Acute coronary syndrome emergency treatment strategies: Improved treatment and reduced mortality in patients with acute coronary syndrome using guideline-based critical care pathways

Corbelli, John; Janicke, David M.; Cziraky, Mark J.; Hoy, Tracey; Corbelli, Jennifer

doi:10.1016/j.ahj.2008.08.022

Cited by 18 publications

(12 citation statements)

References 16 publications

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“…Lowering heart rate is a cornerstone of treatment in patients with acute coronary syndromes. 13,14 However, in many patients after OHCA, b-blockers cannot be used as low blood pressures are common in this group, for example comprising 55% of patients in a large hypothermia study after cardiac arrest. 2 Animal data also suggest a modulating effect of MTH on myocardial infarction, 15,16 but this may be protective only during ischaemia and not reperfusion.…”

Section: Discussionmentioning

confidence: 99%

Haemodynamic consequences of mild therapeutic hypothermia after cardiac arrest

Bergman

Braber

Adriaanse

et al. 2010

European Journal of Anaesthesiology

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MTH after OHCA lowered the heart rate. Despite induction of hypothermia with cold fluids, filling pressures decreased. Lower mean arterial pressure and cardiac output were observed during MTH, without deleterious effect on ScVO2. Lactate levels were elevated during MTH; however, levels did not correlate with outcome. Although the need for vasopressors and inotropes increases, this hypothermia-induced metabolic beta-blocker-like effect seems to have no negative effect on oxygen consumption and only temporarily affects anaerobic metabolism. No association of haemodynamic changes during MTH with outcome was found.

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Section: Discussionmentioning

confidence: 99%

Haemodynamic consequences of mild therapeutic hypothermia after cardiac arrest

Bergman

Braber

Adriaanse

et al. 2010

European Journal of Anaesthesiology

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“…Despite the recognised advantages of evidence based care (Corbelli et al 2009) gaps between evidence based treatment strategies and actual practice currently exist within Australia. For example, Chew et al (2007) and Walters et al (2008) found that some ACS patients are undertreated and there are significant delays in patients receiving guidelines based treatment.…”

Section: A National Acs Registrymentioning

confidence: 99%

“…According to the American College of Cardiology (ACC) and American Heart Association (AHA) ACS management guidelines, there needs to be a multidisciplinary continuum of care that stems from the initial onset of symptoms to post hospital discharge and rehabilitation. Corbelli et al (2009) suggests that without an integrated pathway of care, appropriate therapy may be underused in ACS patients because of limited application of best clinical practice as well as poor communication between health service providers.…”

Section: A Multidisciplinary Approach To Acs Carementioning

confidence: 99%

Availability of highly sensitive troponin assays and acute coronary syndrome care: insights from the SNAPSHOT registry

Cullen

French

Briffa

et al. 2015

Medical Journal of Australia

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Objectives: To examine differences in care and inhospital course of patients with possible acute coronary syndrome (ACS) in Australia and New Zealand based on whether a highly sensitive (hs) troponin assay was used at the hospital to which they presented. Design, setting and patients: A snapshot study of consecutive patients presenting to hospitals in Australia and New Zealand from 14 to 27 May 2012 with possible ACS. Main outcome measures: Rates of major adverse cardiac events (inhospital death, new or recurrent myocardial infarction, stroke, cardiac arrest or worsening heart failure); association between assay type and outcome (via propensity score matching and a generalised estimating equation [GEE]; averages of the predicted outcomes among patients who were treated with and without the availability of an hs assay (via inverse probability‐weighting [IPW] with regression‐adjusted estimators). Results: 4371 patients with possible ACS were admitted to 283 hospitals. Over half of the hospitals (156 [55%]) reported using the hs assay and most patients (2624 [60%]) had hs tests (P = 0.004). Use of the hs assay was independent of hospital coronary revascularisation capability. Patients tested with the hs assay had more non‐invasive investigations (exercise tests, stress echocardiography, stress nuclear scans, and computed tomography coronary angiography) than those tested with the sensitive assay. However, there were no differences between the groups in rates of angiography or revascularisation. All adjusted analyses showed a consistently lower rate of inhospital events, including recurrent heart failure in patients for whom the hs assay was used (GEE odds ratio, 0.75; 95% CI, 0.60–0.94; P = 0.014); IPW analysis showed a 2.3% absolute reduction in these events with the use of the hs assay (P = 0.018). Conclusion: Use of hs troponin testing of patients hospitalised with possible ACS was associated with an increased rate of non‐invasive cardiac investigations and fewer inhospital adverse events.

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“…En este estudio se logró un cumplimiento en el uso de medicamentos recomendados para todos los pacientes estudiados mayor al 90%, el cual fue superior al alcanzado por otros estudios que han implementado rutas críticas 18,23,24 (tabla 4). Se resalta que en algunos de estos estudios se demostró disminución de la mortalidad.…”

Section: Discussionunclassified