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1.
Expert Rev Cardiovasc Ther ; 18(1): 41-51, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31941396

RESUMO

Introduction: The emphasis on clinical trials to inform evidence-based medicine remains paramount within the cardiovascular community. Although such high-quality evidence is often translated into national and international guidelines, there exists a large gap between guideline development and guideline implementation into daily clinical practice.Areas covered: This article outlines barriers that impede guideline adherence and possible strategies to overcome such barriers. Barriers intrinsic and extrinsic to clinicians are discussed. The structured process of guideline implementation including guideline adoption, diffusion, and dissemination is discussed. Lastly, the authors review in detail the current and potential future elements of guideline diffusion and dissemination.Expert opinion: Improving guideline adherence remains challenging as it requires understanding of and navigation through various barriers. However, further research specific to cardiovascular medicine guidelines is necessary to better understand the objective effectiveness of various strategies employed by guideline writers and medical societies to improve adherence. The cost-effectiveness of nationwide dissemination strategies in improving guideline adherence and patient outcomes is also necessary but is largely unknown.


Assuntos
Doenças Cardiovasculares/terapia , Fidelidade a Diretrizes , Guias de Prática Clínica como Assunto , Análise Custo-Benefício , Medicina Baseada em Evidências , Humanos
2.
Cardiovasc Drugs Ther ; 33(1): 105-117, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30684116

RESUMO

Atrial fibrillation is a well-known risk factor for cardioembolic stroke; a number of risk stratification scoring systems have been developed to help differentiate which patients would stand to benefit from anticoagulation. However, these scoring systems cannot be utilized in patients whose atrial fibrillation has not been diagnosed. As implantable cardiac monitors become more prevalent, it becomes possible to identify occult, subclinical atrial fibrillation. With this data, it is also possible to examine the relationship between episodes of paroxysmal atrial fibrillation and thromboembolism and the total burden of paroxysmal atrial fibrillation and thromboembolic risk. The data gleaned from these devices provides insight and raises questions regarding the underlying mechanism of thromboembolism in atrial fibrillation, and in doing so, exposes shortcomings in the present clinical use of current risk scoring systems, specifically, the inability to account for atrial fibrillation burden and to apply scores at all in subclinical atrial fibrillation.


Assuntos
Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Acidente Vascular Cerebral/etiologia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Doenças Assintomáticas , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/fisiopatologia , Tomada de Decisão Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/prevenção & controle
4.
Am J Surg ; 204(5): 643-8, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22921150

RESUMO

BACKGROUND: The US Food and Drug Administration recently approved a transcatheter aortic valve for patients for whom open heart surgery is prohibitively risky. METHODS: A multidisciplinary heart valve team partnered with administration to launch a transcatheter aortic valve replacement (TAVR) program. Clinical registries were used to show robust valve caseloads and outcomes at our Veterans Affairs (VA) facility and to project future volumes. A TAVR business plan was approved by the VA leadership as part of a multiphase project to upgrade and expand our surgical facilities. RESULTS: The heart valve team completed a training program that included simulations and visits to established TAVR centers. Patients were evaluated and screened through a streamlined process, and the program was initiated successfully. CONCLUSIONS: Establishing a TAVR program at a VA facility requires a multidisciplinary team with experience in heart valve and endovascular therapies and a supportive administration willing to invest in a sophisticated infrastructure.


Assuntos
Estenose da Valva Aórtica/cirurgia , Procedimentos Endovasculares/métodos , Implante de Prótese de Valva Cardíaca/métodos , Hospitais de Veteranos , Equipe de Assistência ao Paciente/organização & administração , Desenvolvimento de Programas/métodos , Valva Aórtica , Estenose da Valva Aórtica/economia , Educação Médica Continuada , Procedimentos Endovasculares/economia , Procedimentos Endovasculares/instrumentação , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/economia , Implante de Prótese de Valva Cardíaca/instrumentação , Hospitais de Veteranos/economia , Hospitais de Veteranos/organização & administração , Humanos , Desenvolvimento de Programas/economia , Texas , Estados Unidos , United States Department of Veterans Affairs
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