American heart journal
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American heart journal · Oct 2006
The impact of emergency department structure and care processes in delivering care for non-ST-segment elevation acute coronary syndromes.
We sought to assess the influence of emergency department (ED) structure and care processes on adherence to practice guidelines for the treatment of patients with non-ST-segment elevation acute coronary syndromes. ⋯ Quality improvement strategies that have the full support of hospital administration, focus on increasing collaboration between emergency physicians and other health care providers, and specified protocol-driven management algorithm may be the most successful methods for improving the care and outcomes of patients with non-ST-segment elevation acute coronary syndromes.
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American heart journal · Oct 2006
Interhospital transfer for early revascularization in patients with ST-elevation myocardial infarction complicated by cardiogenic shock--a report from the SHould we revascularize Occluded Coronaries for cardiogenic shocK? (SHOCK) trial and registry.
Early revascularization (ERV) in patients with ST-elevation myocardial infarction (STEMI) and cardiogenic shock (CS) reduces mortality rates. Patients admitted to hospitals without revascularization capability have high mortality rates and are not often transferred for ERV. ⋯ Despite longer time to treatment, transfer patients are a selected population with similar adjusted inhospital mortality and ERV benefit as direct-admit patients. Selected patients with STEMI and CS admitted to hospitals without revascularization capability should be transferred to centers with revascularization capability for immediate angiography.
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American heart journal · Oct 2006
Home defibrillation: a feasibility study in myocardial infarction survivors at intermediate risk of sudden death.
Out-of-hospital cardiac arrest occurs at home in 65-80% of cases and is often witnessed. We designed a study to explore the feasibility of a home defibrillation program (a) evaluating the retention of cardiopulmonary resuscitation and automated external defibrillators (AED) use skills (BLSD) (b) assessing the impact on anxiety, depression, and quality of life and (c) recording the critical issues emerging from program implementation. ⋯ BLSD performance of families of post-myocardial infarction patients decreases over time, even though the ability to operate AEDs appears to be the least affected component. Compliance with retraining sessions and AED checks declines over time and is improved if they are combined with clinical appointments. The implementation of a home defibrillation program does not affect anxiety, depression, or the quality of life.
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American heart journal · Sep 2006
Comparative StudyASymptomatic atrial fibrillation and Stroke Evaluation in pacemaker patients and the atrial fibrillation Reduction atrial pacing Trial (ASSERT).
Asymptomatic atrial fibrillation (AF) is common and may have the same prognostic implications as symptomatic AF. Among patients receiving dual-chamber pacemakers, it is now possible to quantify asymptomatic AF accurately. Most of these episodes are of short duration, often lasting only seconds to minutes and are called atrial high-rate episodes (AHRE) to distinguish them from the longer episodes of overt AF. ⋯ The second hypothesis to be tested is that overdrive atrial pacing will reduce the risk of symptomatic AF in pacemaker patients without a previous history of AF. Finally, a 400-patient substudy will use the noninvasive testing capabilities of the patients' pacemaker to evaluate changes in atrial electrophysiology over 2 years. This substudy will determine if atrial electrical remodeling is detectable in pacemaker patients and if it is associated with the development of AF.
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American heart journal · Sep 2006
Comparative StudyTemporal trends and drug exposures in pulmonary hypertension: an American experience.
Reports have linked anorexigen intake to an increased risk of pulmonary arterial hypertension (PAH). With the rise in anorexigen use in the latter half of the last decade, we established a surveillance network within the United States to monitor temporal trends in the number of reported cases of PAH. We also studied whether use of anorexigens and other drugs differed among patients with pulmonary hypertension of different etiologies. ⋯ No epidemic of anorexigen-related PAH was evident during the study period. As persons who had taken fenfluramine or dexfenfluramine were particularly likely to be referred for evaluation of pulmonary hypertension, it is unlikely that the failure to detect an anorexigen-induced rise in primary pulmonary hypertension was because of underascertainment. The association between fenfluramine derivatives and PAH is consistent with the risk elevations previously reported.