Cardiology Commons^™

In-Hospital Depression Predicts Early Hospital Readmission After An Acute Coronary Syndrome: Preliminary Data From Trace-Core, David Mcmanus, Jane Saczynski, Molly Waring, Milena Anatchkova, Richard Mcmanus, Robert Goldberg, Jeroan Allison, David Parish, Hamza Awad, Jerry Gurwitz, Arlene Ash, Catarina Kiefe

Richard H. McManus

Background: Hospital systems, patients and providers seek to avert rehospitalizations within 30 days for patients admitted with an acute coronary syndrome (ACS). Rehospitalizations within 30 days of discharge are often considered preventable and to reflect poor in-hospital management or discharge practices. However, independent associations of psychosocial factors with early rehospitalization in patients admitted with an ACS have not been examined. Methods: A multi-racial cohort of 1,540 patients admitted with an ACS reported psychosocial factors via standardized questionnaires in an in-hospital interview. One month following discharge, patients were interviewed via phone and reported hospital readmissions. We used logistic regression models to …

Long-Term Survival For Patients With Acute Decompensated Heart Failure According To Ejection Fraction Findings, Andrew Coles, Kimberly Fisher, Chad Darling, Jorge Yarzebski, David Mcmanus, Joel Gore, Darleen Lessard, Robert Goldberg

Jorge L. Yarzebski

Limited data exist about the long-term prognosis of patients with acute decompensated heart failure (ADHF) further stratified according to ejection fraction (EF) findings. The primary objective of this population-based observational study was to characterize and compare trends in long-term prognosis after an episode of ADHF across 3 EF strata. Hospital medical records were reviewed for 3,604 residents of the Worcester, Massachusetts, metropolitan area who were discharged after ADHF from all 11 medical centers in central Massachusetts during 1995, 2000, 2002, and 2004 and had EF measurements during their index hospitalizations. The average age of this population was 75 years, most …

Sex Differences In Cardiac Arrest Survivors Who Receive Therapeutic Hypothermia, Marna Greenberg, Amy Ahnert, Nainesh Patel, Courtney Bennett, Nicole Elliott, Mark Lundquist, Andrew Miller, Ellina Feiner, Anita Kurt, Bernadette Gl-Porter, Mercedes Rios-Scott, David Burmeister

Marna R Greenberg DO, MPH, FACEP

OBJECTIVE: Sex differences have not been well defined for patients undergoing therapeutic hypothermia (TH). We aimed to determine sex differences in mortality and Cerebral Performance Category (CPC) scores at discharge among those receiving TH. METHODS: This retrospective cohort study used data abstracted from an "ICE alert" database, an institutional protocol expediting mild TH for postarrest patients. Quality assurance variables (such as age, time to TH, CPC scores, and mortality) were reviewed and compared by sex. χ(2) Test and Wilcoxon rank sum test were used. Stepwise logistic regression was used to assess the association between mortality and sex, while controlling for …

Diagnostic Performance Of Cardiac Troponin I For Early Rule-In And Rule-Out Of Acute Myocardial Infarction: Results Of A Prospective Multicenter Trial, Alan Storrow, Robert Christenson, Richard Nowak, Deborah Diercks, Adam Singer, Alan Wu, Erik Kulstad, Frank Lovecchio, Christian Fromm, Gary Headden, Tracie Potis, Christopher Hogan, Jon Schrock, Daniel Zelinski, Marna Greenberg, James Ritchie, Janna Chamberlin, Kurtis Bray, Daniel Rhodes, Deirdre Trainor, Dawn Holmes, Paula Southwick

Marna R Greenberg DO, MPH, FACEP

OBJECTIVES: To compare emergency department TnI serial sampling intervals, determine optimal diagnostic thresholds, and report representative diagnostic performance characteristics for early rule-in and rule-out of MI. METHODS: We prospectively measured TnI (AccuTnI+3™, Beckman Coulter) at serial time intervals in 1929 subjects with chest pain or equivalent ischemic symptoms suggestive of acute coronary syndromes at 14 medical centers. Diagnosis was adjudicated by an independent central committee. RESULTS: TnI ≥0.03ng/mL provided 96.0% sensitivity and 89.4% specificity at 1-3h after admission, and 94.9% sensitivity and 86.7% specificity at 3-6h. NPV (rule-out, non-MI) was 99.5% at 1-3h, and 99.0% at 3-6h when TnI is …

General Practitioners' Use Of Different Cardiovascular Risk Assessment Strategies: A Qualitative Study, Carissa Bonner, Jesse Jansen, Shannon Mckinn, Les Irwig, J. Doust, Paul Glasziou, Andrew Hayen, Kirsten Mccaffery

Jenny Doust

Objectives: To identify factors that influence the extent to which general practitioners use absolute risk (AR) assessment in cardiovascular disease (CVD) risk assessment. Design, setting and participants: Semi-structured interviews with 25 currently practising GPs from eight Divisions of General Practice in New South Wales, Australia, between October 2011 and May 2012. Data were analysed using framework analysis. Results: The study identified five strategies that GPs use with patients in different situations, defined in terms of the extent to which AR was used and the reasons given for this: the AR-focused strategy, used when AR assessment was considered useful for the …

Comparison Of Insulin Infusion Protocols Targeting 110-140 Mg/Dl In Patients After Cardiac Surgery., Vasudev Magaji, Shriddha Nayak, Amy Donihi, Lauren Willard, Srinivasa Jampana, Parachur Nivedita, Raymond Eder, Jann Johnston, Mary Korytkowski

Vasudev G Magaji MD, MS

BACKGROUND: Continuous intravenous insulin infusion (CII) following coronary artery bypass graft (CABG) surgery reduces postoperative complications and hospitalization duration. Because of limited data evaluating outcomes of CII with revised glycemic targets (110-140 mg/dL) in cardiac surgery, this study compared efficacy and safety of two different CII protocols having revised targets. SUBJECTS AND METHODS: This is a retrospective study comparing two different protocols between August 2009 and March 2010. Protocol 1 consists of four algorithms, and Protocol 2 is a table to adjust CII. Blood glucose (BG) and CII rates were recorded for 48 h postoperatively or CII discontinuation. Efficacy was …

Efficacy And Safety Of Continuous Insulin Infusion Protocols With Glycemic Targets Of 110-140 Mg/Dl In Patients With And Without Diabetes Following Cardiac Surgery, Shriddha Nayak, Vasudev Magaji, Amy Donihi, Lauren Willard, Srinivasa Jampana, Parachur Nivedita, Raymond Eder, Jann Johnston, Mary Korytkowski

Vasudev G Magaji MD, MS

No abstract provided.

Simultaneous Very Late Angiographic Stent Thrombosis Of 2 Drug-Eluting Stents: A Case Report, Joseph Quercia, Bryan Kane, Kathleen Kane

Kathleen E Kane MD

No abstract provided.

Angiographic Recognition Of Ostial Left Main Coronary Artery Stenosis: Case Report., R M Macmillan, Bruce Feldman, V Maranhao

Bruce A. Feldman DO

Ostial left main coronary stenosis has a poor prognosis and increased mortality rate with coronary arteriography. Due to its anatomic location, visualization of the stenosis may be difficult. A high index of suspicion based upon only a few signs should prompt the physician to perform certain maneuvers to obtain the correct diagnosis. Four illustrative cases are presented and discussed.

Long Term Stemi Outcome Data Acquisition, Tina Ruhf Rn, Orlando E. Rivera Rn, Nainesh C. Patel Md, Bruce Feldman Do, J Patrick Kleaveland Md, Mercedes Rios-Scott Bs, Kevin T. Whalen Bs, Susan Bernhard Bs, David A. Cox Md

Bruce A. Feldman DO

No abstract provided.

Mi Alert St-Segment Elevation Myocardial Infarction (Stemi) Real Time Data Feedback: A Patient Quality Of Care Initiative, Orlando Rivera, Nainesh Patel, Bruce Feldman

Bruce A. Feldman DO

No abstract provided.

Left Atrial Enlargement Is Associated With Postoperative Respiratory Failure And Mortality, Bertrand N. Mukete Md, Christina Dunbar Do, Mph, Matthew M. Miller Do, Sherrine Eid Mph, Bruce Feldman Do

Bruce A. Feldman DO

No abstract provided.

One Year Outcomes Of A Pre-Hospital Myocardial Infarction Alert 3 Process, Gerald Coleman Do, Andrew C. Miller Do, David Richardson Md, David A. Cox Md, Nainesh Patel Md, J Patrick Kleaveland Md, Bruce Feldman Do, Ron Freudenberger Md, Richard S. Mackenzie Md

Bruce A. Feldman DO

No abstract provided.

Impact Of Pre-Hospital Myocardial Infarction Alert Process Education On Door To Balloon Times At Sites Within A Regional Heart Center, Gerald Coleman Do, Andrew C. Miller Do, David Richardson Md, David Cox Md, Nainesh C. Patel Md, J Patrick Kleaveland Md, Bruce Feldman Do, Ron Freudenberger Md, Richard S. Mackenzie Md

Bruce A. Feldman DO

No abstract provided.

Rapid Door To Balloon Time In The Treatment Of Acute St- Elevation Myocardial Infarction Meaningfully Reduces Overall Hospital Stay, Amit N. Nanavati Md, Nainesh Patel Md, Bruce Feldman Do, J Patrick Kleaveland Md, Orlando E. Rivera Rn, David A. Cox Md

Bruce A. Feldman DO

No abstract provided.

Radiofrequency Ablation Improving Lv Function In Cardiomyopathy Secondary To Low Burden Of Premature Ventricular Complexes, Nasir Shariff, Daniel Makowski, Vadim Levin

Vadim A Levin MD

No abstract provided.

Addressing The Controversy Of Rate-Versus-Rhythm Control In Atrial Fibrillation, Tahmeed Contractor, Vadim Levin, Ravi Desai, Francis E Marchlinski

Vadim A Levin MD

Atrial fibrillation is the most common sustained cardiac arrhythmia and significantly increases patient risk of stroke, cardiomyopathy, and mortality. Rate versus rhythm control as the "best" treatment strategy remains an issue of considerable, ongoing debate. A multitude of clinical trials have compared the 2 strategies and have not shown any benefit of one approach over the other. However, the trials were conducted in specific subgroups of patients and demonstrated low success rates with antiarrhythmic drug (AAD) therapy and a high incidence of adverse AAD effects. Sub-analyses of the trials have confirmed that successful rhythm control with sinus rhythm restoration is …

Addressing The Controversy Of Rate-Versus-Rhythm Control In Atrial Fibrillation, Tahmeed Contractor, Vadim Levin, Ravi Desai, Francis E Marchlinski

Ravi V Desai MD

Atrial fibrillation is the most common sustained cardiac arrhythmia and significantly increases patient risk of stroke, cardiomyopathy, and mortality. Rate versus rhythm control as the "best" treatment strategy remains an issue of considerable, ongoing debate. A multitude of clinical trials have compared the 2 strategies and have not shown any benefit of one approach over the other. However, the trials were conducted in specific subgroups of patients and demonstrated low success rates with antiarrhythmic drug (AAD) therapy and a high incidence of adverse AAD effects. Sub-analyses of the trials have confirmed that successful rhythm control with sinus rhythm restoration is …

Cardiopulmonary Resuscitation Prescription Program: A Pilot Randomized Comparator Trial, Marna Greenberg, Gavin Barr, Valerie Rupp, Nainesh Patel, Kevin Weaver, Kimberly Hamilton, James Reed

Marna R Greenberg DO, MPH, FACEP

No abstract provided.

Gender Disparity In Non St Elevation Myocardial Infarction Cardiac Care: A Unique Illustration, Marna Greenberg, R Llaguri, Monisha Bindra, Valerie Rupp, Sharon Kimmel, William Bond, Richard Mackenzie

Marna R Greenberg DO, MPH, FACEP

No abstract provided.

Gender Differences In Acute Cardiac Care: Where It’S Not, Marna Greenberg, Richard Mackenzie, David Richardson, Michael Rossi, Valerie Rupp, Anne Crown, Sharon Kimmel

Marna R Greenberg DO, MPH, FACEP

No abstract provided.

Invited Commentary On: Orthotopic Heart Transplantation In Patients With Metabolic Risk Factors, Nicholas Cavarocchi, Paul Mather

Nicholas C Cavarocchi MDJ

This is invited commentary to the following article: Kilic, A., Conte, J. V., Shah, A. S., & Yuh, D. D. (2012). Orthotopic heart transplantation in patients with metabolic risk factors. Annals of Thoracic Surgery, 93(3), 718-724.

Ecmo-State Of The Art, Nicholas Cavarorocchi, Md

Nicholas C Cavarocchi MDJ

Dr. Cavarocchi is an Associate Professor of Surgery who holds a faculty appointment in the Department of Surgery at Thomas Jefferson University Hospital in Philadelphia, PA. He is also the Director of Cardiac Critical Care and Surgical Care Unit at Jefferson. In 2007, he was names as one of the countries top surgeons. He specializes in cardiothoracic surgery.

Presentation runs for 1 hour and 2 minutes.

Anomalous Right Coronary Artery Arising From The Pulmonary Artery, Ashish Kabra, James Wu, Matthew Martinez

James K Wu MD

No abstract provided.

Fabry's Disease With Lvot Obstruction: Diagnosis And Management, Jacob Blount, James Wu, Matthew Martinez

James K Wu MD

A 46-year-old male was diagnosed with hypertrophic cardiomyopathy (HCM) and severe left ventricular outflow tract (LVOT) obstruction. Genetic testing revealed that this was a "mimic of HCM" and the true diagnosis was Fabry's disease, although there were no other clinical features of Fabry's. Despite maximal medical therapy he remained symptomatic from the outflow tract gradient and required surgical myectomy for symptom relief. This case illustrates the diagnosis of an HCM mimic by genetic testing.

Durability, Reliability, Viability: 48 Year-Survival Of A Starr-Edwards Mitral Valve, Bilal Ayub, Justin Guthier, James Wu

James K Wu MD

No abstract provided.

Venous Thromboembolism In Patients With Heart Failure: In-Hospital And Chronic Use Of Anti-Coagulants For Prevention, Nasir Shariff, Abdul Aleem, Vadim Levin, Sudip Nanda, Matthew Martinez, Stacey Smith, Ronald Freudenberger

Vadim A Levin MD

No abstract provided.

Ranolazine—Treatment Of Ventricular Tachycardia And Symptomatic Ventricular Premature Beats In Ischemic Cardiomyopathy, Sudip Nanda, Vadim Levin, Matthew Martinez, Ronald Freudenberger

Vadim A Levin MD

No abstract provided.

Atrial Fibrillation In Patients With Heart Failure: Role Of Catheter Ablation Therapies, Nasir Shariff, Abdul Aleem, Vadim Levin, Mukesh Singh, Nauman Islam, Ronald Freudenberger

Vadim A Levin MD

No abstract provided.

Interatrial Conduction Correlates With Optimal Atrioventricular Timing In Cardiac Resynchronization Therapy Devices, Vadim Levin, Mehdi Razavi, Robert Coll, James Coles, Aleksandre Sambelashvili

Vadim A Levin MD

No abstract provided.