American heart journal
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American heart journal · Dec 2008
Independent prognostic value of echocardiography and N-terminal pro-B-type natriuretic peptide in patients with heart failure.
Echocardiographic indices of cardiac structure and function and natriuretic peptide levels are strong predictors of mortality in patients with heart failure. Whether cardiac ultrasound and natriuretic peptides provide independent prognostic information is uncertain. ⋯ Left ventricular size and function and left atrial and right atrial sizes are significant predictors of all-cause mortality in patients with heart failure, independent of NT-proBNP levels and other clinical variables.
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American heart journal · Dec 2008
Trends in presenting characteristics and hospital mortality among patients with ST elevation and non-ST elevation myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006.
Although ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction (AMI) have been the focus of intense clinical investigation, limited information exists on characteristics and hospital mortality of patients not enrolled in clinical trials. Previous large databases have reported declining mortality of patients with STEMI but have not noted substantial mortality change among those with NSTEMI. ⋯ This large, observational database from 1990 to 2006 shows increasing prevalence of NSTEMI and, despite higher risk profile on presentation, falling risk-adjusted hospital mortality in patients with either STEMI or NSTEMI.
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American heart journal · Dec 2008
Optimizing cardiology capacity to reduce emergency department boarding: a systems engineering approach.
Patient safety and emergency department (ED) functionality are compromised when inefficient coordination between hospital departments impedes ED patients' access to inpatient cardiac care. The objective of this study was to determine how bed demand from competing cardiology admission sources affects ED patients' access to inpatient cardiac care. ⋯ Scheduling and bed management practices based on measured patient transfer patterns can reduce inpatient bed blocking, optimize hospital capacity, and improve ED patient access.
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American heart journal · Dec 2008
Trends in quality of care for patients with acute myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006.
Trends in the use of guideline-based treatment for acute myocardial infarction (AMI) as well as its association with patient outcomes have not been summarized in a large, longitudinal study. Furthermore, it is unknown whether gender-, race-, and age-based care disparities have narrowed over time. ⋯ Adherence to American Heart Association/American College of Cardiology practice guidelines has improved care of patients with AMI and is associated with significant reductions in in-hospital mortality rates. However, persistent gaps in overall care as well as care disparities remain and suggest the need for ongoing quality improvement efforts.
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American heart journal · Dec 2008
Direction of blood flow from the left ventricle during cardiopulmonary resuscitation in humans: its implications for mechanism of blood flow.
Common mechanisms proposed to explain forward blood flow during cardiopulmonary resuscitation (CPR) include the cardiac and thoracic pumps. However, the exact role of the left ventricle in promoting forward blood flow during standard CPR in humans is mostly unknown. The aim of this study was to explore the role of the left ventricle in generating forward blood flow during standard CPR in humans by observing the direction of blood flow during CPR. ⋯ Retrograde flow to the left atrium and forward blood flow onto the aorta on left ventricular contrast echocardiography during the compression phase suggests that extrinsic compression of the left ventricle by external chest compression acts as a pump in generating blood flow during standard CPR in humans.