563 results match your criteria Critical Pathways in Cardiology[Journal]


Genomic Analysis of an Obesity Paradox: A Microarray Study of the Aortas of Morbidly Obese Decedents With Mild and Severe Atherosclerosis.

Crit Pathw Cardiol 2019 03;18(1):57-60

From the Department of pathology.

Background: Atherosclerosis of the aorta and coronary arteries is still one of the major causes of death. We recently reported obesity paradox between body mass index and atherosclerosis of the aortas (AA) in morbidly obese decedent patients. The cause of this obesity paradox is unknown. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375103PMC
March 2019
2 Reads

Improving Door-to-needle Times in the Treatment of Acute Ischemic Stroke Across a Canadian Province: Methodology.

Crit Pathw Cardiol 2019 03;18(1):51-56

From the Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB.

Background: Alteplase is a proven medical treatment for acute ischemic stroke; however, the effectiveness of this treatment is highly time dependent. Therefore, it is imperative that hospitals treat acute ischemic stroke patients as quickly as possible. The measure, door-to-needle time, is the time from hospital arrival to when alteplase administration begins. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000173DOI Listing
March 2019
1 Read

Mobile Geolocation Technology to Improve Multidisciplinary Care of Patients With Ventricular Assist Devices: A Feasibility Study.

Crit Pathw Cardiol 2019 03;18(1):47-50

From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA.

We evaluated the feasibility of a mobile phone-based geolocation technology in patients with ventricular assist devices (VAD). We prospectively enrolled VAD patients with a smartphone for 6 months. A proprietary mobile technology platform (Position Health, Reading, MA) was downloaded onto Apple or Android smartphones. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000160DOI Listing

Adherence to NSTEMI Guidelines in the Emergency Department: Regression to Reality.

Crit Pathw Cardiol 2019 03;18(1):40-46

Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.

Background: Adherence to guidelines for the initial treatment of ST-Segment Elevation Myocardial Infarction has been thoroughly studied, whereas the study of emergency department (ED) adherence to guidelines for Non-ST-Segment Elevation Myocardial Infarction-Acute Coronary Syndrome (NSTEMI-ACS) has been much scarcer. The recommended guidelines for the initial prompt workup and treatment of NSTEMI-ACS remains a challenge.

Aim: We studied adherence to guidelines for NSTEMI in the ED. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000165DOI Listing
March 2019
1 Read

Diagnostic and Prognostic Role of the Modified Diamond-Forrester Model in Combination With Coronary Calcium Score in Acute Chest Pain Patients.

Crit Pathw Cardiol 2019 03;18(1):32-39

From the Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY.

Background: The aim of this study was to evaluate whether pretest probability (PTP) assessment using the Diamond-Forrester Model (DFM) combined with coronary calcium scoring (CCS) can safely rule out obstructive coronary artery disease (CAD) and 30-day major adverse cardiovascular events (MACE) in acute chest pain patients.

Methods: We retrospectively evaluated consecutive patients, age ≥18 years, with no known CAD, negative initial electrocardiogram, and troponin level. All patients had coronary computed tomographic angiography (CCTA) with CCS, and our final cohort consisted of 1988 patients. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000167DOI Listing
March 2019
10 Reads

Effect of Age on Procedural Success, Complications, and Clinical Outcome From a Large Angioplasty Registry.

Crit Pathw Cardiol 2019 03;18(1):23-31

University of Arizona College of Medicine, Tucson, AZ.

Background: Increasing age appears to be a risk factor for adverse outcome in patients undergoing percutaneous coronary intervention (PCI). The goal of this study was to compare procedural success, complications, and 12 months major adverse cardiac events (MACE) based on age using a large angioplasty registry.

Methods: This registry included 10,412 patients with at least 12-month follow-up from April 1993 to April 2011. Read More

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http://Insights.ovid.com/crossref?an=00132577-201903000-0000
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http://dx.doi.org/10.1097/HPC.0000000000000158DOI Listing
March 2019
2 Reads

Emergency Department Observation Unit Utilization Among Older Patients With Chest Pain.

Crit Pathw Cardiol 2019 03;18(1):19-22

From the Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT.

Background: Although some emergency department observation units (EDOUs) may exclude patients over 65 years old, our EDOU accepts patients up to 79 years old. We assessed the utilization of our EDOU by older patients (those 65-79 years old).

Methods: We prospectively enrolled emergency department (ED) patients with chest pain. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000166DOI Listing
March 2019
5 Reads

One-Hour High Sensitivity Troponin Testing: A Safe and Effective Triage Tool for the Emergency Department.

Crit Pathw Cardiol 2019 03;18(1):16-18

Royal Berkshire NHS Foundation Trust, Reading, United Kingdom.

The latest European Society of Cardiology guideline on the management of acute coronary syndromes without persistent ST-elevation stipulates several acceptable pathways through which patients presenting with chest pain can be assessed for unstable coronary disease. This article reviews the data behind the "rule-in and rule-out algorithm," which can exclude acute myocardial infarction within 1 hour of presentation through the use of fifth generation high-sensitivity troponin assays. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000162DOI Listing
March 2019
2 Reads

Symptoms Predictive of Acute Myocardial Infarction in the Troponin Era: Analysis From the TRAPID-AMI Study.

Crit Pathw Cardiol 2019 03;18(1):10-15

Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.

The TRAPID-AMI (High Sensitivity Cardiac Troponin T assay for rapid Rule-out of Acute Myocardial Infarction) study evaluated a rapid "rule-out" acute myocardial infarction (AMI). We evaluated what symptoms were associated with AMI as part of a substudy of TRAPID-AMI. There were 1282 patients evaluated from 12 centers in Europe, the United States of America, and Australia from 2011 to 2013. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000163DOI Listing
March 2019
3 Reads

ACES (Accelerated Chest Pain Evaluation With Stress Imaging) Protocols Eliminate Testing Disparities in Patients With Chest Pain.

Crit Pathw Cardiol 2019 03;18(1):5-9

Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC.

Background: Patients from racial and ethnic minority groups presenting to the Emergency Department (ED) with chest pain experience lower odds of receiving stress testing compared with nonminorities. Studies have demonstrated that care pathways administered within the ED can reduce health disparities, but this has yet to be studied as a strategy to increase stress testing equity.

Methods: A secondary analysis from 3 randomized clinical trials involving ED patients with acute chest pain was performed to determine whether a care pathway, ACES (Accelerated Chest pain Evaluation with Stress imaging), reduces the racial disparity in index visit cardiac testing between African American (AA) and White patients. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375104PMC
March 2019
2 Reads

Acceptance of the Chest Pain Unit Certification Process: Current Status in Germany.

Crit Pathw Cardiol 2018 12;17(4):212-214

Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.

The nationwide German certification process of specialized chest pain units is unique in Europe. By February 2018, 269 units had already been successfully certified. With that number, more than half of all catheter laboratories across the country offering service on a 24/7 basis for interventional treatment in myocardial infarction take part in that certified chest pain program - with still increasing tendency. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000152DOI Listing
December 2018
1 Read

Are Prior Aspirin Users With ST-Elevation Myocardial Infarction at Increased Risk of Adverse Events and Worse Angiographic Features?

Crit Pathw Cardiol 2018 12;17(4):208-211

From the Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Despite its clinical benefits, aspirin has been considered one of the predictors of worse outcomes in patients with unstable angina/non-ST-segment-elevation myocardial infarction. Nevertheless, such association has not been demonstrated in patients with ST-elevation myocardial infarction (STEMI). Five hundred eighty-six STEMI patients undergoing primary percutaneous coronary intervention were evaluated including 116 prior aspirin users. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000159DOI Listing
December 2018
1 Read

Facilitators and Barriers to Reducing Emergency Department Admissions for Chest Pain: A Qualitative Study.

Crit Pathw Cardiol 2018 12;17(4):201-207

Brigham and Women's Hospital, Boston, MA.

Background: Chest pain of possible cardiac etiology is a leading reason for emergency department (ED) visits and hospitalizations nationwide. Evidence suggests outpatient management is safe and effective for low-risk patients; however, ED admission rates for chest pain vary widely. To identify barriers and facilitators to outpatient management after ED visits, we performed a multicenter qualitative study of key stakeholders. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000145DOI Listing
December 2018
1 Read

Implementation of the HEART Pathway: Using the Consolidated Framework for Implementation Research.

Crit Pathw Cardiol 2018 12;17(4):191-200

Departments of Emergency Medicine, Implementation Science, and Epidemiology and Prevention, Wake Forest School of Medicine, One Medical Center Boulevard, Winston-Salem, NC.

Objective: The HEART Pathway is an evidence-based decision tool for identifying emergency department (ED) patients with acute chest pain who are candidates for early discharge, to reduce unhelpful and potentially harmful hospitalizations. Guided by the Consolidated Framework for Implementation Research, we sought to identify important barriers and facilitators to implementation of the HEART Pathway.

Study Setting: Data were collected at 4 academic medical centers. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234854PMC
December 2018
18 Reads

Incorporation of the HEART Score Into a Low-risk Chest Pain Pathway to Safely Decrease Admissions.

Crit Pathw Cardiol 2018 12;17(4):184-190

From the Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, FL.

Chest pain can be a challenging complaint to manage in the emergency department. A missed diagnosis can result in significant morbidity or mortality, whereas avoidable testing and hospitalizations can lead to increased health care costs, contribute to hospital crowding, and increase risks to patients. The HEART score is a validated decision aid to identify patients at low risk for acute coronary syndrome who can be safely discharged without admission or objective cardiac testing. Read More

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http://Insights.ovid.com/crossref?an=00132577-201812000-0000
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http://dx.doi.org/10.1097/HPC.0000000000000155DOI Listing
December 2018
16 Reads

Prognostic Utility of the HEART Score in the Observation Unit.

Crit Pathw Cardiol 2018 12;17(4):179-183

From the Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI.

The evaluation of individuals with possible acute myocardial infarction (AMI) is time consuming and costly. Risk stratification early during an acute care encounter presents an opportunity for increased delivery of high-value care. We sought to evaluate if the HEART score could be used in the triage of low-risk versus high-risk patients directly home without cardiac testing. Read More

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http://Insights.ovid.com/crossref?an=00132577-201812000-0000
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http://dx.doi.org/10.1097/HPC.0000000000000157DOI Listing
December 2018
14 Reads

Implementation of High-Sensitivity Cardiac Troponin: Challenges From the International Experience.

Crit Pathw Cardiol 2018 12;17(4):173-178

Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA.

Objective: Implementation of the newly approved high-sensitivity cardiac troponin (hs-cTn) in the United States presents a challenge for clinical practice. Sex-specific cutoffs, clinical protocols, and workflows will likely require modifications before implementation.

Methods: We conducted a cross-sectional survey of international physicians and laboratorians already utilizing hs-cTn for the evaluation of acute myocardial infarction. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234850PMC
December 2018
1 Read

Unexpected Cardiac MRI Findings in Patients Presenting to the Emergency Department for Possible Acute Coronary Syndrome.

Crit Pathw Cardiol 2018 09;17(3):167-171

Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC.

Background: Stress cardiac magnetic resonance imaging (CMR) has become increasingly used in patients presenting to the emergency department (ED) with symptoms concerning for acute coronary syndrome (ACS). We hypothesized that CMR detects a number of alternative diagnoses (diagnoses other than ACS that could explain symptoms) and incidental findings in patients presenting to the ED for potential ACS.

Methods: We prospectively enrolled adult patients who presented to an academic ED from 2011 to 2015 for possible ACS and subsequently had an adenosine stress perfusion CMR as part of their diagnostic evaluation. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000148DOI Listing
September 2018
13 Reads

Serum Uric Acid and Atrial Fibrillation: Meta-analysis.

Crit Pathw Cardiol 2018 09;17(3):161-166

Department of Mathematics and Statistics, Toledo University, Toledo, OH.

Hyperuricemia has been recently speculated to be associated with the development of atrial fibrillation (AF). A meta-analysis of observational studies was conducted to explore the relationship between serum uric acid (SUA) and AF. We searched the MEDLINE, EMBASE, and CINAHL databases and performed extensive bibliography search to identify studies with mean SUA level for patients with and without AF. Read More

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http://Insights.ovid.com/crossref?an=00132577-201809000-0000
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http://dx.doi.org/10.1097/HPC.0000000000000150DOI Listing
September 2018
28 Reads

The Impact of Formal Training and Certification on the Relationship Between Volume and Outcomes in Percutaneous Coronary Interventions.

Crit Pathw Cardiol 2018 09;17(3):155-160

From the Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.

Background: Little data are available on the impact of formal training and certification on the relationship between volumes and outcome in percutaneous coronary interventions (PCIs).The objective of this report is to study the relationship between PCI volume and outcome for a formally trained interventional cardiologist who is certified by the American Board on Internal Medicine - Interventional Cardiology subspecialty board.

Methods: The operator witnessed 3 different PCI volumes/yr over a 15-year practice period (2000-2014): <50 PCI/yr (years 2000-2006; n = 179), 50-100 PCI/yr (years 2007-2010; n = 256), and >100 PCI/yr (years 2011-2014; n = 427). Read More

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http://dx.doi.org/10.1097/HPC.0000000000000153DOI Listing
September 2018
1 Read

A New Feasible Syncope Risk Score Appropriate for Emergency Department: A Prospective Cohort Study.

Crit Pathw Cardiol 2018 09;17(3):151-154

From the Tehran Heart Center and School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Background: We aimed to compare current syncope risk stratification scores and propose a new more feasible and easy-to-use one.

Methods: In this prospective cohort study, we enrolled all patients (≥18 years) with chief complaint of syncope if they were not eligible for admission in terms of high-risk features. San Francisco Syncope Rule, Osservatorio Epidemiologico sulla Sincope nel Lazio, and risk stratification of syncope in the emergency department scores were compared in our population. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000146DOI Listing
September 2018
5 Reads

Importance of a Risk Stratification Strategy to Identify High-risk Patients Presenting With Cocaine-associated Acute Coronary Syndrome.

Crit Pathw Cardiol 2018 09;17(3):147-150

From the University of Miami Miller School of Medicine, Graduate Medical Education, Department of Medicine, Devision of Cardiology at JFK Medical Center, Atlantis, FL.

Objective: Current guidelines recommend treating patients with cocaine-associated chest pain, unstable angina, or myocardial infarction similarly to patients with traditional acute coronary syndrome (ACS). Risk stratifying these patients could potentially reduce unnecessary procedures and improve resource utilization.

Methods: This is a retrospective cross-sectional analysis of 258 patients presenting with cocaine-associated ACS who underwent cardiac catheterization in a community teaching hospital between 2006 and 2015. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000147DOI Listing
September 2018
17 Reads

Role of Hypertension and Other Clinical Variables in Prognostication of Patients Presenting to the Emergency Department With Major Bleeding Events.

Crit Pathw Cardiol 2018 09;17(3):139-146

Intervention Radiology, North-West District Tuscany HealthCare, Apuane General Hospital, Massa-Carrara, Italy.

Background: Clinical variables including hypertension could be linked with major bleeding events and death beyond vitamin K antagonist (warfarin) or direct oral anti-coagulants (DOACs) treatment strategy.

Methods: Subgroup analysis of major bleeding (primary endpoint) associated with clinical variables, site of bleeding, ongoing antithrombotics, reversal treatment or blood transfusion, outcomes (secondary endpoints) was performed in patients with bleeding events submitted to hard 5:1 propensity-score matching for hypertension.

Results: Enrolled patients were 2,792 (mean age, 65. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000139DOI Listing
September 2018
5 Reads

Continuum of Care for Acute Coronary Syndrome: Optimizing Treatment for ST-Elevation Myocardial Infarction and Non-St-Elevation Acute Coronary Syndrome.

Crit Pathw Cardiol 2018 09;17(3):114-138

President, EMCREG-International, Professor of Emergency Medicine, Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH.

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http://dx.doi.org/10.1097/HPC.0000000000000151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6072372PMC
September 2018
19 Reads

Atrial Fibrillation and the Weekend Effect Regarding Cardioversion, Length of Stay, Readmission, and Mortality.

Crit Pathw Cardiol 2018 09;17(3):111-113

From the Montefiore Medical Center, Bronx, NY.

Background: The weekend effect is a phenomenon in which worse outcomes have been found to occur over the weekend. This has been investigated in the context of stroke, ST-elevation myocardial infarction, and pulmonary embolism among others. Atrial fibrillation (AF) is the most common sustained arrhythmia, and admissions for AF have been increasing. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000128DOI Listing
September 2018
5 Reads

Monocyte Chemoattractant Protein-1 as a Predictor of Coronary Atherosclerosis in Patients Receiving Coronary Angiography.

Crit Pathw Cardiol 2018 06;17(2):105-110

From the Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC.

Background: Animal studies suggest that monocyte chemoattractant protein-1 (MCP-1) is a promising biomarker for coronary artery atherosclerosis (CAA), but human studies have been inconclusive.

Objective: To determine potential relationships between plasma MCP-1 and CAA in patients with acute chest pain.

Methods: A secondary analysis of 150 patients enrolled in emergency department chest pain risk stratification clinical investigations was conducted. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5959046PMC
June 2018
5 Reads

Contrast-Enhanced Stress Echocardiography and Myocardial Perfusion Imaging in Patients Hospitalized With Chest Pain: A Randomized Study.

Crit Pathw Cardiol 2018 06;17(2):98-104

From the Department of Medicine, Division of Cardiology, Denver Health Medical Center, Denver CO.

Ultrasound contrast-enhanced stress echocardiography improves endocardial visualization, but diagnostic test rates versus stress myocardial perfusion imaging (MPI) have not been studied. A prospective randomized trial was performed between April 2012 and October 2014 at a single-center, safety net hospital. Hospitalized patients referred for noninvasive stress imaging were randomized 1:1 to stress echocardiography or stress MPI. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000141DOI Listing
June 2018
6 Reads

Angiographic Characteristics of ST-Elevation Myocardial Infarction Patients With Infarct-related Coronary Artery Ectasia Undergoing Primary Percutaneous Coronary Intervention.

Crit Pathw Cardiol 2018 06;17(2):95-97

From the Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Coronary ectasia accounts for 0.3%-4.9% of patients undergoing coronary angiography. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000143DOI Listing
June 2018
3 Reads

HEART Failure? Episodes of Missed Major Cardiac Events When Applying the HEART Pathway to an Observation Unit Population.

Crit Pathw Cardiol 2018 06;17(2):88-94

From the Department of Hospital Medicine, Duke University Health Systems, Durham, NC.

Objective: The HEART Pathway risk prediction tool (HEART score plus serial troponin measures at 0 and 3 hours post-presentation) is used to identify low-risk patients with chest pain who may qualify for safe, early discharge. We calculated the percentage of patients in our observation unit that qualified as low risk using HEART Pathway, as well as their associated outcomes.

Methods: We retrospectively reviewed charts on 966 consecutive patients admitted to our observation unit for chest pain (January 2015 to February 2016); HEART Pathway scores were retrospectively calculated and serial cardiac troponin values logged. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000137DOI Listing
June 2018
2 Reads

Evaluation of Compliance with a Weight-based Nurse-driven Heparin Nomogram in a Tertiary Academic Medical Center.

Crit Pathw Cardiol 2018 06;17(2):83-87

From the Department of Pharmacy, Brigham and Women's Hospital, Boston, MA.

Background: Recently, our institution adopted a weight-based nurse-driven heparin titration protocol that relies on nurses ordering laboratories, adjusting doses, and initiating boluses. Numerous institutions have implemented similar protocols with reported success.

Methods: A single-center retrospective analysis was conducted at the Brigham and Women's Hospital in Boston, Massachusetts that included all patients who were initiated on the weight-based nurse-driven heparin nomogram during a 30-day period. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000113DOI Listing
June 2018
3 Reads

Angiography-guided Multivessel Percutaneous Coronary Intervention Versus Ischemia-guided Percutaneous Coronary Intervention Versus Medical Therapy in the Management of Significant Disease in Non-Infarct-related Arteries in ST-Elevation Myocardial Infarction Patients With Multivessel Coronary Disease.

Crit Pathw Cardiol 2018 06;17(2):77-82

Princess Margaret Hospital, Lai Chi Kok, Hong Kong.

Background: In ST-elevation myocardial infarction (STEMI) patients with multivessel (MV) disease, after primary percutaneous coronary intervention (PCI), emerging evidence suggests that significant disease in non-infarct-related coronary arteries (IRAs) should be routinely stented. Whether this procedure should be guided by angiography alone or ischemia testing is unclear.

Methods: All STEMI patients treated with primary PCI between January 1, 2005, and December 31, 2012, at a tertiary cardiology center were reviewed retrospectively. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000144DOI Listing
June 2018
5 Reads

Medication Administration Delays in Non-ST Elevation Myocardial Infarction: Analysis of 1002 Patients Admitted to an Academic Medical Center.

Crit Pathw Cardiol 2018 06;17(2):73-76

Division of Cardiovascular Medicine, University of Florida, Gainesville, FL.

Our goal was to assess adherence to American College of Cardiology/American Heart Association guideline-based medical therapy in patients admitted with type I non-ST elevation myocardial infarction (NSTEMI) and to determine factors associated with medication administration delay. We performed a retrospective analysis using data from the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry. Baseline patient demographics, 12-lead electrocardiogram (ECG) findings, laboratory values, medications administered and the time they were administered, and in-hospital clinical outcomes were collected. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000142DOI Listing
June 2018
2 Reads

The Incidence of Myocardial Injury after Loading Doses of Clopidogrel versus Prasugrel in the Candidates for Percutaneous Coronary Intervention: A Randomized Controlled Trial.

Crit Pathw Cardiol 2018 06;17(2):69-72

Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Prevention of myocardial injury is an essential issue in percutaneous coronary intervention (PCI). We compared the incidence of myocardial injury after loading doses of clopidogrel versus prasugrel in the candidates for PCI.

Methods: In this randomized-controlled clinical trial, we enrolled 88 stable angina patients, candidate for PCI. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000114DOI Listing
June 2018
9 Reads

Advances in the Treatment of Stable Coronary Artery Disease and Peripheral Artery Disease.

Authors:
W Brian Gibler

Crit Pathw Cardiol 2018 06;17(2):53-68

President, EMCREG-International, Professor of Emergency Medicine, University of Cincinnati Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH.

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http://dx.doi.org/10.1097/HPC.0000000000000149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5965920PMC
June 2018
2 Reads

Two-year Follow-up of Patients With Unstable Angina/Non-ST Segment Elevation Myocardial Infarction Undergoing Early Invasive Strategy: Predictors of Normal or Near-Normal Coronary Angiography and Mortality.

Crit Pathw Cardiol 2018 03;17(1):47-52

Background: Predictors of normal or near-normal coronary angiography (NONCAG) in patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) and their importance regarding the prognosis are not understood. Accordingly, we determined these predictors as well as mortality risk factors at 2-year follow-up of UA/NSTEMI patients managed by the early invasive strategy.

Methods: We prospectively studied consecutive patients with UA/NSTEMI managed with the early invasive strategy at Tehran Heart Center, in 1-year period. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000108DOI Listing
March 2018
7 Reads

Complementary Diagnostic Value of Heart Type Fatty Acid-binding Protein in Early Detection of Acute Myocardial Infarction.

Crit Pathw Cardiol 2018 03;17(1):43-46

Background: Heart-type fatty acid-binding protein (H-FABP) is a novel biomarker for myocardial injury. We compared the use of H-FABP with serum levels of cardiac troponin-T (cTnT) and creatine kinase-MB (CK-MB) in the diagnosis of patients suspicious to acute myocardial infarction (AMI).

Methods: From October 2013 to December 2014, 182 consecutive patients suspicious to acute coronary syndrome were enrolled in this study, who presented within the past 6 hours from the onset of symptoms. Read More

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http://Insights.ovid.com/crossref?an=00132577-201803000-0000
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http://dx.doi.org/10.1097/HPC.0000000000000107DOI Listing
March 2018
16 Reads

Positive Predictive Value of Noninvasive Stress Testing Is Poor in the Real World.

Crit Pathw Cardiol 2018 03;17(1):38-42

Abnormal noninvasive stress test (NIST) findings do not always correlate with angiographically significant (luminal obstruction ≥50%) coronary artery disease. Positive predictive value (PPV) of NIST in the real clinical practice is not well known. The goal of this retrospective study was to determine the PPV of NIST and assess the factors affecting PPV in a US community hospital. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000116DOI Listing
March 2018
12 Reads

Development of an Outpatient Guideline for Optimal Anticoagulation Bridging in Patients With Durable Mechanical Circulatory Support.

Crit Pathw Cardiol 2018 03;17(1):32-37

Patients with durable mechanical circulatory support are at increased risk of thromboembolic and bleeding complications. Current guidelines recommend that these patients receive chronic anticoagulation with warfarin to maintain a target international normalized ratio (INR) as specified by device manufacturers. Limited data exist regarding management of subtherapeutic INRs in this setting. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000131DOI Listing
March 2018
10 Reads

Contrast-Induced Nephropathy in STEMI Patients With and Without Chronic Kidney Disease.

Crit Pathw Cardiol 2018 03;17(1):25-31

Introduction: Contrast-induced nephropathy (CIN) following percutaneous coronary intervention (PCI) is associated with adverse outcomes; however, there are scarce data comparing clinical outcomes of post-PCI CIN in ST elevation myocardial infarction (STEMI) patients with and without chronic kidney disease (CKD). We sought to assess the incidence, clinical predictors, and short-term and long-term clinical outcomes of post-PCI CIN in STEMI patients with and without CKD.

Methods: We performed a retrospective observational cohort study involving 554 patients who underwent PCI for STEMI from February 2010 to November 2013. Read More

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http://Insights.ovid.com/crossref?an=00132577-201803000-0000
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http://dx.doi.org/10.1097/HPC.0000000000000123DOI Listing
March 2018
9 Reads

ECG-to-Decision Time Impact on 30-Day Mortality and Reperfusion Times for STEMI Care.

Crit Pathw Cardiol 2018 03;17(1):19-24

Objectives: Little data are published on the unique care performance metric of electrocardiogram-to-decision time (E2Decide) for primary percutaneous coronary intervention (PCI) treatment of ST-elevation myocardial infarction (STEMI). The objective of this study is to evaluate E2Decide time on mortality and delayed reperfusion.

Methods: This was a retrospective study of STEMI activations treated with primary PCI at 2 PCI-capable hospitals located in Duluth, Minnesota, and Fargo, North Dakota, originating in 3 different settings: (1) primary PCI-capable hospital emergency departments, (2) non-PCI facilities, and (3) in the field by emergency medical services. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000130DOI Listing
March 2018
5 Reads

Clinical Outcomes of Transferred Versus Onsite Primary Percutaneous Coronary Intervention for Patients With STEMI: Time to Look Beyond Door to Balloon Time.

Crit Pathw Cardiol 2018 03;17(1):13-18

Background: It is currently unknown if the delay due to practical aspects associated with transfer of patients from a non-percutaneous coronary intervention (PCI) facility to a primary PCI facility is associated with adverse outcomes.

Methods: We conducted a retrospective cohort study of all patients who presented with ST-segment elevation myocardial infarction (STEMI) and underwent primary PCI in 2 large regional STEMI centers in Massachusetts between January 2005 and June 2009. The cohort was divided into onsite patients who presented directly to the primary PCI center and transferred patients referred from another facility. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000117DOI Listing
March 2018
7 Reads

Experiences of a One-hour Algorithm in Chest Pain Patients With a Nonelevated Troponin T at Presentation.

Crit Pathw Cardiol 2018 03;17(1):6-12

Background: We aimed to evaluate the use of a 1-hour measurement of high-sensitivity cardiac troponin T (hs-cTnT) in an emergency department (ED) population of chest pain patients with a nonelevated baseline hs-cTnT and to examine the prevalence of early dynamic changes in hs-cTnT and the association with admission rate, diagnosis, and outcome.

Methods: All patients with a chief complaint of chest pain presenting to the ED of Karolinska University Hospital, Solna, Sweden, from December 2014 to September 2015 who had a baseline hs-cTnT of ≤14 ng/L and a second value obtained within >30 to ≤90 minutes were followed for 30 days regarding admission, readmission, myocardial infarction (MI), and death.

Results: A total of 1091 patients were included. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000138DOI Listing
March 2018
11 Reads

Implementation of an Early Discharge Protocol and Chest Pain Clinic for Low-Risk Chest Pain in the Emergency Department.

Crit Pathw Cardiol 2018 03;17(1):1-5

Background: Most of the patients presenting to emergency department with chest pain are at low risk of adverse events. Identifying high-risk patients can be challenging and resource intensive.

Methods: We created a protocol to assist early discharge of low-risk adults with chest pain from emergency department. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000136DOI Listing
March 2018
10 Reads

Community Outreach in Terms of Early Heart Attack Care as a New Way of Thinking in Chest Pain Center/Unit Care Giving-Commentary on the German Chest Pain Unit Network.

Crit Pathw Cardiol 2017 12;16(4):167-168

From the *Society of Cardiovascular Patient Care; †West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Duisburg-Essen, Essen, Germany; and ‡Department of Cardiology, Arnsberg Medical Center, Arnsberg, Germany.

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http://dx.doi.org/10.1097/HPC.0000000000000127DOI Listing
December 2017
19 Reads

Impact of Sex on Long-term Clinical Outcomes After Percutaneous Coronary Intervention.

Crit Pathw Cardiol 2017 12;16(4):161-166

From the *Tehran Heart Center, General Cardiology Department, Tehran University of Medical Sciences; †Tehran Heart Center, Interventional Cardiology Department, Tehran University of Medical Sciences; ‡Internal Medicine Department, Shariati Hospital, Tehran University of Medical Sciences; §Tehran Heart Center, Research Department, Tehran University of Medical Sciences; ¶University of Arizona, Tucson, AZ; ‖CareMore, Tucson, AZ; **Tabriz University of Medical Sciences, Tabriz, Iran; and ††Tehran Heart Center, Electrophysiology Department, Tehran University of Medical Sciences.

Aims: To evaluate the impact of sex on long-term clinical outcomes after percutaneous coronary intervention (PCI).

Methods: In a large prospective cohort, 5664 patients (1716 women and 3948 men) who underwent PCI in a tertiary cardiac center between March 2007 and March 2010 were enrolled. Patients were followed up for median of 74. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000126DOI Listing
December 2017
13 Reads

Potassium Chloride Sustained Release Dosing Pathway in an Academic Medical Center.

Crit Pathw Cardiol 2017 12;16(4):158-160

From the Department of Pharmacy, Brigham and Women's Hospital, Boston, MA.

Potassium supplementation can be administered intravenously or orally with either immediate release or sustained release formulations. Sustained release potassium chloride allows for delayed absorption and peak effects. In the inpatient setting, it is important to monitor and prevent both hypokalemia and hyperkalemia. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000134DOI Listing
December 2017
6 Reads

Patient Ethnicity Predicts Poor Health Access and Gaps in Perception of Personal Cardiovascular Risk Factors.

Crit Pathw Cardiol 2017 12;16(4):147-157

From the *Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven CT; †Department of Emergency Medicine, Albany Medical Center, Albany, NY; and ‡Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.

Background: Focus of health literacy campaigns has centered around raising awareness. It is unknown whether awareness of coronary artery disease risk factors accurately reflects personalization of one's own cardiovascular risk.

Methods: A cross-sectional survey was performed in consecutive patients presenting with chest pain admitted to an observation unit of a tertiary care hospital. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000132DOI Listing
December 2017
7 Reads

Troponin Limit of Detection Plus Cardiac Risk Stratification Scores to Rule Out Acute Myocardial Infarction and 30-Day Major Adverse Cardiac Events in ED Patients.

Crit Pathw Cardiol 2017 12;16(4):142-146

*Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA; and †Department of Emergency Medicine, UT Southwestern Medical Center.

When screening for acute myocardial infarction (AMI), troponin levels below the 99th percentile, including those below the limit of detection (LOD), are considered normal. We hypothesized that a low-risk HEART score (0-3) or ACS Pretest Probability Assessment <2% plus a single troponin below the LOD would rule out both AMI and 30-day major adverse cardiac events (MACE). We studied all patients who presented to a single academic emergency department and received a troponin I (Siemens Ultra Troponin I) from September 1, 2013, to November 13, 2013 (n=888). Read More

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http://dx.doi.org/10.1097/HPC.0000000000000129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5690549PMC
December 2017
20 Reads

Efficacy of Implementation of a Chest Pain Center at a Community Hospital.

Crit Pathw Cardiol 2017 12;16(4):135-141

From the *Department of Emergency Medicine, Southern California Heart Centers, San Gabriel, CA; and †Garfield Medical Center, Monterey Park, CA.

Introduction: Chest pain is the second leading cause for emergency department (ED) visits in the United States; however, <20% of the patients have acute coronary syndrome that require immediate attention. The HEART score is designed for rapid risk stratification of ED chest pain patients using the following criteria: history, electrocardiogram, age, risk factors, and troponin. It has been shown to be superior in identifying patients with low (HEART score 0-3) and high (7-10) risk of major adverse cardiac events, who can then be rapidly discharged or admitted for intervention. Read More

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http://dx.doi.org/10.1097/HPC.0000000000000133DOI Listing
December 2017
10 Reads