American heart journal
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American heart journal · Jul 2012
The impact of achieving perfect care in acute coronary syndrome: the role of computer assisted decision support.
Attainment of every performance measure or perfect care (PC) is used as a tool for measuring hospital quality of care. We sought to describe the effect of achieving PC on subsequent outcomes in patients admitted with acute coronary syndrome (ACS) and to determine whether computerized physician order entry enabled with decision support (CPOE-DS) would enhance the likelihood of achieving PC and improvements in clinical outcomes. ⋯ Achievement of PC is a valid measure of quality of care in the hospitalized ACS patient and is associated with improved survival. CPOE-DS is feasible in the care process for ACS and can increase attainment of PC.
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American heart journal · Jun 2012
Randomized Controlled Trial Multicenter StudyIntraaortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock: design and rationale of the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial.
In current guidelines, intraaortic balloon pumping (IABP) is considered a class 1 indication in cardiogenic shock complicating acute myocardial infarction. However, evidence is mainly based on retrospective or prospective registries with a lack of randomized clinical trials. Therefore, IABP is currently only used in 20% to 40% of cardiogenic shock cases. The hypothesis of this trial is that IABP in addition to early revascularization by either percutaneous coronary intervention or coronary artery bypass grafting will improve clinical outcome of patients in cardiogenic shock. ⋯ The IABP-SHOCK II trial addresses important questions regarding the efficacy and safety of IABP in addition to early revascularization in patients with cardiogenic shock complicating myocardial infarction.
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American heart journal · Jun 2012
Randomized Controlled TrialRacial differences in hospice use and patterns of care after enrollment in hospice among Medicare beneficiaries with heart failure.
We examined racial differences in patterns of care and resource use among Medicare beneficiaries with heart failure after enrollment in hospice. ⋯ Rates of hospice use have increased over time for both white and nonwhite patients. Nonwhite patients were less likely than white patients to enroll in hospice and had higher resource use after electing hospice care, regardless of disenrollment status.
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American heart journal · Jun 2012
Multi-marker strategy of natriuretic peptide with either conventional or high-sensitivity troponin-T for acute coronary syndrome diagnosis in emergency department patients with chest pain: from the "Rule Out Myocardial Infarction using Computer Assisted Tomography" (ROMICAT) trial.
Compared to troponin alone, a dual-marker strategy with natriuretic peptides may improve acute coronary syndrome (ACS) diagnosis with a single blood draw and provide physiologic information regarding underlying heart disease. We evaluate the value of adding natriuretic peptides (myocyte stress markers) to troponins (myocardial injury markers) for diagnosing ACS in emergency department patients with chest pain. ⋯ Among emergency department patients with low-intermediate likelihood of ACS, combining natriuretic peptides with either conventional or highly-sensitive troponin improved discriminatory capacity and allowed for better reclassification of ACS, findings supported by structural and functional CT results.
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American heart journal · Jun 2012
Randomized Controlled TrialA pilot randomized study of ranolazine for reduction of myocardial damage during elective percutaneous coronary intervention.
Ranolazine is a new antianginal drug that reduces intracellular sodium and calcium accumulation during ischemia, thus potentially limiting myocardial ischemia. It remains unknown, however, if the drug can play a role in the pathophysiology of periprocedural myocardial infarction. The aim of this study was to verify in a randomized study if pretreatment with ranolazine before percutaneous coronary intervention (PCI) has any protective effect on periprocedural myocardial damage. ⋯ Pretreatment with ranolazine 1,000 mg twice daily for 7 days significantly reduced procedural myocardial injury in elective PCI.