CJC Open最新文献

{"title":"Natural Causes of Sports- and Recreation-Related Deaths in the General Population: A 14-Year Review in Québec, Canada","authors":"Philippe Richard PhD ,&nbsp;Jérémie Sylvain-Morneau M.Sc ,&nbsp;Paul-André Perron PhD ,&nbsp;Philippe Joubert MD, PhD ,&nbsp;Paul Poirier MD, PhD","doi":"10.1016/j.cjco.2024.09.002","DOIUrl":"10.1016/j.cjco.2024.09.002","url":null,"abstract":"<div><h3>Background</h3><div>This study analyzed trends in the frequencies and rates of natural deaths associated with sport and recreation activities in Québec, Canada, from January 2006 to December 2019, and investigated their etiology and characteristics.</div></div><div><h3>Methods</h3><div>This descriptive retrospective study utilized data from coroner reports, as well as autopsy and police reports. Activity-specific incidence rates were calculated using participation data from the <em>Étude des blessures subies au cours de la pratique d’activités récréatives et sportives au Québec</em> (ÉBARS) and Canadian census population data.</div></div><div><h3>Results</h3><div>A total of 297 natural deaths occurred, resulting in a population-based death rate of 0.26 per 100,000 person-years. The participation-based rate was 0.23 per 100,000 participant-years, focusing only on the 24 matching activities in both editions of the ÉBARS. Cycling (20.5%; n = 61), ice hockey (8.8%; n = 26), and hunting (8.1%; n = 24) were associated with the highest frequencies and rates of death. Most of the deaths (95.3%; n = 283) were of cardiac origin, with acute coronary syndrome and malignant cardiac arrhythmia identified as the most common causes. Automated external defibrillators were unavailable at 65% of death sites, and bystander cardiopulmonary resuscitation was performed in 60.9% of cases. Men accounted for the vast majority (92.6%; n = 275) of deaths. Death rates increased starting from age 35, peaking in males 45 and over.</div></div><div><h3>Conclusions</h3><div>Efforts aimed at screening for cardiovascular risk factors and ensuring the widespread availability of automated external defibrillators at recreational sites, including remote areas such as hunting territories, could reduce the incidence of natural deaths associated with sport and recreation activities in Québec.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 1","pages":"Pages 53-66"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Innovative Use of Concurrent Transcaval Access and the BASILICA Procedure to Facilitate Transcatheter Aortic Valve Replacement (TAVR)","authors":"Daniel G. Brieger MBBS ,&nbsp;Karan Rao Bmed, MD, MPH ,&nbsp;Alex Baer MSN, MSHM ,&nbsp;Malcolm Anastasius MBBS, PhD ,&nbsp;Chris Choong MA, MB, BChir, PhD ,&nbsp;Paul D. Mahoney MD ,&nbsp;Peter S. Hansen MBBS, PhD ,&nbsp;Ravinay Bhindi MBBS, MSc, PhD","doi":"10.1016/j.cjco.2024.09.018","DOIUrl":"10.1016/j.cjco.2024.09.018","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 1","pages":"Pages 70-74"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Preferences in Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) Screening and ICD Implantation: Canadian ARVC Registry Substudy","authors":"Sandra L. Carroll PhD, RN ,&nbsp;Daryl Pullman PhD ,&nbsp;Martin Gardner MD, FRCPC ,&nbsp;Andrew D. Krahn MD, FRCPC, FHRS ,&nbsp;Jeff S. Healey MD, FRCPC","doi":"10.1016/j.cjco.2024.10.007","DOIUrl":"10.1016/j.cjco.2024.10.007","url":null,"abstract":"<div><h3>Background</h3><div>Arrhythmogenic right ventricular cardiomyopathy (ARVC) is typically diagnosed following an arrhythmic event or during screening after a family member experiences sudden cardiac death. Implantation of a defibrillator (ICD) improves survival but can be associated with morbidity and risks, an important consideration within a shared decision-making context. This study examined patient decisional needs and preferences surrounding ARVC screening and prophylactic ICD implantation.</div></div><div><h3>Methods</h3><div>This Canadian ARVC registry substudy included 20 new patients and/or families offered ARVC screening (the screen group), and 27 diagnosed ARVC patients who were offered an ICD. Measures included the following: the Decisional Conflict Scale; preference and benefit–risk visual analogue scales; the Medical Outcomes Study Short Form-36 (SF-36); and exercise restriction. Descriptive analysis was employed, and results are reported as mean (standard deviation) or proportions.</div></div><div><h3>Results</h3><div>ICD patients reported having lower decisional conflict scores—19.6 (13.6) compared to the screen group patients—33.1 (32.2). The visual analogue scale results showed lower benefit and risk clarity scores for screen group patients—6.6 (3.6)—compared to those offered ICD implantation—7.4 (2.6). More screen group patients (55%) reported restricting exercise than did ICD patients (30%). In both groups, the Medical Outcomes Study Short Form-36 Physical Component Summary scores were higher than population norms—50 (standard deviation 10): the screen group, 52.0 (8.8); the ICD group, 54.1 (7.4), and the Mental Component Summary scores were slightly lower—the screen group, 47.7 (10.8); the ICD group, 49.7 (8.9).</div></div><div><h3>Conclusions</h3><div>Patients undergoing ARVC screening reported greater decisional conflict and lower benefit and risk clarity compared to patients diagnosed with ARVC who were offered an ICD. Screen group patients were more restrictive in their exercise. Understanding patient preferences and needs during ARVC screening and ICD candidacy can assist in improving decision support with patients and families.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 1","pages":"Pages 27-34"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid Reversal of Pulmonary Hypertension by High-Dose Thiamine Supplementation: A Case Report","authors":"Tomonari Moriizumi MD ,&nbsp;Takahiro Hiraide MD ,&nbsp;Mizuki Momoi MD ,&nbsp;Yoshiki Shinya MD ,&nbsp;Yoshikazu Kishino MD ,&nbsp;Yasuyuki Shiraishi MD ,&nbsp;Wataru Iai MD ,&nbsp;Keisuke Matsumura MD ,&nbsp;Shun Kohsaka MD ,&nbsp;Masaki Ieda MD","doi":"10.1016/j.cjco.2024.09.013","DOIUrl":"10.1016/j.cjco.2024.09.013","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 12","pages":"Pages 1534-1537"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Implementation Science to Evaluate the Implementation of Patient-Reported Outcome Measures (PROMs) in a Clinical Heart Failure Care Setting","authors":"Sarah V.C. Lawrason MSc, PhD ,&nbsp;Heather Ross MSc, MD ,&nbsp;Michael McDonald MD ,&nbsp;Juan Duero Posada MD ,&nbsp;Samantha Engbers BAH ,&nbsp;Anne Simard MHSc","doi":"10.1016/j.cjco.2024.09.012","DOIUrl":"10.1016/j.cjco.2024.09.012","url":null,"abstract":"<div><h3>Background</h3><div>Patients with heart failure (HF) can experience a poor quality-of-life (QOL), recurring hospitalizations, and progressive disease symptoms. Patient-reported outcome measures (PROMs) integrate patients’ voices into clinical care, by assessing patient symptoms, function, and QOL. In 2022, PROMs were incorporated into the electronic health record system (Epic) at a large academic hospital in Toronto, Ontario, Canada. The purpose of this study was to use implementation-science frameworks to systematically evaluate the uptake and integration of PROMs into clinical HF care.</div></div><div><h3>Methods</h3><div>The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework guided this mixed-methods, 1-year, quality-improvement project. Data sources included the following: clinician use of PROMs; patient-level data on completed PROMs; and semistructured interviews with clinicians. The PROM was the Kansas City Cardiomyopathy Questionnaire-12, which captures 4 domains related to HF—symptom frequency, physical limitations, social limitations, and QOL (KCCQ-12 is used as an example case of PROMs in general). Quantitative data were analyzed using descriptive statistics; qualitative data were analyzed using behaviour-change frameworks and latent content analysis.</div></div><div><h3>Results</h3><div>Over the course of 1 year, more patients were assigned to PROMs, a higher proportion of patients completed PROMs, and approximately 80% of patients had high scores on the questionnaire. Clinicians experience barriers—related to attention and decision processes, the environmental context, and their professional role—to integrating PROMs into practice. Suggested changes to improve PROM uptake include adding language licenses for PROM translations, reducing cognitive load for clinicians who are assigning and interpreting PROMs in the Epic system, and championing modelling of use of PROMs in practice.</div></div><div><h3>Conclusions</h3><div>This study demonstrates the benefit of using implementation science frameworks, to evaluate the implementation of PROMs in practice and provide actionable recommendations to health systems.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 12","pages":"Pages 1443-1452"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The MuCAYAplus Study—Influence of Physical Activity and Metabolic Parameters on the Structure and Function of the Cardiovascular System in Young Athletes","authors":"Jonas Haferanke MSc ,&nbsp;Lisa Baumgartner Dr. rer. nat. ,&nbsp;Laura Willinger Dr. rer. nat. ,&nbsp;Thorsten Schulz Dr. Sportwiss ,&nbsp;Frauke Mühlbauer MD ,&nbsp;Tobias Engl Dipl.-Sportwiss ,&nbsp;Heidi Weberruß PhD ,&nbsp;Hande Hofmann Dr. rer. nat. ,&nbsp;Paulina Wasserfurth Dr. rer. nat. ,&nbsp;Karsten Köhler Prof. Dr. rer. nat. ,&nbsp;Renate Oberhoffer-Fritz Prof. Dr. med.","doi":"10.1016/j.cjco.2024.09.005","DOIUrl":"10.1016/j.cjco.2024.09.005","url":null,"abstract":"<div><div>Exercise has a significant impact on the cardiovascular (CV) health of children and adolescents, with resultant alterations in CV structure and function being evident, even at an early age. Engagement in regular, moderate physical activity (PA) is associated with long-term CV health benefits and a reduced risk of CV disease and mortality later in life. However, competitive sports often involve PA training intensities that are beyond recommended levels for young athletes, potentially leading to adverse CV outcomes. This situation emphasizes the importance of early monitoring of CV status, to prevent detrimental adaptations to intense physical exercise. The Munich Cardiovascular Adaptations in Young Athletes Study (MuCAYA^plus; <span><span>NCT06259617</span><svg><path></path></svg></span>) aims to investigate the as-yet-unclear adaptations to intense exercise that occur in young athletes. The study focuses on various factors, including CV health, PA, cardiopulmonary performance, body composition, eating habits, and biochemical markers.</div><div>In this longitudinal, prospective study, a sample of 250 young competitive athletes (aged 10-17 years) will undergo yearly examinations at the Institute of Preventive Pediatrics at the Technical University of Munich (TUM), over the span of 3 years. The testing protocol includes the following: anthropometric measurements; basic medical examinations; electrocardiography, with blood-pressure and pulse-wave analysis; echocardiography; sonography of the carotid artery; blood sampling for laboratory analysis; cardiopulmonary exercise testing on a bicycle ergometer; and participant completion of questionnaires regarding PA (the Motorik-Modul Longitudinal Study PA Questionnaire [MoMo-PAQ]) and nutrition.</div><div>Areas that are not yet fully understood are how exercise influences cardiac and vascular remodeling during long-term exercise, and how different biochemical and metabolic parameters, body composition, and nutrition impact such adaptations. The MuCAYA^plus study seeks to address these gaps in knowledge and provide comprehensive evidence on the longitudinal effects of exercise on the CV system of young athletes.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 12","pages":"Pages 1549-1557"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Vanessa's Law on the Reporting of Serious Adverse Events: A Retrospective Study Among Antiplatelet Users in a Tertiary-Care Cardiology Centre","authors":"Laura Blonde Guefack Djiokeng BSc ,&nbsp;Shweta Todkar RN, PhD ,&nbsp;Sonia Corbin RN, BSc ,&nbsp;Maude Lavallée RN, MSc ,&nbsp;Pallavi Pradhan MSc ,&nbsp;Magalie Thibault BA, MSc ,&nbsp;Marie-Eve Piché MD, PhD ,&nbsp;Julie Méthot BPharm, PhD ,&nbsp;Anick Bérard PhD ,&nbsp;Jennifer Midiani Gonella RN, PhD ,&nbsp;Fernanda Raphael Escobar Gimenes RN, PhD ,&nbsp;Rosalie Darveau PharmD, MSc ,&nbsp;Isabelle Cloutier BPharm, MSc ,&nbsp;Jacinthe Leclerc RN, PhD","doi":"10.1016/j.cjco.2024.09.003","DOIUrl":"10.1016/j.cjco.2024.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Antiplatelet drugs, such as clopidogrel, ticagrelor, prasugrel, and acetylsalicylic acid, may be associated with a risk of adverse events (AEs). Vanessa's Law was enacted to strengthen regulations to protect Canadians from drug-related side effects (with mandatory reporting of serious adverse events [SAEs]).</div></div><div><h3>Objective</h3><div>To determine whether Vanessa's Law has led to an increase in SAE reporting among antiplatelet users.</div></div><div><h3>Methods</h3><div>This descriptive retrospective study was conducted from January, 2018-December, 2021. Included are 260 adult antiplatelet users (cohorts: 2018 [n = 64]; 2019 [n = 79]; 2020 [n = 73]; 2021 [n = 44]) hospitalized at the Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval. The main diagnostic of hospitalization was coded using the International Classification of Diseases,10th revision, Canadian version, and data related to demographic characteristics, hospitalization length-of-stay, drugs administered, and AEs were extracted.</div></div><div><h3>Results</h3><div>The 260 antiplatelet users were hospitalized mainly for diseases of the circulatory system (codes [I00-I99]; 2018, 75 %; 2019, 71 %; 2020, 71 %; 2021, 77 %) or diseases of the respiratory system (codes [J00-J99]; 2018, 6 %; 2019, 8 %; 2020, 4 %; 2021, 7 %). The median age was 70 years. The median duration of hospital stay was 3 days. Among the 1395 AEs recorded during the study, 12 % were SAEs. None of the SAEs (or AEs) was reported to Health Canada, either before or after Vanessa’s Law implementation.</div></div><div><h3>Conclusions</h3><div>These results provide the first picture of reporting trends for SAEs among antiplatelet users in Canada. Investigation of the underreporting of SAEs is needed, as the implementation of a mandatory policy does not seem to have had a favourable impact.</div></div><div><h3>Clinical Trial Registration</h3><div>135263.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 12","pages":"Pages 1527-1533"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Midterm Outcomes of Right Anterior Mini Thoracotomy Aortic Valve Replacement","authors":"Ali Fatehi Hassanabad MD, MSc ,&nbsp;Mortaza Fatehi Hassanabad MSc ,&nbsp;Muhammad Israr-Ul-Haq BN ,&nbsp;Andrew Maitland MD ,&nbsp;William D.T. Kent MD, MSc","doi":"10.1016/j.cjco.2024.09.004","DOIUrl":"10.1016/j.cjco.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Contemporary surgical approaches for aortic valve replacement (AVR) include full median sternotomy, hemi-sternotomy, and a right anterior mini thoracotomy (RAMT) approach. We report the midterm outcomes of RAMT for isolated AVR.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted, reporting the midterm outcomes of patients who underwent isolated RAMT AVR. The primary outcomes were death and disabling stroke within 30-days of surgery. The secondary outcomes were survival at latest follow-up assessment, hospital readmission for aortic valve disease, prosthetic valve function, and incidence of structural valve deterioration requiring reintervention on the aortic valve.</div></div><div><h3>Results</h3><div>Seventy patients underwent isolated RAMT AVR between February 2016 and February 2018. One patient died from a cardiac cause within 30 days of surgery, whereas none experienced disabling postoperative strokes. The mean follow-up period for the cohort was 74.46 ± 7.54 months. At 95 months, a total of 49 patients were alive. During the follow-up period, 2 patients underwent median sternotomy, 1 for mitral valve replacement and tricuspid repair, and 1 for coronary artery bypass grafting. At last follow-up assessment, the average mean transvalvular gradient was 12.11 ± 9.15 mm Hg. One patient developed prosthetic valve infective endocarditis, and 1 patient was found to have prosthetic valve thrombosis. Prosthetic valve function was normal in 66 patients. At 95 months, freedom from aortic valve reintervention was 98.6%, as 1 patient required redo aortic root surgery.</div></div><div><h3>Conclusions</h3><div>RAMT AVR can be done safely in the appropriate patient population. Midterm outcomes at our centre are promising, and they suggest that this approach is a good option for managing aortic stenosis.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 12","pages":"Pages 1484-1490"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harmonizing Cardiovascular Health Data from National Surveys: Challenges and Opportunities","authors":"Bridget Vermeulen PhD,&nbsp;Lisa J. Ware PhD,&nbsp;Gastón Perman MD,&nbsp;Innocent Maposa PhD,&nbsp;Darwin R. Labarthe PhD","doi":"10.1016/j.cjco.2024.08.009","DOIUrl":"10.1016/j.cjco.2024.08.009","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 12","pages":"Pages 1501-1502"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a High-sensitivity Troponin Assay for Adult Patients Who Present to the Emergency Department With Chest Pain: The Role of Clinical Decision Support","authors":"Brian H. Rowe MD, MSc ,&nbsp;Esther Yang MSc ,&nbsp;Shandra Doran MD, PhD ,&nbsp;Michelle Graham MD ,&nbsp;Sean Van Diepen MD ,&nbsp;Joshua E. Raizman PhD ,&nbsp;Albert K.Y. Tsui PhD","doi":"10.1016/j.cjco.2024.09.010","DOIUrl":"10.1016/j.cjco.2024.09.010","url":null,"abstract":"<div><h3>Background</h3><div>The objective of this study was to assess the health outcomes for patients who present to the emergency department (ED) with cardiac chest pain after the implementation of an accelerated diagnostic protocol using a high-sensitivity troponin assay (hs-TnI).</div></div><div><h3>Methods</h3><div>This prospective before-after cohort study used population-based linked health administrative data for adult patients who presented to a Canadian urban ED with chest pain of suspected cardiac origin over a 2-year study period. The primary outcome was ED length of stay (LOS). Secondary outcomes included operational and clinical outcomes within 30 days of the index ED visit.</div></div><div><h3>Results</h3><div>During the study period, 4339 patients were included, with 2031 in the conventional troponin group and 2308 in the hs-TnI group. Overall, the median age was 56 years and 52% were male. The median ED LOS was reduced from 430 minutes to 400 minutes after protocol implementation (median difference, -30.0; 95% confidence interval, -47.8 to -12.3). For discharged patients who underwent serial troponin tests, the LOS was 89 minutes shorter (95% confidence interval, -110.8 to -67.2). The proportion of patients discharged increased from 73% to 78% after implementation (<em>P</em> = 0.0001). At 30 days, there were no differences in hospital readmission or major adverse event outcomes.</div></div><div><h3>Conclusions</h3><div>Using clinical decision support, the implementation of a new hs-TnI and accelerated diagnostic protocol was associated with shorter ED LOS and fewer hospitalizations for adult patients with chest pain who were assessed in the ED. These results suggest that the protocol is effective and safe in real-world clinical settings.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 12","pages":"Pages 1491-1500"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}