American heart journal
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American heart journal · Sep 2011
Randomized Controlled Trial Multicenter Study Comparative StudyTemporal changes in emergency department triage of patients with acute myocardial infarction and the effect on outcomes.
All patients who present to an emergency department (ED) are triaged. The ED triage score may determine when patients are seen by a physician. Half of patients with acute myocardial infarction (AMI) were given a low priority score in Ontario in 2000/2001. We assessed the appropriateness of ED triage and its association with quality indicators and outcomes in a more recent AMI cohort and compared this with previous findings. ⋯ Emergency department triage of patients with AMI improved substantially over 5 years. For the third of patients with AMI who continue to receive a low priority score, including 25% of patients with STEMI, the associated delays in diagnosis and therapy were greater than previously and were associated with increased hospital LOS and mortality. Given the impact of this initial, cursory assessment, hospital systems should consider monitoring the quality of their ED triage.
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American heart journal · Sep 2011
Randomized Controlled Trial Multicenter Study Comparative StudyColchicine prevents early postoperative pericardial and pleural effusions.
No preventive pharmacologic strategies have been proven efficacious for the prevention of postoperative effusions after cardiac surgery. Colchicine is safe and efficacious for the prevention of pericarditis. On this basis, we realized a substudy of the COPPS trial to assess the efficacy and safety of colchicine for the prevention of postoperative pericardial and pleural effusions. ⋯ Colchicine is safe and efficacious for the primary prevention of postoperative effusions after cardiac surgery.
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American heart journal · Sep 2011
Randomized Controlled Trial Multicenter Study Comparative StudyMode of hospital presentation in patients with non-ST-elevation myocardial infarction: implications for strategic management.
Contemporary non-ST-elevation myocardial infarction-acute coronary syndrome guidelines emphasize early-risk stratification and optimizing therapy including an invasive strategy in high-risk patients. To assess the feasibility of initiating this strategy in the prehospital environment, we examined how such patients are transported to hospital, their risk profile, and the proportion potentially eligible for such a strategy. ⋯ Regional strategies using risk-based triage, early medical therapy, and timely triage to percutaneous coronary intervention centers represents an unrealized opportunity to enhance ST-segment elevation myocardial infarction care.
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American heart journal · Sep 2011
Multicenter Study Comparative Study Clinical TrialBerlin Heart EXCOR Pediatric ventricular assist device Investigational Device Exemption study: study design and rationale.
Currently, there are no Food and Drug Administration-approved devices available that can provide long-term mechanical circulatory support to smaller children with severe heart failure as a bridge to heart transplant (HT). In recent years, the Berlin Heart EXCOR Pediatric ventricular assist device (VAD) has emerged as a potential treatment option. Systematic data on the safety and efficacy of the EXCOR are limited. ⋯ The Berlin Heart IDE clinical study will be the first bridge-to-HT VAD study designed exclusively for children. It is anticipated that the study will provide important information on the safety and efficacy of the Berlin Heart EXCOR Pediatric in children while providing valuable lessons into the design and conduct of future VAD studies in children.
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American heart journal · Sep 2011
Multicenter Study Comparative StudyThe CHADS2 score predicts ischemic stroke in the absence of atrial fibrillation among subjects with coronary heart disease: data from the Heart and Soul Study.
We sought to evaluate the prognostic performance of the CHADS(2) score for prediction of ischemic stroke/transient ischemic attack (TIA) in subjects with coronary heart disease (CHD) without atrial fibrillation (AF). ⋯ The CHADS(2) score predicts ischemic stroke/TIA in subjects with stable CHD and no baseline AF. The event rate in non-AF subjects with high CHADS(2) scores (5-6) was comparable with published rates in AF patients with moderate CHADS(2) scores (1-2), a population known to derive benefit from stroke prevention therapies. These findings should inform efforts to determine whether stroke prevention therapies or screening for silent AF may benefit subjects with stable CHD and high CHADS(2) scores.