Rapid-access cardiology services: can these reduce the burden of acute chest pain on Australian and New Zealand health services?

2017 ◽  
Vol 47 (9) ◽  
pp. 986-991 ◽  
Author(s):  
Harry Klimis ◽  
Aravinda Thiagalingam ◽  
Mikhail Altman ◽  
Emily Atkins ◽  
Gemma Figtree ◽  
...  
Keyword(s):  
New Zealand ◽  
Chest Pain ◽  
Health Services ◽  
Acute Chest Pain ◽  
Rapid Access

scholarly journals Soluble urokinase plasminogen activator receptor (suPAR) predicts 2-year cardiovascular events in patients after acute chest pain

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Chew-Harris ◽  
S Appleby ◽  
R.W Troughton ◽  
A.M Richards ◽  
C.J Pemberton
Keyword(s):  
Heart Failure ◽  
Logistic Regression ◽  
New Zealand ◽  
Chest Pain ◽  
Plasminogen Activator ◽  
Acute Chest Pain ◽  
Funding Source ◽  
Urokinase Plasminogen Activator Receptor ◽  
Prognostic Performance ◽  
Plasminogen Activator Receptor

Abstract Background Soluble urokinase plasminogen activator receptor (suPAR) is an emerging biomarker of sub-inflammation related to plaque instability. Its modulation may reflect on immune dysfunction related to cardiovascular (CVD) outcomes. We assessed the prognostic performance of suPAR to predict 2-year clinical outcomes in patients with acute chest pain, suspicious of acute coronary syndromes. Methods A total of 812 patients presenting to the emergency department with the primary complaint of acute chest pain were prospectively recruited. Baseline suPAR concentrations were measured at presentation using the ViroGates CE-marked ELISA. Standard cardiac markers including hsTnT and NT-proBNP (both Roche) were also measured. Data for all biomarkers were treated as continuous and expressed as median [interquartile range (IQR)]. Statistical assessment was made using SPSS v25 (IBM). Groups were compared by Mann-Whitney U test/Spearman's rho. Prognostic performance of suPAR in comparison with hsTnT and NT-proBNP to predict the primary outcomes of new myocardial infarction (MI), new heart failure (HF), all cause readmission, and the composite of major adverse cardiac events (MACE) were assessed using binary logistic regression after the adjustment of traditional risk factors. Results In the entire chest pain cohort [median age: 63 yrs (IQR: 54–74), 34% female], 156/812 of patients had adjudicated AMI [STEMI (n=22)/NSTEMI (n=134)]. suPAR concentrations were found to be lower in males (Spearman's Rho, r=−0.17, P<0.0001) and in those with eGFR ≥60mL/min/1.73m2 (n=439) (r=−0.40, P<0.0001), but elevated in those older than 65 years (n=372) (r=0.55, P<0.0001). During the 2-year follow-up period, there were 54 fatalities, 287 recorded as having new CVD events, 46 diagnosed with new heart failure, 71 with new MI (66 NSTEMI/5 STEMI), 54 with new unstable angina, 126 patients classified with MACE and 190 patients who were readmitted into hospital within 1-year from presentation. In logistic regression analyses, the odds ratio (OR) of suPAR; 8.5 (95% CI:1.8–40.9) to predict a 2-year event (for example new total CVD events) was stronger than hsTnT; OR: 1.2 (95% CI: 0.9–1.5) and NT-proBNP; OR: 0.8 (95% CI:0.8–1.3) (P<0.0001) (Figure). Further, incorporation of baseline suPAR values into multivariate models for predicting events, such as MACE at 2-years (adjusted for age, gender and eGFR), resulted in an improvement in the C-statistic from 0.72 to 0.76. Conclusion In this acute chest pain cohort, suPAR concentrations are independent predictors of cardiovascular outcomes at 2 years. suPAR may add value in the risk assessment of patients with acute chest pain. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Health Research Council of New Zealand, National Heart Foundation of New Zealand

scholarly journals Atuação dos enfermeiros na dor aguda torácica: Revisão integrativa

2016 ◽  
Vol 6 (4) ◽  
pp. 59
Author(s):  
Joao Carlos Alves dos Santos
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Health Services ◽  
Latin American ◽  
Research Question ◽  
Acute Chest Pain ◽  
Integrative Review ◽  
Coronary Syndrome ◽  
Individualized Care ◽  
The Individual

<p>A dor torácica é uma queixa comum nos serviços de saúde e os enfermeiros devem estar preparados para o primeiro atendimento bem como o cuidado de maior duração nas unidades especializadas ou não para o atendimento integral<strong>. </strong>Objetivou-se analisar a produção da literatura nacional sobre a realidade da ação do enfermeiro na dor torácica aguda sugestiva de síndrome coronariana aguda nos serviços de saúde. O trabalho<strong> </strong>trata-se de uma revisão integrativa realizada na base de dados da Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) no portal eletrônico da Biblioteca Virtual em Saúde (BVS). Utilizaram-se os descritores em português. Selecionaram-se publicações no corte temporal, de 2011 à 2016. Foram sistematizados por intermédio de um instrumento, seguido de leitura com análise textual, temática e interpretativa dos dados. Encontraram-se ao todo 359 produções científicas. Todavia, apenas 10 estudos foram selecionados e revisados conforme os critérios de inclusão. A maioria das produções fizeram apontamentos assinalando proposições ou lacunas sobre as contri­buições de sua pesquisa para literatura. Identificou-se que dentro da atuação do enfermeiro frente à síndrome coronariana aguda destacam-se o cuidado sistematizado individualizado; conhecimento sobre exames e medicações e aspectos de relação do paciente com o agravo cardíaco na perspectiva individual, socioeconômica e psicológica. Existem poucas<strong> </strong>produções nos últimos anos em detrimento da enorme relevância do tema e por se um tema constantemente atualizado. Vários domínios da enfermagem, em especial das atividades do enfermeiro, ainda não foram discutidas na literatura sobre a realidade do profissional com o tema abordado. Entretanto, a presente revisão integrativa pôde contribuir para a ampliação e disseminação de conhecimentos referentes à questão pesquisada, servindo de fonte de informação.</p><p align="center"><strong><em>The work of nurses in acute chest pain: An integrative review</em></strong><strong></strong></p><p><strong>Abstract</strong>: Chest pain is a common complaint in the health services and nurses must be prepared for the first service as well as the care of longer duration in specialized units or not for the comprehensive care. Objective: analyzing what has been produced in the national literature on reality of nurses’ action in acute chest pain suggestive of acute coronary syndrome in health services. The work this is an integrative review, performed in the Latin American database and Caribbean Health Sciences (LILACS) on the electronic portal of the Virtual Health Library (VHL). We used the descriptors in Portuguese. We selected publications in the temporal cutting, from 2011 to 2016. They were summarized by means of an instrument, followed by reading in textual, thematic and interpretation analysis of the data. We found a total of 359 scientific productions. However, only 10 studies were selected and reviewed according to the inclusion criteria. Most productions made notes indicating propositions or gaps on contributions of their search for literature. It was found that in the work of the nurse facing the acute coronary syndrome the individualized care is highlighted; knowledge of tests and medications and aspects of patient’s relationship with heart condition in the individual, socioeconomic and psychological perspective. There are few productions in recent years at the expense of huge relevance of the theme and since it is a constantly updated theme. Several areas of nursing and especially the nurse’s activities have not yet been discussed in the literature on the reality of the professional with the relevant topic. However, this integrative review could contribute to the expansion and dissemination of knowledge related to the research question, serving as a source of information.</p>

P3408The signal peptide of CNP is a novel predictor of MI, MACE and bleeding risk in chest pain patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C J Pemberton ◽  
J A Lee ◽  
S Aldous ◽  
S Appleby ◽  
J Chew-Harris ◽  
...  
Keyword(s):  
New Zealand ◽  
Chest Pain ◽  
Signal Peptide ◽  
Predictive Ability ◽  
Acute Chest Pain ◽  
Bleeding Risk ◽  
Protective Role ◽  
Continuous Variables ◽  
St Depression ◽  
Health Research Council

Abstract Aim CNP is an important vascular and cardiac derived member of the natriuretic peptide family. We have previously provided the first reports that the signal peptide of CNP (CNPsp) is present in the human circulation and is elevated in those with chest pain suspicious of ACS. Here, show that CNPsp levels are highly predictive of new MI, MACE and post-index bleeding in patients presenting with potential ACS. Methods We prospectively recruited 493 patients presenting with the primary complaint of acute chest pain to our hospital ED. Patients were adjudicated as ACS by 2 independent cardiologists in accordance with ESC guidelines with hsTnI as biomarker. Plasma EDTA samples taken at presentation and 2 hours after were interrogated for CNPsp measurements using our validated, specific assay. Clinical data/variables, standard biochemistry analytes, hsTnT and NT-proBNP (both Roche Cobas e411) were also measured. Statistical assessments were made using SPSS v23. Data for all biomarkers were treated as continuous variables and are presented as median (interquartile range, (IQR)). Statistical assessment of the comparative abilities of CNPsp, hsTnT, NT-proBNP and hsTnI (log values) to predict new MACE, MI, bleeding and mortality within 2 yrs of index presentation was undertaken using a logistic regression base model (95% CI) that included all clinical variables and hsTnI and hsTnT and NT-proBNP, with CNPsp added to into the multivariate analyses. Results Of the 493 recruited patients (median age 63 (IQR: 54–73, 35% female), 148 were adjudicated to have ACS (30%, 109 MI, 39 UAP). Presentation CNPsp levels were not higher in those with adjudicated ACS versus non-ACS (51, (45–65) vs. 50, (42–63) pmol/L, P=0.412), did not correlate with hsTnI, hsTnT or NT-proBNP, but were significantly lower in those with a history of MI (49, (42–59) vs. 51, (43–64) pmol/L, P=0.044). In contrast, they were significantly higher in those with ECG ST-depression (56, (47–85) vs. 50 (42–62) pmol/L, P=0.038). In the multivariate regression model of all 493 patients, lower values of CNPsp were a significant multivariate predictor of new MI (n=37, 95% CI: 0.06–0.89, P=0.038), MACE (n=64, 95% CI: 0.08–0.81, P=0.020) and new bleeding (n=40, 95% CI: 0.05–0.63, P=0.005) within 2 years of presentation. This predictive ability was additive and independent from NT-proBNP and troponin. Conclusion This is the first report that CNPsp measurement provides meaningful and independent risk assessment of important outcomes in ACS patients. In particular, the fact that lower levels of CNPsp are predictive of negative MI, MACE and bleeding outcomes suggests that CNPsp may have an unappreciated protective role in the cardiovascular system. Acknowledgement/Funding Health Research Council of New Zealand; Heart Foundation of New Zealand

Plasma Fibrinopeptide A and Beta-Thromboglobulin in Patients with Chest Pain

1983 ◽  
Vol 50 (02) ◽  
pp. 541-542 ◽  
Author(s):  
J T Douglas ◽  
G D O Lowe ◽  
C D Forbes ◽  
C R M Prentice
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Unstable Angina ◽  
Plasma Levels ◽  
Thrombin Generation ◽  
Acute Chest Pain ◽  
Fibrinopeptide A ◽  
Control Hospital ◽  
Hospital Patients ◽  
Platelet Release

SummaryPlasma levels of β-thromboglobulin (BTG) and fibrinopeptide A (FPA), markers of platelet release and thrombin generation respectively, were measured in 48 patients within 3 days of admission to hospital for acute chest pain. Twenty-one patients had a confirmed myocardial infarction (MI); 15 had unstable angina without infarction; and 12 had chest pain due to noncardiac causes. FPA and BTG were also measured in 23 control hospital patients of similar age. Mean plasma BTG levels were not significantly different in the 4 groups. Mean plasma FPA levels were significantly higher in all 3 groups with acute chest pain when compared to the control subjects (p < 0.01), but there were no significant differences between the 3 groups. Increased FPA levels in patients with acute chest pain are not specific for myocardial infarction, nor for ischaemic chest pain.

Is Pacific language ability protective of prevalence of mental disorders among Pacific peoples in New Zealand?

2018 ◽  
Vol 21 (1) ◽  
pp. 10-16 ◽  
Author(s):  
Eirenei Taua'i ◽  
Rose Richards ◽  
Jesse Kokaua
Keyword(s):  
Mental Health ◽  
New Zealand ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
Common Mental Disorders ◽  
Mental Health Disorder ◽  
Positive Role ◽  
Pacific People ◽  
Language Promotion

Aims: To explore associations between experiences of mental illness, migration status and languages spoken among Pacific adults living in NZ. Methods: SURVEY FREQ and SURVEY LOGISTIC procedures in SAS were applied to data from Te Rau Hinengaro: The New Zealand (NZ) Mental Health Survey, a survey of 12,992 New Zealand adults aged 16 and over in 2003/2004. Pacific people were over sampled and this paper focuses on the 2374 Pacific participants but includes, for comparison, 8160 non-Maori-non-Pacific (NMNP) participants. Results: Pacific migrant respondents had the lowest prevalence of mental disorders compared to other Pacific peoples. However, Pacific immigrants were also less likely to use mental health services, suggesting an increased likelihood of experiencing barriers to available mental health care. Those who were born in NZ and who were proficient in a Pacific language had the lowest levels of common mental disorders, suggesting a protective effect for the NZ-born population. Additionally, access to mental health services was similar between NZ-born people who spoke a Pacific language and those who did not. Conclusions: We conclude that, given the association between Pacific language and reduced mental disorder, there may be a positive role for Pacific language promotion in efforts to reduce the prevalence of mental health disorder among Pacific communities in NZ.

Investigating Decrease in Radiation Dose using Acute Chest Pain Coronary CT with 128 slice MDCT Scanner

2018 ◽  
Vol 20 (1) ◽  
pp. 23-32
Author(s):  
Yong-Seob Kim ◽  
◽  
Cheon-Ung Park ◽  
Eun-Jung Kim ◽  
Sook-Hee Lee ◽  
...  
Keyword(s):  
Chest Pain ◽  
Radiation Dose ◽  
Acute Chest Pain ◽  
Coronary Ct ◽  
Mdct Scanner
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