Hopefully, when a cardiac patient first presents to the emergency room you will be able to answer the above Herman’s Hermit’s lyrics with a yes; but, what strategies can be integrated into the cath lab that improve care and outcomes for MI and heart failure (HF) patients even further?
News this week centers on matters of the heart, and various researchers have provided strategies and protocols that can improve care, cut mortality and prevent HF readmission.
First, a study published in JAMA showed that the use of evidence-based in-hospital MI treatments— reperfusion treatments like thrombolysis or primary PCI and drug therapy—increased between 1996 and 2007, and during this same time period, mortality at both 30 days and one-year decreased.
Jernberg et al found that while use of clopidogrel was 0 percent in 1996, usage reached 82 percent by 2007. During the same period, in-hospital mortality decreased from almost 13 percent to 7.2 percent.
Additionally, the REVERSE-STEMI study showed implementing a strategy that sends an interventionalist to STEMI patients, rather than utilizing a patient-transfer model, improves long-term results and shortens door-to-balloon times (D2B). The study carried out at five centers throughout Shanghai, China enrolled almost 400 STEMI patients and showed that patients randomized to the interventionalist-transfer group saw shorter D2B times compared to those patients who were transferred to a primary PCI-ready hospital.
In cases where a specialist was dispatched directly to the hospital where the STEMI patient presented, patients had higher rates of survival and were more likely to be free of adverse cardiac events compared to those in the patient-transfer group.
News coming from the annual leadership meeting of the American College of Cardiovascular Administrators in Chicago, showed that developing a multidisciplinary team-based approach to HF care decreased readmissions by 11 percent within six months of implementation.
During the study, Scripps Health in San Diego piloted a strategy called the Advanced Practice Nurse intervention for high-risk HF patients that included a focus on patient education and follow-up. After implementation, the facility realized an 11 percent drop in hospital HF readmissions. The researchers suggested that a larger focus should surround streamlining patient education materials and using a team-based approach.
Lastly, a commentary published in JAMA this week suggests that when an algorithm that includes a six-axis model of care is used clinicians can better evaluate acute HF syndrome patients at presentation. “This six axis tool allows physicians to develop a clear clinical picture of the problem for individual patients without overlooking important details,” Mihai Gheorghiade, MD, told Cardiovascular Business.
The six-axis model includes: 1) Clinical Severity, (2) Blood Pressure, (3) Heart Rate and Rhythm, (4) Precipitants, (5) Comorbidities, (6) DeNovo HF.
Integrating these approaches and protocols to HF care can improve the outcomes of these high-risk patients. What innovative protocols are using to improve outcomes in HF patients? Let us know.
Senior Writer , Cardiovascular Business News