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11.
Int J Cardiol ; 312: 24-26, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32339543
13.
Circulation ; 141(20): e810-e816, 2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32216640

RESUMO

In response to the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, the Chinese Society of Cardiology (CSC) issued this consensus statement after consulting with 125 medical experts in the fields of cardiovascular disease and infectious disease. The over-arching principles laid out here are the following: 1) Consider the prevention and control of COVID-19 transmission as the highest priority, including self-protection of medical staff; 2) Patient risk assessment of both infection and cardiovascular issues. Where appropriate, preferential use of conservative medical therapeutic approaches to minimize disease spread; 3) At all times, medical practices and interventional procedures should be conducted in accordance with the directives of the infection control department of local hospitals and local health commissions.


Assuntos
Betacoronavirus , Serviço Hospitalar de Cardiologia/organização & administração , Doenças Cardiovasculares , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/psicologia , Doenças Cardiovasculares/terapia , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Humanos , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Pneumonia Viral/diagnóstico , Guias de Prática Clínica como Assunto , Medição de Risco , Telemedicina
16.
Circ Cardiovasc Qual Outcomes ; 12(5): e005251, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31092020

RESUMO

Background Hospital management practices are associated with cardiovascular process of care measures and patient outcomes. However, management practices related to acute cardiac care in India has not been studied. Methods and Results We measured management practices through semistructured, in-person interviews with hospital administrators, physician managers, and nurse managers in Kerala, India between October and November 2017 using the adapted World Management Survey. Trained interviewers independently scored management interview responses (range: 1-5) to capture management practices ranging from performance data tracking to setting targets. We performed univariate regression analyses to assess the relationship between hospital-level factors and management practices. Using Pearson correlation coefficients and mixed-effect logistic regression models, we explored the relationship between management practices and 30-day major adverse cardiovascular events defined as all-cause mortality, reinfarction, stroke, or major bleeding. Ninety managers from 37 hospitals participated. We found suboptimal management practices across 3 management levels (mean [SD]: 2.1 [0.5], 2.0 [0.3], and 1.9 [0.3] for hospital administrators, physician managers, and nurse managers, respectively [ P=0.08]) with lowest scores related to setting organizational targets. Hospitals with existing healthcare quality accreditation, more cardiologists, and private ownership were associated with higher management scores. In our exploratory analysis, higher physician management practice scores related to operation, performance, and target management were correlated with lower 30-day major adverse cardiovascular event. Conclusions Management practices related to acute cardiac care in participating Kerala hospitals were suboptimal but were correlated with clinical outcomes. We identified opportunities to strengthen nonclinical practices to improve patient care.


Assuntos
Serviço Hospitalar de Cardiologia/organização & administração , Doenças Cardiovasculares/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Administração Hospitalar , Equipe de Assistência ao Paciente/organização & administração , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Adulto , Idoso , Doenças Cardiovasculares/diagnóstico , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Índia , Liderança , Masculino , Pessoa de Meia-Idade , Enfermeiras Administradoras/organização & administração , Diretores Médicos/organização & administração , Fatores de Tempo , Resultado do Tratamento
17.
N Z Med J ; 132(1489): 39-47, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30703778

RESUMO

AIM: Chest pain is a common symptom that creates significant anxiety for patients until a diagnosis can be offered. However, hospital cardiology services can struggle to cope with referral demands from primary care. The aim of this paper is to describe the development and implementation of a nurse-led chest pain service, its care processes and clinical outcomes to show feasibility, safety and sustainability. METHOD: We retrospectively analysed referral, demographic, cardiovascular risk, management and clinical outcome data relating to patients assessed in the nurse-led chest pain clinic in a large metropolitan district health board. RESULTS: Between January 2010 to December 2016, 3,587 patients attended the clinic, median 2.6 weeks (IQR 2-3) from referral to attendance. 1,921 (54%) were male and 2,059 (57%) were less than 60 years old. Most patients, 3,059 (85%), had an exercise tolerance test (ETT) and of those, 294 (10%) were positive, 572 (18%) non-diagnostic and 2,193 (72%) negative. Cardiovascular disease (CVD) prevention medication was added or modified for 1,150 (32%) patients, all patients who smoked were offered cessation support and all patients were provided with tailored lifestyle advice depending on their absolute CVD risk. Of the 319 (9%) referred for a diagnostic coronary angiogram, 205 (64%) had important coronary disease. The majority of patients, 2,088 (58%) were able to be discharged without any further investigation planned. Over a median follow-up period of 3.6 years, we identified 14 (0.4%) cardiac-related deaths, median (IQR) 2 (1-4) years from review to death. CONCLUSION: The nurse-led clinic offers an enhanced prevention focus that is sustainably managing large numbers of patients with outcomes similar to international studies and within recommended local timeframes.


Assuntos
Dor no Peito , Doença das Coronárias , Clínicas de Dor/organização & administração , Padrões de Prática em Enfermagem/organização & administração , Atenção Primária à Saúde/métodos , Encaminhamento e Consulta/organização & administração , Serviço Hospitalar de Cardiologia/organização & administração , Serviço Hospitalar de Cardiologia/estatística & dados numéricos , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Doença das Coronárias/diagnóstico , Doença das Coronárias/epidemiologia , Assistência à Saúde/métodos , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Avaliação de Processos e Resultados em Cuidados de Saúde , Gestão de Riscos
18.
Recenti Prog Med ; 110(1): 33-41, 2019 Jan.
Artigo em Italiano | MEDLINE | ID: mdl-30720015

RESUMO

INTRODUCTION: Heart failure (HF) is a main issue of modern healthcare system. Patient affected are continuously growing in number and age; therefore, an integrated management between different parts of healthcare system is crucial to optimize outcome and sustainability. So far, little is known about clinical pathways of HF patients in Sicily. METHODS: On initiative of the Regional HF Group of the Italian Association of Hospital Cardiologists (ANMCO), we decided to census all the Cardiology Unit of Sicily. A simple questionnaire elaborated by the group and exploring clinical and organizational matters of HF was sent to the Units. The answer arrived on a voluntary basis. RESULTS: 41/46 Units sent back the filled questionnaire. Five typologies of units were represented, based on complexity [1. Outpatient units; 2. Units without Intensive Care Unit (ICU); 3. Units with ICU; 4. Units with ICU and Cath Lab; 5. Units with ICU, Cath lab and Cardiac Surgery). A dedicated HF unit is present only in half centers, but it is formally recognized solely in 22% of Units. These Units have scarce dedicated staff and activity is predominantly based on personal initiative. Diagnostic and therapeutic tools are used appropriately in most of them, even though congestion is judged mainly through physical exam and echocardiography. Differently from the indications of the guidelines, post discharge titration of therapy lacks in almost 30% of centers. DISCUSSION AND CONCLUSIONS: In Sicily, HF is managed on a plan mainly based on personal initiative. The quality is sufficiently good but a more appropriate and structured organization in particular of the follow-up seems a necessary and improvable requirement in view of quality measurers and economic sustainability of health care.


Assuntos
Serviço Hospitalar de Cardiologia/estatística & dados numéricos , Unidades de Cuidados Coronarianos/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Insuficiência Cardíaca/terapia , Serviço Hospitalar de Cardiologia/organização & administração , Unidades de Cuidados Coronarianos/organização & administração , Procedimentos Clínicos/estatística & dados numéricos , Assistência à Saúde/organização & administração , Pesquisas sobre Serviços de Saúde , Humanos , Sicília
19.
Trials ; 20(1): 95, 2019 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-30704508

RESUMO

BACKGROUND: Acute heart failure (AHF) is one of the most common diagnoses for elderly patients in the emergency department (ED), with an admission rate above 80% and 1-month mortality around 10%. The European guidelines for the management of AHF are based on moderate levels of evidence, due to the lack of randomized controlled trials and the scarce evidence of any clinical added value of a specific treatment to improve outcomes. Recent reports suggest that the very early administration of full recommended therapy may decrease mortality. However, several studies have highlighted that elderly patients often received suboptimal treatment. Our hypothesis is that an early care bundle that comprises early and comprehensive management of symptoms, along with prompt detection and treatment of precipitating factors should improve AHF outcome in elderly patients. METHODS/DESIGN: ELISABETH is a stepped-wedge, cluster randomized controlled, clinical trial in 15 emergency departments in France recruiting all patients aged 75 years and older with a diagnosis of AHF. The tested intervention is a care bundle with a checklist that mandates detection and early treatment of AHF precipitating factors, early and intensive treatment of congestion with intravenously administered nitrate boluses, and application of other recommended treatment (low-dose diuretics, non-invasive ventilation when indicated, and preventive low-molecular-weight heparin). Each center is randomized to the order in which they will switch from a "control period" to an "intervention period." All centers begin the trials with the control period for 2 weeks, then after each 2-week step a new center will enter the intervention period. At the end of the trial, all clusters will receive the intervention regimen. The primary outcome is the number of days alive and out of the hospital at 30 days. DISCUSSION: If our hypothesis is confirmed, this trial will strengthen the level of evidence of AHF guidelines and stress the importance of the associated early and comprehensive treatment of precipitating factors. This trial could be the first to report a reduction in short-term morbidity and mortality in elderly AHF patients. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03683212. Prospectively registered on 25 September 2018.


Assuntos
Serviço Hospitalar de Cardiologia/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Insuficiência Cardíaca/terapia , Pacotes de Assistência ao Paciente , Doença Aguda , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Lista de Checagem , Feminino , França , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
20.
Angiology ; 70(6): 547-553, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30630345

RESUMO

BACKGROUND: Hajj is the largest human gathering with over 2 million people. We evaluated the effect of bundle care intervention on mortality. METHODS: A population-based, before and after study compared the effect of an intervention on mortality. The intervention included recruitment of cardiac team, introducing 24/7 catheterization service, cardiac coordination, standardized cardiac care pathways, and establishment of an effective transportation system. RESULTS: Cardiac mortality accounted for about 52% of all in-hospital deaths before intervention in 2009. This decreased significantly to 43.3%, 32.5%, and 19.7% in 2009, 2010, and 2011, respectively. In-hospital mortality of acute coronary syndromes was 4.7%, 4.6%, and 3.0%, in the years 2009, 2010, and 2011, respectively. Mortality due to other causes remained largely unaffected. There was no significant change in the national mortality due to cardiac causes over the same period provided a reassurance that the observed improvement in in-hospital acute coronary syndrome mortality was not due to overall improvement in health care. The numbers of cardiac catheterization procedures increased 3-fold and cardiac surgical procedures increased 5-fold between 2009 and 2011. CONCLUSIONS: In this study, we found that an evidence-based intensive bundle care intervention substantially reduced the cardiac mortality among the pilgrims assembling for Hajj in Makkah.


Assuntos
Árabes , Serviço Hospitalar de Cardiologia/organização & administração , Comportamento Ritualístico , Procedimentos Clínicos/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Cardiopatias/terapia , Islamismo , Pacotes de Assistência ao Paciente , Cateterismo Cardíaco , Procedimentos Cirúrgicos Cardíacos , Estudos de Viabilidade , Cardiopatias/diagnóstico , Cardiopatias/etnologia , Cardiopatias/mortalidade , Mortalidade Hospitalar , Humanos , Equipe de Assistência ao Paciente/organização & administração , Avaliação de Programas e Projetos de Saúde , Arábia Saudita/epidemiologia , Fatores de Tempo , Transporte de Pacientes/organização & administração , Resultado do Tratamento
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