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Commerford PJ. Covid-19 and cardiovascular disease. Cardiovasc J Afr 2021; 32:177. [PMID: 34519759 PMCID: PMC8756009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
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Pareek N, Yeoh J, Macaya F, Cannata S, Kanyal R, Bharucha A, Adamo M, Salinas P, Shah AM, Dworakowski R, MacCarthy P, Byrne J. Association of social containment on ST-segment elevation myocardial infarction presentations during the COVID-19 pandemic. Coron Artery Dis 2021; 32:1-3. [PMID: 32976246 PMCID: PMC7709881 DOI: 10.1097/mca.0000000000000965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/22/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Nilesh Pareek
- King’s Health Partners Cardiovascular, King’s College Hospital NHS Foundation Trust and Guy’s & St Thomas’ NHS Foundation Trust
- School of Cardiovascular Medicine & Sciences, BHF Centre of Excellence, King’s College London, London, U.K
| | - Julian Yeoh
- King’s Health Partners Cardiovascular, King’s College Hospital NHS Foundation Trust and Guy’s & St Thomas’ NHS Foundation Trust
- School of Cardiovascular Medicine & Sciences, BHF Centre of Excellence, King’s College London, London, U.K
| | - Fernando Macaya
- Hospital Clinico San Carlos, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
| | - Stefano Cannata
- King’s Health Partners Cardiovascular, King’s College Hospital NHS Foundation Trust and Guy’s & St Thomas’ NHS Foundation Trust
| | - Ritesh Kanyal
- King’s Health Partners Cardiovascular, King’s College Hospital NHS Foundation Trust and Guy’s & St Thomas’ NHS Foundation Trust
- School of Cardiovascular Medicine & Sciences, BHF Centre of Excellence, King’s College London, London, U.K
| | - Apurva Bharucha
- King’s Health Partners Cardiovascular, King’s College Hospital NHS Foundation Trust and Guy’s & St Thomas’ NHS Foundation Trust
- School of Cardiovascular Medicine & Sciences, BHF Centre of Excellence, King’s College London, London, U.K
| | - Marianna Adamo
- ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Pablo Salinas
- Hospital Clinico San Carlos, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
| | - Ajay M Shah
- King’s Health Partners Cardiovascular, King’s College Hospital NHS Foundation Trust and Guy’s & St Thomas’ NHS Foundation Trust
- School of Cardiovascular Medicine & Sciences, BHF Centre of Excellence, King’s College London, London, U.K
| | - Rafal Dworakowski
- King’s Health Partners Cardiovascular, King’s College Hospital NHS Foundation Trust and Guy’s & St Thomas’ NHS Foundation Trust
- School of Cardiovascular Medicine & Sciences, BHF Centre of Excellence, King’s College London, London, U.K
| | - Philip MacCarthy
- King’s Health Partners Cardiovascular, King’s College Hospital NHS Foundation Trust and Guy’s & St Thomas’ NHS Foundation Trust
- School of Cardiovascular Medicine & Sciences, BHF Centre of Excellence, King’s College London, London, U.K
| | - Jonathan Byrne
- King’s Health Partners Cardiovascular, King’s College Hospital NHS Foundation Trust and Guy’s & St Thomas’ NHS Foundation Trust
- School of Cardiovascular Medicine & Sciences, BHF Centre of Excellence, King’s College London, London, U.K
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Ricciardi E, La Malfa G, Guglielmi G, Cenni E, Micali M, Corsello LM, Lopena P, Manco L, Pontremoli R, Moscatelli P, Murdaca G, Musso N, Montecucco F, Ameri P, Porto I, Pende A, Canepa M. Characteristics of current heart failure patients admitted to internal medicine vs. cardiology hospital units: the VASCO study. Intern Emerg Med 2020; 15:1219-1229. [PMID: 32172459 DOI: 10.1007/s11739-020-02304-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/26/2020] [Indexed: 12/17/2022]
Abstract
The majority of patients hospitalized for heart failure (HF) are admitted to internal medicine (IM) rather than to cardiology (CA) units, but to date few studies have analyzed the characteristics of these two populations. In this snapshot survey, we compared consecutive patients admitted for HF in six IM units vs. one non-intensive CA unit. During the 6-month survey period, 467 patients were enrolled (127 in CA, 27.2% vs. 340 in IM, 72.8%). IM patients were almost 10 years older (CA 75 ± 10, IM 82 ± 8 years; p < 0.001), more frequently female (CA 39%, IM 55%; p = 0.002) and living at home alone (CA 12%, IM 21%; p = 0.017). The leading cause of hospitalization in both groups was acute worsening of HF (CA 42%, IM 53%; p = 0.031), followed by atrial fibrillation (CA 29%, IM 12%; p < 0.001) and infections (CA 24%, IM 27%; p = 0.563). Ischemic (CA 43%, IM 30%; p = 0.008) and dilated cardiomyopathy patients (CA 21%, IM 12%; p < 0.001) were primarily admitted to CA unit, whereas those with hypertensive heart disease to IM (CA 3%, IM 39%; p < 0.001). Left ventricular ejection fraction (LVEF) was available in 96% of CA patients, but only in 60% of IM patients (p = 0.001). Among patients with LVEF measured, those with LVEF < 40% were predominantly admitted to CA (CA 60%, IM 14%; p < 0.001), whereas those with LVEF ≥ 50% were admitted to IM (CA 21%, IM 33%; p = 0.019); 26% of IM patients were discharged without a known LVEF. Medical treatments also significantly differed, according to patients' clinical and instrumental characteristics in each unit. This study demonstrates important differences between HF patients hospitalized in CA vs. IM, and the need for a greater interaction between these two medical specialties for a better care of HF patients.
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Affiliation(s)
- Elisa Ricciardi
- Clinica di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giovanni La Malfa
- Clinica di Malattie dell'Apparato Cardiovascolare con UTIC, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Giulia Guglielmi
- Clinica di Malattie dell'Apparato Cardiovascolare con UTIC, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Elisabetta Cenni
- Divisione di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Micali
- Clinica di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Moisio Corsello
- Clinica di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Patrizia Lopena
- Clinica di Medicina Interna 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Manco
- Clinica di Medicina Interna 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Roberto Pontremoli
- Clinica di Medicina Interna 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Moscatelli
- Divisione di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giuseppe Murdaca
- Clinica di Medicina Interna ad Orientamento Immunologico, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Natale Musso
- Clinica Endocrinologica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fabrizio Montecucco
- Clinica di Medicina Interna 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pietro Ameri
- Clinica di Malattie dell'Apparato Cardiovascolare con UTIC, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Italo Porto
- Clinica di Malattie dell'Apparato Cardiovascolare con UTIC, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Aldo Pende
- Clinica di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Canepa
- Clinica di Malattie dell'Apparato Cardiovascolare con UTIC, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
- Department of Internal Medicine, University of Genova, Genoa, Italy.
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Kadoya Y, Zen K, Wakana N, Yanishi K, Senoo K, Nakanishi N, Yamano T, Nakamura T, Matoba S. Knowledge, perception, and level of confidence regarding COVID-19 care among healthcare workers involved in cardiovascular medicine: a web-based cross-sectional survey in Japan. J Cardiol 2020; 77:239-244. [PMID: 32859452 PMCID: PMC7414383 DOI: 10.1016/j.jjcc.2020.07.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/04/2020] [Accepted: 07/20/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The pandemic of coronavirus disease 2019 (COVID-19) has a significant impact on daily practice in cardiovascular medicine. The preparedness of healthcare workers (HCWs) can affect the spread of infection and the maintenance of the healthcare system. This study aimed to investigate the knowledge, perception, and level of confidence regarding COVID-19 care among HCWs involved in cardiovascular medicine. METHODS A cross-sectional, web-based study about COVID-19 was performed between April 22 and May 7, 2020, among 311 HCWs in cardiovascular departments. The demographic information, COVID-19-related knowledge, and perception and level of confidence toward COVID-19 care were assessed. RESULTS The median age of the participants was 38 years, and 215 (69.8%) were male. There were 134 (43.1%) physicians and 177 (56.9%) non-physician HCWs. The HCWs, especially non-physician HCWs, had insufficient knowledge about infection-prevention measures for COVID-19, such as how to isolate patients with COVID-19, how to use personal protective equipment, and how to prevent infection during aerosol-generating procedures. Most HCWs showed a low level of confidence toward COVID-19 care, and such poor confidence was associated with the lack of knowledge on optimal infection-prevention measures. CONCLUSIONS This survey revealed the lack of knowledge about adequate infection-prevention measures for COVID-19. More attention should be paid to the preparedness of HCWs, and educating and supporting HCWs involved in cardiovascular medicine is an urgent need.
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Affiliation(s)
- Yoshito Kadoya
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Noriyuki Wakana
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Kenji Yanishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Keitaro Senoo
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Naohiko Nakanishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Tetsuhiro Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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Lorca R, López Triviño R, Morís C. Cardio-onco-hematology patients’ management in the context of the current COVID-19 pandemic. Revista Española de Cardiología (English Edition) 2020; 73:694-695. [PMID: 32553449 PMCID: PMC7269923 DOI: 10.1016/j.rec.2020.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/06/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Rebeca Lorca
- Programa de Cardio-Onco-Hematología, Área del Corazón, Hospital Universitario Central de Asturias (HUCA), Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (IISPA), Oviedo, Asturias, Spain.
| | - Reyes López Triviño
- Programa de Cardio-Onco-Hematología, Área del Corazón, Hospital Universitario Central de Asturias (HUCA), Oviedo, Asturias, Spain
| | - César Morís
- Programa de Cardio-Onco-Hematología, Área del Corazón, Hospital Universitario Central de Asturias (HUCA), Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (IISPA), Oviedo, Asturias, Spain
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Horne MP, Estes KR. Implementation of a new cardiology hospital service leveraging nurse practitioners to improve patient access and outcomes. J Am Assoc Nurse Pract 2020; 33:231-238. [PMID: 32384362 DOI: 10.1097/jxx.0000000000000421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 02/24/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Delays in patient access due to excessive wait times for clinic consult appointments impair timely diagnosis and treatment, resulting in worse outcomes. LOCAL PROBLEM Average days wait (ADW) for clinic consult appointments for the cardiology group of a regional managed care organization was too long. A quality improvement project (QIP) was undertaken to improve efficiency/efficacy of patient coverage and reduce ADW by implementing a new cardiology hospital service with expanded roles for nurse practitioners (NPs). METHODS AND INTERVENTION The QIP used the Institute for Healthcare Improvement's Model for Improvement. The new cardiology hospital service deployed a group of 11 cardiologists and three cardiology NPs who rotated between hospital and clinic service. Two cardiologists and one NP covered all cardiology inpatients, alleviating the need for clinic-assigned cardiologists to also see hospitalized patients, thus improving capacity. The primary measure was ADW, whereas secondary measures included patient satisfaction with access, hospital readmissions, clinic cancellations, and provider job satisfaction. RESULTS All measures were assessed on pre/post 6-month averages. Average days wait reduced from 28 to 14; patient satisfaction improved from 39% to 52%; readmissions reduced from 13.2% to 9.7%, and provider job satisfaction with the intervention was 91% positive. There were no significant changes in potential confounding factors and no identified negative consequences. CONCLUSIONS Implementation of a cardiology hospital service leveraging NPs was feasible, increased capacity to improve patient access and associated outcomes, and did not manifest any known adverse impacts.
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Affiliation(s)
| | - Krista R Estes
- University of Colorado College of Nursing, Aurora, Colorado
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Berge T, Bull-Hansen B, Solberg EE, Heyerdahl ER, Jørgensen KN, Vinge LE, Aarønæs M, Øie E, Hyldmo I. Screening for symptoms of depression and anxiety in a cardiology department. Tidsskr Nor Laegeforen 2019; 139:18-0570. [PMID: 31592606 DOI: 10.4045/tidsskr.18.0570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Depression and anxiety are common in patients with cardiac disease and predict a poorer prognosis, increased mortality and reduced compliance with treatment. National and international guidelines recommend procedures for screening, but there is a lack of studies of such practices in Norwegian hospitals. The objective of this study was to implement a simple screening method for symptoms of depression and anxiety in patients with cardiac disease. MATERIAL AND METHOD Patients in the Department of Cardiology at Diakonhjemmet Hospital who had valvular heart disease, tachyarrhythmia, myocardial infarction or heart failure were screened for symptoms of depression, anxiety and panic attacks with the aid of five questions from the Patient Health Questionnaire-2 (PHQ-2), Generalized Anxiety Disorder Scale-2 (GAD-2) and Patient Health Questionnaire - Somatic, Anxiety, and Depressive Symptom Scales (PHQ-SADS). The patients were recruited from the outpatient clinic or ward at least one month after acute heart disease. RESULTS A total of 57 of 232 patients reported symptoms of depression or anxiety when screened. The screening method was easy to implement, but time constraints and uncertainty regarding procedures for follow-up and the effect of following up the patients were reported. INTERPRETATION Good tools and methods are available for screening for symptoms of depression and anxiety and anxiety in patients with cardiac disease. More studies are needed regarding the benefits of screening, at what stage of the disease it should be performed, and whether it should be performed by the primary and/or the specialist health services.
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Honigberg MC, Lander BS, Baliyan V, Jones-O'Connor M, Healy EW, Scholtz JE, Nagurney JT, Hoffmann U, Ghoshhajra BB, Natarajan P. Preventive Management of Nonobstructive CAD After Coronary CT Angiography in the Emergency Department. JACC Cardiovasc Imaging 2019; 13:437-448. [PMID: 31326481 DOI: 10.1016/j.jcmg.2019.04.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/26/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study sought to assess medical management of patients found to have nonobstructive coronary artery disease (CAD) on coronary computed tomography angiography (CCTA) performed in the emergency department (ED). BACKGROUND Contemporary recognition and management of nonobstructive CAD discovered on CCTA performed in the ED is unknown. METHODS Patients undergoing CCTA in the authors' hospital's ED between November 2013 and March 2018 who also received primary care within the authors' health system were studied. All patients with nonobstructive CAD, defined as 1% to 49% maximum luminal stenosis on CCTA, were included, along with a control group without CAD in a 1 case:1 control fashion. Ten-year atherosclerotic cardiovascular disease (ASCVD) risk prior to CCTA was estimated using the Pooled Cohort Equations. Management changes were recorded until 6 months after CCTA. Multivariate logistic regression tested the association between CCTA result and follow-up statin prescription, adjusting for cardiovascular risk factors and baseline statin use. RESULTS The cohort included 510 patients with nonobstructive CAD and 510 controls. Prevalence of statin prescription increased from 38.8% to 56.1% among patients with nonobstructive CAD (p < 0.001) and 18.0% to 20.4% among controls (p = 0.01), representing a 7.1-fold relative difference (95% confidence interval [CI]: 4.4 to 23.0; p < 0.001) in multivariate analysis. However, 30.0% of patients with nonobstructive CAD and ≥20% 10-year ASCVD risk were not prescribed a statin at the end of follow-up. Cardiologist evaluation was independently associated with statin prescription after adjustment for ASCVD risk factors (odds ratio [OR] 4.4; 95% CI: 2.4 to 8.5; p < 0.001). A Coronary Artery Disease Reporting and Data System class 1 to 2 result was associated with lower low-density lipoprotein cholesterol by 12.1 mg/dl at mean 1.9-year follow-up (p < 0.001). CONCLUSIONS Incidental subclinical atherosclerosis on CCTA performed in the ED increases the likelihood of statin prescription, but opportunities to improve allocation of indicated preventive therapies remain.
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Affiliation(s)
- Michael C Honigberg
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Bradley S Lander
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Vinit Baliyan
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Maeve Jones-O'Connor
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Emma W Healy
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jan-Erik Scholtz
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Department of Radiology, Harvard Medical School, Boston, Massachusetts; Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - John T Nagurney
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Udo Hoffmann
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Brian B Ghoshhajra
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Pradeep Natarajan
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts; Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts.
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Hao Y, Liu J, Liu J, Yang N, Smith SC, Huo Y, Fonarow GC, Ge J, Taubert KA, Morgan L, Zhou M, Xing Y, Ma CS, Han Y, Zhao D. Sex Differences in In-Hospital Management and Outcomes of Patients With Acute Coronary Syndrome. Circulation 2019; 139:1776-1785. [PMID: 30667281 DOI: 10.1161/circulationaha.118.037655] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Yongchen Hao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
| | - Jing Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
| | - Jun Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
| | - Na Yang
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
| | - Sidney C Smith
- Division of Cardiology, University of North Carolina, Chapel Hill (S.C.S.)
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China (Y. Huo)
| | - Gregg C Fonarow
- Division of Cardiology, Geffen School of Medicine at University of California, Los Angeles (G.C.F.)
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, China (J.G.)
| | - Kathryn A Taubert
- Department of International Science, American Heart Association, Basel, Switzerland (K.A.T.)
| | - Louise Morgan
- International Quality Improvement Department, American Heart Association, Dallas, TX (L.M.)
| | - Mengge Zhou
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
| | - Yueyan Xing
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, China (C.- S.M.)
| | - Yaling Han
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Liaoning, China (Y. Han)
| | - Dong Zhao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
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Abstract
BACKGROUND Care for patients with heart failure (HF) in Poland requires improvement. OBJECTIVES The aim of this study was to define the journey of the HF patient, taking into account the specialization of the hospital ward and further, highly specialized outpatient care. MATERIAL AND METHODS Using the medical system CliniNET®, we analyzed 214 consecutive patients hospitalized due to HF (International Statistical Classification of Diseases and Health Related Problems - ICD-10: I50) in the period from September 1 to December 31, 2015, and also the data from post-discharge outpatient care in a 3-month period. To fairly compare the management of care and outcomes of patients hospitalized in the internal medicine (IM) ward and in the cardiac ward, propensity score matching was performed. The multivariate regression analysis was performed to determine the independent predictors of the hospital ward selection and the risk of rehospitalization due to HF and/or death. RESULTS The majority of patients were hospitalized due to HF for the first time (72%) and in the cardiac ward (65%). For 55% of rehospitalized patients, the subsequent admission was within 3 months after initial discharge. The independent predictors of a higher risk of rehospitalization due to HF and/or death were ischemic heart disease, atrial fibrillation (AF), chronic kidney disease (CKD), mineralocorticoid antagonism (MRA) therapy, and hospitalization in the last year (for all, p < 0.05). Internal medicine ward patients differed from cardiac ward patients in: mode of admission (urgent 100% vs 83.5%; p < 0.001), length of hospitalization (median: 8 days vs 5 days; p = 0.001), death rate (24% vs 4.3%; p < 0.001), echocardiography (43% vs 98%; p < 0.001), and N-terminal prohormone B-type natriuretic peptide (NT-proBNP) measurements (43% vs 96%; p < 0.001). The burden of 5-9 accompanying diseases enhanced the choice of the cardiac ward (p < 0.05), while age and urgent mode of hospitalization decreased the chance of being referred to the cardiac ward (p < 0.01). Cardiac patients were more likely to receive β-blockers, diuretics, angiotensin receptor blockers (ARB), and MRA. Over 90% of cardiac ward patients were referred to cardiac ambulatory care after discharge from hospital, while among patients discharged from the IM ward, this rate was 60% (p < 0.001). CONCLUSIONS There were significant differences among the 2 wards in relation to the course of hospitalization and post-discharge outpatient care.
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Affiliation(s)
- Anna Chuda
- Department of Noninvasive Cardiology, Chair of Internal Medicine and Cardiology, Medical University of Lodz, Poland
| | - Joanna Berner
- Department of Noninvasive Cardiology, Chair of Internal Medicine and Cardiology, Medical University of Lodz, Poland
| | - Małgorzata Lelonek
- Department of Noninvasive Cardiology, Chair of Internal Medicine and Cardiology, Medical University of Lodz, Poland
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Shimada YJ, Gibo K, Tsugawa Y, Goto T, Yu EW, Iso H, Brown DF, Hasegawa K. Bariatric surgery is associated with lower risk of acute care use for cardiovascular disease in obese adults. Cardiovasc Res 2019; 115:800-806. [PMID: 30357327 PMCID: PMC11008727 DOI: 10.1093/cvr/cvy266] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/22/2018] [Accepted: 10/23/2018] [Indexed: 04/13/2024] Open
Abstract
AIMS Studies have suggested relationships between obesity and cardiovascular disease (CVD) morbidity. However, little is known about whether substantial weight reduction affects the risk of CVD-related acute care use in obese patients with CVD. The objective of this study was to determine whether bariatric surgery is associated with decreased risk of CVD-related acute care use. METHODS AND RESULTS We performed a self-controlled case series study of obese adults with CVD who underwent bariatric surgery, using population-based emergency department (ED), and inpatient samples in California, Florida, and Nebraska from 2005 to 2011. The primary outcome was ED visit or unplanned hospitalization for CVD. We used conditional logistic regression to compare the risk during sequential 12-month periods, using pre-surgery months 13-24 as the reference period. We identified 11 106 obese adults with CVD who underwent bariatric surgery. During the reference period, 20.6% [95% confidence interval (CI), 19.8-21.3%] of patients had an ED visit or unplanned hospitalization for CVD. The risk did not significantly change in the subsequent 12-month pre-surgery period [adjusted odds ratio (aOR) 0.98; 95% CI, 0.93-1.04; P = 0.42]. By contrast, in the first 12-month period after bariatric surgery, the risk significantly decreased (aOR 0.91; 95% CI, 0.86-0.96; P = 0.002). The risk remained reduced in the subsequent 13-24 months post-bariatric surgery (aOR 0.84; 95% CI, 0.79-0.89; P < 0.001). There was no reduction in the risk in separate obese populations that underwent non-bariatric surgery (i.e. cholecystectomy, hysterectomy). By CVD category, the risk of acute care use for coronary artery disease (CAD), heart failure (HF), and hypertension decreased after bariatric surgery, whereas that of dysrhythmia and venous thromboembolism transiently increased (Bonferroni corrected P < 0.05 for all comparisons). CONCLUSION Bariatric surgery is associated with a lower risk of overall CVD-related ED visit or unplanned hospitalization. The decline was mainly driven by reduced risk of acute care use for CAD, HF, and hypertension after bariatric surgery.
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Affiliation(s)
- Yuichi J. Shimada
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, 622 West 168th Street, PH3-342, New York, NY 10032, USA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA
| | - Koichiro Gibo
- Department of Emergency Medicine, Okinawa Prefectural Chubu Hospital, 281 Miyazato, Uruma, Okinawa, Japan
| | - Yusuke Tsugawa
- Division of General Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, 911 Broxton Avenue, Los Angeles, CA, USA
| | - Tadahiro Goto
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 125 Nashua Street, Suite 920, Boston, MA, USA
| | - Elaine W. Yu
- Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Their 1051, Boston, MA, USA; and
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - David F.M. Brown
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 125 Nashua Street, Suite 920, Boston, MA, USA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 125 Nashua Street, Suite 920, Boston, MA, USA
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Pessinaba S, Atti YDM, Baragou S, Yayehd K, Pio M, Afassinou YM, Kpelafia M, Kaziga WD, Simwetare MF, D'alméida R, Aloumon M, Agbétiafa M, Panchut Nsangou N, Damorou F. [Thrombolysis in pulmonary embolism with high mortality risk: Experience of a cardiology department in sub-Saharan Africa]. Ann Cardiol Angeiol (Paris) 2019; 68:28-31. [PMID: 30290914 DOI: 10.1016/j.ancard.2018.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 08/24/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION High-risk pulmonary embolism (PE) accounts for 5% of total acute PE and is a life-threatening emergency requiring immediate therapeutic management by fibrinolysis. The objective of this work is to describe the experience of thrombolysis in high-risk PE in a cardiology department in Togo. PATIENTS AND METHODS This is an analytical and descriptive study carried out in the cardiology department of the Campus teaching hospital of Lomé over a period of 5 years (August 2012 to July 2017) concerning patients hospitalized for high-risk mortality PE and having undergone streptokinase thrombolysis. RESULTS Twenty-eight of the 102 PE were at high risk of mortality (27.5%). They were 9 men and 19 women with an average age of 61.9±14.1 years. The mean systolic blood pressure was 65mmHg and 50% of the patients were placed on dobutamine. Thrombolysis was performed in 22 of the 28 patients (78.6%). Eighteen patients had a short protocol and 4 a long protocol. The mortality rate was 32.1% or 13.6% in the thrombolysis PE versus 100% in the non-thrombolysis PE (P=0.01). Causes of death in thrombolysis were persistent shock (2 cases) at the end of thrombolysis and sudden death occurred 1 month after hospitalization. The average hospital stay was 18.8 days. CONCLUSION The high-risk PE remains today a pathology burdened with heavy mortality. Thrombolysis remains the first treatment to reduce this mortality.
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Affiliation(s)
- S Pessinaba
- Service de cardiologie, CHU Campus Lomé, 03 BP, 30284 Lomé, Togo.
| | - Y D M Atti
- Service de cardiologie, CHU Campus Lomé, 03 BP, 30284 Lomé, Togo
| | - S Baragou
- Service de cardiologie, CHU Sylvanus, Olympio, Togo
| | - K Yayehd
- Service de cardiologie, CHU Campus Lomé, 03 BP, 30284 Lomé, Togo
| | - M Pio
- Service de cardiologie, CHU Sylvanus, Olympio, Togo
| | | | - M Kpelafia
- Service de cardiologie, CHU Campus Lomé, 03 BP, 30284 Lomé, Togo
| | - W D Kaziga
- Service de cardiologie, CHU Campus Lomé, 03 BP, 30284 Lomé, Togo
| | - M F Simwetare
- Service de cardiologie, CHU Campus Lomé, 03 BP, 30284 Lomé, Togo
| | - R D'alméida
- Service de cardiologie, CHU Campus Lomé, 03 BP, 30284 Lomé, Togo
| | - M Aloumon
- Service de cardiologie, CHU Campus Lomé, 03 BP, 30284 Lomé, Togo
| | - M Agbétiafa
- Service de cardiologie, CHU Campus Lomé, 03 BP, 30284 Lomé, Togo
| | | | - F Damorou
- Service de cardiologie, CHU Campus Lomé, 03 BP, 30284 Lomé, Togo
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Santos-Martínez LE, Lozano-Torres VM, Flores-García CA, Soto-Márquez P, Rodríguez-Almendros NA, Meza-López LR, Campos-Larios JZ, Calderón-Abbo MC. [Pulmonary endarterectomy. Initial report in a cardiology hospital]. Rev Med Inst Mex Seguro Soc 2019; 56:478-485. [PMID: 30777416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Currently the options for treatment of chronic thromboembolic pulmonary hypertension can be pulmonary endarterectomy, pulmonary angioplasty and pharmacological treatment. OBJECTIVE To show the feasibility of performing pulmonary endarterectomy in a cardiology hospital. METHODS From December 2013 to June 2014 a serie of consecutive cases was studied according to the guidelines of the Fifth World Symposium of Pulmonary Hypertension. Its antecedents, clinical characteristics, functional class, hemodynamics, exercise capacity were defined in pre and post-operative conditions. RESULTS Three cases, two males with A + blood group and one female O + with presence of antiphospholipid antibodies; the three patients with prior history of pulmonary embolism, obese, with dyspnea and syncope; preoperative systolic pulmonary pressures were 60, 50, 59 mm Hg, and post-operative 43, 33, 21 mm Hg; functional class III/IV vs. I/IV; walked meters 320, 266, 252 vs. 480, 527, 0, respectively. One patient died, not related to surgery, due to multiple organ failure 40 days after surgery. CONCLUSIONS Pulmonary endarterectomy is a feasible procedure with clinical and hemodynamic improvement.
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Affiliation(s)
- Luis Efrén Santos-Martínez
- Instituto Mexicano del Seguro Social, Hospital de Cardiología, Departamento de Hipertensión Pulmonar y Función Ventricular Derecha. Ciudad de México, México
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Deschodt M, Van Grootven B, Jeuris A, Devriendt E, Dierckx de Casterlé B, Dubois C, Fagard K, Herregods MC, Hornikx M, Meuris B, Rex S, Tournoy J, Milisen K, Flamaing J. Geriatric CO-mAnagement for Cardiology patients in the Hospital (G-COACH): study protocol of a prospective before-after effectiveness-implementation study. BMJ Open 2018; 8:e023593. [PMID: 30344179 PMCID: PMC6196878 DOI: 10.1136/bmjopen-2018-023593] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Although the majority of older patients admitted to a cardiology unit present with at least one geriatric syndrome, guidelines on managing heart disease often do not consider the complex needs of frail older patients. Geriatric co-management has demonstrated potential to improve functional status, and reduce complications and length of stay, but evidence on the effectiveness in cardiology patients is lacking. This study aims to determine if geriatric co-management is superior to usual care in preventing functional decline, complications, mortality, readmission rates, reducing length of stay and improving quality of life in older patients admitted for acute heart disease or for transcatheter aortic valve implantation, and to identify determinants of success for geriatric co-management in this population. METHODS AND ANALYSIS This prospective quasi-experimental before-and-after study will be performed on two cardiology units of the University Hospitals Leuven in Belgium in patients aged ≥75 years. In the precohort (n=227), usual care will be documented. A multitude of implementation strategies will be applied to allow for successful implementation of the model. Patients in the after cohort (n=227) will undergo a comprehensive geriatric assessment within 24 hours of admission to stratify them into one of three groups based on their baseline risk for developing functional decline: low-risk patients receive proactive consultation, high-risk patients will be co-managed by the geriatric nurse to prevent complications and patients with acute geriatric problems will receive an additional medication review and co-management by the geriatrician. ETHICS AND DISSEMINATION The study protocol was approved by the Medical Ethics Committee UZ Leuven/KU Leuven (S58296). Written voluntary (proxy-)informed consent will be obtained from all participants at the start of the study. Dissemination of results will be through articles in scientific and professional journals both in English and Dutch and by conference presentations. TRIAL REGISTRATION NUMBER NCT02890927.
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Affiliation(s)
- Mieke Deschodt
- Gerontology and Geriatrics, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven—University of Leuven, Leuven, Belgium
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
| | - Bastiaan Van Grootven
- Research Foundation, Flanders, Belgium
- Department of Public Health and Primary Care, University of Leuven - KU Leuven, Leuven, Belgium
| | - Anthony Jeuris
- Department of Public Health and Primary Care, University of Leuven - KU Leuven, Leuven, Belgium
| | - Els Devriendt
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Christophe Dubois
- Department of Cardiovascular Diseases, KU Leuven—University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Katleen Fagard
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Marie-Christine Herregods
- Department of Cardiovascular Diseases, KU Leuven—University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Miek Hornikx
- Department of Cardiovascular Diseases, KU Leuven—University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meuris
- Department of Cardiovascular Diseases, KU Leuven—University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Jos Tournoy
- Gerontology and Geriatrics, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven—University of Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Koen Milisen
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Johan Flamaing
- Gerontology and Geriatrics, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven—University of Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
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Corré J, Douard H. [Rationalization of biological tests in cardiology department]. Sante Publique 2018; 30:689-695. [PMID: 30767484 DOI: 10.3917/spub.186.0689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Laboratory tests usually complete clinical examinations for diagnostic, prognostic and even therapeutical care. However, French doctors might too easily prescribe such examinations without knowing their cost. As a matter of fact, the prescription is sometimes excessive or unjustified. Cardiology is not an exception, with costly laboratory tests. OBJECTIVE To show that the relevance of each additional test prescription, in a cardiology department, allows a significant reduction of the examination volumes and costs, with no prejudicial effect on patients' care. METHODS Two consecutive 2-year periods, between November 1st 2011 and October 31st 2015, - before and after the development of a policy of rationalization of additional tests - were compared. All the patients admitted in our cardiology department during these periods were prospectively included.During 4 years, the volume and the cost of prescription of the most frequent laboratory tests were studied, considering successive half-year periods. RESULTS After rationalizing, there was a significant reduction of prescription of the laboratory tests (CBC -72%, BNP -92%, troponin -82%, CRP -89%, liver test -87%, lipid status -80%, TSH -80%, p<0.01).No serious adverse events were reported and no death rate increase was noticed. CONCLUSION Rationalizing allows a significant reduction of complementary examinations, with no additional risk for the patient.
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Tan FC, Yap J, Allen JC, Tan O, Tan SY, Matchar DB, Chua TS. Triaging Primary Care Patients Referred for Chest Pain to Specialist Cardiology Centres: Efficacy of an Optimised Protocol. Ann Acad Med Singap 2018; 47:56-62. [PMID: 29549371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Patients referred for chest pain from primary care have increased, along with demand for outpatient cardiology consultations. We evaluated 'Triage Protocol' that implements standardised diagnostic testing prior to patients' first cardiology consultation. MATERIALS AND METHODS Under the 'Triage Protocol', patients referred for chest pain were pretriaged using a standardised algorithm and subsequently referred for relevant functional diagnostic cardiology tests before their initial cardiology consultation. At the initial cardiology consultation scheduled by the primary care provider, test results were reviewed. A total of 522 triage patients (mean age 55 ± 13, male 53%) were frequency-matched by age, gender and risk cohort to 289 control patients (mean age: 56 ± 11, male: 52%). Pretest risk of coronary artery disease was defined according to a Modified Duke Clinical Score (MDCS) as low (<10), intermediate (10-20) and high (>20). The primary outcome was time from referral to diagnosis (days). Secondary outcomes were total visits, discharge rate at first consultation, patient cost and adverse cardiac outcomes. RESULTS The 'Triage Protocol' resulted in shorter times from referral to diagnosis (46 vs 131 days; P <0.0001) and fewer total visits (2.4 vs 3.0; P <0.0001). However, triage patients in low-risk groups experienced higher costs due to increased testing (S$421 vs S$357, P = 0.003). Adverse cardiac event rates under the 'Triage Protocol' indicated no compromise to patient safety (triage vs control: 0.57% vs 0.35%; P = 1.000). CONCLUSION By implementing diagnostic cardiac testing prior to patients' first specialist consultation, the 'Triage Protocol' expedited diagnosis and reduced subsequent visits across all risk groups in ambulatory chest pain patients.
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Affiliation(s)
- Francine Cl Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore
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18
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Ilangkovan N, Mickley H, Diederichsen A, Lassen A, Sørensen TL, Sheta HM, Stæhr PB, Mogensen CB. Clinical features and prognosis of patients with acute non-specific chest pain in emergency and cardiology departments after the introduction of high-sensitivity troponins: a prospective cohort study. BMJ Open 2017; 7:e018636. [PMID: 29275346 PMCID: PMC5770919 DOI: 10.1136/bmjopen-2017-018636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the incidence of clinical, cardiac-related endpoints and mortality among patients presenting to an emergency or cardiology department with non-specific chest pain (NSCP), and who receive testing with a high-sensitivity troponin. A second objective was to identify risk factors for the above-noted endpoints during 12 months of follow-up. DESIGN A prospective multicentre study. SETTING Emergency and cardiology departments in Southern Denmark. SUBJECTS The study enrolled 1027 patients who were assessed for acute chest pain in an emergency or cardiology department, and in whom a myocardial infarction or another obvious reason for chest pain had been ruled out. Patients were enrolled from September 2014 to June 2015 and followed for 1 year. MAIN OUTCOME MEASURES Clinical, cardiac-related endpoints (cardiac-related death, acute myocardial infarction, unstable angina and coronary revascularisation) and all-cause mortality. RESULTS Over a period of 1 year, cardiac-related endpoints were found in 19 patients (1.9%): 0 patients experienced cardiac-related death, 2 (0.2%) had myocardial infarction, 4 (0.4%) had unstable angina pectoris and 17 (1.7%) underwent coronary revascularisation. All-cause mortality was observed in seven patients (0.7%). When compared with the general population, the standardised mortality ratio did not differ. The risk factors associated with the study endpoints included male gender, body mass index >25 kg/m2, previous known coronary artery disease, hypertension, hypercholesterolaemia, diabetes mellitus and the use of statins. A total of 73% of the endpoints occurred in males. CONCLUSION The prognosis for patients with NSCP is favourable, with a 1-year mortality after discharge that is comparable with the background population. Few clinical endpoints took place during follow-up, and those that did were predominantly in males.
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Affiliation(s)
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Axel Diederichsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Annmarie Lassen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Thomas L Sørensen
- Department of Internal Medicine, Hospital of Southern Denmark, Sonderborg, Denmark
| | | | - Peter B Stæhr
- Department of Cardiology, Hospital of Southern Denmark, Aabenraa, Denmark
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Tan EM, Nagpal A, DeSimone DC, Anderson B, Linderbaum J, De Ziel T, Li Z, Sohail MR, Cha YM, Loomis E, Espinosa R, Friedman PA, Greason K, Schiller H, Virk A, Wilson WR, Steckelberg JM, Baddour LM. Impacts of a care process model and inpatient electrophysiology service on cardiovascular implantable electronic device infections: a preliminary evaluation. J Interv Card Electrophysiol 2017; 50:117-124. [PMID: 28844107 DOI: 10.1007/s10840-017-0282-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/10/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Cardiovascular implantable electronic device infection (CIEDI) rates are rising. To improve outcomes, our institution developed an online care process model (CPM) and a specialized inpatient heart rhythm service (HRS). METHODS This retrospective review compared hospital length of stay (LOS), mortality, and times to subspecialty consultation and procedures before and after CPM and HRS availability. RESULTS CPM use was associated with shortened time to surgical consultation (median 2 days post-CPM vs. 3 days pre-CPM, p = 0.0152), pocket closure (median 4 vs. 5 days, p < 0.0001), and days to new CIED implant (median 7 vs. 8 days, p = 0.0126). Post-HRS patients were more likely to have a surgical consultation (OR 7.01, 95% CI 1.56-31.5, p = 0.011) and shortened time to pocket closure (coefficient - 2.21 days, 95% CI - 3.33 to - 1.09, p < 0.001), compared to pre-HRS. CONCLUSIONS The CPM and HRS were associated with favorable outcomes, but further integration of CPM features into hospital workflow is needed.
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Affiliation(s)
- Eugene M Tan
- Division of Infectious Diseases, Mayo Clinic, 200 First St S.W., Rochester, MN, 55905, USA.
| | - Avish Nagpal
- Infectious Diseases, Sanford Health, Fargo, ND, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Mayo Clinic, 200 First St S.W., Rochester, MN, 55905, USA
| | - Brenda Anderson
- Anesthesia Clinical Research Unit, Mayo Clinic, Rochester, MN, USA
| | | | - Thomas De Ziel
- Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Zhuo Li
- Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Muhammad R Sohail
- Division of Infectious Diseases, Mayo Clinic, 200 First St S.W., Rochester, MN, 55905, USA
| | - Yong-Mei Cha
- Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Erica Loomis
- Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN, USA
| | - Raul Espinosa
- Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Kevin Greason
- Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Henry Schiller
- Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN, USA
| | - Abinash Virk
- Division of Infectious Diseases, Mayo Clinic, 200 First St S.W., Rochester, MN, 55905, USA
| | - Walter R Wilson
- Division of Infectious Diseases, Mayo Clinic, 200 First St S.W., Rochester, MN, 55905, USA
| | - James M Steckelberg
- Division of Infectious Diseases, Mayo Clinic, 200 First St S.W., Rochester, MN, 55905, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic, 200 First St S.W., Rochester, MN, 55905, USA
- Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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Evans LW, van Woerden H, Davies GR, Fone D. Impact of service redesign on the socioeconomic inequity in revascularisation rates for patients with acute myocardial infarction: a natural experiment and electronic record-linked cohort study. BMJ Open 2016; 6:e011656. [PMID: 27797993 PMCID: PMC5093375 DOI: 10.1136/bmjopen-2016-011656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIM To investigate the impact of service redesign in the provision of revascularisation procedures on the historical socioeconomic inequity in revascularisation rates for patients with acute myocardial infarction (AMI). DESIGN Natural experiment and retrospective cohort study using linked data sets in the Secure Anonymised Information Linkage databank. NON-RANDOMISED INTERVENTION An increase in the capacity of revascularisation procedures and service redesign in the provision of revascularisation in late 2011 to early 2012. SETTING South Wales cardiac network, Census 2011 population 1 359 051 aged 35 years and over. PARTICIPANTS 9128 participants admitted to an NHS hospital with a first AMI between 1 January 2010 and 30 June 2013, with 6-months follow-up. MAIN OUTCOME MEASURE Hazard ratios (HRs) for the time to revascularisation for deprivation quintiles, age, gender, comorbidities, rural-urban classification and revascularisation facilities of admitting hospital. RESULTS In the preintervention period, there was a statistically significant decreased adjusted risk of revascularisation for participants in the most deprived quintile compared to the least deprived quintile (HR 0.80; 95% CI 0.69 to 0.92, p=0.002). In the postintervention period, the increase in revascularisation rates was statistically significant in all quintiles, and there was no longer any statistically significant difference in the adjusted revascularisation risk between the most and the least deprived quintile (HR 1.04; 95% CI 0.89 to 1.20, p<0.649). However, inequity persisted for those aged 75 years and over (HR 0.40; 95% CI 0.35 to 0.46, p<0.001) and women (HR 0.77; 95% CI 0.70 to 0.86, p<0.001). CONCLUSIONS Socioeconomic inequity of access to revascularisation was no longer apparent following redesign of revascularisation services in the south Wales cardiac network, although inequity persisted for women and those aged 75+ years. Increasing the capacity of revascularisation did not differentially benefit participants from the least deprived areas.
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Affiliation(s)
- Lloyd W Evans
- Public Health Wales Observatory, Public Health Wales, Carmarthen, UK
| | | | - Gareth R Davies
- Public Health Wales Observatory, Public Health Wales, Carmarthen, UK
| | - David Fone
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Abstract
One hundred and thirty-six men with coronary artery disease were randomly assigned to a hospital-based or home-based exercise program of 3 sessions per week. A treadmill test was carried out with the modified Naughton protocol. After 3 months, 125 patients (92%) with a mean age of 55 ± 11 years had completed the study. Maximum workload achieved increased by 65% [(12.40 ± 1.32 vs. 7.50 ± 0.85 metabolic equivalent units (METs)] in the hospital-based group, and by 17% (8.86 ± 0.9 vs. 7.56 ± 0.78 METs) in the home-based group ( p = 0.0001). The heart rate-blood pressure product, an index of myocardial oxygen consumption, decreased at rest by 19% in the hospital-based group but was unchanged in the home-based group ( p = 0.0001). The heart rate-blood pressure product at 5 and 7 METs activity level decreased 28% and 26%, respectively, in the hospital-based group vs. 8% and 2% in the home-based group ( p = 0.0001). It was concluded that hospital-based exercise training in patients with coronary artery disease improves functional capacity and decreases the myocardial oxygen consumption index at rest and during exercise.
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Affiliation(s)
- Arash Arya
- Department of Cardiology, Rajaie Cardiovascular Medical Center, Mellat Park, Vali-Asr Avenue, Tehran 19969-11151, Iran.
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Di Martino M, Alagna M, Cappai G, Mataloni F, Lallo A, Perucci CA, Davoli M, Fusco D. Adherence to evidence-based drug therapies after myocardial infarction: is geographic variation related to hospital of discharge or primary care providers? A cross-classified multilevel design. BMJ Open 2016; 6:e010926. [PMID: 27044584 PMCID: PMC4823440 DOI: 10.1136/bmjopen-2015-010926] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To measure the adherence to polytherapy after myocardial infarction (MI), to compare the proportions of variation attributable to hospitals of discharge and to primary care providers, and to identify determinants of adherence to medications. SETTING This is a population-based study. Data were obtained from the Information Systems of the Lazio Region, Italy (5 million inhabitants). PARTICIPANTS Patients hospitalised with incident MI in 2007-2010. OUTCOME MEASURE The outcome was chronic polytherapy after MI. Adherence was defined as a medication possession ratio ≥0.75 for at least three of the following drugs: antiplatelets, β-blockers, ACEI angiotensin receptor blockers, statins. DESIGN AND ANALYSIS A 2-year cohort study was performed. Cross-classified multilevel models were applied to analyse geographic variation and compare proportions of variability attributable to hospitals of discharge and primary care providers. The variance components were expressed as median ORs MORs. If the MOR is 1.00, there is no variation between clusters. If there is considerable between-cluster variation, the MOR will be large. RESULTS A total of 9606 patients were enrolled. About 63% were adherent to chronic polytherapy. Adherence was higher for patients discharged from cardiology wards (OR=1.56 vs other wards, p<0.001) and for patients with general practitioners working in group practice (OR=1.14 vs single-handed, p=0.042). A relevant variation in adherence was detected between local health districts (MOR=1.24, p<0.001). When introducing the hospital of discharge as a cross-classified level, the variation between local health districts decreased (MOR=1.13, p=0.020) and the variability attributable to hospitals of discharge was significantly higher (MOR=1.37, p<0.001). CONCLUSIONS Secondary prevention pharmacotherapy after MI is not consistent with clinical guidelines. The relevant geographic variation raises equity issues in access to optimal care. Adherence was influenced more by the hospital that discharged the patient than by the primary care providers. Cross-classified models proved to be a useful tool for defining priority areas for more targeted interventions.
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Affiliation(s)
- Mirko Di Martino
- Department of Epidemiology, Lazio Regional Health Service, Roma, Italy
| | - Michela Alagna
- Faculty of Education—Free University of Bolzano, Bolzano, Italy
| | - Giovanna Cappai
- Department of Epidemiology, Lazio Regional Health Service, Roma, Italy
| | | | - Adele Lallo
- Department of Epidemiology, Lazio Regional Health Service, Roma, Italy
| | | | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Roma, Italy
| | - Danilo Fusco
- Department of Epidemiology, Lazio Regional Health Service, Roma, Italy
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Musey PI, Studnek JR, Garvey L. Characteristics of ST Elevation Myocardial Infarction Patients Who Do Not Undergo Percutaneous Coronary Intervention After Prehospital Cardiac Catheterization Laboratory Activation. Crit Pathw Cardiol 2016; 15:16-21. [PMID: 26881815 DOI: 10.1097/hpc.0000000000000069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To assess the clinical and electrocardiographic characteristics of patients diagnosed with ST elevation myocardial infarction (STEMI) that are associated with an increased likelihood of not undergoing percutaneous coronary intervention (PCI) after prehospital Cardiac Catheterization Laboratory activation in a regional STEMI system. METHODS We performed a retrospective analysis of prehospital Cardiac Catheterization Laboratory activations in Mecklenburg County, North Carolina, between May 2008 and March 2011. Data were extracted from the prehospital patient record, the prehospital electrocardiogram, and the regional STEMI database. The independent variables of interest included objective patient characteristics as well as documented cardiac history and risk factors. Analysis was performed using descriptive statistics and logistic regression. RESULTS Two hundred thirty-one prehospital activations were included in the analysis. Five independent variables were found to be associated with an increased likelihood of not undergoing PCI: increasing age, bundle branch block, elevated heart rate, left ventricular hypertrophy, and non-white race. The variables with the most significance were any type of bundle branch block [adjusted odds ratios (AOR), 5.66; 95% confidence interval (CI), 1.91-16.76], left ventricular hypertrophy (AOR, 4.63; 95% CI, 2.03-10.53), and non-white race (AOR, 3.53; 95% CI, 1.76-7.08). Conversely, the only variable associated with a higher likelihood of undergoing PCI was the presence of arm pain (AOR, 2.94; 95% CI, 1.36-6.25). CONCLUSIONS Several of the above variables are expected electrocardiogram mimics; however, the decreased rate of PCI in non-white patients highlights an area for investigation and process improvement. This may guide the development of prehospital STEMI protocols, although avoiding false positive and inappropriate activations.
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Affiliation(s)
- Paul I Musey
- From the *Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN; †Mecklenburg Emergency Medical Services Agency, Charlotte, NC; and ‡Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC
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Abstract
Chest pain is the second most common emergency department (ED) presentation in the United States. Cardiac computed tomography angiography (CCTA) now plays an important role in the evaluation of patients with suspected acute coronary syndrome in the ED setting. In this article, we review the available techniques focused on the use of CCTA to evaluate patients fosr coronary atherosclerosis for timely triage of acute chest pain.
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Affiliation(s)
- Nam Ju Lee
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Harold Litt
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
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Affiliation(s)
- David L Cohen
- Care of Older People, Northwick Park Hospital, Harrow HA1 3UJ, UK
| | - Robin Kearney
- Care of Older People, Northwick Park Hospital, Harrow HA1 3UJ, UK
| | - Megan Griffiths
- Care of Older People, Northwick Park Hospital, Harrow HA1 3UJ, UK
| | | | - Rajaram Bathula
- Care of Older People, Northwick Park Hospital, Harrow HA1 3UJ, UK
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Burns PA, Flynn PA, Rennie IM. Importance of location of neurointerventional skills in thrombectomy for acute stroke. BMJ 2015; 351:h4605. [PMID: 26320166 DOI: 10.1136/bmj.h4605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fan G, He S, Chen Z. Musculoskeletal Pain and Cancer Risk of Staff Working With Fluoroscopically Guided Procedures. J Am Coll Cardiol 2015; 66:759-60. [PMID: 26249000 DOI: 10.1016/j.jacc.2015.04.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/23/2015] [Indexed: 11/29/2022]
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Affiliation(s)
- Andrew Apps
- Department of Cardiology, High Wycombe Hospital, Bucks, HP11 2TT, UK
| | - Soroosh Firoozan
- Department of Cardiology, High Wycombe Hospital, Bucks, HP11 2TT, UK
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Borghini A, Mercuri A, Turchi S, Chiesa MR, Piccaluga E, Andreassi MG. Increased circulating cell-free DNA levels and mtDNA fragments in interventional cardiologists occupationally exposed to low levels of ionizing radiation. Environ Mol Mutagen 2015; 56:293-300. [PMID: 25327629 DOI: 10.1002/em.21917] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 09/30/2014] [Indexed: 06/04/2023]
Abstract
Circulating cell-free DNA (ccf-DNA) and mtDNA (ccf-mtDNA) have often been used as indicators of cell death and tissue damage in acute and chronic disorders, but little is known about changes in ccf-DNA and ccf-mtDNA concentrations following radiation exposure. The aim of the study was to investigate the impact of chronic low-dose radiation exposure on serum ccf-DNA levels and ccf-mtDNA fragments (mtDNA-79 and mtDNA-230) of interventional cardiologists working in high-volume cardiac catheterization laboratory to assess their possible role as useful radiation biomarkers. We enrolled 50 interventional cardiologists (26 males; age = 48.4 ± 10 years) and 50 age- and gender-matched unexposed controls (27 males; age = 47.6 ± 8.3 years). Quant-iT™ dsDNA High-Sensitivity assay was used to measure circulating ccf-DNA isolated from serum samples. Quantitative analysis of mtDNA fragments was performed by real-time PCR. No significant relationships were found between ccf-DNA and ccf-mtDNA, and age, gender, smoking, or other clinical parameters. Ccf-DNA levels (44.2 ± 31.1 vs. 30.6 ± 19.2 ng/ml, P = 0.013), ccf-mtDNA-79 (2.6 ± 2.1 vs. 1.1 ± 0.8, P < 0.01), and ccf-mtDNA-230 copies (2.0 ± 1.8 vs. 1.04 ± 0.9, P = 0.02) were significantly higher in interventional cardiologists compared with the non-exposed group. In a subset (n = 15) of interventional cardiologists with a reliable reconstruction of cumulative professional exposure (59.7 ± 48.4 mSv; range: 1.4-182 mS), ccf-DNA (53.2 ± 41.3 vs. 36.4 ± 22.9 and 32.2 ± 20.5, P = 0.08), mtDNA-79 (2.4 ± 2.1 vs. 2.03 ± 1.7 and 1.09 ± 0.82, P = 0.05), and mtDNA-230 (2.0 ± 2.2 vs. 1.5 ± 1.4 and 1.04 ± 0.9, P = 0.09) tended to be significantly increased in high-exposure subjects compared with both low-exposure interventional cardiologists and controls. Our results provide evidence for a possible role of circulating DNA as a relevant biomarker of cellular damage induced by exposure to chronic low-dose radiation.
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Affiliation(s)
- Andrea Borghini
- Genetics Research Unit, CNR Institute of Clinical Physiology, Pisa, Italy
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Nepovinnykh NV, Lyamina NP, Ptichkina NM. [Assessment of functional food of general version of diet in cardiac hospital]. Vopr Pitan 2015; 84:38-43. [PMID: 26402941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The efficacy of functional food was evaluated in general embodiment diet of cardiological hospital in patients receiving oxygen-containing products (oxygen smoothies) based on protein-carbohydrate raw materials (dairy whey) with dietary fiber. 60 patients were included in local open, prospective, parallel-group study; among them 36 men and 24 women aged 60-75 years, meeting the following criteria: patients with chronic heart failure I-IV functional class, are hospitalized in the cardiology department, have no contraindications to enteral oxygen therapy and sign an informed consent form. The main group comprised 30 patients, which along with standard therapy received enteral oxygen therapy. 30 patients from the control group received standard therapy and aerated non-oxygen mixture (placebo). Standard therapy included cardioprotective drugs, diuretics and concomitant therapy (enzyme preparations) depended upon the clinical status of the patient. Patients received 500 ml of a cocktail within 10-15 minutes daily for 10 days for 1-1,5 hours before the main meal. The studies revealed the most pronounced clinical effect of enteral oxygen therapy in relation to clinical symptoms and side effects caused by drug administrations. After 3-4 procedures patients with chronic heart failure treated with enteral oxygen therapy had a decrease in fatigue, increase physical performance, improve appetite, emotional lability. By the end the positive dynamics of oxygen therapy on the above grounds was detected in 90% of patients. Monitoring pulse oximetry showed a significant increase of oxygen saturation as a result of the course of enteral oxygen therapy: oxygen saturation increased from 98.13 ± 0.13 to 99.17 ± 0.13% (p < 0.001) while in the control group from 98.12 ± 0.20 to 98.19 ± 0.19% (p < 0.01). Physical activity increased from 318 ± 15 to 389 ± 13 m (p < 0.001), in the control group--from 331 ± 17 to 362 ± 15 m (p < 0.05) in the main group on the test results with the 6-minutes walk test. In the main group dyspnea Borg changed from 11 to 7 scores as compared to the control group--from 11 to 9 scores. Analysis of the results showed the advisability of incorporating developed oxygen-containing products in diet therapy of cardiac patients to reduce the severity of side effects from taking of drugs administration to normalize the process of digestion, to improve the overall health of patients.
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Szyszka A, Pajak A, Pohl M, Kaszuba D. [Smoking cessation during hospitalization on cardiology ward]. Przegl Lek 2015; 72:152-154. [PMID: 26731874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Among the modifiable risk factors smoking has the most impact on cardiovascular mortality. Among patients with cardiovascular disease benefits of quitting smoking outweigh those associated with commonly prescribed drugs. Hospitalization in the ward seems to be a good time to motivate the patient to take this step. In our paper we present the effectiveness of different methods to achieve this goal.
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Sakai M, Kato A, Kobayashi N, Nakamura R, Okawa S, Sato Y. Improved Lung Cancer Detection in Cardiovascular Outpatients by the Pulmonologist-based Interpretation of Chest Radiographs. Intern Med 2015; 54:2991-7. [PMID: 26631881 DOI: 10.2169/internalmedicine.54.4171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Pulmonologists and cardiologists view chest radiographs differently. Lung cancer may therefore go undetected in patients referred to cardiovascular departments. We aimed to determine the clinical benefit of the additional interpretation of chest radiographs by pulmonologists in study involving cardiovascular outpatients. METHODS A retrospective review of chest radiographs of outpatients attending a Japanese cardiovascular hospital between April 2000 and March 2010 was conducted. Lung cancer patients were categorized into 3 groups: group C, patients in whom tumors were detected by a cardiologist at the first visit; group P, patients in whom tumors were detected by the additional interpretation of a chest radiographs by a pulmonologist after a lesion was missed by a cardiologist; and group H, patients from an earlier period in which chest radiographs were only examined by a cardiologist. RESULTS Cardiologists detected 9 cases of lung cancer in groups C and H from 2,430 and 2,288 radiographs, respectively. Pulmonologists detected 10 cases of lung cancer (group P) and 3 other malignancies that were previously undetected, giving a miss rate of 52.6% for the cardiologists. Tumor diameters were significantly smaller in group P than in group C or H. Furthermore, a significantly higher number of the tumors in group P were of an early stage and resectable, with more superposing structures than in groups C or H. CONCLUSION The additional pulmonologist-based interpretations significantly increased the detection rate of operable tumors that mostly corresponded to the early T1 stage; this serves offers a potential clinical benefit in reducing the period of time from patient presentation to the diagnosis of lung cancer.
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Affiliation(s)
- Mitsuaki Sakai
- Department of Thoracic Surgery, Tsukuba Medical Center Hospital, Japan
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Samadoulougou A, Temoua Naibe D, Mandi G, Yameogo RA, Kabore E, Millogo G, Yameogo NV, Kologo JK, Thiam Tall A, Toguyeni BJY, Zabsonre P. [Evaluation of the level of knowledge of patients on treatment with vitamin K antagonists in Ouagadougou cardiology department]. Pan Afr Med J 2014; 19:286. [PMID: 25870741 PMCID: PMC4391894 DOI: 10.11604/pamj.2014.19.286.5411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 10/31/2014] [Indexed: 11/28/2022] Open
Abstract
Introduction Les antivitamines K (AVK), traitement anticoagulant oral le plus largement prescrit, posent un réel problème de santé publique du fait de leur risque iatrogène. L'objectif de cette étude était de préciser le niveau de connaissance des patients sur la gestion de leur traitement par les AVK. Méthodes Il s'est agi d'une enquête transversale descriptive réalisée au CHU-Yalgado Ouédraogo, sur une période de 03 mois : du 1er mars au 31 mai 2012. Un questionnaire a été administré aux patients bénéficiant d'un traitement AVK depuis au moins un mois. Résultats Soixante-dix patients ont été inclus dans l'étude dont 30 hommes. L'âge moyen était de 49 ans ± 16 ans. Les cardiopathies et la maladie thromboembolique veineuse justifiant l'institution du traitement AVK étaient retrouvées respectivement dans 58,6% et 41,4% des cas. Le nom de l'AVK et la raison exacte du traitement étaient connus respectivement dans 91,4% et 67,1% des cas. Plus de la moitié des patients (68,6%) savaient que les AVK rendaient le sang plus fluide. Quarante-six patients (65,7%) citaient l'INR comme examen biologique de surveillance du traitement et seulement 28 patients (40%) connaissaient les valeurs cibles. La majorité des patients ne connaissait pas les risques encourus en cas de surdosage (72,8%) et de sous-dosage (71,4%). Une automédication par anti-inflammatoire non stéroïdien était signalée par 18 patients (25,7%). Les choux (74,3%) et la laitue (62,9%), aliments à consommer avec modération, étaient les plus cités. Conclusion Les connaissances des patients sur la gestion des AVK étaient fragmentaires et insuffisantes pour assurer la sécurité et l'efficacité du traitement. La création d'un programme d'éducation thérapeutique sur les AVK s'avère alors nécessaire.
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Affiliation(s)
- André Samadoulougou
- Service de Cardiologie du CHU Yalgado Ouedraogo, Ouagadougou, Burkina Faso ; Unité de Formation et de Recherche en Science de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Germain Mandi
- Service de Cardiologie du CHU Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | | | - Elisé Kabore
- Service de Cardiologie du CHU Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - Georges Millogo
- Service de Cardiologie du CHU Yalgado Ouedraogo, Ouagadougou, Burkina Faso ; Unité de Formation et de Recherche en Science de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Nobila Valentin Yameogo
- Service de Cardiologie du CHU Yalgado Ouedraogo, Ouagadougou, Burkina Faso ; Unité de Formation et de Recherche en Science de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Anna Thiam Tall
- Service de Cardiologie du CHU Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | | | - Patrice Zabsonre
- Service de Cardiologie du CHU Yalgado Ouedraogo, Ouagadougou, Burkina Faso ; Unité de Formation et de Recherche en Science de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
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Timóteo AT, Miranda F, Carmo MM, Ferreira RC. Optimal cut-off value for homeostasis model assessment (HOMA) index of insulin-resistance in a population of patients admitted electively in a Portuguese cardiology ward. ACTA MEDICA PORT 2014; 27:473-9. [PMID: 25203956 DOI: 10.20344/amp.5180] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 07/01/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Insulin resistance is the pathophysiological key to explain metabolic syndrome. Although clearly useful, the Homeostasis Model Assessment index (an insulin resistance measurement) has not been systematically applied in clinical practice. One of the main reasons is the discrepancy in cut-off values reported in different populations. We sought to evaluate in a Portuguese population the ideal cut-off for Homeostasis Model Assessment index and assess its relationship with metabolic syndrome. MATERIAL AND METHODS We selected a cohort of individuals admitted electively in a Cardiology ward with a BMI < 25 Kg/m2 and no abnormalities in glucose metabolism (fasting plasma glucose < 100 mg/dL and no diabetes). The 90th percentile of the Homeostasis Model Assessment index distribution was used to obtain the ideal cut-off for insulin resistance. We also selected a validation cohort of 300 individuals (no exclusion criteria applied). RESULTS From 7 000 individuals, and after the exclusion criteria, there were left 1 784 individuals. The 90th percentile for Homeostasis Model Assessment index was 2.33. In the validation cohort, applying that cut-off, we have 49.3% of individuals with insulin resistance. However, only 69.9% of the metabolic syndrome patients had insulin resistance according to that cut-off. By ROC curve analysis, the ideal cut-off for metabolic syndrome is 2.41. Homeostasis Model Assessment index correlated with BMI (r = 0.371, p < 0.001) and is an independent predictor of the presence of metabolic syndrome (OR 19.4, 95% CI 6.6 - 57.2, p < 0.001). DISCUSSION Our study showed that in a Portuguese population of patients admitted electively in a Cardiology ward, 2.33 is the Homeostasis Model Assessment index cut-off for insulin resistance and 2.41 for metabolic syndrome. CONCLUSION Homeostasis Model Assessment index is directly correlated with BMI and is an independent predictor of metabolic syndrome.
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Affiliation(s)
- Ana Teresa Timóteo
- Serviço de Cardiologia. Hospital de Santa Marta. Centro Hospitalar Lisboa Central. Lisboa. Portugal
| | - Fernando Miranda
- Serviço de Patologia Clínica. Hospital de Santa Marta. Centro Hospitalar Lisboa Central. Lisboa. Portugal
| | - Miguel Mota Carmo
- Serviço de Cardiologia. Hospital de Santa Marta. Centro Hospitalar Lisboa Central. Lisboa. Portugal
| | - Rui Cruz Ferreira
- Serviço de Cardiologia. Hospital de Santa Marta. Centro Hospitalar Lisboa Central. Lisboa. Portugal
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["Time to laugh e.V." visits children in the LMU Uniclinic on the Grosshadern Campus. With many entertainers the "Time to Laugh" Organization provides variety in the daily clinic routine ]. Kinderkrankenschwester 2014; 33:186. [PMID: 24902352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Ciuraszkiewicz K, Sielski J, Janion-Sadowska A, Stern A, Zychowicz J, Kaziród-Wolski K, Paluchowski M. [Influenza infection in intensive cardiac care unit patients]. Pol Merkur Lekarski 2014; 36:203-205. [PMID: 24779221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Infection with influenza type A virus may cause serious cardiovascular complications, such as myocarditis, heart failure, acute myocardial infarction. Also infection with influenza type AH1N1 may contribute to aggravation of cardiac disorders, i.e. acute coronary syndrome, heart failure, cardiogenic shock, severe ventricular arrythmias. One of the most fatal complication of influenza is pneumonia leading to acute respiratory insufficiency requiring artifitial ventilation. Symptoms of respiratory tract infections durnig influenza epidemy should always be treated with a high index of suspicion. Early diagnosis and adequate antiviral treatment may prevent those complications. A series of four cases of patients hospitalised in intensive cardiac care unit due to suspected cardiac dyspnea and finally diagnosed as a cardiac disease complicated by influenza pneumonia is presented.
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Fischer E, Thieffry E. [Organizing patient education in cardiology]. Rev Infirm 2014; 63:35-37. [PMID: 24654334 DOI: 10.1016/j.revinf.2013.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A central element of the care management of patients with heart failure, therapeutic patient education mobilises caregivers into forming a multi-disciplinary team. In this article, a hospital team shares the different stages in the construction and implementation of a programme for use with hospitalised patients and in consultations. To do this, the nurses undertook training to acquire new educational skills.
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Abstract
Diabetic muscle infarction (DMI) is a rare complication of long-standing diabetes mellitus. This is the first case of DMI reported by cardiologists. A 49-year-old patient with a history of diabetes and hypertension for only two years was admitted to the cardiac ward due to pain in the left thigh with pitting edema in both lower extremities. Magnetic resonance imaging finally confirmed the presence of DMI in the left thigh, which was improved by treatment with anticoagulants, analgesics and rest. However, the typical clinical symptoms of DMI were unrecognizable at the start of treatment, which may be attributed to a lack of awareness of this rare condition among non-endocrinologist physicians.
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Affiliation(s)
- Chao-Ping Yu
- Department of Cardiology, Pi County People's Hospital, China
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Moraes MAPD, Rodrigues J, Cremonesi M, Polanczyk C, Schaan BD. Management of diabetes by a healthcare team in a cardiology unit: a randomized controlled trial. Clinics (Sao Paulo) 2013; 68:1400-7. [PMID: 24270950 PMCID: PMC3812557 DOI: 10.6061/clinics/2013(11)03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 05/30/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of healthcare team guidance in the implementation of a glycemic control protocol in the non-intensive care unit of a cardiology hospital. METHODS This was a randomized clinical trial comparing 9 months of intensive guidance by a healthcare team on a protocol for diabetes care (Intervention Group, n = 95) with 9 months of standard care (Control Group, n = 87). Clinicaltrials.gov: NCT01154413. RESULTS The mean age of the patients was 61.7±10 years, and the mean glycated hemoglobin level was 71±23 mmol/mol (8.7±2.1%). The mean capillary glycemia during hospitalization was similar between the groups (9.8±2.9 and 9.1±2.4 mmol/l for the Intervention Group and Control Group, respectively, p = 0.078). The number of hypoglycemic episodes (p = 0.77), hyperglycemic episodes (47 vs. 50 in the Intervention Group and Control Group, p = 0.35, respectively), and the length of stay in the hospital were similar between the groups (p = 0.64). The amount of regular insulin administered was 0 (0-10) IU in the Intervention Group and 28 (7-56) IU in the Control Group (p<0.001), and the amount of NPH insulin administered was similar between the groups (p = 0.16). CONCLUSIONS While guidance on a glycemic control protocol given by a healthcare team resulted in a modification of the therapeutic strategy, no changes in glycemic control, frequency of episodes of hypoglycemia and hyperglycemia, or hospitalization duration were observed.
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Affiliation(s)
- Maria Antonieta P de Moraes
- Clinical Research Center, Instituto de Cardiologia, Fundação Universitária de Cardiologia, Porto AlegreRS, Brazil
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Barnes GD, Katz A, Desmond JS, Kronick SL, Beach J, Chetcuti SJ, Bates ER, Gurm HS. False activation of the cardiac catheterization laboratory for primary PCI. Am J Manag Care 2013; 19:671-675. [PMID: 24304215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES We sought to evaluate trends in door-to-balloon (D2B) times and false activation rates for the cardiac catheterization laboratory (CCL) in patients presenting to the emergency department (ED) with acute ST-elevation myocardial infarction (STEMI). In patients with STEMI, national efforts have focused on reducing D2B times for primary percutaneous coronary intervention (P-PCI). This emphasis on time-to-treatment may increase the rate of false CCL activations and unnecessary healthcare utilization. STUDY DESIGN Retrospective quality improvement chart review. METHODS We examined all emergent CCL activations for P-PCI between 2007 and 2011 at the University of Michigan Hospital. False activation was defined as emergent CCL activation when the patient did not require CCL care or emergent cardiology evaluation in the ED. Pre-hospital or ED false activation rates and mean D2B time were retrospectively determined by chart review. RESULTS The CCL was activated 717 times for suspected STEMI. The number of CCL activations increased from 96 in 2007 to 190 in 2011. False CCL activations accounted for 28% of all prehospital and 29% of all ED activations. The false activation rate increased from 15% of all cases in 2007 to 40% of all cases in 2011. The median D2B time decreased from 67 minutes in 2007 to 55 minutes in 2011. CONCLUSIONS Over a 5-year period with a strong emphasis on reducing D2B times, there has been an increased CCL false activation rate for P-PCI.
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Affiliation(s)
- Geoffery D Barnes
- CVC Cardiovascular Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5853. E-mail:
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Carlson J. Under scrutiny: cardiologists feeling pressure over 70% criterion. Mod Healthc 2013; 43:12-13. [PMID: 23878918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Bagger H. [PCI should be decentralized. The National Board of Health and the Danish Society of Cardiology ought to take the debate]. Ugeskr Laeger 2013; 175:380. [PMID: 23530280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Heathfield E, Hussain T, Qureshi S, Valverde I, Witter T, Douiri A, Bell A, Beerbaum P, Razavi R, Greil GF. Cardiovascular magnetic resonance imaging in congenital heart disease as an alternative to diagnostic invasive cardiac catheterization: a single center experience. CONGENIT HEART DIS 2013; 8:322-7. [PMID: 23331640 DOI: 10.1111/chd.12032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The study aims to assess whether the increasing use of cardiovascular magnetic resonance imaging in place of diagnostic cardiac catheterization in the management of pediatric patients with congenital heart disease has had an impact on pediatric cardiac care. DESIGN Retrospective analysis of data was used. SETTING The study was performed at the Evelina Children's Hospital Cardiology Department. PATIENTS. : Elective diagnostic cardiac catheterization or magnetic resonance imaging (MRI) from 2005-2010 are included (n = 896). OUTCOME MEASURES Indication, length of stay, and incidence of complications were recorded. In cases used to plan surgery, 30-day survival following the procedure was recorded. Surgical outcomes were compared between the two groups. Surgical outcomes planned using MRI were compared with national outcomes from Congenital Cardiac Audit Database. RESULTS For catheterizations (50 patients, [31 male, median age 3 years, interquartile range 1 to 12]), median hospital stay was 1 day (interquartile range 0 to 3), and complications occurred in 11 (22%). Median hospital stay for MRI (846 patients [517 male, median age 3 years, interquartile range 0 to 9]) was significantly shorter: 0 days (interquartile range 0 to 1, P <.001), with fewer complications (16 [1.9%], P <.0001). Twenty-four catheter and 283 MRI patients underwent surgery within 18 months. One catheter patient (2.0%) and four MRI patients (1.4%) died within 30 days (P =.48). CONCLUSION Replacing catheterization with cardiovascular magnetic resonance imaging has resulted in reduced rates of complication and shorter hospital stays without a significant impact on surgical outcome.
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Affiliation(s)
- Emily Heathfield
- King's College London BHF Centre, Division of Imaging Science, Biomedical Research Centre, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
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Martine Bonhôte B, Mülhauser S, Shaha M. [Impetus for a change in life style]. Krankenpfl Soins Infirm 2013; 106:13-15. [PMID: 23802355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Dalloul G, Feldman D, Haddad N, Amruthlal Jain SK, Zarghami J, Zughaib M. Carotid artery stenting in a community hospital: a success story. J Invasive Cardiol 2013; 25:3-6. [PMID: 23293167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Carotid endarterectomy (CEA) is an effective procedure for reducing the risk of stroke in patients with carotid artery atherosclerosis. The evolution of carotid artery stenting (CAS) has made this a viable alternative to CEA in appropriate patient populations. We sought to evaluate the safety and efficacy of CAS in a high-risk population, in an effort to report such results in a medium-size community hospital. The data were then compared with the results published in the CREST and SAPPHIRE trials. METHODS The records of 280 consecutive patients undergoing carotid artery stenting between January 2005 and December 2011 were reviewed. A total of 271 patients were included in the final analysis. The clinical endpoints included cerebrovascular accident, myocardial infarction, and death in the perioperative period. RESULTS A total of 155 men (57.2%) and 116 women (42.8%) underwent CAS. A total of 259 carotid interventions (95.6%) were successful. Two of 271 patients (0.7%) experienced a minor neurologic event post procedure, with 1 patient death (0.35%) recorded. No perioperative myocardial infarctions were encountered. CONCLUSION Our findings indicate that our institution has been able to safely and effectively introduce and carry out CAS as a substitute to CEA in patients that are at high risk for surgery with results comparable to those published in large-scale clinical trials. Further studies are needed to verify whether these results can be generalized to other community hospitals, as well as to refine qualification criteria for performing physicians. Furthermore, the applicability of these results to normal-risk patients is currently being investigated.
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Affiliation(s)
- Ghassan Dalloul
- Division of Cardiology, Providence Hospital and Medical Center, Southfield, MI 48075 USA.
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Molden MM, Brown CL, Griffith BE. At the heart of integration: aligning physicians and administrators to create new value. Front Health Serv Manage 2013; 29:3-16. [PMID: 23858984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Because of its ability to create real incremental value for patients and providers, physician-hospital integration will continue to play a major role in transforming the way healthcare is delivered. Integration is more than a transaction, and without developing the right culture, new integrated organizations will struggle to transform their current model of care. Confronted with regulatory and specialty-specific environmental forces, cardiovascular physicians have integrated with health systems at a higher rate than other specialties have. In 2007, Piedmont Healthcare launched Piedmont Heart as the first integrated cardiovascular care delivery program affiliated with a community healthcare system in greater Atlanta. Piedmont Healthcare had successfully brought together hospitals and cardiovascular physicians in an organizational structure that allowed for the right culture, resulting in true integration and patient-centered care. Today, Piedmont Heart is one of the largest physician groups in the United States focused on delivering high-quality outcomes, aligning multidisciplinary cardiovascular initiatives, and allowing for smart, strategic growth. It has taken Piedmont Heart nearly five years to create new, incremental value from its center-of-excellence organizational structure, clinical pathways development, and Patient First program. Piedmont Heart had the advantage of starting earlier than many other physician-hospital integrated structures. As US healthcare moves from an industry driven by volume to one focused on value, it is organizations like Piedmont Heart that continue to drive smart integration forward and focus on innovation, despite potential disruption, that will be successful.
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O'Shea P, Daly R, Kasim S, Tormey WP. B-type natriuretic peptide in the cardiology department. Ir Med J 2012; 105:341-343. [PMID: 23495547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Heart Failure is one of the fastest growing cardiovascular diseases of the 21st century. Echocardiogram is considered the gold standard for diagnosis, but is costly, time consuming and not readily accessible to all patients. Our aim was to assess the diagnostic utility of BNP to risk stratify patients for ECHO. Seventy-four GP referred, non-pregnant patients of > or = 18 years with a working diagnosis of HF were recruited. Patients were given two appointments to attend the Cardiology Department and at each, were examined by the same cardiologist, had their medications recorded and blood drawn for BNP analysis. ECHO was performed at the second visit. The diagnosis of HF was confirmed in 49 of 74 patients (66%). The clinical utility of BNP to rule-in HF was evaluated using ROC curve analysis. The AUC was satisfactory at 0.691 (C.I. 0.573-0.793). The positive likelihood ratio (+LR) was 5.87, negative likelihood ratio (-LR) was 0.58, the positive predictive value was 92% and a negative predictive value was 47%. One-third of patients (n = 25) had a BNP >178 pg/mL, 23 of whom had HF confirmed. At this decision threshold BNP correctly classified 23 of 25 patients who were confirmed not to have HF (Specificity for HF of 92%). A BNP of > or = 178 pg/mL can be used to prioritise GP patients for ECHO.
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Affiliation(s)
- P O'Shea
- Department of Clinical Biochemistry, Galway University Hospitals, Galway.
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