation of individuals with possible acute myocardial infarction (AMI) is time consuming and costly. Risk stratification early during an acute care encounter presents an opportunity for increased delivery of high-value care. We sought to evaluate if the HEART score could be used in the triage of low-risk versus high-risk patients directly home without cardiac testing. Retrospective review of 838 patients placed in an observation unit for evaluation of AMI was done at a single-center, tertiary care teaching hospital...
December 2018: Critical Pathways in Cardiology
Stacey J Howell, Ezra A Amsterdam, Bryn E Mumma, Javier E López, Nam K Tran
OBJECTIVE: Implementation of the newly approved high-sensitivity cardiac troponin (hs-cTn) in the United States presents a challenge for clinical practice. Sex-specific cutoffs, clinical protocols, and workflows will likely require modifications before implementation. METHODS: We conducted a cross-sectional survey of international physicians and laboratorians already utilizing hs-cTn for the evaluation of acute myocardial infarction. RESULTS: Twenty-two of 54 (41%) eligible participants completed the survey, representing 9 countries and 18 hospitals...
December 2018: Critical Pathways in Cardiology
Cole E Ziegler, David M Painter, Joseph B Borawski, Raymond J Kim, Han W Kim, Alexander T Limkakeng
BACKGROUND: Stress cardiac magnetic resonance imaging (CMR) has become increasingly used in patients presenting to the emergency department (ED) with symptoms concerning for acute coronary syndrome (ACS). We hypothesized that CMR detects a number of alternative diagnoses (diagnoses other than ACS that could explain symptoms) and incidental findings in patients presenting to the ED for potential ACS. METHODS: We prospectively enrolled adult patients who presented to an academic ED from 2011 to 2015 for possible ACS and subsequently had an adenosine stress perfusion CMR as part of their diagnostic evaluation...
September 2018: Critical Pathways in Cardiology
Stella Pak, Yan Yatsynovich, Damian Valencia, Tian Chen
Hyperuricemia has been recently speculated to be associated with the development of atrial fibrillation (AF). A meta-analysis of observational studies was conducted to explore the relationship between serum uric acid (SUA) and AF. We searched the MEDLINE, EMBASE, and CINAHL databases and performed extensive bibliography search to identify studies with mean SUA level for patients with and without AF. Key search terms were "atrial fibrillation" and "uric acid." Under the random-effects model, the pooled standardized difference in means between patients with and without AF was calculated...
September 2018: Critical Pathways in Cardiology
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