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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

https://caltcm.memberclicks.net/assets/documents/acc_aha_chf_2013_guidelines.pdf

2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

ACC/AHA
: American College of Cardiology/American Heart Association
ACCF/AHA
: American College of Cardiology Foundation/American Heart Association
ACE
: angiotensin-converting enzyme
ACEI
: angiotensin-converting enzyme inhibitor
ACS
: acute coronary syndrome
AF
: atrial fibrillation

/pdf/2016-esc-guidelines-for-the-diagnosis-and-treatment-of-acute-z18hg30pp1.pdf

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation : The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).

/pdf/2015-esc-guidelines-for-the-management-of-acute-coronary-6did6h5nxk.pdf

2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)

/pdf/arrhythmiasof-clinical-electrocardiography-atrial-54jmcj5296.pdf

arrhythmiasof clinical electrocardiography: Atrial

Background Ambulance clinicians use pre-alert calls to inform receiving emergency departments (EDs) of the arrival of a critically unwell patient that will require a specialised response. Little is known about how a decision to pre-alert is made and how this is communicated and acted upon in the receiving ED. Whilst appropriate use of pre-alerts benefits patient care, their overuse carries a risk of harm or opportunity costs. The impact of pre-alerts on ambulance clinicians, ED staff and patients is not currently well understood. Methods We are conducting a mixed methods study with five inter-related work packages. We will analyse 12 months of routine data from ambulance pre-alerts in three regions to identify factors in the variation of pre-alert use, including pre-hospital decision-making. We will undertake a national online Qualtrics survey of ambulance clinician perspectives and experience of pre-alerts. We will explore the impacts of a pre-alert on staff, ED facilities and the patient using semi-structured interviews with ambulance clinicians, ED staff, patients and carers and undertake non-participant observation of ED pre-alert response. Expected Results We will describe current pre-alert practice using 12 months’ data for 3 Ambulance Services, including volume and types of pre-alerts. We will identify specific conditions or patient groups for whom pre-alerts are most likely to lead to change in clinical practice, or for whom action is unlikely to provide benefit. We will hold a feedback workshop in which we will share and discuss our findings with key stakeholders. Conclusions Current variation in pre-alert processes, both pre-hospital and in-hospital and the impact on patient care is not understood. The outputs of this study will establish an evidence base to update national guidance for pre-alert practice and identify areas of good pre-alert practice for both ambulance service and Emergency Department staff.

/pdf/pp26-exploring-the-use-of-pre-hospital-pre-alerts-and-their-183pwg3g.pdf

PP26 Exploring the use of pre-hospital pre-alerts and their impact on patients, ambulance service and emergency department staff: protocol for a mixed methods study

You should seek approval for your final project before investing a lot of effort. Here are the general criteria: your project must use either a text file or a database to provide long term storage of information your project must use menus or multiple forms your project must have a well-designed user interface your project must be reasonably robust-validates user input your project must solve a well-defined problem Ideally, your project will relate to some program that you would already like to write, or emulate some software that you already use. However, if you cannot think up a project, then I'd suggest looking at Programming Challenges at the end of chapters 9 and 10 for ideas. For your project, you will need to submit: A. the zip file containing all the code and data files needed by your program B. a written document with the following sections: problem specification-describe the problem you program is trying to solve I want you to submit a preliminary draft (steps 1-4 below) by Friday, April 10 which you can incorporate into your final written document. Recall that the general steps for developing a Visual Basic application include: Understanding the problem 1. Clearly define what the application is to do: purpose, inputs, processing, outputs Design screens 2. Visualize application running and design its user interface – sketch it on paper 3. Make a list of the controls needed, decide on their names, and write a description 4. Define the values of each control's relevant properties design of your program-overview of how you solved the problem with your program user's guide for your program The very last possible time for submitting your project is Friday, May 8 of Final's week (sooner would be much better). If you wish, teams of two can work on a single project. However, I'll have higher expectations when I grade the projects.

Final project description

Objectives To estimate the cost-effectiveness of early CT coronary angiography (CTCA) for intermediate risk patients with suspected acute coronary syndrome (ACS), compared with standard care Methods We performed within-trial economic analysis using data from the RAPID-CTCA randomised trial, and long-term modelling of cost-effectiveness using secondary data sources to estimate the cost-effectiveness of early CTCA compared with standard care for patients with suspected ACS attending acute hospitals in the UK. Cost-effectiveness was estimated as the incremental cost per quality-adjusted life year (QALY) gained, and the probability of each strategy being cost-effective at varying willingness-to-pay per QALY gained. Results The within-trial analysis showed that there were no demonstrable differences in costs or QALYs between early CTCA and standard care, with point estimates suggesting higher costs (£7414 vs £6845: mean difference £569, 95% CI -£208 to £1335; p=0.1521) and lower QALYs (0.749 vs 0.758, mean difference −0.009, 95% CI −0.026 to 0.010; p=0.377) in the CTCA arm. The long-term economic analysis suggested that, on average, CTCA was slightly less effective than standard care alone with 0.025 quality-adjusted life years lost per patient treated and was more expensive with additional costs of £481 per patient treated. At a threshold of £20 000 per QALY, CTCA has 24% probability of being cost-effective. Conclusions There are no demonstrable differences in within-trial costs and QALYs, and long-term cost-effectiveness modelling suggested higher long-term costs with CTCA and uncertain effect on long-term QALYs, making routine use of CTCA for suspected ACS unlikely to be a cost-effective use of NHS resources.

Cost-effectiveness of rapid assessment of potential ischaemic heart disease with CT coronary angiography

Aims, Objectives and Background Clinical prediction models are often developed using composite outcomes, based on the implicit assumption that the predictors have similar associations with each component outcome. Using an example of a clinical prediction tool for adverse outcome in suspected COVID-19, we aimed to test this assumption and determine whether using a composite outcome led to suboptimal prediction of individual elements of the composite outcome. Method and Design We reanalysed data from the Pandemic Respiratory Infection Emergency System Triage (PRIEST) study; data was collected from 20,891 patients attending 73 emergency departments with suspected COVID-19 and was used to develop a clinical score predicting a composite outcome of mortality or receipt of major organ support up to 30 days following attendance. In this reanalysis we created Least Absolute Shrinkage and Selection Operator (LASSO) multiple regression models to produce unrestricted prediction models for (1) the composite outcome, (2) mortality, and (3) receipt of major organ support. Results and Conclusion Unrestricted regression models had c-statistics of 0.86 (95% Confidence Interval (CI) 0.85–0.86) for mortality, 0.78 (95% CI 0.77–0.80) for receipt of major organ support, and 0.82 (95% CI 0.82–0.83) for the composite outcome. Key variables in the clinical score (increased age, reduced performance status and reduced consciousness) predicted increased risk for mortality and the composite outcome but decreased or no significant risk for receipt of major organ support. The assumption that predictors have similar associations with individual elements of a composite outcome may not hold. Clinical prediction models may incur a ‘composite outcome fallacy’ if they are driven by predicting one element of the composite outcome but used to predict another. Further research into other clinical prediction score with composite outcomes is required.

Steve Goodacre

Papers

arrhythmiasof clinical electrocardiography: Atrial

PP26 Exploring the use of pre-hospital pre-alerts and their impact on patients, ambulance service and emergency department staff: protocol for a mixed methods study

Final project description

Cost-effectiveness of rapid assessment of potential ischaemic heart disease with CT coronary angiography

1522 The composite outcome fallacy in the PRIEST COVID-19 clinical prediction score