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Yan N, Wei L, Li Z, Song Y. Establishment of a nomogram model for acute chest pain triage in the chest pain center. Front Cardiovasc Med 2023; 10:930839. [PMID: 37025691 PMCID: PMC10070711 DOI: 10.3389/fcvm.2023.930839] [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: 04/28/2022] [Accepted: 03/02/2023] [Indexed: 04/08/2023] Open
Abstract
Background Acute myocardial infarction (AMI) is the leading life-threatening disease in the emergency department (ED), so rapid chest pain triage is important. This study aimed to establish a clinical prediction model for the risk stratification of acute chest pain patients based on the Point-of-care (POC) cardiac troponin (cTn) level and other clinical variables. Methods We conducted a post-hoc analysis of the database from 6,019 consecutive patients (excluding prehospital-diagnosed non-cardiac chest pain patients) attending a local chest pain center (CPC) in China between October 2016 and January 2019. The plasma concentration of cardiac troponin I (cTnI) was measured using a POC cTnI (Cardio Triage, Alere) assay. All the eligible patients were randomly divided into training and validation cohorts by a 7:3 ratio. We performed multivariable logistic regression to select variables and build a nomogram based on the significant predictive factors. We evaluated the model's generalization ability of diagnostic accuracy in the validation cohort. Results We analyzed data from 5,397 patients that were included in this research. The median turnaround time (TAT) of POC cTnI was 16 min. The model was constructed with 6 variables: ECG ischemia, POC cTnI level, hypotension, chest pain symptom, Killip class, and sex. The area under the ROC curve (AUC) in the training and validation cohorts was 0.924 and 0.894, respectively. The diagnostic performance was superior to the GRACE score (AUC: 0.737). Conclusion A practical predictive model was created and could be used for rapid and effective triage of acute chest pain patients in the CPC.
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Affiliation(s)
- Na Yan
- Department of Emergency, TEDA International Cardiovascular Hospital, Clinical School of Cardiovascular Disease, Tianjin Medical University, Tianjin, China
| | - Ling Wei
- Department of Emergency, TEDA International Cardiovascular Hospital, Clinical School of Cardiovascular Disease, Tianjin Medical University, Tianjin, China
- Department of Emergency, TEDA Hospital, Tianjin, China
| | - Zhiwei Li
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Yu Song
- Department of Emergency, TEDA International Cardiovascular Hospital, Clinical School of Cardiovascular Disease, Tianjin Medical University, Tianjin, China
- Department of Emergency, TEDA Hospital, Tianjin, China
- Correspondence: Yu Song
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Ricci F, Neumann JT, Rübsamen N, Sörensen NA, Ojeda F, Cataldo I, Zeller T, Schäfer S, Hartikainen TS, Golato M, Palermi S, Zimarino M, Blankenberg S, Westermann D, De Caterina R. High-sensitivity troponin I with or without ultra-sensitive copeptin for the instant rule-out of acute myocardial infarction. Front Cardiovasc Med 2022; 9:895421. [PMID: 36017085 PMCID: PMC9395923 DOI: 10.3389/fcvm.2022.895421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/26/2022] [Indexed: 12/26/2022] Open
Abstract
Background The instant, single-sampling rule-out of acute myocardial infarction (AMI) is still an unmet clinical need. We aimed at testing and comparing diagnostic performance and prognostic value of two different single-sampling biomarker strategies for the instant rule-out of AMI. Methods From the Biomarkers in Acute Cardiac Care (BACC) cohort, we recruited consecutive patients with acute chest pain and suspected AMI presenting to the Emergency Department of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany. We compared safety, effectiveness and 12-month incidence of the composite endpoint of all-cause death and myocardial infarction between (i) a single-sampling, dual-marker pathway combining high-sensitivity cardiac troponin I (hs-cTnI) and ultra-sensitive copeptin (us-Cop) at presentation (hs-cTnI ≤ 27 ng/L, us-Cop < 10 pmol/L and low-risk ECG) and (ii) a single-sampling pathway based on one-off hs-cTnI determination at presentation (hs-cTnI < 5 ng/L and low-risk ECG). As a comparator, we used the European Society of Cardiology (ESC) 0/1-h dual-sampling algorithm. Results We enrolled 1,136 patients (male gender 65%) with median age of 64 years (interquartile range, 51–75). Overall, 228 (20%) patients received a final diagnosis of AMI. The two single-sampling instant rule-out pathways yielded similar negative predictive value (NPV): 97.4% (95%CI: 95.4–98.7) and 98.7% (95%CI: 96.9–99.6) for dual-marker and single hs-cTnI algorithms, respectively (P = 0.11). Both strategies were comparably safe as the ESC 0/1-h dual-sampling algorithm and this was consistent across subgroups of early-comers, low-intermediate risk (GRACE-score < 140) and renal dysfunction. Despite a numerically higher rate of false-negative results, the dual-marker strategy ruled-out a slightly but significantly higher percentage of patients compared with single hs-cTnI determination (37.4% versus 32.9%; P < 0.001). There were no significant between-group differences in 12-month composite outcome. Conclusions Instant rule-out pathways based on one-off determination of hs-cTnI alone or in combination with us-Cop are comparably safe as the ESC 0/1 h algorithm for the instant rule-out of AMI, yielding similar prognostic information. Instant rule-out strategies are safe alternatives to the ESC 0/1 h algorithm and allow the rapid and effective triage of suspected AMI in patients with low-risk ECG. However, adding copeptin to hs-cTn does not improve the safety of instant rule-out compared with the single rule-out hs-cTn at very low cut-off concentrations.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti-Pescara, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Casa di Cura Villa Serena, Città Sant’Angelo, Pescara, Italy
- *Correspondence: Fabrizio Ricci,
| | - Johannes T. Neumann
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Johannes T. Neumann,
| | - Nicole Rübsamen
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Nils A. Sörensen
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Francisco Ojeda
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Ivana Cataldo
- Unit of Clinical Pathology, SS. Annunziata University Hospital, Chieti, Italy
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Sarina Schäfer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Tau S. Hartikainen
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Maria Golato
- Unit of Clinical Pathology, SS. Annunziata University Hospital, Chieti, Italy
| | - Stefano Palermi
- Public Health Department, University of Naples Federico II, Naples, Italy
| | - Marco Zimarino
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti-Pescara, Italy
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Dirk Westermann,
| | - Raffaele De Caterina
- Casa di Cura Villa Serena, Città Sant’Angelo, Pescara, Italy
- Cardiology Division, Pisa University Hospital and University of Pisa, Pisa, Italy
- Raffaele De Caterina,
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Dawson LP, Smith K, Cullen L, Nehme Z, Lefkovits J, Taylor AJ, Stub D. Care Models for Acute Chest Pain That Improve Outcomes and Efficiency. J Am Coll Cardiol 2022; 79:2333-2348. [DOI: 10.1016/j.jacc.2022.03.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
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Brütsch R, Zahn R, Zeymer U. [Acute coronary syndrome in the prehospital phase and in the emergency department]. DIE ANAESTHESIOLOGIE 2022; 71:485-492. [PMID: 35925145 DOI: 10.1007/s00101-022-01129-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Acute coronary syndrome is the most common reason for the deployment of emergency medical services in Germany. Approximately 20-25% of all medical emergencies result from the indications for the suspicion of acute coronary syndrome. A substantial proportion of the total mortality rate is observed in the preclinical phase. Consequently, targeted diagnostics and treatment are of particular importance in this early phase. This article provides recommendations for the approach to patients with acute coronary syndrome in the prehospital phase and in the emergency department.
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Affiliation(s)
- René Brütsch
- Medizinische Klinik B, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen, Deutschland
| | - Ralf Zahn
- Medizinische Klinik B, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen, Deutschland
| | - Uwe Zeymer
- Medizinische Klinik B, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen, Deutschland.
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Deutschland.
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Vrints CJM. ACVC goes global: a short history of a 10-year young association. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:1204-1205. [PMID: 34725685 DOI: 10.1093/ehjacc/zuab095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Christiaan J M Vrints
- Department of Cardiology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650 Edegem, Belgium
- Department GENCOR, University of Antwerp, Universiteitsplein 1, 2610 Antwerpen, Belgium
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Das akute Koronarsyndrom in der prähospitalen Phase und in der Notaufnahme. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00856-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Breuckmann F, Nabavi DG, Post F, Grau AJ, Giannitsis E, Hochadel M, Senges J, Busse O, Münzel T. [Comparison between chest pain units and stroke units : Essential components of the vascular emergency care system: comparison of structure, certification process, quality benchmarking and reimbursement]. Herz 2021; 46:141-150. [PMID: 32990815 PMCID: PMC7523490 DOI: 10.1007/s00059-020-04984-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/17/2020] [Accepted: 08/26/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chest pain units (CPU) and stroke units (SU) have both become established as essential components of clinical emergency care. For both instances dedicated certification processes are installed. Up to summer 2020, 290 CPUs and 335 SUs have been successfully certified. OBJECTIVE The aim of this review is to compare the structures and the current certification situation of CPUs and SUs. Also, the younger CPU certification process is compared to the long established SU certification standard. MATERIAL UND METHODS The comparison includes the historical background, the certification process, quality benchmarking, possible additive structures, the current status of certification in Germany, the transfer of the concept to the European level as well as reimbursement issues. RESULTS Both certification concepts show clear analogies. Evidence for SUs is supported by a positive Cochrane analysis and for CPUs there are many studies from the German CPU registry. The main differences include a uniform CPU system versus a multistep SU system of certification. Furthermore, SU have obligatory elements of quality documentation but only facultative quality indicator assessment for CPUs. From an economic viewpoint operation and procedural key (OPS) numbers guarantee a better reflection of the use of resources in the complex treatment of stroke, which could not yet be established for CPUs. CONCLUSION The well-established CPU concept could additionally benefit from a superordinate quality control. Adequate quality benchmarking appears to be fundamental for gap analyses and for the establishment of a separate remuneration structure. In this respect the German Society for Cardiology as the certifying institution is required to establish an appropriate mechanism within the framework of regular updates of criteria.
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Affiliation(s)
- Frank Breuckmann
- Medizinische Klinik I, Herz-Jesu-Krankenhaus Dernbach, Südring 8, 56428, Dernbach, Deutschland.
| | - Darius G Nabavi
- Neurologie mit Stroke Unit, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - Felix Post
- Klinik für Kardiologie, Katholisches Klinikum Koblenz-Montabaur, Koblenz, Deutschland
| | - Armin J Grau
- Klinik für Neurologie, Klinikum Ludwigshafen, Ludwigshafen am Rhein, Deutschland
| | - Evangelos Giannitsis
- Zentrum für Kardiologie, Angiologie, Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Matthias Hochadel
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Deutschland
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Deutschland
| | - Otto Busse
- Deutsche Schlaganfall-Gesellschaft, Berlin, Deutschland
| | - Thomas Münzel
- Zentrum für Kardiologie, Kardiologie I, Universitätsmedizin Mainz, Mainz, Deutschland
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Breuckmann F, Settelmeier S, Rassaf T, Hochadel M, Nowak B, Voigtländer T, Giannitsis E, Senges J, Münzel T. Unexpected high level of severe events even in low-risk profile chest pain unit patients. Herz 2021; 47:374-379. [PMID: 34463785 PMCID: PMC9355921 DOI: 10.1007/s00059-021-05064-9] [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: 10/09/2020] [Revised: 04/25/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022]
Abstract
AIMS Early heart attack awareness programs are thought to increase efficacy of chest pain units (CPU) by providing live-saving information to the community. We hypothesized that self-referral might be a feasible alternative to activation of emergency medical services (EMS) in selected chest pain patients with a specific low-risk profile. METHODS AND RESULTS In this observational registry-based study, data from 4743 CPU patients were analyzed for differences between those with or without severe or fatal prehospital or in-unit events (out-of-hospital cardiac arrest and/or in-unit death, resuscitation or ventricular tachycardia). In order to identify a low-risk subset in which early self-referral might be recommended to reduce prehospital critical time intervals, the Global Registry of Acute Coronary Events (GRACE) score for in-hospital mortality and a specific low-risk CPU score developed from the data by multivariate regression analysis were applied and corresponding event rates were calculated. Male gender, cardiac symptoms other than chest pain, first onset of symptoms and a history of myocardial infarction, heart failure or cardioverter defibrillator implantation increased propensity for critical events. Event rates within the low-risk subsets varied from 0.5-2.8%. Those patients with preinfarction angina experienced fewer events. CONCLUSIONS When educating patients and the general population about angina pectoris symptoms and early admission, activation of EMS remains recommended. Even in patients without any CPU-specific risk factor, self-referral bears the risk of severe or fatal pre- or in-unit events of 0.6%. However, admission should not be delayed, and self-referral might be feasible in patients with previous symptoms of preinfarction angina.
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Affiliation(s)
- Frank Breuckmann
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.
| | - Stephan Settelmeier
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Matthias Hochadel
- Institute for Myocardial Infarction Research Foundation, Ludwigshafen, Germany
| | - Bernd Nowak
- Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
| | | | | | - Jochen Senges
- Institute for Myocardial Infarction Research Foundation, Ludwigshafen, Germany
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
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Baloch F, Khan A, Kabani A, Fatimi S, Tai J, Khan AH, Hashmi S, Aslam M. Role of Dedicated Cardiac Emergency Unit in Early Identification and Management of Acute Myocardial Infarction in a Developing Country of South Asia. Cureus 2020; 12:e11423. [PMID: 33312819 PMCID: PMC7727776 DOI: 10.7759/cureus.11423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background The care of patients presenting with chest pain to multidisciplinary services hospital gets compromised due to the busy triage system. A separate and specialized equipped cardiac emergency unit (CAR-ERU) can improve patient's outcomes. Objectives To enhance early recognition and treatment of acute myocardial infarction (AMI) patients. To sustain key performance quality indicators (KPIs) for AMI. Methods In October 2016, a separate CAR-ERU was established inside the multidisciplinary emergency department (MED). A dedicated specialized heart-lung and vascular teams were hired under the supervision of service line leadership. The KPIs that were identified benchmark with international practice guidelines. Data were collected and stored for analysis. Exemption from the ethical review committee was obtained. Results A total of 2914 patients visited CAR-ERU from October 2016 to September 2017 for a period of one year. Out of which 30% were diagnosed with acute coronary syndrome (ACS) and this included 8% diagnosis with ST-segment elevation myocardial infarction (STEMI). Over 98.8% of the electrocardiogram (ECG) was done within 10 minutes of arrival while aspirin was given to 96.5% of patients within one hour. The door to balloon time (DBT) of <90 min was achieved in 70% of patients. A significant reduction in length of stay in the emergency department and financial burden was noted. Sustainability of major KPI was observed over the subsequent years. Conclusion The introduction of a dedicated CAR-EU improved clinical outcomes, reduced length of stay and financial burden in AMI patients managed in CAR-EU. Our tertiary care hospital is the first one of its kind to take this quality initiative in a lower-middle-income country (LMIC) Pakistan.
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Affiliation(s)
- Farhala Baloch
- Medicine/Cardiology, The Aga Khan University, Karachi, PAK
| | - Amina Khan
- School of Nursing, The Aga khan University, Karachi, PAK
| | | | - Saulat Fatimi
- Cardiothoracic Surgery, The Aga Khan University, Karachi, PAK
| | - Javed Tai
- Cardiology, The Aga Khan Hospital, Karachi, PAK
| | - Aamir H Khan
- Medicine/Cardiology, The Aga Khan University, Karachi, PAK
| | - Shiraz Hashmi
- Cardiothoracic Surgery, The Aga Khan University, Karachi, PAK
| | - Mazeera Aslam
- School of Nursing, The Aga Khan University, Karachi, PAK
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Geyer M, Wild J, Münzel T, Gori T, Wenzel P. State of the Art-High-Sensitivity Troponins in Acute Coronary Syndromes. Cardiol Clin 2020; 38:471-479. [PMID: 33036710 DOI: 10.1016/j.ccl.2020.06.001] [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: 10/23/2022]
Abstract
In cases of suspected acute coronary syndrome (ACS), rapid and accurate diagnosis is essential to establish effective evidence-based medical treatment. Patients' history, clinical examination, 12-lead electrocardiogram, and cardiac biomarkers are cornerstones in initial management. Since high-sensitivity cardiac troponins were established, they have markedly expedited and revolutionized rule-in and rule-out pathways of patients with ACS and changed our everyday clinical practice. Thus, they have become an indispensable tool in daily routine in emergency units. This review focuses on historical and contemporary standards in laboratory biomarkers of myocardial injury and discusses their implication in the context of the updated universal definition of myocardial infarction.
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Affiliation(s)
- Martin Geyer
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany.
| | - Johannes Wild
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Tommaso Gori
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Philip Wenzel
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
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Capacity changes in German certified chest pain units during COVID-19 outbreak response. Clin Res Cardiol 2020; 109:1469-1475. [PMID: 32476041 PMCID: PMC7261510 DOI: 10.1007/s00392-020-01676-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/19/2020] [Indexed: 01/17/2023]
Abstract
Background We sought to determine structure and changes in organisation and bed capacities of certified German chest pain units (CPU) in response to the emergency plan set-up as a response to the SARS-CoV-2 pandemic. Methods and results The study was conducted in the form of a standardised telephone interview survey in certified German CPUs. Analyses comprised the overall setting of the CPU, bed capacities, possibilities for ventilation, possible changes in organisation and resources, chest pain patient admittance, overall availability of CPUs and bail-out strategies. The response rate was 91%. Nationwide, CPU bed capacities decreased by 3% in the early phase of COVID-19 pandemic response, exhibiting differences within and between the federal states. Pre-pandemic and pandemic bed capacities stayed below 1 CPU bed per 50,000 inhabitants. 97% of CPUs were affected by internal reorganisation pandemic plans at variable extent. While we observed a decrease of CPU beds within an emergency room (ER) set-up and on intermediate care units (ICU), beds in units being separated from ER and ICU were even increased in numbers. Conclusions Certified German CPUs are able to maintain adequate coverage for chest pain patients in COVID-19 pandemic despite structural changes. However, at this time, it appears important to add operating procedures during pandemic outbreaks to the certification criteria of forthcoming guidelines either at the individual CPU level or more centrally steered by the German Cardiac Society or the European Society of Cardiology.
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12
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German chest pain unit registry: data review after the first decade of certification. Herz 2020; 46:24-32. [PMID: 32232516 DOI: 10.1007/s00059-020-04912-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 01/24/2020] [Accepted: 03/03/2020] [Indexed: 01/12/2023]
Abstract
In 2008, the German Cardiac Society (GCS) introduced a certification program for specialized chest pain units (CPUs). In order to benchmark the performance of the certified CPUs, a nationwide German CPU registry was established. Since then, data for more than 34,000 patients have been included. The concept of certified CPUs in Germany has been widely accepted and its success is underlined by its recent inclusion in national and international guidelines. As of December 2019, 286 CPUs have been successfully certified or recertified by the GCS. This review focuses on the data retrieved from the CPU registry during the first decade of certification. As demonstrated by 16 manuscripts stemming from the registry, certified German CPUs demonstrate high quality of care in acute coronary syndrome and beyond. It is also noted that the German CPU registry allowed for further analysis of the gap in guideline adherence. With the current update of the CPU certification criteria, central data collection as a best-practice criterion will be abandoned, and after some productive years the registry has temporarily been stopped.
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Breuckmann F, Hochadel M, Grau AJ, Giannitsis E, Münzel T, Senges J. Quality benchmarks for chest pain units and stroke units in Germany. Herz 2020; 46:89-93. [PMID: 31970463 DOI: 10.1007/s00059-019-04881-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 10/05/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chest pain units (CPUs) and stroke units (SUs) provide specialized multidisciplinary in-hospital management for acute chest pain and ischemic stroke. We analyzed exemplary equivalent quality benchmarks in both concepts. MATERIAL AND METHODS Data from the German CPU registry (2012-2015; 45 certified CPUs, 5881 patients) were compared with data from the SU registry of Rhineland-Palatinate (2011-2015; 29 SUs; 40,380 patients). Parameters comprised demographics, symptoms, diagnosis, medication, critical time intervals, therapeutics, and in-unit outcome. RESULTS Non-ST-segment elevation myocardial infarction (47.4%) and ischemic stroke (63.0%) were the most frequent entities. An electrocardiogram was performed on average within 7 min in CPUs, cranial imaging within 49 min in SUs. The mean time interval from admission until coronary intervention or lysis was 42 min or 57 min, respectively. Rates of antiplatelet therapy (90.1% vs. 96.0%), brain imaging, and coronary angiography were high (99.3% vs. 81.1%) and the mortality was low (0.8% for CPUs vs. 3.6% for SUs). The length of stay was shorter in CPUs (1.5 days vs. 4.4 days). CONCLUSION As reimbursement for emergency medicine in Germany was recently rearranged, quality benchmarking has gained incremental importance. Mandatory joint quality measurement in both concepts ensuring gap analysis and process improvement is encouraged.
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Affiliation(s)
- Frank Breuckmann
- Department of Cardiology, Herz-Jesu-Krankenhaus Dernbach, Südring 8, 56428, Dernbach, Germany.
| | - Matthias Hochadel
- Institute for Myocardial Infarction Research Foundation Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - Armin J Grau
- Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Evangelos Giannitsis
- Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Münzel
- Cardiology I, Center for Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Jochen Senges
- Institute for Myocardial Infarction Research Foundation Ludwigshafen, University of Heidelberg, Heidelberg, Germany
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14
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Stepinska J, Lettino M, Ahrens I, Bueno H, Garcia-Castrillo L, Khoury A, Lancellotti P, Mueller C, Muenzel T, Oleksiak A, Petrino R, Guimenez MR, Zahger D, Vrints CJ, Halvorsen S, de Maria E, Lip GY, Rossini R, Claeys M, Huber K. Diagnosis and risk stratification of chest pain patients in the emergency department: focus on acute coronary syndromes. A position paper of the Acute Cardiovascular Care Association. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:76-89. [PMID: 31958018 DOI: 10.1177/2048872619885346] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This paper provides an update on the European Society of Cardiology task force report on the management of chest pain. Its main purpose is to provide an update on the decision algorithms and diagnostic pathways to be used in the emergency department for the assessment and triage of patients with chest pain symptoms suggestive of acute coronary syndromes.
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Affiliation(s)
- Janina Stepinska
- Department of Intensive Cardiac Therapy, Institute of Cardiology, Poland
| | | | - Ingo Ahrens
- Department of Cardiology and Medical Intensive Care, Augustinerinnen Hospital, Germany
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain and Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain
| | | | - Abdo Khoury
- Department of Emergency Medicine and Critical Care Clinical Investigation Center, University Hospital of Besançon, France
| | | | - Christian Mueller
- Cardiovascular Research Institute, University Hospital of Basel, Switzerland
| | - Thomas Muenzel
- Universitätsmedizin Mainz, Zentrum für Kardiologie, Germany
| | - Anna Oleksiak
- Department of Intensive Cardiac Therapy, Institute of Cardiology, Poland
| | | | | | - Doron Zahger
- Department of Cardiology, Soroka University Medical Center, Israel
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15
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Non-specific chest pain and subsequent serious cardiovascular readmissions. Int J Cardiol 2019; 291:1-7. [DOI: 10.1016/j.ijcard.2019.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/07/2019] [Accepted: 04/01/2019] [Indexed: 11/18/2022]
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16
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Chest Pain Unit Network in Germany: Its Effect on Patients With Acute Coronary Syndromes. J Am Coll Cardiol 2019; 69:2459-2460. [PMID: 28494983 DOI: 10.1016/j.jacc.2017.03.562] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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17
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Leonardi S, Bueno H, Ahrens I, Hassager C, Bonnefoy E, Lettino M. Optimised care of elderly patients with acute coronary syndrome. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 7:287-295. [DOI: 10.1177/2048872618761621] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Sergio Leonardi
- Fondazione IRCCS Policlinico S. Matteo, Coronary Care Unit, Pavia, Italy
| | - Hector Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain
- Instituto de investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - Ingo Ahrens
- Department of Cardiology and Medical Intensive Care, Augustinerinnen Hospital, Germany
- Faculty of Medicine, University of Freiburg, Germany
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Hospices Civils de Lyon, France
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18
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Breuckmann F, Rassaf T. Early heart attack care as a prehospital programme designed to supplement the established chest pain unit concept in Germany. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 9:93-94. [PMID: 29417828 DOI: 10.1177/2048872618759316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, University Duisburg-Essen, Germany
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