Optimizing Patient Outcomes in Emergency Cardiac Care Through Advances in Technology: Nurse Scientists in Action

Abstract

his issue of the Journal of Emergency Nursing (JEN) is focused on cardiovascular disease, a growing concern among our aging population and beyond. Cardiovascular disease is the top killer in the United States and worldwide, and cardiovascular emergencies account for approximately 10% of all ED visits in the US. 1,2 More than 8 million patients with chest pain and/or anginal equivalent symptoms (eg, shortness of breath and diaphoresis) present to emergency departments each year, accounting for the second most common cause of ED visits for adults. 2 In 2019 alone, it was estimated that every 40 seconds, 1 American would suffer from an acute myocardial infarction, nearly 720,000 would suffer from a new coronary event, and approximately 335,000 would have a recurrent cardiac event. 3 Emergency nurses are often the first point of contact for individuals presenting with cardiac symptoms. We are required to differentiate rapidly between life-threatening conditions and non-life-threatening ones and determine accurately which course of treatment will result in optimal patient outcomes. 4 Acute coronary syndrome (ACS) is a spectrum of clinical syndromes (ST-elevation myocardial infarction, non-ST elevation myocardial infarction, and unstable angina) reflecting the progression of coronary artery occlusion. 5 Time is of the essence as myocardial infarction ensues after 20 minutes, and complete necrosis of myocardial cells can occur after 2 to 6 hours with total artery occlusion. 6,7 Prolonged ischemic time (duration and extent of ischemia) is associated with poor outcomes (eg, death and heart failure). 8 Early symptom recognition and intervention to restore blood flow to the affected artery within 30 minutes have the potential to prevent or minimize these events. 9,10 ACS is often an elusive and challenging diagnosis that depends on rapid assessment, triage, and risk stratification. 11 Emergency nurses are charged with identifying and recognizing quickly individuals who present with symptoms suggestive of ACS. Symptom recognition and timely reperfusion minimize ischemic time, salvage the myocardium, preserve left ventricular function, and improve survival. [12][13][14][15][16] We rely on assessment and triage for rapid clinical decision making, such as the acquisition of an electrocardiogram (ECG) within 10 minutes of presentation to the emergency department. 13,17 I suspect it is the combination of the excitement and challenge of these encounters that draws many of us to the field of emergency nursing.Technology offers us new opportunities to refine the assessment and triage of cardiac patients in the emergency department. In this issue of JEN, we learn about the innovative ways in which clinicians are integrating rapidly evolving technology to advance patient care and improve outcomes. Pon et al 18 report on their quality improvement project to evaluate the causes of high dilTIAZem dosing for individuals presenting to the emergency department with atrial fibrillation (AF). AF is the most frequent arrhythmia seen in the eme...