Abstract P281: Impact of Transradial Approach on Quality of Care for Percutaneous Coronary Intervention: A Single Center Experience

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Chuntao Wu ◽  
Duanping Liao ◽  
Anne-Marie Dyer ◽  
Helen Chen ◽  
Ian C Gilchrist
Keyword(s):  
Quality Of Care ◽  
Lower Risk ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Transfemoral Approach ◽  
Transradial Approach ◽  
Risk Of Bleeding ◽  
The Difference

Background: Transradial cardiac catheterization has only been used in a small fraction of percutaneous coronary intervention (PCI) procedures in the United States, despite of the evidence that it may be associated with a lower risk of bleeding and mortality following PCI compared to the transfemoral approach. Objective: To evaluate the impact of the transradial approach on adverse outcomes following PCI and its potential of being a process to improve the quality of care for PCI in a single-center practice. Methods: We compared the risks of post-procedural adverse outcomes including in-hospital mortality, bleeding, and vascular complications between the 462 transradial and the 625 transfemoral cases who had undergone PCI procedures between January 2007 and March 2009. The difference in length of stay following PCI between the two entry approaches was also examined. Results: Compared to the transfemoral approach, the transradial cardiac catheterization was associated with significantly lower risk of bleeding (2.60% (12 of 462) vs. 6.08% (38 of 625); adjusted odds ratio (aOR)=0.34, 95% confidence interval (CI): 0.17-0.68, P=0.002) and vascular complications (0% vs. 1.44% (9 of 625), P=0.01). Although the trend was that the transradial approach was associated with lower risk of in-hospital mortality, the difference was not statistically significant (0.87% (4 of 462) vs. 2.24% (14 of 625); aOR=0.55, 95% CI: 0.14-2.10, P=0.38). Transradial patients were more likely to be discharged on the same day of procedure (14.2% vs. 2.2%, P<0.0001). Conclusion: The transradial approach is related to lower risk of bleeding and vascular complications. Introducing this approach to practice could improve the quality of care for PCI.

scholarly journals Comparison of In-Hospital Outcomes of ST Elevation Myocardial Infarction in Patients Undergoing Transradial and Transfemoral Primary Percutaneous Coronary Intervention

2019 ◽  
Vol 11 (2) ◽  
pp. 98-104
Author(s):  
Fahdia Afroz ◽  
Mir Jamal Uddin ◽  
Md Khalquzzaman ◽  
Mohammad Ullah ◽  
Mohammad Khalilur Rahman Siddiqui ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Transfemoral Approach ◽  
Transradial Approach ◽  
Group I ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Group Ii

Background: Primary percutaneous coronary intervention (PPCI) has been performed traditionally by using femoral approach. Transradial approach has become increasingly popular as it is likely to be less complicating, more comfortable and relatively cost effective having mortality and morbidity benefits. The aim of the study was to compare the in-hospital outcomes of transradial PPCI with that of transfemoral route. Methods: A total of 80 patients with ST elevation myocardial infarction (STEMI) who underwent PPCI were enrolled in the study. Patients were divided in two groups. Group-I: transradial PPCI; and Group-II: transfemoral PPCI. All patients were followed up during the period of hospital stay and adverse outcomes were observed and compared between the groups. Results: The result showed that bleeding took place in 2.5% patient of Group-I and 15% patients of Group- II. Vascular complications occurred in 2.5% and 12.5% patients of Group-I and Group-II, respectively. In Group-II, 7.5% patients died with none in Group-I. In Group-II, 37.5% patients experienced some sort of adverse outcomes whereas only 15% of the patients of Group-I did have such experiences (p<0.05). Bleeding and vascular complications were significantly more in Group-II (p<0.05). The mean hospital stay time was significantly lower in Group-I (p<0.001). Conclusions: Transradial PPCI is safer than transfemoral approach in respect of procedural and post procedural complications including bleeding, vascular complications and mortality. So, transradial approach may be an attractive alternative to conventional transfemoral approach and can be practiced routinely for PPCI. Cardiovasc. j. 2019; 11(2): 98-104

Downsizing – the Future of Interventional Cardiology

2012 ◽  
Vol 7 (1) ◽  
pp. 28
Author(s):  
Giovanni Amoroso ◽  
Keyword(s):  
Contrast Agent ◽  
Vascular Complications ◽  
Cost Savings ◽  
Length Of Hospital Stay ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Transradial Approach ◽  
Technical Developments ◽  
Coronary Procedures ◽  
Angiographic Image

The concept of downsized catheters (i.e., using catheters smaller than 6 French) for invasive coronary procedures, such as diagnostic cardiac catheterisation and percutaneous coronary intervention, has been developing over the years, particularly as a result of the rise of the transradial approach. Recent advances have allowed the use of smaller and sheathless catheters, which confer a number of advantages – such as fewer vascular complications, reduced use of contrast agent and reduced haemostasis – thus increasing patient safety and comfort and allowing more rapid patient mobilisation. Reductions in patient complications, number and length of hospital stay, and amount of contrast agent used can also lead to cost savings. While the use of smaller catheters has been hindered in the past because of poor angiographic image quality, new automated contrast injectors have helped overcome this limitation. There is a need to make interventional cardiologists worldwide more aware of the benefits of downsizing, in the light of the latest technical developments and the increased use of transradial approach.

scholarly journals Surgical adverse outcomes and patients' evaluation of quality of care: inherent risk or reduced quality of care?

2008 ◽  
Vol 84 (988) ◽  
pp. 93-98 ◽  
Author(s):  
P J Marang-van de Mheen ◽  
N van Duijn-Bakker ◽  
J Kievit
Keyword(s):  
Quality Of Care ◽  
Adverse Outcomes ◽  
Inherent Risk

Surgical Adverse Outcomes in Patients with Serious Mental Illnes

2021 ◽  
Vol 1 (4) ◽  
pp. 71-75
Author(s):  
Gerry Armando
Keyword(s):  
Mental Illness ◽  
Quality Of Care ◽  
Serious Mental Illness ◽  
Adverse Outcomes ◽  
Medical Procedure ◽  
Key Factor ◽  
Comorbidity Status

Serious mental illness (SMI) influences 3 % of the populace and incorporates handicapping types of despondency and uneasiness, just as maniacal issues, for example, bipolar and schizophrenia. Patients with schizophrenia were known to have a higher risk of complications during hospitalization. Quality of care has become the key factor in reducing their potential mortality afterwards. Patients with SMI were substantially less liable to have significant medical procedure, in the wake of controlling for age, other segment measures, and illness trouble. For patients of a similar age, sex, race and comorbidity status, having a previous genuine psychological instability passed on a significantly diminished probability of careful mediation. Clinical and careful hospitalizations for people with schizophrenia had in some measure double the chances of a few kinds of unfriendly occasions than those for people without schizophrenia. These antagonistic occasions were related with poor clinical and financial results during the emergency clinic confirmation. Endeavors to decrease these unfriendly occasions should turn into an examination need.

scholarly journals Benchmarking as a quality of care improvement tool for patients with ST-elevation myocardial infarction: an NCDR ACTION Registry experience in Latin America

2019 ◽  
Vol 32 (1) ◽  
pp. A1-A8
Author(s):  
Adriano Caixeta ◽  
Marcelo Franken ◽  
Marcelo Katz ◽  
Pedro A Lemos ◽  
Ivanise Gomes ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Quality Of Care ◽  
Angiotensin Receptor Blockers ◽  
Coronary Intervention ◽  
Hospital Performance ◽  
St Elevation Myocardial Infarction ◽  
Process Of Care ◽  
Converting Enzyme Inhibitors ◽  
St Elevation

Abstract Objective We aim to examine the effect of benchmarking on quality-of-care metrics in patients presenting with ST-elevation myocardial infarction (STEMI) through the implementation of the American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) ACTION Registry. Design From January 2005 to December 2017, 712 patients underwent primary percutaneous coronary intervention PCI—499 before NCDR ACTION Registry implementation (prior to 2013) and 213 after implementation. Setting STEMI. Participants 712 patients. Intervention(s) Primary PCI. Main Outcome Measure(s) We examined hospital performance for the quality indicators in processes and outcomes of the management of patients presenting with STEMI. Outcome measures include door-to-balloon time (DBT), antiplatelet therapy and anti-ischemic drugs prescribed at discharge from pre-NCDR ACTION Registry to post-implementation. Results There was improvement in DBT, decreasing from 94 min in 2012 (before NCDR adoption) to reach a median of 47 min in 2017 (Ptrend &lt; 0.001). The percentage of cases with the optimal DBT of &lt; 90 min increased from 55.8% before to 90.1% after the implementation of the NCDR ACTION Registry (Ptrend &lt; 0.001). The rate of aspirin (90.3–100%, P &lt; 0.001), P2Y12 inhibitor (70.1–78.4%, P = 0.02), beta-blocker (76.8–100%, P &lt; 0.001) and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (60.1–99.5%, P &lt; 0.001) prescribed at discharge increased from pre-NCDR ACTION Registry to post-implementation. Adjusted mortality before and after NCDR ACTION Registry implementation showed significant change (from 9.04 to 5.92%; P = 0.027). Conclusions The introduction of the ACC NCDR ACTION Registry led to incremental gains in the quality in STEMI management through the benchmarking of process of care and clinical outcomes, achieving reduced DBT, improving guideline-directed medication adherence and increasing patient safety, treatment efficacy and survival.

scholarly journals Can the adherence to quality of care indicators for early rheumatoid arthritis in clinical practice reduce risk of hospitalisation? Retrospective cohort study based on the Record Linkage of Rheumatic Disease study of the Italian Society for Rheumatology

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038295
Author(s):  
Anna Zanetti ◽  
Carlo Alberto Scirè ◽  
Lisa Argnani ◽  
Greta Carrara ◽  
Antonella Zambon
Keyword(s):  
Rheumatoid Arthritis ◽  
Cohort Study ◽  
Quality Of Care ◽  
Retrospective Cohort Study ◽  
Lower Risk ◽  
Retrospective Cohort ◽  
Quality Standards ◽  
Standards Of Care ◽  
Adherence Score

ObjectiveTo describe the adherence to quality of care indicators in early rheumatoid arthritis (RA) and to evaluate its impact on the risk of hospitalisation in a real-world setting.DesignRetrospective cohort study.SettingPatients with early-onset RA identified from healthcare regional administrative databases by means of a validated algorithm between 2006 and 2012 in the Lombardy region (Italy).ParticipantsThe study cohort included 14 203 early-onset RA (71% female, mean age 60 years).Outcome measuresFor each patient, a summary adherence score was calculated starting from the compliance to six quality indicators: (1–2) methotrexate or sulfasalazine or leflunomide with/without glucocorticoids, (3–4) other disease-modifying antirheumatic drugs (DMARDs) with/without glucocorticoids, (5) early interruption of glucocorticoids, (6) early clinical assessment.The relationship between low, intermediate and high categories of the summary score and the 12-month risk of hospitalisation for all causes and for RA was assessed.ResultsDuring a follow-up of 1 year, 2609 hospitalisations occurred, of which 704 were for RA (main or secondary diagnosis) and 252 primarily for RA. In a 7-year period (2006–2012), early DMARDs and timely clinical monitoring treatment increased (from 52% to 62% p trend <0.001 and from 25% to 30% p trend 0.009, respectively).Intermediate and high summary adherence score categories (compared with the low category) were related significantly with a lower risk of hospitalisation (adjusted HR 0.85 (95% CI 0.77 to 0.93), p<0.001 and HR 0.76 (95% CI 0.69 to 0.84), p<0.001, respectively). Among the indicators of the adherence score, early DMARD prescription showed the strongest positive impact, while long-term use of glucocorticoids was the worst negative one.ConclusionIn early RA, adherence to quality standards of care is associated with a lower risk of hospitalisation. Future interventions to improve the adherence to quality standards of care in this setting should decrease the risk of hospitalisation with a significant impact on individual and population health.

scholarly journals Association between body mass index and outcomes after percutaneous coronary intervention in multiethnic South East Asian population: a retrospective analysis of the Malaysian National Cardiovascular Disease Database—Percutaneous Coronary Intervention (NCVD-PCI) registry

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e017794 ◽  
Author(s):  
Zaid Azhari ◽  
Muhammad Dzafir Ismail ◽  
Ahmad Syadi Mahmood Zuhdi ◽  
Norashikin Md Sari ◽  
Imran Zainal Abidin ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Lower Risk ◽  
East Asian ◽  
Vascular Complications ◽  
Asian Population ◽  
Coronary Intervention ◽  
Hospital Death ◽  
Percutaneous Coronary ◽  
Overweight Group ◽  
National Cardiovascular

ObjectiveTo examine the relationship between body mass index (BMI) and outcomes after percutaneous coronary intervention (PCI) in a multiethnic South East Asian population.SettingFifteen participating cardiology centres contributed to the Malaysian National Cardiovascular Disease Database—Percutaneous Coronary Intervention (NCVD-PCI) registry.Participants28 742 patients from the NCVD-PCI registry who had their first PCI between January 2007 and December 2014 were included. Those without their BMI recorded or BMI <11 kg/m2or >70 kg/m2were excluded.Main outcome measuresIn-hospital death, major adverse cardiovascular events (MACEs), vascular complications between different BMI groups were examined. Multivariable-adjusted HRs for 1-year mortality after PCI among the BMI groups were also calculated.ResultsThe patients were divided into four groups; underweight (BMI <18.5 kg/m2), normal BMI (BMI 18.5 to <23 kg/m2), overweight (BMI 23 to <27.5 kg/m2) and obese (BMI ≥27.5 kg/m2). Comparison of their baseline characteristics showed that the obese group was younger, had lower prevalence of smoking but higher prevalence of diabetes, hypertension and dyslipidemia. There was no difference found in terms of in-hospital death, MACE and vascular complications after PCI. Multivariable Cox proportional hazard regression analysis showed that compared with normal BMI group the underweight group had a non-significant difference (HR 1.02, p=0.952), while the overweight group had significantly lower risk of 1-year mortality (HR 0.71, p=0.005). The obese group also showed lower HR but this was non-significant (HR 0.78, p=0.056).ConclusionsUsing Asian-specific BMI cut-off points, the overweight group in our study population was independently associated with lower risk of 1-year mortality after PCI compared with the normal BMI group.

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