Interpreting the Interpretations: The Use of Structured Reporting Improves Referring Clinicians' Comprehension of Coronary CT Angiography Reports

BackgroundEfficiency of coronary CT angiography (CCTA) in clinical practice depends on precise reporting and accurate result interpretation.ObjectiveWe sought to assess referring clinicians' understanding of patients' coronary artery disease (CAD) severity and to compare satisfactions of the free-form impression (FFI) with satisfactions of the structured impression (SI) section of CCTA reports.Materials and methodsFifty clinical CCTA reports from May 2011 to April 2012 were retrospectively selected (25 FFI and 25 SI), to include cases with the entire spectrum of CAD (6 categories encompassing normal, minimal, mild, moderate, severe stenosis, and occlusion). A survey containing only randomized blinded impressions was distributed to 4 cardiologists and 2 cardiac imaging specialists. Clinician interpretation was examined regarding (Q1) worst stenosis severity, (Q2) number of vessels with significant stenosis, and (Q3) the presence of nonevaluable segments. Agreement proportions and Cohen's kappa were evaluated between FFI versus SI. Satisfactions were measured with respect to content, clarity, and clinical effectiveness.ResultsQ1 agreement was excellent for both FFI and SI (by 6 categories: 80% versus 85%; P > .05; kappa: 0.87 versus 0.89; by no CAD versus nonsignificant versus significant CAD: 99% versus 97%; P > .05; kappa: 0.99 versus 0.94). Q2 agreement improved from fair to moderate (53% versus 68%; P = .04; kappa 0.31 versus 0.52). Q3 agreement was moderate (90% versus 87%; P > .05; kappa 0.57 versus 0.58). Satisfactions with impressions were high and similar for FFI and SI for clinicians.ConclusionStructured impressions were shown to improve result interpretation agreement from fair to moderate with regard to the number of vessels with significant stenosis

Renal insufficiency, bleeding and prescription of discharge medication in patients undergoing percutaneous coronary intervention in the National Heart, Lung, and Blood Institute (NHLBI) Dynamic Registry.

AIMS: To establish the relationship between renal insufficiency, bleeding and prescription of cardiovascular medication. METHODS AND RESULTS: This was a prospective, multi-center, cohort study of consecutive patients undergoing PCI during three NHLBI Dynamic Registry recruitment waves. Major and minor bleeding, access site bleeding and rates of prescription of cardiovascular medication at discharge were determined based on estimated glomerular filtration rate (eGFR). Renal insufficiency was an independent predictor of major adverse cardiovascular events (MACE). Bleeding events and access site bleeding requiring transfusion were significantly associated with degrees of renal insufficiency (p CONCLUSIONS: Renal insufficiency is associated with bleeding in patients undergoing PCI. Patients with renal insufficiency are less likely to receive recommended discharge pharmacotherapy

Statins Improve the Resolution of Established Murine Venous Thrombosis: Reductions in Thrombus Burden and Vein Wall Scarring

Despite anticoagulation therapy, up to one-half of patients with deep vein thrombosis (DVT) will develop the post-thrombotic syndrome (PTS). Improving the long-term outcome of DVT patients at risk for PTS will therefore require new approaches. Here we investigate the effects of statins—lipid-lowering agents with anti-thrombotic and anti-inflammatory properties—in decreasing thrombus burden and decreasing vein wall injury, mediators of PTS, in established murine stasis and non-stasis chemical-induced venous thrombosis (N = 282 mice). Treatment of mice with daily atorvastatin or rosuvastatin significantly reduced stasis venous thrombus burden by 25% without affecting lipid levels, blood coagulation parameters, or blood cell counts. Statin-driven reductions in VT burden (thrombus mass for stasis thrombi, intravital microscopy thrombus area for non-stasis thrombi) compared similarly to the therapeutic anticoagulant effects of low molecular weight heparin. Blood from statin-treated mice showed significant reductions in platelet aggregation and clot stability. Statins additionally reduced thrombus plasminogen activator inhibitor-1 (PAI-1), tissue factor, neutrophils, myeloperoxidase, neutrophil extracellular traps (NETs), and macrophages, and these effects were most notable in the earlier timepoints after DVT formation. In addition, statins reduced DVT-induced vein wall scarring by 50% durably up to day 21 in stasis VT, as shown by polarized light microscopy of picrosirius red-stained vein wall collagen. The overall results demonstrate that statins improve VT resolution via profibrinolytic, anticoagulant, antiplatelet, and anti-vein wall scarring effects. Statins may therefore offer a new pharmacotherapeutic approach to improve DVT resolution and to reduce the post-thrombotic syndrome, particularly in subjects who are ineligible for anticoagulation therapy

Irish Heart Attack Audit National Report 2017-2020

The Heartbeat audit of ST elevation myocardial infarction (STEMI) care was first developed in 2012 in order to assess the effectiveness and quality of the newly formed National Clinical Programme for Acute Coronary Syndrome (NCP-ACS) STEMI optimal reperfusion service under the auspices of Professor Kieran Daly, Health Service Executive (HSE) Clinical Lead, and Dr Siobhan Jennings, Consultant in Public Health Medicine, HSE. In 2019, this audit and attendant database came under the governance of the National Office of Clinical Audit (NOCA) by agreement with the HSE and evolved into the Irish Heart Attack Audit (IHAA). Although this is the first national IHAA report, it continues on from the two previously published NCP-ACS reports on the state of STEMI services across the country based on data collected in 2014 (HSE, 2015) and 2016 (HSE, 2018a). With a maturing database and systematic analytic capabilities through the NOCA structure, this report provides a detailed evaluation of STEMI care in Ireland for the years 2017 to 2020.<br