10 aastat Eesti müokardiinfarktiregistrit

Eesti Arst 2022:101(Lisa 1):1-5

Implementation of Departmental Quality Strategies Is Positively Associated with Clinical Practice: Results of a Multicenter Study in 73 Hospitals in 7 European Countries.

BACKGROUND: Given the amount of time and resources invested in implementing quality programs in hospitals, few studies have investigated their clinical impact and what strategies could be recommended to enhance its effectiveness. OBJECTIVE: To assess variations in clinical practice and explore associations with hospital- and department-level quality management systems. DESIGN: Multicenter, multilevel cross-sectional study. SETTING AND PARTICIPANTS: Seventy-three acute care hospitals with 276 departments managing acute myocardial infarction, deliveries, hip fracture, and stroke in seven countries. INTERVENTION: None. MEASURES: Predictor variables included 3 hospital- and 4 department-level quality measures. Six measures were collected through direct observation by an external surveyor and one was assessed through a questionnaire completed by hospital quality managers. Dependent variables included 24 clinical practice indicators based on case note reviews covering the 4 conditions (acute myocardial infarction, deliveries, hip fracture and stroke). A directed acyclic graph was used to encode relationships between predictors, outcomes, and covariates and to guide the choice of covariates to control for confounding. RESULTS AND LIMITATIONS: Data were provided on 9021 clinical records by 276 departments in 73 hospitals. There were substantial variations in compliance with the 24 clinical practice indicators. Weak associations were observed between hospital quality systems and 4 of the 24 indicators, but on analyzing department-level quality systems, strong associations were observed for 8 of the 11 indicators for acute myocardial infarction and stroke. Clinical indicators supported by higher levels of evidence were more frequently associated with quality systems and activities. CONCLUSIONS: There are significant gaps between recommended standards of care and clinical practice in a large sample of hospitals. Implementation of department-level quality strategies was significantly associated with good clinical practice. Further research should aim to develop clinically relevant quality standards for hospital departments, which appear to be more effective than generic hospital-wide quality systems

Incidence, Management, and Outcome of Out-of-Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OHCA) affects 35,000 Australians each year and only 12% will survive to hospital discharge. The first step to improving OHCA survivorship is to develop a registry to track performance, identify areas for improvement, and measure the effectiveness of solutions. The Northern Adelaide Local Health Network (NALHN) services a population at high risk for OHCA in the northern suburbs of Adelaide, South Australia. The primary aim of this thesis was to develop a hospital based registry to determine incidence, management, and outcome of OHCA within NALHN. Methods: This thesis outlines (a) the development and validation of the NALHN OHCA registry, and (b) retrospective analyses of registry and associated data. The NALHN OHCA registry was developed in accordance with the Utstein-style guidelines as a prospective population-based quality assurance registry of all OHCAs treated at NALHN hospitals. A simple and consistent clinical definition of OHCA was proposed to allow inclusion of nonemergency medical service (EMS) attended OHCAs. Methods of case identification were developed and tested according to the accuracy (sensitivity and positive predictive value) of each source, both individually and combined. Data-linkage was established with the SA Ambulance Service Cardiac Arrest Registry (SAAS-CAR) to quantify age-standardised incidence, baseline characteristics, and outcomes stratified by sex for EMS-treated OHCA, non-EMS witnessed presumed cardiac and obvious non-cardiac sub-cohorts, and hospitalised cohorts. Cardiologist management of cases transported to hospital was assessed by measuring the sensitivity of the decision for emergency coronary angiography with respect to the need for acute revascularisation. Finally, clinical characteristics and outcomes associated with mode of death and adjudicated aetiology were explored in hospitalised patients. Results: From 2011 onwards, all OHCA cases treated within a NALHN hospital were included in the NALHN OHCA registry. No single data-source identified all OHCAs, but a combination of ED coding and existing clinical registries provided a valid method used to augment EMS-based data. The NALHN catchment area had high incidence of OHCA and there were sex-differences in incidence and outcome, but these were primarily driven by low rates of ventricular fibrillation and differences in underlying aetiology in women. In presumed cardiac patients treated at hospital, emergency coronary angiography was appropriately ruled out, and somewhat effectively ruled in, by both experienced interventional cardiologists and a clinical score. In-hospital mode of death was primarily due to cardiovascular instability for deaths in the ED, while deaths after admission were due to neurological injury. Mode of death was significantly associated with age, timing of death, and precipitating aetiology, but not sex. Non-cardiac aetiologies represented 40% of the NALHN OHCA cohort and were associated with poor outcome. Conclusions: The incidence, management, and outcome of OHCA within northern Adelaide was characterised by establishing a high-definition hospital-based registry. The NALHN OHCA registry provides ongoing surveillance of OHCA within northern Adelaide. The results are currently being used to inform development of hospital guidelines, as well as interventions that aim to improve cardiology management and neurological prognostication, and ultimately, OHCA survivorship.Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 202

A trombocita aggregáció gátló kezelés monitorozásának klinikai relevanciái perkután koronária intervención átesett betegek körében

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No reflow phenomenon in percutaneous coronary interventions in ST-segment elevation myocardial infarction

AbstractPercutaneous coronary intervention (PCI) is effective in opening the infarct related artery and restoring thrombolysis in myocardial infarction flow 3 (TIMI-flow 3) in large majority of ST-elevation myocardial infarction (STEMI). However there remain a small but significant proportion of patients, who continue to manifest diminished myocardial reperfusion despite successful opening of the obstructed epicardial artery. This phenomenon is called no-reflow. Clinically it manifests with recurrence of chest pain and dyspnea and may progress to cardiogenic shock, cardiac arrest, serious arrhythmias and acute heart failure. No reflow is regarded as independent predictor of death or recurrent myocardial infarction. No reflow is a multi-factorial phenomenon. However micro embolization of atherothrombotic debris during PCI remains the principal mechanism responsible for microvascular obstruction. This review summarizes the pathogenesis, diagnostic methods and the results of various recent randomized trials and studies on the prevention and management of no-reflow

Cardiovascular health:The importance of measuring patient-reported health status

A scientific statement from the American Heart Association Keywords: cardiovascular diseases; health care evaluation mechanisms; health status; health surveys; patient

2023 ESC Guidelines for the management of acute coronary syndromes.

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Az 1-es típusú diabetes ok-specifikus halálozása és a major szövődmények túlélését befolyásoló tényezők

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CRT Survey II: a European Society of Cardiology survey of cardiac resynchronisation therapy in 11 088 patients—who is doing what to whom and how?

Background: Cardiac resynchronisation therapy (CRT) reduces morbidity and mortality in appropriately selected patients with heart failure and is strongly recommended for such patients by guidelines. A European Society of Cardiology (ESC) CRT survey conducted in 2008–2009 showed considerable variation in guideline adherence and large individual, national and regional differences in patient selection, implantation practice and follow-up. Accordingly, two ESC associations, the European Heart Rhythm Association and the Heart Failure Association, designed a second prospective survey to describe contemporary clinical practice regarding CRT. Methods and results: A survey of the clinical practice of CRT-P and CRT-D implantation was conducted from October 2015 to December 2016 in 42 ESC member countries. Implanting centres provided information about their hospital and CRT service and were asked to complete a web-based case report form collecting information on patient characteristics, investigations, implantation procedures and complications during the index hospitalisation. The 11 088 patients enrolled represented 11% of the total number of expected implantations in participating countries during the survey period; 32% of patients were aged ≥75 years, 28% of procedures were upgrades from a permanent pacemaker or implantable cardioverter-defibrillator and 30% were CRT-P rather than CRT-D. Most patients (88%) had a QRS duration ≥130 ms, 73% had left bundle branch block and 26% were in atrial fibrillation at the time of implantation. Large geographical variations in clinical practice were observed. Conclusion: CRT Survey II provides a valuable source of information on contemporary clinical practice with respect to CRT implantation in a large sample of ESC member states. The survey permits assessment of guideline adherence and demonstrates variations in patient selection, management, implantation procedure and follow-up strategy