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Data Standards for ACS & CAD

Data Standards for ACS & CAD

With the emergence of electronic health records (EHRs) and administrative and professional databases, it’s critical to facilitate clear communication and assure the accurate interchange of data and information. Clinical data standards are important for managing patients, assessing outcomes, and conducting research. Having a broad agreement on a common vocabulary and a standardized list of data elements helps lay the groundwork for future clinical registries and quality- improvement initiatives. It also can be used in the development of performance measures. An Important Update In 2013, the American College of Cardiology (ACC) and American Heart Association (AHA), in conjunction with 11 other organizations, developed a list of key data elements with standardized definitions for patients with acute coronary syndromes (ACS) and coronary artery disease (CAD). The document was published jointly in the Journal of the American College of Cardiology and Circulation. It updates information on elements specific to ACS that were released in 2001. CAD was added because of the overlap between the two conditions. The ACC/AHA publication listed key data elements and provided detailed definitions in seven categories, including demographics and admissions; history and risk factors; clinical presentation; diagnostic procedure; invasive therapeutic intervention; medications; and outcomes. The document is organized in tabular form to be a helpful tool for everyday use. Special attention is also given to important predictors of outcomes, including laboratory results and clinical presentation. This information should be mandatory reading for clinical investigators, quality assurance personnel, and research nurses. For cardiologists, the latest terminology and methods may seem obvious at first glance. However, even the most sophisticated practitioners can discover better ways to communicate and describe ambiguous...
The Impact of Depression on ED Stays in ACS Patients

The Impact of Depression on ED Stays in ACS Patients

Studies suggest that about 30% of patients with acute coronary syndrome (ACS) experience symptoms of depression during hospitalization. These patients are nearly twice as likely to die from ACS or have recurrent cardiac disease when compared with those who aren’t depressed. The ED is often the first point of contact for treating ACS patients, and recent research suggests that psychosocial factors may impact aspects of care in the ED, including length of stay (LOS). Depression, ACS, & LOS It has been hypothesized that longer ED LOS may be associated with adverse clinical outcomes for those with ACS, especially among those with depression. In a recent issue of BMC Emergency Medicine, my colleagues and I sought to determine if depressed ACS patients experienced different ED care than those without depression. After reviewing data from 120 participants, we found that currently depressed ACS patients spent an average of 5.4 more hours in the ED than those who had never been depressed. Not surprisingly, our study also revealed that presentation to the ED during off-peak hours was associated with longer ED LOS. Interestingly, no significant associations were observed with other demographic variables that might be expected to influence ED LOS, including race, ethnicity, or neighborhood income. Furthermore, these variables did not appear to account for the association between depression and ED LOS. Making Interpretations Data from our study are preliminary, but indicate that there is likely an association between depression and longer ED LOS. There are several possible explanations for this finding. Depression may influence how ACS patients present to the ED, report their symptoms, recruit family members or friends to accompany...
Interpreting Troponin Tests: Coming to a New Consensus

Interpreting Troponin Tests: Coming to a New Consensus

Since its introduction in the early 1990s, cardiac troponin testing has been predominantly used to diagnose or rule out myocardial infarction (MI) in patients with possible symptoms of MI. However, it has become clear that a positive troponin indicates that cardiac injury has occurred, but it is not specific for the etiology of the injury. “Experience with troponin testing has also showed that higher levels identify patients at greater risk for adverse events, regardless of the clinical setting (eg, MI, heart failure, or non-cardiac etiologies),” explains L. Kristin Newby, MD, MHS, FACC, FAHA. “However, more recent studies have raised questions about cardiac troponin cutoffs that should be used for diagnostic and prognostic interpretations and the particular importance of the clinical context in making those interpretations.” In the Journal of the American College of Cardiology, Dr. Newby and colleagues from seven professional societies, led by the American College of Cardiology, released a consensus statement to help clinicians determine when to order troponin testing and how to interpret results. The document provides a framework for clinicians to interpret results of troponin testing in a useful mechanism-based construct. Key Recommendations on Troponin Testing According to the consensus statement, physicians should adopt the definition of MI that was recently updated in order to fully understand the implications of elevated troponin levels. “The universal definition of MI, which was updated in 2012, is important because it provides a standard framework in which to apply troponin testing for a diagnosis of MI and emphasizes not only troponin levels, but also the importance of clinical symptoms of MI,” Dr. Newby says. In addition, the consensus statement...

Revised Guidelines for Evidence-Based PCI

Over the last decade, significant advances and innovations have rapidly evolved in the use of PCI for patients with coronary artery disease (CAD). The American College of Cardiology (ACC)/American Heart Association (AHA), together with the Society for Cardiovascular Angiography and Interventions (SCAI), released a revised clinical guideline for the management of CAD patients undergoing PCI. Published in the December 6, 2011 Journal of the American College of Cardiology, the update emphasizes careful selection of CAD treatment and includes the most extensive section to date on revascularization. The Heart Team Concept for PCI and CABG “The heart team includes an interventional cardiologist and a cardiac surgeon who review patient history and anatomy, discuss whether PCI and/or CABG are appropriate, and explain these options in detail with patients before a treatment option is chosen,” says Glenn N. Levine, MD, who chaired the ACC/AHA/SCAI guideline writing committee. The guidelines include a Class I recommendation for utilizing a heart team approach in patients with unprotected left main CAD and/or complex CAD in cases where the optimal revascularization strategy is not straightforward. New Section on CAD Revascularization For the first time ever, the CAD revascularization section was developed through a collaboration that involved experts from the ACC, AHA, and SCAI on both PCI and CABG. According to the guidelines, CABG is recommended for improving survival in patients with significant left main coronary artery stenosis, as well as those with significant stenoses in three major coronary arteries or in the proximal left anterior descending artery and one other major coronary artery. CABG or PCI is recommended for survivors of sudden cardiac death with presumed ischemia-mediated...

ACC.12 Highlights for Surgeons

New research was recently presented at ACC.12, the annual scientific meeting of the American College of Cardiology, from March 24-27 in Chicago. The features below highlight just some of the studies that emerged from the meeting that pertain specifically to the surgeon audience.  >> Positive Outcomes Observed With TAVI >> Assessing the Safety of On- & Off-Pump CABG >> TAVR Comparable to Open-Heart Surgery at 2 Years >> Bariatric Surgery Yields Big Rewards for Obese Diabetics >> Underweight Patients at Increased Risk During ICD Procedures >> Improving the Quality of ACS Care       Positive Outcomes Observed With TAVI The Particulars: Transcatheter aortic valve implantation (TAVI) involves insertion of a bioprosthetic valve into a diseased native aortic valve and represents a potentially less invasive option than surgical replacement. Currently, TAVI has been used mostly in non-operable patients. Data Breakdown: A study was conducted in high-risk patients with severe aortic stenosis who underwent TAVI at 44 centers. Major adverse cardiac and cerebrovascular events at 30-days follow-up occurred in 8.3% of patients receiving TAVI. Total mortality, cardiac mortality, stroke, and life-threatening or disabling bleeding rates were 4.5%, 2.2%, 2.9%, and 4.9%, respectively. Persistent, significant improvements in aortic valve function were also observed. Take Home Pearl: In high operative risk and non-operable patients, TAVI appears to be safe and effective. Assessing the Safety of On- & Off-Pump CABG The Particulars: CABG is one of the most commonly performed cardiac operations, but small randomized trials and meta-analyses have yet to determine conclusively if less-invasive off-pump CABG has better outcomes than on-pump CABG. Data Breakdown: A trial of nearly 5,000 patients with coronary artery disease...
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