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Heart Association Guidelines (heart + association_guideline)
Kinds of Heart Association Guidelines Selected AbstractsGuideline Implementation Research: Exploring the Gap between Evidence and Practice in the CRUSADE Quality Improvement InitiativeACADEMIC EMERGENCY MEDICINE, Issue 11 2007Andra L. Blomkalns MD Translating research results into routine clinical practice remains difficult. Guidelines, such as the 2002 American College of Cardiology/American Heart Association Guidelines for the Management of Patients with Unstable Angina and non-ST-segment elevation myocardial infarction, have been developed to provide a streamlined, evidence-based approach to patient care that is of high quality and is reproducible. The Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation (CRUSADE) Quality Improvement Initiative was developed as a registry for non,ST-segment elevation acute coronary syndromes to track the use of guideline-based acute and discharge treatments for hospitalized patients, as well as outcomes associated with the use of these treatments. Care for more than 200,000 patients at more than 400 high-volume acute care hospitals in the United States was tracked in CRUSADE, with feedback provided to participating physicians and hospitals regarding their performance over time and compared with similar institutions. Such access to data has proved important in stimulating improvements in non,ST-segment elevation acute coronary syndromes care at participating hospitals for delivery of acute and discharge guideline-based therapy, as well as improving outcomes for patients. Providing quality improvement methods such as protocol order sets, continuing education programs, and a CRUSADE Quality Improvement Initiative toolbox serve to actively stimulate physician providers and institutions to improve care. The CRUSADE Initiative has also proven to be a fertile source of research in translation of treatment guidelines into routine care, resulting in more than 52 published articles and 86 abstracts presented at major emergency medicine and cardiology meetings. The cycle for research of guideline implementation demonstrated by CRUSADE includes four major steps,observation, intervention, investigation, and publication,that serve as the basis for evaluating the impact of any evidence-based guideline on patient care. Due to the success of CRUSADE, the American College of Cardiology combined the CRUSADE Initiative with the National Registry for Myocardial Infarction ST-segment elevation myocardial infarction program to form the National Cardiovascular Data Registry,Acute Coronary Treatment & Intervention Outcomes Network Registry beginning in January 2007. [source] Cumulative Dose of Hypertension Predicts Outcome in Intracranial Hemorrhage Better Than American Heart Association GuidelinesACADEMIC EMERGENCY MEDICINE, Issue 8 2007Christopher W. Barton MD BackgroundHypertension is common after intracranial hemorrhage (ICH) and may be associated with higher mortality and adverse neurologic outcome. The American Heart Association recommends that blood pressure be maintained at a mean arterial pressure (MAP) less than 130 mm Hg to prevent secondary brain injury. ObjectivesTo prospectively evaluate whether a new method of assessing hypertension in ICH more accurately identifies patients at risk for adverse outcomes. MethodsThe authors prospectively studied all patients presenting to two University of California, San Francisco hospitals with acute ICH from June 1, 2001, to May 31, 2004. Factors related to acute hospitalization were recorded in a database, including all charted vital signs for the first 15 days. Patients were followed up for one year, with their modified Rankin Scale (mRS) score at 12 months as primary outcome. Hypertension dose was determined as the area under the curve between patient MAP and a cut point of 110 mm Hg while in the emergency department (ED). The dose was adjusted for time spent in the ED (dose/timeed [d/ted]). Hypertension dose was divided into four categories (none, and progressive tertiles). Multivariate logistic regression was used to calculate the odds ratio for adverse mRS by tertiles of d/ted. ResultsA total of 237 subjects with an ED average (±SD) length of stay of 3.42 (±3.7) hours were enrolled. In a multivariate logistic regression model controlling for the effects of age, volume of hemorrhage, presence of intraventricular hemorrhage, race, and preexisting hypertension, there was a 4.7- and 6.1-fold greater likelihood of an adverse neurologic outcome (by mRS) at one and 12 months, respectively, in the highest d/ted tertile relative to the referent group without hypertension. ConclusionsHypertension after acute ICH is associated with adverse neurologic outcome. The dose of hypertension may more accurately identify patients at risk for adverse outcomes than the American Heart Association guidelines and may lead to better outcomes if treated when identified in this manner. [source] The Impact of Race on the Acute Management of Chest PainACADEMIC EMERGENCY MEDICINE, Issue 11 2003Arvind Venkat MD Abstract Objectives: African Americans with acute coronary syndromes receive cardiac catheterization less frequently than whites. The objective was to determine if such disparities extend to acute evaluation and noninterventional treatment. Methods: Data on adults with chest pain (N= 7,935) presenting to eight emergency departments (EDs) were evaluated from the Internet Tracking Registry of Acute Coronary Syndromes. Groups were selected from final ED diagnosis: 1) acute myocardial infarction (AMI), n= 400; 2) unstable angina/non,ST-elevation myocardial infarction (UA/NSTEMI), n= 1,153; and 3) nonacute coronary syndrome chest pain (non-ACS CP), n= 6,382. American College of Cardiology/American Heart Association guidelines for AMI and UA/NSTEMI were used to evaluate racial disparities with logistic regression models. Odds ratios (ORs) were adjusted for age, gender, guideline publication, and insurance status. Non-ACS CP patients were assessed by comparing electrocardiographic (ECG)/laboratory evaluation, medical treatment, admission rates, and invasive and noninvasive testing for coronary artery disease (CAD). Results: African Americans with UA/NSTEMI received glycoprotein IIb/IIIa receptor inhibitors less often than whites (OR, 0.41; 95% CI = 0.19 to 0.91). African Americans with non-ACS CP underwent ECG/laboratory evaluation, medical treatment, and invasive and noninvasive testing for CAD less often than whites (p < 0.05). Other nonwhites with non-ACS CP were admitted and received invasive testing for CAD less often than whites (p < 0.01). African Americans and other nonwhites with AMI underwent catheterization less frequently than whites (OR, 0.45; 95% CI = 0.29 to 0.71 and OR, 0.40; 95% CI = 0.17 to 0.92, respectively). A similar disparity in catheterization was noted in UA/NSTEMI therapy (OR, 0.53; 95% CI = 0.40 to 0.68 and OR, 0.68; 95% CI = 0.47 to 0.99). Conclusions: Racial disparities in acute chest pain management extend beyond cardiac catheterization. Poor compliance with recommended treatments for ACS may be an explanation. [source] Failure to distinguish systemic-onset juvenile idiopathic arthritis from incomplete Kawasaki disease in an infantJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 10 2007Haruki Komatsu Abstract: In an infant, an initial diagnosis of incomplete Kawasaki disease was made according to the American Heart Association guidelines. However, the diagnosis of systemic-onset juvenile idiopathic arthritis was established later. Physicians need to recognize that systemic-onset juvenile idiopathic arthritis can be mistaken for incomplete Kawasaki disease, even when the guidelines are used. [source] Homocysteine and cardiovascular disease: A review of current recommendations for screening and treatmentJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 3 2005KarenL. Purpose To review the literature for, and provide advanced practice nurses (APNs) with, current recommendations for screening and treatment of hyperhomocysteinemia. Data sources Medscape literature search of selected research studies and related journal articles. Conclusions While data from most epidemiologic studies support the argument that hyperhomocysteinemia is an independent risk factor for cardiovascular disease, the debate continues as to when screening and treating patients is appropriate. The consensus is that more randomized controlled trials are needed to further study the benefits of routine screening and the efficacy of treating hyperhomocysteinemia. Implications for practice Until the results of ongoing clinical trials are available, APNs should follow the American Heart Association guidelines for screening for elevated levels of homocysteine and continue to promote a well-balanced diet that includes foods rich in folic acid as part of health promotion through primary prevention. [source] The use of vasopressin for treating vasodilatory shock and cardiopulmonary arrestJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2009DACVIM, Richard D. Scroggin Jr. Abstract Objective , To discuss 3 potential mechanisms for loss of peripheral vasomotor tone during vasodilatory shock; review vasopressin physiology; review the available animal experimental and human clinical studies of vasopressin in vasodilatory shock and cardiopulmonary arrest; and make recommendations based on review of the data for the use of vasopressin in vasodilatory shock and cardiopulmonary arrest. Data Sources , Human clinical studies, veterinary experimental studies, forum proceedings, book chapters, and American Heart Association guidelines. Human and Veterinary Data Synthesis , Septic shock is the most common form of vasodilatory shock. The exogenous administration of vasopressin in animal models of fluid-resuscitated septic and hemorrhagic shock significantly increases mean arterial pressure and improves survival. The effect of vasopressin on return to spontaneous circulation, initial cardiac rhythm, and survival compared with epinephrine is mixed. Improved survival in human patients with ventricular fibrillation, pulseless ventricular tachycardia, and nonspecific cardiopulmonary arrest has been observed in 4 small studies of vasopressin versus epinephrine. Three large studies, though, did not find a significant difference between vasopressin and epinephrine in patients with cardiopulmonary arrest regardless of initial cardiac rhythm. No veterinary clinical trials have been performed using vasopressin in cardiopulmonary arrest. Conclusion , Vasopressin (0.01,0.04 U/min, IV) should be considered in small animal veterinary patients with vasodilatory shock that is unresponsive to fluid resuscitation and catecholamine (dobutamine, dopamine, and norepinephrine) administration. Vasopressin (0.2,0.8 U/kg, IV once) administration during cardiopulmonary resuscitation in small animal veterinary patients with pulseless electrical activity or ventricular asystole may be beneficial for myocardial and cerebral blood flow. [source] Cumulative Dose of Hypertension Predicts Outcome in Intracranial Hemorrhage Better Than American Heart Association GuidelinesACADEMIC EMERGENCY MEDICINE, Issue 8 2007Christopher W. Barton MD BackgroundHypertension is common after intracranial hemorrhage (ICH) and may be associated with higher mortality and adverse neurologic outcome. The American Heart Association recommends that blood pressure be maintained at a mean arterial pressure (MAP) less than 130 mm Hg to prevent secondary brain injury. ObjectivesTo prospectively evaluate whether a new method of assessing hypertension in ICH more accurately identifies patients at risk for adverse outcomes. MethodsThe authors prospectively studied all patients presenting to two University of California, San Francisco hospitals with acute ICH from June 1, 2001, to May 31, 2004. Factors related to acute hospitalization were recorded in a database, including all charted vital signs for the first 15 days. Patients were followed up for one year, with their modified Rankin Scale (mRS) score at 12 months as primary outcome. Hypertension dose was determined as the area under the curve between patient MAP and a cut point of 110 mm Hg while in the emergency department (ED). The dose was adjusted for time spent in the ED (dose/timeed [d/ted]). Hypertension dose was divided into four categories (none, and progressive tertiles). Multivariate logistic regression was used to calculate the odds ratio for adverse mRS by tertiles of d/ted. ResultsA total of 237 subjects with an ED average (±SD) length of stay of 3.42 (±3.7) hours were enrolled. In a multivariate logistic regression model controlling for the effects of age, volume of hemorrhage, presence of intraventricular hemorrhage, race, and preexisting hypertension, there was a 4.7- and 6.1-fold greater likelihood of an adverse neurologic outcome (by mRS) at one and 12 months, respectively, in the highest d/ted tertile relative to the referent group without hypertension. ConclusionsHypertension after acute ICH is associated with adverse neurologic outcome. The dose of hypertension may more accurately identify patients at risk for adverse outcomes than the American Heart Association guidelines and may lead to better outcomes if treated when identified in this manner. 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