Time to Defibrillation After Onset of Ventricular Fibrillation and Ventricular Tachycardia Cardiac Arrest at Thomas Jefferson University Hospital and Jefferson Hospital for Neurosciences.

Aims for Improvement Improve average time to defibrillation after VFib/pVTach cardiac arrest to \u3c 2 minutes within an 8 month interval at TJUH and JHN. Improve the percent of VFib/pVTach cardiac arrests that are defibrillated within the recommended 2 minute interval by 30% at TJUH/JHN within an 8 month interva

Outpatient Mineralocorticoid Receptor Antagonist Prescription Rate for Heart Failure

Aims for Improvement: Improve MRA prescription rate in the outpatient cardiology clinic by 25

Pericardial Effusion with Tamponade Physiology in a Patient with Multiple Myeloma

A 78-yeaer old African American female with a past medical history of IgA Kappa Multiple Myseloma was transfered to the Cardiovascular Intensive Care Unit (CVICU) at Thomas Jefferson University Hospital (TJUH) after being diagnosed with a pericardial effusion with tamponade physiology at an outside hospital

Procedural and Clinical Outcomes of Transitioning to High Power Short Duration Guided Ablation for Atrial Fibrillation

Introduction: High-power short-duration (HPSD; 50W for up to 15s) ablation is a novel way to use a contact force-sensing catheter optimized for power-controlled radiofrequency ablation of atrial fibrillation (AF). Our goal was to compare the procedural and clinical outcomes of AF ablation with HPSD to previous ablation methods used, including standard-power standard duration (SPSD; 20-25W, up to 60s) and temperature-controlled non-contact (TCNC; 20-40W, up to 60s). Methods: Procedural and clinical data was from consecutive cases of patients with paroxysmal or persistent AF undergoing pulmonary vein isolation with HPSD, TCNC and SPSD between 7/1/13 to 11/1/19. A total of 171 patients were studied (76 HPSD, 44 TCNC, 51 SPSD). Results: There was no difference in age, sex, or AF type between groups. Radiofrequency ablation time was shorter when comparing HPSD to SPSD (71 vs 101min; p\u3c0.01), HPSD to TCNC (71 vs 146min; p\u3c0.01), and SPSD to TCNC groups (101 vs 146min; p\u3c0.01). There was no difference in sinus rhythm maintenance after 3 or 12-months between groups overall, and when stratified by AF type, left atrial volume, CHA2DS2-VASc score, or left ventricular EF. There was a numerical difference in safety with no adverse events in HPSD (0/76 in HPSD vs 1/51 in SPSD vs 3/44 in TCNC; p=0.06). Discussion: AF ablation utilizing HPSD ablation reduced procedure times with similar sinus rhythm maintenance compared to SPSD and TCNC ablation. This supports the movement to replace SPSD and TCNC with the novel HPSD approach. Further research is warranted with larger populations and longer follow-up

Improving Time to Defibrillation at Thomas Jefferson University Hospital

Aims for Improvement Increase in timely defibrillation by 30% over 1 year Decrease in the amount of Vfib/VTach cardiac arrests that are not defibrillated to \u3c1% within a 1 year time fram

Evaluating the Efficacy of a Nursing-Driven versus Provider-Driven Heparin Protocol

At Thomas Jefferson University Hospital patients who require heparin infusions are monitored either by nursing alone or the resident and the nurse together. This project aims to determine: Which protocol more efficiently shortens the time to therapeutic? Are patients therapeutic longer under a certain protocol? Do more patients under either protocol suffer from bleeding complications

Trends and outcomes of transcatheter aortic valve implantation in aortic insufficiency: A nationwide readmission database analysis

Transcatheter aortic valve implantation (TAVI) has increasingly been utilized in patients with aortic insufficiency (AI) with insufficient data on its safety. The Nationwide Readmissions Database (NRD) was queried to identify patients undergoing TAVI for AI. Net clinical events (composite of in-hospital mortality, stroke, major bleeding) and procedural complications were assessed using a propensity-score matched (PSM) analysis to calculate adjusted odds ratios (OR). A total of 185,703 (AI 3873, aortic stenosis [AS] 181,830) patients were included in the analysis. Due to a significant difference in the baseline characteristics, a matched sample of 7929 patients (AI 3873, AS 4056) was selected. At index admission, the adjusted odds of in-hospital NACE (aOR 2.0, 95% CI 1.59-2.51), mortality (aOR 3.06, 95% CI 2.38-5.47), major bleeding (aOR 1.53, 95% CI 1.13-2.06) and valvular complications (aOR 9.48, 95% CI 6.73-13.38) were significantly higher in patients undergoing TAVI for AI compared with those undergoing TAVI for AS. However, there was no significant difference in the incidence of NACE, mortality, stroke, major bleeding, and need for permanent pacemaker implantation at 30- and 180-days follow-up. TAVI in AI was associated with a higher risk of periprocedural NACE, mortality, and major bleeding. The risk of these complications attenuated at 30- and 180-day readmission