Showing papers by "Kim A. Eagle published in 2001"

ACC/AHA Guidelines for Percutaneous Coronary Intervention (Revision of the 1993 PTCA Guidelines)—Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1993 Guidelines for Percutaneous Transluminal Coronary Angioplasty) Endorsed by the Society for Cardiac Angiography and Interventions

Abstract: The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines was formed to gather information and make recommendations about appropriate use of technology for the diagnosis and treatment of patients with cardiovascular disease. Percutaneous coronary

Lowering cardiac risk in noncardiac surgery

Abstract: A 65-year-old man requires resection of an abdominal aortic aneurysm. He has a remote history of myocardial infarction and rare episodes of angina. Recent coronary angiography revealed more than 70...

Simple Bedside Additive Tool for Prediction of In-Hospital Mortality After Percutaneous Coronary Interventions

Abstract: Background Risk-adjustment models for percutaneous coronary intervention (PCI) mortality have been recently reported, but application in bedside prediction of prognosis for individual patients remains untested. Methods and Results Between July 1, 1997 and September 30, 1999, 10 796 consecutive procedures were performed in a consortium of 8 hospitals. Predictors of in-hospital mortality were identified by use of multivariate logistic regression analysis. The final model was validated by use of the bootstrap technique. Additional validation was performed on an independent data set of 5863 consecutive procedures performed between October 1, 1999, and August 30, 2000. An additive risk-prediction score was developed by rounding coefficients of the logistic regression model to the closest half-integer, and a visual bedside tool for the prediction of individual patient prognosis was developed. In this patient population, the in-hospital mortality rate was 1.6%. Multivariate regression analysis identified acute m...

Complete atrioventricular block after valvular heart surgery and the timing of pacemaker implantation

Abstract: The natural history of patients who developed complete atrioventricular block after valvular heart surgery was investigated to determine the optimal timing for pacemaker implantation. Patients who developed complete atrioventricular block within 24 hours after operation, which then persisted for > 48 hours, were unlikely to recover; such patients could potentially undergo earlier pacemaker implantation if otherwise ready for discharge.

Coil Embolization of a Periprosthetic Mitral Valve Leak Associated With Severe Hemolytic Anemia

Abstract: 55-year-old man presented with severe fatigue, anorexia, and weight loss. His past medical history was significant for diabetes mellitus, severe mitral annulus calcification, aortic and mitral valve replacement, prosthetic mitral valve endocarditis complicated by periprosthetic mitral regurgitation, and repeat mitral valve replacement 2 months before admission. Admission hemoglobin was 6 g/dL and additional laboratory evaluation was consistent with severe hemolytic anemia. A transesophageal echocardiogram (TEE) revealed a periprosthetic mitral valve leak that we believed to be the cause of the hemolytic anemia (Figure 1). During initial hospitalization, the patient remained transfusion dependent. Figure 1. Transesophageal images obtained before …

Effect of postoperative atrial fibrillation on length of stay after cardiac surgery (the postoperative atrial fibrillation in cardiac surgery study [PACS2])

Abstract: Atrial fibrillation (AF) after cardiac surgery is thought to increase length of stay (LOS). A clinical pathway focused on the management of postoperative AF, including prophylaxis with beta blockers, was implemented to assess the effect of AF on LOS after cardiac surgery. Data were obtained on consecutive cardiac surgery patients in preoperative normal sinus rhythm, no prior history of AF, and no chronic antiarrhythmic therapy from January to May 1995 (control) and November 1996 to June 1997 (pathway). Statistical analysis was performed to assess the effect of postoperative AF on the LOS, clinical outcomes, and cost after cardiac surgery. Despite the clinical pathway, the LOS (7 days for both periods; p = 0.12) and incidence of AF (28.9% vs 28.4%; p = 0.92) remained unchanged. Unadjusted direct costs were 15% higher in the pathway period (p <0.001). Increased rates of beta-blocker therapy had a marginal effect on the incidence of postoperative AF, except in the group who only underwent primary coronary artery bypass graft surgery (31.2% vs 25.3%; p = 0.31). Multivariate analysis revealed that AF contributed only 1 to 1.5 days to the LOS. Thus, this investigation represents the most recent analysis of the effects of postoperative AF on LOS, clinical outcomes, and cost after cardiac surgery. Unlike prior studies, the impact of postoperative AF is less prominent in the current era of cardiac surgical care regardless of the presence of a clinical pathway addressing AF.

Of Nicks and Time

Abstract: Stage A 32-year-old man with a history of asthma and “crack” cocaine use presented to the emergency department after an episode of syncope. Earlier that evening, he had smoked crack cocaine several times. Shortly after his last use, he began to have sharp chest pain, which radiated to his shoulders and was associated with dizziness and diaphoresis, followed by a sudden loss of consciousness. His wife, who witnessed the event, described him as “foaming at the mouth” and having involuntary trembling of his arms and legs. He was brought immediately to the emergency department. Stage The patient reported no shortness . . .

Clinical outcomes and costs associated with a first episode of uncomplicated atrial fibrillation presenting to the emergency room

Abstract: A trial fibrillation (AF) is a frequent reason for emergency room visits.1 Traditional practice has been to admit patients with new AF for management.2 Despite this widespread practice pattern, the clinical utility of this approach is uncertain, as evidenced by a recent retrospective review of patients with acute, uncomplicated AF.3 A retrospective chart review was performed on all patients presenting with AF to the emergency room at a university hospital from September 1997 to November 1998, to assess the impact of a first episode of uncomplicated AF on clinical outcomes, length of stay, and actual direct costs. • • • Patients meeting the following eligibility criteria had data abstracted: (1) newly diagnosed or new onset AF; (2) uncomplicated clinical status at initial presentation, with no indication for hospital admission other than AF; (3) age between 18 and 75 years; (4) no contraindications to anticoagulation; and (5) no symptomatic congestive heart failure or known left ventricular ejection fraction ,30%. Forty-seven patients were identified. AF was confirmed in each case and the records were abstracted for baseline clinical and demographic information, clinical outcomes, medical management, length of stay, and clinical follow-up after initial presentation. Actual direct costs were calculated using the Transition Systems, Inc., cost allocation system (Eclipsys Corporation, Delray Beach, Florida). The costs of diagnostic testing (echocardiography, stress testing) related to AF after discharge performed on an outpatient basis were included. Subgroup analyses were performed based on the disposition of the patient after emergency room evaluation and on the presence or absence of spontaneous conversion of AF to sinus rhythm. Bivariate comparisons were made using Fisher’s exact test, chi-square test, or Pearson’s chi-square test, and means were compared across groups using Student’s t test. SAS version 6.2 (SAS Institute, Cary, North Carolina) was used for analyses. A p value ,0.05 was considered significant. The study group consisted of 47 patients with a mean age of 57 6 16 years (range 18 to 75). Baseline clinical and demographic characteristics are listed in Table 1. The use of rate control, anticoagulation, and resource utilization after initial presentation are shown in Table 2. The mean length of stay was 1.72 6 0.99 days (range 1 to 5) and the mean actual direct cost was $1,989 6 $1,583 dollars (range $202 to $4,430). The 25th and 75th percentiles for length of stay were 1 and 2 days, and for actual direct costs were $1,171 and $2,443. Among the 47 patients, 39 patients (83%) were admitted to the hospital and 8 patients (17%) were discharged from the emergency room. Mean age and gender ratio did not differ between the admitted paFrom the Cardiovascular Division, Washington University, St. Louis, Missouri; the Heart Care Program, Consortium for Health Outcomes, Innovation, and Cost Effectiveness Studies, and the Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan. Drs. Kim and Eagle were supported by a research grant from Pharmacia-Upjohn Pharmaceuticals, Kalamazoo, Michigan. Dr. Kim’s address is: Campus Box 8086, Cardiovascular Division,Washington University in St. Louis, 660 S. Euclid Ave., St. Louis, Missouri 63110. E-mail: mkim@im.wustl.edu. Manuscript received September 14, 2000; revised manuscript received and accepted January 24, 2001. TABLE 1 Clinical Features of the Study Group (n 5 47)