Critical Pathways in Cardiology最新文献

{"title":"Medical Management Versus PCI in Patients with Stable Angina: An Updated Systematic Review and Meta-analysis.","authors":"Prakash Upreti, Ankit Hanmandlu, Abdul Rasheed Bahar, Mohammad Hamza, Mustafa Turkmani, Azeem Rathore, Jawad Basit, Kripa Rajak, Farah Yasmin, Salman Abdul Basit, M Chadi Alraies","doi":"10.1097/HPC.0000000000000406","DOIUrl":"10.1097/HPC.0000000000000406","url":null,"abstract":"<p><strong>Background: </strong>Despite the clinical guidelines favoring medical therapy for stable angina, the optimal management of these patients remains unclear. Here, we compare medical management (MM) versus percutaneous coronary intervention (PCI) in patients with stable angina.</p><p><strong>Methods: </strong>An extensive literature search was conducted using PubMed and Embase to identify randomized controlled trials of interest. Data were extracted and analyzed using a random-effects model to calculate pooled odds ratios (OR).</p><p><strong>Results: </strong>Our meta-analysis of 28 randomized controlled trials included 9346 PCI patients and 9503 medically managed patients. The mean age was 62.5 ± 7.6 years in the PCI group and 62.8 ± 7.4 years in the other group. Men comprised 68% and 70% of the PCI and MM groups, respectively.Over a mean follow-up of 2.64 years, PCI was associated with a significantly lower incidence of myocardial infarction compared with MM (OR, 0.84; 95% CI, 0.74-0.96; P = 0.01). Although PCI showed trends toward lower odds of unplanned revascularizations and major adverse cardiovascular (CV) events, these differences were not statistically significant. There were no differences in outcomes of freedom from angina, unstable angina, nonfatal myocardial infarction, stroke, all-cause mortality, or CV death.</p><p><strong>Conclusion: </strong>Advances in CV imaging and catheterization techniques have improved risk stratification and outcomes of PCI in stable angina. Further research is needed to identify clinical subgroups that benefit most from each treatment modality.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0406"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catheter Ablation Versus Antiarrhythmic Drugs for Ventricular Tachycardia: A Systematic Review and Meta-Analysis.","authors":"Sufyan Shahid, Shehroze Tabassum, Muhammad Abdullah Ali, Umama Alam, Zoya Ejaz, Zaryab Bacha, Subtain Haider Solahri, Hritvik Jain, Salman Khalid, Raheel Ahmed","doi":"10.1097/HPC.0000000000000407","DOIUrl":"10.1097/HPC.0000000000000407","url":null,"abstract":"<p><p>Sustained ventricular tachycardia (VT) and fibrillation-related sudden cardiac death account for nearly 450,000 deaths annually in the United States. Catheter ablation (CA) and antiarrhythmic drugs (AADs) are commonly used to manage VT recurrence; however, their comparative efficacy and safety remain uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing CA and AADs in patients with ischemic cardiomyopathy and implantable cardioverter-defibrillators (ICDs). PubMed, Embase, and Cochrane Cochrane Central Register of Controlled Trials (CENTRAL) Library were searched up to February 15, 2025. Primary outcomes included all-cause mortality, cardiovascular mortality, VT storm, and appropriate ICD shock. Secondary outcomes included inappropriate ICD shock, appropriate antitachycardia pacing, heart failure hospitalization, stroke/transient ischemic attack, and myocardial infarction. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Three RCTs encompassing 587 patients (287 CA, 300 AADs) were included. No significant differences were found between CA and AADs in all-cause mortality (RR, 0.88; 95% CI, 0.63-1.22; P = 0.43), cardiovascular mortality (RR, 1.23; 95% CI, 0.77-1.98; P = 0.39), VT storm (RR, 0.76; 95% CI, 0.39-1.46; P = 0.41), or appropriate ICD shock (RR, 0.87; 95% CI, 0.69-1.10; P = 0.24). Secondary outcomes, including inappropriate ICD shock, antitachycardia pacing, heart failure hospitalization, stroke/transient ischemic attack, and myocardial infarction, were also comparable between the 2 groups. In this meta-analysis of RCTs, CA and AADs demonstrated comparable efficacy and safety in patients with VT. Larger high-quality trials are warranted to confirm these findings and further define the role of CA as a potential first-line therapy.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0407"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Fasting and Nonfasting Regimens Outcomes Before Catheterization Laboratory Procedures: A Systematic Review and Meta-Analysis.","authors":"Shayan Shojaei, Asma Mousavi, Hanieh Radkhah, Mehrdad Mahalleh, Soheil Rahmati, Parnian Soltani, Mashood Ahmad Farooqi, Mohammad Moein Ashrafi, Sepideh Jame Bozorgi, Ali Moradi, Mani K Askari, Khurram Nasir, Jaime P Almandoz, Diaa Hakim, Toshiki Kuno, Kaveh Hosseini","doi":"10.1097/HPC.0000000000000402","DOIUrl":"10.1097/HPC.0000000000000402","url":null,"abstract":"<p><p>Guidelines recommend fasting before catheterization laboratory (cath lab) procedures. However, recent studies question the necessity of fasting, suggesting that fasting may not provide significant clinical benefits. This study aims to evaluate the existing evidence between outcomes for patients with fasting and nonfasting regimens. We conducted a comprehensive search for randomized controlled trials comparing fasting and nonfasting protocols before cath lab procedures. Outcomes included hypoglycemia, aspiration pneumonia, contrast nephropathy, all-cause mortality, and cardiovascular mortality. A random effects meta-analysis was performed to derive odds ratios (ORs) and 95% confidence intervals (CIs). The meta-analysis included 8 randomized controlled trials with a total of 3068 participants: 1544 in the fasting group and 1524 in the nonfasting group. Compared with fasting, nonfasting was not associated with significant differences in hypoglycemia (OR = 0.77, 95% CI, 0.44-1.34), aspiration pneumonia (OR = 1.33, 95% CI, 0.38-4.72), contrast nephropathy (OR = 1.82, 95% CI, 0.88-3.75), all-cause mortality (OR = 1.29, 95% CI, 0.51-3.28), or cardiovascular mortality (OR = 0.94, 95% CI, 0.22-4.05). Nonfasting regimens show no significant differences in safety outcomes compared with fasting, suggesting it may be implemented to improve patient experience without compromising safety. Larger trials are needed to confirm the safety of nonfasting regimens. Summary of outcomes (CEID, cardiac implantable electronic device; PCI, percutaneous coronary intervention; TAVR, transcatheter aortic valve replacement). The design features graphical elements sourced from Servier Medical Art, which are provided by Servier under the Creative Commons Attribution 4.0 unported license.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0402"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Chronic Total Occlusion (CTO) Scoring Systems on Procedural Success and Patient Outcomes.","authors":"Hany Tawfik Abdelrazek, Hatem Hossam Mowafy, Mahmoud Abdelghany Hassan, Mohamed Ashraf Shawky, Soliman Belal Soliman","doi":"10.1097/HPC.0000000000000408","DOIUrl":"10.1097/HPC.0000000000000408","url":null,"abstract":"<p><strong>Background: </strong>Chronic total occlusion (CTO) lesions in coronary arteries present a significant challenge, often resulting in referrals for coronary artery bypass graft surgery. Successful percutaneous coronary intervention (PCI) for CTOs demands an accurate assessment of procedural potential.</p><p><strong>Methods: </strong>This study aimed to compare the efficacy of different CTO scoring systems in predicting the PCI procedural success and the associated patient complications. It included patients with a CTO in at least one coronary artery who were scheduled for elective PCI based on objective evidence of ischemia. Experienced operators performed the PCI, recorded procedural variables, and assessed complications.</p><p><strong>Results: </strong>Our findings indicated that the Japan CTO (J-CTO) score had the highest positive predictive value at 88.89%, closely followed by the CL CTO score at 88.79%, the CASTLE CTO score at 86.84%, and lastly, the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS) CTO score at 86.51%. All scores fell within an acceptable specificity range of 59.2% to 76.3%, while accuracy varied from 62.61% to 72.52%. We also estimated these values using the best Youden index, which was 0.362 for J-CTO, 0.355 for Euro CTO (CASTLE), 0.330 for CL CTO, and 0.283 for PROGRESS CTO, thus maximizing sensitivity and specificity at a particular point. The relation between CTO scores and complications showed comparable differences with no statistical significance and no correlation regarding the cutoff value.</p><p><strong>Conclusions: </strong>This study shows that J-CTO and CASTLE provide slightly greater accuracy in predicting complex CTO PCI success compared to PROGRESS CTO and CL. However, the ostial location score did not demonstrate statistical significance in our patients.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0408"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body Mass Index and In-Hospital Management and Outcomes of Pulmonary Embolism: A Nationwide Analysis.","authors":"Aryan Mehta, Mridul Bansal, Jay Patel, Ashwin Pillai, Joseph J Ingrassia, Pieter S de Klerk, J Dawn Abbott, Saraschandra Vallabhajosyula","doi":"10.1097/HPC.0000000000000411","DOIUrl":"10.1097/HPC.0000000000000411","url":null,"abstract":"<p><strong>Background: </strong>Limited data exist on the impact of body mass index (BMI) on the outcomes of admissions with acute pulmonary embolism (PE).</p><p><strong>Methods: </strong>All adult (≥18 years) admissions with a primary diagnosis of PE were identified using the National Inpatient Sample (2016-2020) and categorized using BMI into underweight (<19.9 kg/m 2 ), normal (19.9-24.9 kg/m 2 ), and overweight/obese (>24.9 kg/m 2 ). Outcomes included in-hospital mortality, utilization of PE therapies, and resource utilization.</p><p><strong>Results: </strong>Of 904,260 admissions, 1.8%, 70.4%, and 27.7% were underweight, normal, and overweight/obese, respectively. Underweight admissions were on average older (70.8 ± 0.2, 64.6 ± 0.05, 58.2 ± 0.07 years), male (56.7%, 49%, 58.3%) with higher comorbidity (Elixhauser Index 5.8 ± 0.03, 4 ± 0.06, 5.1 ± 0.09), from a lower socioeconomic status, and with Medicare insurance compared to normal and overweight/obese categories ( P < 0.001). The underweight cohort had higher rates of acute organ failure, bleeding complications, strokes, shock, and higher mechanical ventilation and hemodialysis use. In contrast to the underweight group, normal and overweight/obese groups had higher rates of mechanical thrombectomy (0.3%, 1.1%, 1.9%), systemic thrombolysis (1.5%, 2.6%, 4.2%), catheter directed therapy (0.9%, 3%, 5.8%), and surgical thrombectomy (0.0%, 0.1%, 0.2%) ( P < 0.001). Compared to the normal cohort (3.3%), the underweight cohort had higher [7.8%; odds ratio 1.85 (95% confidence interval 1.54-2.21)], whereas the overweight/obese cohort had lower [2.2%; odds ratio 0.47 (95% confidence interval 0.42-0.52)] in-hospital mortality (both P < 0.001). The underweight cohort had longer hospitalization stays, higher hospitalization costs, and were discharged home less frequently.</p><p><strong>Conclusions: </strong>Compared to those with normal BMI, underweight status was associated with worse outcomes in those hospitalization with acute PE.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0411"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Radiofrequency Catheter Ablation in Brugada syndrome: A Systematic Review and Meta-Analysis.","authors":"Hassaan Abid, Syed Wajihullah Shah, Furqan Ahmad Sethi, Muhammad Abdullah Ali, Naveed Ahmed Khan, Iqra Shahid, Zaryab Bacha, Rimsha Adnan, Mohammad Aitzaz Hassan, Fazia Khattak, Sangeen Khan, Soban Ali Qasim","doi":"10.1097/HPC.0000000000000420","DOIUrl":"10.1097/HPC.0000000000000420","url":null,"abstract":"<p><p>Radiofrequency catheter ablation (CA) has emerged as a therapeutic strategy for Brugada syndrome (BrS), particularly for patients with recurrent ventricular fibrillation (VF) and implantable cardioverter-defibrillator (ICD) shocks. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of CA compared with standard management. PubMed, Embase, and Scopus were searched from inception to August 2025 for randomized controlled trials and adjusted observational studies enrolling BrS patients undergoing CA versus ICD-only therapy, pharmacotherapy, or observation. Five studies (2 RCTs, 3 cohorts) comprising 510 patients (296 ablation; 214 control) were included. The primary outcome was ventricular arrhythmia recurrence; secondary outcomes were procedural complications and ICD-related complications. Pooled analysis demonstrated that CA significantly reduced ventricular arrhythmia recurrence (RR 0.20; 95% CI 0.05-0.75; P=0.02), with consistent benefit in randomized trials. No significant differences were observed in procedural complications (RR 0.81; 95% CI 0.32-2.01; P=0.65) or ICD-related complications (RR 1.16; 95% CI 0.49-2.78; P=0.73). Certainty of evidence ranged from moderate to very low based on GRADE. In conclusion, CA is an effective intervention for reducing recurrent ventricular arrhythmias in BrS without an increase in procedural or device-related adverse events. These findings support the expanding role of substrate-based ablation as a disease-modifying therapy in appropriately selected BrS patients.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impella in Cardiogenic Shock: An Updated Meta-Analysis.","authors":"Ryan Berry, Mobeen Haider, Prakash Upreti, Mohammad Hamza, Junaid Mir, Krutarth Pandya, Mubashar Karamat, Munis Ahmed, M Azfar Bilal, Yasemin Bahar, Usman Naseer, Mowaffak Alraiyes, M Chadi Alraies","doi":"10.1097/HPC.0000000000000409","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000409","url":null,"abstract":"<p><p>Despite technological advancements, mortality remains high in patients with myocardial infarction complicated by cardiogenic shock. Impella is increasingly used as an adjunct to standard treatment due to its hemodynamic benefits, though mixed study results limit its adoption. This meta-analysis aims to clarify Impella's efficacy by focusing on high-quality data from RCTs and cohort studies. A comprehensive literature search was conducted for randomized controlled trials and cohort studies comparing Impella with intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO). Assessed metrics included mortality, clinical events, and hematologic markers. Data was analyzed using the Mantel-Haenszel random-effects model. Of 787 articles, 12 studies (4918 patients) met the inclusion criteria. Impella groups showed significant increases in thrombosis risk (RR: 4.94) and had a higher bleeding risk compared to IABP (RR: 1.98) but a lower risk compared to ECMO (RR: 0.66). All other comparisons did not reach statistical significance. Despite updated data and a stringent quality threshold, the hemodynamic benefits of Impella and the device's risk of thrombosis and bleeding were high. Future trials should emphasize patient selection, timing of placement, and operator proficiency to evaluate Impella's efficacy and safety better.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Profile and Outcomes of ST-Elevation Myocardial Infarction in Patients Under 45 Years.","authors":"Matheus Sacco Gomes, Otávio de Oliveira Marques, Gregório Furian Rossler Zanchi, Wagner Azevedo, AntoniaStumpf Martins, Marina Porto Nassif, Pedro Augusto Martins Barcellos, Pedro Castilhos de Freitas Crivelaro, Marco Wainstein, Guilherme Pinheiro Machado, Sandro Cadaval Gonçalves","doi":"10.1097/HPC.0000000000000403","DOIUrl":"10.1097/HPC.0000000000000403","url":null,"abstract":"<p><strong>Background: </strong>ST-segment elevation myocardial infarction (STEMI) remains a leading cause of global mortality. Although overall incidence is declining, this trend is less evident among younger individuals, emphasizing the need to better understand modifiable risk factors and clinical outcomes in this population.</p><p><strong>Objective: </strong>This study aimed to analyze the clinical profile and outcomes of young patients with STEMI undergoing primary percutaneous coronary intervention in a contemporary cohort.</p><p><strong>Methodology: </strong>This prospective cohort study included patients aged ≥18 years with confirmed STEMI treated with primary percutaneous coronary intervention at a tertiary university hospital from March 2011 to January 2025. Patients were stratified into two groups: young (≤45 years) and older (>45 years). The primary outcome was inhospital mortality. A two-sided significance level of P < 0.05 was adopted.</p><p><strong>Results: </strong>A total of 2050 patients were included; 191 (9.3%) were ≤45 years old (mean age: 39.9 years). Younger patients showed significantly lower inhospital mortality (4.2% vs. 12.1%; P = 0.001), shorter median length of stay (5 vs. 6 days; P = 0.001), and lower incidence of long-term major adverse cardiovascular and cerebrovascular events (15.2% vs. 24.7%; P = 0.003). They had a higher prevalence of active smoking (57.1% vs. 40.6%; P < 0.001), illicit drug use (18.3% vs. 10.0%; P < 0.001), HIV infection (4.7% vs. 2.2%; P = 0.003), and family history of coronary artery disease (24.2% vs. 12.4%; P < 0.001).</p><p><strong>Conclusions: </strong>Young STEMI patients presented with fewer comorbidities and lower inhospital mortality, but a higher prevalence of behavioral risk factors. These findings highlight the need for targeted preventive strategies and early detection to improve long-term outcomes.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0403"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Outcomes of Overexpanding Versus Conventional Sizing in Transcatheter Aortic Valve Replacement for Borderline Aortic Annulus: A Meta-Analysis.","authors":"Ahmad Mustafa, Ryan Kaple, Chapman Wei, Yuriy Dudiy, Sung-Han Yoon, Perry Wengrofsky, Vladimir Jelnin, George Batsides, Rachel Spallone, Elie Elmann, Mark Anderson, David Landers, Craig Basman","doi":"10.1097/HPC.0000000000000392","DOIUrl":"10.1097/HPC.0000000000000392","url":null,"abstract":"<p><p>Approximately 20%-40% of patients that present for transcatheter aortic valve replacement with a balloon-expandable transcatheter heart valve (THV) fall into a borderline aortic annulus size (BAAS). There are potential benefits to overexpanding an undersized THV (OE-THV) in such cases that include reduced electrical disturbances and annular injury at the expense of increased paravalvular leak (PVL). We conducted a meta-analysis of data comparing conventional-sized versus OE-THV strategy for BAAS and reviewed the literature for balloon-expandable-THV in such cases. 9 nonrandomized studies that compared a conventional strategy to OE-THV in patients with BAAS were included in our study. Our findings suggest that there is no difference in mortality, stroke, mean gradient, or significant PVL. There was a trend towards fewer pacemakers in patients receiving an OE-THV. Borderline aortic annulus measurements are common in patients undergoing transcatheter aortic valve replacement and there appears to be equipoise between conventional sizing versus OE-THV. Future detailed studies are required to evaluate short- and long-term outcomes among strategies.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0392"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limited Diagnostic Yield of Long-Term Rhythm Monitoring for ED Observation Unit Patients Evaluated for Transient Ischemic Attack.","authors":"Zohayr A Khan, Salvatore Lumia, Wesley Iobst, Stephen Sokolosky, Amy K Guzik, Benjamin T Hutchison, Mary A Wittler, Patrick S Reynolds, Nicklaus P Ashburn","doi":"10.1097/HPC.0000000000000398","DOIUrl":"10.1097/HPC.0000000000000398","url":null,"abstract":"<p><strong>Background: </strong>Patients evaluated for transient ischemic attack (TIA) in the emergency department observation unit (EDOU) may be discharged with a long-term rhythm monitor to assess for atrial fibrillation (AF) and atrial flutter (AFL). We aimed to assess the diagnostic yield of long-term rhythm monitoring for diagnosing AF and AFL in an EDOU cohort of patients evaluated for TIA.</p><p><strong>Methods: </strong>We conducted an observational cohort study, in which patients ≥18 years old who were evaluated in the EDOU TIA Protocol at an academic tertiary care center from July 1, 2021 to December 1, 2023 were accrued. This analysis included patients who received a long-term rhythm monitor (Zio Patch) at the time of EDOU discharge. Monitor results were reviewed for diagnoses of AF or AFL. Diagnostic yield, defined as the proportion receiving monitoring who had a new diagnosis of AF or AFL, was calculated with an exact 95% confidence interval (95% CI) and used to determine the number needed to test.</p><p><strong>Results: </strong>Of the 523 EDOU TIA protocol patients, 59.7% (312/523) were female, 29.6% (155/523) were non-White, and the mean age was 65.9 ± 14.9 years. At discharge, 18.4% (96/523) received long-term rhythm monitoring, which identified AF in 5.2% (5/96) and AFL in 1.0% (1/96). However, 3 of these patients already had known AF/AFL. Thus, the yield for diagnosing new AF/AFL was 3.1% (3/96, 95% CI, 0.7%-8.9%), with a number needed to test of 32.</p><p><strong>Conclusions: </strong>The diagnostic yield of long-term rhythm monitoring for diagnosing AF/AFL among discharged EDOU TIA protocol patients was low, suggesting it may be overprescribed in this population.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0398"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}