Publications by authors named "B M Rahel"

30 Publications

URGENT 1.5: diagnostic accuracy of the modified HEART score, with fingerstick point-of-care troponin testing, in ruling out acute coronary syndrome.

Neth Heart J 2021 Nov 24. Epub 2021 Nov 24.

Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands.

Background: The HEART score is a validated risk stratification tool for chest pain patients presenting to the emergency department and was recently investigated for implementation in a pre-hospital setting. Fingerstick (capillary blood) point-of-care (POC) troponin testing enables quick measurements outside the hospital and seems easier to implement than the current venous blood sampling techniques. This study investigates the diagnostic accuracy of the modified HEART score, integrating fingerstick POC troponin testing, in ruling out acute coronary syndrome (ACS).

Methods: The data of 96 patients with chest pain, included in a study investigating a novel POC troponin device under development at the cardiac emergency department, were analysed retrospectively. Based on the patients' admission data and capillary POC high-sensitivity troponin I (hs-cTnI) results, the modified HEART score was determined. The outcome measure, for evaluating the diagnostic accuracy of the modified HEART score, was the occurrence of ACS.

Results: Of the total study population, 33 patients (34%) were diagnosed with ACS. Seventeen patients (18%) were classified as low risk (0-3 points) and one patient (6%) in this group was diagnosed with ACS. The sensitivity and negative predictive value of the modified HEART score was 97.0 and 97.6%, respectively.

Conclusion: The modified HEART score, integrating capillary POC hs-cTnI results, is a promising tool for ruling out ACS in patients with chest pain presenting to the cardiac emergency department. These results encourage prospective investigation into the integration of fingerstick POC troponin testing in the modified HEART score in a pre-hospital setting.
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http://dx.doi.org/10.1007/s12471-021-01646-8DOI Listing
November 2021

Association between vertebral fractures and coronary artery calcification in current and former smokers in the ECLIPSE cohort.

Osteoporos Int 2020 Feb 25;31(2):297-305. Epub 2019 Nov 25.

NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands.

In smokers and former smokers from the ECLIPSE cohort, there is an association between prevalent vertebral fractures (VFs) and coronary artery calcification (CAC). Chest CT scans provide the opportunity to evaluate VFs and CAC, which are potentially important comorbidities, each of which is amenable to effective interventions.

Introduction: Prevalence of VFs among smokers and patients with chronic obstructive pulmonary disease (COPD) is high, and an association between CAC and osteoporosis has been described. We investigated the associations between VFs and CAC (expressed in Agatston score) in (former) smokers.

Methods: Current and former smokers from the ECLIPSE study (designed to determine underlying COPD progression mechanisms) were studied. Baseline Agatston score (zero (0), medium (1-400), or high (> 400)), baseline bone attenuation (BA), and prevalent and incident VFs (vertebrae T-L) were assessed on CT.

Results: A total of 586 subjects were included (mean age 59.8 ± 8.3; 62.3% men; 70.1% with COPD; 21.0% with prevalent VFs; 196 with zero, 266 with medium, and 124 with high Agatston score). Of these, 23.4% suffered incident VFs within 3 years. In multivariate models, prevalent VFs were associated with medium (1.83 [95% CI 1.01-3.30]) and with high (OR = 3.06 [1.45-6.47]) Agatston score. After adjustment for BA, prevalent VFs were still associated with high (OR = 2.47 [1.13-5.40]), but not significantly with medium Agatston score (OR = 1.57 [0.85-2.88]). Similarly, after adjustment for BA, high (OR = 2.06 [1.02-4.13]) but not medium Agatston score (OR = 1.61 [0.88-2.94]) was associated with prevalent VFs. Agatston score at baseline was not associated with short-term VF incidence.

Conclusion: In (former) smokers, there was an association between prevalent VFs and Agatston score. Chest CT scans provide the opportunity to also evaluate for VFs and CAC, which are potentially important comorbidities, each of which is amenable to effective interventions.
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http://dx.doi.org/10.1007/s00198-019-05218-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7010611PMC
February 2020

Characteristics of a novel citizen rescue system for out-of-hospital cardiac arrest in the Dutch province of Limburg: relation to incidence and survival.

Neth Heart J 2019 Feb;27(2):100-107

Department of Cardiology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre+, Maastricht, The Netherlands.

Background: We evaluated the characteristics of a novel text message system notifying citizen rescuers in cases of out-of-hospital circulatory arrest (OHCA) in the Dutch province of Limburg, including their relation to incidence and survival.

Methods And Results: The study area comprised 2,153 km (831 mi) with 1.12 mio. inhabitants. During the 2‑year study period approximately 9,000 volunteers were registered, about 60% male, 59% with no experience in actual resuscitation, and 27.4% healthcare professionals. The system was not activated in 557 of 1,085 (51.3%) OHCAs, frequently because there was no resuscitation setting present yet at the time of the emergency call. Rescuers were notified on 1,076 occasions, with no resuscitation setting being present in 548 of 1,076 (50.9%) notifications. OHCA incidence rates were 67 per 100,000 inhabitants per year, 95 per 100,000 men and 39 per 100,000 women standardised for age with the European Standard Population. The mean number of notifications per volunteer was 1.3 times per year. Higher volunteer density was related to increased survival if at least one volunteer attended the cardiac arrest. If the density exceeded 0.75%, survival increased to 34.8% compared to 20.6% at a density below 0.25%.

Conclusion: In about half of OHCAs needing resuscitation the system was activated and in approximately half of the notifications resuscitation proved to be justified. Volunteers are notified 1.3 times per year on average. Survival was related to volunteer density, suggesting that further improvement can be achieved by increasing the number of citizen rescuers.
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http://dx.doi.org/10.1007/s12471-018-1215-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352615PMC
February 2019

Non-cardiac chest pain: prognosis and secondary healthcare utilisation.

Open Heart 2018;5(2):e000859. Epub 2018 Oct 15.

Department of Cardiology, University Medical Centre, Utrecht, The Netherlands.

Objective: Presentations of non-cardiac chest pain (NCCP) to the emergency department (ED) are increasing. More knowledge of prognosis and healthcare utilisation of patients with NCCP is necessary to optimise their management.

Methods: This study is a prospective, observational, prevalence-based cohort study conducted from September 2015 to February 2016 with 1-year follow-up including all patients 18 years and older referred to the ED with chest pain. Discharge diagnoses, mortality, major adverse cardiac events (MACE), re-presentations to the ED, hospitalisations, cardiac interventions and outpatient monitoring were assessed.

Results: More than 60% of the 1239 patients presenting with chest pain were discharged with NCCP. The all-cause 1-year mortality rate of patients with NCCP was 2.3% compared with 7.2% in patients with cardiac chest pain (CCP) (p<0.001) and the occurrence of MACE was 5.1% vs 8.3%, respectively (p=0.026). Previous history of coronary artery disease (CAD) in patients with NCCP was identified as a predictive factor for MACE (OR 4.30 (95% CI 1.24 to 14.89), p=0.021). Patients with NCCP had more non-invasive interventions than patients with CCP (proportion of 0.225 vs 0.165 per patient, p<0.001) and 13.7% of patients with NCCP re-presented at the ED within 1  year.

Conclusion: The majority of patients referred to the ED with chest pain are discharged with NCCP. The prognosis of patients with NCCP is better than patients with CCP; however, they are at risk for MACE due to a history of CAD. Patients with NCCP moreover use a substantial amount of medical resources, stressing the importance of good triage to minimise unnecessary healthcare utilisation while still preventing MACE.
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http://dx.doi.org/10.1136/openhrt-2018-000859DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6196943PMC
February 2021

Correction to: Circumstances and causes of sudden circulatory arrests in the Dutch province of Limburg and the involvement of citizen rescuers.

Neth Heart J 2018 03;26(3):171-172

Department of Cardiology, CAPHRI school for Public Health and Primary Care, Maastricht University Medical Centre+, Maastricht, The Netherlands.

Correction to:Neth Heart J 2017 https://doi.org/10.1007/s12471-017-1057-1 In the version of the article originally published online, there was an error in the last section of the Discussion. It is stated that 'In 42% of the OHCAs a volunteer alert would have been appropriate, but the alert system ….
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http://dx.doi.org/10.1007/s12471-018-1078-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5818377PMC
March 2018
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