Feasibility of an Automated Fast Healthcare Interoperability Resources-based 12-lead Electrocardiogram Mobile Alert System (Preprint)

2019 ◽  
Author(s):  
Sujeong Hur ◽  
Won Chul Cha ◽  
Jeanhyoung Lee ◽  
Taerim Kim ◽  
Dong Kyung Chang ◽  
...  
Keyword(s):  
Information Transfer ◽  
Tertiary Care ◽  
Mobile App ◽  
Care Hospital ◽  
Alert System ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Feasibility Test ◽  
Time Critical ◽  
Median Interval

BACKGROUND Timely information transfer is more important in the emergency care setting because it is associated with the clinical outcome. For patients with time-critical acute coronary syndrome, reporting of electrocardiogram (ECG) findings is the most important component of the treatment process. OBJECTIVE This study aimed to develop and implement an automated Fast Healthcare Interoperability Resources (FHIR)-based 12-lead ECG mobile alert system in an emergency department (ED). METHODS An automated FHIR-based 12-lead ECG alert system was developed. The system aimed to generate alert for potential ST-elevation myocardial infarction (STEMI) patients. A feasibility test was carried out in the ED of an academic tertiary care hospital from November 14 to December 7, 2018. The system generate alert based on 12-lead ECG readings from the device. The alert was transmitted to the physicians both via mobile app and EMR. A retrospective analysis was performed for patients ≥18 years of age admitted to the ED. The automated FHIR-based 12-lead ECG alert system processing interval was defined as the time from ED arrival and 12-lead ECG capture to the time when FHIR-based notification was transmitted. We analyzed the 12-lead ECG process intervals and the clinical characteristics. In this study, a successful transmission is defined as transmit the FHIR-based notification within 5 minutes. RESULTS The automated FHIR-based 12-lead ECG alert transmission system was developed and used the “Observation” FHIR resource. There were 3,812 emergency visits during the study period. A total of 1,581 12-lead ECGs were captured. The FHIR system generated 155 alerts. Alert patient were significantly older, and the percentage of males was higher. Among 155 alerts, 146 (94%) were transmitted successfully. In the group with cardiac-related symptoms, the median interval from arrival to 12-lead ECG capture was 74.4 min (IQR 15.6 – 211.2 min). The median interval was 106.5 min (IQR 28.5 – 251.6 min) in the non cardiac-related symptoms. The group with cardiac-related symptoms, the median of 2.7 min (IQR 2.3 – 2.9 min) from 12-lead ECG capture to FHIR notification. The median of 2.9 min (IQR 2.5 – 3.3 min) in the non cardiac-related symptoms. The median interval of 9 (6%) unsuccessful cases was 69.1 min (IQR 37.6 – 100.7 min) in the group with cardiac-related symptoms. The non cardiac-related symptoms group, the median was 20 min (IQR 10.8 – 34.8 min). CONCLUSIONS We found that an automated FHIR-based 12-lead ECG mobile alert system was feasible in the ED.

scholarly journals Challenges in Timely Pharmacological Reperfusion Therapy of Acute ST-Elevation Myocardial Infarction Patients: A Cross-sectional Study

2021 ◽  
Author(s):  
Prakriti Snehil ◽  
Anwar Hussain Ansari ◽  
Praloy Chakraborty ◽  
Niveditha Devasenapathy
Keyword(s):  
Myocardial Infarction ◽  
Thrombolytic Therapy ◽  
Tertiary Care ◽  
Reperfusion Therapy ◽  
St Elevation Myocardial Infarction ◽  
System Level ◽  
Care Hospital ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
St Elevation

Introduction: Acute ST-Elevation Myocardial Infarction (STEMI) is the most severe presentation of an Acute Coronary Syndrome (ACS) resulting from sudden occlusion of one of the major epicardial coronary arteries resulting in myocardial injury and necrosis within minutes to few hours. Despite Primary Percutaneous Coronary Intervention (PPCI) being the gold standard, thrombolytic therapy is still the most common form of reperfusion therapy in eligible patients of acute STEMI even in large metropolitan cities in India. Aim: To find the proportion of STEMI patients receiving thrombolytic therapy within four hours of the onset of symptoms and within 30 minutes of reaching the hospital and to explore factors related to Pain-To-Door (P2D) delay. Materials and Methods: This was a single-centre cross-sectional observational study of 147 STEMI patients conducted at a tertiary care hospital in the National Capital Territory (India). from February to May 2017. Ethical clearance was obtained from the Institute’s Ethics Committee. All patients were interviewed and their medical records reviewed. Factors related to delay in reaching hospital and association of patient characteristics with those receiving thrombolytic therapy were explored using univariable and multivariable logistic regression. Results: Mean age of the study population was 52.1±13.1 years and 121 (82.3%) were men. Median P2D time was 4.7 hours (IQR- 2.2-17.0). Overall, 64 (43.5%) of 147 patients reached the hospital within four hours of chest pain. Only 5 (3.4%) patients availed ambulance to reach the hospital. Distance from the hospital, seeking care elsewhere and delay in reaction to symptom were reasons for the delay (>4 hours). Median Door-To-Needle (D2N) time was 45.9 minutes (IQR- 30.6-61.2). Patients who reached the hospital at night were more likely to be thrombolysed after adjusting for time to reach the hospital. Conclusion: Significant P2D and Door-To-Balloon (D2B) delays still exist in large metro cities in India. Action is needed both at the population level as well as system level to reduce these delays.

Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ghufran adnan ◽  
Osman Faheem ◽  
Maria Khan ◽  
Pirbhat Shams ◽  
Jamshed Ali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Reduction Rate ◽  
Care Hospital ◽  
Chi Square ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Drastic Increase ◽  
Chi Square Test ◽  
The Difference

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

scholarly journals Effect of Gender on the Outcomes of ST-Elevation Myocardial Infarction at a Tertiary Care Hospital in Riyadh, Saudi Arabia

Cureus ◽  
2020 ◽  
Author(s):  
Mohammed S Alharbi ◽  
Bander K Alanazi ◽  
Ibrahim A Alquhays ◽  
Nawaf A Alhamied ◽  
Abdullah Al Shimemeri
Keyword(s):  
Myocardial Infarction ◽  
Saudi Arabia ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
St Elevation Myocardial Infarction ◽  
Care Hospital ◽  
St Elevation

A STUDY OF RISK FACTORS, CLINICAL PRESENTATION AND CORONARY ANGIOGRAPHIC PROFILE IN YOUNG PATIENTS WITH ACUTE MYOCARDIAL INFACTION IN A TERTIARY CARE HOSPITAL IN EASTERN INDIA

2021 ◽  
pp. 24-26
Author(s):  
Auriom Kar ◽  
Mainak Mukhopadhyay ◽  
Shivesh Sahai ◽  
Kajal Ganguly ◽  
Sukanya Banerjee
Keyword(s):  
Tertiary Care ◽  
Geographical Area ◽  
Young Patients ◽  
Myocardial Necrosis ◽  
Regional Wall Motion ◽  
Healthy Person ◽  
Cerebrovascular Diseases ◽  
Care Hospital ◽  
Medical College ◽  
Coronary Syndrome

INTRODUCTION Acute coronary syndrome is a devastating disease because an otherwise healthy person may die or become disabled without warning. Cerebrovascular diseases (CVD) are no longer conned by geographical area or by age, sex, or socioeconomic boundaries. Heart disease has already reached epidemic proportions in poorer countries also. AIMS AND OBJECTIVESAMI was dened as typical rise and fall of cardiac markers of myocardial necrosis with at least one of the following: Ischemic symptoms, Electrocardiogram (ECG) changes indicative of ischemia (ST elevation or depression), Development of Pathological Q waves in ECG and Echocardiograph evidence of new regional wall motion abnormality. MATERIALS AND METHODS SETTING AND STUDYPOPULATION- Hospital based study in Nil Ratan Sircar Medical College and Hospital among the patients admitted in department of Cardiology SAMPLE SIZE- 50 patients STUDYPERIOD- From January 2016-December 2017 STUDYDESIGN- Prospective observational study. RESULT AND ANALYSIS We found that 30% of our patients were hypertensive this is more than reported in various studies .61,62 Though Hypertension is therefore less common in young MI patients than in older patient but in my study 30% of patients less than 40 yrs were hypertensive. CONCLUSION Normotensive and non obese patients had more likelihood of normal CAG and their association was statistically signicant. Young patients with positive family h/0 CAD had more prevalence of LMCAdisease and thrombus and their correlation is statistically signicant.

scholarly journals Caracterização do perfil e complicações intra-hospitalares dos pacientes submetidos ao cateterismo cardíaco em um hospital terciário

2017 ◽  
Vol 27 (1) ◽  
pp. 24806
Author(s):  
Débora Ferreira Braga ◽  
Gustavo Paes Silvano ◽  
Thainá Ferreira Furtado Pereira ◽  
Fabiana Schuelter-Trevisol ◽  
Daisson José Trevisol
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Hospital Stay ◽  
Cardiac Catheterization ◽  
Tertiary Care ◽  
Care Hospital ◽  
Puncture Site ◽  
Coronary Syndrome ◽  
Vessel Disease ◽  
Triple Vessel Disease

DOI: 10.15448/1980-6108.2017.1.24806 Aims: To evaluate the profile of patients undergoing cardiac catheterization and in-hospital complications associated with the procedure.Methods: Cross-sectional analysis of baseline data of a retrospective cohort study conducted in a tertiary care hospital in southern Brazil between 2007 and 2013. The study included patients undergoing diagnostic or therapeutic cardiac catheterization. The data were extracted from electronic medical records using a standardized form and stored in a database for further analysis.Results: Out of 994 assessed patients, 584 (58.8%) were male. The mean age was 61.4 years. Hypertension was the most prevalent risk factor, followed by dyslipidemia and diabetes mellitus. Regarding clinical presentation, 550 (55.3%) patients had acute coronary syndrome, 402 (40.4%) had stable angina, and 42 (4.2%) were asymptomatic. Cineangiography was normal in 152 (15.3%) patients and abnormal in 842 (84.7%). Of these, 251 (29.8%)  had single vessel disease, 190 (22.6%) had double vessel disease, and 401 (47.6%) had triple vessel disease. The overall incidence of complications was 15.6%, and 1% of the patients suffered some kind of major event (death during the procedure and neurological complications during their hospital stay). Other complications included acute kidney injury (1.4%) and local vascular complications (13.2%), mainly hematoma at the puncture site. Fifty (5%) patients died during the hospital stay, 46 (92%) of them from cardiac causes. Conclusions: The patients undergoing cardiac catheterization were predominantly male, with mean age of 61.4 years. The most frequent risk factors for cardiovascular disease included hypertension, dyslipidemia, and diabetes mellitus. Most of the patients had triple vessel disease. The main indication for the procedure was acute coronary syndrome. The overall incidence of complications was 15.6% with predominance of hematoma at the puncture site.

scholarly journals Is it time to rethink how we page physicians? Understanding paging patterns in a tertiary care hospital

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Luke Witherspoon ◽  
Emily Nham ◽  
Hamidreza Abdi ◽  
Ali Dergham ◽  
Thomas Skinner ◽  
...  
Keyword(s):  
Emergency Room ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Temporal Trends ◽  
Care Hospital ◽  
Surgical Service ◽  
Physician Burnout ◽  
Ottawa Hospital ◽  
Hospital Units ◽  
Median Interval

Abstract Background Frequent pages can disrupt workflow, interrupt patient care, and may contribute to physician burnout. We hypothesized that paging volumes followed consistent temporal trends, regardless of the medical or surgical service, reflecting systems based issues present in our hospitals. Methods A retrospective review of the hospital paging systems for 4 services at The Ottawa Hospital was performed. Resident paging data from April 1 to July 31, 2018 were collected for services with a single primary pager number including orthopaedic surgery, general surgery, neurology, and neurosurgery. Trends in paging volume during the 4-month period were examined. Variables examined included the location of origin of the page (emergency room vs. inpatient unit), and day/time of the page. Results During the study period, 25,797 pages were received by the 4 services, averaging 211 (± Standard Deviation (SD) 12) pages per day. 19,371 (75%) pages were from in-patient hospital units, while 6426 (24%) were pages from the emergency room. The median interval between pages across all specialties was 22:30 min. Emergency room pages peaked between 16:30 and 20:00, while in-patient units peaked between 17:30 and 18:30. Conclusions Each service experienced frequent paging with similar patterns of marked increases at specific times. This study identifies areas for future study about what the factors are that contribute to the paging patterns observed.

P2661Ventricular fibrillation during acute STEMI is not associated with early repolarization pattern on ECG recorded prior to the index ischemic episode

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M M Demidova ◽  
J Carlson ◽  
D Erlinge ◽  
P G Platonov
Keyword(s):  
Tertiary Care ◽  
Coronary Event ◽  
Acute Ischemia ◽  
Care Hospital ◽  
Acute Coronary Event ◽  
Early Repolarization ◽  
High Prevalence ◽  
Ischemic Episode ◽  
St Elevation ◽  
Qrs Duration

Abstract Background Generally considered as benign, ECG early repolarization (ER) pattern was recently claimed to be an indicator of increased susceptibility to fatal arrhythmias during acute ischemia. The victims of sudden cardiac death have been reported to have high prevalence of ER comparing with survivors of acute coronary event. We aimed to test the association between the ER pattern on resting ECG recorded prior to ST-elevation myocardial infarction (STEMI) and the risk of ventricular fibrillation (VF) during acute phase of STEMI in non-selected population of STEMI patients. Methods For STEMI patients admitted to a tertiary care hospital for primary PCI during 2007–2010 (n=2286), all ECGs recorded prior to the date of admission with STEMI were extracted from a digital archive. The latest ECG recorded prior to the index STEMI was used for analysis. After excluding ECGs with paced rhythm and intraventricular blocks with QRS duration ≥120ms, the remaining ECGs were processed using the Glasgow algorithm allowing automatic ER detection. The association between ER-pattern on historical ECG and VF during the first 48 hours of STEMI was tested using logistic regression. Results Historical ECGs were available for 1584 patients; 124 of them were excluded due to a paced rhythm or wide QRS, leaving 1460 patients available for analysis (age 68±12 years, 67% male). The time from historical ECG to STEMI was 16 (IQR 4–49) months. ER pattern was present on historical ECG in 272 of 1460 (18.6%) (ER+ group), among them in 90 (33%) – in inferior leads, in 116 (43%) – in lateral leads, in 66 (24%) – both in inferior and lateral leads. ER+ patients were younger both at the time of historical ECG (64±13 vs 66±19; p=0.041) and at the time of STEMI (67±12 vs 68±12; p=0.033), and had lower heart rate on historical ECG (68±12 vs 73±15; p<0.001) than ER- patients. ER+ and ER- groups did not differ regarding clinical characteristics and conventional ECG measurements. The course of STEMI was complicated by VF in 106 patients (17 of them from ER+ group). The occurrence of VF during STEMI was not associated with ER-pattern on historical ECG (OR 0.875 95% CI 0.518–1.479; p=0.618). There was no association of ER pattern with VF before reperfusion (OR 0.54 95% CI 0.25–1.21; p=0.135) or reperfusion VF (OR 1.28 95% CI 0.55–3.01; p=0.569). No association was observed with regard to localization (inferior or lateral) of ER-pattern either. Conclusion In a non-selected population of STEMI patients the presence of ER-pattern on ECG recorded prior to the acute coronary event was not associated with VF during the first 48 hours of STEMI.

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