American heart journal
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American heart journal · Jul 2008
Impact of do-not-resuscitation orders on quality of care performance measures in patients hospitalized with acute heart failure.
Heart failure (HF) is one of the leading causes of morbidity and mortality among Americans. Despite increased interest in end-of-life care, the implications of do-not-resuscitate (DNR) orders in acutely ill patients with HF remain unclear. The goals of this observational study were to describe the use of DNR orders and their impact on treatment approaches in residents of a large New England metropolitan area hospitalized with acute heart failure. ⋯ The use of quality assurance measures in acute HF is markedly lower in patients with DNR orders. The implications of DNR orders need to be further clarified in the treatment of patients with acute HF.
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American heart journal · Jul 2008
Comparative StudyDo specialty cardiac hospitals have greater adherence to acute myocardial infarction and heart failure process measures? An empirical assessment using Medicare quality measures: quality of care in cardiac specialty hospitals.
Supporters of specialty hospitals claim these facilities provide better patient care; however, empirical data on quality of care in specialty hospitals are limited. ⋯ Quality of care in specialty cardiac hospitals is similar to quality in competing general hospitals and top-ranked cardiac care hospitals, as measured by compliance with AMI and HF performance indicators. Quality of care appears to be slightly better for top-ranked cardiac hospitals as compared to general hospitals, but the overall performance of all hospitals is high.
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American heart journal · Jul 2008
Comparative StudyFactors that influence the use of ambulance in acute coronary syndrome.
National guidelines recommend activation of the emergency medical service by patients who have symptoms of acute coronary syndrome (ACS). In spite of this, only 50% to 60% of persons with myocardial infarction initiate care by using the emergency medical service. The aim of this study was to define factors influencing the use of ambulance in ACS. ⋯ Symptoms, patient characteristics, ACS characteristics, and perceptions and knowledge were all associated with ambulance use in ACS. The fact that knowledge increases ambulance use and the need for behavioral change pose a challenge for health-care professionals.
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American heart journal · Jul 2008
Platelet collagen receptor glycoprotein VI as a possible novel indicator for the acute coronary syndrome.
Platelet collagen receptor glycoprotein VI (GPVI) plays a critical role in acute coronary thrombosis. This prospective study examined the predictive value of GPVI for acute coronary syndromes (ACS) in a large consecutive group of patients with symptomatic coronary artery disease to identify the high-risk cohort with imminent coronary events. ⋯ Surface expression of GPVI is enhanced in patients with ACS and indicates an imminent acute coronary event before irreversible myocardial necrosis is evident. High GPVI levels are associated with increased residual platelet aggregation despite antiplatelet therapy. Therefore, GPVI is useful to identify the subgroup of patients with a high risk for coronary stent thrombosis and thromboischemic events.