Critical pathways in cardiology
-
Observational Study
Chest Pain Risk Scores Can Reduce Emergent Cardiac Imaging Test Needs With Low Major Adverse Cardiac Events Occurrence in an Emergency Department Observation Unit.
To compare and evaluate the performance of the HEART, Global Registry of Acute Coronary Events (GRACE), and Thrombolysis in Myocardial Infarction (TIMI) scores to predict major adverse cardiac event (MACE) rates after index placement in an emergency department observation unit (EDOU) and to determine the need for observation unit initiation of emergent cardiac imaging tests, that is, noninvasive cardiac stress tests and invasive coronary angiography. ⋯ Chest pain risk stratification via clinical decision tool scores can minimize the need for emergent cardiac imaging tests with less than 1% MACE occurrence, especially when the HEART score is used.
-
Multicenter Study
Association Between Hospital Practices and Door-in-door-out Time in ST-segment Elevation Myocardial Infarction.
Current guidelines suggest a "door-in-door-out" (DIDO) time of 30 minutes or shorter for patients with ST-segment elevation myocardial infarction (STEMI) who arrive at a STEMI referral hospital and are transferred to a STEMI-receiving center for primary percutaneous coronary intervention. Experts previously identified 18 system practices as critical for reducing DIDO times. The objective of this study was to describe how frequently these critical practices are used and to determine whether their use was associated with shorter DIDO times. ⋯ These findings highlight the difficulty in achieving the 30-minute DIDO goal and the need for continued focus on strategies for reducing DIDO time, including system-wide quality improvement programs.
-
Patients with known coronary artery disease presenting to the emergency department (ED) with chest pain are often admitted, yet may not be having an acute coronary syndrome (ACS). ⋯ Application of these risk scores may reduce the number of potentially avoidable admissions and their associated hazards and costs.
-
Case Reports
A Novel Pretreatment Regimen for Breakthrough Radiocontrast Media Anaphylaxis in Cardiac Patients.
Radiocontrast media allergy is a severe and potentially life-threatening condition. This creates a clinical dilemma for cardiac patients who require urgent interventions with radiocontrast media. Several pretreatment regimens have been suggested for patients with prior immediate hypersensitivity reactions to radiocontrast media. Despite using pretreatment regimens, breakthrough reactions have been reported in 2.1%-18% of patients with radiocontrast media allergy. Little is known about management of patients with a history of breakthrough radiocontrast media anaphylaxis who require urgent lifesaving procedures. ⋯ This protocol is both safe and effective in mitigating anaphylaxis in cardiac patients.