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Baker PO, Karim SR, Smith SW, Meyers HP, Robinson AE, Ibtida I, Karim RM, Keller GA, Royce KA, Puskarich MA. Artificial Intelligence Driven Prehospital ECG Interpretation for the Reduction of False Positive Emergent Cardiac Catheterization Lab Activations: A Retrospective Cohort Study. PREHOSP EMERG CARE 2024:1-9. [PMID: 39235330 DOI: 10.1080/10903127.2024.2399218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/26/2024] [Accepted: 08/19/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVES Data suggest patients suffering acute coronary occlusion myocardial infarction (OMI) benefit from prompt primary percutaneous intervention (PPCI). Many emergency medical services (EMS) activate catheterization labs to reduce time to PPCI, but suffer a high burden of inappropriate activations. Artificial intelligence (AI) algorithms show promise to improve electrocardiogram (ECG) interpretation. The primary objective was to evaluate the potential of AI to reduce false positive activations without missing OMI. METHODS Electrocardiograms were categorized by (1) STEMI criteria, (2) ECG integrated device software and (3) a proprietary AI algorithm (Queen of Hearts (QOH), Powerful Medical). If multiple ECGs were obtained and any one tracing was positive for a given method, that diagnostic method was considered positive. The primary outcome was OMI defined as an angiographic culprit lesion with either TIMI 0-2 flow; or TIMI 3 flow with either peak high sensitivity troponin-I > 5000 ng/L or new wall motion abnormality. The primary analysis was per-patient proportion of false positives. RESULTS A total of 140 patients were screened and 117 met criteria. Of these, 48 met the primary outcome criteria of OMI. There were 80 positives by STEMI criteria, 88 by device algorithm, and 77 by AI software. All approaches reduced false positives, 27% for STEMI, 22% for device software, and 34% for AI (p < 0.01 for all). The reduction in false positives did not significantly differ between STEMI criteria and AI software (p = 0.19) but STEMI criteria missed 6 (5%) OMIs, while AI missed none (p = 0.01). CONCLUSIONS In this single-center retrospective study, an AI-driven algorithm reduced false positive diagnoses of OMI compared to EMS clinician gestalt. Compared to AI (which missed no OMI), STEMI criteria also reduced false positives but missed 6 true OMI. External validation of these findings in prospective cohorts is indicated.
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Affiliation(s)
- Peter O Baker
- Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | - Stephen W Smith
- Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
- Hennepin Healthcare, Department of Emergent Medicine, Minneapolis, Minnesota
| | - H Pendell Meyers
- Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina
| | - Aaron E Robinson
- Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
- Hennepin Healthcare, Department of Emergent Medicine, Minneapolis, Minnesota
- Hennepin EMS, Hennepin Healthcare, Minneapolis, Minnesota
| | - Ishmam Ibtida
- Division of Cardiology, Stony Brook University, Stony Brook, New York
| | - Rehan M Karim
- Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
- Department of Cardiology, Hennepin Healthcare, Minneapolis, Minnesota
| | | | | | - Michael A Puskarich
- Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
- Hennepin Healthcare, Department of Emergent Medicine, Minneapolis, Minnesota
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Almesned A, Bhat YA. The Effectiveness of Leadership Interventions on Cardiologists' Performance Using Benchmarking as a Tool. Cureus 2024; 16:e66744. [PMID: 39268325 PMCID: PMC11391163 DOI: 10.7759/cureus.66744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Aligned with the Health Sector Transformation Strategy of Saudi Vision 2030, the study analyzed the attitudes and behaviors of cardiologists toward change and identified factors that could either facilitate or hinder the success of leadership interventions. At our cardiac center, the cath lab department is at the forefront of operations, accounting for 80% of the procedures. Our team members may not be fully equipped with the necessary attitudes and behaviors to drive successful improvement projects. Therefore, our top priority is ensuring they remain productive and engaged throughout the process. This is especially crucial because 60% of our budget is allocated to the cath lab department. OBJECTIVES The study aimed to assess the effectiveness of a leadership intervention on cardiologists' performance in terms of safety, speed, and cost. The research analyzed the behavior and attitude of cardiologists towards change and encouraged progress and collaborative learning between doctors, using benchmarking as a tool. Besides, the study sought to determine the contribution of the interventions used to overall efficiency in performing interventions. This case study focuses on four main aspects of the program. First, it aims to explore an innovative approach to improving the PSCCQ cath lab for patients. Second, it assesses the collective effort of all participants involved in the program. Third, it analyzes the program results and compares them with those of international experiences. And finally, it examines the program's potential benefits for our patients. METHODS The study's objectives were evaluated through qualitative analysis of in-depth interviews and quantitative data analysis of three variables in the cath lab: radiation dose, time, and inventory. The reason for using mixed methods was to comprehensively understand the same concept from different angles. RESULTS According to the study, participants improved the safety and effectiveness of our cath lab by reducing the radiation dose and its cost. The study revealed a 52% decrease in the radiation dose for diagnostic cases and an 11% decrease for interventional cases. Similarly, the cost of the radiation dose decreased by 28% for diagnostic cases and 11% for interventional cases. During the observation, it was noted that the participants were highly engaged and willing to adapt to the situation. Some even viewed it as an opportunity for personal growth and improvement in the cath lab. However, they stressed the significance of awareness as a crucial element in improving their behavior and reinforcing it as the foundation for maintaining progress. Furthermore, the study revealed that collaborative work among the participants could have been more optimal. CONCLUSION The study concludes that implementing innovative improvements to the cath lab was a necessary yet complex undertaking. Participants were more inclined to embrace the changes when they were easily understandable and motivating. The study recommends the appointment of a change agent, the establishment of benchmarks, and the creation of a collaborative working environment between leaders and staff. Above all, the leader should support and sponsor the change to facilitate the transition at various levels.
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Affiliation(s)
| | - Yasser A Bhat
- Pediatric Cardiology, Prince Sultan Cardiac Center Qassim, Buraidah, SAU
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Khandaker MAH, Panduranga P. Not all Postmyocardial Infarction Ventricular Septal Rupture Need Immediate Surgery: Role of Cardiogenic Shock Classification. Heart Views 2021; 22:141-145. [PMID: 34584627 PMCID: PMC8445139 DOI: 10.4103/heartviews.heartviews_138_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/31/2021] [Indexed: 11/04/2022] Open
Abstract
A 56-year-old man presented with acute anterior ST elevation myocardial infarction. Initially he was thrombolysed at a peripheral hospital and a transthoracic echocardiography revealed multiple (2-3 mm) apical muscular ventricular septal defects suggesting ventricular septal rupture (VSR), with the largest measuring 10mm with left to right shunt and max gradient was 74 mmHg. His left ventricular ejection fraction was 45%. A coronary angiogram revealed tight proximal (95%) and mid segments (80%) stenosis in the left anterior descending artery (LAD) but diffusely diseased distally. Another significant stenosis (80%) was present at the ostium of the right posterior descending artery (r-PDA). He was in Society for Cardiovascular Angiography and Intervention (SCAI) cardiogenic shock Stage B, hence cardiac surgeons advised conservative medical treatment in order to stabilize the infarct area with view of good surgical outcome. Although, there was a dilemma between the surgeon and the cardiologist regarding timing VSR closure, classification of shock stages helped to delay surgery. Eventually, he was taken for surgery at the 18th day of admission with a graft to r-PDA rather to LAD (due to difficult visualization) and repair of VSR with Gortex patch. In conclusion, in all patients with post MI VSR, SCAI shock stages classification has to be applied in determining the timing of surgery.
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Affiliation(s)
| | - Prashanth Panduranga
- Department of Cardiology, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman
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Naidu SS, Abbott JD, Bagai J, Blankenship J, Garcia S, Iqbal SN, Kaul P, Khuddus MA, Kirkwood L, Manoukian SV, Patel MR, Skelding K, Slotwiner D, Swaminathan RV, Welt FG, Kolansky DM. SCAI expert consensus update on best practices in the cardiac catheterization laboratory: This statement was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Rhythm Society (HRS) in April 2021. Catheter Cardiovasc Interv 2021; 98:255-276. [PMID: 33909349 DOI: 10.1002/ccd.29744] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 12/28/2022]
Abstract
The current document commissioned by the Society for Cardiovascular Angiography and Interventions (SCAI) and endorsed by the American College of Cardiology, the American Heart Association, and Heart Rhythm Society represents a comprehensive update to the 2012 and 2016 consensus documents on patient-centered best practices in the cardiac catheterization laboratory. Comprising updates to staffing and credentialing, as well as evidence-based updates to the pre-, intra-, and post-procedural logistics, clinical standards and patient flow, the document also includes an expanded section on CCL governance, administration, and approach to quality metrics. This update also acknowledges the collaboration with various specialties, including discussion of the heart team approach to management, and working with electrophysiology colleagues in particular. It is hoped that this document will be utilized by hospitals, health systems, as well as regulatory bodies involved in assuring and maintaining quality, safety, efficiency, and cost-effectiveness of patient throughput in this high volume area.
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Affiliation(s)
- Srihari S Naidu
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - J Dawn Abbott
- Cardiovascular Institute of Lifespan, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jayant Bagai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Blankenship
- Cardiology Division, The University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Sohah N Iqbal
- Mass General Brigham Salem Hospital, Salem, Massachusetts, USA
| | | | - Matheen A Khuddus
- The Cardiac and Vascular Institute and North Florida Regional Medical Center, Gainesville, Florida, USA
| | - Lorrena Kirkwood
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | | | - Manesh R Patel
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - David Slotwiner
- Division of Cardiology, New York Presbyterian, Weill Cornell Medicine Population Health Sciences, Queens, New York, USA
| | - Rajesh V Swaminathan
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Frederick G Welt
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Daniel M Kolansky
- Division of Cardiovascular Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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