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Parisi EJ, Chung EH. Palpitations in athletes: diagnosis, workup and treatment. Heart 2023:heartjnl-2022-321726. [PMID: 37562948 DOI: 10.1136/heartjnl-2022-321726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
Palpitations are a common reason for athletes to seek medical care. Although often benign, palpitations may serve as a harbinger for underling cardiac pathology. Given the unique challenges in this population, this review will serve to discuss the basic underlying pathophysiology, which may predispose athletes to palpitations. In addition, we will review the aetiologies, diagnostic evaluation, management and counselling strategies for some of the most common diagnoses seen in athletes.
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Affiliation(s)
- Erika J Parisi
- Internal Medicine/Cardiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Eugene H Chung
- Internal Medicine/Cardiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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2
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Vicent L, Rosillo N, Moreno G, Salguero-Bodes R, Goñi C, Bernal JL, Seara G, Bueno H. Sex differences in patterns of referral and resource utilization in the cardiology clinic: an outpatient analysis. Front Cardiovasc Med 2023; 10:1202960. [PMID: 37588036 PMCID: PMC10425536 DOI: 10.3389/fcvm.2023.1202960] [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] [Received: 04/09/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023] Open
Abstract
Aims Women may have different management patterns than men in specialised care. Our aim was to assess potential sex differences in referral, management and outcomes of patients attending outpatient cardiac consultations. Methods and results Retrospective observational analysis of patients ≥18 years referred for the first time from primary care to a tertiary hospital cardiology clinic in 2017-2018, comparing reasons for referral, decisions and post-visit outcomes by sex.A total of 5,974 patients, 2,452 (41.0%) men aged 59.2 ± 18.6 years and 3,522 (59.0%) women aged 64.5 ± 17.9 years (P < 0.001) were referred for a first cardiology consultation. The age-related referral rates were higher in women. The most common reasons for consultation were palpitations in women (n = 676; 19.2%) and ECG abnormalities in men (n = 570; 23.2%). Delays to cardiology visits and additional tests were similar. During 24 months of follow-up, women had fewer cardiology hospitalisations (204; 5.8% vs. 229; 9.3%; P = 0.003) and lower mortality (65; 1.8% vs. 66; 2.7%; P = 0.028), but those aged <65 years had more emergency department visits (756; 48.5% vs. 560; 39.9%, P < 0.001) than men. Conclusion There are substantial sex differences in primary care cardiology referral patterns, including causes, rates, decisions and outcomes, which are only partially explained by age differences. Further research is needed to understand the reasons for these differences.
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Affiliation(s)
- Lourdes Vicent
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Nicolás Rosillo
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Department of Preventive Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Guillermo Moreno
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Spain
| | - Rafael Salguero-Bodes
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Clara Goñi
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - José Luis Bernal
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Control Management Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Germán Seara
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Héctor Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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3
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Narrow Complex Tachycardias. Emerg Med Clin North Am 2022; 40:717-732. [DOI: 10.1016/j.emc.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Probst MA, Janke AT, Haimovich AD, Venkatesh AK, Lin MP, Kocher KE, Nemnom MJ, Thiruganasambandamoorthy V. Development of a Novel Emergency Department Quality Measure to Reduce Very Low-Risk Syncope Hospitalizations. Ann Emerg Med 2022; 79:509-517. [PMID: 35487840 PMCID: PMC9117517 DOI: 10.1016/j.annemergmed.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE Emergency department (ED) evaluations for syncope are common, representing 1.3 million annual US visits and $2 billion in related hospitalizations. Despite evidence supporting risk stratification and outpatient management, variation in syncope hospitalization rates persist. We sought to develop a new quality measure for very low-risk adult ED patients with syncope that could be applied to administrative data. METHODS We developed this quality measure in 2 phases. First, we used an existing prospective, observational ED patient data set to identify a very low-risk cohort with unexplained syncope using 2 variables: age less than 50 years and no history of heart disease. We then applied this to the 2019 Nationwide Emergency Department Sample (NEDS) to assess its potential effect, assessing for hospital-level factors associated with hospitalization variation. RESULTS Of the 8,647 adult patients in the prospective cohort, 3,292 (38%) patients fulfilled these 2 criteria: age less than 50 years and no history of heart disease. Of these, 15 (0.46%) suffered serious adverse events within 30 days. In the NEDS, there were an estimated 566,031 patients meeting these 2 criteria, of whom 15,507 (2.7%; 95% confidence interval [CI] 2.48% to 3.00%) were hospitalized. We found substantial variation in the hospitalization rates for this very low-risk cohort, with a median rate of 1.7% (range 0% to 100%; interquartile range 0% to 3.9%). Factors associated with increased hospitalization rates included a yearly ED volume of more than 80,000 (odds ratio [OR] 3.14; 95% CI 2.02 to 4.89) and metropolitan teaching status (OR 1.5; 95% CI 1.24 to 1.81). CONCLUSION In summary, our novel syncope quality measure can assess variation in low-value hospitalizations for unexplained syncope. The application of this measure could improve the value of syncope care.
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Affiliation(s)
- Marc A Probst
- Department of Emergency Medicine, Columbia University Medical Center, New York, NY.
| | - Alexander T Janke
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Adrian D Haimovich
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Michelle P Lin
- Department of Emergency Medicine and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Keith E Kocher
- Department of Emergency Medicine and Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Marie-Joe Nemnom
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Physical and mental health in young adults with heart disease - a national survey of Norwegian university students. Cardiol Young 2022; 32:257-265. [PMID: 34100351 DOI: 10.1017/s1047951121001815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Young adults with heart disease constitute a growing group with the risk of cognitive and physical impairment. The knowledge of their academic performance and mental and physical health is, however, scant. This study aimed to compare young adults with CHDs or arrhythmia with their peers. METHODS Information on physical health (Somatic Symptom Scale-8), mental health problems (Hopkins Symptoms Checklist-25), quality of life (Satisfaction With Life Scale), physical activity, and academic performance was collected online in a national cross-sectional survey in Norway among students in higher education (the SHoT2018 study). RESULTS Among 50,054 students, 172 (0.34%) reported CHD and 132 (0.26%) arrhythmias. Students reporting arrhythmias scored significantly higher than the control group on somatic symptoms (OR = 2.3 (95% CI: 1.62-3.27)), anxiety (OR = 1.60 (1.08-2.37)), depression (OR = 1.49 (1.05-2.11)), self-harm, and suicide attempt (OR = 2.72 (1.56-4.75)), and lower quality of life (OR 1.64 (1.16-2.32)) and more loneliness (OR = 1.99 (1.28-3.10)) compared to participants without heart disease. Participants with CHD reported an increased somatic symptom burden (OR = 1.58 (1.16-2.16)). Despite a tendency to a higher score, this group did not differ significantly from the control group on anxiety or depression, quality of life, or loneliness. However, the risk of self-harm thoughts and suicidality was significantly increased (OR for suicide attempt 2.22 (1.3-3.77)). There was no difference between the groups on academic performance. CONCLUSIONS Although Norwegian students with heart disease reported more somatic symptoms, their academic progress was not reduced compared to students without heart disease. Students with CHD or arrhythmias showed an increased risk of self-harm thoughts and suicidality.
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Tsaregorodtsev DA, Shelukha PA, Romasenko LV, Beraya MM, Sokolov AV. Panic Attacks in Patients with Supraventricular Tachycardia: Problems of Differential Diagnosis and Impact on Quality of Life. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2022. [DOI: 10.20996/1819-6446-2021-12-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To study the psychosomatic relationships and quality of life (QOL) of patients with paroxysmal supraventricular tachycardia (SVT) depending on the presence or absence of panic attacks (PA) in comparison with patients with heartbeat against the background of somatoform autonomic dysfunction.Material and methods. The study included patients with SVT and heart attacks due to sinus tachycardia in the context of somatoform autonomic disorder (SAD). All patients were interviewed to identify anxiety and depressive disorders (Hospital Anxiety and Depression Scale [HADS] and Hamilton's Depression Scale), QOL assessment (SF-36 questionnaire), and they were also consulted by a psychiatrist who established the presence or absence of PA. According to a visual analogue scale, in points from 0 to 6, we assessed the general state of our patients' health (0 points corresponded to complete health, and 6 points corresponded to a serious illness) and the effect of heartbeat on well-being (0 points - no arrhythmia, 6 points - arrhythmia «nterferes with life»).Results. The study included 96 patients: 60 with SVT (21 men, 39 women, average age was 51 [33; 61] years) and 36 with heart attacks caused by sinus tachycardia in the framework of somatoform autonomic disorder (10 men, 26 women, average age was 33 [27; 41] years). Panic disorder was diagnosed in the SVT group in 17 patients, accounting for 28.3%. Only 7 patients (41%) could clearly differentiate between SVT and PA attacks. The low sensitivity of the HADS questionnaire in patients with SVT determined the need to consult a psychiatrist for the diagnosis of panic disorders.Conclusion. PA is typical for 28.3% of patients with SVT. The combination of SVT with PA reduces the QOL of patients due to its mental components, including due to the more frequent occurrence of depressive symptoms. Patients with SAD subjectively perceive the heartbeat as a more significant factor affecting health, compared with patients with SVT. Difficulties in the differential diagnosis of PA and SVT paroxysms in real clinical practice often lead to the appointment of the same therapy without taking into account the differences in the genesis of heartbeats.
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Affiliation(s)
| | - P. A. Shelukha
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - L. V. Romasenko
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - M. M. Beraya
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - A. V. Sokolov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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Baman JR, Mathew DT, Jiang M, Passman RS. Mobile Health for Arrhythmia Diagnosis and Management. J Gen Intern Med 2022; 37:188-197. [PMID: 34282532 PMCID: PMC8288067 DOI: 10.1007/s11606-021-07007-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/25/2021] [Indexed: 01/04/2023]
Abstract
Palpitations are a common symptom managed by general practitioners and cardiologists; atrial fibrillation (AF) is the most common arrhythmia in adults. The recent commercial availability of smartphone-based devices and wearable technologies with arrhythmia detection capabilities has revolutionized the diagnosis and management of these common medical issues, as it has placed the power of arrhythmia detection into the hands of the patient. Numerous mobile health (mHealth) devices that can detect, record, and automatically interpret irregularities in heart rhythm and abrupt changes in heart rate using photoplethysmography (PPG)- and electrocardiogram-based technologies are now commercially available. As opposed to prescription-based external rhythm monitoring approaches, these devices are more inexpensive and allow for longer-term monitoring, thus increasing sensitivity for arrhythmia detection, particularly for patients with infrequent symptoms possibly due to cardiac arrhythmias. These devices can be used to correlate symptoms with cardiac arrhythmias, assess efficacy and toxicities of arrhythmia therapies, and screen the population for serious rhythm disturbances such as AF. Although several devices have received clearance for AF detection from the United States Food & Drug Administration, limitations include the need for ECG confirmation for arrhythmias detected by PPG alone, false positives, false negatives, charging requirements for the battery, and financial cost. In summary, the growth of commercially available devices for remote, patient-facing rhythm monitoring represents an exciting new opportunity in the care of patients with palpitations and known or suspected dysrhythmias. Physicians should be familiar with the evidence that underlies their added value to patient care and, importantly, their current limitations.
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Affiliation(s)
- Jayson R Baman
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Daniel T Mathew
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael Jiang
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rod S Passman
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Arrhythmia Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Abstract
Cancer and cardiovascular diseases (CVD) are among the leading causes of death worldwide. In response to the growing population of cancer patients and survivors with CVD, the sub-specialty of cardio-oncology has been developed to better optimise their care. Palpitations are one of the most common presenting complaints seen in the emergency room or by the primary care provider or cardiologist. Palpitations are defined as a rapid pulsation or abnormally rapid or irregular beating of the heart and present a complex diagnostic entity with no evidence-based guidelines currently available. Palpitations are a frequent occurrence in people with cancer, and investigations and treatment are comparable to that in the general population although there are some nuances. Cancer patients are at a higher risk of arrhythmogenic causes of palpitations and non-arrhythmogenic causes of palpitations. This review will appraise the literature with regards to the development and management of palpitations in the cancer patient.
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Affiliation(s)
- Hani Essa
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart and Chest Hospital Liverpool, UK
| | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart and Chest Hospital Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University Aalborg, Denmark
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Establishing a Smartphone Ambulatory ECG Service for Patients Presenting to the Emergency Department with Pre-Syncope and Palpitations. ACTA ACUST UNITED AC 2021; 57:medicina57020147. [PMID: 33562066 PMCID: PMC7915873 DOI: 10.3390/medicina57020147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 11/23/2022]
Abstract
Background and Objectives: The Investigation of Palpitations in the ED (IPED) study showed that a smartphone-based event recorder increased the number of patients in whom an electrocardiogram (ECG) was captured during symptoms over five-fold to more than 55% at 90 days compared to standard care and concluded that this safe, non-invasive and easy-to-use device should be considered part of on-going care to all patients presenting acutely with unexplained palpitations or pre-syncope. This study reports the process of establishing a smartphone palpitation and pre-syncope ambulatory care Clinic (SPACC) service. Materials and Methods: A clinical standard operating procedure (SOP) was devised, and funding was secured through a business case for the purchase of 40 AliveCor devices in the first instance. The clinic was launched on 22 July 2019. Results: Between 22 July 2019 and 31 October 2019, 68 patients seen in the emergency departments (EDs) with palpitations or pre-syncope were referred to SPACC. Of those, 30 were male and 38 were female, and the mean age was 45.8 years old (SD 15.1) with a range from 18 years old to 80 years old. A total of 50 (74%) patients underwent full investigation. On the first assessment, seven (10%) patients were deemed to have non-cardiac palpitations and were not fitted with the device. All patients who underwent full investigation achieved symptomatic rhythm correlation most with sinus rhythm, ventricular ectopics, or bigeminy. A symptomatic cardiac dysrhythmia was detected in six (8.8%) patients. Three patients had supraventricular tachycardia (4%), two had atrial fibrillation (3%), and one had atrial flutter (2%). Qualitative feedback from the SPACC team suggested several areas where improvement to the clinic could be made. Conclusion: We believe a smartphone palpitation service based on ambulatory care is simple to implement and is effective at detecting cardiac dysrhythmia in ED palpitation patients.
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Park SY, Kong HH, Kim MJ, Yoon YS, Lee SH, Im S, Seo JH. Clinical performance of medical students in Korea in a whole-task emergency station in the objective structured clinical examination with a standardized patient complaining of palpitations. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2020; 17:42. [PMID: 33321555 PMCID: PMC7856094 DOI: 10.3352/jeehp.2020.17.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
This study assessed the clinical performance of 150 third-year medicalstudents in Busan, Korea in a whole-task emergency objective structured clinical examination station that simulated a patient with palpitations visiting the emergency department. The examination was conducted from November 25 to 27, 2019. Clinical performance was assessed as the number and percentage of students who performed history-taking (HT), a physical examination (PE), an electrocardiography (ECG) study, patient education (Ed), and clinical reasoning (CR), which were items on the checklist. It was found that 18.0% of students checked the patient’s pulse, 51.3% completed an ECG study, and 57.9% explained the results to the patient. A sizable proportion (38.0%) of students did not even attempt an ECG study. In a whole-task emergency station, students showed good performance on HT and CR, but unsatisfactory results for PE, ECG study, and Ed. Clinical skills educational programs for subjected student should focus more on PE, timely diagnostic tests, and sufficient Ed.
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Affiliation(s)
- Song Yi Park
- Department of Emergency Medicine, Dong-A University College of Medicine, Busan, Korea
- Department of Medical Education, Dong-A University College of Medicine, Busan, Korea
| | - Hyun-Hee Kong
- Department of Parasitology, Dong-A University College of Medicine, Busan, Korea
| | - Min-Jeong Kim
- Department of Medical Education and Neurology, Kosin University College of Medicine, Busan, Korea
| | - Yoo Sang Yoon
- Department of Emergency Medicine, Inje University College of Medicine, Busan, Korea
| | - Sang-Hwa Lee
- Department of Medical Education, Dong-A University College of Medicine, Busan, Korea
| | - Sunju Im
- Department of Medical Education, Pusan National University School of Medicine, Busan, Korea
| | - Ji-Hyun Seo
- Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Medical Education, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang National Institute of Health Sciences, Jinju, Korea
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11
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Darrat Y, Elayi CS. Gender Variations in the management of supraventricular tachycardia: Time to act! PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1284. [PMID: 31390068 DOI: 10.1111/pace.13769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/03/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Claude-Samy Elayi
- University of Florida, Division of Cardiovascular Medicine, Jacksonville, Florida
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12
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Bobbo M, Amoroso S, Tamaro G, Gesuete V, D'agata Mottolese B, Barbi E, Ventura A. Retrospective study showed that palpitations with tachycardia on admission to a paediatric emergency department were related to cardiac arrhythmias. Acta Paediatr 2019; 108:328-332. [PMID: 29972706 DOI: 10.1111/apa.14486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/22/2018] [Accepted: 07/02/2018] [Indexed: 11/29/2022]
Abstract
AIM This retrospective study reviewed the prevalence and long-term prognosis of children aged 0-18 with palpitations who were admitted to the emergency department (ED) of an Italian paediatric hospital. METHODS We examined all admissions to the ED of the IRCCS Burlo Garofolo between January 2009 and December 2015 by selecting triage diagnoses of palpitations. The hospital discharge cards were reviewed to assess vital parameters, physical examinations, diagnostic tests, cardiology consultations and final diagnoses. RESULTS Of the 142 803 patients who attended our ED for any reason, 96 (0.07%) complained of palpitations. Despite this low prevalence, it was noteworthy that 13.5% had a real underlying arrhythmic cause and needed medical assistance. Over half (52.1%) were women and the mean age was 12.7 years. At the long-term follow-up, at a mean of 47 ± 23 months, 53.8% of patients with a cardiac arrhythmia had received medical therapy and 46.1% had undergone trans-catheter ablation for supraventricular tachycardia. A heart rate above 146 beats per minute or palpitations for more than an hour was statistically related to a cardiac arrhythmia. CONCLUSION Palpitations were an infrequent cause of admission to our ED, but 13.5% who displayed them had an underlying cardiac arrhythmia.
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Affiliation(s)
- Marco Bobbo
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”; Trieste Italy
| | | | | | - Valentina Gesuete
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”; Trieste Italy
| | | | - Egidio Barbi
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”; Trieste Italy
- University of Trieste; Trieste Italy
| | - Alessandro Ventura
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”; Trieste Italy
- University of Trieste; Trieste Italy
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Reed MJ, Grubb NR, Lang CC, O'Brien R, Simpson K, Padarenga M, Grant A, Tuck S, Keating L, Coffey F, Jones L, Harris T, Lloyd G, Gagg J, Smith JE, Coats T. Multi-centre Randomised Controlled Trial of a Smartphone-based Event Recorder Alongside Standard Care Versus Standard Care for Patients Presenting to the Emergency Department with Palpitations and Pre-syncope: The IPED (Investigation of Palpitations in the ED) study. EClinicalMedicine 2019; 8:37-46. [PMID: 31193636 PMCID: PMC6537555 DOI: 10.1016/j.eclinm.2019.02.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 02/07/2019] [Accepted: 02/15/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with palpitations and pre-syncope commonly present to Emergency Departments (EDs) but underlying rhythm diagnosis is often not possible during the initial presentation. This trial compares the symptomatic rhythm detection rate of a smartphone-based event recorder (AliveCor) alongside standard care versus standard care alone, for participants presenting to the ED with palpitations and pre-syncope with no obvious cause evident at initial consultation. METHODS Multi-centre open label, randomised controlled trial. Participants ≥ 16 years old presenting to 10 UK hospital EDs were included. Participants were randomised to either (a) intervention group; standard care plus the use of a smartphone-based event recorder or (b) control group; standard care alone. Primary endpoint was symptomatic rhythm detection rate at 90 days. Trial registration number NCT02783898 (ClinicalTrials.gov). FINDINGS Two hundred forty-three participants were recruited over an 18-month period. A symptomatic rhythm was detected at 90 days in 69 (n = 124; 55.6%; 95% CI 46.9-64.4%) participants in the intervention group versus 11 (n = 116; 9.5%; 95% CI 4.2-14.8) in the control group (RR 5.9, 95% CI 3.3-10.5; p < 0.0001). Mean time to symptomatic rhythm detection in the intervention group was 9.5 days (SD 16.1, range 0-83) versus 42.9 days (SD 16.0, range 12-66; p < 0.0001) in the control group. The commonest symptomatic rhythms detected were sinus rhythm, sinus tachycardia and ectopic beats. A symptomatic cardiac arrhythmia was detected at 90 days in 11 (n = 124; 8.9%; 95% CI 3.9-13.9%) participants in the intervention group versus 1 (n = 116; 0.9%; 95% CI 0.0-2.5%) in the control group (RR 10.3, 95% CI 1.3-78.5; p = 0.006). INTERPRETATION Use of a smartphone-based event recorder increased the number of patients in whom an ECG was captured during symptoms over five-fold to more than 55% at 90 days. This safe, non-invasive and easy to use device should be considered part of on-going care to all patients presenting acutely with unexplained palpitations or pre-syncope. FUNDING This study was funded by research awards from Chest, Heart and Stroke Scotland (CHSS) and British Heart Foundation (BHF) which included funding for purchasing the devices. MR was supported by an NHS Research Scotland Career Researcher Clinician award.
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Affiliation(s)
- Matthew J. Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
- Edinburgh Acute Care, Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, The Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
- Corresponding author at: Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK.
| | - Neil R. Grubb
- Department of Cardiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Christopher C. Lang
- Department of Cardiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Rachel O'Brien
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Kirsty Simpson
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Mia Padarenga
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Alison Grant
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Sharon Tuck
- Edinburgh Clinical Research Facility, Epidemiology and Statistics Core, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Liza Keating
- Emergency Department, Royal Berkshire NHS Foundation Trust, Reading RG1 5AN, UK
| | - Frank Coffey
- DREEAM - Department of Research and Education in Emergency medicine, Acute medicine and Major trauma, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Derby Road, Nottingham, NG7 2UH, UK
| | - Lucy Jones
- Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield Rd, Calow, Chesterfield S44 5BL, UK
| | - Tim Harris
- Barts Health NHS Trust, Whitechapel, London E1 1BB, UK
| | - Gavin Lloyd
- Royal Devon and Exeter Hospital, Barrack Rd, Exeter EX2 5DW, UK
| | - James Gagg
- Department of Emergency Medicine, Musgrove Park Hospital, Taunton & Somerset NHS Foundation Trust, Taunton TA1 5DA, UK
| | - Jason E. Smith
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK
| | - Tim Coats
- Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
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Fahimi J, Kanzaria HK, Mongan J, Kahn KL, Wang RC. Potential Effect of the Protecting Access to Medicare Act on Use of Advanced Diagnostic Imaging in the Emergency Department: An Analysis of the National Hospital Ambulatory Care Survey. Radiology 2019; 291:188-193. [PMID: 30694161 DOI: 10.1148/radiol.2019181650] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Clinical decision support is increasingly used to enhance clinicians' exposure to established evidence and patient information during an episode of patient care. Pending legislation specifies clinical decision support before performing advanced imaging at emergency department (ED) visits. Purpose To estimate the volume of advanced imaging tests (CT and MRI) that would require use of clinical decision support to achieve Protecting Access to Medicare Act (PAMA) compliance in the ED. Materials and Methods A retrospective, cross-sectional analysis of ED visits was conducted by using data from the 2012-2015 National Hospital Ambulatory Care Survey. PAMA-related visits were identified by selecting the patient reasons for visit (RFVs) related to the eight clinical conditions. Results Among the adult ED visits, 26.7% (20 506 of 77 299, representing 113 000 000 visits across 4 years, or 28 000 000 visits annually) patients presented with a RFV consistent with a PAMA priority clinical area (PCA). Among visits in which a patient described an RFV code consistent with a PAMA PCA, up to 22.9% (4681 of 20 506; 95% confidence interval: 21.8%, 24.1%) patients underwent advanced imaging, translating to approximately 6 000 000 visits annually. Conclusion Protecting Access to Medicare Act legislation targets eight priority clinical areas, estimated to be prevalent among one in four adult emergency department visits. CT and/or MRI studies are performed during up to 23% of these visits. Depending on the particular clinical decision support systems selected within a health system, and how they are implemented, the potential volume of studies in which clinicians must interact with clinical decision support system may either exceed or fall short of these estimates. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Forman in this issue.
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Affiliation(s)
- Jahan Fahimi
- From the Department of Emergency Medicine (J.F., H.K.K., R.C.W.), Center for Healthcare Value (J.F.), Philip R. Lee Institute for Health Policy Studies (H.K.K.), and Department of Radiology and Biomedical Imaging (J.M.), University of California, San Francisco, 505 Parnassus Ave, L126, San Francisco, CA 94143-0209; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif (K.L.K.); and RAND Corporation, Santa Monica, Calif (K.L.K.)
| | - Hemal K Kanzaria
- From the Department of Emergency Medicine (J.F., H.K.K., R.C.W.), Center for Healthcare Value (J.F.), Philip R. Lee Institute for Health Policy Studies (H.K.K.), and Department of Radiology and Biomedical Imaging (J.M.), University of California, San Francisco, 505 Parnassus Ave, L126, San Francisco, CA 94143-0209; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif (K.L.K.); and RAND Corporation, Santa Monica, Calif (K.L.K.)
| | - John Mongan
- From the Department of Emergency Medicine (J.F., H.K.K., R.C.W.), Center for Healthcare Value (J.F.), Philip R. Lee Institute for Health Policy Studies (H.K.K.), and Department of Radiology and Biomedical Imaging (J.M.), University of California, San Francisco, 505 Parnassus Ave, L126, San Francisco, CA 94143-0209; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif (K.L.K.); and RAND Corporation, Santa Monica, Calif (K.L.K.)
| | - Katherine L Kahn
- From the Department of Emergency Medicine (J.F., H.K.K., R.C.W.), Center for Healthcare Value (J.F.), Philip R. Lee Institute for Health Policy Studies (H.K.K.), and Department of Radiology and Biomedical Imaging (J.M.), University of California, San Francisco, 505 Parnassus Ave, L126, San Francisco, CA 94143-0209; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif (K.L.K.); and RAND Corporation, Santa Monica, Calif (K.L.K.)
| | - Ralph Charles Wang
- From the Department of Emergency Medicine (J.F., H.K.K., R.C.W.), Center for Healthcare Value (J.F.), Philip R. Lee Institute for Health Policy Studies (H.K.K.), and Department of Radiology and Biomedical Imaging (J.M.), University of California, San Francisco, 505 Parnassus Ave, L126, San Francisco, CA 94143-0209; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif (K.L.K.); and RAND Corporation, Santa Monica, Calif (K.L.K.)
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Reed MJ, Grubb NR, Lang CC, O'Brien R, Simpson K, Padarenga M, Grant A, Tuck S. Multi-centre randomised controlled trial of a smart phone-based event recorder alongside standard care versus standard care for patients presenting to the Emergency Department with palpitations and pre-syncope - the IPED (Investigation of Palpitations in the ED) study: study protocol for a randomised controlled trial. Trials 2018; 19:711. [PMID: 30594256 PMCID: PMC6311046 DOI: 10.1186/s13063-018-3098-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/02/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Palpitations and pre-syncope are together responsible for 300,000 annual Emergency Department (ED) attendances in the United Kingdom (UK). Diagnosis of the underlying rhythm is difficult as many patients are fully recovered on ED arrival; and examination and presenting electrocardiogram (ECG) are commonly normal. The only way to establish the underlying heart rhythm is to capture an ECG during symptoms. Recent technology advances have led to several novel ECG monitoring devices appearing on the market. This trial aims to compare the symptomatic rhythm detection rate at 90 days of one such smart phone-based event recorder (AliveCor Heart Monitor and AliveECG) with standard care for participants presenting to the ED with palpitations and pre-syncope and no obvious cause in the ED. METHODS/DESIGN This is a multi-centre hospital ED / Acute Medical Unit (AMU) open label, randomised controlled trial. Participants will be recruited in 10 tertiary and district general hospitals in the UK. Participants aged ≥ 16 years presenting with an episode of palpitations or pre-syncope with no obvious cause and whose underlying ECG rhythm during these episodes remains undiagnosed after clinical assessment will be included. Participants will be randomised to either: (1) the intervention arm, standard care plus the use of a smart phone-based event recorder; or (2) the control arm, standard care. Primary endpoint will be symptomatic rhythm detection rate at 90 days. A number of secondary clinical, process and cost-effectiveness endpoints will be collected and analysed. Analysis will be on an intention-to-treat basis. DISCUSSION The Investigation of Palpitations in the ED (IPED) study aims to recruit 242 participants across 10 hospital sites. It will be the first study to investigate the ability of a smart phone-based event recorder to detect symptomatic cardiac rhythms compared to standard care for ED patients with palpitations and pre-syncope with no obvious cause in the ED. This smart phone event recorder will allow ED patients who have presented with palpitations or pre-syncope to record their ECG tracing if they have a further episode and may increase the rate of underlying rhythm diagnosis. TRIAL REGISTRATION ClinicalTrials.gov, NCT02783898 . Registered on 26 May 2016.
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Affiliation(s)
- Matthew J Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK. .,College of Medicine and Veterinary Medicine, University of Edinburgh, The Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
| | - Neil R Grubb
- Department of Cardiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Christopher C Lang
- Department of Cardiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Rachel O'Brien
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Kirsty Simpson
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Mia Padarenga
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Alison Grant
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Sharon Tuck
- Edinburgh Clinical Research Facility, Epidemiology and Statistics Core, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
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Tan ESJ, Seow SC, Kojodjojo P, Singh D, Yeo WT, Lim TW. Optimal duration and predictors of diagnostic utility of patient-activated ambulatory ECG monitoring. HEART ASIA 2018; 10:e011061. [PMID: 30555536 DOI: 10.1136/heartasia-2018-011061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/08/2018] [Accepted: 10/07/2018] [Indexed: 11/03/2022]
Abstract
Objective We studied the optimal duration of ambulatory event monitors for symptomatic patients and the predictors of detected events. Methods Patients with palpitations or dizziness received a patient-activated handheld event monitor which records 30 s single-lead ECG strips. Patients were monitored in an ambulatory setting for a range of 1-4 weeks and ECG strips interpreted by five independent electrophysiologists. Event pick-up rates and clinical covariates were analysed. Results Of 335 consecutive adults (age 50±16 years, 58% female) with palpitations (94%) and dizziness (25%) monitored, 286 patients (85%) reported events, and clinically significant events were detected in 86 (26%) patients. Of these 86 patients, 26% had ≥2 significant events, and 73% had events detected in the first 3 days. No significant events were detected after 12 days. The most common ECG abnormalities detected were premature ventricular ectopy (38%), premature atrial ectopy (37%) and atrial fibrillation (AF)/atrial flutter (34%). A history of AF (adjusted OR (AOR) 4.2, 95% CI 1.1 to 15.8), previous arrhythmia (AOR 2.8, 95% CI 2.3 to 5.9) and previous abnormal ambulatory monitoring (AOR 3.4, 95% CI 1.0 to 9.4) were associated with detection of clinically significant events. Patients older than 50 years were 82% more likely to have a clinically significant event (OR 1.8, 95% CI 1.3 to 3.6). Conclusion Patient-activated ambulatory event monitoring for 7 days may be sufficient in the diagnosis of symptomatic patients as significant events first detected beyond 10 days were rare. Patients with a history of AF, arrhythmia or previous abnormal ambulatory monitoring may require even shorter monitoring periods.
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Affiliation(s)
- Eugene S J Tan
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Swee-Chong Seow
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Devinder Singh
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Wee Tiong Yeo
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Toon Wei Lim
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
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Le VT, Muhlestein JB. Use of Wearable Technologies for Early Diagnosis and Management of Acute Coronary Syndromes and Arrhythmias. CURRENT CARDIOVASCULAR RISK REPORTS 2018. [DOI: 10.1007/s12170-018-0588-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Clementy N, Fourquet A, Andre C, Bisson A, Pierre B, Fauchier L, Babuty D, Angoulvant D. Benefits of an early management of palpitations. Medicine (Baltimore) 2018; 97:e11466. [PMID: 29995805 PMCID: PMC6076186 DOI: 10.1097/md.0000000000011466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Palpitations are a frequent symptom in the general population, and if cardiac arrhythmias are the most frequent etiology, their diagnosis may be uncertain. We sought to see whether a specialized management of palpitations is associated with a high diagnostic accuracy in patients presenting with palpitations.Consecutive patients addressed for isolated palpitations in our outpatient cardiac unit were prospectively included in this observational cohort study. The initial management was standardized: 12-lead electrocardiogram (ECG) as early as possible, ECG monitoring, potentially followed by an individualized management.On 688 consecutive patients prospectively included, cardiac arrhythmia as the cause of palpitations was found in 81% of cases (77% of atrial arrhythmias, 15% of junctional tachycardia, and 8% of ventricular arrhythmias). A total of 96% of diagnoses were made during initial management. Prehospital ECG (92%) and ECG at admission (67%) had the best positivity rates.A specialized management of patients presenting with lone palpitations allows the diagnostic of a cardiac arrhythmia in >80% of cases. Earliness of an ECG recording remains the key element in the diagnostic approach of these patients.
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Hidden details in cases with palpitation complaints: Type D personality depression and anxiety. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.378038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yun BJ, Chou SC, Nagurney JM, White BA, Wittmann CW, Raja AS. ED utilization of medical clearance testing for psychiatric admission: National Hospital Ambulatory Medical Care Survey analysis. Am J Emerg Med 2017; 36:745-748. [PMID: 28988848 DOI: 10.1016/j.ajem.2017.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Routine medical clearance testing of emergency department (ED) patients with acute psychiatric illnesses in the absence of a medical indication has minimal proven utility. Little is known about the variations in clinical practice of ordering medical clearance tests. METHODS This study was an analysis of data from the annual United States National Hospital Ambulatory Medical Care Survey from 2010 to 2014. The study population was defined as ED visits by patients ≥18years old admitted to a psychiatric facility. We sought to determine the percentage of these ED visits in which at least one medical clearance test was ordered. Using a multivariate logistic regression model, we also evaluated whether patient visit factors or regional variation was associated with use of medical clearance tests. RESULT A medical clearance test was ordered in 80.4% of ED visits ending with a psychiatric admission. Multivariate logistic regression demonstrated a statistically significant increased odds ratio (OR) of medical clearance testing based on age (OR 1.02, 95%CI 1.01, 1.03), among visits involving an injury or poisoning (OR 2.38, 95%CI 1.54, 3.68), and in the Midwest region as compared to the Northeast region (OR 2.2, 95% confidence interval [CI] 1.09, 4.46), after adjusting for other predictors. DISCUSSION Our study demonstrated that, on a national level, 4 out of 5 ED visits resulting in a psychiatric facility admission had a medical clearance test ordered. Future research is needed to investigate the reasons underlying the discrepancies in ordering patterns across the U.S., including the effect of local psychiatric admission policies.
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Affiliation(s)
- Brian J Yun
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Center for Research in Emergency Department Operations (CREDO), Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Shih-Chuan Chou
- Harvard Medical School, Boston, MA, USA; Division of Health Policy Research and Translation, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Justine M Nagurney
- Harvard Medical School, Boston, MA, USA; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
| | - Benjamin A White
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Center for Research in Emergency Department Operations (CREDO), Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Curtis W Wittmann
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Ali S Raja
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Center for Research in Emergency Department Operations (CREDO), Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Abstract
Though life expectancy sex differences are decreasing in many Western countries, men experience higher mortality rates at all ages. Men are often reluctant to seek medical care because health help-seeking is strongly linked to femininity, male weakness, and vulnerability. Many men are also more likely to access emergency care services in response to injury and/or severe pain instead of engaging primary health care (PHC) services. Nurse practitioners are well positioned to increase men's engagement with PHC to waylay the pressure on emergency services and advance the well-being of men. This article demonstrates how nurse practitioners can work with men in PHC settings to optimize men's self-health and illness prevention and management. Four recommendations are discussed: (1) leveling the hierarchies, (2) talking it through, (3) seeing diversity within patterns, and (4) augmenting face-to-face PHC services. In terms of leveling the hierarchies nurse practitioners can engage men in effectual health decision making. Within the interactions detailed in the talking it through section are strategies for connecting with male patients and mapping their progress. In terms of seeing diversity with in patterns and drawing on the plurality of masculinities, nurse practitioners are encouraged to adapt a variety of age sensitive assessment tools to better intervene and guide men's self-health efforts. Examples of community and web based men's health resources are shared in the augmenting face-to-face PHC services section to guide the work of nurse practitioners. Overall, the information and recommendations shared in this article can proactively direct the efforts of nurse practitioners working with men.
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Affiliation(s)
- Marina B. Rosu
- University of British Columbia, Vancouver, British Columbia, Canada
| | - John L. Oliffe
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary T. Kelly
- University of British Columbia, Vancouver, British Columbia, Canada
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Dogan H, Oztop D, Eker OO, Ozsoy SD, Özkartal CŞ, Arıcıoğlu F, Tüzün E, Keleş R, Kandemir C, Şirvancı S, Küçükali Cİ, Utkan T, Şahin TD, Yazir Y, Halbutoğulları ZS, Gocmez SS, Arıcıoğlu F, Gülbahar ÖSB, Mahmood A, Zsoldos E, Allan CL, Topiwala A, Ebmeier KP, Ceylan V, Kose S, Akin E, Turkcapar MH, Akin E, Kose S, Ceylan V, Temel G, Turkcapar MH, Kose S, Yalcin M, Akin E, Ceylan V, Turkcapar H, Badur I, Badur NB, Kıvrak Y, Taşdelen Y, Yağcı İ, Aydın F, Aytekin AI, Saka M, Aydin S, Garip B, Kayir H, Öztürk P, Zincir S, Yükselir C, Unal FE, Gıca Ş, Hariri AG. 9th International Congress on Psychopharmacology & 5th International Symposium on Child and Adolescent Psychopharmacology. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1310447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Wilken J. Evidence-based Recommendations for the Evaluation of Palpitations in the Primary Care Setting. Med Clin North Am 2016; 100:981-9. [PMID: 27542418 DOI: 10.1016/j.mcna.2016.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Palpitations are a symptom of many cardiac and noncardiac conditions. The patient's history, physical examination, appropriately directed laboratory tests, and basic electrocardiogram are helpful in evaluating palpitations and may be essential to finding a diagnosis. There are many outpatient options for the evaluation of palpitations caused by a presumed cardiogenic cause. These evaluation tools include Holter monitor, event monitor, transtelephonic electrocardiographic monitor, treadmill exercise stress test, echocardiography, and electrophysiologic studies. Most patients can be evaluated as an outpatient, but there are reasons, such as hemodynamic compromise, that may require admission to an inpatient setting to complete the diagnostic workup.
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Affiliation(s)
- Joel Wilken
- Department of Medicine, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA; University of Connecticut, School of Medicine, 263 Farmington Avenue, CT 06030, USA.
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Probst MA, Kanzaria HK, Hoffman JR, Mower WR, Moheimani RS, Sun BC, Quigley DD. Emergency Physicians' Perceptions and Decision-making Processes Regarding Patients Presenting with Palpitations. J Emerg Med 2015; 49:236-43.e2. [PMID: 25943288 DOI: 10.1016/j.jemermed.2015.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/15/2015] [Accepted: 02/18/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Palpitations are a common emergency department (ED) complaint, yet relatively little research exists on this topic from an emergency care perspective. OBJECTIVES We sought to describe the perceptions and clinical decision-making processes of emergency physicians (EP) surrounding patients with palpitations. METHODS We conducted 21 semistructured interviews with a convenience sample of EPs. We recruited participants from academic and community practice settings from four regions of the United States. The transcribed interviews were analyzed using a combination of structural coding and grounded theory approaches with ATLAS.ti, a qualitative data analysis software program (version 7; Atlas.ti Scientific Software Development GmbH, Berlin, Germany). RESULTS EPs perceive palpitations to be a common but generally benign chief complaint. EPs' clinical approach to palpitations, with regards to testing, treatment, and ED management, can be classified as relating to one or more of the following themes: (1) risk stratification, (2) diagnostic categorization, (3) algorithmic management, and (4) case-specific gestalt. With regard to disposition decisions, four main themes emerged: (1) presence of a serious diagnosis, (2) perceived need for further cardiac testing/monitoring, (3) presence of key associated symptoms, (4) request of other physician or patient desire. The interrater reliability exercise yielded a Fleiss' kappa measure of 0.69, indicating substantial agreement between coders. CONCLUSION EPs perceive palpitations to be a common but generally benign chief complaint. EPs rely on one or more of four main clinical approaches to manage these patients. These findings could help guide future efforts at developing risk-stratification tools and clinical algorithms for patients with palpitations.
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Affiliation(s)
- Marc A Probst
- Department of Emergency Medicine, School of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hemal K Kanzaria
- Department of Emergency Medicine, School of Medicine, University of California, Los Angeles, Los Angeles, California; U.S. Department of Veterans Affairs, VA West Los Angeles Medical Center, Los Angeles, California
| | - Jerome R Hoffman
- Department of Emergency Medicine, School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - William R Mower
- Department of Emergency Medicine, School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Roya S Moheimani
- Department of Emergency Medicine, School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Benjamin C Sun
- Department of Emergency Medicine, Center for Policy Research-Emergency Medicine, Oregon Health & Science University, Portland, Oregon
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Matura LA, McDonough A, Carroll DL. Symptom Prevalence, Symptom Severity, and Health-Related Quality of Life Among Young, Middle, and Older Adults With Pulmonary Arterial Hypertension. Am J Hosp Palliat Care 2014; 33:214-21. [PMID: 25294227 DOI: 10.1177/1049909114554079] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a chronic, life threatening illness that affects primarily women. The purpose of this study was to describe the prevalence of PAH symptoms and to determine whether there are differences in symptom severity and HRQOL in PAH symptoms among young, middle, and older adults with PAH. A cross sectional design was utilized. For all the age groups, shortness of breath (SOB) on exertion and fatigue were the two most prevalent symptoms. SOB on exertion had the highest symptom severity scores followed by fatigue for all groups. Symptom severity was significantly different among the groups for palpitations, abdominal swelling and nausea. For components of HRQOL, physical functioning worsened with age. All groups had diminished general health, role physical and vitality levels. There are some differences in symptom prevalence, symptom severity and HRQOL among young, middle and older adults. Awareness of these differences is important for healthcare providers to know and assess overtime. Palliative care should be an integral part of caring for patients with PAH.
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Affiliation(s)
- Lea Ann Matura
- School of Nursing, University of Pennsylvania, Philadelphia , PA, USA
| | - Annette McDonough
- Massachusetts General Hospital, University of Massachusetts, Lowell, MA, USA
| | - Diane L Carroll
- Munn Center for Nursing Research, Institute for Patient Care, Boston, MA, USA
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Kanzaria HK, Probst MA, Ponce NA, Hsia RY. The association between advanced diagnostic imaging and ED length of stay. Am J Emerg Med 2014; 32:1253-8. [PMID: 25176565 PMCID: PMC7199801 DOI: 10.1016/j.ajem.2014.07.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/28/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE There has been a rise in advanced diagnostic imaging (ADI) use in the emergency department (ED). Increased utilization may contribute to longer length of stay (LOS), but prior reports have not considered improved methods for modeling skewed LOS data. METHODS The 2010 National Hospital Ambulatory Medical Care Survey data were analyzed by 5 common ED chief complaints. Generalized linear model (GLM) was compared to quantile and ordinary least squares (OLS) regression to evaluate the association between ADI and ED LOS. Receipt of computed tomography or magnetic resonance imaging was the primary exposure. Emergency department LOS was the primary outcome. RESULTS Of the 33,685 ED visits analyzed, 17% involved ADI. The median LOS for patients without ADI was 138 minutes compared to 252 minutes for those who received ADI. Overall, GLM offered the most unbiased estimates, although it provided similar adjusted point estimates to OLS for the marginal change in LOS associated with ADI. The effect of imaging differed by LOS quantile, especially for patients with abdominal pain, fever, and back symptoms. CONCLUSIONS Generalized linear model offered an improved modeling approach compared to OLS and quantile regression. Consideration of such techniques may facilitate a more complete view of the effect of ADI on ED LOS.
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Affiliation(s)
- Hemal K Kanzaria
- Robert Wood Johnson Foundation Clinical Scholars program, US Department of Veterans Affairs, Emergency Medicine Center, University of California Los Angeles, 10940 Wilshire Blvd, Suite 710, Los Angeles, CA.
| | - Marc A Probst
- Emergency Medicine K12 Scholar, Department of Emergency Medicine, Mount Sinai Medical Center
| | - Ninez A Ponce
- Department of Health Policy and Management, University of California Los Angeles, Fielding School of Public Health, UCLA Center for Health Policy Research
| | - Renee Y Hsia
- Department of Emergency Medicine, University of California San Francisco, San Francisco General Hospital
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