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Discharging Patients After Elective PCI

Among Medicare recipients, PCI is one of the most commonly performed cardiac procedures in the United States, with more than 1 million procedures being performed each year. Research has shown that the risks associated with PCI are highest within the first 24 to 48 hours after the procedure. Fortunately, both short- and long-term outcomes after PCI have improved substantially over the years because of the evolution of devices, technology, and pharmacotherapy. Despite recent advances, patients are usually observed overnight in the hospital after elective PCI to monitor for complications, sometimes in short-stay units and other times on traditional nursing floors as inpatients. This practice occurs even though some studies suggest that these patients can be discharged home safely on the same day of PCI without the need for overnight observation. The potential benefits of same-day discharge of patients include the elimination of an overnight hospital stay for patients, increased bed availability for the hospital, and cost savings. New Data on Discharge of PCI Patients Little is known about how often patients are discharged home the same day as their PCI. To shed light on the matter, my colleagues and I conducted a study using data from more than 107,000 patients aged 65 and older from the National Cardiovascular Data Registry CathPCI Registry and linked it with CMS claims data. Patients were either discharged the same day as their procedure or 24 or more hours after it. The investigation, published in the October 5, 2011 JAMA, examined trends in death or rehospitalization occurring within 2 days and by 30 days after PCI. “Same-day discharge was rarely implemented in low-risk Medicare...

Conference Highlights: ACC.12

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. Angioplasty Safe at Community Hospitals Should LDL Be Targeted Early in Life? Improving BP Control With Telemedicine A Checklist to Reduce HF Readmissions Visualization Encourages Statin Adherence & Lifestyle Changes Improving the Quality of ACS Care Angioplasty Safe at Community Hospitals The Particulars: Community hospitals without cardiac surgery units have traditionally performed angioplasties only in emergency situations. Patients needing elective angioplasty have typically been transferred to hospitals with on-site cardiac surgery units. A recent guideline from the American College of Cardiology and American Heart Association questioned the need for such transfers. Data Breakdown: In a study, nearly 19,000 patients were randomized to undergo elective angioplasty at a facility with on-site cardiac surgery or at one of 60 community hospitals that had undergone special preparations to perform angioplasty. No differences were observed in death rates between the two facility types. Furthermore, no significant differences were seen in rates of complications, such as bleeding, renal failure, and stroke. Take Home Pearl: With appropriate preparation, community hospitals without on-site cardiac surgery units appear to have the capability to safely and effectively perform elective angioplasty. Should LDL Be Targeted Early in Life? The Particulars: Patients with high LDL cholesterol often do not begin treatment to lower their LDL levels until after coronary heart disease (CHD) has been quietly developing for years. Coronary atherosclerosis begins early in life. It has been hypothesized that lowering LDL at a younger...
Conference Highlights: ISET 2012

Conference Highlights: ISET 2012

New research was presented at ISET 2012, the annual International Symposium on Endovascular Therapy, on January 15-19 in Miami Beach. The features below highlight just some of the studies that emerged from the meeting. » A New Approach to Managing Unstoppable Nosebleeds  » Cryoablation Deemed Effective in Ovarian Cancer » MS Patients Report Benefits With Angioplasty » Fibromuscular Dysplasia Frequently Undiagnosed Treating DVT in Pregnant Women The Particulars: Studies have shown that DVT is four to six times more common in pregnant women than in non-pregnant women. Research suggests that many pregnant women with DVT often forgo the most effective treatments—surgery or catheter-directed thrombolysis—because they fear that doing so may harm their unborn children. Data Breakdown: In a study of 11 pregnant women with DVT, two underwent surgery to remove the clot, and nine were treated with a bath of thrombolytic medications delivered directly into the clot. Removal of the clot was successful in all cases, and all but one pregnancy resulted in successful birth. One woman who miscarried 1 week after treatment suffered from antiphospholipid antibody syndrome, which the researchers believe likely caused the miscarriage. Take Home Pearl: Aggressive treatment with surgery or catheter-directed thrombolysis for pregnant women with DVT appears to be safe. Aggressive treatment was also shown to prevent serious complications and death.     A New Approach to Managing Unstoppable Nosebleeds [back to top] The Particulars: Unstoppable nosebleeds can cause anemia and may lead to other more serious complications, including heart attack. When packing the nose with gauze, inflating a balloon to stop blood flow, or cauterizing the vessels in the nose fail, surgery or embolization are the...

Surgery Update 2011

Read an exclusive collection of articles on recent topics in surgery, including insights in treating SFA & popliteal arteries, preventing postoperative pneumonia, balancing life with a career in surgery, managing charcot foot,  high-risk patients for EVAR, and reducing cardiovascular events after...

Conference Highlights: The 2010 Veith Symposium

The 37th annual Veith Symposium was held from November 17 to 21 in New York City. The features below highlight some of the news emerging from the meeting. Analyzing Different Stenting Approaches for Restenosis The Particulars: Few studies have compared the use of drug-eluting stents after angioplasty with balloon angioplasty and bare-metal stenting in the treatment of restenosis. The Zilver PTX (Cook Medical, Inc.) is the first drug-eluting stent approved for the superficial femoral artery and is currently under investigation in the United States for use in restenosis. Researchers conducted a study comparing the Zilver PTX drug-eluting stent after angioplasty with balloon angioplasty and bare-metal stenting. Data Breakdown: The study enrolled 479 patients at 56 institutions in the United States, Japan, and Germany, with 241 patients randomized to the Zilver PTX group and 238 to the bare-metal stenting group. Demographics and lesion characteristics were similar for the groups. Approximately, half of the bare-metal stenting group experienced acute failure and underwent secondary randomization in which 59 and 61 patients were assigned to provisional stenting with Zilver bare-metal stents and Zilver PTX, respectively. Study results met the 12-month primary endpoint goals showing non-inferiority and superior patency for the Zilver PTX as compared with a bare-metal stenting group. Endpoints included event-free survival, stent integrity by radiographic core laboratory analysis, and primary patency by Duplex ultrasound core laboratory analysis. There was also significant clinical improvement with the Zilver PTX. Take Home Pearl: The Zilver PTX drug-eluting peripheral stent appears to be safe and effective for the treatment of restenosis when compared with bare-metal stenting. Ultrasound-Accelerated CDT Beneficial in PE Treatment The Particulars: Pulmonary...
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