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Clinical risk stratification in the emergency department predicts long-term cardiovascular outcomes in a population-based cohort presenting with acute chest pain: primary results of the Olmsted county chest pain study.
Medicine (Baltimore)
September 2009
From Division of Cardiovascular Diseases and Internal Medicine (GSR, DRH, VM), Division of Emergency Medical Services and Internal Medicine (PAS), Division of Biomedical Statistics and Informatics (RJL, HJW), and Section of Health Services Evaluation (KT), Mayo Clinic College of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota; and Mount Sinai School of Medicine Cardiovascular Institute (MEF, AA, SB, LR), New York, New York.
The long-term cardiovascular outcomes of a population-based cohort presenting to the emergency department (ED) with chest pain and classified with a clinical risk stratification algorithm are not well documented. The Olmsted County Chest Pain Study is a community-based study that included all consecutive patients presenting with chest pain consistent with unstable angina presenting to all EDs in Olmsted County, Minnesota. Patients were classified according to the Agency for Health Care Policy and Research (AHCPR) criteria.
View Article and Find Full Text PDFAssessing the effect of publication of clinical guidelines on the management of unstable angina and non-ST elevation myocardial infarction in the TIMI III (1990-1993) and the GUARANTEE (1995-1996) Registries.
Crit Pathw Cardiol
September 2002
Department of Medicine and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Background: The clinical guidelines for unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI) published in 1994 by the Agency for Health Care Policy Research (AHCPR) were intended to help improve treatment. No large study, however, has evaluated the effect of the guidelines on clinical practice
Methods: We compared the treatment of 3,318 patients admitted with UA/NSTEMI in the preguideline Thrombolysis in Myocardial Infarction (TIMI) III Registry (1990-1993) and 2,948 patients enrolled in the postguideline Global Unstable Angina Registry and Treatment Evaluation (GUARANTEE) Registry (1995-1996).
Results: More patients in GUARANTEE received guideline-recommended medication than did those in TIMI III, specifically beta-blockers (50.
Does concordance with guideline triage recommendations affect clinical care of patients with possible acute coronary syndrome?
Med Decis Making
September 2007
Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, USA.
Background: The Agency for Health Care Policy and Research (AHCPR) Unstable Angina Practice Guideline recommends outpatient management for patients at low risk and admission to a monitored bed for patients at intermediate-high risk of adverse short-term outcomes, but the clinical consequences of adhering to these recommendations are unclear.
Methods: This analysis included 7466 adults who presented to the emergency department (ED) with symptoms of possible acute coronary syndrome (ACS) and who participated in 3 prospective clinical effectiveness trials during the period 1993 to 2001. The authors used logistic regression to assess the impact of concordance with guideline triage recommendations on subsequent diagnostic testing, follow-up care, and 30-day mortality and applied propensity score methods to adjust for selection bias.
The impact of unstable angina guidelines in the triage of emergency department patients with possible acute coronary syndrome.
Med Decis Making
February 2007
Department of Medicine, Population Health Sciences, University of Wisconsin - Madison, USA.
Objective: The primary aim of this study is to determine whether implementing the Agency for Health Care Policy and Research (AHCPR) Unstable Angina Practice Guideline improves emergency physician's decision making in patients with symptoms of possible acute coronary syndrome (ACS), including those for whom the diagnosis of unstable angina is uncertain.
Methods: The authors conducted a prospective guideline implementation trial with pre-post design in the emergency departments of 1 university hospital and 1 university-affiliated community teaching hospital from January 2000 to May 2001. They enrolled 1140 adults who presented with chest pain or other symptoms of possible ACS.
The incremental value of troponin-I testing in patients with intermediate risk unstable angina.
Clin Cardiol
November 2004
Cardiovascular Institute, Mount Sinai School of Medicine, New York, USA.
Background: Classification of patients with unstable angina (UA) by Agency for Health Care Policy and Research (AHCPR) guidelines in the emergency department reliably stratifies risk of death or myocardial infarction (MI) for triage to outpatient evaluation (low-risk), hospitalization (high-risk), or additional testing (intermediate-risk). Cardiac troponin-I elevation may identify patients at higher risk, but the incremental value may vary with AHCPR clinical risk.
Hypothesis: The objective of this study was to determine whether cardiac troponin-I had any additional value beyond triage based upon history, physical examination, and electrocardiogram, in the evaluation of patients with UA.
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