The association of cardiovascular risk factors and complexity and severity of coronary artery disease with contrast volume (CV) remains unknown. We assessed the predictive factors of CV use during elective and emergent cardiac catheterization (CC). Electronic medical records from 2010 to 2013 were retrospectively reviewed. A total of 708 patients were eligible. On multivariable regression analysis, the presence of obstructed coronary arteries was associated with CV (P = .01, β = -14.17), with greater CV used in patients with single or double vessel disease compared to those with triple vessel disease. The presence of lesions with >70% stenosis in major epicardial arteries (P = .019, β = 24.39) and ST-segment elevation myocardial infarction (P = .001, β = 36.14) was associated with increased CV use. Elevated B-type natriuretic peptide (P = .036, β = -17.23) and increase in Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score (P = .024, β = -29.06) were associated with decreased CV use. These aforementioned associations were attenuated after adjusting for percutaneous coronary intervention. Our findings may help predict patient populations who could be exposed to increased CV during CC, thereby possibly increasing their risk of contrast-induced nephropathy.

Objective: As the number of older adults living in the United States grows, the gap between the capacity of home-based primary care (HBPC) services and the community demand will continue to widen. Older adults, living longer with mobility difficulties and multiple chronic medical conditions, often prefer to age in place, and new models of care are needed to meet this need. This article provides a framework for an innovative emergency medical technician (EMT)-facilitated telehealth program, the mobile telemedicine technician (MTT) program, which aims to increase access to medical care and efficiency within an HBPC program. Design: A descriptive framework outlining the deployment of an innovative telehealth model. Setting: An HBPC program serving homebound seniors in downstate New York. Participants: Homebound individuals enrolled in an HBPC program with advanced age (over half >90 years), 67% with 5–6 activities of daily living (ADL) dependencies, and high rates of dementia, congestive heart failure, chronic obstructive pulmonary disease (COPD), and diabetes requiring evaluation and treatment of acute conditions. Interventions: HBPC program enrollees requiring evaluation and treatment of acute conditions received a home visit from a telehealth-enabled EMT who has received additional training to provide in-home care. Following an evaluation, the EMT facilitated a telehealth visit via a two-way video conference between the patient and the primary care physician. Main outcome measures: Description of a novel telehealth care model, preliminary results from the first 100 MTT visits including the reason for visit, patient/caregiver, physician, and telehealth-enabled EMT satisfaction survey results. Results: The primary care provider was able to evaluate twice as many patients in a given time period using the new model as in the regular home visit care model. The most common visit reasons were related to skin conditions (22%), neurological conditions (19%), cardiovascular conditions (16%), and respiratory conditions (15%). Satisfaction rates were high from patients/caregivers (45% response rate, 60% strongly agreed and 29% agreed that they were satisfied with the care delivery experience), physician (six surveys over time from one physician, 100% strongly agreed on the effectiveness of care delivery model), and telehealth-enabled EMTs (eight surveys from four EMTs, 100% strongly agreed that they were satisfied with the care delivery experience). Conclusions: In this descriptive article, we outline a new model of care using telehealth-enabled EMTs making home visits to connect with a patient’s primary care physician who is centrally located. This model shows promise for expanding primary care services within the home.

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