Effects on costs of frontline diagnostic evaluation in patients suspected of angina: coronary computed tomography angiography vs. conventional ischaemia testing.

Aims: The aim of this study was to investigate in patients with stable angina the effects on costs of frontline diagnostics by exercise-stress testing (ex-test) vs. coronary computed tomography angiography (CTA).

Methods And Results: In two coronary units at Lillebaelt Hospital, Denmark, 498 patients were identified in whom either ex-test (n = 247) or CTA (n = 251) were applied as the frontline diagnostic strategy in symptomatic patients with a low-intermediate pre-test probability of coronary artery disease (CAD).

Extended heart failure clinic follow-up in low-risk patients: a randomized clinical trial (NorthStar).

Background: Outpatient follow-up in specialized heart failure clinics (HFCs) is recommended by current guidelines and implemented in most European countries, but the optimal duration of HFC programmes has not been established. Nor is it known whether all or only high-risk patients, e.g.

Frontline diagnostic evaluation of patients suspected of angina by coronary computed tomography reduces downstream resource utilization when compared to conventional ischemia testing.

It has been proposed that the increasing use of coronary computed tomographic angiography (CTA) may introduce additional unnecessary diagnostic procedures. However, no previous study has assessed the impact on downstream test utilization of conventional diagnostic testing relative to CTA in patients suspected of angina. The purpose of this study was to investigate the consequences of frontline exercise-stress testing (Ex-test) versus CTA on downstream test utilization in clinical practice.

Design and methodology of the NorthStar Study: NT-proBNP stratified follow-up in outpatient heart failure clinics -- a randomized Danish multicenter study.

Background: Randomized clinical trials have shown that newly discharged and symptomatic patients with chronic heart failure (CHF) benefit from follow-up in a specialized heart failure clinic (HFC). Clinical stable and educated patients are usually discharged from the HFC when on optimal therapy. It is unknown if risk stratification using natriuretic peptides could identify patients who would benefit from longer-term follow-up.

[Thrombolysis in treatment of cardiac arrest caused by pulmonary embolism].

Some cases of pulmonary embolism are complicated by cardiac arrest. We report such a case in which treatment included thrombolysis during cardiopulmonary resuscitation. Complete recovery was achieved.

Treatment with beta-blockers in nurse-led heart failure clinics: titration efficacy and predictors of failure.

Background: Beta-blockers (BBs) are a cornerstone in the treatment of chronic heart failure (HF), but several surveys have documented that many patients are not offered treatment or are not titrated to target doses. In part to address this problem, specialized, nurse-led HF clinics have been initiated in many countries. However, little information is available to describe if such programs are successful in initiating and up-titrating BBs in daily clinical practice.

Prevalence and prognostic significance of atrial fibrillation in outpatients with heart failure due to left ventricular systolic dysfunction.

Introduction: Atrial fibrillation (AF) is common in patients with heart failure (HF) due to left ventricular systolic dysfunction (LVSD), with conflicting prognostic data. The aim of our study was to assess the prevalence and incidence of AF in patients with HF and to determine the prognostic impact of baseline AF and the development of new onset AF.

Methods And Results: We included 1019 outpatients with HF due to LVSD; follow-up time ranged from 3 to 64 months.

[Educational project at the medical department, Fredericia Hospital].

Introduction: The purpose of this project was to introduce a newly developed educational program consisting of a new concept with metacompetences. Our aim was to evaluate the need for new educational methods and to clarify the educational capacity of our clinic.

Materials And Methods: The duration of the project was two years; it was allocated to pre-registration house officers.

[Dilated cardiomyopathy as a side effect of treatment with infliximab].

We report a case of heart failure after infusion of Remicade (infliximab) in a patient without heart insufficiency. The patient, a 25-year-old woman with inflammatory bowel disease, developed new-onset heart failure after receiving TNF antagonist therapy. After the treatment was discontinued and heart failure therapy was started, the patient improved significantly.

Effects of a nurse-based heart failure clinic on drug utilization and admissions in a community hospital setting.

Objective: To evaluate the effect of a nurse-led heart failure clinic on drug therapy and hospitalization in a community hospital setting.

Design: Prospective, observational study of outpatients referred to a heart failure clinic. Nurses directed drug uptitration and delivered patient education.