Broader CMR or SPECT imaging reduces unnecessary angiography

Posted on by Kurt Jensen

Results from the CE-MARC 2 trial, announced today at the European Society of Cardiology (ESC) Congress, suggest that unnecessary angiography could be significantly reduced by favoring noninvasive cardiovascular magnetic resonance (CMR) imaging or single photon emission computed tomography (SPECT) to initially investigate patients with suspected coronary artery disease (CAD).

These findings could have an "important impact on referral rates for invasive coronary angiography," says the ESC press release.

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Taking Telemetry Out of the Hospital Improves Outcomes, Reduces Alarm Fatigue

Posted on by Kurt Jensen

A new study suggests the use of an off-site cardiac telemetry central monitoring unit (CMU) could improve telemetry alarms for non-intensive care unit patients and reduce the number of monitored patients—without increasing cardiopulmonary arrest events.

The study, published August 2 in the Journal of the American Medical Association, studied all non-intensive care unit patients at Cleveland Clinic and three other regional hospitals over a period of thirteen months. An off-site CMU applied "standardized cardiac telemetry" for 99,048 patients during that time.

The Data

Among the study's population, emergency response team (ERT) activation occurred for 3,243 patients. 979 of those patients had rhythm or rate changes occurring up to one hour prior to the ERT activation. The CMU detected and provided accurate notification for 772—or 79 percent—of those events, according to the study's abstract.

For 105 patients, the CMU provided "discretionary direct ERT notification" for events requiring urgent clinical intervention, reads the abstract. Slightly more than one in four of those patients went on to experience cardiopulmonary arrest events—27 patients, or 26 percent. Return to circulation was achieved in 25 of those patients, or 93 percent.

Telemetry standardization also reduced the number of patients monitored by 15.5 percent per week through eliminating low-risk patients.

How the Central Monitoring Unit Works

The study's model used one monitoring technician to provide continuous cardiac monitoring for up to 48 patients, providing blood pressure, pulse oximetry, and respiratory rate notifications on request, according to the JAMA media release. A lead technician also provided oversight and supervision for real-time rhythm interpretation.

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Comparing New Leadless Pacemakers: Micra vs. Nanostim

Posted on by Kurt Jensen

On the back of encouraging Phase III trial results, Medtronic's "Micra" leadless pacemaker was approved by the U.S. Food and Drug Administration in April, beating St. Jude Medical's "Nanostim" to approval—but does it have more limitations?

For leadless pacemakers, size matters.

Despite being small for pacemakers, both devices are rather large for transfemoral catheterization—the access site for both devices.

Sheaths for St. Jude Medical's Nanostim device measure 18 French or 6mm in diameter, to which Dr. Prapa Kanagaratnam of St. Mary's Hospital, Imperial College, London expressed some concern. "An 18-F sheath is a big sheath to put in the leg," he said to heartwire.

"A lot of the patients we're putting these devices into are small, elderly people," said Dr. Kanagaratnam. "So it's still a procedure that we feel anxious about."

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Routine Cardiac Catheterization Expanding to Saturdays?

Posted on by Kurt Jensen

Expanding availability of elective, non-emergent cardiac catheterization services to Saturdays might significantly reduce length of stay, with no effect on clinical quality reports a recent economic impact study.

The study, published online in the American Journal of Managed Care found that reduced length of stay did not result in total cost savings, however.

In January 2009, Mayo Clinic Rochester expanded cardiac catheterization service availability (CSA) to Saturdays with the "goal of timely access with improved efficiency of care," write the authors.

Despite succeeding in greatly reducing length of stay—a statistically significant, adjusted average of 1.73 days—total costs of care were similar prior to CSA expansion.

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